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- Title
Self-directed therapy programmes for arm rehabilitation after stroke: a systematic review.
- Authors
Da Silva, R. H.; Moore, S. A.; Price, C. I.
- Abstract
Background: Arm recovery after stroke requires high levels of intensive rehabilitation. We investigated the effectiveness of increasing therapy through self-directed arm interventions in adult stroke survivors. Method: A systematic review of Medline, EMBASE, CINAHL, SCOPUS, and IEEEXplore was carried out. Studies of stroke arm interventions were included where >50% of the time spent in therapy was initiated and carried out by the participant. Quality of the evidence was assessed using the PEDro scale and Cochrane risk of bias tool. Results/Findings: A total of 38 studies (n =1151 participants) were included (19 randomized controlled trials and 19 before-after studies). Studies were grouped according to no technology or additional technology used (no technology n = 5; interactive gaming n = 6; electrical stimulation (ES) n =11; constraint-induced movement therapy (CIMT) n = 6; robotic devices n = 7; mirror therapy n = 1; tele-rehabilitation n = 5). A beneficial effect on arm function was found for self-directed interventions using CIMT (n = 105; standardized mean difference (SMD) 0.39, 95% confidence interval (CI) -0.00 to 0.78) and ES (n = 94; SMD 0.50, 95% CI 0.08 to 0.91). CIMT and therapy programmes without technology improved independence in activities of daily living. Sensitivity analysis demonstrated arm function benefit for patients >12 months post-stroke (n = 145; SMD 0.52, 95% CI 0.21,0.82) but not at 0-3,3-6,or 6-12 months. Discussion: CIMT shows benefit for both arm function and independence, but evidence of effectiveness also exists for self-directed ES and therapy programmes that increase practice without additional technology. Conclusion: Self-directed interventions can enhance recovery after stroke but the effect varies according to the approach used and timing after stroke.
- Subjects
ARM physiology; CINAHL database; CONFIDENCE intervals; CONVALESCENCE; HEALTH; MEDICAL information storage &; retrieval systems; LIFE skills; MEDLINE; HEALTH self-care; SYSTEMATIC reviews; BIBLIOGRAPHIC databases; STROKE rehabilitation
- Publication
Clinical Rehabilitation, 2018, Vol 32, Issue 10, p1412
- ISSN
0269-2155
- Publication type
Abstract
- DOI
10.1177/0269215518784346