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Title: Comparison of bilateral and unilateral upper limb training in people with stroke : a systematic review and meta-analysis
Authors: Chen, PM 
Kwong, PWH 
Lai, CKY 
Ng, SSM 
Issue Date: 2019
Source: PLoS one, 23 May 2019, v. 14, no. 5, e0216357, p. 1-21
Abstract: Background and objectives Bilateral upper limb training (BULT) and unilateral upper limb training (UULT) are two effective strategies for the recovery of upper limb motor function after stroke. This meta-analysis aimed to compare the improvements in motor impairment and functional performances of people with stroke after BULT and UULT.
Research design and methods This systematic review and meta-analysis identified 21 randomized controlled trials (RCTs) met the eligibility criteria from CINAHL, Medline, Embase, Cochrane Library and PubMed. The outcome measures were the Fugl-Meyer Assessment of Upper Extremity (FMA-UE), Wolf Motor Function Test (WMFT), Action Research Arm Test (ARAT) and Box and Block Test (BBT), which are validated measures of upper limb function.
Results Twenty-one studies involving 842 subjects with stroke were included. Compared with UULT, BULT yielded a significantly greater mean difference (MD) in the FMA-UE (MD = 2.21, 95% Confidence Interval (CI), 0.12 to 4.30, p = 0.04; l(2) = 86%, p<0.001). However, a comparison of BULT and UULT yielded insignificant mean difference (MD) in terms of the time required to complete the WMFT (MD = 0.44; 95%CI, -2.22 to 3.10, p = 0.75; l(2) = 55%, p = 0.06) and standard mean difference (SMD) in terms of the functional ability scores on the WMFT, ARAT and BBT (SMD = 0.25; 95%CI, -0.02 to 0.52, p = 0.07; l(2) = 54%, p = 0.02).
Discussion and implications Compared to UULT, BULT yielded superior improvements in the improving motor impairment of people with stroke, as measured by the FMA-UE. However, these strategies did not yield significant differences in terms of the functional performance of people with stroke, as measured by the WMFT, ARAT and BBT. More comparative studies of the effects of BULT and UULT are needed to increase the reliability of these conclusions.
Publisher: Public Library of Science
Journal: PLoS one 
EISSN: 1932-6203
DOI: 10.1371/journal.pone.0216357
Rights: Copyright: © 2019 Chen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
The following publication Chen P-m, Kwong PWH, Lai CKY, Ng SSM (2019) Comparison of bilateral and unilateral upper limb training in people with stroke: A systematic review and meta-analysis. PLoS ONE 14(5): e0216357, 21 pages is available at
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