The effectiveness of extracorporeal shock wave therapy to reduce lower limb spasticity in stroke patients: a systematic review and meta-analysis.

Objective: To assess the effectiveness of Extracorporeal Shock Wave Therapy (ESWT) to reduce lower limb spasticity in adult stroke survivors.Data Sources: A systematic review of Medline/Pubmed, CENTRAL, CINAHL, PEDro database, REHABDATA, Scielo, Scopus, Web of Science, Trip Database, and Epistemonikos from 1980 to December 2018 was carried out.Review Methods: The bibliography was screened to identify clinical trials (controlled and before-after) that used ESWT to reduce spasticity in stroke survivors. Two reviewers independently screened references, selected relevant studies, extracted data, and assessed risk of bias by PEDro scale. The primary outcome was spasticity.Results: A total of 12 studies (278 participants) were included (5 randomized controlled trials, 1 controlled trial, and 6 before-after studies). A meta-analysis was performed by randomized controlled trials. A beneficial effect on spasticity was found. The mean difference (MD) was 0.58; 95% confidence interval (CI) 0.30 to 0.86 and also in subgroup analysis (short, medium, and long term). The MD for range of motion was 1.81; CI -0.20 to 3.82 and for lower limb function the standard mean difference (SMD) was 0.34; 95% CI -0.09 to 0.77. Sensitivity analysis demonstrated a better beneficial effect for myotendinous junction. MD was 1.5; 95% CI -2.44 to 5.44 at long-term (9 weeks).Conclusion: The ESWT (radial/focused) would be a good non-invasive rehabilitation strategy in chronic stroke survivors to reduce lower limb spasticity, increase ankle range of motion, and improve lower limb function. It does not show any adverse events and it is a safe and effective method.

Long-term follow-up of a randomized controlled trial on additional core stability exercises training for improving dynamic sitting balance and trunk control in stroke patients.

OBJECTIVE: Analyse the effect of core stability exercises in addition to conventional physiotherapy training three months after the intervention ended. DESIGN: A randomized controlled trial. SETTING: Outpatient services. SUBJECTS: Seventy-nine stroke survivors. INTERVENTIONS: In the intervention period, both groups underwent conventional physiotherapy performed five days/week for five weeks, and in addition the experimental group performed core stability exercises for 15 minutes/day. Afterwards, during a three-month follow-up period, both groups underwent usual care that could eventually include conventional physiotherapy or physical exercise but not in a controlled condition. MAIN MEASURES: Primary outcome was trunk control and dynamic sitting balance assessed by the Spanish-Version of Trunk Impairment Scale 2.0 and Function in Sitting Test. Secondary outcomes were standing balance and gait evaluated by the Berg Balance Scale, Tinetti Test, Brunel Balance Assessment, Spanish-Version of Postural Assessment Scale for Stroke and activities of daily living using the Barthel Index. RESULTS: A total of 68 subjects out of 79 completed the three-month follow-up period. The mean difference (SD) between groups was 0.78 (1.51) points ( p = 0.003) for total score on the Spanish-Version of Trunk Impairment Scale 2.0, 2.52 (6.46) points ( p = 0.009) for Function in Sitting Test, dynamic standing balance was 3.30 (9.21) points ( p= 0.009) on the Berg Balance Scale, gait was 0.82 (1.88) points ( p = 0.002) by Brunel Balance Assessment (stepping), and 1.11 (2.94) points ( p = 0.044) by Tinetti Test (gait), all in favour of core stability exercises. CONCLUSIONS: Core stability exercises plus conventional physiotherapy have a positive long-term effect on improving dynamic sitting and standing balance and gait in post-stroke patients.

Validation of the Spanish version of the Trunk Impairment Scale Version 2.0 (TIS 2.0) to assess dynamic sitting balance and coordination in post-stroke adult patients.

BACKGROUND: In recent years the Trunk Impairment Scale version 2.0 (TIS 2.0) has been a frequently used scale to assess dynamic sitting balance and trunk control for stroke patients. OBJECTIVE: To translate the TIS 2.0 into Spanish and validate it as an instrument to evaluate dynamic sitting balance and trunk control and coordination for post-stroke adult patients. METHODS: The original version was translated into Spanish and was agreed by a team of experts. A back-translation into English was subsequently performed and sent to the original author, who approved this version. 58 post-stroke patients' performance was recorded on a videotape. These videos were then used to carry out four measurements to assess the intra-rater and inter-rater reliability, two of these were performed by the same rater and the third and fourth by a second and third rater. RESULTS: The reliability was calculated by the Kappa index, and was superior to 0.80 for intra-rater reliability, while inter-rater reliability varied from 0.487 to 1. Cronbach's alpha for internal consistency was 0.896 and to subscales dynamic sitting balance and coordination were 0.899 and 0.613 respectively. Intra-class correlations (ICC) for the summed scores of the different subscales were above 0.90 for all of them. CONCLUSION: The Spanish version of the TIS 2.0 is valid and reliable, and can be recommended for use in the evaluation of dynamic sitting balance and trunk control and coordination in future research on post-stroke patients. Guidelines for treatment and level of quality of trunk activity can be derived from its use.

