Effectiveness of technological interventions to improve upper limb motor function in people with stroke in low- and middle-income countries: Protocol for a systematic review and meta-analysis

Abstract

IntroductionStroke is one of the main causes of disability in low- and middle-income countries (LMIC), frequently presenting with upper extremity paresis and causing major functional dependence. It requires high dose and intense rehabilitation which implies high economic costs, consequently limiting this therapy in LMIC. There are multiple technological interventions that facilitate rehabilitation either in intensity, adherence and motor evaluation; or enable access to rehabilitation such as robots, games or virtual reality, sensors, electronic devices and tele-rehabilitation. Their efficacy has been mainly evaluated in high-income countries, hence the importance of conducting a systematic review in LMIC settings.ObjectivesTo measure the efficacy of technological interventions vs. classical physical rehabilitation in the upper extremity motor function in people who had suffered a first or recurrent episode of stroke in LMIC.Methods and analysisThis protocol is consistent with the methodology recommended by the PRISMA-P and the Cochrane handbook for systematic reviews of interventions. We propose to do a systematic review and meta-analysis. In order to do so, we will perform an electronic search in PubMed, Global Index Medicus and Physiotherapy Evidence Database. No date range parameters will be used. Randomized controlled trials (RCT) published in English, Spanish, French and Portuguese, with the primary outcome focusing on upper limb motor function, will be included. Two reviewers will screen all retrieved titles, abstracts and full texts, perform the evaluation of the risk of bias and extract all data independently. The risk of bias of the included RCT will be evaluated by the Cochrane Collaboration’s tool. A qualitative synthesis will be provided in text and tables, to summarize the main results of the selected publications.The heterogeneity between studies will be assessed through the I2 statistic. If there is sufficient homogeneity across outcomes, a meta-analysis will be considered. The outcomes to be evaluated will be motor functionality of the upper extremity, performance for activities of daily living and quality of life, through measurement scales.ConclusionsThis systematic review will provide evidence regarding the efficacy of multiple technological interventions to improve motor function of upper extremity in individuals with stroke in LMIC. Based on this analysis, we will be able to assess whether these interventions are also effective and feasible in the recovery of functionality after stroke in low- and middle-income countries, and thus offer recommendations in these areas.

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“…It is well known that the recovery of motor function in upper extremities, particularly in the hand, is harder to achieve compared to in lower extremities due to its complex structure, specialized functions. 15 Jang et al investigated the motor outcomes in 23 patients with a complete middle cerebral artery territory infarct, about 70% of these patients were able to walk independently after 3–6 months, but no patient achieved functional hand recovery. 10 …”

“…It is well known that the recovery of motor function in upper extremities, particularly in the hand, is harder to achieve compared to in lower extremities due to its complex structure, specialized functions. 15 Jang et al investigated the motor outcomes in 23 patients with a complete middle cerebral artery territory infarct, about 70% of these patients were able to walk independently after 3-6 months, but no patient achieved functional hand recovery. 10 As mentioned earlier, while many treatment methods have been developed, there is a lack of effective therapies that can facilitate the recovery of patients from subacute phase post-stroke, and rehabilitation is the only method that is known to contribute to the functional recovery.…”