PEDro Scale Research Articles

Effect of Adapted Physical Activity in Children and Young Adults with Cerebral Palsy: A Systematic Review

Cerebral palsy (CP) is considered the most common cause of disability in childhood. People suffering from CP are characterized by deficits that limit their abilities and make it difficult to perform daily activities. The application of adapted physical activity (APA) physiotherapy programs has interested many researchers over the years. This systematic review aimed to examine and evaluate the existing evidence on the effects of various APA in different domains of life of children and young adults with CP. The review will fill the existing knowledge gaps in the literature, offer suggestions for future research, and build evidence-based practices in APA for people with CP. The PRISMA guidelines were followed. The research was conducted by searching several scientific databases, including PubMed, Google Scholar, ResearchGate, and science direct. The inclusion criteria consisted of randomized controlled trials published from 2015 to 2021, full text in the English language, and a sample aged (15-30 years) with a medical diagnosis of CP. Studies that used adapted physical activity (APA) interventions were also included as long as they matched the predetermined standards. The methodological quality was assessed according to the PEDro scale. A total of 14 studies met the inclusion criteria. The samples covered all levels of the gross motor function classification system (GMFCS I-V) with an age range of 16–29 years and both genders. The results showed diversity and improvements in various health parameters of children and young adults with CP. APA significantly affects the motor and psychosocial status of young people with CP and may function as a therapeutic supplement in the existing physiotherapy programs.

목척수손상환자의 호흡근훈련의 효과

Purpose: This systematic review was designed to analyze studies examining the effects of respiratory muscle training on cervical spinal cord injury.
 Methods: Randomized controlled trials on the rehabilitation of patients with cervical spinal cord injury were searched using four databases: Physiotherapy Evidence Database (PEDro), PubMed, and Google Scholar. Five studies were selected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, and the PEDro scale was used for qualitative analysis. For rehabilitation, a protocol including respiratory training and physical activity was selected.
 Results: Of the 135 studies identified in the 2019-2022 period, three were finally selected. All studies performed respiratory muscle training for 30-40 min a day, 5 days a week, for 6-12 weeks. Performing a meta-analysis was difficult because of differences in the study design, and all studies reported significant improvement in respiratory function compared with that in the control group.
 Conclusion: The literature on various respiratory muscle training for cervical spinal cord injury is scarce. However, it is confirmed that respiratory muscle training has a positive effect on not only respiratory function but also neuroplasticity, cardiovascular autonomic function, and quality of life in patients with cervical spinal cord injury.

Effect of Resistance Training on Body Composition, Hemodynamic Parameters and Exercise Tolerance among Patients with Coronary Artery Disease: A Systematic Review

Effectiveness and safety of Resistance Training in treating various Cerebrovascular Disease diagnoses have drawn attention in recent years. Patients suffering with coronary artery disease should be offered individually tailored Resistance Training in their exercise regimen. Resistance Training was developed to help individuals with their functional status, mobility, physical performance, and muscle strength. The objective of this review was to collect, summarize and present information on the state of science focusing on usefulness, viability, safety and efficacy of Resistance Training in treating coronary artery disease and enhancing the aerobic capacity and improving overall health-related quality of life. The review is prepared in accordance with Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Searches were conducted in Cochrane Library, PubMed/MEDLINE, PEDro and Scopus database. PEDro scale was used for methodological quality assessment of included studies. Two independent reviewers determined the inclusion criteria of studies by classifying interventions based on core components, outcome measures, diagnostic population and rated the quality of evidence and strength of recommendations using GRADE criteria. Total 13 studies with 1025 patients were included for the detailed analysis. Findings emphasize the importance of assessing effectiveness and safety of Resistance Training in individuals with coronary artery disease. Patient specific designed exercise programs as Resistance Training targets at enhancing patients' exercise tolerance, improves hemodynamic response and muscular strength with reduction in body fat composition. Resistance Training is an effective exercise that should be incorporated to counteract the loss of muscle strength, muscle mass, and physiological vulnerability, as well as to combat the associated debilitating effects on physical functioning, mobility and overall independence and Quality of Life during rehabilitation of patients with coronary artery disease.

