The effectiveness of physiotherapy sitting balance treatments on sitting balance outcomes in early sub-acute stroke. A systematic review and meta-analysis

Background: Difficulties with sitting balance are common after stroke. The ability to sit unsupported is imperative for many daily tasks and correlated to more positive outcomes. There is limited research on “sitting balance” therapeutic interventions and their impact. This systematic review and meta-analysis aims to investigate the effectiveness of physiotherapy sitting balance treatments on sitting balance outcomes in people up to 3-months post-stroke. Methods: The PRISMA checklist was followed and the review registered on PROSPERO. Seven electronic databases were searched to October 2023 (updated in January 2025) for studies comparing treatments focussing on sitting balance in adults who had suffered a cerebral stroke in the last three months. Studies were included if treatment was predominantly completed in sitting postures and reported sitting balance outcomes. Studies were assessed for eligibility, and data extraction and risk of bias was completed by two independent reviewers. Results: Data from 16 studies (623 participants) was synthesised narratively. Sitting balance interventions were classified into four main categories: weight shift and reaching; core stability exercises; environmental modifications; and task practice. A random effects meta-analysis conducted on eight studies (342 participants) revealed interventions to be beneficial for sitting balance (primary outcome: mean difference Trunk Impairment Scale 3.02; 95% confidence interval 2.19 to 3.86). Four studies demonstrated low risk of bias; and four showed some concerns. Conclusions: The current sitting balance treatments offered to early sub-acute stroke patients show significant improvements in sitting balance primary outcome. Sitting balance treatments can be categorised into four sub-types, helping to standardise clinical application and ensure consistency in future research. Systematic Review Registration Number: PROSPERO CRD42023444050. Contribution of the Paper: • Sitting balance impairment is significantly improved with therapy interventions completed in sitting. • Four main categories of sitting balance treatments have been researched in the subacute stroke population.