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de Sousa DG1,2,3, Harvey LA2,3, Dorsch S4, Glinsky JV2,3
1Graythwaite Rehabilitation Centre, Ryde Hospital, Northern Sydney Local Health District, Eastwood, Australia, 2John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, Australia, 3Sydney Medical School Northern, University of Sydney, Sydney, Australia, 4Faculty of Health Sciences, Australian Catholic University, Sydney, Australia
Background: The loss of strength after stroke is a common and important impairment. The average strength of the affected upper and lower limb in people who have had a severe stroke ranges from 30% to 50% of age-matched controls. This loss of strength can result in profound activity limitations and participation restrictions. Therefore, we need to know which interventions are effective for improving strength after stroke. Repetitive practice of tasks such as walking or reaching and manipulation is a major component of rehabilitation after stroke. Repetitive practice is known to be effective for reducing activity limitations with many systematic reviews confirming this. However, less is known about the effects of repetitive practice on strength after stroke and no systematic reviews have specifically investigated this issue. Since repetitive practice is widely used and recommended in rehabilitation after stroke it is important to understand if interventions involving repetitive practice are effective for improving strength.
Purpose: The research questions for this systematic review were: Do interventions involving repetitive practice improve strength after stroke? Are any improvements in strength accompanied by improvements in activity?
Methods: A systematic review of randomised trials with meta-analysis was conducted. Participants were adults who have had a stroke. The intervention was any intervention involving repetitive practice compared to no intervention or a sham intervention. The primary outcome was voluntary strength in muscles trained as part of the intervention. The secondary outcomes were measures of upper and lower limb activity.
Results: Fifty-two studies were included. The overall standardised mean difference (SMD) of repetitive practice on strength was examined by pooling post intervention scores from 46 studies involving 1928 participants. The SMD of repetitive practice on strength when the upper and lower limb studies were combined was 0.25 (95% CI 0.16 to 0.34, I2 = 44%) in favour of repetitive practice. Twenty-four studies with a total of 912 participants investigated the effects of repetitive practice on upper limb activity after stroke. The SMD was 0.15 (95% CI 0.02 to 0.29, I2 = 50%) in favour of repetitive practice on upper limb activity. Twenty studies with a total of 952 participants investigated the effects of repetitive practice on lower limb activity after stroke. The SMD was 0.25 (95% CI 0.12 to 0.38, I2 = 36%) in favour of repetitive practice on lower limb activity.
Conclusion(s): Interventions involving repetitive practice improve strength after stroke, and these improvements are accompanied by improvements in activity. When compared to mean baseline strength, the relative increase in upper and lower limb strength with repetitive practice is 15% (95% CI 3 to 26) and 28% (95% CI 18 to 39), respectively.
Implications: Prior to this review it was not known whether improvements in activity with repetitive practice are accompanied by improvements in strength. This systematic review provides evidence that interventions involving repetitive practice do improve strength after stroke, and these improvements are accompanied by improvements in activity. This suggests that repetitive practice should be prioritised as an intervention that can improve both strength and activity in people after stroke.
Keywords: stroke, repetitive practice, meta-analysis
Funding acknowledgements: N/A
Purpose: The research questions for this systematic review were: Do interventions involving repetitive practice improve strength after stroke? Are any improvements in strength accompanied by improvements in activity?
Methods: A systematic review of randomised trials with meta-analysis was conducted. Participants were adults who have had a stroke. The intervention was any intervention involving repetitive practice compared to no intervention or a sham intervention. The primary outcome was voluntary strength in muscles trained as part of the intervention. The secondary outcomes were measures of upper and lower limb activity.
Results: Fifty-two studies were included. The overall standardised mean difference (SMD) of repetitive practice on strength was examined by pooling post intervention scores from 46 studies involving 1928 participants. The SMD of repetitive practice on strength when the upper and lower limb studies were combined was 0.25 (95% CI 0.16 to 0.34, I2 = 44%) in favour of repetitive practice. Twenty-four studies with a total of 912 participants investigated the effects of repetitive practice on upper limb activity after stroke. The SMD was 0.15 (95% CI 0.02 to 0.29, I2 = 50%) in favour of repetitive practice on upper limb activity. Twenty studies with a total of 952 participants investigated the effects of repetitive practice on lower limb activity after stroke. The SMD was 0.25 (95% CI 0.12 to 0.38, I2 = 36%) in favour of repetitive practice on lower limb activity.
Conclusion(s): Interventions involving repetitive practice improve strength after stroke, and these improvements are accompanied by improvements in activity. When compared to mean baseline strength, the relative increase in upper and lower limb strength with repetitive practice is 15% (95% CI 3 to 26) and 28% (95% CI 18 to 39), respectively.
Implications: Prior to this review it was not known whether improvements in activity with repetitive practice are accompanied by improvements in strength. This systematic review provides evidence that interventions involving repetitive practice do improve strength after stroke, and these improvements are accompanied by improvements in activity. This suggests that repetitive practice should be prioritised as an intervention that can improve both strength and activity in people after stroke.
Keywords: stroke, repetitive practice, meta-analysis
Funding acknowledgements: N/A
Topic: Neurology: stroke
Ethics approval required: No
Institution: N/A
Ethics committee: N/A
Reason not required: This is a systematic review
All authors, affiliations and abstracts have been published as submitted.
