Yaemrattanakul W1,2, Jackson J1, Gillmeister H3
1University of Essex, School of Sport, Rehabilitation and Exercise Sciences, Colchester, United Kingdom, 2Prince of Songkla University, Department of Physical Therapy, Songkhla, Thailand, 3University of Essex, Department of Psychology, Colchester, United Kingdom
Background: During the last decade, an increasing number of researchers investigated the effects of meditation in patients with stroke (Merriman et al. 2015). In 2013, there were two systematic reviews about mindfulness in stroke patients (Lazaridou et al. 2013; Lawrence et al. 2013). However, the reviews did not focus on motor function.
Purpose: This systematic review assesses the effect of meditation on motor function and explores the potential benefits of meditation in patients with stroke.
Methods: This review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement (Shamseer et al. 2015). The review was registered with the International Prospective Register of Systematic Reviews (PROSPERO). Registration number CRD42018098989. The search included papers published up to June 2018 and reported in the English language. All outcome measures were included; the primary outcome was motor function and the secondary outcomes were any other measures. The literature search was undertaken using 1) health sciences databases; MEDLINE, Cochrane Library, CINAHL, PsycINFO, EMBASE; 2) databases outside health sciences, and 3) unpublished studies databases. The databases were searched using the following terms: “stroke” or “cerebrovascular disease” in combination with “meditation” or “mindfulness” or “mindfulness-based intervention”. Additionally, reference lists of selected articles and other reviews were screened for additional eligible studies.
Results: Thirteen eligible studies were included in the review consisting of one randomized controlled trial (RCT), 3 non-RCTs, 6 uncontrolled studies, and 3 case reports between 2007 and 2018 with 152 participants. The interventions used in the studies included 3 mindfulness-based cognitive therapy (MBCT) or component of MBCT, 3 mindfulness-based stress reduction (MBSR), 4 mindfulness meditation (MM), 1 MM combined with aphasia mindfulness meditation programme, 1 Brahama Viharas, and 1 mindfulness-based intervention (MBI). The majority of included studies were focused on aphasia (N=5), mental fatigue (N=4), and anxiety and depression (N=2). There were only 3 studies measuring motor function; 1) Wang et al. (2018) measured ambulation ability with Berg Balance Scale (BBS), 10-Metre Walk Test (10MWT), and Functional Ambulation Classification Scale (FAC), 2) Moustgaard et al. (2007) measured mobility and upper extremity domains with Stroke Specific Quality of Life Scale (SS-QOL) and measured physical components with the 36-Item Short-Form General Health Survey (SF-36), and 3) Merriman et al. (2015) measured physical domain with WHO Quality of Life-BREF (WHOQoL-BREF). The studies achieved revised Cochrane risk of bias scores in the range of 1 to 4 points (mean=2.38, SD=1.04).
Conclusion(s): We found insufficient evidence to conduct a quantitative meta-analyses due to variation of interventions and measure outcomes. There was only one non-controlled study reporting statistically significant improvements of MBCT on motor function of mobility and upper extremity domains of SS-QOL and physical component of SF-36.
Implications: Meditation is safe and can have beneficial effects in patients with stroke on physiological, psychological, psychosocial, and neuropsychological outcomes, especially anxiety, depression, mental fatigue, and aphasia. No serious adverse events were reported. Further research is necessary of high-quality studies with larger sample sizes to confirm the results.
Keywords: Stroke, Meditation, Motor function
Funding acknowledgements: The first author (WY) is a Ph.D. student who is funded by Faculty of Medicine, Prince of Songkla University, Thailand.
Purpose: This systematic review assesses the effect of meditation on motor function and explores the potential benefits of meditation in patients with stroke.
Methods: This review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement (Shamseer et al. 2015). The review was registered with the International Prospective Register of Systematic Reviews (PROSPERO). Registration number CRD42018098989. The search included papers published up to June 2018 and reported in the English language. All outcome measures were included; the primary outcome was motor function and the secondary outcomes were any other measures. The literature search was undertaken using 1) health sciences databases; MEDLINE, Cochrane Library, CINAHL, PsycINFO, EMBASE; 2) databases outside health sciences, and 3) unpublished studies databases. The databases were searched using the following terms: “stroke” or “cerebrovascular disease” in combination with “meditation” or “mindfulness” or “mindfulness-based intervention”. Additionally, reference lists of selected articles and other reviews were screened for additional eligible studies.
Results: Thirteen eligible studies were included in the review consisting of one randomized controlled trial (RCT), 3 non-RCTs, 6 uncontrolled studies, and 3 case reports between 2007 and 2018 with 152 participants. The interventions used in the studies included 3 mindfulness-based cognitive therapy (MBCT) or component of MBCT, 3 mindfulness-based stress reduction (MBSR), 4 mindfulness meditation (MM), 1 MM combined with aphasia mindfulness meditation programme, 1 Brahama Viharas, and 1 mindfulness-based intervention (MBI). The majority of included studies were focused on aphasia (N=5), mental fatigue (N=4), and anxiety and depression (N=2). There were only 3 studies measuring motor function; 1) Wang et al. (2018) measured ambulation ability with Berg Balance Scale (BBS), 10-Metre Walk Test (10MWT), and Functional Ambulation Classification Scale (FAC), 2) Moustgaard et al. (2007) measured mobility and upper extremity domains with Stroke Specific Quality of Life Scale (SS-QOL) and measured physical components with the 36-Item Short-Form General Health Survey (SF-36), and 3) Merriman et al. (2015) measured physical domain with WHO Quality of Life-BREF (WHOQoL-BREF). The studies achieved revised Cochrane risk of bias scores in the range of 1 to 4 points (mean=2.38, SD=1.04).
Conclusion(s): We found insufficient evidence to conduct a quantitative meta-analyses due to variation of interventions and measure outcomes. There was only one non-controlled study reporting statistically significant improvements of MBCT on motor function of mobility and upper extremity domains of SS-QOL and physical component of SF-36.
Implications: Meditation is safe and can have beneficial effects in patients with stroke on physiological, psychological, psychosocial, and neuropsychological outcomes, especially anxiety, depression, mental fatigue, and aphasia. No serious adverse events were reported. Further research is necessary of high-quality studies with larger sample sizes to confirm the results.
Keywords: Stroke, Meditation, Motor function
Funding acknowledgements: The first author (WY) is a Ph.D. student who is funded by Faculty of Medicine, Prince of Songkla University, Thailand.
Topic: Neurology: stroke; Neurology
Ethics approval required: Yes
Institution: National Institute for Health Research
Ethics committee: International prospective register of systematic reviews (PROSPERO)
Ethics number: CRD42018098989
All authors, affiliations and abstracts have been published as submitted.
