Moving towards precision post-stroke rehabilitation: A systematic review and meta-analysis of wearable sensor-derived walking activities in daily living
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Background
Physical rehabilitation interventions can enhance functional capacity after stroke, but improved ability doesn’t always lead to better real-world performance. Understanding this gap is key to optimizing post-stroke recovery strategies.
Objectives
This research aimed to evaluate the effectiveness of physical rehabilitation interventions specifically exercise, behavior change techniques (BCTs), or their combination on real-world walking measured using wearable sensors and capacity (gait speed and walking endurance) outcomes in stroke survivors.
Methods
This systematic review and meta-analysis followed PRISMA guidelines. Comprehensive searches were conducted in Medline, Embase, CINAHL, and Scopus up to January 2025. Randomized controlled trials involving stroke survivors receiving physical rehabilitation interventions—exercise, BCTs, or both—compared to exercise-only or usual care were included. Outcomes assessed were daily steps, gait speed (comfortable and fastest), and endurance (6-minute walk test). Meta-analyses using random-effects models (STATA 18) reported standardized mean differences (SMDs) and 95% confidence intervals (CIs). Heterogeneity was evaluated using I² statistics.
Results
Of 1,782 references screened, 28 studies met the inclusion criteria, and 23 were included in meta-analyses comprising 2,327 participants. Exercise-only interventions produced a small but significant improvement in daily steps (SMD = 0.23; 95% CI: 0.03 to 0.44; I 2 = 36.6%; moderate certainty ), and moderate improvements in both comfortable gait speed (SMD = 0.38; 95% CI: 0.19 to 0.57; I 2 = 35.5%; moderate certainty ) and endurance (SMD = 0.39; 95% CI: 0.26 to 0.52; I 2 = 0%; moderate certainty ). BCT-only interventions demonstrated a larger effect on daily steps (SMD = 0.41; 95% CI: 0.19 to 0.63; I 2 = 0%; moderate certainty). In contrast, combined exercise and BCT interventions did not yield significant improvements in any outcomes and were supported by very low to low certainty of evidence.
Conclusion
Exercise-only interventions improve gait speed and endurance after stroke, with small gains in daily steps. BCT-only interventions yield greater improvements in daily walking activity. Combined interventions show limited added benefit.
Protocol registration
This study has been registered in PROSPERO (No. CRD42023411679)
