Rehabilitation interventions for improving balance following stroke: An overview of systematic reviews

Effect of protein consumption and supplementation on body composition and functional capacity in cardiovascular disease patients undergoing cardiovascular rehabilitation: A systematic review and meta-analysis

Cardiovascular diseases (CVD) remain the leading cause of death worldwide. Nutritional strategies, including protein intake, play a crucial role in cardiovascular rehabilitation by supporting overall health and recovery. This review explores the hypothesis that protein supplementation enhances muscle mass, leading to improved body composition and functional capacity in CVD patients. We conducted a systematic review of randomized controlled trials (RCTs) in accordance with the Cochrane Manual for Systematic Reviews of Interventions, with the protocol registered under CRD42022292687. A comprehensive search strategy, incorporating population, intervention, and study design terms, was executed across PubMed, EMBASE, Scopus, and Web of Science from data inception to February 1, 2024. Study quality was assessed using the Cochrane risk of bias tool (RoB 2.0), and meta-analysis was performed with statistical packages in Rstudio 3.6.2. From 10 939 initial citations, seven RCTs and three pilot RCTs met the eligibility criteria. Sample sizes ranged from 11 to 70 participants, with mean ages between 55 and 80 years. The narrative synthesis revealed mixed effects of protein supplementation on body composition and functional capacity. Lean body mass improvements were observed in several trials, particularly when protein intake was combined with resistance training. However, reductions in adipose tissue were inconsistent. Functional capacity enhancements-such as improved handgrip strength and 10-meter walk test performance-were observed in some trials, especially those using whey or leucine-enriched protein supplements. However, findings on VO2 peak, a key indicator of exercise capacity, were inconclusive, some trials reporting improvements while others showed no significant effect. Risk of bias varied from low to high across trials, and heterogeneity in intervention types, protein dosages, and study durations limited direct comparisons. Outcomes classified with very low certainty of evidence included body mass index, the 6-minute walk test, and VO2 peak or maximum. Meanwhile, low-certainty evidence was found for handgrip strength, fat mass, and lean body mass. In conclusion, while protein supplementation may support improvements in body composition and functional capacity, variability in protein types and dosages prevents a clear recommendation for CVD patients in cardiovascular rehabilitation. Further high-quality trials with larger sample sizes are needed to establish more specific protein intake guidelines for this population.

Effectiveness of Telehealth-Based Exercise Interventions for Patients With Stroke: A Meta-Analysis of Randomised Controlled Trials

AIM

To explore the effects of telehealth-based exercise interventions on balance, motor function, walking ability and activities of daily living (ADLs) in patients with stroke.

DESIGN

Meta-analysis of randomised controlled trials.

METHODS

This meta-analysis of randomised controlled trials was reported to follow the PRISMA statement and the Cochrane Handbook guidelines. The study employed either a fixed-effects model or a random-effects model according to the statistical heterogeneity observed.

DATA SOURCES

The literature search was performed in six databases including PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, PsycINFO and CINAHL from inception to December 2023.

RESULTS

A total of 15 randomised controlled trials were included in this meta-analysis. Most of the studies were evaluated for some concerns. The quality of the evidence in this analysis ranged from low to moderate in terms of the outcome. Meta-analysis revealed that telehealth-based exercise interventions presented significant effects on walking ability, motor function and ADLs in patients with stroke. Nonetheless, the balance remained unaffected by statistical significance.

CONCLUSION

Telehealth-based exercise interventions could effectively improve walking ability, motor function and ADLs in patients with stroke; however, the impact on balance was not significant. Telehealth-based exercise interventions are recommended for stroke survivors residing in remote areas or facing economic constraints.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

This meta-analysis showed that telehealth-based exercise interventions could bring benefits to the rehabilitation of patients with stroke. Telehealth-based exercise interventions should be considered effective to better promote the rehabilitation of patients.

REPORTING METHOD

The study was reported in compliance with the PRISMA statement.

PATIENT OR PUBLIC CONTRIBUTION

None.

TRIAL REGISTRATION

PROSPERO (https://www.crd.york.ac.uk/PROSPERO): CRD42024501015.

The effect of brief, repetitive balance training on balance and fall risk in older people with stroke: A randomized controlled trial

ObjectiveTo evaluate the effect of integrating a specific balance-training program focused on static balance to the conventional rehabilitation program on dynamic balance, risk of falls, and activities of daily living (ADLs) in older adults post-stroke.DesignA single-blinded randomized controlled trial.SettingInstitutional Intermediate Care Hospital.SubjectsPost-stroke older adults in a subacute phase without cognitive impairment, aged 65 years and older, exhibiting trunk control in a seated position for 30 seconds without supporting the arms.InterventionThe control group underwent the usual treatment, consisting of 60-minute physiotherapy sessions, 5 days per week, for 30 days. The experimental group integrated into the usual treatment 15 minutes of the balance-training program (45 min + 15 min).Main measuresBalance impairment (Mini-BESTest and Berg Balance Scale (BBS), risk of falls (BBS), and independence for ADLs (Barthel Index)) were assessed at baseline, 15 and 30 days after the start of interventions.ResultsSeventy-one post-stroke patients (77.7 ± 9.0 years, 49.2% women) were randomized into the experimental (n = 35) or control (n = 36) groups. The experimental group showed improved dynamic balance at day 15 (Mini-BESTest: 2.90 [1.05-4.77], p = 0.003; BBS: 4.31 [1.41-7.23], p = 0.004) and day 30 (Mini-BESTest: 6.06 [2.85-9.27], p < 0.001; BBS: 8.24 [2.96-13.53], p = 0.003), as well as greater independence levels (11 [2.75-19.23], p = 0.010) compared to the control group. The control group showed higher risk of falls on day 15 (p = 0.035) and day 30 (p = 0.003) than the experimental group.ConclusionsA simple, easily reproducible approach designed by and for the older adult to rehabilitate post-stroke impairments effectively improved balance, functional gait, risk of falls, and ADLs.

Effects of transcranial direct current stimulation combined with motor relearning program on strength and balance in stroke patients

Background

A stroke is characterized by neurological deficits that result in compromised muscle strength and balance, impacting the overall wellbeing of the patient, including decreased quality of life, socialization and participation in daily activities. The aim of the study is to determine the effects of transcranial direct current stimulation combined with a motor relearning program on strength and balance in sub-acute stroke patients.

Methods

The randomized controlled trial involved 44 subacute stroke patients, randomly assigned to either the experimental group (n = 22) or control group (n = 22). The intervention included anodal transcranial direct current stimulation (tDCS) for the experimental group and sham stimulation with a motor relearning program for the control groups. Assessments were conducted using manual muscle testing for muscle strength and the Berg Balance Scale for balance at baseline, the fourth week, and the eighth week.

Results

There were no statistically significant effects in the experimental group for either strength or balance (p-value > 0.05) but there were time effects for both variables especially during the intervention period in both the experimental and control groups.

Conclusion

There does not appear to be any short term or long-term additional effects of anodal transcranial direct current stimulation on strength and balance in subacute stroke patients.

Eccentric strengthening vs. conventional therapy in sub-acute stroke survivors: a randomized controlled trial

Spastic paresis, a frequent consequence of stroke, is characterized by both neurological and muscular alterations, leading to decreased muscle strength, increased passive muscle stiffness, and subsequently, diminished functional capacity. Although conventional rehabilitation programs are effective in enhancing muscle strength, they often fail to yield clinically significant improvements in functional capacities. Eccentric Training (ET) has shown promise in addressing the shortened muscle fascicle lengths and joint contractures commonly observed in stroke survivors. Despite the prevalence of contractures and rigidity in this population, the effects of ET on the structural and mechanical properties of muscles remain underexplored. This study aims to investigate the impact of ET on gait speed in sub-acute stroke patients compared to conventional therapy. Additionally, we aim to explore the effects of ET on the mechanical properties, structural characteristics, and neuromuscular parameters of the plantar flexors. A randomized controlled trial will be conducted, adhering to CONSORT guidelines, with participants assigned to either a Conventional Therapy Group or an Eccentric Training Group. Assessments will be conducted at baseline, and after ET intervention, encompassing clinical, biomechanical, and functional evaluations. This study seeks to provide empirical evidence on the efficacy of ET in improving motor outcomes in sub-acute stroke patients, thereby informing more effective rehabilitation strategies.

Home-based functional electrical stimulation protocol for people with chronic stroke. Efficacy and usability of a single-center cohort

BACKGROUND

Stroke survivors often face challenges in recovery and reintegration after acute care. Home-based rehabilitation, incorporating advanced technologies like Functional Electrical Stimulation (FES), shows promise for improving long-term outcomes by providing more accessible, high-intensity, and task-oriented rehabilitation outside traditional clinical settings.

METHOD

This study assessed efficacy and usability of a 10-week home-based rehabilitation protocol for 52 individuals with chronic stroke. The intervention featured a cloud-based platform, a mobile application, and functional electrical stimulation devices. Participants were categorized into groups for tailored exercise training and received both synchronous and asynchronous sessions. Efficacy was measured through standardized motor function tests, while usability was evaluated based on adherence, patient satisfaction, and the frequency of technical support requests.

RESULTS

High adherence (74.03%) and a satisfaction of 73% were observed. On average, patients performed on average 414 min of unsupervised exercise per week. Significant improvement, including a median decrease of 6.08 s (22%) in Timed Up and Go (TUG) [z (24) = 4.17, p < 0.001], a median decrease of 4.04 s (17%) in Five Times Sit to Stand (5STS) [z (28) = 3.96, p < 0.001], Motor Assessment Scale (MAS) showed a mean increase of 3.2 ± 2.8 points, paired t-test [t (20) = -5.01 p < 0.001] and an increase of 0.095 m/s (28%) in 10-Meter Walk Test (10MWT) [z (24) = 3.71, p < 0.001]. Clinical relevance was observed in all outcome measures compared with the reported Minimum Detectable Change.

CONCLUSION

This evaluation of a home-based physiotherapy protocol indicates that integrating FES devices with virtual platforms and mobile applications can sustain high adherence while improving functional outcomes in chronic stroke rehabilitation. The prescription of high-intensity training, significant improvements in balance, gait, and overall functionality were observed, highlighting the viability of this approach for home-based programs.

