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Effectiveness of interventions for
upper limb recovery after stroke
Fiona Coupar, Alex Pollock, Phil Rowe,
Christopher Weir and Peter Langhorne
Research question
Which interventions targeted at
the upper limb are effective?
Methods – Systematic Review
Inclusion criteria – RCT
– Stroke
– UL targeted interventions
– UL functional or impairment outcomes
– Comparisons: placebo, no treatment,
standard care
Cochrane stroke group trials register
Standard SR methodology
Review profile
11000 titles
827 abstracts
Ten interventionsConstraint Induced Movement Therapy (CIMT);
Electrostimulation; Robotics; Repetitive Task Training;
Therapy approaches; Increased intensity;
EMG biofeedback;
Imagery; Splinting; Bilateral training
72 trials
Constraint-induced movement therapy
Trials Allocation concealment Intention to treat Blinding
22 4 4 18
Electrostimulation
Trials Allocation concealment Intention to treat Blinding
13 2 0 7
Electromechanical / Robotic devices
Trials Allocation concealment Intention to treat Blinding
10 3 2 7
Repetitive task training
Trials Allocation concealment Intention to treat Blinding
8 5 1 6
Approach of therapy
Trials Allocation concealment Intention to treat Blinding
5 2 1 3
Intensity of therapy
Trials Allocation concealment Intention to treat Blinding
4 3 1 4
Biofeedback
Trials Allocation concealment Intention to treat Blinding
4 4 0 3
Mental practice / Imagery
Trials Allocation concealment Intention to treat Blinding
4 0 0 3
Splinting
Trials Allocation concealment Intention to treat Blinding
3 2 2 3
Bilateral arm training
Trials Allocation concealment Intention to treat Blinding
2 1 0 2
Limitations
Heterogeneity
Nature of included trials
Strengths
Comprehensive searching
Only RCTs included
Explicit and systematic methods
SummarySome evidence of benefit from:
–CIMT
– Imagery/mental practice
–Robotics
–EMG biofeedback
Applicability & generalisability
limitations
Repetitive, intense, task-specific
practice
Implications
Clinical Research
