Stoykov 2009

Methods	Randomised controlled trial Stratified into 2 impairment levels based on Fugl‐Meyer upper extremity scores (19 to 28 or 29 to 40) Within each group of 12 participants a randomised computer‐generated list provided group assignment
Participants	24 participants Inclusion criteria: Fugl‐Meyer upper extremity score 19 to 40, ≥ 6 months post‐stroke, cortical or subcortical lesion, ability to follow 2‐step commands, 18 to 80 years of age, no evidence of cerebellum or brainstem involvement, no evidence of field cut, no evidence of neglect, ability to give informed consent, no symptomatic cardiac failure or unstable angina, no uncontrolled hypertension, no significant orthopaedic or pain conditions in affected upper extremity, no severe obstructive pulmonary disease
Interventions	Group 1 (12 participants): unilateral training Group 2 (12 participants): bilateral training Training consisted of 6 training tasks that incorporated both discrete movements (2 tasks) and rhythmic movements (4 tasks), paced by a metronome Initially most tasks completed for 20 repetitions, which was gradually increased to 40 repetitions Therapeutic challenge was increased throughout the training period 3 training sessions of 1 hour duration completed each week for 8 weeks were completed Profession of individual administering training not reported
Outcomes	Primary outcome: functional movement ‐ arm functional movement: Motor Assessment Scale (upper arm function and combined upper limb movements; upper arm function scores used for analysis); hand functional movement: Motor Assessment Scale (hand movements and advanced hand movements; hand movement scores used for analysis) Secondary outcome: motor impairment ‐ motor impairment scales: Motor Status Score (total scale, shoulder/elbow scale and wrist/hand scale; total scale selected for use in analysis); strength outcomes: muscle strength comparator dynamometer for arm strength and Jamar dynamometer for grip strength (arm strength outcome selected for use in analysis)
Notes	Data presented in paper in graph format ‐ mean and SE for Motor Assessment Scale and Motor Status Score Means estimated from graph and standard deviation calculated from estimated standard error to allow for inclusion in statistical pooling 2 review authors independently estimated the values from the graphs; the average of the 2 estimates was used in the analysis Unable to include strength outcome in analysis as separate results for the 2 groups (unilateral and bilateral) not presented A non‐significant result between the groups reported in the paper on these measures and this indicated in the results section
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	High risk	Computer‐generated list provided group assignment but first author enrolled participants and provided both treatment interventions
Blinding of outcome assessor?	Low risk	Single rater completed outcome assessments blinded to group allocation and study methodology
Intention to treat analysis?	Unclear risk	Not reported; no drop‐outs reported
Baseline similarity	Low risk	No differences between groups evident No significant differences reported between groups in terms of age, years post‐stroke or baseline Fugl‐Meyer upper extremity score