The effect of Tai Chi exercise on motor function and sleep quality in patients with stroke: A meta-analysis

ObjectiveThe meta-analysis is to objectively evaluate the efficacy of Tai Chi exercise for motor function and sleep quality in patients with stroke.MethodsRandomized controlled trials(RCTs) about the effects of Tai Chi versus a non-exercise or conventional rehabilitation exercise control group on motor function and sleep quality in patients with stroke were searched from multiple electronic databases(PubMed, Web of Science, the Cochrane Library, EMBASE, AMED, CBM, CNKI, Wanfang and VIP) until August 2016. Two investigators independently screened eligible studies, extracted data, and assessed the methodological quality by using the quality evaluation criteria for RCTs recommended by Cochrane Handbook. Then meta-analysis was performed by RevMan5.3 software.ResultsA total of 17 RCTs with 1209 participants were included. The meta-analysis indicated that there was a significant difference on improving the balance function(P < 0.001) and ability of daily activity (P = 0.0003) of patients with stroke between Tai Chi group and control group. However, no significant effect was found on Tai Chi for walking function and sleep quality(P > 0.05).ConclusionTai Chi exercise can significantly improve the balance function and ability of daily activities of patients with stroke, and there are no significant differences in walking function and sleep quality. Therefore, lots of multicenter, large-sample, higher quality randomized controlled trials are needed to verify the effects of Tai Chi exercise in improving walking function and sleep quality for patients with stroke.     

Effectiveness of Technology-Based Distance Physical Rehabilitation Interventions for Improving Physical Functioning in Stroke: A Systematic Review and Meta-analysis of Randomized Controlled Trials

ObjectiveTo study the effectiveness of technology-based distance physical rehabilitation interventions on physical functioning in stroke.Data SourcesA systematic literature search was conducted in 6 databases from January 2000 to May 2018.Study SelectionInclusion criteria applied the patient, intervention, comparison, outcome, study design framework as follows: (P) stroke; (I) technology-based distance physical rehabilitation interventions; (C) any comparison without the use of technology; (O) physical functioning; (S) randomized controlled trials (RCTs). The search identified in total 693 studies, and the screening of 162 full-text studies revealed 13 eligible studies.Data ExtractionThe studies were screened using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines and assessed for methodological quality and quality of evidence. Meta-analysis was performed if applicable.Data SynthesisA total of 13 studies were included, and online video monitoring was the most used technology. Seven outcomes of physical functioning were identified—activities of daily living (ADL), upper extremity functioning, lower extremity functioning, balance, walking, physical activity, and participation. A meta-analysis of 6 RCTs indicated that technology-based distance physical rehabilitation had a similar effect on ADL (standard mean difference 0.06; 95% confidence interval: ?0.22 to 0.35, P=.67) compared to the combination of traditional treatments (usual care, similar and other treatment). Similar results were obtained for other outcomes, except inconsistent findings were noted for walking. Methodological quality of the studies and quality of evidence were considered low.ConclusionsThe findings suggest that the effectiveness of technology-based distance physical rehabilitation interventions on physical functioning might be similar compared to traditional treatments in stroke. Further research should be performed to confirm the effectiveness of technology-based distance physical rehabilitation interventions for improving physical functioning of persons with stroke.     

Interventions to Promote Long-Term Participation in Physical Activity After Stroke: A Systematic Review of the Literature

Objective

To investigate the effects of interventions to promote long-term participation in physical activity (PA) on measures of frequency, duration, or intensity of PA at 3 months or longer in community-dwelling stroke survivors.

Data Sources

MEDLINE, Cumulative Index to Nursing and Allied Health (CINAHL), PsycINFO, and Cochrane Library of Systematic Reviews between 1987 and December 2012. Search terms included “physical activity, exercise promotion,” “stroke,” “behavior change interventions,” and their synonyms.

Study Selection

Randomized controlled trials or comparison studies involving stroke survivors, with follow-up of ≥3 months, examining interventions to increase long-term participation in PA.

