Associations Between Time After Stroke and Exercise Training Outcomes: A Meta‐Regression Analysis

Marzolini, Susan; Wu, Che‐Yuan; Hussein, Rowaida; Xiong, Lisa Y.; Kangatharan, Suban; Peni, A; Cooper, Christopher R.; Lau, Kylie S. K.; Makhdoom, Ghislaine Nzodjou; Pakosh, Maureen; Zaban, Stephanie A.; Nguyen, Michelle; Banihashemi, Mehrzad; Swardfager, Walter

doi:10.1161/jaha.121.022588

Cited by 11 publications

(10 citation statements)

References 211 publications

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“…It should be noted that the differences in demographic indices including age and post-injury time may influence the efficacy of rehabilitation treatments [43,50,51]. However, to our surprise, the meta-regression showed that the mean age was not a significant predictor of effect size for the outcome parameters in this review.…”

Section: Discussionmentioning

confidence: 53%

Effects of non-invasive brain stimulation on motor function after spinal cord injury: a systematic review and meta-analysis

Chen

Pan

et al. 2023

J NeuroEngineering Rehabil

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Background In recent years, non-invasive brain stimulation (NIBS) has been used for motor function recovery. However, the effects of NIBS in populations with spinal cord injury (SCI) remain unclear. This study aims to conduct a meta-analysis of the existing evidence on the effects and safety of NIBS against sham groups for motor dysfunction after SCI to provide a reference for clinical decision-making. Methods Two investigators systematically screened English articles from PubMed, MEDLINE, Embase, and Cochrane Library for prospective randomized controlled trials regarding the effects of NIBS in motor function recovery after SCI. Studies with at least three sessions of NIBS were included. We assessed the methodological quality of the selected studies using the evidence-based Cochrane Collaboration’s tool. A meta-analysis was performed by pooling the standardized mean difference (SMD) with 95% confidence intervals (CI). Results A total of 14 randomized control trials involving 225 participants were included. Nine studies used repetitive transcranial magnetic stimulation (rTMS) and five studies used transcranial direct current stimulation (tDCS). The meta-analysis showed that NIBS could improve the lower extremity strength (SMD = 0.58, 95% CI = 0.02–1.14, P = 0.004), balance (SMD = 0.64, 95% CI = 0.05–1.24, P = 0.03), and decrease the spasticity (SMD = − 0.64, 95% CI = − 1.20 to − 0.03, P = 0.04). However, the motor ability of the upper extremity in the NIBS groups was not statistically significant compared with those in the control groups (upper-extremity strength: P = 0.97; function: P = 0.56; and spasticity: P = 0.12). The functional mobility in the NIBS groups did not reach statistical significance when compared with the sham NIBS groups (sham groups). Only one patient reported seizures that occurred during stimulation, and no other types of serious adverse events were reported. Conclusion NIBS appears to positively affect the motor function of the lower extremities in SCI patients, despite the marginal P-value and the high heterogeneity. Further high-quality clinical trials are needed to support or refute the use and optimize the stimulation parameters of NIBS in clinical practice.

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Section: Discussionmentioning

confidence: 53%

Effects of non-invasive brain stimulation on motor function after spinal cord injury: a systematic review and meta-analysis

Chen

Pan

et al. 2023

J NeuroEngineering Rehabil

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“…These meta-regressions were attempted only when there were at least 10 available studies and (for categorical independent variables) at least 3 studies in each category 2. When there were sufficient studies, the primary analysis was stratified by stroke chronicity (the first meta-regression variable above) based on the aims of this study and established differences in effect sizes between subacute and chronic stroke studies 28. Additional meta-regressions were attempted only within chronicity subgroups to avoid likely confounding.…”

Section: Methodsmentioning

confidence: 99%

Moderate to Vigorous Intensity Locomotor Training After Stroke: A Systematic Review and Meta-analysis of Mean Effects and Response Variability

