Effects of intensity of rehabilitation after stroke. A research synthesis.

نویسندگان

  • G Kwakkel
  • R C Wagenaar
  • T W Koelman
  • G J Lankhorst
  • J C Koetsier
چکیده

BACKGROUND AND PURPOSE A research synthesis was performed to (1) critically review controlled studies evaluating effects of different intensities of stroke rehabilitation in terms of disabilities and impairments and (2) quantify patterns by calculating summary effect sizes. The influences of organizational setting of rehabilitation management, blind recording, and amount of rehabilitation on the summary effect sizes were calculated. METHODS A Medline literature search was performed for a critical review of the literature. The internal and external validity of the studies was evaluated. In addition, a meta-analysis was performed by applying the fixed (Hedges's g) effects model. RESULTS The effects of different intensities of rehabilitation were studied in nine controlled studies involving 1051 patients. Analysis of the methodological quality revealed scores varying from 14% to 47% of the maximum feasible score. Meta-analysis demonstrated a statistically significant summary effect size for activities of daily living (0.28 +/- 0.12). Lower summary effect sizes (0.19 +/- 0.17) were found for studies in which experimental and control groups were treated in the same setting compared with studies in which the two groups of patients were treated in different settings (0.40 +/- 0.19). Variables defined on a neuromuscular level (0.37 +/- 0.24) showed larger summary effect sizes than variables defined on a functional level (0.10 +/- 0.21). Weighting individual effect sizes for the difference in amount of rehabilitation between experimental and control groups resulted in larger summary effect sizes for activities of daily living and functional outcome parameters for studies that were not confounded by organizational setting. CONCLUSIONS A small but statistically significant intensity-effect relationship in the rehabilitation of stroke patients was found. Insufficient contrast in the amount of rehabilitation between experimental and control conditions, organizational setting of rehabilitation management, lack of blinding procedures, and heterogeneity of patient characteristics were major confounding factors.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Effects of Visual Biofeedback Therapy on Postural Balance of Stroke Patients

Purpose: Postural balance deficit is one of the common post-stroke disabilities. Providing visual biofeedback while balance activities are performed is a way to improve postural balance disorders following stroke. But among the research published, there is incoherency about the positive effects of visual biofeedback therapy. The purpose of this study was to investigate the effects of usin...

متن کامل

Neuroplasticity and neuromotor synergies in context of rehabilitation after stroke: a systematic review

Background: Alterations of neuroplasticity and cortical excitability are important pathophysiological factors in stroke. Modulation of the neuroplasticity has been proposed as an underlying mechanism of recovery in different neurological disorders. But it is not still clear how the CNS faces the complexity of muscle control. Neuroplastic processes may be used for the functional improvement of s...

متن کامل

The immediate effects of dry needling for ankle and toe plantar flexors on spasticity and balance in patients with stroke

Background: Spasticity is one of the most important symptoms of stroke, which leads to movement constraints and disability. The presence of spasticity in the ankle and toe plantar flexor muscles disturbs the balance and gait of patients with stroke. Dry needling has been introduced as a new method for the treatment of spasticity. The aim of this study was to investigate the immediate effects of...

متن کامل

The Effect of Static Magnet Therapy on Pain-Free Shoulder Passive Range of Motion in Patients with Shoulder Subluxation after Stroke: A Randomized Clinical Trial

Introduction: One of the stroke complications is hemiplegia, which can cause subluxation of the shoulder joint and reduce the passive range of motion of the affected shoulder, resulting in limited movement. This study aimed to evaluate the effect of static magnet therapy on pain-free shoulder passive range of motion in patients with shoulder subluxation after stroke. Methods: This clinical tri...

متن کامل

The effect of home-based stroke rehabilitation on quality of life of stroke survivors and their family caregiver's strain

Background: Rehabilitation is a main part of stroke treatment. Stroke causes reduced quality of life (QOL) among stroke survivors and significant strain on Caregivers.However, family role on the rehabilitation team andprogram should present on family-based. Aim: The effect of home-based stroke rehabilitation on quality of life of stroke survivors and their family caregiver strain. Method: This ...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:
  • Stroke

دوره 28 8  شماره 

صفحات  -

تاریخ انتشار 1997