The effects of vestibular rehabilitation on balance in stroke: a systematic review and Meta-analysis

Background: Vestibular Rehabilitation (VR) is a treatment to optimize vestibular function and sensory integration. It has demonstrated positive treatment effects in some neurological conditions.

Objective: Patients after stroke often have balance and sensory impairments: yet there is no consensus on whether VR is useful in this population. This review assessed if VR can provide an effective treatment to optimize balance performance after stroke.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, four electronic databases were systematically searched for research studies comparing VR against routine care or controls in adults who had suffered a cerebral stroke in the last year. Study outcome data were collated and summarised narratively and a meta-analysis on balance outcomes was conducted using a random effects model.

Results: Six randomised controlled trial studies met the inclusion criteria for this systematic review, with all being included in the meta-analysis. The pooled standardised mean difference (SMD) favoured the intervention as a beneficial treatment for balance recovery, with an effect of large magnitude (0.94; 95% confidence interval [CI] 0.39 to 1.48). No studies excessively influenced the primary outcome. No evidence for heterogeneity was revealed. Two studies showed low risk of bias, three some concerns and one high risk on the Cochrane Risk of Bias tool for randomised trials tool.

Conclusions: Vestibular rehabilitation is beneficial for improving balance in stroke patients with mild-moderate balance dysfunction. Further research is needed on the application of VR in stroke patients to explore its clinical use in more detail.