Rehabilitation Interventions for Upper Limb Function in the First Four Weeks Following Stroke: A Systematic Review and Meta-Analysis of the Evidence

Wattchow, Kimberley A.; McDonnell, Michelle N.; Hillier, Susan

doi:10.1016/j.apmr.2017.06.014

Cited by 62 publications

(31 citation statements)

References 104 publications

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“…These programs usually include physiotherapy and occupational therapy sessions on a daily basis during the first 6 months and up to a year following the stroke . In these sessions, a wide range of techniques are used, although a recent meta‐analysis only supported the use of modified constraint‐induced movement therapy and task‐specific training in the first 4 weeks poststroke . In addition, other emerging evidence‐based techniques could be introduced into the rehabilitation programs as add‐on treatments to boost the recovery of stroke patients .…”

Section: Introductionmentioning

confidence: 99%

“…7 In these sessions, a wide range of techniques are used, although a recent meta-analysis only supported the use of modified constraint-induced movement therapy and task-specific training in the first 4 weeks poststroke. 8 In addition, other emerging evidencebased techniques could be introduced into the rehabilitation programs as add-on treatments to boost the recovery of stroke patients. 9,10 These techniques are designed to improve not only motor deficits but doi: 10.1111/nyas.13590 also other relevant aspects, including motivation, treatment adherence, and mood, all of which are known to contribute to the success of the rehabilitation process.…”

Section: Introductionmentioning

confidence: 99%

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Music‐supported therapy in the rehabilitation of subacute stroke patients: a randomized controlled trial

Grau-Sánchez

Duarte

Ramos-Escobar

et al. 2018

Annals of the New York Academy of Sciences

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The effect of music-supported therapy (MST) as a tool to restore hemiparesis of the upper extremity after a stroke has not been appropriately contrasted with conventional therapy. The aim of this trial was to test the effectiveness of adding MST to a standard rehabilitation program in subacute stroke patients. A randomized controlled trial was conducted in which patients were randomized to MST or conventional therapy in addition to the rehabilitation program. The intensity and duration of the interventions were equated in both groups. Before and after 4 weeks of treatment, motor and cognitive functions, mood, and quality of life (QoL) of participants were evaluated. A follow-up at 3 months was conducted to examine the retention of motor gains. Both groups significantly improved their motor function, and no differences between groups were found. The only difference between groups was observed in the language domain for QoL. Importantly, an association was encountered between the capacity to experience pleasure from music activities and the motor improvement in the MST group. MST as an add-on treatment showed no superiority to conventional therapies for motor recovery. Importantly, patient's intrinsic motivation to engage in musical activities was associated with better motor improvement.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Music‐supported therapy in the rehabilitation of subacute stroke patients: a randomized controlled trial

Grau-Sánchez

Duarte

Ramos-Escobar

et al. 2018

Annals of the New York Academy of Sciences

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“…Effective rehabilitation involves high-dose, intensive, task-specific activity [ 11 ]. Meta-analyses of randomized controlled trials suggest there is a dose-response relationship, with higher doses of rehabilitation resulting in better outcomes [ 12 - 14 ]. However, studies describing usual stroke care illustrate that the dose of UL rehabilitation received by people with stroke is extremely low, with as little as 4-6 minutes in physiotherapy sessions and 11-17 minutes in occupational therapy sessions [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Haptic Nudges Increase Affected Upper Limb Movement During Inpatient Stroke Rehabilitation: Multiple-Period Randomized Crossover Study

