Physical Therapist Involved Physical Activity Interventions: A Systematic Review and Meta-Analysis

Little is known about the delivery of physical therapy services to promote physical activity (PA) for adults with neurologic conditions. This systematic review aimed to: (1) identify the roles of physical therapists (PTs) in the delivery of PA interventions, (2) describe PA intervention types, and (3) explore the efficacy of physical therapy PA interventions.

This systematic review included randomized controlled trials of interventions including physical therapy, PA or exercise, and PA health promotion in adults with neurologic conditions. Database searches included: PubMed MEDLINE, Embase, CINAHL, PsycINFO, and CENTRAL. Meta-analyses were performed for accelerometry-based and self-report measures of PA; meta-regressions explored moderators.

Sixty articles met the inclusion criteria, representing 54 unique trials with 15,874 participants. Most articles had a moderate quality of reporting (85%) and a high risk of bias (RoB) (90%). PA interventions led to small, but significant effects on direct measures of PA (effect size [ES] = 0.18, CI 95% , 0.01, 0.35). Small-moderate effects were present when articles with high RoB were excluded (n = 6, ES = 0.36, CI 95% , 0.05, 0.67). Meta-regressions suggested that interventions including both PA and behavior change techniques were more positive than either intervention alone (β = 0.43, CI 95% , 0.23, 0.62).

PTs used direct and supervisory roles to deliver effective PA interventions, particularly using interventions combining PA and behavior change techniques. However, heterogeneity of PA measures limits the interpretation of the meta-analyses. Further research should develop consensus on feasible direct measures of PA outcome measures to use in research and clinical practice for adult neurologic populations.