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Journal of Physiotherapy Jun 2013What is the intra-rater and inter-rater relative reliability of the Berg Balance Scale? What is the absolute reliability of the Berg Balance Scale? Does the absolute... (Meta-Analysis)
Meta-Analysis Review
QUESTIONS
What is the intra-rater and inter-rater relative reliability of the Berg Balance Scale? What is the absolute reliability of the Berg Balance Scale? Does the absolute reliability of the Berg Balance Scale vary across the scale?
DESIGN
Systematic review with meta-analysis of reliability studies.
PARTICIPANTS
Any clinical population that has undergone assessment with the Berg Balance Scale.
OUTCOME MEASURES
Relative intra-rater reliability, relative inter-rater reliability, and absolute reliability.
RESULTS
Eleven studies involving 668 participants were included in the review. The relative intrarater reliability of the Berg Balance Scale was high, with a pooled estimate of 0.98 (95% CI 0.97 to 0.99). Relative inter-rater reliability was also high, with a pooled estimate of 0.97 (95% CI 0.96 to 0.98). A ceiling effect of the Berg Balance Scale was evident for some participants. In the analysis of absolute reliability, all of the relevant studies had an average score of 20 or above on the 0 to 56 point Berg Balance Scale. The absolute reliability across this part of the scale, as measured by the minimal detectable change with 95% confidence, varied between 2.8 points and 6.6 points. The Berg Balance Scale has a higher absolute reliability when close to 56 points due to the ceiling effect. We identified no data that estimated the absolute reliability of the Berg Balance Scale among participants with a mean score below 20 out of 56.
CONCLUSION
The Berg Balance Scale has acceptable reliability, although it might not detect modest, clinically important changes in balance in individual subjects. The review was only able to comment on the absolute reliability of the Berg Balance Scale among people with moderately poor to normal balance.
Topics: Disability Evaluation; Humans; Observer Variation; Physical Therapy Modalities; Postural Balance; Reproducibility of Results
PubMed: 23663794
DOI: 10.1016/S1836-9553(13)70161-9 -
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 -
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 -
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 -
Journal of Orthopaedic Surgery and... Mar 2022To determine the benefits of aquatic physical therapy as a rehabilitation strategy for knee osteoarthritis patients. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To determine the benefits of aquatic physical therapy as a rehabilitation strategy for knee osteoarthritis patients.
METHODS
Electronic databases systematically searched up to July 2021.
RESULTS
580 RCTs were selected. A total of thirteen studies comprising 883 participants were included in the study. For pain, meta-analyses showed that aquatic physical therapy is associated with a significant change in Western Ontario and McMaster University Osteoarthritis Index (WOMAC) pain (SMD = - 1.09, 95%CI - 1.97, - 0.21, p = 0.02) and visual analog scale (VAS) (SMD = - 0.55, 95%CI - 0.98, - 0.12, p = 0.01). In addition, for physical function, meta-analyses showed that aquatic physical therapy effectively improved WOMAC physical function (SMD = - 0.57, 95%CI - 1.14, - 0.01, p = 0.05). However, our findings showed no significant improvements in symptoms of joints, quality of life (QOL), flexibility, and body composition with knee osteoarthritis. For muscle strength, we found that aquatic physical therapy can only improve knee extension muscle strength (MD = 2.11, 95%CI 0.02, 4.20, p = 0.05). Additionally, for walking ability, we observed that aquatic physical therapy effectively reduced Timed-Up-and-Go Test (TUGT) in a large degree (MD = - 0.89, 95%CI - 1.25, - 0.53, p < 0.05).
CONCLUSIONS
According to the findings reported in the studies analyzed in the review, aquatic physical therapy had a positive effect on the pain, physical function, knee extension muscle strength, and walking ability among people with knee osteoarthritis.
Topics: Humans; Osteoarthritis, Knee; Physical Therapy Modalities; Postural Balance; Quality of Life; Time and Motion Studies
PubMed: 35346294
DOI: 10.1186/s13018-022-03069-6 -
The Cochrane Database of Systematic... Apr 2014Various approaches to physical rehabilitation may be used after stroke, and considerable controversy and debate surround the effectiveness of relative approaches. Some... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Various approaches to physical rehabilitation may be used after stroke, and considerable controversy and debate surround the effectiveness of relative approaches. Some physiotherapists base their treatments on a single approach; others use a mixture of components from several different approaches.
