7.9.2 Does task specific practice improve functional recovery after stroke? A cochrane systematic review (293)

Beverley French, Senior Research Fellow, Department of Nursing, University of Central Lancashire, Preston, United Kingdom Co authors: Lois Thomas, Michael Leathley, Christopher Sutton, Joanna McAdam, Anne Forster, Peter Langhorne, Christopher Price, Andrew Walker & Caroline Watkins bfrench1@uclan.ac.uk

Abstract:

Introduction:

The repeated practice of the functional movements required for relearning everyday tasks such as walking and dressing is a key feature of some approaches to stroke rehabilitation, and could be a useful component of the nursing contribution to functional recovery. This Cochrane systematic review aimed to determine if repetitive task training after stroke improves functional abilities, and if the amount, timing, or type of task practice modified the effects.

Methods:

We searched the Cochrane Stroke Trials Register, published, unpublished and non-English language databases, and conference proceedings; we also followed up secondary references, searched citations and contacted authors for all relevant trials. The review included randomised and quasi-randomised trials. The intervention had to include an active motor sequence performed repetitively within a single training session; and a quantifiable level of practice with a clear functional goal. Cochrane review methods were used and the results from individual trials were combined using meta-analytic techniques appropriate to the data extracted.

Results:

The review included fourteen trials with 771 participants. Results showed small to moderate effects on walking distance and speed, sit-to-stand, and activities of daily living, with small, borderline significant effects on functional ambulation and global motor function. There were no statistically significant effects for quality of life, or any of the upper limb function measures. The amount or timing of practice did not modify the effects, but the effects of the type of practice were modified for lower limbs.

Conclusions:

RTT resulted in modest improvement in lower limb function, but not in upper limb function, and evidence for sustained effect was limited. Training effects may be sufficient to impact on activities of daily living. Further research is needed to explore what types and amounts of repetitive task training can contribute to nursing and therapy activity, and how to maintain functional gain.

Biography:

I am a Senior Research Fellow in Evidence Based Practice in the Department of Nursing. I completed my Ph.D. in 2001 on research use in nursing. Publications from that focussed on information need, organisational context, risk management, outcome measurement, skills for evidence-based practice and strategies for uptake and dissemination of research findings into practice. My main research interests are in knowledge management and knowledge transfer, systematic review, and evidence synthesis I have recently participated in systematic reviews for the Health Technology Assessment Programme, Social Care Institute for Excellence, National Institute for Health and Clinical Excellence and the Department of Health, in stroke care and aspects of public health.