Effects of a 6-Week Aquatic Treadmill Exercise Program on Cardiorespiratory Fitness and Walking Endurance in Subacute Stroke Patients: A PILOT TRIAL

Effects of exercise intervention on exercise capacity and cardiopulmonary function in patients with atrial fibrillation: A randomized controlled trial systematic review and meta-analysis

BACKGROUND

Atrial fibrillation (AF) is a common cardiac arrhythmia that significantly impacts the cardiopulmonary function and quality of life of patients. Despite various treatment strategies, non-pharmacological interventions, particularly exercise interventions, have gained attention in recent years.

OBJECTIVE

Through systematic review and meta-analysis, this study explores the impact of physical activity on the exercise capacity and quality of life of AF patients. It assesses the safety, clinical outcomes, and physiological mechanisms of exercise intervention in the treatment of AF.

METHODS

The systematic review and individual patient data (IPD) meta-analysis method were employed, following the PRISMA-IPD guidelines, for literature selection, data extraction, and quality assessment. The analysis focused on the impact of exercise on the cardiopulmonary function and quality of life of AF patients in randomized controlled trials.

RESULTS

A total of 12 randomized controlled trials involving 287 AF patients were included. Meta-analysis demonstrated a significant improvement in the 6-minute walk test capacity (SMD=87.87, 95% CI [42.23, 133.51]), static heart rate improvement (SMD=-7.63, 95% CI [-11.42, -3.85]), and cardiopulmonary function enhancement (SMD=2.37, 95% CI [0.96, 3.77]) due to exercise. There was also a significant improvement in the quality of life (SMD=0.720, 95% CI [0.038, 1.402]).

CONCLUSION

Exercise has a significant effect on improving exercise capacity and cardiopulmonary function in patients with atrial fibrillation. Particularly, high-intensity exercise training has a more significant impact on improving cardiopulmonary function and exercise capacity, emphasizing the importance of personalized exercise plans in enhancing the cardiopulmonary health of AF patients. Further research is needed to explore the effects of exercise on improving the quality of life in the future.

PROSPERO ID

CRD2023493917.

Current exercise-based rehabilitation impacts on poststroke exercise capacity, blood pressure, and lipid control: a meta-analysis

Objectives

This systematic review aimed to evaluate the impact of post-stroke exercise-based rehabilitation programs on blood pressure, lipid profile, and exercise capacity.

Methods

Through a systemic search of literature from inception to 2024 using five databases, we analyzed data on the mean difference (MD) using a meta-analysis method to estimate effectiveness.

Results

Thirty-seven randomized control trials were included encompassing various exercises such as aerobic, resistance, stretching, exergaming, robot-assisted training, and community-based training. Significant improvement was illustrated at discharge in systolic [MD 2.76 mmHg; 95% confidence interval (CI) -1.58 to 3.92, P < 0.05] and diastolic (MD 1.28 mmHg; 95% CI 0.54-2.12, P < 0.05) blood pressure and peak oxygen volume (MD -0.29 ml/kg/min; 95% CI -0.53 to 0.05, P < 0.05). We also observed significant improvement at discharge in high-density lipoprotein only after resistance exercise from two articles and low-density lipoprotein only in the intervention groups compared to the control groups from ten articles.

Conclusion

Overall, current exercise-based rehabilitation programs significantly improve blood pressure and exercise capacity in patients with stroke at discharge. However, lipoprotein changes remained inconclusive. Although ameliorative changes were noted in most variables, more research is needed to determine optimum exercise intensity, type combination, and health education to reduce post-stroke complications and mortality.

Systematic Review Registration

https://doi.org/10.17605/OSF.IO/X89FW.

Effect of robot-assisted gait training on improving cardiopulmonary function in stroke patients: a meta-analysis

OBJECTIVE

Understanding the characteristics related to cardiorespiratory fitness after stroke can provide reference values for patients in clinical rehabilitation exercise. This meta- analysis aimed to investigate the effect of robot-assisted gait training in improving cardiorespiratory fitness in post-stroke patients, compared to conventional rehabilitation training.

METHODS

PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, CBM, CNKI and Wanfang databases were searched until March 18th, 2024. Randomized controlled trials (RCTs) comparing the effectiveness of robot-assisted gait training versus control group were included. The main outcome variable was peak oxygen uptake. 6-minute walking test, peak heart rate, peak inspiratory expiratory ratio as our secondary indicators. RevMan 5.3 software was used for statistical analysis.

RESULTS

A total of 17 articles were included, involving 689 subjects. The results showed a significant effect for robot-assisted gait training to improve VO2peak (MD = 1.85; 95% CI: -0.13 to 3.57; p = 0.04) and 6WMT (MD = 19.26; 95% CI: 10.43 to 28.08; p < 0.0001). However, no significant difference favouring robot-assisted gait training were found in HRpeak (MD = 3.56; 95% CI: -1.90 to 9.02; p = 0.20) and RERpeak (MD = -0.01; 95% CI: -0.04 to 0.01; p = 0.34).

CONCLUSION

These results showed that robot-assisted gait training may have a beneficial effect in improving VO2peak and 6WMT, with a moderate recommendation level according to the GRADE guidelines.

Enhancing early functional independence following cardiac surgery: a quality improvement programme

Early mobility and activity programmes following cardiac surgery are vital for improved patient outcomes, as they accelerate the recovery of functional capacity and walking distance. We observed that only 5.3% of our patients achieved a Functional Independence Measurement (FIM) score of 80% or more by the third postoperative day (POD). Additionally, the average 6-minute walk distance achieved by the fourth POD was only 188 m. Therefore, a quality improvement (QI) project was implemented with the aim of attaining a FIM score of 80% by the third POD for more than 80% of patient underwent/undergoing cardiac surgery without complications.A model-for-improvement framework was used to drive continuous improvement. This project was implemented in February 2021. Baseline data were prospectively collected between November 2020 and January 2021 (preintervention). Outcomes were analysed using standard control chart rules to detect changes over time. Unpaired Student t-tests assessed significant differences in mean levels between two groups, (preintervention vs postintervention).χ2 tests were conducted between the two groups according to gender and patient satisfaction scores.The percentage of patients who achieved a FIM score of 80% or more by the third POD gradually increased to 91.4% 5 months following programme implementation and was sustained thereafter. The mean patient FIM score significantly improved to 81.20±3.77 (p<0.001) by the third POD. Similarly, the mean 6-minute walk distance increased to 267.90±36.10 m (p<0.001) by the fourth POD. The percentage of patients who displayed the level of confidence needed to carry out activities of daily living (ADL) and exercises independently at home increased to 89.4% (p<0.001) by the fifth POD. No adverse events associated with the mobility and activity programme were reported.This QI project demonstrated a substantial improvement in patient functional independence, walking distance and the level of confidence needed to independently carry out ADL and exercises following cardiac surgery.

Water-based therapeutic exercise in stroke: a scoping review

PURPOSE

To (1) describe the state of the literature on water-based therapeutic exercise (WBTE) for people living with stroke, (2) describe the content and structure of interventions, (3) summarize the effects of interventions described in the literature, and (4) identify gaps in the literature limiting application and implementation.

MATERIALS AND METHODS

Scoping review methodology described by Arksey and O'Malley (2005) and Levac et al. (2010). Electronic databases were searched for articles with eligibility criteria including: (1) adult stroke survivors (18 years or older) of any type (ischemic/hemorrhagic) or stage (acute/chronic) in any setting, and (2) the study intervention involved WBTE to address a post-stroke deficit.

RESULTS

40 articles were included in this review. Five trials had a treatment control, 20 had an active comparison. Calculated intervention effect sizes demonstrated a strong effect of WBTE on balance and gait related outcomes in 80% of controlled and comparison trials.