OBJECTIVES
To determine whether physical rehabilitation approaches are effective in recovery of function and mobility in people with stroke, and to assess if any one physical rehabilitation approach is more effective than any other approach.For the previous versions of this review, the objective was to explore the effect of 'physiotherapy treatment approaches' based on historical classifications of orthopaedic, neurophysiological or motor learning principles, or on a mixture of these treatment principles. For this update of the review, the objective was to explore the effects of approaches that incorporate individual treatment components, categorised as functional task training, musculoskeletal intervention (active), musculoskeletal intervention (passive), neurophysiological intervention, cardiopulmonary intervention, assistive device or modality.In addition, we sought to explore the impact of time after stroke, geographical location of the study, dose of the intervention, provider of the intervention and treatment components included within an intervention.
SEARCH METHODS
We searched the Cochrane Stroke Group Trials Register (last searched December 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 12, 2012), MEDLINE (1966 to December 2012), EMBASE (1980 to December 2012), AMED (1985 to December 2012) and CINAHL (1982 to December 2012). We searched reference lists and contacted experts and researchers who have an interest in stroke rehabilitation.
SELECTION CRITERIA
Randomised controlled trials (RCTs) of physical rehabilitation approaches aimed at promoting the recovery of function or mobility in adult participants with a clinical diagnosis of stroke. Outcomes included measures of independence in activities of daily living (ADL), motor function, balance, gait velocity and length of stay. We included trials comparing physical rehabilitation approaches versus no treatment, usual care or attention control and those comparing different physical rehabilitation approaches.
DATA COLLECTION AND ANALYSIS
Two review authors independently categorised identified trials according to the selection criteria, documented their methodological quality and extracted the data.
MAIN RESULTS
We included a total of 96 studies (10,401 participants) in this review. More than half of the studies (50/96) were carried out in China. Generally the studies were heterogeneous, and many were poorly reported.Physical rehabilitation was found to have a beneficial effect, as compared with no treatment, on functional recovery after stroke (27 studies, 3423 participants; standardised mean difference (SMD) 0.78, 95% confidence interval (CI) 0.58 to 0.97, for Independence in ADL scales), and this effect was noted to persist beyond the length of the intervention period (nine studies, 540 participants; SMD 0.58, 95% CI 0.11 to 1.04). Subgroup analysis revealed a significant difference based on dose of intervention (P value < 0.0001, for independence in ADL), indicating that a dose of 30 to 60 minutes per day delivered five to seven days per week is effective. This evidence principally arises from studies carried out in China. Subgroup analyses also suggest significant benefit associated with a shorter time since stroke (P value 0.003, for independence in ADL).We found physical rehabilitation to be more effective than usual care or attention control in improving motor function (12 studies, 887 participants; SMD 0.37, 95% CI 0.20 to 0.55), balance (five studies, 246 participants; SMD 0.31, 95% CI 0.05 to 0.56) and gait velocity (14 studies, 1126 participants; SMD 0.46, 95% CI 0.32 to 0.60). Subgroup analysis demonstrated a significant difference based on dose of intervention (P value 0.02 for motor function), indicating that a dose of 30 to 60 minutes delivered five to seven days a week provides significant benefit. Subgroup analyses also suggest significant benefit associated with a shorter time since stroke (P value 0.05, for independence in ADL).No one physical rehabilitation approach was more (or less) effective than any other approach in improving independence in ADL (eight studies, 491 participants; test for subgroup differences: P value 0.71) or motor function (nine studies, 546 participants; test for subgroup differences: P value 0.41). These findings are supported by subgroup analyses carried out for comparisons of intervention versus no treatment or usual care, which identified no significant effects of different treatment components or categories of interventions.
AUTHORS' CONCLUSIONS
Physical rehabilitation, comprising a selection of components from different approaches, is effective for recovery of function and mobility after stroke. Evidence related to dose of physical therapy is limited by substantial heterogeneity and does not support robust conclusions. No one approach to physical rehabilitation is any more (or less) effective in promoting recovery of function and mobility after stroke. Therefore, evidence indicates that physical rehabilitation should not be limited to compartmentalised, named approaches, but rather should comprise clearly defined, well-described, evidenced-based physical treatments, regardless of historical or philosophical origin.
