The Effectiveness of Core Exercising for Postural Control in Patients with Stroke: A Systematic Review and Meta-Analysis.

ABSTRACT

OBJECTIVE: Patients with stroke frequently present postural control impairment. This review aimed to assess the effectiveness of core exercising on postural control in patients with stroke. TYPE Systematic review and meta-analysis. LITERATURE SURVEY Systematic review in the following databases PubMed/MEDLINE, Web of Science, ScienceDirect, CINAHL, Scopus, and Physiotherapy Evidence Database (PEDro). Studies up to July 2019 were included. METHODOLOGY: Studies were included if the sample was composed of adults with stroke, the intervention followed a core exercising approach (alone or combined with another intervention), and the study was a randomized controlled trial including at least one measurement related to posture control. Studies were independently screened for inclusion and data were extracted by two researchers, with a third researcher arbitrating any disputes. Study quality was assessed using the Downs and Black scale. SYNTHESIS: After screening of 1540 records, a total of 14 studies met the specified inclusion criteria and involved 520 participants. Two studies exhibited "excellent" quality and five exhibited "poor" quality. The meta-analysis was performed with data from the Trunk Impairment Scale (mean difference 0.98; 95% confidence interval, 0.69 to 1.27; P < .001), Berg Balance Scale (mean difference 0.27; 95% confidence interval, -0.25 to 0.79; P = .317), and Timed Up and Go test (mean difference -0.09; 95% confidence interval, -0.49 to 0.31; P = .656). The results favored core exercising alone or in combination with proprioceptive neuromuscular facilitation when compared with conventional training or proprioceptive neuromuscular facilitation in patients with stroke. No significant differences in total values were found in the other measures. CONCLUSIONS: The studies reviewed suggest that core exercising alone or in combination with other therapies had an impact on trunk performance when compared with conventional training in patients with stroke. However, total analyses did not show significant differences for the other measures related to balance ability analyzed.