A Comparison of Bilateral and Unilateral Upper-Limb Task Training in Early Poststroke Rehabilitation: A Randomized Controlled Trial

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.

Key Words: Cerebrovascular accident, Motor activity, Randomized controlled trial, Rehabilitation, Upper extremity

List of Abbreviations: ADLs, activities of daily living, ANOVA, analysis of variance, ARAT, Action Research Arm Test, CI, confidence interval, HADS, Hospital Anxiety and Depression Scale, HRQOL, health-related quality of life, 9HPT, Nine-Hole Peg Test, MBI, Modified Barthel Index, NHP, Nottingham Health Profile, RMA, Rivermead Motor Assessment, RCT, randomized controlled trial