The effect of altering a single component of a rehabilitation programme on the functional recovery of stroke patients

The purpose of this study was to evaluate the effect of altering a single component of a rehabilitation programme (e.g. adding bilateral practice alone) on functional recovery following stroke, defined using a measure of activity. A search was conducted of Medline/Pubmed, CINAHL and Web of Science. Two independent reviewers assessed eligibility. Randomized controlled trials were included if all participants received the same base intervention, and the experimental group experienced alteration of a single component of the training programme. This could be manipulation of an intrinsic component of training (e.g. intensity) or the addition of a discretionary component (e.g. augmented feedback). One reviewer extracted the data and another independently checked a subsample (20%). Quality was appraised according to the PEDro scale. Thirty-six studies (n = 1724 participants) were included. These evaluated nine training components: mechanical degrees of freedom, intensity of practice, load, practice schedule, augmented feedback, bilateral movements, constraint of the unimpaired limb, mental practice and mirrored-visual feedback. Manipulation of the mechanical degrees of freedom of the trunk during reaching and the addition of mental practice during upper limb training were the only single components found to independently enhance recovery of function following stroke.

This review provides limited evidence to support the idea that altering a single component of a rehabilitation programme realises greater functional recovery for stroke survivors. Additional investigations are needed to determine the most effective single components of rehabilitation programmes, and the combinations that may enhance functional recovery.