Summary of findings for the main comparison. Circuit class therapy compared with other intervention for improving mobility.
| Circuit class therapy compared with other intervention for improving mobility | ||||||
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Patient or population: people with stroke Settings: in hospital or community Intervention: mobility‐related circuit class therapy Comparison: any other intervention | ||||||
| Outcomes | Illustrative comparative effects (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed effect | Absolute effect | |||||
| Other intervention | Mobility‐related circuit class therapy | |||||
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Walking capacity: 6mWT Continous measure of distance walked in 6 minutes in m |
The mean 6mWT distance ranged across control groups from 106 m to 441 m | The mean 6mWT distance in the intervention groups was
60.86 m further (44.55 to 77.17) |
835 (10) | ⊕⊕⊕⊝ moderate | Applicable: difference greater than minimal clinically important difference (MDC) = 34.4m Eng 2004, and 95% CI of difference does not cross MDC Test for differences between subgroups 'early' versus 'later' (< 1 year vs > 1 year post stroke) were not significant. Some studies have unclear risk of bias (downgraded) |
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Walking speed Continuous measure of walking speed measured over a short distance in m/s |
The mean gait speed ranged across control groups from 0.43 m/s to 1.3 m/s | The mean gait speed in the intervention groups was 0.15 m/s faster (0.10 to 0.19) | 744 (8) | ⊕⊕⊕⊝ moderate | Applicable: difference greater than MDC = 0.06 m/s Perera 2006, and 95% CI of difference does not cross MDC Some studies have unclear risk of bias (downgraded) |
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Balance and mobility Timed up and go test. Standing up, walking, returning to sit down in seconds |
The mean speed ranged across control groups from 15 s to 28.6 s. | The mean speed in the intervention group was 3.62 s faster (‐6.06 to ‐1.16) | 488 (5) | ⊕⊕⊝⊝ low |
Applicable: somewhat as difference is not greater than MDC (8 s or 28%) (downgraded). Some studies have unclear risk of bias (downgraded) |
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Independence in mobility Functional ambulation classification. Indicates need for assistance/not to safely mobilise |
The number of independent participants ranged across the control groups from 2 to 92 | The odds ratio of independent classifications in favour of the intervention group was 1.91 (1.01 to 3.6) | 469 (3) | ⊕⊕⊕⊝ moderate | Applicable: better odds of independence in walking is clinically useful. Some studies have unclear risk of bias (downgraded) |
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| Physical ability Stroke Impact Scale. A self report of overall physical ability (subscale of total Impact) | The mean score for the control groups ranged from 55.4 to 83.73 points (higher is better) | The mean score for the intervention groups was 2.91 points higher (0.00 to 5.82) | 437 (2) | ⊕⊕⊝⊝ low |
Applicable: only somewhat as the mean change score should be 4.5 points to be regarded as clinically important (downgraded) Only two trials (downgraded) |
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Adverse events (falls) from all available trials Counts of numbers of falls |
High risk population | RD 0.03 (‐0.02 to 0.08) | 815 (8) | ⊕⊝⊝⊝ very low | Applicable: 8 out of 17 studies reported falls; 4 of these studies reported no falls in either group. Only small number of studies reported that falls occurred (low event rate with low reporting), wide CIs Difference not statistically significant (downgraded) Some studies have unclear risk of bias (downgraded) Heterogeneity I2 > 50%, (downgraded) |
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| 91.4 per 1000 | 134 per 1000 | |||||
| CI: confidence interval; RD: risk difference; MDC: minimal detectable change | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of effect. Moderate quality: We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of effect, but there is a possibility that it is substantially different. Low quality: OUr confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of effect. Very low quality: We have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect. | ||||||