Efficacy and Dose of Rehabilitation Approaches for Severe Upper Limb Impairments and Disability during Early Acute and Subacute Stroke: A Systematic Review

Abstract

Objective The purpose of this study was to examine the evidence of the efficacy of rehabilitation approaches for improving severe upper limb impairments and disability during acute and early subacute stroke, taking into consideration the dosage of therapy. Methods Randomized controlled trials from PubMed, Web of Science, and Scopus databases were searched by 2 independent researchers. Studies were selected if they involved active rehabilitation interventions that were conducted in the acute stage (<7 days after stroke) or the early subacute stage (>7 days-3 months after stroke), with the aim of improving severe upper limb motor impairments and disability. Data were extracted on the basis of the type and effect of rehabilitation interventions and on the dosage (duration, frequency, session length, episode difficulty, and intensity). Study quality was assessed using the Physiotherapy Evidence Database Scale. Results Twenty-three studies (1271 participants) with fair to good methodological quality were included. Only 3 studies were performed in the acute stage. Regardless of the type of intervention, upper limb rehabilitation was found to be beneficial for severe upper limb impairments and disability. Robotic therapy and functional electrical stimulation were identified as the most popular upper limb interventions; however, only a limited number of studies showed their superiority over a dose-matched control intervention for severe upper limb impairments in the subacute stage. A longer rehabilitation session length (<60 minutes) did not seem to have a larger impact on the magnitude of improved upper limb impairments. Conclusion Different rehabilitation approaches seem to improve severe upper limb impairments and disability in the subacute stage after stroke; however, they are not distinctly superior to standard care or other interventions provided at the same dosage. Impact Robotic therapy and functional electrical stimulation add variety to rehabilitation programs, but their benefit has not been shown to exceed that of standard care. Further research is necessary to identify the impact of dosage parameters (eg, intensity) on severe upper limb motor impairments and function, especially in the acute stage.