Subgroup analyses for upper limb interventions are based on trials providing measures of arm function. Trials that only provide measures of hand function84or sitting balance/reach66,76,77are therefore excluded. Subgroup analyses are presented for type, amount and timing of intervention, and to consider the impact of
Review: Repetitive functional task practice (including RTT, CIMT, TM)
Comparison: 02 Upper limb function Outcome: 03 Sitting balance/reach
Study Treatment Control SMD (fixed) Weight SMD (fixed)
or subcategory N Mean (SD) N Mean (SD) (95% CI) (%) (95% CI)
01 RTT
de Sèze 200176 10 3.30 (0.80) 10 3.00 (0.80) 9.61 0.36 (–0.53 to 1.24) Dean 199766 10 12.00 (0.95) 9 10.80 (0.90) 7.49 1.24 (0.23 to 2.24) Howe 200577 15 –1.90 (0.80) 18 –2.10 (0.70) 15.89 0.26 (–0.43 to 0.95) Langhammer 200068 29 5.40 (0.90) 24 5.00 (1.50) 25.38 0.33 (–0.22 to 0.87) Van Vliet 200570 42 4.54 (1.49) 43 4.63 (1.42) 41.63 –0.06 (–0.49 to 0.36)
Subtotal (95% CI) 106 104 100.00 0.23 (–0.05 to 0.50)
Test for heterogeneity: 2 = 5.88, df = 4 (p = 0.21), I2 = 32.0%
Test for overall effect: Z = 1.61 (p = 0.11)
Total (95% CI) 106 104 100.00 0.23 (–0.05 to 0.50)
Test for heterogeneity: 2 = 5.88, df = 4 (p = 0.21), I2 = 32.0%
Test for overall effect: Z = 1.61 (p = 0.11)
–4 –2 0 2 4
Favours control Favours treatment
FIGURE 4 Sitting balance/reach
specific trial features on the results. The
classification of trials for each subgroup analysis is given in Appendix 6.
Type of intervention
Subgroups compared the treatment effects for eight RTT trials recruiting 467 participants, and seven CIMT trials recruiting 76 participants (Figure 6). The impact of RTT on upper limb
function post-treatment just failed to reach statistical significance (SMD 0.17, 95% CI –0.03 to 0.36). The impact of CIMT on arm function showed some heterogeneity (I2= 41%), but not sufficient to necessitate the use of a random-effects approach. There was a large and statistically significant effect size (SMD 0.77, 95% CI 0.26 to 1.29). The difference between effect sizes for CIMT and RTT was statistically significant (p = 0.03).
22
Review: Repetitive functional task practice (including RTT, CIMT, TM)
Comparison: 02 Upper limb function Outcome: 04 Follow-up
Study Treatment Control SMD (fixed) Weight SMD (fixed)
or subcategory N Mean (SD) N Mean (SD) (95% CI) (%) (95% CI)
01 Under 6 months post-therapy
Boake, 200684 9 0.16 (0.06) 7 0.10 (0.10) 5.65 0.71 (–0.32 to 1.74) de Sèze, 200176 10 3.60 (0.50) 10 3.40 (0.60) 7.62 0.35 (–0.54 to 1.23) Howe, 200577 15 2.50 (1.30) 16 1.90 (0.50) 11.43 0.60 (–0.12 to 1.32)
Subtotal (95% CI) 34 33 24.70 0.55 (0.06 to 1.04)
Test for heterogeneity: 2 = 0.32, df = 2 (p = 0.85), I2 = 0%
Test for overall effect: Z = 2.19 (p = 0.03) 02 6–12 months post-therapy
Blennerhassett, 200450 10 –23.60 (12.20) 11 –31.00 (33.20) 8.04 0.28 (–0.58 to 1.14) Langhammer, 200068 27 3.90 (2.50) 27 3.50 (2.80) 20.90 0.15 (–0.39 to 0.68) Van Vliet, 200570 42 3.45 (2.40) 45 3.77 (2.37) 33.65 –0.13 (–0.55 to 0.29) Winstein, 200471 17 9.67 (5.80) 16 10.98 (6.20) 12.72 –0.21 (–0.90 to 0.47)
