Force platform feedback for standing balance training after stroke.
BACKGROUND
Standing balance deficits are common in individuals after stroke. One way to address these deficits is to provide the individual with feedback from a force platform while balance activities are performed. The feedback can take visual and/or auditory form.


OBJECTIVE
To determine if visual or auditory force platform feedback improves the clinical and force platform standing balance outcomes in clients with stroke.


METHODS
We searched the Cochrane Stroke Group trials register (last searched December 2003), and the following electronic bibliographic databases: the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2003), MEDLINE (1966 to May 2003), EMBASE (1974 to May 2003), CINAHL (1982 to May 2003), PEDro (May 2003), CIRRIE (May 2003) and REHABDATA (May 2003). Reference lists of articles were reviewed and manufacturers of equipment were contacted.


METHODS
Randomized controlled trials comparing force platform with visual feedback and/or auditory feedback to other balance treatments.


METHODS
Two reviewers independently assessed trials for inclusion, methodological quality, and data extraction. Trials were combined for meta-analysis according to outcome and type of feedback.


RESULTS
We included seven trials (246 participants). Force platform feedback did not improve clinical measures of balance when moving or walking (Berg Balance Scale and Timed Up and Go). Significant improvements in laboratory force platform indicators of stance symmetry were found for regimens using visual feedback (standardised mean difference (SMD) -0.68, 95% confidence interval (CI) -1.31 to -0.04, p = 0.04) and the concurrent visual and auditory feedback (weighted mean difference (WMD) -4.02, 95% CI -5.99 to -2.04, p = 0.00007). There were no significant effects on laboratory postural sway indicators, clinical outcomes or measures of function at follow-up assessment.


CONCLUSIONS
Force platform feedback (visual or auditory) improved stance symmetry but not sway in standing, clinical balance outcomes or measures of independence.
Barclay-Goddard
R
R
School of Medical Rehabilitation, Department of Physical Therapy, University of Manitoba, School of Medical Rehabiltation, R106-771 McDermot Ave., Winnipeg, Manitoba, Canada, R3E 0T6. barclayg@ms.umanitoba.ca
Stevenson
T
T
Poluha
W
W
Moffatt
M E K
ME
Taback
S P
SP
D001676:Biofeedback, Psychology / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D004856:Postural Balance / Q000502:physiology*; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation