Predictive factors and dose–response effect of rehabilitation for upper limb induced recovery after stroke: systematic review with proportional meta-analyses

IF 3.1 3区医学 Q1 REHABILITATION Physiotherapy Pub Date : 2024-08-03 DOI:10.1016/j.physio.2024.101417

Silvia Salvalaggio , Silvia Gianola , Martina Andò , Luisa Cacciante , Greta Castellini , Alex Lando , Gianluca Ossola , Giorgia Pregnolato , Sebastian Rutkowski , Anna Vedovato , Chiara Zandonà , Andrea Turolla

{"title":"Predictive factors and dose–response effect of rehabilitation for upper limb induced recovery after stroke: systematic review with proportional meta-analyses","authors":"Silvia Salvalaggio , Silvia Gianola , Martina Andò , Luisa Cacciante , Greta Castellini , Alex Lando , Gianluca Ossola , Giorgia Pregnolato , Sebastian Rutkowski , Anna Vedovato , Chiara Zandonà , Andrea Turolla","doi":"10.1016/j.physio.2024.101417","DOIUrl":null,"url":null,"abstract":"<div><h3>Background and purpose</h3><div>To date, factors with predictive value for upper limb (UL) recovery after stroke are acknowledged, but little is known on clinical features predicting outcome in response to rehabilitation. The purpose of this review is to investigate whether any factor allows identification of Responders to rehabilitation, and whether clinically important recovery of motor function relies on modalities and dose of intervention received, at different times after stroke.</div></div><div><h3>Methods</h3><div>A systematic review with proportional meta-analysis was conducted. Longitudinal single-cohort studies on patients undergoing rehabilitation after stroke were included. Predictive features investigated in the included studies were reported. The primary outcome was the Fugl-Meyer Assessment for Upper Extremity, and effect sizes (ES) of different rehabilitation doses were calculated.</div></div><div><h3>Results</h3><div>Only 6% of the included studies (<em>n</em> = 141) investigated predictive factors. Studies providing more than 30 hours of therapy induced small to large clinical effect (ES from 0.38 to 0.88). Task-oriented approach led to the largest effect, both in the subacute (ES = 0.88) and chronic (ES = 0.71) phases. Augmenting interventions provided higher effect in the chronic rather than subacute phase. Integrity of the corticospinal tract, preservation of arm motor function and specific genetic biomarkers were found to be associated with motor recovery</div></div><div><h3>Discussion and conclusions</h3><div>Trials on motor recovery after stroke should incorporate analysis of factors associated with rehabilitation outcomes. Task-oriented interventions should be delivered more than 30 hours (high dose) to induce the greatest improvement.</div></div><div><h3>Systematic Review Registration Number</h3><div>Systematic Review Registration Number PROSPERO CRD42021258188.</div></div><div><h3>Contribution of the Paper</h3><div><ul><li><span>•</span><span><div>Demographic characteristics of patients are not associated with rehabilitation-induced upper limb motor outcomes after stroke.</div></span></li><li><span>•</span><span><div>Brain lesion characteristics and residual motor function were found to be the main potential predictive factors of rehabilitation-induced upper limb recovery after stroke.</div></span></li><li><span>•</span><span><div>Task-oriented interventions had the most significant clinical effect, both in the subacute and chronic phases after stroke.</div></span></li><li><span>•</span><span><div>Augmenting interventions are useful in the chronic phase after stroke, if delivered for a minimum of 10 hours.</div></span></li><li><span>•</span><span><div>Priming interventions are more useful in the chronic phase after stroke when 10 to 30 hours of treatment are delivered.</div></span></li></ul></div></div>","PeriodicalId":54608,"journal":{"name":"Physiotherapy","volume":"125 ","pages":"Article 101417"},"PeriodicalIF":3.1000,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Physiotherapy","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0031940624004267","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"REHABILITATION","Score":null,"Total":0}

引用次数: 0

Abstract

Background and purpose

To date, factors with predictive value for upper limb (UL) recovery after stroke are acknowledged, but little is known on clinical features predicting outcome in response to rehabilitation. The purpose of this review is to investigate whether any factor allows identification of Responders to rehabilitation, and whether clinically important recovery of motor function relies on modalities and dose of intervention received, at different times after stroke.

