The effect of altering a single component of a rehabilitation programme on the functional recovery of stroke patients: a systematic review and meta-analysis.
OBJECTIVE
To evaluate the effect of altering a single component of a rehabilitation programme (e.g. adding bilateral practice alone) on functional recovery after stroke, defined using a measure of activity.


METHODS
A search was conducted of Medline/Pubmed, CINAHL and Web of Science.


METHODS
Two reviewers independently assessed eligibility. Randomized controlled trials were included if all participants received the same base intervention, and the experimental group experienced alteration of a single component of the training programme. This could be manipulation of an intrinsic component of training (e.g. intensity) or the addition of a discretionary component (e.g. augmented feedback). One reviewer extracted the data and another independently checked a subsample (20%). Quality was appraised according to the PEDro scale.


RESULTS
Thirty-six studies (n = 1724 participants) were included. These evaluated nine training components: mechanical degrees of freedom, intensity of practice, load, practice schedule, augmented feedback, bilateral movements, constraint of the unimpaired limb, mental practice and mirrored-visual feedback. Manipulation of the mechanical degrees of freedom of the trunk during reaching and the addition of mental practice during upper limb training were the only single components found to independently enhance recovery of function after stroke.


CONCLUSIONS
This review provides limited evidence to support the supposition that altering a single component of a rehabilitation programme realises greater functional recovery for stroke survivors. Further investigations are required to determine the most effective single components of rehabilitation programmes, and the combinations that may enhance functional recovery.
1Division of Physiotherapy, The University of Queensland Brisbane, Brisbane, Australia.
Kathryn S
KS
Hayward
Ruth N
RN
Barker
Richard G
RG
Carson
Sandra G
SG
Brauer
D000203:Activities of Daily Living; D000368:Aged; D016206:Databases, Bibliographic; D006801:Humans; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011788:Quality of Life; D020127:Recovery of Function; D012046:Rehabilitation / Q000379:methods; D000071939:Stroke Rehabilitation
Stroke; recovery of function; rehabilitation programme; systematic review