Investigating the Clinical Significance and Research Discrepancies of Balance Training in Degenerative Cerebellar Disease: A Systematic Review.
Scott Barbuto, Sheng-Han Kuo, Joel Stein
PMID 32467491WHAT IT FOUND
Balance training may reduce ataxia severity scores in genetic degenerative cerebellar disease, but not all studies showed benefit and balance tests were not clinically meaningful.
Gait speed improved when programs included walking exercises.
Key findings
01In 12 of the 14 included studies that measured ataxia severity before and after training, 9 reported improvement after programs that included balance training; on the SARA scale, improvements ranged from a decrease of 0.4 to 5.2 points.
02Gait speed was measured in 8 studies, and 3 reported improvement; those 3 programs included walking exercises.
03138 of the 255 participants received balance training combined with other training, including strengthening, stretching, or gait training, so the review cannot separate the contribution of balance training alone.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The 14 studies were very different in diagnosis, training type, dose, and outcome measures, so the review could not pool results or run a meta-analysis. Sample sizes were small, ranging from 8 to 42 participants per study, and only three studies enrolled more than 20 subjects. Risk of bias varied across studies, including sampling, selection, performance, and measurement bias, and some assessors were not blinded. Many participants received balance training plus other training, so the effect of balance training alone cannot be separated. Balance test improvements were statistically significant in some studies but were not clinically meaningful when compared with other neurologic populations. Home training adherence was often based on self-report, and shorter, less frequent, or less challenging training may explain studies without benefit. The review included people with at least mild ataxia, and ambulation status varied, so it may not apply to all patients.
Declared interests
The authors reported no financial disclosures.
The easy way to misread this
Do not read this review as showing that balance training alone produces clinically meaningful balance improvement. Many studies gave balance training with other exercises, and the balance test changes were not clinically meaningful when compared with other neurologic populations.