Sensory retraining of the leg after stroke: systematic review and meta-analysis

Abstract

Objective: This systematic review aimed to investigate the effects of interventions intended for retraining leg somatosensory function on somatosensory impairment, and secondary outcomes of balance and gait, after stroke. Data sources: Databases searched from inception to 16 January 2019 included Cochrane Library, PubMed, MEDLINE, CINAHL, EMBASE, PEDro, PsycINFO, and Scopus. Reference lists of relevant publications were also manually searched. Review methods: All types of quantitative studies incorporating interventions that intended to improve somatosensory function in the leg post stroke were retrieved. The Quality Assessment Tool for Quantitative Studies was used for quality appraisal. Standardised mean differences were calculated and meta-analyses were performed using preconstructed Microsoft Excel spreadsheets. Results: The search yielded 16 studies, comprising 430 participants, using a diverse range of interventions. In total, 10 of the included studies were rated weak in quality, 6 were rated moderate, and none was rated strong. Study quality was predominantly affected by high risk of selection bias, lack of blinding, and the use of somatosensory measures that have not been psychometrically evaluated. A significant heterogeneous positive summary effect size (SES) was found for somatosensory outcomes (SES: 0.52; 95% confidence interval (CI): 0.04 to 1.01; I 2 = 74.48%), which included joint position sense, light touch, and two-point discrimination. There was also a significant heterogeneous positive SES for Berg Balance Scale scores (SES: 0.62; 95% CI: 0.10 to 1.14; I 2 = 59.05%). Gait SES, mainly of gait velocity, was not significant. Conclusion: This review suggests that interventions used for retraining leg somatosensory impairment after stroke significantly improved somatosensory function and balance but not gait.

The effect of sensory discrimination training on sensorimotor performance in individuals with central neurological conditions: A systematic review

“…Four previous systematic reviews have investigated the efficacy of somatosensory discrimination training interventions for people following stroke (Chia et al, 2019;Schabrun and Hillier, 2009;Serrada et al, 2019;Turville et al, 2019). Although there was some evidence in favour of the experimental interventions as an efficacious treatment option, like the findings in this review, the evidence was limited by small sample size, inconsistency in clinical outcome measures and poor-quality studies.…”

“…Turville et al (2019) assessed the efficacy of somatosensory training interventions in the upper limb including both randomised and non-randomised controlled trialsonly two RCTs were reviewedone also included in this review (Carey et al, 2011) and a second in which the sensory intervention was not in keeping with the definition used in this study because direct feedback on task performance was not given. Chia et al (2019) reviewed the efficacy of somatosensory retraining of the lower limb including all quantitative types of studies, two RCTs (Lynch et al, 2007;Morioka and Yagi, 2003) of which were also included in this review. This systematic review serves to fill a gap in the literature because it includes a more diverse population expanding from stroke to neurological conditions; its included studies are in keeping with the recommended gold standard (RCTs) and it has followed the Cochrane Collaboration methodology adopting use of the GRADE approach in an attempt to capture high-quality studies (Higgins et al, 2020a(Higgins et al, , 2020b.…”

“…Four systematic reviews have investigated the efficacy of SDT for people following stroke (Chia et al, 2019;Schabrun and Hillier, 2009;Serrada et al, 2019;Turville et al, 2019). They found some evidence towards its effectiveness for improving somatosensory function in the lower and upper limbs but ultimately conclude that this is limited due to poorquality study designs, inadequately powered with inconsistencies in outcome measurement tools.…”

Passive Biaxial Ankle Movement Training with Electrical Stimulation for Ankle Sensorimotor Function in Chronic Stroke

“…The performance of complex functions, such as walking, involves various factors including muscle strength [31][32][33], spasticity [32], cognition [34], motor function [33,34], and balance [31,33], as well as sensory information. A recent meta-analysis showed that leg somatosensory retraining after stroke signi cantly improved the somatosensory function and balance but not the gait [35]. However, this meta-analysis included only a few ankle proprioception-related training, and a 2-week proprioception training of the big toe and ankle was reported to be effective for improving light touch, postural control, and gait but not proprioception [36].…”

Effects of Passive Bi-axial Ankle Movement Training with Electrical Stimulation on Ankle Sensorimotor Functions in Stroke Patients: A Randomized Controlled Pilot Study

“…The performance of complex functions, such as walking, involves various factors including muscle strength [31][32][33], spasticity [32], cognition [34], motor function [33,34], and balance [31,33], as well as sensory information. A recent meta-analysis showed that leg somatosensory retraining after stroke signi cantly improved the somatosensory function and balance but not the gait [35].…”