The effect of altering a single component of a rehabilitation programme on the functional recovery of stroke patients: a systematic review and meta-analysis

Abstract

Objective:

To evaluate the effect of altering a single component of a rehabilitation programme (e.g. adding bilateral practice alone) on functional recovery after stroke, defined using a measure of activity.

Data sources:

A search was conducted of Medline/Pubmed, CINAHL and Web of Science.

Review methods:

Two reviewers independently assessed eligibility. Randomized controlled trials were included if all participants received the same base intervention, and the experimental group experienced alteration of a single component of the training programme. This could be manipulation of an intrinsic component of training (e.g. intensity) or the addition of a discretionary component (e.g. augmented feedback). One reviewer extracted the data and another independently checked a subsample (20%). Quality was appraised according to the PEDro scale.

Results:

Thirty-six studies (n = 1724 participants) were included. These evaluated nine training components: mechanical degrees of freedom, intensity of practice, load, practice schedule, augmented feedback, bilateral movements, constraint of the unimpaired limb, mental practice and mirrored-visual feedback. Manipulation of the mechanical degrees of freedom of the trunk during reaching and the addition of mental practice during upper limb training were the only single components found to independently enhance recovery of function after stroke.

Conclusion:

This review provides limited evidence to support the supposition that altering a single component of a rehabilitation programme realises greater functional recovery for stroke survivors. Further investigations are required to determine the most effective single components of rehabilitation programmes, and the combinations that may enhance functional recovery.

Keywords

Stroke rehabilitation programme recovery of function systematic review

Get full access to this article

View all access options for this article.

References

Taub

Uswatte

King

Morris

Crago

Chatterjee

. A placebo-controlled trial of constraint-induced movement therapy for upper extremity after stroke. Stroke 2006; 37: 1045–1049.

Taub

Uswatte

Mark

Morris

. The learned nonuse phenomenon: Implications for rehabilitation. Eura Medicophys 2006; 42: 241–256.

Morris

Taub

Mark

. Constraint-induced movement therapy (CI therapy): Characterising the intervention protocol. Eura Medicophys 2006; 42: 257–268.

Foley

Salter

Teasell

. Specialised stroke services: A meta-analysis comparing three models of care. Cerebrovascular Diseases 2007; 23: 194–202.

Stroke Unit Trialists’ Collaboration. Organised inpatient (stroke unit) care for stroke. Cochrane Database of Systematic Reviews 2007; 3: CD000197.

Ezendam

Bongers

Jannink

MJA

. Systematic review of the effectiveness of mirror therapy in upper extremity function. Disabil Rehabil 2009; 31: 2135–2149.

Thieme

Mehrholz

Pohl

Behrens

Dohle

. Mirror therapy for improving motor function after stroke. Cochrane Database of Systematic Reviews 2012; 3: CD008449.

Coupar

Pollock

van Wijck

Morris

Langhorne

. Simultaneous bilateral training for improving arm function after stroke. Cochrane Database of Systematic Reviews 2010; 4: CD006432.

Stewart

Cauraugh

Summers

. Bilateral movement training and stroke rehabilitation: A systematic review and meta-analysis. J Neurological Sci 2006; 244: 89–95.

10.

Cooke

Mares

Clark

Tallis

Pomeroy

. The effect of increased dose of exercise-based therapies to enhance motor recovery after stroke: A systematic review and meta-analysis. BMC Med 2010; 8: 60–73.

11.

Kwakkel

. Impact of intensity of practice after stroke: Issues for consideration. Disabil Rehabil 2006; 28: 823–830.

12.

Veerbeek

Koolstra

Ket

JCF

van Wegen

Kwakkel

. Effects of augmented exercise therapy on outcome of gait and gait-related activities in the first 6 months after stroke: A meta-analysis. Stroke 2012; 42: 3311–3315.

13.

Braun

Beurskens

Borm

Schack

Wade

. The effects of mental practice in stroke rehabiltiation: A systematic review. Arch Phys Med Rehabil 2006; 87: 842–852.

14.

Nilsen

Gillen

Gordon

. Use of mental practice to improve upper limb recovery after stroke: A systematic review. Am J Occupat Therapy 2010; 64: 695–708.

