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Table 1 Characteristics of studies and outcomes

From: Perseverance with technology-facilitated home-based upper limb practice after stroke: a systematic mixed studies review

Author
(Year)
Country
Study design Participants Intervention Qualitative perseverance data collection and outcomes Quantitative perseverance data collection and outcomes
Data collection method Stage of perseverance Surrogate measures Outcomes for surrogate measures Measures of factors Outcomes for measures of factors
1 2 3 SS CS Other
Qualitative
Donoso-Brown (2015)
USA [10]
Qualitative
descriptive
n = 10a
10 stroke survivors
56.3 (44–69) years
6M:4F
Chronic
NGT
45 min/session
1 session/day
5 days/week
4 weeks
Semi-structured
interviews
X X X  
Emmerson (2018)
Australia [39]
Phenomenology n = 10b
10 stroke survivors
2 family members
72 (51–85) years
10M:0F
Early Subacute-Chronic
iPad
Dose variable
4 weeks
In-depth
semi-
structured
interviews
X X X  
O’Brien Cherry (2017)
USA [52]
Ethnography n = 10c
10 stroke survivors
Unknown number of family members
62.2 (49–88) years
10M:0F
Early Subacute-Chronic
HandMentor Pro™
1-2hrs/day
 ≥ 1 session/day
7 days/week
12 weeks
Observation,
in-depth
semi-
structured
interviews
X X X  
Parker (2014)
UK [54]
Realistic
evaluation
n = 5
5 stroke survivors
5 family members
71 (62–79) years
4M:1F
Late Subacute-Chronic
SMART System
Sessions/day not
reported
Days/week not
reported
5 weeks
Observation,
interviews,
diary
X X   
Sivan (2016)
UK [59]
Specific
qualitative
methodology
not reported
n = 17d
17 stroke survivors
7 therapists
56.4 years
14M:3F
Chronic
hCAAR
30 min/session
1 session/day
5 days/week
8 weeks
Semi-
structured
interviews
X X X  
Wingham (2015)
UK [65]
Specific
qualitative
methodology
not reported
n = 18e
18 stroke survivors
10 family members
65 (35–84) years
11M:7F stroke survivors
8M:2F family members
Early Subacute-Chronic
Nintendo Wii Sports™
45 min/session
1 session/day
7 days/week
6 weeks
Semi-
structured
interviews
X X X  
Quantitative
Adie (2017)
UK [28]
RCT n = 235 (E 117, C 118)e
E 66.8 (SD 14.6), C 68.0
(SD 11.9) years
E 66M:51F, C 65M:53F
Acute-Chronic
Nintendo Wii Sports™
45 min/session
1 session/day
7 days/week
6 weeks
X X   Adherence
Dropouts
82%T
Desire not to continue (3); Medically deteriorated
(4); Unable to contact (4)
Incomplete
data (4)
ARAT
COPM
EQ-5D-3L
MAL
SIS
NT
NT
NT
NT
NT
Y
Y
N
U
U
 
Basteris (2015)
Netherlands, Italy [30]
Case Series n = 7f
53.7 (34–66) years
5M:2F
Chronic
SCRIPT*
30 min/session
1 session/day
6 days/week
6 weeks
  X   Adherence 50%T  
Bernocchi (2018)
Italy [31]
Case Series n = 21
69 (62–75) years
14M:7F
Early Subacute- Chronic
Glorhea Lite™
45 min/session
1 session/day
6 days/week
8 weeks
X X   Adherence
Dropouts
79%T
Death (1)
Medically
deteriorated
(1); Nursing home admission (1); Desire not to continue (1)
BI
Grip strength
mAS
Motricity Index
NHPT
Pain VAS
Y
Y
N
Y
Y
N
U
U
U
U
U
U
 
Brokaw (2015)
USA [33]
Case Study n = 1
49 years
F
Chronic
HAMSTER,
HandSOME
30 min/session
1 session/day
5 days/week
4 weeks
X    Adherence 95%S FMA
JHFT
SIS-16
NT
NT
NT
N
U
N
 