Data Extraction

Preferred reporting items for systematic reviews and meta-analyses guidelines informed data extraction. Risk of bias was assessed using the Cochrane Collaboration tool. Two reviewers independently reviewed abstracts and extracted data.

Data Synthesis

Of 2888 studies, 11 involving 1704 participants were included. Risk of bias occurred in randomization methods and blinding. Limited data and study heterogeneity meant that data pooling was not possible. Odds ratios and continuous data as weighted mean differences, however, were calculated using fixed-effect models and 95% confidence intervals. Two intervention types were identified: individualized tailored counseling with or without supervised exercise (n=6 studies) and supervised exercise with advice (n=5 studies). Three studies illustrated increased odds of meeting recommended PA levels and participation in PA at 12 months after tailored counseling (P<.05). Two studies showed improved step count at 3 months with supervised exercise only (P<.05); however, PA levels had declined by 3 months. Tailored home exercise was the only predominantly exercise-based intervention to demonstrate higher PA participation at 12 months.

Conclusions

This study provides some evidence that tailored counseling alone or with tailored supervised exercise improves long-term PA participation and functional exercise capacity after stroke better than does tailored supervised exercise with general advice only. Interventions to improve participation in PA should incorporate PA-specific tailored counseling based on sound behavioral theory to promote long-term participation in PA.     

乳腺癌术后患者功能康复训练效果的系统评价

目的评价功能康复训练对改善乳腺癌术后患者患侧肢体功能和生活质量的效果。方法计算机检索Cochrane Database of Systematic Renews（2007年第2期）、JBI Database of Systematic Reviews、MEDLINE（1966～2008）、EMbase（1989～2007）、CINAHL（Cumulative Index to Nursing and Allied Health literature）、CBMdisc（1978～2008）、CNKI（1994～2008）中关于康复训练对改善乳腺癌术后患者肢体功能和生活质量的随机对照试验,同时筛检纳入文献的参考文献。由3名研究者对文献质量进行严格评价和资料提取,对符合质量标准的RCT进行Meta分析。结果共纳入19个RCT。9个RCT的结果显示,肢体功能康复训练对改善患者术后的关节活动度有显著作用。4项研究结果表明全身康复运动训练对改善患者的心肺功能、提高身体耐力方面有显著作用,6项研究结果显示乳腺癌术后系统的康复运动对提高其健康相关生活质量有显著效果,6项研究结果表明康复训练对缓解治疗期间的疲乏症状有显著意义。在康复训练的时机上选择上,术后早期开始康复训练是积极而安全的措施。结论乳腺癌术后患者开展肢体渐进式康复训练和全身康复运动可有效改善患者的患肢功能,提高生活质量,对缓解化疗和放疗患者疲乏症状有一定的效果。     

Combining the benefits of tele-rehabilitation and virtual reality-based balance training: a systematic review on feasibility and effectiveness

Purpose: A motivational surrounding is desirable in stroke rehabilitation considering the need to train repetitively to improve balance, even after discharge from rehabilitation facilities. This review aims to investigate whether it is feasible to combine virtual reality (VR) which allows exercising in game-like environments with tele-rehabilitation in a community-dwelling stroke population.

Methods: Literature searches were conducted in five databases, for example, PubMed and the Cochrane Library. Randomized controlled trial (RCT) and non-RCT investigating feasibility and effectiveness of VR-based tele-rehabilitation were included. Based on the risk of bias and study design, methodological quality is ranked according to the GRADE guidelines.

Results: Seven studies (n?=?120) were included, of which four are RCTs. Evidence regarding therapy adherence and perceived enjoyment of VR, as well as a cost–benefit of tele-rehabilitation emphasizes feasibility. Equal effects are reported comparing this approach to a therapist-supervised intervention in the clinical setting on balance and functional mobility.