Subtotal (95% CI) 96 99 75.30 –0.02 (–0.31 to 0.26)
Test for heterogeneity: 2 = 1.42, df = 3 (p = 0.70), I2 = 0%
Test for overall effect: Z = 0.17 (p = 0.86)
–10 –5 0 5 10
Favours control Favours treatment
FIGURE 5 Arm function: follow-up at 0–6 months and more than 6 months post-therapy
23
Review: Repetitive functional task practice (including RTT, CIMT, TM)
Comparison: 03 Subgroup analyses: upper limb Outcome: 01 Type of intervention
Study Treatment Control SMD (fixed) Weight SMD (fixed)
or subcategory N Mean (SD) N Mean (SD) (95% CI) (%) (95% CI)
01 RTT
Blennerhassett, 200450 15 4.90 (1.90) 15 5.10 (1.50) 6.45 –0.11 (–0.83 to 0.60) Higgins, 200652 47 29.00 (17.00) 44 28.00 (19.00) 19.58 0.06 (–0.36 to 0.47) Kwakkel, 199953 27 20.00 (22.00) 34 10.00 (19.00) 12.59 0.48 (–0.03 to 1.00) Langhammer, 200068 29 4.70 (2.00) 24 4.10 (2.30) 11.21 0.28 (–0.27 to 0.82) Turton, 199069 12 13.83 (6.00) 10 12.25 (7.20) 4.66 0.23 (–0.61 to 1.07) Van Vliet, 200570 42 3.88 (2.23) 43 3.69 (2.38) 18.30 0.08 (–0.34 to 0.51) Winstein, 200471 20 9.58 (5.70) 20 9.47 (6.30) 8.62 0.02 (–0.60 to 0.64) Yen, 200572 13 –2.57 (0.93) 17 –3.06 (1.54) 6.24 0.36 (–0.37 to 1.09)
Subtotal (95% CI) 205 207 87.66 0.17 (–0.03 to 0.36)
Test for heterogeneity: 2 = 3.18, df = 7 (p = 0.87), I2 = 0%
Test for overall effect: Z = 1.67 (p = 0.09) 02 CIMT
Alberts, 200483 5 –28.89 (24.80) 5 –25.02 (17.96) 2.14 –0.16 (–1.40 to 1.08) Atteya, 200479 2 52.00 (6.00) 2 51.50 (10.50) 0.85 0.03 (–1.94 to 2.00) Dromerick, 200081 11 52.80 (5.90) 9 44.30 (11.10) 3.75 0.95 (0.01 to 1.89) Page, 200180 2 53.00 (6.00) 2 51.00 (10.00) 0.74 0.14 (–1.97 to 2.25) Page, 200582 5 49.80 (3.27) 5 35.80 (3.56) 0.56 3.70 (1.28 to 6.12) Taub, 199373 4 8.10 (0.42) 5 6.90 (0.70) 1.13 1.79 (0.07 to 3.50) Wittenberg, 200374 9 7.54 (2.04) 7 5.85 (2.79) 3.16 0.67 (–0.35 to 1.69)
Subtotal (95% CI) 38 35 12.34 0.77 (0.26 to 1.29)
Test for heterogeneity: 2 = 10.18, df = 6 (p = 0.12), I2 = 41.0%
Test for overall effect: Z = 2.93 (p = 0.003)
Total (95% CI) 243 242 100.00 0.24 (0.06, 0.42)
Test for heterogeneity: 2 = 17.99, df = 14 (p = 0.21), I2 = 22.2%
Test for overall effect: Z = 2.59 (p = 0.010)
–10 –5 0 5 10
Favours control Favours treatment
FIGURE 6 Subgroup analysis: type of intervention – upper limb trials
Dosage of task practice
Seven trials (five RTT, two CIMT) with 399 participants provided up to 20 hours’ task practice. Eight trials (three RTT, five CIMT) with 163 participants provided more than 20 hours’
task practice (Figure 7). There was substantial heterogeneity (I2= 50.8%) in the trials providing
up to 20 hours’ task practice, Using a random-effects model to combine the random-effects from individual trials, while the estimated effect was greater for the subgroup with more than 20 hours of task practice, the difference between subgroups failed to reach statistical significance (p = 0.18).
24
Review: Repetitive functional task practice (including RTT, CIMT, TM) Comparison: 03 Subgroup analyses: upper limb
Outcome: 02 Dosage of task practice
Study Treatment Control SMD (random) Weight SMD (random)
or subcategory N Mean (SD) N Mean (SD) (95% CI) (%) (95% CI)
01 0–20 hours
Blennerhassett, 200450 15 4.90 (1.90) 15 5.10 (1.50) 7.47 –0.11 (–0.83 to 0.60) Dromerick, 200081 11 52.80 (5.90) 9 44.30 (11.10) 4.80 0.95 (0.01 to 1.89) Higgins, 200652 47 29.00 (17.00) 44 28.00 (19.00) 15.53 0.06 (–0.36 to 0.47) Langhammer, 200068 29 4.70 (2.00) 24 4.10 (2.30) 11.12 0.28 (–0.27 to 0.82) Page, 200582 5 49.80 (3.27) 5 35.80 (3.56) 0.82 3.70 (1.28 to 6.12) Van Vliet, 200570 42 3.88 (2.23) 43 3.69 (2.38) 14.97 0.08 (–0.34 to 0.51) Winstein, 200471 20 9.58 (5.70) 20 9.47 (6.30) 9.28 0.02 (–0.60 to 0.64)
Subtotal (95% CI) 169 160 63.99 0.22 (–0.12 to 0.57)
Test for heterogeneity: 2 = 12.20, df = 6 (p = 0.06), I2 = 50.8%
Test for overall effect: Z = 1.27 (p = 0.20) 02 More than 20 hours
Alberts, 200483 5 –28.89 (24.80) 5 –25.02 (17.96) 2.92 –0.16 (–1.40 to 1.08) Atteya, 200479 2 52.00 (6.00) 2 51.50 (10.50) 1.23 0.03 (–1.94 to 2.00) Kwakkel, 199953 27 20.00 (22.00) 34 10.00 (19.00) 11.99 0.48 (–0.03 to 1.00) Page, 200180 2 53.00 (6.00) 2 51.00 (10.00) 1.08 0.14 (–1.97 to 2.25) Taub, 199373 4 8.10 (0.42) 5 6.90 (0.70) 1.60 1.79 (0.07 to 3.50) Turton, 199069 12 13.83 (6.00) 10 12.25 (7.20) 5.76 0.23 (–0.61 to 1.07) Wittenberg, 200374 9 7.54 (2.04) 7 5.85 (2.79) 4.14 0.67 (–0.35 to 1.69) Yen, 200572 13 –2.57 (0.93) 17 –3.06 (1.54) 7.28 0.36 (–0.37 to 1.09)
Subtotal (95% CI) 74 82 36.01 0.42 (0.10 to 0.75)
Test for heterogeneity: 2 = 4.00, df = 7 (p = 0.78), I2 = 0%
Test for overall effect: Z = 2.56 (p = 0.01)
Total (95% CI) 243 242 100.00 0.27 (0.05 to 0.49)
Test for heterogeneity: 2 = 17.99, df = 14 (p = 0.21), I2 = 22.2%
Test for overall effect: Z = 2.39 (p = 0.02)
–10 –5 0 5 10
Favours control Favours treatment
FIGURE 7 Subgroup analysis: dosage of task practice – upper limb trials
Time since stroke
Nine trials (four RTT, five CIMT) with 364 participants measured arm function in
participants up to 6 months post-stroke. Six trials (four RTT, two CIMT) with 189 participants included participants more than 6 months
post-stroke (Figure 8). There was some
heterogeneity in trials 0–6 months post-stroke (I2= 34.8%), but not sufficient to warrant using a random-effects model. The difference between subgroups did not reach statistical significance (p = 0.65).
