Rehabilitation interventions for upper limb function in the first four weeks following stroke: a systematic review and meta-analysis of the evidence

Publication date: Available online 20 July 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Kimberley A. Wattchow, Michelle N. McDonnell, Susan L. Hillier
ObjectiveTo investigate the therapeutic interventions reported in the research literature, and synthesize their effectiveness in improving upper limb (UL) function in the first four weeks post-stroke.Data sourcesElectronic databases, trial registries and hand searching was conducted, from inception until June 2016.Study selectionRandomised controlled trials (RCTs), controlled trials and interventional studies with pre/post-test design were included for adults within four 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 to usual care, sham or another technique.Data extractionTwo reviewers independently assessed eligibility of full texts, and methodologic quality of included studies using the Cochrane 'Risk of bias tool'.Data synthesis104 trials (83 RCTs, 21 non-randomised studies) were included (n=5,225 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) (standardised mean difference, SMD 1.09, 95% confidence intervals, CI 0.21, 1.97) and task-specific training (SMD 0.37, 95% CI 0.05 to 0.68). Evidence was found to support supplementary use of biofeedback and electrical stimulation. Use of Bobath therapy was not supported.ConclusionsUse of mCIMT and task-specific training was supported, as was supplementary use of biofeedback and electrical simulation, within the acute phase post-stroke. Further high quality studies into the initial four weeks post-stroke are needed to determine therapies for targeted functional UL outcomes.



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