Do trunk exercises improve trunk and upper extremity performance, post stroke? A systematic review and meta-analysis

Abstract

Background: Post-stroke trunk control is reported to be associated with trunk performance and recovery of the upper limb, but the evidence for the influence of trunk exercise on both of these is unclear. Objective: To evaluate the effect of trunk exercises on trunk performance post-stroke, and to determine if these exercises result in improved upper limb function. Methods: A comprehensive search of the literature published between January 1990 and February 2017 was conducted using the following electronic databases; AMED, CINAHL, Cochrane Library, EMBASE, MEDLINE, PsychInfo and SPORTDiscus. Only randomized, controlled trials, published in English, evaluating the effect of trunk exercises on trunk performance and/or upper limb function post-stroke, were included. Results: A total of 17 studies involving 599 participants were analysed. Meta-analysis showed that trunk exercises had a large significant effect on trunk performance post-stroke. This effect varied from very large for acute stroke to medium for subacute and chronic stroke. None of the included studies had measured the effect of trunk exercise on upper limb impairment or functional activity. Conclusions: Trunk exercises improve trunk performance for people with acute, subacute and chronic strokes. As yet there is no evidence to support the effect of trunk exercise on upper limb function.

Cerebellar Theta-Burst Stimulation Combined With Physiotherapy in Subacute and Chronic Stroke Patients: A Pilot Randomized Controlled Trial

“…Trunk dysfunction is common in poststroke patients and leads to a lack of trunk control, a loss of core stability, and an increased risk of falls. 37,38 In this study, the TIS scores increased in both groups. A possible explanation for this result might be that trunk control training based on the Bobath concept 39 was included in physiotherapy, and this training can provide increased improvement in trunk function, balance, and gait in stroke patients compared with routine exercises.…”

The effectiveness of trunk training on trunk control, sitting and standing balance and mobility post-stroke: a systematic review and meta-analysis

“…Time post stroke varied from 15 days to 47 months after stroke diagnosis; 10 studies examined the effect of additional trunk training compared to only conventional training or no therapy. 15–36 The remaining 12 studies examined the effect of trunk training compared to a control training programme such as upper limb training, 20,27 conventional training, 21,22,24,26,33 cognitive training, 18,19 general exercises 30 and stretching exercises 23 and neuromuscular electrical stimulation. 25 The majority of exercises consisted of core stability exercises such as bridging, dead bug position, upper and lower trunk flexion, extension and rotation, for the trunk training groups on both stable and unstable surfaces.…”

“…First, 20 studies assessed trunk control and sitting balance, 15–28,30–32,34–36 of which the majority found significant effects on the total Trunk Impairment Scale SMD 1.34 (95% CI: 0.96–1.71), the dynamic subscale SMD 1.33 (95% CI: 0.95–1.71), the coordination subscale SMD 1.08 (95% CI: 0.57–1.59) and reaching ability SMD 1.54 (95% CI: 1.06–2.02; Figures 2 and 3). However, the static subscale of the Trunk Impairment Scale did not result in a significant treatment effect SMD 0.18 (95% CI: −0.09 to 0.45).…”

“…4,5 Several studies already investigated the effect of trunk training on trunk control, sitting and standing balance and mobility. [6][7][8][9] These reviews concluded that trunk training is able to improve trunk control and sitting balance assessed by the Trunk Impairment Scale. The overall treatment effect of both the dynamic and coordination subscale improved significantly compared to controls, while the static subscale did not.…”

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

“…In recent years, some researchers in neurorehabilitation have become interested in exercises focused on the “core” area of the body because it serves as the center of the functional kinetic chain 8 . Previous systematic reviews have shown that trunk exercises including selective movements of the upper and lower part of the trunk in supine and/or sitting position 9 improve trunk performance 10,11 and sitting and standing balance in people with stroke 11 …”