25
Review: Repetitive functional task practice (including RTT, CIMT, TM)
Comparison: 03 Subgroup analyses: upper limb Outcome: 03 Time since stroke
Study Treatment Control SMD (fixed) Weight SMD (fixed)
or subcategory N Mean (SD) N Mean (SD) (95% CI) (%) (95% CI)
01 0–6 months
Alberts, 200483 5 –28.89 (24.80) 5 –25.02 (17.96) 2.14 –0.16 (–1.40 to 1.08) Atteya, 200479 2 52.00 (6.00) 2 51.50 (10.50) 0.85 0.03 (–1.94 to 2.00) Dromerick, 200081 11 52.80 (5.90) 9 44.30 (11.10) 3.75 0.95 (0.01 to 1.89) Kwakkel, 199953 27 20.00 (22.00) 34 10.00 (19.00) 12.59 0.48 (–0.03 to 1.00) Langhammer, 200068 29 4.70 (2.00) 24 4.10 (2.30) 11.21 0.28 (–0.27 to 0.82) Page, 200180 2 53.00 (6.00) 2 51.00 (10.00) 0.74 0.14 (–1.97 to 2.25) Page, 200582 5 49.80 (3.27) 5 35.80 (3.56) 0.56 3.70 (1.28 to 6.12) Van Vliet, 200570 42 3.88 (2.23) 43 3.69 (2.38) 18.30 0.08 (–0.34 to 0.51) Winstein, 200471 20 9.58 (5.70) 20 9.47 (6.30) 8.62 0.02 (–0.60 to 0.64)
Subtotal (95% CI) 143 144 58.77 0.28 (0.04 to 0.51)
Test for heterogeneity: 2 = 12.27, df = 8 (p = 0.14), I2 = 34.8%
Test for overall effect: Z = 2.28 (p = 0.02) 02 More than 6 months
Blennerhassett, 200450 15 4.90 (1.90) 15 5.10 (1.50) 6.45 –0.11 (–0.83 to 0.60) Higgins, 200652 47 29.00 (17.00) 44 28.00 (19.00) 19.58 0.06 (–0.36 to 0.47) Taub, 199373 4 8.10 (0.42) 5 6.90 (0.70) 1.13 1.79 (0.07 to 3.50) Turton, 199069 12 13.83 (6.00) 10 12.25 (7.20) 4.66 0.23 (–0.61 to 1.07) Wittenberg, 200374 9 7.54 (2.04) 7 5.85 (2.79) 3.16 0.67 (–0.35 to 1.69) Yen, 200572 13 –2.57 (0.93) 17 –3.06 (1.54) 6.24 0.36 (–0.37 to 1.09)
Subtotal (95% CI) 100 98 41.23 0.19 (–0.09 to 0.47)
Test for heterogeneity: 2 = 5.51, df = 5 (p = 0.36), I2 = 9.2%
Test for overall effect: Z = 1.31 (p = 0.19)
Total (95% CI) 243 242 100.00 0.24 (0.06 to 0.42)
Test for heterogeneity: 2 = 17.99, df = 14 (p = 0.21), I2 = 22.2%
Test for overall effect: Z = 2.59 (p = 0.010)
–10 –5 0 5 10
Favours control Favours treatment
FIGURE 8 Subgroup analysis: time since stroke – upper limb trials
Allocation concealment
Trials were grouped according to whether
allocation concealment was judged to be adequate (five RTT trials) or inadequate/unclear (ten trials:
three RTT, seven CIMT) (Figure 9). There was some heterogeneity observed in the
‘inadequate/unclear’ subgroup (I2= 27.3%).
The difference between subgroups was
statistically significant (p = 0.08), indicating that the effect of RFTP was greater for trials where allocation concealment was either inadequate or unclear.
