A systematic review protocol of timing, efficacy and cost effectiveness of upper limb therapy for motor recovery post-stroke

Kathryn S. Hayward, Sharon F. Kramer, Vincent Thijs, Julie Ratcliffe, Nick S. Ward, Leonid Churilov, Laura Jolliffe, Dale Corbett, Geoffrey Cloud, Tina Kaffenberger, Amy Brodtmann, Julie Bernhardt, Natasha A. Lannin

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Background: Improving upper limb (UL) motor recovery after stroke represents a major clinical and scientific goal. We aim to complete three systematic reviews to estimate the (1) association between time to start of UL therapy and motor recovery, (2) relative efficacy of different UL therapy approaches post-stroke and (3) cost-effectiveness of UL therapy interventions. Methods: We have designed a systematic review protocol to address three systematic review questions that were each registered with PROSPERO. The search will be conducted in MEDLINE, EMBASE, and Cochrane Controlled Register of Trials. We will include randomised controlled trials, non-randomised clinical trials, before-after studies and observational studies of adult stroke survivors with an average stroke onset < 6 months, undergoing hospital-based therapy to improve UL function. Eligible interventions will aim to promote UL functional recovery. Two reviewers will independently screen, select and extract data. Study risk of bias will be appraised using appropriate tools. Clinical measures of motor recovery will be investigated (primary measure Fugl Meyer UL assessment), as well as measures of health-related quality of life (primary measure EQ-5D) and all cost-effectiveness analyses completed. Secondary outcomes include therapy dose (minutes, weeks, repetitions as available) and safety (i.e. adverse events, serious adverse events). A narrative synthesis will describe quality and content of the evidence. If feasible, we will conduct random effects meta-analyses where appropriate. Discussion: We anticipate the findings of this review will increase our understanding of UL therapy and inform the generation of novel, data-driven hypotheses for future UL therapy research post-stroke. Systematic review registration: PROSPERO, http://www.crd.york.ac.UK/PROSPERO/display record.php?ID=CRD42018019367, http://www.crd.york.ac.UK/PROSPERO/display record.php?ID=CRD42018111629, http://www.crd.york.ac.UK/PROSPERO/display-record.php?ID=CRD42018111628.

Original languageEnglish
Article number187
JournalSystematic Reviews
Issue number1
Publication statusPublished - 25 Jul 2019

Bibliographical note

Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.


  • Protocol
  • Recovery
  • Rehabilitation
  • Stroke
  • Systematic review
  • Therapy
  • Upper limb


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