Efficiency of physical rehabilitation on postural imbalance after stroke: Systematic review and meta-analysis

Objective Balance disorders are frequently seen after stroke resulting in limited physical activities. The effects of current physical rehabilitations aiming at reducing postural imbalance are varied with low levels of evidence. Objectives: i) to determine the efficiency of physical rehabilitation methods on the recovery of postural imbalance in patients after stroke; ii) to assess which method is more effective when compared with one another. Material/Patients and methods Search strategy: we searched Medline , Embase , Pedro , Cochrane Central Register of Controlled Trials , Pascal and Francis from inception to October 2015. All published and unpublished studies and conferences were searched. Selection criteria: – randomised controlled trials; – physical rehabilitation methods aiming at recovering postural imbalance; – in adults with stroke. Outcome measures were: the Berg Balance Scale (BBS), the Postural Assessment Scale for Stroke (PASS), static posturographic parameters (in sitting or standing conditions) and all other measurements of weight bearing distribution. Data collection and analysis : two authors (AH, JDM) independently screened the articles on title, abstract and finally on full study report, according to our selection criteria. The methodological quality of studies was evaluated and the data were extracted. In addition to outcomes, measures of independence in activities of daily living (ADL) and the Barthel index (BI) were extracted. Subgroup analyses are planned according to the location of brain lesions (hemispheric, brainstem or cerebellum), the type of approaches (top-down or bottom-up), the methodological quality of studies and the overall time of rehabilitation. Results We identified 9937 relevant studies. We excluded 8093 on titles, 1364 on abstracts and 294 on full study reports. Finally, 186 studies were included. Discussion - Conclusion The interest is to determine the effects of all physical rehabilitation methods: i) not only on the postural parameters (posturography), but also on the limitations of activity (BBS, PASS) and on the independence of patients (IB, AVQ); ii) and according to the location of the brain lesions, in order to adapt the strategies of rehabilitation.