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Self-directed therapy programmes for arm rehabilitation after stroke: a systematic review

Lookup NU author(s): Ruth Da Silva, Sarah Moore, Professor Christopher PriceORCiD



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


Aim: To investigate the effectiveness of self-directed arm interventions in adult stroke survivors.Methods: A systematic review of Medline, EMBASE; CINAHL; SCOPUS and IEEEXplore up to February 2018 was carried out. Studies of stroke arm interventions were included where more than 50% of the time spent in therapy was initiated and carried out by the participant. Quality of the evidence was assessed using the Cochrane risk of bias tool.Results: 40 studies (n= 1172 participants) were included (19 RCTs and 21 before-after studies). Studies were grouped according to no-technology or the main additional technology used (no technology n=5; interactive gaming n=6; electrical stimulation n=11; constraint- induced movement therapy n=6; robotic and dynamic orthotic devices n= 8; mirror therapy n= 1; tele-rehabilitation n=2; wearable devices n=1).A beneficial effect on arm function was found for self-directed interventions using constraint- induced movement therapy (n=105; SMD 0.39, 95% confidence interval -0.00 to 0.78) andelectrical stimulation (n=94; SMD 0.50, 95% confidence interval 0.08 to 0.91). Constraint- induced movement therapy and therapy programmes without technology improved independence in activities of daily living. Sensitivity analysis demonstrated arm function benefit for patients >12 months post-stroke (n=145; SMD 0.52, 95% CI 0.21, 0.82) but not at0-3; 3-6 or 6-12 months.Conclusions: Self-directed interventions can enhance arm recovery after stroke but the effect varies according to the approach used and timing. There were benefits identified from self- directed delivery of constraint-induced movement therapy, electrical stimulation and therapy programmes that increase practice without using additional technology.

Publication metadata

Author(s): Da-Silva RH, Moore SA, Price CI

Publication type: Review

Publication status: Published

Journal: Clinical Rehabilitation

Year: 2018

Volume: 32

Issue: 8

Pages: 1022-1036

Print publication date: 01/08/2018

Online publication date: 13/05/2018

Acceptance date: 15/04/2018

ISSN (print): 0269-2155

ISSN (electronic): 1477-0873


DOI: 10.1177/0269215518775170