Signal¹,

McLaren²,

Rashid³

et al. 2020

JMIR Mhealth Uhealth

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Background As many as 80% of stroke survivors experience upper limb (UL) disability. The strong relationships between disability, lost productivity, and ongoing health care costs mean reducing disability after stroke is critical at both individual and society levels. Unfortunately, the amount of UL-focused rehabilitation received by people with stroke is extremely low. Activity monitoring and promotion using wearable devices offer a potential technology-based solution to address this gap. Commonly, wearable devices are used to deliver a haptic nudge to the wearer with the aim of promoting a particular behavior. However, little is known about the effectiveness of haptic nudging in promoting behaviors in patient populations. Objective This study aimed to estimate the effect of haptic nudging delivered via a wrist-worn wearable device on UL movement in people with UL disability following stroke undertaking inpatient rehabilitation. Methods A multiple-period randomized crossover design was used to measure the association of UL movement with the occurrence of haptic nudge reminders to move the affected UL in 20 people with stroke undertaking inpatient rehabilitation. UL movement was observed and classified using movement taxonomy across 72 one-minute observation periods from 7:00 AM to 7:00 PM on a single weekday. On 36 occasions, a haptic nudge to move the affected UL was provided just before the observation period. On the other 36 occasions, no haptic nudge was given. The timing of the haptic nudge was randomized across the observation period for each participant. Statistical analysis was performed using mixed logistic regression. The effect of a haptic nudge was evaluated from the intention-to-treat dataset as the ratio of the odds of affected UL movement during the observation period following a “Planned Nudge” to the odds of affected limb movement during the observation period following “No Nudge.” Results The primary intention-to-treat analysis showed the odds ratio (OR) of affected UL movement following a haptic nudge was 1.44 (95% CI 1.28-1.63, P<.001). The secondary analysis revealed an increased odds of affected UL movement following a Planned Nudge was predominantly due to increased odds of spontaneous affected UL movement (OR 2.03, 95% CI 1.65-2.51, P<.001) rather than affected UL movement in conjunction with unaffected UL movement (OR 1.13, 95% CI 0.99-1.29, P=.07). Conclusions Haptic nudging delivered via a wrist-worn wearable device increases affected UL movement in people with UL disability following stroke undertaking inpatient rehabilitation. The promoted movement appears to be specific to the instructions given. Trial Registration Australia New Zealand Clinical Trials Registry 12616000654459; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370687&isReview=true

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“…There are also some comprehensive systematic reviews on general function treatment of upper limb after stroke56–58 or other specific problems, such as motor dysfunction,59 60 sensory impairment,61 spasticity,62 63 decreased quality of life,64 and shoulder pain and subluxation 65–67. In addition, other important issues of upper limb rehabilitation after stroke, like timing of intervention,68 dose of training,69 effects of severity on motor recovery,24 outcome measures70–75 and predictors of functional restoration76 77 were systematically reviewed as well. However, much less attention has been paid to the systematic review of hand function rehabilitation after moderate to severe stroke 78–83.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of interventions to improve hand motor function in individuals with moderate to severe stroke: a systematic review protocol

et al. 2019

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IntroductionThe human hand is extremely involved in our daily lives. However, the rehabilitation of hand function after stroke can be rather difficult due to the complexity of hand structure and function, as well as neural basis that supports hand function. Specifically, in individuals with moderate to severe impairment following a stroke, previous evidence for effective treatments that recover hand function in this population is limited, and thus has never been reviewed. With the progress of rehabilitation science and tool development, results from more and more clinical trials are now available, thereby justifying conducting a systematic review.Methods and analysisThis systematic review protocol is consistent with the methodology recommended by the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols and the Cochrane handbook for systematic reviews of interventions. Electronic searches will be carried out in the PubMed, CINAHL, Physiotherapy Evidence Database and Cochrane Library databases, along with manual searches in the reference lists from included studies and published systematic reviews. The date range parameters used in searching all databases is between January 1999 and January 2019. Randomised controlled trials (RCTs) published in English, with the primary outcome focusing on hand motor function, will be included. Two reviewers will screen all retrieved titles, abstracts and full texts, perform the evaluation of the risk bias and extract all data independently. The risk of bias of the included RCTs will be evaluated by the Cochrane Collaboration’s tool. A qualitative synthesis will be provided in text and table, to summarise the main results of the selected publications. A meta-analysis will be considered if there is sufficient homogeneity across outcomes. The quality of the included publications will be evaluated by the Grading of Recommendations Assessment, Development and Evaluation system from the Cochrane Handbook for Systematic Reviews of Interventions.Ethics and disseminationNo ethical approval is needed, and the results of this review will be disseminated via peer-reviewed publications and conference presentations.Trial registration numberCRD42019128285.

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Rehabilitation Interventions for Upper Limb Function in the First Four Weeks Following Stroke: A Systematic Review and Meta-Analysis of the Evidence

Cited by 62 publications

References 104 publications

Music‐supported therapy in the rehabilitation of subacute stroke patients: a randomized controlled trial

Music‐supported therapy in the rehabilitation of subacute stroke patients: a randomized controlled trial

Haptic Nudges Increase Affected Upper Limb Movement During Inpatient Stroke Rehabilitation: Multiple-Period Randomized Crossover Study

Effectiveness of interventions to improve hand motor function in individuals with moderate to severe stroke: a systematic review protocol

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