Does repetitive task training improve functional
activity after stroke? A Cochrane systematic review and meta-analysis
Beverley French, Lois Thomas , Michael Leathley, Christopher Sutton, Joanna McAdam, Anne Forster, Peter Langhorne, Christopher Price, Andrew Walker, Caroline Watkins
Objective: To determine if repetitive task training after stroke improves functional activity.
Design: Systematic review and meta-analysis of trials comparing repetitive task training with attention control or usual care.
Data sources: The Cochrane Stroke Trials Register, electronic databases of published, unpublished and non-English language papers; conference proceedings, reference lists, and trial authors.
Review methods: Included studies were randomized/quasi-randomized trials in adults after stroke where an active motor sequence aiming to improve functional activity was performed repetitively within a single training session. We used Cochrane Collaboration methods, resources, and software.
Results: We included 14 trials with 17 intervention-control pairs and 659 participants. Results were statistically significant for walking distance (mean difference 54. 6, 95% confidence interval (95% CI) 17. 5, 91. 7); walking speed (standardized mean difference (SMD) 0. 29, 95% CI 0. 04, 0. 53); sit-to-stand (standard effect estimate 0. 35, 95% CI 0. 13, 0. 56), and activities of daily living: SMD 0. 29, 95% CI 0. 07, 0. 51; and of borderline statistical significance for measures of walking ability (SMD 0. 25, 95% CI 0. 00, 0. 51), and global motor function (SMD 0. 32, 95% CI –0. 01, 0. 66). There were no statistically significant differences for hand/arm functional activity, lower limb functional activity scales, or sitting/standing balance/reach.
Conclusion: Repetitive task training resulted in modest improvement across a range of lower limb outcome measures, but not upper limb outcome measures. Training may be sufficient to have a small impact on activities of daily living. Interventions involving elements of repetition and task training are diverse and difficult to classify: the results presented are specific to trials where both elements are clearly present in the intervention, without major confounding by other potential mechanisms of action.
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