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Effects of augmented exercise therapy time after stroke: a meta-analysis
Gert Kwakkel1, Roland van Peppen, Robert C Wagenaar
1Department of Physical Therapy and Research Institute for Fundamental and Clinical Human Movement Sciences, VU University Medical Center, Amsterdam, The Netherlands. g.kwakkel@vumc.nl
Stroke
|October 9, 2004
Summary
Increased augmented exercise therapy time (AETT) shows small benefits for activities of daily living (ADL) post-stroke, especially within six months. A minimum of 16 hours more therapy is recommended for significant ADL improvements.
Area of Science:
- Neurology
- Rehabilitation Medicine
- Clinical Trials
Background:
- Stroke significantly impacts patients' ability to perform daily activities, walk, and maintain dexterity.
- Optimizing rehabilitation strategies, particularly exercise therapy intensity, is crucial for functional recovery.
Purpose of the Study:
- To systematically review the effects of augmented exercise therapy time (AETT) intensity on activities of daily living (ADL), walking, and dexterity in stroke patients.
Main Methods:
- A comprehensive database search (1966-2003) identified randomized controlled trials (RCTs) investigating exercise intensity in stroke patients.
- Meta-analysis calculated effect sizes (ES) for ADL, walking speed, and dexterity.
- Cumulative meta-analysis assessed the impact of AETT dose and timing.
Main Results:
- A small but statistically significant positive effect of AETT was found for ADL at the end of intervention.
- Significant benefits were observed for studies within six months post-stroke, requiring at least 16 hours of additional therapy for notable ADL gains.
- Improvements were also noted for instrumental ADL and gait speed, but not dexterity.
Conclusions:
- Augmented exercise therapy offers a small, favorable impact on ADL in stroke survivors.
- Therapy input augmented by at least 16 hours within the first six months post-stroke is associated with significant ADL improvements.
- Clinically relevant treatment effects on instrumental ADL and gait speed are achievable with increased exercise intensity.