Smith James, Nagy Philip, Tod David, Holland Carol, Jarvis Hannah
Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom.
PLoS One. 2025 Jan 29;20(1):e0318567. doi: 10.1371/journal.pone.0318567. eCollection 2025.
Strokes are becoming more common, and with improving survival rates, the prevalence of stroke survivors has increased. Almost half of chronic stroke survivors are cognitively impaired, and healthcare services are struggling to manage these patients, leaving some feeling "abandoned". Several systematic reviews have investigated the effect of physical exercise and cognition-orientated interventions on post-stroke cognitive impairment, and have produced conflicting findings, making it difficult for clinicians and guideline producers to make evidence-based decisions. This overview of reviews aims to provide a comprehensive overview of systematic reviews investigating the effect of physical exercise and cognition-orientated interventions on post-stroke cognitive function, assess methodological quality and certainty of evidence, and identify sources of discordance between these reviews.
Eight databases-Embase, Medline, CINAHL, Psycinfo, SPORTDiscus, The Cochrane Database of Systematic reviews, Epistemonikos, and Scopus-plus grey literature sources will be searched. The eligibility criteria include systematic reviews of trials that included an adult stroke population and investigated physical exercise and/or cognition-orientated interventions. Only reviews that assessed at least one of the DSM-5 neurocognitive domains will be included. Screening, data extraction, and quality appraisal will be conducted by two independent reviewers. Methodological quality, certainty of evidence, and primary study overlap will be assessed using the AMSTAR-2, GRADE, and GROOVE tools, respectively. Interventions will be grouped into exercise, cognition-orientated, and combined interventions, and findings will be synthesised narratively. Heterogeneity assessment will be conducted to identify factors causing discordance between reviews.
The findings of this overview will allow decision makers to make evidence-based decisions, stratified by methodological quality and certainty of evidence. Heterogeneity assessment may identify factors causing discordance between systematic reviews, which could inform the design of future studies.
Registration: PROSPERO CRD42024534179.
中风正变得越来越常见，随着生存率的提高，中风幸存者的患病率也在上升。几乎一半的慢性中风幸存者存在认知障碍，而医疗服务机构在管理这些患者方面面临困难，导致一些患者感觉被“遗弃”。几项系统评价研究了体育锻炼和以认知为导向的干预措施对中风后认知障碍的影响，但结果相互矛盾，这使得临床医生和指南制定者难以做出基于证据的决策。本综述旨在全面概述系统评价，这些评价研究了体育锻炼和以认知为导向的干预措施对中风后认知功能的影响，评估方法学质量和证据的确定性，并确定这些评价之间不一致的来源。
将检索八个数据库——Embase、Medline、CINAHL、Psycinfo、SPORTDiscus、Cochrane系统评价数据库、Epistemonikos和Scopus——以及灰色文献来源。纳入标准包括对包含成年中风人群并研究体育锻炼和/或以认知为导向的干预措施的试验进行系统评价。仅纳入评估了DSM-5神经认知领域中至少一项的评价。筛选、数据提取和质量评估将由两名独立的评审员进行。将分别使用AMSTAR-2、GRADE和GROOVE工具评估方法学质量、证据的确定性和原始研究的重叠情况。干预措施将分为运动、以认知为导向和联合干预三类，并对结果进行叙述性综合。将进行异质性评估，以确定导致评价之间不一致 的因素。
本综述 的结果将使决策者能够根据方法学质量和证据的确定性进行分层，做出基于证据的决策。异质性评估可能会识别出导致系统评价之间不一致 的因素，这可为未来研究的设计提供参考。
注册编号：PROSPERO CRD42024534179。
