Sorinola I.1, Williams S.1, Hathaway M.1
1King's College London, Division of Health and Social Care Research, Academic Department of Physiotherapy, London, United Kingdom
Background: With advances in healthcare, the number of people surviving acquired brain dysfunctions is rising, with resultant long term neurological conditions. These individuals are often challenged by difficulties in postural control, balance, transfers, gait, fatigue and incoordination, which impacts on their activity and societal participation. In spite of the increased number of research in this area in recent years, there is still a need to better understand factors that influence performance across all domains of functioning, especially activity and participation, to inform treatment planning and implementation.
Purpose: To summarise associations between trunk performance and functional outcomes in patients with acquired brain dysfunctions, and evaluate the effects of targeted training on trunk performance and functional outcome.
Methods: Medline, Embase, CINAHL, Cochrane Library, Web of Science and Scopus databases were searched with no temporary limits up to June, 2016. Observational studies involving adults with Stroke, Multiple Sclerosis (MS), Parkinsons Disease (PD) or Traumatic Brain Injury (TBI) exploring the relationships between trunk performance and functional outcomes, or randomised-controlled trials (RCTs) evaluating effect of trunk training in comparison to conventional therapy or no intervention, on trunk performance, balance, mobility or functional independence were identified. Study quality was assessed with the Effective Public Health Practice Project (EPHPP) and Cochrane Risk of Bias Tool for observational and RCTs studies respectively. The relationship between trunk function and functional outcomes (balance, mobility and functional independence) were analysed narratively and the effect of trunk training on trunk performance and functional outcomes were summarised across studies as mean or standardised mean differences (MD or SMD) with 95% confidence intervals.
Results: A total of 29 studies (14 observational, 15 RCTs) were included. There was insufficient evidence for the relationship between trunk performance and functional outcomes in MS, PD or TBI . Moderate to strong relationships exist between trunk performance and functional outcomes in stroke. The synthesis of evidence indicate a large effect in favour of trunk training for trunk performance in acute (SMD = 0.82; 95% CI 0.14, 1.51; P = 0.02) and chronic stroke (MD = 3.27; CI 2.11, 4.42; P 0.00001), balance (SMD = 1.36; CI 0.06, 2.65; P = 0.04), mobility (SMD = 0.82; CI 0.29, 1.34; P = 0.002) and functional independence (SMD = 0.55; CI -0.09, 1.20; P = 0.09) in acute stroke. Low quality evidence was found for PD and MS and none for TBI.
Conclusion(s): The association between trunk performance and functional outcomes as well as the evidence from RCTs strongly suggest the targeting of trunk training to optimise functional outcomes in stroke patients. There is a need to explore whether such relationships exists for MS, PD or TBI.
Implications: Trunk training could be a beneficial approach to improving functional outcomes in long term neurological rehabilitation. Physiotherapists should consider targeted training for these individuals.
Funding acknowledgements: There was no funding for this study.
Topic: Disability & rehabilitation
Ethics approval: This study does not require ethical considerations.
All authors, affiliations and abstracts have been published as submitted.
