Increasing the Intensity of Rehabilitation to Improve Activity after Stroke: Systematic Review Protocol
|Emma J Schneider1,2*, Natasha A Lannin1-3 and Louise Ada4|
|1Department of Occupational Therapy, Faculty of Health Sciences, La Trobe University, Bundoora, VIC 3086, Australia|
|2Occupational Therapy Department, Alfred Health, The Alfred, VIC, 55 Commercial Road, Prahran, VIC 3181, Australia|
|3John Walsh Centre for Rehabilitation Research, Sydney Medical School (Northern), The University of Sydney, Kolling Institute, NSW, Australia|
|4Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, PO BOX 170, Lidcombe, NSW 2141, Australia|
|Corresponding Author :||Emma Schneider
Occupational Therapy Department, Alfred Health The Alfred
VIC, 55 Commercial Road, Prahran, VIC 3181, Australia
Tel: (+61) 0390766000
Fax: (+61) 0390762920
E-mail: [email protected]
|Received October 17, 2014; Accepted November 13, 2014; Published November 15, 2014|
|Citation: Schneider EJ, Lannin NA, Ada L (2014) Increasing the Intensity of Rehabilitation to Improve Activity after Stroke: Systematic Review Protocol. J Clin Trials 4:195. doi:10.4172/2167-0870.1000195|
|Copyright: © 2014 Schneider EJ, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
Question: Repetitive practice facilitates motor learning after stroke but the effect of a rehabilitation program which provides an extra amount of the same, repetitive practice per week remains unknown. This protocol paper describes the methods to address the questions of a planned systematic review:
(1) Does extra practice per week of the same rehabilitation lead to improved activity in stroke survivors? and
(2) What is the amount of extra rehabilitation that needs to be provided to achieve an effect?
Method: A systematic review will be conducted, commencing with a search of Medline, EMBASE, CINAHL, and CENTRAL databases. Randomised and non-randomized controlled trials that compare stroke rehabilitation programs involving similar content but different duration (recorded as therapy time per day or week) will be included. The outcome of interest will be activity, represented by walking ability or upper limb ability. The methodological quality of included studies will be assessed independently by two reviewers using the PEDro scale. Data will be extracted by two reviewers and will be pooled in a meta-analysis where there is sufficient homogeneity. We will calculate mean differences (MD) or standardized mean differences (SMD) and 95% CI for continuous outcomes as appropriate. We will calculate a Pearson correlation coefficient and ROC calculation to define the amount (in hours) of extra rehabilitation that needs to be provided to achieve improved activity in stroke survivors.
Discussion: Findings will explore the relationship between increasing intensity of rehabilitation and improved activity in stroke survivors, and provide guidance to rehabilitation clinicians, inform policy and provide future directions for research.
Systematic review registration: PROSPERO CRD42012003221.