A Systematic Review of Upper Extremity Outcome Measures Assessed in Randomized Controlled Trials of Post-Stroke Upper Extremity Rehabilitation in Low-to-Middle-Income and High-Income Countries.

Abstract

Objective: To systematically review Randomized Controlled Trials (RCTs) of post-stroke upper extremity (UE) motor rehabilitation interventions to identify the outcome measures used in studies in low-to-middle-income countries (LMICs) and high-income countries (HICs) and describe the differences in the context of the International Classification of Functioning Disability and Health (ICF).

Data sources: Five databases "Embase, PubMed, CINAHL, Scopus and Web of Science" were searched from 1960 to April 1, 2021.

Study selection: Studies were included if they were: 1) RCTs or RCT crossovers in English; 2) with ≥50% participants affected by ischemic/hemorrhagic stroke; 3) participants ≥18 years old, 4) used an intervention for the hemiparetic UE as the primary objective of the study.

Data extraction: Title and abstract screening and full-text studies were reviewed, and data for included studies were extracted by two independent investigators. The study quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. Data analyses were performed using SPSS (V29.0).

Data synthesis: Of 5,408 records, 1,276 RCTs were eligible, 298 RCTs were conducted in LMICs and 978 in HICs. A higher percentage of RCTs in LMICs employed body structure and function outcome measures for central nervous system (e.g. Fugl Meyer Assessment) and tone and range of motion (e. g. modified Ashworth Scale) as well as activity outcome measures for general activities of daily living (e.g. Barthel Index). In HICs, a higher percentage of RCTs utilized body structure and function outcome measures assessing strength (e.g. Motricity index), activity outcome measures examining motor specific activity (e. g. Action Research Arm Test, Wolf Motor Function Test) and dexterity (e.g. Box and Block Test), as well as participation outcome measures (e. g. Stroke Impact Scale).

Conclusions: There were significant differences in the outcome measures chosen for assessing post stroke UE rehabilitation interventions by researchers in LMICs and HICs. This suggests that there might be potential resource and expertise as well as timing constraints that influences the choice of outcome measures in RCTs between HICs and LMICs and highlights the need for investigating the availability of resources, infrastructure, and expertise and their impact on the feasibility and practicality of employing different outcome measures in different countries.