A comparison of bilateral and unilateral upper-limb task training in early poststroke rehabilitation: a randomized controlled trial

Jacqui H. Morris (Lead / Corresponding author), Frederike van Wijck, Sara Joice, Simon A. Ogston, Ingrid Cole, Ronald S. MacWalter

    Research output: Contribution to journalArticle

    49 Citations (Scopus)

    Abstract

    Objective: To compare the effects of bilateral task training with unilateral task training on upper-limb outcomes in early poststroke rehabilitation.

    Design: A single-blinded randomized controlled trial, with outcome assessments at baseline, post intervention (6wk), and follow-up (18wk).

    Setting: Inpatient acute and rehabilitation hospitals.

    Participants: Patients were randomized to receive bilateral training (n=56) or unilateral training (n=50) at 2 to 4 weeks poststroke onset.

    Intervention: Supervised bilateral or unilateral training for 20 minutes on weekdays over 6 weeks using a standardized program.

    Main Outcome Measures: Upper-limb outcomes were assessed by Action Research Arm Test (ARAT), Rivermead Motor Assessment upper-limb scale, and Nine-Hole Peg Test (9HPT). Secondary measures included the Modified Barthel Index, Hospital Anxiety and Depression Scale, and Nottingham Health Profile. All assessment was conducted by a blinded assessor.

    Results: No significant differences were found in short-term improvement (0-6wk) on any measure (P >.05). For overall improvement (0-18wk), the only significant between-group difference was a change in the 9HPT (95% confidence interval [CI], 0.0-0.1; P=.05) and ARAT pinch section (95% CI, 0.3-5.6; P=.03), which was lower for the bilateral training group. Baseline severity significantly influenced improvement in all upper-limb outcomes (P <.05), but this was irrespective of the treatment group.

    Conclusions: Bilateral training was no more effective than unilateral training, and in terms of overall improvement in dexterity, the bilateral training group improved significantly less. Intervention timing, task characteristics, dose, and intensity of training may have influenced the results and are therefore areas for future investigation.

    Original languageEnglish
    Pages (from-to)1237-1245
    Number of pages9
    JournalArchives of Physical Medicine and Rehabilitation
    Volume89
    Issue number7
    DOIs
    Publication statusPublished - Jul 2008

    Fingerprint

    Upper Extremity
    Rehabilitation
    Randomized Controlled Trials
    Health Services Research
    Outcome Assessment (Health Care)
    Confidence Intervals
    Inpatients
    Anxiety
    Depression
    Health
    Therapeutics

    Keywords

    • Cerebrovascular accident
    • Motor activity
    • Randomized controlled trial
    • Rehabilitation
    • Upper extremity
    • Chronic stroke patients
    • Motor assessment
    • Arm function
    • Recovery
    • Movements
    • Reliability
    • Performance
    • Impairment
    • Activation

    Cite this

    Morris, Jacqui H. ; van Wijck, Frederike ; Joice, Sara ; Ogston, Simon A. ; Cole, Ingrid ; MacWalter, Ronald S. / A comparison of bilateral and unilateral upper-limb task training in early poststroke rehabilitation: a randomized controlled trial. In: Archives of Physical Medicine and Rehabilitation. 2008 ; Vol. 89, No. 7. pp. 1237-1245.
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    title = "A comparison of bilateral and unilateral upper-limb task training in early poststroke rehabilitation: a randomized controlled trial",
    abstract = "Objective: To compare the effects of bilateral task training with unilateral task training on upper-limb outcomes in early poststroke rehabilitation.Design: A single-blinded randomized controlled trial, with outcome assessments at baseline, post intervention (6wk), and follow-up (18wk).Setting: Inpatient acute and rehabilitation hospitals.Participants: Patients were randomized to receive bilateral training (n=56) or unilateral training (n=50) at 2 to 4 weeks poststroke onset.Intervention: Supervised bilateral or unilateral training for 20 minutes on weekdays over 6 weeks using a standardized program.Main Outcome Measures: Upper-limb outcomes were assessed by Action Research Arm Test (ARAT), Rivermead Motor Assessment upper-limb scale, and Nine-Hole Peg Test (9HPT). Secondary measures included the Modified Barthel Index, Hospital Anxiety and Depression Scale, and Nottingham Health Profile. All assessment was conducted by a blinded assessor.Results: No significant differences were found in short-term improvement (0-6wk) on any measure (P >.05). For overall improvement (0-18wk), the only significant between-group difference was a change in the 9HPT (95{\%} confidence interval [CI], 0.0-0.1; P=.05) and ARAT pinch section (95{\%} CI, 0.3-5.6; P=.03), which was lower for the bilateral training group. Baseline severity significantly influenced improvement in all upper-limb outcomes (P <.05), but this was irrespective of the treatment group.Conclusions: Bilateral training was no more effective than unilateral training, and in terms of overall improvement in dexterity, the bilateral training group improved significantly less. Intervention timing, task characteristics, dose, and intensity of training may have influenced the results and are therefore areas for future investigation.",
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    author = "Morris, {Jacqui H.} and {van Wijck}, Frederike and Sara Joice and Ogston, {Simon A.} and Ingrid Cole and MacWalter, {Ronald S.}",
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    A comparison of bilateral and unilateral upper-limb task training in early poststroke rehabilitation: a randomized controlled trial. / Morris, Jacqui H. (Lead / Corresponding author); van Wijck, Frederike; Joice, Sara; Ogston, Simon A.; Cole, Ingrid; MacWalter, Ronald S.

