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Meta-Analysis
. 2010 Jul 7;2010(7):CD007513.
doi: 10.1002/14651858.CD007513.pub2.

Circuit class therapy for improving mobility after stroke

Coralie English  1 , Susan L Hillier
Affiliations
Meta-Analysis

Circuit class therapy for improving mobility after stroke

Coralie English et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Circuit class therapy (CCT) offers a supervised group forum for people after stroke to practise tasks, enabling increased practise time without increasing staffing.

Objectives: To examine the effectiveness and safety of CCT on mobility in adults with stroke.

Search strategy: We searched the Cochrane Stroke Group Trials Register (last searched October 2009), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2, 2009), MEDLINE (1950 to November 2008), EMBASE (1980 to November 2008), CINAHL (1982 to November 2008) and 14 other electronic databases (to November 2008). We also searched proceedings from relevant conferences, reference lists and unpublished theses; contacted authors of published trials and other experts in the field; and searched relevant clinical trials and research registers.

Selection criteria: Randomised or quasi-randomised controlled trials including people over 18 years old diagnosed with stroke of any severity, at any stage, or in any setting, receiving CCT.

Data collection and analysis: Two review authors independently selected trials for inclusion, assessed methodological quality and extracted data.

Main results: We included six trials involving 292 participants. Participants were long-term stroke survivors living in the community or receiving inpatient rehabilitation. All could walk 10 metres with or without assistance. Four studies measured walking capacity and three measured gait speed, demonstrating that CCT was superior to the comparison intervention (Six Minute Walk Test: mean difference (MD), fixed 76.57 metres, 95% confidence interval (CI) 38.44 to 114.70, P < 0.0001; gait speed: MD, fixed 0.12 m/s, 95% CI 0.00 to 0.24, P = 004). Two studies measured balance, showing a superior effect in favour of CCT (Step Test: MD, fixed 3.00 steps, 95% CI 0.08 to 5.91, P = 0.04; activities-specific balance and confidence: MD, fixed 7.76, 95% CI 0.66 to 14.87, P = 0.03). Studies also measured other balance items showing no difference in effect. Length of stay (two studies) showed a significant effect in favour of CCT (MD, fixed -19.73 days, 95% CI -35.43 to -4.04, P = 0.01). Only two studies measured adverse events (falls during therapy): all were minor.

Authors' conclusions: CCT is safe and effective in improving mobility for people after moderate stroke and may reduce inpatient length of stay. Further research is required, investigating quality of life, participation and cost-benefits, that compares CCT to standard care and that also investigates the differential effects of stroke severity, latency and age.

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Conflict of interest statement

Both authors have published a trial investigating the use of CCT with people with stroke (English 2007).

Figures

Figure 1
Figure 1
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
Figure 2
Figure 2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
Analysis 1.1
Analysis 1.1
Comparison 1 Circuit class therapy versus other, Outcome 1 6mWT.
Analysis 1.2
Analysis 1.2
Comparison 1 Circuit class therapy versus other, Outcome 2 Gait speed.
Analysis 1.3
Analysis 1.3
Comparison 1 Circuit class therapy versus other, Outcome 3 Step Test.
Analysis 1.4
Analysis 1.4
Comparison 1 Circuit class therapy versus other, Outcome 4 Timed Up and Go.
Analysis 1.5
Analysis 1.5
Comparison 1 Circuit class therapy versus other, Outcome 5 Berg Balance Scale.
Analysis 1.6
Analysis 1.6
Comparison 1 Circuit class therapy versus other, Outcome 6 Activities‐specific Balance Confidence Scale.
Analysis 1.7
Analysis 1.7
Comparison 1 Circuit class therapy versus other, Outcome 7 Length of stay.
Analysis 1.8
Analysis 1.8
Comparison 1 Circuit class therapy versus other, Outcome 8 Gait speed: sensitivity analysis.
Analysis 1.9
Analysis 1.9
Comparison 1 Circuit class therapy versus other, Outcome 9 Berg Balance Scale: sensitivity analysis.
Analysis 1.10
Analysis 1.10
Comparison 1 Circuit class therapy versus other, Outcome 10 Length of stay: sensitivity analysis.
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References

References to studies included in this review

    1. Blennerhassett J, Dite W. Additional task‐related practice improves mobility and upper limb function early after stroke: a randomised controlled trial. Australian Journal of Physiotherapy 2004;50:219‐24. - PubMed
    1. Dean C, Richards C, Malouin F. Task‐related circuit training improves performance of locomotor tasks in chronic stroke: a randomised controlled pilot trial. Archives of Physical Medicine and Rehabilitation 2000;81:409‐17. - PubMed
    1. English C, Hillier S, Stiller K, Warden‐Flood A. Circuit class therapy versus individual physiotherapy sessions during inpatient stroke rehabilitation: a controlled trial. Archives of Physical Medicine and Rehabilitation 2007;88:955‐63. - PubMed
    1. Marigold D, Eng J, Dawson A, Inglis J, Harris J, Gylfadóttir S. Exercise leads to faster postural reflexes, improved balance and mobility, and fewer falls in older persons with chronic stroke. Journal of the American Geriatrics Society 2005;53:426‐3. - PMC - PubMed
    1. Mudge S, Stott N, Barber P. Circuit‐based rehabilitation improves gait endurance but not usual walking activity in chronic stroke: a randomised clinical trial. Archives of Physical Medicine and Rehabilitation 2009;90(12):1989‐96. - PubMed

References to studies excluded from this review

    1. Blennerhassett J. The value of circuit classes in stroke rehabilitation. International Journal of Therapy and Rehabilitation 2008;15(6):272.
    1. Brogårdh C, Sjölund B. Constraint‐induced movement therapy in patients with stroke: a pilot study on effects of small group training and of extended mitt use. Clinical Rehabilitation 2006;20:218‐27. - PubMed
    1. Chu KS, Eng JJ, Dawson AS, Harris JE, Ozkaplan A, Gylfadóttir S. Water‐based exercise for cardiovascular fitness in people with chronic stroke: a randomised controlled trial. Archives of Physical Medicine and Rehabilitation 2004;85:870‐4. - PMC - PubMed
    1. English C, Hillier S, Stiller K. Incidence and severity of shoulder pain does not increase with the use of circuit class therapy during inpatient stroke rehabilitation: a controlled trial. Australian Journal of Physiotherapy 2008;54:41‐6. - PubMed
    1. French B, Leathley M, Sutton C, McAdam J, Thomas A, Forster A, et al. A systematic review of repetitive functional task practice with modelling of resource use, costs and effectiveness. Health Technology Assessment 2008;12(30):1‐117. - PubMed

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