Effect of task-based bilateral arm training on upper limb recovery after stroke: A systematic review and meta-analysis

Alexander Gnanaprakasam; Suruliraj Karthikbabu; N Ravishankar; John M Solomon

doi:10.1016/j.jstrokecerebrovasdis.2023.107131

Effect of task-based bilateral arm training on upper limb recovery after stroke: A systematic review and meta-analysis

J Stroke Cerebrovasc Dis. 2023 Jul;32(7):107131. doi: 10.1016/j.jstrokecerebrovasdis.2023.107131. Epub 2023 May 4.

Authors

Alexander Gnanaprakasam¹, Suruliraj Karthikbabu², N Ravishankar³, John M Solomon⁴

Affiliations

¹ Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.
² Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India; KMCH College of Physiotherapy, Kovai Medical Center Research and Educational Trust, Coimbatore, The Tamil Nadu Dr. M.G.R. Medical University, India. Electronic address: karthikbabu78@gmail.com.
³ Department of Biostatistics, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India.
⁴ Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India; Centre for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, India. Electronic address: john.solomon@manipal.edu.

PMID: 37148628
DOI: 10.1016/j.jstrokecerebrovasdis.2023.107131

Abstract

Objective: Upper limb recovery is a crucial component of stroke rehabilitation aimed to maximize functional activities and reduce disability. Using both arms post stroke is essential to carry out many functional activities but the evidence on bilateral arm training (BAT) is understudied. To investigate the evidence for efficacy of task-based BAT on upper limb recovery, function, and participation post stroke.

Methods: We included 13 randomized controlled trials, and methodological quality was assessed using Cochrane risk of bias tool and the PEDro scale. The outcome measures such as Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), Box and Block Test (BBT), Modified Barthel Index (MBI), Functional Independence Measure (FIM), and Stroke Impact Scale (SIS) were synthesized and analysed based on ICF.

Results: When comparing BAT with control group, BAT showed improvement in the pooled standard mean difference (SMD) of FMA-UE (SMD= 0.62, 95% confidence interval (CI), 0.12 to 1.12, p = 0.01; I²=83%). The control group showed significant improvement in MAL-QOM (SMD= -0.10, 95%CI, -0.77 to 0.58, p = 0.78; I²=89%). Compared to conventional group, BAT showed a significant improvement in BBT (SMD= 0.52, 95%CI, 0.04 to 1.00, p = 0.03; I²=0%). When compared with BAT, unimanual training yielded a significant improvement (SMD= -0.60, 95%CI, -0.98 to -0.22, p = 0.002; I²=0%) in MAL-QOM. In real-life participation, the control group showed improvement in SIS (SMD= -0.17, 95% (CI), -0.70 to 0.37, p = 0.54; I²=48%) over BAT.

Conclusions: Task-based BAT appears to improve upper limb motor function post stroke. The benefits of task-based BAT on activity performance and participation in real life are not statistically significant.

Keywords: Bilateral arm training; Functional training; Stroke; Task training; Upper limb recovery.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Activities of Daily Living
Humans
Recovery of Function
Stroke Rehabilitation*
Stroke* / diagnosis
Stroke* / therapy
Upper Extremity