Comparative Effectiveness of Upper Limb Exercise Interventions in Individuals With Stroke: A Network Meta-Analysis

Area of Science:

• Neurorehabilitation
• Clinical Neurology
• Physical Therapy

Background:

• Upper limb motor impairments are common after stroke.
• Identifying the most effective exercise interventions is crucial for recovery.
• This study compares various upper limb exercise interventions for acute/subacute stroke.

Approach:

• Systematic review and network meta-analysis of randomized controlled trials (RCTs).
• Included individuals within 6 months of stroke onset.
• Assessed upper limb motor function, activities of daily living, and social participation.

Key Points:

• Analyzed 119 RCTs with 5553 participants and 41 treatment categories.
• Electrical stimulation + task-specific training, high-volume constraint-induced movement therapy, and strength training were most effective.
• Effect sizes (Hedge's g) ranged from 0.65 to 1.03.

Conclusions:

• Electrical stimulation + task-specific training (low evidence), high-volume constraint-induced movement therapy (moderate evidence), and strength training (low evidence) improved motor function.
• Results were sensitive to high risk of bias, warranting further investigation.
• Well-designed studies are needed to confirm efficacy, especially for electrical stimulation combined with task-specific training.