Effects of hydrokinesitherapy on balance and walking ability in stroke survivors: a systematic review and meta-analysis of randomized controlled studies

Guanli Xie; Tao Wang; Bo Jiang; Yan Su; Xiaoxia Tang; Ying Guo; Jianglong Liao

doi:10.1186/s11556-019-0227-0

Effects of hydrokinesitherapy on balance and walking ability in stroke survivors: a systematic review and meta-analysis of randomized controlled studies

Eur Rev Aging Phys Act. 2019 Nov 13:16:21. doi: 10.1186/s11556-019-0227-0. eCollection 2019.

Authors

Guanli Xie^#¹, Tao Wang^#², Bo Jiang³, Yan Su², Xiaoxia Tang², Ying Guo², Jianglong Liao^{4

5}

Affiliations

¹ 1Yunnan University of Chinese Medicine, Kunming, Yunnan China.
² 2Kunming Municipal Hospital of Traditional Chinese Medicine, 2628 Xianyuan Road, Cheng Gong District, Kunming, 650500 Yunnan China.
³ 3Kunming Municipal Hospital of Traditional Chinese Medicine and the Jiang Bo Famous Medical Studio, Kunming, Yunnan China.
⁴ Kunming Combination of Chinese and Western Medicine Minimally Invasive Spine Technology Center, Kunming, Yunnan China.
⁵ 5Kunming Municipal Hospital of Traditional Chinese Medicine, 223 Guanxing Road, Guan Du District, Kunming, 650200 Yunnan China.

^# Contributed equally.

Abstract

Background: Balance and walking impairment are common dysfunctions after stroke. Emerging data has demonstrated that hydrokinesitherapy may have a positive influence on improvement of balance and walking ability. However, there is no firm evidence to support these results. Therefore, the aim of this review is to evaluate the effects of hydrokinesitherapy in stroke survivors systematically.

Methods: Medline, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, CINAHL and SPORTDiscus were systemic searched from their inception to Septemter 30, 2018. RevMan 5.3 software was used to perform data synthesis. The fixed-effect model or random-effect model was employed according to the results of heterogeneity test. The mean differences (MD) or standardized mean difference (SMD) was used to evaluate the pooled effect of hydrokinesitherapy on balance function, walking ability and activty of daily life (ADL).

Results: A total of 13 studies were included involving 381 stroke survivors. Meta-analysis results indicated that hydrokinesitherapy could improve balance ability based on three test: Berg balance scale (BBS: MD = 3.84, 95% confidence interval (95% CI) 2.84 to 4.86, P < 0.001), Time Up To Go Test (TUGT: MD = - 1.22, 95% CI - 2.25 to - 0.18, P = 0.02, fixed-effect model), Functional Reach Test (FRT: MD = 2.41, 95% CI 1.49 to 3.33, P < 0.001). Additionally, we found a weakly positive effect on walking speed (SMD = 0.75, 95% CI 0.26 to 1.25, P = 0.003) and walking ability test (SMD = 0.36, 95% CI 0.04 to 0.68, P = 0.03). There was no significant difference between experimental group and control group in terms of ADL.

Short conclusion: Hydrokinesitherapy can improve balance function and had a weakly positive effect on walking ability in stroke survivors. We did not find sufficient evidence to indicate that hydrokinesitherapy could improve the ADL of stroke survivors. However, due to the methodological shortcoming and small number of included studies, caution is needed when interpreting these results. Due to imprecision and publication bias, the quality of the evidence was downgraded to "low-quality" for the primary outcomes of balance and walking ability.

Trial registration: CRD42018110787.

Keywords: Balance; Hydrokinesitherapy; Meta-analysis; Stroke; Walking ability.