Priority 15 Stroke Rehabilitation and Long-term Care

UNCERTAINTY: What interventions improve arm function after stroke and when should they be provided? (JLA PSP Priority 15)
Overall ranking	15
JLA question ID	0106/15b
Explanatory note	Improving upper limb function is a core element of stroke rehabilitation needed to maximise patient outcomes and reduce disability. The most up to date (2014) Cochrane Systematic Review (see Evidence) concluded "Currently, no high‐quality evidence can be found for any interventions that are currently used as part of routine practice, and evidence is insufficient to enable comparison of the relative effectiveness of interventions. Effective collaboration is urgently needed to support large, robust RCTs of interventions currently used routinely within clinical practice. Evidence related to dose of interventions is particularly needed, as this information has widespread clinical and research implications".
Evidence	https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010820.pub2/full
Health Research Classification System category	Stroke

Extra information provided by this PSP
Original uncertainty examples	Why isn't there specific exercises for when the hand doesn't work; have lots of exercises for arms and legs but husband kept getting told not a lot they can do when hands stop working? ~ What physical therapy interventions are most effective for improving severe upper limb dysfunction after stroke? ~ What are the best methods for patients to use within their home exercise programmes to optimise upper limb recovery? ~ What can be done to enhance upper limb function?
Submitted by	Stroke Survivor x 11, Carer x 4, Health/social care professional x 24, Research Recommendations x 2, Not stated x 1

Extra information provided by this PSP

Original uncertainty examples

Why isn't there specific exercises for when the hand doesn't work; have lots of exercises for arms and legs but husband kept getting told not a lot they can do when hands stop working? ~ What physical therapy interventions are most effective for improving severe upper limb dysfunction after stroke? ~ What are the best methods for patients to use within their home exercise programmes to optimise upper limb recovery? ~ What can be done to enhance upper limb function?

Submitted by

Stroke Survivor x 11, Carer x 4, Health/social care professional x 24, Research Recommendations x 2, Not stated x 1

PSP information
PSP unique ID	0106
PSP name	Stroke Rehabilitation and Long-term Care
Total number of uncertainties identified by this PSP.	93 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	19/20th April 2021