CONCLUSIONS

This scoping review highlights common parameters of WBTE interventions and provides an inventory of the differences in the treatment approaches utilized in this population. Opportunities for future work include the development of a standardized treatment protocol, qualitative or mixed methodology research, and greater inclusion of more individuals with more severe stroke-related impairments. IMPLICATIONS FOR REHABILITATIONWater-based therapeutic exercise is an approach that may allow stroke survivors to carry out challenging activities in a safe and accessible environment.Water-based interventions for stroke survivors appear to have a beneficial impact on walking and balance.Given that an aquatic environment offers an opportunity for individuals with more significant physical impairments to carry out early practice of walking and balance related tasks, clinicians should explore the feasibility and effectiveness for this subset of stroke survivors.

Effects of Exercise Programs on Functional Capacity and Quality of Life in People With Acquired Brain Injury: A Systematic Review and Meta-Analysis

OBJECTIVE

The aims of this systematic review and meta-analyses were to evaluate the effects of exercise on the functional capacity and quality of life (QoL) of people with acquired brain injury (ABI) and to analyze the influence of training variables.

METHODS

Five electronic databases (MEDLINE, Cochrane Library, CINAHL, SportDiscus, and Web of Science) were searched until October 2021 for clinical trials or experimental studies examining the effects of exercise on the functional capacity and QoL in adults with ABI and comparing exercise interventions with non-exercise (usual care).

RESULTS

Thirty-eight studies were evaluated. A total sample of 2219 people with ABI (exercise, n = 1572; control, n = 647) were included in the quantitative analysis. A greater improvement was observed in walking endurance (z score = 2.84), gait speed (z score = 2.01), QoL physical subscale (z score = 3.42), and QoL mental subscale (z score = 3.00) was observed in the experimental group than in the control group. In addition, an improvement was also observed in the experimental group in the "Timed Up and Go" Test scores and balance without differences from the control group. Significant interactions were also observed between the rehabilitation phases, type, frequency and volume of training, and overall effects.

CONCLUSION

The results suggest that exercise improves functional capacity and QoL regardless of model training, highlighting the effectiveness of long-term exercise that includes short sessions with components such as strength, balance, and aerobic exercise.

IMPACT

The results shown in this systematic review with meta-analysis will allow physical therapists to better understand the effects of training on people with ABI.

Kiruthika, P. Senthil, S. Swathi. Effectiveness of water aerobics in improving chest mobility and pulmonary function in chronic stroke patients

Introduction and Aim:  Stroke is one of the prominent causes of long-term disability. Stroke affects everyone uniquely depending on the level and location of the area affected in the brain and how long the brain tissue was deprived of oxygen. Individuals with stroke usually demonstrate changes in breathing patterns, decreased strength of respiratory muscles, and decreased ventilatory function. The aim of the study is to assess the effects of water aerobics on the pulmonary function of people with stroke.   Materials and Methods: This study was conducted in a clinical setup. A total number of 16 subjects were selected based on the inclusion and exclusion criteria. All the subjects received water aerobic exercises for 40minutes sessions for 4days per week for 12weeks. Pre- and Post-treatment assessments were done by measuring chest expansion and forced vital capacity.   Results: All the 16 subjects completed the 12 weeks water aerobics intervention. After 12 weeks post treatment assessments were taken. The outcome measures, of chest expansion and forced vital capacity showed a significant improvement.   Conclusion: The results of this study show that there is a significant improvement in the chest expansion and pulmonary function after giving water aerobics intervention.

Associations Between Time After Stroke and Exercise Training Outcomes: A Meta-Regression Analysis

