The Use of Portable Devices for the Instrumental Assessment of Balance in Patients with Chronic Stroke: A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Eligibility Criteria for Study Selection
2.2. Search Strategy for the Identification of the Studies
2.3. Review Methods
2.4. Risk of Bias
2.5. Methodological Quality Assessment
3. Results
3.1. Summary of the Main Results
3.2. Methodological Quality
3.3. Risk of Bias within Studies
4. Discussion
4.1. Standing Balance
4.2. Dynamic Balance during Walking
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Sacco, R.L.; Kasner, S.E.; Broderick, J.P.; Caplan, L.R.; Connors, J.J.; Culebras, A.; Elkind, M.S.; George, M.G.; Hamdan, A.D.; Higashida, R.T.; et al. An updated definition of stroke for the 21st century: A statement for healthcare professionals from the American heart association/American stroke association. Stroke 2013, 44, 2064–2089. [Google Scholar] [CrossRef] [PubMed]
- Wafa, H.A.; Wolfe, C.D.A.; Emmett, E.; Roth, G.A.; Johnson, C.O.; Wang, Y. Burden of Stroke in Europe: Thirty-Year Projections of Incidence, Prevalence, Deaths, and Disability-Adjusted Life Years. Stroke 2020, 51, 2418–2427. [Google Scholar] [CrossRef] [PubMed]
- Schmid, A.A.; Van Puymbroeck, M.; Altenburger, P.A.; Dierks, T.A.; Miller, K.K.; Damush, T.M.; Williams, L.S. Balance and balance self-efficacy are associated with activity and participation after stroke: A cross-sectional study in people with chronic stroke. Arch. Phys. Med. Rehabil. 2012, 93, 1101–1107. [Google Scholar] [CrossRef]
- Sackley, C.; Brittle, N.; Patel, S.; Ellins, J.; Scott, M.; Wright, C.; Dewey, M.E. The prevalence of joint contractures, pressure sores, painful shoulder, other pain, falls, and depression in the year after a severely disabling stroke. Stroke 2008, 39, 3329–3334. [Google Scholar] [CrossRef] [PubMed]
- Horak, F.B. Postural orientation and equilibrium: What do we need to know about neural control of balance to prevent falls? Age Ageing 2006, 35 (Suppl. S2), 7–11. [Google Scholar] [CrossRef]
- Xu, T.; Clemson, L.; O’Loughlin, K.; Lannin, N.A.; Dean, C.; Koh, G. Risk Factors for Falls in Community Stroke Survivors: A Systematic Review and Meta-Analysis. Arch. Phys. Med. Rehabil. 2018, 99, 563–573. [Google Scholar] [CrossRef]
- Hugues, A.; Di Marco, J.; Ribault, S.; Ardaillon, H.; Janiaud, P.; Xue, Y.; Zhu, J.; Pires, J.; Khademi, H.; Rubio, L.; et al. Limited evidence of physical therapy on balance after stroke: A systematic review and meta-analysis. PLoS ONE 2019, 14, e0221700. [Google Scholar] [CrossRef]
- Tyson, S.F.; Connell, L.A. How to measure balance in clinical practice. A systematic review of the psychometrics and clinical utility of measures of balance activity for neurological conditions. Clin. Rehabil. 2009, 23, 824–840. [Google Scholar] [CrossRef]
- Mancini, M.; Horak, F.B. The relevance of clinical balance assessment tools to differentiate balance deficits. Eur. J. Phys. Rehabil. Med. 2010, 46, 239–248. [Google Scholar]
- Visser, J.E.; Carpenter, M.G.; van der Kooij, H.; Bloem, B.R. The clinical utility of posturography. Clin. Neurophysiol. 2008, 119, 2424–2436. [Google Scholar] [CrossRef]
