Bilateral movement training and stroke rehabilitation: A systematic review and meta-analysis

Objective and design: Bilateral movement training is being increasingly used as a post-stroke motor rehabilitation protocol. The contemporary emphasis on evidence-based medicine warrants a prospective meta-analysis to determine the overall effectiveness of rehabilitating with bilateral movements. Methods: After searching reference lists of bilateral motor recovery articles as well as PubMed and Cochrane databases, 11 stroke rehabilitation studies qualified for this systematic review. An essential requirement for inclusion was that the bilateral training protocols involved either functional tasks or repetitive arm movements. Each study had one of three common arm and hand functional outcome measures: Fugl-Meyer, Box and Block, and kinematic performance. Results: The fixed effects model primary meta-analysis revealed an overall effect size (ES = 0.732, S.D. = 0.13). These findings indicate that bilateral movement training was beneficial for improving motor recovery post-stroke. Moreover, a fail-safe analysis indicated that 48 null effects would be necessary to lower the mean effect size to an insignificant level. Conclusion: These meta-analysis findings indicate that bilateral movements alone or in combination with auxiliary sensory feedback are effective stroke rehabilitation protocols during the sub-acute and chronic phases of recovery. © 2006 Elsevier B.V. All rights reserved.