Background
Methods
Search strategy
Eligible studies
Ineligible studies
Methodological assessment
Descriptive assessment
Strength | |
Endurance | |
Mobility/stretching | Exercises aimed at improving range of motion |
Basic activities | Activities of arm or hand like grasping, moving objects |
Complex activities | Movement in which whole body is involved |
Functional movement | a movement involving task execution that is not directed towards a clear ADL-goal (e.g. moving blocks from one location to another, stacking rings over a cone) (as opposed to analytical movements, which are movements without a goal, usually occurring in one single movement plane and often occurring in single joints, e.g. shoulder flexion) |
Clear functional goal | a goal that is set during everyday-life activities, hobbies (e.g. washing dishes, grooming activity, dressing oneself, playing golf) |
Client-centred | therapy goals that are set through the involvement of the patient him/herself in the therapy goal decision process. The goals respect patient’s values, preferences, expressed needs and recognize the clients’ experience and knowledge |
Overload/overlearning | training that exceeds the patient’s metabolic muscle capacity(overload) or the performance needed for handling in daily life (overlearning) . Overload is determined by the total time spent on therapeutic activity, the number of repetitions, the difficulty of the activity in terms of coordination, muscle activity type and resistance load, and the intensity, i.e. number of repetitions per time unit. In this review we have scored a high amount of repetitions as determining factor for the presence of overload, as the other factors are rarely described in intervention descriptions. |
Real object | manipulation that makes use of objects that are handled in normal everyday-life activities (e.g. cutlery, hairbrush…). |
Context specific | a training environment (supporting surface, objects, people, room,…) that equals or mimics the natural environment for a specific task execution, in order to include task characteristic sensory/perceptual information, task specific context characteristics and cognitive processes involved |
Exercise progression | Exercises on offer have an increasing difficulty level that is in line with the increasing abilities of the patient, in order to keep the demands of the exercises and challenges optimal for motor learning |
Exercise variety | A variety of exercises was offered to support motor skill learning of a certain task because of the person experiencing different movement and context characteristics (within task variety) and problem solving strategies |
Feedback | specific information on the patient’s motor performance that enhances motor learning and positively influences patient motivation (for more information, the authors refer to) |
Multiple movement planes | Movement that uses more than one degree of freedom of a joint, therefore occurring around multiple joint axes. |
Total skill | The skill is practiced in total, with or without preceding skill component training (e.g. via chaining) |
Customized training load | A training load that suits the individualized treatment targets (e.g. endurance, coordination or strength training) as well as the patient’s capabilities (e.g. 65% of 1 repetition maximum or 85% of 1 repetition maximum for the specific patient). |
Random practice | Each practice session, the exercises are randomly ordered |
Distributed practice | A practice schedule with relatively long rest periods |
Bimanual tasks | Tasks where both arms and hands are involved are included |
Results
Methodological quality assessment
Reference | Tulder | LOE | Design | Patients | Interv CG | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
int val | descr | stat | total | MS type | EDSS | Age | TSFS | TSLE at least | EG (n) | CG (n) | ||||
Gehlsen et al. [24] | 2 | 3 | 2 | 7 | C | CS | ? | ? | 40.2 | ? | ? | 10 | no | |
5 | 6 | 2 | 13 | B | RCT | ? | 1-5.5 | 44 (7.1) | 6 (0–23) | 1 mo | 47 | 48 | no | |
Taylor al. [25] | 5 | 4 | 2 | 11 | C | CS | ? | 0-6.5 | 45.6 (27–61) | 6 (1–13)* | 1 mo | 12 | no | |
Freeman et al. [26] | 4 | 4 | 2 | 10 | B | RCT | SP,PP | 5-9.5 | 43 (25–73) | 15.4 (3–32) | 1 mo | 32 | 34 | WL |
Khan et al. [33] | 9 | 5 | 2 | 16 | A2 | RCT | RR, SP,PP | 0-8 | 49.5 (30–63) | 10.7 (6.3)* | 3 mo | 48 | 50 | WL (maint) |
Mark et al. [27] | 3 | 4 | 2 | 9 | C | Pilot | PP, SP | 6-7 | 56 (50–60) | ? | 3 mo | 5 | no | |
Patti et al. [28] | 7 | 6 | 2 | 15 | A2 | RCT | SP,PP | 4-8 | 25-60 | 1.5 (0.5-2.5) | 3 mo | 58 | 53 | home exerc. |
Jones et al. [29] | 2 | 4 | 1 | 7 | B | CCT | moderate to severe ataxia and PP, SP | ? | 36.9 (8.2) | ? | 1 year | 28 | 9 | WL |
Mathiowetz et al. [30] | 3 | 4 | 2 | 9 | C | CS | B, RR,PP, SP | 2.5-8 | 45 (27–63) | 12 (1–27) | ? | 30 | no | |
Storr et al. [31] | 6 | 4 | 2 | 12 | B | RCT | P, S, RR | 0-9 | 53 (33–66) | 15 (3–45) | 3 mo | 38 | 52 | WL |
