Circuit class therapy for improving mobility after stroke

Abstract

There is moderate evidence that CCT is effective in improving mobility for people after stroke - they may be able to walk further, faster, with more independence and confidence in their balance. The effects may be greater later after the stroke, and are of clinical significance. Further high-quality research is required, investigating quality of life, participation and cost-benefits, that compares CCT with standard care and that also investigates the influence of factors such as stroke severity and age. The potential risk of increased falls during CCT needs to be monitored.

Effectiveness of Circuit‐Based Exercises on Gait Speed, Balance, and Functional Mobility in People Affected by Stroke: A Meta‐Analysis

“…Change in gait speed measured by effect sizes (SMD) ranged from 0.41 to 2.13, and all comparisons were performed between multidimensional rehabilitation versus standard training groups [25]. Regarding other systematic reviews with meta‐analysis on the effectiveness of “task‐oriented circuit” or “task‐oriented approach” in patients with stroke, we observed a statistical significance in MD in favor of the experimental groups of 0.12 (m/s) [10] and 0.35 (m/s) [28], respectively. The present study demonstrated an MD of 0.11 in favor of CBE when compared with other interventions.…”

“…The review of English and Hillier (2010) [28] showed no significant effects for TUGT (MD = –3.08 seconds; CI –7.59, 1.43; P = .18) and BBS (MD = 0.86 points; CI –1.02, 2.74; P = .37), and the study of Wevers et al (2009) [10] showed a significant effect size for TUGT (SMD = 0.26; CI 0.00‐0.51; P = .047) but not for BBS (0.25 points; CI –0.14, 0.49; P = .276) when comparing task‐oriented circuit versus control group (ie, ES for BBS in favor of task‐oriented circuit). Regarding the BBS, this scale can produce a ceiling effect to the use in ambulant stroke survivors, and this could explain the absence of significant effects across studies [28]. This divergence between TUGT and MWT could cause an impact when analyzing postural reactive activity, which is necessary for balance maintenance and consequent bodily functions, like walking.…”

Structure and feasibility of extra practice during stroke rehabilitation: A systematic scoping review

“…Group practice was used in five comparisons in this review (Barreca et al ., ; Blennerhassett & Dite, ; English et al ., ; Song et al ., ). Circuit classes enable practice in a group setting with more than two participants per therapist, and a focus on repetitive practice and progression of exercises (English & Hillier, ). Circuit classes have the added benefit of peer support, social interaction and motivation through competition.…”

“…Repetitive practice reaching beyond arm's length in sitting resulted in improvements in both sitting and standing up ability of stroke survivors in sub‐acute (Dean, Channon & Hall, ) and chronic (Dean & Shepherd, ) stages of recovery. Practicing different gait and gait‐related activities in a circuit class also has resulted in improved walking ability of people after a moderate stroke (English & Hillier, ; Wevers, van de Port, Vermue, Mead & Kwakkel, ).…”

“…Extra practice of upper limb, lower limb and activities of daily living can be structured in a number of ways involving different configurations of personnel and equipment. Circuit classes are resource‐efficient, reducing therapist demands and potentially increasing the amount of practice completed by stroke survivors because of the group setting (English & Hillier, ). Non‐therapists, such as family members, have also been used to reduce staff demands, and help set up and/or supervise practice outside of therapy hours (Galvin, Cusack, O'Grady, Murphy & Stokes, ).…”