Efficacy of sitting balance training with delayed visual feedback among patients with stroke: a randomized crossover clinical trial.

Only 20 participants, split 11 and 9 across the two order groups, which is a small sample for a crossover trial. Standard deviations were very large relative to the mean changes (for example, 73.7 to 84.8 mm for center-of-pressure distance), so individual responses will vary widely and the group means may not reflect a typical patient. Each condition lasted only 5 days, and the authors note that long-term effects are unclear. All participants received 180 minutes of standard rehabilitation daily throughout the study, including facilitation, sitting-to-standing, communication, transfer, toilet training, and ambulation, so the effect of the visual delay cannot be separated from the rest of the therapy. Single-center study with a single device (Sumitomo Riko SR soft vision), so the findings may not transfer to other equipment or settings. The assessor was blinded, but the participants obviously knew whether the feedback was delayed or real-time, so performance could have been influenced by expectation.

All authors declare no conflict of interest. No funding source is named in the text.

Do not read this as proof that a 500 ms visual delay is a proven sitting balance intervention for stroke. The study had 20 participants, very large standard deviations (73.7 to 84.8 mm for center-of-pressure distance), only 5 days of training per condition, and every participant was also receiving 180 minutes of standard rehabilitation daily, including facilitation, sitting-to-standing, communication, transfer, toilet training, and ambulation. The effect of the delay alone cannot be separated from the rest of the therapy, and no long-term follow-up was done.