Conclusions: Tele-rehabilitation could be a promising tool to overcome burdens that restrict accessibility to rehabilitation in the future. VR can increase motivation allowing longer and more training sessions in community-dwelling stroke survivors. Therefore, combining the benefits of both approaches seems convenient. Although evidence is still sparse, functional improvements seem to be equal compared to a similar intervention with therapist-supervision in the clinic, suggesting that for cost-efficient rehabilitation parts of therapy can be transferred to the homes.

• Implications for rehabilitation

• The use of tele-rehabilitation could be a promising tool to overcome burdens that restrict the access of stroke survivors to long-term rehabilitative care.

• VR-based interventions are game-like and therefore seem to provide a motivational environment which allows longer exercise sessions and greater adherence to therapy.

     

八段锦对脑卒中患者肢体功能康复影响的Meta分析

目的系统评价八段锦对脑卒中患者肢体功能康复的影响。方法计算机检索Pubmed、Cochrane图书馆、中国生物医学数据库、万方数据库等,纳入符合标准的随机对照试验,检索时间为建库至2016年11月。纳入文献的方法学质量采用Cochrane偏倚风险评估工具进行评价。应用RevMan 5.3统计软件进行Meta分析。结果最终纳入6篇文献,共涉及443名研究对象。Meta分析结果显示,八段锦组与对照组相比能改善脑卒中患者的平衡功能;八段锦联合平衡功能训练可改善下肢运动功能;八段锦联合常规健康指导或康复治疗,可改善脑卒中患者的日常生活活动能力和神经功能缺损状况。结论八段锦在一定程度上能够促进脑卒中患者肢体功能的康复,但需进一步在大样本中验证其有效性。     

Predictors of upper limb spasticity after stroke? A systematic review and meta-analysis

ObjectiveTo determine the predictive markers for the occurrence of upper limb spasticity in the first 12 months after stroke.Data sourcesA systematic review was undertaken of the databases MEDLINE, EMBASE, CINAHL and PEDRO to 31st December 2017.Study selectionNon-experimental or experimental studies that included a control group with spasticity who did not receive an experimental intervention which investigated at least one variable (explanatory variable) measured at baseline against the development (or not) of spasticity at a future time point within 12 months post stroke were selected independently by two reviewers. Eleven papers met the selection criteria.Study appraisalData were extracted into tabular format using predefined data fields by two reviewers. Study quality was evaluated using the modified Downs and Black tool. Data were analysed using a meta-analysis or narrative review.ResultsTen studies, including 856 participants were analysed. The predictive markers of upper limb spasticity at one month post stroke were: motor 11.25 (odds ratio, OR); [95% CI:2.48, 51.04] and sensory impairments 4.91 (OR); [1.24, 19.46]; haemorrhagic stroke 3.70 (OR); [1.05, 12.98] and age 0.01 (OR) [0.00, 69.89]. Only motor impairment was found as a significant predictor at six months post stroke 30.68 (OR); [1.60, 587.06].LimitationsLow number of studies exploring biomechanical and neurophysiological in addition to behavioural predictors of spasticity were included.Conclusion and implications of key findingsUsing the results, the identified predictive markers have potential to better inform clinical decision-making and to plan specific rehabilitation interventions by physiotherapists for stroke survivors with upper limb spasticity.
Systematic Review Registration Number PROSPERO (ID: CRD42016027642).     

Associations Between Adherence to the Physical Activity and Exercise Program Applied in the LAST Study and Functional Recovery After Stroke