Modified tai chi movement training based on sEMG and movement analysis on improving upper extremities motor function: a protocol for a clinical randomised controlled trial

INTRODUCTION

Stroke survivors often face motor dysfunction, increasing fall risk. Lower extremity muscle weakness is a key factor affecting walking ability. Tai chi (TC) has been shown to improve muscle strength and mobility in patients with stroke more effectively than traditional walking training. However, existing TC programmes for stroke rehabilitation are often too simplified and fail to fully use TC's benefits. Additionally, subjective assessment scales are time-consuming and prone to bias. This study proposes integrating TC's early movement features with neurodevelopmental therapy, using surface electromyography and inertial measurement unit (IMU) sensors to thoroughly analyse diverse TC movements. Tailored exercises, based on stroke-induced impairments, will be objectively assessed through biomechanical analysis.

METHODS AND ANALYSIS

The study unfolds in two phases. The initial phase employs the IMU sensor and electromyography to objectively analyse TC's biomechanics, informing personalised rehabilitation plans aligned with distinct movement impairments. The second phase adopts a randomised, single-blind, parallel controlled trial design involving 60 patients with stroke randomly assigned to either the intervention or control group. The intervention group undergoes biomechanics-based TC training alongside routine rehabilitation for 12 weeks, practicing the 24-form TC three times weekly. The control group engages in routine rehabilitation thrice weekly for the same duration. Primary and secondary outcomes, including kinematic/dynamic data, surface electromyography, motion analysis, comprehensive the international classification of functioning, disability and health Core Set for Stroke, Modified Barthel Index and Fugl-Meyer Assessment, will be evaluated at baseline and post-intervention.

ETHICS AND DISSEMINATION

The study has received approval from the Ethics Committee of Zhongda Hospital Southeast University (2023ZDSYLL378-P01). All prospective participants will receive comprehensive information regarding the study protocol, and their informed consent will be obtained before their participation. Additionally, the trial will be registered with the Chinese Clinical Trial Registry to ensure transparency and compliance with research regulations. Results from this study will be disseminated through peer-reviewed journals, conference presentations and public databases to ensure wide accessibility and to contribute to the advancement of medical knowledge.

PROTOCOL VERSION

2.0 (14 June 2024).

TRIAL REGISTRATION NUMBER

www.chictr.org.cn, identifier ChiCTR2400080158.

Effectiveness of combined robotics and virtual reality on lower limb functional ability in stroke survivors: A systematic review of randomized controlled trials

Lower limb impairments are common consequences of stroke. Robotics and virtual reality (VR) play crucial roles in improving lower limb function post-stroke. This review aims to assess the effects of combined robot and VR interventions on lower limb functional ability poststroke and to provide recommendations for future studies in the rehabilitation field. PubMed, SCOPUS, CINAHL, MEDLINE, EMBASE, and Web of Science were searched from inception to March 1, 2024. Randomized controlled trials (RCTs) involving patients with a stroke, administering combined robot and VR compared with passive (i.e., rest) or active (any intervention), and including at least one outcome evaluating lower limb function (i.e., balance, gait, mobility, muscle tone, muscle strength, range of motion) or activities of daily living were selected. The Cochrane Collaboration tool was employed to evaluate the risk of bias in the included studies. Nine studies met the eligibility criteria. In total, 364 stroke survivors (Mean age 55.62 years) were involved in this review. According to the Cochrane Collaboration tool, five studies were classified as "high quality," "moderate quality" (n=3), and "low quality" (n=1). There are mixed findings on the effects of combined robot and VR on lower limb functional ability in stroke survivors. The evidence for the effects of combined robot and VR on lower limb functional ability post-stroke is promising. Further trials with long-term follow-up are strongly warranted to understand the immediate and long-term effect of combined robot and VR intervention on various lower limb impairments and to define the optimal treatment protocols.

Analysis of risk of bias assessments in a sample of intervention systematic reviews, part I: many aspects of conduct and reporting need improvement

OBJECTIVES

Current standards for systematic reviews (SRs) require adequate conduct and complete reporting of risk of bias (RoB) assessments of the individual studies included in the review. We investigated the conduct and reporting of RoB assessments reported in a sample of SRs of interventions for persons with cerebral palsy (CP).

STUDY DESIGN AND SETTING

We included SRs published from 2014 to 2021. Authors worked in pairs to independently extract data on the characteristics of the SRs and to rate their conduct and reporting. The conduct of RoB assessment was appraised with the three AMSTAR-2 items related to RoB assessment. Reporting completeness was evaluated using the two items related to RoB assessment within studies in the PRISMA 2020 guidelines. We use descriptive statistics to report the consensus data, in accordance with our protocol.

RESULTS

We included 145 SRs. Among the 128 (88.3%) SRs that assessed RoB, the standards for AMSTAR-2 item 9 (use of an adequate RoB tool) were partially or fully satisfied in 73 (57.0%). Across the 128 SRs that assessed RoB, 46 (35.9%) accounted for RoB in interpreting the SR's findings and, of the 49 that included a meta-analysis, 11 (22.4%) discussed the impact of RoB on this. 123 (96.1%) of the 128 SRs named the RoB tool that was used for at least one of the study designs they included, 96 (75.0%) specified the RoB items assessed and 89 (69.5%) reported the findings for each item, 81 (63.2%) fully reported the processes for RoB assessment, 68 (53.1%) reported how an overall RoB judgment was reached, and 74 (57.8%) reported an overall RoB assessment for every study.

CONCLUSION

The selection and application of RoB tools in this sample of SRs about interventions for CP are comparable to those reported in other recent studies. However, most SRs in this sample did not fully meet the appraisal standards of AMSTAR-2 regarding the adequacy of the RoB tool applied and other aspects of RoB assessment conduct; Cochrane SRs were a notable exception. Overall, reporting of RoB assessments was somewhat better than conduct, perhaps reflecting the more widespread uptake of the PRISMA guidelines. Our findings may be generalizable to some extent, considering the extensive literature reporting widespread inadequacies in health care-related intervention SRs and reports from other specialties that document similar RoB assessment deficiencies. As such, this study should remind authors, peer reviewers, and journal editors to follow the RoB assessment reporting guidelines of PRISMA 2020 and to understand the corresponding critical appraisal standards of AMSTAR-2. We recommend a shift of focus from the documentation of inadequate RoB assessments and well-known deficiencies in other components of SRs towards the implementation of changes to address these problems along with plans to evaluate their effectiveness.

Efficacy of hippotherapy simulator exercise program in patients with stroke: a randomized single-blind clinical trial

OBJECTIVES

The aim of this study was to investigate the effect of hippotherapy simulator on balance, postural control, mobility, functional capacity and independence level in people with stroke.

METHODS

This study involved 26 people with stroke aged 18-65, who were randomly assigned to a Hippotherapy Simulator Group (HSG; n = 13) and a Conventional Exercise Group (CEG; n = 13). Patients underwent assessments using the Berg Balance Scale (BBS), Postural Assessment Scale for Stroke (PAS-S), Timed Up and Go Test (TUG), Rivermead Mobility Index (RMI), 2-Minute Walking Test (2-MWT), and Barthel Daily Living Activity Index (BI) to evaluate balance, postural control, mobility, functional capacity, and independence before and after treatment. In the HSG, participants received 30 sessions of conventional exercises and hippotherapy simulator - a mechanical and robotic equipment with a dynamic saddle simulating horse movement - exercises over 6 weeks. Meanwhile, the CEG underwent 30 sessions of conventional exercises alone for 6 weeks.

RESULTS

In the post-therapy evaluation between groups, BBS (p = 0.004) and 2-MWT (p < 0.001) scores were higher in HSG compared to CEG. However, no statistically significant difference was found between the two groups in terms of PAS-S, RMI, TUG and BI scores (p > 0.05). Statistically significant differences were found between BBS, PAS-S, RMI, TUG, BI and 2-MWT scores before and after treatment in both groups (p < 0.05).

CONCLUSIONS

Hippotherapy simulator can be added to conventional exercises to improve balance and functional capacity in people with stroke.

Effectiveness of the A3 robot on lower extremity motor function in stroke patients: A prospective, randomized controlled trial

BACKGROUND

The results of existing lower extremity robotics studies are conflicting, and few relevant clinical trials have examined short-term efficacy. In addition, most of the outcome indicators in existing studies are scales, which are not objective enough. We used the combination of objective instrument measurement and scale to explore the short-term efficacy of the lower limb A3 robot, to provide a clinical reference.

AIM

To investigate the improvement of lower limb walking ability and balance in stroke treated by A3 lower limb robot.

METHODS

Sixty stroke patients were recruited prospectively in a hospital and randomized into the A3 group and the control group. They received 30 min of A3 robotics training and 30 min of floor walking training in addition to 30 min of regular rehabilitation training. The training was performed five times a week, once a day, for 2 wk. The t-test or non-parametric test was used to compare the three-dimensional gait parameters and balance between the two groups before and after treatment.

RESULTS

The scores of basic activities of daily living, Stroke-Specific Quality of Life Scale, FM balance meter, Fugl-Meyer Assessment scores, Rivermead Mobility Index, Stride speed, Stride length, and Time Up and Go test in the two groups were significantly better than before treatment (19.29 ± 12.15 vs 3.52 ± 4.34; 22.57 ± 17.99 vs 4.07 ± 2.51; 1.21 ± 0.83 vs 0.18 ± 0.40; 3.50 ± 3.80 vs 0.96 ± 2.08; 2.07 ± 1.21 vs 0.41 ± 0.57; 0.89 ± 0.63 vs 0.11 ± 0.32; 12.38 ± 9.00 vs 2.80 ± 3.43; 18.84 ± 11.24 vs 3.80 ± 10.83; 45.12 ± 69.41 vs 8.41 ± 10.20; 29.45 ± 16.62 vs 8.68 ± 10.74; P < 0.05). All outcome indicators were significantly better in the A3 group than in the control group, except the area of the balance parameter.

