Abstract
BackgroundStroke rehabilitation aims to optimise function and reduce complications post-stroke. Rehabilitation to optimise physical function post-stroke has beneficial effects for survivors of mild to moderate stroke. However, little is known about the effectiveness of interventions to rehabilitate physical function or manage immobility-related complications for survivors of severe stroke. The systematic review aims to evaluate the effectiveness of rehabilitation interventions on physical function and immobility-related complications in severe stroke and identify topics for future research in this area.MethodsA systematic review of relevant electronic databases (MEDLINE, Embase, CINAHL, AMED, PEDro, DORIS and CENTRAL) between January 1987 and July 2017 will be undertaken to identify eligible published randomised controlled trials (RCTs) in any language. Ongoing RCTs will be identified by searching health-care trial registers (Stroke Trials Registry, ClinicalTrials.gov). Hand searches of identified study reference lists will also be performed. The PRISMA statement will be used to guide the systematic review. Two reviewers will screen search results, select studies using pre-defined selection criteria, extract data from and assess risk of bias for selected studies. Studies comparing the effect of one type of rehabilitation intervention to another or usual care on physical function and immobility-related complications for patients with severe stroke will be included. Studies may include participants with all levels of stroke severity but must provide sub-group analysis based on stroke severity. Studies will focus on any phase of the stroke rehabilitation pathway and will be grouped and analysed according to their timeframe post-stroke into acute and early sub-acute (up to 3 months post-stroke), early sub-acute to late sub-acute (from 3 to 6 months post-stroke) and chronic (greater than 6 months post-stroke). If sufficient studies demonstrate homogeneity, a meta-analysis will pool results of individual outcomes. The GRADE approach will be used to assess the evidence strength.DiscussionThe results of this systematic review will summarise the strength of evidence for rehabilitation interventions used in the rehabilitation of physical function and immobility-related complications in severe stroke and identify gaps in evidence.Systematic review registrationThe systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO)—registration number CRD77737.
Highlights
Stroke rehabilitation aims to optimise function and reduce complications post-stroke
Systematic review registration: The systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO)—registration number CRD77737
Whilst several systematic reviews support the use of rehabilitation interventions to improve aspects of physical function post-stroke, such as motor function, balance, walking speed and activities of daily living [12,13,14], it is not clear from these reviews if these interventions can be provided to stroke survivors with differing levels of stroke severity, severe stroke
Summary
The systematic review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement [33]. Stroke severity will be defined using a score on either a validated and routinely used stroke specific health measure, e.g. National Institutes of Health Stroke Scale (NIHSS), Orpington Prognostic Scale (OPS); functional measure, e.g. Functional Independence Measure (FIM), Barthel Index (BI); or disability measure, e.g. Modified Rankin Scale (mRS) [35,36,37,38,39]. For the purposes of the review, a rehabilitation intervention will be defined as any non-surgical or non-pharmacological intervention used in current clinical practice as part of the usual rehabilitative care of stroke patients. These interventions may be delivered by rehabilitation staff (e.g. physiotherapists, occupational therapists, nurses) or by people who have received training by rehabilitation staff, such as paid or unpaid carers of stroke survivors. The review will note whether the authors have used a recognised framework to describe the intervention, such as the Template for Intervention Description and Replication (TIDier) checklist and guide [45]
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