Boyne,

Miller,

Kubalak

et al. 2023

Journal of Neurologic Physical Therapy

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Background and Purpose: This meta-analysis quantified mean effects of moderate to vigorous intensity locomotor training (LTmv) on walking outcomes in subacute and chronic stroke, and the magnitude of variability in LTmv response. Methods: Databases were searched for randomized trials comparing LTmv with no intervention, nongait intervention, or low-intensity gait training. Comfortable gait speed (CGS), fastest gait speed (FGS), 6-minute walk test (6MWT), walking activity (steps per day), and adverse effect/event (AE) data were extracted. Pooled estimates were calculated for mean changes, AE relative risks, and the standard deviation of response (SDresponse) to LTmv versus control groups, stratified by study chronicity where possible. Results: There were 19 eligible studies (total N = 1096): 14 in chronic stroke (N = 839) and 5 in subacute stroke (N = 257). Compared with control interventions, LTmv yielded significantly greater increases in CGS (chronic, +0.06 m/s [95% confidence interval (CI), 0.01-0.10]; subacute, +0.16 [0.12-0.19]; subacute vs chronic, P = 0.03), FGS (chronic, +0.07 m/s [0.02-0.13]; subacute, +0.21 [0.01, 0.41]; P = 0.04), and 6MWT (chronic, +33 m [24-42]; subacute, +51 [26-77]; P = 0.054) but not steps/day (+260 [−1159 to 1679]). There were no treatment-related serious AEs among 398 LTmv participants in 14 AE-reporting studies. SDresponse estimates indicated substantial response variability: CGS, 0.11 m/s [0.00-0.15]; FGS, 0.14 m/s [−0.00 to 0.20]; and 6MWT, 41 m [27-51]. Discussion and Conclusions: LTmv improves mean walking capacity outcomes in subacute and chronic stroke and does not appear to have high risk of serious harm. Response magnitude varies within and between chronicity subgroups, and few studies have tested effects on daily walking activity or non-serious AEs. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A452).

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“…2 When there were sufficient studies, the primary analysis was stratified by stroke chronicity (the first meta-regression variable above) based on the aims of this study and established differences in effect sizes between subacute and chronic stroke studies. 26 Additional meta-regressions were only attempted within chronicity subgroups to avoid likely confounding.…”

Section: Between-study Heterogeneity Meta-regression and Assessment O...mentioning

confidence: 99%

Moderate to Vigorous Intensity Locomotor Training After Stroke: A Systematic Review and Meta-Analysis of Mean Effects and Individual Response Variability

Boyne

Miller

Kubalak

et al. 2022

Preprint

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Background and Purpose: This meta-analysis quantified mean effects of moderate-to-vigorous intensity locomotor training (LTmv) on walking outcomes in subacute and chronic stroke, and the magnitude of individual variability in LTmv response. Methods: Databases were searched for randomized trials comparing LTmv with no intervention, non-gait intervention or low-intensity gait training. Comfortable gait speed (CGS), fastest gait speed (FGS), 6-minute walk distance (6MWT), walking activity (steps/day) and adverse effect/event (AE) data were extracted. Pooled estimates were calculated for mean changes within and between groups, the relative risk of different AEs, and the standard deviation of individual response (SDIR) to LTmv versus control groups, stratified by study chronicity where possible. Results: There were 19 eligible studies (total N=1,096); 14 in chronic stroke (N=839) and 5 in subacute stroke (N=257). Compared with control interventions, LTmv yielded significantly greater increases in CGS, FGS and 6MWT in both subacute and chronic stroke, with subacute studies showing significantly greater effect sizes for CGS, FGS and nearly 6MWT (p=0.054). In 4 studies reporting steps/day data, LTmv was not significantly different from control interventions. In 14 studies reporting on AEs, there were no treatment-related serious AEs among 398 LTmv participants. SDIR estimates indicated significant individual response variability for CGS, nearly FGS (p=0.0501) and 6MWT. Discussion and Conclusions: LTmv improves mean walking capacity outcomes in subacute and chronic stroke and does not appear to have high risk of serious harm, but response magnitude varies between chronicity subgroups and individuals, and few studies have tested effects on daily walking activity or non-serious AEs.

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Associations Between Time After Stroke and Exercise Training Outcomes: A Meta‐Regression Analysis

Cited by 11 publications

References 211 publications

Effects of non-invasive brain stimulation on motor function after spinal cord injury: a systematic review and meta-analysis

Effects of non-invasive brain stimulation on motor function after spinal cord injury: a systematic review and meta-analysis

Moderate to Vigorous Intensity Locomotor Training After Stroke: A Systematic Review and Meta-analysis of Mean Effects and Response Variability

Moderate to Vigorous Intensity Locomotor Training After Stroke: A Systematic Review and Meta-Analysis of Mean Effects and Individual Response Variability

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