Bilateral training shows greater motor recovery than conventional therapy in subacute stroke patients
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Key Takeaway
Consider bilateral training's potential benefits cautiously in subacute stroke, pending larger trials.
This randomized controlled trial enrolled 40 hemiplegic patients with subacute stroke to compare two rehabilitation approaches over 6 weeks. Group A received conventional task-oriented physiotherapy for the affected side only, while Group B received comprehensive bilateral training that added a strengthening regimen for the unaffected side based on FITT principles. Both groups trained 5 days per week.
Both interventions showed significant improvement in motor recovery measures. For the Fugl-Meyer Assessment of the Lower Extremity, Group A had a mean total score change of 7.15 ± 1.84, while Group B showed 8.45 ± 2.19. Both groups demonstrated significant within-group improvement (p < 0.05), though between-group p-values for FMA were not reported. For Brunnstrom stage of recovery, Group A improved by 1.50 ± 0.65 stages, while Group B improved by 2.70 ± 0.68 stages, with a significant between-group difference (p = 0.0001).
Safety and tolerability data were not reported. Key limitations include the small sample size of 40 patients, absence of confidence intervals or standardized effect sizes for between-group FMA comparisons, and only immediate post-intervention assessment without long-term follow-up. The study was published as an abstract, limiting methodological detail. While the bilateral approach showed promising results in this preliminary trial, particularly for Brunnstrom stage improvement, clinicians should interpret these findings cautiously given the study's limitations and await more robust evidence.
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View Original Abstract ↓
BACKGROUND AND PURPOSE: Most physiotherapists focus on the affected (hemiparetic) side when developing a rehabilitation plan for a hemiplegic patient. The less-affected side is left inactive and begins to lose its qualities, which deconditions the patient's overall rehabilitation. The objective of the study was to compare between extensive bilateral training and traditional rehabilitation methods for motor recovery.
METHODS: Forty hemiplegic patients were selected for this randomized controlled trial. Patients were randomly assigned to two groups: Group A (Conventional Physiotherapy) and Group B (Comprehensive Bilateral Training) using a 1:1 simple randomization scheme. Ethical clearance was obtained from the Institutional Ethics Committee of Datta Meghe Institute of Higher Education and Research (DMIHER, DU), Wardha (Ethical permission number: DMIHER.[DU]/IEC/2024/310), and the study was registered with the Clinical Trials Registry of India (CTRI/2024/11/077143). Eligible participants with subacute stroke were randomly allocated to either Group A (Conventional Physiotherapy) or Group B (Comprehensive Bilateral Training), using the Sequentially Numbered Opaque Sealed Envelope (SNOSE) method. Enrolment in the study, intervention procedures, and outcome assessment followed Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) standards. Patients in Group A received task-oriented approach-oriented training for the affected side, and Group B received strength training for the lower limb using a protocol identical to that of Group A for the unaffected side, for 5 days/week for 6 weeks. A strengthening regimen was designed for the unaffected side, based on the FITT (frequency, intensity, time, type) principles of the American College of Sports Medicine (ACSM). The Fugl-Meyer Assessment of the Lower Extremity (FMA-LE) and the Brunnstrom Stage of Recovery were assessed at baseline and post-rehabilitation.
RESULTS: Both groups showed significant improvement (p < 0.05). Group B showed more significant results both statistically and clinically. The mean total FMA score difference was 7.15 ± 1.84 in Group A and 8.45 ± 2.19 in Group B, reflecting more improvement in Group B. The improvement in the FMA-LE scores indicated a stroke-specific index of disability improvement in both groups. Similarly, the Brunnstrom stage of recovery also showed an excellent improvement in both groups. The mean change was 1.50 ± 0.65 in Group A and 2.70 ± 0.68 in Group B, with a significant between-group difference (p = 0.0001).
CONCLUSION: The findings of this study reveal that, compared with the Affected Side Training Group, both side groups had favourable effects on the stroke-specific disability index in subacute hemiparetic stroke patients, aiding early recovery.
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