This study aimed to comprehensively identify and map rehabilitation strategies for severe upper limb motor impairment in patients with chronic stroke through a scoping review.
A literature search was conducted using PubMed and Web of Science databases for articles published from 1975 to October 15, 2023. The search terms included "randomized controlled trial," "cross-over studies," "stroke," "upper extremity," "chronic," and "rehabilitation." Data were imported into Rayyan software, and duplicates were removed. Two independent reviewers screened titles, abstracts, and full-text articles. Eligible studies included randomized and quasi-randomized controlled trials, and cross-over trials involving participants aged ≥18 years, more than 6 months post-stroke, with a Fugl-Meyer Assessment Upper Extremity score of 22 at the start of the intervention.
The search yielded 744 articles, and after removing duplicates, 603 articles underwent primary screening. Finally, 24 articles were included in this review. Of these, 92% were randomized controlled trials, and 8% were randomized cross-over trials. Major interventions identified were robot-assisted training (25%), non-invasive brain stimulation (20.8%), electrical stimulation (20.8%), brain-computer interface (8.3%), extracorporeal shock wave therapy (4.2%), task-oriented training (4.2%), mirror therapy (4.2%), and biofeedback (4.2%). A risk of bias assessment using the PEDro scale revealed that 18 out of 24 studies scored 6 points or higher, indicating high-quality research in the majority of studies.
This scoping review identified various rehabilitation strategies being researched for severe upper limb motor impairment in chronic stroke patients. The diversity of interventions underscores the need for a clearer understanding of their efficacy to develop optimal rehabilitation strategies for this population.
The findings highlight significant gaps in the current evidence base and emphasize the necessity for further high-quality randomized controlled trials. By mapping existing research, this review provides a foundational reference for future studies aimed at establishing the efficacy of rehabilitation methods for severe upper limb motor impairment in chronic stroke patients. Advancing research in this area is essential to develop evidence-based interventions that can ultimately improve patient outcomes and inform clinical guidelines.
Severe upper limb motor impairment
Rehabilitation strategies
