Self-rehabilitation for stroke patients

Everard, Gauthier [UCL] Luc, Alexandre [UCL] Doumas, Ioannis [UCL] Ajana, Khawla [UCL] Stoquart, Gaëtan [UCL] Edwards, Martin [UCL] Lejeune, Thierry [UCL]

Background: Due to rises in stroke incidence, a lack of resources to implement effective rehabilitation (especially in developing countries) and a significant proportion of patients with remaining impairments after treatment, there is an increased demand for effective and prolonged rehabilitation. Development of self-rehabilitation programs provide an opportunity to meet these increasing demands. Objective: The aim of this meta-analysis was twofold. First, to determine the motor outcome effectiveness of post-stroke self-rehabilitation in comparison to conventional rehabilitation. Second, to understand the effects of trial location (continent), technology, time since stroke (acute/subacute vs chronic), dose (total training duration > vs ≤ 15 hours) and intervention design (self-rehabilitation in addition or in substitution to conventional therapy) on motor outcome(s). Methods: Literature searches were performed using Pubmed, Cochrane Library, Embase, Scopus, PEDro and Google Scholar. Studies were selected if participants were post-stroke adults; the intervention consisted of a self-rehabilitation program; the control group received post-stroke conventional therapy or no treatment; measured outcomes included motor function and activity, and; the study was a randomized controlled trial with a PEDro score ≥ 5. Results: Thirty-three trials were selected (consisting of 2120 participants) and accumulated motor outcome data analysed. Self-rehabilitation programs were shown to be as effective as conventional therapy for post-stroke motor recovery. Trial location, use of technology, stroke stage and intervention design showed equally reliable results. Conclusion: Self-rehabilitation could be used to provide an additional efficient treatment used in combination with conventional therapy after stroke.