Vestibular rehabilitation therapy on balance and gait in patients after stroke: a systematic review and meta-analysis

Lijiao Meng; Qiu Liang; Jianrong Yuan; Siyi Li; Yanlei Ge; Jingyi Yang; Raymond C C Tsang; Quan Wei

doi:10.1186/s12916-023-03029-9

Vestibular rehabilitation therapy on balance and gait in patients after stroke: a systematic review and meta-analysis

BMC Med. 2023 Aug 25;21(1):322. doi: 10.1186/s12916-023-03029-9.

Authors

Lijiao Meng^#^{1

2}, Qiu Liang^#^{1

2}, Jianrong Yuan³, Siyi Li¹, Yanlei Ge^{1

2}, Jingyi Yang^{1

2}, Raymond C C Tsang⁴, Quan Wei^{5

6}

Affiliations

¹ Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, Sichuan, 610041, China.
² Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, Sichuan, 610041, China.
³ Department of Rehabilitation Medicine, Chongqing University Three Gorges Hospital, No. 165. Xin Cheng Road, Chongqing, China.
⁴ Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, No. 11 Yuk Choi Road, Hung Hom, Kowloon, Hong Kong, China.
⁵ Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, Sichuan, 610041, China. weiquan@scu.edu.cn.
⁶ Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, Sichuan, 610041, China. weiquan@scu.edu.cn.

^# Contributed equally.

Abstract

Background: There is limited evidence to support the use of vestibular rehabilitation therapy (VRT) on improving balance and gait in patients after stroke. This systematic review aimed to evaluate the effects of VRT in addition to usual rehabilitation compared with usual rehabilitation on improving balance and gait for patients after stroke.

Methods: This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis statement guidelines. Ten electronic databases were searched up to 1 June 2023 without restrictions in language and publication status. The PEDro scale and the Grading of Recommendations Assessment Development, and Evaluation were used to evaluate the risk of bias and the certainty of evidence. The meta-analysis was conducted with Review Manager 5.3.

Results: Fifteen randomised controlled trials with 769 participants were included. PEDro scale was used to assess the risk of bias with a mean score of 5.9 (0.7). VRT was effective in improving balance for patients after stroke (SMD = 0.59, 95% CI (0.40, 0.78), p < 0.00001), particularly for patients after stroke that occurred within 6 months (SMD = 0.56, 95% CI (0.33, 0.79), p < 0.00001) with moderate certainty of evidence. Subgroup analysis showed that VRT provided as gaze stability exercises combined with swivel chair training (SMD = 0.85, 95% CI (0.48, 1.22), p < 0.00001) and head movements (SMD = 0.75, 95% CI (0.43, 1.07), p < 0.00001) could significantly improve balance. Four-week VRT had better effect on balance improvement (SMD = 0.64, 95% CI (0.40, 0.89), p < 0.00001) than the less than 4-week VRT. The pooled mean difference of values of Timed Up-and-Go test showed that VRT could significantly improve gait function for patients after stroke (MD = -4.32, 95% CI (-6.65, -1.99), p = 0.0003), particularly for patients after stroke that occurred within 6 months (MD = -3.92, 95% CI (-6.83, -1.00), p = 0.008) with moderate certainty of evidence.

Conclusions: There is moderate certainty of evidence supporting the positive effect of VRT in improving balance and gait of patients after stroke.

Trial registration: PROSPERO CRD42023434304.

Keywords: Balance; Gait; Meta-analysis; Stroke; Systematic review; Vestibular rehabilitation.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Exercise Therapy
Gait
Humans
Medicine*
Patients
Randomized Controlled Trials as Topic
Stroke*