Effectiveness of active physiotherapy on physical activity level in community-dwelling stroke survivors: a systematic review and meta-analysis of randomized controlled trials

ABSTRACT Background Stroke survivors are primarily physically inactive. Physiotherapy practice might represent professional support to improve this alarming lifestyle. However, evidence is scarce regarding the effectiveness of active physiotherapy on physical activity level in stroke survivors. Methods We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Participants: Stroke survivors living in the community. Intervention: Any active physiotherapy, i.e., involving exercises that require voluntary effort by the patient. Outcome measure: Physical activity level. Results Out of 5590 identified references, 25 RCTs were eligible, and 21 had available data. Pooling resulted in a small significant effect size in favor of active physiotherapy (standardized mean difference (SMD) 0.22, 95% confidence interval (CI) 0.04 to 0.40, heterogeneity I 2 =65%), and medium significant effect when physical activity level was measured using an objective tool (SMD 0.48, 95% CI 0.03 to 0.92, I 2 =73%). In addition, meta-regression showed that 35% of the variance in trial outcome was explained by the measurement tool (objective or subjective) and 23% by age. Finally, none of the variances were associated with specific dosage in frequency, time, or exercise duration, nor with the severity of the disability. Conclusion Active physiotherapy seems effective in increasing objective physical activity among stroke survivors living in the community. However, the evidence supporting the efficacy of active physiotherapy was found to be of low certainty. Thus, further evidence is required. Registration PROPERO CRD42022315639.