CONCLUSION

For the short-term treatment of patients with subacute stroke, the addition of A3 robotic walking training to conventional physiotherapy appears to be more effective than the addition of ground-based walking training.

A Systematic Review of the Effects of Interactive Telerehabilitation with Remote Monitoring and Guidance on Balance and Gait Performance in Older Adults and Individuals with Neurological Conditions

Recognizing the growing interests and benefits of technology-assisted interactive telerehabilitation in various populations, the aim of this review is to systematically review the effects of interactive telerehabilitation with remote monitoring and guidance for improving balance and gait performance in older adults and individuals with neurological conditions. The study protocol for this systematic review was registered with the international prospective register of systematic reviews (PROSPERO) with the unique identifier CRD42024509646. Studies written in English published from January 2014 to February 2024 in Web of Science, Pubmed, Scopus, and Google Scholar were examined. Of the 247 identified, 17 were selected after initial and eligibility screening, and their methodological quality was assessed with the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies. All 17 studies demonstrated balance and gait performance improvement in older adults and in individuals with stroke, Parkinson's disease, and multiple sclerosis following 4 or more weeks of interactive telerehabilitation via virtual reality, smartphone or tablet apps, or videoconferencing. The findings of this systematic review can inform the future design and implementation of interactive telerehabilitation technology and improve balance and gait training exercise regimens for older adults and individuals with neurological conditions.

Frequency-dependent behavior of paretic and non-paretic leg force during standing post stroke

Maintaining upright posture in quiet standing is an important skill that is often disrupted by stroke. Despite extensive study of human standing, current understanding is incomplete regarding the muscle coordination strategies that produce the ground-on-foot force (F) that regulates translational and rotational accelerations of the body. Even less is understood about how stroke disrupts that coordination. Humans produce sagittal plane variations in the location (center of pressure, xCP) and orientation (Fx/Fz) of F that, along with the force of gravity, produce sagittal plane body motions. As F changes during quiet standing there is a strong correlation between the xCP and Fx/Fz time-varying signals within narrow frequency bands. The slope of the correlation varies systematically with frequency in non-disabled populations, is sensitive to changes in both environmental and neuromuscular control factors, and emerges from the interaction of body mechanics and neural control. This study characterized the xCP versus Fx/Fz relationship as frequency-dependent Intersection Point (IP) heights for the paretic and non-paretic legs of individuals with history of a stroke (n = 12) as well as in both legs of non-disabled controls (n = 22) to reveal distinguishing motor coordination patterns. No inter-leg difference of IP height was present in the control group. The paretic leg IP height was lower than the non-paretic, and differences from control legs were in opposite directions. These results quantify disrupted coordination that may characterize the paretic leg balance deficit and non-paretic leg compensatory behavior, providing a means of monitoring balance impairment and a target for therapeutic interventions.

Neuroprotective effect of the RNS60 in a mouse model of transient focal cerebral ischemia

BACKGROUND

Stroke is a major cause of death, disability, and public health problems. Its intervention is limited to early treatment with thrombolytics and/or endovascular clot removal with mechanical thrombectomy without any available subacute or chronic neuroprotective treatments. RNS60 has reduced neuroinflammation and increased neuronal survival in several animal models of neurodegeneration and trauma. The aim here was to evaluate whether RNS60 protects the brain and cognitive function in a mouse stroke model.

METHODS

Male C57BL/6J mice were subjected to sham or ischemic stroke surgery using 60-minute transient middle cerebral artery occlusion (tMCAo). In each group, mice received blinded daily administrations of RNS60 or control fluids (PNS60 or normal saline [NS]), beginning 2 hours after surgery over 13 days. Multiple neurobehavioral tests were conducted (Neurological Severity Score [mNSS], Novel Object Recognition [NOR], Active Place Avoidance [APA], and the Conflict Variant of APA [APAc]). On day 14, cortical microvascular perfusion (MVP) was measured, then brains were removed and infarct volume, immunofluorescence of amyloid beta (Aβ), neuronal density, microglial activation, and white matter damage/myelination were measured. SPSS was used for analysis (e.g., ANOVA for parametric data; Kruskal Wallis for non-parametric data; with post-hoc analysis).

RESULTS

Thirteen days of treatment with RNS60 reduced brain infarction, amyloid pathology, neuronal death, microglial activation, white matter damage, and increased MVP. RNS60 reduced brain pathology and resulted in behavioral improvements in stroke compared to sham surgery mice (increased memory-learning in NOR and APA, improved cognitive flexibility in APAc).

CONCLUSION

RNS60-treated mice exhibit significant protection of brain tissue and improved neurobehavioral functioning after tMCAo-stroke. Additional work is required to determine mechanisms, time-window of dosing, and multiple dosing volumes durations to support clinical stroke research.

Guidance to best tools and practices for systematic reviews

Data continue to accumulate indicating that many systematic reviews are methodologically flawed, biased, redundant, or uninformative. Some improvements have occurred in recent years based on empirical methods research and standardization of appraisal tools; however, many authors do not routinely or consistently apply these updated methods. In addition, guideline developers, peer reviewers, and journal editors often disregard current methodological standards. Although extensively acknowledged and explored in the methodological literature, most clinicians seem unaware of these issues and may automatically accept evidence syntheses (and clinical practice guidelines based on their conclusions) as trustworthy. A plethora of methods and tools are recommended for the development and evaluation of evidence syntheses. It is important to understand what these are intended to do (and cannot do) and how they can be utilized. Our objective is to distill this sprawling information into a format that is understandable and readily accessible to authors, peer reviewers, and editors. In doing so, we aim to promote appreciation and understanding of the demanding science of evidence synthesis among stakeholders. We focus on well-documented deficiencies in key components of evidence syntheses to elucidate the rationale for current standards. The constructs underlying the tools developed to assess reporting, risk of bias, and methodological quality of evidence syntheses are distinguished from those involved in determining overall certainty of a body of evidence. Another important distinction is made between those tools used by authors to develop their syntheses as opposed to those used to ultimately judge their work. Exemplar methods and research practices are described, complemented by novel pragmatic strategies to improve evidence syntheses. The latter include preferred terminology and a scheme to characterize types of research evidence. We organize best practice resources in a Concise Guide that can be widely adopted and adapted for routine implementation by authors and journals. Appropriate, informed use of these is encouraged, but we caution against their superficial application and emphasize their endorsement does not substitute for in-depth methodological training. By highlighting best practices with their rationale, we hope this guidance will inspire further evolution of methods and tools that can advance the field.

Effect of Whole-Body Vibration on Balance or Proprioception in Nonspecific Chronic Low Back Pain: A Systematic Review

Objective

This systematic review aimed to investigate the effect of whole-body vibration (WBV) on balance or proprioception for patients with nonspecific chronic low back pain (NSCLBP).

Methods

A comprehensive search was conducted using 5 databases-PubMed, Web of Science, Cochrane Library, Science Direct, and Physiotherapy Evidence Database-from inception to January 2022. Randomized clinical trials that examined the efficacy of WBV on balance or proprioception in patients with NSCLBP were incorporated. The methodological quality of each included study was assessed using the Physiotherapy Evidence Database scale.

Results

Our search strategy yielded 5309 articles, of which 7 published randomized clinical trials (313 patients) met the inclusion criteria. Three of the 4 included studies that investigated balance reported significant improvements after WBV, of which 2 were of high methodological quality. The remaining 3 studies investigating proprioception also showed significant improvements after WBV intervention.

Conclusion

Although some studies seem to provide promising results regarding the efficacy of WBV or WBV combined with exercise in improving balance and proprioception in patients with NSCLBP, at present, no definite conclusions can be drawn due to article heterogeneity and lack of clinical trials.

User profile of people contacting a stroke helpline (StrokeLine) in Australia: a retrospective cohort study

BACKGROUND

StrokeLine is a specialised telephone helpline led by health professionals in Australia.

AIMS

(i) To describe the profile of StrokeLine callers; (ii) to understand the reasons people engage with the service and (iii) how StrokeLine responded to the caller's needs.

METHODS

Routine call data were obtained from the StrokeLine between November 2019 and November 2020. Data were extracted and descriptive analyses performed. De-identified free-text data were obtained separately for November 2019 and June 2020 and analysed using qualitative content analysis.

RESULTS

Of the 1429 calls most were from carers, family and friends (38%) or the stroke survivor themselves (34%). Most calls were made by women (64%) and the average age of the stroke survivor was ≥65 years (33%) with the time since the stroke occurred <1 year. The main reason for calling was to manage stroke-related impairments (40%). Providing information, support and advice was the most common action provided by StrokeLine staff (25%). Content analysis of 225 calls revealed most stroke survivors called for emotional support, while carers sought more practical guidance. StrokeLine provided information for referral to relevant services and guidance on what to do next.

CONCLUSIONS

Most calls were received from family and carers, as well as stroke survivors. They contacted StrokeLine for information and advice, practical solutions, emotional support, and referral advice to other services.

Guidance to best tools and practices for systematic reviews

Data continue to accumulate indicating that many systematic reviews are methodologically flawed, biased, redundant, or uninformative. Some improvements have occurred in recent years based on empirical methods research and standardization of appraisal tools; however, many authors do not routinely or consistently apply these updated methods. In addition, guideline developers, peer reviewers, and journal editors often disregard current methodological standards. Although extensively acknowledged and explored in the methodological literature, most clinicians seem unaware of these issues and may automatically accept evidence syntheses (and clinical practice guidelines based on their conclusions) as trustworthy. A plethora of methods and tools are recommended for the development and evaluation of evidence syntheses. It is important to understand what these are intended to do (and cannot do) and how they can be utilized. Our objective is to distill this sprawling information into a format that is understandable and readily accessible to authors, peer reviewers, and editors. In doing so, we aim to promote appreciation and understanding of the demanding science of evidence synthesis among stakeholders. We focus on well-documented deficiencies in key components of evidence syntheses to elucidate the rationale for current standards. The constructs underlying the tools developed to assess reporting, risk of bias, and methodological quality of evidence syntheses are distinguished from those involved in determining overall certainty of a body of evidence. Another important distinction is made between those tools used by authors to develop their syntheses as opposed to those used to ultimately judge their work. Exemplar methods and research practices are described, complemented by novel pragmatic strategies to improve evidence syntheses. The latter include preferred terminology and a scheme to characterize types of research evidence. We organize best practice resources in a Concise Guide that can be widely adopted and adapted for routine implementation by authors and journals. Appropriate, informed use of these is encouraged, but we caution against their superficial application and emphasize their endorsement does not substitute for in-depth methodological training. By highlighting best practices with their rationale, we hope this guidance will inspire further evolution of methods and tools that can advance the field.

