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Objective: To provide information regarding the procedures, safety, tolerability, and measurement properties of the 6-min step test. Data sources: MEDLINE, EMBASE, CINAHL, and SPORTDiscus (from inception until January 2024). Review methods: Studies that examined adults with acute or chronic diseases, and outcomes related to procedures, safety, tolerability, or measurement properties of the 6-min step test were included. Outcome data were summarized and combined in meta-analyses. The quality of included studies was assessed by the Consensus-based Standards for the selection of health Measurement Instruments checklist, and the quality of evidence was determined according to the Grading of Recommendations Assessment, Development, and Evaluation system. Results: Fourteen studies, involving 847 participants, were included. All studies performed the 6-min step test in 6 min; however, some studies varied the step height and the use of upper limb support. The test appears to be safe and well tolerated by individuals. Moderate- to high-quality evidence demonstrated appropriate results for test-retest reliability (4 studies; Intraclass correlation coefficient 0.96; 95% CI 0.91–0.98; n = 125), criterion validity (4 studies; r = 0.53; 95% CI 0.30–0.71; n = 307), and construct validity (4 studies; r = 0.63; 95% CI 0.52–0.73; n = 233). Conclusion: This review provides recommendations for applying the 6-min step test in clinical and research settings. No adverse events were reported, and the test appears to be well tolerated. Adequate results were found for test-retest reliability, criterion validity, and construct validity. Review Registration: PROSPERO (CRD42022347744). [ABSTRACT FROM AUTHOR]

Aims: To examine the effect of manual therapy applied to the cervical joint for reducing pain and improving mouth opening and jaw function in people with TMDs. Methods: A systematic review of randomized controlled trials was performed. Participants were adults diagnosed with TMDs. The experimental intervention was manual therapy applied to the cervical joint compared to no intervention/placebo. Outcome data relating to orofacial pain intensity, pressure pain threshold (PPT), maximum mouth opening, and jaw function were extracted and combined in meta-analyses. Results: The review included five trials involving 213 participants, of which 90% were women. Manual therapy applied to the cervical joint decreased orofacial pain (mean difference: -1.8 cm; 95% CI: -2.8 to -0.9) and improved PPT (mean difference: 0.64 kg/cm²; 95% CI: 0.02 to 1.26) and jaw function (standardized mean difference: 0.65; 95% CI: 0.3 to 1.0). Conclusion: Manual therapy applied to the cervical joint had short-term benefits for reducing pain intensity and improving jaw function in women with TMDs. Further studies are needed to improve the quality of the evidence and to investigate the maintenance of benefits beyond the intervention period. [ABSTRACT FROM AUTHOR]

Objective: This systematic review aimed to examine the effects of home-based exercises in comparison with centre-based exercises for improving the paretic upper limb after stroke. Data sources: AMED, MEDLINE, EMBASE CINAHL, Cochrane, PsycINFO, and PEDro databases. Review methods: Only randomized clinical trials were included. Participants in the reviewed studies were adults at any time after stroke. The experimental intervention was home-based exercises compared with centre-based exercises. Outcome data related to strength, motor recovery, dexterity, activity, and participation were extracted from the eligible trials and combined in meta-analyses. The quality of included trials was assessed by the PEDro scores. The quality of evidence was determined according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Results: Eight trials, involving 488 participants, were included. Most trials (63%) delivered semi-supervised interventions (amount of supervision 3–43%), and three trials provided full supervision. Random-effects meta-analyses provided moderate- to high-quality evidence that home- and centre-based exercises provide similar effects on motor recovery (MD 1.4 points; 95% CI −0.9 to 3.8), dexterity (MD −0.01 pegs/s; 95% CI −0.04 to 0.05), upper limb activity performance (SMD −0.04; 95% CI −0.25 to 0.18), and quality of movement (0.1 points; 95% CI −0.2 to 0.4). Effects on strength were also similar but the quality of the evidence was rated as low. No trials examined effects on participation. Conclusion: Effects of home-based prescribed exercises on upper limb motor recovery, dexterity, and activity are likely to be similar to improvements obtained by centre-based exercises after stroke. [ABSTRACT FROM AUTHOR]

