Effectiveness of Rehabilitation Exercise in Improving Physical Function of Stroke Patients: A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Systematic Data Resource
2.2. Eligibility and Exclusion Criteria
- Patients (P): Patients with a stroke (except where a person without disabilities acts as a person with disabilities)
- Interventions (I): Rehabilitation, exercise, and/or treatment for stroke survivors
- Comparisons (C): No rehabilitation or other intervention
- Outcomes (O): The results after intervention regarding functional improvement, pain reduction, and effectiveness of treatment
2.3. Screening, Selection, and Exrtraction Process
2.4. Assessment of Quality
3. Results
3.1. Study Selection
3.2. Quality Assessment and Risk of Bias
3.3. Study Characteristics
3.4. Exercise Type
3.5. Exercise Type Based on the Stage of Stroke
4. Discussion
4.1. Exercise Type
4.2. Exercise Type Based on the Stage of Stroke
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Selected Paper | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | Score |
---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | 10 |
2 | Yes | Yes | Yes | Yes | Yes | No | No | No | Yes | Yes | Yes | 8 |
3 | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 10 |
4 | Yes | Yes | No | Yes | No | No | Yes | Yes | Yes | Yes | Yes | 8 |
5 | Yes | No | No | Yes | No | No | No | Yes | Yes | Yes | Yes | 6 |
6 | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 11 |
7 | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 11 |
8 | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 11 |
9 | Yes | Yes | No | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | 9 |
10 | Yes | No | No | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 9 |
11 | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 11 |
12 | Yes | Yes | No | Yes | No | No | No | Yes | Yes | Yes | Yes | 7 |
13 | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | 10 |
14 | Yes | Yes | Yes | Yes | Yes | No | No | Yes | Yes | No | Yes | 7 |
15 | Yes | Yes | No | No | No | Yes | No | Yes | Yes | Yes | Yes | 6 |
16 | Yes | Yes | Yes | Yes | Yes | No | No | Yes | Yes | No | Yes | 8 |
17 | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 11 |
18 | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | 11 |
19 | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 11 |
20 | Yes | Yes | No | Yes | No | No | No | Yes | Yes | Yes | Yes | 8 |
21 | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | No | Yes | 10 |
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Study ID | Participants (Number, Intervention, Control) | Intervention | Exercise Type | Control | Assessment | Results |
---|---|---|---|---|---|---|
Bovonsunthonchai et al. (2020) [15] | 40 participants (20, 20) Age: 49.9 Time since stroke : 3–12 months | Structured Progressive Circuit Class Therapy (SPCCT) + MI (Motor imagery) Duration: 90 min Frequency: 3 times/week (4 weeks) | Functional Aerobic | SPCCT + Health Education Duration: 90 min Frequency: 3 times/week (4 weeks) | Temporo-spatial gait: FDM Strength: dynamometer Step length, time: SI | Temporo-spatial gait: + (p < 0.05), except for the step length of the unaffected limb (p = 0.063). Step length: + (p < 0.001) Step time: X (p > 0.05) Hip flexor: + (p = 0.002) Knee extensor: + (p = 0.014) |
Stuart et al. (2019) [16] | 76 participants (43, 33) Age: 63.9 Time since stroke : 5.1 years | APA-Strokes (progressive exercise with gait, standing and seated coordination exercises) Duration: 60 min Frequency: 3 times/week (6 weeks) | Aerobic | Sittercise (performed in a seated position) Duration: 60 min Frequency: 3 times/week (6 weeks) | Gait velocity: 6 MWT BBS (Berg balance scale), SPPB (Short Physical Performance Battery), the 30-foot timed walk, the Stroke Impact Scale (SIS) | Gait speed: + (p = 0.004) 30-foot walk: + (p = 0.02) SPPB: X (p = 0.54) BBS: X (p = 0.23) SIS: X (p = 0.90) |
