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BMC Geriatrics Dec 2021Cognitive impairment (CI) increases an individual's risk of falls due to the role cognition plays in gait control. Older adults with dementia fall 2-3 times more than... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Cognitive impairment (CI) increases an individual's risk of falls due to the role cognition plays in gait control. Older adults with dementia fall 2-3 times more than cognitively healthy older adults and 60-80% of people with dementia fall annually. Practitioners require evidence-based fall prevention best practices to reduce the risk of falls in cognitively impaired adults living in the community.
METHODS
We conducted a systematic review and meta-analysis to identify the effectiveness of primary and secondary fall prevention interventions in reducing falls and fear of falling, and improving gait, balance, and functional mobility. We searched 7 databases for fall prevention interventions involving community-dwelling adults ≥50 years with mild to moderate CI. Reviewers screened citations, extracted data, and assessed risk of bias and certainty of evidence (GRADE). We assessed statistical and methodological heterogeneity and performed a meta-analysis of studies including subgroup analysis based on intervention and risk of bias groupings.
RESULTS
Five hundred nine community-dwelling adults (mean age 67.5 to 84.0 years) with mild to moderate CI from 12 randomized or clinical controlled trials (RCTs/CCTs) were included in this review. Eight studies were exercise interventions, 3 were multifactorial, and 1 provided medication treatment. Fall prevention interventions had significant effects of medium magnitude on fear of falling (standardized mean difference (SMD) -0.73 [- 1.10, - 0.36]), balance (SMD 0.66 [0.19, 1.12]), and functional mobility measured as Timed Up and Go test (SMD -0.56 [- 0.94, - 0.17]) and significant effects of small magnitude on gait control (SMD 0.26 [0.08, 0.43]) all with moderate certainty of evidence. The meta-analysis showed no significant effects for falls (number of events or falls incidence). Sub-analysis showed that exercise and low risk of bias studies remained significant for balance and perceived risk of falls.
CONCLUSION
The effect of fall prevention interventions on direct outcomes, such as falls, remains unclear in cognitively impaired individuals. Exercise interventions are effective at improving fall risk factors, however, high quality studies with longer follow-up and adequate sample sizes are needed to determine their effectiveness on falls directly. There remains a gap in terms of effective fall prevention interventions for older adults with CI.
Topics: Aged; Aged, 80 and over; Cognitive Dysfunction; Fear; Humans; Independent Living; Postural Balance; Time and Motion Studies
PubMed: 34893027
DOI: 10.1186/s12877-021-02641-9 -
Archives of Physical Medicine and... Apr 2021To systematically review the effect of core stability exercises in addition to usual care physiotherapy on patient outcomes after stroke. (Comparative Study)
Comparative Study Meta-Analysis
OBJECTIVE
To systematically review the effect of core stability exercises in addition to usual care physiotherapy on patient outcomes after stroke.
DATA SOURCES
Cumulative Index to Nursing and Allied Health, MEDLINE, Physiotherapy Evidence Database (PEDro), PubMed, and EMBASE were searched to November 2018.
STUDY SELECTION
Eleven randomized controlled trials that compared usual care physiotherapy with usual care physiotherapy with additional core stability exercises in people with stroke were included. The initial search yielded 1876 studies.
DATA EXTRACTION
Two independent reviewers applied inclusion and exclusion criteria and extracted data on methodological quality using the PEDro scale, participant characteristics, intervention details, outcome measures, and results.
DATA SYNTHESIS
Postintervention means and SDs were pooled to calculate either the standardized mean difference (SMD) or the mean difference (MD) and 95% CIs using a random-effects model and inverse variance methods. There was moderate quality evidence to suggest the addition of core stability exercises to usual care physiotherapy improved trunk control (SMD, 0.94; 95% CI, 0.44-1.44; I=69%), functional dynamic balance (SMD, 1.23; 95% CI, 0.5-1.97; I=71%), and walking speed (MD, 0.27m/s; 95% CI, 0.01-0.52; I=40%) in people with acute and chronic stroke. No significant effect was found when assessing functional ambulation categories or the timed Up and Go test, and mixed results were found for global functioning.
CONCLUSIONS
The addition of core stability exercises to usual care physiotherapy after stroke may lead to improved trunk control and dynamic balance. Therefore, core stability exercises should be included in rehabilitation if improvements in these domains will help clients achieve their goals. Future trials should consider incorporating outcomes of body kinematics during functional tasks to assess movement quality and assess participation outcomes.
Topics: Humans; Physical Therapy Modalities; Postural Balance; Randomized Controlled Trials as Topic; Stroke Rehabilitation; Torso
PubMed: 33239203
DOI: 10.1016/j.apmr.2020.09.388 -
Limited evidence of physical therapy on balance after stroke: A systematic review and meta-analysis.PloS One 2019Stroke results in balance disorders and these directly affect autonomy and quality of life. The purpose of this systematic review and meta-analysis was to determine the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Stroke results in balance disorders and these directly affect autonomy and quality of life. The purpose of this systematic review and meta-analysis was to determine the efficacy of physical therapy (PT) on balance and postural control after stroke.
METHODS
We included all randomized controlled trials assessing the efficacy of PT on balance and postural control in adult patients after stroke without language restriction. Medline, Embase/Scopus, Cochrane Central Register of Controlled Trials, PEDro, Pascal, and Francis databases were searched until January 2019. Primary outcomes were balance (Berg Balance scale and Postural Assessment Scale for Stroke) and postural control with postural deviation or stability measurement in sitting or standing static evaluation. A pair of independent reviewers selected studies, extracted data, and assessed risk of bias. Meta-analyses with subgroups (categories of PT, time post-stroke, and lesion location) and meta-regression (duration of PT) were conducted.
RESULTS
A total of 145 studies (n = 5912) were selected from the 13,123 records identified. For balance, evidence was found in favor of the efficacy of functional task-training alone (standardized mean difference 0.39, 95% confidence interval [0.09; 0.68], heterogeneity I2 = 63%) or associated with musculoskeletal intervention and/or cardiopulmonary intervention (0.37, [0.19; 0.55], I2 = 48%), electrostimulation (0.91, [0.49; 1.34], I2 = 52%) immediately after intervention, compared to sham treatment or usual care (ST/UC). For postural deviation eyes open, assistive devices were more effective than no treatment (-0.21, [-0.37; -0.05], I2 = 0%) immediately after intervention; for postural stability eyes open, functional task-training and sensory interventions were more effective than ST/UC (0.97, [0.35; 1.59], I2 = 65% and 0.80, [0.46; 1.13], I2 = 37% respectively) immediately after intervention.
CONCLUSIONS
Functional task-training associated with musculoskeletal intervention and/or cardiopulmonary intervention and sensory interventions seem to be immediately effective in improving balance and postural stability, respectively. The heterogeneity of PT and the weak methodological quality of studies limited the interpretation and the confidence in findings.
Topics: Aged; Humans; Middle Aged; Physical Therapy Modalities; Postural Balance; Publication Bias; Risk; Stroke
PubMed: 31465462
DOI: 10.1371/journal.pone.0221700 -
PM & R : the Journal of Injury,... Mar 2019Individuals with Parkinson disease (PD) present balance and functional mobility disabilities that negatively affect the quality of life (QOL). (Meta-Analysis)
Meta-Analysis
BACKGROUND
Individuals with Parkinson disease (PD) present balance and functional mobility disabilities that negatively affect the quality of life (QOL).
OBJECTIVE
To systematically review the effects of hydrotherapy on balance, functional mobility, QOL, and motor status in patients with PD.
DESIGN
Systematic review and meta-analysis.
PARTICIPANTS
A total of 484 participants were included. The mean age of participants ranged from 54 to 78 years. The average duration of PD ranged from 3 to 10 years.
METHODS
MEDLINE (PubMed), Embase, Cochrane CENTRAL, SCOPUS, Scielo, Physiotherapy Evidence Database (PEDro), and Google Scholar were searched from inception to December 2017. Randomized controlled trials (RCT), non-RCT, and pre-post studies were included.
MAIN OUTCOME MEASUREMENTS
Berg Balance Scale; Timed Up and Go test; Parkinson's disease quality of life and Short Form-36 Health Survey; Unified Parkinson Disease Rating Scale-Part III.
RESULTS
A total of 19 studies were identified, including eight RCTs, three non-RCTs, and eight pre-post studies. Our meta-analysis showed a moderate quality of evidence for positive effects of hydrotherapy combined or not with land-based therapy on balance (133 patients; MD = 2.00 [95% CI, 0.56 to 3.43; I 0%, P = .01]) and functional mobility (133 patients; MD = -1.08 [95% CI, -1.99 to -0.18; I 8%, P = .02]). However, hydrotherapy combined or not with land-based therapy did not improve QOL (76 patients; MD = -6.35 [95% CI, -13.04 to 0.33; I 7%, P = .06]) and motor status (140 patients; MD = -1.11 [95% CI, -3.27 to 1.04; I 0%, P = .31). The risk of bias across the included RCTs was low.
CONCLUSIONS
Hydrotherapy, combined or not with other therapies, may improve balance and functional mobility of patients with PD when compared to land-based therapy alone or usual care.
LEVEL OF EVIDENCE
Level I.
Topics: Humans; Hydrotherapy; Parkinson Disease; Postural Balance; Quality of Life; Range of Motion, Articular
PubMed: 30884205
DOI: 10.1016/j.pmrj.2018.09.031 -
Clinical Rehabilitation Dec 2021To identify the effects of balance and strength training on function, ankle instability and dynamic balance in people with chronic ankle instability. (Meta-Analysis)
Meta-Analysis
Effects of balance training on functionality, ankle instability, and dynamic balance outcomes in people with chronic ankle instability: Systematic review and meta-analysis.
AIM
To identify the effects of balance and strength training on function, ankle instability and dynamic balance in people with chronic ankle instability.
METHOD
The search was conducted on randomized controlled trials that investigated the effects of balance training or strength training in people with chronic ankle instability compared to a control group. Therefore, a systematic electronic search was performed until April 2021 in Pubmed/MEDLINE, Cochrane, and Embase databases. Moreover, an additional search was further performed checking the reference lists of the selected articles. The main outcomes were ankle instability, functionality, and dynamic balance. Finally, a qualitative and quantitative synthesis was performed.
RESULTS
Fifteen randomized controlled trials with 457 volunteers were included. Compared to regular exercise, balance training demonstrated to be more effective in terms of improving functionality (0.81 (0.48, 1.14)), ankle instability (0.77 (0.27, 1.26)), and dynamic balance (0.83 (0.57, 1.10)) outcomes. However, when compared to strength training, the effectiveness of balance training was only greater in terms of the functionality outcome (0.49 (0.06, 0.92)), since no differences were found for instability (0.43 (0.00, 0.85)) and dynamic balance (0.21 (-0.15, 0.58)).
CONCLUSIONS
Based on fair-to-high quality evidence, balance training significantly improves functionality, instability, and dynamic balance outcomes in people with chronic ankle instability Moreover, results of the comparison between balance training versus strength training suggest that the former achieves greater benefits for functionality, but not for instability and dynamic balance.
SYSTEMATIC REVIEW REGISTRATION NUMBER
CRD42021224179.
Topics: Ankle; Ankle Injuries; Ankle Joint; Humans; Joint Instability; Postural Balance; Resistance Training
PubMed: 34058832
DOI: 10.1177/02692155211022009 -
Physical Therapy May 2019Youths with Down syndrome are characterized by deficits in balance/postural stability. One way to palliate balance deficits among this population is through exercise...
BACKGROUND
Youths with Down syndrome are characterized by deficits in balance/postural stability. One way to palliate balance deficits among this population is through exercise interventions. However, to the authors' knowledge, the effects of exercise interventions designed to improve the balance of youths with Down syndrome have never been systematically reviewed.
PURPOSE
The purpose of this review was to summarize the findings from studies examining the effects of exercise interventions designed to improve balance in youths with Down syndrome.
DATA SOURCES
A systematic literature search was performed in 10 databases (Academic Search Complete, CINAHL Plus With Full-Text, Education Source, ERIC, Medline With Full-Text, PsycARTICLES, Psychology and Behavioral Sciences Collection, Scopus, SocINDEX, and SPORTDiscus With Full-Text) on June 12, 2017.
STUDY SELECTION
Randomized controlled trials and controlled trials examining the effects of exercise interventions designed to improve balance in youths with Down syndrome were included.
DATA EXTRACTION
Two authors selected the studies and extracted their characteristics and results. Three authors assessed the risk of bias in the studies using the Cochrane Collaboration tool.
DATA SYNTHESIS
Eleven studies, published between 2010 and 2017, met the inclusion criteria. The findings showed that exercise interventions were more effective than control conditions for improving the static balance of children with Down syndrome and the static-dynamic balance (ie, global balance score obtained with a scale measuring both static and dynamic balance) of children and adolescents with Down syndrome. Nevertheless, the findings on dynamic balance in children and static balance in adolescents were inconclusive.
LIMITATIONS
With a small number of studies and their high risk of bias, the present findings must be interpreted with caution.
CONCLUSIONS
The reviewed exercise interventions were successful in improving the static balance of children with Down syndrome and the static-dynamic balance of children and adolescents with Down syndrome.
Topics: Accidental Falls; Adolescent; Child; Down Syndrome; Exercise Therapy; Humans; Postural Balance
PubMed: 31089706
DOI: 10.1093/ptj/pzz012 -
Clinical Rehabilitation Dec 2018To investigate how dynamic neuromuscular control, postural sway, joint position sense, and incidence of ankle sprain are influenced by balance training in athletes... (Meta-Analysis)
Meta-Analysis
OBJECTIVE:
To investigate how dynamic neuromuscular control, postural sway, joint position sense, and incidence of ankle sprain are influenced by balance training in athletes compared with the control group in randomized clinical trials.
DATA SOURCES:
The search strategy included MEDLINE, Physical Therapy Evidence Database, Cochrane Central Register of Controlled Trials, and Latin American and Caribbean Center on Health Sciences Information. Randomized controlled trials (RCTs) were published by June of 2018.
METHODS:
RCTs that evaluate the effectiveness of proprioception in these outcomes: dynamic neuromuscular control, postural sway, joint position, and the incidence of ankle sprains in athletes aged between 18 and 35 years. Two reviewers independently screened the searched records, extracted the data, and assessed risk of bias. The treatment effect sizes were pooled in a meta-analysis using the RevMan 5.2 software. Internal validity was assessed through topics suggested by Cochrane Collaborations.
RESULTS:
Of the 12 articles included ( n = 1817), eight were in the meta-analysis ( n = 1722). The balance training reduced the incidence of ankle sprains in 38% compared with the control group ( RR: 0.62; 95% CI: 0.43-0.90). In relation to the dynamic neuromuscular control, the training showed increase in the distance of reach in the anterior (0.62 cm, 95% CI: 0.13-1.11), posterolateral (4.22 cm, 95% CI: 1.76-6.68), and posteromedial (3.65 cm, 95% CI: 1.03-6.26) through the Star Excursion Balance test. Furthermore, training seems to improve postural sway and joint position sense.
CONCLUSION:
Balance training reduces the incidence of ankle sprains and increases dynamic neuromuscular control, postural sway, and the joint position sense in athletes.
Topics: Ankle Injuries; Athletic Injuries; Humans; Incidence; Physical Therapy Modalities; Proprioception; Sprains and Strains
PubMed: 29996668
DOI: 10.1177/0269215518788683 -
NeuroRehabilitation 2020Balance deficits are common impairments in individuals with post-traumatic brain injury (TBI). Balance deficits can restrict the activities of daily living and...
BACKGROUND
Balance deficits are common impairments in individuals with post-traumatic brain injury (TBI). Balance deficits can restrict the activities of daily living and productive participation in social life. To date, no systematic reviews have examined the impact of physical therapy intervention on balance post-TBI.
OBJECTIVE
To examine the effects of physical therapy interventions on balance impairments in individuals with TBI.
METHODS
We systematically searched in PubMed, EMBASE, Scopus, PEDro, MEDLINE, REHABDATA, and Web of Science for randomized controlled trials (RCTs), clinical control trials, and pilot studies that examined the effects of physical therapy interventions on balance deficits in individuals post-TBI. The methodological quality was estimated using the Physiotherapy Evidence Database (PEDro) scale.
