Fiona coupar

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