Buick (2016)
Canada, Ireland [34]
Case Series n = 11
64.18 (54–86) years
10M:1F
Chronic
ReJoyce and FES-ET
60 min/session
1 session/day
5 days/week
6 weeks
  X   Dropouts Failed to
complete
intervention
(1)
ARAT Y N  
PIADS Moderate positive
impact on
measures of
competence
(+ 1.01)
adaptability (+ 1.1)
Slight positive impact on self-esteem (+ 0.46)
Burdea (2019)
USA [35]
Case Series n = 7
7 stroke survivors
7 caregivers
64.14 (48–79) stroke
survivors
60.29 (27–74) caregivers
4M:3F stroke survivors
5M:2F caregivers
Chronic
BrightBrainer
20–40 min/
session
1 session/day
5 days/week
4 weeks
X   X Adherence 105%T CAHAI Y N  
Caregiver feedback survey Nil scores > 4/5
FMA N N  
Grip strength Y U  
JHFT N U  
Pinch strength N U  
Stroke survivor feedback survey Score > 4/5 for: useful instruction, decreased boredom, encouraging others to use the device, liking the system overall
UEFI N Y  
UL ROM N U  
Butler (2014)
USA [36]
Case Series n = 13 (UL 9)c
59.7 (41–74) years
12M:1F
Early Subacute-Chronic
HandMentor Pro™
1–2hrs/session
 ≥ 1 session/day
7 days/week
12 weeks
X X X Adherence
Dropouts
13%T
Unknown (1)
ARAT Y Y  
FIM-C N N  
FIM-M Y N  
Satisfaction Survey ‘high’ satisfaction
Donoso-Brown (2014)
USA [37]
Interrupted time
series with non-
parallel control
n = 12a
60 (47–69) years
5M:4F
Chronic
NGT
45min/session
1 session/day
5 days/week
4 weeks
  X X Adherence
Dropouts
79%T
Medically
deteriorated
(1); Lack of time
(2)
CAHAI N N  
ROM N U
sEMG-Game Play N U
sEMG-Lab Assessment Y U
WMFT N N
Emmerson (2017)
Australia [38]
RCT n = 62 (E 30, C 32)b
E 68 (SD 15), C 63 (SD 18) years
E 17M:13F, C 19M:13F
Early Subacute-Chronic
iPad
Dose variable
4 weeks
   X Adherence
Dropouts
62%G
Death (1); Good progress (3)
Grip Strength NT N  
Satisfaction Survey E 71%, C 67%
WMFT-Quality NT N  
WMFT-Time NT N  
Fluet (2019)
USA [40]
RCT n = 11 (E 5, C 6)
E 58 (SD9), C 65 (SD
15) years
M:F not reported
Time since stroke not
reported
HoVRS*
20 min/session
 ≥ 1 session/day
7 days/week
12 weeks
  X   Adherence 68%T BBT NT U  
FMA NT U  
IMI E participants (n = 5) scored higher than C participants (n = 3) at pre- and post-intervention overall, and on interest/ enjoyment subscales
Housley (2016)
USA [43]
Case Series n = 20 (UL 10)
67(± 11.4) years
19M:1F
Early Subacute-Chronic
HandMentor Pro™
1-2hrs/session
 ≥ 1 session/day
7 days/week
12 weeks
X X X Adherence
Dropouts
79%T
Medically
deteriorated
(1)
ARAT Y Y  
FIM-Total N N  
Satisfaction Survey ‘high’ satisfaction
Jordan (2014)
NZ [44]
Interrupted time
series with non-
parallel control
n = 13
68.6 (56.3–79.6) years
M:F not reported
Chronic
Smart Skate
45–60 min/
session
1 session/day
3–5 days/week
4–6 weeks
X    Dropouts Personal
reasons (1)
FMA Y N  
IMI Average 6.12/7
Strength Y U  
King (2012)
NZ [45]
Case Series n = 3
56.3 (47–65) years
2M:1F
Chronic
CyWee Z
Participant selected
dose
8 weeks
X X   Adherence 100%G DASH NT U  
FMA NT N  
IMI Interest/ enjoyment: 31.33/49
Perceived choice: 18.33/49
Perceived competence: 28/42
Value/usefulness: 43.33/49
Effort/importance: 20.66/35
Langan (2013)
USA [46]
Case Series n = 7
56 (47–63) years
5M:2F
Chronic
Stereognosis Training System
60 min/session
1 session/day
5 days/week
6 weeks
  X   Adherence
Dropouts
90%G
Unknown (1)
Kinematics Y U  
Proprioception – Joint Movement N U
Proprioception – Tactile Discrimination N U
WMFT NT U
Lin (2013)
USA [47]
Case Series n = 2
52.5 (48–57) years
0M:2F
Chronic
Looking Glass
60 min/session
1 session/day
7 days/week
X X   Adherence 71%S ARAT
COPM
MAL
ROM
NT
NT
NT
NT
Y
Y
U
U
 
