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Aust J Physiother. 2006;52(4):241-8.

Strengthening interventions increase strength and improve activity after stroke: a systematic review.

Author information

  • 1Faculty of Health Science, The University of Sydney, Lidcombe, NSW 1825, Australia. L.Ada@fhs.usyd.au

Abstract

QUESTION:

Is strength training after stroke effective (ie, does it increase strength), is it harmful (ie, does it increase spasticity), and is it worthwhile (ie, does it improve activity)?

DESIGN:

Systematic review with meta-analysis of randomised trials.

PARTICIPANTS:

Stroke participants were categorised as (i) acute, very weak, (ii) acute, weak, (iii) chronic, very weak, or (iv) chronic, weak.

INTERVENTION:

Strengthening interventions were defined as interventions that involved attempts at repetitive, effortful muscle contractions and included biofeedback, electrical stimulation, muscle re-education, progressive resistance exercise, and mental practice.

OUTCOME MEASURES:

Strength was measured as continuous measures of force or torque or ordinal measures such as manual muscle tests. Spasticity was measured using the modified Ashworth Scale, a custom made scale, or the Pendulum Test. Activity was measured directly, eg, 10-m Walk Test, or the Box and Block Test, or with scales that measured dependence such as the Barthel Index.

RESULTS:

21 trials were identified and 15 had data that could be included in a meta-analysis. Effect sizes were calculated as standardised mean differences since various muscles were studied and different outcome measures were used. Across all stroke participants, strengthening interventions had a small positive effect on both strength (SMD 0.33, 95% CI 0.13 to 0.54) and activity (SMD 0.32, 95% CI 0.11 to 0.53). There was very little effect on spasticity (SMD -0.13, 95% CI -0.75 to 0.50).

CONCLUSION:

Strengthening interventions increase strength, improve activity, and do not increase spasticity. These findings suggest that strengthening programs should be part of rehabilitation after stroke.

PMID:
17132118
[PubMed - indexed for MEDLINE]
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