15.

Ada

Dorsch

Canning

. Strengthening interventions increase strength and improve activity after stroke: A systematic review. Australian J Physiotherapy 2006; 52: 241–248.

16.

Harris

Eng

. Strength training improves upper-limb function in individuals with stroke: A meta-analysis. Stroke 2010; 41: 136–140.

17.

Morris

Dodd

Morris

. Outcome of progressive resistance stregnth traiing following stroke: A systematic review. Clin Rehabil 2004; 18: 833–862.

18.

Van Peppen

RPS

Kwakkel

Wood-Dauphinee

Hendricks

HJM

Van der Wees

Dekker

. The impact of physical therapy on functional outcomes after stroke: What’s the evidence? Clin Rehabil 2004; 18: 833–862.

19.

Subramanian

Massie

Malcolm

Levin

. Does provision of extrinsic feedback result in improved motor learning in the upper limb poststroke? A systematic review of the evidence. Neurorehabil Neural Repair 2010; 24: 113–124.

20.

van Dijk

Michiel

Hermens

. Effect of augmented feedback on motor function of the affected upper extremity in rehabilitation patients: A systematic review of randomised controlled trials. J Rehabil Med 2005; 37: 202–211.

21.

Van Vliet

Wulf

. Extrinsic feedback for motor learning after stroke: What is the evidence? Disabil Rehabil 2006; 28: 831–840.

22.

Hill

Denisenko

Miller

Clements

Batchelor

. Clinical outcome measurement in adult neurological physiotherapy. 4th ed. St Kilda, Victoria: National Neurology Group of the Australian Physiotherapy Association, 2007.

23.

Williams

Hodges

. Skill acquisition in sport: Research, theory and practice. London: Routledge, 2004.

24.

Shumway-Cook

Woollacott

. Motor control: Theory and practical applications. 2nd ed. Baltimore: Lippincott Williams & Wilkins, 2001.

25.

Schmidt

Lee

. Motor control and learning: A behavioural emphasis. 4th ed. Champaign, Illinois: Human Kinetics, 2005.

26.

Magill

. Motor learning and control: concepts and applications. 8th ed. Sydney: McGraw Hill, 2007.

27.

Physiotherapy Evidence Database. 2008. Available from: http://www.pedro.org.au/.

28.

Verhagen

de Vet

de Bie

. The Delphi list: A criteria list for quality assessment of randomised clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol 1998; 51: 1235–1241.

29.

Maher

Sherrington

Herbert

Moseley

Elkins

. Reliability of the PEDro scale for rating quality of randomised controlled trials. Physical Therapy 2003; 83: 713–721.

30.

Hedges

Olkin

. Statistical methods for meta-analysis. Orlanda, Florida: Academic Press, 1985.

31.

Rothstein

Sutton

Borenstein

. Publication bias in meta-analysis: Prevention, assessment and adjustments. San Fransisco: Wiley, 2005.

32.

Borenstein

Hedges

Higgins

JPT

Rothstein

. Introduction to meta-analysis. West Sussex: Wiley & Sons, 2009.

33.

Dohle

Pullen

Nakaten

Kust

Rietz

Karbe

. Mirror therapy promotes recovery from severe hemiparesis: A randomised controlled trial. Neurorehabil Neural Repair 2009; 23: 209–217.

34.

Donaldson

Tallis

Miller

Sunderland

Lemon

Pomeroy

. Effects of conventional physical therapy and functional strength training on upper limb motor recovery after stroke: A randomized phase II study. Neurorehabil Neural Repair 2009; 23: 389–397.

35.

Kwakkel

Wagenaar

Twisk

JWR

Lankhorst

Koetsier

. Intensity of leg and arm training after primary middle-cerebral-artery stroke: A randomised trial. The Lancet 1999; 354: 191–196.

36.

Stoykov

Lewis

Corcos

. Comparison of bilateral and unilateral training for upper extremity hemiparesis in stroke. Neurorehabil Neural Repair 2009; 23: 945–953.

37.