Linder (2013)
USA [48]
Case Study n = 1
54 years
M
Late Subacute
HandMentor Pro™
3 hrs/day (2hours
HMP, 1hour HEP)
5 days/week
8 weeks
X X X Adherence 56%T ARAT NT Y  
FMA NT Y
SIS-ADL NT Y
SIS-Hand Function NT N
SIS-Mobility NT Y
SIS-Strength NT N
WMFT-Time NT Y
WMFT- Quality NT Y
Linder (2015)
USA [49]
RCT n = 99 (E 51, C 48)g
E 59.4(SD 13.6), C 55.5 (SD 12.6) years
E 31M:20F, C 33M:15F
Late Subacute
HandMentor Pro™
3 hrs/day (2hours
HMP, 1hour HEP)
5 days/week
8 weeks
X X   Adherence
Dropouts
112%T
Unknown (8)
SIS-ADL Y Y  
SIS-Hand Function Y Y
SIS-Mobility Y Y
SIS-Strength Y Y
Nijenhuis (2015)
Netherlands, Italy, UK [50]
Case Series n = 24f
59 (34–80) years
10M:11F
Chronic
SCRIPT*
30 min/session
1 session/day
6 days/week
6 weeks
X X   Adherence
Dropouts
58%T
Shoulder
pain (1); Technical
issues (1); Desire not to
continue (1)
ARAT N N  
FMA Y N  
IMI 5.2 (SD 0.9)
MAL N N  
SIS-ADL N N  
SIS-Hand Function N N  
SIS-Mobility Y N  
SIS-Strength Y Y  
SUS 69% (SD 17)
Nijenhuis (2017)
Netherlands [51]
RCT n = 20 (E 10, C 10)
E 58 (48–65), C62 (54–
70) years
E 7M:2F; C 3M:7F
Chronic
SCRIPT
30 min/session
1 session/day
6 days/week
6 weeks
X X   Adherence
Dropouts
66%T
Shoulder
pain (1)
ARAT N N  
BBT N N  
FMA N N  
Grip Strength N N  
IMI E 5.4, C 4.9
MAL N N  
SIS-Overall N N  
Pareto (2011)
Sweden [53]
Case Series n = 3
83 (78–87) years
3M:0F
Late Subacute-Chronic
Curictus Immersive
Workbench
20 min/session
1 session/day
7 days/week
12–21 weeks
X    Adherence 18%T ARAT
BBT
EQ-5D-3L
Grip Strength
NT
NT
NT
NT
Y
U
Y
U
 
Rand (2015)
Israel [57]
RCT n = 24 (E 13, C 11)h
E 59.1 (33–75), C 64.9
(58–80) years
E 9M:4F, C 6M:5F
Chronic
Microsoft X-box
Kinect™ Playstation 2 Eyetoy™
60 min/session
1 session/day
6 days/week
5 weeks
  X X Adherence
Dropouts
63%T
Personal
reasons (2); Desire not to
continue (2)
ARAT
BBT
MAL
Y
Y
Y
N
U
N
 
Sivan (2014)
UK [58]
Case Series n = 17d
56.4 (SD 11.5) years
14M:3F
Chronic
hCAAR
30 min/session
1 session/day
5 days/week
8 weeks
X X   Adherence
Dropouts
43%T
Inadequate
space (1); Unable to
use technology
(1)
ABILHAND Questionnaire Y U  
ARAT Y N
CAHAI Y Y
FMA Y N
mAS Y U
Reaching Y U
Strength Y U
Slijper (2014)
Sweden [60]
Case Series n = 12
58 (26–66) years
5M:6F
Chronic
Gaming Console
Participant selected
dose
5 weeks
X X   Adherence
Dropouts
100%O
Medically
deteriorated
(1)
ABILHAND Questionnaire N Y  
ARAT Y Y
FMA Y Y
Grip Strength Y U
Standen (2017)
UK [62]
RCT Feasibility n = 27 (E 17, C 10)i
E 59 (SD 12.03), C 63
(SD 14.06) years
E 8M:9F, C 8M:2F
Early Subacute-Chronic
Virtual Glove
20 min/session
3 sessions/day
7 days/week
8 weeks
X X X Dropouts Medically
deteriorated
(2); Desire not to
continue (1); Family
commitment
(2)
MAL
NEADL
NHPT
WMFT
Y
N
N
N
Y
U
U
N
 
