Assistive technologies: can they contribute to rehabilitation of the upper limb after stroke?
OBJECTIVE
To systematically identify, review, and explore the evidence for use of assistive technologies (ATs) in poststroke upper limb rehabilitation.


DATA SOURCES
AMED, CINAHL, Cochrane Library, Compendex, CSA Illumina, EMBASE, MEDLINE, PEDro, PyscINFO, and Web of Science were last searched in September 2011.


STUDY SELECTION
Two independent researchers screened for inclusion criteria (adult poststroke subjects, upper limb rehabilitation with an AT). The risk of bias was assessed. Randomized controlled trials of poststroke subjects with baseline equivalence as assessed by blinded assessors were selected for data extraction.


DATA EXTRACTION
Details of subjects, experimental and control treatments, and all outcomes were recorded in a spreadsheet.


DATA SYNTHESIS
These data were used to calculate effect sizes for all outcome measures. Impairment measures ranged from -.39 (95% confidence interval [CI], -1.14 to .62) to 1.46 (95% CI, .72-2.20). Measures of activity effect sizes were from .04 (95% CI, -.35 to .44) to .93 (95% CI, -.39 to 2.25); for Motor Activity Log, from .07 (95% CI, -.66 to .80) to 1.24 (95% CI, .47-2.01); and for participation, from -3.32 (95% CI, -4.52 to 2.11) to 1.78 (95% CI, 0-3.56).


CONCLUSIONS
AT treatments appear to give modest additional benefit when compared with usual care or in addition to usual care. This is most apparent for subjects early poststroke with 2 caveats: high-intensity constraint-induced movement therapy and electrical stimulation exclusively to the shoulder appear detrimental. The heterogeneity of treatment parameters and population characteristics precludes specific recommendations. Research would benefit from modeling studies to explicitly define criteria of population, intervention, comparator, and outcomes for effective treatments before the development of efficiently integrated care pathways.
['Farmer|Sybil Eleanor|SE|', 'Durairaj|Venugopal|V|', 'Swain|Ian|I|', 'Pandyan|Anand David|AD|']
D006801:Humans D017063:Outcome Assessment, Health Care D026741:Physical Therapy Modalities D012656:Self-Help Devices D020521:Stroke D000071939:Stroke Rehabilitation D034941:Upper Extremity
Assistive technology Rehabilitation systematic Review Upper extremity