26
Review: Repetitive functional task practice (including RTT, CIMT, TM)
Comparison: 03 Subgroup analyses: upper limb Outcome: 04 Allocation concealment
Study Treatment Control SMD (fixed) Weight SMD (fixed)
or subcategory N Mean (SD) N Mean (SD) (95% CI) (%) (95% CI)
01 Adequate
Blennerhassett, 200450 15 4.90 (1.90) 15 5.10 (1.50) 6.45 –0.11 (–0.83 to 0.60) Higgins, 200652 47 29.00 (17.00) 44 28.00 (19.00) 19.58 0.06 (–0.36 to 0.47) Kwakkel, 199953 27 20.00 (22.00) 34 10.00 (19.00) 12.59 0.48 (–0.03 to 1.00) Van Vliet, 200570 42 3.88 (2.23) 43 3.69 (2.38) 18.30 0.08 (–0.34 to 0.51) Winstein, 200471 20 9.58 (5.70) 20 9.47 (6.30) 8.62 0.02 (–0.60 to 0.64)
Subtotal (95% CI) 151 156 65.55 0.12 (–0.10 to 0.35)
Test for heterogeneity: 2 = 2.58, df = 4 (p = 0.63), I2 = 0%
Test for overall effect: Z = 1.08 (p = 0.28) 02 Inadequate/unclear
Alberts, 200483 5 –28.89 (24.80) 5 –25.02 (17.96) 2.14 –0.16 (–1.40 to 1.08) Atteya, 200479 2 52.00 (6.00) 2 51.50 (10.50) 0.85 0.03 (–1.94 to 2.00) Dromerick, 200081 11 52.80 (5.90) 9 44.30 (11.10) 3.75 0.95 (0.01 to 1.89) Langhammer, 200068 29 4.70 (2.00) 24 4.10 (2.30) 11.21 0.28 (–0.27 to 0.82) Page, 200180 2 53.00 (6.00) 2 51.00 (10.00) 0.74 0.14 (–1.97 to 2.25) Page, 200582 5 49.80 (3.27) 5 35.80 (3.56) 0.56 3.70 (1.28 to 6.12) Taub, 199373 4 8.10 (0.42) 5 6.90 (0.70) 1.13 1.79 (0.07 to 3.50) Turton, 199069 12 13.83 (6.00) 10 12.25 (7.20) 4.66 0.23 (–0.61 to 1.07) Wittenberg, 200374 9 7.54 (2.04) 7 5.85 (2.79) 3.16 0.67 (–0.35 to 1.69) Yen, 200572 13 –2.57 (0.93) 17 –3.06 (1.54) 6.24 0.36 (–0.37 to 1.09)
Subtotal (95% CI) 92 86 34.45 0.46 (0.15 to 0.77)
Test for heterogeneity: 2 = 12.37, df = 9 (p = 0.19), I2 = 27.3%
Test for overall effect: Z = 2.93 (p = 0.003)
Total (95% CI) 243 242 100.00 0.24 (0.06 to 0.42)
Test for heterogeneity: 2 = 17.99, df = 14 (p = 0.21), I2 = 22.2%
Test for overall effect: Z = 2.59 (p = 0.010)
–10 –5 0 5 10
Favours control Favours treatment
FIGURE 9 Subgroup analysis: allocation concealment – upper limb trials
Post hoc analysis: type of comparison group Seven trials (five RTT, two CIMT) were classified as usual care or alternative treatment, and eight trials (three RTT, five CIMT) were classified as attention-control or no treatment
(Figure 10), with some heterogeneity observed in trials with usual care/alternative treatment controls (I2=46.1%). There was no statistically significant difference between subgroups (p = 0.84).
27
Review: Repetitive functional task practice (including RTT, CIMT, TM) Comparison: 03 Subgroup analyses: upper limb
Outcome: 05 Comparison group
Study Treatment Control SMD (fixed) Weight SMD (fixed)
or subcategory N Mean (SD) N Mean (SD) (95% CI) (%) (95% CI)
01 Usual care/alternative treatment
Dromerick, 200081 11 52.80 (5.90) 9 44.30 (11.10) 3.75 0.95 (0.01 to 1.89) Langhammer, 200068 29 4.70 (2.00) 24 4.10 (2.30) 11.21 0.28 (–0.27 to 0.82) Page, 200582 5 49.80 (3.27) 5 35.80 (3.56) 0.56 3.70 (1.28 to 6.12) Turton, 199069 12 13.83 (6.00) 10 12.25 (7.20) 4.66 0.23 (–0.61 to 1.07) Van Vliet, 200570 42 3.88 (2.23) 43 3.69 (2.38) 18.30 0.08 (–0.34 to 0.51) Winstein, 200471 20 9.58 (5.70) 20 9.47 (6.30) 8.62 0.02 (–0.60 to 0.64) Yen, 200572 13 –2.57 (0.93) 17 –3.06 (1.54) 6.24 0.36 (–0.37 to 1.09)
Subtotal (95% CI) 132 128 53.35 0.26 (0.01 to 0.51)
Test for heterogeneity: 2 = 11.13, df = 6 (p = 0.08), I2 = 46.1%
Test for overall effect: Z = 2.02 (p = 0.04) 02 Attention control/no treatment
Alberts, 200483 5 –28.89 (24.80) 5 –25.02 (17.96) 2.14 –0.16 (–1.40 to 1.08) Atteya, 200479 2 52.00 (6.00) 2 1.50 (10.50) 0.85 0.03 (–1.94 to 2.00) Blennerhassett, 200450 15 4.90 (1.90) 15 5.10 (1.50) 6.45 –0.11 (–0.83 to 0.60) Higgins, 200652 47 29.00 (17.00) 44 28.00 (19.00) 19.58 0.06 (–0.36 to 0.47) Kwakkel, 199953 27 20.00 (22.00) 34 10.00 (19.00) 12.59 0.48 (–0.03 to 1.00) Page, 200180 2 53.00 (6.00) 2 51.00 (10.00) 0.74 0.14 (–1.97 to 2.25) Taub, 199373 4 8.10 (0.42) 5 6.90 (0.70) 1.13 1.79 (0.07 to 3.50) Wittenberg, 200374 9 7.54 (2.04) 7 5.85 (2.79) 3.16 0.67 (–0.35 to 1.69)
Subtotal (95% CI) 111 114 46.65 0.22 (–0.04 to 0.49)
Test for heterogeneity: 2 = 6.82, df = 7 (p = 0.45), I2 = 0%
Test for overall effect: Z = 1.63 (p = 0.10)
Total (95% CI) 243 242 100.00 0.24 (0.06 to 0.42)
Test for heterogeneity: 2 = 17.99, df = 14 (p = 0.21), I2 = 22.2%
Test for overall effect: Z = 2.59 (p = 0.010)
–10 –5 0 5 10
Favours control Favours treatment
FIGURE 10 Subgroup analysis: type of comparison group – upper limb trials
Post hoc analysis: equivalence of therapy time One subgroup comprised seven trials (two RTT, five CIMT) which gave, additional therapy time to the experimental group, and the other contained eight trials (six RTT, two CIMT) where therapy time for experimental and control groups was equivalent (Figure 11). There was some heterogeneity of treatment effects in each subgroup, but not sufficient to merit the use of a random-effects meta-analysis. There was no significant difference between the two subgroups (p = 0.92).
Post hoc analysis: trial size
The median number of participants in the trials was 23. A post hoc analysis was therefore undertaken for trials with under 25 participants
versus those with 25 or more participants (Figure 12). Some heterogeneity was observed in trials with under 25 participants (I2= 38.2%), but not enough to warrant the use of a random-effects model. The difference between effect sizes in the small trial sub-group (<25 participants) and the larger trial sub-group (艌25 participants) was statistically significant (p = 0.06). As the effect in the small trial subgroup (SMD 0.62, 95% CI 0.18 to 1.07) is significantly larger than in the larger trial subgroup (SMD 0.16, 95% CI –0.04 to 0.36), this may indicate some degree of reporting bias in upper limb trials. This is supported by the funnel plot in Figure 13, which has some apparent asymmetry indicating a potential lack of reporting of small negative trials with large standard errors.
28
Review: Repetitive functional task practice (including RTT, CIMT, TM) Comparison: 03 Subgroup analyses: upper limb
Outcome: 06 Equivalence of therapy time
Study Treatment Control SMD (fixed) Weight SMD (fixed)
or subcategory N Mean (SD) N Mean (SD) (95% CI) (%) (95% CI)
01 Additional therapy time
Alberts, 200483 5 –28.89 (24.80) 5 –25.02 (17.96) 2.14 –0.16 (–1.40 to 1.08) Atteya, 200479 2 52.00 (6.00) 2 51.50 (10.50) 0.85 0.03 (–1.94 to 2.00) Page, 200180 2 53.00 (6.00) 2 51.00 (10.00) 0.74 0.14 (–1.97 to 2.25) Page, 200582 5 49.80 (3.27) 5 35.80 (3.56) 0.56 3.70 (1.28 to 6.12) Turton, 199069 12 13.83 (6.00) 10 12.25 (7.20) 4.66 0.23 (–0.61 to 1.07) Winstein, 200471 20 9.58 (5.70) 20 9.47 (6.30) 8.62 0.02 (–0.60 to 0.64) Wittenberg, 200374 9 7.54 (2.04) 7 5.85 (2.79) 3.16 0.67 (–0.35 to 1.69)
Subtotal (95% CI) 55 51 20.76 0.25 (–0.15 to 0.65)
Test for heterogeneity: 2 = 9.44, df = 6 (p = 0.15), I2 = 36.5%
Test for overall effect: Z = 1.23 (p = 0.22) 02 Equivalent therapy time
Blennerhassett, 200450 15 4.90 (1.90) 15 5.10 (1.50) 6.45 –0.11 (–0.83 to 0.60) Dromerick, 200081 11 52.80 (5.90) 9 44.30 (11.10) 3.75 0.95 (0.01 to 1.89) Higgins, 200652 47 29.00 (17.00) 44 28.00 (19.00) 19.58 0.06 (–0.36 to 0.47) Kwakkel, 199953 27 20.00 (22.00) 34 10.00 (19.00) 12.59 0.48 (–0.03 to 1.00) Langhammer, 200068 29 4.70 (2.00) 24 4.10 (2.30) 11.21 0.28 (–0.27 to 0.82) Taub, 199373 4 8.10 (0.42) 5 6.90 (0.70) 1.13 1.79 (0.07 to 3.50) Van Vliet, 200570 42 3.88 (2.23) 43 3.69 (2.38) 18.30 0.08 (–0.34 to 0.51) Yen, 200572 13 –2.57 (0.93) 17 –3.06 (1.54) 6.24 0.36 (–0.37 to 1.09)
Subtotal (95% CI) 188 191 79.24 0.24 (0.03 to 0.44)
Test for heterogeneity: 2 = 8.54, df = 7 (p = 0.29), I2 = 18.0%
Test for overall effect: Z = 2.28 (p = 0.02)
Total (95% CI) 243 242 100.00 0.24 (0.06 to 0.42)
Test for heterogeneity: 2 = 17.99, df = 14 (p = 0.21), I2 = 22.2%
Test for overall effect: Z = 2.59 (p = 0.010)
–10 –5 0 5 10
Favours control Favours treatment
FIGURE 11 Subgroup analysis: equivalence of therapy time – upper limb trials
29
Review: Repetitive functional task practice (including RTT, CIMT, TM) Comparison: 03 Subgroup analyses: upper limb
Outcome: 07 Trial size
Study Treatment Control SMD (fixed) Weight SMD (fixed)
or subcategory N Mean (SD) N Mean (SD) (95% CI) (%) (95% CI)
01 Under 25 participants
Alberts, 200483 5 –28.89 (24.80) 5 –25.02 (17.96) 2.14 –0.16 (–1.40 to 1.08) Atteya, 200479 2 52.00 (6.00) 2 51.50 (10.50) 0.85 0.03 (–1.94 to 2.00) Dromerick, 200081 11 52.80 (5.90) 9 44.30 (11.10) 3.75 0.95 (0.01 to 1.89) Page, 200180 2 53.00 (6.00) 2 51.00 (10.00) 0.74 0.14 (–1.97 to 2.25) Page, 200582 5 49.80 (3.27) 5 35.80 (3.56) 0.56 3.70 (1.28 to 6.12) Taub, 199373 4 8.10 (0.42) 5 6.90 (0.70) 1.13 1.79 (0.07 to 3.50) Turton, 199069 12 13.83 (6.00) 10 12.25 (7.20) 4.66 0.23 (–0.61 to 1.07) Wittenberg, 200374 9 7.54 (2.04) 7 5.85 (2.79) 3.16 0.67 (–0.35 to 1.69)
Subtotal (95% CI) 50 45 17.01 0.62 (0.18 to 1.07)
Test for heterogeneity: 2 = 11.33, df = 7 (p = 0.12), I2 = 38.2%
Test for overall effect: Z = 2.77 (p = 0.006) 02 25 or more participants
Blennerhassett, 200450 15 4.90 (1.90) 15 5.10 (1.50) 6.45 –0.11 (–0.83 to 0.60) Higgins, 200652 47 29.00 (17.00) 44 28.00 (19.00) 19.58 0.06 (–0.36 to 0.47) Kwakkel, 199953 27 20.00 (22.00) 34 10.00 (19.00) 12.59 0.48 (–0.03 to 1.00) Langhammer, 200068 29 4.70 (2.00) 24 4.10 (2.30) 11.21 0.28 (–0.27 to 0.82) Van Vliet, 200570 42 3.88 (2.23) 43 3.69 (2.38) 18.30 0.08 (–0.34 to 0.51) Winstein, 200471 20 9.58 (5.70) 20 9.47 (6.30) 8.62 0.02 (–0.60 to 0.64) Yen, 200572 13 –2.57 (0.93) 17 –3.06 (1.54) 6.24 0.36 (–0.37 to 1.09)
Subtotal (95% CI) 193 197 82.99 0.16 (–0.04 to 0.36)
Test for heterogeneity: 2 = 3.15, df = 6 (p = 0.79), I2 = 0%
Test for overall effect: Z = 1.59 (p = 0.11)
Total (95% CI) 243 242 100.00 0.24 (0.06 to 0.42)
Test for heterogeneity: 2 = 17.99, df = 14 (p = 0.21), I2 = 22.2%
Test for overall effect: Z = 2.59 (p = 0.010)
–10 –5 0 5 10
Favours control Favours treatment FIGURE 12 Subgroup analysis: trial size – upper limb trials
Review: Repetitive functional task practice (including RTT, CIMT, TM)
Comparison: 03 Subgroup analyses: upper limb Outcome: 08 Trial size
–10 –5 0 5 10
0.0
0.4
0.8
1.2
1.6
SE (SMD)
SMD (fixed) FIGURE 13 Funnel plot of precision versus effect size – upper limb trials
30
Review: Repetitive functional task practice (including RTT, CIMT, TM) Comparison: 04 Lower limb function
Outcome: 01 Walking distance
Study Treatment Control WMD (random) Weight WMD (random)
or subcategory N Mean (SD) N Mean (SD) (95% CI) (%) (95% CI)
01 RTT
Blennerhassett, 200450 15 221.00 (65.40) 15 107.00 (85.60) 9.81 114.00 (59.49 to 168.52) Dean, 200067 5 42.03 (30.42) 4 4.76 (4.90) 20.79 37.27 (10.18 to 64.36) Salbach, 200451 44 40.00 (72.00) 47 5.00 (66.00) 20.04 35.00 (6.56 to 63.44)
Subtotal (95% CI) 64 66 50.65 54.59 (17.50 to 91.68)
Test for heterogeneity: 2 = 6.94, df = 2 (p = 0.03), I2 = 71.2%
Test for overall effect: Z = 2.88 (p = 0.004) 02 TM
Ada, 200387 11 99.00 (70.00) 14 13.00 (27.00) 13.09 86.00 (42.28 to 129.72) da Cunha, 200286 6 107.00 (71.52) 7 51.58 (63.00) 6.19 55.42 (–18.42 to 129.26) Eich, 200489 25 90.60 (43.50) 25 55.70 (32.60) 24.17 34.90 (13.59 to 56.21) Macko, 200588 25 281.03 (120.00) 20 264.57 (136.31) 5.90 16.46 (–59.58 to 92.50)
Subtotal (95% CI) 67 66 49.35 48.88 (19.56 to 78.20)
Test for heterogeneity: 2 = 4.84, df = 3 (p = 0.18), I2 = 38.0%
Test for overall effect: Z = 3.27 (p = 0.001)
Total (95% CI) 131 132 100.00 50.05 (29.65 to 70.44)
Test for heterogeneity: 2 = 11.79, df = 6 (p = 0.07), I2 = 49.1%
Test for overall effect: Z = 4.81 (p < 0.00001)
–1000 –500 0 500 1000
Favours control Favours treatment
FIGURE 14 Walking distance