Self-directed therapy programmes for arm rehabilitation after stroke: a systematic review

Area of Science:

• Neurorehabilitation
• Physical Therapy
• Stroke Recovery

Background:

• Adult stroke survivors often experience significant upper limb impairment.
• Self-directed interventions empower patients to take an active role in their rehabilitation.
• Optimizing arm recovery requires exploring effective, participant-led therapeutic strategies.

Purpose of the Study:

• To systematically review the evidence on the effectiveness of self-directed arm interventions in adult stroke survivors.
• To identify specific self-directed approaches that yield the greatest benefits for arm function and daily living activities.
• To analyze the impact of intervention timing on the efficacy of self-directed arm therapy.

Main Methods:

• A comprehensive systematic review was conducted across major biomedical databases (Medline, EMBASE, CINAHL, SCOPUS, IEEE Xplore).
• Studies were included if participants initiated and performed over 50% of their arm therapy.
• Study quality was assessed using the Cochrane risk of bias tool.

Main Results:

• Forty studies involving 1172 participants were analyzed, including randomized controlled trials and before-after studies.
• Self-directed constraint-induced movement therapy (SMD 0.39) and electrical stimulation (SMD 0.50) demonstrated beneficial effects on arm function.
• Significant arm function improvements were observed in patients more than 12 months post-stroke (SMD 0.52).

Conclusions:

• Self-directed interventions can positively impact arm recovery in stroke survivors.
• The effectiveness of these interventions is contingent upon the specific approach and the patient's recovery stage.
• Constraint-induced movement therapy, electrical stimulation, and technology-free programs show particular promise for enhancing arm function and independence.