We aimed to explore clinical outcomes and examine the parameters associated with physical activity in people with DCA.
The PubMed, Cochrane Library, CHINAL, and PEDro databases were searched for relevant randomized controlled trials (RCTs). Data extraction, quality assessment, and heterogeneity analyses were conducted; the GRADE was used to assess the quality of evidence, and a meta-analysis was performed.The PubMed, Cochrane Library, CHINAL, and PEDro databases were searched for relevant randomized controlled trials (RCTs). Data extraction, quality assessment, and heterogeneity analyses were conducted; the GRADE was used to assess the quality of evidence, and a meta-analysis was performed.The PubMed, Cochrane Library, CHINAL, and PEDro databases were searched for relevant randomized controlled trials (RCTs). Data extraction, quality assessment, and heterogeneity analyses were conducted; the GRADE was used to assess the quality of evidence, and a meta-analysis was performed.
Eighteen RCTs that included 315 patients on the scale for assessment and rating of ataxia (SARA) were included. These RCTs showed a serious risk of bias (RoB) and low certainty of evidence for this primary outcome. Overall physiotherapy significantly reduced SARA (MD=-1.41, [95%CI:-2.16, -0.66]); the subgroup analysis showed significant effects: Multi-aspect training program (5studies, MD=-1.59, [95%CI:-5.15, -0.03]), balance training(3 studies, MD=-1.58, [95%CI:-2.55, -0.62]) and aerobic training (3 studies, MD=-1.65, [95%CI:-2.53, -0.77]). However, there were no significant effect of vibration (2 studies, MD=-0.56, [95%CI: -2.05, 0.93]), and dual-task training (1 study, MD=0.24, [95%CI: -6.4, 6.88]). About representable secondary outcome, functional independent measure (FIM) was significantly increased (3 studies, MD=1.39, [95%CI:0.59, 2.19]), and fall frequency was significantly reduced (1 studies, MD=-1.00 times/week, [95%CI: -1.55, -0.45]). Furthermore, attention should be paid to the very high degree of heterogeneity in both outcomes.
Physical therapy may reduce ataxia in people with DCA, especially multi-aspect physical therapy including muscle strength, coordination training, gait training and ADL training can be important. Further, balance training and aerobic training can be recommended to add the program. However, the estimated effect size may change in future studies because the RoB was serious and the certainty of evidence was very low, and the heterogeneity was high in SARA as primary outcome. To establish evidence for physical therapy for people with DCA, high-quality RCTs are required.
Multi-aspect physical therapy programs including balance and aerobic training are the preferred intervention methods of choice to treatment for ataxia in people with DCA.
Systematic review
Meta-analysis