In people who have had a stroke, how comparable are the effects of home-based exercises with those of equivalent centre-based exercises for improving walking speed, balance, mobility and participation? Is the comparability of the effects of these two types of exercise maintained beyond the intervention period? Systematic review of randomised controlled trials. Searches were conducted on MEDLINE, AMED, EMBASE, Cochrane, PsycINFO and PEDro databases, without date or language restrictions. Participants in the reviewed studies were ambulatory adults at any time after stroke. The experimental intervention consisted of home-based exercises, which was compared with equivalent doses of centre-based exercises. Walking speed, balance, mobility and participation. The quality of included trials was assessed using the PEDro scores. Outcome data were extracted from the eligible trials and combined in random-effects meta-analyses. The quality of evidence was determined according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Nine trials involving 609 participants were included. Random-effects meta-analyses provided high-quality evidence that home-based and centre-based exercises provide similar effects on walking speed (MD –0.03 m/s, 95% CI –0.07 to 0.02) and balance (MD 0 points, 95% CI –1 to 2). Results regarding mobility (SMD –0.4, 95% CI –1.3 to 0.4) and participation (MD –5 points, 95% CI –19 to 10) were imprecise. For most outcomes, the effects of home-based exercises and centre-based exercises remained similar beyond the intervention period. Effects of home-based prescribed exercises on walking speed, balance, mobility and participation are likely to be similar to improvements obtained by equivalent doses of centre-based exercises after stroke. PROSPERO (CRD42021254642). [ABSTRACT FROM AUTHOR]

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Background: The effects of mobile applications on upper limb impairments after stroke was not investigated. Aim: To examine the effects of mobile applications for improving upper limb after stroke. Methods: A systematic review of randomized trials was performed. Searches were conducted on MEDLINE/PUBMED, CINAHL, EMBASE, SCOPUS, Web of Science and PEDro databases. Participants were adults after stroke. The experimental intervention was upper limb rehabilitation using mobile applications compared with no/placebo, or rehabilitation without mobile applications. Outcome data related to upper limb outcomes were combined in meta-analyses. The quality of trials was assessed by the PEDro scores. Results: Seven trials (PEDro score 5; n=193; age = 28 to 85 years old) were included. Mobile applications may have a positive effect on upper limb motor impairment (MD 12 points out of 66; 95% CI -6 to 31) but unclear on capacity (MD 2 points out of 32; 95% CI -1.5 to 5.7), strength (MD 0.4 points out of 5; 95% CI -0.3 to 1.2), and dexterity (MD 2 points; 95% CI -2 to 6). Mobile applications may have similar effects of rehabilitation without mobile applications on upper limb motor impairment 18 (SMD 0.4; 95% CI -0.3 to 1.2), capacity (SMD 0.1; 95% CI -0.4 to 0.6), and strength (MD 0 19 Kg; 95% CI -4.3 to 4.3). Conclusion: Mobile applications may improve upper limb motor impairment, but the effects appear to be similar to rehabilitation without mobile applications. [ABSTRACT FROM AUTHOR]

Background: No studies examined the measurements properties of the 6-minute step test in people after stroke. Aim: To analyze the feasibility of a study aimed to check the reliability and validity of the 6-minute step test in people after stroke. Methods: Methodological, feasibility study. Participants were ambulatory adults with stroke, who could step up and down a bench with 20cm height, and provided written consent. The 6-minute step test, the 6-minute walk test, and other questionnaires were applied aimed to characterize the participants. Feasibility was analyzed in terms of recruitment (% of included participants/participants contacted) and retention (% of included participants who completed all evolutions). Preliminary results regarding test-retest reliability, inter-rater reliability, and validity of the 6-minute step test were examined by Intraclass Correlation Coefficients, and Persons's correlation. Ethical approval: 59441422.3.0000.5060. Results: Thirty-six individuals were contacted: 14 accepted to participate and 13 completed all tests. Recruitment was 39% and retention was 93%. Test-retest reliability (ICC 0.98; 95% CI 0.91 to 0.99, n=14), inter-rater reliability (ICC 0.96; 95% CI 0.87 to 0.99, n=13), and validity (r = 0.87; 95% CI 0.61 to 0.96) was considered high. Conclusions: The continuity of the methodological study is feasible and measurement properties of the 6-minute step test should be confirmed in a larger sample. [ABSTRACT FROM AUTHOR]

Background: The abilities to sit down and stand up are typically impaired after stroke.1 Aim: To examine the factors associated with the sit-to-stand performance after stroke. Methods: A cross-sectional study was performed. Participants were ambulatory adults with chronic stroke, who provided written consent prior to data collection. The outcome of interest was sit-to-stand performance (i.e., 5-repetition sit-to-stand test). The potential explanators were personal factors (i.e., age, sex, and time since stroke) and impairments (i.e., tonus - Modified Ashworth Scale, muscle strength - HandHeld dynamometry, motor coordination - LEMOCOT, and dynamic balance - 4-step square test). Significant explanators (p<0.05) were added into a regression analysis. Ethical approval: CAAE06609312.0.0000.5149. Results: A total of 102 individuals with chronic stroke (44 men), and a mean age of 66 (SD 13) years were included. Sit-to-stand performance was significantly correlated with dynamic balance (r=0.61; p<0.01), motor coordination (r=-0.41; p<0.01), and strength of hip extensors (r=-0.28; p=0.02), knee extensors (r=-0.32; p<0.01), and plantar flexors (r=-0.33; p<0.01). Dynamic balance alone explained 37% (t=6.68; p<0.01) of the variance in sit-to-stand performance. When strength of hip extensors was included in the model, the explained variance increased to 41% (t=-2,54; p=0.01). Conclusion: Dynamic balance and strength of the paretic hip extensors best explained sit-to-stand performance after stroke. [ABSTRACT FROM AUTHOR]

