Piron 2009

Methods	RCT Simple randomisation using sequentially numbered, opaque, sealed envelopes. Allocation to 1 of 2 treatment groups was performed by the therapist co‐ordinator of the hospital who was not involved in the participants rehabilitation programme
Participants	36 participants Inclusion criteria: mild to intermediate arm motor impairment on Fugl‐Meyer Upper Extremity Scale; single ischaemic stroke in the area of middle cerebral artery; no apraxia (< 62 points on the de Renzi Test); and no clinical evidence of cognitive impairment that could interfere with verbal comprehension, such as neglect and language disturbances (more than 40 errors in the Token Test)
Interventions	Group  1: conventional physiotherapy in the local health district. Participants performed specific exercises for the upper limb with a strategy of progressive complexity. First, they were requested to control isolated motions without postural control, then postural control was included, and finally complex motions with postural control were practiced. Examples of tasks were to touch different targets arranged in front, manipulate different objects, follow trajectories displayed on a plane and to recognise different arm positions Group 2: telerehabilitation system at home. This consisted of 2 dedicated personal computer‐based workstations; 1 at the participants home; and 1 at the hospital. This generated a virtual environment in which participants executed motor tasks. This was combined with video‐conferencing which permitted the remote control of the participants video camera mobility in order to observe the participants movements during the rehabilitation tasks. The virtual reality system incorporated a 3D motion tracking system to record arm movements. 5 virtual tasks comprising simple arm movements were practised whilst participants watched their movement trajectory on screen compared to an ideal trajectory. Participants received verbal feedback from the therapist about the exactness of the movements Both groups received 1 hour of daily training, 5 days per week for 1 month
Outcomes	Primary outcome 2: functional movement: ABILHAND Scale Secondary outcome 2: motor impairment scale: Fugl‐Meyer Upper Extremity Subscore and Ashworth Scale. Fugl‐Meyer selected for analysis Outcome measures performed 1 month before treatment began, at baseline, immediately after 1 month treatment and at 1 month after treatment ceased (follow‐up)
Notes	No details given as to the training or experience of the therapist delivering the intervention
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	"... selected patients were assigned to 2 groups according to simple randomisation technique using sequentially numbered, opaque sealed envelopes"
Allocation concealment (selection bias)	Low risk	"Allocation was performed by the therapist coordinator of the hospital ... the coordinator was not involved, as care provider, in the patients rehabilitation programme"
Blinding of outcome assessment (detection bias) All outcomes	Low risk	"The examining neurologist was blind to the treatments administered to the participants"
Incomplete outcome data (attrition bias) All outcomes	Low risk	"All patients completed the study ..."
Selective reporting (reporting bias)	Low risk	All pre‐specified outcomes were reported

ADL: activities of daily living CT: computerised tomography MMSE: Mini mental state examination MRI: magnetic resonance imaging NYHA: New York Heart Association PNF: proprioceptive neuromuscular facilitation RCT: randomised controlled trial SD: standard deviation SE: standard error WHO: World Health Organization