title: Increasing the amount of usual rehabilitation improves activity after stroke: a systematic review.
abstract: OBJECTIVE
  In people receiving rehabilitation aimed at reducing activity limitations of the lower and/or upper limb after stroke, does adding extra rehabilitation (of the same content as the usual rehabilitation) improve activity? What is the amount of extra rehabilitation that needs to be provided to achieve a beneficial effect?
  
  
  METHODS
  Systematic review with meta-analysis of randomised trials.
  
  
  METHODS
  Adults aged 18 years or older that had a diagnosis of stroke.
  
  
  METHODS
  Extra rehabilitation with the same content as usual rehabilitation aimed at reducing activity limitations of the lower and/or upper limb.
  
  
  METHODS
  Activity measured as lower or upper limb ability.
  
  
  RESULTS
  A total of 14 studies, comprising 15 comparisons, met the inclusion criteria. Pooling data from all the included studies showed that extra rehabilitation improved activity immediately after the intervention period (SMD=0.39, 95% CI 0.07 to 0.71, I(2)=66%). When only studies with a large increase in rehabilitation (> 100%) were included, the effect was greater (SMD 0.59, 95% CI 0.23 to 0.94, I(2)=44%). There was a trend towards a positive relationship (r=0.53, p=0.09) between extra rehabilitation and improved activity. The turning point on the ROC curve of false versus true benefit (AUC=0.88, p=0.04) indicated that at least an extra 240% of rehabilitation was needed for significant likelihood that extra rehabilitation would improve activity.
  
  
  CONCLUSIONS
  Increasing the amount of usual rehabilitation aimed at reducing activity limitations improves activity in people after stroke. The amount of extra rehabilitation that needs to be provided to achieve a beneficial effect is large.
  
  
  BACKGROUND
  PROSPERO CRD42012003221. [Schneider EJ, Lannin NA, Ada L, Schmidt J (2016) Increasing the amount of usual rehabilitation improves activity after stroke: a systematic review.Journal of Physiotherapy62: 182-187].
authors.affiliation: Discipline of Occupational Therapy, School of Allied Health, College of Science, Health and Engineering, La Trobe University; Occupational Therapy Department, Alfred Health, Melbourne.
authors.forename: Emma J
authors.initials: EJ
authors.lastname: Schneider
authors.affiliation: Discipline of Occupational Therapy, School of Allied Health, College of Science, Health and Engineering, La Trobe University; Occupational Therapy Department, Alfred Health, Melbourne; John Walsh Centre for Rehabilitation Research, Sydney Medical School (Northern), The University of Sydney.
authors.forename: Natasha A
authors.initials: NA
authors.lastname: Lannin
authors.affiliation: Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: Ada
authors.affiliation: Discipline of Occupational Therapy, School of Allied Health, College of Science, Health and Engineering, La Trobe University; Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver BC, Canada.
authors.forename: Julia
authors.initials: J
authors.lastname: Schmidt
mesh_terms: D000203:Activities of Daily Living; D006801:Humans; D020127:Recovery of Function; D000071939:Stroke Rehabilitation / Q000379:methods*; D016896:Treatment Outcome
keywords: Occupational therapy; Physical therapy modalities; Rehabilitation; Review; Stroke