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Factors Associated With Post-Stroke Physical Activity: A Systematic Review and Meta-Analysis

Published:October 19, 2017DOI:https://doi.org/10.1016/j.apmr.2017.09.117

      Abstract

      Objective

      To integrate the literature investigating factors associated with post-stroke physical activity.

      Data Sources

      A search was conducted from database inception to June 2016 across 9 databases: Cochrane, MEDLINE, ProQuest, Web of Science, PsycINFO, Scopus, Embase, CINAHL, and Allied and Complementary Medicine Database. The reference lists of included articles were screened for secondary literature.

      Study Selection

      Cohort and cross-sectional studies were included if they recruited community-dwelling stroke survivors and measured factors associated with physical activity.

      Data Extraction

      Risk of bias was evaluated using the Quality in Prognosis Studies checklist. A meta-analysis was conducted for correlates where there were at least 2 studies that reported a correlation value. Correlation values were used in an effect size measure and converted to a standardized unit with Fisher r to z transformation and conversion back to r method. Results were described qualitatively for studies that could not be pooled.

      Data Synthesis

      There were 2161 studies screened and 26 studies included. Age (meta r=−.17; P≤.001) and sex (meta r=−.01; P=.02) were the nonmodifiable factors that were found to be associated with post-stroke physical activity. The modifiable factors were physical function (meta r=.68–.73; P<.001), cardiorespiratory fitness (meta r=.35; P≤.001), fatigue (meta r=−.22; P=.01), falls self-efficacy (meta r=−.33; P<.001), balance self-efficacy (meta r=.37; P<.001), depression (meta r=−.58 to .48; P<.001), and health-related quality of life (meta r=.38–.43; P<.001). The effect of side of infarct, neglect, and cognition on post-stroke physical activity was inconclusive.

      Conclusions

      Age, sex, physical function, depression, fatigue, self-efficacy, and quality of life were factors associated with post-stroke physical activity. The cause and effect of these relations are unclear, and the possibility of reverse causality needs to be addressed.

      Keywords

      List of abbreviations:

      6MWT (6-minute walk test), BBS (Berg Balance Scale), CI (confidence interval), ES (effect size), FSS (Fatigue Severity Scale), HRQOL (health-related quality of life), MMSE (Mini-Mental State Examination), MoCA (Montreal Cognitive Assessment)
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