Background
Methods
Search strategy
Study selection criteria
Study type
Population
Intervention
Comparator
Outcome measures
Data management and selection procedure
Data extraction
Quality appraisal
Data synthesis
Reference | Country | Setting | Sample Size | Female Sex (n=)/%) | Age (years) Mean ± SD | Injury severity (n=) Moderate/ Severe) | Time post-Injury Mean ± SD (months)+ | PEDro Quality Assessment for RCTs (total) | Control Group comparison |
---|---|---|---|---|---|---|---|---|---|
Bateman et al. 2001 [34] | UK | Inpatient Rehab | I: 24 C: 23 | I: 6 (25%) C: 3 (13%) | I: 35 ± 14 C: 36 ± 13 | I: 0/14 C: 0/12 | I: 5.1 ± 2.9a
C: 5.0 ± 2.2 | 7 | Non-PA intervention (relaxation) |
USA | Home-based | I: 29 C: 40 | 28 (41%) | 44 ± 16 | 10/35 | 100.5 ± 119.9 | 6c
| Non-PA intervention (nutrition coaching) | |
Blake et al. 2009 [37] | UK | Community-based | I: 10 C: 10 | I: 1 (10%) C: 4 (40%) | I: 44 ± 10 C: 46 ± 11 | I: 4/3 C: 4/2 | I: 196.8 ± 108.0 C: 178.8 ± 163.2 | 6 | Non-PA intervention (social & leisure activities) |
Brenner et al. 2012 [38] | USA | Community-based | I: 37 C: 37 | I: 8 (22%) C: 5 (14%) | I: 44 ± 16 C: 44 ± 15 | I: NR C: NR | I: 140.4 ± 165.6 C: 150.0 ± 165.6 | 4 | No intervention (wait-list) |
Brown et al. 2005 [39]d
| USA | Inpatient Rehab | I: 10 C: 9 | I: 3 (30%) C: 3 (33%) | I: 38 ± 12 C: 42 ± 8 | I: 0/10 C: 0/9 | I: 181.2 ± 78.0 C: 199.2 ± 199.2 | 5 | PA intervention (overground gait training) |
Canning et al. 2003 [40]e
| Australia | Inpatient Rehab | I: 13 C: 11 | I: 2 (16%) C: 4 (40%) | I: 25 ± 11 C: 26 ± 10 | I: 0/13 C: 0/11 | I: 2.5 ± 1.5 C: 2.8 ± 0.8 | 7 | No additional intervention (usual rehab) |
Curcio et al. 2020 [41]e
| Italy | Inpatient Rehab | I: 11 C: 11 | I: 6 (60%) C: 5 (50%) | I: 37 ± 15 C: 43 ± 14 | I: 0/11 C: 0/11 | I: 5.8 ± 2.6 C: 4.8 ± 2.7 | 6 | PA intervention (balance training) |
Cuthbert et al. 2014 [42] | USA | Inpatient Rehab | I: 10 C: 10 | I: 3 (30%) C: 4 (40%) | I: 32 (23–56)f
C: 31 (19–64) | I: NR C: NR | I: 1.8 (0.9–2.8)f
C: 3.1 (0.8-4.0) | 6 | PA intervention (balance training) |
Driver et al. 2004 [43] | USA | Outpatient Rehab | I: 8 C: 8 | I: 4 (50%) C: 4 (50%) | I: 39 ± 5 C:38 ± 4 | I: 0/8 C: 0/8 | I: 40.8 ± 17.1 C: 36.6 ± 14.1 | 3 | Non-PA intervention (vocational rehab) |
Driver et al. 2006 [44] | USA | Outpatient Rehab | I: 9 C: 9 | I: 4 (44%) C: 4 (44%) | I: 38 ± 4 C: 35 ± 4 | I: 0/9 C: 0/9 | I: 40.3 ± 14.7 C: 41.2 ± 14.2 | 4 | Non-PA intervention (vocational rehab) |
Driver et al. 2009 [45] | USA | Outpatient Rehab | I: 8 C: 8 | I: 3 (38%) C: 4 (50%) | I: 39 ± 2 C: 38 ± 2 | I: 8/0 C: 8/0 | I: 40.8 ± 14.7 C: 36.2 ± 14.2 | 4 | Non-PA intervention (vocational rehab) |
Esquenazi et al. 2013 [46] | USA | Outpatient Rehab | I: 8 C: 8 | I: 5 (62%) C: 4 (50%) | I: 37 ± 11 C: 42 ± 17 | NR | I: 140.3 ± 71.6 C: 150.4 ± 111.6 | 4 | PA intervention (Manual-Assisted Partial BWSTT) |
Freivogel et al. 2009 [47]g
| Germany | Inpatient Rehab | I: 8 C: 8 | I: 3 (38%) C: 2 (25%) | I: 22 ± 6 C: 26 ± 6 | I: 0/6 C: 0/6 | I: 16.0 ± 15.0 C: 56.0 ± 69.0 | 8 | PA intervention (Partial BWSTT or overground walking) |
Gemmell et al. 2006 [48] | New Zealand | Community-based | I: 9 C: 9 | All: 9 | All: F, 40 ± 12 M, 51 ± 9 | I: NR C: NR | All: 104.4 | 5 | No intervention (wait-list) |
Australia | Community-based | I: 32 C: 30 | I: 5 (15%) C: 4 (12%) | I: 35 ± 15 C: 33 ± 12 | I: 0/32 C: 0/30 | I: 2.6 (1.8-4.0) C: 2.3 (1.5–3.4)h | 8 | PA intervention (home-based exercise) | |
