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

Abstract

Objective: To investigate the effectiveness of trunk training on trunk control, sitting and standing balance and mobility. Data sources: PubMed/MEDLINE, Web of Science, Physiotherapy Evidence Database (PEDro), Cochrane Library, Rehab+ and ScienceDirect were searched until January 2019. Review methods: Randomized controlled trials were included if they investigated the effect of trunk exercises on balance and gait after stroke. Four reviewers independently screened and performed data extraction and risk of bias assessment with the PEDro scale. Disagreements were resolved by a fifth independent reviewer. A meta-analysis was performed to quantitatively describe the results. Results: After screening of 1881 studies, 22 studies and 394 participants met the inclusion criteria. Trunk training was executed as core stability, reaching, weight-shift or proprioceptive neuromuscular facilitation exercises. The amount of therapy varied from a total of 3–36 hours between studies. The median PEDro score was 6 out of 10 which corresponds with a low risk of bias. Meta-analysis was performed with a random-effects model due to differences in study population, interventions received and follow-up length. The overall treatment effect was large for trunk control standardized mean differences (SMD) 1.08 (95% confidence interval (CI): 0.96–1.31), standing balance SMD 0.84 (95% CI: 0.04–0.98) and mobility SMD 0.88 (95% CI: 0.67–1.09). Conclusions: In patients suffering from stroke, there is a strong amount of evidence showing that trunk training is able to improve trunk control, sitting and standing balance and mobility.

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 …”

Pelvic floor dysfunction negatively impacts general functional performance in patients with multiple sclerosis

“…On the contrary, in contrast to our theory on the relevance of the core in the independence of patients with MS, we found studies reporting an absence of improvement in perceived gait limitations as well as in the TUG test 32,33 after a core training program focused on the abdominal musculature. However, this training modality has been shown to be effective for this same purpose in patients with stroke, 11 observing a greater benefit when the abdominal muscles were trained together with the pelvic floor 34 . Thus, it is possible that patients with MS have a greater involvement of the pelvic floor, which is responsible for gait alteration and balance.…”

“…10 Specifically, in the case of patients with neurological pathology, the vast majority of evidence supports a direct association between improvement in function of the abdominal stabilizing muscles and in gait/balance functionality. 11 To the authors' knowledge, however, there is a lack of evidence to assess whether gait functionality can be affected by the condition of the pelvic floor musculature in patients with neurological disease. In fact, the scarce evidence found has only been presented in other population groups.…”

Interaction between locomotion and three subcategories for patients with stroke demonstrating fewer than 37 points on the total functional independence measure upon admission to the recovery ward

“…In dressing-like activities, it is necessary to start sitting and gradually develop the movements 25,26) . A static sitting balance is required for active trunk extension and forwards pelvic tilt 26,27) . To position the trunk forward of the pelvis when sitting, the abdominal, internal oblique muscles, and musculus multifidus lumborum in the trunk are important as are the iliopsoas muscle 25) and gluteus maximus muscles.…”