After stroke, does respiratory muscle training increase respiratory muscle strength and/or endurance? Are any benefits carried over to activity and/or participation? Does it reduce respiratory complications? Systematic review of randomised or quasi-randomised trials. Adults with respiratory muscle weakness following stroke. Respiratory muscle training aimed at increasing inspiratory and/or expiratory muscle strength. Five outcomes were of interest: respiratory muscle strength, respiratory muscle endurance, activity, participation and respiratory complications. Five trials involving 263 participants were included. The mean PEDro score was 6.4 (range 3 to 8), showing moderate methodological quality. Random-effects meta-analyses showed that respiratory muscle training increased maximal inspiratory pressure by 7 cmH2O (95% CI 1 to 14) and maximal expiratory pressure by 13 cmH2O (95% CI 1 to 25); it also decreased the risk of respiratory complications (RR 0.38, 95% CI 0.15 to 0.96) compared with no/sham respiratory intervention. Whether these effects carry over to activity and participation remains uncertain. This systematic review provided evidence that respiratory muscle training is effective after stroke. Meta-analyses based on five trials indicated that 30minutes of respiratory muscle training, five times per week, for 5 weeks can be expected to increase respiratory muscle strength in very weak individuals after stroke. In addition, respiratory muscle training is expected to reduce the risk of respiratory complications after stroke. Further studies are warranted to investigate whether the benefits are carried over to activity and participation. PROSPERO (CRD42015020683). [Menezes KKP, Nascimento LR, Ada L, Polese JC, Avelino PR, Teixeira-Salmela LF (2016) Respiratory muscle training increases respiratory muscle strength and reduces respiratory complications after stroke: a systematic review.Journal of Physiotherapy62: 138-144].

Does mechanically assisted walking increase walking speed or distance in ambulatory people with stroke compared with no intervention/non-walking intervention, or with overground walking? Systematic review with meta-analysis of randomised trials. Ambulatory adults with stroke. Mechanically assisted walking (treadmill or gait trainer) without body weight support. Walking speed measured in m/s during the 10-m Walk Test and walking distance measured in m during the 6-min Walk Test. Nine studies of treadmill training comprising 977 participants were included. Treadmill training resulted in faster walking than no intervention/non-walking intervention immediately after the intervention period (MD 0.14m/s, 95% CI 0.09 to 0.19) and this was maintained beyond the intervention period (MD -0.12m/s, 95% CI 0.08 to 0.17). It also resulted in greater walking distance immediately after the intervention period (MD 40m, 95% CI 27 to 53) and this was also maintained beyond the intervention period (MD 40m, 95% CI 24 to 55). There was no immediate, statistically significant difference between treadmill training and overground training in terms of walking speed (MD 0.05m/s, 95% CI 0.12 to 0.21) or distance (MD -6m, 95% CI -45 to 33). This systematic review provides evidence that, for people with stroke who can walk, treadmill training without body weight support results in faster walking speed and greater distance than no intervention/ non-walking intervention and the benefit is maintained beyond the training period.

To evaluate the effects of different instructions for the assessment of maximum walking speed during the ten-meter walking test with chronic stroke subjects. Participants were instructed to walk under four experimental conditions: (1) comfortable speed, (2) maximum speed (simple verbal command), (3) maximum speed (modified verbal command--"catch a bus") and (4) maximum speed (verbal command + demonstration). Participants walked three times in each condition and the mean time to cover the intermediate 10 meters of a 14-meter corridor was registered to calculate the gait speed (m/s). Repeated-measures ANOVAs, followed by planned contrasts, were employed to investigate differences between the conditions (α=5%). Means, standard deviations and 95% confidence intervals (CI) were calculated. The mean values for the four conditions were: (1) 0.74m/s; (2) 0.85 m/s; (3) 0.93 m/s; (4) 0.92 m/s, respectively, with significant differences between the conditions (F=40.9; p<0.001). Comfortable speed was significantly slower than the maximum speed, indicating that the participants were able to increase speeds when required. Significant differences were observed between the second condition with the third (p=0.002; 95%CI=-0.13 to -0.03) and the fourth conditions (p=0.004; 95%CI=-0.12 to -0.02) with no differences between the third and fourth conditions (p=1.00; 95%CI=-0.04 to 0.05). The results indicated that simple verbal commands were not sufficient to capture maximum gait speed with chronic stroke subjects. Thus, for clinical assessments and research purposes, where measurements of the maximum gait speed are necessary, modified verbal commands or demonstration strategies could be employed by physical therapists to ensure accurate information.

Objective: To investigate the usefulness and performance metrics of three freely-available softwares (Rayyan®, Abstrackr® and Colandr®) for title screening in systematic reviews. Study design and setting: In this methodological study, the usefulness of softwares to screen titles in systematic reviews was investigated by the comparison between the number of titles identified by software-assisted screening and those by manual screening using a previously published systematic review. To test the performance metrics, sensitivity, specificity, false negative rate, proportion missed, workload and timing savings were calculated. A purposely built survey was used to evaluate the rater's experiences regarding the softwares’ performances. Results: Rayyan® was the most sensitive software and raters correctly identified 78% of the true positives. All three softwares were specific and raters correctly identified 99% of the true negatives. They also had similar values for precision, proportion missed, workload and timing savings. Rayyan®, Abstrackr® and Colandr® had 21%, 39% and 34% of false negatives rates, respectively. Rayyan presented the best performance (35/40) according to the raters. Conclusion: Rayyan®, Abstrackr® and Colandr® are useful tools and provided good metric performance results for systematic title screening. Rayyan® appears to be the best ranked on the quantitative and on the raters’ perspective evaluation. The most important finding of this study is that the use of software to screen titles does not remove any title that would meet the inclusion criteria for the final review, being valuable resources to facilitate the screening process.

Does electrical stimulation increase strength after stroke and are any benefits maintained beyond the intervention period or carried over to activity? Systematic review with meta-analysis of randomised or controlled trials. Adults who have had a stroke. Cyclical electrical stimulation applied in order to increase muscle strength. Strength measures had to be representative of maximum voluntary contraction and were obtained as continuous measures of force or torque, or ordinal measures such as manual muscle tests. Activity was measured using direct measures of performance that produced continuous or ordinal data, or with scales that produced ordinal data. Sixteen trials representing 17 relevant comparisons were included in this systematic review. Effect sizes were calculated as standardised mean differences because various muscles were studied and different outcome measures were used. Overall, electrical stimulation increased strength by a standardised mean difference (SMD) of 0.47 (95% CI 0.26 to 0.68) and this effect was maintained beyond the intervention period (SMD 0.33, 95% CI 0.07 to 0.60). Electrical stimulation also improved activity (SMD 0.30, 95% CI 0.05 to 0.56) and this effect was also maintained beyond the intervention period (SMD 0.38, 95% CI 0.09 to 0.66). Cyclical electrical stimulation increases strength and improves activity after stroke. These benefits were maintained beyond the intervention period with a small-to-moderate effect size. The sustained effect on activity suggests that the benefits were incorporated into daily life. Review registration: PROSPERO (CRD42013003895).