Dose of arm activity training during acute and subacute rehabilitation post stroke: a systematic review of the literature

Aim: To determine the dose of activity-related arm training undertaken by stroke survivors during acute and subacute rehabilitation. Methods: A systematic review of PubMed, CINAHL and EMBASE up to December 2014 was completed. Studies were eligible if they defined the dose (time or repetitions) of activity-related arm training using observational methods for a cohort of adult stroke survivors receiving acute or subacute rehabilitation. All studies were quality appraised using an evidence-based learning critical appraisal checklist. Data was analysed by method of documented dose per session (minutes, repetitions), environment (acute or subacute rehabilitation) and therapy discipline (physiotherapy, occupational therapy). Results: Ten studies were included: two observed stroke survivors during acute rehabilitation and eight during subacute rehabilitation. During acute rehabilitation, one study reported 4.1minutes per session during physiotherapy and 11.2minutes during occupational therapy, while another study reported 5.7minutes per session during physiotherapy only. During inpatient rehabilitation, activity-related arm training was on average undertaken for 4minutes per session (range 0.9 to 7.9, n=4 studies) during physiotherapy and 17minutes per session (range 9.3 to 28.9, n=3 studies) during occupational therapy. Repetitions per session were reported by two studies only during subacute rehabilitation. One study reported 23 repetitions per session during physiotherapy and occupational therapy, while another reported 32 repetitions per session across both disciplines. Conclusion: The dose of activity-related arm training during acute and subacute rehabilitation after stroke is limited.