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Increasing the Intensity of Rehabilitation to Improve Activity after Stroke: Systematic Review Protocol

Emma J Schneider, Natasha A Lannin and Louise Ada

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.