THERAPY-Magazin
Vestibular rehabilitation
Learn how vestibular rehabilitation therapy (VRT) improves balance and walking ability in stroke survivors—especially within the first 6 months post-stroke, according to new research.
Jakob Tiebel
Business Owner, N+ Digital Health Agency
A promising method for improving balance and gait in stroke survivors
New evidence suggests that vestibular rehabilitation therapy (VRT) contributes significantly to improving balance and walking function in stroke survivors. The results of a systematic review show that VRT, particularly when used within the first six months after a stroke, effectively improves balance and significantly benefits walking function.
Introduction
Stroke survivors often face challenges in regaining their balance and improving their gait, leading to a significant impact on their quality of life. Vestibular rehabilitation therapy (VRT) has emerged as a potential intervention to overcome these problems. A systematic review by Lijiao Meng and colleagues from the Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine in West China aimed to investigate the effectiveness of VRT in improving balance and gait in post-stroke patients.
Stroke survivors often face challenges in regaining their balance and improving their gait, leading to a significant impact on their quality of life. Vestibular rehabilitation therapy (VRT) has emerged as a potential intervention to overcome these problems. A systematic review by Lijiao Meng and colleagues from the Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine in West China aimed to investigate the effectiveness of VRT in improving balance and gait in post-stroke patients.
Vestibular rehabilitation therapy (VRT) has emerged as a potential intervention for managing balance problems after a stroke.
Methods
Conducted according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), fifteen randomised controlled studies with a total of 769 participants were examined. The researchers assessed the risk of bias using the PEDro scale with an average value of 5.9, which indicates an overall moderate quality of the included studies. In addition, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method was used to assess the certainty of evidence.
Conducted according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), fifteen randomised controlled studies with a total of 769 participants were examined. The researchers assessed the risk of bias using the PEDro scale with an average value of 5.9, which indicates an overall moderate quality of the included studies. In addition, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method was used to assess the certainty of evidence.
Results
The results of the review suggest that VRT is effective in improving balance in stroke survivors (standardised mean difference [SMD] = 0.59, 95% confidence interval [CI] 0.40, 0.78, p<0.00001). The positive effects in patients who received VRT within the first six months after a stroke (SMD = 0.56, 95% CI 0.33, 0.79, p<0.00001) are notable, with moderate certainty of evidence.
Subgroup analyses showed that VRT significantly improved balance, particularly when balance exercises were performed in combination with swivel chair training (SMD = 0.85, 95% CI 0.48, 1.22, p<0.00001) and head movements (SMD = 0.75, 95% CI 0.43, 1.07, p<0.00001). In addition, four weeks of VRT showed a stronger positive effect on improving balance (SMD = 0.64, 95% CI 0.40, 0.89, p < 0.00001) compared to VRT lasting less than four weeks.
With regard to walking function, VRT was found to significantly improve the results of the timed up-and-go test (mean difference [MD] = -4.32, 95% CI -6.65, -1.99, p = 0.0003). Similar to the improvements in balance, the positive effects on gait were more pronounced in patients who received VRT within the first six months after the stroke with moderate certainty of evidence (MD = -3.92, 95% CI -6.83, -1.00, p = 0.008).
The results of the review suggest that VRT is effective in improving balance in stroke survivors (standardised mean difference [SMD] = 0.59, 95% confidence interval [CI] 0.40, 0.78, p<0.00001). The positive effects in patients who received VRT within the first six months after a stroke (SMD = 0.56, 95% CI 0.33, 0.79, p<0.00001) are notable, with moderate certainty of evidence.
Subgroup analyses showed that VRT significantly improved balance, particularly when balance exercises were performed in combination with swivel chair training (SMD = 0.85, 95% CI 0.48, 1.22, p<0.00001) and head movements (SMD = 0.75, 95% CI 0.43, 1.07, p<0.00001). In addition, four weeks of VRT showed a stronger positive effect on improving balance (SMD = 0.64, 95% CI 0.40, 0.89, p < 0.00001) compared to VRT lasting less than four weeks.
With regard to walking function, VRT was found to significantly improve the results of the timed up-and-go test (mean difference [MD] = -4.32, 95% CI -6.65, -1.99, p = 0.0003). Similar to the improvements in balance, the positive effects on gait were more pronounced in patients who received VRT within the first six months after the stroke with moderate certainty of evidence (MD = -3.92, 95% CI -6.83, -1.00, p = 0.008).
The results suggest that the integration of VRT into the rehabilitation process, particularly in the first six months after a stroke, can contribute significantly to improving the overall mobility and functional capacity of stroke survivors.
Conclusions
In summary, there is moderate certainty of evidence for the positive effects of vestibular rehabilitation therapy on improving balance and gait in post-stroke patients. The results suggest that the integration of VRT into the rehabilitation process, particularly in the first six months after a stroke, can contribute significantly to improving the overall mobility and functional capacity of stroke survivors. Further research and clinical studies are needed to validate and refine the specific components of VRT that offer the greatest benefit to this patient group.
In summary, there is moderate certainty of evidence for the positive effects of vestibular rehabilitation therapy on improving balance and gait in post-stroke patients. The results suggest that the integration of VRT into the rehabilitation process, particularly in the first six months after a stroke, can contribute significantly to improving the overall mobility and functional capacity of stroke survivors. Further research and clinical studies are needed to validate and refine the specific components of VRT that offer the greatest benefit to this patient group.
Ambulante Rehabilitation
Fachkreise
Stationäre Rehabilitation
Therapy & Practice
THERAPY 2024-I
THERAPY Magazine
Jakob Tiebel
Business Owner, N+ Digital Health Agency
Jakob Tiebel studied applied psychology with a focus on health economics. He has clinical expertise from his previous therapeutic work in neurorehabilitation. He conducts research and publishes on the theory-practice transfer in neurorehabilitation and is the owner of Native.Health, an agency for digital health marketing.
References:
- Meng L, Liang Q, Yuan J, Li S, Ge Y, Yang J, Tsang RCC, Wei Q. Vestibular rehabilitation therapy on balance and gait in patients after stroke: a systematic review and meta-analysis. BMC Med. 2023 Aug 25;21(1):322. doi: 10.1186/s12916-023-03029-9. PMID: 37626339; PMCID: PMC10464347.
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