Rehabilitation for balance impairment in patients after stroke: a protocol of a systematic review and network meta-analysis

Juan Li, Dongling Zhong, Jing Ye, Mingxing He, Xicen Liu, Hui Zheng, Rongjiang Jin, Shao-Lan Zhang, Juan Li, Dongling Zhong, Jing Ye, Mingxing He, Xicen Liu, Hui Zheng, Rongjiang Jin, Shao-Lan Zhang

Abstract

Introduction: Multiple rehabilitation therapies have been reported to be effective for poststroke balance impairment. However, the comparative effectiveness of these rehabilitation therapies is still unclear. Therefore, the aim of this study is to summarise evidence and identify the most effective rehabilitation therapy for poststroke balance impairment.

Methods and analysis: The following databases will be searched: China Biology Medicine, China National Knowledge Infrastructure, Wan Fang Data, the Chinese Science and Technology Periodical Database, Medline, Excerpt Medical Database (EMBASE), Web of Science, the Cochrane Library, from inception to June 2019. All randomised controlled trials that have used rehabilitation interventions to treat poststroke balance impairment will be included. The primary outcomes are the Berg Balance Scale, the Fugl-Meyer Assessment (balance), the Postural Assessment Scale for Stroke, as well as the function in sitting test, the Sitting Balance Scale, the Ottawa Sitting Scale, the Activities-specific Balance Confidence Scale, the Overall Balance Index and the Brunel Balance Assessment. The secondary outcomes include the Barthel Index, the Functional Ambulation Category Scale, fall rates, the Timed Up and Go test, the MOS 36-Item Short-Form Health Survey, and adverse events. To ensure that all relevant studies are included without personal bias, study selection, data extraction and quality assessment will be performed independently by two reviewers. Risk of bias will be assessed with the Cochrane risk of bias assessment tool. Review Manager V.5.3 software will be used to make bias risk diagram and pairwise meta-analysis, while network data synthesis will be performed using WinBUGS V.1.4.3 and R software.

Ethics and dissemination: Ethics approval is not required for systematic review and network meta-analysis. The results will be submitted to a peer review journal or at a conference.

Trial registration number: PROSPERO (CRD 42018107441).

Keywords: complementary medicine; rehabilitation medicine; stroke medicine; therapeutics.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Flow chart of network meta-analysis for rehabilitation of balance impairment in patients who had a stroke. CBM, China Biology Medicine; CNKI, China National Knowledge Infrastructure; RCT, randomised controlled trial; VIP, the Chinese Science and Technology Periodical Database.

References

    1. GBD 2017 Mortality Collaborators. Global, regional, and national age-sex-specific mortality and life expectancy, 1950-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392:1684–735. 10.1016/S0140-6736(18)31891-9
    1. GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392:1736–88. 10.1016/S0140-6736(18)32203-7
    1. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392:1789–858. 10.1016/S0140-6736(18)32279-7
    1. Shumway-Cook A, Anson D, Haller S. Postural sway biofeedback: its effect on reestablishing stance stability in hemiplegic patients. Arch Phys Med Rehabil 1988;69:395–400.
    1. Forster A, Young J. Incidence and consequences of falls due to stroke: a systematic inquiry. BMJ 1995;311:83–6. 10.1136/bmj.311.6997.83
    1. Schmid AA, Van Puymbroeck M, Altenburger PA, et al. . Balance is associated with quality of life in chronic stroke. Top Stroke Rehabil 2013;20:340–6. 10.1310/tsr2004-340
    1. S Z. The Risk Factors and Nursing of Elderly Cerebrovascular Inpatient Falls. Inner Mongolia Traditional Chinese Medicine 2013;32:157–8.
    1. Yang X, Wang P, Liu C, et al. . The effect of whole body vibration on balance, gait performance and mobility in people with stroke: a systematic review and meta-analysis. Clin Rehabil 2015;29:627–38. 10.1177/0269215514552829
    1. Corbetta D, Imeri F, Gatti R. Rehabilitation that incorporates virtual reality is more effective than standard rehabilitation for improving walking speed, balance and mobility after stroke: a systematic review. J Physiother 2015;61:117–24. 10.1016/j.jphys.2015.05.017
    1. Li Z, Han XG, Sheng J, et al. . Virtual reality for improving balance in patients after stroke: A systematic review and meta-analysis. Clin Rehabil 2016;30:432–40. 10.1177/0269215515593611
    1. Schmid AA, Van Puymbroeck M, Altenburger PA, et al. . Poststroke balance improves with yoga: a pilot study. Stroke 2012;43:2402–7. 10.1161/STROKEAHA.112.658211
    1. Broderick P, Horgan F, Blake C, et al. . Mirror therapy for improving lower limb motor function and mobility after stroke: A systematic review and meta-analysis. Gait Posture 2018;63:208–20. 10.1016/j.gaitpost.2018.05.017
    1. Li Y, Wei Q, Gou W, et al. . Effects of mirror therapy on walking ability, balance and lower limb motor recovery after stroke: a systematic review and meta-analysis of randomized controlled trials. Clin Rehabil 2018;32:1007–21. 10.1177/0269215518766642
    1. Louie DR, Lim SB, Eng JJ. The Efficacy of Lower Extremity Mirror Therapy for Improving Balance, Gait, and Motor Function Poststroke: A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis 2019;28:107–20. 10.1016/j.jstrokecerebrovasdis.2018.09.017
    1. Xu L, Dong Y, Wang M, et al. . Acupuncture for balance dysfunction in patients with stroke: A systematic review protocol. Medicine 2018;97:e11681 10.1097/MD.0000000000011681
    1. Chen BL, Guo JB, Liu MS, et al. . Effect of Traditional Chinese Exercise on Gait and Balance for Stroke: A Systematic Review and Meta-Analysis. PLoS One 2015;10:e0135932 10.1371/journal.pone.0135932
    1. Li GY, Wang W, Liu GL, et al. . Effects of Tai Chi on balance and gait in stroke survivors: A systematic meta-analysis of randomized controlled trials. J Rehabil Med 2018;50:582–8. 10.2340/16501977-2346
    1. Wu S, Chen J, Wang S, et al. . Effect of Tai Chi Exercise on Balance Function of Stroke Patients: A Meta-Analysis. Med Sci Monit Basic Res 2018;24:210–5. 10.12659/MSMBR.911951
    1. Tyson SF, Kent RM. Effects of an ankle-foot orthosis on balance and walking after stroke: a systematic review and pooled meta-analysis. Arch Phys Med Rehabil 2013;94:1377–85. 10.1016/j.apmr.2012.12.025
    1. Choi ET, Kim YN, Cho WS, et al. . The effects of visual control whole body vibration exercise on balance and gait function of stroke patients. J Phys Ther Sci 2016;28:3149–52. 10.1589/jpts.28.3149
    1. Lee MM, Lee KJ, Song CH. Game-Based Virtual Reality Canoe Paddling Training to Improve Postural Balance and Upper Extremity Function: A Preliminary Randomized Controlled Study of 30 Patients with Subacute Stroke. Med Sci Monit 2018;24:2590–8. 10.12659/MSM.906451
    1. Shin JW, Don Kim K. The effect of enhanced trunk control on balance and falls through bilateral upper extremity exercises among chronic stroke patients in a standing position. J Phys Ther Sci 2016;28:194–7. 10.1589/jpts.28.194
    1. Park KH, Kim DY, Kim TH. The effect of step climbing exercise on balance and step length in chronic stroke patients. J Phys Ther Sci 2015;27:3515–8. 10.1589/jpts.27.3515
