The Effectiveness of Perturbation-Based Training in the Treatment of Patients With Stroke: A Systematic Review and Meta-Analysis

Abstract

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).