Abstract
Background: Given the limited healthcare resources in low and middle income countries (LMICs), effective rehabilitation strategies that can be realistically adopted in such settings are required.
Objective: A systematic review of literature was conducted to identify pragmatic solutions and outcomes capable of enhancing stroke recovery and quality of life of stroke survivors for low- and middle- income countries.
Methods: PubMed, HINARI, and Directory of Open Access Journals databases were searched for published Randomized Controlled Trials (RCTs) till November 2018. Only completed trials published in English with non-pharmacological interventions on adult stroke survivors were included in the review while published protocols, pilot studies and feasibility analysis of trials were excluded. Obtained data were synthesized thematically and descriptively analyzed.
Results: One thousand nine hundred and ninety six studies were identified while 347 (65.22% high quality) RCTs were found to be eligible for the review. The most commonly assessed variables (and outcome measure utility) were activities of daily living [75.79% of the studies, with Barthel Index (37.02%)], motor function [66.57%; with Fugl Meyer scale (71.88%)], and gait [31.12%; with 6 min walk test (38.67%)]. Majority of the innovatively high technology interventions such as robot therapy (95.24%), virtual reality (94.44%), transcranial direct current stimulation (78.95%), transcranial magnetic stimulation (88.0%) and functional electrical stimulation (85.00%) were conducted in high income countries. Several traditional and low-cost interventions such as constraint-induced movement therapy (CIMT), resistant and aerobic exercises (R&AE), task oriented therapy (TOT), body weight supported treadmill training (BWSTT) were reported to significantly contribute to the recovery of motor function, activity, participation, and improvement of quality of life after stroke.
Conclusion: Several pragmatic, in terms of affordability, accessibility and utility, stroke rehabilitation solutions, and outcome measures that can be used in resource-limited settings were found to be effective in facilitating and enhancing post-stroke recovery and quality of life.
Introduction
Stroke is a major public health challenge in many Low- and Middle- Income Countries (LMICs) (1, 2). It is a leading cause of disability and premature mortality (3). Stroke is a common cause of severe financial hardship and poverty (4) and resources for stroke care and rehabilitation are sparse in LMICs (5). Rehabilitation services are typically limited and not easily affordable (6, 7). Although, there are several proven therapies and rehabilitation strategies for stroke in high income countries, these are not directly transferrable to LMICs (8). Many LMICs have minimal health care spending and any model of stroke rehabilitation for this region must not only be effective but practical and sustainable in terms of affordability, availability, accessibility and acceptability (7, 8). The global burden associated with stroke underscores the need for strategies to circumvent current trends and check the projected increase in stroke incidence in LMICs (1).
We conducted a systematic review of RCTs of interventions that addressed recovery of functioning, and enhancement of quality of life after stroke and discussed effective, cost-saving and practical rehabilitation models to improve clinical outcomes and quality of life among stroke survivors in LMICs.
The two main objectives of the review are therefore:
To determine effective interventions/modes of care delivery that enhances post-stroke recovery and quality of life and the outcome measures utilized.
To identify effective stroke rehabilitation interventions that would constitute pragmatic (cost-effective, accessible, and utilizable) solutions in lower and middle income countries.
Methods
This systematic review of literature was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Ethical standards necessary for the conduct of a systematic review were maintained. The study was registered with PROSPERO (CRD42020138454).
Search Strategy
We conducted a search of PubMed, HINARI, and Directory of Open Access Journals (DOAJ) databases for articles published up to November 2018 using the Patient-Intervention-Comparison-Outcome (PICO) format with stroke (Patient Problem), non-pharmacologic stroke rehabilitation/neurorehabilitation strategies (Intervention), stroke recovery (Outcome) and quality of life (Outcome) as some of the keywords. We however did not specify comparison groups in the search strategy.
Eligibility Criteria
Only studies that were identified as completed randomized controlled trials (RCTs), that involved adult stroke survivors (age ≥ 18 years) who underwent non-pharmacological rehabilitation in both the intervention and comparison groups, and with available full text were included in this review. However, published protocols, pilot and feasibility studies, and non-English language articles were excluded.
Data Extraction
The titles and abstracts of articles were screened by the authors and studies that did not meet the eligibility criteria were excluded. Full texts of eligible studies were further scrutinized and the following information were obtained and recorded in prepared data extraction form: citation, number of study participants, purpose of the study (specific construct targeted), type of intervention, type of control, and outcome of intervention (between intervention and control groups difference) (see Supplementary Table).
Quality Appraisal
The quality of the articles was assessed using JADAD scale (9). The scale also known as the Oxford quality scoring system has 7 items with a maximum score of 5 and a minimum score of 0. For the purpose of this review, studies with JADAD scores <3 were rated as low quality while those with scores ≥3 were rated as high quality studies.
Data Synthesis
Thematic presentation of findings of the reviewed studies was done in line with the objectives of the review. Stroke recovery and their outcomes were operationalized using the broad categories of functioning based on the International Classification of Functioning, Disability and Health (ICF) conceptual framework (10). Thus, stroke rehabilitation interventions and outcomes assessed in the various studies were presented according to their effects on the recovery of body functions, activity and participation. The efficacy of trial interventions on quality of life was also presented as a separate theme. Stroke care models identified as effective in the reviewed articles were also presented as a specific theme. Summaries of the quality of studies that addressed each of the themes were presented.
Results
A total of 1996 studies were obtained from the electronic searches of the databases, while the findings of 347 studies with available full text articles were synthesized and presented. One thousand, six hundred and thirty-five articles were excluded because they did not meet with the inclusion criteria while 15 articles that contained duplicate data were also excluded. Details are presented in the PRISMA flowchart (Figure 1).
Figure 1
Methodological Qualities of the Included Studies
In general, most of the studies (65.22%) included in this review were high quality trials (JEDAD Scores ≥3). Majority of the studies (>70.00%) with Transcranial Direct Current Stimulation (t-CDS), Virtual Reality (VR), Body Weight Supported Treadmill Training (BWSTT), mental practice, Task Oriented Therapy (TOT), muscle stretching exercises, speech therapy, participation based therapies, Community Based Rehabilitation (CBR), Home Based Rehabilitation (HBR), family/care-giver led therapy, and telerehabilitation were high quality trials. However, studies whose interventions hinged on robotics, Constraint Induced Movement Therapy (CIMT), Occupational Therapy (OT), Early Therapy, Cognitive Therapy, Quality of Life Centered Care were found to have an almost equal distributions in methodological quality as shown in Table 1.
Table 1
| SN | Therapy | Low Quality | References | High Quality | References | Total | ||
|---|---|---|---|---|---|---|---|---|
| f | % | f | % | |||||
| 1 | Robotics | 17 | 42.50 | (11–27) | 23 | 57.50 | (28–47) | 40 |
| 2 | t-DCS | 5 | 26.32 | (48–52) | 14 | 73.68 | (30, 41, 53–61) | 19 |
| 3 | TMS | 10 | 33.33 | (62–71) | 20 | 66.67 | (65, 72–90) | 30 |
| 4 | FES | 6 | 33.33 | (91–96) | 12 | 66.67 | (97–108) | 18 |
| 5 | VR | 7 | 26.92 | (109–115) | 19 | 73.08 | (116–125) | 26 |
| 6 | Video Game | 2 | 66.67 | (126, 127) | 1 | 33.33 | (128) | 3 |
| 7 | BWSTT | 3 | 27.27 | (129–131) | 8 | 72.73 | (132–139) | 11 |
| 8 | OT | 8 | 50.00 | (17, 110, 140–143) | 8 | 50.00 | (54, 81, 144–146) | 16 |
| 9 | CIMT | 18 | 47.37 | (141, 147–162) | 20 | 52.63 | (36, 163–180) | 38 |
| 10 | Mirror Therapy | 5 | 33.33 | (19, 62, 181–183) | 10 | 66.67 | (184–193) | 15 |
| 11 | Mental Practice | 2 | 28.57 | (194, 195) | 5 | 71.43 | (145, 196–198) | 7 |
| 12 | TOT | 6 | 25.00 | (199–204) | 18 | 75.00 | (33, 37, 83, 205–216) | 24 |
| 13 | Muscle Strength Tr | 5 | 35.71 | (217–221) | 9 | 64.29 | (74, 222–228) | 14 |
| 14 | Muscle Stretching | 0 | 0.00 | 3 | 100.00 | (229–231) | 3 | |
| 15 | Cognitive Therapy | 3 | 42.86 | (216, 232, 233) | 4 | 57.14 | (234–237) | 7 |
| 16 | Speech Therapy | 0 | 0.00 | 4 | 100.00 | (84, 238–240) | 4 | |
| 17 | Aerobic Exercise/Physical Activity | 18 | 40.91 | (48, 109, 232, 241–255) | 26 | 59.09 | (205, 255–282) | 44 |
| 18 | Particip-Based Rx | 1 | 20.00 | (251) | 4 | 80.00 | (283–286) | 5 |
| 19 | QoL Centered Care | 8 | 42.11 | (287–294) | 11 | 57.89 | (225, 236, 295–303) | 19 |
| 20 | CBR | 1 | 20.00 | (304) | 4 | 80.00 | (305–308) | 5 |
| 21 | HBR | 3 | 13.64 | (309–311) | 19 | 86.36 | (190, 248, 303, 311–326) | 22 |
| 22 | Family/CG led Rx | 1 | 16.67 | (327) | 5 | 83.33 | (328–332) | 6 |
| 23 | Self-Management | 1 | 50.00 | (333) | 1 | 50.00 | (334) | 2 |
| 24 | Telerehabilitation | 1 | 25.00 | (335) | 3 | 75.00 | (312, 336, 337) | 4 |
| 25 | Early Therapy | 5 | 55.56 | (156, 338, 339) | 4 | 44.44 | (340–343) | 9 |
| Total | 136 | 34.78 | 255 | 65.22 | ||||
Summary of the methodological qualities of the included studies based on therapeutic techniques (n = 347).
t-DCS, Transcranial Direct Current Stimulation; TMS, Transcranial Magnetic Stimulation; FES, Functional Electrical Stimulation; VR, Virtual Reality; BWSTT, Body Weight-Supported Treadmill Training; OT, Occupational Therapy; CIMT, Constraint-Induced Movement Therapy; TOT, Task-Oriented Therapy; Tr, Training; Particip, Participation; QoL, Quality of Life; CBR, Community-Based Rehabilitation; HBR, Home-Based Rehabilitation; CG, Caregiver; Rx, Therapy.
Locations of Studies With Innovatively High Technology Interventions
A total of 40 studies (11–50) conducted in 15 countries made use of Robot Therapy (RT). Majority (95.24) of these RT studies were done in high income countries such as USA (33.33%), Italy (14.29%) Taiwan (11.90%) etc. Very few studies (4.76%) were conducted in upper middle income countries (China and Georgia) while none was found in the lower middle and lower income countries. Also, of the 19 studies (16, 29, 51–64, 344) that compared the effects of transcranial direct current stimulation, 78.95% were conducted in high income countries, few (21.05%) in upper-middle-income countries, and none was found from lower-middle and lower income countries. Similarly, most of the trials on the effectiveness of virtual reality (94.44%), transcranial magnetic stimulation (88.0%) and functional electrical stimulation (85.00%) were conducted in high income countries as shown in Figure 2.
Figure 2
Outcome Measures Reported and Their Utility
Using the ICF classification model, 24 themes representing constructs in the function/structure (impairment) domain were found in the included studies. A total of 160 studies (66.57%) out of the 347 reviewed studies assessed motor function. Other outcomes such as balance (19.31%), muscle strength (16.43%), spasticity (12.39%), and depression (12.39%) were among the most assessed function/structure related outcomes. Majority (71.88%) of the studies that assessed motor function utilized Fugl Meyer Assessment scale. Other frequently used tools for assessing motor function were Wolf Motor Function Test (16.25%), Action Reach Arm Test (13.75%) and Box and Block Test (12.50%) as shown in Table 2.
Table 2
| Construct | Outcome measure | x + (y) | f | % | Rel. % | References |
|---|---|---|---|---|---|---|
| Motor function | FMA | 115(+0) | 115 | 33.14 | 71.88 | (11, 13, 14, 16, 17, 19, 24–27, 30–44, 46, 47, 49, 50, 52, 54, 56–58, 60, 61, 63–66, 73, 76, 77, 81, 83, 85, 87, 88, 92, 93, 95, 97, 98, 100, 102, 104, 105, 109, 111, 112, 116, 121, 122, 129, 132, 135, 137, 140, 144, 145, 151, 154, 155, 157, 159, 162, 163, 165–167, 178–180, 184–191, 194, 197, 200, 202, 205, 206, 209, 215, 222, 246, 260, 265, 274, 295, 311, 318, 323, 327, 337, 344–347) |
| WMFT | 13(+13) | 26 | 7.49 | 16.25 | (31, 36, 60, 75, 79, 81, 83, 98, 111, 128, 141, 147, 150, 156, 158, 160, 161, 163, 166, 173–175, 215, 344, 346) | |
| BBT | 4(+16) | 20 | 5.76 | 12.50 | (30, 34, 38, 40, 51, 88, 89, 104, 105, 114, 116, 120, 185, 186, 200, 202, 214, 215, 335, 345) | |
| ARAT | 7(+15) | 22 | 6.34 | 13.75 | (24, 98, 109, 116, 121, 149, 153, 163, 172, 180, 187, 189–191, 195, 205, 207, 209, 220, 268) | |
| MAS | 12(+2) | 14 | 4.03 | 8.75 | (22, 144, 176, 210, 211, 231, 250, 253, 277, 280, 281, 300, 307, 312) | |
| MI | 3(+6) | 9 | 2.59 | 5.63 | (44, 68, 88, 108, 116, 194, 251, 265, 282) | |
| (m)RS | 0(+7) | 7 | 2.02 | 4.38 | (76, 104, 109, 116, 121, 163, 210) | |
| MSS | 0(+3) | 3 | 0.86 | 1.88 | (25–27) | |
| EMG | 0(+2) | 2 | 0.58 | 1.25 | (83, 87) | |
| RMA | 2(+0) | 2 | 0.58 | 1.25 | (171, 204) | |
| Others | 4(+3) | 7 | 0.29a | 0.63a | SSS (133), FIM (193), AMAT (106), STREAM (269), [RPSS (112), MFT (203), CAHAI (262)] | |
| Total | 160 (+71) | Σx=160 | 46.11 | 100.00 | ||
| Muscle strength | MRC | 12(+0) | 12 | 3.46 | 23.08 | (11, 26, 27, 34, 38, 43, 70, 76, 79, 83, 140, 144) |
| MI | 4(+1) | 5 | 1.44 | 9.62 | (28, 32, 34, 106, 270) | |
| MPS | 2(+0) | 2 | 0.58 | 3.85 | (24, 25) | |
| Peak torque | 4(+0) | 4 | 1.15 | 7.69 | (48, 75, 108, 267) | |
| Dynamometer | 14(+0) | 14 | 4.03 | 26.92 | (55, 63, 86, 96, 207, 214, 215, 218, 219, 227, 228, 278, 296, 317) | |
| EMG | 3(+2) | 5 | 1.44 | 9.62 | (107, 200, 206, 218, 226) | |
| MMT | 3(+0) | 3 | 0.86 | 5.77 | (121, 137, 206) | |
| Virgometer | 2(+0) | 2 | 0.58 | 3.85 | (247, 250) | |
| 1RM | 1(+1) | 2 | 0.58 | 3.85 | (223, 228) | |
| Hand grip | 3(+0) | 3 | 0.86 | 5.77 | (59, 69, 237) | |
| Others | 4 (+1) | 5 | 0.29a | 1.92a | HSS (80), KTPB (70), Pinch gauge (71), PGBT (120), Myometer (220) | |
| Total (Σf) | 52(+5) | Σx=52 | 14.99 | 100.00 | ||
| Balance | BBS | 34(+0) | 34 | 9.80 | 68.00 | (11, 13, 22, 23, 92, 102, 103, 110, 119, 127, 129, 134, 135, 139, 144, 217, 222, 242, 247, 250, 265, 266, 270, 273, 276, 278, 279, 299, 306, 312, 314, 318, 323, 343) |
| TUG | 6(+6) | 12 | 3.46 | 24.00 | (5, 11, 36, 49, 103, 107, 110, 119, 124, 250, 265, 348) | |
| ABC | 0(+2) | 2 | 0.58 | 4.00 | (129, 135) | |
| FRT | 3(+1) | 4 | 1.15 | 8.00 | (119, 271, 281, 321) | |
| FTSTS | 1(+1) | 2 | 0.58 | 4.00 | (48, 244) | |
| Fall calendar | 2(+0) | 2 | 0.58 | 4.00 | (248, 316) | |
| LoS | 1(+1) | 2 | 0.58 | 4.00 | (199, 273) | |
| Others | 3(+6) | 9 | 0.29a | 2.00a | BBA (102), PSV (110), COP (113), BPM (125) SQ (126), FABS (199), PASS (267), BMS (273), PPA (315) | |
| Total | 50(+17) | Σx=50 | 14.41 | 100.00 | ||
| Muscle tone (spasticity) | (m)AS | 37(+0) | 37 | 10.66 | 90.24 | (12, 14, 19, 24, 25, 27–29, 31, 32, 34, 41, 56, 63, 65, 66, 68, 73, 91, 96, 99, 112, 138, 145, 189, 192, 202, 204, 219, 230, 247, 250, 267, 312, 345, 346, 349) |
| CSS | 2(+0) | 2 | 0.58 | 4.88 | (107, 259) | |
| Others | 2(+2) | 4 | 0.29a | 2.44a | EMG (68), H/M ratio (94), Pendulum Test (94), Myotron-3D (186) | |
| Total (Σf) | 41(+2) | Σx=41 | 11.82 | 100.00 | ||
| Depression | HAD-S | 16(+0) | 16 | 4.61 | 38.10 | (12, 216, 233, 236, 248, 260, 269, 277, 281, 291, 303, 308, 316, 328, 330, 332) |
| CES-D | 4(+0) | 4 | 1.15 | 9.52 | (21, 196, 289, 297, 319) | |
| BDI | 4(+0) | 4 | 1.15 | 9.52 | (24, 89, 121, 300) | |
| GDS | 7(+0) | 7 | 2.02 | 16.67 | (153, 214, 253, 283, 290, 299, 312) | |
| GHQ | 2(+0) | 2 | 0.58 | 4.76 | (142, 304) | |
| Others | 9(+1) | 10 | 0.29a | 2.38a | SADQ-H (80), IMTEQ (111), PHQ (222), ARS-D (244), STAI (299), Kessler-10 (289), MADS (292), DASS (305), Zungseas (340), SAS (216) | |
| Total (Σf) | 42(+1) | Σx=42 | 12.10 | 100.00 | ||
| Pain | VAS | 8(+0) | 8 | 2.31 | 66.67 | (28, 99, 183, 190, 231, 287, 295, 345) |
| FMA | 2(+0) | 2 | 0.58 | 16.67 | (24, 189) | |
| Others | 2 (+1) | 3 | 0.29a | 8.33a | PNS (346), WBF (153), RAI (231) | |
| Total (Σf) | 12(+1) | Σx=12 | 3.46 | 100.00 | ||
| Speech | WAB | 2(+0) | 2 | 0.58 | 12.50 | (59, 72) |
| ASRS | 2(+0) | 2 | 0.58 | 12.50 | (80, 84) | |
| BDAE | 2(+1) | 3 | 0.86 | 18.75 | (82, 84, 240) | |
| AAT | 3(+0) | 3 | 0.86 | 18.75 | (67, 170, 238) | |
| PAS | 2(+0) | 2 | 0.58 | 12.50 | (195, 224) | |
| Others | 5 (+10) | 14 | 0.29a | 6.25a | TOM (239), COAST (37), CCAS (78), COM-B (350), DRS (68), [VfDS (217), HSS (80), PICA (240), BNT (82), SVPN (82), CAL (170), Milan protocol (238), FCP (240), Token Test (238), CPNT (84)] | |
| Total (Σf) | 16(+10) | Σx=16 | 4.61 | 100.00 | ||
| Cognitive/Executive Fxn | ACER | 2(+0) | 2 | 0.58 | 7.69 | (12, 118) |
| TMT | 4(+1) | 5 | 1.44 | 19.23 | (118, 234–236, 342) | |
| MMSES | 5(+0) | 5 | 1.44 | 19.23 | (216, 232, 248, 293, 317) | |
| MCA | 2(+1) | 3 | 0.86 | 11.54 | (216, 298, 306) | |
| Others | 10 (11) | 21 | 0.29a | 3.85a | Token Test (138), THT (89), CL (197), SART (237), SPMSQ (289), PGCM (311), MAQ (196), CTT (198), VDS (234), CT-50CT (313), [VMIQ (197), S-CNPT (89), CFQ (235), AVLT (196), RBMT (197), Picture arrangement (118), CWST (234), BST (235), SPM (235), ESS (237), StSS (237)] | |
| Total (Σf) | 26(+13) | Σx=26 | 7.49 | 100.00 | ||
| Range of motion (ROM) | Goniometer | 8(+0) | 8 | 2.31 | 72.73 | (66, 91, 100, 105, 229–231, 345) |
| Others | 3(+0) | 3 | 0.29a | 9.09a | MCbA (282), 3D-MA (210); Reaching (40) | |
| Total (Σf) | 11(+0) | Σx=11 | 3.17 | 100.00 | ||
| CVS, hemat and respiratory function | VO2 max | 3(+0) | 3 | 0.86 | 21.43 | (44, 134, 278) |
| HR | 2(+1) | 3 | 0.86 | 21.43 | (44, 108, 275) | |
| MIP | 2(+0) | 2 | 0.58 | 14.29 | (224, 249) | |
| PCI | 2(+0) | 2 | 0.58 | 14.29 | (271, 286) | |
| Others | 5(+14) | 19 | 0.29a | 7.14a | 02 pulse (44), PC (255), IME (249), BP (44), MPV (255), SBMBDS (263), MEP (224), RPE (44), FVC (263), Vent Resp (44), CBF (232), FEVI (263), Borg's Scale (138), WBC (255), WHS (138), RBC (255), 2 MWT (348), Hg (255), FEV/FVC (263) | |
| Total (Σf) | 14(+15) | Σx=14 | 4.03 | 100.00 | ||
| Structural dysfunction | X-ray | 1(+0) | 1 | 0.29 | 33.33 | (99) |
| fMRI | 1(+0) | 1 | 0.29 | 33.33 | (151) | |
| LVM | 1(+0) | 1 | 0.29 | 33.33 | (158) | |
| Total | 3(+0) | Σx=3 | 0.86 | 100.00 | ||
| Cortical excitability | TMS | 6(+0) | 6 | 1.73 | 33.33 | (58, 71, 90, 156, 187, 274) |
| rMT | 4(+2) | 6 | 1.73 | 33.33 | (68, 70, 80, 83, 90, 187) | |
| MEP | 4(+4) | 8 | 2.31 | 44.44 | (62, 63, 70, 74, 83, 87, 90, 187) | |
| aMT | 0(+2) | 2 | 0.58 | 11.11 | (70, 80) | |
| MMA | 0(+2) | 2 | 0.58 | 11.11 | (68, 83) | |
| fMRI | 4(+0) | 4 | 1.15 | 22.22 | (59, 210, 336, 349) | |
| Others | 0(+2) | 2 | 0.29a | 5.56a | [SICI (67), ICF (67)] | |
| Total (Σf) | 18(+12) | Σx=18 | 5.19 | 100.00 | ||
| Perception and sensation | 2PD | 3(+0) | 3 | 0.86 | 23.08 | (176, 184, 251) |
| Others | 10 (+1) | 11 | 0.29a | 7.69a | Ns (130) NSA (188) CBS (258) Oxford Scale (138) SCT (189) Light Trash (282) [Cutaneous Threshold (184)] NEIVEQ (243) Brush mood (183) RASP (186) AMT (245) | |
| Total (Σf) | 13(+1) | Σx=13 | 3.74 | 100.00 | ||
| Posture | TCT | 3(+0) | 3 | 0.86 | 60.00 | (106, 138, 251) |
| Others | 2(+1) | 3 | 0.29a | 20.00a | PASS (102), SBMS (94), [mRS (138)] | |
| Total (Σf) | 5(+1) | Σx=5 | 1.44 | 100.00 | ||
| Hemineglect | BIT | 1(+0) | 1 | 0.29 | 50.00 | (191) |
| Albert Test | 1(+0) | 1 | 0.29 | 50.00 | (138) | |
| Total | 2(+0) | Σx=2 | 0.58 | 100.00 | ||
| Attitude and belief | ABC | 2(+0) | 2 | 0.58 | 22.22 | (216, 222) |
| Others | 7(+0) | 7 | 0.29a | 11.11a | SEOEE (203), LSES (284), FES (336), GSES (234), CABS (351), SEQ (262), SSEQ (333) | |
| Total (Σf) | 9(+0) | Σx=9 | 2.59 | 100.00 | ||
| Infection | FLUTS-Q | 1(+0) | 1 | 0.29 | – | (226) |
| flexibility | EFT | 1(+0) | 1 | 0.29 | – | (226) |
| fatigue/Stress | CSI | 6(+0) | 6 | 1.73 | 50.00 | (303, 312, 317, 322, 330) |
| CBS | 2(+0) | 2 | 0.58 | 16.67 | (314, 328) | |
| Others | 2(+2) | 4 | 0.29a | 8.33 | CIS-F (269), [GHQ (352), SOL-f (269) RSS (350)] | |
| Total (Σf) | 12(+0) | Σx=12 | 3.46 | 100.00 | ||
| Social support | PRO-85 | 1(+0) | 1 | 0.29 | – | (291) |
| Fxn | IIQ | 1(+0) | 1 | 0.29 | – | (303) |
| COST | Fin. Acct. | 1(+0) | 1 | 0.29 | 50.00 | (345) |
| Econ. Eval | 1(+0) | 1 | 0.29 | 50.00 | (312) | |
| Total | 2(+0) | Σx=2 | 0.58 | 100.00 | ||
| Satisfaction | GAS | 2(+0) | 2 | 0.58 | 22.22 | (185, 272) |
| Others | 7(+1) | 8 | 0.29a | 11.11a | VAS (269), SASC-19 (291), WHOQoL (284), Likert Scale (304), PSS (330), SSMBP (333), SSPS (336), [PoSS (330)] | |
| Total (Σf) | 9(+1) | Σx=9 | 2.59 | 100.00 |
Function- and structure-related outcome measures and their utility scores (n = 347).
na, n% for each of the outcome measures; x, exclusive frequency; y, repeated frequency, f, sum of x and y; % = (f/347*100); Rel %, (f/Σx*100).
FMA, Fugl Meyer Assessment Scale; WMFT, Wolf Motor Function Test; BBT, Box and Block Test; ARAT, Action Reach Arm Test; MAS, Motor Assessment Scale; MI, Motricity Index; (m)RS, (modified) Rankin Scale; MSS, Motor Status Scale; RMA, Rivermead Motor Assessment AMAT, Action Reach Arm Test; RPSS, Reaching Performance Scale for Stroke; SSS, Scandinavian Stroke Scale; FIM, Functional Independence Measure; MFT, Motor Function Test; CAHAI, Chedoke Arm and Hand Activity Inventory; STREAM, Stroke Rehabilitation Assessment for Movement; MRC, Medical Research Council Scale for Muscle Strength; MPS, Motor Power Scale; EMG, Electromyogram; MMT, Manual Muscle Test; 1RM, One Repetition Maximum; HSS, Hemiplegic Stroke Scale; KT PB, Keyboard Tapping and Peg Board Task; ROM, Range of Motion; BBS, Bergs Balance Scale; TUG, Time Up and Go test; ABC, Activity specific Balance Confidence scale; FRT, Functional Reach Test; FTSTS, Five Times Sit to Stand Test; LoS, Level of Support; BBA, Brunel Balance Scale; PSV, Postural Say Velocity; CoP, Center of Pressure; BPM, Balance Performance Monitor; SQ, Semistructured Questionnaire; FABS, Fullerton Advanced Balance Scale; PASS, Postural Assessment Scale for Stroke; BMS, Balance Master System; PPA, Physiological profile Assessment; (m)AS, (modified) Ashworth Scale; CSS, Composite Spasticity Scale; H-M ratio, Hoffman Reflect–Motor Response ratio; HAD-S, Hospital Anxiety and Depression Scale; CES-D, Center for Epidemiologic Studies Depression Scale; BDI, Beck's Depression Inventory; GDS, Geriatric Depression Scale; GHQ, General Health Questionnaire; SADQ-H, Stroke Aphasic Depression Questionnaire—Hospital Version; IMTEQ, Intrinsic Motivational Task Evaluation Questionnaire; PHQ, Patient Health Questionnaire; ARS-D, Aphasia Rating Scale for Depression; STAI, State Trait Anxiety Inventory; MADS, Montgomery Asberg Depression Scale; DASS, Depression Anxiety Stress Scale; SAS, Self-rating Anxiety Scale; VAS, Visual Analog Scale; PNS, Pain Numerical Scale; WBF, Wong-Baker Faces Pain Scale; RAI, Resident Assessment Instrument; WAB, Western Aphasia Battery; ASRS, Apraxia of Speech Rating Scale; BDAE, Boston Diagnostic Aphasia Examination; AAT, Aachen Aphasia Test; PAS, Penetration Aspiration Scale; TOM, Therapy Outcome Measure; COAST, Communication Outcomes After Stroke Scale; CCAS, Concise Chinese Aphasia Scale; COM-B, Capability, Opportunity, Motivation—Behavior model; VfDS, Videofluoroscopic Dysphagia Scale; HSS, Hemiplegic Stroke Scale; PICA, Porch Index of Communicative Ability; BNT, Boston Naming Test; SVPN, Solutions with Virtual Private Networks; CAL, Communicative Activity Log; FCP, Functional Communication Profile; CPNT, Computerized Picture Naming Test; DRS, Dysphagia Rating Scale; ACE, Addenbrooke's Cognitive Examination; TMT, Trail Making Test; MMSES, Mini-Mental Stroke Examination Scale; ROM, Range of Motion; MCA, Montreal Cognitive Assessment scale; THT, Tower of Hanoi Task; CL, Cognitive Log; VMIQ, Vividness of Movement Imagery Questionnaire; SART, Sustained Attention to Response Test; S-CNT, Seoul Computerized Neuropsychiatric Test; CFQ, Cognitive Failure Questionnaire; SPMSQ, Short Portable Mental Status Questionnaire; PGCM, Philadelphia Geriatric Center Morale Scale; MAQ, Meta-memory in Adulthood Questionnaire; AVLT, Auditory Verbal Learning Test; CTT, Color Test Trial; RBMT, Rivermead Behavioral Memory Test; VDS, Verbal Digital Test; CWST, Color–Word Stroop Test; BST, Block Span Test; DST, Digit Span Test; SPM, Standard Progressive Matrices; ESS, European Sleepiness Scale; StSS, Strafford Sleepiness Scale; CT-50 CT, CT-50 Cognitive Test; MCbA, Motor Club Assessment; 3D-MA, 3D Motion Analysis; CVS, Cardiovascular System; VO2Max, Maximal Oxygen Consumption; HR, Heart Rate; MIP, Maximum Inspiratory pressure; PCI, Physiological Cost Index; PC, Platelet Count; IME, Inspiratory Muscular Endurance; BP, Blood Pressure; MPV, Mean Platelet Volume; SBMBDS, Shortness of Breath Modified Borg Dyspnea Scale; MEP, Maximum Expiratory Pressure; RPE, Rate Perceived Exertion; FVC, Forced Vital Capacity; Vent-Resp, Ventilatory Response; CBF, Cerebral Blood Flow; FEV1, Forced Expiratory Volume in 1 s; WBC, White Blood Count; RBC, Red Blood Count; 2 MWT, 2 minute Walk Test; fMRI, functional Magnetic Resonance Imaging; LVM, Longitudinal Voxel Morphology; TMS, Transcranial Magnetic Imaging; rMT, rest Motor Threshold; MEP, Motor Evoked Potential; aMT, active Motor Threshold; MMA, Motor Map Area; SICI, Short-Interval Intracortical Inhibition; ICF, Intra-Cortical Facilitation; 2PD, Two point Discrimination; NS, Numerical Scale; RASP, Rivermead Assessment of Somatosensory Performance; NSA, Nottingham Sensory Assessment; CBS, Catherine Bergego Scale; SCT, Star Cancellation Test; NEI-VFQ, National Eye Institute Visual functioning Questionnaire; TCT, Trunk Control Test; PASS, Posture Assessment Scale for Stroke; SBMS, Smart Balance Master System; BIT, Behavioral Inattention Test; SEOEE, Short Self-efficacy and Outcomes Expectations for Exercise; LSES, Liverpool Self-Efficacy Scale; FES, Falls Efficacy Scale; GSES, General Self-Efficacy Scale; CABS, Cerebrovascular Attitudes and Beliefs Scale; SEQ, Self-Efficacy Questionnaire; SSEQ, Stroke Self-Efficacy Questionnaire; FLUTS-Q, Female Lower Urinary Tract Symptom Questionnaire; EFT, Eriksen Flanker Test; CSI, Carer Strain Index; CBS, Caregiver Burden Scale; CIS-f, Checklist Individual Strength—subscale fatigue; SOL-f, Self-Observation List—fatigue subscale; RSS, Relatives' Stress Scale; PRO-85, Personal Resource Questionnaire; IIQ, Incontinence Impact Questionnaire; Fin Acct, Financial Account, Econ. Eval, Economic Evaluation; GAS, Goal Attainment Scale; SASC, Satisfaction-With-Stroke-Care questionnaire; WHOQoL, WHO Quality of Life Scale; PSS, Patient Satisfaction with Services; SSMBP, Stroke Self-Management Behaviors Performance Scale; PoSS, Pound Satisfaction Scale.
Table 3 summarized the utility scores of outcome measures (Activities of Daily Living [ADL], Gait, and Mobility) in the Activity domain of the ICF classification system. A total of 208 studies (75.79%) out of the 347 studies in this review assessed ADL. Majority of these studies used Barthel Index or its modification (37.02%), Motor Activity Log (20.19%) and Functional Independence Measure (17.31%). In the same vein, 75 (31.2%) and 46 (14.70%) of the included studies assessed gait and mobility outcomes, respectively. Six minutes walk test (46.67%) and 10 meters walk test (38.67%) were the most utilized tool for assessing gait outcomes, while Functional Ambulatory Capacity (26.09%) and Rivermead Mobility Index (26.09%) were the most utilized outcomes for assessing post stroke mobility.
Table 3
| Construct | Outcome measure | x + (y) | f | % | Rel. % | References |
|---|---|---|---|---|---|---|
| ADL | FAS | 1(+2) | 3 | 0.86 | 1.44 | (44, 161, 195) |
| FIM | 30(+6) | 36 | 10.37 | 17.31 | (19, 26, 42, 47, 49, 65, 66, 93, 112, 122, 132, 136, 137, 149, 153–155, 157, 164, 177, 179, 191, 192, 230, 237, 242, 244, 266, 277, 283, 285, 305, 317, 320, 348) | |
| ABILhand | 3(+3) | 6 | 1.73 | 2.88 | (15, 47, 114, 176, 186, 190) | |
| (m)BI | 75(+2) | 77 | 22.19 | 37.02 | (11, 13, 28, 29, 34, 38, 42, 44, 53, 56, 61, 69, 70, 73, 76, 77, 88, 89, 92, 95, 100, 102, 109, 121, 138, 140, 144, 145, 152, 167, 185, 189, 197, 214, 231–233, 247, 248, 251, 253, 254, 260, 266, 267, 270, 272, 276, 282, 291, 293–295, 297, 298, 302–304, 306–308, 310, 312–314, 316, 320, 322, 328–332, 334, 340, 353) | |
| MAL | 39(+3) | 42 | 12.10 | 20.19 | (15, 17, 30, 31, 33, 36, 37, 41, 43, 47, 59, 100, 110, 149, 154, 155, 157–162, 165, 167, 171–173, 176–180, 183, 186, 188, 195, 311, 345, 347) | |
| ARAT | 8(+1) | 9 | 2.59 | 4.33 | (14, 33, 37–39, 50, 52, 53, 311) | |
| WMFT | 5(+3) | 8 | 2.31 | 3.85 | (19, 40, 46, 52, 68, 87, 183, 251) | |
| JTHFT | 7 | 7 | 2.02 | 3.37 | (54, 58, 120, 145, 211, 280, 335) | |
| 9HPT | 6(+3) | 9 | 2.59 | 4.33 | (163, 166, 172, 214, 220, 268, 269, 299, 325) | |
| IADL Scale | 2(+1) | 3 | 0.86 | 1.44 | (129, 135, 165) | |
| NEADL | 2(+6) | 8 | 2.31 | 3.85 | (142, 146, 155, 157, 251, 277, 307, 328) | |
| MFT | 3(+0) | 3 | 0.86 | 1.44 | (99, 104, 148) | |
| AMAT | 2(+0) | 2 | 0.58 | 0.96 | (97, 98) | |
| FAI | 3(+8) | 11 | 3.17 | 5.29 | (22, 23, 149, 197, 282, 292, 293, 308, 310, 329, 332) | |
| OAR | 1(+2) | 3 | 0.86 | 1.44 | (247, 275, 276) | |
| CMSA | 3(+1) | 4 | 1.15 | 1.92 | (45, 124, 134, 237) | |
| Purdue Pegbox | 2(+0) | 2 | 0.58 | 0.96 | (55, 251) | |
| mRS | 2(+2) | 4 | 1.15 | 1.92 | (238, 291, 312, 337) | |
| E-ADL | 1(+1) | 2 | 0.58 | 0.96 | (304, 326) | |
| SIS | 1(+1) | 2 | 0.58 | 0.96 | (103, 122) | |
| TEMPA | 1(+1) | 2 | 0.58 | 0.96 | (214, 215) | |
| Others | 11(+9) | 20 | 0.29a | 0.48a | e-keyboard (57), SVIPT (51), Pen Recrider (143), UMCIT (106), SST (281), SHFT (176), AFT (194), HAP (286), YPAS (203), TUG (317), SIADL (252), [BBT (39), CAHAL (45), PPT (237), SOE (194), RMA (353), LHS (303), NHP (293), VAS (293), SAS (348)] | |
| Total (Σf) | 208(+55) | Σx=208 | 75.79 | 100.00 | ||
| Gait | 5 MWT | 2(+0) | 2 | 0.58 | 2.67 | (22, 281) |
| 10 mWT | 29(+0) | 29 | 8.36 | 38.67 | (11, 29, 42, 48, 74, 92, 101, 103, 108, 119, 125, 129, 130, 136, 138, 139, 186, 241, 265, 270, 271, 277, 308, 314, 315, 323, 325, 348, 349) | |
| 6 MWT | 23(+12) | 35 | 10.09 | 46.67 | (22, 23, 29, 42, 96, 101, 103, 129, 130, 132, 134–138, 212, 214, 219, 221, 223, 228, 237, 241, 247, 250, 266, 269, 276, 278, 279, 286, 314, 315, 323, 349) | |
| FAC | 3(+3) | 6 | 1.73 | 8.00 | (22, 44, 65, 88, 348, 349) | |
| GAITrite | 3(+3) | 6 | 1.73 | 8.00 | (22, 87, 103, 123, 125, 213) | |
| RMI | 0(+2) | 2 | 0.58 | 2.67 | (22, 349) | |
| (m)EFAP | 1(+4) | 5 | 1.44 | 6.67 | (23, 91, 96, 101, 103) | |
| Camera | 2(+1) | 3 | 0.86 | 4.00 | (175, 178, 186) | |
| FGS | 1(+1) | 2 | 0.58 | 2.67 | (219, 221) | |
| Others | 11(+7) | 18 | 0.29a | 1.33a | 3 MWT (261), 50 MWT (106), Force plate (20), DMA (167), PSM (262), CGS (297), POMA (49), PMS (113), WGS (127), FSS (227), Digital Recording (181), [PAV (261), Symmetry (88), PCI (108), SAM (135), mMAS (125), RVGA (212), Paper walking print (212)] | |
| Total (Σf) | 75(+33) | Σx=75 | 31.12 | 100.00 | ||
| Mobility | FAC | 12(+0) | 12 | 3.46 | 26.09 | (115, 133, 136, 138, 139, 144, 193, 212, 261, 265, 267, 277) |
| TUG | 7(+0) | 7 | 2.02 | 15.22 | (221, 241, 242, 247, 271, 277, 280) | |
| (m)RMI | 9(+3) | 12 | 3.46 | 26.09 | (227, 245, 251, 261, 265, 270, 272, 277, 298, 308, 310, 332) | |
| Accelerometer | 6(+0) | 6 | 1.73 | 13.04 | (36, 40, 71, 181, 197, 262) | |
| STREAM | 2(+0) | 2 | 0.58 | 4.35 | (214, 349) | |
| Others | 10(+2) | 12 | 0.29a | 2.17a | RBCT (167), Independent walk (130), Video (203), Reaction time (182), HTM (201), MAC (258), Optotrack (215), 2 mWT (124), FQOM (324), mMAS (321), [UMT (168), PMV (182)] | |
| Total (Σf) | 46(+5) | Σx=46 | 14.70 | 100.00 |
Activity-related outcome measures and their utility scores (n = 347).
na, n% for each of the outcome measures; x, exclusive frequency; y, repeated frequency, f, sum of x and y; %=(f/347*100); Rel % =(f/Σx*100).
ADL, Activities of Daily Living; FAS, Functional Assessment Scale; FIM, Functional Independence Measure; (m)BI, (modified) Barthel Index; MAL, Motor Activity Log; ARAT, Action Research Arm Test; WMFT, Wolf Motor Function Test; JTHFT, Jebsen Taylor Hand Function Test; 9HPT, Nine Hole Peg Test; IADL-Scale, Instrumental Activities of Daily Living Scale; NEADL, Nottingham Extended Activities of Daily Living Scale; MFT, Manual Function Test; AMAT, Arm Motor Ability Test; FAI, Frenchay Activities Index; OAR, Older Americans Resources and Services; CMSA, Chedoke Master Stroke Assessment; mRS, modified Rankin Scale; E-ADL, Extended Activities of Daily Scale; SIS, Stroke Impact Scale; SVIPT, Sequential Visual Isometric Pinch Task; UMCIT, Upright Motor Control Test; SST Sit-to-Stand Test; SHFT, Sollerman Hand Function Test; AFT, Arm Functional Test; HAP, Human Activity Profile; YPAS, Yale Physical Activity Survey; TUG, Time Up and Go test; SIADL, Sunnaas Index of Activity of Daily Living; BBT, Box and Block Test; CAHAL, Chedoke Arm & Hand Activity Inventory; PPT, Purdue Pegboard Test; SOE, Speed of Execution; RMA, Rivermead Motor Assessment scale; LHS, London Handicap Scale; NHP, Nottingham Health Profile; VAS, Visual Analog Scale; SAS, Stroke Activity Scale; 5 MWT, 5 minute Walk Test; 10 mWT, 10-Meter Walk Test; 6 MWT, 6 minute Walk Test; FAC, Functional Ambulatory Capacity; RMI, Rivermead Mobility Index; (m)EFAP, (modified)Emory Functional Ambulatory Profile; FGS, Fast Gait Speed; 3 MWT, 3 minute Walk Test; 50 mWT, 50-Meter Walk Test; DMA, Dartfish motion analysis software; PSM, Pressure Sensitive Mat; CGS, Comfortable Gait Speed; POMA, Performance-Oriented Mobility Assessment; PMS, Pressure Mat System; WGS, Wisconsin Gait Scale; FSS, Foot Steps Symmetry; PAV, Peak Angular Velocity; PCI, Physiological Cost Index; SAM, Step Activity Monitor; mMAS, modified Motor Assessment Scale; RVGA, Rivermead Visual Gait Assessment; STREAM, Stroke Rehabilitation Assessment of Movement; RBCT, Rhythmic Bimanual Coordination Tasks; HTM, Hand-To-Mouth task; MAC = Mobility Assessment Course; 2 mWT, 2-Meter Walk Test; FQoM, Functional Quality of Movement Scale; UMT, Unimanual Motor Task; PMV, Peak Movement Velocity.
Quality of life (QoL), post stroke reintegration and stroke impact were the three generated themes representing outcomes in the participation domain of the ICF model. Out of the 59 studies (20.17% of the included studies) that assessed QoL, SF-36 (35.59%) and Stroke Impact Scale [SIS] (30.51%) were the most utilized outcome measures. Also, SIS (21.74%) was the most utilized outcome measure in assessing post-stroke reintegration. From the 32 studies that assessed stroke severity/recovery, NIH stroke scale (50.00%) was the most frequently used outcome measure. In the same vein, SIS (45.16%) was the most utilized tool for assessing stroke impact as shown in Table 4.
Table 4
| Construct | Outcome measure | x + (y) | f | % | Rel. % | References |
|---|---|---|---|---|---|---|
| QoL | SIS | 18(+0) | 18 | 5.19 | 30.51 | (17, 18, 21, 31, 43, 129, 149, 153, 154, 159, 179, 187, 189, 299, 306, 320, 328, 346) |
| EuroQol | 10(+0) | 10 | 2.88 | 16.95 | (37, 121, 190, 196, 227, 300, 302, 304, 305, 313) | |
| SF-36 | 19(+2) | 21 | 6.05 | 35.59 | (23, 37, 77, 264, 277, 288–291, 294, 296, 297, 301, 303, 307, 310, 315, 317, 320, 332, 340) | |
| SSQoL | 4(+0) | 4 | 1.15 | 6.78 | (66, 103, 235, 298) | |
| WHOQoL | 0(+2) | 2 | 0.58 | 3.39 | (196, 296) | |
| NHP | 4(+0) | 4 | 1.15 | 6.78 | (247, 248, 276, 292) | |
| SA-SIP | 2(+0) | 2 | 0.58 | 3.39 | (319, 321) | |
| SSS | 1(+2) | 3 | 0.86 | 5.08 | (109, 264, 294) | |
| Others | 1(+5) | 6 | 0.29a | 1.69a | EQVAS (309), [HUI (18) RS (302), N-QoL (296), QoLI (300), GHQ (332)] | |
| Total (Σf) | 59(+11) | Σx=59 | 20.17 | 100.00 | ||
| Reintegration | SIS | 5(+0) | 5 | 1.44 | 21.74 | (42, 203, 219, 221, 314) |
| AAP | 2(+0) | 2 | 0.58 | 8.70 | (129, 315) | |
| COPM | 3(+0) | 3 | 0.86 | 13.04 | (141, 145, 235) | |
| NLQ | 2(+0) | 2 | 0.58 | 8.70 | (142, 146) | |
| RNLI | 2(+0) | 2 | 0.58 | 8.70 | (289, 330) | |
| Others | 7(+2) | 9 | 0.29a | 4.35a | Social support lest (196), 0.8ms-2 mobilization (220), TRIP (206), RTWQ (298), LIFE-H (300), PASIPD (278), LHS (332), [IPA (196), Pedometer (315)] | |
| Total (Σf) | 21(+2) | Σx=21 | 6.63 | 100.00 | ||
| Stroke severity/Recovery | NIHSS | 16(+0) | 16 | 4.61 | 50.00 | (22, 24, 28, 68, 69, 76, 80, 85, 86, 95, 148, 153, 187, 222, 311, 347) |
| CNS | 2(+0) | 2 | 0.58 | 6.25 | (29, 237) | |
| (m)RS | 2(+2) | 4 | 1.15 | 12.50 | (187, 222, 313, 322) | |
| RLOC | 2(+0) | 2 | 0.58 | 6.25 | (233, 281) | |
| SIAS | 2(+0) | 2 | 0.58 | 6.25 | (64, 279) | |
| OPS | 2(+0) | 2 | 0.58 | 6.25 | (320, 323) | |
| Others | 6(+3) | 9 | 0.29a | 3.13a | fMRI (58), NDS (353), GPES (266), PSQ (297), SSS (324), SOEQ (351), [OAD (233), ESS (96), mBI (311)] | |
| Total (Σf) | 32(+3) | Σx=32 | 9.22 | 100.00 | ||
| Stroke impact | SIS | 14(+0) | 14 | 4.03 | 45.16 | (24, 46, 96, 103, 118, 135, 150, 153, 163, 166, 208, 279, 284, 289) |
| SF-36 | 4(+0) | 4 | 1.15 | 12.90 | (22, 236, 242, 286) | |
| BRS | 5(+0) | 5 | 1.44 | 16.13 | (65, 86, 192, 193, 230) | |
| NHP | 3(+0) | 3 | 0.86 | 9.68 | (252, 322, 326) | |
| Death | 2(+0) | 2 | 0.58 | 6.45 | (109, 294) | |
| Others | 3(+0) | 3 | 0.29a | 9.68a | Complications (350), GHQ (146), SA-SIP (269) | |
| Total (Σf) | 31(+0) | Σx=31 | 8.93 | 100.00 |
Participation-related outcome measures and their utility scores (n = 347).
na, n% for each of the outcome measures; x, exclusive frequency; y, repeated frequency, f, sum of x and y; %=(f/347*100); Rel % =(f/Σx*100).
SIS, Stroke Impact Scale; SF-36, 36-item Short Form Survey; NHP, Nottingham Health Profile; SA-SIP, Stroke Adapted Sickness Impact Profile; SSS, Scandinavian Stroke Scale; EQVAS, Euroquol visual analog scale; HUI, Health Utilities Index; NQoL, Nocturnal QoL Questionnaire; QoLI, Quality of Life Index; GHQ, General Health Questionnaire; AAP, Adelaide Activities Profile; COPM, Canadian Occupational Performance Measure; NLQ, Nottingham Leisure Questionnaire; RNLI, Reintegration to Normal Living Index; TRIP, Test Ride for Investigating Practical fitness to drive; RTWQ, Return to Work Questionnaire; LIFE-H, Assessment of Life Habits; PASPID, Physical Activity Scale for individuals with Physical Disabilities; LHS, London Handicap Scale; IPA, the Impact on Participation and Autonomy; NIHSS, National Institute of Health Stroke Scale; CNS, Canadian Neurological Scale; (m)RS, (modified) Ranking Scale; RLOC, Recovery Locus of Control Scale; BRS, Brunnstrom Recovery Scale; SIAS, Stroke Impairment Assessment Set; OPS, Orpington Prognostic Scale; fMRI, functional Magnetic Resonance Imaging; NDS, Neurologic Deficit Scale; PSQ, Patient Satisfaction Questionnaire; SOEQ, Stages of Exercise Questionnaire; OAD, Observer Assessed Disability; ESS, European Stroke Scale; mBI, modified Barthel Index.
Synthesized Themes for Stroke Intervention
Motor Relearning Therapy (Motor Function, Muscle Strength, Balance and Muscle Tone, Activities of Daily Living, Gait, and Mobility)
One hundred and sixty trials examined the effects of various neurorehabilitation techniques on trunk, upper and lower extremity motor function while 52, 50, and 41 studies were on muscle strength, balance and muscle tone, respectively. Also included in the motor relearning interventions were the 208 trials on Activities of Daily Living (ADL), 108 and 51 trials on gait and mobility, respectively. These neurorehabilitation techniques include innovatively high technology interventions such as robotic therapy (11–50), transcranial direct current stimulation (16, 29, 51–64, 344), transcranial magnetic stimulation (66–94), functional electrical stimulation (95–112), virtual reality (113–129), and video game (130–132). Many of these trials reported “within-group” improvement in motor functioning outcomes in both intervention and control groups (usually conventional therapy) with no “between-group differences” in these outcomes. Similarly, most of the identified traditional and relatively low-technology neurorehabilitation techniques such as body weight supported treadmill (133–143), occupational therapy (33, 56, 80, 123, 144–150), constraint induced movement therapy (23, 147, 151–184), mirror therapy (39, 68, 185–197), mental therapy (145, 198–202), task oriented training (20, 24, 83, 123, 144–150) muscle strengthening and stretching exercises (73, 221–235) had significant effects on improving motor functioning.
Cognitive Therapy
Eight trials (116, 236–242) on the efficacy of post-stroke cognitive rehabilitation were reviewed. Three studies utilized technology-based techniques namely virtual reality (116), lumosity brain trainer (239), and continuous positive Airway Pressure (CPAP) (232). Other trials utilized relatively low technology interventions such as comprehensive rehabilitation training (236), experential/traditional music (237), aerobic exercise (238), lifestyle course (240), and workbook based intervention (242). While virtual reality and CPAP resulted in significantly better improvement in Neurocognitive functions when compared with conventional therapy, lumosity brain trainer had no significant effect on cognitive function. Among the relatively low technology interventions, comprehensive rehabilitation training, experiential/traditional music and workbook based interventions significantly improved cognitive functions of stroke survivors more than conventional therapy.
Speech Therapy
Four studies (84, 243–245), on therapies for post-stroke aphasia and dysarthria were reviewed. One study (243), compared the effect of music therapy combined with Speech and Language Therapy (SLT) on aphasia with SLT alone and found that the combined therapy significantly improved speech and language functions of aphasic stroke patients. However, best practice communication therapy protocol delivered by speech and language therapist (244) and standard speech therapy (245) had no significantly different effect on functional communication ability of stroke survivors. Also, a trial that evaluated the effects of repetitive transcranial magnetic stimulation (rTMS) on aphasia found no between- group difference between recipients of the intervention and those who received sham rTMS (84).
Aerobic Exercise/Physical Activity Based Training
Forty four studies (48, 51, 205, 237, 246–289) evaluated the effects of a variety of aerobic exercises and physical activity based interventions on different aspects of the activity construct. Activities examined in the reviewed studies included mobility (255, 258, 261, 263, 265, 269, 270, 272, 278, 281, 282), general activities of daily living as assessed with Barthel Index or its modification (257, 261, 265, 269, 272, 277, 282, 285, 287–289), or Functional Independence Measure (51, 264, 278); and upper limb functional activities (51, 256, 257, 261, 274).
The interventions trialed included body weight supported treadmill training (274), Bobath programme (280), proprioceptive neuromuscular faccilitation (246), interval/continuous aerobic exercise (248), accelerometer mediated walking (259), intensive/regular exercises (261, 276, 277), early/late training (268), fast/slow training (263), motor imagery activities (269, 272), sit-to-stand-training (205, 273), transcranial direct current stimulation (51), hydrotherapy (247), accupunture (286), orthotic device (260) augumented physiotherapy (257, 281, 282, 284, 290).
Other Therapies
These include participation based therapy (290–294), quality of life centered care (240, 295–310, 345), community based rehabilitation (311–315), home based rehabilitation (132, 193, 316–335), self-management (336, 337), family or care giver-led training (340–342, 350, 353, 354), telerehabilitation (317, 343, 346, 349), and early therapy/rehabilitation (174, 338, 339, 347, 348, 351, 352, 355, 356).
Discussion
Interventions
Motor Relearning Therapy
Several motor relearning interventions have been proposed for use in stroke rehabilitation to enhance motor function, activity and participation recovery after stroke and these interventions can be broadly categorized as traditional/conventional and emerging trends. Many of the trials included in this review largely confirmed the efficacy of conventional (sometimes termed “usual care”) interventions for the improvement of upper and lower limb muscle strength, balance, and coordination. Interventions found to be effective include task-specific training (138), therapist-assisted locomotor training (144). The efficacy of other interventions that may not fit into the category of conventional therapies but which also do not necessarily require high instrumentation was also reported. These include constraint- induced movement therapy (164, 172, 178), mirror therapy (185, 196, 197), and task oriented training (209, 210, 215, 216). Although many of these interventions are not costly especially because they do not require high technology gadgets and equipments, they can however be labor intensive. In most Low and Middle Income Countries (LMICs) where gross shortage of qualified rehabilitation specialists and centers appears intractable, the utilization of effective but personnel-demanding rehabilitation strategies may not be sustainable and pragmatic. The difficulties associated with utilizing conventional and low technology therapies in LMICs are further made worse by the increasing incidence and prevalence of stroke in these settings (357). The provision of conventional rehabilitation after stroke in these resource-limited settings would therefore require an aggressive focus by all stakeholders including government of those countries, policy-makers, the rehabilitation professionals, non-governmental organization and foreign collaborators on training and employment of needed rehabilitation manpower. It might be argued that while the findings of this review support the utility of pragmatic, conventional stroke rehabilitation solutions, there is a likelihood that what is considered conventional or routine care in many of the reviewed studies may not exactly depict usual care in LMICs. However, a recent systematic review of stroke rehabilitation interventions that are currently in use in LMICs provided evidence on the efficacy of low-cost physical rehabilitation interventions in improving post-stroke functional outcomes (358). Standardization of what constitutes effective conventional stroke therapies would therefore be required in LMICs and can be achieved by ensuring that training curricula for rehabilitation disciplines and relevant clinical practice guidelines place emphasis on effective evidence-based stroke rehabilitation interventions.
It is important to note that the shortage of rehabilitation professionals in LMICs is however not solely due to the non-availability of these professionals but also results from the limited employment opportunities or openings. Also worthy of mention is the limited or outright lack of utilization of lower grade health workers that could provide basic and less-specialized stroke treatments. A typical example is that of Nigeria, the most populous country on the African continent, where physiotherapy assistants are largely not in place in the country contrary to the practice in many high-income countries (359). Another case in point is the under-utilization of post-qualification internship programme that provides a pool of fresh graduates that can augment rehabilitation personnel requirements, with many health institutions grossly rationing the employment of interns due to lack of funds for remuneration and this renders such entry-level professionals under-employed and under-utilized. The adoption of a stroke quadrangle strategy (360), that proposes pragmatic solutions on issues of rehabilitation professional shortage is therefore required. However, another strategy that has gained traction in recent times is to circumvent manpower demanding conventional therapies and adopt technology driven alternatives.
Many emerging high technology stroke rehabilitation strategies have been trialed. In this review, we found several RCTs that evaluated the effect of robotic training, virtual reality training, transcranial direct current stimulation (tDCS), transcranial magnetic stimulation, functional electrical stimulation on various aspects of physical functioning. Many of these interventions are expensive and are not affordable in settings with insufficient financial resources. Although many of the trials show that these interventions despite their high cost are not more effective than conventional therapies, a likely advantage is that automated interventions like robotic therapies require minimal input from rehabilitation professionals in terms of time and efforts. Therefore, given the efficacy of robotic therapy and the fact that its utilization in stroke rehabilitation may mitigate the labor intensive and personnel tasking nature of many conventional therapies, affordable stroke rehabilitation robotics that are feasible for use in low-resource countries are being produced, and assessed for efficacy (361).
Cognitive Therapy
Cognitive reserve (defined as the ability to cope with brain damage) has been postulated to influence functional ability (362), and this buttresses the need for cognitive therapy during stroke rehabilitation. Similar to what obtains with the therapies for motor relearning, interventions that address post-stroke cognitive function are available in low technology and high technology forms (363). While virtual reality was reported to result in marked improvement in post-stroke cognitive functions (116), and interactive video game a potentially beneficial treatment (249), computer-based cognitive training was neither superior to mock training nor waiting list in its effect on subjective cognitive functioning (250). Hence, the utilization of technology in post-stroke cognitive rehabilitation may not guarantee a positive outcome. The use of aerobic exercise to address post-stroke cognitive impairment as was reported (238), may be considered as a more practical approach in LMICs. There is however a dearth of studies on effective post-stroke cognitive rehabilitation strategies from LMICs (1). Given the burden of post-stroke cognitive impairment especially in terms of its prevalence (364), and its potentially negative impact on other important constructs such as activities of daily living (365), participation (366), and quality of life (367), there is an urgent need to identify effective interventions that can be easily incorporated into real-life practice in LMICs.
Speech Therapy
The use of regular communication mechanism was found to be more effective in promoting recovery from aphasia compared to intensive aphasia therapy (251). Similarly, the use of enhanced communication therapy (245), and rTMS (84) to address the speech function of stroke patients with aphasia did not confer any additional advantage on its recipients. Although these findings may suggest that further studies are required to identify effective therapies for post-stroke speech impairments, it is important to note that the efficacy or otherwise of therapies for post-stroke speech impairments also depends on the lesion site (368) and severity of the brain injury. Therefore, identifying pragmatic solutions for recovery of speech function after stroke in LMICs may need to be accompanied by availability of neuroimaging equipment that will aid in accurately diagnosing and identifying the site and extent of the brain injury.
Quality of Life Centered Care
Quality of life of stroke patients represents a broad index of stroke recovery (369) and its improvement is considered as the ultimate goal of stroke rehabilitation (360). The findings of this review which showed that many of stroke trials targeting other constructs such as motor function (367), cognition (370), and functional activity (138) also evaluated the global effect of such interventions on the post-stroke quality of life is therefore not surprising. Many of the interventions that were effective in improving motor function, activity and participation were also found to improve quality of life. This is not unexpected as several observational studies have shown that many of these specific functioning constructs significantly influence or predict the multi-dimensional construct—quality of life even in other neurological conditions (371). Hence, since many of the interventions that were found to facilitate the various components of post-stroke functioning also resulted in significant improvement in post-stroke quality of life, pragmatic solutions for stroke recovery may also represent pragmatic solutions for improved quality of life after stroke.
Models of Stroke Rehabilitation
Task Shifting
Task shifting has been described as an attractive option for healthcare optimization and sustainability in LMICs (372, 373). It is a process of moving or shifting appropriate task to health workers with shorter training and fewer qualifications (371). Task shifting involves deliberate delegation of specific task(s) to the least costly health worker in order to free up specialists who are in limited supply to provide more complex care for people who critically require such care (374).
The need to explore task shifting of rehabilitation activities to non-health workers such as informal or family caregivers as a potentially sustainable alternative to conventional rehabilitation, and an affordable strategy in meeting rehabilitation demands in LMICs has also been identified (375–377). The trials included in this review however did not find sufficient evidence and justification for the adoption of such a task shifting model in stroke rehabilitation. The ATTEND trial in India (a middle-income country) examined the effectiveness of a family-led stroke rehabilitation model in improving clinical outcomes with the conclusion that the model was not superior to usual care in terms of important outcomes such as death, dependency and re-hospitalization, and potentially constitutes a waste of already limited resources (378). Similarly, the TRACS trial found no significant difference in stroke patients' recovery, mood and quality of life, and caregivers' burden and perceived cost-effectiveness of a stroke caregivers training programmes (379). In line with the suggestions of the authors of the ATTEND trial, future studies will be required to examine if task-shifting in stroke rehabilitation to healthcare assistants would yield better clinical outcomes. For example, the findings of a previous study in Nigeria showed that non-neurologist healthcare workers were receptive to, and substantially assimilated stroke-specific knowledge disseminated at a task shifting training workshop (380).
Community-/Home-Based Rehabilitation
Community rehabilitation may constitute a cost-effective and pragmatic model of stroke rehabilitation in LMICs. Traditionally, rehabilitation services for stroke patients are offered in hospitals which are largely urban-based and inaccessible to many stroke survivors, especially those in rural areas. Improving accessibility to rehabilitation services requires implementation of existing public health programmes developed by the World Health Organization for stroke prevention and treatment (381). These include primary health care and its community-based rehabilitation counterpart (382), and home-based rehabilitation. One of the trials we reviewed, the Locomotor Experience Applied Post-Stroke (LEAPS) trial, showed that home-administered strength and balance training resulted in improvement in functional walking among community-dwelling stroke survivors. Furthermore, the home-based exercise protocol utilized in the LEAPS trial was found to be as effective as the more expensive institutional-based body-weight-supported treadmill training and hence can be considered practical and feasible for adoption in LMICs (138).
An intervention programme comprising task-specific exercises was similarly associated with improvement in motor function, postural balance, community reintegration, quality of life, and walking speed among stroke survivors treated at a primary health center in Nigeria (383). Furthermore, the Nigerian study showed that physiotherapy services delivered at primary health centers in the community resulted in similar outcomes as home-based physiotherapy services (367). Thus, home exercise interventions seem a more pragmatic form of therapy for stroke survivors with a higher likelihood of compliance (138). Community-/home-based rehabilitation can therefore be regarded as effective models for improving access to stroke care, care efficiency, coordination, and continuity in LMICs.
Self-Management
Though rarely used in the context of stroke (384), application of self-management interventions for stroke rehabilitation has stimulated research interest in recent years (337), Despite the fact that stroke is an acute event, stroke survivors experience physical and psychosocial challenges in the recovery trajectory which renders stroke a chronic condition (385). Challenges faced include depression, functional and mobility disability, reduction in life roles, and a lack of social support (386). Yet, rehabilitation for stroke survivors are targeted at improving physical function, while minimal attention is given to the psychosocial consequences of stroke (385, 386). To overcome these challenges, rehabilitation strategies that support stroke survivors to manage their health and lives and maximize their full potentials are necessary (337). Self-management is an emerging strategy for engaging stroke survivors in their own care. Evidence suggests that self-management programmes can impact on clinical outcomes and psychological health of patients with a range of long-term conditions (387, 388). It could influence an individual's ability to cope with their condition, and enhance quality of life (387). Self-management in stroke rehabilitation requires conscious effort by survivors themselves to deal with stroke-related disabilities, prevent stroke recurrence, and overcome challenges of long-term recovery (111). However, evidence base for its effectiveness in stroke care is still emerging (337, 389).
Tele-Rehabilitation
Tele-rehabilitation entails remote delivery and supervision of rehabilitation services (390). It can be considered as a viable rehabilitation alternative for stroke patients with limited access to usual rehabilitation services resulting from logistical, financial, and geographical barriers to rehabilitation centers (391). The studies included in this review showed that telerehabilitation was effective in improving falls efficacy (349), quality of life (390) and reducing depression (390), and carer stress (317) after stroke. Translation of these budding opportunities and existing evidence-based interventions into pragmatic and cost-effective solutions in LMICs remains a huge challenge. Research efforts are needed to develop cost-effective robotic devices that can perform the above functions in harsher environments characterized by extreme economic hardship (per country), intermittent electricity supply and limited expert supervisors (361). Technology assisted rehabilitation as a viable option to task-shifting is the subject of current trials (392). The feasibility and acceptability of using smart phone for self-management of stroke patients has been evaluated (393).
Limitation
A major perceived limitation of this study is the loose thematic inclusion of some constructs such as quality of life, stroke severity, recovery, and impact under the participation component of ICF.
Conclusion
This review showed that various approaches to stroke rehabilitation that may be adopted in LMICs exist. These however must be considered within the context and framework of the health system and available resources. Studies on how to adapt existing approaches and to develop novel ones for stroke rehabilitation in LMICs are needed. However, since many of the expensive innovative stroke therapies obtained in the review lack comparative advantage over low-cost traditional ones in terms of efficacy, the emphasis in LMICs should be the strengthening and expansion of the rehabilitation workforce, and provision of adequate rehabilitation centers to ensure access to effective conventional stroke rehabilitation solutions in those settings. Efforts at designing and producing low-cost versions of the expensive innovative stroke rehabilitation solution that will be compatible with the socio-economic, built and energy environment of LMICs should however also be encouraged, supported and funded.
Statements
Author contributions
EE contributed in the conceptualization of this study, sorting and extraction of data, quantitative analysis, and editing of the final manuscript. PO contributed in the conceptualization, data sorting and extraction, and qualitative analysis and draft preparation. KN took part in the conceptualization of the study, data sorting and extraction, and editing of the manuscript. OO contributed in the literature search and writing of the discussion and conclusion. VO took part in the data sorting phase and in writing the introductory section. TH was involved in the conceptualization of study and consultation and mentoring. MO was involved with the conceptualization, organization of the team, consultation and mentoring, editing and final approval of the final version of the manuscript.
Funding
MO is supported by the NIH (SIREN U54HG007479, SIBS Genomics R01NS107900, ARISES R01NS115944-01, H3Africa CVD Supplement 3U24HG009780-03S5, and CaNVAS 1R01NS114045-01).
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Supplementary material
The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fneur.2020.00337/full#supplementary-material
References
1.
YanLLLiCChenJMirandaJJLuoRBettgerJet al. Prevention, management, and rehabilitation of stroke in low-and middle-income countries. eNeurologicalSci. (2016) 2:21–30. 10.1016/j.ensci.2016.02.011
2.
KimASJohnstonSC. Temporal and geographic trends in the global stroke epidemic. Stroke. (2013) 44(Suppl. 1):S123–5. 10.1161/STROKEAHA.111.000067
3.
KalkondeYVDeshmukhMDSahaneVPuthranJKakarmathSAgavaneVet al. Stroke is the leading cause of death in rural Gadchiroli, India: a prospective community-based study. Stroke. (2015) 46:1764–8. 10.1161/STROKEAHA.115.008918
4.
HeeleyEAndersonCSHuangYJanSLiYLiuMet al. Role of health insurance in averting economic hardship in families after acute stroke in China. Stroke. (2009) 40:2149–56. 10.1161/STROKEAHA.108.540054
5.
FeiginVLForouzanfarMHKrishnamurthiRMensahGAConnorMBennettDAet al. Global and regional burden of stroke during 1990-2010: findings from the global burden of disease study 2010. Lancet. (2014) 383:245–55. 10.1016/S0140-6736(13)61953-4
6.
MirandaJJZamanMJ. Exporting failure: why research from rich countries may not benefit the developing world. Rev Saúde Pública. (2010) 44:185–9. 10.1590/S0034-89102010000100020
7.
DielemanJLTemplinTSadatNReidyPChapinAForemanKet al. National spending on health by source for 184 countries between 2013 and 2040. Lancet. (2016) 387:2521–35. 10.1016/S0140-6736(16)30167-2
8.
World Health Organization. World Report on Disability: World Health Organization; 2011. Geneva: WHO Press (2011).
9.
HalpernSHDouglasMJ. Appendix: Jadad scale for reporting randomized controlled trials. In: Halpern SH, Douglas MJ, editors. Evidence-Based Obstetric Anesthesia. Oxford: Blackwell Publishing Ltd. (2005). p. 237–8.
10.
World Health Organization. International Classification of Functioning, Disability, and Health: Children & Youth Version: ICF-CY. World Health Organization (2007).
11.
ParkJChungY. The effects of robot-assisted gait training using virtual reality and auditory stimulation on balance and gait abilities in persons with stroke. Neurorehabilitation. (2018) 43:1–9. 10.3233/NRE-172415
12.
DaunoravicieneKAdomavicieneAGrigonyteAGriškevičiusJJuoceviciusA. Effects of robot-assisted training on upper limb functional recovery during the rehabilitation of poststroke patients. Technol Health Care. (2018) 26:533–42. 10.3233/THC-182500
13.
VillafañeJHTaveggiaGGaleriSBissolottiLMullèCImperioGet al. Efficacy of short-term robot-assisted rehabilitation in patients with hand paralysis after stroke: a randomized clinical trial. Hand. (2018) 13:95–102. 10.1177/1558944717692096
14.
HanEYImSHKimBRSeoMJKimMO. Robot-assisted gait training improves brachial-ankle pulse wave velocity and peak aerobic capacity in subacute stroke patients with totally dependent ambulation: randomized controlled trial. Medicine. (2016) 95:e5078. 10.1097/MD.0000000000005078
15.
MoroneGAnnicchiaricoRIosaMFedericiAPaolucciSCortésUet al. Overground walking training with the i-Walker, a robotic servo-assistive device, enhances balance in patients with subacute stroke: a randomized controlled trial. J Neuroeng Rehabil. (2016) 13:47. 10.1186/s12984-016-0155-4
16.
StraudiSFregniFMartinuzziCPavarelliCSalvioliSBasagliaN. tDCS and robotics on upper limb stroke rehabilitation: effect modification by stroke duration and type of stroke. BioMed Res Int. (2016) 2016:5068127. 10.1155/2016/5068127
17.
LeeY-YLinK-CChengH-JWuC-YHsiehY-WChenC-K. Effects of combining robot-assisted therapy with neuromuscular electrical stimulation on motor impairment, motor and daily function, and quality of life in patients with chronic stroke: a double-blinded randomized controlled trial. J Neuroeng Rehabil. (2015) 12:96. 10.1186/s12984-015-0088-3
18.
HuX-LTongRK-YHoNSXueJ-JRongWLiLS. Wrist rehabilitation assisted by an electromyography-driven neuromuscular electrical stimulation robot after stroke. Neurorehabil Neural Repair. (2015) 29:767–76. 10.1177/1545968314565510
19.
SalePFranceschiniMMazzoleniSPalmaEAgostiMPosteraroF. Effects of upper limb robot-assisted therapy on motor recovery in subacute stroke patients. J Neuroeng Rehabil. (2014) 11:104. 10.1186/1743-0003-11-104
20.
LemmensRJTimmermansAAJanssen-PottenYJPullesSAGeersRPBakxWGet al. Accelerometry measuring the outcome of robot-supported upper limb training in chronic stroke: a randomized controlled trial. PLoS ONE. (2014) 9:e96414. 10.1371/journal.pone.0096414
21.
SalePMazzoleniSLombardiVGalafateDMassimianiMPPosteraroFet al. Recovery of hand function with robot-assisted therapy in acute stroke patients: a randomized-controlled trial. Int J Rehabil Res. (2014) 37:236–42. 10.1097/MRR.0000000000000059
22.
AngKKChuaKSGPhuaKSWangCChinZYKuahCWKet al. A randomized controlled trial of EEG-based motor imagery brain-computer interface robotic rehabilitation for stroke. Clin EEG Neurosci. (2015) 46:310–20. 10.1177/1550059414522229
23.
HsiehY-WLinK-CHorngY-SWuC-YWuT-CKuF-L. Sequential combination of robot-assisted therapy and constraint-induced therapy in stroke rehabilitation: a randomized controlled trial. J Neurol. (2014) 261:1037–45. 10.1007/s00415-014-7345-4
24.
TimmermansAALemmensRJMonfranceMGeersRPBakxWSmeetsRJet al. Effects of task-oriented robot training on arm function, activity, and quality of life in chronic stroke patients: a randomized controlled trial. J Neuroeng Rehabil. (2014) 11:45. 10.1186/1743-0003-11-45
25.
HesseSHeßAWernerCCKabbertNBuschfortR. Effect on arm function and cost of robot-assisted group therapy in subacute patients with stroke and a moderately to severely affected arm: a randomized controlled trial. Clin Rehabil. (2014) 28:637–47. 10.1177/0269215513516967
26.
BrokawEBNicholsDHolleyRJLumPS. Robotic therapy provides a stimulus for upper limb motor recovery after stroke that is complementary to and distinct from conventional therapy. Neurorehabil Neural Repair. (2014) 28:367–76. 10.1177/1545968313510974
27.
AbdollahiFCase LazarroEDListenbergerMKenyonRVKovicMBogeyRAet al. Error augmentation enhancing arm recovery in individuals with chronic stroke: a randomized crossover design. Neurorehabil Neural Repair. (2014) 28:120–8. 10.1177/1545968313498649
28.
WuC-YYangC-LLinK-CWuL-L. Unilateral versus bilateral robot-assisted rehabilitation on arm-trunk control and functions post stroke: a randomized controlled trial. J Neuroeng Rehabil. (2013) 10:35. 10.1186/1743-0003-10-35
29.
OchiMSaekiSOdaTMatsushimaYHachisukaK. Effects of anodal and cathodal transcranial direct current stimulation combined with robotic therapy on severely affected arms in chronic stroke patients. J Rehabil Med. (2013) 45:137–40. 10.2340/16501977-1099
30.
KelleyCPChildressJBoakeCNoserEA. Over-ground and robotic-assisted locomotor training in adults with chronic stroke: a blinded randomized clinical trial. Disabil Rehabil Assist Technol. (2013) 8:161–8. 10.3109/17483107.2012.714052
31.
HsiehY-WWuC-YLinK-CYaoGWuK-YChangY-J. Dose-response relationship of robot-assisted stroke motor rehabilitation: the impact of initial motor status. Stroke. (2012) 43:2729–34. 10.1161/STROKEAHA.112.658807
32.
KimHMillerLMFedulowISimkinsMAbramsGMBylNet al. Kinematic data analysis for post-stroke patients following bilateral versus unilateral rehabilitation with an upper limb wearable robotic system. IEEE Trans Neural Syst Rehabil Eng. (2012) 21:153–64. 10.1109/TNSRE.2012.2207462
33.
WuC-YYangC-LChuangL-LLinK-CChenH-CChenM-Det al. Effect of therapist-based versus robot-assisted bilateral arm training on motor control, functional performance, and quality of life after chronic stroke: a clinical trial. Phys Ther. (2012) 92:1006–16. 10.2522/ptj.20110282
34.
ChangWHKimMSHuhJPLeePKKimY-H. Effects of robot-assisted gait training on cardiopulmonary fitness in subacute stroke patients: a randomized controlled study. Neurorehabil Neural Repair. (2012) 26:318–24. 10.1177/1545968311408916
35.
AbdullahHATarryCLambertCBarrecaSAllenBO. Results of clinicians using a therapeutic robotic system in an inpatient stroke rehabilitation unit. J Neuroeng Rehabil. (2011) 8:50. 10.1186/1743-0003-8-50
36.
ConroySSWhitallJDipietroLJones-LushLMZhanMFinleyMAet al. Effect of gravity on robot-assisted motor training after chronic stroke: a randomized trial. Arch Phys Med Rehabil. (2011) 92:1754–61. 10.1016/j.apmr.2011.06.016
37.
LiaoW-WWuC-YHsiehY-WLinK-CChangW-Y. Effects of robot-assisted upper limb rehabilitation on daily function and real-world arm activity in patients with chronic stroke: a randomized controlled trial. Clin Rehabil. (2012) 26:111–20. 10.1177/0269215511416383
38.
WagnerTHLoACPeduzziPBravataDMHuangGDKrebsHIet al. An economic analysis of robot-assisted therapy for long-term upper-limb impairment after stroke. Stroke. (2011) 42:2630–2. 10.1161/STROKEAHA.110.606442
39.
BurgarCGLumPSScreminAGarberSLVan der LoosHKenneyDet al. Robot-assisted upper-limb therapy in acute rehabilitation setting following stroke: Department of Veterans Affairs multisite clinical trial. J Rehabil Res Dev. (2011) 48:445–58. 10.1682/JRRD.2010.04.0062
40.
MoroneGBragoniMIosaMDe AngelisDVenturieroVCoiroPet al. Who may benefit from robotic-assisted gait training? A randomized clinical trial in patients with subacute stroke. Neurorehabil Neural Repair. (2011) 25:636–44. 10.1177/1545968311401034
41.
EmaraTHMoustafaRRElnahasNMElganzouryAMAbdoTAMohamedSAet al. Repetitive transcranial magnetic stimulation at 1Hz and 5Hz produces sustained improvement in motor function and disability after ischaemic stroke. Eur J Neurol. (2010) 17:1203–9. 10.1111/j.1468-1331.2010.03000.x
42.
MirelmanAPatrittiBLBonatoPDeutschJE. Effects of virtual reality training on gait biomechanics of individuals post-stroke. Gait Posture. (2010) 31:433–7. 10.1016/j.gaitpost.2010.01.016
43.
KutnerNGZhangRButlerAJWolfSLAlbertsJL. Quality-of-life change associated with robotic-assisted therapy to improve hand motor function in patients with subacute stroke: a randomized clinical trial. Phys Ther. (2010) 90:493–504. 10.2522/ptj.20090160
44.
SchwartzISajinAFisherINeebMShochinaMKatz-LeurerMet al. The effectiveness of locomotor therapy using robotic-assisted gait training in subacute stroke patients: a randomized controlled trial. PMR. (2009) 1:516–23. 10.1016/j.pmrj.2009.03.009
45.
HidlerJNicholsDPelliccioMBradyKCampbellDDKahnJHet al. Multicenter randomized clinical trial evaluating the effectiveness of the lokomat in subacute stroke. Neurorehabil Neural Repair. (2009) 23:5–13. 10.1177/1545968308326632
46.
HornbyTGCampbellDDKahnJHDemottTMooreJLRothHR. Enhanced gait-related improvements after therapist-versus robotic-assisted locomotor training in subjects with chronic stroke: a randomized controlled study. Stroke. (2008) 39:1786–92. 10.1161/STROKEAHA.107.504779
47.
VolpeBTLynchDRykman-BerlandAFerraroMGalganoMHoganNet al. Intensive sensorimotor arm training mediated by therapist or robot improves hemiparesis in patients with chronic stroke. Neurorehabil Neural Repair. (2008) 22:305–10. 10.1177/1545968307311102
48.
LumPSBurgarCGVan der LoosMShorPC. MIME robotic device for upper-limb neurorehabilitation in subacute stroke subjects: a follow-up study. J Rehabil Res Dev. (2006) 43:631. 10.1682/JRRD.2005.02.0044
49.
FasoliSEKrebsHIFerraroMHoganNVolpeBT. Does shorter rehabilitation limit potential recovery poststroke?Neurorehabil Neural Repair. (2004) 18:88–94. 10.1177/0888439004267434
50.
FasoliSEKrebsHISteinJFronteraWRHoganN. Effects of robotic therapy on motor impairment and recovery in chronic stroke. Arch Phys Med Rehabil. (2003) 84:477–82. 10.1053/apmr.2003.50110
51.
KlomjaiWAneksanBPheungphrarattanatraiAChantanachaiTChoowongNBunleukhetSet al. Effect of single-session dual-tDCS before physical therapy on lower-limb performance in sub-acute stroke patients: a randomized sham-controlled crossover study. Ann Phys Rehabil Med. (2018) 61:286–91. 10.1016/j.rehab.2018.04.005
52.
ManjiAAmimotoKMatsudaTWadaYInabaAKoS. Effects of transcranial direct current stimulation over the supplementary motor area body weight-supported treadmill gait training in hemiparetic patients after stroke. Neurosci Lett. (2018) 662:302–5. 10.1016/j.neulet.2017.10.049
53.
OveisgharanSOrganjiHGhorbaniA. Enhancement of motor recovery through left dorsolateral prefrontal cortex stimulation after acute ischemic stroke. J Stroke Cerebrovasc Dis. (2018) 27:185–91. 10.1016/j.jstrokecerebrovasdis.2017.08.026
54.
FanJVoisinJMilotMHHigginsJBoudriasMH. Transcranial direct current stimulation over multiple days enhances motor performance of a grip task. Ann Phys Rehabil Med. (2017) 60:329–333. 10.1016/j.rehab.2017.07.001
55.
KohC-LLinJ-HJengJ-SHuangS-LHsiehC-L. Effects of transcranial direct current stimulation with sensory modulation on stroke motor rehabilitation: a randomized controlled trial. Arch Phys Med Rehabil. (2017) 98:2477–84. 10.1016/j.apmr.2017.05.025
56.
IlićNVDubljanin-RaspopovićENedeljkovićUTomanović-VujadinovićSMilanovićSDPetronić-MarkovićIet al. Effects of anodal tDCS and occupational therapy on fine motor skill deficits in patients with chronic stroke. Restor Neurol Neurosci. (2016) 34:935–45. 10.3233/RNN-160668
57.
AllmanCAmadiUWinklerAMWilkinsLFilippiniNKischkaUet al. Ipsilesional anodal tDCS enhances the functional benefits of rehabilitation in patients after stroke. Sci Transl Med. (2016) 8:330re1. 10.1126/scitranslmed.aad5651
58.
Au-YeungSSWangJChenYChuaE. Transcranial direct current stimulation to primary motor area improves hand dexterity and selective attention in chronic stroke. Am J Phys Med Rehabil. (2014) 93:1057–64. 10.1097/PHM.0000000000000127
59.
WuDQianLZorowitzRDZhangLQuYYuanY. Effects on decreasing upper-limb poststroke muscle tone using transcranial direct current stimulation: a randomized sham-controlled study. Arch Phys Med Rehabil. (2013) 94:1–8. 10.1016/j.apmr.2012.07.022
60.
ZimermanMHeiseKFHoppeJCohenLGGerloffCHummelFC. Modulation of training by single-session transcranial direct current stimulation to the intact motor cortex enhances motor skill acquisition of the paretic hand. Stroke. (2012) 43:2185–91. 10.1161/STROKEAHA.111.645382
61.
NairDGRengaVLindenbergRZhuLSchlaugG. Optimizing recovery potential through simultaneous occupational therapy and non-invasive brain-stimulation using tDCS. Restor Neurol Neurosci. (2011) 29:411–20. 10.3233/RNN-2011-0612
62.
YouDSKimD-YChunMHJungSEParkSJ. Cathodal transcranial direct current stimulation of the right Wernicke's area improves comprehension in subacute stroke patients. Brain Lang. (2011) 119:1–5. 10.1016/j.bandl.2011.05.002
63.
LindenbergRRengaVZhuLNairDSchlaugG. Bihemispheric brain stimulation facilitates motor recovery in chronic stroke patients. Neurology. (2010) 75:2176–84. 10.1212/WNL.0b013e318202013a
64.
KimD-YLimJ-YKangEKYouDSOhM-KOhB-Met al. Effect of transcranial direct current stimulation on motor recovery in patients with subacute stroke. Am J Phys Med Rehabil. (2010) 89:879–86. 10.1097/PHM.0b013e3181f70aa7
65.
FiglewskiKBlicherJUMortensenJSeverinsenKENielsenJFAndersenH. Transcranial direct current stimulation potentiates improvements in functional ability in patients with chronic stroke receiving constraint-induced movement therapy. Stroke. (2017) 48:229–32. 10.1161/STROKEAHA.116.014988
66.
HuXYZhangTRajahGBStoneCLiuLXHeJJet al. Effects of different frequencies of repetitive transcranial magnetic stimulation in stroke patients with non-fluent aphasia: a randomized, sham-controlled study. Neurol Res. (2018) 40:459–65. 10.1080/01616412.2018.1453980
67.
LongHWangHZhaoCDuanQFengFHuiNet al. Effects of combining high-and low-frequency repetitive transcranial magnetic stimulation on upper limb hemiparesis in the early phase of stroke. Restor Neurol Neurosci. (2018) 36:21–30. 10.3233/RNN-170733
68.
KimJYimJ. Effects of high-frequency repetitive transcranial magnetic stimulation combined with task-oriented mirror therapy training on hand rehabilitation of acute stroke patients. Med Sci Mon. (2018) 24:743. 10.12659/MSM.905636
69.
ChervyakovAVPoydashevaAGLyukmanovRHSuponevaNAChernikovaLAPiradovMAet al. Effects of navigated repetitive transcranial magnetic stimulation after stroke. J Clin Neurophys. (2018) 35:166–72. 10.1097/WNP.0000000000000456
70.
WatanabeKKudoYSugawaraENakamizoTAmariKTakahashiKet al. Comparative study of ipsilesional and contralesional repetitive transcranial magnetic stimulations for acute infarction. J Neurol Sci. (2018) 384:10–4. 10.1016/j.jns.2017.11.001
71.
AşkinATosunADemirdalÜS. Effects of low-frequency repetitive transcranial magnetic stimulation on upper extremity motor recovery and functional outcomes in chronic stroke patients: A randomized controlled trial. Somatosens Mot Res. (2017) 34:102–7. 10.1080/08990220.2017.1316254
72.
ChoJYLeeAKimMSParkEChangWHShinY-Iet al. Dual-mode noninvasive brain stimulation over the bilateral primary motor cortices in stroke patients. Restor Neurol Neurosci. (2017) 35:105–14. 10.3233/RNN-160669
73.
ChaHGKimMK. Effects of strengthening exercise integrated repetitive transcranial magnetic stimulation on motor function recovery in subacute stroke patients: a randomized controlled trial. Technol Health Care. (2017) 25:521–9. 10.3233/THC-171294
74.
DuJTianLLiuWHuJXuGMaMet al. Effects of repetitive transcranial magnetic stimulation on motor recovery and motor cortex excitability in patients with stroke: a randomized controlled trial. Eur J Neurol. (2016) 23:1666–72. 10.1111/ene.13105
75.
ZhengC-JLiaoW-JXiaW-G. Effect of combined low-frequency repetitive transcranial magnetic stimulation and virtual reality training on upper limb function in subacute stroke: a double-blind randomized controlled trail. J Huazhong Univ Sci Technol. (2015) 35:248–54. 10.1007/s11596-015-1419-0
76.
WangC-PHsiehC-YTsaiP-YWangC-TLinF-GChanR-C. Efficacy of synchronous verbal training during repetitive transcranial magnetic stimulation in patients with chronic aphasia. Stroke. (2014) 45:3656–62. 10.1161/STROKEAHA.114.007058
77.
WangC-CWangC-PTsaiP-YHsiehC-YChanR-CYehS-C. Inhibitory repetitive transcranial magnetic stimulation of the contralesional premotor and primary motor cortices facilitate poststroke motor recovery. Restor Neurol Neurosci. (2014) 32:825–35. 10.3233/RNN-140410
78.
KhedrEMAboEl-Fetoh NAliAMEl-HammadyDHKhalifaHAttaHet al. Dual-hemisphere repetitive transcranial magnetic stimulation for rehabilitation of poststroke aphasia: a randomized, double-blind clinical trial. Neurorehabil Neural Repair. (2014) 28:740–50. 10.1177/1545968314521009
79.
GalvãoSCBDos SantosRBCDos SantosPBCabralMEMonte-SilvaK. Efficacy of coupling repetitive transcranial magnetic stimulation and physical therapy to reduce upper-limb spasticity in patients with stroke: a randomized controlled trial. Arch Phys Med Rehabil. (2014) 95:222–9. 10.1016/j.apmr.2013.10.023
80.
AboMKakudaWMomosakiRHarashimaHKojimaMWatanabeSet al. Randomized, multicenter, comparative study of NEURO versus CIMT in poststroke patients with upper limb hemiparesis: the NEURO-VERIFY Study. Int J Stroke. (2014) 9:607–12. 10.1111/ijs.12100
81.
BarwoodCHMurdochBERiekSO'SullivanJDWongALloydDet al. Long term language recovery subsequent to low frequency rTMS in chronic non-fluent aphasia. Neurorehabilitation. (2013) 32:915–28. 10.3233/NRE-130915
82.
ThielAHartmannARubi-FessenIAngladeCKrachtLWeiduschatNet al. Effects of noninvasive brain stimulation on language networks and recovery in early poststroke aphasia. Stroke. (2013) 44:2240–6. 10.1161/STROKEAHA.111.000574
83.
SungW-HWangC-PChouC-LChenY-CChangY-CTsaiP-Y. Efficacy of coupling inhibitory and facilitatory repetitive transcranial magnetic stimulation to enhance motor recovery in hemiplegic stroke patients. Stroke. (2013) 44:1375–82. 10.1161/STROKEAHA.111.000522
84.
WaldowskiKSeniówJLeśniakMIwańskiSCzłonkowskaA. Effect of low-frequency repetitive transcranial magnetic stimulation on naming abilities in early-stroke aphasic patients: a prospective, randomized, double-blind sham-controlled study. Scientific World J. (2012) 2012:518568. 10.1100/2012/518568
85.
SeniówJBilikMLeśniakMWaldowskiKIwanskiSCzłonkowskaA. Transcranial magnetic stimulation combined with physiotherapy in rehabilitation of poststroke hemiparesis: a randomized, double-blind, placebo-controlled study. Neurorehabil Neural Repair. (2012) 26:1072–9. 10.1177/1545968312445635
86.
SasakiNMizutaniSKakudaWAboM. Comparison of the effects of high-and low-frequency repetitive transcranial magnetic stimulation on upper limb hemiparesis in the early phase of stroke. J Stroke Cerebrovasc Dis. (2013) 22:413–8. 10.1016/j.jstrokecerebrovasdis.2011.10.004
87.
WangR-YTsengH-YLiaoK-KWangC-JLaiK-LYangY-R. rTMS combined with task-oriented training to improve symmetry of interhemispheric corticomotor excitability and gait performance after stroke: a randomized trial. Neurorehabil Neural Repair. (2012) 26:222–30. 10.1177/1545968311423265
88.
MarconiBFilippiGMKochGGiacobbeVPecchioliCVersaceVet al. Long-term effects on cortical excitability and motor recovery induced by repeated muscle vibration in chronic stroke patients. Neurorehabil Neural Repair. (2011) 25:48–60. 10.1177/1545968310376757
89.
ChangWHKimY-HBangOYKimSTParkYHLeePK. Long-term effects of rTMS on motor recovery in patients after subacute stroke. J Rehabil Med. (2010) 42:758–64. 10.2340/16501977-0590
90.
KimBRKimD-YChunMHYiJHKwonJS. Effect of repetitive transcranial magnetic stimulation on cognition and mood in stroke patients: a double-blind, sham-controlled trial. Am J Phys Med Rehabil. (2010) 89:362–8. 10.1097/PHM.0b013e3181d8a5b1
91.
KhedrEMAbo-ElfetohN. Therapeutic role of rTMS on recovery of dysphagia in patients with lateral medullary syndrome and brainstem infarction. J Neurol Neurosurg Psychiatry. (2010) 81:495–9. 10.1136/jnnp.2009.188482
92.
KhedrEAbdel-FadeilMFarghaliAQaidM. Role of 1 and 3 Hz repetitive transcranial magnetic stimulation on motor function recovery after acute ischaemic stroke. Eur J Neurol. (2009) 16:1323–30. 10.1111/j.1468-1331.2009.02746.x
93.
TakeuchiNTadaTToshimaMChumaTMatsuoYIkomaK. Inhibition of the unaffected motor cortex by 1 Hz repetitive transcranial magnetic stimulation enhances motor performance and training effect of the paretic hand in patients with chronic stroke. J Rehabil Med. (2008) 40:298–303. 10.2340/16501977-0181
94.
TakeuchiNChumaTMatsuoYWatanabeIIkomaK. Repetitive transcranial magnetic stimulation of contralesional primary motor cortex improves hand function after stroke. Stroke. (2005) 36:2681–6. 10.1161/01.STR.0000189658.51972.34
95.
GaneshGSKumariRPattnaikMMohantyPMishraCKaurPet al. Effectiveness of Faradic and Russian currents on plantar flexor muscle spasticity, ankle motor recovery, and functional gait in stroke patients. Physiother Res Int. (2018) 23:e1705. 10.1002/pri.1705
96.
DujovićSDMaleševićJMaleševićNVidakovićASBijelićGKellerTet al. Novel multi-pad functional electrical stimulation in stroke patients: a single-blind randomized study. Neurorehabilitation. (2017) 41:791–800. 10.3233/NRE-172153
97.
Marquez-ChinCBagherSZivanovicVPopovicMR. Functional electrical stimulation therapy for severe hemiplegia: randomized control trial revisited: la simulation électrique fonctionnelle pour le traitement d'une hémiplégie sévère: un essai clinique aléatoire revisité. CJOT. (2017) 84:87–97. 10.1177/0008417416668370
98.
KnutsonJSGunzlerDDWilsonRDChaeJ. Contralaterally controlled functional electrical stimulation improves hand dexterity in chronic hemiparesis: a randomized trial. Stroke. (2016) 47:2596–602. 10.1161/STROKEAHA.116.013791
99.
CarricoCCheletteKCIIWestgatePMSalmon-PowellENicholsLSawakiL. A randomized trial of peripheral nerve stimulation to enhance modified constraint-induced therapy after stroke. Am J Phys Med Rehabil. (2016) 95:397. 10.1097/PHM.0000000000000476
100.
JangYYKimTHLeeBH. Effects of brain-computer interface-controlled functional electrical stimulation training on shoulder subluxation for patients with stroke: a randomized controlled trial. Occup Ther Int. (2016) 23:175–85. 10.1002/oti.1422
101.
KimTKimSLeeB. Effects of action observational training plus brain-computer interface-based functional electrical stimulation on paretic arm motor recovery in patient with stroke: a randomized controlled trial. Occup Ther Int. (2016) 23:39–47. 10.1002/oti.1403
102.
BethouxFRogersHLNolanKJAbramsGMAnnaswamyTBrandstaterMet al. Long-term follow-up to a randomized controlled trial comparing peroneal nerve functional electrical stimulation to an ankle foot orthosis for patients with chronic stroke. Neurorehabil Neural Repair. (2015) 29:911–22. 10.1177/1545968315570325
103.
ChenDYanTLiGLiFLiangQ. Functional electrical stimulation based on a working pattern influences function of lower extremity in subjects with early stroke and effects on diffusion tensor imaging: a randomized controlled trial. Zhonghua Yi Xue Za Zhi. (2014) 94:2886–92.
104.
BethouxFRogersHLNolanKJAbramsGMAnnaswamyTMBrandstaterMet al. The effects of peroneal nerve functional electrical stimulation versus ankle-foot orthosis in patients with chronic stroke: a randomized controlled trial. Neurorehabil Neural Repair. (2014) 28:688–97. 10.1177/1545968314521007
105.
KimHLeeGSongC. Effect of functional electrical stimulation with mirror therapy on upper extremity motor function in poststroke patients. J Stroke Cerebrovasc Dis. (2014) 23:655–61. 10.1016/j.jstrokecerebrovasdis.2013.06.017
106.
LoH-CHsuY-CHsuehY-HYehC-Y. Cycling exercise with functional electrical stimulation improves postural control in stroke patients. Gait Posture. (2012) 35:506–10. 10.1016/j.gaitpost.2011.11.017
107.
SolopovaITihonovaDGrishinAIvanenkoY. Assisted leg displacements and progressive loading by a tilt table combined with FES promote gait recovery in acute stroke. Neurorehabilitation. (2011) 29:67–77. 10.3233/NRE-2011-0679
108.
KnutsonJSHarleyMYHiselTZHoganSDMaloneyMMChaeJ. Contralaterally controlled functional electrical stimulation for upper extremity hemiplegia: an early-phase randomized clinical trial in subacute stroke patients. Neurorehabil Neural Repair. (2012) 26:239–46. 10.1177/1545968311419301
109.
AmbrosiniEFerranteSFerrignoGMolteniFPedrocchiA. Cycling induced by electrical stimulation improves muscle activation and symmetry during pedaling in hemiparetic patients. IEEE Trans Neural Syst Rehabil Eng. (2012) 20:320–30. 10.1109/TNSRE.2012.2191574.22514205
110.
EmbreyDGHoltzSLAlonGBrandsmaBAMcCoySW. Functional electrical stimulation to dorsiflexors and plantar flexors during gait to improve walking in adults with chronic hemiplegia. Arch Phys Med Rehabil. (2010) 91:687–96. 10.1016/j.apmr.2009.12.024
111.
YanTHui-ChanCWLiLS. Functional electrical stimulation improves motor recovery of the lower extremity and walking ability of subjects with first acute stroke: a randomized placebo-controlled trial. Stroke. (2005) 36:80–5. 10.1161/01.STR.0000149623.24906.63
112.
BurridgeJTaylorPHaganSWoodDESwainID. The effects of common peroneal stimulation on the effort and speed of walking: a randomized controlled trial with chronic hemiplegic patients. Clin Rehabil. (1997) 11:201–10. 10.1177/026921559701100303
113.
ChoiY-HPaikN-J. Mobile game-based virtual reality program for upper extremity stroke rehabilitation. J Vis Exp. (2018) 2018:e56241. 10.3791/56241
114.
AşkinAAtarEKoçyigitHTosunA. Effects of Kinect-based virtual reality game training on upper extremity motor recovery in chronic stroke. Somatosen Mot Res. (2018) 35:25–32. 10.1080/08990220.2018.1444599
115.
CalabròRSNaroARussoMLeoADe LucaRBallettaTet al. The role of virtual reality in improving motor performance as revealed by EEG: a randomized clinical trial. J Neuroeng Rehabil. (2017) 14:53. 10.1186/s12984-017-0268-4
116.
FariaALAndradeASoaresLBadiaSB. Benefits of virtual reality based cognitive rehabilitation through simulated activities of daily living: a randomized controlled trial with stroke patients. J Neuroeng Rehabil. (2016) 13:96. 10.1186/s12984-016-0204-z
117.
InTLeeKSongC. Virtual reality reflection therapy improves balance and gait in patients with chronic stroke: randomized controlled trials. Med Sci Monit. (2016) 22:4046. 10.12659/MSM.898157
118.
LeeSKimYLeeBH. Effect of virtual reality-based bilateral upper extremity training on upper extremity function after stroke: a randomized controlled clinical trial. Occup Ther Int. (2016) 23:357–68. 10.1002/oti.1437
119.
ChoiY-HKuJLimHKimYHPaikN-J. Mobile game-based virtual reality rehabilitation program for upper limb dysfunction after ischemic stroke. Restor Neurol Neurosci. (2016) 34:455–63. 10.3233/RNN-150626
120.
KongK-HLohY-JThiaEChaiANgC-YSohY-Met al. Efficacy of a virtual reality commercial gaming device in upper limb recovery after stroke: a randomized, controlled study. Top Stroke Rehabil. (2016) 23:333–40. 10.1080/10749357.2016.1139796
121.
ChoKHKimMKLeeH-JLeeWH. Virtual reality training with cognitive load improves walking function in chronic stroke patients. Tohoku J Exp Med. (2015) 236:273–80. 10.1620/tjem.236.273
122.
McEwenDTaillon-HobsonABilodeauMSveistrupHFinestoneH. Virtual reality exercise improves mobility after stroke: an inpatient randomized controlled trial. Stroke. (2014) 45:1853–5. 10.1161/STROKEAHA.114.005362
123.
ChoKHLeeKJSongCH. Virtual-reality balance training with a video-game system improves dynamic balance in chronic stroke patients. Tohoku J Exp Med. (2012) 228:69–74. 10.1620/tjem.228.69
124.
SubramanianSKLourençoCBChilingaryanGSveistrupHLevinMF. Arm motor recovery using a virtual reality intervention in chronic stroke: randomized control trial. Neurorehabil Neural Repair. (2013) 27:13–23. 10.1177/1545968312449695
125.
KiperPPironLTurollaAStozekJToninP. The effectiveness of reinforced feedback in virtual environment in the first 12 months after stroke. Neurol Neurochir Polska. (2011) 45:436–44. 10.1016/S0028-3843(14)60311-X
126.
YangSHwangWHTsaiYCLiuFKHsiehLFChernJS. Improving balance skills in patients who had stroke through virtual reality treadmill training. Am J Phys Med Rehabil. (2011) 90:969–78. 10.1097/PHM.0b013e3182389fae
127.
KimJHJangSHKimCSJungJHYouJH. Use of virtual reality to enhance balance and ambulation in chronic stroke: a double-blind, randomized controlled study. Am J Phys Med Rehabil. (2009) 88:693–701. 10.1097/PHM.0b013e3181b33350
128.
BroerenJClaessonLGoudeDRydmarkMSunnerhagenKS. Virtual rehabilitation in an activity centre for community-dwelling persons with stroke. Cerebrovasc Dis. (2008) 26:289–96. 10.1159/000149576
129.
YouSHJangSHKimY-HHallettMAhnSHKwonY-Het al. Virtual reality-induced cortical reorganization and associated locomotor recovery in chronic stroke: an experimenter-blind randomized study. Stroke. (2005) 36:1166–71. 10.1161/01.STR.0000162715.43417.91
130.
RandDGivonNAvrech BarM. A video-game group intervention: Experiences and perceptions of adults with chronic stroke and their therapists: intervention de groupe à l'aide de jeux vidéo: expériences et perceptions d'adultes en phase chronique d'un accident vasculaire cérébral et de leurs ergothérapeutes. Can J Occup Ther. (2018) 85:158–68. 10.1177/0008417417733274
131.
DalalKKJoshuaAMNayakAMithraPMisriZUnnikrishnanB. Effectiveness of prowling with proprioceptive training on knee hyperextension among stroke subjects using videographic observation-a randomised controlled trial. Gait Posture. (2018) 61:232–7. 10.1016/j.gaitpost.2018.01.018
132.
EmmersonKBHardingKETaylorNF. Home exercise programmes supported by video and automated reminders compared with standard paper-based home exercise programmes in patients with stroke: a randomized controlled trial. Clin Rehabil. (2017) 31:1068–77. 10.1177/0269215516680856
133.
GamaGLCelestinoMLBarelaJAForresterLWhitallJBarelaAM. Effects of gait training with body weight support on a treadmill versus overground in individuals with stroke. Arch Phys Med Rehabil. (2017) 98:738–45. 10.1016/j.apmr.2016.11.022
134.
SrivastavaATalyABGuptaAKumarSMuraliT. Bodyweight-supported treadmill training for retraining gait among chronic stroke survivors: A randomized controlled study. Ann Phys Rehabil Med. (2016) 59:235–41. 10.1016/j.rehab.2016.01.014
135.
MacKay-LyonsMMcDonaldAMathesonJEskesGKlusM-A. Dual effects of body-weight supported treadmill training on cardiovascular fitness and walking ability early after stroke: a randomized controlled trial. Neurorehabil Neural Repair. (2013) 27:644–53. 10.1177/1545968313484809
136.
NadeauSEWuSSDobkinBHAzenSPRoseDKTilsonJKet al. Effects of task-specific and impairment-based training compared with usual care on functional walking ability after inpatient stroke rehabilitation: LEAPS Trial. Neurorehabil Neural Repair. (2013) 27:370–80. 10.1177/1545968313481284
137.
HøyerEJahnsenRStanghelleJKStrandLI. Body weight supported treadmill training versus traditional training in patients dependent on walking assistance after stroke: a randomized controlled trial. Disab Rehabil. (2012) 34:210–9. 10.3109/09638288.2011.593681
138.
DuncanPSullivanKBehrmanAAzenSWuSNadeauSet al. LEAPS investigative team. Body-weight-supported treadmill rehabilitation after stroke. N Engl J Med. (2011) 364:2026–36. 10.1056/NEJMoa1010790
139.
DalyJJZimbelmanJRoenigkKLMcCabeJPRogersJMButlerKet al. Recovery of coordinated gait: randomized controlled stroke trial of functional electrical stimulation (FES) versus no FES, with weight-supported treadmill and over-ground training. Neurorehabil Neural Repair. (2011) 25:588–96. 10.1177/1545968311400092
140.
DeanCMAdaLBamptonJMorrisMEKatrakPHPottsS. Treadmill walking with body weight support in subacute non-ambulatory stroke improves walking capacity more than overground walking: a randomised trial. J Physiother. (2010) 56:97–103. 10.1016/S1836-9553(10)70039-4
141.
AdaLDeanCMMorrisMESimpsonJMKatrakP. Randomized trial of treadmill walking with body weight support to establish walking in subacute stroke: the MOBILISE trial. Stroke. (2010) 41:1237–42. 10.1161/STROKEAHA.109.569483
142.
FranceschiniMCardaSAgostiMAntenucciRMalgratiDCisariC. Walking after stroke: what does treadmill training with body weight support add to overground gait training in patients early after stroke? A single-blind, randomized, controlled trial. Stroke. (2009) 40:3079–85. 10.1161/STROKEAHA.109.555540
143.
NilssonLCarlssonJDanielssonAFugl-MeyerAHellströmKKristensenLet al. Walking training of patients with hemiparesis at an early stage after stroke: a comparison of walking training on a treadmill with body weight support and walking training on the ground. Clin Rehabil. (2001) 15:515–27. 10.1191/026921501680425234
144.
ShinJ-HRyuHJangSH. A task-specific interactive game-based virtual reality rehabilitation system for patients with stroke: a usability test and two clinical experiments. J Neuroeng Rehabil. (2014) 11:32. 10.1186/1743-0003-11-32
145.
LiangC-CHsiehT-CLinC-HWeiY-CHsiaoJChenJ-C. Effectiveness of thermal stimulation for the moderately to severely paretic leg after stroke: serial changes at one-year follow-up. Arch Phys Med Rehabil. (2012) 93:1903–10. 10.1016/j.apmr.2012.06.016
146.
LinZYanT. Long-term effectiveness of neuromuscular electrical stimulation for promoting motor recovery of the upper extremity after stroke. J Rehabil Med. (2011) 43:506–10. 10.2340/16501977-0807
147.
HaynerKGibsonGGilesGM. Comparison of constraint-induced movement therapy and bilateral treatment of equal intensity in people with chronic upper-extremity dysfunction after cerebrovascular accident. Am J Occup Ther. (2010) 64:528–39. 10.5014/ajot.2010.08027
148.
LoganPAGladmanJRAveryAWalkerMFDyasJGroomL. Randomised controlled trial of an occupational therapy intervention to increase outdoor mobility after stroke. BMJ. (2004) 329:1372–5. 10.1136/bmj.38264.679560.8F
149.
ParkerCJGladmanJRDrummondAEDeweyMELincolnNBBarerDet al. A multicentre randomized controlled trial of leisure therapy and conventional occupational therapy after stroke. Total study group. Trial of occupational therapy and leisure. Clin Rehabil. (2001) 15:42–52. 10.1191/026921501666968247
150.
NelsonDLKonoskyKFlehartyKWebbRNewerKHazbounVPet al. The effects of an occupationally embedded exercise on bilaterally assisted supination in persons with hemiplegia. Am J Occup Ther. (1996) 50:639–46. 10.5014/ajot.50.8.639
151.
StockRThraneGAnkeAGjoneRAskimT. Early versus late-applied constraint-induced movement therapy: a multisite, randomized controlled trial with a 12-month follow-up. Physiother Res Int. (2018) 23:e1689. 10.1002/pri.1689
152.
DoussoulinAArancibiaMSaizJSilvaALuengoMSalazarAP. Recovering functional independence after a stroke through modified constraint-induced therapy. Neurorehabilitation. (2017) 40:243–9. 10.3233/NRE-161409
153.
LiuKPBalderiKLeungTLYueASLamNCCheungJTet al. A randomized controlled trial of self-regulated modified constraint-induced movement therapy in sub-acute stroke patients. Eur J Neurol. (2016) 23:1351–60. 10.1111/ene.13037
154.
ThraneGAskimTStockRIndredavikBGjoneRErichsenAet al. Efficacy of constraint-induced movement therapy in early stroke rehabilitation: a randomized controlled multisite trial. Neurorehabil Neural Repair. (2015) 29:517–25. 10.1177/1545968314558599
155.
BangD-HShinW-SChoiS-J. The effects of modified constraint-induced movement therapy combined with trunk restraint in subacute stroke: a double-blinded randomized controlled trial. Clin Rehabil. (2015) 29:561–9. 10.1177/0269215514552034
156.
van DeldenAEBeekPJRoerdinkMKwakkelGPeperCE. Unilateral and bilateral upper-limb training interventions after stroke have similar effects on bimanual coupling strength. Neurorehabil Neural Repair. (2015) 29:255–67. 10.1177/1545968314543498
157.
van DeldenAEPeperCENienhuysKNZijpNIBeekPJKwakkelG. Unilateral versus bilateral upper limb training after stroke: the upper limb training after stroke clinical trial. Stroke. (2013) 44:2613–6. 10.1161/STROKEAHA.113.001969
158.
FritzSLPetersDMMerloAMDonleyJ. Active video-gaming effects on balance and mobility in individuals with chronic stroke: a randomized controlled trial. Top Stroke Rehabil. (2013) 20:218–25. 10.1310/tsr2003-218
159.
LangKCThompsonPAWolfSL. The EXCITE Trial: reacquiring upper-extremity task performance with early versus late delivery of constraint therapy. Neurorehabil Neural Repair. (2013) 27:654–63. 10.1177/1545968313481281
160.
TregerIAidinofLLehrerHKalichmanL. Modified constraint-induced movement therapy improved upper limb function in subacute poststroke patients: a small-scale clinical trial. Top Stroke Rehabil. (2012) 19:287–93. 10.1310/tsr1904-287
161.
KrawczykMSidawayMRadwanskaAZaborskaJUjmaRCzłonkowskaA. Effects of sling and voluntary constraint during constraint-induced movement therapy for the arm after stroke: a randomized, prospective, single-centre, blinded observer rated study. Clin Rehabil. (2012) 26:990–8. 10.1177/0269215512442661
162.
BrunnerICSkouenJSStrandLI. Is modified constraint-induced movement therapy more effective than bimanual training in improving arm motor function in the subacute phase post stroke? A randomized controlled trial. Clin Rehabil. (2012) 26:1078–86. 10.1177/0269215512443138
163.
HuseyinsinogluBEOzdinclerARKrespiY. Bobath concept versus constraint-induced movement therapy to improve arm functional recovery in stroke patients: a randomized controlled trial. Clin Rehabil. (2012) 26:705–15. 10.1177/0269215511431903
164.
WuC-YChenY-ALinK-CChaoC-PChenY-T. Constraint-induced therapy with trunk restraint for improving functional outcomes and trunk-arm control after stroke: a randomized controlled trial. Phys Ther. (2012) 92:483–92. 10.2522/ptj.20110213
165.
WangQZhaoJ-LZhuQ-XLiJMengP-P. Comparison of conventional therapy, intensive therapy and modified constraint-induced movement therapy to improve upper extremity function after stroke. J Rehabil Med. (2011) 43:619–25. 10.2340/16501977-0819
166.
WuC-YChuangL-LLinK-CChenH-CTsayP-K. Randomized trial of distributed constraint-induced therapy versus bilateral arm training for the rehabilitation of upper-limb motor control and function after stroke. Neurorehabil Neural Repair. (2011) 25:130–9. 10.1177/1545968310380686
167.
WolfSLThompsonPAWinsteinCJMillerJPBlantonSRNichols-LarsenDSet al. The EXCITE stroke trial: comparing early and delayed constraint-induced movement therapy. Stroke. (2010) 41:2309–15. 10.1161/STROKEAHA.110.588723
168.
LinK-CChungH-YWuC-YLiuH-LHsiehY-WChenI-Het al. Constraint-induced therapy versus control intervention in patients with stroke: a functional magnetic resonance imaging study. Am J Phys Med Rehabil. (2010) 89:177–85. 10.1097/PHM.0b013e3181cf1c78
169.
AzabMAl-JarrahMNazzalMMaayahMAbu SammourMJamousM. Effectiveness of constraint-induced movement therapy (CIMT) as home-based therapy on barthel index in patients with chronic stroke. Top Stroke Rehabil. (2009) 16:207–11. 10.1310/tsr1603-207
170.
DromerickALangCBirkenmeierRWagnerJMillerJVideenTet al. Very early constraint-induced movement during stroke rehabilitation (VECTORS): a single-center RCT. Neurology. (2009) 73:195–201. 10.1212/WNL.0b013e3181ab2b27
171.
BrogårdhCVestlingMSjölundBH. Shortened constraint-induced movement therapy in subacute stroke-no effect of using a restraint: a randomized controlled study with independent observers. J Rehabil Med. (2009) 41:231–6. 10.2340/16501977-0312
172.
LinK-CChangY-FWuC-YChenY-A. Effects of constraint-induced therapy versus bilateral arm training on motor performance, daily functions, and quality of life in stroke survivors. Neurorehabil Neural Rep. (2009) 23:441–8. 10.1177/1545968308328719
173.
LinK-CWuC-YLiuJ-SChenY-THsuC-J. Constraint-induced therapy versus dose-matched control intervention to improve motor ability, basic/extended daily functions, and quality of life in stroke. Neurorehabil Neural Repair. (2009) 23:160–5. 10.1177/1545968308320642
174.
SawakiLButlerAJLengXWassenaarPAMohammadYMBlantonSet al. Constraint-induced movement therapy results in increased motor map area in subjects 3 to 9 months after stroke. Neurorehabil Neural Repair. (2008) 22:505–13. 10.1177/1545968308317531
175.
LinK-CWuC-YLiuJ-S. A randomized controlled trial of constraint-induced movement therapy after stroke. Reconstr Neurosurg. (2008) 101:61–4. 10.1007/978-3-211-78205-7_10
176.
GauthierLVTaubEPerkinsCOrtmannMMarkVWUswatteG. Remodeling the brain plastic structural brain changes produced by different motor therapies after stroke. Stroke. (2008) 39:1520. 10.1161/STROKEAHA.107.502229
177.
PageSJLevinePLeonardASzaflarskiJPKisselaBM. Modified constraint-induced therapy in chronic stroke: results of a single-blinded randomized controlled trial. Phys Ther. (2008) 88:333–40. 10.2522/ptj.20060029
178.
WolfSLWinsteinCJMillerJPThompsonPATaubEUswatteGet al. Retention of upper limb function in stroke survivors who have received constraint-induced movement therapy: the EXCITE randomised trial. Lancet Neurol. (2008) 7:33–40. 10.1016/S1474-4422(07)70294-6
179.
LinKCWuCYWeiTHLeeCYLiuJS. Effects of modified constraint-induced movement therapy on reach-to-grasp movements and functional performance after chronic stroke: a randomized controlled study. Clin Rehabil. (2007) 21:1075–86.
180.
WuC-YChenC-LTangSFLinK-CHuangY-Y. Kinematic and clinical analyses of upper-extremity movements after constraint-induced movement therapy in patients with stroke: a randomized controlled trial. Arch Phys Med Rehabil. (2007) 88:964–70. 10.1016/j.apmr.2007.05.012
181.
WuC-YChenC-LTsaiW-CLinK-CChouS-H. A randomized controlled trial of modified constraint-induced movement therapy for elderly stroke survivors: changes in motor impairment, daily functioning, and quality of life. Arch Phys Med Rehabil. (2007) 88:273–8. 10.1016/j.apmr.2006.11.021
182.
WolfSLWinsteinCJMillerJPTaubEUswatteGMorrisDet al. Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. JAMA. (2006) 296:2095–104. 10.1001/jama.296.17.2095
183.
PageSJSistoSLevinePMcGrathRE. Efficacy of modified constraint-induced movement therapy in chronic stroke: a single-blinded randomized controlled trial. Arch Phys Med Rehabil. (2004) 85:14–8. 10.1016/S0003-9993(03)00481-7
184.
Van der LeeJHWagenaarRCLankhorstGJVogelaarTWDevilléWLBouterLM. Forced use of the upper extremity in chronic stroke patients: results from a single-blind randomized clinical trial. Stroke. (1999) 30:2369–75. 10.1161/01.STR.30.11.2369
185.
AryaKNPandianSPuriV. Mirror illusion for sensori-motor training in stroke: a randomized controlled trial. J Stroke Cerebrovasc Dis. (2018) 27:3236–46. 10.1016/j.jstrokecerebrovasdis.2018.07.012
186.
SchickTSchlakeH-PKalluskyJHohlfeldGSteinmetzMTrippFet al. Synergy effects of combined multichannel EMG-triggered electrical stimulation and mirror therapy in subacute stroke patients with severe or very severe arm/hand paresis. Restor Neurol Neurosci. (2017) 35:319–32. 10.3233/RNN-160710
187.
HarmsenWJBussmannJBSellesRWHurkmansHLRibbersGM. A mirror therapy-based action observation protocol to improve motor learning after stroke. Neurorehabil Neural Repair. (2015) 29:509–16. 10.1177/1545968314558598
188.
SellesRWMichielsenMEBussmannJBStamHJHurkmansHLHeijnenIet al. Effects of a mirror-induced visual illusion on a reaching task in stroke patients: implications for mirror therapy training. Neurorehabil Neural Repair. (2014) 28:652–9. 10.1177/1545968314521005
189.
LinKCHuangPCChenYTWuCYHuangWL. Combining afferent stimulation and mirror therapy for rehabilitating motor function, motor control, ambulation, and daily functions after stroke. Neurorehabil Neural Repair. (2014) 28:153–62. 10.1177/1545968313508468
190.
StinearCMPetoeMAAnwarSBarberPAByblowWD. Bilateral priming accelerates recovery of upper limb function after stroke: a randomized controlled trial. Stroke. (2014) 45:205–10. 10.1161/STROKEAHA.113.003537
191.
WuCYHuangPCChenYTLinKCYangHW. Effects of mirror therapy on motor and sensory recovery in chronic stroke: a randomized controlled trial. Arch Phys Med Rehabil. (2013) 94:1023–30. 10.1016/j.apmr.2013.02.007
192.
ThiemeHBaynMWurgMZangeCPohlMBehrensJ. Mirror therapy for patients with severe arm paresis after stroke–a randomized controlled trial. Clin Rehabil. (2013) 27:314–24. 10.1177/0269215512455651
193.
MichielsenMESellesRWvan der GeestJNEckhardtMYavuzerGStamHJet al. Motor recovery and cortical reorganization after mirror therapy in chronic stroke patients: a phase II randomized controlled trial. Neurorehabil Neural Repair. (2011) 25:223–33. 10.1177/1545968310385127
194.
CacchioADe BlasisEDe BlasisVSantilliVSpaccaG. Mirror therapy in complex regional pain syndrome type 1 of the upper limb in stroke patients. Neurorehabil Neural Repair. (2009) 23:792–9. 10.1177/1545968309335977
195.
DohleCPullenJNakatenAKustJRietzCKarbeH. Mirror therapy promotes recovery from severe hemiparesis: a randomized controlled trial. Neurorehabil Neural Repair. (2009) 23:209–17. 10.1177/1545968308324786
196.
YavuzerGSellesRSezerNSutbeyazSBussmannJBKoseogluFet al. Mirror therapy improves hand function in subacute stroke: a randomized controlled trial. Arch Phys Med Rehabil. (2008) 89:393–8. 10.1016/j.apmr.2007.08.162
197.
SutbeyazSYavuzerGSezerNKoseogluBF. Mirror therapy enhances lower-extremity motor recovery and motor functioning after stroke: a randomized controlled trial. Arch Phys Med Rehabil. (2007) 88:555–9. 10.1016/j.apmr.2007.02.034
198.
AbenLHeijenbrok-KalMHPondsRWBusschbachJJRibbersGM. Long-lasting effects of a new memory self-efficacy training for stroke patients: a randomized controlled trial. Neurorehabil Neural Repair. (2014) 28:199–206. 10.1177/1545968313478487
199.
TimmermansAAVerbuntJAvan WoerdenRMoennekensMPernotDHSeelenHA. Effect of mental practice on the improvement of function and daily activity performance of the upper extremity in patients with subacute stroke: a randomized clinical trial. J Am Med Dir Assoc. (2013) 14:204–12. 10.1016/j.jamda.2012.10.010
200.
RiccioIIolasconGBarillariMGimiglianoRGimiglianoF. Mental practice is effective in upper limb recovery after stroke: a randomized single-blind cross-over study. Eur J Phys Rehabil Med. (2010) 46:19–25.
201.
PageSJLevinePLeonardAC. Effects of mental practice on affected limb use and function in chronic stroke. Arch Phys Med Rehabil. (2005) 86:399–402. 10.1016/j.apmr.2004.10.002
202.
LiuKPChanCCLeeTMHui-ChanCW. Mental imagery for promoting relearning for people after stroke: a randomized controlled trial. Arch Phys Med Rehabil. (2004) 85:1403–8. 10.1016/j.apmr.2003.12.035
203.
KhumsapsiriNSiriphornAPooranawatthanakulKOungphalachaiT. Training using a new multidirectional reach tool improves balance in individuals with stroke. Physiother Res Int. (2018) 23:e1704. 10.1002/pri.1704
204.
JonsdottirJThorsenRAprileIGaleriSSpannocchiGBeghiEet al. Arm rehabilitation in post stroke subjects: a randomized controlled trial on the efficacy of myoelectrically driven FES applied in a task-oriented approach. PLoS ONE. (2017) 12:e0188642. 10.1371/journal.pone.0188642
205.
JungKJungJInTKimTChoH-Y. The influence of task-related training combined with transcutaneous electrical nerve stimulation on paretic upper limb muscle activation in patients with chronic stroke. Neurorehabilitation. (2017) 40:315–23. 10.3233/NRE-161419
206.
FolkertsMAHijmansJMElsinghorstALMulderijYMurgiaADekkerR. Effectiveness and feasibility of eccentric and task-oriented strength training in individuals with stroke. Neurorehabilitation. (2017) 40:459–71. 10.3233/NRE-171433
207.
WilligenburgNWMcNallyMPHewettTEPageSJ. Portable myoelectric brace use increases upper extremity recovery and participation but does not impact kinematics in chronic, poststroke hemiparesis. J Mot Behav. (2017) 49:46–54. 10.1080/00222895.2016.1152220
208.
CarricoCCheletteKCWestgatePMPowellENicholsLFleischerAet al. Nerve stimulation enhances task-oriented training in chronic, severe motor deficit after stroke: a randomized trial. Stroke. (2016) 47:1879–84. 10.1161/STROKEAHA.116.012671
209.
KimSHParkJHJungMYYooEY. Effects of task-oriented training as an added treatment to electromyogram-triggered neuromuscular stimulation on upper extremity function in chronic stroke patients. Occup Ther Int. (2016) 23:165–74. 10.1002/oti.1421
210.
HubbardIJCareyLMBuddTWLeviCMcElduffPHudsonSet al. A randomized controlled trial of the effect of early upper-limb training on stroke recovery and brain activation. Neurorehabil Neural Repair. (2015) 29:703–13. 10.1177/1545968314562647
211.
GharibNMAboumousaAMElowishyAARezk-AllahSSYousefFS. Efficacy of electrical stimulation as an adjunct to repetitive task practice therapy on skilled hand performance in hemiparetic stroke patients: a randomized controlled trial. Clin Rehabil. (2015) 29:355–64. 10.1177/0269215514544131
212.
CruzVTBentoVRuanoLRibeiroDDFontãoLMateusCet al. Motor task performance under vibratory feedback early poststroke: single center, randomized, cross-over, controled clinical trial. Sci Rep. (2014) 4:5670. 10.1038/srep05670
213.
KimTHInTSChoH-Y. Task-related training combined with transcutaneous electrical nerve stimulation promotes upper limb functions in patients with chronic stroke. Tohoku J Exp Med. (2013) 231:93–100. 10.1620/tjem.231.93
214.
ShaughnessyMMichaelKResnickB. Impact of treadmill exercise on efficacy expectations, physical activity, and stroke recovery. J Neurosci Nurs. (2012) 44:27. 10.1097/JNN.0b013e31823ae4b5
215.
VermaRNarayan AryaKGargRSinghT. Task-oriented circuit class training program with motor imagery for gait rehabilitation in poststroke patients: a randomized controlled trial. Top Stroke Rehabil. (2011) 18(Suppl. 1):620–32. 10.1310/tsr18s01-620
216.
YangY-RWangR-YChenY-CKaoM-J. Dual-task exercise improves walking ability in chronic stroke: a randomized controlled trial. Arch Phys Med Rehabil. (2007) 88:1236–40. 10.1016/j.apmr.2007.06.762
217.
HigginsJSalbachNMWood-DauphineeSRichardsCLCôtéRMayoNE. The effect of a task-oriented intervention on arm function in people with stroke: a randomized controlled trial. Clin Rehabil. (2006) 20:296–310. 10.1191/0269215505cr943oa
218.
MichaelsenSMDannenbaumRLevinMF. Task-specific training with trunk restraint on arm recovery in stroke: randomized control trial. Stroke. (2006) 37:186–92. 10.1161/01.STR.0000196940.20446.c9
219.
ChenSCChenYLChenCJLaiCHChiangWHChenWL. Effects of surface electrical stimulation on the muscle-tendon junction of spastic gastrocnemius in stroke patients. Disabil Rehabil. (2005) 27:105–10. 10.1080/09638280400009022
220.
ThielmanGTDeanCMGentileA. Rehabilitation of reaching after stroke: task-related training versus progressive resistive exercise. Arch Phys Med Rehabil. (2004) 85:1613–8. 10.1016/j.apmr.2004.01.028
221.
EomMJChangMYOhDHKimHDHanNMParkJS. Effects of resistance expiratory muscle strength training in elderly patients with dysphagic stroke. Neurorehabilitation. (2017) 41:747–52. 10.3233/NRE-172192
222.
RoseDKNadeauSEWuSSTilsonJKDobkinBHPeiQet al. Locomotor training and strength and balance exercises for walking recovery after stroke: response to number of training sessions. Phys Ther. (2017) 97:1066–74. 10.1093/ptj/pzx079
223.
IveyFMPriorSJHafer-MackoCEKatzelLIMackoRFRyanAS. Strength training for skeletal muscle endurance after stroke. J Stroke Cerebrovasc Dis. (2017) 26:787–94. 10.1016/j.jstrokecerebrovasdis.2016.10.018
224.
Guillén-SolàAMessagi SartorMBofill SolerNDuarteEBarreraMCMarcoE. Respiratory muscle strength training and neuromuscular electrical stimulation in subacute dysphagic stroke patients: a randomized controlled trial. Clin Rehabil. (2017) 31:761–71. 10.1177/0269215516652446
225.
AidarFJde OliveiraRJde MatosDGMazini FilhoMLMoreiraOCde OliveiraCEPet al. A randomized trial investigating the influence of strength training on quality of life in ischemic stroke. Top Stroke Rehabil. (2016) 23:84–9. 10.1080/10749357.2015.1110307
226.
ShinDCShinSHLeeMMLeeKJSongCH. Pelvic floor muscle training for urinary incontinence in female stroke patients: a randomized, controlled and blinded trial. Clin Rehabil. (2016) 30:259–67. 10.1177/0269215515578695
227.
ClarkDJPattenC. Eccentric versus concentric resistance training to enhance neuromuscular activation and walking speed following stroke. Neurorehabil Neural Repair. (2013) 27:335–44. 10.1177/1545968312469833
228.
FlansbjerU-BLexellJBrogårdhC. Long-term benefits of progressive resistance training in chronic stroke: a 4-year follow-up. J Rehabil Med. (2012) 44:218–21. 10.2340/16501977-0936
229.
CookeEVTallisRCClarkAPomeroyVM. Efficacy of functional strength training on restoration of lower-limb motor function early after stroke: phase I randomized controlled trial. Neurorehabil Neural Repair. (2010) 24:88–96. 10.1177/1545968309343216
230.
DonaldsonCTallisRMillerSSunderlandALemonRPomeroyV. Effects of conventional physical therapy and functional strength training on upper limb motor recovery after stroke: a randomized phase II study. Neurorehabil Neural Repair. (2009) 23:389–97. 10.1177/1545968308326635
231.
LeeMJKilbreathSLSinghMFZemanBLordSRRaymondJet al. Comparison of effect of aerobic cycle training and progressive resistance training on walking ability after stroke: a randomized Sham exercise-controlled study. J Am Geriatr Soc. (2008) 56:976–85. 10.1111/j.1532-5415.2008.01707.x
232.
FlansbjerU-BMillerMDownhamDLexellJ. Progressive resistance training after stroke: effects on muscle strength, muscle tone, gait performance and perceived participation. J Rehabil Med. (2008) 40:42–8. 10.2340/16501977-0129
233.
GhasemiEKhademi-KalantariKKhalkhali-ZaviehMRezasoltaniAGhasemiMBaghbanAAet al. The effect of functional stretching exercises on neural and mechanical properties of the spastic medial gastrocnemius muscle in patients with chronic stroke: a randomized controlled trial. J Stroke Cerebrovasc Dis. (2018) 27:1733–42. 10.1016/j.jstrokecerebrovasdis.2018.01.024
234.
SahinNUgurluHAlbayrakI. The efficacy of electrical stimulation in reducing the post-stroke spasticity: a randomized controlled study. Disab Rehabil. (2012) 34:151–6. 10.3109/09638288.2011.593679
235.
GustafssonLMcKennaK. A programme of static positional stretches does not reduce hemiplegic shoulder pain or maintain shoulder range of motion-a randomized controlled trial. Clin Rehabil. (2006) 20:277–86. 10.1191/0269215506cr944oa
236.
ChengCLiuXFanWBaiXLiuZ. Comprehensive rehabilitation training decreases cognitive impairment, anxiety, and depression in poststroke patients: a randomized, controlled study. J Stroke Cerebrovasc Dis. (2018) 27:2613–22. 10.1016/j.jstrokecerebrovasdis.2018.05.038
237.
FotakopoulosGKotliaP. The value of exercise rehabilitation program accompanied by experiential music for recovery of cognitive and motor skills in stroke patients. J Stroke Cerebrovasc Dis. (2018) 27:2932–2939. 10.1016/j.jstrokecerebrovasdis.2018.06.025
238.
TangAEngJJKrassioukovAVTsangTSLiu-AmbroseT. High- and low-intensity exercise do not improve cognitive function after stroke: a randomized controlled trial. J Rehabil Med. (2016) 48:841–6. 10.2340/16501977-2163
239.
WentinkMMBergerMAde KloetAJMeestersJBandGPWolterbeekRet al. The effects of an 8-week computer-based brain training programme on cognitive functioning, QoL and self-efficacy after stroke. Neuropsychol Rehabil. (2016) 26:847–65. 10.1080/09602011.2016.116217
240.
LundAMicheletMSandvikLWyllerTSveenU. A lifestyle intervention as supplement to a physical activity programme in rehabilitation after stroke: a randomized controlled trial. Clin Rehabil. (2012) 26:502–12. 10.1177/0269215511429473
241.
RyanCMBayleyMGreenRMurrayBJBradleyTD. Influence of continuous positive airway pressure on outcomes of rehabilitation in stroke patients with obstructive sleep apnea. Stroke. (2011) 42:1062–7. 10.1161/STROKEAHA.110.597468
242.
JohnstonMBonettiDJoiceSPollardBMorrisonVFrancisJJet al. Recovery from disability after stroke as a target for a behavioural intervention: results of a randomized controlled trial. Disabil Rehabil. (2007) 29:1117–27. 10.1080/03323310600950411
243.
RaglioAOasiOGianottiMRossiAGouleneKStramba-BadialeM. Improvement of spontaneous language in stroke patients with chronic aphasia treated with music therapy: a randomized controlled trial. Int J Neurosci. (2016) 126:235–42. 10.3109/00207454.2015.1010647
244.
BowenAHeskethAPatchickEYoungADaviesLVailAet al. Effectiveness of enhanced communication therapy in the first four months after stroke for aphasia and dysarthria: a randomised controlled trial. BMJ. (2012) 345:e4407. 10.1136/bmj.e4407
245.
LincolnNBMcGuirkEMulleyGPLendremWJonesACMitchellJR. Effectiveness of speech therapy for aphasic stroke patients. A randomised controlled trial. Lancet. (1984) 1:1197–200. 10.1016/S0140-6736(84)91690-8
246.
KimBRKangTW. The effects of proprioceptive neuromuscular facilitation lower-leg taping and treadmill training on mobility in patients with stroke. Int J Rehabil Res. (2018) 41:343–8. 10.1097/MRR.0000000000000309
247.
EyvazNDundarUYesilH. Effects of water-based and land-based exercises on walking and balance functions of patients with hemiplegia. Neurorehabilitation. (2018) 43:237–46. 10.3233/NRE-182422
248.
EkechukwuENDOmotoshoIOHamzatTK. Comparative effects of interval and continuous aerobic training on haematological variables post-stroke-a randomized clinical trial. J Physiother Rehabil Sci. (2017) 9:1–8. 10.4314/ajprs.v9i1-2.1
249.
Rozental-IluzCZeiligGWeingardenHRandD. Improving executive function deficits by playing interactive video-games: secondary analysis of a randomized controlled trial for individuals with chronic stroke. Eur J Phys Rehabil Med. (2016) 52:508–15.
250.
van de VenRMSchmandBGroetEVeltmanDJMurreJM. The effect of computer-based cognitive flexibility training on recovery of executive function after stroke: rationale, design and methods of the TAPASS study. BMC Neurol. (2015) 15:144. 10.1186/s12883-015-0397-y
251.
StahlBMohrBDreyerFRLuccheseGPulvermüllerF. Using language for social interaction: communication mechanisms promote recovery from chronic non-fluent aphasia. Cortex. (2016) 85:90–9. 10.1016/j.cortex.2016.09.021
252.
CrottyMvan den BergMHayesAChenCLangeKGeorgeS. Hemianopia after stroke: a randomized controlled trial of the effectiveness of a standardised versus an individualized rehabilitation program, on scanning ability whilst walking1. Neurorehabilitation. (2018) 43:201–9. 10.3233/NRE-172377
253.
De LucaRAragonaBLeonardiSTorrisiMGallettiBGallettiFet al. Computerized training in poststroke aphasia: what about the long-term effects? A randomized clinical trial. J Stroke Cerebrovasc Dis. (2018) 27:2271–6. 10.1016/j.jstrokecerebrovasdis.2018.04.019
254.
Ten BrinkAFVisser-MeilyJMASchutMJKouwenhovenMEijsackersALHNijboerTCW. Prism adaptation in rehabilitation? No additional effects of prism adaptation on neglect recovery in the subacute phase poststroke: a randomized controlled trial. Neurorehabil Neural Repair. (2017) 31:1017–28. 10.1177/1545968317744277
255.
KerrADawsonJRobertsonCRowePQuinnTJ. Sit to stand activity during stroke rehabilitation. Top Stroke Rehabil. (2017) 24:562–6. 10.1080/10749357.2017.1374687
256.
HammerbeckUYousifNHoadDGreenwoodRDiedrichsenJRothwellJC. Chronic stroke survivors improve reaching accuracy by reducing movement variability at the trained movement speed. Neurorehabil Neural Repair. (2017) 31:499–508. 10.1177/1545968317693112
257.
BallesterBRMaierMSan Segundo MozoRMCastañedaVDuffAVerschurePFMJ. Counteracting learned non-use in chronic stroke patients with reinforcement-induced movement therapy. J Neuroeng Rehabil. (2016) 13:74. 10.1186/s12984-016-0178-x
258.
PomeroyVMRowePClarkAWalkerAKerrAChandlerEet al. A randomized controlled evaluation of the efficacy of an ankle-foot cast on walking recovery early after stroke: swift cast trial. Neurorehabil Neural Repair. (2016) 30:40–8. 10.1177/1545968315583724
259.
MansfieldAWongJSBryceJBruntonKInnessELKnorrSet al. Use of accelerometer-based feedback of walking activity for appraising progress with walking-related goals in inpatient stroke rehabilitation: a randomized controlled trial. Neurorehabil Neural Repair. (2015) 29:847–57. 10.1177/1545968314567968
260.
KimJParkJHYimJ. Effects of respiratory muscle and endurance training using an individualized training device on the pulmonary function and exercise capacity in stroke patients. Med Sci Monit. (2014) 20:2543–9. 10.12659/MSM.891112
261.
LanghammerBLindmarkBStanghelleJK. Physiotherapy and physical functioning post-stroke: exercise habits and functioning 4 years later? Long-term follow-up after a 1-year long-term intervention period: a randomized controlled trial. Brain Inj. (2014) 28:1396–405. 10.3109/02699052.2014.919534
262.
LoganPAArmstrongSAveryTJBarerDBartonGRDarbyJet al. Rehabilitation aimed at improving outdoor mobility for people after stroke: a multicentre randomised controlled study (the Getting out of the House Study). Health Technol Assess. (2014) 18:1–113. 10.3310/hta18290
263.
van NunenMPGerritsKHKonijnenbeltMJanssenTWde HaanA. Recovery of walking ability using a robotic device in subacute stroke patients: a randomized controlled study. Disabil Rehabil Assist Technol. (2015) 10:141–8. 10.3109/17483107.2013.873489
264.
MonticoneMAmbrosiniEFerranteSColomboR. ‘Regent Suit' training improves recovery of motor and daily living activities in subjects with subacute stroke: a randomized controlled trial. Clin Rehabil. (2013) 27:792–802. 10.1177/0269215513478228
265.
HsuHWLeeCLHsuMJWuHCLinRHsiehCLet al. Effects of noxious versus innocuous thermal stimulation on lower extremity motor recovery 3 months after stroke. Arch Phys Med Rehabil. (2013) 94:633–41. 10.1016/j.apmr.2012.11.021
266.
MorrisJHVan WijckF. Responses of the less affected arm to bilateral upper limb task training in early rehabilitation after stroke: a randomized controlled trial. Arch Phys Med Rehabil. (2012) 93:1129–37. 10.1016/j.apmr.2012.02.025
267.
ZedlitzAMRietveldTCGeurtsACFasottiL. Cognitive and graded activity training can alleviate persistent fatigue after stroke: a randomized, controlled trial. Stroke. (2012) 43:1046–51. 10.1161/STROKEAHA.111.632117
268.
TilsonJKWuSSCenSYFengQRoseDRBehrmanALet al. Characterizing and identifying risk for falls in the LEAPS study: a randomized clinical trial of interventions to improve walking poststroke. Stroke. (2012) 43:446–52. 10.1161/STROKEAHA.111.636258
269.
BraunSMBeurskensAJKleynenMOudelaarBScholsJMWadeDT. A multicenter randomized controlled trial to compare subacute 'treatment as usual' with and without mental practice among persons with stroke in Dutch nursing homes. J Am Med Dir Assoc. (2012) 13:85.e1-7. 10.1016/j.jamda.2010.07.009
270.
ErelSUygurFEngin SimsekIYakutY. The effects of dynamic ankle-foot orthoses in chronic stroke patients at three-month follow-up: a randomized controlled trial. Clin Rehabil. (2011) 25:515–23. 10.1177/0269215510390719
271.
BrittoRRRezendeNRMarinhoKCTorresJLParreiraVFTeixeira-SalmelaLF. Inspiratory muscular training in chronic stroke survivors: a randomized controlled trial. Arch Phys Med Rehabil. (2011) 92:184–90. 10.1016/j.apmr.2010.09.029
272.
Bovend'EerdtTJDawesHSackleyCIzadiHWadeDT. An integrated motor imagery program to improve functional task performance in neurorehabilitation: a single-blind randomized controlled trial. Arch Phys Med Rehabil. (2010) 91:939–46. 10.1016/j.apmr.2010.03.008
273.
TungFLYangYRLeeCCWangRY. Balance outcomes after additional sit-to-stand training in subjects with stroke: a randomized controlled trial. Clin Rehabil. (2010) 24:533–42. 10.1177/0269215509360751
274.
YangYRChenIHLiaoKKHuangCCWangRY. Cortical reorganization induced by body weight-supported treadmill training in patients with hemiparesis of different stroke durations. Arch Phys Med Rehabil. (2010) 91:513–8. 10.1016/j.apmr.2009.11.021
275.
DevosHAkinwuntanAENieuwboerATantMTruijenSDe WitLet al. Comparison of the effect of two driving retraining programs on on-road performance after stroke. Neurorehabil Neural Repair. (2009) 23:699–705. 10.1177/1545968309334208
276.
LanghammerBStanghelleJKLindmarkB. An evaluation of two different exercise regimes during the first year following stroke: a randomised controlled trial. Physiother Theory Pract. (2009) 25:55–68. 10.1080/09593980802686938
277.
LanghammerBStanghelleJKLindmarkB. Exercise and health-related quality of life during the first year following acute stroke. A randomized controlled trial. Brain Inj. (2008) 22:135–45. 10.1080/02699050801895423
278.
MeadGEGreigCACunninghamILewisSJDinanSSaundersDHet al. Stroke: a randomized trial of exercise or relaxation. J Am Geriatr Soc. (2007) 55:892–9.
279.
PangMYEngJJDawsonASMcKayHAHarrisJE. A community-based fitness and mobility exercise program for older adults with chronic stroke: a randomized, controlled trial. J Am Geriatr Soc. (2005) 53:1667–74. 10.1111/j.1532-5415.2005.53521.x
280.
WangRYChenHIChenCYYangYR. Efficacy of bobath versus orthopaedic approach on impairment and function at different motor recovery stages after stroke: a randomized controlled study. Clin Rehabil. (2005) 19:155–64. 10.1191/0269215505cr850oa
281.
BlennerhassettJDiteW. Additional task-related practice improves mobility and upper limb function early after stroke: a randomised controlled trial. Aust J Physiother. (2004) 50:219–24. 10.1016/S0004-9514(14)60111-2
282.
Glasgow Augmented Physiotherapy Study (GAPS) group. Can augmented physiotherapy input enhance recovery of mobility after stroke? A randomized controlled trial. Clin Rehabil. (2004). 18:529–37. 10.1191/0269215504cr768oa
283.
BylNRoderickJMohamedOHannyMKotlerJSmithAet al. Effectiveness of sensory and motor rehabilitation of the upper limb following the principles of neuroplasticity: patients stable poststroke. Neurorehabil Neural Repair. (2003) 17:176–91. 10.1177/0888439003257137
284.
PartridgeCMackenzieMEdwardsSReidAJayawardenaSGuckNet al. Is dosage of physiotherapy a critical factor in deciding patterns of recovery from stroke: a pragmatic randomized controlled trial. Physiother Res Int. (2000) 5:230–40. 10.1002/pri.203
285.
RønningOMGuldvogB. Stroke unit versus general medical wards, II: neurological deficits and activities of daily living: a quasi-randomized controlled trial. Stroke. (1998) 29:586–90.
286.
KjendahlASällströmSOstenPEStanghelleJKBorchgrevinkCF. A one year follow-up study on the effects of acupuncture in the treatment of stroke patients in the subacute stage: a randomized, controlled study. Clin Rehabil. (1997) 11:192–200. 10.1177/026921559701100302
287.
HuiELumCMWooJOrKHKayRL. Outcomes of elderly stroke patients. Day hospital versus conventional medical management. Stroke. (1995) 26:1616–9. 10.1161/01.STR.26.9.1616
288.
DePippoKLHolasMARedingMJMandelFSLesserML. Dysphagia therapy following stroke: a controlled trial. Neurology. (1994) 44:1655–60. 10.1212/WNL.44.9.1655
289.
SunderlandATinsonDJBradleyELFletcherDLangton HewerRWadeDT. Enhanced physical therapy improves recovery of arm function after stroke. A randomised controlled trial. J Neurol Neurosurg Psychiatry. (1992) 55:530–5. 10.1136/jnnp.55.7.530
290.
GravenCBrockKHillKDCottonSJoubertL. First year after stroke: an integrated approach focusing on participation goals aiming to reduce depressive symptoms. Stroke. (2016) 47:2820–7. 10.1161/STROKEAHA.116.013081
291.
SabariegoCBarreraAENeubertSStier-JarmerMBostanCCiezaA. Evaluation of an ICF-based patient education programme for stroke patients: a randomized, single-blinded, controlled, multicentre trial of the effects on self-efficacy, life satisfaction and functioning. Br J Health Psychol. (2013) 18:707–28. 10.1111/bjhp.12013
292.
GillLSullivanKA. Boosting exercise beliefs and motivation through a psychological intervention designed for poststroke populations. Top Stroke Rehabil. (2011) 18:470–80. 10.1310/tsr1805-470
293.
StrasserDCFalconerJAStevensABUomotoJMHerrinJBowenSEet al. Team training and stroke rehabilitation outcomes: a cluster randomized trial. Arch Phys Med Rehabil. (2008) 89:10–5. 10.1016/j.apmr.2007.08.127
294.
OlneySJNymarkJBrouwerBCulhamEDayAHeardJet al. A randomized controlled trial of supervised versus unsupervised exercise programs for ambulatory stroke survivors. Stroke. (2006) 37:476–81. 10.1161/01.STR.0000199061.85897.b7
295.
PanRZhouMCaiHGuoYZhanLLiMet al. A randomized controlled trial of a modified wheelchair arm-support to reduce shoulder pain in stroke patients. Clin Rehabil. (2018) 32:37–47. 10.1177/0269215517714830
296.
AdaLFoongchomcheayALanghammerBPrestonEStantonRRobinsonJet al. Lap-tray and triangular sling are no more effective than a hemi-sling in preventing shoulder subluxation in those at risk early after stroke: a randomized trial. Eur J Phys Rehabil Med. (2017) 53:41–8. 10.23736/S1973-9087.16.04209-X
297.
TibaekSGardGDehlendorffCIversenHKBiering-SoerensenFJensenR. Can pelvic floor muscle training improve quality of life in men with mild to moderate post stroke and lower urinary tract symptoms?Eur J Phys Rehabil Med. (2017) 53:416–25. 10.23736/S1973-9087.16.04119-8
298.
WongFKYeungSM. Effects of a 4-week transitional care programme for discharged stroke survivors in Hong Kong: a randomised controlled trial. Health Soc Care Commun. (2015) 23:619–31. 10.1111/hsc.12177
299.
NtsieaMVVan AswegenHLordSOlorunjuSS. The effect of a workplace intervention programme on return to work after stroke: a randomised controlled trial. Clin Rehabil. (2015) 29:663–73. 10.1177/0269215514554241
300.
ImminkMAHillierSPetkovJ. Randomized controlled trial of yoga for chronic poststroke hemiparesis: motor function, mental health, and quality of life outcomes. Top Stroke Rehabil. (2014) 21:256–71. 10.1310/tsr2103-256
301.
RochetteAKorner-BitenskyNBishopDTeasellRWhiteCLBravoGet al. The YOU CALL-WE CALL randomized clinical trial: Impact of a multimodal support intervention after a mild stroke. Circ Cardiovasc Qual Outcomes. (2013) 6:674–9. 10.1161/CIRCOUTCOMES.113.000375
302.
BeinottiFChristofolettiGCorreiaNBorgesG. Effects of horseback riding therapy on quality of life in patients post stroke. Top Stroke Rehabil. (2013) 20:226–32. 10.1310/tsr2003-226
303.
Markle-ReidMOrridgeCWeirRBrowneGGafniALewisMet al. Interprofessional stroke rehabilitation for stroke survivors using home care. Can J Neurol Sci. (2011) 38:317–34. 10.1017/S0317167100011537
304.
ClaiborneN. Effectiveness of a care coordination model for stroke survivors: a randomized study. Health Soc Work. (2006) 31:87–96. 10.1093/hsw/31.2.87
305.
BoterHHESTIA Study Group. Multicenter randomized controlled trial of an outreach nursing support program for recently discharged stroke patients. Stroke. (2004) 35:2867–72. 10.1161/01.STR.0000147717.57531.e5
306.
FjaertoftHIndredavikBJohnsenRLydersenS. Acute stroke unit care combined with early supported discharge. Long-term effects on quality of life. A randomized controlled trial. Clin Rehabil. (2004) 18:580–6. 10.1191/0269215504cr773oa
307.
TibaekSJensenRLindskovGJensenM. Can quality of life be improved by pelvic floor muscle training in women with urinary incontinence after ischemic stroke? A randomised, controlled and blinded study. Int Urogynecol J Pelvic Floor Dysfunct. (2004) 15:117–23. 10.1007/s00192-004-1124-1
308.
SulchDPerezIMelbournAKalraL. Randomized controlled trial of integrated (managed) care pathway for stroke rehabilitation. Stroke. (2000) 31:1929–34. 10.1161/01.STR.31.8.1929
309.
IndredavikBBakkeFSlørdahlSARoksethRHåheimLL. Stroke unit treatment improves long-term quality of life: a randomized controlled trial. Stroke. (1998) 29:895–9. 10.1161/01.STR.29.5.895
310.
RønningOMGuldvogB. Outcome of subacute stroke rehabilitation: a randomized controlled trial. Stroke. (1998) 29:779–84. 10.1161/01.STR.29.4.779
311.
KhanFAmatyaBElmalikALoweMNgLReidIet al. An enriched environmental programme during inpatient neuro-rehabilitation: a randomized controlled trial. J Rehabil Med. (2016) 48:417–25. 10.2340/16501977-2081
312.
AskimTMørkvedSEngenARoosKAasTIndredavikB. Effects of a community-based intensive motor training program combined with early supported discharge after treatment in a comprehensive stroke unit: a randomized, controlled trial. Stroke. (2010) 41:1697–703. 10.1161/STROKEAHA.110.584284
313.
LincolnNBWalkerMFDixonAKnightsP. Evaluation of a multiprofessional community stroke team: a randomized controlled trial. Clin Rehabil. (2004) 18:40–7. 10.1191/0269215504cr700oa
314.
DonnellyMPowerMRussellMFullertonK. Randomized controlled trial of an early discharge rehabilitation service: the belfast community stroke trial. Stroke. (2004) 35:127–33. 10.1161/01.STR.0000106911.96026.8F
315.
GreenJForsterABogleSYoungJ. Physiotherapy for patients with mobility problems more than 1 year after stroke: a randomised controlled trial. Lancet. (2002) 359:199–203. 10.1016/S0140-6736(02)07443-3
316.
ZondervanDKFriedmanNChangEZhaoXAugsburgerRReinkensmeyerDJet al. Home-based hand rehabilitation after chronic stroke: randomized, controlled single-blind trial comparing the musicglove with a conventional exercise program. J Rehabil Res Dev. (2016) 53:457–72. 10.1682/JRRD.2015.04.0057
317.
ChenJJinWDongWSJinYQiaoFLZhouYFet al. Effects of home-based telesupervising rehabilitation on physical function for stroke survivors with hemiplegia: a randomized controlled trial. Am J Phys Med Rehabil. (2017) 96:152–160. 10.1097/PHM.0000000000000559
318.
RasmussenRSØstergaardAKjærPSkerrisASkouCChristoffersenJet al. Stroke rehabilitation at home before and after discharge reduced disability and improved quality of life: a randomised controlled trial. Clin Rehabil. (2016) 30:225–36. 10.1177/0269215515575165
319.
ZondervanDKAugsburgerRBodenhoeferBFriedmanNReinkensmeyerDJCramerSC. Machine-based, self-guided home therapy for individuals with severe arm impairment after stroke: a randomized controlled trial. Neurorehabil Neural Repair. (2015) 29:395–406. 10.1177/1545968314550368
320.
WangTCTsaiACWangJYLinYTLinKLChenJJet al. Caregiver-mediated intervention can improve physical functional recovery of patients with chronic stroke: a randomized controlled trial. Neurorehabil Neural Repair. (2015) 29:3–12. 10.1177/1545968314532030
321.
ChaiyawatPKulkantrakornK. Randomized controlled trial of home rehabilitation for patients with ischemic stroke: impact upon disability and elderly depression. Psychogeriatrics. (2012) 12:193–9. 10.1111/j.1479-8301.2012.00412.x
322.
DeanCMRisselCSherringtonCSharkeyMCummingRGLordSRet al. Exercise to enhance mobility and prevent falls after stroke: the community stroke club randomized trial. Neurorehabil Neural Repair. (2012) 26:1046–57. 10.1177/1545968312441711
323.
ChaiyawatPKulkantrakornK. Effectiveness of home rehabilitation program for ischemic stroke upon disability and quality of life: a randomized controlled trial. Clin Neurol Neurosurg. (2012) 114:866–70. 10.1016/j.clineuro.2012.01.018
324.
MayoNEScottSCAhmedS. Case management poststroke did not induce response shift: the value of residuals. J Clin Epidemiol. (2009) 62:1148–56. 10.1016/j.jclinepi.2009.03.020
325.
CrottyMGilesLCHalbertJHardingJMillerM. Home versus day rehabilitation: a randomised controlled trial. Age Ageing. (2008) 37:628–33. 10.1093/ageing/afn141
326.
PageSJLevinePTeepenJHartmanEC. Resistance-based, reciprocal upper and lower limb locomotor training in chronic stroke: a randomized, controlled crossover study. Clin Rehabil. (2008) 22:610–7. 10.1177/0269215508088987
327.
DesrosiersJNoreauLRochetteACarbonneauHFontaineLViscogliosiCet al. Effect of a home leisure education program after stroke: a randomized controlled trial. Arch Phys Med Rehabil. (2007) 88:1095–100. 10.1016/j.apmr.2007.06.017
328.
StudenskiSDuncanPWPereraSRekerDLaiSMRichardsL. Daily functioning and quality of life in a randomized controlled trial of therapeutic exercise for subacute stroke survivors. Stroke. (2005) 36:1764–70. 10.1161/01.STR.0000174192.87887.70
329.
McClellanRAdaL. A six-week, resource-efficient mobility program after discharge from rehabilitation improves standing in people affected by stroke: placebo-controlled, randomised trial. Aust J Physiother. (2004) 50:163–7. 10.1016/S0004-9514(14)60154-9
330.
AskimTRohwederGLydersenSIndredavikB. Evaluation of an extended stroke unit service with early supported discharge for patients living in a rural community. A randomized controlled trial. Clin Rehabil. (2004) 18:238–48. 10.1191/0269215504cr752oa
331.
DuncanPStudenskiSRichardsLGollubSLaiSMRekerDet al. Randomized clinical trial of therapeutic exercise in subacute stroke. Stroke. (2003) 34:2173–80. 10.1161/01.STR.0000083699.95351.F2
332.
AndersenHEEriksenKBrownASchultz-LarsenKForchhammerBH. Follow-up services for stroke survivors after hospital discharge–a randomized control study. Clin Rehabil. (2002) 16:593–603. 10.1191/0269215502cr528oa
333.
RoderickPLowJDayRPeasgoodTMulleeMATurnbullJCet al. Stroke rehabilitation after hospital discharge: a randomized trial comparing domiciliary and day-hospital care. Age Ageing. (2001) 30:303–10. 10.1093/ageing/30.4.303
334.
Widén HolmqvistLvon KochLKostulasVHolmMWidsellGTeglerHet al. A randomized controlled trial of rehabilitation at home after stroke in southwest Stockholm. Stroke. (1998) 29:591–7. 10.1161/01.STR.29.3.591
335.
GladmanJRLincolnNBBarerDH. A randomised controlled trial of domiciliary and hospital-based rehabilitation for stroke patients after discharge from hospital. J Neurol Neurosurg Psychiatry. (1993) 56:960–6. 10.1136/jnnp.56.9.960
336.
LoSHSChangAMChauJPC. Stroke self-management support improves survivors' self-efficacy and outcome expectation of self-management behaviors. Stroke. (2018) 49:758–760. 10.1161/STROKEAHA.117.019437
337.
SitJWChairSYChoiKCChanCWLeeDTChanAWet al. Do empowered stroke patients perform better at self-management and functional recovery after a stroke? A randomized controlled trial. Clin Interv Aging. (2016) 11:1441–50. 10.2147/CIA.S109560
338.
LinZCTaoJGaoYLYinDZChenAZChenLD. Analysis of central mechanism of cognitive training on cognitive impairment after stroke: resting-state functional magnetic resonance imaging study. J Int Med Res. (2014) 42:659–68. 10.1177/0300060513505809
339.
TangQTanLLiBHuangXOuyangCZhanHet al. Early sitting, standing, and walking in conjunction with contemporary Bobath approach for stroke patients with severe motor deficit. Top Stroke Rehabil. (2014) 21:120–7. 10.1310/tsr2102-120
340.
TillingKCoshallCMcKevittCDaneskiKWolfeC. A family support organiser for stroke patients and their carers: a randomised controlled trial. Cerebrovasc Dis. (2005) 20:85–91. 10.1159/000086511
341.
DeyPWoodmanMGibbsASteeleRStocksSJWagstaffSet al. Early assessment by a mobile stroke team: a randomised controlled trial. Age Ageing. (2005) 34:331–8. 10.1093/ageing/afi102
342.
MantJCarterJWadeDTWinnerS. Family support for stroke: a randomised controlled trial. Lancet. (2000) 356:808–13. 10.1016/S0140-6736(00)02655-6
343.
WanLHZhangXPMoMMXiongXNOuCLYouLMet al. Effectiveness of goal-setting telephone follow-up on health behaviors of patients with ischemic stroke: a randomized controlled trial. J Stroke Cerebrovasc Dis. (2016) 25:2259–70. 10.1016/j.jstrokecerebrovasdis.2016.05.010
344.
BologniniNVallarGCasatiCLatifLAEl-NazerRWilliamsJet al. Neurophysiological and behavioral effects of tDCS combined with constraint-induced movement therapy in poststroke patients. Neurorehabil Neural Repair. (2011) 25:819–29. 10.1177/1545968311411056
345.
MantJCarterJWadeDTWinnerS. The impact of an information pack on patients with stroke and their carers: a randomized controlled trial. Clin Rehabil. (1998) 12:465–76. 10.1191/026921598668972226
346.
CareyJRDurfeeWKBhattENagpalAWeinsteinSAAndersonKMet al. Comparison of finger tracking versus simple movement training via telerehabilitation to alter hand function and cortical reorganization after stroke. Neurorehabil Neural Repair. (2007) 21:216–32. 10.1177/1545968306292381
347.
FaulknerJTzengYCLambrickDWoolleyBAllanPDO'DonnellTet al. A randomized controlled trial to assess the central hemodynamic response to exercise in patients with transient ischaemic attack and minor stroke. J Hum Hypertens. (2017) 31:172–7. 10.1038/jhh.2016.72
348.
PanXL. Efficacy of early rehabilitation therapy on movement ability of hemiplegic lower extremity in patients with acute cerebrovascular accident. Medicine. (2018) 97:e9544. 10.1097/MD.0000000000009544
349.
ChumblerNRLiXQuigleyPMoreyMCRoseDGriffithsPet al. A randomized controlled trial on stroke telerehabilitation: the effects on falls self-efficacy and satisfaction with care. J Telemed Telecare. (2015) 21:139–43. 10.1177/1357633X15571995
350.
Torres-Arreola LdelPDoubova DubovaSVHernandezSFTorres-ValdezLEConstantino-CasasNPGarcia-ContrerasFet al. Effectiveness of two rehabilitation strategies provided by nurses for stroke patients in Mexico. J Clin Nurs. (2009) 18:2993–3002. 10.1111/j.1365-2702.2009.02862.x
351.
LiuNCadilhacDAAndrewNEZengLLiZLiJet al. Randomized controlled trial of early rehabilitation after intracerebral hemorrhage stroke: difference in outcomes within 6 months of stroke. Stroke. (2014) 45:3502–7. 10.1161/STROKEAHA.114.005661
352.
DraperBBowringGThompsonCVan HeystJConroyPThompsonJ. Stress in caregivers of aphasic stroke patients: a randomized controlled trial. Clin Rehabil. (2007) 21:122–30. 10.1177/0269215506071251
353.
ForsterADickersonJYoungJPatelAKalraLNixonJet al. A cluster randomised controlled trial and economic evaluation of a structured training programme for caregivers of inpatients after stroke: the TRACS trial. Health Technol Assess. (2013) 17:1–216. 10.3310/hta17460
354.
HarrisJEEngJJMillerWCDawsonAS. The role of caregiver involvement in upper-limb treatment in individuals with subacute stroke. Phys Ther. (2010) 90:1302–10. 10.2522/ptj.20090349
355.
CummingTBThriftAGCollierJMChurilovLDeweyHMDonnanGAet al. Very early mobilization after stroke fast-tracks return to walking: further results from the phase II AVERT randomized controlled trial. Stroke. (2011) 42:153–8. 10.1161/STROKEAHA.110.594598
356.
SorbelloDDeweyHMChurilovLThriftAGCollierJMDonnanGet al. Very early mobilisation and complications in the first 3 months after stroke: further results from phase ii of a very early rehabilitation trial (AVERT). Cerebrovasc Dis. (2009) 28:378–83. 10.1159/000230712
357.
EzejimoforMCChenYFKandalaNBEzejimoforBCEzeabasiliACStrangesSet al. Stroke survivors in low-and middle-income countries: a meta-analysis of prevalence and secular trends. J Neurol Sci. (2016) 364:68–76. 10.1016/j.jns.2016.03.016
358.
DeeMLennonOO'SullivanC. A systematic review of physical rehabilitation interventions for stroke in low and lower-middle income countries. Disab Rehabil. (2020) 42:473–501. 10.1080/09638288.2018.1501617
359.
ObembeAOOnigbindeATAdedoyinRAAdetunmbiOG. Opinion of a section of Nigerian physiotherapists on training and utilization of middle level workers. J Nigeria Soc Physiother. (2009) 16:23–30. 10.1186/s12913-019-3994-4
360.
OwolabiMO. Impact of stroke on health-related quality of life in diverse cultures: the Berlin-Ibadan multicenter international study. Health Qual Life Outcomes. (2011) 9:81. 10.1186/1477-7525-9-81
361.
JohnsonMJRaiRBarathiSMendoncaRBustamante-VallesK. Affordable stroke therapy in high-, low-and middle-income countries: from theradrive to rehab cares, a compact robot gym. J Rehabil Assist Technol Eng. (2017) 4:2055668317708732. 10.1177/2055668317708732
362.
KwakkelGLanninNABorschmannKEnglishCAliMChurilovLet al. Standardized measurement of sensorimotor recovery in stroke trials: consensus-based core recommendations from the stroke recovery and rehabilitation roundtable. Neurorehabil Neural Repair. (2017) 31:784–92. 10.1177/1545968317732662
363.
GillespieDCBowenAChungCSCockburnJKnappPPollockA. Rehabilitation for post-stroke cognitive impairment: an overview of recommendations arising from systematic reviews of current evidence. Clin Rehabil. (2015) 29:120–8. 10.1177/0269215514538982
364.
AkinyemiROOwolabiMOIharaMDamascenoAOgunniyiADotchinCet al. Stroke, cerebrovascular diseases and vascular cognitive impairment in Africa. Brain Res Bull. (2019) 145:97–108. 10.1016/j.brainresbull.2018.05.018
365.
HamzatTKOlaleyeOAAkinwumiOB. Functional ability, community reintegration and participation restriction among community-dwelling female stroke survivors in Ibadan. J Health Sci. (2014) 24:43–8. 10.4314/ejhs.v24i1.6
366.
HamzatTKEkechukwuENDOlaleyeAO. Comparison of community reintegration and selected stroke specific characteristics in Nigerian male and female stroke survivors. J Physiother Rehabil Sci. (2014) 6:27–31. 10.4314/ajprs.v6i1-2.4
367.
OlaleyeOAHamzatTKOwolabiMO. Stroke rehabilitation: should physiotherapy intervention be provided at a Primary Health Care Centre or the patients' place of Domicile?Disab Rehabil. (2014) 36:49–54. 10.3109/09638288.2013.777804
368.
PriceCJSeghierMLLeffAP. Predicting language outcome and recovery after stroke: the PLORAS system. Nat Rev Neurol. (2010) 6:202. 10.1038/nrneurol.2010.15
369.
Nichols-LarsenDSClarkPZeringueAGreenspanABlantonS. Factors influencing stroke survivors' quality of life during subacute recovery. Stroke. (2005) 36:1480–4. 10.1161/01.STR.0000170706.13595.4f
370.
PucciarelliGAusiliDGalbusseraAAReboraPSaviniSSimeoneSet al. Quality of life, anxiety, depression and burden among stroke caregivers: a longitudinal, observational multicentre study. J Adv Nurs. (2018) 74:1875–87. 10.1111/jan.13695
371.
EkechukwuENDIkrecheroJOEzeukwuAOEgwuonwuAVUmarLBadaruUM. Determinants of quality of life among community dwelling persons with spinal cord injury: A path analysis. J Clin Pract. (2017) 20:163–9. 10.4103/1119-3077.187328
372.
World Health Organization. Task Shifting to Tackle Health Worker Shortages. Geneva: World Health Organization (2007).
373.
EatonJMcCayLSemrauMChatterjeeSBainganaFArayaRet al. Scale up of services for mental health in low-income and middle-income countries. Lancet. (2011) 378:1592–603. 10.1016/S0140-6736(11)60891-X
374.
DawsonAJBuchanJDuffieldCHomerCSWijewardenaK. Task shifting and sharing in maternal and reproductive health in low-income countries: a narrative synthesis of current evidence. Health Policy Plan. (2014) 29:396–408. 10.1093/heapol/czt026
375.
JoshiRAlimMKengneAPJanSMaulikPKPeirisDet al. Task shifting for non-communicable disease management in low and middle income countries-a systematic review. PLoS ONE. (2014) 9:e103754. 10.1371/journal.pone.0103754
376.
GovindarajanVRamamurtiR. Delivering world-class health care, affordably. Harvard Bus Rev. (2013) 91:117–22. Available online at: https://hbr.org/2013/11/delivering-world-class-health-care-affordably
377.
LanghornePde VilliersLPandianJD. Applicability of stroke-unit care to low-income and middle-income countries. Lancet Neurol. (2012) 11:341–8. 10.1016/S1474-4422(12)70024-8
378.
LindleyRIAndersonCSBillotLForsterAHackettMLHarveyLAet al. Family-led rehabilitation after stroke in India (ATTEND): a randomised controlled trial. Lancet. (2017) 390:588–99. 10.1016/S0140-6736(17)31447-2
379.
ForsterADickersonJYoungJPatelAKalraLNixonJet al. A structured training programme for caregivers of inpatients after stroke (TRACS): a cluster randomised controlled trial and cost-effectiveness analysis. Lancet. (2013) 382:2069–76. 10.1016/S0140-6736(13)61603-7
380.
AkinyemiROOwolabiMOAdebayoPBAkinyemiJOOtubogunFMUvereEet al. Task-shifting training improves stroke knowledge among Nigerian non-neurologist health workers. J Neurol Sci. (2015) 359:112–6. 10.1016/j.jns.2015.10.019
381.
NorrvingBKisselaB. The global burden of stroke and need for a continuum of care. Neurology. (2013) 80:S5–12. 10.1212/WNL.0b013e3182762397
382.
MenonPB. Developing community-based rehabilitation services for the disabled by the primary health care approach. Int Rehabil Med. (1984) 6:64–6. 10.3109/03790798409166761
383.
OlaleyeOAHamzatTKOwolabiMO. Development and evaluation of the primary healthcare-based physiotherapy intervention and its effects on selected indices of stroke recovery. Int J Ther Rehabil. (2013) 20:443–9. 10.12968/ijtr.2013.20.9.443
384.
ParkeHLEpiphaniouEPearceGTaylorSJSheikhAGriffithsCJet al. Self-management support interventions for stroke survivors: a systematic meta-review. PLoS ONE. (2015) 10:e131448. 10.1371/journal.pone.0131448
385.
EkechukwuNOlaleyeOHamzatT. Clinical and psychosocial predictors of community reintegration of stroke survivors three months post in-hospital discharge. J Health Sci. (2017) 27:27–34. 10.4314/ejhs.v27i1.5
386.
JonesFRiaziANorrisM. Self-management after stroke: time for some more questions?Disab Rehabil. (2013) 35:257–64. 10.3109/09638288.2012.691938
387.
de SilvaD. Helping People Help Themselves: a Review of the Evidence Considering Whether it is Worthwhile to Support Self-management. Health Foundation (2011).
388.
CoulterAEllinsJ. Effectiveness of strategies for informing, educating, and involving patients. BMJ. (2007) 335:24. 10.1136/bmj.39246.581169.80
389.
LennonSMcKennaSJonesF. Self-management programmes for people post stroke: a systematic review. Clin Rehabil. (2013) 27:867–78. 10.1177/0269215513481045
390.
McCueMFairmanAPramukaM. Enhancing quality of life through telerehabilitation. Phys Med Rehabil Clin. (2010) 21:195–205. 10.1016/j.pmr.2009.07.005
391.
LinderSMRosenfeldtABBayRCSahuKWolfSLAlbertsJL. Improving quality of life and depression after stroke through telerehabilitation. Am J Occup Ther. (2015) 69:6902290020p1-0. 10.5014/ajot.2015.014498
392.
HassettLAllenNvan den BergM. Feedback-based technologies for adult physical rehabilitation. In: Hayre CM, Muller D, Scherer M, editors. Everyday Technologies in Healthcare. (2019). p. 143–73. 10.1201/9781351032186-9
393.
SureshkumarKMurthyGVMunuswamySGoenkaSKuperH. ‘Care for Stroke', a web-based, smartphone-enabled educational intervention for management of physical disabilities following stroke: feasibility in the Indian context. BMJ Innov. (2015) 1:127–36. 10.1136/bmjinnov-2015-000056
Summary
Keywords
pragmatic solution, stroke recovery, quality of life, low- and middle-income countries, innovatively high technology interventions, systematic review
Citation
Ekechukwu END, Olowoyo P, Nwankwo KO, Olaleye OA, Ogbodo VE, Hamzat TK and Owolabi MO (2020) Pragmatic Solutions for Stroke Recovery and Improved Quality of Life in Low- and Middle-Income Countries—A Systematic Review. Front. Neurol. 11:337. doi: 10.3389/fneur.2020.00337
Received
31 January 2020
Accepted
07 April 2020
Published
25 June 2020
Volume
11 - 2020
Edited by
Laszlo Csiba, University of Debrecen, Hungary
Reviewed by
Vitalie Lisnic, Nicolae Testemitanu State University of Medicine and Pharmacy, Moldova; Katharina Stibrant Sunnerhagen, University of Gothenburg, Sweden; Vida Demarin, Sisters of Mercy Health System, United States
Updates
Copyright
© 2020 Ekechukwu, Olowoyo, Nwankwo, Olaleye, Ogbodo, Hamzat and Owolabi.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Mayowa Ojo Owolabi mayowaowolabi@yahoo.com
This article was submitted to Stroke, a section of the journal Frontiers in Neurology
†These authors have contributed equally to this work and share first authorship
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.