The Effects of Upper Limb Motor Recovery on Submovement Characteristics among the Patients with Stroke: A Meta-Analysis

Objective To evaluate the evidence related to the effect of upper limb motor recovery on submovement characteristics, including duration, amplitude, overlap, interpeak distance, and the number of submovements in stroke patients using a meta-analysis. Type of Study Meta-analysis. Literature Survey The literature search was restricted to articles written in English published from inception to October 2018 in Web of Science, PubMed, Science Direct, IEEE Explore, MEDLINE, CDSR, Scopus, Compendex, Wiley Online Library, Springer Link, and REHABDATA. Methodology Studies were included if they encompassed adult participants with a clinical diagnosis of stroke who underwent upper limb rehabilitation and if they assessed and reported submovement characteristics as the outcome measures in pre- and posttreatment stages. Changes in submovement characteristics between pre- and postinterventions were compared using the standardized mean difference (SMD). Finally, a test for heterogeneity and publication bias was implemented for all meta-analyses. Synthesis Among the 188 retrieved articles, seven of them (one randomized controlled trial, six pre-post) involving 259 patients were selected for meta-analysis. Based on the results, the overall observed changes in all meta-analyses were statistically significant. In total, submovement amplitude (SMD 0.624, 95% confidence interval [CI] [0.356, 0.893]), duration (SMD 0.61, 95% CI [0.332, 0.888]), and overlap (SMD 0.928, 95% CI [0.768, 1.088]) increased whereas interpeak distance (SMD -0.278, 95% CI [-0.42, -0.137]), and the total number of submovements (SMD -0.804, 95% CI [-1.069, -0.538]) decreased. Conclusions The submovements appeared to become longer, fewer, and more overlapped with motor recovery. Based on the results, the ability of the neural system to blend submovements increased in both acute/subacute and chronic patients during recovery. Therefore, assessing the submovements during recovery can be a new quantitative measure of motor improvement, providing another means of comparing rehabilitation interventions and individualizing therapy for stroke patients.