The effects of unimanual and bimanual massed practice on upper limb function in adults with cervical spinal cord injury: a systematic review

Abstract Background Individuals with cervical spinal cord injury (cSCI) have identified improving upper limb function as their most important rehabilitation goal. Unimanual massed practice (UMP) and bimanual massed practice (BMP) may help achieve this. Objectives To evaluate and compare the effects of UMP and BMP on upper limb function in adults with cSCI. Data sources Cochrane Central Register of Controlled Trials, PubMed, CINAHL, Web of Science and PEDro until April 2016. Study selection Studies investigating the effects of UMP and/or BMP on upper limb function in adults with cSCI. Data extraction and synthesis Data was extracted using a standardised form. Studies were appraised using a modified version of the Cochrane risk of bias tool. The findings were qualitatively synthesised. Results Five randomised controlled trials and 2 case studies were included. Six studies included UMP, three included BMP, and two compared these approaches. Overall the studies reported that UMP and BMP improved upper limb function, particularly when combined with electrical stimulation, with no clear differences between UMP and BMP. These findings should be interpreted with caution however, as 6 studies presented a high or unclear risk of bias for all functional upper limb outcome measures included, and the remaining study was a small pilot study with no control group. Conclusion Although the findings of the included studies support the use of UMP and BMP in adults with cSCI, only 7 studies, all with significant limitations, were included; hence robust conclusions cannot be drawn and further research is warranted. PROSPERO registration number: CRD42016037365