Effects of Wearable Sensor-Based Balance and Gait Training on Balance, Gait, and Functional Performance in Healthy and Patient Populations: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

n = 1, type 3: n = 3) or combined different types of training paradigms within their intervention (type 1 and 2: n = 2; all types: n = 2). The meta-analyses revealed significant overall effects of WS training on static steady-state balance outcomes including mediolateral (eyes open: Hedges' g = 0.82, CI: 0.43-1.21; eyes closed: g = 0.57, CI: 0.14-0.99) and anterior-posterior sway (eyes open: g = 0.55, CI: 0.01-1.10; eyes closed: g = 0.44, CI: 0.02-0.86). No effects on habitual gait speed were found in the meta-analysis ( g = -0.19, CI: -0.68 to 0.29). Two RCTs reported significant improvements for selected gait variables including single support time, and fast gait speed. One study identified effects on proactive balance (Alternate Step Test), but no effects were found for the Timed Up and Go test and the Berg Balance Scale. Two studies reported positive results on feasibility and usability. Only one study was performed in an unsupervised setting. Conclusion: This review provides evidence for a positive effect of WS training on static steady-state balance in studies with usual care controls and studies with conventional balance training controls. Specific gait parameters and proactive balance measures may also be improved by WS training, yet limited evidence is available. Heterogeneous training paradigms, small sample sizes, and short intervention durations limit the validity of our findings. Larger studies are required for estimating the true potential of WS technology. © 2017 S. Karger AG, Basel KeywordsInertial measurement unit · Force sensor · Postural balance · Gait · Biofeedback · Exergame · Systematic review Abstract Background: Wearable sensors (WS) can accurately measure body motion and provide interactive feedback for supporting motor learning. Objective: This review aims to summarize current evidence for the effectiveness of WS training for improving balance, gait and functional performance. Methods: A systematic literature search was performed in PubMed, Cochrane, Web of Science, and CINAHL. Randomized controlled trials (RCTs) using a WS exercise program were included. Study quality was examined by the PEDro scale. Metaanalyses were conducted to estimate the effects of WS balance training on the most frequently reported outcome parameters. Results: Eight RCTs were included (Parkinson n = 2, stroke n = 1, Parkinson/stroke n = 1, peripheral neuropathy n = 2, frail older adults n = 1, healthy older adults n = 1). The sample size ranged from n = 20 to 40. Three types of training paradigms were used: (1) static steady-state balance training, (2) dynamic steady-state balance training, which includes gait training, and (3) proactive balance training. RCTs either used one type of training paradigm (type 2:

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“…A meta-analysis of seven small RCTs of IMU-based interventions for static or dynamic balance with feedback in adults with Parkinson's, stroke, and peripheral neuropathy and frail older adults found significant overall effects of training, especially for up to 36 sessions, on static steady-state balance and possibly several gait outcomes [43]. The APDM balance system has also shown promise in persons with a mild traumatic brain injury in detecting excessive sway [44].…”

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“…Todos los estudios fueron superiores a 6, indicando una buena calidad metodológica según el estudio realizado por Gordt K y cols. 30 , excepto el estudio realizado por Hoffman y cols. 27 27 , en otro 26 mujeres con sobrepeso de mediana edad (30-48 años) 28 y en el tercer estudio se analizaron a 10 atletas de diferentes edades (18-45 años) 29 .…”

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“…Increases in life expectancy and societal aging have highlighted functional problems experienced by the elderly during daily life and prompted studies on rehabilitation and improving quality of life [1,2]. Balance is an important aspect of rehabilitation and the most basic factor in terms of ambulation and the risk of falls during everyday activities [1,3,4]. Balance maintains body posture and reduces fall risk [5,6] and may be classified as static or dynamic.…”