Dromerick

Lang

Birkenmeier

. Very early contraint-induced movement during stroke rehabilitation (VECTORS). A single centre RCT. Neurology 2009; 73: 195–201.

38.

Glasgow Augmented Physiotherapy Study Group. Can augmented physiotherapy input enhance recovery of mobility after stroke? A randomised controlled trial. Clin Rehabil 2004; 18: 529–537.

39.

Hsu

S-S

M-H

Wang

Y-H

Yip

P-K

Chiu

J-W

Hseih

C-L

. Dose-response relation between neuromuscular electrical stimulation and upper-extremity function in patients with stroke. Stroke 2010; 41: 821–824.

40.

Lincoln

Parry

Vass

. Randomised, controlled trial to evaluate increased intensity of physiotherapy treatment of arm function after stroke. Stroke 1999; 30: 573–579.

41.

Rodgers

Mackintosh

Price

. Does an early increased-intensity interdisciplinary upper limb therapy program following acute stroke improve outcome? Clin Rehabil 2003; 17: 579–589.

42.

Sivenius

Pyorala

Heinonen

Salonen

Reikkinen

. The significance of intensity of rehabilitation of stroke: A controlled trial. Stroke 1985; 16: 928–931.

43.

Sunderland

Tinson

Bradley

Fletcher

Langton Hewer

Wade

. Enhanced physical therapy improves recovery of arm function after stroke. A randomised controlled trial. J Neurol Neurosurg Psychiatry 1992; 55: 530–535.

44.

Smith

Goldenber

Ashburn

. Remedial therapy after stroke: A randomised controlled trial. BMJ 1981; 282: 517–520.

45.

Cauraugh

Kim

. Stroke motor recovery: Active neuromuscular stimulation and repetitive practice schedules. J Neurol Neurosurg Psychiatry 2003;74:1562–6.

46.

Bradley

Hart

Mandana

Flowers

Riches

Sanderson

. Electromyographic biofeedback for gait training after stroke. Clin Rehabil 1998; 12: 11–22.

47.

Dobkin

Plummer-D’Amato

Elashoff

Lee

and SIRROWS Group. International randomized clinical trial, stroke inpatient rehabilitation with reinforcement of walking speed (SIRROWS), improves outcomes. Neurorehabil Neural Repair 2010; 24: 235–242.

48.

Gilmore

Spaulding

. Motor learning and the use of videotape feedback after stroke. Topics in Stroke Rehabil 2009; 2007: 28–36.

49.

Grant

Brouwer

Culham

Vandervoort

. Balance retraining following acute stroke: A comparison of two methods. Can J Rehabil 1997; 11: 69–73.

50.

Sackley

Lincoln

. Single blind randomised controlled trial of visual feedback after stroke: Effects on stance symmetry and function. Disabil Rehabil 1997; 19: 536–546.

51.

Walker

Brouwer

Culham

. Use of visual feedback in retraining balance following acute stroke. Physical Therapy 2000; 80: 886–895.

52.

Armagan

Tascioglu

Oner

. Electromyographic biofeedback in the treatment of the hemiplegic hand: A placebo controlled trial. Am J Phys Med Rehabil 2003; 82: 856–861.

53.

Crow

Lincoln

Nouri

De Weerdt

. The effectiveness of EMG biofeedback in the treatment of arm function after stroke. Int Disabil Stud 1989;11:155–60.

54.

Cauraugh

Kim

. Two coupled motor recovery protocols are better than one: Electromyogram-triggered neuromuscular stimulation and bilateral movements. Stroke 2002; 33: 1589–1594.

55.

Lum

Burgar

Van der Loos

Shor

Majmundar

Yap

. MIME robotic device for upper-limb neurorehabilitation in subacute stroke subjects: A follow-up study. J Rehabil Res Devel 2006; 43: 631–642.

56.

Morris

van Wijck

Joice

Ogston

Cole

MacWalter

. A comparison of bilateral and unilateral upper-limb task training in early poststroke rehabilitation: A randomised controlled trial. Arch Phys Med Rehabil 2008; 89: 1237–1245.

57.

