Thijs LAA1, Denissen S2, Lubbe A2, Willemssens A2, Norah A3,4, Turk R5, Hughes A-M5, Lemmens R6,7,8, Verheyden G1
1KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium, 2KU Leuven - University of Leuven, Leuven, Belgium, 3University of Southampton, Southampton, United Kingdom, 4Prince Sattam University, Al-Kharj, Saudi Arabia, 5Univeristy of Southampton, Southampton, United Kingdom, 6KU Leuven - University of Leuven, Department of Neurosciences, Experimental Neurology, and Leuven Brain Institute, Leuven, Belgium, 7VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium, 8University Hospital Leuven, Department of Neurology, Leuven, Belgium
Background: The trunk is the core of the body and plays a key role in stabilizing the body during sitting balance and movements of the extremities and head. Trunk function is significantly reduced after stroke compared to healthy controls. Trunk training is acknowledged as an important element in post-stroke rehabilitation with a considerable amount of published clinical trials. In these trials, a diversity of trunk training therapies and protocols were applied and it is unclear which type of trunk training has the greatest effect on trunk function during rehabilitation. Furthermore, the impact of variation in duration of trunk training on trunk function is uncertain.
Purpose: To systematically review the literature concerning the effectiveness of different types and duration of trunk training in sitting or supine position on trunk function post-stroke.
Methods: Two independent investigators searched MEDLINE, EMBASE, CINAHL, COCHRANE and PEDro and results were evaluated for eligibility. Our review was performed according to PRIMSA guidelines. The standardized mean difference (SMD) and 95% confidential interval (CI) of each type of trunk training therapy was used to analyze the overall effect size. A SMD greater than 1.2 was defined by guidelines as a very large effect size. To analyze the effect of differences in duration of therapy between the experimental and control group, we pooled results of all included trials. Then we compared the SMD in the subgroup where total minutes of therapy in both the experimental and control group were equal, with the subgroup where the experimental group received more minutes of therapy compared to the control group.
Results: We included 29 trials, involving 1028 participants. In the meta-analysis we distinguished seven types of trunk training therapies. For four trunk-training therapies, the SMD value is equal or greater than 1.2; Trunk training on an unstable surface (7 trials) provided a SMD of 1.20, 95%CI=0.67-1.73. Trunk training aiming to shift the body weight to the limits of the sitting ability (5 trials) resulted in a SMD of 1.27, 95% CI=0.87-1.68. Trunk therapy focusing on improving sitting balance by reaching beyond arm's length (3 trials) gave a SMD of 1.44, 95%CI=0.97-1.90. Selective trunk training with a focus on selective movements of the upper (shoulder girdle) and lower part (pelvic girdle) of the trunk (8 trials) resulted in the highest SMD of 1.91, 95%CI=1.09-2.73.
If the experimental and control group received the same amount of therapy (20 trials), expressed in minutes, the SMD was 1.33, 95%CI=1.14-1.53, which shows an overlapping range with the subgroup of 13 trials where the experimental group received more therapy compared to the control group (SMD=1.05, 95%CI=0.85-1.25).
Conclusion(s): After stroke, different types of training improve trunk function. Surprisingly duration and extent of this training does not appear to modify the effect.
Implications: Trunk training on an unstable surface, weight-shift training, reaching therapy in sitting and performing selective trunk movements have a very large effect on improving trunk function after stroke and appear the clinical method of choice when providing post-stroke trunk training.
Keywords: Trunk, Stroke, Systematic Review
Funding acknowledgements: None
Purpose: To systematically review the literature concerning the effectiveness of different types and duration of trunk training in sitting or supine position on trunk function post-stroke.
Methods: Two independent investigators searched MEDLINE, EMBASE, CINAHL, COCHRANE and PEDro and results were evaluated for eligibility. Our review was performed according to PRIMSA guidelines. The standardized mean difference (SMD) and 95% confidential interval (CI) of each type of trunk training therapy was used to analyze the overall effect size. A SMD greater than 1.2 was defined by guidelines as a very large effect size. To analyze the effect of differences in duration of therapy between the experimental and control group, we pooled results of all included trials. Then we compared the SMD in the subgroup where total minutes of therapy in both the experimental and control group were equal, with the subgroup where the experimental group received more minutes of therapy compared to the control group.
Results: We included 29 trials, involving 1028 participants. In the meta-analysis we distinguished seven types of trunk training therapies. For four trunk-training therapies, the SMD value is equal or greater than 1.2; Trunk training on an unstable surface (7 trials) provided a SMD of 1.20, 95%CI=0.67-1.73. Trunk training aiming to shift the body weight to the limits of the sitting ability (5 trials) resulted in a SMD of 1.27, 95% CI=0.87-1.68. Trunk therapy focusing on improving sitting balance by reaching beyond arm's length (3 trials) gave a SMD of 1.44, 95%CI=0.97-1.90. Selective trunk training with a focus on selective movements of the upper (shoulder girdle) and lower part (pelvic girdle) of the trunk (8 trials) resulted in the highest SMD of 1.91, 95%CI=1.09-2.73.
If the experimental and control group received the same amount of therapy (20 trials), expressed in minutes, the SMD was 1.33, 95%CI=1.14-1.53, which shows an overlapping range with the subgroup of 13 trials where the experimental group received more therapy compared to the control group (SMD=1.05, 95%CI=0.85-1.25).
Conclusion(s): After stroke, different types of training improve trunk function. Surprisingly duration and extent of this training does not appear to modify the effect.
Implications: Trunk training on an unstable surface, weight-shift training, reaching therapy in sitting and performing selective trunk movements have a very large effect on improving trunk function after stroke and appear the clinical method of choice when providing post-stroke trunk training.
Keywords: Trunk, Stroke, Systematic Review
Funding acknowledgements: None
Topic: Neurology: stroke
Ethics approval required: No
Institution: UZ KU Leuven
Ethics committee: Medical Ethics Committee UZ KU Leuven / Research
Reason not required: This abstract is based on a review of the literature.
All authors, affiliations and abstracts have been published as submitted.
