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Aerobic Exercise- subacute

Canadian Best Practices

Recommendations

  • Following appropriate medical evaluation, patients should participate regularly in an aerobic exercise program that takes into consideration the patient’s co-morbidities and functional limitations, to improve gait speed, endurance, stroke risk factor profile, mood and possibly cognitive abilities [Evidence Levels: Early-Level B; Late-Level B]. (1)
  • Stroke survivors should be provided with a cardiovascular fitness program to maximize functional outcomes after stroke (and as part of overall vascular risk reduction). Patients should be prescribed modified activities to allow age appropriate target heart rates to be achieved for 20 to 30 minutes three times per week [Evidence Level B]. (1)
  • The Evidence-based Review of Stroke Rehabilitation (EBRSR) examined the evidence related to cardiovascular and aerobic exercise following stroke and concluded that there was strong evidence to suggest that, "while cardiovascular training post-stroke improves level of physical fitness and gait performance, it does not result in additional improvements in activities of daily living performance" (2)
  • A systematic review of seven RCTs investigated the effect of exercise for patients in the acute, sub-acute and chronic stages post-stroke. The findings from this review suggested a significant benefit of exercise therapy regardless of the phase of recovery after stroke (3)

Sources

  1. Lindsay MP, Gubitz G, Bayley M, Hill MD, Davies-Schinkel C, Singh S, and Phillips S. Canadian Best Practice Recommendations for Stroke Care (Update 2010). On behalf of the Canadian Stroke Strategy Best Practices and Standards Writing Group. 2010; Ottawa, Ontario Canada: Canadian Stroke Network.
  2. Teasell R, Foley NC, Salter K et al. EBRSR: evidence-based review of stroke rehabilitation. 10th ed. London (ON): EBRSR; 2007.
  3. Pang MY, Eng JJ, Dawson AS, et al. The use of aerobic exercise training in improving aerobic capacity in individuals with stroke: a meta-analysis. Clin Rehabil 2006; 20-97-111.
  4. Teasell R, Foley NC, Salter K et al. EBRSR: evidence-based review of stroke rehabilitation. 10th ed. London (ON): EBRSR; 2007.

  5. Pang MY, Eng JJ, Dawson AS, et al. The use of aerobic exercise training in improving aerobic capacity in individuals with stroke: a meta-analysis. Clin Rehabil 2006; 20-97-111.

     

 

1a (Strong) Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings
1b(Moderate) 1 RCT of high quality (PEDro ≥ 6)
2a (Limited) At least 1 fair quality RCT (PEDro = 4-5)
2b (Limited) At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.)
3(Consensus) Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results
4 (Conflicting) Conflicting evidence of 2 or more equally well-designed studies
5 (No evidence) No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines)

 

Blood oxygen level.

1a (Strong) Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings
1b(Moderate) 1 RCT of high quality (PEDro ≥ 6)
2a (Limited) At least 1 fair quality RCT (PEDro = 4-5)
2b (Limited) At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.)
3(Consensus) Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results
4 (Conflicting) Conflicting evidence of 2 or more equally well-designed studies
5 (No evidence) No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines)

1a (Strong) Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings
1b(Moderate) 1 RCT of high quality (PEDro ≥ 6)
2a (Limited) At least 1 fair quality RCT (PEDro = 4-5)
2b (Limited) At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.)
3(Consensus) Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results
4 (Conflicting) Conflicting evidence of 2 or more equally well-designed studies
5 (No evidence) No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines)

 

1a (Strong) Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings
1b(Moderate) 1 RCT of high quality (PEDro ≥ 6)
2a (Limited) At least 1 fair quality RCT (PEDro = 4-5)
2b (Limited) At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.)
3(Consensus) Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results
4 (Conflicting) Conflicting evidence of 2 or more equally well-designed studies
5 (No evidence) No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines)

 

*high quality = PEDro score 6-10

*fair quality = PEDro score 4-5

*poor quality = PEDro score ≤ 3

The PEDro scale was developed by the Physiotherapy Evidence Database to determine the quality of clinical trials. The PEDro scale consists of a checklist of 10 scored yes-or-no questions pertaining to the internal validity and the statistical information provided. Please click on the link for more information: http://www.pedro.org.au/english/downloads/pedro-scale/

*high quality = PEDro score 6-10

*fair quality = PEDro score 4-5

*poor quality = PEDro score ≤ 3

The PEDro scale was developed by the Physiotherapy Evidence Database to determine the quality of clinical trials. The PEDro scale consists of a checklist of 10 scored yes-or-no questions pertaining to the internal validity and the statistical information provided. Please click on the link for more information: http://www.pedro.org.au/english/downloads/pedro-scale/

A randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.