Thielbar (2020)
USA [64]
Randomised
Crossover
Trial
n = 20 (First SU 10, First MU 10)
First SU 59.7 (SD 10.5) years
First MU 59.8 (SD 4.8) years
First SU 8M:2F, First MU 9M:1F
Chronic
VERGE
60 min/session
1 session/day
4 days/week
4 weeks
  X   Adherence 84%G FMA Y N  
IMI Value/usefulness: 6.6/7
Effort/importance: 6.4/7
Interest/enjoyment: > 5.5/7
Perceived competence: > 5.5/7
Wittmann (2016)
Switzerland [66]
Case Series n = 11
60 (42–73) years
5M:6F
Late Subacute–Chronic
ArmeoSenso System
Participant selected
dose
6 weeks
X X X Adherence 100%G Automated Reaching Assessment Y U  
FMA Y N
ROM N U
WMFT N Y
Wolf (2015)
USA [67]
RCT n = 99 (E 51, C 48)g
E 59.1 (SD 12.2), C 54.7 (SD 14.1) years
E 25M:26F, C 31M:17F
Early Subacute-Late
Subacute
HandMentor Pro™
3 hrs/day (C 3 hours HEP; E 2 hours HMP,
1 hour HEP)
5 days/week
8 weeks
X X   Adherence
Dropouts
112%T
Medically
deteriorated
(1); Poor
adherence
(1); Desire not to
continue (1)
Moved onto
other
therapy (1); Incomplete
data (3)
ARAT Y N  
FMA Y Y
WMFT-Quality Y N
WMFT-Time Y N
Yacoby (2019)
Israel [68]
RCT n = 24 (E 13, C 11)h
E 59.1 (33–74), C 64.9
(58–80) years
E 9M:4F, C 6M:5F
Chronic
Microsoft Kinect™ or Sony EyeToy™
60 min/session
1 session/day
6 days/week
5 weeks
X X X Adherence
Dropouts
63%T
Personal
reasons (2);
Desire not to
continue (2)
Perceived enjoyment 4.1/5
Perceived exertion 11.8/20
Perceived UL improvement 5/13 participants
Satisfaction 3.9/5
Mixed methods
Alankus (2010)
USA [29]
QL: Case Study
QT: Case Study
n = 1j
62 years
F
Chronic
Looking Glass
60–75 min/
session
 ≥ 1 session/day
5 days/week
6 weeks
Semi-
structured
in-depth
interviews
X   X Adherence 101%T ARAT NT N  
RPS NT U
Bhattacharjya (2019)
USA [32]
QL: Specific
qualitative
methodology
not reported
QT: Case Series
n = 2
Age not reported
M:F not reported
Time since stroke not
reported
mRehab*
120 reps
 ≥ 1 session/day
5 days/week
6 weeks
Interview X X   Adherence 75%S  
Fu (2019)
USA [41]
QT: Case Series
QL: Specific
qualitative
methodology
not reported
n = 7
59.42 (40–77) years
4M:3F
Chronic
CCFES
45 min/session
2 sessions/day
6 days/week
12 weeks
Participant
journals
Interview
X X X Adherence
Dropouts
110%T
Poor
adherence
(1); Medically
deteriorated
(1); Other
commitment
(2)
AMAT
FMA
NT
NT
U
N
 
Hayward (2015)
Australia [42]
QL: Specific
qualitative
methodology
not reported
QT: Case Study
n = 1
1 stroke survivor
1 caregiver
57 years
M
Chronic
SMART Arm
60–80 reps/session
 ≥ 1 session/day
5 days/week
4 weeks
Observation,
researcher
and
participant
journals
X X X Adherence 140%R MAL NT Y  
mAS NT U
MAS NT U
Ritchie Articular Index NT U
SIS NT U
Strength NT U
Tardieu Scale NT U
Proffitt (2011)
USA [55]
QL: Specific
methodology
not reported
QT: Case Study
n = 1j
62 years
F
Chronic
Looking Glass
60–75 min/ session
1 session/day
5 days/week
6 weeks
Observation,
semi-
structured
interviews,
participant
journal
  X X Adherence 100%G ACS
ARAT
ROM
RPS
NT
NT
NT
NT
U
N
U
U
 