ObjectiveTo investigate the associations between participants’ adherence to a physical activity and exercise program after stroke and functional recovery 18 months after inclusion.DesignSecondary analyses of the intervention arm in the multisite randomized controlled trial Life After Stroke (LAST).SettingPrimary health care services in 3 Norwegian municipalities.ParticipantsOf the participants enrolled (N=380), 186 (48.9%) were randomized to the intervention. The study sample comprised community dwelling individuals included 3 months after stroke, with mean age of 71.7 ± 11.9 years and 82 (44.1%) women. According to the National Institutes of Health Stroke Scale, 97.3% were diagnosed as having mild (National Institutes of Health Stroke Scale<8) and 2.7% with moderate (8-16 on the National Institutes of Health Stroke Scale) stroke.InterventionMonthly coaching by physiotherapists encouraging participants to adhere to 30 minutes of daily physical activity and 45-60 minutes of weekly exercise.Main Outcome MeasuresThe primary outcome was Motor Assessment Scale (MAS). Secondary outcome measures were 6-minute walk test, Timed Up and Go (TUG), Berg Balance Scale (BBS), and the physical domains of the Stroke Impact Scale (SIS). Adherence was assessed by combining participants’ training diaries and physiotherapists’ reports.ResultsThe relationship between adherence and functional recovery was analyzed with simple and multiple linear regression models. Adjusted for age, sex, dependency, and cognition, results showed statistically significant associations between adherence and functional outcomes after 18 months, as measured by MAS, TUG, BBS, and SIS (P≤.026).ConclusionsIncreased adherence to physical activity and exercise was associated with improved functional recovery after mild to moderate stroke. This emphasizes the importance of developing adherence-enhancing interventions. Dose-response studies are recommended for future research.     

不同康复治疗计划对脑卒中患者功能恢复的影响

目的　观察急性脑卒中患者早期系统康复治疗的有效性 ,探讨恢复期不同康复治疗计划对功能恢复的影响。方法　将 45例发病在 2周内的脑卒中患者随机分为康复组 (2 3例 )和对照组 (2 2例 ) ,康复组又分为康复A组 1 1例 (住院系统康复治疗 1 2周 )和康复B组 1 2例 (住院系统康复治疗 4周后出院由治疗师上门指导家庭康复训练 8周 )。采用Fugl Meyer法、Barthel指数法于治疗前及治疗 4周和 1 2周后评定各组患者的运动功能和日常活动能力。结果　治疗前各组Fugl Meyer及Barthel积分相近 ,差异均无显著性意义(P >0 .0 5) ;治疗 4周和 1 2周后 ,康复组Fugl Meyer及Barthel积分均明显高于对照组 ,差异有非常显著性意义 (P <0 .0 1 ) ;治疗前和治疗 4周后康复A组和B组的Fugl Meyer及Barthel积分差异没有显著性意义 (P >0 .0 5) ;治疗 1 2周后康复A组Fugl Meyer值明显高于康复B组 ,差异有非常显著性意义 (P <0 .0 1 ) ,而两组Barthel积分差异没有显著性意义 (P >0 .0 5)。结论　早期系统康复治疗可以有效地提高患者的运动功能和改善ADL能力 ,恢复期继续给予至少 8周家庭指导康复训练则更有利于提高患者的独立生活能力 ,并可减少医疗费用、缩短住院时间及利用可用的资源 ,促进患者的全面康复     

Virtual Reality Rehabilitation With Functional Electrical Stimulation Improves Upper Extremity Function in Patients With Chronic Stroke: A Pilot Randomized Controlled Study

Objective

To compare virtual reality (VR) combined with functional electrical stimulation (FES) with cyclic FES for improving upper extremity function and health-related quality of life in patients with chronic stroke.

Selection for inpatient rehabilitation after acute stroke: a systematic review of the literature

Hakkennes SJ, Brock K, Hill KD. Selection for inpatient rehabilitation after acute stroke: a systematic review of the literature.

Objective

To identify patient-related factors that have been found to correlate with functional outcomes post acute stroke to guide clinical decision making with regard to rehabilitation admission after acute stroke.

Data Sources

We systematically searched the scientific literature between 1966 and January 2010. The primary source of studies was the electronic databases Medline, CINAHL, and Embase. The search was supplemented with citation tracking.

Study Selection

Two reviewers independently applied the inclusion criteria to identify relevant articles from the citations obtained through the literature search. Eligible studies included systematic reviews of prognostic indicators, studies of prognostic indicators of acute discharge disposition, and studies of rehabilitation admission criteria after acute stroke. Of the 8895 studies identified, 83 articles, representing 79 studies, were included in the review.

Data Extraction

One reviewer extracted the data relating to the participants, prognostic indicators, and outcomes. A second reviewer independently checked data extracted with disagreement resolved by a third reviewer. Quality of included studies was assessed for internal and external validity.

Data Synthesis

Of the 79 studies, 26 were systematic reviews of prognostic indicators of functional level and/or discharge disposition, 48 were studies of prognostic indicators of acute discharge disposition, and 6 were studies of rehabilitation selection criteria. The methodologic quality of the included studies was generally poor. Age, cognition, functional level after stroke, and, to a lesser extent, continence were found to have a consistent association with outcome across all 3 research areas. In addition, stroke severity was also associated with acute discharge disposition, final discharge disposition, and functional level. Sex and side of stroke appeared to have no association across all 3 of the research areas.

Conclusions

This review highlights a number of important prognostic indicators and rehabilitation selection criteria that may assist clinicians in improving selection procedures and standardizing access to inpatient rehabilitation after stroke, although the quality of many studies is low. Further high quality studies and reviews of prognostic indicators and clinician decision making with regards to rehabilitation acceptance are required.     

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.     

Optimising long-term participation in physical activities after stroke: Exploring new ways of working for physiotherapists

There is now good empirical evidence of physical and functional benefits for individuals with stroke from long-term engagement in a range of physical activities. However, long-term participation of stroke survivors in physical activity after rehabilitation is low, and maximum benefits are not being achieved. This article reviews relevant literature and evidence, and suggests that physiotherapists are ideally placed to support patients in long-term participation in activity as they prepare patients for the end of physical rehabilitation. However, this requires the development, testing and application of stroke-specific evidence-based behavioural and motivational interventions that are feasible in clinical practice, take account of the role of carers, and seek to address the barriers to activity faced by stroke survivors at the end of rehabilitation. It also requires physiotherapists to take a leading role in developing appropriate policies and strategies with other exercise professionals and services to address the transition from rehabilitation to an active lifestyle following stroke.     

肌内效贴对脑卒中患者下肢功能影响的Meta分析

目的评价肌内效贴(KT)对脑卒中患者下肢功能的影响。方法计算机检索PubMed、Cochrane Library、Embase、中国知网、中国生物医学文献数据库、万方数据库、维普中文科技期刊数据库,选取2000年1月1日至2019年10月1日发表的关于KT对脑卒中患者下肢功能影响的随机对照试验研究。由2名研究者独立筛选文献,评价文献质量提取资料,采用Rev Man 5.3软件进行Meta分析。结果纳入13项随机对照研究,共932例患者。Meta分析结果显示,在下肢步行功能方面,实验组较对照组更能提高脑卒中患者的步行速度[MD=-3.06,95%CI(-4.46,-1.67),P=<0.0001],改善步行能力[MD=0.52,95%CI(0.27,0.77),P<0.0001];在平衡功能方面,实验组脑卒中患者的平衡能力[MD=7.74,95%CI(6.96,8.53),P<0.00001],预测跌倒能力[MD=7.74,95%CI(6.96,8.53),P<0.00001]均优于对照组;在肌力方面,可提高实验组脑卒中患者的股四头肌肌力[MD=0.35,95%CI(0.10,0.59),P=0.005],改善小腿三头肌肌力[MD=-0.38,95%CI(-0.50,-0.27),P<0.00001];提高下肢运动功能[SMD=0.69,95%CI(0.47,0.91),P<0.00001];改善患者日常活动能力,提高生活质量[MD=13,95%CI(10.41,15.58),P<0.00001]。结论KT有助于提高脑卒中患者的平衡能力、运动能力、肌力,改善生活质量。     

