The purpose of this study was to investigate the effects of combining balance training and AOT on upper limb performance in people with subacute to chronic stroke over 12 weeks.
This single-blinded (assessor), multi-centred randomised controlled trial was conducted in outpatient physiotherapy units in Sabah, East Malaysia, from 2022 to 2023. Forty-five participants were randomised into an intervention group (n=23) and a control group (n=22). The intervention group received combined balance training and AOT, while the control group received AOT only. Both groups attended weekly 30-minute AOT sessions, during which participants viewed upper limb task videos from a first-person perspective. The intervention group received an additional 20 minutes of balance training, including exercises such as sit-to stand and functional reach training. Pre- and post-intervention assessments included the Fugl-Meyer Assessment Upper Extremity (FMA-UE), Upper Extremity Motor Assessment Scale (UE-MAS), and Berg Balance Scale (BBS). Data analysis included Wilcoxon Signed-Rank tests for within-group comparisons, as well as Independent-samples t-tests and Mann-Whitney U tests for between-group comparisons, with a significance level set at p0.05.
Both groups demonstrated significant within-group improvements in upper limb performance (p0.001) and balance function (p0.001). The intervention group improved FMA-UE scores by a mean of 1.65 points, with a mean rank of 23.38, compared to the control group's mean rank of 17.63; however, this difference was not statistically significant (p=0.121). Clinical factors such as stroke location (cortical or subcortical), which were not assessed, may influence the effects of balance training. A strong correlation between FMA-UE and UE-MAS scores (Spearman’s ρ=0.596) suggests that UE-MAS may be a practical alternative for assessing upper limb performance in settings where resources or assessment time are limited.
AOT is effective for upper limb recovery post-stroke. Adding balance training to AOT may enhance upper limb motor performance. Future research with larger samples may provide clearer insights into the added value of combining these interventions.
The study's findings could inform physiotherapy practice by supporting the use of AOT as a low-technology intervention in upper limb stroke rehabilitation, particularly in resource-constrained settings.
action observation therapy
balance training
