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

Abstract

IntroductionStroke 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 analysisWe 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 disseminationNo 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 numberProspero CRD42016037966;Pre-results.

Publication language and the estimate of treatment effects of physical therapy on balance and postural control after stroke in meta-analyses of randomised controlled trials

“…The study presented herein is a secondary analysis of a previously published meta-analysis, Hugues et al, 2019 [29]. For the latter, we established a protocol following the recommendations of the PRISMA statement [30] and the Cochrane Collaboration [15], which was registered in PROSPERO (CRD42016037966), and published [31]. We therefore only briefly report herein the method used.…”

“…EMBASE until October 2015, SCOPUS thereafter), Cochrane Central Register of Controlled Trials, PEDro, Pascal, and Francis databases from inception until 14 January 2019. The search strategy and keywords are described in the published protocol and the meta-analysis [29,31]. Unpublished trials and grey literature were searched by contacting experts, reading conference proceedings, and with the help of a librarian.…”

“…Two independent authors (AH, JDM) selected all records according to the selection criteria, then conducted data extraction and assessed risk of bias for each study included. In case of disagreement for the selection and the extraction, we requested the judgement of three other authors (GR, IB, FG) to resolve conflicts [31]. In case of disagreement for the assessment of the risk of bias, we also asked the judgement of two other authors (MC, FG) to resolve conflicts [31].…”

“…In case of disagreement for the selection and the extraction, we requested the judgement of three other authors (GR, IB, FG) to resolve conflicts [31]. In case of disagreement for the assessment of the risk of bias, we also asked the judgement of two other authors (MC, FG) to resolve conflicts [31]. We extracted data related to study design, participant characteristics, risk of bias, PT characteristics, and outcomes [29,31].…”

<p>Evaluation of Postural Stability and Transverse Abdominal Muscle Activity in Overweight Post-Stroke Patients: A Prospective, Observational Study</p>

“…16 In the acute phase of stroke, over 80% of subjects present a postural imbalance. 17 The risk of falls is increased by 73% in the 6 months following a stroke. What is more, stroke is a major cause of falls in 42% of the patients.…”