Factors associated with post-stroke physical activity: a systematic review and meta-analysis.

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 nine databases: Cochrane, Medline, ProQuest, Web of Science ISI, PsycInfo, Scopus, Embase, CINAHL and AMED. 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 two studies that reported a correlation value. Correlation values were used in an effect size measure and converted to a standardised 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:

2161 studies were screened and 26 studies were included. Age (meta r=-0.17; p=<0.001) and gender (meta r=-0.01; p=0.02) were the non-modifiable factors that were found to be associated with post-stroke physical activity. The modifiable factors were physical function (meta r=0.68-0.73; p<0.001), cardiorespiratory fitness (meta r=0.35; p=<0.001), fatigue (meta r=-0.22; p=0.01), falls self-efficacy (meta r=-0.33; p<0.001), balance self-efficacy (meta r=0.37; p<0.001), depression (meta r=-0.58-0.48; p<0.001) and health-related quality of life (meta r=0.38-0.43; p<0.001). The impact of side of infarct, neglect and cognition on post-stroke physical activity were inconclusive.

CONCLUSIONS:

Age, gender, physical function, depression, fatigue, self-efficacy and quality of life were factors associated with post-stroke physical activity. The cause and effect of these relationships are unclear and the possibility of reverse causality needs to be addressed.