    1. Hahn J, Shin S, Lee W. The effect of modified trampoline training on balance, gait, and falls efficacy of stroke patients. J Phys Ther Sci 2015;27:3351–4. 10.1589/jpts.27.3351
    1. Shin YJ, Lee DH, Kim MK. The effect of newly designed multi joint ankle foot orthosis on the gait and dynamic balance of stroke patients with foot drop. J Phys Ther Sci 2017;29:1899–902. 10.1589/jpts.29.
    1. Association TtCDCotCM. Various types of diagnosis of cerebrovascular diseases. Chinese Journal of Neurology 1996;29:379–81.
    1. Department of Disease Control MoH, Division of Neurology, Chinese Medical Association. Guidelines for the Prevention and Treatment of Cerebrovascular Diseases in China. Chinese Journal of Modern Nervous Diseases 2007;7:200–8.
    1. Group SAoEec. Stroke Diagnosis and Curative Effect Evaluation Standard (Trial). Journal of Beijing University of Traditional Chinese Medicine 1996;19:55–6.
    1. Fugl-Meyer AR, Jääskö L, Leyman I, et al. . The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med 1975;7:13–31.
    1. Tyson SF, DeSouza LH. Reliability and validity of functional balance tests post stroke. Clin Rehabil 2004;18:916–23. 10.1191/0269215504cr821oa
    1. Yelnik A, Bonan I. Clinical tools for assessing balance disorders. Neurophysiol Clin 2008;38:439–45. 10.1016/j.neucli.2008.09.008
    1. Blum L, Korner-Bitensky N. Usefulness of the Berg Balance Scale in stroke rehabilitation: a systematic review. Phys Ther 2008;88:559–66. 10.2522/ptj.20070205
    1. F-m AR. Post strok heimplgia assessment of physical properties. Scand J Rehab Med 1980;7:85.
    1. Benaim C, Pérennou DA, Villy J, et al. . Validation of a standardized assessment of postural control in stroke patients: the Postural Assessment Scale for Stroke Patients (PASS). Stroke 1999;30:1862–8.
    1. Mao HF, Hsueh IP, Tang PF, et al. . Analysis and comparison of the psychometric properties of three balance measures for stroke patients. Stroke 2002;33:1022–7. 10.1161/01.STR.0000012516.63191.C5
    1. Chien CW, Hu MH, Tang PF, et al. . A comparison of psychometric properties of the smart balance master system and the postural assessment scale for stroke in people who have had mild stroke. Arch Phys Med Rehabil 2007;88:374–80. 10.1016/j.apmr.2006.11.019
    1. Liaw LJ, Hsieh CL, Lo SK, et al. . The relative and absolute reliability of two balance performance measures in chronic stroke patients. Disabil Rehabil 2008;30:656–61. 10.1080/09638280701400698
    1. Gorman SL, Rivera M, McCarthy L. Reliability of the Function in Sitting Test (FIST). Rehabil Res Pract 2014;2014:1–6. 10.1155/2014/593280
    1. Medley A, Thompson M. Development, reliability, and validity of the Sitting Balance Scale. Physiother Theory Pract 2011;27:471–81. 10.3109/09593985.2010.531077
    1. Guan Q, Han H, Li Y, et al. . Activities-specific Balance Confidence (ABC) Scale adapted for the mainland population of China. Clin Rehabil 2012;26:648–55. 10.1177/0269215511427748
    1. Mohan G, Pal PK, Sendhil KR, et al. . Quantitative evaluation of balance in patients with spinocerebellar ataxia type 1: a case control study. Parkinsonism Relat Disord 2009;15:435–9. 10.1016/j.parkreldis.2008.10.003
    1. Tyson SF, Hanley M, Chillala J, et al. . The relationship between balance, disability, and recovery after stroke: predictive validity of the Brunel Balance Assessment. Neurorehabil Neural Repair 2007;21:341–6. 10.1177/1545968306296966
    1. Mudaliar MR, Yiragamreddy SR, Tejashwani PP, et al. . Quality of Life in Stroke Patients Using SSQoL Scale and Barthel Index. Indian Journal of Pharmacy Practice 2018;11:44–50. 10.5530/ijopp.11.1.8
    1. Weng C STZ, Min L. The value of the timed “up and go” test at the evaluation of functional mobility in stroke patients. Chinese Journal of Rehabilitation Theory & Practice 2004.
    1. Higgins JP, Altman DG, Gøtzsche PC, et al. . The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928 10.1136/bmj.d5928
    1. Atkins D, Best D, Briss PA, et al. . Grading quality of evidence and strength of recommendations. BMJ 2004;328:1490 10.1136/bmj.328.7454.1490
    1. Zeng Xiantao LW, Sheng L, et al. . How to understand and use the GRADE system correctly. Chinese Journal of Evidence-based Medicine 2011;11:985–90.
    1. Sterne JA, Sutton AJ, Ioannidis JP, et al. . Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ 2011;343:d4002 10.1136/bmj.d4002

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться