Balance training in stroke patients – a systematic review of randomized, controlled trials

Abstract

The purpose of this review was to investigate and summarize the scientific evidence base for physiotherapy interventions aimed at restoring balance after stroke without extensive technical equipment. A search was performed in the Medline, Cochrane, Cinahl and PEDro databases. Key words were "stroke'', "balance'' and, "physiotherapy''. The search was limited to randomized, controlled trials (RCTs) in English. For classifying study quality and relevance, the PEDro scale was used for methodological ratings and power analyses were noted. Fourteen RCTs of 360 titles were included. Six studies were of high quality and six were of medium quality. Results in the acute phase showed evidence regarding supported standing for severely impaired patients. In the sub-acute phase, intense, supervised home-exercise programmes were superior to standard care. Several activity-focused approaches to balance challenges were efficient. It also appeared possible for post-stroke persons in the late phase to improve their balance. All but one study showed at least one statistically significant or clinically relevant improvement within or between groups. This systematic review suggests that balance following stroke could be improved by a variety of physiotherapeutic interventions performed without the use of extensive technical equipment.