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

Publication date: September 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 9

Author(s): Shamala Thilarajah, Benjamin F. Mentiplay, Kelly J. Bower, Dawn Tan, Yong Hao Pua, Gavin Williams, Gerald Koh, Ross A. Clark

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.

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