The effectiveness of trunk training on trunk control, sitting and standing balance and mobility post-stroke: a systematic review and meta-analysis

Objective: To investigate the effectiveness of trunk training on trunk control, sitting and standing balance and mobility. Data sources: PubMed/MEDLINE, Web of Science, Physiotherapy Evidence Database (PEDro), Cochrane Library, Rehab+ and ScienceDirect were searched until January 2019. Review methods: Randomized controlled trials were included if they investigated the effect of trunk exercises on balance and gait after stroke. Four reviewers independently screened and performed data extraction and risk of bias assessment with the PEDro scale. Disagreements were resolved by a fifth independent reviewer. A meta-analysis was performed to quantitatively describe the results. Results: After screening of 1881 studies, 22 studies and 394 participants met the inclusion criteria. Trunk training was executed as core stability, reaching, weight-shift or proprioceptive neuromuscular facilitation exercises. The amount of therapy varied from a total of 3-36 hours between studies. The median PEDro score was 6 out of 10 which corresponds with a low risk of bias. Meta-analysis was performed with a random-effects model due to differences in study population, interventions received and follow-up length. The overall treatment effect was large for trunk control standardized mean differences (SMD) 1.08 (95% confidence interval (CI): 0.96-1.31), standing balance SMD 0.84 (95% CI: 0.04-0.98) and mobility SMD 0.88 (95% CI: 0.67-1.09). Conclusions: In patients suffering from stroke, there is a strong amount of evidence showing that trunk training is able to improve trunk control, sitting and standing balance and mobility.