title: Efficiency of physical therapy on postural imbalance after stroke: study protocol for a systematic review and meta-analysis.
abstract: Stroke frequently results in balance disorders, leading to lower levels of activity and a diminution in autonomy. Current physical therapies (PT) aiming to reduce postural imbalance have shown a large variety of effects with low levels of evidence. The objectives are to determine the efficiency of PT in recovering from postural imbalance in patients after a stroke and to assess which PT is more effective.
  
  
  
  We will search several databases from inception to October 2015. Only randomised controlled trials assessing PT to recover from poststroke postural imbalance in adults will be considered.Outcome measures will be the Berg Balance Scale (BBS), the Postural Assessment Scale for Stroke (PASS), the 'weight-bearing asymmetry' (WBA), the 'centre of pressure' (COP) and the 'limit of stability' (LOS). WBA, COP and LOS are measured by a (sitting or standing) static evaluation on force plate or another device.Two independent reviewers will screen titles, abstracts and full-text articles, evaluate the risk of bias and will perform data extraction. In addition to the outcomes, measures of independence will be analysed. This study will aim at determining the effects of PT on the function (WBA, COP, LOS), the activity (BBS, PASS) and the independence of patients. Subgroup analyses will be planned according to the location of brain lesion (hemispheric, brainstem or cerebellum), the time since stroke (early, late, chronic), the PT (type, main aim (direct effect or generalisation), overall duration), the type of approaches (top-down or bottom-up) and the methodological quality of studies.
  
  
  
  No ethical statement will be required. The results will be published in a peer-reviewed journal. This meta-analysis aims at managing the rehabilitation after postural imbalance by PT after a stroke.
  
  
  
  Prospero CRD42016037966;Pre-results.
authors.affiliation: Service de médecine physique et réadaptation, Hôpital Henry-Gabrielle, Hospices Civils de Lyon, Saint-Genis-Laval, France.|Inserm UMR-S 1028, CNRS UMR 5292, ImpAct, Centre de Recherche en Neurosciences de Lyon, Université Lyon, Bron, France.|Plate-forme Mouvement et Handicap, Hôpital Henry-Gabrielle, Hospices Civils de Lyon, Saint-Genis-Laval, France.
authors.forename: A
authors.initials: A
authors.lastname: Hugues
authors.affiliation: Service de médecine physique et réadaptation, Hôpital Raymond Poincaré, Assistance Publique des Hôpitaux de Paris, Garches, France.
authors.forename: J
authors.initials: J
authors.lastname: Di Marco
authors.affiliation: UMR 5558 CNRS Lyon, Université de Lyon 1, Lyon, France.
authors.forename: P
authors.initials: P
authors.lastname: Janiaud
authors.affiliation: Pôle Information Médicale Évaluation Recherche, Hospices Civils de Lyon, Lyon, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Xue
authors.affiliation: Rovisco Pais Rehabilitation Centre, Tocha, Portugal.|Medicine Faculty of Oporto University, Oporto, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Pires
authors.affiliation: International Agency of Research on Cancer, World Health Organisation, Lyon, France.
authors.forename: H
authors.initials: H
authors.lastname: Khademi
authors.affiliation: UMR 5558 CNRS Lyon, Université de Lyon 1, Lyon, France.
authors.forename: M
authors.initials: M
authors.lastname: Cucherat
authors.affiliation: Service de médecine physique et de réadaptation, CHU Rennes, Rennes, France.
authors.forename: I
authors.initials: I
authors.lastname: Bonan
authors.affiliation: UMR 5558 CNRS Lyon, Université de Lyon 1, Lyon, France.|Service de Pharmacologie Toxicologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France.
authors.forename: F
authors.initials: F
authors.lastname: Gueyffier
authors.affiliation: Service de médecine physique et réadaptation, Hôpital Henry-Gabrielle, Hospices Civils de Lyon, Saint-Genis-Laval, France.|Inserm UMR-S 1028, CNRS UMR 5292, ImpAct, Centre de Recherche en Neurosciences de Lyon, Université Lyon, Bron, France.|Plate-forme Mouvement et Handicap, Hôpital Henry-Gabrielle, Hospices Civils de Lyon, Saint-Genis-Laval, France.
authors.forename: G
authors.initials: G
authors.lastname: Rode
mesh_terms: D002531:Cerebellum; D054022:Cerebrum; D006801:Humans; D015201:Meta-Analysis as Topic; D026741:Physical Therapy Modalities; D004856:Postural Balance; D012107:Research Design; D020521:Stroke / Q000503:physiopathology*; D000071939:Stroke Rehabilitation; D000078202:Systematic Reviews as Topic
keywords: balance; efficiency; meta-analysis; physical therapy; postural imbalance