Time Post-Stroke and Upper Extremity Stroke Motor Recovery Rehabilitation: A Meta-Analysis

Background: Understanding the impact of timing of post-stroke motor recovery research trials is critical for clinical care. Objective: To examine and compare differences in Fugl-Meyer Assessment Upper Extremity (FMA-UE) scores at 2 different time points post-stroke on the effectiveness of upper extremity (UE) rehabilitation interventions compared to conventional care or sham therapy controls in stroke rehabilitation randomized controlled trials (RCTs). Methods: A meta-analysis was conducted in accordance with PRISMA guidelines. Searches were conducted in CINAHL, Embase, PubMed, Scopus, and Web of Science, up to April 1st, 2021. Inclusion criteria were: (1) English RCTs of adults (≥18 years) diagnosed with stroke; (2) examined a single intervention for stroke UE rehabilitation; (3) used conventional care/sham as the control arm; and (4) assessed FMA-UE as one of the outcome measures. Results: 157 RCTs were included, including 17 types of interventions. In the acute and subacute phases post stroke, 16 interventions were assessed, and the analyses of 11 interventions showed significant beneficial effects. In the chronic post-stroke phase, 9 intervention types were assessed, and 7 of them showed significant improvements. Greater FMA-UE score improvements were found for the same interventions in the acute and subacute post-stroke phases when compared to the chronic phase. Conclusions: Interventions studied in the acute and subacute phases showed greater magnitude improvements in the FMA-UE scores compared to the chronic phase. The effectiveness of upper extremity rehabilitation interventions may be underestimated when studied exclusively in the chronic phase, with some of the observed differences potentially attributable to variations in baseline severity.