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Purpose: To investigate the effectiveness of perturbation-based training (PBT) on balance and balance confidence in patients with stroke. Methods: Systematic searching was performed from inception to November 2021. The inclusion criteria were RCTs assessed the effectiveness of PBT in patients with stroke. Data regarding participants, intervention parameters, outcome measures, follow-up, and main results were extracted. The outcomes were balance and balance confidence. Methodological quality and quality of evidence were assessed using the Physiotherapy Evidence Database (PEDro) scale and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system; respectively. Data analysis: A total of 7 articles )271 patients) were included. A meta-analysis using a random-effect model was performed on 6 studies. Standardized mean difference (SMD) with a 95% confidence interval was calculated for balance and balance confidence. Results: PEDro scale revealed 5 good-quality and 2 fair-quality studies. The currently available evidence showed significant effect of PBT in improving balance (SMD 0.60 [95% CI 0.15-1.06]; P = .01; very low-quality evidence) and non-significant in improving balance confidence (SMD 0.11 [95% CI −0.24 to 0.45]; P = .55; low-quality evidence). Conclusion: PBT may improve balance in patients with stroke, however its effect on balance confidence was limited. The quality of the evidence was low or very low with little confidence in the effect estimate, which suggests further high-quality trials are required. Registration: PROSPERO registration number (CRD42021291474).

Objective: The aim of this systematic review and meta-analysis was to investigate the effectiveness of telerehabilitation on improving balance and functional mobility in stroke survivors. Methods: Comprehensive searching was conducted from inception to May 2022. The inclusion criteria were studies evaluating the effectiveness of telerehabilitation in stroke survivors. Data regarding participants, intervention, outcome measures, and main results were extracted. PEDro scale and the Grading of Recommendations Assessment Development and Evaluation (GRADE) were used to assess the methodological quality and quality of evidence, respectively. Data Analysis: A total of fourteen articles )594 patients) were included. A meta-analysis using a random-effect model was performed on thirteen studies )530 patients). Standardized mean difference (SMD) with 95% confidence interval (CI) was calculated for balance and functional mobility. Results: PEDro scale revealed ten good-quality studies, three fair-quality studies, and one poor-quality study. According to the available evidence, telerehabilitation has a small effect size in improving both balance (SMD 0.33 [95% CI 0.03 to 0.63]; P =0.03; low quality of evidence) and functional mobility (SMD 0.27 [95% CI 0.02 to 0.52]; P =0.03; low quality of evidence). Conclusion: Telerehabilitation may improve balance and functional mobility in stroke survivors. However, it is evident that more high-quality research is required due to the existence of low to very low-quality evidence with limited confidence in the effect estimate. Registration: PROSPERO registration number (CRD42022306410).

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