THE ROLE OF STRENGTH TRAINING IN PREVENTING MUSCULOSKELETAL INJURIES AMONG FEMALE AND MALE SOCCER PLAYERS

Introduction The occurrence of sports injuries among soccer players causes both financial and health losses, which is why preventing them is crucial. Science should provide reliable data on how different interventions affect the occurrence of sports injuries among athletes. Aim The review aims to analyse the quality of evidence proofed by the studies on the effectiveness of strength training in preventing sports injuries in soccer players. Material and methods Five databases were used in the review: Web of Science, Embase, Cochrane Library, Academic Search Ultimate, and Pubmed. Keywords used included: soccer players, strength training, hypertrophy training, protocol, injury rate, burden, and prevalence. Quality evaluation of studies found was performed using PEDro scale. Results Of the 646 studies researched, only 4 met the criteria of being applicable to this systematic review. Conclusions All four studies confirmed the decrease in the number of injuries and absence days per 1000h of exposure due to strength training; nonetheless, the lack of standardized protocol based on knowledge efficient at building strength makes the conclusion unreliable.

The maximum phonation time as marker for voice treatment efficacy: A network meta-analysis.

There is a diversity in treatment approaches for voice therapy in which aerodynamic treatment effects between the approaches are lacking. The evidence of voice treatments on the maximum phonation time (MPT) was quantified using the statistical approach of a network meta-analysis (NMA). Three databases and manual search from inception to November 2021 were evaluated. Studies were considered which were reports of randomised controlled/clinical trials (RCT) evaluating the efficacy of a specific voice therapy treatment using MPT as an outcome measure in adult participants with voice disorders. Studies were excluded if participants had been diagnosed with neurological-motor-speech disorders or who were vocally healthy. Furthermore, no medical, pharmacological, or technical instrumental treatments were used. Preferred Reporting Items for systematic reviews and meta-analyses extension statement guidelines were followed. Two reviewers independently screened citations, extracted data, and assessed risk of bias using PEDro scale. Random effects model was used for meta-analysis. We identified finally 12 RCT studies (treatment groups n=285, and control group without an intervention n=62). Eight interventions were evaluated. The only effective intervention with a significant effect was vocal function exercises (VFE) (mean pre-post difference 6.16 s, 95% confidence interval, 1.18-11.13 s). VFE effectively improved MPT from pre- to post-treatment in comparison with other voice interventions which were identified in the present NMA. Further high-quality intervention studies with large samples sizes, multidimensional measures, and homogeneous groups of dysphonia are needed to support evidence-based practice in laryngology.

Role of structured exercise programs in polycystic ovary syndrome: a systematic review

Background Polycystic Ovary Syndrome (PCOS) is an endocrine disorder affecting up to 10% of women of reproductive age. Several pharmacological and non-pharmacological interventions are used to manage symptoms in women with PCOS. Objective The objective of this review was to identify and discuss evidence pertaining specifically to the benefits of structured exercise programs on clinical features and biomarkers relevant to PCOS. Methods Potential studies published between 2000 and 2019 were identified by systematically searching PubMed, Cochrane Library, and CINAHL by using key concepts of PCOS. The PEDro scale was used to evaluate studies’ strength of evidence. Result Thirteen manuscripts of moderate to strong quality were identified. All studies involved structured exercise regimes lasting from 8 weeks to 24 weeks duration with variable frequency (2–5 sessions per week) and duration (25–60 min). Most of the studies reported improvements in menstrual cyclicity, Ferriman-Gallwey scores, testosterone, DHEA-S, sex hormone binding globulin levels and free androgen index scores. Conclusion Structured well-defined aerobic and resistance training protocols, independently or in combination with diet control, that lasted for at least 12 weeks led to improvements in a number of clinical parameters and biomarkers related to PCOS.

Exergame-Assisted Rehabilitation for Preventing Falls in Older Adults at Risk: A Systematic Review and Meta-Analysis

Introduction: Exergaming is increasingly employed in rehabilitation for older adults. However, their effects on fall rate and fall risk remain unclear. Methods: We conducted a systematic review and meta-analysis that included randomized controlled trials (RCTs) comparing exergame-assisted rehabilitation with control groups, published in French or English, from Web of Science, CINHAL, Embase, Medline, and CENTRAL (last search in June 2021). Two reviewers independently assessed the studies. Risk of bias was assessed using RoB2, PEDRO scale, and the GRADE system. The outcomes of interest were (a) fall rate, (b) risk of falling, measured by the Short Physical Performance Battery (SPPB), Timed Up and Go (TUG), One-Leg Stance, or Berg Balance Scale (BBS), (c) fear of falling, measured with the Fall Efficacy Scale (FES-I) or the Activities-specific Balance Confidence (ABC) score. Data were pooled and mean differences (MDs) between exergame and control groups were calculated using a random-effects model. Results: Twenty-seven RCTs were included (1,415 participants, including 63.9% of women, with mean age ranging from 65 to 85.2 years old). Exergame-assisted interventions were associated with a reduction in the incidence of falls (4 studies, 316 participants, MD = −0.91 falls per person per year; 95% CI: −1.65 to −0.17, p = 0.02, moderate quality). Regarding fall risk (20 studies included, low-quality evidence), SPPB did not change (MD = 0.74; 95% CI: −0.12 to 1.60, p = 0.09), but all other scores were improved: BBS (MD = 2.85; 95% CI: 1.27 to −4.43, p = 0.0004), TUG (MD = −1.46; 95% CI: −2.21 to −0.71, p = 0.0001) and One-Leg Stance (MD = 7.09; 95% CI: 4.21 to 9.98, p < 0.00001). Fear of falling scores (FES-I and ABC) showed no difference. Conclusion: There is moderate-quality evidence of a reduction in the fall rate with exergame-assisted rehabilitation and low-quality evidence suggesting a mild reduction in the risk of falling. Statistically significant benefits from exergame-assisted rehabilitation did not achieve clinically meaningful changes in risk of falling assessments.

Effects on Respiratory Pressures, Spirometry Biomarkers, and Sports Performance after Inspiratory Muscle Training in a Physically Active Population by Powerbreath®: A Systematic Review and Meta-Analysis.

Sports performance in athletes can be limited by respiratory factors, so it is understandable to propose that inspiratory muscle training (IMT) can improve respiratory function and exercise performance. Power-Breathe® (PwB) is a sectorized respiratory muscle training tool that uses a resistive load to train IMT. There is currently a growing interest in respiratory muscle training, so we set out to systematically assess the effects of IMT with PwB on respiratory parameters and athletic performance in physically active, healthy adults. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, the Cochrane and PEDro scales to assess methodological quality, effect size using the Rosenthal formula, and the Cochrane tool for estimation of risk of bias, studies searchable in Medline, Web of Science, and Cochrane. In addition, for the performance of the meta-analysis, the documentation and quantification of the heterogeneity in each meta-analysis were directed through the Cochran's Q test and the I2 statistic; in addition, a publication bias analysis was performed using funnel plots. Of the total of 241 studies identified in the search, 11 studies for the systematic review and nine for the meta-analysis met the exclusion and/or inclusion criteria. IMT, with PwB, showed significant improvements in maximal inspiratory pressure (MIP) and substantial improvements in forced vital capacity (FVC) in the meta-analysis results. Also, sports performance was significantly increased by IMT with PwB. In conclusion, the use of PwB is an IMT tool that improves respiratory and sports performance.

Effectiveness of proprioceptive training in athletes with and without ankle instability: systematic review

