Unilateral vs Bilateral Hybrid Approaches for Upper Limb Rehabilitation in Chronic Stroke: A Randomized Controlled Trial

Arch Phys Med Rehabil. 2019 Dec;100(12):2225-2232. doi: 10.1016/j.apmr.2019.06.021. Epub 2019 Aug 14.


Objective: To investigate the effects of unilateral hybrid therapy (UHT) and bilateral hybrid therapy (BHT) compared with robot-assisted therapy (RT) alone in patients with chronic stroke.

Design: A single-blind, randomized controlled trial.

Setting: Four hospitals.

Participants: Outpatients with chronic stroke and mild to moderate motor impairment (N=44).

Intervention: UHT combined unilateral RT (URT) and modified constraint-induced therapy. BHT combined bilateral RT (BRT) and bilateral arm training. The RT group received URT and BRT. The intervention frequency for the 3 groups was 90 min/d 3 d/wk for 6 weeks.

Main outcome measures: Fugl-Meyer Assessment (FMA, divided into the proximal and distal subscale) and Stroke Impact Scale (SIS) version 3.0 scores before, immediately after, and 3 months after treatment and Wolf Motor Function Test (WMFT) and Nottingham Extended Activities of Daily Living (NEADL) scale scores before and immediately after treatment.

Results: The results favored BHT over UHT on the FMA total score and distal score at the posttest (P=.03 and .04) and follow-up (P=.01 and .047) assessment and BHT over RT on the follow-up FMA distal scores (P=.03). At the posttest assessment, the WMFT and SIS scores of the 3 groups improved significantly without between-group differences, and the RT group showed significantly greater improvement in the mobility domain of NEADL compared with the BHT group (P<.01).

Conclusions: BHT was more effective for improving upper extremity motor function, particularly distal motor function at follow-up, and individuals in the RT group demonstrated improved functional ambulation post intervention.

Trial registration: ClinicalTrials.gov NCT02451280.

Keywords: Randomized controlled trial; Rehabilitation; Robotics; Stroke; Therapy.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living
  • Adult
  • Aged
  • Biomechanical Phenomena
  • Chronic Disease
  • Disability Evaluation
  • Exercise Therapy / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Range of Motion, Articular
  • Recovery of Function
  • Robotics*
  • Single-Blind Method
  • Stroke Rehabilitation / methods*
  • Upper Extremity / physiopathology*

Associated data

  • ClinicalTrials.gov/NCT02451280