Morris 2008

Methods	Randomised controlled trial Randomly allocated using concealed web‐based randomisation Stratified according to side of hemiplegia, stroke classification and baseline ARAT
Participants	106 participants Inclusion criteria: acute unilateral stroke confirmed by CT; persistent upper limb impairment (< 6 on each upper limb sections of Motor Assessment Scale); ability to participate in 30‐minute physiotherapy sessions; ability to sit unsupported for 1 minute; no severe neglect, aphasia or cognitive impairment that would limit participation; no previous stroke resulting in residual disability; no pre‐morbid arm impairment; no hemiplegic shoulder pain; ability to provide informed consent
Interventions	Group 1 (50 participants): unilateral; performed 4 tasks (moving dowelling peg, moving block, grasp empty glass and take to mouth and point to targets) with affected arm Group 2 (56 participants): bilateral; performed same 4 tasks with each arm simultaneously The intervention protocol was progressive and standardised Systematic feedback was provided on performance Training lasted 20 minutes a session 5 weekdays a week over 6 weeks in addition to usual therapy As many trials as possible were completed in each session with a maximum of 30 trials of each task, maximum of 120 trials per session 2 senior stroke rehabilitation physiotherapists with 15 years experience conducted the intervention
Outcomes	Primary outcome: performance in activities daily living: Barthel Index Primary outcome: functional movement ‐ arm functional movement: ARAT; hand functional movement: Nine Hole Peg Test Secondary outcome: motor impairment ‐ motor impairment scales: Rivermead Motor Assessment (upper limb section) Hospital Anxiety and Depression Scale and Nottingham Health Profile also used as outcome measures but not relevant to this review
Notes	End of intervention outcome assessment (6 weeks) used in analysis Outcome measures also recorded after 18 weeks (97 participants) At 6 weeks: 4 drop‐outs from Group 1 (died, moved away, requested withdrawal) and 5 drop‐outs from Group 2 (died, moved away, requested withdrawal) Change and final outcome scores presented Outcome scores used in analysis
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	Concealed, remote web‐based randomisation
Blinding of outcome assessor?	Low risk	Blinded to treatment allocation and otherwise not involved in trial
Intention to treat analysis?	High risk	Analysis done on complete data sets only. Statistical comparison did show drop‐outs in both groups to be similar
Baseline similarity	Low risk	‐