Patients between 1-6 months post-stroke are identified as in sub-acute stage of recovery.

*high quality = PEDro score 6-10

*fair quality = PEDro score 4-5

*poor quality = PEDro score ≤ 3

The PEDro scale was developed by the Physiotherapy Evidence Database to determine the quality of clinical trials. The PEDro scale consists of a checklist of 10 scored yes-or-no questions pertaining to the internal validity and the statistical information provided. Please click on the link for more information: http://www.pedro.org.au/english/downloads/pedro-scale/

*high quality = PEDro score 6-10

*fair quality = PEDro score 4-5

*poor quality = PEDro score ≤ 3

The PEDro scale was developed by the Physiotherapy Evidence Database to determine the quality of clinical trials. The PEDro scale consists of a checklist of 10 scored yes-or-no questions pertaining to the internal validity and the statistical information provided. Please click on the link for more information: http://www.pedro.org.au/english/downloads/pedro-scale/

A randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.

Patients between 1-6 months post-stroke are identified as in sub-acute stage of recovery.

*high quality = PEDro score 6-10

*fair quality = PEDro score 4-5

*poor quality = PEDro score ≤ 3

The PEDro scale was developed by the Physiotherapy Evidence Database to determine the quality of clinical trials. The PEDro scale consists of a checklist of 10 scored yes-or-no questions pertaining to the internal validity and the statistical information provided. Please click on the link for more information: http://www.pedro.org.au/english/downloads/pedro-scale/

A randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.

Patients between 1-6 months post-stroke are identified as in sub-acute stage of recovery.

*high quality = PEDro score 6-10

*fair quality = PEDro score 4-5

*poor quality = PEDro score ≤ 3

The PEDro scale was developed by the Physiotherapy Evidence Database to determine the quality of clinical trials. The PEDro scale consists of a checklist of 10 scored yes-or-no questions pertaining to the internal validity and the statistical information provided. Please click on the link for more information: http://www.pedro.org.au/english/downloads/pedro-scale/

A randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.

Patients between 1-6 months post-stroke are identified as in sub-acute stage of recovery.

*high quality = PEDro score 6-10

*fair quality = PEDro score 4-5

*poor quality = PEDro score ≤ 3

The PEDro scale was developed by the Physiotherapy Evidence Database to determine the quality of clinical trials. The PEDro scale consists of a checklist of 10 scored yes-or-no questions pertaining to the internal validity and the statistical information provided. Please click on the link for more information: http://www.pedro.org.au/english/downloads/pedro-scale/

A randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.

Patients between 1-6 months post-stroke are identified as in sub-acute stage of recovery.

*high quality = PEDro score 6-10

*fair quality = PEDro score 4-5

*poor quality = PEDro score ≤ 3

The PEDro scale was developed by the Physiotherapy Evidence Database to determine the quality of clinical trials. The PEDro scale consists of a checklist of 10 scored yes-or-no questions pertaining to the internal validity and the statistical information provided. Please click on the link for more information: http://www.pedro.org.au/english/downloads/pedro-scale/

*high quality = PEDro score 6-10

*fair quality = PEDro score 4-5

*poor quality = PEDro score ≤ 3

The PEDro scale was developed by the Physiotherapy Evidence Database to determine the quality of clinical trials. The PEDro scale consists of a checklist of 10 scored yes-or-no questions pertaining to the internal validity and the statistical information provided. Please click on the link for more information: http://www.pedro.org.au/english/downloads/pedro-scale/

A randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.

Patients between 1-6 months post-stroke are identified as in sub-acute stage of recovery.

