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Hugues A1,2, Di-Marco J3,4, Janiaud P5, Xue Y6, Zhu J7, Pires J8,9, Khademi H10, Rubio L11, Hernandez Bernal P12, Bahar Y13, Charvat H14, Szulc P15, Carolina C16,17,18, Won H19,20, Cucherat M5,21, Bonan I22,23, Gueyffier F5,21, Rode G2,24
1Hôpital Henry-Gabrielle, Hospices Civils de Lyon, Service de Médecine Physique et Réadaptation et Plate-forme ‘Mouvement et Handicap‘, Lyon, France, 2Centre de Recherche en Neurosciences de Lyon (CRNL), Inserm UMR-S 1028, CNRS UMR 5292, Université de Lyon, Université Lyon 1, Equipe 'ImpAct', Bron, France, 3Assistance Publique des Hôpitaux de Paris, Paris, France, 4Université Paris Descartes, Paris, France, 5UMR 5558 CNRS Lyon, Université de Lyon, Université Lyon 1, Lyon, France, 6Université de Lyon, Université Claude Bernard Lyon 1, Université Saint-Étienne, HESPER EA 7425, Lyon, France, 7Université Jiaotong de Shanghai, Département de Pharmacologie, Shanghai, China, 8Rovisco Pais Rehabilitation Centre, Tocha, Portugal, 9Medicine Faculty of Oporto University, Oporto, Portugal, 10International Agency for Research on Cancer, World Health Organization, Lyon, France, 11Centro Lescer, Madrid, Spain, 12Rehaklinik Zihlschlach, Neurologisches Rehabilitationszentrum, Zihlschlacht, Switzerland, 13Hitit University Erol Olcok Training and Research Hospital, Corum, Turkey, 14Center for Public Health Sciences, National Cancer, Division of Prevention, Tokyo, Japan, 15INSERM UMR 1033, Université de Lyon, Université Lyon 1, Hôpital Edouard Herriot, Lyon, France, 16INSERM U 1028, CNRS UMR 5292, Centre de Recherche en Neuroscience de Lyon, Université de Lyon, Université Lyon 1, Translational and Integrative Group in Epilepsy Research (TIGER), Lyon, France, 17Institut des Epilepsies (IDEE), Université de Lyon, Université Lyon 1, Lyon, France, 18Centre Hospitalier Universitaire Vaudois, Department of Clinical Neurosciences, Lausanne, Switzerland, 19Université Grenoble Alpes, UMR 5316 Litt & Arts, Grenoble, France, 20Kyung-Hee-University, Seoul, Korea (South), 21Groupement Hospitalier Est, Hospices Civils de Lyon, Service Hospitalo-Universitaire de Pharmaco-Toxicologie, Bron, France, 22Centre Hospitalier Universitaire de Rennes, Service de Médecine Physique et de Réadaptation, Rennes, France, 23Université Rennes 1, Inserm Unité U 746, Equipe 'VisAGeS', Rennes, France, 24Hôpital Henry-Gabrielle, Hospices Civils de Lyon, Service de Médecine Physique et Réadaptation et Plate-Forme 'Mouvement et Handicap', Lyon, France
Background: Stroke results in imbalance which decreases activity, autonomy and quality of life. Many trials investigated the effects of physical therapy (PT) and current recommendations are limited.
Purpose: To determine the efficacy of PT on the recovery of balance and postural control in adult patients after stroke.
Methods: A systematic review and meta-analysis were performed according to the Cochrane and PRISMA recommendations (Hugues et al., 2017). Medline, Embase, Cochrane Central Register of Controlled Trials, PEDro, Pascal and Francis databases were searched from inception until 31 October 2015. All randomised controlled trials investigating the efficacy of PT on balance and postural control in adult patients after stroke (18 years or above) without language restriction were included. Two independent reviewers screened the studies, extracted data and assessed risk of bias. Primary outcomes were balance (measured by the Berg Balance Scale or the Postural Assessment Scale for Stroke), postural deviation (measured by the weight bearing on limbs or the position of the centre of pressure (COP) during static assessment) and postural stability (measured by all COP sway or limit of stability parameters during sitting or standing static assessment). Secondary outcomes were autonomy. All data are available on the dataverse® project website (https://dataverse.org/)
Results: We selected 93 studies out of 11,717 records (total participants included: n=3611, mean by trial: 38.8, SD: 45.1). Forty-five studies in other language than English were translated.
