Hands-on therapy interventions for upper limb motor dysfunction following stroke.

BACKGROUND Recent studies have attempted to disaggregate therapeutic intervention packages by looking at the impact of structure and process characteristics of environment upon outcome. However, what is commonly referred to as the 'black box' of therapy has yet to be comprehensively unpacked. This failure to analyse the components of therapy means that it remains unclear how much therapy should be provided, who should provide it, and which patients should be targeted to ensure that functional outcomes are maximized. This review, therefore, seeks to assess the effectiveness of specific therapeutic interventions in the rehabilitation of the paretic upper limb post stroke. OBJECTIVES To identify if specific hands-on therapeutic interventions enhance motor activity and function of the upper limb post stroke. SEARCH STRATEGY We searched the trials registers of the Cochrane Stroke Group (March 2010), the Cochrane Complementary Medicine Field (March 2010) and the Cochrane Rehabilitation and Related Therapies Field (March 2010); MEDLINE (1966 to March 2010); AMED (1985 to March 2010); EMBASE (1980 to March 2010); CINAHL (1982 to March 2010); the Physiotherapy Evidence Database (PEDro) (March 2010); and the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 1). In an effort to identify other published, unpublished and ongoing trials we planned to handsearch journals, searched ongoing trials registers, reviewed reference lists, and contacted relevant professional organizations. SELECTION CRITERIA Randomized controlled trials (RCTs) involving adults aged 18 years or over and including descriptions of specific hands-on interventions and techniques, rather than packages or approaches to treatment. DATA COLLECTION AND ANALYSIS Following completion of the searches, two review authors independently assessed the trials and extracted data using a data extraction pro forma. The same two review authors independently recorded and documented the methodological quality of the trials. MAIN RESULTS Three studies, involving a total of 86 participants, met all the selection criteria and were included in the review. However, extreme levels of heterogeneity were evident. Therefore, we could not undertake a meta-analysis of the results and completed a narrative synthesis instead. AUTHORS' CONCLUSIONS Overall, the review demonstrated that the limited evidence of benefit of stretching, passive exercises and mobilization, when applied to the hemiplegic upper limb following stroke, merits further research.