A Systematic Review of the Long-Term Effects of Using Smartphone- and Tablet-Based Rehabilitation Technology for Balance and Gait Training and Exercise Programs

Recent advances in wearable motion sensors, mobile devices, the Internet of Things, and telecommunications have created new potential for telerehabilitation. Recognizing that there is no systematic review of smartphone- or tablet-based balance and gait telerehabilitation technology for long-term use (i.e., four weeks or more), this systematic review summarizes the effects of smartphone- or tablet-based rehabilitation technology on balance and gait exercise and training in balance and gait disorders. The review examined studies written in English published from 2013 to 2023 in Web of Science, Pubmed, Scopus, and Google Scholar. Of the 806 studies identified, 14 were selected, and the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies was applied to evaluate methodological quality. The systematic review concluded that all 14 studies found balance and gait performance improvement after four weeks or more of balance and gait telerehabilitation. Ten of the 14 studies found that carry-over effects (improved functional movements, muscle strength, motor capacity, cognition, and reduced fear of falling and anxiety levels) were maintained for weeks to months. The results of the systematic review have positive technical and clinical implications for the next-generation design of rehabilitation technology in balance and gait training and exercise programs.

Guidance to best tools and practices for systematic reviews

Data continue to accumulate indicating that many systematic reviews are methodologically flawed, biased, redundant, or uninformative. Some improvements have occurred in recent years based on empirical methods research and standardization of appraisal tools; however, many authors do not routinely or consistently apply these updated methods. In addition, guideline developers, peer reviewers, and journal editors often disregard current methodological standards. Although extensively acknowledged and explored in the methodological literature, most clinicians seem unaware of these issues and may automatically accept evidence syntheses (and clinical practice guidelines based on their conclusions) as trustworthy. A plethora of methods and tools are recommended for the development and evaluation of evidence syntheses. It is important to understand what these are intended to do (and cannot do) and how they can be utilized. Our objective is to distill this sprawling information into a format that is understandable and readily accessible to authors, peer reviewers, and editors. In doing so, we aim to promote appreciation and understanding of the demanding science of evidence synthesis among stakeholders. We focus on well-documented deficiencies in key components of evidence syntheses to elucidate the rationale for current standards. The constructs underlying the tools developed to assess reporting, risk of bias, and methodological quality of evidence syntheses are distinguished from those involved in determining overall certainty of a body of evidence. Another important distinction is made between those tools used by authors to develop their syntheses as opposed to those used to ultimately judge their work. Exemplar methods and research practices are described, complemented by novel pragmatic strategies to improve evidence syntheses. The latter include preferred terminology and a scheme to characterize types of research evidence. We organize best practice resources in a Concise Guide that can be widely adopted and adapted for routine implementation by authors and journals. Appropriate, informed use of these is encouraged, but we caution against their superficial application and emphasize their endorsement does not substitute for in-depth methodological training. By highlighting best practices with their rationale, we hope this guidance will inspire further evolution of methods and tools that can advance the field.

Guidance to best tools and practices for systematic reviews

Data continue to accumulate indicating that many systematic reviews are methodologically flawed, biased, redundant, or uninformative. Some improvements have occurred in recent years based on empirical methods research and standardization of appraisal tools; however, many authors do not routinely or consistently apply these updated methods. In addition, guideline developers, peer reviewers, and journal editors often disregard current methodological standards. Although extensively acknowledged and explored in the methodological literature, most clinicians seem unaware of these issues and may automatically accept evidence syntheses (and clinical practice guidelines based on their conclusions) as trustworthy.A plethora of methods and tools are recommended for the development and evaluation of evidence syntheses. It is important to understand what these are intended to do (and cannot do) and how they can be utilized. Our objective is to distill this sprawling information into a format that is understandable and readily accessible to authors, peer reviewers, and editors. In doing so, we aim to promote appreciation and understanding of the demanding science of evidence synthesis among stakeholders. We focus on well-documented deficiencies in key components of evidence syntheses to elucidate the rationale for current standards. The constructs underlying the tools developed to assess reporting, risk of bias, and methodological quality of evidence syntheses are distinguished from those involved in determining overall certainty of a body of evidence. Another important distinction is made between those tools used by authors to develop their syntheses as opposed to those used to ultimately judge their work.Exemplar methods and research practices are described, complemented by novel pragmatic strategies to improve evidence syntheses. The latter include preferred terminology and a scheme to characterize types of research evidence. We organize best practice resources in a Concise Guide that can be widely adopted and adapted for routine implementation by authors and journals. Appropriate, informed use of these is encouraged, but we caution against their superficial application and emphasize their endorsement does not substitute for in-depth methodological training. By highlighting best practices with their rationale, we hope this guidance will inspire further evolution of methods and tools that can advance the field.

Guidance to best tools and practices for systematic reviews

Data continue to accumulate indicating that many systematic reviews are methodologically flawed, biased, redundant, or uninformative. Some improvements have occurred in recent years based on empirical methods research and standardization of appraisal tools; however, many authors do not routinely or consistently apply these updated methods. In addition, guideline developers, peer reviewers, and journal editors often disregard current methodological standards. Although extensively acknowledged and explored in the methodological literature, most clinicians seem unaware of these issues and may automatically accept evidence syntheses (and clinical practice guidelines based on their conclusions) as trustworthy.A plethora of methods and tools are recommended for the development and evaluation of evidence syntheses. It is important to understand what these are intended to do (and cannot do) and how they can be utilized. Our objective is to distill this sprawling information into a format that is understandable and readily accessible to authors, peer reviewers, and editors. In doing so, we aim to promote appreciation and understanding of the demanding science of evidence synthesis among stakeholders. We focus on well-documented deficiencies in key components of evidence syntheses to elucidate the rationale for current standards. The constructs underlying the tools developed to assess reporting, risk of bias, and methodological quality of evidence syntheses are distinguished from those involved in determining overall certainty of a body of evidence. Another important distinction is made between those tools used by authors to develop their syntheses as opposed to those used to ultimately judge their work.Exemplar methods and research practices are described, complemented by novel pragmatic strategies to improve evidence syntheses. The latter include preferred terminology and a scheme to characterize types of research evidence. We organize best practice resources in a Concise Guide that can be widely adopted and adapted for routine implementation by authors and journals. Appropriate, informed use of these is encouraged, but we caution against their superficial application and emphasize their endorsement does not substitute for in-depth methodological training. By highlighting best practices with their rationale, we hope this guidance will inspire further evolution of methods and tools that can advance the field.

Guidance to Best Tools and Practices for Systematic Reviews

» Data continue to accumulate indicating that many systematic reviews are methodologically flawed, biased, redundant, or uninformative. Some improvements have occurred in recent years based on empirical methods research and standardization of appraisal tools; however, many authors do not routinely or consistently apply these updated methods. In addition, guideline developers, peer reviewers, and journal editors often disregard current methodological standards. Although extensively acknowledged and explored in the methodological literature, most clinicians seem unaware of these issues and may automatically accept evidence syntheses (and clinical practice guidelines based on their conclusions) as trustworthy.» A plethora of methods and tools are recommended for the development and evaluation of evidence syntheses. It is important to understand what these are intended to do (and cannot do) and how they can be utilized. Our objective is to distill this sprawling information into a format that is understandable and readily accessible to authors, peer reviewers, and editors. In doing so, we aim to promote appreciation and understanding of the demanding science of evidence synthesis among stakeholders. We focus on well-documented deficiencies in key components of evidence syntheses to elucidate the rationale for current standards. The constructs underlying the tools developed to assess reporting, risk of bias, and methodological quality of evidence syntheses are distinguished from those involved in determining overall certainty of a body of evidence. Another important distinction is made between those tools used by authors to develop their syntheses as opposed to those used to ultimately judge their work.» Exemplar methods and research practices are described, complemented by novel pragmatic strategies to improve evidence syntheses. The latter include preferred terminology and a scheme to characterize types of research evidence. We organize best practice resources in a Concise Guide that can be widely adopted and adapted for routine implementation by authors and journals. Appropriate, informed use of these is encouraged, but we caution against their superficial application and emphasize their endorsement does not substitute for in-depth methodological training. By highlighting best practices with their rationale, we hope this guidance will inspire further evolution of methods and tools that can advance the field.

Umbrella Review of Primary Care Treatments for Adults With Chronic Low Back Pain

OBJECTIVES

The purpose of this study was to identify, critically assess, and summarize evidence of the effectiveness of primary care treatments for adults with non-specific chronic low back pain (NSCLBP).

METHODS

We conducted an umbrella review of systematic reviews focusing on primary care treatments for NSCLBP. We searched the PubMed and Cochrane library databases for systematic reviews of randomized controlled trials (RCTs) evaluating primary care treatments for adults with NSCLBP published between January 2007 and March 2021. Two reviewers independently assessed the quality of these systematic reviews using the AMSTAR checklist. We selected systematic reviews with a low or moderate risk of bias and graded the evidence based on Grading of GRADE criteria.

RESULTS

Among the initial 66 systematic reviews meeting our inclusion criteria, 19 systematic reviews with low or moderate bias risk were selected for analysis. These reviews included a total of 365 studies involving 62 832 participants. The evidence suggested moderate to high support for the effectiveness of certain primary care treatments in improving pain and function in NSCLBP patients. These treatments included NSAIDs and opioids compared to placebos, spinal manipulation versus exercise/physical therapy, and MBR versus exercise/education/advice/no treatment.

