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 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.