Cochrane Overview
2015; Lippincott Williams & Wilkins; Volume: 46; Issue: 3 Linguagem: Inglês
10.1161/strokeaha.114.008295
ISSN1524-4628
AutoresAlex Pollock, Sybil Farmer, Marian Brady, Peter Langhorne, Gillian Mead, Jan Mehrholz, Frederike van Wijck,
Tópico(s)Cerebral Palsy and Movement Disorders
ResumoHomeStrokeVol. 46, No. 3Cochrane Overview Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessResearch ArticlePDF/EPUBCochrane OverviewInterventions for Improving Upper Limb Function After Stroke Alex Pollock, PhD, Sybil E. Farmer, PhD, Marian C. Brady, PhD, Peter Langhorne, PhD, Gillian E. Mead, MD, Jan Mehrholz, PhD and Frederike van Wijck, PhD Alex PollockAlex Pollock From the Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU) (A.P., S.E.F., M.C.B.) and Institute of Applied Health Research (F.v.W.), Glasgow Caledonian University, United Kingdom; Academic Section of Geriatric Medicine, University of Glasgow, United Kingdom (P.L.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (G.E.M.); and Wissenschaftliches Institut, Klinik Bavaria, Kreischa, Germany (J.M.). , Sybil E. FarmerSybil E. Farmer From the Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU) (A.P., S.E.F., M.C.B.) and Institute of Applied Health Research (F.v.W.), Glasgow Caledonian University, United Kingdom; Academic Section of Geriatric Medicine, University of Glasgow, United Kingdom (P.L.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (G.E.M.); and Wissenschaftliches Institut, Klinik Bavaria, Kreischa, Germany (J.M.). , Marian C. BradyMarian C. Brady From the Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU) (A.P., S.E.F., M.C.B.) and Institute of Applied Health Research (F.v.W.), Glasgow Caledonian University, United Kingdom; Academic Section of Geriatric Medicine, University of Glasgow, United Kingdom (P.L.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (G.E.M.); and Wissenschaftliches Institut, Klinik Bavaria, Kreischa, Germany (J.M.). , Peter LanghornePeter Langhorne From the Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU) (A.P., S.E.F., M.C.B.) and Institute of Applied Health Research (F.v.W.), Glasgow Caledonian University, United Kingdom; Academic Section of Geriatric Medicine, University of Glasgow, United Kingdom (P.L.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (G.E.M.); and Wissenschaftliches Institut, Klinik Bavaria, Kreischa, Germany (J.M.). , Gillian E. MeadGillian E. Mead From the Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU) (A.P., S.E.F., M.C.B.) and Institute of Applied Health Research (F.v.W.), Glasgow Caledonian University, United Kingdom; Academic Section of Geriatric Medicine, University of Glasgow, United Kingdom (P.L.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (G.E.M.); and Wissenschaftliches Institut, Klinik Bavaria, Kreischa, Germany (J.M.). , Jan MehrholzJan Mehrholz From the Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU) (A.P., S.E.F., M.C.B.) and Institute of Applied Health Research (F.v.W.), Glasgow Caledonian University, United Kingdom; Academic Section of Geriatric Medicine, University of Glasgow, United Kingdom (P.L.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (G.E.M.); and Wissenschaftliches Institut, Klinik Bavaria, Kreischa, Germany (J.M.). and Frederike van WijckFrederike van Wijck From the Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU) (A.P., S.E.F., M.C.B.) and Institute of Applied Health Research (F.v.W.), Glasgow Caledonian University, United Kingdom; Academic Section of Geriatric Medicine, University of Glasgow, United Kingdom (P.L.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (G.E.M.); and Wissenschaftliches Institut, Klinik Bavaria, Kreischa, Germany (J.M.). Originally published3 Feb 2015https://doi.org/10.1161/STROKEAHA.114.008295Stroke. 