Proffitt (2015)
USA [56]
QL: Grounded
Theory
QT: Case Series
n = 4
57.25 (54–64) years
2M:2F
Chronic
Mystic Isle
4 hrs/week
6 weeks
Semi-
structured
interviews
  X   Adherence 63%T COPM NT N  
FMA NT N  
SS-QOL NT U  
SUS 2.70/5
Standen
(2015)
UK [61]
QL: Specific
methodology
not reported
QT: Prospective
Cohort Study
n = 13i
59 (40–82) years
5M:8F
Early Subacute-Chronic
Virtual Glove
20 min/session
3 sessions/day
7 days/week
8 weeks
Interviews X X X Adherence
Dropouts
17%T
Medically
deteriorated
(2); Family
commitment
(2)
 
Szturm (2020)
Canada [63]
QL: Qualitative
Descriptive
QT: Case Series
n = 10
58 (SD 12) years
6M:4F
Late Subacute-Chronic
GTP
20 min/session
1 session/day
4 sessions/week
16 weeks
Semi-
structured
interviews
X X   Adherence
Dropouts
100%T
Unable to
use technology
(2)
Grip Strength NT N  
Movement onset time – movement variance NT U
Object manipulation – average NT U
Object manipulation – success rate NT U
WMFT – Quality NT Y
WMFT – Time NT Y
  1. “Outcomes for measures of factors” within experimental group
  2. *Participants self-selected dose; a−jSample duplication; Adherence based on: GGeneral adherence reported; Rreps/time on task; Snumber of sessions; Ttime in therapy
  3. ACS Activity Card Sort, Acute—1–7 days post stroke, AMES Assisted Movement With Enhanced Sensation, ARAT Action Research Arm Test, BBT Box and Block Test, BI Barthel Index, C Control, CAHAI Chedoke Arm and Hand Activity Inventory, CCFES Contralaterally Controlled Functional Electrical Stimulation, Chronic  > 6 months post-stroke, COPM Canadian Occupational Performance Measure, CS Clinically Significant Change, DASH Disabilities of the Arm, Shoulder and Hand, E Experimental, Early Subacute 7 days–3 months post-stroke, EQ-5D-3L EuroQual Health State Record, F Female, FIM Functional Independence Measure, FMA Fugl-Meyer Assessment, hCAAR Home-based Computer Assisted Arm Rehabilitation, GTP Game-assisted Telerehabilitation Platform, HAMSTER Home Arm Movement Stroke Training Environment, HandSOME Hand Spring Operated Movement Enhancer, Hyper-acute 0-24hours post-stroke, IMI Intrinsic Motivation Inventory, JHFT Jebsen Hand Function Test, Late Subacute 3-6 months post-stroke, M Male, MAL Motor Activity Log, mAS Modified Ashworth Scale, MAS –Motor Assessment Scale, mRehab Mobile Rehabilitation, MU Multi-user, N No, NEADL Nottingham Extended Activities of Daily Living Scale, NGT NeuroGame Therapy, NHPT Nine Hole Peg Test, NT Statistical Significance Not Tested, P Participant, PIADS Psychosocial Impact of Assistive Devices Scale, QL Qualitative, QT Quantitative, ReJoyce The Rehabilitation Joystick for Arm and Hand Exercises, RCT Randomised Controlled Trial, ROM Range of Motion, RPS Reaching Performance Scale, SCRIPT Supervised Care and Rehabilitation Involving Personal Telerobotics, SD Standard Deviation;. sEMG Surface Electromyography, SIS Stroke Impact Scale, SMART Arm Sensorimotor Active Rehabilitation Training of the Arm, SS Statistically Significant Change, SS-QOL Stroke Specific Quality of Life Scale, SU Single-user, SUS System Usability Scale, U unable to determine CS (no MCID, insufficient data), VERGE Virtual Environment for Rehabilitative Gaming Exercises, WMFT Wolf Motor Function Test, Y Yes