Simultaneous bilateral training for improving arm function after stroke.
BACKGROUND
Simultaneous bilateral training, the completion of identical activities with both arms simultaneously, is one intervention to improve arm function and reduce impairment.


OBJECTIVE
To determine the effects of simultaneous bilateral training for improving arm function after stroke.


METHODS
We searched the Cochrane Stroke Trials Register (last searched August 2009) and 10 electronic bibliographic databases including the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2009), MEDLINE, EMBASE, CINAHL and AMED (August 2009). We also searched reference lists and trials registers.


METHODS
Randomised trials in adults after stroke, where the intervention was simultaneous bilateral training compared to placebo or no intervention, usual care or other upper limb (arm) interventions. PRIMARY OUTCOMES were performance in activities of daily living (ADL) and functional movement of the upper limb. SECONDARY OUTCOMES were performance in extended activities of daily living and motor impairment of the arm.


METHODS
Two authors independently screened abstracts, extracted data and appraised trials. Assessment of methodological quality was undertaken for allocation concealment, blinding of outcome assessor, intention-to-treat, baseline similarity and loss to follow up.


RESULTS
We included 18 studies involving 549 relevant participants, of which 14 (421 participants) were included in the analysis (one within both comparisons). Four of the 14 studies compared the effects of bilateral training with usual care.


METHODS
results were not statistically significant for performance in ADL (standardised mean difference (SMD) 0.25, 95% confidence interval (CI) -0.14 to 0.63); functional movement of the arm (SMD -0.07, 95% CI -0.42 to 0.28) or hand (SMD -0.04, 95% CI -0.50 to 0.42).


RESULTS
no statistically significant results. Eleven of the 14 studies compared the effects of bilateral training with other specific upper limb (arm) interventions.


METHODS
no statistically significant results for performance of ADL (SMD -0.25, 95% CI -0.57 to 0.08); functional movement of the arm (SMD -0.20, 95% CI -0.49 to 0.09) or hand (SMD -0.21, 95% CI -0.51 to 0.09).


RESULTS
one study reported a statistically significant result in favour of another upper limb intervention for performance in extended ADL. No statistically significant differences were found for motor impairment outcomes.


CONCLUSIONS
There is insufficient good quality evidence to make recommendations about the relative effect of simultaneous bilateral training compared to placebo, no intervention or usual care. We identified evidence that suggests that bilateral training may be no more (or less) effective than usual care or other upper limb interventions for performance in ADL, functional movement of the upper limb or motor impairment outcomes.
Coupar
Fiona
F
Academic Section of Geriatric Medicine, University of Glasgow, University Block, Glasgow Royal Infirmary, Glasgow, UK, G4 0SF.
Pollock
Alex
A
van Wijck
Frederike
F
Morris
Jacqui
J
Langhorne
Peter
P
D000203:Activities of Daily Living; D000328:Adult; D001132:Arm; D006801:Humans; D009043:Motor Activity; D010291:Paresis / Q000534:rehabilitation*; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation
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