Luft 2004

Methods	Randomised controlled trial using a stratified block allocation scheme (variable block size, allocation 1:1)
Participants	21 participants Inclusion criteria: residual upper extremity spastic hemiparesis following single cortical or subcortical ischaemic stroke; ability to move affected limb (at least partial range movement against gravity); completed 3 to 6 months of rehabilitation therapy; adequate language and neurocognitive function to understand instructions; no multiple strokes, history of other neurological disease, chronic pain or emotional disorders
Interventions	Group 1 (12 participants): usual care (DMTE based on neurodevelopmental principles) Group 2 (9 participants): BATRAC BATRAC consisted of pushing and pulling bilaterally, either in synchrony or alternation, 2 independent handles sliding in the traverse plane. It consisted of hour‐long therapy sessions (4 x 5‐minute movement periods interspersed with 10‐minute rest periods) 3 times per week for 6 weeks DMTE was based on neurodevelopmental principles and included mobilisation, weight‐bearing and opening a closed fist; the exercises were administered in a standard format and equal to the time used for BATRAC Profession of individual(s) providing training unclear (assume physiotherapist)
Outcomes	Primary outcome: functional movement ‐ arm functional movement: WMAT (time to complete 14 functional tasks with affected arm and hand and University of Maryland Arm Questionnaire for Stroke) (WMAT selected) Secondary outcome: motor impairment ‐ Fugl‐Meyer Motor Performance Test (upper limb section); strength outcomes: WMAT (strength) and dynamometry (elbow and shoulder strength) (WMAT strength selected) fMRI and EMG variables also recorded ‐ these were not relevant to this review
Notes	Bilateral training group also received rhythmic auditory cueing, to guide the speed of the movements Discussion amongst review authors led to the conclusion that the rhythmic auditory cueing could be viewed as an adjunct or guide to the bilateral training and that therefore this study was relevant to this review (i.e. the rhythmic auditory cueing has not been considered as another intervention) This study is a substudy of a larger study designed to investigate the effect of BATRAC SEM presented in paper, this was converted into SD units and entered into the analysis Change scores presented in paper and used in analysis WMFT (time) data inverted for analysis (multiplied by ‐1)
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	High risk	No mention of allocation concealment
Blinding of outcome assessor?	Low risk	‐
Intention to treat analysis?	High risk	No mention of intention‐to‐treat analysis; reasons for drop‐out reported
Baseline similarity	High risk	No difference in terms of age, time since stroke, or baseline scores but significantly more women in Group 1 (unilateral group)