Abstract WMP29: Effects of Mind-Body Intervention on Fall-Related Outcomes for Stroke Survivors: A Systematic Review and Meta-Analysis

Abstract

Introduction: Fall is a common clinical problem for people after stroke, which can impact their functional recovery and cause physical and psychosocial disturbances. Mind-body intervention may be beneficial for fall management. This review aimed to assess the effects of mind-body intervention on fall-related outcomes for stroke survivors. Methods: Seven English databases and four Chinese databases were searched from inception to August 2023. Two reviewers independently conducted study screening, risk of bias assessment and data extraction. Cochrane Risk of Bias Tool 2.0 and Grading of Recommendations Assessment, Development and Evaluation were adopted to assess the risk of bias and certainty of evidence. Meta-analyses were performed using Review Manager 5.4 and narrative syntheses were adopted if necessary. Results: Twenty-two randomised controlled trials were included. The included interventions consisted of meditative exercise (e.g., Tai Chi, yoga), imagery and biofeedback approaches. The pooled results showed that mind-body intervention reduced the incidence of falls (RR = 0.28, 95% CI: 0.15 to 0.54, I 2 = 0%) and the number of fallers (RR = 0.43, 95% CI: 0.22 to 0.85, I 2 = 0%) over the study period. Despite not reducing the number of survivors having fear of falling, it could significantly increase fall efficacy at short- (<1 month: SMD = 0.84, 95% CI: 0.38 to 1.30, I 2 = 88%) and medium-term post-intervention (1 to < 6 months: SMD = 0.37, 95% CI: 0.05 to 0.69, I 2 = 0%). Mind-body intervention could significantly improve balance (SMD = 1.56, 95% CI: 0.85 to 2.28, I 2 = 95%), but had non-significant effects on mobility, functional independence and quality of life. Besides, meditative exercise and imagery showed greater effects on fall efficacy and balance than biofeedback intervention. For all outcomes, we judged the evidence as very low or low certainty. Conclusions: Low- to very low-certainty evidence suggests that mind-body intervention, especially meditative and imagery approaches, can be effective in improving fall-related outcomes for stroke survivors, e.g., reducing fall incidence and fallers, and increasing fall efficacy and balance. Further rigorous large-scale randomised controlled trials are recommended to strengthen the existing evidence.