Background: The proprioceptive program is directly related to neuromuscular control, which uses proprioceptive afferences to provide dynamic stabilization of the joint. Some variables can be considered risk factors for injuries, such as sprains, sudden and unexpected movement activities, simple quick changes of direction, soil type or footwear, among others. The balance training program contributes to lower injury rates and increases sports performance rate. Thus works the perception and maintenance of postural balance from information coming from sensory afferences. Objective: To perform a systematic review and verify the effect of proprioceptive training on ankle joint in athletes. Methods: A search for clinical trials was performed in the PUBMED, WEB OF SCIENCE, PEdro and SCIELO databases, the terms used for the search were “Proprioception”, “Athletic” and “Rehabilitation”, with the filters: articles published between the years of 2015 to 2020 and research in humans. Only studies published in the English language that addressed the proposed theme were included. The PEDro scale was used to evaluate the quality of studies with clinical trials, where studies with a score lower than 6/10 on the scale were excluded. Results: With the search 69 articles were found, removing the duplicates we obtained 67 eligible articles, of these, 15 studies met the inclusion and exclusion criteria. After complete analysis, 9 studies were included. Conclusion: Proprioceptive training in athletes, lasting at least three weeks with weekly protocols composed of dynamic exercises directed at individuals with ankle instability is totally effective for both joint injury prevention and rehabilitation. In addition to the increase of variables such as postural balance, coordination, postural control and functional performance.

Robot-assisted rehabilitation for children with neurological disabilities: Results of the Italian consensus conference CICERONE.

The use of robotic technologies in pediatric rehabilitation has seen a large increase, but with a lack of a comprehensive framework about their effectiveness. An Italian Consensus Conference has been promoted to develop recommendations on these technologies: definitions and classification criteria of devices, indications and limits of their use in neurological diseases, theoretical models, ethical and legal implications. In this paper, we present the results for the pediatric age. A systematic search on Cochrane Library, PEDro and PubMed was performed. Papers published up to March 1st, 2020, in English, were included and analyzed using the methodology of the Centre for Evidence-Based Medicine in Oxford, AMSTAR2 and PEDro scales for systematic reviews and RCT, respectively. Some positives aspects emerged in the area of gait: an increased number of children reaching the stance, an improvement in walking distance, speed and endurance. Critical aspects include the heterogeneity of the studied cases, measurements and training protocols. Many studies demonstrate the benefits of robotic training in developmental age. However, it is necessary to increase the number of trials to achieve greater homogeneity between protocols and to confirm the effectiveness of pediatric robotic rehabilitation.

Efficacy of Conservative Therapy in Overhead Athletes with Glenohumeral Internal Rotation Deficit: A Systematic Review and Meta-Analysis

To evaluate the effectiveness of conservative therapy in range of movement (ROM), strength, pain, subacromial space and physical function, in overhead athletes with glenohumeral internal rotation deficit (GIRD). A systematic review and meta-analysis was designed, and the protocol was registered in PROSPERO (CRD42021281559). The databases searched were: PubMed, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, Web of Science and SCOPUS. Randomized controlled trials (RCTs) involving conservative therapy applied in overhead athletes with GIRD were included. Two independent assessors evaluated the quality of the studies with the PEDro scale, and with the Cochrane Risk-of-Bias tool. The overall quality of the evidence was assessed using GRADE. Data on outcomes of interest were extracted by a researcher using RevMan 5.4 software. Estimates were presented as standardized mean differences (SMD) with 95% confidence intervals (CIs). A total of eleven studies involving 514 overhead athletes were included in the systematic review; of these 8 were included in the meta-analysis. The methodological quality of the included RCTs ranged from high to low. Conservative therapy showed significant improvements in internal rotation, adduction, physical function and subacromial space. Conservative therapy based on stretch, passive joint and muscular mobilizations can be useful to improve the internal rotation and adduction ROM, subacromial space, and physical function of the shoulder in overhead athletes with glenohumeral internal rotation deficit.

Physiotherapy Efficacy of Mulligan Technique in Subacromial Conflict: Literature Review

General Information: The subacromial conflict is a disorder of gleno-humeral joint that results from compression of soft tissue.The Mulligan concept based on the biomechanical and anatomical concepts of the human body. Purpose: Evaluation of the effectiveness of the MulliGan technique in subacromial conflict. Methodology: The study is Review (Literature Review) and was conducted in 6 electronic databases. Randomized type studies were included in our study. The tests used to assess subacromial conflict were: Visual Analog Scale; Disabilities of the Arm, Shoulder and Hand; Short Form-36; Pressure pain threshold; Current pain severity; Numeric Rating Scale; Goniometer; Constant shoulder score. Results: From 65 studies found, only 6 include our study criteria. The study of Yanwu Wang, has the maximum scoring according to the Pedro scale, was evaluated with 10 points. Conclusions: The MulliGan technique resulted effective in treating subacromial conflict.&#x0D; &#x0D; Received: 23 September 2022 / Accepted: 28 November 2022 / Published: 20 December 2022

Efficacy of Robot-Assisted Gait Therapy Compared to Conventional Therapy or Treadmill Training in Children with Cerebral Palsy: A Systematic Review with Meta-Analysis.