*high quality = PEDro score 6-10

*fair quality = PEDro score 4-5

*poor quality = PEDro score ≤ 3

The PEDro scale was developed by the Physiotherapy Evidence Database to determine the quality of clinical trials. The PEDro scale consists of a checklist of 10 scored yes-or-no questions pertaining to the internal validity and the statistical information provided. Please click on the link for more information: http://www.pedro.org.au/english/downloads/pedro-scale/

A randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.

Patients between 1-6 months post-stroke are identified as in sub-acute stage of recovery.

*high quality = PEDro score 6-10

*fair quality = PEDro score 4-5

*poor quality = PEDro score ≤ 3

The PEDro scale was developed by the Physiotherapy Evidence Database to determine the quality of clinical trials. The PEDro scale consists of a checklist of 10 scored yes-or-no questions pertaining to the internal validity and the statistical information provided. Please click on the link for more information: http://www.pedro.org.au/english/downloads/pedro-scale/

*high quality = PEDro score 6-10

*fair quality = PEDro score 4-5

*poor quality = PEDro score ≤ 3

The PEDro scale was developed by the Physiotherapy Evidence Database to determine the quality of clinical trials. The PEDro scale consists of a checklist of 10 scored yes-or-no questions pertaining to the internal validity and the statistical information provided. Please click on the link for more information: http://www.pedro.org.au/english/downloads/pedro-scale/

A randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.

Patients between 1-6 months post-stroke are identified as in sub-acute stage of recovery.

 

*high quality = PEDro score 6-10

*fair quality = PEDro score 4-5

*poor quality = PEDro score ≤ 3

The PEDro scale was developed by the Physiotherapy Evidence Database to determine the quality of clinical trials. The PEDro scale consists of a checklist of 10 scored yes-or-no questions pertaining to the internal validity and the statistical information provided. Please click on the link for more information: http://www.pedro.org.au/english/downloads/pedro-scale/

A randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.

Patients between 1-6 months post-stroke are identified as in sub-acute stage of recovery.

*high quality = PEDro score 6-10

*fair quality = PEDro score 4-5

*poor quality = PEDro score ≤ 3

The PEDro scale was developed by the Physiotherapy Evidence Database to determine the quality of clinical trials. The PEDro scale consists of a checklist of 10 scored yes-or-no questions pertaining to the internal validity and the statistical information provided. Please click on the link for more information: http://www.pedro.org.au/english/downloads/pedro-scale/

A randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.

Patients between 1-6 months post-stroke are identified as in sub-acute stage of recovery.

*high quality = PEDro score 6-10

*fair quality = PEDro score 4-5

*poor quality = PEDro score ≤ 3

The PEDro scale was developed by the Physiotherapy Evidence Database to determine the quality of clinical trials. The PEDro scale consists of a checklist of 10 scored yes-or-no questions pertaining to the internal validity and the statistical information provided. Please click on the link for more information: http://www.pedro.org.au/english/downloads/pedro-scale/

A randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.

Patients between 1-6 months post-stroke are identified as in sub-acute stage of recovery.

*high quality = PEDro score 6-10

*fair quality = PEDro score 4-5

*poor quality = PEDro score ≤ 3

The PEDro scale was developed by the Physiotherapy Evidence Database to determine the quality of clinical trials. The PEDro scale consists of a checklist of 10 scored yes-or-no questions pertaining to the internal validity and the statistical information provided. Please click on the link for more information: http://www.pedro.org.au/english/downloads/pedro-scale/

A randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.

Patients between 1-6 months post-stroke are identified as in sub-acute stage of recovery.

1a (Strong) Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings
1b(Moderate) 1 RCT of high quality (PEDro ≥ 6)
2a (Limited) At least 1 fair quality RCT (PEDro = 4-5)
2b (Limited) At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.)
3(Consensus) Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results
4 (Conflicting) Conflicting evidence of 2 or more equally well-designed studies
5 (No evidence) No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines)

1a (Strong) Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings
1b(Moderate) 1 RCT of high quality (PEDro ≥ 6)
2a (Limited) At least 1 fair quality RCT (PEDro = 4-5)
2b (Limited) At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.)
3(Consensus) Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results
4 (Conflicting) Conflicting evidence of 2 or more equally well-designed studies
5 (No evidence) No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines)

1a (Strong) Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings
1b(Moderate) 1 RCT of high quality (PEDro ≥ 6)
2a (Limited) At least 1 fair quality RCT (PEDro = 4-5)
2b (Limited) At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.)
3(Consensus) Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results
4 (Conflicting) Conflicting evidence of 2 or more equally well-designed studies
5 (No evidence) No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines)

1a (Strong) Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings
1b(Moderate) 1 RCT of high quality (PEDro ≥ 6)
2a (Limited) At least 1 fair quality RCT (PEDro = 4-5)
2b (Limited) At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.)
3(Consensus) Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results
4 (Conflicting) Conflicting evidence of 2 or more equally well-designed studies
5 (No evidence) No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines)

1a (Strong) Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings
1b(Moderate) 1 RCT of high quality (PEDro ≥ 6)
2a (Limited) At least 1 fair quality RCT (PEDro = 4-5)
2b (Limited) At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.)
3(Consensus) Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results
4 (Conflicting) Conflicting evidence of 2 or more equally well-designed studies
5 (No evidence) No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines)

1a (Strong) Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings
1b(Moderate) 1 RCT of high quality (PEDro ≥ 6)
2a (Limited) At least 1 fair quality RCT (PEDro = 4-5)
2b (Limited) At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.)
3(Consensus) Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results
4 (Conflicting) Conflicting evidence of 2 or more equally well-designed studies
5 (No evidence) No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines)

1a (Strong) Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings
1b(Moderate) 1 RCT of high quality (PEDro ≥ 6)
2a (Limited) At least 1 fair quality RCT (PEDro = 4-5)
2b (Limited) At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.)
3(Consensus) Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results
4 (Conflicting) Conflicting evidence of 2 or more equally well-designed studies
5 (No evidence) No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines)

1a (Strong) Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings
1b(Moderate) 1 RCT of high quality (PEDro ≥ 6)
2a (Limited) At least 1 fair quality RCT (PEDro = 4-5)
2b (Limited) At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.)
3(Consensus) Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results
4 (Conflicting) Conflicting evidence of 2 or more equally well-designed studies
5 (No evidence) No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines)

1a (Strong) Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings
1b(Moderate) 1 RCT of high quality (PEDro ≥ 6)
2a (Limited) At least 1 fair quality RCT (PEDro = 4-5)
2b (Limited) At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.)
3(Consensus) Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results
4 (Conflicting) Conflicting evidence of 2 or more equally well-designed studies
5 (No evidence) No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines)

1a (Strong) Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings
1b(Moderate) 1 RCT of high quality (PEDro ≥ 6)
2a (Limited) At least 1 fair quality RCT (PEDro = 4-5)
2b (Limited) At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.)
3(Consensus) Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results
4 (Conflicting) Conflicting evidence of 2 or more equally well-designed studies
5 (No evidence) No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines)

1a (Strong) Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings
1b(Moderate) 1 RCT of high quality (PEDro ≥ 6)
2a (Limited) At least 1 fair quality RCT (PEDro = 4-5)
2b (Limited) At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.)
3(Consensus) Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results
4 (Conflicting) Conflicting evidence of 2 or more equally well-designed studies
5 (No evidence) No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines)

1a (Strong) Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings
1b(Moderate) 1 RCT of high quality (PEDro ≥ 6)
2a (Limited) At least 1 fair quality RCT (PEDro = 4-5)
2b (Limited) At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.)
3(Consensus) Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results
4 (Conflicting) Conflicting evidence of 2 or more equally well-designed studies
5 (No evidence) No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines)

1a (Strong) Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings
1b(Moderate) 1 RCT of high quality (PEDro ≥ 6)
2a (Limited) At least 1 fair quality RCT (PEDro = 4-5)
2b (Limited) At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.)
3(Consensus) Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results
4 (Conflicting) Conflicting evidence of 2 or more equally well-designed studies
5 (No evidence) No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines)