Table 4: Summary of randomized control trial data in this review on longitudinal participation outcomes after stroke.

AuthorYearCountrySettingInterventionAge (yr) mean (SD), median (IQR)Sex (% male)Time poststroke (months) mean (SD) or median [range]Association on participation

Bertilsson et al. [49]2016SwedenInpatient and communityClient-centred ADL intervention specifically guided by client needs and expressed desires, focused on enabling the person with stroke to become an active agent in daily activities and participation in everyday life, and the caregivers were invited to participate in rehabilitation as much as they wanted.Client-centred 74.1 (9.5), usual 71.3 (10.1)Client-centred 53%, usual care 62%Not describedThere was no significant difference between those receiving client-centred ADL intervention and usual care in terms of participation at 12 months.
Combs-Miller et al. [53]2014USAResearch laboratory and communityComparison of two types of walking training: body weight-supported and overground.Body weight-supported 56.20 (7.61), overground walking 65.50 (6.17)Body weight-supported 40%, overground walking 70%Body weight-supported 62.3 (48.6), overground walking 60.0 (51.7)No evidence found to support this type of intervention (body weight-supported or overground walking training) on improving participation.
Desrosiers et al. [56]2007CanadaCommunityLeisure education program at home once a week for 8–12 weeks. Control participants () were visited at home at a similar frequency.Intervention 61 (5), control 60 (5)Intervention 16 (57.1), control 12 (42.9)Months: experimental 24.5 (25.7), control 32.7 (37.8)Some evidence to support the use of this leisure education program for improving the number of minutes of leisure and number of leisure activities participated in compared to control group.
Flansbjer et al. [62]2008SwedenCommunityProgressive resistance training on muscle strength, muscle tone, gait performance, and perceived participation after stroke.Intervention 61 (5), control 60 (5)Intervention 60%, control 56%Baseline: intervention 18.9 (7.9), control 20 (11.6)Some evidence to support this type of intervention (supervised progressive resistance training of the knee extensors and flexors) compared to usual care on improving participation after the intervention and maintained at 5 months.
Guidetti et al. [64]2015SwedenCommunityThe CADL intervention was conducted within a client-centred context. The UADL interventions varied in extent and methods according to the knowledge and clinical experience of the individual OT and according to the routines and praxis of the participating rehabilitation units.CADL 74 (10), UADL 71 (11)CADL 57%, UADL 63%CADL 25 [6–96], UADL 28 [3–115]There were no differences between the groups regarding changes in perceived participation, independence in ADL, or life satisfaction during the first 12 months. There was a trend towards a clinically meaningful positive change in perceived participation that favoured client-centred ADL intervention. Good design.
Kluding et al. [71]2013USACommunityStandard treatment versus electric stimulation therapy to improve foot drop.Interventions 60.7 (12.2), control 61.6 (11.0)Intervention 56.8%, control 43.2%Intervention 4.8 (5.3) yrs, control 4.3 (4.1) yrsNo difference in participation between the intervention of 30 weeks of either foot drop stimulator or a standard ankle foot orthosis.
Kootker et al. [72]2017NetherlandsCommunityIndividually tailored CBT for reducing depressive symptoms.CBT 61 (45–79), CCT 61 (25–76)CBT 61.3%, CCT 63.3%CBT 26 [2–243], CCT 21.5 [2–138]Some evidence to support the use of both CBT and CCT to improve participation at this level of intervention.
Kutner et al. [73]2010USAInpatient and communityThis preliminary study explored change in patient-reported, health-related quality of life associated with robotic-assisted therapy combined with reduced therapist-supervised training. Sixty hours of therapist-supervised repetitive task practice (RTP) was compared with 30 hours of RTP combined with 30 hours of robotic-assisted therapy.RTP 51.0 (11.3), combined therapy group 61.9 (13.4)Total 59%, RTP 71%, combined therapy group 50%Total days 234.4 (121.8), RTP days 184.1 (126.5), combined therapy group days 269.6 (111.1)Significant differences in participation pre- and postintervention for RTP group at 2 months follow-up but not for combined therapy group.
Lund et al. [78]2011NorwayCommunityA lifestyle course in combination with physical activity (intervention group) compared with physical activity alone (control group). Both programmes were held once a week for nine months.Intervention 75 (7.2), control 79 (6.5)Intervention, control 43%Intervention 161 (178) days, control 137 (124) daysNo statistically significant differences between the groups at the nine-month follow-up.
Mayo et al. [82]2013CanadaCommunityTwo dose-equivalent interventions, one involving stationary cycling and the other disability-targeted intervention, were tested. Both protocols required daily moderate intensity exercise at home building up to 30 minutes per day. One group exercised on a stationary bicycle; the second group carried out mobility exercises and brisk walking. An observer-blinded, randomized, pragmatic, trial with repeated measures. At baseline and after 1, 6, and 12 months of exercise and home-based assessments at 3 and 9 months.Cycle 67.7 (14.4), exercise 67.8 (12.3)Cycle 80%, exercise 59%Cycle days 265.4 (131.8), exercise days 252.0 (165.3)A significant effect for role participation was found in the exercise group for cycling versus exercise.
