Developing Evidence-Based Practice of Limb Activation Techniques for the Remediation of Motor Dysfunction in Patients with Post-Stroke Neglect
: A Systematised Review and Critical Appraisal of Intervention Reporting

  • Victoria Collie

    Student thesis: Master's ThesisMaster of Science by Research


    Background: For clinicians to translate research into clinical practice, they require evidence of intervention effectiveness from high-quality studies and a full description of the intervention
    (Yamato et al. 2016 p121). A thorough and complete description allows the intervention to be fully evaluated in terms of effectiveness and it ensures accurate replication by clinicians and the development of research (Hoffmann et al. 2014). Accurate intervention descriptions have been found to be lacking in healthcare research and are a potentially modifiable barrier to the translation of evidence into practice (Hoffmann et al. 2015).

    One particular area where confusion is currently prevalent is in the advocacy of Limb Activation Techniques (LAT) in the treatment of post stroke neglect (an impairment which prevents a
    person from interacting with their left side). Whilst LAT is consistently referred to in research as an effective treatment, there is little clarity about what exactly this technique is, how it should be applied in practice and what quantifies as “effective” results. Evaluating the quality and completeness of intervention reporting may be an important step in the development of LAT as an evidence-based intervention. This study will appraise the completeness of current intervention reporting of LAT, using a snap-shot of the literature focusing on motor outcomes.

    Study Purpose: To determine whether LAT can be translated into clinical practice in the remediation of motor dysfunction in patients with left neglect in the first six months post stroke.

    Methods: A systematic review approach was conducted to identify all primary research investigating the effect of LAT on motor outcomes in the first 6 months post stroke in patients presenting with left neglect. Both published and unpublished literature was searched for using MEDLINE, CINAHL, AMED, PEDro, OT Seeker, PsycINFO, ProQuest Dissertations, ProQuest, CENTRAL, TRIP, OpenGrey and Google Scholar. An overview of methodological quality was ascertained using a modified version McMasters Quality appraisal tool (Law et al. 1998), by two separate reviewers. The TIDiER checklist (Hoffmann et al. 2014), was used to appraise the completeness of intervention reporting and to present the intervention details. Data pertinent to study and participant characteristics and treatment results were also extracted.

    Results: Seven studies met the inclusion criteria. The overall completeness of intervention reporting was lacking with the lowest score of 42% and the highest 71%. The provision of intervention details highlighted there to be no standardisation in what the technique or protocols for LAT are with four broad techniques being identified; Limb Alert Devices, Active Assisted Exercises, Functional Electrical Stimulation, and a Mixed Programme (Constraint Induced Movement Therapy, Active Assisted Exercise, Passive Stretches and a Functional Electrical Stimulation glove). Six of the seven studies reported an intervention effect; however, no study was large enough for results to generalise and study quality ranged from the lowest at 41% to the highest of 80%.

    Conclusion: The incomplete description of intervention reporting in the seven included studies and the variability of what is reported, limits the replication of LAT into clinical practice. This study does provide an insight into what the current research has reported on the LAT interventions to enable both clinicians and research to critically evaluate and build on future research.
    Date of Award2019
    Original languageEnglish
    Awarding Institution
    • Coventry University
    SupervisorSimon Igo (Supervisor), Louise Sewell (Supervisor), Andrew King (Supervisor) & Gillian Ward (Supervisor)

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