Group versus individual delivery of upper limb intervention for adults post-stroke: A systematic review and meta-analysis

Abstract

Objective: To systematically review the evidence and examine the effectiveness of group-based UL intervention versus individual therapy, in decreasing impairment and improving UL function post-stroke.Data SourcesA comprehensive search of four key databases (CINAHL, Embase, Emcare, and MEDLINE) identified relevant studies published from inception through to November 2024. Review methods: Two reviewers independently performed screening for inclusion according to selection criteria. Eligible studies provided dose-matched group and individual UL rehabilitation programs. Outcomes that measured UL impairment (Fugl-Meyer Upper Extremity Test) or function (Action Research Arm Test) were extracted for meta-analysis. Methodological quality was assessed using the PEDro scale. Results: Of 3291 publications, eight studies were included (n = 348) (seven randomised controlled trials and one controlled trial) of poor to good quality. A random effects meta-analysis model was conducted. Statistical significance was determined using analysis of covariance. No significant effects were shown in the meta-analyses on the effect of group versus individual therapy on UL impairment (mean difference 0.87, 95% CI: -0.87 to 2.62, p = .327) or function (mean difference 1.53, 95% CI: -0.23 to 3.29, p = .089). Results were limited by small sample sizes and substantial heterogeneity, with wide variation in intervention type, dosage and setting.Conclusion: Meta-analyses suggest group-based UL intervention may be as effective as intervention delivered one-to-one, post-stroke. Additional studies of large sample size and rigorous methodology are necessary to substantiate these findings. Future research should investigate which types of UL intervention are most effective when provided in group-based settings across the different stages of stroke recovery.