Vikman et al. [32] | 4 | 4 | 2 | 10 | C | CS/CCT** | RR,SP,PP | 4-6.5 | 55.8 (10.3) | 18.3 (2–43) | ? | 40 + 18 | 18 | WL |
Descriptive analysis
Patients
Intervention
Set | Intervention | Outcome measures | Results | |||||||
---|---|---|---|---|---|---|---|---|---|---|
References | ICF level | Content | Weeks | Freq/ week | Freq/day | Intensity ('/day) | ICF level | Motor outcome UE | ||
Gehlsen et al. [24] | out | FU | aquatic exercise (including freestyle swimming) | 10 | 3 | 1 | 60 (60- 75% max heart rate) | FU | peak force, work, power (fatigue) | *improvement in force (ES:0.94), power(ES:0.79) and total work(ES:0.72); (not on fatigue (ES:0.23)) |
in/out | FU | exercise program: strenght + aerobic | 26 | 3-4 (resistance); 1(endurance) | ? | ? | FU + ACT | FU:UE endurance; ACT:FIM, MSFC (including 9HPT); BBT | *difference between groups on UE endurance, MSFC (ES:0.1)(mainly due to mobility factor); (not on BBT; FIM (ES:0.15)) | |
Taylor al. [25] | out | FU | PRE: UE (3ex)(and LE (3ex)):2x10-12rep | 10 | 2 | 1 | 60 | FU + ACT | FU:Arm press (1RM and endurance) | *improvement on arm press 1RM (ES:0.31); not on arm endurance (ES:0.47) (* improvement on MSIS-29 physical(ES:0.65)) |
Freeman et al. [26] | in | ACT | MD: patient tailored; towards functional goals | 3 | ? | PT:2; OT: 1; + MD | 135 | ACT | FIMmotor; (EDSS) | *improvement in comparison with control on FIM motor (selfcare; sphincter; transfer)(ES:0.21); (not on EDSS) |
Khan et al. [33] | in/out | ACT | MD:individual, achievable functional goal oriented | 7#
| in: 5; out: 2-3 | in:3; out2 | in: 180; out:60 | ACT | FIMmotor | *difference between groups on FIM motor (ES:1.13) and subscales (self care; sphincter; transfers); (not on MSIS (ES:0.23) or GHQ) |
Mark et al. [27] | out | ACT | CIMT | 2-10 | ? | 1 | 180 (30 h total) | ACT | WMFT; MAL | *improvement MAL (ES2.66), WMFT functional ability (1.17); not on WMFT performance time(ES:0.91) |
Patti et al. [28] | out | ACT | comprehensive individualised goal-oriented program | 6##
| 6 | ? | ? | ACT (+FU) | ACT:FIMmotor; (FU:EDSS; FSS) | *difference between groups on FIM mot (ES:0.78) and subscales; not on EDSS or FSS |
Jones et al. [29] | in | FU + ACT | PT and OT: promoting normal posture and movement (weight baering, approximation,..), stabilisation, equipment, damping and weighting | 8 days | 7 | 2 | 60 | FU + ACT | ACT:NPI, JTHF, (FU:FSS) | *difference between groups on NPI and on 4 of 20 JTHF items; not on FSS (FU) |
Mathiowetz et al. [30] | in | FU + ACT | MD: OT: compensatory strategies, adapted equipment, conserve enerergy; hand strength; PT:mobility, endurance, strength, streching | 5-7 | 7 | ? | ? | ACT | RIC-FAC | *improvement on all subscales (transfer, toileting, feeding, grooming, dressing upper body, dressing lower body) before-after (ES:0.33-1.19)(also after-follow-up (ES:0.52-1.35), except for feeding)(ES:0.23) |
Storr et al. [31] | in | ACT + FU | MD: PT:individualised: joint mobilisation, stretching, relaxtion, balance, coordination, ambulation, hydro-, hypotherapy; OT | 3-5 | PT:4–5: OT: 3; self training 5 | ? | PT: 45; OT 30; zelf training 30 | ACT (FU) | ACT:GNDS, 9HPT; (FU:EDSS, MSIS) | no *difference between groups on any of outcome measures: 9HPT(ES: 0.01); GNDS(ES 0.08) |
Vikman et al. [32] | out | FU + ACT | MD: standard inpatients; PT: group session: strenght, mobility, aquatic, balance; OT: hand therapy | 3 | ind: 5PT, 3OT; group: 5 PT, 5OT | ind: 1PT,1OT; group: 3PT, 1OT (handfunction) | 170 | ACT + FU | ACT:BBT, 9HPT, BI, MSFC; FU: Grip strength | A and B:* improvement in MSFC (ES:0.27); and on some of subscales of BBT (ES:0.16) and 9HPT(ES:0.1); not * on BI (ES:0.03) or grip strength (ES:0.08); A* on SF-36 |
Training components
References | Str | End | Mob | Basic | Comp | FuM | Goal | CC | O/O | RO | CS | Pro | Var | FB | MMP | TS | CTL | Ran | Distr | Bim | Total |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Gehlsen et al. [24] | 0 | 1 | 0 | 0 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 1 | 1 | 1 | 0 | 0 | 1 | 8 |
1 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 3 | |
Taylor et al. [25] | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 4 |
Freeman et al. [26] | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 3 |
Khan et al. [33] | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 4 |
Mark et al. [27] | 0 | 0 | 0 | 0 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 0 | 0 | 1 | 12 |
Patti et al. [28] | 0 | 0 | 0 | 0 | 1 | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 4 |
Jones et al. [29] | 1 | 1 | 0 | 1 | 0 | 1 | 0 | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 6 |
Mathiowetz et al. [30] | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 8 |
Storr et al. [31] | 0 | 0 | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 0 | 0 | 0 | 1 | 5 |
Vikman et al. [32] | 1 | 0 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 3 |
Frequencies | 5 | 4 | 3 | 3 | 5 | 7 | 2 | 6 | 2 | 2 | 1 | 4 | 1 | 0 | 5 | 3 | 2 | 0 | 0 | 5 | 60 |