Rehabilitation interventions for upper limb function in the first four weeks following stroke: a systematic review and meta-analysis of the evidence

Damn it all. Write this up into a fucking protocol so that these stupid meta-analysis and systematic reviews never need to be done again. A great stroke association president would take care of this problem, but since we have fucking failures of stroke associations failure will continue indefinitely.

Rehabilitation interventions for upper limb function in the first four weeks following stroke: a systematic review and meta-analysis of the evidence

Kimberley A. Wattchow, B. Physiotherapy (Hons)

School of Health Sciences, University of South Australia, Australia

Michelle N. McDonnell, PhD, B. App Sci Physio (Hons)Correspondence information about the author PhD, B. App Sci Physio (Hons) Michelle N. McDonnellEmail the author PhD, B. App Sci Physio (Hons) Michelle N. McDonnell

Senior Lecturer; Stroke and Rehabilitation Research Group, School of Health Sciences, University of South Australia, Australia

Susan L. Hillier, PhD, B. App Sci Physio

Associate Professor and Dean: Research, School of Health Sciences; Sansom Institute for Health Research, University of South Australia, Australia

DOI: http://dx.doi.org/10.1016/j.apmr.2017.06.014

• Abstract

Abstract

Objective

To investigate the therapeutic interventions reported in the research literature, and synthesize their effectiveness in improving upper limb (UL) function in the first four weeks post-stroke.

Data sources

Electronic databases, trial registries and hand searching was conducted, from inception until June 2016.

Study selection

Randomised controlled trials (RCTs), controlled trials and interventional studies with pre/post-test design were included for adults within four weeks of any type of stroke with UL impairment. Participants all received an intervention of any physiotherapeutic or occupational therapeutic technique designed to address impairment or activity of the affected UL, which could be compared to usual care, sham or another technique.

Data extraction

Two reviewers independently assessed eligibility of full texts, and methodologic quality of included studies using the Cochrane ‘Risk of bias tool’.

Data synthesis

104 trials (83 RCTs, 21 non-randomised studies) were included (n=5,225 participants). Meta-analyses of RCTs only (20 comparisons), and narrative syntheses were completed. Key findings included significant positive effects for modified constraint-induced movement therapy (mCIMT) (standardised mean difference, SMD 1.09, 95% confidence intervals, CI 0.21, 1.97) and task-specific training (SMD 0.37, 95% CI 0.05 to 0.68). Evidence was found to support supplementary use of biofeedback and electrical stimulation. Use of Bobath therapy was not supported.

Conclusions

Use of mCIMT and task-specific training was supported, as was supplementary use of biofeedback and electrical simulation, within the acute phase post-stroke. Further high quality studies into the initial four weeks post-stroke are needed to determine therapies for targeted functional UL outcomes.
You came up with totally useless information, nothing here can be directly used to get survivors to 100% recovery.