Pang et al. [86]2005CanadaCommunity19 weeks (1-hour sessions, 3 sessions per week). Intervention included the Fitness and Mobility Exercise (FAME) program 10 minutes initially, with increment of 5 minutes every week, up to 30 minutes of continuous exercise as tolerated.Intervention group 65.8 (9.1), control 64.7 (8.4)79%Intervention yrs 5.2 (5.0), control yrs 5.1 (3.6)There was no significant time × group interaction on participation.
Parker et al. [87]2001United KingdomCommunityOccupational therapy interventions at home for up to six months after recruitment, minimum of 10 sessions lasting not less than 30 minutes each. The treatment goals set in the ADL group were in terms of improving independence in self-care tasks, and therefore, treatment involved practicing these tasks (such as preparing a meal or walking outdoors). For the leisure group, goals were set in terms of leisure activity, and so, interventions included practicing the leisure tasks as well as any ADL tasks necessary to achieve the leisure objective.Leisure 72 (65–79), ADL 71 (66–78), control 72 (65–78)Leisure 58%, ADL 62%, control 54%Not describedAt six months and compared to the control group, those allocated to leisure therapy had nonsignificantly better leisure participation scores. Those allocated to the ADL group had nonsignificantly worse leisure scores compared to controls. The results were similar at 12 months.
Rochette et al. [91]2013CanadaCommunityYOU CALL participants were provided with the name and phone number of a trained healthcare professional whom they were free to contact should they feel the need. WE CALL participants received a multimodal support intervention including new or ongoing issues, family functioning, and individualized risk factors. Call frequency was weekly for the first 2 months, biweekly during the third month, and monthly for the past 3 months and included support material and referrals as needed.YOU CALL 63.2 (12.4), WE CALL 61.7 (12.7)YOU CALL 53.2%, WE CALL 62%Not describedNo significant differences were seen between groups at 6 months. Significant improvements in social participation for both groups from 6 to 1 year. No significance between group differences.
Sabariego et al. [92]2013GermanyInpatient and communityICF-based patient-education programme. The programme was performed by a psychologist in 1-hr sessions over 5 days. The group size was four participants, and it was a closed group.Intervention 55.3 (12.6), control 59.3 (12.7)Intervention 63%, control 45%Intervention days 151.1 (399.3), control days 149.5 (634.7)Participation improved for both groups, but no between-group difference was found. Large study, good design. Exploratory post hoc model identified life satisfaction, self-efficacy, memory, and mood as significant factors for change with SIS-P as dependent variable.
Sandberg et al. [93]2016SwedenCommunitySixty minutes of group aerobic exercise, including 2 sets of 8 minutes of exercise with intensity up to exertion level 14 or 15 of 20 on the Borg rating of perceived exertion scale, twice weekly for 12 weeks.Intervention 71.3 (7.0), control 70.4 (8.1)50%Intervention days 4.9 (5.8), control days 6.3 (7.3)Significant change in SIS-P from preintervention to postintervention (aerobic exercise versus no therapy); also, significant time effect within groups but nonsignificant group × time effect and nonsignificant between-subjects’ effects.
Studenski et al. [97]2005USACommunityThe 36-session, 12-week, home-based exercise program, supervised by an occupational or physical therapist, targeted strength (major muscle groups of the upper and lower extremity using elastic bands and body weight), balance, and endurance (using an exercise bicycle) and encouraged use of the affected upper extremity. There were structured protocols for the exercise tasks, criteria for progression, and guidelines for reintroducing therapy after intercurrent illness. After completing the intervention, participants received written guidelines for continued exercise.Intervention 68.5 (9.0), usual care 70.4 (11.3)53%Intervention days 77.5 (28.7), usual care days 74.1 (27.2)Support for this intervention (home-based exercise program) compared to usual care immediately after the intervention but not at 6-month follow-up.
Tielemans et al. [99]2015NetherlandsCommunityThe 10-week self-management intervention consisted of 7 sessions, 6 × 2 h sessions in the first 6 weeks and 1 × 2 h booster session in week 10. It was provided to groups of 4–8 participants by 2 rehabilitation professionals (e.g., psychologist or occupational therapist) at hospitals and rehabilitation centre outpatient facilities. The intervention aimed to teach proactive action planning strategies within 4 themes: “handling negative emotions,” “social relations and support,” “participation in society,” and “less visible stroke consequences.” The 10-week education intervention consisted of 3 × 1 h sessions in the first 6 weeks and 1 × 1 h booster session in week 10. It was provided in groups of 4–8 participants by one rehabilitation professional at hospital and rehabilitation centre outpatient facilities.Self-management 55.2 (8.9), education 58.8 (8.7)Self-management 54.8%, education 60%Self-management 15.6 (20.9), education 21.9 (34.1)No significant differences between self-management and education intervention, on either primary or secondary outcome measures, but there were trends towards a difference in participation restriction at follow-up.

Note. ADL: activity of daily living; CBT: client-centred therapy; CBT: cognitive behavioral therapy; ICF: International Classification of Functioning, Disability and Health; RTP: repetitive task practice.