Programi kućnih terapija za funkcionalni oporavak ruku nakon moždanog udara
Abstract
Background
With an increased focus on home‐based stroke services and the undertaking of programmes, targeted at upper limb recovery within clinical practice, a systematic review of home‐based therapy programmes for individuals with upper limb impairment following stroke was required.
Objectives
To determine the effects of home‐based therapy programmes for upper limb recovery in patients with upper limb impairment following stroke.
Search methods
We searched the Cochrane Stroke Group's Specialised Trials Register (May 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2), MEDLINE (1950 to May 2011), EMBASE (1980 to May 2011), AMED (1985 to May 2011) and six additional databases. We also searched reference lists and trials registers.
Selection criteria
Randomised controlled trials (RCTs) in adults after stroke, where the intervention was a home‐based therapy programme targeted at the upper limb, compared with placebo, or no intervention or usual care. Primary outcomes were performance in activities of daily living (ADL) and functional movement of the upper limb. Secondary outcomes were performance in extended ADL and motor impairment of the arm.
Data collection and analysis
Two review authors independently screened abstracts, extracted data and appraised trials. We undertook assessment of risk of bias in terms of method of randomisation and allocation concealment (selection bias), blinding of outcome assessment (detection bias), whether all the randomised patients were accounted for in the analysis (attrition bias) and the presence of selective outcome reporting.
Main results
We included four studies with 166 participants. No studies compared the effects of home‐based upper limb therapy programmes with placebo or no intervention. Three studies compared the effects of home‐based upper limb therapy programmes with usual care. Primary outcomes: we found no statistically significant result for performance of ADL (mean difference (MD) 2.85; 95% confidence interval (CI) ‐1.43 to 7.14) or functional movement of the upper limb (MD 2.25; 95% CI ‐0.24 to 4.73)). Secondary outcomes: no statistically significant results for extended ADL (MD 0.83; 95% CI ‐0.51 to 2.17)) or upper limb motor impairment (MD 1.46; 95% CI ‐0.58 to 3.51). One study compared the effects of a home‐based upper limb programme with the same upper limb programme based in hospital, measuring upper limb motor impairment only; we found no statistically significant difference between groups (MD 0.60; 95% CI ‐8.94 to 10.14).
Authors' conclusions
There is insufficient good quality evidence to make recommendations about the relative effect of home‐based therapy programmes compared with placebo, no intervention or usual care.
PICOs
Laički sažetak
Programi kućnih terapija za funkcionalni oporavak ruku nakon moždanog udara
Nakon moždanog udara, česti su problemi s rukom i oporavak je često ograničen. Ovaj sustavni pregled je analizirao četiri studije, u koje je bilo uključeno ukupno 166 ispitanika, kako bi se utvrdilo može li sudjelovanje u programima terapije koji se provode u domu pacijenta, a kojima je cilj oporavak problema s rukom, poboljšati izvođenje svakodnevnih aktivnosti, funkcionalne pokrete ruke, izvođenje opsežnijih svakodnevnih aktivnosti i poremećaje motorike ruke. U usporedbi s uobičajenom skrbi, kućni programi nisu pokazali nikakvu razliku u učinku, ni u jednom od promatranih ishoda. U usporedbi s programima za rehabilitaciju ruku koji se provode u bolnici, utvrđeno je da kućni programi za ruke nisu ni manje ni više učinkoviti za ishode vezane za motoričke poremećaje ruku. Dokazi u ovom području su ograničeni, i potrebna su dodatna istraživanja kako bi se utvrdio učinak kućnih terapija.
