Dynamic hand orthoses for the recovery of hand and arm function in adults after stroke: A systematic review and meta-analysis of randomised controlled trials

ABSTRACT

Background

Repetitive, functional-based rehabilitation is recommended after stroke. However, impaired active digital extension is common after stroke, which limits functional-based rehabilitation and recovery. Non-robotic dynamic hand orthoses (DHOs) may address this.

Objectives

We did a systematic review and meta-analysis to determine whether non-robotic DHOs improve upper limb recovery after stroke in comparison to i)placebo or no intervention and ii)usual care.

Methods:

We followed PRISMA guidelines. We included randomized controlled trials (RCTs) assessing upper limb recovery associated with the use of non-robotic DHOs in adults after stroke. Outcomes of interest were functional upper limb movement and activities of daily living.

We performed searches on 27 September 2019 in 10 bibliographic databases including Cochrane Stroke Groups Specialized Trials Register and Cochrane Central Register of Controlled Trials. We also searched gray literature and citations from included studies.

Two reviewers independently screened abstracts and full text, extracted data and assessed risk of bias using a Cochrane risk of bias tool.

Results

We reviewed 7225 titles and included four studies involving 56 randomized participants, all with a high risk of bias. A positive effect in favor of non-robotic DHOs was observed for two outcomes; upper limb function (mean difference (MD) 6.23, 95% confidence interval (CI) 0.28–12.19 (p = 0.04)) and dexterity (MD 2.99, 95% CI 0.39–5.60 (p = 0.02).

Conclusions

The results are encouraging but included studies were small with high risk of bias meaning there is currently insufficient evidence that non-robotic DHOs improve upper limb recovery after stroke.

Review Registration

PROSPERO, CRD42020179180. Registered on 20 May 2020.

KEYWORDS:

• Stroke
• upper limb
• hand
• rehabilitation
• dynamic hand orthosis
• randomized-controlled trial
• systematic review

Acknowledgments

We would like to thank NHS Greater Glasgow and Clyde Librarian Services for the help and expertise they provided during the literature search for this review.

Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article and/or its supplementary materials.

Disclosure of interest

The authors are conducting an RCT involving a DHO called a SaeboGlove. Saebo Ltd who make this DHO loan SaeboGloves to the study. Saebo Ltd has no other involvement in the study.

Ethics and informed consent

Ethical approval and informed consent were not required to conduct this review.

Supplementary data

Supplemental data for this article can be accessed on the publisher’s website.

Additional information

Funding

This work was supported by Chest Heart and Stroke Scotland[ResFell19/173].