Objective To evaluate the effectiveness of rehabilitation interventions on physical function and immobility-related complications in severe stroke.
Design Systematic review of electronic databases (Medline, Excerpta Medica database, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Physiotherapy Evidence Database, Database of Research in Stroke, Cochrane Central Register of Controlled Trials) searched between January 1987 and November 2018.
Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement guided the review. Randomised controlled trials comparing the effect of one type of rehabilitation intervention to another intervention, usual care or no intervention on physical function and immobility-related complications for patients with severe stroke were included. Studies that recruited participants with all levels of stroke severity were included only if subgroup analysis based on stroke severity was performed. Two reviewers screened search results, selected studies using predefined selection criteria, extracted data and assessed risk of bias for selected studies using piloted proformas. Marked heterogeneity prevented meta-analysis and a descriptive review was performed. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess evidence strength.
Results 28 studies (n=2677, mean age 72.7 years, 49.3% males) were included in the review. 24 studies were rated low or very low quality due to high risk of bias and small sample sizes. There was high-quality evidence that very early mobilisation (ie, mobilisation with 24 hours poststroke) and occupational therapy in care homes were no more effective than usual care. There was moderate quality evidence supporting short-term benefits of wrist and finger neuromuscular electrical stimulation in improving wrist extensor and grip strength, additional upper limb training on improving upper limb function and additional lower limb training on improving upper limb function, independence in activities of daily living, gait speed and gait independence.
Conclusions There is a paucity of high-quality evidence to support the use of rehabilitation interventions to improve physical function and reduce immobility-related complications after severe stroke. Future research investigating more commonly used rehabilitation interventions, particularly to reduce poststroke complications, is required.
PROSPERO registration number CRD42017077737
- stroke medicine
- occupational therapy
- rehabilitation medicine
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Contributors MPMG is the guarantor of the review. MPMG, CS and CMK were involved in the design of the protocol and systematic review. MPMG conducted scoping searches. MPMG and JJ piloted the inclusion/exclusion form. MPMG piloted the data extraction form. MPMG was the first reviewer and JJ was the second reviewer for the systematic review. AD provided statistical support for the systematic review. MPMG drafted the manuscript. All authors read and approved the final manuscript.
Funding This project forms part of MPMG’s PhD which is funded by The Dunhill Medical Trust (grant number RT62/0116). The funder has had no input on the design of the protocol and will have no input on the analysis and interpretation of the results of the systematic review, or publication of the systematic review.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.
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