Proprioceptive Neuromuscular Facilitation-Based Physical Therapy on the Improvement of Balance and Gait in Patients with Chronic Stroke: A Systematic Review and Meta-Analysis

Phan The Nguyen, Li-Wei Chou, Yueh-Ling Hsieh, Phan The Nguyen, Li-Wei Chou, Yueh-Ling Hsieh

Abstract

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 velocity with 10MWT (p < 0.001) when compared to the control. This review indicates that PNF is a potential treatment strategy in chronic stroke rehabilitation on balance and gait speed. Further high-quality research is required for concluding a consensus of intervention and research on PNF.

Keywords: gait; postural balance; proprioceptive neuromuscular facilitation; stroke; stroke rehabilitation.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart for study selection for systematic review and meta-analysis.
Figure 2
Figure 2
The risk of bias assessment summary using the Cochrane Risk of Bias Assessment tool. The L sign indicates a low risk of bias, H indicates a high risk of bias and U sign indicates an unclear risk of bias [22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40].
Figure 3
Figure 3
Forest plot of effect of PNF intervention on BBS scores. Abbreviations: IV: inverse variance; CI: confidence interval; SD: standard deviation. Refs. [22,24,28,29,30,34].
Figure 4
Figure 4
(A) Forest plot of effect of PNF intervention on FRT. Refs [28,29,31,34]; (B) sensitivity analysis of effect of PNF intervention on FRT. Abbreviations: IV: inverse variance; CI: confidence interval; SD: standard deviation. Refs. [29,30,31,34].
Figure 5
Figure 5
Forest plot of effect of PNF intervention on TUG test. Abbreviations: IV: inverse variance; CI: confidence interval; SD: standard deviation. Refs [26,28,29,33,34].
Figure 6
Figure 6
Forest plot of effect of PNF intervention on 10MWT. Abbreviations: IV: inverse variance; CI: confidence interval; SD: standard deviation. Refs. [23,25,26,27,29].

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