Strength training improves upper-limb function in individuals with stroke: a meta-analysis.

Abstract

After stroke, maximal voluntary force is reduced in the arm and hand muscles, and upper-limb strength training is 1 intervention with the potential to improve function. We performed a meta-analysis of randomized controlled trials. Electronic databases were searched from 1950 through April 2009. Strength training articles were assessed according to outcomes: strength, upper-limb function, and activities of daily living. The standardized mean difference (SMD) was calculated to estimate the pooled effect size with random-effect models. From the 650 trials identified, 13 were included in this review, totaling 517 individuals. A positive outcome for strength training was found for grip strength (SMD=0.95, P=0.04) and upper-limb function (SMD=0.21, P=0.03). No treatment effect was found for strength training on measures of activities of daily living. A significant effect for strength training on upper-limb function was found for studies including subjects with moderate (SMD=0.45, P=0.03) and mild (SMD=0.26, P=0.01) upper-limb motor impairment. No trials reported adverse effects. There is evidence that strength training can improve upper-limb strength and function without increasing tone or pain in individuals with stroke.