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

Abstract

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.

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  • Authors+Show Affiliations

    ,

    Department of Physical Therapy, University Hospital Vrije Universiteit, Amsterdam, Netherlands. Fysiother@AZVU.NL

    , , ,

    Source

    Stroke 28:8 1997 Aug pg 1550-6

    MeSH

    Activities of Daily Living
    Cerebrovascular Disorders
    Humans
    Occupational Therapy
    Physical Therapy Modalities
    Rehabilitation
    Time Factors

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    9259747

    Citation

    Kwakkel, G, et al. "Effects of Intensity of Rehabilitation After Stroke. a Research Synthesis." Stroke, vol. 28, no. 8, 1997, pp. 1550-6.
    Kwakkel G, Wagenaar RC, Koelman TW, et al. Effects of intensity of rehabilitation after stroke. A research synthesis. Stroke. 1997;28(8):1550-6.
    Kwakkel, G., Wagenaar, R. C., Koelman, T. W., Lankhorst, G. J., & Koetsier, J. C. (1997). Effects of intensity of rehabilitation after stroke. A research synthesis. Stroke, 28(8), pp. 1550-6.
    Kwakkel G, et al. Effects of Intensity of Rehabilitation After Stroke. a Research Synthesis. Stroke. 1997;28(8):1550-6. PubMed PMID: 9259747.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Effects of intensity of rehabilitation after stroke. A research synthesis. AU - Kwakkel,G, AU - Wagenaar,R C, AU - Koelman,T W, AU - Lankhorst,G J, AU - Koetsier,J C, PY - 1997/8/1/pubmed PY - 1997/8/1/medline PY - 1997/8/1/entrez SP - 1550 EP - 6 JF - Stroke JO - Stroke VL - 28 IS - 8 N2 - 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. SN - 0039-2499 UR - https://www.unboundmedicine.com/medline/citation/9259747/full_citation L2 - http://Insights.ovid.com/pubmed?pmid=9259747 DB - PRIME DP - Unbound Medicine ER -