Background Knowledge gaps exist regarding the effect of time elapsed after stroke on the effectiveness of exercise training interventions, offering incomplete guidance to clinicians. Methods and Results To determine the associations between time after stroke and 6-minute walk distance, 10-meter walk time, cardiorespiratory fitness and balance (Berg Balance Scale score [BBS]) in exercise training interventions, relevant studies in post-stroke populations were identified by systematic review. Time after stroke as continuous or dichotomized (≤3 months versus >3 months, and ≤6 months versus >6 months) variables and weighted mean differences in postintervention outcomes were examined in meta-regression analyses adjusted for study baseline mean values (pre-post comparisons) or baseline mean values and baseline control-intervention differences (controlled comparisons). Secondary models were adjusted additionally for mean age, sex, and aerobic exercise intensity, dose, and modality. We included 148 studies. Earlier exercise training initiation was associated with larger pre-post differences in mobility; studies initiated ≤3 months versus >3 months after stroke were associated with larger differences (weighted mean differences [95% confidence interval]) in 6-minute walk distance (36.3 meters; 95% CI, 14.2-58.5), comfortable 10-meter walk time (0.13 m/s; 95% CI, 0.06-0.19) and fast 10-meter walk time (0.16 m/s; 95% CI, 0.03-0.3), in fully adjusted models. Initiation ≤3 months versus >3 months was not associated with cardiorespiratory fitness but was associated with a higher but not clinically important Berg Balance Scale score difference (2.9 points; 95% CI, 0.41-5.5). In exercise training versus control studies, initiation ≤3 months was associated with a greater difference in only postintervention 6-minute walk distance (baseline-adjusted 27.3 meters; 95% CI, 6.1-48.5; fully adjusted, 24.9 meters; 95% CI, 0.82-49.1; a similar association was seen for ≤6 months versus >6 months after stroke (fully adjusted, 26.6 meters; 95% CI, 2.6-50.6). Conclusions There may be a clinically meaningful benefit to mobility outcomes when exercise is initiated within 3 months and up to 6 months after stroke.

Systematic review of aquatic physical exercise programs on functional fitness in older adults

The practice of physical exercise is recommended in the prevention of the deterioration of neuromuscular functions in aging. The objectives of this systematic review were to describe the protocols used and the functional fitness indicators evaluated in aquatic exercise programs in adults aged 50 to 80 years. The Pubmed database was used. The keywords were: 1) Physical exercise program or protocols or duration or type of exercise or aquatic exercise, frequency or intensity or indicators; 2) Adults or older adults; 3) Training or indicators, functional fitness, physical fitness. The search strategy considered the components of the Population, Interventions, Comparators, Outcomes, and Study design (PICOS) tool. Nine experimental studies were identified. These studies developed protocols to improve functional fitness in adults aged 50 to 80 years. They were based on sessions of 2 to 5 per week, the work time per session was 30 to 60min, intensities varied between 50 to 95% and totaled between 4 to 24 weeks of intervention. The activities were based on aquatic gymnastic exercises aimed at muscular strengthening of the upper and lower extremities, as well as coordination, balance, agility, cycling and walking exercises submerged in water. The protocols developed to improve functional fitness in adults aged 50 to 80 years were based on general physical exercise prescription guidelines (frequency, duration, intensity and type of activity). The application of aquatic exercises based on gymnastic exercises can provoke positive responses on functional fitness if worked at least 2 to 5 times per week, 30 to 60min/day and at intensities of 50 to 95%. These systematized indicators can be used by professionals working with adults to create and promote aquatic programs to improve functional fitness.

The novel effectiveness of Tai Chi on cardiopulmonary fitness among stroke patients in the recovery phase: a study protocol for a randomized controlled trial

BACKGROUND

Stroke is the leading cause of death worldwide. China faces a similar risk of stroke as developed countries because of considerable changes in lifestyle, such as overeating and smoking. Tai Chi is a traditional form of mind-body exercise that has been widely practiced in China for thousands of years. However, there are few studies on the effect of Tai Chi on the cardiopulmonary function of stroke patients in the recovery phase. Therefore, it is necessary to observe the effect of Tai Chi on the cardiorespiratory fitness of patients after stroke.

METHODS

This is a parallel-design, two-arm, analyst assessor-blinded, randomized controlled trial. A total of 226 stroke patients in the recovery phase will be recruited and assigned randomly to a control group or Tai Chi group at a 1:1 ratio. The patients in the Tai Chi group will perform the Tai Chi exercise. The patients in the control group will perform walking exercises. Patients in both groups will receive conventional treatments and healthy education. The primary outcomes will be VO2peak and scores on the MOS item short form health survey (SF-36) scale. Secondary outcomes will include vital capacity (VC), ejection fractions (EF), and cardiac output (CO). The assessments of the tests will be performed at three time points (before exercise, at the end of exercise, and 6 weeks after exercise). Adverse events will be recorded faithfully during the study.

