This systematic review evaluates the effects of interventions involving repetitive practice on strength and activity in people with stroke. Randomised controlled trials conducted in adult participants with a diagnosis of stroke (acute or chronic) compared to a sham or no intervention were included. The primary outcome of this review was strength. The secondary outcomes were activity of the affected upper and lower limb. Risk of bias was assessed with the Cochrane risk of bias tool. In total, 52 studies were included, with 46 studies (n = 1928) in the meta-analysis for strength. Interventions included task-specific training, electromyography-triggered functional movement, robotics, constrained-induced movement therapy, Bobath, cycling, assistive technology, video games, whole body vibration, mirror therapy, and water-based exercises. The overall standardised mean difference of repetitive practice on strength when the upper and lower limb studies were combined was 0.25 (95% CI 0.16 to 0.34). The most common intervention was task-specific training (18 studies, 931 participants) had a standardised mean difference of 0.21 (95% CI 0.08 to 0.34) on strength. The intervention with the largest effect on strength was constraint-induced movement therapy (2 studies, 22 participants), with a standardised mean difference of 1.49 (95% CI 0.44 to 2.54). Twenty-four studies (n = 912 participants) investigated the effects of repetitive practice on upper limb activity, with repetitive practice being superior to control conditions (standardised mean difference 0.15, 95% CI 0.02 to 0.29). Larger effects were observed for repetitive practice on lower limb activity (20 studies, 952 participants), with a standardised mean difference of 0.25 (95% CI 0.12 to 0.38). Interventions involving repetitive practice improve strength after stroke, and the improvement in strength is accompanied by improvements in activity.
De Sousa et al. Interventions involving repetitive practice improve strength after stroke: a systematic review. J Physiother 2018;64(4):210-21
