Repetitive task training for improving functional ability after stroke

 

Abstract

Background

The active practice of task-specific motor activities is a component of current approaches to stroke rehabilitation.

Objectives

To determine if repetitive task training after stroke improves global, upper or lower limb function, and if treatment effects are dependent on the amount, type or timing of practice.

Search methods

We searched the Cochrane Stroke Trials Register (October 2006), The Cochrane Library, MEDLINE, EMBASE, eight additional electronic databases (to September 2006), and OT search (to March 2006). We also searched for unpublished/non-English language trials, conference proceedings, combed reference lists, requested information on bulletin boards, and contacted trial authors.

Selection criteria

Randomised/quasi-randomised trials in adults after stroke, where the intervention was an active motor sequence performed repetitively within a single training session, aimed towards a clear functional goal, and where the amount of practice could be quantified.

Data collection and analysis

Two authors independently screened abstracts, extracted data and appraised trials. Assessment of methodological quality was undertaken for allocation concealment, blinding, loss to follow up and equivalence of treatment. We contacted trial authors for additional information.

Main results

Fourteen trials with 17 intervention-control pairs and 659 participants were included. Primary outcomes: results were statistically significant for walking distance (mean difference (MD) 54.6, 95% CI 17.5 to 91.7); walking speed (standardised mean difference (SMD) 0.29, 95% CI 0.04 to 0.53); sit-to-stand (standard effect estimate 0.35, 95% CI 0.13 to 0.56); and of borderline statistical significance for functional ambulation (SMD 0.25, 95% CI 0.00 to 0.51), and global motor function (SMD 0.32, 95% CI -0.01 to 0.66). There were no statistically significant differences for hand/arm function, or sitting balance/reach. Secondary outcomes: results were statistically significant for activities of daily living (SMD 0.29, 95% CI 0.07 to 0.51), but not for quality of life or impairment measures. There was no evidence of adverse effects. Follow-up measures were not significant for any outcome at six or 12 months. Treatment effects were not modified by intervention amount or timing, but were modified by intervention type for lower limbs.

Authors' conclusions

Repetitive task training resulted in modest improvement in lower limb function, but not upper limb function. Training may be sufficient to impact on daily living function. However, there is no evidence that improvements are sustained once training has ended. The review potentially investigates task specificity rather more than repetition. Further research should focus on the type and amount of training, and how to maintain functional gain.

 

Plain language summary

Repetitive task training for improving functional ability after stroke

Stroke can cause problems with movement, often down just one side of the body. All limbs can be affected, and while some recovery is common over time, about one third of people will have continuing problems. This review of 14 studies with 659 participants looked at whether repeated practice of tasks similar to those commonly performed in daily life could improve functional abilities. In comparison with usual care or placebo groups, people who practiced functional tasks showed modest improvements in walking speed, walking distance and the ability to stand from sitting, but improvements in leg function were not maintained six months later. Repetitive task practice had no effect on arm or hand function. There was a small amount of improvement in ability to manage activities of daily living. Training effects were no different for people whether early or late after stroke. Further research is needed to determine the best type of task practice, and whether more sustained practice could show better results.

 

摘要

背景

重複性的任務訓練對於改善中風後的生活功能能力

積極實踐特定任務的動作活動，是當前中風復健方法的一部分。

目標

為了確定是否重複的任務訓練真能夠改善腦中風後全體，上，下肢體功能，以及治療效果是否取決於實行的數量，類型或時間。

搜尋策略

我們搜尋了Cochrane Stroke Trials Register (2006年10月), The Cochrane Library, MEDLINE, EMBASE, CINAHL, AMED, SportDiscus, Science Citation Index, Index to Theses, ZETOC, PEDro, and OT Seeker (到2006年9月), and OT search (到2006年3月)。我們也搜查未發表/非英語語言的試驗，會議記錄，整理參考文獻目錄，公告欄上要求的資訊，並聯絡試驗的作者。

選擇標準

成人中風後的隨機/半隨機試驗，介入方式在一個單一的訓練課程中是一個可以重複積極運動進行的序列，目的是建立一個明確的功能目標，並且實踐的數值是可以量化的。

資料收集與分析

兩位作者獨立檢查摘要、所提取的數據以及評價試驗。質量評價方法以隱藏分配，蒙蔽，追蹤的遺失和治療之等值來開展。我們接觸了試驗作者以獲得更多訊息。

主要結論

14個內含有17個控制與對照和659個參與者的試驗包括在內。主要預後結果為：結果在步行距離有顯著性的影響(mean difference (MD) 54.6, 95% CI 17.5 to 91.7)；步行速度(standardised mean difference (SMD) 0.29, 95% CI 0.04 to 0.53)，由坐姿站起(standard effect estimate 0.35, 95% CI 0.13 to 0.56);和統計意義上處於有意義及沒意義邊緣的行走功能(SMD 0.25, 95% CI 0.00 to 0.51)，和整體運動功能(SMD 0.32, 95% CI −0.01 to 0.66) 。在手/手臂功能或坐姿到達平衡上在統計學的角度來看沒有顯著差異，。在次要預後結果上：結果有對於日常生活活動有顯著性的影響(SMD 0.29, 95% CI 0.07 to 0.51)，但不是指對生活品質或損傷的量度上。在副作用上則是沒有相關證據。在6個或12個月的後續措施則在任何結果上都是不顯著的。治療效果上並沒有被介入的數量或時間上做修正，但有被介入干預的下肢類型作修正。

作者結論

重複任務的訓練能夠輕微改善下肢功能，但不包含上肢功能。訓練可能足以影響日常生活功能。但是，沒有證據表明在訓練已經結束之後還能持續。在這次檢審中對於訓練任務的特殊性的探討大於重複性。進一步的研究應集中在訓練的類型和數量上，以及如何保持功能性的增益。

翻譯人

本摘要由奇美醫院黃志傑翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

為了改善中風後的功能方面能力所作的重複任務性的訓練。中風可能會造成運動方面以及身體向一方傾斜的問題。所有的肢體可能會受到影響，雖然隨著時間恢復是普遍的，但仍約三分之一的人有繼續存在的問題。本次包含14項以及659個參與者的研究就是在看是否反覆實踐與日常生活中的任務相類似的活動能夠提高功能的能力。相比之下與通常的治療或安慰劑的群體，實踐功能性任務的人們顯示出在步行速度，步行距離和由坐而站的能力得到溫和改善，但是腿部功能的改善並不會維持到六個月之後。重複任務做法則沒有影響手臂或是手的功能。對於管理能力日常生活活動則有少量的改善生活。中風後實行訓練的時間早晚不會有訓練效果上的差異。對於確定最佳類型任務的做法，以及更持久的練習是否能有更好的預後結果還需要進一步研究。