The Occupational Therapy team at Better Rehabilitation reviewed the following article; “Interventions for Improving Upper Limb Function After Stroke” (Pollock et al. 2014).
The objective of this article was to complete a Cochrane overview by synthesizing systematic reviews on interventions provided to improve upper limb function post stroke. As such, this Cochrane review was identified to have upmost relevance to our Occupational Therapy practice, as upper limb rehabilitation is a key area of stroke rehabilitation that we practice to maximize function and increase participation and independence in various activities of daily life.
The Cochrane Database of Systematic Reviews, the Database of Reviews of Effects, and PROSPERO were comprehensively searched, from which 40 completed reviews (19 Cochrane; 21 non-Cochrane) were included. Evidence included was current to June 2013.
The reviews explored 18 different interventions, as well as the dose of the intervention and the setting in which the intervention 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 included (which were given control interventions, no treatment and 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 and a relatively high dose of repetitive task practice; thus, 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 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. 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. In addition, we will focus on investigating the use therapeutic interventions, such as virtual reality and CIMT, which are currently not used routinely in our clinical practice. In summary, as allied 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.