Date Presented 04/05/19
This systematic review aimed to evaluate the effects of action-observation therapy in patients with stroke. The findings showed that action-observation therapy had a moderate- or moderate-to-high effectiveness in different aspects of rehabilitation outcomes compared with conventional treatment. The overall results suggested that action-observation therapy is a beneficial intervention in stroke rehabilitation to improve upper-extremity motor function, daily performance, and participation of patients.
Primary Author and Speaker: Tzu-Hsuan Peng
Contributing Authors: Yu-Wei Hsieh, Jun-Ding Zhu
PURPOSE: Stroke is the leading cause of long-term disability in adults worldwide. In the last decade, action observation therapy (AOT) has been a new approach based on mirror neuron system in stroke rehabilitation. Augmentation of motor-based techniques with cognitive strategies (e.g., action observation) has been listed as one of top 10 recommendations from the occupational therapy practice guidelines for adults with stroke. In AOT, patients are commonly asked to observe the actions performed by another healthy person and then to practice the same actions. Some studies revealed that the patients gained improvements after receiving AOT. This systematic review aimed to evaluate the treatment effects of AOT on upper-extremity motor function, daily performance and participation in patients with stroke.
DESIGN: This was a systematic review and meta-analysis study. We systematically reviewed and analyzed the AOT literature according to the study selection criteria: (1) study was a randomized controlled trial; (2) both the experiment group and control group were applied in each study, and the experiment group contained action observation session; (3) patients in each study were older than 18 years old; (4) the whole study was written in English; and (5) at least one of the outcome measures was related to motor function of upper-extremity. Two reviewers excluded the irrelevant articles by screening the titles and abstracts of articles.
METHOD: The selected articles were searched from the electronic databases, including PubMed, Scopus, OTseeker, and Cochrane Library. The following keywords were used: (Stroke OR CVA OR hemiplegia) AND (UE OR “hand function” OR “upper extremity” OR arm* OR hand*) AND (“action observation”). Two reviewers evaluated the methodological quality of eligible studies by using the PEDro scale. Meta-analysis was conducted by using the Comprehensive Meta-Analysis Version 3.0 software.
RESULTS: There were 7 articles included and analyzed in this review based on the selection criteria and they were all published between 2007 and 2017. A total of 321 patients were involved in the analysis. The overall sample size of each study ranged from 12 to 90 patients. Among the selected studies, the quality of 4 articles was high and that of 3 articles was moderate. Compared with conventional rehabilitation treatment, the AOT had a moderate effect size on upper-extremity motor function (Hedge’s g = 0.525; p < 0.001), and a moderate to high effect size on the daily performance and participation outcomes (Hedge’s g = 0.687; p = 0.004). In addition, for the studies using the same treatment dosage between the 2 intervention groups, the AOT had a moderate effect size on upper-extremity motor function compared with the control group (Hedge’s g = 0.527; p < 0.001). Moreover, the AOT had a moderate effect size on motor function while it was applied to the patients in subacute stroke phase (Hedge’s g = 0.509; p < 0.001). There was no heterogeneity among the studies included in these analyses, except for the model of daily performance and participation outcome (Q = 7.857; I2 = 61.818%; df = 3).
CONCLUSION: This review supports that AOT is a beneficial intervention in stroke rehabilitation to improve upper-extremity motor function, daily performance and participation in patients. The AOT showed moderate or moderate to high effect sizes in different aspects of rehabilitation outcomes compared with conventional rehabilitation. Further randomized controlled trials with larger scale and well designed to investigate the effects of AOT are warranted.
References
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