Led by Glasgow Caledonian University (GCU), researchers have emphasised that high-quality research is urgently required. They call for large well-designed randomised controlled trials of a number of promising treatments, including constraint-induced movement therapy CIMT, mental practice, mirror therapy and virtual reality, and further primary research for several specific interventions.
Problems with arm function (upper limb impairments) are very common after a stroke. These upper limb impairments commonly include difficulty moving and co-ordinating the arms, hands and fingers, often resulting in difficulty carrying out daily activities such as eating, dressing and washing.
The two-year £84,000 research project was conducted as a major Cochrane Overview of research evidence, the first relating to stroke care, funded by the Chief Scientist Office (CSO).
The aim of the project was to help people easily access information about effective interventions, and to help them compare the effects of different interventions by bringing together all systematic reviews of interventions provided to improve upper limb (arm) function after stroke.
Cochrane publishes systematic reviews of primary research in human health care and health policy, and are internationally recognised as the highest standard in evidence-based health care.
The research was led by Dr Alex Pollock, Senior Research Fellow at the Nursing Midwifery and Allied Health Professions (NMAHP) Research Unit at Glasgow Caledonian University in collaboration with partners from the Universities of Glasgow and Edinburgh.
More than half of people with upper limb impairment after stroke will still have problems many months to years after their stroke. Improving arm function is a core element of rehabilitation. Many possible interventions have been developed; these may involve different exercises or training, specialist equipment or techniques, or they could take the form of a drug (pill or injection) given to help arm movement.
The research team found that there is currently no high-quality evidence is available for any interventions currently used as part of routine practice. They did find moderate-quality evidence which shows that some interventions may be effective: constraint-induced movement therapy (CIMT), mental practice, mirror therapy, interventions for sensory impairment, virtual reality and a relatively high dose of repetitive task practice. For other interventions which are currently used in clinical practice there is only low or very low quality evidence.
The review spanned analysis of 40 systematic reviews (19 Cochrane reviews and 21 non-Cochrane reviews) which covered 18 different types of interventions, as well as the dose of the intervention and the setting in which the intervention was delivered. These reviews varied in relation to the populations included (initial upper limb impairment and stroke severity) and in relation to the comparison groups included (which were given control interventions, no treatment and conventional therapy).
Dr Pollock said: “This Overview clearly signposts clinical decision makers directly to where there is evidence of effective treatments, this makes it much easier for clinicians to access this evidence and choose the treatment which will be best for their individual patient. Stroke rehabilitation research has progressed substantially over the last 20 years, but this Overview highlights that we urgently need some really big and well-planned clinical trials. It is really important that researchers work together to address this challenge.”
Glasgow Caledonian University: Nursing Midwifery and Allied Health Professions (NMAHP) Research Unit