Yoon 2014.
| Methods | Randomisation by random card Blinded outcome assessor No information about withdrawals Single centre, inpatients |
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| Participants | Korea Recruited from the Department of Rehabilitation Medicine at Pusan National University Yangsan Hospital 26 participants: 9 intervention, 9 control, 8 arm restraint plus mirror therapy Inclusion criteria: 10° of active wrist extension, 10° of active thumb abduction/extension and 10° active extension in at least 2 additional digits; possibility of simple communication; patients who could maintain a sitting position for more than 30 minutes Exclusion criteria: depression; inability to co‐operate in the treatment; inability to perform the active task training for musculoskeletal problems; spasticity; complex regional pain syndrome or secondary adhesive capsulitis Mean age (SD): intervention group: 64.33 (8.54) years, control group: 60.56 (16.94) years, arm restraint plus mirror therapy group 47.36 (14.4) years % women: intervention group 33%, control group: 55%, arm restraint plus mirror therapy group 25% Stroke details: ischaemic or haemorrhagic; 67% with right hemiparesis in treatment group, 44% with right hemiparesis in control group; 62% with right hemiparesis in arm restraint plus mirror therapy group Time since stroke, mean (SD): intervention group 0.6 (0.3) months, control group 0.8 (0.4) months, arm restraint plus mirror therapy group 0.8 (0.38) months |
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| Interventions | This trial had 3 arms: the intervention group performed CIMT; a comparison group performed CIMT plus mirror therapy; and the control group CIMT versus CIMT plus mirror therapy versus control CIMT: fine motor exercise under the supervision of occupational therapist plus conventional physiotherapy plus self exercise Amount of restraint: 6 hours per day Anatomical region restraint: arm plus hand CIMT plus mirror therapy: fine motor exercise under the supervision of occupational therapist plus conventional physiotherapy plus mirror therapy with flexion/extension of the shoulder, elbow, wrist, finger, and pronation/supination of the forearm Control: self‐exercise program Session duration: CIMT: 6 hours of exercise, plus 40 minutes of conventional physiotherapy plus 30 minutes of self exercise daily; CIMT plus mirror therapy: 6 hours of exercise, plus 40 minutes of conventional physiotherapy, plus 30 minutes of mirror therapy daily; Control group: 60 minutes of self exercise, plus 40 minutes of conventional physiotherapy All for 5 days a week for 2 weeks |
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| Outcomes | Measures pre/post treatment
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| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "they were assigned into three groups by picking a random card with numbers on them" |
| Allocation concealment (selection bias) | Unclear risk | No information provided |
| Blinding (performance bias and detection bias) All outcomes | Low risk | Quote: "... the results were compared between the three groups by the blinded observers" |
| Incomplete outcome data addressed? (Post‐treatment) | Unclear risk | The study provided no information about withdrawals |
9HPT: Nine‐Hole Peg Test, a test measuring finger‐hand co‐ordination in terms of the time it takes a patient to place nine pegs in a 5‐in by 5‐in board then remove them
16HPT: Sixteen‐Hole Peg Test: the time needed to place 16 pegs (2.15.9 cm) in a pegboard with 16 holes determined with a stopwatch
ADL: activities of daily living
AMAT: Arm Motor Activity Test, 16 timed items
AMPS: Assessment of Motor and Process Skills, a real‐time test in which patients do prescribed functional tasks that are videotaped and scored by a viewer
AoU: amount of use
ARAT: Action Research Arm Test, 19 items, 57‐point test divided into four categories (grasp, grip, pinch and gross movement), each item graded on a 4‐point ordinal scale (anchored 0 = can perform no part of the test, 3 = performs the test normally)
BAT: Bilateral arm training
BATRAC: Bilateral arm training with rhythmic auditory cueing
BI: Barthel Index
BLMA: Birgitta Lindmarks Motor Assessment
Box and Block Test: assesses unilateral gross manual dexterity
CI: control intervention
CIMT: constraint‐induced movement therapy
CIT: constraint‐induced therapy
CMII: Chedoke‐McMaster Impairment Inventory, a 7‐point scale ranging from 1 to 7 that presents 7 stages of motor recovery for arm, hand, postural control and shoulder pain, assessed with a severity scale
COPM: Canadian Occupational Performance Measure, a structured clinical assessment that allows participants to self‐rate goals of therapy in the categories of self‐care, productivity, and leisure
CVA: Cerebrovascular accident
dCIT: distributed constraint‐induced therapy
EMF: Emory Motor Function test, 16 timed items (2 strength items and 1 quality of movement item)
EmNSA: Erasmus modification of the Nottingham Sensory Assessment to measure the sense of touch, pressure, proprioception, and sharp‐blunt discrimination in the upper limb
FAI: Frenchay Activities Index, a self‐report scale, measures a person's perception of instrumental ADL participation at 3 or 6 months. It contains 15 items that can be separated into 3 factors: domestic chores, leisure/work, and outdoor activities. Each item is scored on a 0 to 3 point scale. Higher scores indicate better performance.
