Comparison of bilateral and unilateral upper limb training in people with stroke: A systematic review and meta-analysis.
BACKGROUND AND OBJECTIVES:Bilateral upper limb training (BULT) and unilateral upper limb training (UULT) are two effective strategies for the recovery of upper limb motor function after stroke. This meta-analysis aimed to compare the improvements in motor impairment and functional performances of pe...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2019-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0216357 |
| _version_ | 1830447969389772800 |
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| author | Pei-Ming Chen Patrick W H Kwong Claudia K Y Lai Shamay S M Ng |
| author_facet | Pei-Ming Chen Patrick W H Kwong Claudia K Y Lai Shamay S M Ng |
| author_sort | Pei-Ming Chen |
| collection | DOAJ |
| description | BACKGROUND AND OBJECTIVES:Bilateral upper limb training (BULT) and unilateral upper limb training (UULT) are two effective strategies for the recovery of upper limb motor function after stroke. This meta-analysis aimed to compare the improvements in motor impairment and functional performances of people with stroke after BULT and UULT. RESEARCH DESIGN AND METHODS:This systematic review and meta-analysis identified 21 randomized controlled trials (RCTs) met the eligibility criteria from CINAHL, Medline, Embase, Cochrane Library and PubMed. The outcome measures were the Fugl-Meyer Assessment of Upper Extremity (FMA-UE), Wolf Motor Function Test (WMFT), Action Research Arm Test (ARAT) and Box and Block Test (BBT), which are validated measures of upper limb function. RESULTS:Twenty-one studies involving 842 subjects with stroke were included. Compared with UULT, BULT yielded a significantly greater mean difference (MD) in the FMA-UE (MD = 2.21, 95% Confidence Interval (CI), 0.12 to 4.30, p = 0.04; I2 = 86%, p<0.001). However, a comparison of BULT and UULT yielded insignificant mean difference (MD) in terms of the time required to complete the WMFT (MD = 0.44; 95%CI, -2.22 to 3.10, p = 0.75; I2 = 55%, p = 0.06) and standard mean difference (SMD) in terms of the functional ability scores on the WMFT, ARAT and BBT (SMD = 0.25; 95%CI, -0.02 to 0.52, p = 0.07; I2 = 54%, p = 0.02). DISCUSSION AND IMPLICATIONS:Compared to UULT, BULT yielded superior improvements in the improving motor impairment of people with stroke, as measured by the FMA-UE. However, these strategies did not yield significant differences in terms of the functional performance of people with stroke, as measured by the WMFT, ARAT and BBT. More comparative studies of the effects of BULT and UULT are needed to increase the reliability of these conclusions. |
| first_indexed | 2024-12-21T07:31:33Z |
| format | Article |
| id | doaj.art-09b419f4ff8847d08e464c4b5b293ae3 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-21T07:31:33Z |
| publishDate | 2019-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-09b419f4ff8847d08e464c4b5b293ae32022-12-21T19:11:32ZengPublic Library of Science (PLoS)PLoS ONE1932-62032019-01-01145e021635710.1371/journal.pone.0216357Comparison of bilateral and unilateral upper limb training in people with stroke: A systematic review and meta-analysis.Pei-Ming ChenPatrick W H KwongClaudia K Y LaiShamay S M NgBACKGROUND AND OBJECTIVES:Bilateral upper limb training (BULT) and unilateral upper limb training (UULT) are two effective strategies for the recovery of upper limb motor function after stroke. This meta-analysis aimed to compare the improvements in motor impairment and functional performances of people with stroke after BULT and UULT. RESEARCH DESIGN AND METHODS:This systematic review and meta-analysis identified 21 randomized controlled trials (RCTs) met the eligibility criteria from CINAHL, Medline, Embase, Cochrane Library and PubMed. The outcome measures were the Fugl-Meyer Assessment of Upper Extremity (FMA-UE), Wolf Motor Function Test (WMFT), Action Research Arm Test (ARAT) and Box and Block Test (BBT), which are validated measures of upper limb function. RESULTS:Twenty-one studies involving 842 subjects with stroke were included. Compared with UULT, BULT yielded a significantly greater mean difference (MD) in the FMA-UE (MD = 2.21, 95% Confidence Interval (CI), 0.12 to 4.30, p = 0.04; I2 = 86%, p<0.001). However, a comparison of BULT and UULT yielded insignificant mean difference (MD) in terms of the time required to complete the WMFT (MD = 0.44; 95%CI, -2.22 to 3.10, p = 0.75; I2 = 55%, p = 0.06) and standard mean difference (SMD) in terms of the functional ability scores on the WMFT, ARAT and BBT (SMD = 0.25; 95%CI, -0.02 to 0.52, p = 0.07; I2 = 54%, p = 0.02). DISCUSSION AND IMPLICATIONS:Compared to UULT, BULT yielded superior improvements in the improving motor impairment of people with stroke, as measured by the FMA-UE. However, these strategies did not yield significant differences in terms of the functional performance of people with stroke, as measured by the WMFT, ARAT and BBT. More comparative studies of the effects of BULT and UULT are needed to increase the reliability of these conclusions.https://doi.org/10.1371/journal.pone.0216357 |
| spellingShingle | Pei-Ming Chen Patrick W H Kwong Claudia K Y Lai Shamay S M Ng Comparison of bilateral and unilateral upper limb training in people with stroke: A systematic review and meta-analysis. PLoS ONE |
| title | Comparison of bilateral and unilateral upper limb training in people with stroke: A systematic review and meta-analysis. |
| title_full | Comparison of bilateral and unilateral upper limb training in people with stroke: A systematic review and meta-analysis. |
| title_fullStr | Comparison of bilateral and unilateral upper limb training in people with stroke: A systematic review and meta-analysis. |
| title_full_unstemmed | Comparison of bilateral and unilateral upper limb training in people with stroke: A systematic review and meta-analysis. |
| title_short | Comparison of bilateral and unilateral upper limb training in people with stroke: A systematic review and meta-analysis. |
| title_sort | comparison of bilateral and unilateral upper limb training in people with stroke a systematic review and meta analysis |
| url | https://doi.org/10.1371/journal.pone.0216357 |
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