Effectiveness of Conservative Nonpharmacologic Therapies for Pain,Disability, Physical Capacity,and Physical Activity Behavior in Patients With Degenerative Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis

ObjectiveTo investigate the effectiveness of conservative nonpharmacologic therapies on pain, disability, physical capacity, and physical activity outcomes in patients with degenerative lumbar spinal stenosis (LSS).Data SourcesSystematic search of MEDLINE, EMBASE, CENTRAL, and PsycINFO from inception to November 4, 2019, without language restrictions.Study SelectionPairs of review authors independently identified randomized controlled trials published in peer-reviewed scientific journals reporting on the effects of rehabilitation interventions on pain intensity (back or leg), disability, symptom severity, physical capacity, physical activity behavior, or adverse events (secondary outcome) in adults with LSS. The search identified 1718 records; data from 21 reports of 19 trials (1432 patients) were included.Data ExtractionReview author pairs independently extracted data and assessed included studies. We assessed risk of bias with the Cochrane tool, and overall study quality with the Grading of Recommendations Assessment, Development and Evaluation classification.Data SynthesisWe pooled data using random-effects meta-analyses; treatment effects were reported as mean differences (MD) and 95% confidence intervals (CI). Directed exercise and manual therapy was superior to self-directed or group exercise for improving short-term walking capacity (MD, 293.3 m; 95% CI, 61.7-524.9 m; low-quality evidence), back pain (MD, –1.1; 95% CI, –1.8 to –0.4; moderate quality evidence), leg pain (MD, –.9; 95% CI, –0.2 to –1.5; moderate-quality evidence), and symptom severity (MD, –0.3; 95% CI, –0.4 to –0.2; low quality evidence). There is very low quality evidence that rehabilitation is no better than surgery at improving intermediate- or long-term disability. Single trials provided conflicting evidence of effectiveness for a variety of therapies.ConclusionsFor patients with LSS, there is low- to moderate-quality evidence that manual therapy with supervised exercises improves short-term walking capacity and results in small improvements in pain and symptom severity compared with self-directed or group exercise. The choice between rehabilitation and surgery for LSS is very uncertain owing to the very low quality of available evidence.     

Determinants of Social Participation at 1, 3, and 6 Months Poststroke in Benin

ObjectiveTo build a model of prediction of social participation of community-dwelling stroke survivors in Benin at 1 month, 3 months, and 6 months.DesignAn observational study with evaluations at 1 month, 3 months, and 6 months poststroke. Correlational analyses and multivariate linear regressions were performed.SettingOutpatient rehabilitation centers in Benin.ParticipantsA volunteer sample of 91 stroke patients was enrolled at baseline; 64 (70%) patients completed all the study (N=64): 70% male and 52% right hemiparesis.InterventionNot applicable.Main Outcome MeasuresParticipants were evaluated with the Participation Measurement Scale, ACTIVLIM-Stroke (activities of daily living [ADL]), Stroke Impairment Assessment Set, 6-minute walk test, Hospital Anxiety and Depression Scale, and the modified Rankin Scale.ResultsThe significant predictors of social participation after controlling the confounders were the following: at 1 month ADL (0.4 [0.3, 0.6]) and depression (‒0.6 [‒0.8, ‒0.2]) with total model R²=0.44; at 3 months ADL (0.58 [0.4, 0.7]) and depression (‒0.58 [‒0.5, ‒0.7]) with total model R²=0.65; and at 6 months ADL (0.31 [0.2, 0.5]), impairments (‒0.82 [‒0.5, ‒0.7]), and depression (‒0.94 [‒0.8, ‒0.2]) with total model R²=0.78.ConclusionsUsing socioculturally tailored tools, the present study identified ADL performance (ACTIVLIM-Stroke), depression (Hospital Anxiety Depression Scale), and overall impairments (Stroke Impairment Assessment Set) as the significant determinants of social participation (Participation Measurement Scale) poststroke in Benin. These findings will be a valuable resource for rehabilitation stakeholders in evaluating interventions, programs, and policies designed to encourage social participation for stroke patients.     

