Limited evidence of physical therapy on balance after stroke: A systematic review and meta-analysis (original) (raw)
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BMJ open, 2017
Stroke frequently results in balance disorders, leading to lower levels of activity and a diminution in autonomy. Current physical therapies (PT) aiming to reduce postural imbalance have shown a large variety of effects with low levels of evidence. The objectives are to determine the efficiency of PT in recovering from postural imbalance in patients after a stroke and to assess which PT is more effective. We will search several databases from inception to October 2015. Only randomised controlled trials assessing PT to recover from poststroke postural imbalance in adults will be considered.Outcome measures will be the Berg Balance Scale (BBS), the Postural Assessment Scale for Stroke (PASS), the 'weight-bearing asymmetry' (WBA), the 'centre of pressure' (COP) and the 'limit of stability' (LOS). WBA, COP and LOS are measured by a (sitting or standing) static evaluation on force plate or another device.Two independent reviewers will screen titles, abstracts and ...
PLOS ONE, 2019
Background The aim of this study was to synthesize evidence from systematic reviews, to summarise the effects of rehabilitation interventions for improving balance in stroke survivors. Methods We conducted an overview of systematic reviews (SRs). We included Cochrane Systematic Reviews and non-Cochrane Systematic Reviews of randomized-controlled clinical trials and not-randomized clinical trials, in all types of stroke, comparing the effects of interventions, control interventions and no interventions on balance-related outcomes. We conducted a comprehensive search of electronic databases, from inception to December 2017. Data extracted included: number and type of participants, type of intervention, control intervention, method of assessing risk of bias of primary studies, balance outcome measures and results of statistical meta-analyses. Methodological quality of included reviews was assessed using AMSTAR 2. A narrative description of the characteristics of the SRs was provided and results of meta-analyses summarised with reference to their methodological quality. Results 51 SRs (248 primary studies and 10,638 participants) met the inclusion criteria and were included in the overview. All participants were adults with stroke. A wide variety of different balance and postural control outcomes were included. 61% of SRs focussed on the effectiveness of physical therapy, 20% virtual reality, 6% electromechanical devices, 4% Tai-Chi, whole body vibration and circuit training intervention, and 2% cognitive rehabilitation. The methodology of 54% of SRs were judged to be of a "low or critically low" quality, 23% "moderate" quality and 22% "high" quality.
Effects of Exercise Therapy on Balance Capacity in Chronic Stroke
Stroke, 2016
A fter stroke, a main goal of rehabilitation is to promote independence in activities of daily living. An important determinant of activities of daily living performance is standing balance, which is a strong predictor of functional recovery 1,2 and walking capacity 3,4 and an important risk factor for falls 5 after stroke. Although the vast majority (75%) of people after stroke regain independent standing-balance capacity, 6 weightbearing asymmetry and increased postural sway often persist, as well as a diminished capacity to voluntarily shift body weight or to withstand external perturbations. 7 Hence, a key Background and Purpose-The purpose of this systematic review and meta-analysis was to investigate the effects of exercise training on balance capacity in people in the chronic phase after stroke. Furthermore, we aimed to identify which training regimen was most effective. Methods-Electronic databases were searched for randomized controlled trials evaluating the effects of exercise therapy on balance capacity in the chronic phase after stroke. Studies were included if they were of moderate or high methodological quality (PEDro score ≥4). Data were pooled if a specific outcome measure was reported in at least 3 randomized controlled trials. A sensitivity analysis and consequent subgroup analyses were performed for the different types of experimental training (balance and/or weight-shifting training, gait training, multisensory training, high-intensity aerobic exercise training, and other training programs).