Topics: Activities of Daily Living; Adult; Biofeedback, Psychology; Humans; Leg; Motor Skills; Physical Therapy Modalities; Posture; Proprioception; Randomized Controlled Trials as Topic; Recovery of Function; Stroke Rehabilitation
PubMed: 24756870
DOI: 10.1002/14651858.CD001920.pub3 -
Gait & Posture Jul 2019Proprioception is one of the most significant factors in balance, joint stability, graceful movement, coordination, and injury prevention. It involves a wide set of...
BACKGROUND
Proprioception is one of the most significant factors in balance, joint stability, graceful movement, coordination, and injury prevention. It involves a wide set of receptors located within joints, muscles, and tendons. Given the neurophysiological processes involved in proprioception response are multiple and complex, there is not one single method to measure it. Particularly, proprioception of the knee joint, whether it is healthy, affected by osteoarthritis, or after replacement, is the most investigated by in literature.
RESEARCH QUESTION
This review addresses the analysis of proprioception in the knee joint before and after total knee arthroplasty (TKA). The aim is to obtain an overview of the proprioceptive skills in subjects who suffered from osteoarthritis and were subjected to knee replacement, evaluating changes in proprioception before and after the surgery.
METHODS
The research was conducted within four databases: Web of Science®, PubMed Central®, Cochrane®, and PEDro®, between January 2008 and February 2018. Accurate exclusion criteria and selection strategy were applied to screen the 170 articles found.
RESULTS
Ultimately, 13 papers were fully evaluated and included in this review, divided into two classes: i) works directly measuring proprioception, ii) studies indirectly evaluating proprioception. Contrasting results emerged from the analysis, and no consensus was found in the literature about the improvement or worsening in proprioception before and after TKA.
SIGNIFICANCE
Since currently there is high variability in methods, protocol and parameters used to evaluate knee proprioception, further investigations based on a consistent dataset, a well-defined protocol, measurable outcomes, timeline follow-ups, and rehabilitation programs should be performed in order to obtain reliable results on the effects of TKA on knee proprioception and balance.
Topics: Arthroplasty, Replacement, Knee; Humans; Knee Joint; Osteoarthritis, Knee; Postoperative Period; Preoperative Period; Proprioception
PubMed: 31129387
DOI: 10.1016/j.gaitpost.2019.05.005 -
The Physician and Sportsmedicine Oct 2022Shin splint is one of the most common sports injuries after strenuous exercise. Kinesiology taping (KT) is a popular noninvasive remedy used in sports-related disorders,... (Review)
Review
BACKGROUND
Shin splint is one of the most common sports injuries after strenuous exercise. Kinesiology taping (KT) is a popular noninvasive remedy used in sports-related disorders, with the potential effects of relieving pain, facilitating proprioception, modulating muscle activation and correcting abnormal movement patterns. However, the exact efficacy of KT on shin splints is still unknown, and previous findings are inconsistent. Hence, this study aimed to conduct a systematic review to evaluate the current status of relevant evidence on its efficacy.
METHODS
The review was performed according to the PRISMA guidelines, and a systematic search of the literature was conducted in December 2020. Electronic databases, Embase, Scopus, Medline, Web of Science, PubMed and Biomed Central were searched for the identification of pertinent studies with pre-defined key terms on shin splints and KT.
RESULTS
Four studies with a total sample size of 141 participants were included and analyzed. Two studies had within-subject designs, whereas the other two were randomized clinical trials. Although the positive results of KT were reported by the studies, methodological quality varied from poor to moderate according to the Physiotherapy Evidence Database Scale or Non-Randomized Studies-of Interventions.
CONCLUSION
In conclusion, this review revealed that the efficacy of KT on shin splints remains not clear. Evidence that supports its effectiveness in individuals with shin splints is currently limited. Further studies with good methodological quality and study design are warranted.
Topics: Athletic Injuries; Athletic Tape; Humans; Medial Tibial Stress Syndrome; Physical Therapy Modalities; Proprioception
PubMed: 34176444
DOI: 10.1080/00913847.2021.1949253 -
Complementary Therapies in Medicine Oct 2023Acupuncture or similar needling therapy has long been used to improve well-being, but its effectiveness in management of chronic ankle instability (CAI) is unclear. To... (Meta-Analysis)
Meta-Analysis Review
Effects of acupuncture or similar needling therapy on pain, proprioception, balance, and self-reported function in individuals with chronic ankle instability: A systematic review and meta-analysis.
OBJECTIVE
Acupuncture or similar needling therapy has long been used to improve well-being, but its effectiveness in management of chronic ankle instability (CAI) is unclear. To investigate the efficacy of acupuncture or similar needling therapy on pain, proprioception, balance, and self-reported function in individuals with CAI.
METHODS
Nine databases (PubMed, Embase, Cochrane Library, Web of Science, EBSCO, PEDro, CNKI, WanFang, and CQVIP) were systematically searched from inception to April 2023. This study included randomized controlled trials involving acupuncture or similar needling therapy as an intervention for individuals with CAI. Data were extracted independently by two assessors using a standardized form. Literature quality and risk bias were assessed by using the PEDro scale.
RESULTS
Twelve trials (n = 571) were found, of which the final meta-analysis was conducted with eight. Different studies employ varying treatments, including specific needle types, techniques, and therapeutic frameworks. Compared to control without acupuncture or similar needling therapy, acupuncture or similar needling intervention resulted in improved pain (WMD 1.33, 95 % CI 0.14-2.52, I²=90 %, p = 0.03), proprioception (active joint position sense, WMD 1.71, 95 % CI 0.95-2.48, I²=0 %, p < 0.0001), balance (SMD 0.54, 95 % CI 0.03-1.04, I²=46 %, p = 0.04), and self-reported function (Cumberland Ankle Instability Tool (WMD 2.92, 95 % CI 0.94-4.90, I²=78 %, p = 0.004); American Orthopedic Foot and Ankle Society (WMD 9.36, 95 % CI 6.57-12.15, I²=0 %, p < 0.001); Foot and Ankle Ability Measure: activities of daily living (WMD 5.09, 95 % CI 1.74-8.44, I²=0 %, p = 0.003)) for individuals with CAI.
CONCLUSIONS
The available evidence suggests that acupuncture or similar needling therapy may improve pain, proprioception, balance, and self-reported function in individuals with CAI, but more trials are needed to verify these findings. Furthermore, various needles and techniques using in different studies have resulted in methodologic limitations that should be addressed in the future.
Topics: Humans; Self Report; Activities of Daily Living; Ankle; Acupuncture Therapy; Proprioception; Pain; Joint Instability; Randomized Controlled Trials as Topic
PubMed: 37666474
DOI: 10.1016/j.ctim.2023.102983 -
Arquivos de Neuro-psiquiatria May 2022Falls are a major problem in public health since they are an important cause of morbidity and mortality. To evaluate the risk of fall and prescribe preventive... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Falls are a major problem in public health since they are an important cause of morbidity and mortality. To evaluate the risk of fall and prescribe preventive interventions may be a challenging task.
OBJECTIVES
The objectives of this study are to summarize the most relevant information on the topic "falls in the elderly" and to give a critical view and practical clinical approach on this topic.
METHODS
In March 2022, a search of Pubmed database was performed, using the terms "fall elderly", fall prevention", "fall risk", with the following parameters: five years, review, systematic review, meta-analysis, practice guidelines.
RESULTS
There are several risk factors for falls that can be grouped in different areas (psychosocial, demographic, medical, medication, behavioral, environmental). The clinical evaluation of an older adult prone to falls must include identification of risk factors through history and examination and identification of risk of falls through an assessment tool such as gait velocity, functional reach test, timed up and go, Berg balance test, and miniBEST test. Fall prevention strategies can be single or multiple, and physical activity is the most cited. Technology can be used to detect and prevent falls.
CONCLUSION
A systematic approach to the older patient in risk of falls is feasible and may impact fall prevention.
Topics: Aged; Exercise; Gait; Humans; Physical Therapy Modalities; Postural Balance; Risk Factors
PubMed: 35976297
DOI: 10.1590/0004-282X-ANP-2022-S107