Hand-Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) in adults with chronic stroke: a randomized controlled trial
In brief
A 50-hour stroke therapy improved bimanual use through three months
In a randomized trial of 46 adults with chronic stroke, a two-week, 50-hour therapy program improved bimanual hand use compared with usual rehabilitation, with gains still seen three months later. Participants also improved on several measures of arm function and daily activities, but the trial found no significant between-group benefit on lower-limb measures.
- Journal
- Annals of physical and rehabilitation medicine (Q1)
- Published
- 31 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Estelle Gathy, Daniela Ebner-Karestinos, Astrid Carton de Tournai, Enimie Herman, Rodrigo Araneda, Zélie Rosselli, et al.
- PMID
- 42966330
- DOI
- 10.1016/j.rehab.2026.102189
Why clinicians should know about it
- Picked for Rehabilitation (top studies of the week, 1 November 2026): Randomized trial of intensive chronic stroke motor rehabilitation
Abstract
BACKGROUND: Stroke rehabilitation guidelines recommend goal-oriented, task-specific, intensive interventions. Yet most programs emphasize upper extremity (UE) recovery, overlooking lower extremities (LEs) and trunk, which are essential for activities of daily living. Consequently, Hand-Arm Bimanual Intensive Therapy Including LEs (HABIT-ILE) represents a promising approach for stroke rehabilitation. OBJECTIVE: This randomized controlled trial aimed to determine the effect of HABIT-ILE and to compare its efficacy with a control group in adults with chronic hemiparetic stroke by promoting greater improvements across the body functions, activity, and participation domains of the International Classification of Functioning, Disability and Health. METHODS: Forty-six adults with hemiparetic chronic stroke were randomized to either a 2-week (50 h, 5 h/day) HABIT-ILE camp-setting program in Brussels, Belgium, or to continue their usual neurorehabilitation (mean = 4 h 36 min) for over the same period. Participants were assessed before, immediately, and at 3 months after intervention using the Adult Assisting Hand Assessment Stroke (Ad-AHA Stroke, primary outcome), the Canadian Occupational Performance Measure (COPM), the Fugl Meyer Assessment for UEs (FMA-UE), the Wolf Motor Function Test (WMFT), the ABILHAND-CS and ACTIVLIM-CS questionnaires, the six-minute walk test, the modified Rankin Scale and the Stroke Impact Scale (SIS). RESULTS: The ANCOVA revealed a significant between-groups difference favoring the HABIT-ILE group (TG), with a time effect observed for the Ad-AHA Stroke (TG: at 2 weeks = +6.24% of logits; at 3 months = +7.05% of logits), WMFT (Functional Ability Scale, all P ≤ 0.041), and COPM (P < 0.001, performance and satisfaction) at both 2 weeks and 3 months. We found a similar significant effect for the SIS (hand function, P = 0.003) at 2 weeks and the FMA-UE and ABILHAND-CS at 3 months (all P ≤ 0.033). We observed no significant between-group differences for the other outcomes, including LEs measures. CONCLUSION: In adults with chronic stroke, HABIT-ILE intervention significantly improved spontaneous bimanual use, motor function, and ability of the paretic UE (both externally rated and self-perceived) and reduced participation restrictions compared with the control group. TRIAL REGISTRATION: This randomized controlled trial was registered on December 11th, 2020, on ClinicalTrials.gov as "HABIT-ILE in Adults With Chronic Stroke (HABIT-ILE Stroke)", with the registration number NCT04664673 (https://clinicaltrials.gov/study/NCT04664673?cond=NCT04664673&rank=).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.