Spinal manipulative therapy for low back pain: A systematic review

Abstract

Objectives: Gather and analyse relevant literature on spinal manipulative therapy for low back pain through systematic review to present a balanced and impartial summary of the findings. The aim of this systematic review was to investigate the efficacy of spinal manipulative therapy in patients with low back pain.

Methods: Databases searched included COCHRANE, MEDLINE, EMBASE, PEDro, PUBMED, WEB OF KNOWLEDGE, INGENTA CONNECT and GOOGLE SCHOLAR between January 2000 and January 2008. Sixteen articles were retrieved. Standardised inclusion and exclusion criteria were applied to select articles relevant to the review question. Seven studies were excluded and nine studies were included. In the next step, the methodological quality of the included studies was assessed with the PEDro scale, which rated the studies from 0 to 10.

Results: Methodological quality scores ranged from 4 to 8 out of a possible 10. Spinal manipulative therapy can be preferred for short-term relief of low back pain when compared with general exercise and dynamic strengthening exercises, which is revealed by a high quality study, moderate quality studies and a low quality study. Spinal manipulative therapy combined with exercise is more effective than exercise alone, which is revealed by a high quality study.

Conclusions: Further studies are needed to improve the quality of the evidence. There is evidence that spinal manipulative therapy combined with exercise is more effective than other procedures like spinal manipulative therapy, exercise or physician consultation alone.     

Work Motivating Factors in Rehabilitation: A Brief Review

Abstract

Background: Back pain is a common condition for which chiropractic treatment is often recommended.

Aim: To evaluate critically the evidence for or against the effectiveness of chiropractic spinal manipulation for back pain.

Data sources: Five independent literature searches were carried out and bibliographies were searched.

Study selection: Only randomised clinical trials of chiropractic spinal manipulation with patients suffering from back pain were included.

Data extraction: The authors extracted data on trial design, methodological quality, sample size, patient characteristics, nature of intervention, outcome measures, follow-up and results.

Main results: Twelve studies could be included. They related to all forms of back pain. Many trials had significant methodological shortcomings. Some degree of superiority of chiropractic spinal manipulation over control interventions was noted in 5 studies. More recent trials and those with adequate follow-up periods tended to be negative.

Conclusions: The effectiveness of chiropractic spinal manipulation is not supported by compelling evidence from the majority of randomised clinical trials.     

Methodological quality of studies on the measurement properties of neck pain and disability questionnaires: a systematic review

Objective

The aim of this study was to obtain an overview of the methodological quality of studies on the measurement properties of neck pain and disability questionnaires and to describe how well various aspects of the design and statistical analyses of studies on measurement properties are performed.

Methods

A systematic review was performed of published studies on the measurement properties of neck pain and disability questionnaires. Two reviewers independently rated the quality of the studies using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. This checklist was developed in an international Delphi consensus study.

Results

A total of 47 articles were included on the measurement properties of 8 different questionnaires. The methodological quality of the included studies was adequate on some aspects (often, adequate statistical analyses are used for assessing reliability, measurement error, and construct validity) but can be improved on other aspects. The most important methodological aspects that need to be improved are as follows: assessing unidimensionality in internal consistency analysis, stable patients and similar test conditions in studies on reliability and measurement error, and more emphasis on the relevance and comprehensiveness of the items in content validity studies. Furthermore, it is recommended that studies on construct validity and responsiveness should be based on predefined hypotheses and that better statistical methods should be used in responsiveness studies.

Conclusion

Considering the importance of adequate measurement properties, it is concluded that, in the field of measuring neck pain and disability, there is room for improvement in the methodological quality of studies measurement properties.     

The Effectiveness of Thoracic Spine Manipulation for the Management of Musculoskeletal Conditions: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Abstract

Thoracic spine manipulation (TSM) is an intervention practiced by different professions, and recently an incursion of research using TSM has been published. The purpose of this review was to examine the effectiveness of TSM for the management of musculoskeletal conditions and the quality of trials that included TSM techniques. A comprehensive search of online databases was performed, and first authors of studies identified were contacted. Thirteen randomized clinical trials were included in the final review. The methodological quality of all studies was assessed using the 10-point PEDro scale. Seven of the 13 studies were of high quality. Three studies looked at TSM for treatment of shoulder conditions; however, there is limited evidence to support the use of TSM for shoulder conditions. Nine studies used TSM for the management of neck conditions. The meta-analysis identified a subset of homogeneous studies evaluating neck pain. The value of the pooled estimator (1.33) was statistically significant for the treatment effect of TSM in the studies with researcher effect removed (95 % confidence interval: 1.15, 1.52). This analysis suggests there is sufficient evidence to support the use of TSM for specific subgroups of patients with neck conditions. This review also identifies the need for further studies to examine the effectiveness of TSM to treat shoulder conditions and the effectiveness of TSM on neck conditions with long-term follow-up studies.     