Background: Less than 50% of stroke survivors return to work.1 No studies examined the loss of work productivity among those who returned to work. Aim: To analyze the feasibility of applying the Work Limitation Questionnaire (WLQ) after stroke. Methods: Methodological, feasibility study. Participants were adults, who returned to work after stroke and provided written consent. The WLQ was applied twice in-person and once by telephone. Feasibility was analyzed in terms of recruitment (% of included participants/participants contacted) and retention (% of included participants who answered the WLQ three times). Preliminary results regarding test-retest reliability and validity of the telephone application were examined by mean differences and Intraclass Correlation Coefficients. Ethical approval: 61611022.00000.5060. Results: Twenty-seven individuals were contacted: 12 accepted to participate and answered the WLQ three times. Recruitment was 44% and retention was 100%. The 12 participants (6 women) reported 68% (SD 38) of work productivity loss. Test-retest reliability was high (ICC 0.99; 95% CI 0.98 to 0.99) with no differences between in-person applications (MD 2%; 95% CI -3 to 9). Reliability of the telephone application was high (ICC 0.90; 95% CI 66 to 0.97) with no differences with in-person application (MD 4%; 95% CI -20 to 11). Conclusions: The continuity of the methodological study is feasible and measurement properties of the WLQ should be confirmed in a larger sample. [ABSTRACT FROM AUTHOR]

Background: People after stroke typically experience limitations in climbing stairs.1,2 Aim: To examine the effect of exercises for improving stair climbing after stroke. Methods: A systematic review of randomized trials was performed. Searches were conducted on MEDLINE, EMBASE, Cochrane Library, AMED, and PEDro databases. Participants were ambulatory adults, who have had a stroke. The experimental intervention was physical exercises for the paretic lower limb compared with no intervention/placebo. Outcome data related to stair climbing performance were combined in meta-analyses. The quality of trials was assessed by the PEDro scores and the quality of evidence was determined according to GRADE. Results: Nine trials (PEDro 5), involving 314 participants were included. The mean age of participants ranged from 50 to 68 years old. The examined interventions were strength training, task-oriented training, or a combination of strength training with aerobic or task-oriented training. Very-low quality evidence indicated that exercises improve stair climbing performance by SMD 0.4 (95% CI 0 to 0.8), and the time to ascent/descent stairs by MD 3.4 seconds (95% CI 0.4 to 6.5). Conclusion: This systematic review provided evidence that six weeks of planned, structured, and repetitive exercises (50 min, 4 times per week) improve stair climbing performance of moderately disabled individuals with chronic stroke. [ABSTRACT FROM AUTHOR]

Background: Reduced ankle range of motion is related to walking limitations after stroke.1,2 Aim: To examine the effects of mobilization with movement for improving ankle range of motion and walking after stroke. Methods: A systematic review of randomized trials was performed. Searches were conducted on MEDLINE, CINAHL, EMBASE and PEDro databases. Participants were ambulatory adults after stroke. The experimental intervention was mobilization with movement compared with no/placebo/minimal intervention. Outcome data related to ankle range of motion, and walking spatiotemporal parameters were combined in metaanalyses. The quality of trials was assessed by the PEDro scores, and the quality of evidence was determined according to the GRADE system. Results: Eight trials (PEDro score 6), involving 218 participants, were included. The mean age of participants ranged from 46 to 62 years old. Low-quality evidence suggested that mobilization with movement improves ankle range of motion (MD 3.5º; 95% CI 2 to 5). Moderate-quality evidence suggested improvements on walking speed (MD 0.08 m/s; 95% CI 0.05 to 0.10), cadence (MD 10 steps/min; 95% CI 7 to 12), and step length (MD 4 cm; 95% CI 2 to 6). Conclusion: This systematic review indicated that 5 sets of 10 repetitions of mobilization with movement, applied 3 times a week, for 4 weeks, in association with walking training, improve ankle range of motion and walking after stroke. Review Registration: PROSPERO (CRD42023405130). [ABSTRACT FROM AUTHOR]