[Spanish translation and validation of the Postural Assessment Scale for Stroke Patients (PASS) to assess balance and postural control in adult post-stroke patients]. / Traducción y validación al español de la Postural Assessment Scale for Stroke Patients (PASS) para la valoración del equilibrio y del control postural en pacientes postictus.

INTRODUCTION: In the last years the Postural Assessment Scale for Stroke Patients (PASS) has become in the most common utility to assess balance and postural control in adult patients who have suffered a stroke, especially in the acute and subacute phase. AIM: To translate the PASS into Spanish and to validate it as an instrument to evaluate balance and postural control in adult stroke patients in Spain. PATIENTS AND METHODS: The French version was translated into Spanish, this version was agreed by a team of experts. Later a back-translation was made into French and was sent to original author, who approved this version. To assess the interrater and intrarater reliability were performed four measurements on 60 post-stroke patients which was recorded a videotape. Two of these measurements were performed by the same rater, and the third and fourth by a second and third rater. RESULTS: The values refer to the total score of the scale and reflect a reliability of 0.999. They also show a reliability greater than 0.90 in each of the items in both intrarater and interrater comparisons as an internal consistency of 0.94. CONCLUSIONS: The Spanish version of PASS is valid and can reliably evaluate balance and postural control for adult stroke survivors.

TITLE: Traduccion y validacion al español de la Postural Assessment Scale for Stroke Patients (PASS) para la valoracion del equilibrio y del control postural en pacientes postictus.Introduccion. En los ultimos años, la Postural Assessment Scale for Stroke Patients (PASS) se ha convertido en la escala mas utilizada para valorar el equilibrio y el control postural en pacientes adultos que han sufrido un ictus, especialmente en la fase aguda y subaguda. Objetivo. Traducir y validar la PASS para la poblacion española como instrumento de valoracion del equilibrio y el control postural en pacientes adultos postictus. Pacientes y metodos. Se tradujo al español la version original francesa de la PASS; dicha version fue consensuada por un equipo de expertos. Posteriormente se hizo una retrotraduccion al frances y se envio al autor de la escala, el cual aprobo dicha version. Seguidamente se evaluo la fiabilidad intra e interobservador; para ello se llevaron a cabo cuatro mediciones a 60 pacientes postictus, a partir de una videograbacion. Dos de estas mediciones fueron realizadas por el mismo observador, y la tercera y cuarta, por un segundo y tercer observadores. Resultados. Los valores obtenidos referidos a la puntuacion total de la escala reflejan un indice de fiabilidad del 0,999; tambien muestran una fiabilidad superior a 0,90 en cada uno de los items, tanto en las comparaciones intraobservador como interobservador, y una consistencia interna del 0,94. Conclusion. La version española de la PASS es valida y fiable para valorar el equilibrio y el control postural en pacientes adultos postictus.

Traducción y validación al español de la Postural Assessment Scale for Stroke Patients (PASS) para la valoración del equilibrio y del control postural en pacientes postictus / Spanish translation and validation of the Postural Assessment Scale for Stroke Patients (PASS) to assess balance and postural control in adult post-stroke patients

Introducción. En los últimos años, la Postural Assessment Scale for Stroke Patients (PASS) se ha convertido en la escala más utilizada para valorar el equilibrio y el control postural en pacientes adultos que han sufrido un ictus, especialmente en la fase aguda y subaguda. Objetivo. Traducir y validar la PASS para la población española como instrumento de valoración del equilibrio y el control postural en pacientes adultos postictus. Pacientes y métodos. Se tradujo al español la versión original francesa de la PASS; dicha versión fue consensuada por un equipo de expertos. Posteriormente se hizo una retrotraducción al francés y se envió al autor de la escala, el cual aprobó dicha versión. Seguidamente se evaluó la fiabilidad intra e interobservador; para ello se llevaron a cabo cuatro mediciones a 60 pacientes postictus, a partir de una videograbación. Dos de estas mediciones fueron realizadas por el mismo observador, y la tercera y cuarta, por un segundo y tercer observadores. Resultados. Los valores obtenidos referidos a la puntuación total de la escala reflejan un índice de fiabilidad del 0,999; también muestran una fiabilidad superior a 0,90 en cada uno de los ítems, tanto en las comparaciones intraobservador como interobservador, y una consistencia interna del 0,94. Conclusión. La versión española de la PASS es válida y fiable para valorar el equilibrio y el control postural en pacientes adultos postictus (AU)

Introduction. In the last years the Postural Assessment Scale for Stroke Patients (PASS) has become in the most common utility to assess balance and postural control in adult patients who have suffered a stroke, especially in the acute and subacute phase. Aim. To translate the PASS into Spanish and to validate it as an instrument to evaluate balance and postural control in adult stroke patients in Spain. Patients and methods. The French version was translated into Spanish, this version was agreed by a team of experts. Later a back-translation was made into French and was sent to original author, who approved this version. To assess the interrater and intrarater reliability were performed four measurements on 60 post-stroke patients which was recorded a videotape. Two of these measurements were performed by the same rater, and the third and fourth by a second and third rater. Results. The values refer to the total score of the scale and reflect a reliability of 0.999. They also show a reliability greater than 0.90 in each of the items in both intrarater and interrater comparisons as an internal consistency of 0.94. Conclusi (AU)