Simultaneous Bilateral Training for Improving Arm Function after Stroke
After stroke, there is no evidence of the efficacy of bilateral training as compared with usual care or other upper limb interventions for performance in ADL, functional movement of the upper limb or motor impairment outcomes. Level of evidence: "D"A Cochrane review [Abstract] 1 included 14 RCTs with a total of 549 subjects with stroke.
- Four of the 14 studies compared the effects of bilateral training with usual care. Primary outcomes were performance in activities of daily living (ADL) and functional movement of the upper limb. Secondary outcomes were performance in extended ADL and motor impairment of the arm. Primary outcomes: results were not statistically significant for performance in ADL (standardised mean difference (SMD) 0.25, 95% CI -0.14 to 0.63); functional movement of the arm (SMD -0.07, 95% CI -0.42 to 0.28) or hand (SMD -0.04, 95% CI -0.50 to 0.42). Secondary outcomes: no statistically significant results.
- Eleven of the 14 studies compared the effects of bilateral training with other specific upper limb (arm) interventions. Primary outcomes: no statistically significant results for performance of ADL (SMD -0.25, 95% CI -0.57 to 0.08); functional movement of the arm (SMD -0.20, 95% CI -0.49 to 0.09) or hand (SMD -0.21, 95% CI -0.51 to 0.09). Secondary outcomes: one study reported a statistically significant result in favour of another upper limb intervention for performance in extended ADL. No statistically significant differences were found for motor impairment outcomes.
Comment: The quality of the evidence is downgraded by study quality (inadequate allocation concealment, lack of blinding), inconsistency (heterogeneity in interventions) and imprecise results (limited study size for each comparison).
References
- Coupar F, Pollock A, van Wijck F, Morris J, Langhorne P. Simultaneous bilateral training for improving arm function after stroke. Cochrane Database Syst Rev 2010 Apr 14;4:CD006432. [PubMed]