FIM: Functional Independence Measure, 5 items that specifically assess upper extremity function. Each item is scored on a 7‐point ordinal scale
FIM2: Functional Independence Measure, 18 items grouped into six sub scales. Each item is scored on a 7‐point ordinal scale
FIM3: Functional Independence Measure, 6 items that specifically assess upper extremity function. Each item is scored on a 7‐point ordinal scale
FMA: Fugl‐Meyer Assessment, a 66‐point upper extremity section of the Fugl‐Meyer Assessment of Motor Recovery After Stroke which assesses impairment using a 3‐point ordinal scale ( 0 = cannot perform to 2 = can perform fully)
FMA2: Fugl‐Meyer Assessment, a 33‐point upper extremity section of the Fugl‐Meyer Assessment of Motor Recovery After Stroke Assessment, which assesses impairment using a 3‐point ordinal scale (0 = cannot perform to 2 = can perform fully)
FU: Forced use
GPT: Grooved Pegboard Test, a test of dexterity that evaluates the speed with which the patient grasps and inserts 25 pegs (3 cm long, 5 mm diameter) into a grid of vertical holes in a horizontal 10 cm2 surface. It indicates the number of pegs placed per second for each hand
MAL: Motor Activity Log, a semi‐structured interview comprising 30 ADL tasks graded on a 6‐point AoU scale and a 6‐point Quality of Movement (QoM) scale
MAL2: Motor Activity Log, a semi‐structured interview comprising 14 ADL tasks graded on a 6‐point AoU scale and a 6‐point Quality of Movement (QoM) scale
MAL3: Motor Activity Log, a semi‐structured interview comprising 28 ADL tasks graded on a 6‐point AoU scale and a 6‐point Quality of Movement (QoM) scale
MAS: Motor Assessment Scale, a performance‐based scale developed for assessing everyday motor function in patients with stroke. Eight areas of motor function are assessed using a 7‐point scale (0 to 6)
MAS2: Modified Motor Assessment Scale, items used for upper extremity only; both arms were tested, consisting of 15 tasks from gross arm to fine finger movements in a 0–5 point scale
MASh: Modified Ashworth Scale, grades spasticity on the International Classification of Functioning level of body functions (muscle tone functions)
mCIMT: modified constraint‐induced movement therapy
MESUPES: Motor Evaluation Scale for Arm in Stroke Patients, a scale that takes the quality of upper limb movement into account during the evaluation of arm performance after stroke
MFT: Manual Function Test, assess various functions of the paralysed upper limb in hemiplegic patients post stroke in performing simple tasks
MI: Motricity Index, to measure strength in the upper limbs
MMSE: Mini Mental State Examination
NIHSS: The National Institute of Health Stroke Scale. assesses cognitive, sensory, and motor impairments as an indicator of overall stroke severity
PET: positron emission tomography
PNF: proprioceptive neuromuscular facilitation
RMAAS: Rivermead Motor Assessment Arm Scale: motor performance test
SD: standard deviation
SHFT: Sollerman Hand Function Test, consisting of 20 sub‐tests reflecting daily hand activities (type of grasp, quality of movement and speed of performance assessed in a 0–4 point scale)
SIS: Stroke Impact Scale
TC: Therapeutic climbing
TF: Traditional physiotherapy
TMS: transcranical magnetic stimulation
UE: upper extremity
WMFT: Wolf Motor Function Test, 17 simple limb movements and tasks with the affected arm. 15 items are timed and two assess strength
WMFT2: Wolf Motor Function Test, 19 simple limb movements and tasks with the affected arm. 17 items are timed and two assess strength