Rehabilitation interventions for improving balance following stroke: An overview of systematic reviews.

Author: Arienti C1, Lazzarini SG1, Pollock A2, Negrini S1,3
1IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.
2Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, United Kingdom.
3Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Conference/Journal: PLoS One.
Date published: 2019 Jul 19
Other: Volume ID: 14 , Issue ID: 7 , Pages: e0219781 , Special Notes: doi: 10.1371/journal.pone.0219781. eCollection 2019. , Word Count: 284

BACKGROUND: The aim of this study was to synthesize evidence from systematic reviews, to summarise the effects of rehabilitation interventions for improving balance in stroke survivors.

METHODS: We conducted an overview of systematic reviews (SRs). We included Cochrane Systematic Reviews and non-Cochrane Systematic Reviews of randomized-controlled clinical trials and not-randomized clinical trials, in all types of stroke, comparing the effects of interventions, control interventions and no interventions on balance-related outcomes. We conducted a comprehensive search of electronic databases, from inception to December 2017. Data extracted included: number and type of participants, type of intervention, control intervention, method of assessing risk of bias of primary studies, balance outcome measures and results of statistical meta-analyses. Methodological quality of included reviews was assessed using AMSTAR 2. A narrative description of the characteristics of the SRs was provided and results of meta-analyses summarised with reference to their methodological quality.

RESULTS: 51 SRs (248 primary studies and 10,638 participants) met the inclusion criteria and were included in the overview. All participants were adults with stroke. A wide variety of different balance and postural control outcomes were included. 61% of SRs focussed on the effectiveness of physical therapy, 20% virtual reality, 6% electromechanical devices, 4% Tai-Chi, whole body vibration and circuit training intervention, and 2% cognitive rehabilitation. The methodology of 54% of SRs were judged to be of a "low or critically low" quality, 23% "moderate" quality and 22% "high" quality.

CONCLUSIONS: There are 51 SRs of evidence relating to the effectiveness of interventions to improve balance in people with stroke, but the majority of these are of poor methodological quality, limiting our ability to draw clear implications. Only 22% of these SRs were judged to be of high quality, highlighting the need to address important methodological issues within rehabilitation research.

PMID: 31323068 DOI: 10.1371/journal.pone.0219781