Trunk Training Following Stroke

HomeStrokeVol. 54, No. 9Trunk Training Following Stroke Free AccessArticle CommentaryPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessArticle CommentaryPDF/EPUBTrunk Training Following Stroke Liselot Thijs, Eline Voets, Stijn Denissen, Jan Mehrholz, Bernhard Elsner, Robin Lemmens and Geert Verheyden Liselot ThijsLiselot Thijs Department of Rehabilitation Sciences, KU Leuven, Belgium (L.T., E.V., G.V.). Search for more papers by this author , Eline VoetsEline Voets Department of Rehabilitation Sciences, KU Leuven, Belgium (L.T., E.V., G.V.). Search for more papers by this author , Stijn DenissenStijn Denissen https://orcid.org/0000-0003-2852-5530 AIMS laboratory, Center for Neurosciences, UZ Brussel, Vrije Universiteit Brussel, Belgium (S.D.). icometrix, Leuven, Belgium (S.D.). Search for more papers by this author , Jan MehrholzJan Mehrholz https://orcid.org/0000-0002-7180-5434 Department of Public Health, Dresden Medical School, Technical University Dresden, Germany (J.M.). Search for more papers by this author , Bernhard ElsnerBernhard Elsner https://orcid.org/0000-0002-2519-5030 Institute of Health Sciences, Department of Physiotherapy, Universität zu Lübeck, Germany (B.E.). Search for more papers by this author , Robin LemmensRobin Lemmens https://orcid.org/0000-0002-4948-5956 Department of Neurosciences, Experimental Neurology, KU Leuven, Belgium (R.L.). Department of Neurology, University Hospitals Leuven, Belgium (R.L.). Search for more papers by this author and Geert VerheydenGeert Verheyden Correspondence to: Geert Verheyden, PhD, Department of Rehabilitation, KU Leuven – University of Leuven, Tervuursevest 101, Box 1501 3001, Leuven, Belgium. Email E-mail Address: [email protected] https://orcid.org/0000-0003-3095-8175 Department of Rehabilitation Sciences, KU Leuven, Belgium (L.T., E.V., G.V.). Search for more papers by this author Originally published28 Aug 2023https://doi.org/10.1161/STROKEAHA.123.043490Stroke. 2023;54:e427–e428Trunk training literature suggests beneficial effects for improving motor and functional outcome after stroke but the summarized effect on independence in activities of daily living (ADL) is unclear. In this Cochrane review, we provided an updated overview on the effectiveness of trunk training on ADL compared with both nondose-matched (trials with more training duration in the experimental compared with the control intervention) and dose-matched control groups (trials with equal training duration in the experimental and control intervention).SEARCH METHODSWe searched the Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, Embase, and 5 other databases to October 25, 2021.SELECTION CRITERIAWe selected randomized controlled trials comparing trunk training versus nondose-matched or dose-matched control therapy including adults (18 years or older) with either ischemic or hemorrhagic stroke. Primary outcome measure was ADL and secondary outcomes included trunk function, arm-hand function and activity, standing balance, leg function, walking ability, and quality of life.RESULTSIn total, we evaluated 17191 search results, and we included 68 trials with 2585 participants. For nondose-matched trials, we found that trunk training improved ADL (Figure [A]; standardized mean difference=0.96 [95% CI, 0.69–1.24]; P<0.001; 5 trials, 283 participants, very low-certainty evidence). There was also a positive effect in favor of training for trunk function (14 trials, 466 participants), arm-hand function (2 trials, 74 participants), arm-hand activity (1 trial, 30 participants), standing balance (11 trials, 410 participants), leg function (1 trial, 64 participants), walking ability (11 trials, 383 participants), and quality of life (2 trials, 108 participants).Download figureDownload PowerPointFigure. Effect of trunk training after stroke on activities of daily living. Results and pooled analysis for nondose-matched comparisons (A) and dose-matched comparisons (B). df indicates degrees of freedom; and I2, heterogeneity; and IV, inverse variance.When pooling dose-matched trials, we found no effect of trunk training on ADL (Figure [B]; standardized mean difference=0.10 [95% CI, −0.17 to 0.37]; P=0.48; 9 trials; 229 participants; very low-certainty evidence). Trunk training ameliorated trunk function (36 trials, 1217 participants), standing balance (22 trials, 917 participants), leg function (4 trials, 254 participants), walking ability (19 trials, 535 participants), and quality of life (2 trials, 111 participants).DISCUSSIONThis review1 suggests that trunk training improves basic ADL, trunk function, standing balance, walking ability, upper and lower limb function, and quality of life. Notably for the primary outcome, we found a beneficial effect in nondose-matched trials which was absent in dose-matched trials. The role of nondose versus dose-matched in the design of clinical trials is an important finding, which deserves further study and consideration in systematic reviews and meta-analyses. Overall, the certainty of evidence was low to very low, mainly due to methodological limitations of studies and small sample sizes. This field would certainly benefit from a high-quality phase III randomized controlled trial with ADL as primary outcome measure, including a follow-up measurement and reporting adverse events. Several trunk training approaches were identified. Trunk training on an unstable surface provided positive outcomes for ADL, trunk function, standing balance, and walking ability. The results of this review support the regular inclusion of trunk training as part of rehabilitation in clinical practice when training people with stroke in both the sub-acute and chronic phase after stroke.ARTICLE INFORMATIONAcknowledgmentsThis article is based on a Cochrane Review published in The Cochrane Library 2023, Issue 3 (see www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and The Cochrane Library should be consulted for the most recent version of the review.Sources of FundingNone.Disclosures S. Denissen is an industrial PhD student in collaboration with icometrix, supported by a Baekeland grant (HBC.2019.2579, Belgium). Dr Verheyden received funding from KU Leuven (RUN-17-00175, Belgium) and EU Horizon 2020 Eurostars (E! 11323). Drs Thijs and Verheyden could be identified as the first author of an included study. E. Voets and Dr Lemmens could be identified as a coauthor of an included study.FootnotesFor Sources of Funding and Disclosures, see page e428.Correspondence to: Geert Verheyden, PhD, Department of Rehabilitation, KU Leuven – University of Leuven, Tervuursevest 101, Box 1501 3001, Leuven, Belgium. Email geert.verheyden@kuleuven.beREFERENCES1. Thijs L, Voets E, Denissen S, Mehrholz J, Elsner B, Lemmens R, Verheyden GS. Trunk training following stroke.Cochrane Database Syst Rev. 2023; 3:CD013712. doi: 10.1002/14651858.CD013712.pub2CrossrefGoogle Scholar eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetails September 2023Vol 54, Issue 9 Advertisement Article InformationMetrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.123.043490PMID: 37639516 Originally publishedAugust 28, 2023 Keywordsmotor rehabilitationactivities of daily livingphysiotherapybalancewalkingPDF download Advertisement SubjectsMeta Analysis