Effectiveness of active physiotherapy on physical activity level in community-dwelling stroke survivors: a systematic review and meta-analysis of randomized controlled trials

Background Stroke survivors are primarily physically inactive. Physiotherapy practice might represent professional support to improve this alarming lifestyle. However, evidence is scarce regarding the effectiveness of active physiotherapy on physical activity level in stroke survivors. Methods We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Participants: Stroke survivors living in the community. Intervention: Any active physiotherapy, i.e., involving exercises that require voluntary effort by the patient. Outcome measure: Physical activity level. Results Out of 5590 identified references, 25 RCTs were eligible, and 21 had available data. Pooling resulted in a small significant effect size in favor of active physiotherapy (standardized mean difference (SMD) 0.22, 95% confidence interval (CI) 0.04 to 0.40, heterogeneity I [2][1]=65%), and medium significant effect when physical activity level was measured using an objective tool (SMD 0.48, 95% CI 0.03 to 0.92, I [2][1]=73%). In addition, meta-regression showed that 35% of the variance in trial outcome was explained by the measurement tool (objective or subjective) and 23% by age. Finally, none of the variances were associated with specific dosage in frequency, time, or exercise duration, nor with the severity of the disability. Conclusion Active physiotherapy seems effective in increasing objective physical activity among stroke survivors living in the community. However, the evidence supporting the efficacy of active physiotherapy was found to be of low certainty. Thus, further evidence is required. Registration PROPERO CRD42022315639. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Acknowledgments: We thank for Dr Jean Joël Bigna Rim for the support in statistics Sources of Funding: This research was supported by the funds of the French Society of Physiotherapy (Société Française de Physiothérapie, SFP) ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: N/A I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data available on request from the authors [1]: #ref-2