The impact of stroke on bone properties and muscle-bone relationship: a systematic review and meta-analysis.

To systematically review available evidence related to the characteristics of bone changes post-stroke and the relationship between various aspects of muscle function (e.g., strength, spasticity) and bone properties after stroke onset. An extensive online database search was undertaken (last search in January 2019). Articles that examined the bone properties in stroke patients were included. The quality of the studies was evaluated with the National Institutes of Health (NIH) Study Quality Assessment Tools. Publication bias of meta-analyses was assessed using the Egger's regression asymmetry test. The selection and evaluation of the articles were conducted by two independent researchers. Fifty-nine studies were identified. In subacute and chronic stroke studies, the skeletal sites in the paretic limbs sustained a more pronounced decline in bone quality than did their counterparts in the non-paretic limbs. The rate of changes showed a decelerating trend as post-stroke duration increased, but the timing of achieving the steady rate differed across skeletal sites. The magnitude of bone changes in the paretic upper limb was more pronounced than the paretic lower limb. There was a strong relationship between muscle strength/mass and bone density/strength index. Muscle spasticity seemed to have a negative impact on bone integrity in the paretic upper limb, but its influence on bone properties in the paretic lower limb was uncertain. Substantial bone changes in the paretic limbs occurred particularly in the first few months after stroke onset. Early intervention, muscle strength training, and long-term management strategies may be important to enhance bone health post-stroke. This review has also revealed the knowledge gaps which should be addressed in future research.

Chronic effects of stroke on hip bone density and tibial morphology: a longitudinal study.

UNLABELLED: The study aimed to quantify the long-term effects of stroke on tibial bone morphology and hip bone density. Only the trabecular bone mineral density and bone strength index in the hemiparetic tibial distal epiphysis showed a significant decline among individuals who had sustained a stroke 12-24 months ago. INTRODUCTION: This study aims to determine the changes in bone density and morphology in lower limb long bones during a 1-year follow-up period and their relationship to muscle function in chronic stroke patients. METHODS: Twenty-eight chronic stroke patients (12-166 months after the acute stroke event at initial assessment) and 27 controls underwent bilateral scanning of the hip and tibia using dual-energy X-ray absorptiometry and peripheral quantitative computed tomography, respectively. Each subject was re-assessed 1 year after the initial assessment. RESULTS: Twenty stroke cases and 23 controls completed all assessments. At the end of the follow-up, the paretic tibial distal epiphysis suffered significant decline in trabecular bone density (-1.8 ± 0.6 %, p = 0.006) and bone strength index (-2.7 ± 0.6 %, p < 0.001). More severe decline in the former was associated with poorer leg muscle strength (ρ = 0.447, p = 0.048) and motor recovery (ρ = 0.489, p = 0.029) measured at initial assessment. The loss in trabecular bone density remained significant among those whose stroke onset was 12-24 months ago (p < 0.001), but not among those whose stroke onset was beyond 24 months ago (p > 0.05) at the time of initial assessment. The changes of outcomes in the tibial diaphysis, except for cortical bone mineral content on the non-paretic side (-1.3 ± 0.3 %, p = 0.003), and hip bone density were well within the margin of error for precision. CONCLUSIONS: There is evidence of continuous trabecular bone loss in the paretic tibial distal epiphysis among chronic stroke patients, but it tends to plateau after 2 years of stroke onset. The steady state may have been reached earlier in the hip and tibial diaphysis.

Psychometric properties of dual-task balance assessments for older adults: a systematic review.

BACKGROUND: The ability to maintain balance while simultaneously performing a cognitive task is essential for daily living and has been implicated as a risk factor of falls in older adults. AIMS: To evaluate the evidence related to the psychometric properties of dual-task balance assessments in older adults. METHODS: An extensive literature search of electronic databases was conducted. Articles were included if they evaluated the psychometric properties of dual-task balance assessment tools in older adults. The data were extracted by two independent researchers and confirmed with the principal investigator. The methodology quality of each study was rated by using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. RESULTS: Twenty-six articles were included in this systematic review. For dual-task static standing balance assessments, the center of pressure-related parameters (displacement, velocity) and reaction time measurements were reliable but not useful for prediction of falls. For walking balance assessments, the gait outcomes derived generally demonstrated good to excellent reliability (intraclass correlation coefficient >0.75), but their ability to predict falls varied. Outcomes derived from the cognitive tasks and the dual-task cost (dual-task performance minus single-task performance) mostly demonstrated low to fair reliability. The methodological quality of majority of studies was poor to fair, mainly due to small sample size. CONCLUSIONS: Among the dual-task balance assessments examined, the reliability and validity varied. The findings of this review should be useful in guiding the selection of dual-task balance measures in future research.