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This study investigates whether adding Boccia exercises to conventional rehabilitation improves upper extremity muscle thickness and grip strength in individuals with hemiparesis following stroke. The research aims to determine if Boccia training can enhance muscle morphology and functional strength beyond standard physical therapy.
Loss of upper extremity function after stroke significantly reduces independence in daily living. Changes in muscle morphology (muscle thickness, echogenicity, pennation, etc.) can affect strength, coordination, and functional performance. Boccia is a sport originally designed for individuals with special needs, encouraging hand-eye coordination, targeting, and force-controlled repetitions. Due to these characteristics, it has been suggested that boccia may positively impact both motor control and muscle tone; however, its effects on muscle morphology and grip strength in hemiparetic individuals have been limitedly studied. This study will investigate the contribution of boccia exercises to conventional physiotherapy on upper extremity muscle thickness and grip strength.
Primary objective: To evaluate whether boccia exercises provide significant improvements in upper extremity muscle thickness and grip strength after hemiparesis, in addition to conventional physical therapy.
Hypothesis: Participants who receive up to nine weeks of extended or eight weeks (8 weeks in the protocol) of boccia practice will show greater improvements in upper extremity muscle thickness and grip strength than those who receive conventional physical therapy alone.
This study is a parallel-group, random assignment controlled trial. The total sample included 22 stroke (hemiparetic) individuals; participants were randomly assigned to two groups: Boccia + physical therapy (Boc, n = 12) and physical therapy alone (Ctrl, n = 10). Assessments will be conducted at pre-intervention (baseline) and post-intervention (after 8 weeks). Assessors will be blinded to the measurements; complete blinding of operators and participants is not possible.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Boccia Exercise Group | Experimental | Participants in this group will receive conventional physical therapy combined with Boccia exercises three times per week for 8 weeks. Each session lasts approximately 45-60 minutes and includes warm-up, Boccia skill drills (target aiming, throwing control), and cool-down activities. |
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| Control Group | Active Comparator | Participants in this group will receive only conventional physical therapy three times per week for 8 weeks. The program includes strengthening, range of motion, and task-specific functional exercises matched in duration and frequency to the experimental group. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Boccia exercise | Other | Boccia exercises differ significantly from other rehabilitation interventions for individuals with physical disabilities. Traditional physical therapy or exercise programs often involve repetitive, motivating movements that lack motivation and cannot be directly linked to individuals' daily activities. However, thanks to its game-based structure, Boccia offers a fun and functional exercise platform. This increases individuals' motivation to participate, facilitates continuity, and brings a more natural setting to the rehabilitation process. Furthermore, Boccia supports the active use of upper extremity muscles and the development of balance and coordination, while also encouraging social interaction and a sense of competition. Therefore, Boccia's game-based and accessible structure offers a more applicable and sustainable approach to developing motor skills and increasing functional independence in individuals with physical disabilities compared to other traditional interventions. |
| Measure | Description | Time Frame |
|---|---|---|
| upper extremity muscle thickness | Muscle thickness of selected upper extremity muscles (e.g., biceps brachii, triceps brachii, deltoid) is measured using ultrasonography. Measurements are taken at standard anatomic locations with the participant in a relaxed, resting position. Thickness is recorded in millimeters (mm) and represents the distance between the superficial and deep aponeuroses of the muscle. Assessments are performed before (baseline) and after (8 weeks) the intervention by blinded assessors to assess changes in muscle morphology. | 8 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Grip Strength | Maximum voluntary grip strength of the affected hand is measured using a hand dynamometer. Participants are seated with the elbow flexed at 90° and the forearm in neutral position. Three trials are performed, with brief rest periods between attempts, and the highest value (in kilograms, kg) is recorded. Assessments are conducted pre-intervention (baseline) and post-intervention (after 8 weeks) by blinded assessors to evaluate changes in upper extremity functional strength. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| EMRE B HAZAR, Master Degree | Bayburt University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Bayburt Unıversity | Bayburt | Merkez | 69000 | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 41699666 | Derived | Hazar EB, Guder BC, Hazar K, Gok UD, Alkhamees NH, Ibrahim ZM, Al-Mhanna SB, Batrakoulis A. Upper extremity muscle thickness and grip strength following a boccia-based intervention in hemiparetic individuals. BMC Sports Sci Med Rehabil. 2026 Feb 16;18(1):170. doi: 10.1186/s13102-026-01601-3. |
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| ID | Type | URL | Comment |
|---|---|---|---|
| The individual participant dat | Individual Participant Data Set | View IPD |
IPD will not be shared to protect participant privacy and comply with ethical and legal regulations.
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Nov 15, 2025 | Nov 15, 2025 | Prot_SAP_000.pdf |
| ICF | No | No | Yes | Informed Consent Form | Nov 19, 2025 | Nov 19, 2025 | ICF_001.pdf |
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| ID | Term |
|---|---|
| D020521 | Stroke |
| ID | Term |
|---|---|
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
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| ID | Term |
|---|---|
| D026741 | Physical Therapy Modalities |
| ID | Term |
|---|---|
| D013812 | Therapeutics |
| D012046 | Rehabilitation |
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Interventional Study Model:
Design: Randomized Controlled, Parallel Assignment, Pretest-Posttest Design Allocation: Randomized Intervention Model: Parallel Assignment Masking: Single (Outcomes Assessor) Primary Purpose: Treatment / Rehabilitation
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| physiotherapy | Other | Conventional physical therapy (physiotherapy) is a proven rehabilitation approach aimed at improving upper extremity function, muscle strength, and range of motion in hemiparetic individuals who have had a stroke. The program includes strengthening exercises, joint mobilization, task-oriented functional activities, and motor relearning techniques. Sessions are individualized and tailored to the participant's clinical condition to increase independent participation in activities of daily living in hemiparetic individuals. Regular and structured practice helps prevent the development of muscle atrophy and contractures and maximize functional gains. |
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| 8 weeks |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |