Introduction
Methods
Design
Inclusion and exclusion criteria (review criteria)
Identification of relevant articles
Assessment of methodological quality
Data extraction
Meta-analyses
Results
Identification of included studies
Characteristics of included studies
Author | CEBM level | PEDro Score | Diagnosis | Sample size | Duration (wks) | Intensity (Frequency per week, Minutes/day) | |
---|---|---|---|---|---|---|---|
Enrolled: tot; | Age (Mean +/− standard deviation) years | ||||||
Buccino G. et al.; 2018 [20] | 1b | 9/10 | CP | 18 | 5 to 11 | 3 | 5 session per week, 30 min each session |
Fu J et al.; 2017 [21] | 1b | 7/10 | Sub-acute stroke | 53 | 62.04 +/− 9.93 (AOT group); 59.76 +/− 10.57 (control group) | 8 | 6 times/week, 20 min/day |
Kirkpatrick E et al.; 2016 [22] | 2b | 6/10 | UCP | 70 | 3 to 10 | 12 | 5 sessions per week, 15 min each session |
Kim CH et al.; 2016 [23] | 1b | 9/10 | Sub-acute stroke | 22 | 62.78 +/− 9.85 (AOT group); 61.49 +/− 8.64 (control group) | 4 | 5 times/week, 40 min/day |
Zhu M-H et al.; 2015 [1] | 1b | 7/10 | Stroke | 61 | 42–75 | 8 | 6 times/week, 30 min/day |
Kim E et al.; 2015 [24] | 2b | 3/10 | Stroke | 12 | n.s. | 6 | 5 sessions per week, 30 min per day |
Kim E et al.; 2015 [25] | 2b | 3/10 | Stroke | 12 | n.s. | 6 | 5 sessions per week, 30 min per session |
Sale P et al.;2014 [26] | 1b | 8/10 | Subacute ischaemic stroke | 67 | 66.50 ± 12.70 | 4 | 5 days/week, two 15-min daily session at least 60-min interval apart |
Sgandurra G et al.; 2013 [5] | 1b | 8/10 | UCP | 24 | 5–15 | 3 | 15 consecutive working days, 60-min (including the rest periods) rehabilitation sessions |
Lee D et al.; 2013 [27] | 2b | 5/10 | Chronic stroke | 33 | 63 ± 3.70 (Observation) 62 ± 1.50 (Action practice) 61 ± 2.30 (Combined) 60 ± 5.90 (control) | 3 | 5 sessions per week, 10-min / day |
Cowles T et al.; 2013 [28] | 1b | 7/10 | Early after stroke | 29 | 60–89 | 3 | Each day for 15 working days, two 30 min sessions (approximately 6- to 8-min periods divided by 2 to 4 min of resting), separated by a 10 min rest |
Buccino G et al.;2012 [3] | 1b | 7/10 | CP (12 UCP 3 bilateral CP) | 15 | mean age = 6.80 | 3 | 5 times per week, 15 min/day |
Franceschini M. et al.;2012 [29] | 1b | 7/10 | Stroke | 102 | n.s. | 4 | 5 sessions per week; 20 sessions (15 min =3 min sequence observations and 2 min action performances for 3 sequences); each session repeated twice a day, at least 60 min |
Ertelt D. et al.; 2007 [6] | 2b | 6/10 | Stroke | 16 | 38–69 | 4 | 18 consecutive working days, 18 sessions of 90 min each |
Author | Experimental group | Control group | Study Outcome | Results: differences between experimental and control group | |
---|---|---|---|---|---|
Type of AOT | Videos (perspectives) | Type of intervention | |||
Buccino G. et al.; 2018 [20] | 15 videos of task of daily action subdivided in ¾ motor segments | Different perspectives | Videos with no specific motor content + execution of same actions at the EG | MUUL, AHA | After treatment, the functional score gain was significantly different in the EG and CG |
Fu J et al.; 2017 [21] | Observation (10 min) + imitating (10 min) Actions: Many different movements in different directions with different complexity | Each action was filmed from 2 different angles | Observe videos of different geometric patterns and symbols + performed action as the EG | FMA, WMFT, MBI, MEP | FMA, WMFT, MBI increased significantly compared with that before therapy in both groups. The indexes were significantly higher in the EG group compare to the CG |
Kirkpatrick E et al.; 2016 [22] | watch a parent perform a movement + execution | (no video) egocentric viewpoint | Purposeful action observation program (without the observation) | AHA, MA2, ABILHAND-Kids | no between-group differences in AHA, MA2, or ABILHAND-Kids at 3 and 6 months vs baseline |
Kim CH et al.; 2016 [23] | Observation (9 min), followed by a break (1 min to organize + practicing (30 min) Actions: Task-oriented training consisted of performing task based on ADLs | Each video provided 3 views simultaneously: front, side and top | The same tasks during a 30 min period, without watching the video | FMA, BBT, MBI, MAS | The mean change of FMA, BBT, and MBI in the AOT was significantly different between groups. No differences at MAS |
Zhu M-H et al.; 2015 [1] | Observation followed by the action Actions: total of 30 actions showing many different movements or more complex actions | Straight on (20s), right above (15 s) and right inside (15 s) | Routine rehabilitation treatment and nursing | FMA, MBI, MAS | FMA, BI and MAS scores were significantly better after treatment in the EG compared to the CG |
Kim E et al.; 2015 [24] | Observation of 2 from a variety of activities per session selected by patients, repeated over 1 week | n.s. | Perform the purposeful AO program without observing actions | WMFT | The EG showed significantly greater improvement compared with the CG |
Kim E et al.; 2015 [25] | Observation of 2 daily life activities per session selected by patients repeated over 1 week | n.s. | Perform the AOT assignments, without the observational part | 3D motion analysis system | EG showed improvement than the CG (no significant). Both groups showed improvements in average velocity, trajectory ratio, and movement degree, but not statistically significant |
Sale P et al.;2014 [26] | Observation followed by performing the same tasks (2 min) from the easiest to the most complex action Actions: 20 daily activities composed by 3 different meaningful motor sequences displayed in order of ascending difficulty | first-person | Control Treatment: 5 static images displaying objects, without any animal or human being, for 3 min + to perform the same tasks of the EG | BBT, FMA | Significant higher gain for EG than CG, with respect to functional measures taken at T1 and T2. Left hemiparetic subjects achieved significantly greater benefits compared to the right ones. FMA and BBT between groups, statistically significant differences only for left hemiparetic. |
Sgandurra G et al.; 2013 [5] | 15 sets of daily life, un- or bi-manual goal-related actions of increasing complexity | First-person perspective | To watch computer games + verbally instructions to perform same actions as AOT group | AHA, MUUL, ABILHAND-Kids | Significant AHA within-group differences at all follow-up assessments. At T1 significant between-group difference and at T2 and T3 at the limits of significance. No differences at MUUL and ABILHAND-Kids |
Lee D et al.; 2013 [27] | AOT group: observation of task video of drinking behaviour (5 min) followed by the actions (5 min) | From the front of the model | Observation group: observation of a task video (20 times); APG: repeatedly practiced actions performed during the preliminary test for 10 min; CG: neither watched the video nor practiced the actions | Number of times the full drinking action was performed in 1 min | All groups showed statistically significant improvements compared to CG. Combined group had a significant higher number of drinking behaviors than Observation group, immediately after and 1 week after the experiment. No statistical differences between the Combined and the AOT group |
Cowles T et al.; 2013 [28] | Observation (1–2 min) followed by action (4–6 min) performed simultaneously with the therapist | No video | CPT as deemed appropriate | MI, ARAT | The median (95% CI) between-group difference was not statistically significant |
Buccino G et al.;2012 [3] | motor tasks of actions related to the children’s daily lives | Different perspectives | Video (no specific motor content) + execution of same actions as the EG | MUUL | After treatment, the functional score gain was significantly different in the EG and CG |
Franceschini M. et al.;2012 [29] | Observation of 1 task per day consisting in three different 3-min meaningful motor sequences, from the easiest to the most complex action + to imitate the observed motor sequence. The actions were 20 daily activities | first-person | Control treatment or “sham” AO = to observe for 5 min 5 static images (no motor content) + to perform UL movements as well as feasible for 2 min according to a standard sequence, simulating those performed by the EG | BBT, FAT, FMA, MAS, FIMM | Differences between the 2 groups were found from T0 to T1 and from T1 to T2. However, no difference was found on either change in BBT performance from T1 to T2. No significant difference between the study groups was found in the FIMM and FMA performance |
Ertelt D. et al.; 2007 [6] | 6 min videos showing daily life hand/upper limb actions + 6 min of repetitive practice of the observed actions with their paretic UL. 3 hand/upper limb movements of increasing complexity each day | 3 different perspectives | Same as the EG but sequences of geometric symbols and letters. The practiced hand and upper limb actions were performed by instruction of the therapist in the exact order as they were practiced in the experimental condition | FAT, WMFT, SIS | Significant improvement of motor functions as compared to T0, and compared with CG, maintained for at least 8 weeks after the end of the intervention. Neural activations between EG and CG after training shows significant rise in bilateral ventral premotor cortex, bilateral superior temporal gyrus and supplementary motor area |
Author | CEBM level | PEDro Score | Diagnosis | Sample size | Duration (wks) | Intensity (frequency per week, minutes/day) | |
---|---|---|---|---|---|---|---|
Enrolled tot; | Age (Mean +/− standard deviation) years | ||||||
Kim JC et al.; 2017 [30] | 1b | 8/10 | Chronic stroke | 21 | 57.08 ± 7.29 (AOPT group); 52.92 ± 8.21 LIOPT (control group) | 3 | 3 days/week, 15 min × 2 /day; |
Bae S et al.; 2017 [31] | 1b | 7/10 | Chronic stroke | 18 | 49.50 ± 10.60 (DASI); 49.67 ± 8.78 (control group) | 4 | 5 days /week, 20 min day |
Park HJ et al.; 2017 [32] | 1b | 7/10 | Chronic stroke | 25 | 57.33 ± 6.89 AOT group; 55.08 ± 8.12 control group | 4 | 3 sessions per week, 30 min for video |
Lee et al.; 2017 [33] | 2b | 5/10 | Chronic stroke | 35 | 62.80 ± 7.40 (AOTA group); 57.27 ± 5.70 (MTA group) 59.80 ± 6.70 (AOT group) | 6 | 3 times per week, 30 min/day |
Park and Hwangbo; 2015 [34] | 2b | 4/10 | Chronic stroke | 40 | 51.15 ± 14.81 AOGT; 48.65 ± 12.81 GGT; | 8 | 5 times per week, 30 min per session |
Park HR et al.; 2014 [35] | 1b | 7/10 | Chronic stroke | 21 | 55.91 ± 9.10 (AOT group); 54.80 ± 12.22 (control group) | 4 | 3 times per week, 30 min/day |
Kim JH et al.; 2013 [36] | 2b | 6/10 | Chronic stroke | 27 | 55.30 ± 12.10 AOT group; 54.80 ± 8.80 MIT group; 59.80 ± 8.90 PT group | 4 | 5 times / week, 30 min for session |
Kim JH et Lee BH; 2013 [37] | 2b | 6/10 | Chronic stroke | 27 | 55.30 ± 12.10 AOT group; 54.80 ± 8.80 MIT group; 59.80 ± 8.90 PT group. | 4 | 5 times / week, 30 min for session |
Author | Experimental group | Control group | Study Outcome | Results: differences between experimental and control group | |
---|---|---|---|---|---|
Type of AOT | Videos (perspective; speed) | Type of intervention | |||
Kim J-C et al.; 2017 [30] | Observation (2 min 30 s) + 12 min 30 s for physical training × 2/day Actions: tasks related to STW and imitated actions. 16 tasks with adjusted difficulty and condition based on patient’s functional status and level | n.s. | Observe static landscape photos + physical training as the EG | WDI, LOS, TUG, DGI | No significant difference in the TUG, DGI, and WDI between the AOPT and LIOPT groups. Significant difference in LOS between the AOPT and LIOPT groups |
Bae S et al.; 2017 [31] | 20 min. Video of dorsiflexion of the contralateral ankle recorded in advance whit simultaneously application of ETFES, movement of the contralateral ankle, induced by ETFES shown live on a monitor during subjects’ performance | n.s. | Patients were instructed to dorsiflex upon FES application. A Microstim device was used to apply FES by bipolar placement of the electrodes. Asymmetrical biphasic waves were applied for 20 min with valgus position | MRCP was measured by the QEEG-8; the H reflexes with Neuro-EMG-Micro, EMG, and Biorescue system for assessment of the effects of ETFES with AOT | MRCP in MP at C4 and dynamic balance (LOS) showed significant differences between DASI and control group |
Park HJ et al.; 2017 [32] | video clips of walking on even and uneven ground, in a complex and unpredictable community environment, in a parking lot, shopping center | 3 different directions (front back, side), 2 different filming speeds: normal and half times normal speed. | 30 min video clips of static landscape pictures; any human or animal representation were excluded | 10MWT | In EG walking function and ambulation confidence was significantly different between the pre- and post-intervention, whereas the CG showed a significant difference only in the 10MWT |
Lee et al.; 2017 [33] | Observation (15 min) + execution (15 min) Actions: dorsiflexor training composed of 3 stages of active assistive exercise. 1 stage: knee joint extensor and dorsiflexor training. 2 stage: knee joint flexor and dorsiflexor training. 3 stage: hip and knee joint flexor and dorsiflexor training | Front and lateral side videos were produced separately for the left and right hemiplegic subjects | The MTA group received mirror therapy for 15 min/day and physical training of the same motions without a mirror for 15 min/day. The AOT group conducted action observation only for 30 min/day | OBI, ABI, MBI, Postural stability and fall risk, mEFAP | No significant difference was found between the groups on all outcome measures |
Park and Hwangbo; 2015 [34] | AOGT: 3 min video+ 1 min break + 5 min walking training + 1–2 min break. (x3) | n.s. | GGT: 12 min video with break (3 min) showing images of nature unrelated with walking + 20 min walking training | Balance ability: sway area, sway speed, limit of stability by analysis system using biofeedback, AP1153BioRescue. Gait ability: TUG, 10MWT | There were significant differences in the sway speed, in the limit of stability, in TUG and 10 MWT between the two groups after the experiment but not in the sway area |
Park HR et al.; 2014 [35] | Observation (10 min) of video clips + sessions of walking training (20 min). 4 Tasks for functional training frequently experienced in premorbid life including weight shifting to the affected side, walking on straight and curved paths, walking on even and uneven surfaces, crossing obstacle. | 2 filming speed options (normal and half- speeds) in the front, back and side views in twice sequence | Observation of video clips showing different landscape images (10 min) + perform the same walking tasks as the EG | 10MWT, DGI, Gait Symmetry Score | The difference between the pre- and post-test values of the 10MWT, figure-of-8 walk test, and DGI showed statistically significant differences between the EG and CG |
Kim JH et al.; 2013 [36] | Observation (20 min) + Physical training with a therapist (10 min). Actions: 4 stages including trunk flexion, trunk rotation, sit to stand, and crossing obstacles. | n.s. | MIG: 20 min of motor imagery program played through a computer speaker + physical training for 10 min based on the training contents. PTG: training of the trunk for learning supine to rolling movements, sit to stand, and normal gait pattern | EEG data quantitative analysis using Telescan 2.9. Raw EEG data were converted into frequencies, then relative alpha power (8–13/4–50 Hz) and relative beta power (13–20/4–50 Hz) were analyzed | There were no significantly differences between the 3 groups |
Kim JH et Lee BH; 2013 [37] | Observation of task video (20 min) + physical training with a therapist (10 min) Actions divided in 4 stages: Stage 1) pelvic tilting, trunk flexion and extension, and trunk rotation in the sitting position; Stage 2) sit to stand and stand to sit; Stage 3) weight shift to the front and back, left and right; Stage 4) gait level surface and step over obstacle | The video was produced separately for patients with left hemiplegia and right hemiplegia | MIG: 20 min of motor imagery program + physical training for 10 min as in the EG program. PTG: training of the trunk for learning supine to rolling movements, sit-to-stand, normal gait pattern, as well as training of the lower extremity, weight shifting, and gait level surface and gait stairs | TUG, the functional reaching test, the walking ability questionnaire, the functional ambulation category. Spatiotemporal gait parameters were collected using a GAITRite system | No significant differences in any outcome measure were observed between the AOT group and the MIG, except for Stride length. Significant difference was observed between the AOT group and the PTG in the TUG, gait speed, cadence, and single limb support of the affected side |