Structure and feasibility of extra practice during stroke rehabilitation: A systematic scoping review

Background/aim: Improved motor performance is related to the amount of practice completed after a stroke. Australian guidelines recommend that at least one hour of active practice should be completed per day. Yet active practice levels remain low. The aims of this scoping review were to describe how extra practice at the activity level is structured for stroke survivors, and explore the feasibility of participants completing extra practice. Methods: A systematic search was conducted of five electronic databases up to August 2015. Trials were included when the intended dose of the control intervention was less than the experimental intervention. The structure of extra practice was classified by the level of supervision, type of personnel, and whether equipment was used. Feasibility of practice was explored by comparing the intended and actual dose of practice completed. Results: Thirty‐five trials, comprising 40 comparisons were included. Multiple configurations of personnel, supervision and equipment were used to structure extra practice. The structure most often used was full supervision by staff without equipment (30 comparisons), typically involving a therapist (17 comparisons), with equipment being used occasionally (12 comparisons). Sixteen comparisons reported both the intended and the actual dose of extra practice completed. The mean percentage of actual extra practice completed was 80% (SD 18) of the intended dose. Conclusions: Extra practice during rehabilitation after stroke is most often structured using full supervision by a therapist, and appears feasible for stroke survivors to complete. Less often, extra practice is structured using equipment, non‐therapists and/or group classes.