http://cre.sagepub.com/content/early/2013/08/06/0269215513497601.abstract
Abstract
Objective: To evaluate the effect of altering a single component of a rehabilitation programme (e.g. adding bilateral practice alone)
on functional recovery after stroke, defined using a measure of activity.
Data sources: A search was conducted of Medline/Pubmed, CINAHL and Web of Science.
Review methods: Two
reviewers independently assessed eligibility. Randomized controlled
trials were included if all participants received
the same base intervention, and the experimental
group experienced alteration of a single component of the training
programme.
This could be manipulation of an intrinsic
component of training (e.g. intensity) or the addition of a
discretionary component
(e.g. augmented feedback). One reviewer
extracted the data and another independently checked a subsample (20%).
Quality was
appraised according to the PEDro scale.
Results: Thirty-six studies (n
= 1724 participants) were included. These evaluated nine training
components: mechanical degrees of freedom, intensity of
practice, load, practice schedule, augmented
feedback, bilateral movements, constraint of the unimpaired limb, mental
practice
and mirrored-visual feedback. Manipulation of
the mechanical degrees of freedom of the trunk during reaching and the
addition
of mental practice during upper limb training
were the only single components found to independently enhance recovery
of function
after stroke.
Conclusion: This
review provides limited evidence to support the supposition that
altering a single component of a rehabilitation programme
realises greater functional recovery for stroke
survivors. Further investigations are required to determine the most
effective
single components of rehabilitation programmes,
and the combinations that may enhance functional recovery.
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