CONCLUSIONS

Recommendations for specific primary care treatments for NSCLBP in adults remain inconclusive. Further high-quality systematic reviews and RCTs are needed to better understand the effectiveness of these treatments. Future RCTs should prioritize the assessment of NSAIDs, opioids, spinal manipulation, and MBR, as they appear promising for improving NSCLBP outcomes in certain comparisons.

Immersive Virtual Reality in Post-Stroke Rehabilitation: A Systematic Review

In recent years, next to conventional rehabilitation's techniques, new technologies have been applied in stroke rehabilitation. In this context, fully immersive virtual reality (FIVR) has showed interesting results thanks to the level of immersion of the subject in the illusional world, with the feeling of being a real part of the virtual environment. This study aims to investigate the efficacy of FIVR in stroke rehabilitation. PubMed, Web of Science and Scopus were screened up to November 2022 to identify eligible randomized controlled trials (RCTs). Out of 4623, we included 12 RCTs involving post-acute and chronic stroke survivors, with a total of 350 patients (234 men and 115 women; mean age 58.36 years). High heterogeneity of the outcomes considered, the results showed that FIVR provides additional benefits, in comparison with standard rehabilitation. In particular, results showed an improvement in upper limb dexterity, gait performance and dynamic balance, influencing patient independence. Therefore, FIVR represents an adaptable, multi-faceted rehabilitation tool that can be considered in post-stroke rehabilitation, improving the compliance of the patients to the treatment and increasing the level of functioning and quality of life of stroke survivors.

Guidance to best tools and practices for systematic reviews1

Data continue to accumulate indicating that many systematic reviews are methodologically flawed, biased, redundant, or uninformative. Some improvements have occurred in recent years based on empirical methods research and standardization of appraisal tools; however, many authors do not routinely or consistently apply these updated methods. In addition, guideline developers, peer reviewers, and journal editors often disregard current methodological standards. Although extensively acknowledged and explored in the methodological literature, most clinicians seem unaware of these issues and may automatically accept evidence syntheses (and clinical practice guidelines based on their conclusions) as trustworthy.A plethora of methods and tools are recommended for the development and evaluation of evidence syntheses. It is important to understand what these are intended to do (and cannot do) and how they can be utilized. Our objective is to distill this sprawling information into a format that is understandable and readily accessible to authors, peer reviewers, and editors. In doing so, we aim to promote appreciation and understanding of the demanding science of evidence synthesis among stakeholders. We focus on well-documented deficiencies in key components of evidence syntheses to elucidate the rationale for current standards. The constructs underlying the tools developed to assess reporting, risk of bias, and methodological quality of evidence syntheses are distinguished from those involved in determining overall certainty of a body of evidence. Another important distinction is made between those tools used by authors to develop their syntheses as opposed to those used to ultimately judge their work.Exemplar methods and research practices are described, complemented by novel pragmatic strategies to improve evidence syntheses. The latter include preferred terminology and a scheme to characterize types of research evidence. We organize best practice resources in a Concise Guide that can be widely adopted and adapted for routine implementation by authors and journals. Appropriate, informed use of these is encouraged, but we caution against their superficial application and emphasize their endorsement does not substitute for in-depth methodological training. By highlighting best practices with their rationale, we hope this guidance will inspire further evolution of methods and tools that can advance the field.

Tai Chi increases functional connectivity and decreases chronic fatigue syndrome: A pilot intervention study with machine learning and fMRI analysis

BACKGROUND

The latest guidance on chronic fatigue syndrome (CFS) recommends exercise therapy. Tai Chi, an exercise method in traditional Chinese medicine, is reportedly helpful for CFS. However, the mechanism remains unclear. The present longitudinal study aimed to detect the influence of Tai Chi on functional brain connectivity in CFS.

METHODS

The study recruited 20 CFS patients and 20 healthy controls to receive eight sessions of Tai Chi exercise over a period of one month. Before the Tai Chi exercise, an abnormal functional brain connectivity for recognizing CFS was generated by a linear support vector model. The prediction ability of the structure was validated with a random forest classification under a permutation test. Then, the functional connections (FCs) of the structure were analyzed in the large-scale brain network after Tai Chi exercise while taking the changes in the Fatigue Scale-14, Pittsburgh Sleep Quality Index (PSQI), and the 36-item short-form health survey (SF-36) as clinical effectiveness evaluation. The registration number is ChiCTR2000032577 in the Chinese Clinical Trial Registry.

RESULTS

1) The score of the Fatigue Scale-14 decreased significantly in the CFS patients, and the scores of the PSQI and SF-36 changed significantly both in CFS patients and healthy controls. 2) Sixty FCs were considered significant to discriminate CFS (P = 0.000, best accuracy 90%), with 80.5% ± 9% average accuracy. 3) The FCs that were majorly related to the left frontoparietal network (FPN) and default mode network (DMN) significantly increased (P = 0.0032 and P = 0.001) in CFS patients after Tai Chi exercise. 4) The change of FCs in the left FPN and DMN were positively correlated (r = 0.40, P = 0.012).

CONCLUSION

These results demonstrated that the 60 FCs we found using machine learning could be neural biomarkers to discriminate between CFS patients and healthy controls. Tai Chi exercise may improve CFS patients' fatigue syndrome, sleep quality, and body health statement by strengthening the functional connectivity of the left FPN and DMN under these FCs. The findings promote our understanding of Tai Chi exercise's value in treating CFS.

Using Mirror Therapy to Optimize the Efficacy of Balance Programs for Older Adults With Poststroke Balance Impairment

PURPOSE

Poststroke rehabilitation is an inevitable element of the treatment for stroke survivors. This study aimed to investigate the effect of balance training with mirror therapy in older adults with poststroke balance impairment.

DESIGN/METHODS

The study adopted a two-arm randomized clinical trial and included 38 older adults with poststroke balance impairment. The intervention group received balance exercises with mirror therapy, whereas the control group received the same balance exercises without mirror therapy (a nonreflective plate was used instead). The patient outcome, the balance score, was measured using the Berg Balance Scale. Analysis of covariance was used for statistical analysis.

RESULTS

Results showed that balance exercises combined with mirror therapy were significantly more effective than balance exercises without mirror therapy in improving balance in the stroke survivors (p < .001).

CONCLUSION

Mirror therapy combined with regular balance exercises is an effective and practical method for enhancing balance in older adults suffering from balance impairment.

CLINICAL RELEVANCE

Balance training combined with containing mirror therapy may be included in the rehabilitation programs of older adults with poststroke balance impairment.

Efeitos da vibração do tendão muscular no equilíbrio após acidente vascular cerebral: revisão sistemática

RESUMO Após o acidente vascular cerebral (AVC), as pessoas apresentam combinações complexas de déficits sensoriais, motores, cognitivos e emocionais que podem afetar o equilíbrio estático e dinâmico. O objetivo do estudo foi compilar e resumir as principais características e achados de protocolos utilizados em pesquisas que investigaram os efeitos da vibração no tendão muscular no equilíbrio estático e dinâmico em adultos com AVC. Trata-se de uma revisão sistemática, registrada na PROSPERO (CRD42022303874), em que foram realizadas buscas nas bases de dados PubMed, Cochrane, LILACS, SciELO, MEDLINE, Science Direct e PEDro, durante o mês de janeiro de 2022, por meio da combinação de palavras-chave relacionadas a “stroke”, “balance”, “muscle tendon vibration” e “randomized controlled trial”. A qualidade metodológica foi avaliada através da escala PEDro. Foram identificados 1.560 estudos, dos quais 11 foram incluídos, publicados entre 1994 e 2020, envolvendo 242 adultos pós-AVC. Apenas cinco estudos utilizaram a vibração como intervenção e verificaram melhora no equilíbrio estático e dinâmico. Seis estudos analisaram a interferência da vibração no controle postural, observando que o equilíbrio foi afetado durante a aplicação da vibração e que os indivíduos precisaram de mais tempo para se recuperar ou não sofreram diferenças significativas. Verificou-se que os efeitos da vibração do tendão muscular podem melhorar o equilíbrio em pessoas com AVC e influenciar o controle postural através de mecanismos proprioceptivos da vibração. Entretanto, são necessários mais estudos de alta qualidade metodológica para atingir um consenso em relação aos protocolos de tratamento com vibração do tendão muscular e sua recomendação na prática clínica.

Effects of muscle tendon vibration on balance after stroke: systematic review

ABSTRACT After cerebrovascular accident (CVA), people have complex combinations of sensory, motor, cognitive, and emotional deficits, which can affect static and dynamic balance. This study aimed to compile and summarize the main features and findings of protocols used in research that investigated the effects of muscle tendon vibration on static and dynamic balance in adults with stroke. This is a systematic review, registered in PROSPERO (CRD42022303874), in which searches were performed in the databases PubMed, Cochrane, LILACS, SciELO, MEDLINE, Science Direct, and PEDro, during the month of January 2022, using the combination of keywords related to “stroke,” “balance,” “muscle tendon vibration,” “randomized controlled trial.” Methodological quality was assessed using the PEDro scale. A total of 1,560 studies were identified, 11 of which were included, between the years 1994 to 2020, involving 242 post-stroke adults. Only five studies used vibration as an intervention and found an improvement in static and dynamic balance. Six studies analyzed the interference of vibration on postural control, showing that balance was affected during the application of vibration and that individuals needed more time to recover or did not experience significant differences. We found that the effects of muscle tendon vibration may be able to improve balance in people with stroke and influence postural control by proprioceptive mechanisms of vibration. However, more studies of high methodological quality are needed to reach a consensus regarding muscle tendon vibration treatment protocols and their recommendation in clinical practice.

