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The effectiveness of group exercise for improving activity and participation in adult stroke survivors: a systematic review
Authors:Gavin Church  Jack Parker  Lauren Powell  Susan Mawson
Institution:School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, South Yorkshire S14DA, United Kingdom
Abstract:BackgroundFollowing post stroke rehabilitation, group exercise interventions can be used to continue improving cardiovascular fitness, activity levels, balance, gait, movement efficiency, and strengthening. However, little is known of the effectiveness of group exercise for improving activity and participation in stroke survivors.ObjectivesThis review aims to assess the effectiveness of group exercise for improving activity and participation in adult stroke survivors.Data sourcesDatabases searched were MEDLINE, Web of Science (Core collection), CINAHL, and the Cochrane Library.Study eligibility criteriaRandomised controlled trials (RCTs) of group exercise using validated outcome measures of activity and participation for post stroke rehabilitation. Two independent reviewers assessed all abstracts, extracted data, conducted a narrative synthesis and assessed the quality of all included articles. The Cochrane Risk of Bias Tool assessed methodological quality and included outcome measure quality was assessed.Results14 RCTs were included (n = 624 chronic stroke survivors collectively). Studies ranged between 12 and 243 stroke participants with an average of left:right hemisphere lesions of 32:39 and average age was 66.7 years. Although intervention and control groups improved, no significant difference between group differences were evident.Conclusionand implications of key findings: The review found improvements are short-term and less evident at long-term follow up with little improvements in participation after 6 months. However, this review was limited to the standard of intervention reporting. Further research should consider consistency in measuring underpinning mechanisms of group exercise interventions, which may explain the lack of activity changes in long-term follow-up.
Systematic review registration number PROSPEROCRD42017078917.
Keywords:Corresponding author    RCT  randomised controlled trial  UK  United Kingdom  NHS  National Health Service  ICF  International Classification of Functioning Disability and Health  PRISMA  Preferred Reporting Items for Systematic Reviews and Meta-Analysis  CVA  Cardiovascular Accident  TIA  Transient Ischemic Attack  HIIT  High Intensity Interval Training  MeSH  Medical Subject Heading  EBRSR  Evidence Based Review of Stroke Rehabilitation  MCID  Minimally Clinically Important Difference  TUG  Timed Up and Go Test  6MWT  6 Minute Walk Test  MAS-arm  Motor Assessment Scale upper lib-arm  MAS-hand  Motor Assessment Scale upper limb-hand  WMFT  Wolf Motor Function Test  SIS  Stroke Impact Scale  FAI  Frenchay Activities Index  RMI  Rivermead Mobility Index  NHP  Nottingham Health Profile  SF36  Medical outcomes study 36-item short form questionnaire  version 2  FIM  Functional Independence Measure  GHQ  General Health Questionnaire  HADs  Hospital Anxiety and Depression Scale  SRD  Smallest Real Difference  BBS  Berg Balance Scale  Stroke  Rehabilitation  Group exercise  Function  Intensity
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