Rehabilitation interventions for improving balance following stroke: An overview of systematic reviews.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2019
2019
Historique:
received:
07
12
2018
accepted:
01
07
2019
entrez:
20
7
2019
pubmed:
20
7
2019
medline:
10
3
2020
Statut:
epublish
Résumé
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. 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. 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. There are 51 SRs of evidence relating to the effectiveness of interventions to improve balance in people with stroke, but the majority of these are of poor methodological quality, limiting our ability to draw clear implications. Only 22% of these SRs were judged to be of high quality, highlighting the need to address important methodological issues within rehabilitation research.
Sections du résumé
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.
CONCLUSIONS
There are 51 SRs of evidence relating to the effectiveness of interventions to improve balance in people with stroke, but the majority of these are of poor methodological quality, limiting our ability to draw clear implications. Only 22% of these SRs were judged to be of high quality, highlighting the need to address important methodological issues within rehabilitation research.
Identifiants
pubmed: 31323068
doi: 10.1371/journal.pone.0219781
pii: PONE-D-18-35041
pmc: PMC6641159
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0219781Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Biomed Res Int. 2015;2015:342529
pubmed: 26539480
Complement Ther Clin Pract. 2017 Nov;29:35-47
pubmed: 29122267
J Phys Ther Sci. 2014 Dec;26(12):1993-6
pubmed: 25540515
PLoS One. 2017 Sep 21;12(9):e0185188
pubmed: 28934308
Neurorehabil Neural Repair. 2017 Oct-Nov;31(10-11):877-884
pubmed: 29233072
Stroke. 2016 Jun;47(6):e98-e169
pubmed: 27145936
PM R. 2018 Apr;10(4):398-409
pubmed: 29111465
Cochrane Database Syst Rev. 2013 Jul 01;(7):CD003586
pubmed: 23813503
Syst Rev. 2017 Nov 21;6(1):231
pubmed: 29162130
Cochrane Database Syst Rev. 2011 Oct 05;(10):CD008388
pubmed: 21975779
NeuroRehabilitation. 2013;33(4):575-92
pubmed: 24018373
J Clin Epidemiol. 2018 Jul;99:24-32
pubmed: 29526556
PLoS One. 2015 Jul 10;10(7):e0132634
pubmed: 26161653
Cochrane Database Syst Rev. 2007 Jan 24;(1):CD001920
pubmed: 17253468
Stroke. 2016 Oct;47(10):2603-10
pubmed: 27633021
Int J Environ Res Public Health. 2018 Jun 20;15(6):
pubmed: 29925770
BMC Med Res Methodol. 2013 Sep 17;13:116
pubmed: 24044807
PLoS Med. 2009 Jul 21;6(7):e1000097
pubmed: 19621072
Clin Rehabil. 2015 Dec;29(12):1168-77
pubmed: 25681409
Top Stroke Rehabil. 2017 Jan;24(1):68-79
pubmed: 27309680
Clin Rehabil. 2015 Jul;29(7):627-38
pubmed: 25311142
J Stroke Cerebrovasc Dis. 2014 Apr;23(4):759-70
pubmed: 23928347
Transl Stroke Res. 2016 Feb;7(1):3-11
pubmed: 26639659
Neurotherapeutics. 2011 Jul;8(3):319-29
pubmed: 21691873
J Rehabil Med. 2006 Jan;38(1):3-9
pubmed: 16548079
J Stroke Cerebrovasc Dis. 2015 Dec;24(12):2660-8
pubmed: 26483155
Clin Rehabil. 2004 Dec;18(8):833-62
pubmed: 15609840
Med Sci Monit Basic Res. 2018 Dec 03;24:210-215
pubmed: 30504762
Ann Phys Rehabil Med. 2016 Apr;59(2):114-24
pubmed: 26969343