Ribeiro et al. (2020) [17] | 38 participants (19, 19) Age: 57 Time since stroke : 3 months | Constraint-induced movement therapy (CIMT): treadmill training with load (5% of body weight) on the nonparetic limb Duration: 30 min Frequency: 2 times/week (9 sessions) | Aerobic | Treadmill training without load Duration: 30 min Frequency: 2 times/week (9 sessions) | Ground reaction force (GRF) from static and dynamic trials Swing time symmetry ratio | Static GRF of the paretic limb: + (p = 0.037) Control group’s dynamic GRF: + (p = 0.021) Swing time: X (p = 0.190) |
Manji et al. (2018) [18] | 30 participants (15, 15) Age: 62.2 Time since stroke : at least 4 months | Transcranial direct current stimulation (tDCS) + body weight-supported treadmill training (BWSTT) → Sham stim + body weight-supported treadmill training (BWSTT) Duration: 20 min Frequency: 7 times/week (2 sessions) | Aerobic | * Crossover design G1: tDCS + BWSTT → Sham stim + BWSTT G2: Sham stim + BWSTT → tDCS + BWSTT | Gait speed: 10 MWT Walking ability: Timed Up and Go (TUG) Lower limb: FMA-LE, TCT, POMA | G1′s Gait speed: + (p < 0.005) G1′s Walking ability: + (p < 0.005) Effect with the groups or interaction: X |
Cecchi et al. (2021) [19] | 224 participants (113, 111) Age: 68.5 Time since stroke : 46.5 days | Robotic rehabilitation + conventional physiotherapy (6 times/week) Duration: 45 min Frequency: 5 days/week (30sessions) | Functional (passive) | Task-oriented exercises) + Conventional physiotherapy (6 times/week) | FMA-UE | Age-FMA-UE: X (p = 0.603) * Age is associated with the outcome after conventional but not robotic rehabilitation. |
Shimodozono et al. (2012) [20] | 49rticipants (26, 23) Age: 65 Time since stroke : 6.8 weeks | Repetitive facilitative exercise (elicit movement of the shoulder, elbow, wrist, and fingers + passive stretching) + dexterity-related training (30 min) Duration: 40 min Frequency: 5 days/week (20 sessions) | Functional (passive) | Conventional upper-extremity rehabilitation program | ARAT(Action Research Arm Test) FMA | ARAT: + (p = 0.009) FMA: + (p = 0.019) |
Marzolini et al. (2018) [21] | 68 participants (35, 33) Age: 63.7 Time since stroke : 11.5 months | Aerobic and resistance training (AT + RT) Duration: 20–60 min Frequency:5 times/wk (6 months) (duration or intensity was increased)-2 sessions (AT) 8weeks-2 sessions (RT) (1 to 2 sets of 10 to 11 exercises) | Aerobic Resistance (isotonic) | AT | Cardiorespiratory Fitness, Body Composition and Dietary Assessment. Maximal Isometric Strength 6 MWT, Sit-to-Stand and Stair Climb Performance Exercise Logs, Adherence to Exercise, Exercise Performance, and Adverse Event Reporting | Body lean mass: + (p = 0.039) Predominantly trunk: + (p = 0.02) affected-side limbs: + (p = 0.04), VO2VT: + (p = 0.046) Muscular strength: + (p < 0.03) Both groups yielded similar and significant improvements: 6 MWT: X (p = 0.8) VO2peak: X (p = 0.9) Sit-to-stand time: X (p = 0.05), Stair climb performance: X (p = 0.97) |
Jong et al. (2013) [22] | 46 participants (23, 23) Age: 57.2 Time since stroke : 43 days | Multidisciplinary stroke rehabilitation (Cyclic neuromuscular electrical stimulation (NMES)) Duration: 45 min Frequency: 2 times/wk (16 sessions) | Functional (passive) | Sham stretch positioning procedure + simultaneous sham conventional TENS | ROM Pain in the hemiplegic shoulder: Shoulder Q | Passive range of motion: X (p = 0.217) No significant difference between the groups (r2 = 1.53, p = 0.217 |
Hung et al. (2019) [23] | 68 participants (20, 10) Age: 55.54 Time since stroke : 23 months | Robot-assisted therapy (RT) BMT robot vs. IMT robot Duration: 90–100 min Frequency: 5 times/wk (20 sessions) | Functional (passive) | Individualized occupational therapy | FMA-UE Muscle spasticity: MAS Quality of movement: MAL Muscle strength of the affected arm: MRC | FMA-UE: IMT > BMT (p < 0.01) MAS: IMT + (p = 0.01), BMT X (p = 0.55) CT X (p = 0.44) MAL: IMT + (p = 0.01) BMT X (p = 0.55) CT X (p = 0.44) MRC: IMT X (p = 0.27) BMT + (p = 0.01) CT: X (p = 0.3) |
Hsieh et al. (2018) [24] | 44 participants (32, 12) Age: 54 Time since stroke : 21 months | Robot-assisted therapy (RT) P-IMT vs. D-IMT Duration: 90–100 min Frequency: 5 times/wk (20 sessions) | Functional (passive) | Conventional rehabilitation +FTP | FMA-UE Muscle spasticity: MAS Quality of movement: MAL Muscle strength of the affected arm: MRC Wrist-worn accelerometers | Total MRC: D-IMT > P-IMT, CT (p = 0.04, p = 0.04) FMA:X (p = 0.77), proximal FMA: X (p = 0.97), proximal MRC: X (p = 0.12) * Distal upper-limb robotic rehabilitation using the D-IMT had superior effects on distal muscle strengthen |
Patten et al. (2013) [25] | 19 participants (9, 10) Age: 68 Time since stroke : 12 months | HYBRID (combined Functional Training Practice + Power training) Duration: 75 min Frequency: 5 times/wk (24 sessions) | Resistance (isokinetic) Functional | * Crossover design G1: FTP→HYBRID G2: HYBRID→FTP | FMA-UE the Ashworth Scale WMFT-FAS Functional Independence Measure: FIM | WMFT-FAS: HYBRID > FTP (p < 0.05) Treatment order: X (p = 0.43) FMA: X (p > 0.05) FIM: + (HYB > FTP, p < 0.05) Ashworth score: X (p > 0.05) |
Chae et al. (2020) [26] | 23 participants (17, 6) Age: 61.4 Time since stroke : at least 6 months | Smart watch based Home-based rehabilitation Duration: 30 min Frequency: 12 weeks | Functional | Tele-rehabilitation service | FMA-UE WMFT-FAS Grip power ROM BDI: Beck Depression Inventory | WMAFT: + (p = 0.02) Grip power: X (p = 0.46) FMA-UE: X (p = 0.34) ROM: flexion: + (p < 0.001) Extension: X (p = 0.16) Internal rotation: + (p = 0.001) External rotation: X (p = 0.2) |
Corti et al. (2012) [27] | 14 participants (14) Age: 59.8 Time since stroke : 15 weeks | Dynamic resistance training (POWER) vs. Functional task practice (FTP) Duration: 90 min Frequency: 3 days/wk (30 sessions) | Resistance (isokinetic) Functional | * Crossover design (10 week+10 week) Order1: FTP→POWER Order2: POWER→FTP | UEFMMS the Ashworth Scale European Stroke Scale CMHAI Kinematics of functional reach to grasp | Treatment effect (FTP vs. POWER): X (both groups improved without differential treatment effects) Treatment order: X (p > 0.05) Period effect: X (p > 0.05) Kinematic: Treatment effect: POWER > FTP Treatment order: G2 > G1 |
Annino et al. (2019) [28] | 37 participants (19, 18) Age: 68.6 Time since stroke : null | Supervised physical therapy + Segmental muscle vibration (SPT-SMV) Duration: 30 min Frequency: 3 days/wk (24 sessions) | Functional (passive) | Supervised physical therapy (SPT) | Barthel index (BI) the Ashworth Scale (MAS) Manual muscle testing (MMT) ROM | Both groups improved in BI, Elbow ROM, Elbow muscles strength Muscle tone in elbow joint improved only in SPT-SMV (p = 0.008) |
Han et al. (2012) [29] | 32 participants (11, 10, 11) Age: 50.2 Time since stroke : 38–42 days | Different intensities of arm rehabilitation training (correct positioning and carrying of the arm; passive, assisted and active movements; strength training; practice of functional activities) Duration: G1: 1 h/G2: 2 h/G3: 3 h Frequency: 5 days/wk (30 sessions) | Resistance (isotonic) Functional (passive) | 1 h (group A) 2 h (group B) 3 h (group C) | FMA-UE ARAT (Action Research Arm Test) Barthel index (BI) | FMA and ARAT: Group C > A, B (p < 0.05) BI: X (p > 0.05). |
