A Comparison of Bilateral and Unilateral Upper-Limb Task Training in Early Poststroke Rehabilitation: A Randomized Controlled Trial
Presented in part to the UK Stroke Forum, December 7, 2006, Harrogate, UK, and the World Confederation of Physical Therapy Congress, June 4, 2007, Vancouver, BC, Canada.
Abstract
Morris JH, van Wijck F, Joice S, Ogston SA, Cole I, MacWalter RS. A comparison of bilateral and unilateral upper-limb task training in early poststroke rehabilitation: a randomized controlled trial.
Objective
To compare the effects of bilateral task training with unilateral task training on upper-limb outcomes in early poststroke rehabilitation.
Design
A single-blinded randomized controlled trial, with outcome assessments at baseline, postintervention (6wk), and follow-up (18wk).
Setting
Inpatient acute and rehabilitation hospitals.
Participants
Patients were randomized to receive bilateral training (n=56) or unilateral training (n=50) at 2 to 4 weeks poststroke onset.
Intervention
Supervised bilateral or unilateral training for 20 minutes on weekdays over 6 weeks using a standardized program.
Main Outcome Measures
Upper-limb outcomes were assessed by Action Research Arm Test (ARAT), Rivermead Motor Assessment upper-limb scale, and Nine-Hole Peg Test (9HPT). Secondary measures included the Modified Barthel Index, Hospital Anxiety and Depression Scale, and Nottingham Health Profile. All assessment was conducted by a blinded assessor.
Results
No significant differences were found in short-term improvement (0−6wk) on any measure (P>.05). For overall improvement (0−18wk), the only significant between-group difference was a change in the 9HPT (95% confidence interval [CI], 0.0−0.1; P=.05) and ARAT pinch section (95% CI, 0.3−5.6; P=.03), which was lower for the bilateral training group. Baseline severity significantly influenced improvement in all upper-limb outcomes (P<.05), but this was irrespective of the treatment group.
Conclusions
Bilateral training was no more effective than unilateral training, and in terms of overall improvement in dexterity, the bilateral training group improved significantly less. Intervention timing, task characteristics, dose, and intensity of training may have influenced the results and are therefore areas for future investigation.
aAlliance for Self-Care Research, University of Dundee, Dundee, UK
bCommunity Health Sciences, University of Dundee, Dundee, UK
cDepartment of Medicine and Therapeutics, University of Dundee, Dundee, UK
dSchool of Health Sciences, Queen Margaret University, Edinburgh, UK
eDepartments of Physiotherapy, Ninewells Hospital, Dundee, UK.
Reprint requests to Jacqui H. Morris, MSc, Clinical Research Fellow, Alliance for Self-Care Research, University of Dundee, 11 Airlie Pl, Dundee DD1 4HJ, UK
Supported by the Chief Scientist Office, Scottish Executive Health Department (grant no. CHZ/4/80).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.
ABSTRACT