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Stroke

Perturbation-Based Training for Improving Balance and Preventing Falls in Stroke Survivors: A Systematic Review and Meta-Analysis

Thursday, November 2, 2023
10:20 AM – 10:26 AM  
Location: Station 2

    Non-presenting Author(s)

  • NA

    Nahla A. Almatrafi, n/a

    MS.c.PT,
    Department of Physical Therapy, Faculty of applied Medical Science, Umm Al-Qura University, Makkah, Saudi Arabia.
    Makkah, Saudi Arabia

    • Presenting Author(s)

  • MA

    Mohamed Salaheldien Alayat, n/a

    Associate Professor of Physical Therapy
    Faculty of Applied Medical Science, Mecca, Saudi Arabia
    Makkah, Makkah, Saudi Arabia

    • Non-presenting Author(s)

  • AE

    Amir A. ElFiky, n/a

    Ph.D.PT, associate professor
    Department of Physical Therapy, Faculty of applied Medical Science, Umm Al-Qura University, Makkah, Saudi Arabia.
    Makkah, Makkah, Saudi Arabia

Objective(s): To investigate the effectiveness of perturbation-based training (PBT) on balance improvement and fall prevention in stroke survivors.

Data Sources: Systematic searching was performed via MEDLINE, PubMed, Web of Science, Scopus, EBSCO, Science Direct, Physiotherapy Evidence Database (PEDro), REHABDATA, Cochrane (CENTRAL), ClinicalTrials.gov, Grey Literature Report databases and reference lists of all eligible studies.

Study Selection: Two independent reviewers applied a search for randomized controlled trials (RCT) studies investigated the effect of PBT on balance improvement and fall prevention in patients with stroke. The primary outcome was balance, while the secondary outcomes were rate of falls and number of fallers.

Data Extraction: Data regarding participants, intervention parameters, outcome measures, follow-up, and main results were extracted.

Data Synthesis: Methodological quality was assessed by PEDro scale, and the level of evidence was assessed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. A random-effect model of meta-analysis was performed on seven studies. The standardized mean difference (SMD), with 95% confidence interval (CI), and overall effect size were calculated. A total of seven articles (271 patients) were included. PEDro scale revealed five good-quality and two fair-quality studies. The level of evidence showed significant effect of PBT in improving balance (SMD 0.60 [95% CI 0.15 to 1.06]; P=0.01; six studies; very low-quality evidence) and non-significant on reducing falls rate (Rate ratio 0.52 [95% CI 0.24 to 1.14]; P=0.10; two studies; low-quality evidence) and number of fallers (Risk ratio 0.80 [95% CI 0.59 to 1.10]; P=0.17; two studies; low-quality evidence).

Conclusions: PBT may improve balance in stroke survivors, however, its effect on preventing falls was limited. The presence of low and very low-quality evidence with little confidence in the effect estimate suggests additional high-quality studies.

Author(s) Disclosures: No conflict of interest.

Learning Objectives:

  • Define Perturbation-based training as an interventional method used for balance training in patients with stroke.
  • Estimate the effect size for the Perturbation-based training on balance and fall risk in patients with stroke.
  • Classify the included studies which demonstrate the Perturbation-based training based on the methodological quality and level of evidence.