Interventions involving repetitive practice improve strength after stroke: a systematic review

Abstract Questions Do interventions involving repetitive practice improve strength after stroke? Are any improvements in strength accompanied by improvements in activity? Design Systematic review of randomised trials with meta-analysis. Participants Adults who have had a stroke. Intervention Any intervention involving repetitive practice compared with no intervention or a sham intervention. Outcome measures The primary outcome was voluntary strength in muscles trained as part of the intervention. The secondary outcomes were measures of lower limb and upper limb activity. Results Fifty-two studies were included. The overall SMD of repetitive practice on strength was examined by pooling post-intervention scores from 46 studies involving 1928 participants. The SMD of repetitive practice on strength when the upper and lower limb studies were combined was 0.25 (95% CI 0.16 to 0.34, I 2 =44%) in favour of repetitive practice. Twenty-four studies with a total of 912 participants investigated the effects of repetitive practice on upper limb activity after stroke. The SMD was 0.15 (95% CI 0.02 to 0.29, I 2 =50%) in favour of repetitive practice on upper limb activity. Twenty studies with a total of 952 participants investigated the effects of repetitive practice on lower limb activity after stroke. The SMD was 0.25 (95% CI 0.12 to 0.38, I 2 =36%) in favour of repetitive practice on lower limb activity. Conclusion Interventions involving repetitive practice improve strength after stroke, and these improvements are accompanied by improvements in activity. Review registration PROSPERO CRD42017068658. [de Sousa DG, Harvey LA, Dorsch S, Glinsky JV (2018) Interventions involving repetitive practice improve strength after stroke: a systematic review. Journal of Physiotherapy 64: 210–221]