- Paillard, T.; Noé, F. Techniques and Methods for Testing the Postural Function in Healthy and Pathological Subjects. Biomed. Res. Int. 2015, 2015, 891390. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Petró, B.; Papachatzopoulou, A.; Kiss, R.M. Devices and tasks involved in the objective assessment of standing dynamic balancing—A systematic literature review. PLoS ONE 2017, 12, e0185188. [Google Scholar] [CrossRef] [PubMed]
- Gawronska, A.; Pajor, A.; Zamyslowska-Szmytke, E.; Rosiak, O.; Jozefowicz-Korczynska, M. Usefulness of mobile devices in the diagnosis and rehabilitation of patients with dizziness and balance disorders: A state of the art review. Clin. Interv. Aging 2020, 15, 2397–2406. [Google Scholar] [CrossRef] [PubMed]
- Smith, L.S.; Wilkins, N. Mind the Gap: Approaches to Addressing the Research-to-Practice, Practice-to-Research Chasm. Public Health Manag. Pract. 2018, 24, S6–S11. [Google Scholar] [CrossRef] [PubMed]
- Bruyneel, A.-V.; Dubé, F. Best Quantitative Tools for Assessing Static and Dynamic Standing Balance after Stroke: A Systematic Review. Physiother. Can. 2021, 73, 329–340. [Google Scholar] [CrossRef]
- Peters, J.; Abou, L.; Wong, E.; Dossou, M.S.; Sosnoff, J.J.R.L. Smartphone-based gait and balance assessment in survivors of stroke: A systematic review. Disabil. Rehabil. Assist. Technol. 2022, 18, 1–11. [Google Scholar] [CrossRef]
- Van Ooteghem, K.; Mansfield, A.; Inness, E.L.; Killingbeck, J.; Sibley, K.M. Integrating Technology into Clinical Practice for the Assessment of Balance and Mobility: Perspectives of Exercise Professionals Practicing in Retirement and Long-term Care. Arch. Rehabil. Res. Clin. Transl. 2020, 2, 100041. [Google Scholar] [CrossRef]
- Sibley, K.M.; Gardner, P.; Bentley, D.C.; Khan, M.; McGlynn, M.; Shing, P.; Shaffer, J.; O’Hoski, S.; Salbach, N.M. Exploring factors influencing physiotherapists’ perceptions of measuring reactive balance following a theory-based multi-component intervention: A qualitative descriptive study. Disabil. Rehabil. 2021, 44, 4709–4716. [Google Scholar] [CrossRef]
- García-Rudolph, A.; Laxe, S.; Saurí, J.; Opisso, E.; Tormos, J.M.; Bernabeu, M. Evidence of chronic Stroke rehabilitation interventions in activities and participation outcomes: Systematic review of meta-analyses of randomized controlled trials. Eur. J. Phys. Rehabil. Med. 2019, 55, 695–709. [Google Scholar] [CrossRef]
- Bernhardt, J.; Hayward, K.; Kwakkel, G.; Ward, N.; Wolf, S.L.; Borschmann, K.; Krakauer, J.W.; Boyd, L.A.; Carmichael, S.T.; Corbett, D.; et al. Agreed definitions and a shared vision for new standards in stroke recovery research: The Stroke Recovery and Rehabilitation Roundtable taskforce. Int. J. Stroke 2017, 12, 444–450. [Google Scholar] [CrossRef]
- Hutton, B.; Catalá-López, F.; Moher, D. The PRISMA statement extension for systematic reviews incorporating network metaanalysis: PRISMA-NMA. Med. Clin. (Barc.) 2016, 147, 262–266. [Google Scholar] [CrossRef] [PubMed]
- Cashin, A.G.; McAuley, J.H. Clinimetrics: Physiotherapy Evidence Database (PEDro) Scale. J. Physiother. 2020, 66, 59. [Google Scholar] [CrossRef]
- Centre for Evidence-Based Medicine. Oxford Centre for Evidence-Based Medicine Levels of Evidence (March 2009). Available online: https://www.cebm.net/2009/06/oxford-centre-evidencebased-medicine-levels-evidence-march-2009/ (accessed on 3 July 2022).
