Effect of Task-Oriented Motor Training on Upper Limb Functional Recovery in Post-Stroke Patients: A Randomized Controlled Trial

Abstract

Background: Upper limb motor impairment affects approximately 70–80% of stroke survivors and constitutes a primary determinant of functional independence and quality of life. Task-oriented motor training (TOT) engages neuroplastic recovery through repetitive, goal-directed functional practice, yet evidence from low- and middle-income country (LMIC) rehabilitation settings remains limited. Objective: To evaluate the efficacy of structured task-oriented motor training on upper limb motor recovery, arm function, motor performance efficiency, and functional independence compared to conventional physiotherapy in subacute post-stroke patients. Methods: A single-blind, parallel-group randomized controlled trial was conducted at a tertiary care neurorehabilitation centre in Khyber Pakhtunkhwa, Pakistan. One hundred and two subacute stroke patients (2–6 months post-ictus) were allocated by computer-generated randomization to TOT (n = 51) or conventional physiotherapy (n = 51), each receiving 45–60 minutes of supervised therapy five sessions per week for six weeks. Primary outcome was the Fugl-Meyer Assessment–Upper Extremity (FMA-UE); secondary outcomes included the Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), and Barthel Index. Intention-to-treat analysis with multiple imputation was applied; Bonferroni correction controlled for multiple comparisons. Results: Ninety-five participants completed post-intervention assessment (TOT: n = 48; control: n = 47). The TOT group demonstrated significantly greater improvements across all outcomes: FMA-UE (MD = +3.9, 95% CI: 2.5–5.3; d = 0.58), ARAT (MD = +4.4, 95% CI: 2.7–6.1; d = 0.52), WMFT (MD = −2.1 s, 95% CI: −3.2 to −1.0; d = 0.46), and Barthel Index (MD = +5.4, 95% CI: 3.2–7.6; d = 0.49); all p < 0.0125 after Bonferroni correction. TOT group improvements exceeded established minimal clinically important difference thresholds for all outcomes. Conclusion: Structured task-oriented motor training yields clinically meaningful, statistically robust improvements in upper limb motor recovery and functional independence following stroke, and represents an effective, low-resource-compatible rehabilitation strategy for LMIC clinical settings.