Motor, gait and balance disorders reduce functional capabilities for activities of daily living in children with cerebral palsy (CP). Robot-assisted gait therapy (RAGT) is being used to complement conventional therapy (CT) or treadmill therapy (TT) in CP rehabilitation. The aim of this systematic review is to assess the effect of RAGT on gait, balance and functional independence in CP children, in comparison to CT or TT. We have conducted a systematic review with meta-analysis. A search in PubMed Medline, Web of Science, Scopus, CINAHL, PEDro and SciELO has been conducted for articles published until October 2022. Controlled clinical trials (CCT), in which RAGT was compared to TT or CT and assessed gait speed, step and stride length, width step, walking distance, cadence, standing ability, walking, running and jumping ability, gross motor function and functional independence in children with CP, have been included. Methodological quality was assessed with the PEDro scale and the pooled effect was calculated with Cohen's Standardized Mean Difference (SMD) and its 95% Confidence Interval (95% CI). A total of 15 CCTs have been included, providing data from 413 participants, with an averaged methodological quality of 5.73 ± 1.1 points in PEDro. The main findings of this review are that RAGT shows better results than CT in the post-intervention assessment for gait speed (SMD 0.56; 95% CI 0.03 to 1.1), walking distance (SMD 2; 95% CI 0.36 to 3.65) and walking, running and jumping ability (SMD 0.63; 95% CI 0.12 to 1.14). This study shows that the effect of RAGT is superior to CT on gait speed, walking distance and walking, running and jumping ability in post-intervention, although no differences were found between RAGT and TT or CT for the remaining variables.

Effect of extracorporeal shock wave therapy on pain and function in patients with knee osteoarthritis: a systematic review with meta-analysis and grade recommendations

Objective To investigate extracorporeal shock wave therapy effect on knee osteoarthritis compared to a sham or kinesiotherapy by a systematic review and meta-analysis of randomized clinical trials. Data Sources The search was performed in: Cochrane Library, PubMed, PEDro, Web of Science, EMBASE, Scopus, LILACS, and Scielo. Review methods We performed the online search until October, 2022. The following terms were used (Osteoarthritis) AND (“knee joint”) AND (“Extracorporeal Shockwave Therapy”). Eligibility criteria: (1) randomized clinical trials; (2) effects comparison of shockwave therapy to a sham or kinesiotherapy in individuals with knee osteoarthritis; (3) pain and physical function as outcome variables. Risk of bias assessed using the PEDro scale. PROSPERO registration (CRD42021235597). Results We identified 4217 studies, and 12 were included in the qualitative synthesis and the meta-analysis, totaling 403 individuals submitted to the intervention and 331 control individuals. Compared to sham, shockwave was favored in short-term for the function outcome (SMD = −1.93; 95%CI: [−2.77; −1.09]; I² = 83%; P < 0.01). For the pain outcome, the shockwave was favored in the short (MD = −2.05; 95%CI: [−2.59; −1.51]; I² = 84%; P < 0.01), medium (MD = −3.46; 95%CI: [−4.03; −2.89]; I² = 0%; P < 0.01) and long-term (MD = −2.01; 95%CI: [−3.36; −0.65]; I² = 98%; P < 0.01). The association with kinesiotherapy was favored in the short term for the function outcome (SMD = -1.88; 95%CI: [−2.98; −0.78]; I² = 94%; P < 0.01) and favored for the pain outcome in the short (MD = −1.44; 95%CI: [−1.81; −1.07]; I² = 37%; P = 0.14), medium (MD = −1,31; 95%CI: [−1.76; −0,85]; I² = 0%; P = 0.41), and long terms (MD = −1.63; 95%CI: [−1.73; −1.52]; I² = 0%; P = 0.43). Conclusion Shockwave therapy may improve functionality in patients with knee osteoarthritis in the short term and pain in all follow-up moments, compared with sham. When associated to kinesiotherapy, it may improve function in the short term and pain in all follow-up time points, although improvement in pain may not be clinically significant.

The Effects of Motor Imagery on Pain in Lower Limb Sports Injuries: A Systematic Review and Meta-Analysis.

This review evaluated the efficacy of Motor Imagery intervention in athletes with lower limb sports injuries that could affect their pain levels during rehabilitation. We carried out a thorough research of the scientific literature for RCT studies in athletes with lower limb musculoskeletal sports injuries including search terms Motor Imagery AND pain, Motor Imagery AND sport injuries, Motor Imagery AND lower limb. We searched 3 major databases, PubMed, Scopus, and ScienceDirect, with the search period ranging from their inception until May 2022. We assessed the quality of the studies using the PEDro Scale and the data was recorded and extracted with the use of Mendeley software. The search criteria resulted in a pool of 10.107 possible articles. Upon completion of the selection procedure, only 3 RCT studies met the inclusion criteria with a total of 60 injured athletes (n = 18 with ankle sprain and n = 42 with ACL injuries). The meta-analysis showed no statistically significant positive effects of MI intervention on pain intensity after lower limb sports injuries (n = 60; MD = -1.57; 95% CI: -3.60 to 0.46; I2 = 50%; p = 0.13). The limited number of studies could justify the statistically insignificant effect of MI, but although the methodological quality of the studies was moderate to high, the heterogeneity of them was also relatively high. More RCT's are required to explore the effect of MI on pain in athletes with lower limb injuries in order to address psychophysiological processes during rehabilitation.

Phonophoresis through Nonsteroidal Anti-Inflammatory Drugs for Knee Osteoarthritis Treatment: Systematic Review and Meta-Analysis.

Knee osteoarthritis (OA) is the most common joint disease. The administration of nonsteroidal anti-inflammatory drugs (NSAIDs) by phonophoresis is a therapeutic alternative to relieve pain in inflammatory pathologies. The main aim was to analyze the efficacy of the application of NSAIDs by phonophoresis in knee OA. A systematic review and meta-analysis of controlled clinical trials were performed between January and March 2021 in the following databases: Web of Science, Scopus, PubMed, Cinahl, SciELO, and PEDro. The PEDro scale was used to evaluate the level of evidence of the selected studies. The RevMan 5.4 statistical software was used to obtain the meta-analysis. Eight studies were included, of which five were included in the meta-analysis, involving 195 participants. The NSAIDs used through phonophoresis were ibuprofen, piroxicam, diclofenac sodium, diclofenac diethylammonium, ketoprofen, and methyl salicylate. The overall result for pain showed not-conclusive results, but a trend toward significance was found in favor of the phonophoresis group compared to the control group (standardized mean difference (SMD) = -0.92; 95% confidence interval: -1.87-0.02). Favorable results were obtained for physical function (SMD = -1.34; 95% CI: -2.00-0.68). Based on the selected studies, the application of NSAIDs by phonophoresis is effective in relieving the symptoms of knee OA. Future long-term studies are recommended.

Proprioceptive Focal Stimulation (Equistasi®) for gait and postural balance rehabilitation in patients with Parkinson's disease: A systematic review.

Gait and postural deficits are the most common impairments in patients with Parkinson's Disease (PD). These impairments often reduce patients' quality of life. Equistasi® is a wearable proprioceptive stabilizer that converts body thermic energy into mechanical vibration. No systematic reviews have been published investigating the influences of Equistasi® on gait and postural control in patients with PD. This review aimed to examine the effects of proprioceptive focal stimulation (Equistasi®) on gait deficits and postural instability in patients with PD. PubMed, Scopus, PEDro, REHABDATA, web of science, CHAINAL, EMBASE, and MEDLINE were searched from inception to July 2021. The methodological quality of the selected studies was evaluated using the Physiotherapy Evidence Database (PEDro) scale. Five studies met the eligibility criteria. The scores on the PEDro scale ranged from 3 to 8, with a median score of 8. The results showed evidence for the benefits of the proprioceptive focal stimulation (Equistasi®) on gait and postural stability in individuals with PD. Proprioceptive focal stimulation (Equistasi®) appears to be safe and well-tolerated in patients with PD. Proprioceptive focal stimulation (Equistasi®) may improve gait ability and postural stability in patients with PD. Further high-quality studies with long-term follow-ups are strongly needed to clarify the long-term effects of proprioceptive focal stimulation (Equistasi®) in patients with PD.

The Effectiveness of Telerehabilitation on Balance and Functional Mobility in Patients with Stroke: A Systematic Review and Meta-Analysis.

The aim of this systematic review and meta-analysis was to investigate the effectiveness of telerehabilitation on improving balance and functional mobility in stroke survivors. Comprehensive searching was conducted from inception to May 2022. The inclusion criteria were studies evaluating the effectiveness of telerehabilitation in stroke survivors. Data regarding participants, intervention, outcome measures, and main results were extracted. PEDro scale and the Grading of Recommendations Assessment Development and Evaluation (GRADE) were used to assess the methodological quality and quality of evidence, respectively. A total of fourteen articles) 594 patients) were included. A meta-analysis using a random-effect model was performed on thirteen studies )530 patients). Standardized mean difference (SMD) with 95% confidence interval (CI) was calculated for balance and functional mobility. Results: PEDro scale revealed ten good-quality studies, three fair-quality studies, and one poor-quality study. According to the available evidence, telerehabilitation has a small effect size in improving both balance (SMD 0.33 [95% CI 0.03 to 0.63]; P =0.03; low quality of evidence) and functional mobility (SMD 0.27 [95% CI 0.02 to 0.52]; P =0.03; low quality of evidence). Telerehabilitation may improve balance and functional mobility in stroke survivors. However, it is evident that more high-quality research is required due to the existence of low to very low-quality evidence with limited confidence in the effect estimate. PROSPERO registration number (CRD42022306410).

Dropout rate in randomised controlled trials of balance and gait rehabilitation in multiple sclerosis: is it expected to be different for virtual reality-based interventions? A systematic review with meta-analysis and meta-regression.

The online version contains supplementary material available at 10.1007/s10055-022-00733-4.

Multicomponent or Resistance Training for Nursing Home Residents: A Systematic Review With Meta-Analysis.

To perform a systematic review with meta-analysis to verify the effects of multicomponent and resistance training on the physical performance in older adult residents in long-term care, as well as to compare these modalities. Systematic review with meta-analysis of randomized controlled trials. Older adults age over 60years who are nursing home residents in long-term care. Seven electronic databases (PubMed, Embase, Central, Web of Science, SportDiscus, LILACS, and SCIELO) were searched from their inception until May 1, 2022. The methodological quality was assessed using PEDro scale. Mean difference and 95% confidence interval were pooled using a random-effects model. The significance level established was P value of ≤.05 for all analyses. A total of 30 studies were included in the qualitative review (n= 1887, mean age 82.68years and 70% female). Multicomponent training appeared in 19 studies and resistance training in 12 studies. Out of these, 17 studies were incorporated into the meta-analysis. Multicomponent training and resistance training showed statistically significant difference (P ≤ .05) in the physical performance of institutionalized older adults compared with the control groups (usual care); this was evaluated with the Short Physical Performance Battery (+1.2 points;+2 points), 30-second chair-stand (approximately+3 repetitions; both), and Timed Up and Go (-4seconds on mean; both) tests. Comparisons between multicomponent and resistance training did not show statistically significant differences in any of the physical outcomes evaluated. The studies provide evidence that both multicomponent training and resistance training may be effective in improving the physical performance of institutionalized older adults. Further studies with more representative sample numbers, an improvement in methodological quality, and a more specified prescription of the training used are necessary.