Effectiveness of interventions for upper limb recovery after stroke: a systematic review

Background: Upper limb deficits are common following stroke and have a significant impact on disability and health. Rehabilitation interventions for the upper limb usually focus on reducing impairment and increasing function. However, the design and evaluation of such interventions is complex. We carried out a systematic review to identify the effectiveness of interventions targeted at upper limb recovery. Methods: We searched the Cochrane Stroke Group trials register for randomised trials of an intervention aimed specifically at upper limb recovery compared to placebo, no treatment or standard care. We included outcomes related to impaired movement or related functions of the upper limb. Two reviewers allocated each trial to a particular intervention, assessed methodological quality and extracted data. Means and standard deviations were extracted and combined within meta-analyses to derive a standardised mean difference (SMD) and 95% confidence intervals (CI). Results: Ten interventions had more than one relevant randomised controlled trial. A statistically significant result was found in favour of five interventions: EMG biofeedback (SMD 0.41 95% CI 0.05 to 0.77); electrostimulation (SMD 0.31 95% CI 0.06 to 0.56); mental practice/imagery (SMD 0.84 95% CI 0.34 to 1.33); robotics (SMD 0.61 95% 0.30 to 0.92) and constraint induced movement therapy (SMD 0.73 95% CI 0.54 to 0.91). No significant result was found for repetitive task training, spliniting/orthoses, increased intensity, neurophysiological approach (Bobath) or bilateral training. Conclusions: This review is limited by the heterogeneity of the trials, in terms of study design, analysis and quality. Despite the limitations these data provide a concise and informative summary of the available evidence for interventions targeted at upper limb recovery and suggests that a number of interventions may be beneficial for upper limb recovery. This paper was presented at the XVIII European Stroke Conference, in 2009.