Hassett et al. 2012 [51] | Australia | Inpatient & Outpatient Rehab | I: 20 C: 20 | I: 6 (30%) C: 7 (35%) | I: 39 ± 17 C: 29 ± 11 | I: 0/20 C: 0/20 | I: 3.7 (2.0-4.9) C: 3.1 (2.1–5.6)h | 7 | PA intervention (Circuit class, no HR feedback) |
Katz-Leurer et al. 2009 [52]i
| Israel | Home-based | I: 10 C: 10 | I: 3 (30%) C: 3 (30%) | I: 8 ± 4 C: 9 ± 3 | I: 0/5 C: 0/5 | I: NR C: NR | 7 | No intervention |
Kleffelgaard et al. 2019 [53]j
| Norway | Outpatient Rehab | I: 33 C: 32 | I: 23 (70%) C: 22 (71%) | I: 38 ± 12 C: 41 ± 14 | I: NR C: NR | I: 3.9 ± 2.2 C: 3.4 ± 1.9 | 8 | No additional intervention (usual rehab) |
McMillan et al. 2002 [54]k
| UK | Community-based | I: 47 C: 48 | I: 8 (21%) C: 12 (25%) | I: 31 ± 13 C: 36 ± 13 | I: NR C: NR | I: NR C: NR | 6 | No intervention |
Särkämö et al. 2021 [55]b
| Finland | Outpatient rehab | I: 6 C: 5 | I: 3 (50%) C: 1 (20% | I: 36 ± 6 C: 35 ± 14 | I: 0/6 C: 0/5 | I: 110.4 ± 30.0 C: 69.6 ± 37.2 | 7 | No intervention (wait-list) |
Straudi et al. 2017 [56]l
| Italy | Inpatient & Outpatient Rehab | I: 11 C: 10 | I: 2 (16%) C: 2 (22%) | I: 30 ± 16 C: 37 ± 10 | I: NR C: NR | I: 24.0 ± 72.0 C: 96.0 ± 192.0 | 5 | PA intervention (balance training) |
Tefertiller et al. 2019 [57] | USA | Home-based | I: 31 C: 32 | I: 8 (26%) C: 16 (50%) | I: 48 ± 12 C: 50 ± 12 | I: NR C: NR | I: 99.6 ± 110.4 C: 102.0 ± 87.6 | 5 | PA intervention (home-based balance training) |
Wilson et al. 2006 [58]e
| USA | Inpatient Rehab | I: 20 C: 20 | I: 1 (5%) C: 2 (11%) | I: 33 ± 14 C: 26 ± 9 | I: NR C: NR | I: 4.0 ± 3.5 C: 2.8 ± 1.8 | 7 | No additional intervention (usual gait rehab) |
Results
Search results and overview
Study characteristics
Participant characteristics
Intervention characteristics
Reference | PA Classification | PA Type | Supervised (by whom) | Intensity | Dose Parameters | Group Training (Size) | Location | Progression |
---|---|---|---|---|---|---|---|---|
Inpatient Rehabilitation | ||||||||
Bateman et al. 2001 [34] | Structured Aerobic Exercise | Cycle Ergometer | Yes (Physiotherapist) | 60–80% age predicted HRmax
| 30-min, 3*/week, 12 weeks | No | Four regional neurologic inpatient rehabilitation units | Exercise time was increased as individually tolerated until the patients were able to cycle for 30-min. Work rate (watts) was then adjusted to raise each individual’s HR into a training zone: 60–80% of age-predicted HRmax
|
Brown et al. 2005 [39] | Structured Gait/ Balance/ Functional Exercise | Body-Weight Supported Treadmill Training | Yes (Physiotherapist) | 30% BWS 0.2–2.3 miles/hr speed | 15-min, 2*/week, 14 weeks | No | NR | Reduction in BWS by 10% until 10% BWS was achieved, then reduction by 5%. All reductions were based on achieving 10 consecutive heel strikes bilaterally. Treadmill speed was increased as tolerated. |
Canning et al. 2003 [40] | Structured Gait/ Balance/ Functional Exercise | Repetitive Sit-to-Stands and step-up exercises | Yes (Physiotherapist) | NR | 5*/week, 4 weeks (duration NR) | No | Brain Injury Rehabilitation Unit | Increased complexity by multitasking i.e., holding cup of water. Increased speed, lowering of chair from 110–90% of lower leg length by week four. Aim was to complete 100 sit-to-stand repetitions and 60 step-ups daily, 5*days/week. |
Curcio et al. 2020 [41] | Structured Gait/ Balance/ Functional Exercise | Aquatic therapy targeting enhanced postural stability and gait exercises | Yes (Physiotherapist) | NR | 45-min, 3*/week, 4 weeks | NR | Hydro pool, Neurorehabilitation hospital | NR |
Cuthbert et al. 2014 [42] | Structured Gait/ Balance/ Functional Exercise | VR-based balance therapy (Nintendo Wii) | Yes (Physiotherapist) | NR | 15-min, 4*/week, 4 weeks | No | Hospital Gym | NR |
Freivogel et al. 2009 [47] | Structured Gait/ Balance/ Functional Exercise | Robotic Body-Weight Supported Treadmill Training (LokoHelp) | Yes (Physiotherapist) | Maximal treadmill speed tolerable by participant | 30-min, 3–5*/week, 6 weeks | No | Inpatient Hospital gym | Initial BWS ranged from 10-30% and was reduced as soon as possible |
Wilson et al. 2006 [58] | Structured Gait/ Balance/ Functional Exercise | Partial Body-Weight Supported gait training | Yes (Physiotherapists and assistants) | NR | Max 60-min, 2*/week, 8 weeks | No | Hospital gym | % BWS reduced when participant showed no sign of discomfort with walking pace. Treadmill speed also increased when no assistance was needed, and participant showed no signs of discomfort or discoordination due to walking pace. |
Outpatient Rehabilitation
| ||||||||
Esquenazi et al. 2013 [46] | Structured Gait/ Balance/ Functional Exercise | Robotic Body Weight Supported Treadmill Training | Yes (Physiotherapist) | Based on Self-Selected Velocity and/or Maximum Velocity at 10–20% BWS | 60-75-min, 3*/week, 6–8 weeks | No | NR | After every 3rd training session: If either self-selected velocity or maximum velocity increased by at least 10% compared with the last assessment, the training speed increased by 10%; otherwise, training speed increased by the greater (%) of the two. If a decrease in either self-selected velocity or maximum velocity occurred, no change in training speed was implemented. |
Kleffelgaard et al. 2019 [53] | Structured Gait/ Balance/ Functional Exercise | Vestibular Rehab & PA | Yes (Physiotherapist) | NR | 2*/week, 8 weeks (duration NR) | Yes (2–5) | Metropolitan University | Feedback from each patient during the group sessions and their exercise diary was used to determine the parameters of the exercises throughout the intervention period. Resolution of increased symptoms within 15-30-min after the exercise session was used as a general guideline for modification and progression of the exercises. The PA was completed at home and included individually modified exercises such as walking, biking, and skiing |
Särkämö et al. 2021 [55] | Structured Gait/ Balance/ Functional Exercise | Dance-Based Rehab | Yes (Dance teacher and a Physiotherapist) | NR | 60-min, 2*/week, 12 weeks | No | Specialised Rehab Centre | Exercises are progressed depending on individual progress and can be done sitting or standing, alone or supported and the difficulty level and the number and type of each exercise/movement can be adjusted. |
Community-based
| ||||||||
Blake et al. 2009 [37] | Sport & Physical Recreation | Tai Chi Qigong | Yes (Qigong Instructor) | NR | 60-min, 1*/week, 8 weeks | Yes (unclear) | Community Day Centre | NR |
Brenner et al. 2012 [38] | Promotion Overall PA | Health and Wellness Therapy Group | Yes (Allied Health Facilitators) | NA | 90-min, 1*/week, 12 weeks | Yes (7–8) | Veterans Medical Centre | NA |
Driver et al. 2004 [43] | Structured Multicomponent Exercise | Aquatics programme | Yes (Instructor – qualifications not specified) | 50-70% HRR | 60-min, 3*/week, 8 weeks | Yes (8, but 1-on-1 instruction) | Local swimming pool | Participants wore a HR monitor throughout sessions and were instructed to stay between 50-70% of HRR |
Driver et al. 2006 [44] | Structured Multicomponent Exercise | Aquatics programme | Yes (Instructor – qualifications not specified) | 50-70% HRR | 60-min, 3*/week, 8 weeks | Yes (9, but 1-on-1 instruction) | Local swimming pool | Participants wore a HR monitor throughout sessions and were instructed to stay between 50-70% of HRR |