PT was more effective than no treatment for the short-term recovery of balance (standardized mean difference 0.48, 95% confidence interval [0.36, 0.59]), mediolateral postural deviation with eyes open (EO) (-0.27, [-0.42, -0.13]) and postural stability EO (0.31, [0.06, 0.57]), with an expansion to autonomy (0.36, [0.21, 0.51]). At long-term there was no effect for all outcomes.
PT was more effective than sham treatment or usual care for the short-term recovery of balance (0.30, [0.11, 0.48]), mediolateral postural deviation EO (-0.59, [-1.08, -0.09]) and postural stability (EO: 0.91, [0.34, 1.48]; EC: 0.98, [0.35, 1.62]), with an expansion to autonomy (0.43, [0.07, 0.80]). At long-term there was no effect for all outcomes.
The quality of short-term effects was judged as moderate for balance and low to moderate for postural control by the grades of recommendation, assessment, development, and evaluations from Cochrane.
Conclusion(s): PT was helpful to improve balance, to decrease postural asymmetry and to improve postural stability, with an expansion of these effects to autonomy, in stroke patients immediately after intervention. There was no long-term effect.
Implications: PT can be used to recover balance and postural control after stroke. Future researches could focus on the development of PT aiming at long-term plasticity.
Keywords: Stroke, balance, meta-analysis
Funding acknowledgements: None
Purpose: To determine the efficacy of PT on the recovery of balance and postural control in adult patients after stroke.
Methods: A systematic review and meta-analysis were performed according to the Cochrane and PRISMA recommendations (Hugues et al., 2017). Medline, Embase, Cochrane Central Register of Controlled Trials, PEDro, Pascal and Francis databases were searched from inception until 31 October 2015. All randomised controlled trials investigating the efficacy of PT on balance and postural control in adult patients after stroke (18 years or above) without language restriction were included. Two independent reviewers screened the studies, extracted data and assessed risk of bias. Primary outcomes were balance (measured by the Berg Balance Scale or the Postural Assessment Scale for Stroke), postural deviation (measured by the weight bearing on limbs or the position of the centre of pressure (COP) during static assessment) and postural stability (measured by all COP sway or limit of stability parameters during sitting or standing static assessment). Secondary outcomes were autonomy. All data are available on the dataverse® project website (https://dataverse.org/)
Results: We selected 93 studies out of 11,717 records (total participants included: n=3611, mean by trial: 38.8, SD: 45.1). Forty-five studies in other language than English were translated.
PT was more effective than no treatment for the short-term recovery of balance (standardized mean difference 0.48, 95% confidence interval [0.36, 0.59]), mediolateral postural deviation with eyes open (EO) (-0.27, [-0.42, -0.13]) and postural stability EO (0.31, [0.06, 0.57]), with an expansion to autonomy (0.36, [0.21, 0.51]). At long-term there was no effect for all outcomes.
PT was more effective than sham treatment or usual care for the short-term recovery of balance (0.30, [0.11, 0.48]), mediolateral postural deviation EO (-0.59, [-1.08, -0.09]) and postural stability (EO: 0.91, [0.34, 1.48]; EC: 0.98, [0.35, 1.62]), with an expansion to autonomy (0.43, [0.07, 0.80]). At long-term there was no effect for all outcomes.
The quality of short-term effects was judged as moderate for balance and low to moderate for postural control by the grades of recommendation, assessment, development, and evaluations from Cochrane.
Conclusion(s): PT was helpful to improve balance, to decrease postural asymmetry and to improve postural stability, with an expansion of these effects to autonomy, in stroke patients immediately after intervention. There was no long-term effect.
Implications: PT can be used to recover balance and postural control after stroke. Future researches could focus on the development of PT aiming at long-term plasticity.
Keywords: Stroke, balance, meta-analysis
Funding acknowledgements: None
Topic: Neurology: stroke
Ethics approval required: No
Institution: None
Ethics committee: none
Reason not required: no research on patients but on studies (méta-analysis)
All authors, affiliations and abstracts have been published as submitted.