Circuit-Based Rehabilitation Improves Gait Endurance but Not Usual Walking Activity in Chronic Stroke: A Randomized Controlled Trial

Mudge S, Barber PA, Stott NS. Circuit-based rehabilitation improves gait endurance but not usual walking activity in chronic stroke: a randomized controlled trial.

Objective

To determine whether circuit-based rehabilitation would increase the amount and rate that individuals with stroke walk in their usual environments.

Design

Single-blind randomized controlled trial.

Setting

Rehabilitation clinic.

Participants

Sixty participants with a residual gait deficit at least 6 months after stroke originally enrolled in the study. Two withdrew in the initial phase, leaving 58 participants (median age, 71.5y; range, 39.0–89.0y) who were randomized to the 2 intervention groups.

Interventions

The exercise group had 12 sessions of clinic-based rehabilitation delivered in a circuit class designed to improve walking. The control group received a comparable duration of group social and educational classes.

Main Outcome Measures

Usual walking performance was assessed using the StepWatch Activity Monitor. Clinical tests were gait speed (timed 10-meter walk) and endurance (six-minute walk test [6MWT]), confidence (Activities-Based Confidence Scale), self-reported mobility (Rivermead Mobility Index [RMI]), and self-reported physical activity (Physical Activity and Disability Scale).

Results

Intention-to-treat analysis revealed that the exercise group showed a significantly greater distance for the 6MWT than the control group immediately after the intervention (P=.030) but that this effect was not retained 3 months later. There were no changes in the StepWatch measures of usual walking performance for either group. The exercise and control groups had significantly different gait speed (P=.038) and scores on the RMI (P=.025) at the 3-month follow-up. These differences represented a greater decline in the control group compared with the exercise group for both outcome measures.

Conclusions

Circuit-based rehabilitation leads to improvements in gait endurance but does not change the amount or rate of walking performance in usual environments. Clinical gains made by the exercise group were lost 3 months later. Future studies should consider whether rehabilitation needs to occur in usual environments to improve walking performance.     

Efficacy of rehabilitative techniques in reducing hemiplegic shoulder pain in stroke: Systematic review and meta-analysis

Background: Hemiplegic shoulder pain (HSP) is a disabling complication affecting stroke survivors. In this context, rehabilitation might play a key role in its clinical management. Recent systematic reviews of the impact of rehabilitative approaches on pain reduction in patients with HSP are lacking.Objective: This systematic review of randomized controlled trials (RCTs) with meta-analysis aimed to investigate the efficacy of rehabilitative techniques in reducing HSP in stroke survivors.Methods: PubMed, Scopus, and Web of Science were searched from inception to March 8, 2021 to identify RCTs of stroke survivors with HSP undergoing specific rehabilitative techniques combined with conventional therapy to reduce pain intensity. A network meta-analysis and meta-analysis of the Bayesian network of random effects were performed. The risk of bias of studies was assessed with Version 2 of the Cochrane Risk of Bias tool for randomized trials.Results: Of 1139 articles identified, 12 were included in the final synthesis. We analyzed data for 723 stroke survivors, reporting a significant overall decrease in pain intensity after a rehabilitative approach by the Bayesian meta-analysis (standardized mean difference 2.78, 95% confidence interval 0.89;-4.59; p = 0.003). We report a significant reduction in HSP with botulinum toxin type A injection (p = 0.001), suprascapular nerve pulsed radiofrequency (p = 0.030), suprascapular nerve block (p = 0.020), and trigger-point dry needling (p = 0.005) as compared with conventional rehabilitation. Concerning the effect size, we identified a Bayesian factor₁₀ of 97.2, with very strong evidence of superiority of rehabilitative techniques.Conclusions: The present systematic review and meta-analysis showed that adding other rehabilitative techniques to conventional rehabilitation was significantly more effective than conventional rehabilitation alone in the complex management of patients affected by HSP.