Article

AIM: To investigate the effectiveness of self-directed arm interventions in adult
stroke survivors. METHODS:
A systematic review of Medline, EMBASE, CINAHL, SCOPUS
and IEEE Xplore 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:
A total of 40 studies ( n
= 1172 participants) were included (19 randomized controlled trials (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; telerehabilitation 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;
standardized mean difference (SMD) 0.39, 95% confidence interval (CI) -0.00 to
0.78) and electrical stimulation ( n = 94; SMD 0.50, 95% CI 0.08-0.91).
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 poststroke ( n = 145;
SMD 0.52, 95% CI 0.21-0.82) but not at 0-3, 3-6 or 6-12 months. CONCLUSION:
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.

Langue : ANGLAIS