Methods

A systematic review with proportional meta-analysis was conducted. Longitudinal single-cohort studies on patients undergoing rehabilitation after stroke were included. Predictive features investigated in the included studies were reported. The primary outcome was the Fugl-Meyer Assessment for Upper Extremity, and effect sizes (ES) of different rehabilitation doses were calculated.

Results

Only 6% of the included studies (n = 141) investigated predictive factors. Studies providing more than 30 hours of therapy induced small to large clinical effect (ES from 0.38 to 0.88). Task-oriented approach led to the largest effect, both in the subacute (ES = 0.88) and chronic (ES = 0.71) phases. Augmenting interventions provided higher effect in the chronic rather than subacute phase. Integrity of the corticospinal tract, preservation of arm motor function and specific genetic biomarkers were found to be associated with motor recovery

Discussion and conclusions

Trials on motor recovery after stroke should incorporate analysis of factors associated with rehabilitation outcomes. Task-oriented interventions should be delivered more than 30 hours (high dose) to induce the greatest improvement.

Systematic Review Registration Number

Systematic Review Registration Number PROSPERO CRD42021258188.

Contribution of the Paper

•
Demographic characteristics of patients are not associated with rehabilitation-induced upper limb motor outcomes after stroke.
•
Brain lesion characteristics and residual motor function were found to be the main potential predictive factors of rehabilitation-induced upper limb recovery after stroke.
•
Task-oriented interventions had the most significant clinical effect, both in the subacute and chronic phases after stroke.
•
Augmenting interventions are useful in the chronic phase after stroke, if delivered for a minimum of 10 hours.
•
Priming interventions are more useful in the chronic phase after stroke when 10 to 30 hours of treatment are delivered.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

中风后上肢诱发康复的预测因素和剂量-反应效应：系统综述与比例荟萃分析

背景和目的迄今为止，对中风后上肢（UL）恢复具有预测价值的因素已得到公认，但对预测康复效果的临床特征却知之甚少。本综述旨在研究是否有任何因素可以识别康复反应者，以及在中风后的不同时期，运动功能的临床重要恢复是否取决于所接受干预的方式和剂量。研究纳入了对脑卒中后接受康复治疗的患者进行的纵向单队列研究。报告了所纳入研究的预测特征。结果仅有 6% 的纳入研究（n = 141）调查了预测因素。治疗时间超过 30 小时的研究产生了由小到大的临床效果（ES 从 0.38 到 0.88）。以任务为导向的方法在亚急性期（ES = 0.88）和慢性期（ES = 0.71）的疗效最大。增强干预在慢性期比亚急性期的效果更高。讨论与结论有关中风后运动恢复的试验应包括对康复结果相关因素的分析。系统综述注册号系统综述注册号 PROSPERO CRD42021258188.Contribution of the Paper-患者的人口统计学特征与中风后康复诱导的上肢运动结果无关。-脑损伤特征和残余运动功能是脑卒中后康复诱导上肢恢复的主要潜在预测因素。-以任务为导向的干预在脑卒中后的亚急性期和慢性期均具有最显著的临床效果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Physiotherapy 医学-康复医学

CiteScore

6.40

自引率

3.00%

发文量

377

审稿时长

82 days

期刊介绍： Physiotherapy aims to publish original research and facilitate continuing professional development for physiotherapists and other health professions worldwide. Dedicated to the advancement of physiotherapy through publication of research and scholarly work concerned with, but not limited to, its scientific basis and clinical application, education of practitioners, management of services and policy. We are pleased to receive articles reporting original scientific research, systematic reviews or meta-analyses, theoretical or debate articles, brief reports and technical reports. All papers should demonstrate methodological rigour.