Effects of intensity of rehabilitation after stroke: A research synthesis

Gert Kwakkel, Robert C. Wagenaar, Tim W. Koelman, Gustaaf J. Lankhorst, Johan C. Koetsier

Research output: Contribution to journalArticleAcademicpeer-review

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.

Original languageEnglish
Pages (from-to)1550-1556
Number of pages7
JournalStroke
Volume28
Issue number8
DOIs
Publication statusPublished - 1 Jan 1997

Cite this

Kwakkel, Gert ; Wagenaar, Robert C. ; Koelman, Tim W. ; Lankhorst, Gustaaf J. ; Koetsier, Johan C. / Effects of intensity of rehabilitation after stroke : A research synthesis. In: Stroke. 1997 ; Vol. 28, No. 8. pp. 1550-1556.
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Effects of intensity of rehabilitation after stroke : A research synthesis. / Kwakkel, Gert; Wagenaar, Robert C.; Koelman, Tim W.; Lankhorst, Gustaaf J.; Koetsier, Johan C.

In: Stroke, Vol. 28, No. 8, 01.01.1997, p. 1550-1556.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Effects of intensity of rehabilitation after stroke

T2 - A research synthesis

AU - Kwakkel, Gert

AU - Wagenaar, Robert C.

AU - Koelman, Tim W.

AU - Lankhorst, Gustaaf J.

AU - Koetsier, Johan C.

PY - 1997/1/1

Y1 - 1997/1/1

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.

AB - 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.

KW - Activities of daily living

KW - Cerebrovascular disorders

KW - Meta- analysis

KW - Rehabilitation

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U2 - 10.1161/01.STR.28.8.1550

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JO - Stroke

JF - Stroke

SN - 0039-2499

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