Driver et al. 2009 [45] | Structured Multicomponent Exercise | Aquatics programme | Yes (Instructor – qualifications not specified) | 50-70% HRR | 60-min, 3*/week, 8 weeks | Yes (8, but 1-on-1 instruction) | Local swimming poola
| Participants wore a HR monitor throughout sessions and were instructed to stay between 50-70% of HRR |
Gemmell et al. 2006 [48] | Sport & Physical Recreation | Tai Chi | Yes (Tai Chi Instructor) | NR | 45-min, 2*/week, 6 weeks | Yes (9) | NR | The course consisted of various Tai Chi basics, including breathing and stepping techniques and five forms from the 38-step frame. |
Hassett et al. 2009 [49] | Structured Multicomponent Exercise | Aerobic and muscle strength training | Yes (Personal Trainer) | Aerobic: Moderate-intensity, symptom limited such that they were breathing hard but able to talk. Strength: 6 muscle groups targeted, 3*10 or 2*15 sets/repetitions | 60-min, 3*/week, 12 weeks | No | Local fitness centre | The personal trainer determined how best to complete and progress the exercises. |
McMillan et al. 2002 [54] | Structured Aerobic Exerciseb
| Physical Exercise | Yes (the 5*45-min sessions were supervised by a therapist) | NR | 5*45-min sessions over 4 weeks supervised & daily independent practice (duration NR) | Unclear | NR | NR |
Home-based
| ||||||||
Promotion Overall PA | Walking | Yes (Remote supervision by a Research Assistant/Coach) | NR | 7*/week, 12 weeks (no daily time limit) | No | Participant’s home | Participants were given the goal of a 5% increase in daily steps over their individual baseline for the first week. In subsequent weeks, the daily step goal was increased by the same number of steps until the participant reached a 40% increase in week eight and maintained the 40% increase over baseline for the last four weeks of the study. | |
Katz-Leurer et al. 2009 [52] | Structured Gait/ Balance/ Functional Exercise | Sit-to-Stands and step- ups | Yes (Parents) | Weeks 1–2: 50% max performance; Weeks 3–6: up to 75% max performance (max performance = No. sit-to-stands and No. step-ups forward and sideward in 1-min) | 15-min, 5*/week, 6 weeks | No | Participant’s home | Increase repetitions |
Tefertiller et al. 2019 [57] | Structured Gait/ Balance/ Functional Exercise | VR exercise targeting balance in standing | Yes (Physiotherapist) | Basic, intermediate, and advanced | 30-min, 3–4*/week, 12 weeks | No | Participant’s home | Following week six testing, exercise difficulty was updated based on Community Balance and Mobility scale stratification. |
Inpatient & Outpatient Rehab
| ||||||||
Hassett et al. 2012 [51] | Structured Multicomponent Exercise | Circuit class with HR feedback | Yes (Physiotherapy undergraduate students, Physiotherapy assistants, Physiotherapists) | HR training zone was calculated as ≥ 50% HRR using the Karvonen equation | 60-min, 3*/week, 2 weeks | Yes (average of 8, but up to 14) | Brain Injury Unit Gym | Supervising staff used the information from the heart rate monitor to provide encouragement regarding the intensity of exercise and to progress exercises where possible (e.g., lowering the height of the chair for the sit-to-stand station). |
Straudi et al. 2017 [56] | Structured Gait/ Balance/ Functional Exercise | Video game-based exercise targeting balance in standing | Yes (Physiotherapist) | NR | 60-min, 3*/week, 6 weeks | No | University Hospital | Each video game had a progression over time according to patients’ abilities and successes. |