title: Strengthening interventions increase strength and improve activity after stroke: a systematic review.
abstract: OBJECTIVE
  Is strength training after stroke effective (ie, does it increase strength), is it harmful (ie, does it increase spasticity), and is it worthwhile (ie, does it improve activity)?
  
  
  METHODS
  Systematic review with meta-analysis of randomised trials.
  
  
  METHODS
  Stroke participants were categorised as (i) acute, very weak, (ii) acute, weak, (iii) chronic, very weak, or (iv) chronic, weak.
  
  
  METHODS
  Strengthening interventions were defined as interventions that involved attempts at repetitive, effortful muscle contractions and included biofeedback, electrical stimulation, muscle re-education, progressive resistance exercise, and mental practice.
  
  
  METHODS
  Strength was measured as continuous measures of force or torque or ordinal measures such as manual muscle tests. Spasticity was measured using the modified Ashworth Scale, a custom made scale, or the Pendulum Test. Activity was measured directly, eg, 10-m Walk Test, or the Box and Block Test, or with scales that measured dependence such as the Barthel Index.
  
  
  RESULTS
  21 trials were identified and 15 had data that could be included in a meta-analysis. Effect sizes were calculated as standardised mean differences since various muscles were studied and different outcome measures were used. Across all stroke participants, strengthening interventions had a small positive effect on both strength (SMD 0.33, 95% CI 0.13 to 0.54) and activity (SMD 0.32, 95% CI 0.11 to 0.53). There was very little effect on spasticity (SMD -0.13, 95% CI -0.75 to 0.50).
  
  
  CONCLUSIONS
  Strengthening interventions increase strength, improve activity, and do not increase spasticity. These findings suggest that strengthening programs should be part of rehabilitation after stroke.
authors.affiliation: Faculty of Health Science, The University of Sydney, Lidcombe, NSW 1825, Australia. L.Ada@fhs.usyd.au
authors.forename: Louise
authors.initials: L
authors.lastname: Ada
authors.forename: Simone
authors.initials: S
authors.lastname: Dorsch
authors.forename: Colleen G
authors.initials: CG
authors.lastname: Canning
mesh_terms: D000368:Aged; D015444:Exercise / Q000502:physiology; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D053580:Muscle Strength / Q000502:physiology*; D018908:Muscle Weakness / Q000503:physiopathology; D026741:Physical Therapy Modalities; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation