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Interventions involving repetitive practice improve strength after stroke: a systematic review
Davide G de Sousa1, Lisa A Harvey2, Simone Dorsch3
1Graythwaite Rehabilitation Centre, Ryde Hospital; John Walsh Centre for Rehabilitation Research, Kolling Institute; Sydney Medical School Northern, University of Sydney.
Questions:
Do interventions involving repetitive practice improve strength after stroke? Are any improvements in strength accompanied by improvements in activity?
Design:
Systematic review of randomised trials with meta-analysis.
Participants:
Adults who have had a stroke.
Intervention:
Any intervention involving repetitive practice compared with no intervention or a sham intervention.
Outcome Measures:
The primary outcome was voluntary strength in muscles trained as part of the intervention. The secondary outcomes were measures of lower limb and upper limb activity.
Results:
Fifty-two studies were included. The overall 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:
Interventions involving repetitive practice improve strength after stroke, and these improvements are accompanied by improvements in activity.
Review Registration:
PROSPERO CRD42017068658. [de Sousa DG, Harvey LA, Dorsch S, Glinsky JV (2018) Interventions involving repetitive practice improve strength after stroke: a systematic review. Journal of Physiotherapy 64: 210-221].
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