Summers

Kagerer

Garry

Hiraga

Loftus

Cauraugh

. Bilateral and unilateral movement training on upper limb function in chronic stroke patients: A TMS study. J Neurological Sci 2007; 252: 76–82.

58.

Brogardh

Vestling

Sjolund

. Shortened constraint induced movement therapy in subacute stroke – No effect of using a restraint: A randomized controlled study with independent observers. J Rehabil Med 2009; 41: 231–236.

59.

Hammer

Lindmark

. Effects of forced use on arm function in the subacute phase after stroke: A randomized, clinical pilot study. Physical Therapy 2009; 89: 526–539.

60.

Ploughman

Corbett

. Can forced-use therapy be clinically applied after stroke? An exploratory randomized controlled trial. Arch Phys Med Rehabil 2004; 85: 1417–1423.

61.

Malouin

Richards

Durand

Doyon

. Added value of mental practice combined with a small amount of physical practice on the relearning of rising and sitting post stroke: A pilot study. J Neurolog Phys Therapy 2009; 33: 195–202.

62.

Page

Levine

Leonard

. Effects of mental practice on affected limb use and function in chronic stroke. Arch Phys Med Rehabil 2005; 86: 399–402.

63.

Page

Levine

Leonard

. Mental practice in chronic stroke: Results of a randomised, placebo-controlled trial. Stroke 2007; 38: 1293–1297.

64.

Yavuzer

Selles

Sezer

. Mirror therapy improves hand function in subacute stroke: A randomised controlled trial. Arch Phys Med Rehabil 2008; 89: 393–398.

65.

Pronovost

Berenholtz

Goeschel

. Improving patient safety in intensive care units in Michigan. Journal of Critical Care 2008; 23: 207–221.

66.

Kwakkel

van Peppen

RPS

Wagenaar

. Effects of augmented exercise therapy time after stroke: A meta-analysis. Stroke 2004; 35: 2529–2536.

67.

Peurala

Kantanen

Sjogren

Paltamaa

Karhula

Heinonen

. Effectiveness of constraint-induced movement therapy on activity and participation after stroke: A systematic review and meta-analysis of randomised controlled trials. Clin Rehabil 2012; 26: 209–223.

68.

Bernstein

. The co-ordination and regulation of movement. Oxford, England: Pergamon Press; 1967.

69.

Cauraugh

Lodha

Naik

Summers

. Bilateral movement training and stroke motor recovery progress: A structured review and meta-analysis. Human Movement Sci 2010; 29: 853–870.

70.

French

Thomas

Leathley

. Repetitive task training for improving functional ability after stroke. Cochrane Database of Systematic Reviews 2007; 4: CD006073.

71.

Taub

Crago

Uswatte

. Constraint-induced movement therapy: A new approach to treatment in physical rehabilitation. Rehabil Psychol 1998; 43: 152–170.

72.

Woodbury

Howland

McGuirk

. Effects of trunk restraint combined with intensive task practice on poststroke upper extremity reach and function: A pilot study. Neurorehabil Neural Repair 2009; 23: 78–91.

73.

Michaelsen

Dannenbaum

Levin

. Task-specific training with trunk restraint on arm recovery in stroke: Randomised controlled trial. Stroke 2006; 37: 186–192.

74.

Lee

M-J

Kilbreath

Singh

. Comparison of effect of aerobic cycle training and progressive resistance training on walking ability after stroke: A randomised sham exercise-controlled study. J Am Geriatrics Soc 2008; 56: 976–985.

75.

Moreland

Goldsmith

Huijbregts

. Progressive resistance strengthening exercises after stroke: A single-blind randomized controlled trial. Arch Phys Med Rehabil 2003; 84: 1433–1440.

76.

Cauraugh

Kim

. Stroke motor recovery: Active neuromuscualr stimulation and repetitive practice schedules. J Neurol Neurosurg Psychiatry 2003; 74: 1562–1566.

77.

Sutbeyaz

Yavuzer

Sezer

Koseoglu

. Mirror therapy enhances lower-extermity motor recovery and motor functioning after stroke: A randomised controlled trial. Arch Phys Med Rehabil 2007; 88: 555–559.