Cerebellar repetitive transcranial magnetic stimulation modulates the motor learning of visually guided voluntary postural control task

We investigated whether vermal cerebellar low-frequency repetitive transcranial magnetic stimulation (crTMS) affects motor learning of visually guided postural tracking training (VTT) using foot center of pressure (COP) as well as the stability and sensory contribution of upright standing. Twenty-one healthy volunteers participated (10 in the sham-crTMS group and 11 in the active-crTMS group). For VTT, participants stood on the force plate 1.5 m from the monitor on which the COP and target moved in a circle. Participants tracked the target with their own COP for 1 min, and 10 VTT sessions were conducted. The tracking error (TE) was compared between trials. Active- or sham-crTMS sessions were conducted prior to VTT. At baseline (before crTMS), pre-VTT (after crTMS), and post-VTT, the COP trajectory during upright static standing under four conditions (eyes, open/closed; surface, hard/rubber) was recorded. Comparison of the length of the COP trajectory or path and sensory-contribution-rate showed no significant difference between baseline and pre- and post-VTT. There was a significant decrease in TE in the sham-crTMS but not in the active-crTMS group. VTT and crTMS did not immediately affect the stability and sensory contribution of upright standing; however, crTMS immediately affected motor learning. The vermal cerebellum may contribute to motor learning of voluntary postural control.

Effects of Creatine Supplementation and Progressive Resistance Training in Stroke Survivors

The purpose was to investigate the effects of progressive resistance training (PRT) and creatine supplementation in stroke survivors. Participants were randomized to one of two groups: creatine (n = 5; 51 ± 16y) or placebo (n = 3; 73 ± 8y) during 10 weeks of supervised PRT. Prior to and following PRT and supplementation, assessments were made for body composition (lean tissue and fat mass), muscle thickness, muscle strength (1-repetition maximum), functional exercise capacity (6-minute walk test, Berg Balance Scale; BBS), cognition (Montreal Cognitive Assessment; MoCA), and symptoms of anxiety (Generalized Anxiety Disorder Assessment-7; GAD-7) and depression (Center for Epidemiological Studies Depression Scale; CES-D). There were time main effects for leg press strength (increased; p = 0.001), chest press strength (increased; p = 0.003), elbow flexor muscle thickness (increased; p = 0.007), BBS (increased; p = 0.002), MoCA (increased; p = 0.031) and CES-D (decreased; p = 0.045). There was a group x time interaction for the 6 minute walk test (p = 0.039). The creatine group significantly increased walking distance over time (p = 0.002) with no change in the placebo group (p = 0.120). Ten weeks of PRT had some positive effects on measures of muscle strength and size, balance, cognition and depression. The addition of creatine to PRT significantly improved walking performance in stroke survivors.

AMSTAR 2 appraisal of systematic reviews and meta-analyses in the field of heart failure from high-impact journals

BACKGROUND

The Measurement Tool to Assess systematic Reviews (AMSTAR) 2 is a critical appraisal tool for systematic reviews (SRs) and meta-analyses (MAs) of interventions. We aimed to perform the first AMSTAR 2-based quality assessment of heart failure-related studies.

METHODS

Eleven high-impact journals were searched from 2009 to 2019. The included studies were assessed on the basis of 16 domains. Seven domains were deemed critical for high-quality studies. On the basis of the performance in these 16 domains with different weights, overall ratings were generated, and the quality was determined to be "high," "moderate," "low," or "critically low."

RESULTS

Eighty-one heart failure-related SRs with MAs were included. Overall, 79 studies were of "critically low quality" and two were of "low quality." These findings were attributed to insufficiency in the following critical domains: a priori protocols (compliance rate, 5%), complete list of exclusions with justification (5%), risk of bias assessment (69%), meta-analysis methodology (78%), and investigation of publication bias (60%).

CONCLUSIONS

The low ratings for these potential high-quality heart failure-related SRs and MAs challenge the discrimination capacity of AMSTAR 2. In addition to identifying certain areas of insufficiency, these findings indicate the need to justify or modify AMSTAR 2's rating rules.

The Effect of Music-Based Rhythmic Auditory Stimulation on Balance and Functional Outcomes after Stroke

Purpose: the purpose of this paper was to evaluate the effects of music-based rhythmic auditory stimulation on balance and motor function after stroke and whether there are differences depending on the affected hemisphere, lesion site and age. Materials and Methods: This study was an observational and longitudinal study. Adult stroke survivors (n = 28), starting no later than 3 weeks after a stroke, conducted 90 min sessions of music-based rhythmic auditory stimulation 3 days a week, in addition to 60 min a day of conventional physiotherapy. Balance ability was evaluated using the Mini Best Test and the Tinetti Test; motor function was evaluated using the Motor Assessment Scale. Results: All of the participants significantly improved their balance ability and motor function variables upon comparing scores at discharge and admission. Intragroup differences were observed upon comparing subgroups of patients by lesion site and by the degree of motor impairment. Age, stroke type and affected hemisphere seemed not to be directly related to the amount of improvement. Conclusions: This study suggests that the effects of music-based rhythmic auditory stimulation (RAS) on balance ability and motor function varies depending on the scale or test used for evaluation and on the variables that the tests measure. Patients with hemiparesis seemed to improve more than those with hemiplegia.

Influence of Core-Stability Exercises Guided by a Telerehabilitation App on Trunk Performance, Balance and Gait Performance in Chronic Stroke Survivors: A Preliminary Randomized Controlled Trial

Stroke is one of the main causes of disability. Telerehabilitation could face the growing demand and a good strategy for post-stroke rehabilitation. The aim of this study is to examine the possible effects of therapeutic exercises performed by an App on trunk control, balance, and gait in stroke survivors. A preliminary 12-week randomized controlled trial was developed. Thirty chronic stroke survivors were randomly allocated into two groups. Both groups performed conventional physiotherapy, in addition to, the experimental group (EG) had access to a telerehabilitation App to guide home-based core-stability exercises (CSE). Trunk performance was measured with the Spanish-Trunk Impairment Scale (S-TIS 2.0) and Spanish-Function in Sitting Test. Balance and gait were measured with Spanish-Postural Assessment Scale for Stroke patient, Berg Balance Scale and an accelerometer system. In EG was observed an improvement of 2.76 points in S-TIS 2.0 (p = 0.001). Small differences were observed in balance and gait. Adherence to the use of the App was low. CSE guided by a telerehabilitation App, combined with conventional physiotherapy, seem to improve trunk function and sitting balance in chronic post-stroke. Active participation in the rehabilitation process should be increased among stroke survivors. Further confirmatory studies are necessary with a large sample size.

Telerehabilitation for balance rehabilitation in the subacute stage of stroke: A pilot controlled trial

BACKGROUND

Telerehabilitation has been proposed as an effective strategy to deliver post-stroke specific exercise.

OBJECTIVE

To assess the effectiveness and feasibility of core stability exercises guided by a telerehabilitation App after hospital discharge.

METHODS

Extension of a prospective controlled trial. Subacute stage stroke survivors were included at the time of hospital discharge where they had participated in a previous 5-week randomized controlled trial comparing conventional physiotherapy versus core stability exercises. After discharge, patients from the experimental group were offered access to telerehabilitation to perform core stability exercises at home (AppG), while those from the control group were subject to usual care (CG). The Spanish-version of the Trunk Impairment Scale 2.0 (S-TIS 2.0), Function in Sitting Test (S-FIST), Berg Balance Scale (BBS), Spanish-version of Postural Assessment for Stroke Patients (S-PASS), the number of falls, Brunel Balance Assessment (BBA) and Gait were assessed before and after 3 months intervention.

RESULTS

A total of 49 subjects were recruited. AppG showed greater improvement in balance in both sitting and standing position and gait compared with CG, although no statistically significant differences were obtained.

CONCLUSION

Core stability exercises Telerehabilitation as a home-based guide appears to improve balance in post-stroke stage. Future studies are necessary to confirm the effects as well as identifying strategies to increase telerehabilitation adherence.

Effects of Tai Chi Exercise on Balance Function in Stroke Patients: An Overview of Systematic Review

Background

Tai chi (TC) has received increased attention in stroke rehabilitation, yet services are greatly underutilized. An increasing number of systematic reviews and meta-analyses (SRs/MAs) have begun to investigate the effects of TC on balance function in stroke patients. The aim of this current study was to systematically collate, appraise, and synthesize the results of these SRs/MAs using a systematic overview.

Methods

Eight databases were searched: PubMed, Cochrane Library, Embase, Web of Science, CNKI, SinoMed, Chongqing VIP, and Wanfang Data. SRs/MAs of TC on balance function in stroke patients were included. Literature selection, data extraction, and assessment of the review quality were performed by two independent reviewers. Methodological quality was assessed by the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), reporting quality by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and evidence quality by Grading of Recommendations, Assessment, Development, and Evaluation (GRADE).

Results

Nine SRs/MAs were included in this study. For methodological quality, what resulted in unsatisfactory methodological quality was noncompliance with critical item 4 (using a comprehensive literature search strategy) and critical item 7 (providing the list of excluded research literature). For reporting quality, what resulted in unsatisfactory reporting quality was inadequate reporting of Q1 (protocol and registration), Q8 (search), Q15 (risk of bias across studies), Q16 (additional analyses), Q22 (risk of bias across studies), Q23 (additional analysis), and Q27 (funding). For GRADE, the evidence quality was high in 0, moderate in 3, low in 11, and very low in 6. Risk of bias was the most common factor leading to downgrading of evidence, followed by inconsistency, imprecision, publication bias, and indirectness.

Conclusions

TC may have beneficial effects on balance function in stroke survivors; however, this finding is limited by the generally low methodology, reporting quality, and evidence quality for published SRs/MAs.

Maze Control Training on Kinesthetic Awareness in Patients with Stroke: A Randomized Controlled Trial

Objective

To determine the influence of adding maze control training to the selected conventional physical therapy on kinesthetic awareness in patients with chronic stroke.

Methods

Thirty adult patients of both genders with chronic cerebral stroke were assigned to control and experimental groups randomly: the control group (A) received the selected conventional physical therapy rehabilitation program, while the experimental group (B) received the same program as group A in addition to the maze control training. Measurements for sway index, risk of fall, and knee proprioception before and after 8 weeks of treatment (24 sessions; three times per week).

Results

There were significant decreases of both sway index and risk of fall in both groups (p ≤ 0.001 in all measures), significant improvements of the knee proprioception in 30° and 75° in the experimental group (p value = 0.016 and ≤0.001, respectively). The in-between groups' comparison showed significant differences corresponding to both the sway index and risk of fall (p ≤ 0.001), and a significant difference in 75° (p ≤ 0.001).

