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(Stroke. 2009;40:2450.)
© 2009 American Heart Association, Inc.

Original Contributions

Effects of Task-Oriented Circuit Class Training on Walking Competency After Stroke

A Systematic Review

Lotte Wevers, MSc; Ingrid van de Port, PhD; Mathijs Vermue, MSc; Gillian Mead, MD, PhD Gert Kwakkel, PhD

From the Center of Excellence for Rehabilitation Medicine Utrecht (L.W., I.v.d.P., G.K.), Rehabilitation Center De Hoogstraat, Utrecht, The Netherlands; the Department of Neurology and Neurosurgery (L.W., I.v.d.P., M.V., G.K.), Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, The Netherlands; VU University Medical Center, the Department of Rehabilitation Medicine (G.K.), Amsterdam, The Netherlands; and the University of Edinburgh (G.M.), Royal Infirmary, Little France Crescent, Edinburgh, UK.

Correspondence to Gert Kwakkel, PhD, Chair of Neurorehabilitation, Department of Rehabilitation Medicine, VU University Medical Center, de Boelelaan 1117, 1081 HV Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands. E-mail g.kwakkel{at}vumc.nl

Background and Purpose— There is increasing interest in the potential benefits of circuit class training after stroke, but its effectiveness is uncertain. Our aim was to systematically review randomized, controlled trials of task-oriented circuit class training on gait and gait-related activities in patients with stroke.

Methods— A computer-aided literature search was performed to identify randomized, controlled trials in which the experimental group received task-oriented circuit class training focusing on the lower limb. Studies published up to March 2008 were included. The methodological quality of each study was assessed and studies with the same outcome variable were pooled by calculating the summary effect sizes using fixed or random effects models.

Results— Six of the 445 studies screened, comprising 307 participants, were included. Physiotherapy Evidence Database scores ranged from 4 to 8 points with a median of 7.5 points. The meta-analysis demonstrated significant homogeneous summary effect sizes in favor of task-oriented circuit class training for walking distance (0.43; 95% CI, 0.17 to 0.68; P<0.001), gait speed (0.35; 95% CI, 0.08 to 0.62; P=0.012), and a timed up-and-go test (0.26; 95% CI, 0.00 to 0.51; P=0.047). Nonsignificant summary effect sizes in favor of task-oriented circuit class training were found for the step test and balance control.

Conclusions— This meta-analysis supports the use of task-oriented circuit class training to improve gait and gait-related activities in patients with chronic stroke. Further research is needed to investigate the cost-effectiveness and its effects in the subacute phase after stroke, taking comorbidity into account, and to investigate how to help people maintain and improve their physical abilities after their rehabilitation program ends.

Key Words: exercise therapy • physical fitness • rehabilitation • stroke • systematic review