Circuit class therapy for improving mobility after stroke


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Review question

Is circuit class therapy better than conventional physiotherapy for improving people’s walking after a stroke?

Background

After stroke, people can have difficulty walking. They may become slower, only manage short distances, and may need assistance. They may lose balance more easily and be more fatigued. This can mean they walk even less, and so walking ability can worsen. Rehabilitation can help improve walking, but it is hard to access, particularly later after stroke. Circuit class therapy involves working in groups (rather than individually with a therapist), and doing specific practice of meaningful tasks, and may offer a solution that is more accessible.

Study characteristics

This is an update of the original review in 2010. We considered studies comparing circuit class therapy with conventional therapy for people with stroke, and included only high-quality studies with a low risk of being biased. We were interested in studies that compared these two approaches and their effects on the way people walk, how far, how fast, and how independently. We also looked for studies that investigated if the circuit classes were more or less likely to be harmful than conventional approaches. The evidence is current to January 2017.

Main results

We found seventeen studies, involving 1297 participants, that compared circuit class rehabilitation with usual care or sham rehabilitation. Most trials reported the benefits of circuit classes for improving walking ability. More specifically, we combined the results from the studies and found moderate evidence that circuit classes were more effective in improving the person’s ability to walk further, more independently, and faster and, in some cases, to balance more easily and confidently when compared with other types of therapy. There was a suggestion that people might fall more often in the circuit classes, and that they may be able to get home from rehabilitation hospital more quickly, but these two aspects were not confirmed using statistics. We also found that the positive effects of the circuit classes were experienced equally by people who had had their stroke more than a year ago compared with people who had had their stroke within the year. This means people can continue to improve longer after their stroke than was previously reported. More research is needed to see if it works for all people with any severity of stroke and if some tasks are better to practise than others.

Quality of the evidence

The quality of the studies overall was acceptable, given it is difficult to keep some aspects tightly controlled in rehabilitation studies. However, we have downgraded the quality rating to ‘moderate’ to acknowledge that some trials have the potential for bias.