Bilateral arm training in the chronic phase of stroke rehabilitation: a systematic review and meta-analysis

Abstract

Objective: Bilateral arm training (BAT) is an intervention utilized in rehabilitating upper-extremity paresis. The objective of this study was to conduct a systematic review and meta-analysis on the evidence for BAT on upperlimb paresis in the chronic phase of stroke.
Methods: A literature search of multiple databases (MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, OT Seeker ) was conducted for relevant randomized controlled trials (RCTs) published in the English language that met inclusion criteria. Studies must have included BAT as part of treatment and participants must have been ’‰¥6 months post stroke. Methodological quality of each study was assessed using the PEDro scale (maximum score=10).
Results: Eight RCTs satisfied the inclusion criteria (PEDro scores 1-7) for a total pooled sample size of 131 subjects (88 males and 43 females). The mean age of subjects was 57.6±4.1 years (range 50.7-64.8 years) and the mean time since stroke was 43.8±34.8 months (range 13.9-114.0 months). Among study endpoints, only the Fugl-Meyer Assessment tool showed significant improvement in motor impairment whereby the BAT groups improved, on average, 3.77 points whereas the control group improved just 1.23 points (Difference of Means = 1.46±0.662; p=0.028).
Conclusion: Overall, BAT showed a general trend in improvement over standard therapy, although it was not statistically significant. Future studies with improved methodological quality (e.g., strict inclusion criteria, protocol standardization) and larger sample sizes are needed to appropriately assess the benefit of BAT in stroke patients.