    In: Archives of Physical Medicine and Rehabilitation, Vol. 89, No. 7, 07.2008, p. 1237-1245.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - A comparison of bilateral and unilateral upper-limb task training in early poststroke rehabilitation: a randomized controlled trial

    AU - Morris, Jacqui H.

    AU - van Wijck, Frederike

    AU - Joice, Sara

    AU - Ogston, Simon A.

    AU - Cole, Ingrid

    AU - MacWalter, Ronald S.

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    N2 - Objective: To compare the effects of bilateral task training with unilateral task training on upper-limb outcomes in early poststroke rehabilitation.Design: A single-blinded randomized controlled trial, with outcome assessments at baseline, post intervention (6wk), and follow-up (18wk).Setting: Inpatient acute and rehabilitation hospitals.Participants: Patients were randomized to receive bilateral training (n=56) or unilateral training (n=50) at 2 to 4 weeks poststroke onset.Intervention: Supervised bilateral or unilateral training for 20 minutes on weekdays over 6 weeks using a standardized program.Main Outcome Measures: Upper-limb outcomes were assessed by Action Research Arm Test (ARAT), Rivermead Motor Assessment upper-limb scale, and Nine-Hole Peg Test (9HPT). Secondary measures included the Modified Barthel Index, Hospital Anxiety and Depression Scale, and Nottingham Health Profile. All assessment was conducted by a blinded assessor.Results: No significant differences were found in short-term improvement (0-6wk) on any measure (P >.05). For overall improvement (0-18wk), the only significant between-group difference was a change in the 9HPT (95% confidence interval [CI], 0.0-0.1; P=.05) and ARAT pinch section (95% CI, 0.3-5.6; P=.03), which was lower for the bilateral training group. Baseline severity significantly influenced improvement in all upper-limb outcomes (P <.05), but this was irrespective of the treatment group.Conclusions: Bilateral training was no more effective than unilateral training, and in terms of overall improvement in dexterity, the bilateral training group improved significantly less. Intervention timing, task characteristics, dose, and intensity of training may have influenced the results and are therefore areas for future investigation.

    AB - Objective: To compare the effects of bilateral task training with unilateral task training on upper-limb outcomes in early poststroke rehabilitation.Design: A single-blinded randomized controlled trial, with outcome assessments at baseline, post intervention (6wk), and follow-up (18wk).Setting: Inpatient acute and rehabilitation hospitals.Participants: Patients were randomized to receive bilateral training (n=56) or unilateral training (n=50) at 2 to 4 weeks poststroke onset.Intervention: Supervised bilateral or unilateral training for 20 minutes on weekdays over 6 weeks using a standardized program.Main Outcome Measures: Upper-limb outcomes were assessed by Action Research Arm Test (ARAT), Rivermead Motor Assessment upper-limb scale, and Nine-Hole Peg Test (9HPT). Secondary measures included the Modified Barthel Index, Hospital Anxiety and Depression Scale, and Nottingham Health Profile. All assessment was conducted by a blinded assessor.Results: No significant differences were found in short-term improvement (0-6wk) on any measure (P >.05). For overall improvement (0-18wk), the only significant between-group difference was a change in the 9HPT (95% confidence interval [CI], 0.0-0.1; P=.05) and ARAT pinch section (95% CI, 0.3-5.6; P=.03), which was lower for the bilateral training group. Baseline severity significantly influenced improvement in all upper-limb outcomes (P <.05), but this was irrespective of the treatment group.Conclusions: Bilateral training was no more effective than unilateral training, and in terms of overall improvement in dexterity, the bilateral training group improved significantly less. Intervention timing, task characteristics, dose, and intensity of training may have influenced the results and are therefore areas for future investigation.

    KW - Cerebrovascular accident

    KW - Motor activity

    KW - Randomized controlled trial

    KW - Rehabilitation

    KW - Upper extremity

    KW - Chronic stroke patients

    KW - Motor assessment

    KW - Arm function

    KW - Recovery

    KW - Movements

    KW - Reliability

    KW - Performance

    KW - Impairment

    KW - Activation

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