Efficiency of physical therapy on postural imbalance after stroke: study protocol for a systematic review and meta-analysis

A Hugues, J Di Marco, P Janiaud, Y Xue, J Pires, H Khademi, M Cucherat, I Bonan, F Gueyffier, G Rode, A Hugues, J Di Marco, P Janiaud, Y Xue, J Pires, H Khademi, M Cucherat, I Bonan, F Gueyffier, G Rode

Abstract

Introduction: 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.

Methods and analysis: 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 full-text articles, evaluate the risk of bias and will perform data extraction. In addition to the outcomes, measures of independence will be analysed. This study will aim at determining the effects of PT on the function (WBA, COP, LOS), the activity (BBS, PASS) and the independence of patients. Subgroup analyses will be planned according to the location of brain lesion (hemispheric, brainstem or cerebellum), the time since stroke (early, late, chronic), the PT (type, main aim (direct effect or generalisation), overall duration), the type of approaches (top-down or bottom-up) and the methodological quality of studies.

Ethics and dissemination: No ethical statement will be required. The results will be published in a peer-reviewed journal. This meta-analysis aims at managing the rehabilitation after postural imbalance by PT after a stroke.

Trial registration number: Prospero CRD42016037966;Pre-results.

Keywords: balance; efficiency; meta-analysis; physical therapy; postural imbalance.

Conflict of interest statement

PJ presents a conflict of interest with GlaxoSmithKline. Her PhD thesis was supported by GSK. PJ will contribute in this study by helping to search electronic databases. She will not participate in the selection process and in the analyses.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

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