Comparison of the Effectiveness Between Bilateral and Unilateral Training for Distal Upper Extremity among Patients with Stroke: A Systematic Review and Meta-Analysis

Abstract

Purpose

Hemiplegia in the distal upper extremity (dUE) is a common post-stroke impairment that severely limits daily activities and functional recovery. Although upper-extremity rehabilitation typically focuses on unilateral training (UT), bilateral training (BT) is gaining recognition for its effectiveness in promoting post-stroke motor recovery. Few studies have characterized the effect of BT on dUE; therefore, the degree to which the effectiveness of BT can be predicted by clinical factors, such as patient characteristics and intervention settings, remains unclear. This study investigated the effectiveness of BT versus that of UT on dUE hemiplegia and analyzed the factors determining BT effectiveness.

Methods

A systematic literature search was conducted in PubMed, Embase, Cochrane Library, Scopus, and Web of Science for randomized controlled trials (RCTs) published before March 2024. The study included RCTs that evaluated motor recovery in post-stroke patients with dUE hemiplegia, using outcome measures such as the Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Action Research Arm Test, Wolf Motor Function Test, Box and Block Test, and the modified Ashworth Scale. Data were extracted on the effectiveness of BT and UT, focusing on motor function improvements. Subgroup analyses were conducted based on stroke onset timing and intervention settings.

Results

A total of 12 RCTs were included. The results showed that BT led to greater improvements in UE motor function (FMA-UE score, P = 0.04) and dUE function (FMA-UE distal score, P = 0.02) compared to UT. Subgroup analyses identified that stroke survivors with ≥4 weeks post-stroke onset (P = 0.03), and a treatment duration of at least 4 weeks (P = 0.0006) showed greater benefit from BT.

Conclusion

BT was more effective than UT for post-stroke motor recovery in both UE and dUE. Although stroke onset timing and intervention settings may influence BT outcomes, caution is needed when applying these findings due to the small number of studies and the heterogeneity of the included studies.