Association between glenohumeral subluxation and hemiplegic shoulder pain in patients with stroke

Abstract

Background: Glenohumeral subluxation (GHS) and hemiplegic shoulder pain (HSP) are the most common musculoskeletal complications reported in patients with stroke. These secondary problems present considerable challenges to the rehabilitation of the upper limb.

Objective: The aim of this review was to evaluate the evidence on the association between shoulder subluxation and pain in patients with stroke.

Method: A systematic online search was conducted of MEDLINE, EMBASE, CINAHL, AMED, Biomed Central, and the Cochrane Library. The search was supplemented by hand searching of relevant journals and citation tracking of the retrieved papers. All primary studies published in English language fulfilling the review’s inclusion criteria were included. Five reviewers independently appraised the methodological quality of the selected studies. Any discrepancies were resolved following discussions.

Results: Of the 148 articles that were identified by the search, 14 studies met the criteria to be included in the review. Seven studies found an association and seven studies did not find an association between subluxation and pain. The methodological quality of the studies varied considerably and studies used a wide range of outcome measures to assess both subluxation and pain.

Conclusions: Irrespective of any association, both subluxation and pain can independently have an impact on functional rehabilitation. Management of these clinical outcomes is critical in clinical practice and clinicians should continue to prevent and reduce these post-stroke secondary complications to enhance upper limb function.     

Effectiveness of manual therapy in the treatment of non-specific neck pain: a review

Abstract

The aim of the current review was to assess the evidence for the effectiveness of cervical spine manipulation and mobilisation in the treatment of non-specific neck pain. A review of the literature was performed in a systematic format, based upon a structured search of six computerised bibliographic databases, together with manual searching of selected journals and reference lists to identify randomised clinical trials (RCTs) researching the effectiveness of manual therapy in the treatment of non-specific neck pain. The methodological quality of the studies was assessed using a set of pre-defined criteria adapted from Koes et al. (Koes BW, Assendelft WJJ, van der Heijden GJMG, Bouter LM, Knipschild PG. Spinal manipulation and mobilisation for back and neck pain: a blinded review. BMJ 1991; 303 :1298–303) and updated in the light of recent literature.

A total of 12 RCTs met the selection criteria. The scores achieved for methodological quality of the studies ranged from 25 points to 67 points out of a possible 100 points. Only four RCTs scored above 50 points: two of these reached a positive conclusion about the effectiveness of spinal manual therapy in the treatment of non-specific neck pain, and two a negative conclusion. Eight RCTs scored below 50 points; six of these reached a positive conclusion and two a negative conclusion.

RCTs researching the effectiveness of manual therapy for non-specific neck pain demonstrate methodological shortcomings in both design and reporting. The effectiveness of spinal manual therapy on non-specific neck pain remains inconclusive. The available evidence favoured spinal manual therapy when it was used in conjunction with exercise, particularly in the treatment of patients with chronic non-specific neck pain. Further, well-designed RCTs are needed to draw valid conclusions about the effectiveness of spinal manual therapy on nonspecific neck pain. In such future RCTs, placebo treatments should be designed to be indistinguishable (as far as possible) from manual therapy, and without the specific effects of active therapy. Furthermore, psychosocial factors should be considered prior to randomisation of patients by using appropriate measures.     

Augmented reality applications in rehabilitation to improve physical outcomes

Abstract

Background: Augmented reality (AR) is a relatively new technology which blends virtual objects with real scenes in real time and this may be an effective intervention to use in rehabilitation.

Objectives: To systematically review the evidence for the effectiveness of AR applications on rehabilitation outcomes within a physical context.

Method: A systematic search of the literature using specified search terms that included studies of any quantitative design testing AR applications in rehabilitation within a physical context.

