Core Stability Exercises in Addition to Usual Care Physiotherapy Improve Stability and Balance After Stroke: A Systematic Review and Meta-analysis

OBJECTIVE

To systematically review the effect of core stability exercises in addition to usual care physiotherapy on patient outcomes after stroke.

DATA SOURCES

Cumulative Index to Nursing and Allied Health, MEDLINE, Physiotherapy Evidence Database (PEDro), PubMed, and EMBASE were searched to November 2018.

STUDY SELECTION

Eleven randomized controlled trials that compared usual care physiotherapy with usual care physiotherapy with additional core stability exercises in people with stroke were included. The initial search yielded 1876 studies.

DATA EXTRACTION

Two independent reviewers applied inclusion and exclusion criteria and extracted data on methodological quality using the PEDro scale, participant characteristics, intervention details, outcome measures, and results.

DATA SYNTHESIS

Postintervention means and SDs were pooled to calculate either the standardized mean difference (SMD) or the mean difference (MD) and 95% CIs using a random-effects model and inverse variance methods. There was moderate quality evidence to suggest the addition of core stability exercises to usual care physiotherapy improved trunk control (SMD, 0.94; 95% CI, 0.44-1.44; I²=69%), functional dynamic balance (SMD, 1.23; 95% CI, 0.5-1.97; I²=71%), and walking speed (MD, 0.27m/s; 95% CI, 0.01-0.52; I²=40%) in people with acute and chronic stroke. No significant effect was found when assessing functional ambulation categories or the timed Up and Go test, and mixed results were found for global functioning.

CONCLUSIONS

The addition of core stability exercises to usual care physiotherapy after stroke may lead to improved trunk control and dynamic balance. Therefore, core stability exercises should be included in rehabilitation if improvements in these domains will help clients achieve their goals. Future trials should consider incorporating outcomes of body kinematics during functional tasks to assess movement quality and assess participation outcomes.

Continuation of treatment of drug misusers between primary and secondary care in the South West

Focal points

Communication and information: the experience of radiotherapy patients

The purpose of this study was to explore patients' own accounts of their experiences of having cancer and undergoing radiotherapy treatment. The respondents were suffering from either cancer of the head and neck or lung region. The methodology was qualitative and the method used to collect data was semistructured, audio-taped interviews. Overall the study reflected a high degree of satisfaction with care. However, it did highlight some problems regarding insufficient information about the side-effects of treatment. It was also apparent that difficulties existed in satisfying individual requirements for information about treatment options and prognosis. Data which characterized another level of communication emphasized how health professionals' demeanour and statements of understanding can assist patients in coping with the challenge of having cancer. By providing in-depth feedback about patients' experiences of serious illness, it is concluded that this type of research can contribute to enhancing patient care.