Conclusion

Adding maze control training to the selected conventional physical therapy improved the kinesthetic awareness in patients with chronic stroke.

Effects of Balance Exercise Assist Robot training for patients with hemiparetic stroke: a randomized controlled trial

Background

Robot-assisted rehabilitation for patients with stroke is promising. However, it is unclear whether additional balance training using a balance-focused robot combined with conventional rehabilitation programs supplements the balance function in patients with stroke. The purpose of this study was to compare the effects of Balance Exercise Assist Robot (BEAR) training combined with conventional inpatient rehabilitation training to those of conventional inpatient rehabilitation only in patients with hemiparetic stroke. We also aimed to determine whether BEAR training was superior to intensive balance training.

Methods

This assessor-blinded randomized controlled trial included 60 patients with first-ever hemiparetic stroke, admitted to rehabilitation wards between December 2016 and February 2019. Patients were randomly assigned to one of three groups, robotic balance training and conventional inpatient rehabilitation (BEAR group), intensive balance training and conventional inpatient rehabilitation (IBT group), or conventional inpatient rehabilitation-only (CR group). The intervention duration was 2 weeks, with assessments conducted pre- and post-intervention, and at 2 weeks follow-up. The primary outcome measure was a change in the Mini-Balance Evaluation Systems Test (Mini-BESTest) score from baseline.

Results

In total, 57 patients completed the intervention, and 48 patients were evaluated at the follow-up. Significant improvements in Mini-BESTest score were observed in the BEAR and IBT groups compared with in the CR group post-intervention and after the 2-week follow-up period (P < 0.05).

Conclusions

The addition of balance exercises using the BEAR alongside conventional inpatient rehabilitation improved balance in patients with subacute stroke.

Trial registration

https://www.umin.ac.jp/ctr; Unique Identifier: UMIN000025129. Registered on 2 December 2016.

Analysis of influencing factors of rehabilitation treatment effect in patients with first-episode stroke

OBJECTIVE

To explore the influencing factors of rehabilitation treatment effect in patients with first-episode stroke and provide a theoretical basis for clinical practice.

METHODS

The clinical data of patients with first-episode stroke who received rehabilitation treatment in our hospital from January 2015 to January 2019 were collected and analyzed retrospectively. The Modified Barthel Index (MBI) and Frenchay Activity Scale (FAS) were used to evaluate the rehabilitation treatment effect. Spearman rank correlation analysis was carried out to investigate the relationship between the data characteristics and rehabilitation treatment effect, and univariate and multivariate logistic regression analyses were conducted to explore the independent factors influencing the rehabilitation treatment effect in the first-episode stroke group.

RESULTS

In this study, 786 cases of 873 patients with first-episode stroke were included, with an effective inclusion rate of 90.0%. Univariate analysis showed that MBI and FAS scores were statistically different among patients with different ages, history of hypertension, the number of residual symptoms, depression status, attitude towards rehabilitation, starting time of rehabilitation, rehabilitation treatment duration, and family environment scores (all P<0.05). According to the Spearman rank correlation analysis, age, residual symptoms, depressive status, and starting time of rehabilitation were all negatively correlated with MBI score (r = -0.584, -0.683, -0.573, -0.783) and FAS score (r = -0.438, -0.771, -0.552, -0.599), while the scores of MBI (r = 0.683, 0.572, 0.662) and FAS (r = 0.735, 0.603, 0.724) were positively correlated with the scores of rehabilitation treatment attitude, rehabilitation treatment duration and family environment (all P<0.05). Moreover, according to multivariate logistic regression analysis, age, the number of remaining symptoms, depression status, attitude towards rehabilitation treatment, starting time of rehabilitation treatment, rehabilitation treatment duration, and family environment score could independently affect MBI and FAS scores of patients with stroke (all P<0.05).

CONCLUSION

Age, the number of residual symptoms, depression status, attitude towards rehabilitation treatment, starting time of rehabilitation treatment, rehabilitation treatment duration, and family environment score are independent factors for rehabilitation treatment effect in patients with first-episode stroke.

Effects of exergaming on functional outcomes in people with chronic stroke: A systematic review and meta-analysis

AIMS

The aim of this review is to synthesize and evaluate effectiveness of exergaming on balance, lower limb functional mobility and functional independence in individuals with chronic stroke.

DESIGN

The present review is a systematic review and meta-analysis. The review is written in accordance with the guidelines from the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) DATA SOURCE: Searches were conducted across seven databases (PubMed, EMBASE, Web of Science, CINAHL, CENTRAL, Scopus and PEDro) and in grey literature from inception until January 2021.

REVIEW METHODS

Only randomized controlled trials (RCTs) written in English were included. All eligible studies were assessed for risk of bias by two reviewers independently. Meta-analyses were performed using RevMan 5.4.1 software. Narrative syntheses were adopted whenever meta-analysis was inappropriate. The overall quality of evidence from included studies was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework.

RESULTS

4511 records were retrieved, with 32 RCTs eligible for inclusion and 27 RCTs included in meta-analysis. Meta-analyses reported statistically significant small effect sizes favouring exergaming on balance (pooled standardized mean difference [SMD] = 0.25, 95% confidence interval [CI, 0.08-0.41], p = .004), lower limb functional mobility (pooled SMD = 0.29, 95% CI [0.08-0.50], p = .007) and functional independence (pooled SMD = 0.41, 95% CI [0.09-0.73], p = .01). Most of the included studies failed to provide adequate description of the measures taken to prevent bias.

CONCLUSION

Exergaming has favourable effects on improving balance, lower limb functional mobility and functional independence among individuals with chronic stroke, making it a suitable adjunct to conventional physiotherapy.

IMPACT

People with chronic stroke have difficulty achieving the required rehab intensity. Exergaming can help individuals with chronic stroke to undertake further rehabilitation exercises at home. It can be a suitable adjunct to conventional physiotherapy.

A Novel Virtual Reality Training Strategy for Poststroke Patients: A Randomized Clinical Trial

Stroke patients suffer impairments including sensory, motor, visual, and cognitive areas, as well as gait and balance manifestations making activities of daily living difficult. In such conditions, virtual reality training can be a potential rehabilitation tool in comparison to conventional physical therapy to cater to the burden of this disability; hence, this randomized clinical trial compared the effects of virtual reality training and conventional physical therapy on balance and lower extremity function in stroke patients. The sample of 68 poststroke participants from Kanaan Physical Therapy and Spine Clinic, Lahore, Pakistan, were divided into N = 34 cases each using the lottery method with one group given virtual reality training and the other received conventional physical therapy. Each group received 60 minutes intervention, 3 days per week for 6 weeks. The Berg balance scale and the Fugl-Meyer assessment-lower extremity scale were employed for data collection preintervention, immediate postintervention, and 6 weeks postintervention. The statistically significant differences between virtual reality and conventional physical therapy groups for the Berg Balance score (p < 0.001), Fugl-Meyer assessment (FMA)-lower extremity domains of FMA-motor function (p < 0.001), FMA-joint pain, and joint range (p < 0.001); however, there is no significant difference (p=0.202) for time vs. group interaction and significant (p < 0.001) for the time main effect for FMA sensation. Hence, virtual reality training is more effective to restore balance and lower extremity function compared to conventional physical therapy in stroke patients. The results of the study have significant implications for the clinicians with better case management enhancing quality of life of patients along with the dearth of local literature, thus providing base for future research from a developing country's perspective.

Virtual Reality and Physiotherapy in Post-Stroke Functional Re-Education of the Lower Extremity: A Controlled Clinical Trial on a New Approach

Numerous Virtual Reality (VR) systems address post-stroke functional recovery of the lower extremity (LE), most of them with low early applicability due to the gait autonomy they require. The aim of the present study was to evaluate the feasibility of a specific VR treatment and its clinical effect on LE functionality, gait, balance, and trunk control post-stroke. A controlled, prospective, clinical trial was carried out with 20 stroke patients, who were divided into two groups: the first group (VR + CP; n = 10) received combined therapy of 1 h VR and 1 h of conventional physiotherapy (CP) and the second group (CP; n = 10) received 2 h of CP (5 days/week, for 3 weeks). The following pre-post-intervention measuring scales were used: Functional Ambulatory Scale (FAC), Functional Independence Measure (FIM), Fugl-Meyer Assessment (FM), Berg Balance Scale (BBS), and Trunk Control Test (TCT). Only VR + CP showed a significant improvement in FAC. In FIM, CP presented a tendency to significance, whereas VR + CP showed significance. Both groups improved significantly in FM (especially in amplitude/pain in VR + CP and in sensitivity in CP) and in BBS. In TCT, there was a non-significant improvement in both groups. The results indicate that the intervention with VR is a feasible treatment in the post-stroke functional re-education of the LE, with the potential to be an optimal complement of CP.

Quality appraisal of systematic reviews of interventions for children with cerebral palsy reveals critically low confidence

AIM

To evaluate the methodological quality of recent systematic reviews of interventions for children with cerebral palsy in order to determine the level of confidence in the reviews' conclusions.

METHOD

A comprehensive search of 22 databases identified eligible systematic reviews with and without meta-analysis published worldwide from 2015 to 2019. We independently extracted data and used A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR-2) to appraise methodological quality.

RESULTS

Eighty-three systematic reviews met strict eligibility criteria. Most were from Europe and Latin America and reported on rehabilitative interventions. AMSTAR-2 appraisal found critically low confidence in 88% (n=73) because of multiple and varied deficiencies. Only 7% (n=6) had no AMSTAR-2 critical domain deficiency. The number of systematic reviews increased fivefold from 2015 to 2019; however, quality did not improve over time.

INTERPRETATION

Most of these systematic reviews are considered unreliable according to AMSTAR-2. Current recommendations for treating children with CP based on these flawed systematic reviews need re-evaluation. Findings are comparable to reports from other areas of medicine, despite the general perception that systematic reviews are high-level evidence. The required use of current widely accepted guidance for conducting and reporting systematic reviews by authors, peer reviewers, and editors is critical to ensure reliable, unbiased, and transparent systematic reviews. What this paper adds Confidence was critically low in the conclusions of 88% of systematic reviews about interventions for children with cerebral palsy (CP). Quality issues in the sample were not limited to systematic reviews of non-randomized trials, or to those about certain populations of CP or interventions. The inclusion of meta-analysis did not improve the level of confidence in these systematic reviews. Numbers of systematic reviews on this topic increased over the 5 search years but their methodological quality did not improve.

