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.
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: Strokeparticipants 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 strokeparticipants, 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.
Authors: Jerzy A Zoladz; Zbigniew Szkutnik; Joanna Majerczak; Marcin Grandys; Krzysztof Duda; Bruno Grassi Journal: Eur J Appl Physiol Date: 2012-04-24 Impact factor: 3.078
Authors: Wouter J Harmsen; Ladbon Khajeh; Gerard M Ribbers; Majanka H Heijenbrok-Kal; Emiel Sneekes; Fop van Kooten; Sebastian Neggers; Rita J van den Berg-Emons Journal: Phys Ther Date: 2019-07-01
Authors: Carel G M Meskers; Alfred C Schouten; Jurriaan H de Groot; Erwin de Vlugt; Bob J J van Hilten; Frans C T van der Helm; Hans J H Arendzen Journal: J Neuroeng Rehabil Date: 2009-07-23 Impact factor: 4.262