Circuit Class Therapy for Improving Mobility after Stroke

Circuit class therapy appears to improve mobility after stroke. It appears to be effective when delivered either in early or late periods after stroke. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 17 studies with a total of 1297 subjects. Participants were stroke survivors living in the community or receiving inpatient rehabilitation. Time since stroke onset varied from within one month to more than one year post stroke. Most could walk 10 metres without assistance. Ten studies (n=835) measured walking capacity ( walking distance in 6 minutes) demonstrating that circuit class therapy (CCT) was superior to the comparison intervention (6-Minute Walk Test: MD 60.86 m, 95% CI 44.55 to 77.17. Eight studies (n=744) measured gait speed, again finding in favour of CCT compared with other interventions (MD 0.15 m/s, 95% CI 0.10 to 0.19). Both of these effects are considered clinically meaningful. We were able to pool other measures to demonstrate the superior effects of CCT for aspects of walking and balance (Timed Up and Go: 5 studies, n=488, MD -3.62 seconds, 95% CI -6.09 to -1.16; Activities of Balance Confidence scale: 2 studies, n=103, MD 7.76, 95% CI 0.66 to 14.87). Two other pooled balance measures failed to demonstrate superior effects (Berg Blance Scale and Step Test). Independent mobility, as measured by the Stroke Impact Scale, Functional Ambulation Classification and the Rivermead Mobility Index, also improved more in CCT interventions compared with others. Length of stay showed a non-significant effect in favour of CCT (2 trials, n=217, MD -16.35, 95% CI -37.69 to 4.99). Eight trials (n=815) measured adverse events (falls during therapy): there was a non-significant effect of greater risk of falls in the CCT groups (RD 0.03, 95% CI -0.02 to 0.08). Time after stroke did not make a difference to the positive outcomes.