Inpatient trunk exercises after recent stroke: An update meta-analysis of randomized controlled trials

Article type: Review Article

Authors: Souza, Daniele Costa Borges^{a; b} | de Sales Santos, Matheus^{b; c} | da Silva Ribeiro, Nildo Manoel^{b; c; d; e} | Maldonado, Igor Lima^{a; b; f; g; h; i; *}

Affiliations: [a] Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil | [b] Divisão de Neurologia e Epidemiologia, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil | [c] Programa de Pós-Graduação em Processos Interativos dos Órgãos e Sistemas, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil | [d] Departamento de Fisioterapia, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil | [e] Unidade de Reabilitação, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil | [f] Unidade Neuro-Músculo-Esquelética, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil | [g] Departamento de Biomorfologia, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil | [h] Le Studium Loire Valley Institute for Advanced Studies, Orléans, France | [i] UMR 1253, iBrain, Université de Tours, Inserm, Tours, France

Correspondence: [*] Address for correspondence: Igor Lima Maldonado, BMath, MD, PhD, Le Studium Loire Valley Institute for Advanced Studies, UMR 1253, iBrain, Université de Tours, Inserm, 10 Boulevard Tonnellée, 37032 Tours, France. Tel.: +33 2 47 36 61 37; Fax: +33 2 47 36 62 07; E-mail: igorlimamaldonado@gmail.com.

Abstract: INTRODUCTION:Although the role of trunk exercises in the chronic phase of stroke is acknowledged, the addition of specific inpatient training in the subacute stage is a matter of debate and varies among centers. Recent new evidence suggests the question should be revisited. OBJECTIVE:To assess the impact of the addition of specific trunk training to inpatient rehabilitation protocols after a recent stroke. METHODS:A systematic review was performed assessing the impact of inpatient trunk training. The search was performed in LILACS, SciELO, PEDro, Cochrane, and NCBI PubMed databases for clinical trials published up to December 31st, 2017. The initial bibliographic research identified 3202 articles. After analyzing the titles, 19 abstracts were selected for detailed analysis. After application of the eligibility criteria, the final selection included nine studies. Outcome measurements from the same evaluation instruments were submitted to a meta-analysis to improve homogeneity (7 studies). RESULTS:All patients in the included studies were recruited less than three months after a stroke. Seven studies assessed trunk control using the Trunk Impairment Scale (TIS). There was a significant improvement in trunk control with a pooled increase in TIS score of 3.3 points from the baseline (CI95:2.54–4.06, p < 0.0001). Three studies assessed balance using the Brunel Balance Assessment (BBA) scale. There was also a significant improvement in balance with a pooled increase in BBA score of 2.7 points (CI95:1.5–4.03, p < 0.0001). The Berg Balance Scale was used for balance assessment in three studies. The meta-analysis of their results showed a pooled increase of 13.2 points (CI95:9.49–16.84, p < 0.0001). Weight transfer was evaluated in four studies using different methods. The addition of inpatient trunk exercises was associated with an improvement in the ability to transfer the trunk laterally in three studies. CONCLUSION:The introduction of trunk-based inpatient training protocols brings short-term benefits in trunk performance and balance in stroke patients.

Keywords: Stroke, neurological rehabilitation, postural balance, exercise therapy

DOI: 10.3233/NRE-182585

Journal: NeuroRehabilitation, vol. 44, no. 3, pp. 369-377, 2019