In this review, the authors included 17 trials (n=1,297 participants) which evaluated the effects of circuit class rehabilitation compared to usual care or sham rehabilitation for people after stroke of any type, severity and stage. Circuit class therapy was defined as physical rehabilitation in a group environment, with no more than one staff member per three patients. One circuit class per week for four weeks was the minimum dosage required for inclusion in the review. Only studies reporting interventions that focused on repetitive practice of functional tasks arranged in a circuit with the aim of improving mobility, were included. Ten studies (835 participants) measured walking capacity (Six-Minute Walk Test) demonstrating that circuit class therapy was superior to other interventions (mean difference (MD) 60.86 m, 95% confidence interval (CI) 44.55 to 77.17). Eight studies (744 participants) measured gait speed, again finding in favor of circuit class therapy compared with other interventions (MD 0.15 m/s, 95% CI 0.10 to 0.19). Circuit class therapy also demonstrated superior effects in other aspects of walking and balance (Timed Up and Go: five studies, 488 participants, MD -3.62 seconds, 95% CI -6.09 to -1.16; Activities of Balance Confidence scale: two studies, 103 participants, MD 7.76, 95% CI 0.66 to 14.87). There was low quality of evidence that no adverse events (e.g., falls during therapy) are associated with circuit class therapy. There is moderate quality evidence that circuit class therapy provides a clinically important benefit in mobility for people after stroke. More studies investigating quality of life and cost-benefits are needed.
English C et al. Circuit class therapy for improving mobility after stroke. Cochrane Database Syst Rev 2017;Issue 6.
