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Revista de Neurologia Sep 2019Stroke is the leading cause of disability in adulthood. Recently the improvement of virtual reality technologies has been used in the rehabilitation of stroke patients. (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Stroke is the leading cause of disability in adulthood. Recently the improvement of virtual reality technologies has been used in the rehabilitation of stroke patients.
AIM
To review published research literature on the effects of the virtual reality interventions vs conventional therapy on balance and gait in stroke.
PATIENTS AND METHODS
A systematic and a meta-analysis of randomized controlled trials was performed during March 2018 in the databases: PubMed, PEDro, Web of Science, Scopus, Cochrane Library and Medline at EBSCO. The selection criteria were: randomized controlled trials published in English or Spanish during the past ten years. The PEDro scale evaluated the quality of the methods used in the studies. A total of 14 clinical trials were included in the systemic review, of which 10 contributed information to the meta-analysis.
RESULTS
Favourable results were found on balance (Berg Balance Scale: standardized mean difference, SMD = -1.89; 95% CI: -2.72 to -1.07; Timed Up and Go, SMD: 1.42; 95% CI: 1.03-1.81), and gait (GaitRite platform: cadence, SMD: -1.51, 95% CI: -2.05 to -0.97; step length, SMD: -1.63, 95% CI: -2.18 to -1.08; stride length, SMD: -1.63, 95% CI: -2.18 to -1.08; velocity, SMD: -1.58, 95% CI: -2.97 to -0.18).
CONCLUSION
The results show the potential benefit of virtual reality interventions to recover balance and gait after stroke.
Topics: Gait; Humans; Postural Balance; Randomized Controlled Trials as Topic; Stroke; Stroke Rehabilitation; Telerehabilitation; Treatment Outcome; Virtual Reality
PubMed: 31497866
DOI: 10.33588/rn.6906.2019063 -
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 -
PloS One 2020Dance may help individuals living with Parkinson's disease (PD) improve motor and non-motor symptoms that impact quality of life (QOL). The primary aim of this... (Meta-Analysis)
Meta-Analysis
Dance may help individuals living with Parkinson's disease (PD) improve motor and non-motor symptoms that impact quality of life (QOL). The primary aim of this systematic review of randomized controlled trials (RCTs) was to evaluate the efficacy of dance in improving motor and non-motor symptoms of PD and QOL. The secondary aims of this review were to evaluate the methodological quality of included studies by assessing risk of bias across nine categories and to inform the direction of future research. Peer-reviewed RCTs that included people living with PD at all disease stages and ages and measured the effects of a dance intervention longer than one day were included. Sixteen RCTs involving 636 participants with mild to moderate PD were eligible for inclusion in the qualitative synthesis and nine in the meta-analysis. Overall, the reviewed evidence demonstrated that dance can improve motor impairments, specifically balance and motor symptom severity in individuals with mild to moderate PD, and that more research is needed to determine its effects on non-motor symptoms and QOL. RCTs that use a mixed-methods approach and include larger sample sizes will be beneficial in fully characterizing effects and in determining which program elements are most important in bringing about positive, clinically meaningful changes in people with PD.
Topics: Activities of Daily Living; Cognition; Dancing; Gait; Humans; Mental Health; Motor Disorders; Parkinson Disease; Postural Balance; Quality of Life
PubMed: 32756578
DOI: 10.1371/journal.pone.0236820 -
BMC Musculoskeletal Disorders Apr 2017Exercise is frequently suggested as a treatment option for patients presenting with symptoms of subacromial impingement syndrome. Some would argue implementing a... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Exercise is frequently suggested as a treatment option for patients presenting with symptoms of subacromial impingement syndrome. Some would argue implementing a specific exercise strategy with special focus on correction of kinematic deficits would be superior to general exercise strategy. There is however a lack of evidence comparing such exercise strategies to determine which is the most effective in the treatment of subacromial impingement syndrome. The aim of this review is to evaluate whether implementing specific exercise strategies involving resistive exercises are more effective than a general exercise strategy for the treatment of patients with subacromial impingement syndrome.
METHODS
Randomized controlled trials were identified through an electronic search on PubMed/MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science and PEDro. In addition, article reference lists and Clinicaltrials.gov were searched. Studies were considered eligible if they included interventions with resistive specific exercises as compared to general resistance exercise. Four reviewers assessed risk of bias and methodological quality guided by Cochrane recommendations. Results were synthesised qualitatively or quantitatively, where appropriate.
RESULTS
Six randomized controlled trials were included with 231 participants who experienced symptoms of subacromial impingement syndrome. Four studies evaluated the effectiveness of specific scapular exercise strategy and two studies evaluated the effectiveness of specific proprioceptive strategy. Five studies were of moderate quality and one study was of low quality. No consistent statistical significant differences in outcomes between treatment groups were reported in the studies. Standardized mean difference (SMD) for pain was SMD -0.19 (95% CI -0.61, 0.22) and SMD 0.30 (95% CI -0.16, 0.76) for function.
CONCLUSIONS
There is insufficient evidence to support or refute the effectiveness of specific resistive exercise strategies in the rehabilitation of subacromial impingement syndrome. More high quality research is needed to accurately assess this. This review provides suggestions on how to improve the methodological design of future studies in this area.
Topics: Biomechanical Phenomena; Evaluation Studies as Topic; Exercise Therapy; Feedback, Sensory; Humans; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Resistance Training; Shoulder Impingement Syndrome; Shoulder Pain; Treatment Outcome
PubMed: 28416022
DOI: 10.1186/s12891-017-1518-0 -
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 -
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 -
BioMed Research International 2019The aim of this study was to perform a meta-analysis to examine whether virtual reality (VR) training is effective for lower limb function as well as upper limb and... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The aim of this study was to perform a meta-analysis to examine whether virtual reality (VR) training is effective for lower limb function as well as upper limb and overall function in chronic stroke patients.
