Interventions involving repetitive practice improve strength after stroke: a systematic review

Questions: Do interventions involving repetitive practice improve strength after stroke? Are any improvements in strength accompanied by improvements in activity? Design: Systematic review of randomised trials with meta-analysis. Participants: Adults who have had a stroke. Intervention: Any intervention involving repetitive practice compared with no intervention or a sham intervention. Outcome measures: The primary outcome was voluntary strength in muscles trained as part of the intervention. The secondary outcomes were measures of lower limb and upper limb activity. Results: Fifty-two studies were included. The overall SMD of repetitive practice on strength was examined by pooling post-intervention scores from 46 studies involving 1928 participants. The SMD of repetitive practice on strength when the upper and lower limb studies were combined was 0.25 (95% CI 0.16 to 0.34, I² = 44%) in favour of repetitive practice. Twenty-four studies with a total of 912 participants investigated the effects of repetitive practice on upper limb activity after stroke. The SMD was 0.15 (95% CI 0.02 to 0.29, I² = 50%) in favour of repetitive practice on upper limb activity. Twenty studies with a total of 952 participants investigated the effects of repetitive practice on lower limb activity after stroke. The SMD was 0.25 (95% CI 0.12 to 0.38, I² = 36%) in favour of repetitive practice on lower limb activity. Conclusion: Interventions involving repetitive practice improve strength after stroke, and these improvements are accompanied by improvements in activity. Review registration: PROSPERO CRD42017068658.