Arch Phys Med Rehabil. 2013 Jul;94(7):1377-85
pubmed: 23416220
Cochrane Database Syst Rev. 2016 Nov 14;11:CD006073
pubmed: 27841442
J Stroke Cerebrovasc Dis. 2019 Jan;28(1):107-120
pubmed: 30314760
Neural Plast. 2015;2015:608581
pubmed: 26682073
Cochrane Database Syst Rev. 2017 Dec 08;12:CD011483
pubmed: 29220541
Cochrane Database Syst Rev. 2016 Dec 21;12:CD011058
pubmed: 28002636
Cochrane Database Syst Rev. 2019 May 23;5:CD008388
pubmed: 31120142
Cochrane Database Syst Rev. 2004 Oct 18;(4):CD004129
pubmed: 15495079
BMJ. 2017 Sep 21;358:j4008
pubmed: 28935701
Cochrane Database Syst Rev. 2011 Oct 05;(10):CD008389
pubmed: 21975780
Clin Rehabil. 2016 May;30(5):432-40
pubmed: 26141808
Stroke. 2009 Jul;40(7):2450-9
pubmed: 19461035
Top Stroke Rehabil. 2014 Mar-Apr;21(2):87-100
pubmed: 24710969
PLoS One. 2015 Aug 20;10(8):e0135932
pubmed: 26291978
Phys Ther. 2016 Dec;96(12):1905-1918
pubmed: 27174255
J Clin Epidemiol. 2016 Jan;69:225-34
pubmed: 26092286
Top Stroke Rehabil. 2018 May;25(4):312-320
pubmed: 29473456
J Am Med Dir Assoc. 2015 Nov 1;16(11):923-32
pubmed: 26253322
BMC Neurol. 2012 Jun 22;12:45
pubmed: 22727172
Syst Rev. 2018 Oct 12;7(1):159
pubmed: 30314530
Syst Rev. 2016 Jan 06;5:4
pubmed: 26739283
NeuroRehabilitation. 2014 Jan 1;35(2):205-13
pubmed: 24990030
J Rehabil Med. 2018 Jan 10;50(1):3-7
pubmed: 28862711
Top Stroke Rehabil. 2016 Feb;23(1):15-25
pubmed: 26086177
J Physiother. 2015 Jul;61(3):117-24
pubmed: 26093805
Lancet Neurol. 2009 Aug;8(8):741-54
pubmed: 19608100
J Clin Epidemiol. 2019 Apr;108:26-33
pubmed: 30543911
Cochrane Database Syst Rev. 2017 Jun 02;6:CD007513
pubmed: 28573757
Cochrane Database Syst Rev. 2017 Nov 20;11:CD008349
pubmed: 29156493
J Neurol Phys Ther. 2010 Sep;34(3):127-37
pubmed: 20716987
Neurophysiol Clin. 2015 Nov;45(4-5):335-55
pubmed: 26547547
Top Stroke Rehabil. 2015 Jun;22(3):161-8
pubmed: 26084320
Int J Stroke. 2012 Jan;7(1):47-60
pubmed: 22111955
PLoS One. 2014 Feb 04;9(2):e87987
pubmed: 24505342
Cochrane Database Syst Rev. 2016 Mar 24;3:CD003316
pubmed: 27010219
J Stroke Cerebrovasc Dis. 2015 Oct;24(10):2298-305
pubmed: 26303792
Lancet. 2014 Jan 18;383(9913):245-54
pubmed: 24449944
Disabil Rehabil. 2018 Aug;40(17):1981-1988
pubmed: 28482696
Eur J Neurol. 2015 Mar;22(3):555-e37
pubmed: 25560629
Cochrane Database Syst Rev. 2014 Apr 22;(4):CD001920
pubmed: 24756870
Cochrane Database Syst Rev. 2011 Jan 19;(1):CD008186
pubmed: 21249701
Syst Rev. 2018 Mar 1;7(1):39
pubmed: 29490699
Gait Posture. 2018 Jun;63:208-220
pubmed: 29775908
Stroke. 2009 Apr;40(4):e89-97
pubmed: 19182079
J Rehabil Med. 2018 Jul 17;50(7):582-588
pubmed: 29736553
JAMA. 2014 Jul;312(2):171-9
pubmed: 25005654
Biomed Res Int. 2016;2016:7309272
pubmed: 28053988
Health Inf Manag. 1998 Dec-1999 Feb;28(4):186-8
pubmed: 10387366
PLoS One. 2016 Oct 11;11(10):e0163351
pubmed: 27727288
J Clin Epidemiol. 2013 Jan;66(1):75-7
pubmed: 23177896
Top Stroke Rehabil. 2017 Jul;24(5):394-403
pubmed: 28218021
Top Stroke Rehabil. 2017 Oct;24(7):539-546
pubmed: 28687056
J Clin Epidemiol. 2011 Apr;64(4):383-94
pubmed: 21195583
Phys Ther. 2008 Feb;88(2):156-75
pubmed: 18073267
J Neurosci Nurs. 2011 Dec;43(6):298-307
pubmed: 22089406
Clin Rehabil. 2015 Feb;29(2):120-8
pubmed: 24942480