Effects of reciprocal pedalling exercise on motor function after stroke: A systematic review

Objective: To determine whether there is sufficient research evidence to justify using pedalling to enhance lower-limb motor recovery after stroke. Data Sources: Electronic search of MEDLINE, CINAHL, EMBASE, Pedro, PsychINFO, and relevant Cochrane databases. Lead authors were contacted and reference lists of included papers hand-searched. Study Selections: The review scoping exercise revealed a lack of randomized studies, hence the search did not restrict by study design. The first author and reviewer independently identified papers meeting predefined inclusion criteria. Data Extraction: Data were extracted from outcomes of motor function. Data synthesis was qualitative with reference to potential risk of bias, and outcomes were categorized within the International Classification of Functioning, Disability and Health framework. Data Synthesis: From 1341 titles, 34 full texts were reviewed and 11 studies selected for inclusion. The included studies were heterogeneous across domains including participant characteristics, outcome measures, equipment used, and dose and timing of intervention—meta analysis was not therefore indicated. The risk of bias was assessed as predominantly low but with frequent lack of clarity in reporting of key elements. Studies were generally exploratory with participant numbers ranging from n=1 to n=100. Outcomes were predominantly of body structure/function and activity. Doses ranged from reporting of a single session, to 30 sessions over 12 weeks. A wide variety of equipment was used to produce pedaling movement, including leg cycle ergometers, semi-recumbent devices, and upright cycles. Conclusions: The current evidence is of insufficient quality to justify pedaling as a rehabilitation intervention after stroke. Further controlled trials of standardized pedaling interventions are required before clinical recommendations can be made.