Results: The included 13 studies were of varying designs and generally rated poorly on methodological quality assessment. All studies reported varying degrees of improvement in outcomes with the use of AR applications. The technologies used were mostly in the prototype phase of development and were a mixture of simple and complex systems.

Conclusion: AR applications for rehabilitation in a physical context are still in the early stages of development and thus evidence for effectiveness in rehabilitation is limited. The technology appears not ready for general practical use but the encouraging results support further research.     

Effects of microwave diathermy on signs and symptoms of delayed onset muscle soreness: a systematic review of Japanese primary studies

Background: Delayed onset muscle soreness (DOMS) is a common problem experienced after exercise. The use of heat has been proposed to relieve symptoms. Microwave diathermy (MWD) is a physical modality that produces deep heat in the tissues. Although its use in the Western world has become less common since the 1980s, it is still frequently used in Japan.

Objective: The purpose of this systematic review was to collect and assess Japanese language experimental research regarding the effect of MWD on signs and symptoms of DOMS.

Methods: Three Japanese databases (CiNii, Ichushi and Medical*Online) and five English databases (CINAHL, Embase, MEDLINE, Scopus and Web of Science) were searched until 2 March 2015. Only Japanese-language experimental studies were included. Two Japanese native speakers independently assessed the methodological quality of included studies using the McMaster Critical Review Form. Data were synthesised qualitatively.

Results: Three non-randomised experimental trials investigating the effects of MWD at 2450 MHz on DOMS in elbow flexors were included. All studies had moderate methodological qualities. Two studies reported significant positive effects on active range of motion (ROM) after eccentric exercises. No significant effect was identified in pain, circumference, maximal isometric strength and biochemical markers.

Conclusion: Our systematic review found limited formal evidence about the effect of MWD to improve active elbow ROM for subjects with DOMS. Real effects were difficult to assess due to the potential lack of statistical precision in data derived from small sample sizes. Future research should address the methodological flaws identified in this review, to provide more conclusive evidence.     

Combined somatosensory and motor training to improve upper limb function following stroke: a systematic scoping review

Purpose: The purpose of this systematic scoping review was to (1) identify combined somatosensory and motor training interventions for the upper limb and their training components, and (2) review the efficacy of the combined interventions.

Methods: Participants were adults post-stroke with somatosensory and/or movement deficits in the upper limb. All studies with interventions combining somatosensory and motor training and targeting the affected upper limb were included. Outcome measures were assessments of somatosensory and/or motor impairment and upper limb function.

Results: Ten studies (n?=?219) were included, comprising three randomized controlled trials, two pre-post studies with non-randomized comparison groups, three single-case experimental studies, and two case reports. There was heterogeneity across studies with regards to intervention contents and dosage, participant characteristics, and outcome measures. The interventions included combinations of tactile stimulation/discrimination, proprioceptive stimulation/discrimination, haptic object discrimination/recognition, movement training, and functional training. Only one group study, a non-randomized controlled study with multiple active components and the largest dose of treatment, found significant improvements in fine motor and somatosensory measures. Some improvements were found in case studies.

Conclusion: There was little consistency across ‘combined somatosensory and motor training’ interventions and few have been rigorously tested for efficacy across somatosensory, motor and functional outcomes.     

Effect of Cognitive Stimulation Therapy on Quality of Life: A Critical Review

Abstract

Aims: To determine the strength of the evidence regarding cognitive stimulation therapy (CST) to improve the quality of life of people with mild-to-moderate dementia.

Methods: A critical literature review was conducted to evaluate the methodological quality of relevant studies. The Guidelines for Critical Review (GCR), the Jadad scale, and the Effective Public Health Practice Project (EPHPP) quality assessment tool were used to complete a critical appraisal of the selected articles.

Results: Eight publications were retrieved for review. Three studies indicated significant improvements in overall quality of life. The global EPHPP scores showed two studies were of strong methodological quality, while four were moderate, and two were weak.

Conclusions: Results indicate the potential usefulness of CST for improving quality of life for older adults with mild-to-moderate dementia. With expertise in psychosocial interventions and dedication to evidence-based practice, occupational therapists (OTs) are well-positioned to implement CST.     

The effectiveness of conservative management for disabled throwing shoulder in baseball: a systematic review of Japanese-language primary studies

Background: Conservative management is often the first-choice treatment for baseball players with disabled throwing shoulder (DTS). Considering the high popularity of baseball in Japan, we suspected that there might be some evidence regarding this topic in the Japanese-language literature.

Objective: This study aimed to systematically review Japanese-language primary studies investigating the effectiveness of conservative management for DTS in baseball.

Methods: Eight databases were systematically searched from inception to 7 April 2016. Data on authors, publication years, sample characteristics, types of interventions, outcome measures and results were extracted. Data were synthesised qualitatively.

Results: Seven studies with low evidence level and low-to-moderate study quality were included. Interventions examined in the included studies were downward throwing, combined physiotherapy interventions and joint distension. Forming correction, stretching for posterior shoulder muscles and strengthening exercises to improve scapular/trunk stability were commonly used in combined physiotherapy interventions. Downward throwing and combined physiotherapy interventions corresponded with expert opinions described in the English-language literature. Due to the lack of studies with high level of evidence, however, it was difficult to determine the genuine effects of these interventions.

Conclusion: Our systematic review found limited evidence about the effectiveness of any conservative management for baseball players with DTS. Although downward throwing and combined physiotherapy interventions might be appropriate management in some cases, further studies of higher level of evidence and greater methodological rigour are required.     

Use of single-subject research designs in seating and wheeled mobility research: a scoping review

Abstract

Background: Evidence-based practice (EBP) in seating and wheeled mobility practice is often hindered by a dearth of published research.

Purpose: The purpose of this review was to explore and critically appraise the use of single-subject research designs (SSRDs) in seating and wheeled mobility studies published between January 1995 and May 2018.

Study Selection: Primary source, peer-reviewed SSRDs focused on exploring the impact of a seating and wheeled mobility intervention were included in the review.

Data Extraction: Relevant data extraction, determination of level of evidence, evaluation of methodological rigor, and assessment of the risk of bias were each independently performed.

Data Synthesis: The review yielded 19 studies (2 Level III, 15 Level IV, and 2 Level V). A majority of these studies incorporated a withdrawal-type of SSRD and involved subjects representing patient populations with seating and wheeled mobility needs. Methodological rigor/quality features most commonly absent in the included studies included: blinding/masking, inter-rater or intra-rater reliability, >5 data points in each phase, planned replication (≥3 subjects), procedural fidelity methods, randomization, stability of the data during baseline, statistical analyses and use of subject selection criteria. The limited number of published SSRDs, combined with the lower levels of evidence (Levels III–V) provided by these studies, indicates that the use of SSRDs in seating and wheeled mobility research is in the early stages of development.

Conclusions: Increasing the methodological quality and rigor as well as reporting methods in future SSRDs involving seating and wheeled mobility interventions may help to support EBP in this area.

• Implications for Rehabilitation

• Single-subject research designs (SSRDs) offer both researchers and clinicians the opportunity to contribute to the existing knowledge base in ways that reflect actual clinical practice.

• SSRDs provide flexibility in adapting and modifying seating and wheeled mobility-related assistive technology devices to meet the individual needs of specific subjects.

• SSRDs preserve individual responses to seating and wheeled mobility-related assistive technology devices.

• SSRDs may help to enhance evidence-based practice (EBP) in seating and wheeled mobility practice by spanning the divide between research and practice.

• Increasing the methodological quality and rigor as well as reporting methods in future SSRDs may help to support EBP in seating and wheeled mobility practice.

     

Pulsed electromagnetic energy in management of chronic wounds: a systematic review

Abstract

Objectives: To assess the evidence regarding effectiveness of pulsed electromagnetic energy (PEME) on the healing of chronic wounds; to explore whether there is an optimum treatment regime with regards to total current, pulse amplitude, pulse duration, and duration and frequency of treatments.

Methods: A computerised literature search of the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE and PubMed was performed. Only randomised clinical trials (RCT), controlled trials, and clinical trials that studied a population aged 18 years of age or more and investigated the effects of a type of PEME in the management of a chronic wound were included. The methodological quality of the included trials was assessed qualitatively using a set of formal criteria as recommended by van Tulder et al.

Results: Eleven studies (n=360) out of 40 were included of which six were of high methodological quality. Methodological scores ranged from one to nine (maximum 11) with a mean score of 5·5 (SD=1·73). For venous ulcers, there is strong evidence that PEME is more effective than sham PEME. For pressure and plantar ulcers, there is moderate evidence that PEME, in combination with conventional wound care is better than conventional wound care alone. The heterogeneity in duration, frequency, voltage and magnetic field made it difficult to make detailed comparisons or specific recommendations regarding its application.

Discussion: Further research should focus on controlling baseline recruitment parameters within an RCT, studying vital outcomes, and exploring combinations of parameters regarding optimum usage of PEME.     

Limited scientific evidence supports the use of conservative treatment interventions for pain and function in patients with subacromial impingement syndrome: randomized control trials

Abstract

Background: Different conservative treatment interventions are often used to decrease pain and improve function in patients with subacromial impingement syndrome (SAIS). However, the current evidence to support the use of these interventions has not been established.

Objectives: To determine the evidence for conservative treatment interventions regarding pain and function compared to any intervention for SAIS patients.

Methods: A systematic review of randomized controlled trials, published in English between 1 January 1999 and 31 May 2010, was performed using PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library and manual searching. The methodological quality (PEDro scale) and evidence grade (SBU) were rated. Eight studies were of high quality, four were medium quality, and eight were low quality. Various conservative treatment interventions were evaluated: acupuncture, electrotherapy modalities, exercises, mixed modalities, changing posture, and use of a functional brace.

Results: Limited scientific evidence (LSE) indicates positive effects of exercise and mixed modalities regarding pain and function and high-intensity laser therapy (HILT) regarding pain in SAIS patients. LSE also indicate no effect of electrotherapy modalities, apart from HILT, as treatment for SAIS.

Conclusions: The lack of high quality interventions limits the ability to draw conclusions regarding efficacy from several of the included studies. However, exercise may be as efficient as surgery, manual therapy in combination with exercise seems to be more effective than exercise alone and high-dose exercises seem to be more effective than low-dose exercises. Furthermore, there is contradictory evidence to support the use of acupuncture.     

Post-stroke self-management interventions: a systematic review of effectiveness and investigation of the inclusion of stroke survivors with aphasia

Purpose: To systematically review self-management interventions to determine their efficacy for people with stroke in relation to any health outcome and to establish whether stroke survivors with aphasia were included.

Method: We searched MEDLINE, EMBASE, PsycINFO, CINAHL, The Cochrane Library, and IBSS and undertook gray literature searches. Randomized controlled trials were eligible if they included stroke survivors aged 18?+?in a “self-management” intervention. Data were extracted by two independent researchers and included an assessment of methodological quality.

Results: 24 studies were identified. 11 out of 24 reported statistically significant benefits in favor of self-management. However, there were significant limitations in terms of methodological quality, and meta-analyses (n=?8 studies) showed no statistically significant benefit of self-management upon global disability and stroke-specific quality of life at 3?months or ADL at 3 or 6?months follow-up. A review of inclusion and exclusion criteria showed 11 out of 24 (46%) studies reported total or partial exclusion of stroke survivors with aphasia. Four out of 24 (17%) reported the number of stroke survivors with aphasia included. In nine studies (38%) it was unclear whether stroke survivors with aphasia were included or excluded.

Conclusions: Robust conclusions regarding the effectiveness of poststroke self-management approaches could not be drawn. Further trials are needed, these should clearly report the population included.

• Implications for rehabilitation

• There is a lack of evidence to demonstrate the effectiveness of self-management approaches for stroke survivors.

• It is unclear whether self-management approaches are suitable for stroke survivors with aphasia, particularly those with moderate or severe aphasia.

• Further research is needed to understand the optimal timing for self-management in the stroke pathway and the format in which self-management support should be offered.

     

Measurement properties of existing clinical assessment methods evaluating scapular positioning and function. A systematic review

Abstract

The aims were to compile a schematic overview of clinical scapular assessment methods and critically appraise the methodological quality of the involved studies. A systematic, computer-assisted literature search using Medline, CINAHL, SportDiscus and EMBASE was performed from inception to October 2013. Reference lists in articles were also screened for publications. From 50 articles, 54 method names were identified and categorized into three groups: (1) Static positioning assessment (n?=?19); (2) Semi-dynamic (n?=?13); and (3) Dynamic functional assessment (n?=?22). Fifteen studies were excluded for evaluation due to no/few clinimetric results, leaving 35 studies for evaluation. Graded according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN checklist), the methodological quality in the reliability and validity domains was “fair” (57%) to “poor” (43%), with only one study rated as “good”. The reliability domain was most often investigated. Few of the assessment methods in the included studies that had “fair” or “good” measurement property ratings demonstrated acceptable results for both reliability and validity. We found a substantially larger number of clinical scapular assessment methods than previously reported. Using the COSMIN checklist the methodological quality of the included measurement properties in the reliability and validity domains were in general “fair” to “poor”. None were examined for all three domains: (1) reliability; (2) validity; and (3) responsiveness. Observational evaluation systems and assessment of scapular upward rotation seem suitably evidence-based for clinical use. Future studies should test and improve the clinimetric properties, and especially diagnostic accuracy and responsiveness, to increase utility for clinical practice.     

Acupuncture for treatment of insomnia: An overview of systematic reviews

PurposeTo evaluate the reliability of the methodological quality and outcome measures of systematic review (SR) /meta-analysis (MA) of acupuncture for insomnia.MethodsWe conducted a comprehensive literature search for SRs with MAs in seven international and Chinese databases. Two reviewers independently extracted data and assessed the methodological quality of the reviews according to the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to rate the quality of evidence.ResultsThirty-four reviews were included. The AMSTAR-2 score showed that most of the included studies were of low methodological quality and included only two high-quality literatures. The lowest score were the item 10 (all the studies didn't report on the sources of funding for the studies included in the review), item 7(32 studies didn't provide a list of excluded studies and justify the exclusions) and item 3 (27 studies didn't explain their selection of the study designs for inclusion in the review).ConclusionMost of the reviews included suggested that the acupuncture group was more effective than the control group in the treatment of insomnia, but the methodological quality of most of the studies and the quality of evidence were low.     

The effectiveness of vestibular rehabilitation therapy vs conservative treatment on dizziness: a systematic review and meta-analysis

Abstract

Background: Dizziness is a common condition which may lead to loss of function and disability. Vestibular Rehabilitation Therapy (VRT) may be utilized to affect the vestibular system and reduce dizziness. However, controversy exists regarding the most effective interventions to treat dizziness.

Objectives: To examine the effectiveness of VRT compared to other conservative treatments in reducing dizziness and disability.

Methods: A literature search was performed using different combinations of the terms: dizziness, physical therapy, vertigo, vestibular, cervicogenic dizziness to identify randomized clinical trials comparing VRT to conservative treatments. The Cochrane Risk of Bias Tool was used to assess the quality of each included study. Additionally, a meta-analysis and qualitative analysis of the evidence was performed.

Results: Ten studies were included in the systematic review. Only four studies were included in the meta-analysis due to lack of adequate data reported for continuous outcomes. Eight studies scored less than a 69% on the Cochrane risk of bias tool indicating a low to moderate risk of bias. The meta-analysis revealed that VRT was found to be more effective than conservative treatment for short term outcomes (0–3?weeks) but not long-term outcomes (4 or more weeks). The results from the studies excluded from the meta-analysis but included in the systematic review are inconclusive.

Conclusions: VRT was only found to be more effective than other conservative treatments in the short term.     

Does exercise therapy affect depression or depressive symptoms after stroke?

Abstract

Background and objective: Little is known about the effect of exercise therapy on depression in persons who survive a stroke. The aim of the present review is to summarize the evidence from randomized controlled trials and non-randomized controlled clinical trials regarding the effects of exercise therapy on depression in persons who have suffered a stroke.

Methods: Studies measuring the effect of exercise therapy on depression in persons with stroke were systematically reviewed up to October 2009, by searching the CINAHL, Cochrane Library, EMBASE, MEDLINE, and Physiotherapy Evidence Database (PEDro) electronic databases. After determining the methodological quality using the PEDro scale, a best-evidence synthesis was conducted.

Results: Two controlled clinical trials and seven randomized controlled trials, investigating a wide variety of exercise therapies, were included in this review. PEDro scores ranged from 4 to 8. Six studies found no significant difference in depression scores between the intervention and control groups. Three studies found significant differences between the two groups, in favour of the intervention group. The best-evidence synthesis yielded no evidence for favourable effects of exercise therapy on depression in persons who have suffered a stroke.

Conclusions: The studies included in the present review do not allow the conclusion that exercise therapy has a favourable effect on depression in persons who have suffered a stroke. However, these studies mainly examined the effects of exercise therapy on physical outcomes. Moreover, most studies did not use depression as an inclusion criterion. Future studies should focus their design specifically on participants with a depression and be sufficiently powered.