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Limited evidence of physical therapy on balance after stroke: A systematic review and meta-analysis

Author

Listed:
  • Aurélien Hugues
  • Julie Di Marco
  • Shams Ribault
  • Hugo Ardaillon
  • Perrine Janiaud
  • Yufeng Xue
  • Jin Zhu
  • Jennifer Pires
  • Hooman Khademi
  • Laura Rubio
  • Paloma Hernandez Bernal
  • Yeliz Bahar
  • Hadrien Charvat
  • Pawel Szulc
  • Carolina Ciumas
  • Heiwon Won
  • Michel Cucherat
  • Isabelle Bonan
  • François Gueyffier
  • Gilles Rode

Abstract

Background: Stroke results in balance disorders and these directly affect autonomy and quality of life. The purpose of this systematic review and meta-analysis was to determine the efficacy of physical therapy (PT) on balance and postural control after stroke. Methods: We included all randomized controlled trials assessing the efficacy of PT on balance and postural control in adult patients after stroke without language restriction. Medline, Embase/Scopus, Cochrane Central Register of Controlled Trials, PEDro, Pascal, and Francis databases were searched until January 2019. Primary outcomes were balance (Berg Balance scale and Postural Assessment Scale for Stroke) and postural control with postural deviation or stability measurement in sitting or standing static evaluation. A pair of independent reviewers selected studies, extracted data, and assessed risk of bias. Meta-analyses with subgroups (categories of PT, time post-stroke, and lesion location) and meta-regression (duration of PT) were conducted. Results: A total of 145 studies (n = 5912) were selected from the 13,123 records identified. For balance, evidence was found in favor of the efficacy of functional task-training alone (standardized mean difference 0.39, 95% confidence interval [0.09; 0.68], heterogeneity I2 = 63%) or associated with musculoskeletal intervention and/or cardiopulmonary intervention (0.37, [0.19; 0.55], I2 = 48%), electrostimulation (0.91, [0.49; 1.34], I2 = 52%) immediately after intervention, compared to sham treatment or usual care (ST/UC). For postural deviation eyes open, assistive devices were more effective than no treatment (-0.21, [-0.37; -0.05], I2 = 0%) immediately after intervention; for postural stability eyes open, functional task-training and sensory interventions were more effective than ST/UC (0.97, [0.35; 1.59], I2 = 65% and 0.80, [0.46; 1.13], I2 = 37% respectively) immediately after intervention. Conclusions: Functional task-training associated with musculoskeletal intervention and/or cardiopulmonary intervention and sensory interventions seem to be immediately effective in improving balance and postural stability, respectively. The heterogeneity of PT and the weak methodological quality of studies limited the interpretation and the confidence in findings.

Suggested Citation

  • Aurélien Hugues & Julie Di Marco & Shams Ribault & Hugo Ardaillon & Perrine Janiaud & Yufeng Xue & Jin Zhu & Jennifer Pires & Hooman Khademi & Laura Rubio & Paloma Hernandez Bernal & Yeliz Bahar & Had, 2019. "Limited evidence of physical therapy on balance after stroke: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-22, August.
    • Handle: RePEc:plo:pone00:0221700
    DOI: 10.1371/journal.pone.0221700
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    References listed on IDEAS

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    1. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
    2. Janne Marieke Veerbeek & Erwin van Wegen & Roland van Peppen & Philip Jan van der Wees & Erik Hendriks & Marc Rietberg & Gert Kwakkel, 2014. "What Is the Evidence for Physical Therapy Poststroke? A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 9(2), pages 1-1, February.
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    1. Rosa Cabanas-Valdés & Lídia Boix-Sala & Montserrat Grau-Pellicer & Juan Antonio Guzmán-Bernal & Fernanda Maria Caballero-Gómez & Gerard Urrútia, 2021. "The Effectiveness of Additional Core Stability Exercises in Improving Dynamic Sitting Balance, Gait and Functional Rehabilitation for Subacute Stroke Patients (CORE-Trial): Study Protocol for a Random," IJERPH, MDPI, vol. 18(12), pages 1-17, June.
    2. Ana Mallo-López & Pilar Fernández-González & Patricia Sánchez-Herrera-Baeza & Alicia Cuesta-Gómez & Francisco Molina-Rueda & Ángela Aguilera-Rubio, 2022. "The Use of Portable Devices for the Instrumental Assessment of Balance in Patients with Chronic Stroke: A Systematic Review," IJERPH, MDPI, vol. 19(17), pages 1-12, September.

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