- Choi, Y.H.; Kim, J.D.; Lee, J.H.; Cha, Y.J. Walking and balance ability gain from two types of gait intervention in adult patients with chronic hemiplegic stroke: A pilot study. Assist. Technol. 2019, 31, 112–115. [Google Scholar] [CrossRef] [PubMed]
- Choi, Y.H.; Kim, N.H.; Son, S.M.; Cha, Y.J. Effects of Trunk Stabilization Exercise While Wearing a Pelvic Compression Belt on Walking and Balancing Abilities in Patients with Stroke: An Assessor Blinded, Preliminary, Randomized, Controlled Study. Am J. Phys. Med. Rehabil. 2020, 99, 1048–1055. [Google Scholar] [CrossRef]
- Choi, Y.H.; Son, S.M.; Cha, Y.J. Pelvic Belt Wearing during Exercise Improves Balance of Patients with Stroke: A Randomized, Controlled, Preliminary Trial. J. Stroke Cerebrovasc. Dis. 2021, 30, 105820. [Google Scholar] [CrossRef] [PubMed]
- Maguire, C.C.; Sieben, J.M.; Lutz, N.; van der Wijden, G.; Scheidhauer, H.; de Bie, R. Replacing canes with an elasticated orthotic-garment in chronic stroke patients—The influence on gait and balance. A series of N-of-1 trials. J. Bodyw. Mov. Ther. 2020, 24, 203–214. [Google Scholar] [CrossRef] [PubMed]
- Sahin, I.E.; Guclu-Gunduz, A.; Yazici, G.; Ozkul, C.; Volkan-Yazici, M.; Nazliel, B.; Tekindal, M.A. The sensitivity and specificity of the balance evaluation systems test-BESTest in determining risk of fall in stroke patients. NeuroRehabilitation 2019, 44, 67–77. [Google Scholar] [CrossRef]
- van Meulen, F.B.; Weenk, D.; Buurke, J.H.; van Beijnum, B.J.; Veltink, P.H. Ambulatory assessment of walking balance after stroke using instrumented shoes. J. Neuroeng. Rehabil. 2016, 13, 48. [Google Scholar] [CrossRef]
- Afzal, M.R.; Byun, H.Y.; Oh, M.K.; Yoon, J. Effects of kinesthetic haptic feedback on standing stability of young healthy subjects and stroke patients. J. Neuroeng. Rehabil. 2015, 12, 27. [Google Scholar] [CrossRef]
- Ahulló-Fuster, M.A.; Sánchez-Sánchez, M.L.; Ruescas-Nicolau, M.A.; Fuster-Ribera, M.I. Actividad física, barreras y beneficios en personas con ictus crónico: Estudio transversal de encuesta. Fisioterapia 2019, 41, 275–284. [Google Scholar] [CrossRef]
- Miner, D.G.; Harper, B.A.; Glass, S.M. Validity of Postural Sway Assessment on the Biodex BioSwayTM Compared with the NeuroCom Smart Equitest. J. Sport Rehabil. 2021, 30, 516–520. [Google Scholar] [CrossRef] [PubMed]
- Geronimi, M. Reproductibilité intra- et intersessions du test des limites de stabilité sur plateforme po-dobarométrique. Neurophysiol. Clin. 2014, 44, 139. [Google Scholar] [CrossRef]
- Hou, Y.; Chiu, Y.; Chiang, S.; Chen, H.; Sung, W. Development of a Smartphone-Based Balance. Assessment System for subjects with Stroke. Sensors 2019, 20, 88. [Google Scholar] [CrossRef] [PubMed]
- Llorens, R.; Latorre, J.; Noé, E.; Keshner, E.A. Posturography using the Wii Balance BoardTM. A feasibility study with healthy adults and adults post-stroke. Gait Posture 2016, 43, 228–232. [Google Scholar] [CrossRef] [PubMed]
- Faraldo-García, A.; Santos-Pérez, S.; Crujeiras, R.; Labella-Caballero, T.; Soto-Varela, A. Comparative study of computerized dynamic posturography and the SwayStar system in healthy subjects. Acta Otolaryngol. 2012, 132, 271–276. [Google Scholar] [CrossRef] [PubMed]
- Schepers, H.M.; Van Asseldonk, E.H.F.; Buurke, J.H.; Veltink, P.H. Ambulatory estimation of center of mass displace-ment during walking. IEEE Trans. Biomed. Eng. 2009, 56, 1189–1195. [Google Scholar] [CrossRef] [PubMed]
- Mills, K. Motion analysis in the clinic: There’s an app for that. J. Physiother. 2015, 61, 49–50. [Google Scholar] [CrossRef]
- Roggio, F.; Ravalli, S.; Maugeri, G.; Bianco, A.; Palma, A.; Di Rosa, M.; Musumeci, G. Technological advancements in the analysis of human motion and posture management through digital devices. World J. Orthop. 2021, 12, 467–484. [Google Scholar] [CrossRef]
- Fernández-González, P.; Koutsou, A.; Cuesta-Gómez, A.; Carratalá-Tejada, M.; Miangolarra-Page, J.C.; Molina-Rueda, F. Reliability of Kinovea® Software and Agreement with a Three-Dimensional Motion System for Gait Analysis in Healthy Subjects. Sensors 2020, 20, 3154. [Google Scholar] [CrossRef]
- Eltoukhy, M.; Oh, J.; Kuenze, C.; Signorile, J. Improved kinect-based spatiotemporal and kinematic treadmill gait assessment. Gait Posture 2017, 51, 77–83. [Google Scholar] [CrossRef]
- Dolatabadi, E.; Taati, B.; Mihailidis, A. Concurrent validity of the Microsoft Kinect for Windows v2 for measuring spatiotemporal gait parameters. Med. Eng. Phys. 2016, 38, 952–958. [Google Scholar] [CrossRef] [PubMed]
- Latorre, J.; Colomer, C.; Alcañiz, M.; Llorens, R. Gait analysis with the Kinect v2: Normative study with healthy individuals and comprehensive study of its sensitivity, validity, and reliability in individuals with stroke. J. Neuroeng. Rehabil. 2019, 16, 97. [Google Scholar] [CrossRef] [PubMed] [Green Version]
Author | Type of Study | Sample Characteristics | Outcome Measures | Type of Device |
---|---|---|---|---|
Choi et al. (2021) [26] | RCT | Chronic stroke (N = 24) Age (years): CG 67.4 ± 12.9; IG 64.1 ± 10.5 Sex: CG 7M; 5F; IG 7M; 5F Paretic side: CG 7 right; 5 left; IG 6 right; 6 left Stroke type: CG 3 hemorrhage; 9 infarction IG 1 hemorrhage; 11 infarction Time since stroke (months): CG 9.8 (8.0); IG 9.5 (8.4) Height (cm): CG 161.6 ± 8.8; IG 163.5 ± 8.2 Weight (kg): CG 60.8 ± 9.4; IG 59.8 ± 8.9 Trunk impairment scale (score): CG 12.1 (1.9); IG 12.8 (2.1) | BBT TUG PASS Length and velocity of the COP | BIORescue (analysis system by biofeedback, RM INGENIERIE, Rodez, France) |
Choi et al. (2020) [25] | RCT | Chronic stroke (N = 36) Age (years): CG 67.4 ± 12.9; PG 64.1 ± 10.5 NPG 62.4 ± 12.1 Sex: CG 7M; 5F; PG 7M; 5F; NPG 6M; 6F Paretic side: CG 3 right; 9 left; PG 6 right; 6 left NPG 7 right; 5 left Stroke type: CG 5 hemorrhage; 7 infarction PG 6 hemorrhage; 6 infarction NPG 4 hemorrhage; 8 infarction Time since stroke (months): CG 9.7 (8.0); PG 9.5 (8.4); NPG 9.4 (3.8) Height (cm): CG 161.6 ± 8.8; PG 163.5 ± 8.2 NPG 164.1 (10.1) Weight (kgs): CG 60.8 ± 9.4; PG 59.8 ± 8.9; NPG 62.8 (12.0) | PASS TUG COL path length COL path speed LOS | BIORescue (analysis system by biofeedback, RM INGENIERIE, Rodez, France) |
Maguire et al. (2020) [27] | CT | Chronic stroke (N = 4) Age (years): 50–58 Sex: 3M; 1F Paretic side: 3 right; 1 left Time since stroke (years): 4.5 (± 1.6) Height (m): 1.72–1.88 Mini Mental State Score > 22 BBT ≥ 43 | FGA Trunk angular displacement | SwayStar Balance System: two angular velocity sensors (Fibreoptic gyroscopes) which are attached to a belt and worn by the participants at the level of L2/3 (CoM) |
Choi et al. (2019) [24] | RCT | Chronic stroke (N = 24) Age (years): CG 59.7 ± 10.2; IG 62.8 ± 4.8 Sex: CG 8M; 4F; IG 8M; 4F Paretic side: CG 5 right; 7 left; IG 7 right; 5 left Stroke type: CG 7 hemorrhage; 5 infarction IG 5 hemorrhage; 7 infarction Time since stroke (months): CG 73.0 (31.9); IG 67.2 (43.8) Height (cm): CG 162.9 ± 8.6; IG 166.0 ± 9.4 Weight (kg): CG 63.4 ± 10.5; IG 67.8 ± 8.5 | TUG Static balance ability: COP path length | BIORescue (analysis system by biofeedback, RM INGENIERIE, Rodez, France) |
Sahin et al. (2019) [28] | CT | Chronic stroke (N = 50) Age (years): Faller 53.33 ± 18.93 Non-Faller 64.03 ± 14.65 Sex: Faller 12M; 14F Non-Faller 18M; 6F Paretic side: Faller 15 right; 11 left Non-faller 17 right; 7 left Dominant side: Faller, 26 right; 0 left Non-Faller 22 right; 2 left Time since stroke (months): Faller 30.00 (6.00–60.00) * Non-Faller 33.00 (9.00–89.25) * Modified Rankin Scale (0–6 point): Faller 3 (1–4) * Non-Faller 1 (0–2) * | BESTest BBT ABC PST LOS MSOT | Biodex-BioSway Balance System (SD 950-340, Biodex Medical Systems, Inc., Shirley, NY, USA) |
van Meulen et al. (2016) [29] | CT | Chronic stroke (N = 13) Age (years): 64.1 ± 8.7 Sex: 8M; 5F Paretic side: 2 right; 11 left Dominant side: 12 right; 1 left Time since stroke (years): 2.4 ± 1.8 Height (cm) 173 ± 9.74 Weight (kg) 87 ± 10.89 BBT ≥ 35 Walking aid (N = 5): 3 St; 1 AFO; 2 OS | BBT COP COM | Xsens ForceShoes™ (Xsens Technologies B.V., Enschede, The Netherlands) additionally equipped with ultrasound sensors (instrumented shoes) |
Afzal et al. (2015) [30] | CT | Chronic stroke (N = 8) Age (years): 52 ± 11.9 Sex: 6M; 2F Paretic side: 3 right; 3 left; 2 bilateral Height (cm) 169 ± 6.3 Weight (kgs) 62 ± 5.8 Mini-Mental State Examination mean 21.5 | Trunk tilt angles | Smartphone application |
Ítem | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | Total |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Author-Year | ||||||||||||
Choi et al. (2021) [26] | - | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 8/11 |
Choi et al. (2020) [25] | - | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 8/11 |
Maguire et al. (2020) [27] | - | 1 | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 5/11 |
Choi et al. (2019) [24] | - | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 9/11 |
Sahin et al. (2019) [28] | - | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 4/11 |
Van Meulen et al. (2016) [29] | - | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 4/11 |
Afzal et al. (2015) [30] | - | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 4/11 |
Measurement Tool | Time | Cost | Specialist Equipment | Portability | Total (Max = 10) |
---|---|---|---|---|---|
BIORescue | 3 | 0 | 1 | 2 | 6 |
SwayStar Balance System | 3 | 0 | 2 | 2 | 7 |
Biodex-BioSway Balance System | 3 | 0 | 1 | 1 | 5 |
Xsens ForceShoesTM | 3 | 0 | 2 | 2 | 7 |
Smarthphone | 3 | 3 | 2 | 2 | 10 |
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Mallo-López, A.; Fernández-González, P.; Sánchez-Herrera-Baeza, P.; Cuesta-Gómez, A.; Molina-Rueda, F.; Aguilera-Rubio, Á. The Use of Portable Devices for the Instrumental Assessment of Balance in Patients with Chronic Stroke: A Systematic Review. Int. J. Environ. Res. Public Health 2022, 19, 10948. https://doi.org/10.3390/ijerph191710948
Mallo-López A, Fernández-González P, Sánchez-Herrera-Baeza P, Cuesta-Gómez A, Molina-Rueda F, Aguilera-Rubio Á. The Use of Portable Devices for the Instrumental Assessment of Balance in Patients with Chronic Stroke: A Systematic Review. International Journal of Environmental Research and Public Health. 2022; 19(17):10948. https://doi.org/10.3390/ijerph191710948
Chicago/Turabian StyleMallo-López, Ana, Pilar Fernández-González, Patricia Sánchez-Herrera-Baeza, Alicia Cuesta-Gómez, Francisco Molina-Rueda, and Ángela Aguilera-Rubio. 2022. "The Use of Portable Devices for the Instrumental Assessment of Balance in Patients with Chronic Stroke: A Systematic Review" International Journal of Environmental Research and Public Health 19, no. 17: 10948. https://doi.org/10.3390/ijerph191710948