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Treino propriocetivo como estratégia de intervenção para melhoria do equilíbrio em indivíduos pós-acidente vascular cerebral: uma revisão sistemática
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Advisor(s)
Abstract(s)
Introdução – As alterações no equilíbrio correspondem a mais de metade das consequências provocadas pelo AVC, por isso, continua a ser de extrema importância investigar qual a melhor estratégia de intervenção nestas alterações de acordo com a atual evidência. Apesar de o treino propriocetivo ser considerado um treino válido em indivíduos pós-AVC, o seu contributo para a melhoria do equilíbrio nestes indivíduos permanece por esclarecer. Objetivo – Verificar a eficácia do treino propriocetivo na melhoria do equilíbrio em indivíduos pós-AVC. Métodos – Foi efetuada uma revisão sistemática seguindo as recomendações PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). A pesquisa foi realizada nas bases de dados PubMed, PEDro e ScienceDirect, utilizando termos de pesquisa específicos. A Escala PEDro foi utilizada para avaliar a qualidade metodológica dos estudos. Critérios de inclusão: estudos randomizados controlados (RCT) que incluíssem indivíduos com idade igual ou superior a 18 anos, com diagnóstico de AVC e alterações no equilíbrio, cuja intervenção contemplasse treino propriocetivo e a avaliação tivesse medidas objetivas do equilíbrio. Critérios de exclusão: estudos em indivíduos com outras morbilidades neurológicas, com patologia músculo-esquelética nos membros inferiores ou outro tipo de patologias suscetíveis de influenciar o sistema propriocetivo. Resultados – A pesquisa identificou um total de 855 estudos, dos quais 14 foram incluídos na revisão após a aplicação dos critérios de elegibilidade. Estes envolveram 677 indivíduos com diagnóstico de AVC crónico (sete estudos) e agudo/subagudo (sete estudos). Os tipos de treino propriocetivo utilizados nos grupos de intervenção (GI) consistiram em: equilíbrio; estimulação somatossensorial com vibração ou estimulação elétrica funcional; reposicionamento articular, combinado com fisioterapia convencional, aplicada também nos grupos de controlo (GC). As medidas de avaliação objetiva do equilíbrio utilizadas consistiram nas escalas de equilíbrio de Berg (BBS) e/ou Tinneti (TBS) e Mini-Balance Evaluation Systems Test (Mini-Best). Houve diferenças estatisticamente significativas (p<0,05) entre GI e GC em 10 dos 14 estudos. Conclusão – De acordo com a presente revisão, apesar da heterogeneidade das intervenções (tipo de exercício e duração) e os instrumentos de avaliação usados na análise dos resultados, regista-se uma tendência para a maioria dos estudos incluídos apresentarem resultados positivos nas medidas que avaliam o equilíbrio e o treino propriocetivo.
ABSTRACT Introduction – Balance disorders are responsible for more than half of all stroke consequences. That is why it is still very important to investigate the best intervention strategy for this kind of disorder according to the most recent evidence. Although proprioceptive training is considered a valid type of training in post-stroke individuals, its contribution to improving balance remains to be clarified. Aim – To verify the effectiveness of proprioceptive training to improve balance in post-stroke individuals. Methods – A systematic review was carried out, based on the methodology defined in PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). The databases used were PubMed, PEDro, and ScienceDirect. The methodological quality of the studies was assessed using the PEDro Scale. Inclusion criteria: randomized controlled studies (RCT) in individuals 18 years of age or older, diagnosed with stroke with balance impairments, whose intervention includes proprioceptive training and assessment containing objective measures of balance. Exclusion criteria: studies in individuals with other neurological morbidities, musculoskeletal pathology in the lower limbs, or other types of pathologies likely to influence the proprioceptive system. Results – The database search identified 855 studies, 14 of which were included in this review, according to eligibility criteria. These involved 677 individuals diagnosed with stroke, chronic (seven studies) and acute/subacute (seven studies). The types of proprioceptive training used in the intervention groups (IG) consisted of: balance; somatosensory stimulation with vibration or functional electrical stimulation; and joint repositioning, combined with conventional physiotherapy, also applied in the control groups (CG). The objective balance assessment used consisted of the Berg (BBS) and/or Tinneti (TBS) balance scales and the Mini-Balance Evaluation Systems Test (Mini-BEST). There were statistically significant differences (p<0.05) between IG and CG in 10 out of 14 studies. Conclusion – According to this review, despite the differences between the interventions (like the type and duration of exercises) and the scales used to measure the results, there is a tendency, for most of the included studies, to show improvements in the results of balance and proprioceptive training measures.
ABSTRACT Introduction – Balance disorders are responsible for more than half of all stroke consequences. That is why it is still very important to investigate the best intervention strategy for this kind of disorder according to the most recent evidence. Although proprioceptive training is considered a valid type of training in post-stroke individuals, its contribution to improving balance remains to be clarified. Aim – To verify the effectiveness of proprioceptive training to improve balance in post-stroke individuals. Methods – A systematic review was carried out, based on the methodology defined in PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). The databases used were PubMed, PEDro, and ScienceDirect. The methodological quality of the studies was assessed using the PEDro Scale. Inclusion criteria: randomized controlled studies (RCT) in individuals 18 years of age or older, diagnosed with stroke with balance impairments, whose intervention includes proprioceptive training and assessment containing objective measures of balance. Exclusion criteria: studies in individuals with other neurological morbidities, musculoskeletal pathology in the lower limbs, or other types of pathologies likely to influence the proprioceptive system. Results – The database search identified 855 studies, 14 of which were included in this review, according to eligibility criteria. These involved 677 individuals diagnosed with stroke, chronic (seven studies) and acute/subacute (seven studies). The types of proprioceptive training used in the intervention groups (IG) consisted of: balance; somatosensory stimulation with vibration or functional electrical stimulation; and joint repositioning, combined with conventional physiotherapy, also applied in the control groups (CG). The objective balance assessment used consisted of the Berg (BBS) and/or Tinneti (TBS) balance scales and the Mini-Balance Evaluation Systems Test (Mini-BEST). There were statistically significant differences (p<0.05) between IG and CG in 10 out of 14 studies. Conclusion – According to this review, despite the differences between the interventions (like the type and duration of exercises) and the scales used to measure the results, there is a tendency, for most of the included studies, to show improvements in the results of balance and proprioceptive training measures.
Description
A presente revisão foi financiada pela Fundação para a Ciência e Tecnologia (FCT), fundos do projeto estratégico FCT-IBEB, UIDB/00645/2020; Health & Technology Research Center, ESTeSL – Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, financiada por FCT/MCTES (UIDB/05608/2020 e UIDP/05608/2020).
Keywords
AVC Acidente vascular cerebral Equilíbrio Controlo postural Treino propriocetivo Fisioterapia CVA Stroke Balance Postural control Stability Proprioceptive training Physiotherapy FCT_UIDB/00645/2020 FCT_UIDB/05608/2020 FCT_UIDP/05608/2020
Citation
Fernandes A, Fernandes SR, Fernandes B. Treino propriocetivo como estratégia de intervenção para melhoria do equilíbrio em indivíduos pós-acidente vascular cerebral: uma revisão sistemática. Saúde & Tecnologia. 2024;(30):e770.
Publisher
Escola Superior de Tecnologia da Saúde de Lisboa (Instituto Politécnico de Lisboa)