Dose, Content, and Context of Usual Care in Stroke Upper Limb Motor Interventions: A Systematic Review.
Sarah P Newton, Emily J Dalton, Jia Y Ang and 3 others
PMID 37151039WHAT IT FOUND
Usual care dose for stroke upper limb recovery is highly variable.
Time on task ranged from 8 to 44 minutes per day, and repetitions from 15 to 282 per day. Patients with severe upper limb impairment or cognitive issues received less active practice time.
Key findings
01Only eight studies met inclusion criteria for reporting usual care dose, highlighting a scarcity of data on what patients actually receive in routine practice.
02Dose varies widely: time on task ranged from a median of 8 minutes to 44.4 minutes per day, and repetitions per day ranged from a median of 15 to a mean of 282.
03Context matters: patients with severe upper limb impairment received a median of 33.0 minutes of time on task compared to 67.2 minutes for those with mild impairment in one study.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Only eight studies were included, which is a small number for a systematic review, limiting the generalizability of the findings. Most studies (6 of 8) were conducted in the subacute phase, so findings may not reflect acute or community practice. Data collection dates ranged from 2008 to 2019, meaning some data may not reflect current practice patterns. The review only included studies that reported dose; those reporting content without dose were excluded, potentially underrepresenting the variety of usual care interventions. Inconsistencies in how dose was reported (e.g., time in therapy vs. time on task, mean vs. median) made direct comparison difficult.
Declared interests
The authors declared no potential conflicts of interest and received no financial support.
The easy way to misread this
Do not assume that the 'usual care' control group in a trial represents a standard, high-dose intervention. The review shows that usual care dose is highly variable and often much lower than clinical guidelines recommend, particularly for patients with severe impairment or cognitive deficits.