2015;46:e57–e58Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: January 1, 2015: Previous Version 1 Cochrane Overviews aim to provide a succinct overview of reviews relevant to a specific clinical question. We completed the first stroke-related Cochrane Overview synthesizing systematic reviews of interventions to improve upper limb (UL) function after stroke.1MethodsWe comprehensively searched Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and PROSPERO (Prospective Register of Systematic Reviews) for reviews of randomized controlled trials of stroke patients investigating the effectiveness of UL interventions. Primary outcome: UL function, including measures of arm function (such as ARAT [Action Research Arm Test]) and hand function (such as Jebsen hand function test). Secondary outcomes: motor impairment, activities of daily living. Two reviewers independently applied selection criteria, assessed methodological quality of reviews (using a modified AMSTAR tool), and extracted data. Quality of evidence within reviews was determined using an objective algorithm, developed to apply GRADE [Grading of Recommendations Assessment, Development and Evaluation] levels of evidence, considering participant numbers, trial risk of bias, heterogeneity, and review quality.ResultsSearches identified 1840 records, from which we included 40 reviews (19 Cochrane; 21 non-Cochrane), covering 18 interventions, as well as dose and setting of interventions. The 40 reviews contained 503 studies (18 078 participants). We extracted pooled data from 31 reviews related to 127 comparisons.We judged the quality of evidence to be high for 1 of 127 comparisons, moderate for 49 of 127 comparisons, and low or very low for 77 of 127 comparisons. The high-quality evidence related to the effect of transcranial direct current stimulation, demonstrating no benefit on activities of daily living. There was moderate quality evidence that the following interventions were more beneficial than control interventions for UL function: constraint-induced movement therapy, mental practice, mirror therapy, virtual reality, and a relatively high dose of repetitive task practice, suggesting that these may be effective (see Figure).Download figureDownload PowerPointFigure. Effect of interventions on upper limb function for comparisons with moderate quality evidence (for those comparisons reporting standardized mean differences [SMD]). Comparisons are of intervention versus any other control (including no treatment, control, or usual care), unless otherwise stated.Specific recommendations were derived from the current evidence, highlighting where phase III trials, other primary research, and systematic reviews are required, and the need for improved reporting of trials and reviews.ConclusionsLarge numbers of overlapping reviews relate to interventions to improve UL function after stroke. This overview summarizes current evidence within one accessible, comprehensive document that clearly signposts clinicians and policy makers toward relevant systematic reviews to support decisions.There is no high-quality evidence for any interventions that are currently routine practice, and evidence is insufficient to enable comparison of the relative effectiveness of interventions. Effective collaboration is urgently needed to support definitive randomized controlled trials of interventions used routinely within clinical practice. Evidence related to dose is particularly needed because this has widespread clinical and research implications.AcknowledgmentsThis article is based on a Cochrane Review published in The Cochrane Library 2014, Issue 11 (see www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and The Cochrane Library should be consulted for the most recent version of the review.Sources of FundingThis review update was supported by a project grant from the Chief Scientist Office (CSO), part of the Scottish Government Health and Social Care Directorate.DisclosuresDrs Pollock, Farmer, Mehrholz, Langhorne, and van Wijck are authors on reviews/protocols relevant to this overview. The other authors report no conflicts.FootnotesCorrespondence to Alex Pollock, PhD, NMAHP RU, Buchanan House, Glasgow Caledonian University, Glasgow G4 0BA, United Kingdom. E-mail [email protected]Reference1. Pollock A, Farmer SE, Brady MC, Langhorne P, Mead GE, Mehrholz J, et al. Interventions for improving