Factors associated with balance impairments amongst stroke survivors in northern Benin: A cross-sectional study

Background

Balance impairment is the predominant risk factor for falls in stroke survivors. A fear of falling after stroke can contribute to sedentary lifestyles, increased disability and risk of recurrence, leading to poor quality of life.

Objective

To determine the frequency and factors associated with balance impairments amongst stroke survivors at the University Hospital of Parakou.

Method

This cross-sectional study included adult stroke survivors. Stroke survivors after discharge were enrolled at the University Hospital of Parakou between 01 January 2020 and 30 September 2020. Balance impairments were measured by using the Berg Balance Scale (BBS), the Timed Up and Go (TUG) and the Get Up and Go (GUG) tests.

Results

A total of 54 stroke survivors were included, with a mean age of 58.37 ± 12.42 years and a male predominance of 68.52%. The mean BBS score was 36.87 ± 14.34 with a minimum and a maximum of 10 and 56, respectively. Thirteen (24.07%) had balance impairments (BBS score ≤ 20), 34 (62.96%) had a TUG score ≥ 14 s (abnormal), 9 (16.67%) presented a moderate risk of falling and 6 (11.11%) presented high risk of fall with the GUG test. Post-stroke duration (odds ratio [OR] = 0.04; 95% CI: 0.04–0.30; p < 0.01), severity of disability (OR = 8.33; 95% CI: 1.03–67.14; p = 0.03) and the number of physiotherapy sessions (OR = 0.18; 95% CI: 0.03–0.93; p = 0.02) were significantly associated with balance impairments.

Conclusion

Our results showed that almost one quarter of stroke survivors after discharge at the University Hospital of Parakou had balance impairments. Post-stroke duration, severity of disability and the number of physiotherapy sessions were significantly associated with balance impairments.

Clinical implications

[AQ1] Balance should be regularly assessed in people post-stroke. Further studies should document the content of rehabilitation and any rehabilitative efforts to improve balance in people post-stroke in Benin.

Effect of Executive Dysfunction on Posture Control and Gait after Stroke

Objective

The purpose of the study was to observe the effects of executive dysfunction (ED) on gait and postural control during walking after stroke.

Methods

In this study, 34 subjects with stroke and ED (8 women and 26 men; age, 55.41 ± 7.89 years; time since stroke onset, 1.3 ± 0.12 months) were recruited. Stroop color-word test (SCWT), 10-meter walk test (10MWT), timed-up-and-go test (TUGT), and gait analysis were evaluated. The correlation among the correct number of Stroop tasks (SCWT-C), the number of time-consuming tasks (SCWT-T), the amount of interference (SIE-M and SIE-T) and posture control, and gait-related parameters was analyzed.

Results

The results indicated that SCWT-C was negatively correlated with 10MWT, TUGT, and bilateral symmetry (P < 0.05). However, there was no significant correlation between SCWT-C and stride (P > 0.05). A significant negative correlation was seen between SCWT-C and bilateral symmetry (P < 0.05). There was no significant correlation between SCWT-T and stride (P > 0.05). SCWT-T was positively correlated with TUGT, 10MWT, and bilateral symmetry (P < 0.05). SIE-T was positively correlated with TUGT and bilateral symmetry (P < 0.05). There was no significant correlation between SIE-T and 10MWT or stride (P > 0.05). SIE-M was positively correlated with TUGT and bilateral symmetry (P < 0.05). There was no significant correlation between SIE-T and 10MWT or stride (P > 0.05).

Conclusions

ED is closely related to the decline in postural control and the occurrence of falls. In the early phases of stroke rehabilitation, physiotherapists should focus on the patients' executive function to accelerate the recovery of postural control.

Intervention Effect of Rapid Rehabilitation Nursing Combined with Continuous Nursing after Discharge on Patients with Cerebral Infarction in Recovery Period and the Changes in Motor Function, Mental State, and Quality of Life

OBJECTIVE

To explore the effect of rapid rehabilitation nursing combined with continuous nursing after discharge on patients with cerebral infarction (CI) in recovery period and its influence on motor function, mental state, and quality of life.

METHODS

From January 2018 to December 2020, 136 patients with CI in recovery period were selected and randomly divided into control group (n = 68) and observation group (n = 68). The control group was given routine nursing, and the observation group was given rapid rehabilitation nursing combined with continuous nursing after discharge. The general clinical data of the two groups were recorded, and the nursing efficiency, modified Barthel index scale (MBI), stroke patients motor assessment scale (MAS), self-rating anxiety and depression scale (SAS and SDS), and quality of life assessment scale (QLI) were compared between the two groups.

RESULTS

The nursing effective rate of the observation group (94.12%, 64/68) was higher than that of the control group (82.35%, 56/68) (P < 0.05). The MBI score, MAS score, and QLI score in the observation group were higher than those in the control group, while the SAS and SDS scores in the observation group were lower than those in the control group (P < 0.05).

CONCLUSION

Rapid rehabilitation nursing combined with continuous nursing after discharge can promote the rapid recovery of patients with CI in recovery period, which can improve the patient's motor function, reduce unhealthy psychology, and improve the quality of life.

Image Features of Magnetic Resonance Angiography under Deep Learning in Exploring the Effect of Comprehensive Rehabilitation Nursing on the Neurological Function Recovery of Patients with Acute Stroke

This study was to explore the effects of imaging characteristics of magnetic resonance angiography (MRA) based on deep learning on the comprehensive rehabilitation nursing on the neurological recovery of patients with acute stroke. In this study, 84 patients with acute stroke who were treated in hospital were selected as the research objects, and they were rolled into a control group (routine care) and an experimental group (comprehensive rehabilitation care). The dense dilated block-convolution neural network (DD-CNN) algorithm under deep learning for cerebrovascular was adopted to assess the effect of comprehensive rehabilitation care on the neurological recovery of patients with acute stroke. The results showed that the Berg scale scores, Fugl-Meyer scores, and Functional Independence Measure (FIM) scores of the experimental group of patients after 6 weeks and 12 weeks of comprehensive rehabilitation nursing were greatly different from those before treatment, showing statistical differences (P < 0.05). Compared with conventional magnetic resonance imaging (MRI) images, MRA images based on CNN algorithm, Dense Net algorithm, and DD-CNN algorithm can more clearly show the patient's cerebral artery occlusion. The average dice similarity coefficient (DSC) values of CNN algorithm, Dense Net algorithm, and DD-CNN algorithm were determined to be 84.3%, 95.7%, and 97.8%, respectively; the average sensitivity (Sen) values of the three algorithms were 76.1%, 95.4%, and 96.8%, respectively; and the average accuracy (Acc) values were 87.9%, 96.3%, and 97.9%, respectively. Thus, there were statistically obvious differences among the three algorithms in terms of average values of DSC, Sen, and Acc (P < 0.05). The MRA images processed by the DD-CNN algorithm showed that the degree of neurological recovery of the experimental group was observably greater than that of the control group, and the difference was statistically obvious (P < 0.05). In short, the image features of MRA based on the deep learning DD-CNN algorithm showed good application value in studying the effect of comprehensive rehabilitation nursing on the neurological recovery of patients with acute stroke, and it was worthy of promotion.

Effects of sensory substituted functional training on balance, gait, and functional performance in neurological patient populations: A systematic review and meta-analysis

INTRODUCTION

Sensory Substitution (SS) is the use of one sensory modality to supply environmental information normally gathered by another sense while still preserving key functions of the original sense.

OBJECTIVE

This systematic literature review and meta-analysis summarises and synthesise current evidence and data to estimate the effectiveness of SS supplemented training for improving balance, gait and functional performance in neurological patient populations.

METHODS

A systematic literature search was performed in Cochrane Library, PubMed, Web of Science, and ScienceDirect. Randomized controlled trials (RCTs) using a SS training intervention were included.

RESULTS

Nine RCTs were included. Outcome measures/training paradigms were structured according to the balance framework of Shumway-Cook and Woollacott: Static steady-state, Dynamic steady-state and Proactive balance. Meta-analyses revealed significant overall effects of SS training for all three outcomes, as well as self-assessment and functional capacity outcomes, with Dynamic Steady-State balance and ability of stroke survivors to support bodyweight independently on paretic side lower limb found to have had the largest statistical and clinical effects. Meta-analyses also revealed non-significant retention effects.

CONCLUSION

This review provides evidence in favour of a global positive effect of SS training in improving Static steady-state, Dynamic steady-state and Proactive balance measures, as well as measures of self-assessment and functional capacity in neurological patient populations. Retention of effects were not significant at follow-up assessments, although no intervention met training dosage recommendations. It is important for future research to consider variables such as specific patient population, sensor type, and training modalities in order identify the most effective type of training paradigms.

Ultra-Wide Range Pressure Sensor Based on a Microstructured Conductive Nanocomposite for Wearable Workout Monitoring

Conventional flexible pressure sensors are not suitable for high-pressure applications due to their low saturation pressure. In this study, an ultra-wide range pressure sensor is designed based on the optimized microstructure of the polyimide/carbon nanotubes (PI/CNT) nanocomposite film. The sensing range of the pressure sensor is expanded by adopting polyimide (PI) with a high elastic modulus as a matrix material and its sensitivity is improved through functional sensing film with tip-flattened microdome arrays. As a result, the pressure sensor can measure a wide pressure range (≈ 0-3000 kPa) and possesses the sensitivity of ≈ 5.66 × 10^-3 -0.23 × 10^-3 kPa^-1 with high reliability and durability up to 1000 cycles. The proposed sensor is integrated into the hand and foot pressure monitoring systems for workout monitoring. The representative values of the pressure distribution in the hands and feet during the powerlifting are acquired and analyzed through Pearson's correlation coefficient (PCC). The analyzed results suggest that the pressure sensor can provide useful real-time information for healthcare and sports performance monitoring.