Abstract
Objective
To investigate the therapeutic interventions reported in the research literature and
synthesize their effectiveness in improving upper limb (UL) function in the first
4 weeks poststroke.
Data Sources
Electronic databases and trial registries were searched from inception until June
2016, in addition to searching systematic reviews by hand.
Study Selection
Randomized controlled trials (RCTs), controlled trials, and interventional studies
with pre/posttest design were included for adults within 4 weeks of any type of stroke
with UL impairment. Participants all received an intervention of any physiotherapeutic
or occupational therapeutic technique designed to address impairment or activity of
the affected UL, which could be compared with usual care, sham, or another technique.
Data Extraction
Two reviewers independently assessed eligibility of full texts, and methodological
quality of included studies was assessed using the Cochrane Risk of Bias Tool.
Data Synthesis
A total of 104 trials (83 RCTs, 21 nonrandomized studies) were included (N=5225 participants).
Meta-analyses of RCTs only (20 comparisons) and narrative syntheses were completed.
Key findings included significant positive effects for modified constraint-induced
movement therapy (mCIMT) (standardized mean difference [SMD]=1.09; 95% confidence
interval [CI], .21–1.97) and task-specific training (SMD=.37; 95% CI, .05–.68). Evidence
was found to support supplementary use of biofeedback and electrical stimulation.
Use of Bobath therapy was not supported.
Conclusions
Use of mCIMT and task-specific training was supported, as was supplementary use of
biofeedback and electrical simulation, within the acute phase poststroke. Further
high-quality studies into the initial 4 weeks poststroke are needed to determine therapies
for targeted functional UL outcomes.
Keywords
List of abbreviations:
ADL (activities of daily living), CI (confidence interval), mCIMT (modified constraint-induced movement therapy), MD (mean difference), RCT (randomized controlled trial), ROM (range of motion), SMD (standardized mean difference), UL (upper limb)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 19, 2017
Footnotes
Clinical Trial Registration No.: International Prospective Register of Systematic Reviews (PROSPERO), registration no. CRD42015019226.
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
