Background/Aims: To identify recent advances in motor recovery and rehabilitation post-stroke, and to define recommendations for future trials.
Methods: A systematic search of PubMed was completed from 2020. Eligible studies were randomised controlled trials (RCTs) completed or ongoing with n≥100 participants and systematic reviews of RCTs with meta-analyses. Identified records were synthesised to inform the development of themes, and inform recommendations to advance future stroke recovery trials.
Results: One hundred and twelve studies were identified: 46 RCTs, 27 RCTs protocols, and 39 systematic reviews with meta-analyses. Four themes were defined: (1) Motor training provides the foundation; (2) Mode is a tool to support the delivery of motor training; (3) Motor training may be improved with adjuvants, and (4) Motor trials need a defined measurement strategy. Five recommendations to advance future trials were: (1) Deliver motor training that is evidence-informed; (2) Consider using delivery mode as a tool to support higher dose motor training; (3) Always pair adjuvants with evidence-informed motor training; (4) Select or subgroup participants enrolled in trials according to potentially modifying characteristics; and (5) Match measurement strategies to the research question, main effect of interest, trial phase, population tested, and intervention delivered.
Conclusions: It is clear that the field of stroke recovery does not need any more low-dose, underpowered, proof-of-concept trials in heterogeneous populations. A step forward would be to test evidence-informed bundles of care in subgroups to examine “who, what, when and how much”. Such trials would move beyond a single approach and facilitate enhanced clinician decision-making.