DISCUSSION

If the results are positive, this study will contribute to the establishment of further guided Tai Chi rehabilitation programs.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2000034719 . Registered on 16 July 2020.

Aquatic therapy in stroke rehabilitation: systematic review and meta-analysis

The main object of this systematic review and meta-analysis is to collect the available evidence of aquatic therapy in stroke rehabilitation and to investigate the effect of this intervention in supporting stroke recovery. The PubMed, the Cochrane Central Register of Controlled Trials and the PEDro databases were searched from their inception through to 31/05/2020 on randomized controlled trials evaluating the effect of aquatic therapy on stroke recovery. Subjects´ characteristics, methodological aspects, intervention description, and outcomes were extracted. Effect sizes were calculated for each study and outcome. Overall, 28 appropriate studies (N = 961) have been identified. A comparison with no intervention indicates that aquatic therapy is effective in supporting walking, balance, emotional status and health-related quality of life, spasticity, and physiological indicators. In comparison with land-based interventions, aquatic therapy shows superior effectiveness on balance, walking, muscular strength, proprioception, health-related quality of life, physiological indicators, and cardiorespiratory fitness. Only on independence in activities of daily living the land- and water-based exercise induce similar effects. Established concepts of water-based therapy (such as the Halliwick, Ai Chi, Watsu, or Bad Ragaz Ring methods) are the most effective, aquatic treadmill walking is the least effective. The current evidence is insufficient to support this therapy form within evidence-based rehabilitation. However, the available data indicate that this therapy can significantly improve a wide range of stroke-induced disabilities. Future research should devote more attention to this highly potent intervention.

Evaluation of the Feasibility of a Two-Week Course of Aquatic Therapy and Thalassotherapy in a Mild Post-Stroke Population

Strokes are a leading cause of disability in developed countries. Patients with disabilities need rehabilitation to improve their physical functioning, mental status, and quality of life. Currently, no high-quality evidence can be found attesting the benefits of any of the interventions that are nowadays used. Water-based exercise may improve the physical conditions and quality of life of people in the post-stroke phase. The objective of this study is to test whether aquatic therapy in an enriched environment at the seaside (a thalassotherapy center) could play a role in this condition. A quasi-experimental prospective study consisting of a specific program assessed 62 patients with a mild–moderate disability pre- and post-2 weeks of intensive treatment. They followed a thalassotherapy regimen including aquatic therapy in a sea water pool at 32–34 °C for 45 min daily five times a week. The outcomes measured were the Berg Balance scale, the Timed Up and Go test, the 10-meter walking test, the 6-min walking test, the Pain Visual Analogue Scale, the WHO Well-being index, EuroQoL VAS and EuroQoL 5D. We observed a significant improvement in all outcomes measured (p < 0.001, except mobility EuroQoL p < 0.05), except in the other four dimensions of the EuroQoL 5D and 10-metre walking test (NS). Conclusion: A two-week intensive course of aquatic therapy and thalassotherapy may be beneficial in the short term by reducing pain and improving the functional status and overall well-being of post-stroke patients.

[Possibilities of application of cardio-ankle vascular index in patients with cerebrovascular diseases]

This publication focuses on the feasibility of using the cardio-ankle vascular index (CAVI) in patients with cerebrovascular diseases. The authors consider the pathological conditions and risk factors of stroke associated with increased arterial stiffness, methods for its assessment, the advantages of using CAVI, the experience of using CAVI in patients with cardiovascular diseases, in particular, in neurological patients. The complexity of the application of CAVI in the Russian population, promising directions for determining the index in neurology as well as the importance of CAVI borderline indicators are shown. It is emphasized that stroke patients should be screened with a mandatory study of CAVI.

Aquatic Therapy in Contemporary Neurorehabilitation: An Update

Aquatic therapy has been used extensively in a number of neurologic diseases and pathologies. This review describes disease-specific rehabilitative applications for this population. Recent research has offered scientific support for use in common neurological diseases that are part of rehabilitative practice, and very recent findings may create even firmer support for its use in these as well as other conditions. Stroke, Parkinsonism, and multiple sclerosis are areas that have recently received a significant number of published studies. Dementia is another area that has been more recently studied and received basic science support. Cerebral palsy has also had recent supportive evidence published. Available literature is reviewed to create a more evidence-based support for the use of aquatic therapy in neurorehabilitation.

Guidelines for the Evaluation of Cardiorespiratory Physiotherapy in Stroke Patients

Evaluation of stroke patients is prioritized over therapeutic interventions to restore cardiorespiratory capacity. This study aimed to develop a clinically applicable guideline to evaluate cardiorespiratory physiotherapy in stroke patients based on a literature review and a modified Delphi survey. The literature search included 13,498 articles in PubMed, EMBASE, CINAHL, and Cochrane Library electronic databases. We surveyed previous articles between January 2010 and June 2019. After the option elimination process, a total of 27 documents were selected and analyzed (draft: 18, modified Delphi survey: 9). The results of this research are roughly divided into two categories. First, 31 draft items were extracted, and a modified Delphi survey questionnaire was created from a literature review. Second, an expert was asked to make two modified Delphi surveys and to modify, delete, and supplement the entries in the statistical analysis at each level to finalize the steps to 20 items. The guidelines developed in this study reflect the selective use of cardiorespiratory physiotherapy evaluation methods in the clinical setting, based on the health status of individual patients. Moreover, the guidelines may help physiotherapists make informed decisions based on expert knowledge, thereby playing a crucial role in the patient-centered treatment planning process.

The effect of aquatic physical therapy in patients with stroke: A systematic review and meta-analysis

Objective: The purpose of this study was to evaluate the literature reports of qualitative and quantitative results of physical therapy treatments in the alternative aquatic setting for individuals affected by strokes. Method: PRISMA guidelines were used to carry out the systematic review and meta-analysis. Three bibliographic databases were searched: MEDLINE, PEDro, and the Cochrane Library. Papers included in the study were required to: (a) have a randomized controlled trial (RCT) design of research; and (b) be published in English; (c) be published during the last 10 years (2008-2018). Only randomized controlled trials were employed in the study. The quality of the clinical trials to be included was evaluated according to the Jadad scale. The internal validity was assessed according to the PEDro scale. Results: Eleven RCTs were initially identified in the systematic review. Eight of these were involved in the meta-analysis comparing outcomes and follow-up. Eight studies received a Jadad score of three, indicating a high level of quality. The remaining three studies achieved a lower score which indicated lower qualitative level. Nearly all of the results of the quantitative analysis were statistically significant (P < 0,05) and most of them favored of the experimental group subject to aquatic treatment. Conclusion: Aquatic physical therapy may be a valid means for the rehabilitation of people affected by stroke. The integration of this methodological approach with conventional physical therapy should be considered. However, more studies; a larger number of participants; and varying lengths of follow-up times are necessary.

The effect of aquatic and treadmill exercise in individuals with chronic stroke

ABSTRACT We compared the effect of gait training on treadmill versus deep water on balance and gait in 12 ischemic stroke chronic survivors randomly sorted to the Pool or Treadmill Groups. Berg Scale (BBS) and timed up and go test (TUG) were applied before and after the interventions. Just one person applied all tests and she was blinded for the aims of the study. Surface EMG of the paretic and non-paretic (NP) side muscles were recorded during walking on a treadmill. Three 100-ms epochs were extracted from the EMG related to gait phases: weight acceptance; propulsion; and pre-strike. For each epoch, we calculated the RMS of the EMG signal. Participants did gait training for 9 weeks (3 times/week, 40 minutes/session). The Pool group did the deep-water walking with a swimming belt. The Treadmill group walked on the treadmill at the maximum speed they could stand. The Manova group compared the effect of training, group, side, muscles, and gait phase into the EMG. Anova was used to test the effect of training, group side, and gait phase into BBS, TUG and EMG variables. Pool and Treadmill had increased balance and agility. The highest EMG RMS occurred at the paretic side, for the Treadmill and after training. The mm. tibialis anterior, gastrocnemius lateralis, vastus lateralis, and biceps femoris presented the highest RMS for the NP side; while for mm. rectus femoris and semitendinosus, the paretic side presented the highest RMS. Thus, the both types of exercise lead to similar functional adaptations with different muscular activations during walking.