2013
Introduction: Balance dysfunction, particularly in standing, is a devastating sequel to stroke since the ability to balance is one of the most critical motor control factors in daily life. Physiotherapists use a variety of balance and stability techniques as a part of treatment programmes to improve functional independence in patients following a stroke. However more scientific evidence for the effectiveness of these techniques or programs is required. Purpose: The purpose of this study was to quantify the effect of a balance and stability training program on stability, balance and functional independence in stroke patients. Method: The aims of this study were achieved using a randomised controlled trial. A questionnaire allowed the collection of demographic data from fifty participants who had suffered the first stroke, regardless of gender or race. The Postural Assessment Scale for Stroke patients (PASS), Berg Balance Scale (BBS), Barthel Index (BI) and questionnaire were administered to all fifty participants on the first and last weeks of a twelve week physiotherapy program. For ten weeks twenty five randomly assigned participants in each of the control and experimental groups underwent either normal physiotherapy or stability and balance intervention exercise program respectively. Data Analysis: The raw data was normalized by calculating percent changes for each item for each participant and the pooled data subjected to Wilcoxon signed ranks testing, paired samples signed tests and Pearson's correlations. Results: PASS, BBS and BI scores increased significantly from pre-test to post-tests in both groups, with greater changes noted in the experimental group, showing improvements in stability, balance and function. In addition a strong and significant correlation between stability scores and balance scores suggested that stability is important to improve balance. Similarly a strong and significant correlation between stability and balance scores with function scores confirms the value of stability and balance in improving function. It was further noted that in addition to a certain degree of spontaneous recovery, traditional physiotherapy programs also result in improvement in stability, balance and function but not to the same extent as with the program of treatment which emphasizes stability and balance exercises. Conclusion: A significant improvement in the stability, balance and function in stroke patients was achieved with the balance and stability intervention program. Conventional physiotherapy methods also improved stability, balance and function, but to a lesser extent than the balance and stability training. Contents
Pakistan biomedical journal, 2022
The mortality rate is higher in underdeveloped countries. In Pakistan, however, there is no speci c stroke estimate. The annual occurrence rate is likely to be 250 per 100,000, with 350 expected in the near future [1]. The most wellknown cause of death in the world is stroke. For the rst time, Hippocrates (the father of medicine) coined the term 'apoplexia' to describe the sudden blackout and loss of function caused by a cerebrovascular accident [2]. Stroke has a negative in uence on families due to poor dietary habits [3]. Imbalance is a signi cant aspect of stroke; this attribute demonstrates impairment in both ne and di cult activities; balance incoordination is the most accurate predictor of falls, which also causes panic in stroke patients. The risk of fall con nes the patient from daily activities. That's why balance training needs to be done in post-stroke patients [4,5]. The bene ts of training include developments in functional consequences such as activities of daily living and instrumental activities of daily living [6]. There are a lot of people who have had both acute and chronic strokes. If a person survives a stroke, he will
International Journal of Current Pharmaceutical Research
Objective: Stroke is a leading cause of mortality and disability worldwide. Balance impairment is a common issue among stroke survivors, leading to increased fall risk and decreased quality of life. Visual and verbal cues have shown the potential in improving balance in stroke patients. This study aimed to compare the effectiveness of conventional therapy alone versus conventional therapy combined with visual and verbal cues in balance training during stroke recovery. Methods: Thirty participants with post-stroke hemiplegia were randomly assigned to either a control group or an experimental group. The control group received conventional physical therapy, while the experimental group received additional visual and verbal feedback. The Berg Balance Scale was used to assess balance on the 1st, 15th, and 30th days of the study. Results: Both groups showed improvements in balance over the course of the study. On the 15th day, the experimental group had a significantly higher mean Berg Ba...
Life
The present study aims to determine the potential benefits of PNF on balance and gait function in patients with chronic stroke by using a systematic review and meta-analysis. Systematic review in the following databases: MEDLINE/PubMed, Physiotherapy Evidence Database (PEDro), Cochrane Library and Google Scholar. Studies up to September 2020 are included. A systematic database search was conducted for randomized control trials (RCTs) that investigated the effects of PNF intervention in patients with chronic stroke using balance and gait parameters as outcome measures. The primary outcomes of interest were Berg Balance Scale (BBS), Functional Reach Test (FRT), Timed Up and Go Test (TUG) and 10-Meter Walking Test (10MWT). Nineteen studies with 532 participants were included, of which twelve studies with 327 participants were included for meta-analysis. When the data were pooled, PNF made statistically significant improvements in balance with BBS, FRT and TUG (p < 0.05) or gait velo...
PM & R : the journal of injury, function, and rehabilitation, 2014
To compare the effect of a balance and stability-focused outpatient community-based rehabilitation and a regular physiotherapy program on balance, stability, and perceptions of improvement after acute stroke. A randomized controlled trial in a community-based therapy center. Fifty consecutive patients with a first stroke, who reported to a community-based therapy center over a 7-month period were allocated to the control group (regular physiotherapy) or the experimental group (balance and stability-focused rehabilitation). A program of physiotherapy focused on balance and stability exercises. The control group received the regular physiotherapy program. The Postural Assessment Scale for Stroke Patients (PASS) and the Berg Balance Scale (BBS) monitored stability and balance. The normalized data (PASS and BBS) were analyzed by using analysis of covariance. Qualitative data were thematically described. Internal consistency of baseline PASS and BBS scores was high (Cronbach α, .964 and ...