Abstract
BackgroundSitting for more than 8 h a day has been shown to negatively impact health and mortality while standing is the recommended healthier alternative. Home-based standing programs are commonly recommended for adults who cannot stand and/or walk independently. The aim of this systematic review is to review effectiveness of home-based standing programs for adults with neurological conditions including stroke and spinal cord injury; and to provide dosage guidelines to address body structure and function, activity and participation outcomes.MethodsEight electronic databases were searched, including Cochrane Library databases, MEDLINE, CINAHL and EMBASE. From 376 articles, 36 studies addressing impact of a standing intervention on adults with sub-acute or chronic neurological conditions and published between 1980 and September 2015 were included. Two reviewers independently screened titles, reviewed abstracts, evaluated full-text articles and rated quality and strength of evidence. Evidence level was rated using Oxford Centre for Evidence Based Medicine Levels and quality evaluated using a domain-based risk-of-bias rating. Outcomes were divided according to ICF components, diagnoses and dosage amounts from individual studies. GRADE and the Evidence-Alert Traffic-Lighting system were used to determine strength of recommendation and adjusted in accordance with risk-of-bias rating.ResultsStronger evidence supports the impact of home-based supported standing programs on range of motion and activity, primarily for individuals with stroke or spinal cord injury while mixed evidence supports impact on bone mineral density. Evidence for other outcomes and populations is weak or very weak.ConclusionsStanding should occur 30 min 5 times a week for a positive impact on most outcomes while 60 min daily is suggested for mental function and bone mineral density.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-015-0813-x) contains supplementary material, which is available to authorized users.
Highlights
Sitting for more than 8 h a day has been shown to negatively impact health and mortality while standing is the recommended healthier alternative
A systematic review [12] supported the beneficial effects of standing devices on bone mineral density (BMD), range of motion (ROM), spasticity, and bowel function for participants of all ages with neurological dysfunction
30 mins × 2.3–6.4 × wk Passive ankle dorsiflexion ROM increases in all subjects of (69–192 mins/week) between 3 and 17° at a calculated rate of 0.11 to 1.0°
Summary
Sitting for more than 8 h a day has been shown to negatively impact health and mortality while standing is the recommended healthier alternative. Adults who are non-ambulatory due to neurological conditions such as stroke, spinal cord injury (SCI), acquired or traumatic brain injury or multiple sclerosis (MS) often sit for more than 8 h a day, and as a result, experience painful, problematic and costly secondary complications [4] These include body structure and function impairments [5] such as altered muscle tone or spasticity, range of motion (ROM) limitations or contractures, muscle weakness, constipation, decreased bone mineral density (BMD) with increased risk for fractures and bone pain, as well as activity limitations and participation restrictions. A systematic review of the impact on ROM, spasticity, BMD and activity outcomes only [13], concluded that supported standing may prevent small losses of ankle mobility and that longterm, higher dose programs may slow bone loss
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