What are the Elements of Upper Limb Motor Therapy That May Impact Changes in Neuroimaging Biomarkers After Stroke? A Systematic Review

Abstract

<h3>Objective(s)</h3> To investigate the relationship between the elements of upper limb motor therapy, neuroimaging biomarkers and clinical outcomes. <h3>Data Sources</h3> A systematic search of Cochrane Register of Controlled Trials (CENTRAL), EMBASE and Medline was conducted. <h3>Study Selection</h3> Studies with adult stroke survivors who underwent motor interventions aimed at improving motor function of the upper limb post-stroke were eligible. Included studies indexed change in brain structure or function in addition to motor impairment or activity limitation prior to, and post intervention. <h3>Data Extraction</h3> Quality of each study was assessed using Cochrane Risk-of-Bias Tool (RoB 2) or Risk of Bias in Non-Randomized Studies - of Interventions (ROBINS-I). Intervention reporting was assessed using Template for Intervention Description and Replication (TIDieR) Checklist. Demographic, neuroimaging biomarker and clinical outcome data were extracted. Intervention details were extracted including active ingredients such as type, dose, and difficulty. <h3>Data Synthesis</h3> 3681 records were screened, and 175 full texts were evaluated. Fifty-four studies comprising 88 intervention groups (n=1545 participants) were included. Functional Magnetic Resonance Imaging (fMRI) (48%) and Transcranial Magnetic Stimulation (TMS) (7%) were the most common neuroimaging biomarkers used. Improvement was seen in 43 intervention groups on their neuroimaging biomarkers. 23 groups achieved a MCID on impairment outcomes and 37 groups achieved a MCID on activity outcomes. Only 7 groups demonstrated improvement in both their neuroimaging biomarker, and both impairment and activity outcomes. No consistent combination of elements led to improvements on both neuroimaging biomarkers and motor outcomes. <h3>Conclusions</h3> There is no single element of therapy that drives change neuroimaging biomarkers and clinical outcomes. Deeper investigation is needed into the most effective combinations of elements for specific cohorts with upper limb disability after stroke. <h3>Author(s) Disclosures</h3> No disclosures