Linder et al. (2020) [30] | 43 participants (16, 14, 13) Age: 56 Time since stroke : 13 months | G1: Forced aerobic exercise (60% to 80% of their heartrate reserve) + repetitive task practice (FE + RTP) G2: Voluntary aerobic exercise + RTP (VE + RTP) Duration: 90 min Frequency: 3 times/wk (24 sessions) | Aerobic Functional (passive) | G3: RTP only | 6 MWT | 6 MWT: G1: + (p < 0.001) G2: + (p < 0.001) G3: X (p = 0.21) |
Emmerson et al. (2017) [31] | 62 participants (30, 32) Age: 66 Time since stroke : 4 months | Home exercise video on smart technology and automated reminders (stretching, strengthening, fine motor/coordination) Duration & Frequency depended on the participants (average 38 min/day) | Functional (passive) | Paper-based home exercise program | Adherence WMFT Satisfaction | Adherence: X (p > 0.05) WMFT: X (p > 0.05) Satisfaction: X (p > 0.05) * smart technology was not superior to standard paper-based |
Topcuoglu et al. (2015) [32] | 40 participants (20, 20) Age: 65.95 Time since stroke : 3.5 months | Upper extremity aerobic exercise (UEAE) (arm crank ergometry) Duration: 30 min Frequency: 5 days/wk (20 sessions) | Aerobic | Conventional physiotherapy | CPRS clinical determinants Functional independence measure (FIM) Nottingham Health Profile (NHP) Beck Depression Scale scores (BDS) | FIM sub scores (motor and cognitive): + (p > 0.05) NHP: + (p > 0.005) BDS: + (p = 0.005) Clinical determinants: significant pain relief and decline in signs and symptom |
Jung et al. (2019) [33] | 36 participants (18, 18) Age: 58.5 Time since stroke : 28.65 days | Active shoulder exercise with a sling suspension system Duration: 40 min Frequency: 5 days/wk (20 sessions) | Resistance (isometric) | Bilateral arm training | Shoulder subluxation distance Shoulder proprioception FMA-UE the manual function test (MFT) | Subluxation: + (p = 0.001) Proprioception: + (p = 0.046) FMA: + (p = 0.002) MFT: + (p = 0.007) |
Kerimov et al. (2021) [34] | 24 participants (12, 12) Age: 54.3 Time since stroke : at least 6 months | Isokinetic training in paretic upper extremity Duration: 40 min Frequency: 3 days/wk (12 sessions) | Resistance (isokinetic) | Tailored strengthening exercises with exercise bands | Isokinetic peak torque FMA-UE Stroke Impact Scale (SIS) Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire Grip strength Peak isometric strength | SIS: isokinetic group had higher scores on nearly every domain Extensor peak torque at 60°: + (p = 0.007) Extensor peak isometric muscle strength: + (p = 0.007) DASH after 4weeks after the end of treatment: + (p = 0.014) Grip strength: X (p > 0.05) |
Pinheiro et al. (2021) [35] | 20 participants (10, 10) Age: 66.2 Time since stroke : null (Acute) | Upper limb cycle ergometer (ULCE) Duration: 20 min Frequency: 5 days/wk (20 sessions) | Aerobic | Conventional physiotherapy | Upper limb strength and grip Trunk impairment scale (TIS) Level of independence: Modified Rankin scale (MRS) | ULCE: all variables showed Superior (p = 0.005) TIS: + (p < 0.001) MRS: + (p < 0.001) |
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Lee, K.E.; Choi, M.; Jeoung, B. Effectiveness of Rehabilitation Exercise in Improving Physical Function of Stroke Patients: A Systematic Review. Int. J. Environ. Res. Public Health 2022, 19, 12739. https://doi.org/10.3390/ijerph191912739
Lee KE, Choi M, Jeoung B. Effectiveness of Rehabilitation Exercise in Improving Physical Function of Stroke Patients: A Systematic Review. International Journal of Environmental Research and Public Health. 2022; 19(19):12739. https://doi.org/10.3390/ijerph191912739
Chicago/Turabian StyleLee, Kyung Eun, Muncheong Choi, and Bogja Jeoung. 2022. "Effectiveness of Rehabilitation Exercise in Improving Physical Function of Stroke Patients: A Systematic Review" International Journal of Environmental Research and Public Health 19, no. 19: 12739. https://doi.org/10.3390/ijerph191912739