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What is stroke and how does it affect sufferers?
A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain ruptures or is blocked by a clot, causing brain cells to die. Stroke affects everyone differently and sufferers can experience various physical and mental changes. The most common consequences of stroke are impaired speech, reduced physical abilities, and paralysis or weakness of limbs on one side of the body.
According to the World Health Organisation (WHO), stroke affects 15 million people worldwide and is the leading cause of disability. In Australia, around 50,000 people suffer a stroke each year and there are about half a million stroke survivors.
While many consider older people at a greater risk of stroke, it can happen to anyone at any age. In fact, in Australia, a third of stroke survivors are under the age of 65. There are, however, lifestyle changes to help reduce your risk of stroke including staying active, eating a healthy diet, quitting smoking, avoiding alcohol, and having regular health checks.
With the incidence of stroke significantly increasing over the past 30 years, research is vital for finding ways to reduce the incidence of stroke, improve existing rehabilitation interventions and develop new interventions to help sufferers rehabilitate and enjoy a better quality of life.
Background information on the authors’ research
As the authors of this research article state, improving upper limb function is a ‘core element of stroke rehabilitation’ and needed to ‘increase patient outcomes and reduce disability’.
To select rehabilitation treatments to improve upper limb function post stroke, they comprehensively reviewed interventions from the Cochrane Database of Systematic Reviews, a leading global database in health care operated by researchers, professionals, patients, carers and others interested in health, and PROSPERO, an international register of systematic reviews. They also reviewed non-Cochrane reviews of randomised controlled trials of patients who have suffered stroke, comparing upper limb interventions with no treatment, usual care or alternative treatments.
The author’s systematic review is relevant to our Occupational Therapy practice at Better Rehab, as upper limb rehabilitation is a key area of stroke rehabilitation that we practice to maximise function and increase participation and independence in activities of daily life.
Takeaways of note from the systematic review
The authors reviewed a total of 40 reviews – 19 Cochrane and 21 PROSPERO and other reviews – which together explored 18 different interventions, including the dose of each intervention and the setting in which it was delivered.
Each review varied in relation to the populations included (initial upper limb impairment and stroke severity) and in relation to the comparison groups, which were given control interventions, no treatment or conventional therapy.
The synthesis of the outcomes of these systematic reviews identified moderate-quality evidence showed a beneficial effect of constraint-induced movement therapy (CIMT), mental practice, mirror therapy, interventions for sensory impairment, virtual reality occupational therapy, and a relatively high dose of repetitive task practice, suggesting that these may be effective interventions.
In addition, moderate-quality evidence also indicated that unilateral arm training may be more effective than bilateral arm training. Information, however, was insufficient to reveal the relative effectiveness of different interventions.
Some evidence showed that a greater dose of an intervention is better than a lesser dose. However additional research is required to identify the optimal dose of arm rehabilitation. Furthermore, this systematic review identified that further research, including large randomised controlled trials of CIMT, mental practice, mirror therapy and virtual reality, are required.
As identified throughout this systematic review, some moderate-quality evidence suggests that CIMT, mental practice, mirror therapy, and a relatively high dose of repetitive task practice may be effective interventions for improving upper limb function after stroke.
Our response to the review’s findings
As allied occupational therapy health professionals, we will take into consideration the findings of this systematic review and ensure we select and implement interventions that align with individual patient assessment and expert clinical reasoning and judgement.
As such, we will aim to incorporate these evidenced-based interventions into our ongoing therapy plans, whilst taking into consideration individual patient circumstances and the therapy setting. We will also focus on investigating the use therapeutic interventions, such as virtual reality and CIMT, which are currently not used routinely in our clinical practice.
If you would like to find out more about our personalised Occupational Therapy programs for stroke rehabilitation, please contact our team on 1300 073 422 or email at admin@betterrehab.com.au.
For further information, we encourage you to read the research article Interventions for improving upper limb function after stroke.
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