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UPPER LIMB THERAPY DURING THE FIRST 6-MONTHS AFTER STROKE: A SYSTEMATIC REVIEW OF TIMING, DOSE, AND EFFICACY.
Background and Aims
Early and intense motor intervention is thought to yield greater upper limb recovery post-stroke. This systematic review investigated timing, dose and efficacy of upper limb intervention during the first 6-months post-stroke.
Three databases were searched (PROSPERO:CRD42016048035). Studies that enrolled people ≤6-months post-stroke, aimed to improve upper limb recovery, and completed pre- and post-intervention assessment were included. Studies were examined by timing (recovery epoch), dose and efficacy (minimal clinical important difference, MCID).
261 studies were included, representing 228 (n=9,704 participants) unique datasets. Studies per 5-year interval increased from one (n=37 participants) between 1980-1984 to 91 (n=4,417 participants) between 2015-2019. Participants were enrolled a median 38 days (IQR 22-66) post-stroke. Studies were identified within each recovery epoch: 1 hyperacute, 13 acute, 176 early subacute, 34 late subacute; 4 unable to be categorised. The median intervention and control dose was 45-minutes/session, 1 session/day, 5-days/week for 4-weeks, which was consistent across epochs. For motor impairment, 102 studies contained data to interpret a MCID. In 69% (n=70) of these studies, impairment outcomes were similar (eg. MCID achieved by intervention and control groups). For motor activity, 107 studies contained data to interpret a MCID and 67% (n=72) of activity outcomes were similar.
Despite a large and growing body of research, lack of consistent data elements prevented identification of the optimal timing to commence upper limb intervention post-stroke, and the effect of timing and dose on efficacy. A united research agenda that establishes a biological understanding of timing and dose is needed to progress stroke recovery research.