Some home-based self-managed rehabilitation interventions can improve arm activity after stroke: A systematic review and narrative synthesis

Frontiers in Neurology

Neurology

Ruth Akinlosotu¹  Jean Udo¹  Kelly Westlake¹  Jill Whitall¹  Sandy McCombe Waller²  Andrea Goldstein Shipper³ 

[1] Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, United States;Division of Health, Business, Technology, and Science, Frederick Community College, Frederick, MD, United States;Health Sciences and Human Services Library, University of Maryland, Baltimore, MD, United States;

关键词: stroke;    rehabilitation;    home-based;    self-managed;    systematic review;   

DOI  :  10.3389/fneur.2023.1035256

 received in 2022-09-02, accepted in 2023-01-06,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundThere is an increased need for home-based, self-managed, and low maintenance stroke rehabilitation as well as interest in targeting the arm, which often lags behind leg recovery. Previous reviews have not controlled for concurrent standard of care and the ratio of self-managed care to therapist input.ObjectivesTo determine the effectiveness of home-based, self-managed and low maintenance programs for upper-limb motor recovery in individuals after stroke. A secondary objective explored the adherence to home-based self-managed programs.Data sourcesWe searched PubMed (1809-present), Embase (embase.com, 1974-present), Cochrane CENTRAL Register of Controlled Trials (Wiley), CINAHL (EBSCOhost, 1937-present), Physiotherapy Evidence Database (pedro.org.au), OTseeker (otseeker.com), and REHABDATA (National Rehabilitation Information Center). All searches were completed on June 9, 2022. Bibliographic references of included articles also were searched.Eligibility criteriaRandomized controlled trials (RCT) in adults after stroke, where both intervention and control were home-based, at least 75% self-managed and did not involve concurrent therapy as a confounding factor. Primary outcome was performance in functional motor activities after training. Secondary outcome was sensorimotor impairment. All outcomes after a retention period were also considered secondary outcomes.Data collection and analysisTwo review authors independently screened titles/abstracts, three review authors screened full papers and extracted data, and two review authors undertook assessment of risk of bias (i.e., allocation bias, measurement bias, confounding factors) using the NHLBI Study Quality Assessment Tool.Main resultsWe identified seven heterogenous studies, including five with fair to good quality. All studies had an alternative treatment, dose-equivalent control. Only one trial reported a positive, sustained, between-group effect on activity for the experimental group. The remaining studies reported seven interventions having a within-group training effect with three interventions having sustained effects at follow up. One study reported a between group effect on an impairment measure with no follow-up. Overall adherence rates were high, but three studies reported differential group rates. Compliance with daily logs was higher when the logs were collected on a weekly basis.LimitationsBy excluding studies that allowed concurrent therapy, we likely minimized the number of studies that included participants in the early sub-acute post-stroke stage. By focusing on RCTs, we are unable to comment on other potentially promising home-based, self-managed single cohort programs. By including only published and English language studies, we may have included publication bias.Conclusions and implicationsThere is some evidence that a variety of home-based, self-managed training program can be beneficial after stroke. Future research could compare such programs with natural history controls. Clinicians might utilize home exercise programs with explicit directions and some form of weekly contact to aid compliance.

【 授权许可】

Unknown   
Copyright © 2023 Westlake, Akinlosotu, Udo, Goldstein Shipper, Waller and Whitall.