EFFECTS OF ACTION OBSERVATION THERAPY ON GAIT AND BALANCE IMPAIRMENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

M. Picardi¹, F. Temporiti^2,3, C. Salamone², P. Tropea¹, G. Buccino⁴, M. Corbo¹, R. Gatti^2,3

¹Casa di Cura del Policlinico, Department of Neurorehabilitation Sciences, Milano, Italy, ²IRCCS Humanitas Clinical and Research Center, Physiotherapy Unit, Milano, Italy, ³Humanitas University, Department of Biomedical Sciences, Milano, Italy, ⁴IRCCS San Raffaele Scientific Institute, University, Division of Neuroscience, Milano, Italy

Background: Action Observation Therapy (AOT) has been proposed besides to conventional rehabilitation to improve gait and balance and mitigate the risk of fall in patients with disability. Studies reported AOT benefits on gait and balance deficits in patients with neurological and musculoskeletal disorders. However, a literature search has never been systematically carried out. Furthermore, although rehabilitation is addressed to improve motor impairments causing disability irrespective to the pathology, the quantification of AOT effects on specific gait and balance outcomes irrespective to the motor signs etiology has never been performed.

Purpose: To investigate the effects of AOT in patients with gait and balance impairments.

Methods: A systematic literature search was carried out using MEDLINE via PubMed, EMBASE and Scopus, from inception until December 2021. Randomized controlled trials investigating effects of AOT delivered alone or in association with other treatments on gait and balance outcomes in patients with any type of clinical condition were included. Two independent reviewers appraised records for inclusion, assessed the methodological quality through the ROB-2 tool and extracted the following data: subjects’ characteristics, interventions details and outcomes measures of interest and their relative scores before and after the intervention. Heterogeneity was assessed using I² statistic, and results of homogeneous trials were pooled with random-effects models, using change scores from baseline to post-intervention and their standard deviations to compute a pooled estimate effect. The overall effect was expressed as weighted mean difference (MD) or standardized mean difference (SMD) with 95% confidence intervals (CIs). Finally, evidence quality was assessed using the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) criteria.

Results: Twenty-nine studies (703 patients) including subjects with stroke (364 patients), Parkinson’s disease (177 patients), hip and knee arthroplasties (130 patients) and cerebral palsy (32 patients) were included in the systematic review, and 28 in the meta-analysis. The overall risk of bias was low in 62% of included studies, some concerns were detected in 17% of included studies, while 21% of included studies was judged at high risk of bias. AOT revealed better walking speed (SMD: 0.32; 95%CI: 0.14 to 0.49, I²=0%), walking endurance (MD: 54.26 meters on 6-Minute Walking Test; 95%CI: 37.58 to 70.94 meters, I²=0%), stride length (SMD: 0.29; 95%CI: 0.01 to 0.58, I²=0%) and single limb support duration (MD: 4.12% of gait cycle; 95%CI: 1.03% to 7.21%, I²=0%) compared to placebo or other interventions. Moreover, AOT resulted in better dynamic (SMD: 0.41; 95%CI: 0.22 to 0.61, I²=0%) and static (SMD: 0.53; 95%CI: 0.07 to 0.99, I²=54%) balance, and higher mobility (MD: -1.36 seconds on the Timed Up and Go; 95%CI: -1.94 to -0.77 seconds, I²=0%) compared to placebo or other interventions. Evidence quality ranged from moderate (walking speed and dynamic balance) to low (other outcomes).

Conclusions: AOT improved walking spatial-temporal parameters and endurance, dynamic and static balance, and mobility in patients with gait and balance disorders deriving from different conditions.

Implications: These results suggest a domain-specificity of AOT efficacy, indicating the opportunity to incorporate this approach into rehabilitative interventions of subjects with walking and balance disorders.

Funding acknowledgements: The authors did not receive any funding.

Keywords:
Action Observation Therapy
Gait
Balance

Topics:
Neurology
Disability & rehabilitation

Did this work require ethics approval? No

Reason: The scientific work consists of a systematic review and meta-analysis.