BACKGROUND: The differential effects of bilateral and unilateral training on
upper extremity (UE) function remain unclear.
OBJECTIVE: To compare the effectiveness of bilateral and unilateral training
on UE function and activities of daily living (ADL) after stroke.
METHODS: Randomized controlled trials (RCTs) were selected for inclusion by
two reviewers after searching the following databases: MEDLINE, EMBASE, Cochrane Central
Register of Controlled Trials (CENTRAL), and KoreaMed. Methodological qualities were
assessed using the PEDro scale. Effect size was estimated by calculating the standardized
mean difference (SMD).
RESULTS: Eleven RCTs of sufficient quality were included in our
meta-analysis. The effect size on UE capacity was statistically significant in favor of
the Constraint-Induced Movement Therapy (CIMT) groups (SMD [fixed], g: – 0.34; 95% CI: –
0.59–0.08; p = 0.01; I2 = 0%). No other SMDs were
significant.
CONCLUSION: The CIMT tasks were more effective than bilateral training with
regard to increased UE capacity; however, this result should be cautiously interpreted
since the evaluation tools were designed for assessment of unilateral UE function, not
bilateral UE function. Further, the effect of the CIMT tasks on UE capacity was not
translated into ADL. Considering the disadvantages of CIMT such as fatigue, bilateral
training may be more appropriate for improving ADL.
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