Affiliations:
Department of Occupational Therapy, Yonsei University, South Korea
Correspondence:
[*]
Address for correspondence: Ji-Hyuk Park, #102, Baekun Hall, 1 Yonsei University road, Yonsei University, Wonju-si, Gangwon-do 220-710, South Korea. Tel.: +82 10 9304 9706; Fax: +82 33 760 2496; E-mail: otscientist@yonsei.ac.kr and Hae Yean Park, Ph.D., OT, #106, Baekun Hall, 1 Yonsei University road, Yonsei University, Wonju, Gangwon 220-710, South Korea. Tel.: +82 10 3887 6134; Fax: 82 33 760 2583; E-mail: haepark@yonsei.ac.kr.
Abstract: BACKGROUND: The differential effects of bilateral and unilateral training on upper extremity (UE) function remain unclear. OBJECTIVE: To compare the effectiveness of bilateral and unilateral training on UE function and activities of daily living (ADL) after stroke. METHODS: Randomized controlled trials (RCTs) were selected for inclusion by two reviewers after searching the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and KoreaMed. Methodological qualities were assessed using the PEDro scale. Effect size was estimated by calculating the standardized mean difference (SMD). RESULTS: Eleven RCTs of sufficient quality were included in our meta-analysis. The effect size on UE capacity was statistically significant in favor of the Constraint-Induced Movement Therapy (CIMT) groups (SMD [fixed], g: – 0.34; 95% CI: – 0.59–0.08; p = 0.01; I2 = 0%). No other SMDs were significant. CONCLUSION: The CIMT tasks were more effective than bilateral training with regard to increased UE capacity; however, this result should be cautiously interpreted since the evaluation tools were designed for assessment of unilateral UE function, not bilateral UE function. Further, the effect of the CIMT tasks on UE capacity was not translated into ADL. Considering the disadvantages of CIMT such as fatigue, bilateral training may be more appropriate for improving ADL.