RESULTS
Eight studies published from 2003 to 2019 were included in this study. A total of 259 TBI participants post-TBI were included in this review, 71 (27.41%) of which were females. The methodological quality of the selected studies ranged from low to high. There were no significant differences between experimental interventions, virtual reality (VR), vestibular rehabilitation therapy (VRT), control group interventions, and other traditional physical therapy interventions.
CONCLUSIONS
The evidence about the effects of the physical therapy interventions in improving the balance ability post-TBI was limited. Further randomized controlled trials are strongly warranted to understand the role of physical therapy in patients with TBI who complain about balance deficits.
Topics: Brain Injuries, Traumatic; Humans; Neurological Rehabilitation; Physical Therapy Modalities; Postural Balance; Randomized Controlled Trials as Topic
PubMed: 32508337
DOI: 10.3233/NRE-203047 -
Journal of Hand Therapy : Official... 2017Systematic review. (Review)
Review
STUDY DESIGN
Systematic review.
INTRODUCTION
Constituents of proprioception include our awareness of the position (joint position sense [JPS]) and motion (kinesthesia) of our limbs in space. Proprioceptive deficits are associated with musculoskeletal disorders but remain a challenge to quantify, particularly at the shoulder.
PURPOSE OF THE STUDY
To report the psychometric values of validity, reliability, and responsiveness for shoulder JPS and/or kinesthesia protocols.
METHODS
A review of 5 databases was conducted from inception to July 2016 for studies reporting a psychometric property of a shoulder proprioception protocol. The included studies were evaluated using the QualSyst checklist and COSMIN 4-point scale.
RESULTS
Twenty-one studies were included, yielding 407 participants and 553 evaluated shoulders (n). The included studies support excellent methodological scores using the QualSyst checklist (88.1 ± 9.9%) and good psychometric scores with the COSMIN for reliability (71.1%) and moderate-to-low quality score (50%) for criterion validity. Weighted average intraclass correlation coefficients (ICCs) for intrarater reliability were highest for passive JPS and kinesthesia, ICC = 0.92 ± 0.07 (n = 214) and ICC = 0.92 ± 0.04 (n = 74), respectively. The most reliable movement and tool are internal rotation at 90° of abduction, ICC = 0.88 ± 0.01 (n = 53), and the dynamometer, ICC = 0.92 ± 0.88 (n = 225). Only 2 studies quantify an aspect of validity and no responsiveness indices were reported among the included studies.
CONCLUSION
Based on the results of the included studies, the evaluation of shoulder proprioception is most reliable when using a passive protocol with an isokinetic dynamometer for internal rotation at 90° of shoulder abduction. Standardized protocols addressing the psychometric properties of shoulder proprioception measures are needed.
LEVEL OF EVIDENCE
Level 1a: systematic review.
Topics: Humans; Proprioception; Psychometrics; Range of Motion, Articular; Reproducibility of Results; Shoulder Joint
PubMed: 28641738
DOI: 10.1016/j.jht.2017.05.003 -
Musculoskeletal Surgery Dec 2022The primary aim of this systematic review is to evaluate how postural balance and visual system are related in cross-eyed patients. The secondary goal is to assess the... (Review)
Review
The primary aim of this systematic review is to evaluate how postural balance and visual system are related in cross-eyed patients. The secondary goal is to assess the benefits of eye realignment on motor skills and body balance. Analyzing two different approaches: surgical or conservative, a systematic literature search was conducted using PubMed-Medline, Google Scholar and Cochrane Central in order to identify randomized controlled trials, case series and case-control studies which contained clinical evaluation of balance in strabismic patients as well as re-evaluation after surgery or conservative treatments via posturography to evaluate surface, length and mean speed of the center of pressure (CoP). A total of 11 studies were included in this review. The MINORS score is used to assess the methodological quality of the included studies, and its mean value was 12.8 for non-comparative studies and 17.5 for comparative studies. The postural balance was lower in strabismic patients compared with the control group, with statically higher value (p < 0.05) of surface, length and mean speed of the CoP in the study group. All patients show improvement in stability after surgery, as surface, length and mean speed of the CoP decreased after surgery in all the studies with statistical significance (p < 0.05).
Topics: Humans; Strabismus; Postural Balance; Physical Therapy Modalities; Case-Control Studies
PubMed: 35187611
DOI: 10.1007/s12306-022-00737-y