Background. Stroke commonly affects upper extremity motor abilities, yet there has been very limited success in developing effective rehabilitation interventions to remediate motor impairments, particularly for the upper extremity. Objective. To determine if task-oriented practice administered soon after stroke is more effective than usual care in improving poststroke upper extremity motor recovery and to explore the optimal amount of practice. Methods. A systematic review of the literature was performed from 1950 to November 2012, to identify randomized controlled trials of task-oriented practice compared to usual care, or to different amounts of task-oriented practice to improve motor impairment and activity. Studies were excluded if specific types of interventions were used as comparators or if they were of poor methodological quality. Results. Six studies met the review criteria. Three of the six studies demonstrated a statistically significant effect of task-oriented practice. Study results could not be pooled because of a lack of homogeneity in populations and intervention. Conclusions. The results demonstrate that an increase in the amount of task-oriented practice after stroke may result in less upper extremity impairment; further research on both effect and required dosage is needed as results are inconsistent. 1. Introduction Stroke is the fifth leading cause of disability internationally [1] and it is likely that this is an underestimate of the absolute level of functioning that is lost, especially in low-income countries [2]. Stroke results in disability through loss of function from motor, cognitive, or sensory impairments either individually or in combination. Although stroke survivors can compensate for some of these losses, they often experience substantial residual functional deficits. Motor impairment is the most common deficit after stroke and the major contributor to functional limitations [3]. Motor impairments are a principal target of rehabilitation interventions, and many novel therapeutic approaches for motor recovery have emerged in recent decades [3–18]. Research has focused on lower limb motor impairment more than upper limb partly because lower limb interventions are more easily described, outcomes are more easily quantified, and mobility is considered a key functional consideration after stroke. However, among those who have had a stroke, upper limb recovery is also considered important because it is integral to independence in many activities of daily living [19]. Therefore, interventions designed and tested specifically
References
[1]
S. C. Johnston, S. Mendis, and C. D. Mathers, “Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modelling,” The Lancet Neurology, vol. 8, no. 4, pp. 345–354, 2009.
[2]
K.-S. Hong and J. L. Saver, “Quantifying the value of stroke disability outcomes: WHO global burden of disease project disability weights for each level of the modified rankin scale,” Stroke, vol. 40, no. 12, pp. 3828–3833, 2009.
[3]
P. Langhorne, F. Coupar, and A. Pollock, “Motor recovery after stroke: a systematic review,” The Lancet Neurology, vol. 8, no. 8, pp. 741–754, 2009.
[4]
F. Ferrarello, M. Baccini, L. A. Rinaldi et al., “Efficacy of physiotherapy interventions late after stroke: a meta-analysis,” Journal of Neurology, Neurosurgery and Psychiatry, vol. 82, no. 2, pp. 136–143, 2011.
[5]
E. V. Cooke, K. Mares, A. Clark, R. C. Tallis, and V. M. Pomeroy, “The effects of increased dose of exercise-based therapies to enhance motor recovery after stroke: a systematic review and meta-analysis,” BMC Medicine, vol. 8, article 60, 2010.
[6]
B. French, L. Thomas, M. Leathley et al., “Does repetitive task training improve functional activity after stroke? A Cochrane systematic review and meta-analysis,” Journal of Rehabilitation Medicine, vol. 42, no. 1, pp. 9–14, 2010.
[7]
C. P. Latimer, J. Keeling, B. Lin, M. Henderson, and L. A. Hale, “The impact of bilateral therapy on upper limb function after chronic stroke: a systematic review,” Disability and Rehabilitation, vol. 32, no. 15, pp. 1221–1231, 2010.
[8]
S. H. Peurala, M. P. Kantanen, T. Sj？gren, J. Paltamaa, M. Karhula, and A. Heinonen, “Effectiveness of constraint-induced movement therapy on activity and participation after stroke: a systematic review and meta-analysis of randomized controlled trials,” Clinical Rehabilitation, vol. 26, no. 3, pp. 209–223, 2012.
[9]
K. E. Laver, S. George, S. Thomas, J. E. Deutsch, and M. Crotty, “Virtual reality for stroke rehabilitation,” Cochrane Database of Systematic Reviews, vol. 9, Article ID CD008349, 2011.
[10]
K. Hayward, R. Barker, and S. Brauer, “Interventions to promote upper limb recovery in stroke survivors with severe paresis: a systematic review,” Disability and Rehabilitation, vol. 32, no. 24, pp. 1973–1986, 2010.
[11]
A. A. A. Timmermans, A. I. F. Spooren, H. Kingma, and H. A. M. Seelen, “Influence of task-oriented training content on skilled arm-hand performance in stroke: a systematic review,” Neurorehabilitation and Neural Repair, vol. 24, no. 9, pp. 858–870, 2010.
[12]
J. M. Veerbeek, M. Koolstra, J. C. F. Ket, E. E. H. van Wegen, and G. 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, vol. 42, no. 11, pp. 3311–3315, 2011.
[13]
L. Oujamaa, I. Relave, J. Froger, D. Mottet, and J.-Y. Pelissier, “Rehabilitation of arm function after stroke. Literature review,” Annals of Physical and Rehabilitation Medicine, vol. 52, no. 3, pp. 269–293, 2009.
[14]
A. Zimmermann-Schlatter, C. Schuster, M. A. Puhan, E. Siekierka, and J. Steurer, “Efficacy of motor imagery in post-stroke rehabilitation: a systematic review,” Journal of NeuroEngineering and Rehabilitation, vol. 5, article 8, 2008.
[15]
D. Bonaiuti, L. Rebasti, and P. Sioli, “The constraint induced movement therapy: a systematic review of randomised controlled trials on the adult stroke patients,” Europa Medicophysica, vol. 43, no. 2, pp. 139–146, 2007.
[16]
A. Henderson, N. Korner-Bitensky, and M. Levin, “Virtual reality in stroke rehabilitation: a systematic review of its effectiveness for upper limb motor recovery,” Topics in Stroke Rehabilitation, vol. 14, no. 2, pp. 52–61, 2007.
[17]
M. L. Urton, M. Kohia, J. Davis, and M. R. Neill, “Systematic literature review of treatment interventions for upper extremity hemiparesis following stroke,” Occupational Therapy International, vol. 14, no. 1, pp. 11–27, 2007.
[18]
G. Kwakkel, R. van Peppen, R. C. Wagenaar et al., “Effects of augmented exercise therapy time after stroke: a meta-analysis,” Stroke, vol. 35, no. 11, pp. 2529–2539, 2004.
[19]
R. N. Barker and S. G. Brauer, “Upper limb recovery after stroke: the stroke survivors' perspective,” Disability and Rehabilitation, vol. 27, no. 20, pp. 1213–1223, 2005.
[20]
P. Craig, P. Dieppe, S. Macintyre, S. Michie, I. Nazareth, and M. Petticrew, “Developing and evaluating complex interventions: the new Medical Research Council guidance,” BMJ, vol. 337, article a1655, 2008.
[21]
P. Santaguida, M. Oremus, K. Walker, L. R. Wishart, K. L. Siegel, and P. Raina, “Systematic reviews identify important methodological flaws in stroke rehabilitation therapy primary studies: review of reviews,” Journal of Clinical Epidemiology, vol. 65, no. 4, pp. 358–367, 2012.
[22]
K. N. Arya, R. Verma, R. K. Garg, V. P. Sharma, M. Agarwal, and G. G. Aggarwal, “Meaningful task-specific training (MTST) for stroke rehabilitation: a randomized controlled trial,” Topics in Stroke Rehabilitation, vol. 19, no. 3, pp. 193–211, 2012.
[23]
C. J. Winstein and S. L. Wolf, “Task-oriented training to promote upper extremity recover,” in Stroke Recovery and Rehabilitation, J. Stein, R. L. Harvery, R. F. Macko, C. J. Winstein, and R. D. Zorowitz, Eds., pp. 267–290, Demos Medical, New York, NY, USA, 2009.
[24]
R. A. Schmidt and T. D. Lee, “Conditions of practice,” in Motor Control and Learning: A Behavioral Emphasis, pp. 347–392, Human Kinetics, Ontario, Canada, 2011.
[25]
G. Kwakkel, R. C. Wagenaar, T. W. Koelman, G. J. Lankhorst, and J. C. Koetsier, “Effects of intensity of rehabilitation after stroke: a research synthesis,” Stroke, vol. 28, no. 8, pp. 1550–1556, 1997.
[26]
S. J. Page, A. Schmid, and J. E. Harris, “Optimizing terminology for stroke motor rehabilitation: recommendations from the American Congress of Rehabilitation Medicine Stroke Movement Interventions Subcommittee,” Archives of Physical Medicine and Rehabilitation, vol. 93, no. 8, pp. 1395–1359, 2012.
[27]
G. Kwakkel, “Impact of intensity of practice after stroke: issues for consideration,” Disability and Rehabilitation, vol. 28, no. 13-14, pp. 823–830, 2006.
[28]
A. C. Wallace, P. Talelli, M. Dileone et al., “Standardizing the intensity of upper limb treatment in rehabilitation medicine,” Clinical Rehabilitation, vol. 24, no. 5, pp. 471–478, 2010.
[29]
C. J. Winstein, S. L. Wolf, A. W. Dromerick, et al., “Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE): a randomized controlled trial protocol,” BMC Neurology, vol. 13, no. 1, article 5, 2013.
[30]
M. G. Bowden, M. L. Woodbury, and P. W. Duncan, “Promoting neuroplasticity and recovery after stroke: future directions for rehabilitation clinical trials,” Current Opinion in Neurology, vol. 26, no. 1, pp. 37–42, 2013.
[31]
P. Langhorne, J. Bernhardt, and G. Kwakkel, “Stroke rehabilitation,” The Lancet, vol. 377, no. 9778, pp. 1693–1702, 2011.
[32]
R. L. Birkenmeier, E. M. Prager, and C. E. Lang, “Translating animal doses of task-specific training to people with chronic stroke in 1-hour therapy sessions: a proof-of-concept study,” Neurorehabilitation and Neural Repair, vol. 24, no. 7, pp. 620–635, 2010.
[33]
S. Sehatzadeh, “Effectiveness of increased intensity of rehabilitation in post-stroke patients: a rapid review,” Tech. Rep., Toronton, Canada, 2013.
[34]
World Health Organization, Towards a Common Language for Functioning, Disability and Health: ICF, World Health Organization, Geneva, Switzerland, 2002.
[35]
World Health Organization, “International Classification of Functioning, Disability and Health,” 2001, http://www.who.int/classifications/icf/site/intros/ICF-Eng-Intro.pdf.
[36]
A. Liberati, D. G. Altman, J. Tetzlaff et al., “The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration,” BMJ, vol. 339, article b2700, 2009.
[37]
J. Blennerhassett and W. Dite, “Additional task-related practice improves mobility and upper limb function early after stroke: a randomised controlled trial,” Australian Journal of Physiotherapy, vol. 50, no. 4, pp. 219–224, 2004.
[38]
C. Donaldson, R. Tallis, S. Miller, A. Sunderland, R. Lemon, and V. Pomeroy, “Effects of conventional physical therapy and functional strength training on upper limb motor recovery after stroke: a randomized phase II study,” Neurorehabilitation and Neural Repair, vol. 23, no. 4, pp. 389–397, 2009.
[39]
C. Han, Q. Wang, P. P. Meng, and M. Z. Qi, “Effects of intensity of arm training on hemiplegic upper extremity motor recovery in stroke patients: a randomized controlled trial,” Clinical Rehabilitation, vol. 27, no. 1, pp. 75–81, 2013.
[40]
J. E. Harris, J. J. Eng, W. C. Miller, and A. S. Dawson, “A self-administered graded repetitive arm supplementary program (GRASP) improves arm function during inpatient stroke rehabilitation: a multi-site randomized controlled trial,” Stroke, vol. 40, no. 6, pp. 2123–2128, 2009.
[41]
G. Kwakkel, R. C. Wagenaar, J. W. R. Twisk, G. J. Lankhorst, and J. C. Koetsier, “Intensity of leg and arm training after primary middle-cerebral-artery stroke: a randomised trial,” The Lancet, vol. 354, no. 9174, pp. 191–196, 1999.
[42]
C. J. Winstein, D. K. Rose, S. M. Tan, R. Lewthwaite, H. C. Chui, and S. P. Azen, “A randomized controlled comparison of upper-extremity rehabilitation strategies in acute stroke: a pilot study of immediate and long-term outcomes,” Archives of Physical Medicine and Rehabilitation, vol. 85, no. 4, pp. 620–628, 2004.
[43]
S. Hopewell, M. Clarke, C. Lefebvre, and R. Scherer, “Handsearching versus electronic searching to identify reports of randomized trials,” Cochrane Database of Systematic Reviews, no. 2, Article ID MR000001, 2007.
[44]
S. Ghimire, E. Kyung, W. Kang, and E. Kim, “Assessment of adherence to the CONSORT statement for quality of reports on randomized controlled trial abstracts from four high-impact general medical journals,” Trials, vol. 13, article 77, 2012.
[45]
C. E. Lang, J. R. MacDonald, D. S. Reisman et al., “Observation of amounts of movement practice provided during stroke rehabilitation,” Archives of Physical Medicine and Rehabilitation, vol. 90, no. 10, pp. 1692–1698, 2009.
[46]
L. De Wit, H. Kamsteegt, B. Yadav, G. Verheyden, H. Feys, and W. De Weerdt, “Defining the content of individual physiotherapy and occupational therapy sessions for stroke patients in an inpatient rehabilitation setting. Development, validation and inter-rater reliability of a scoring list,” Clinical Rehabilitation, vol. 21, no. 5, pp. 450–459, 2007.
[47]
M. P. Lindsay, G. Gubitz, M. Bayley, et al., “Canadian best practice recommendations for stroke care (update 2010),” Tech. Rep., Ontario, Canada, 2010.
[48]
N. Foley, S. Pereira, K. Salter, M. Meyer, J. A. McClure, and R. Teasell, “Are recommendations regarding inpatient therapy intensity following acute stroke really evidence-based?” Topics in Stroke Rehabilitation, vol. 19, no. 2, pp. 96–103, 2012.