Effects of hydrokinesitherapy on balance and walking ability in stroke survivors: a systematic review and meta-analysis of randomized controlled studies

BACKGROUND

Balance and walking impairment are common dysfunctions after stroke. Emerging data has demonstrated that hydrokinesitherapy may have a positive influence on improvement of balance and walking ability. However, there is no firm evidence to support these results. Therefore, the aim of this review is to evaluate the effects of hydrokinesitherapy in stroke survivors systematically.

METHODS

Medline, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, CINAHL and SPORTDiscus were systemic searched from their inception to Septemter 30, 2018. RevMan 5.3 software was used to perform data synthesis. The fixed-effect model or random-effect model was employed according to the results of heterogeneity test. The mean differences (MD) or standardized mean difference (SMD) was used to evaluate the pooled effect of hydrokinesitherapy on balance function, walking ability and activty of daily life (ADL).

RESULTS

A total of 13 studies were included involving 381 stroke survivors. Meta-analysis results indicated that hydrokinesitherapy could improve balance ability based on three test: Berg balance scale (BBS: MD = 3.84, 95% confidence interval (95% CI) 2.84 to 4.86, P < 0.001), Time Up To Go Test (TUGT: MD = - 1.22, 95% CI - 2.25 to - 0.18, P = 0.02, fixed-effect model), Functional Reach Test (FRT: MD = 2.41, 95% CI 1.49 to 3.33, P < 0.001). Additionally, we found a weakly positive effect on walking speed (SMD = 0.75, 95% CI 0.26 to 1.25, P = 0.003) and walking ability test (SMD = 0.36, 95% CI 0.04 to 0.68, P = 0.03). There was no significant difference between experimental group and control group in terms of ADL.

SHORT CONCLUSION

Hydrokinesitherapy can improve balance function and had a weakly positive effect on walking ability in stroke survivors. We did not find sufficient evidence to indicate that hydrokinesitherapy could improve the ADL of stroke survivors. However, due to the methodological shortcoming and small number of included studies, caution is needed when interpreting these results. Due to imprecision and publication bias, the quality of the evidence was downgraded to "low-quality" for the primary outcomes of balance and walking ability.

TRIAL REGISTRATION

CRD42018110787.

Effect of hydrokinesitherapy on balance and walking ability in post-stroke patients: A systematic review protocol

INTRODUCTION

Brain stroke is the second most common cause of death and major cause of disability in adults, representing a huge burden on patients and their families. Hydrokinesitherapy, a type of physical rehabilitation, may be beneficial to post-stroke recovery. We will systematically assess the clinical effectiveness and safety of hydrokinesitherapy for rehabilitation of stroke survivors in this review.

METHODS

We will perform a systematic search to identify all potentially relevant published studies on this topic. Online electronic databases including MEDLINE (via PubMed), EMBASE (via embase.com), Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, CINAHL (via EBSCOhost) and SPORTDiscus (via EBSCOhost) will be searched without language restrictions from their inception to September 30, 2018. All relevant randomized controlled trails (RCTs) will be screened according to predetermined inclusion criteria. Two independent reviewers will evaluate the methodological quality of each study included. One reviewer will extract data and another reviewer will check the accuracy. Any disagreements will be discussed with a third reviewer. The posture balance and walking ability will be defined as primary outcomes. Activities of daily living (ADL), drop-out and adverse events will also be assessed as secondary outcomes. The evaluation of methodological quality, data analysis will be completed using Cochrane Review Manager 5.3 according to Cochrane Handbook for Systematic Reviews of Interventions.

TRIAL REGISTRATION NUMBER

CRD42018110787.