Post-stroke lateropulsion and rehabilitation outcomes: a retrospective analysis

Nolan, Jessica; Godecke, Erin; Spilsbury, Katrina; Singer, Barbara

doi:10.1080/09638288.2021.1928300

Cited by 20 publications

(46 citation statements)

References 29 publications

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“…We found publication bias (t = −3.42, p = 0.007), which disappeared (t = −0.13, p = 0.902) when the analysis of lateropulsion prevalence was limited to the 9 studies of supratentorial stroke, 7,[16][17][18]21,22,26,27,40 including 3 with mixed locations although predominating in supratentorial regions. 7,27,40 We then analyzed the effect of diagnostic tools and their cut-off values in these 9 studies.…”

Section: Population Characteristicsmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

“…Sensitivity analyses detailed in Table 2 found a consistency in lateropulsion prevalence whatever the diagnostic tool, especially when the diagnostic process was conservative (i.e., based on a cut-off discarding slight lateropulsion). A robust lateropulsion prevalence could be estimated from the 7 studies that met this condition (1820 individuals) 7,[16][17][18]26,27,40 : 41% (95% CI 33.5-48.5, I 2 = 86.8%) regardless of lateropulsion severity, stroke side, and time since stroke.…”

Section: Population Characteristicsmentioning

confidence: 99%

“…We assume that the one related to age was due to different approaches by countries in referring patients to rehabilitation centers after a stroke. 16 We also assume that the one related to sex was due to a high female proportion 15 in stroke populations of some specific regions. 50 The heterogeneity among lateropulsion prevalence was high, so we investigated its possible causes by subgroups as well as by metaregression analyses.…”

Section: Study Limitationsmentioning

confidence: 99%

“…1,14,15 Only considering pushers would limit the field to individuals with the most severe lateropulsion, for whom the recovery is often delayed. 1,15,16 This situation would miss individuals with a milder form of lateropulsion and precisely those who must have a specific rehabilitation in the acute and subacute phases. Today, lateropulsion is considered more of a postural behavior with a continuum between light and severe forms, often associating 3 signs: lateral body tilt, active pushing from sound limbs to initiate or amplify the body tilt, and resistance to correction.…”

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confidence: 99%

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Lateropulsion Prevalence After Stroke

et al. 2022

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Background and Objectives:Lateropulsion is a deficit of active body orientation with respect to gravity in the frontal plane, mostly observed after a stroke. It magnifies mobility limitations and so represents an emerging target in rehabilitation. Efforts to design specific interventional studies require some basic knowledge of epidemiology, which is insufficient today because many studies focused on a few severe forms in individuals called pushers. The objectives of this study were to bridge this gap.Methods:We systematically searched MEDLINE, EMBASE, CINAHL, and Cochrane Clinical Trials up to 31 May 2021 for original research reporting a prevalence or incidence of post-stroke lateropulsion. We followed MOOSE and PRISMA guidelines. Eligibility for inclusion, data extraction, and study quality (Joanna Briggs Institute guidelines) were evaluated by two reviewers who used a standardized protocol: PROSPERO (CRD42020175037). A random-effects meta-analysis was used to obtain the pooled prevalence, whose heterogeneity was investigated by subgroup analysis (stroke locations and post-stroke phases) and meta-regression.Results:We identified 22 studies (5125 individuals; mean age 68.5 years; 42.6% female; assessed 24 days, on average, after stroke), most published after 2000. The studies’ quality was adequate, with only 8 (36.4%) showing risk of bias. The pooled lateropulsion prevalence was 55.1% (95% confidence interval [CI] [35.9–74.2]) and was consistent across assessment tools. After supratentorial stroke, lateropulsion prevalence was 41% (95%CI [33.5–48.5]), and only 12.5% (95%CI [9.2–15.9]) in individuals with severe lateropulsion, called pushers. Meta-regression did not reveal any effect of age, sex, geographic region, publication year, or study quality. Lateropulsion prevalence progressively decreased from 52.8% (95%CI [40.7–65]) in the acute phase to 37% (95%CI [26.3–47.7]) in the early subacute phase and 22.8% (95%CI [0–46.3]) in the late subacute phase. The ratio of right- to left-hemispheric stroke with lateropulsion increased as a function of time: 1.7 in the acute phase to 7.7 in the late subacute phase. After infratentorial stroke, lateropulsion prevalence was very high, reaching 83.2% (95%CI [63.9–100.3]).Conclusions:Post-stroke lateropulsion prevalence is high, which appeals for its systematic detection to guide early interventions. Uprightness is predominantly controlled from the right hemisphere.

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