Fiona coupar
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Transcript of Fiona coupar
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Effectiveness of interventions for
upper limb recovery after stroke
Fiona Coupar, Alex Pollock, Phil Rowe,
Christopher Weir and Peter Langhorne
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Research question
Which interventions targeted at
the upper limb are effective?
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Methods – Systematic Review
Inclusion criteria – RCT
– Stroke
– UL targeted interventions
– UL functional or impairment outcomes
– Comparisons: placebo, no treatment,
standard care
Cochrane stroke group trials register
Standard SR methodology
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Review profile
11000 titles
827 abstracts
Ten interventionsConstraint Induced Movement Therapy (CIMT);
Electrostimulation; Robotics; Repetitive Task Training;
Therapy approaches; Increased intensity;
EMG biofeedback;
Imagery; Splinting; Bilateral training
72 trials
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Constraint-induced movement therapy
Trials Allocation concealment Intention to treat Blinding
22 4 4 18
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Electrostimulation
Trials Allocation concealment Intention to treat Blinding
13 2 0 7
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Electromechanical / Robotic devices
Trials Allocation concealment Intention to treat Blinding
10 3 2 7
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Repetitive task training
Trials Allocation concealment Intention to treat Blinding
8 5 1 6
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Approach of therapy
Trials Allocation concealment Intention to treat Blinding
5 2 1 3
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Intensity of therapy
Trials Allocation concealment Intention to treat Blinding
4 3 1 4
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Biofeedback
Trials Allocation concealment Intention to treat Blinding
4 4 0 3
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Mental practice / Imagery
Trials Allocation concealment Intention to treat Blinding
4 0 0 3
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Splinting
Trials Allocation concealment Intention to treat Blinding
3 2 2 3
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Bilateral arm training
Trials Allocation concealment Intention to treat Blinding
2 1 0 2
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Limitations
Heterogeneity
Nature of included trials
Strengths
Comprehensive searching
Only RCTs included
Explicit and systematic methods
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SummarySome evidence of benefit from:
–CIMT
– Imagery/mental practice
–Robotics
–EMG biofeedback
Applicability & generalisability
limitations
Repetitive, intense, task-specific
practice
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Implications
Clinical Research