Bilateral versus unilateral upper limb training in (sub)acute stroke: A systematic and meta-analysis

Area of Science:

• Neurorehabilitation
• Stroke Recovery
• Upper Limb Function

Background:

• High-dosage bilateral movements are a potential strategy to enhance upper limb (UL) recovery and bimanual activities after stroke.
• This study focuses on the early (sub)acute phase of stroke, a critical period for rehabilitation interventions.

Purpose of the Study:

• To compare the effectiveness of bilateral versus unilateral upper limb training on motor impairments and functional independence in stroke survivors.
• To evaluate the impact of training type on recovery in the (sub)acute phase post-stroke.

Main Methods:

• Systematic literature search across five databases (PubMed, Scopus, PEDro, ScienceDirect, Web of Science) up to June 2023.
• Inclusion of randomized controlled trials comparing bilateral versus unilateral UL training in stroke survivors (< 6 months post-stroke).
• Meta-analysis using standard mean differences (SMDs) to quantify treatment effects.

Main Results:

• The review included 14 studies with 706 participants.
• Bilateral UL training showed significant improvements in UL impairments (FMA-UE, SMD = 0.48, P = 0.02) compared to unilateral training.
• Significant benefits of bilateral training were observed for functional independence in daily activities (Functional Independence Measure, SMD = 0.45, P = 0.006), particularly in patients with "no motor capacity".

Conclusions:

• Bilateral upper limb training is superior to unilateral training for improving upper limb impairments and functional independence in daily activities in (sub)acute stroke patients.
• Bilateral UL training promotes recovery of both motor impairments and functional abilities in the early phase of stroke.