Comparing Interventions Used in Randomized Controlled Trials of Upper Extremity Motor Rehabilitation Post-stroke in High-Income Countries and Low-to-Middle-Income Countries

Objective

To identify and compare interventions for upper extremity (UE) motor recovery poststroke in randomized controlled trials (RCTs) conducted in high-income countries (HICs) and low-to-middle-income countries (LMICs).

Data Source

Systematic searches were conducted for RCTs published in English in 5 databases (CINAHL, Embase, PubMed, Scopus, and Web of Science) up to April 2021, in line with PRISMA guidelines.

Study Selection

RCTs, including crossover design, were included if they were in English and evaluated an intervention for poststroke UE motor rehabilitation, in an adult population (≥18y) diagnosed with stroke.

Data Extraction

Data on country of origin and type of intervention in each RCT were extracted using a data extraction template in Covidence software. Study screenings and data extraction were performed by 2 independent reviewers.

Data Synthesis

A total of 1276 RCTs met the inclusion criteria, with 978 RCTs conducted in HICs and 298 in LMICs. A significantly larger proportion of RCTs evaluating robotics and task-specific training interventions were conducted in HICs, compared to LMICs (P<.009). In contrast, a higher proportion of RCTs conducted in LMICs examined acupuncture (P<.001) and repetitive transcranial magnetic stimulation (rTMS) (P=.001) when compared to HICs.

Conclusions

Poststroke rehabilitation in LMICs is conducted in a lower resource environment when compared to HICs. Some differences exist in the use of UE motor rehabilitation interventions between LMICs and HICs such as robotics, task-specific training, rTMS, and acupuncture; however, there was no significant difference between HICs and LMICs for most interventions.