title: Trunk restraint to promote upper extremity recovery in stroke patients: a systematic review and meta-analysis.
abstract: BACKGROUND
  Many stroke patients exhibit excessive compensatory trunk movements during reaching. Compensatory movement behaviors may improve upper extremity function in the short-term but be detrimental to long-term recovery.
  
  
  OBJECTIVE
  To evaluate the evidence that trunk restraint limits compensatory trunk movement and/or promotes better upper extremity recovery in stroke patients.
  
  
  METHODS
  A search was conducted through electronic databases from January 1980 to June 2013. Only randomized controlled trials (RCTs) comparing upper extremity training with and without trunk restraint were selected for review. Three review authors independently assessed the methodological quality and extracted data from the studies. Meta-analysis was conducted when there was sufficient homogenous data.
  
  
  RESULTS
  Six RCTs involving 187 chronic stroke patients were identified. Meta-analysis of key outcome measures showed that trunk restraint has a moderate statistically significant effect on improving Fugl-Meyer Upper Extremity (FMA-UE) score, active shoulder flexion, and reduction in trunk displacement during reaching. There was a small, nonsignificant effect of trunk restraint on upper extremity function.
  
  
  CONCLUSIONS
  Trunk restraint has a moderate effect on reduction of upper extremity impairment in chronic stroke patients, in terms of FMA-UE score, increased shoulder flexion, and reduction in excessive trunk movement during reaching. There is insufficient evidence to demonstrate that trunk restraint improves upper extremity function and reaching trajectory smoothness and straightness in chronic stroke patients. Future research on stroke patients at different phases of recovery and with different levels of upper extremity impairment is recommended.
authors: University of Southampton, Southampton, UK Tan Tock Seng Hospital, Singapore, Singapore skw1g12@soton.ac.uk.
authors: Seng Kwee
authors: SK
authors: Wee
authors: University of Southampton, Southampton, UK.
authors: Ann-Marie
authors: AM
authors: Hughes
authors: University of Southampton, Southampton, UK.
authors: Martin
authors: M
authors: Warner
authors: University of Southampton, Southampton, UK.
authors: Jane H
authors: JH
authors: Burridge
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000209:etiology / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D012149:Restraint, Physical; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology*
keywords: compensatory movement; recovery; rehabilitation; stroke; trunk restraint; upper extremity