To the Editor The Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE) trial1 concluded that structured, task-oriented training is not superior to “usual and customary occupational therapy” (UCC) in moderately impaired stroke patients. Several weaknesses diminish confidence in the conclusions.
First, no control was exerted over the UCC content. Most occupational therapists administer repetitive, task-oriented training (ie, the treatment provided to the experimental group) as their usual care.2 Thus, the usual care provided as a control may have approximated therapy administered to patients in the experimental condition. The high resemblance between the UCC and experimental groups—and the fact that repetitive, task-oriented training has level 1A evidence supporting its application3—may at least partially explain why no statistically significant differences emerged between the groups. Additionally, because UCC was neither standardized nor controlled, clinicians likely provided a variety of efficacious, adjunctive modalities, home exercises, or both, as occurs in usual care.
Peters HT, Page SJ. Task-Oriented Rehabilitation Program for Stroke. JAMA. 2016;316(1):101-102. doi:10.1001/jama.2016.5016