upper limb function after stroke.Cochrane Database Syst Rev2014; 11:CD010820. doi: 10.1002/14651858.CD010820.pub2.Google Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Vive S, Bunketorp-Käll L and Carlsson G (2020) Experience of enriched rehabilitation in the chronic phase of stroke, Disability and Rehabilitation, 10.1080/09638288.2020.1768598, 44:3, (412-419), Online publication date: 30-Jan-2022. Hagenberg A, Lambert D, Jussab S, Maltby J and Robinson T (2021) Inter-lateral Referral of Sensation in Health and Disease Using a Mirror Illusion—A Scoping Review, Archives of Clinical Neuropsychology, 10.1093/arclin/acab039, 37:4, (849-864), Online publication date: 16-May-2022. Frolov A, Biryukova E, Bobrov P, Bobrov D, Lekin A, Mokienko O, Lyukmanov R, Kotov S, Kondur A, Ivanova G and Bushkova Y (2021) Final Results of Multi-center Randomized Controlled Trials of BCI-Controlled Hand Exoskeleton Complex Assisting Post-stroke Motor Function Recovery Brain-Computer Interface Research, 10.1007/978-3-030-60460-8_6, (65-77), . Tobler-Ammann B, Weise A, Knols R, Watson M, Sieben J, de Bie R and de Bruin E (2018) Patients' experiences of unilateral spatial neglect between stroke onset and discharge from inpatient rehabilitation: a thematic analysis of qualitative interviews, Disability and Rehabilitation, 10.1080/09638288.2018.1531150, 42:11, (1578-1587), Online publication date: 21-May-2020. Mehrholz J, Pollock A, Pohl M, Kugler J and Elsner B (2020) Systematic review with network meta-analysis of randomized controlled trials of robotic-assisted arm training for improving activities of daily living and upper limb function after stroke, Journal of NeuroEngineering and Rehabilitation, 10.1186/s12984-020-00715-0, 17:1, Online publication date: 1-Dec-2020. Winstein C, Kim B, Kim S, Martinez C and Schweighofer N (2019) Dosage Matters, Stroke, 50:7, (1831-1837), Online publication date: 1-Jul-2019. Luque-Moreno C, Cano-Bravo F, Kiper P, Solís-Marcos I, Moral-Munoz J, Agostini M, Oliva-Pascual-Vaca Á and Turolla A (2019) Reinforced Feedback in Virtual Environment for Plantar Flexor Poststroke Spasticity Reduction and Gait Function Improvement, BioMed Research International, 10.1155/2019/6295263, 2019, (1-9), Online publication date: 27-Dec-2019. Engkasan J, Ahmad-Fauzi A, Sabirin S, Chai C, Abdul-Malek I, Liguori S, Moretti A and Gimigliano F Mapping the primary outcomes reported in Cochrane systematic reviews regarding stroke with the International Classification of Functioning, Disability and Health domains: current trend and future recommendations, European Journal of Physical and Rehabilitation Medicine, 10.23736/S1973-9087.19.05792-7, 55:3 Kwakkel G, Lannin N, Borschmann K, English C, Ali M, Churilov L, Saposnik G, Winstein C, van Wegen E, Wolf S, Krakauer J and Bernhardt J (2017) Standardized measurement of sensorimotor recovery in stroke trials: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable, International Journal of Stroke, 10.1177/1747493017711813, 12:5, (451-461), Online publication date: 1-Jul-2017. Kwakkel G, Lannin N, Borschmann K, English C, Ali M, Churilov L, Saposnik G, Winstein C, van Wegen E, Wolf S, Krakauer J and Bernhardt J (2017) Standardized Measurement of Sensorimotor Recovery in Stroke Trials: Consensus-Based Core Recommendations from the Stroke Recovery and Rehabilitation Roundtable, Neurorehabilitation and Neural Repair, 10.1177/1545968317732662, 31:9, (784-792), Online publication date: 1-Sep-2017. Voinescu A, Sui J and Stanton Fraser D (2021) Virtual Reality in Neurorehabilitation: An Umbrella Review of Meta-Analyses, Journal of Clinical Medicine, 10.3390/jcm10071478, 10:7, (1478) March 2015Vol 46, Issue 3 Advertisement Article InformationMetrics © 2015 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.114.008295 Manuscript receivedDecember 22, 2014Manuscript acceptedDecember 22, 2014Originally publishedFebruary 3, 2015 Keywordsactivities of daily livingstrokehandreview, systematicarmupper extremityPDF download Advertisement SubjectsRehabilitation
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