METHODS
Three databases, OVID, PubMed, and EMBASE, were used to collect articles. The search terms used were "cerebrovascular accident (CVA)," "stroke", and "virtual reality". Consequently, twenty-one studies were selected in the second screening of meta-analyses. The PEDro scale was used to assess the quality of the selected studies.
RESULTS
The total effect size for VR rehabilitation programs was 0.440. The effect size for upper limb function was 0.431, for lower limb function it was 0.424, and for overall function it was 0.545. The effects of VR programs on specific outcomes were most effective for improving muscle tension, followed by muscle strength, activities of daily living (ADL), joint range of motion, gait, balance, and kinematics.
CONCLUSION
The VR training was effective in improving the function in chronic stroke patients, corresponding to a moderate effect size. Moreover, VR training showed a similar effect for improving lower limb function as it did for upper limb function.
Topics: Activities of Daily Living; Chronic Disease; Gait; Humans; Lower Extremity; Postural Balance; Recovery of Function; Stroke; Stroke Rehabilitation; User-Computer Interface; Video Games; Virtual Reality
PubMed: 31317037
DOI: 10.1155/2019/7595639 -
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 -
Journal of Sport and Health Science Mar 2024It is well known that stretch training can induce prolonged increases in joint range of motion (ROM). However, to date more information is needed regarding which... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
It is well known that stretch training can induce prolonged increases in joint range of motion (ROM). However, to date more information is needed regarding which training variables might have greater influence on improvements in flexibility. Thus, the purpose of this meta-analysis was to investigate the effects of stretch training on ROM in healthy participants by considering potential moderating variables, such as stretching technique, intensity, duration, frequency, and muscles stretched, as well as sex-specific, age-specific, and/or trained state-specific adaptations to stretch training.
METHODS
We searched through PubMed, Scopus, Web of Science, and SportDiscus to find eligible studies and, finally, assessed the results from 77 studies and 186 effect sizes by applying a random-effect meta-analysis. Moreover, by applying a mixed-effect model, we performed the respective subgroup analyses. To find potential relationships between stretch duration or age and effect sizes, we performed a meta-regression.
RESULTS
We found a significant overall effect, indicating that stretch training can increase ROM with a moderate effect compared to the controls (effect size = -1.002; Z = -12.074; 95% confidence interval: -1.165 to -0.840; p < 0.001; I = 74.97). Subgroup analysis showed a significant difference between the stretching techniques (p = 0.01) indicating that proprioceptive neuromuscular facilitation and static stretching produced greater ROM than did ballistic/dynamic stretching. Moreover, there was a significant effect between the sexes (p = 0.04), indicating that females showed higher gains in ROM compared to males. However, further moderating analysis showed no significant relation or difference.
CONCLUSION
When the goal is to maximize ROM in the long term, proprioceptive neuromuscular facilitation or static stretching, rather than ballistic/dynamic stretching, should be applied. Something to consider in future research as well as sports practice is that neither volume, intensity, nor frequency of stretching were found to play a significant role in ROM yields.
Topics: Male; Female; Humans; Muscle Stretching Exercises; Sports; Range of Motion, Articular
PubMed: 37301370
DOI: 10.1016/j.jshs.2023.06.002 -
Physical Therapy Jan 2018Researchers recently investigated the effectiveness of virtual reality (VR) in helping children with cerebral palsy (CP) to improve motor function. A systematic review... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Researchers recently investigated the effectiveness of virtual reality (VR) in helping children with cerebral palsy (CP) to improve motor function. A systematic review of randomized controlled trials (RCTs) using a meta-analytic method to examine the effectiveness of VR in children with CP was thus needed.
PURPOSE
The purpose of this study was to update the current evidence about VR by systematically examining the research literature.
DATA SOURCES
A systematic literature search of PubMed, CINAHL, Cochrane Central Register of Controlled Trials, ERIC, PsycINFO, and Web of Science up to December 2016 was conducted.
STUDY SELECTION
Studies with an RCT design, children with CP, comparisons of VR with other interventions, and movement-related outcomes were included.
DATA EXTRACTION
A template was created to systematically code the demographic, methodological, and miscellaneous variables of each RCT. The Physiotherapy Evidence Database (PEDro) scale was used to evaluate the study quality. Effect size was computed and combined using meta-analysis software. Moderator analyses were also used to explain the heterogeneity of the effect sizes in all RCTs.
DATA SYNTHESIS
. The literature search yielded 19 RCT studies with fair to good methodological quality. Overall, VR provided a large effect size ( = 0.861) when compared with other interventions. A large effect of VR on arm function ( = 0.835) and postural control ( = 1.003) and a medium effect on ambulation ( = 0.755) were also found. Only the VR type affected the overall VR effect: an engineer-built system was more effective than a commercial system.
LIMITATIONS
The RCTs included in this study were of fair to good quality, had a high level of heterogeneity and small sample sizes, and used various intervention protocols.
CONCLUSIONS
Then compared with other interventions, VR seems to be an effective intervention for improving motor function in children with CP.
Topics: Adolescent; Cerebral Palsy; Child; Child, Preschool; Humans; Movement; Postural Balance; Randomized Controlled Trials as Topic; Treatment Outcome; Virtual Reality; Virtual Reality Exposure Therapy
PubMed: 29088476
DOI: 10.1093/ptj/pzx107