A comparison of bilateral and unilateral upper-limb task training in early poststroke rehabilitation: a randomized controlled trial

TY - JOUR

T1 - A comparison of bilateral and unilateral upper-limb task training in early poststroke rehabilitation: a randomized controlled trial

AU - Morris, Jacqui H.

AU - van Wijck, Frederike

AU - Joice, Sara

AU - Ogston, Simon A.

AU - Cole, Ingrid

AU - MacWalter, Ronald S.

PY - 2008/7

Y1 - 2008/7

N2 - Objective: To compare the effects of bilateral task training with unilateral task training on upper-limb outcomes in early poststroke rehabilitation.Design: A single-blinded randomized controlled trial, with outcome assessments at baseline, post intervention (6wk), and follow-up (18wk).Setting: Inpatient acute and rehabilitation hospitals.Participants: Patients were randomized to receive bilateral training (n=56) or unilateral training (n=50) at 2 to 4 weeks poststroke onset.Intervention: Supervised bilateral or unilateral training for 20 minutes on weekdays over 6 weeks using a standardized program.Main Outcome Measures: Upper-limb outcomes were assessed by Action Research Arm Test (ARAT), Rivermead Motor Assessment upper-limb scale, and Nine-Hole Peg Test (9HPT). Secondary measures included the Modified Barthel Index, Hospital Anxiety and Depression Scale, and Nottingham Health Profile. All assessment was conducted by a blinded assessor.Results: No significant differences were found in short-term improvement (0-6wk) on any measure (P >.05). For overall improvement (0-18wk), the only significant between-group difference was a change in the 9HPT (95% confidence interval [CI], 0.0-0.1; P=.05) and ARAT pinch section (95% CI, 0.3-5.6; P=.03), which was lower for the bilateral training group. Baseline severity significantly influenced improvement in all upper-limb outcomes (P <.05), but this was irrespective of the treatment group.Conclusions: Bilateral training was no more effective than unilateral training, and in terms of overall improvement in dexterity, the bilateral training group improved significantly less. Intervention timing, task characteristics, dose, and intensity of training may have influenced the results and are therefore areas for future investigation.

AB - Objective: To compare the effects of bilateral task training with unilateral task training on upper-limb outcomes in early poststroke rehabilitation.Design: A single-blinded randomized controlled trial, with outcome assessments at baseline, post intervention (6wk), and follow-up (18wk).Setting: Inpatient acute and rehabilitation hospitals.Participants: Patients were randomized to receive bilateral training (n=56) or unilateral training (n=50) at 2 to 4 weeks poststroke onset.Intervention: Supervised bilateral or unilateral training for 20 minutes on weekdays over 6 weeks using a standardized program.Main Outcome Measures: Upper-limb outcomes were assessed by Action Research Arm Test (ARAT), Rivermead Motor Assessment upper-limb scale, and Nine-Hole Peg Test (9HPT). Secondary measures included the Modified Barthel Index, Hospital Anxiety and Depression Scale, and Nottingham Health Profile. All assessment was conducted by a blinded assessor.Results: No significant differences were found in short-term improvement (0-6wk) on any measure (P >.05). For overall improvement (0-18wk), the only significant between-group difference was a change in the 9HPT (95% confidence interval [CI], 0.0-0.1; P=.05) and ARAT pinch section (95% CI, 0.3-5.6; P=.03), which was lower for the bilateral training group. Baseline severity significantly influenced improvement in all upper-limb outcomes (P <.05), but this was irrespective of the treatment group.Conclusions: Bilateral training was no more effective than unilateral training, and in terms of overall improvement in dexterity, the bilateral training group improved significantly less. Intervention timing, task characteristics, dose, and intensity of training may have influenced the results and are therefore areas for future investigation.

KW - Cerebrovascular accident

KW - Motor activity

KW - Randomized controlled trial

KW - Rehabilitation

KW - Upper extremity

KW - Chronic stroke patients

KW - Motor assessment

KW - Arm function

KW - Recovery

KW - Movements

KW - Reliability

KW - Performance

KW - Impairment

KW - Activation

UR - https://www.scopus.com/pages/publications/45849107673

U2 - 10.1016/j.apmr.2007.11.039

DO - 10.1016/j.apmr.2007.11.039

M3 - Article

SN - 0003-9993

VL - 89

SP - 1237

EP - 1245

JO - Archives of Physical Medicine and Rehabilitation

JF - Archives of Physical Medicine and Rehabilitation

IS - 7

ER -