Abstract
Circuit class therapy (CCT) offers a rehabilitation group forum for people with stroke where they can practice tasks under supervision. The format offers increased practice time without increasing staff.
Objectives
The objective of this review was to examine the effectiveness and safety of CCT on mobility in adults with stroke.
Methods
We searched all relevant databases, trial registries, and unpublished literature from inception to January 2017. We included randomized controlled trials with participants >18 years old and with a diagnosis of stroke, of any severity, latency, and setting, and who received CCT. Our comparisons could be usual care, sham, or another form of therapy. Our primary outcome was an activity-related test of mobility: gait endurance. Secondary outcomes included other activity measures of mobility, balance, or activities of daily living, as well as impairment measures or measures of participation. We also considered length of hospital stay (for inpatient cohorts), self-reported satisfaction, locus of control, economic indicators, and adverse events (including falls and mortality). Trial inclusion, data extraction, risk of bias, and meta-analysis were all conducted by at least 2 reviewers, according to Cochrane standards.
Main Results
We included 17 RCTs involving 1297 stroke survivors, either living in the community and receiving outpatient rehabilitation or were still inpatients receiving within-hospital rehabilitation: most were functionally at the level of walking 10 m or more. We could combine 10 studies (835 participants) with a common measure of walking capacity (distance walked in 6 minutes) with a fixed-effects meta-analysis showing that CCT was superior to the comparison intervention (mean difference, 60.86 m; 95% confidence intervals, 44.5–77.17; Figure). Similarly gait speed was significantly improved in favor of CCT (mean difference, 0.15 m; 95% confidence intervals, 0.10–0.19). Both of these effects are considered clinically meaningful. Two further mobility measures demonstrated superior effects from CCT for other aspects of walking and balance (Timed Up and Go Test and Activities of Balance Confidence); however, two others failed to show superior effects (Berg Balance Scale and the Step Test). Reduced length of stay (for inpatient studies) and increased adverse events (falls) showed a nonsignificant effect of CCT compared with other interventions.
Objectives
The objective of this review was to examine the effectiveness and safety of CCT on mobility in adults with stroke.
Methods
We searched all relevant databases, trial registries, and unpublished literature from inception to January 2017. We included randomized controlled trials with participants >18 years old and with a diagnosis of stroke, of any severity, latency, and setting, and who received CCT. Our comparisons could be usual care, sham, or another form of therapy. Our primary outcome was an activity-related test of mobility: gait endurance. Secondary outcomes included other activity measures of mobility, balance, or activities of daily living, as well as impairment measures or measures of participation. We also considered length of hospital stay (for inpatient cohorts), self-reported satisfaction, locus of control, economic indicators, and adverse events (including falls and mortality). Trial inclusion, data extraction, risk of bias, and meta-analysis were all conducted by at least 2 reviewers, according to Cochrane standards.
Main Results
We included 17 RCTs involving 1297 stroke survivors, either living in the community and receiving outpatient rehabilitation or were still inpatients receiving within-hospital rehabilitation: most were functionally at the level of walking 10 m or more. We could combine 10 studies (835 participants) with a common measure of walking capacity (distance walked in 6 minutes) with a fixed-effects meta-analysis showing that CCT was superior to the comparison intervention (mean difference, 60.86 m; 95% confidence intervals, 44.5–77.17; Figure). Similarly gait speed was significantly improved in favor of CCT (mean difference, 0.15 m; 95% confidence intervals, 0.10–0.19). Both of these effects are considered clinically meaningful. Two further mobility measures demonstrated superior effects from CCT for other aspects of walking and balance (Timed Up and Go Test and Activities of Balance Confidence); however, two others failed to show superior effects (Berg Balance Scale and the Step Test). Reduced length of stay (for inpatient studies) and increased adverse events (falls) showed a nonsignificant effect of CCT compared with other interventions.
| Original language | English |
|---|---|
| Pages (from-to) | e275–e276 |
| Number of pages | 2 |
| Journal | Stroke |
| Volume | 48 |
| Issue number | 10 |
| DOIs | |
| Publication status | Published - Oct 2017 |
| Externally published | Yes |
Keywords
- circuit class therapy
- length of stay
- rehabilitation
- stroke
- task-specific therapy
