Intensity of task-specific training for functional ability post-stroke: Systematic review and meta-analysis

Abstract

Objectives

To evaluate the effectiveness of intensities of task-specific training on upper and lower limbs functions, balance, and quality of life post-stroke.

Data sources

Six electronic databases (Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsycINFO, and Clinical trials.gov registries) were searched up to 19 April 2025.

Review methods

We selected randomized controlled trials with at least one group involving an active repetitive motor sequence. Using an online systematic review application (Covidence), two reviewers screened the studies and extracted the data. Risk of bias was appraised using the standard Cochrane tool. Review Manager 5.4 was used for analysis.

Results

Twenty-six randomized controlled trials involving 1431 stroke survivors were included, with moderate to high risk of bias. Subgroup analyses across most outcomes (arm/hand function, lower limb function, balance, quality of life) showed no significant effects of task-specific training based on dosage variables (frequency, sessions, duration, and repetitions). Although some trends favored higher-dose task-specific training or control, only hand function improved significantly in studies with >20 sessions (SMD = 0.57, p = 0.02; I² = 69). A significant effect on arm function was seen with >50 repetitions (p = 0.001), but evidence quality was very low.

Conclusions

There is insufficient evidence to determine whether higher-intensity task-specific training leads to improved functional outcomes in stroke rehabilitation. Future well-designed trials are needed to explore optimal training intensities and their impact on recovery.

International prospective register of systematic reviews ID CRD42020130991.