Effects of physical therapies aiming directly or indirectly at the recovery of balance after stroke. A meta-analysis - 15/07/18

Doi : 10.1016/j.rehab.2018.05.501

A. Hugues ^1,^2,^⁎ , J. Di-Marco ³, P. Janiaud ⁴, Y. Xue ^5,⁶, J. Zhu ⁷, J. Pires ⁸, H. Khademi ⁹, L. Rubio ¹⁰, P. Hernandez Bernal ¹¹, Y. Bahar ¹², H. Charvat ¹³, P. Szulc ¹⁴, C. Ciumas ^15,¹⁶, H. Won ^17,¹⁸, M. Cucherat ⁴, I. Bonan ¹⁹, F. Gueyffier ²⁰, G. Rode ^1,²
¹ Hospices Civils de Lyon, Centre de Recherche de Neurosciences de Lyon, Université de Lyon, Lyon, France
² Service de Médecine Physique et de Réadaptation, Hôpital Henry Gabrielle, Unité Impact, Plate-forme « Mouvement et Handicap », Saint-Genis Laval, France
³ Assistance publique–Hôpitaux de Paris, Université Paris Descartes, Service de Médecine Physique et de Réadaptation, Paris, France
⁴ CNRS Lyon, Université de Lyon 1, UMR 5558, Lyon, France
⁵ Université de Lyon, Université Claude-Bernard Lyon 1, 69008 Lyon, France
⁶ Université Saint-Étienne, HESPER EA 7425, 42023 Saint-Étienne, France
⁷ Université Jiaotong de Shanghai, Pharmacologie, Shanghai, China
⁸ Medicine Faculty of Oporto University, Rovisco Pais Rehabilitation Centre, Tocha and Oporto, Portugal
⁹ World Heath Organisation, International Agency of Research on Cancer, Lyon, France
¹⁰ Centro Lescer, Rehabilitation, Madrid, Spain
¹¹ Rehaklinik Zihlschlach, Neurologisches Rehabilitationszentrum, Zihlschlacht, Switzerland
¹² Hitit University Erol Olcok Training and Research Hospital, Physical Medicine and Rehabilitation, Corum, Turkey
¹³ Center for Public Health Sciences, National Cancer, Division of Prevention, Tokyo, Japan
¹⁴ Inserm, University of Lyon, UMR 1033, Lyon, France
¹⁵ Inserm U1028, CNRS UMR5292, Centre de Recherche en Neuroscience de Lyon, Université de Lyon, Institute of Epilepsies, Lyon, France
¹⁶ Centre Hospitalier Universitaire Vaudois, Translational and Integrative Group in Epilepsy Research TIGER, Department of Clinical Neurosciences, Lausanne, Switzerland
¹⁷ Université Grenoble Alpes, UMR 5316 Litt&Arts, Grenoble, France
¹⁸ KyungHee University, Séoul, Republic of Korea
¹⁹ CHU de Rennes, Service de médecine physique et de réadaptation, Rennes, France
²⁰ Hospices Civils de Lyon, CNRS Lyon, Université de Lyon 1, Service Hospitalo-Universitaire de Pharmaco-Toxicologie, UMR 5558, Lyon, France

^⁎Corresponding author.

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Résumé

Introduction/Background

After stroke, standing balance is usually described as a predictor of functional recovery. Regarding literature, various type of physical therapy (PT) is used to improve balance. The aim of this meta-analysis is to evaluate the effects of PT directly focused on balance training (DFBT) and theses of PT indirectly focused on balance training (IFBT) on balance after stroke.

Material and method

Randomised controlled trials (RCT), without language restriction, until October 2015, assessing the Berg Balance Scale (BBS), the Postural Assessment Scale for Stroke, the posturographic parameters in static condition and measures of independence in activities of daily living were included. Two independent authors (AH and JDM) led this selection following the Cochrane recommendations (Hugues et al., 2017).

Results

One hundred and ninety-three parallel and crossover RCT from 9337 records were included, involving 8018 subjects [study sample: mean 41.5 (SD 49.7) subjects, age: pooled mean 61.7 (pooled SD 12.78) years]. A significant difference in favor of PT compared to no treatment was immediately found after the intervention for the BBS (DFBT: 7 studies, mean difference [MD] 1.38; 95% confidence interval [CI] [0.71; 2.05]. IFBT: 18 studies, MD 1.88; 95% CI [1.31; 2.45]). Only IFBT PT is more effective than sham treatment or usual care immediately after the intervention for the BBS (DFBT: 1 study, MD 5.33; 95% CI [−4.68; 15.34]. IFBT: 26 studies, MD 1.85; 95% CI [0.67; 3.03]).