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Balance training (proprioceptive training) for patients with rheumatoid arthritis

  1. Kelson NG Silva1,*,
  2. Aline Mizusaki Imoto1,
  3. Gustavo JM Almeida2,
  4. Álvaro N Atallah3,
  5. Maria Stella Peccin4,
  6. Virginia Fernandes Moça Trevisani5

Editorial Group: Cochrane Musculoskeletal Group

Published Online: 12 MAY 2010

Assessed as up-to-date: 27 JUN 2009

DOI: 10.1002/14651858.CD007648.pub2

How to Cite

Silva KNG, Mizusaki Imoto A, Almeida GJM, Atallah ÁN, Peccin MS, Fernandes Moça Trevisani V. Balance training (proprioceptive training) for patients with rheumatoid arthritis. Cochrane Database of Systematic Reviews 2010, Issue 5. Art. No.: CD007648. DOI: 10.1002/14651858.CD007648.pub2.

Author Information

  1. 1

    Brazilian Cochrane Centre, Sao Paulo, SP, Brazil

  2. 2

    University of Pittsburgh, Department of Physical Therapy, Pittsburgh, Pennsylvania, USA

  3. 3

    Universidade Federal de São Paulo / Escola Paulista de Medicina, Brazilian Cochrane Centre, São Paulo, SP, Brazil

  4. 4

    Federal University of São Paulo, Health Sciences Department, Santos, São Paulo, Brazil

  5. 5

    Universidade Federal de São Paulo, Rheumatology/Internal Medicine and Therapeutics, São Paulo, São Paulo, Brazil

*Kelson NG Silva, Brazilian Cochrane Centre, 598, Pedro Toledo Street, Vila Clementino, Sao Paulo, SP, 04039-001, Brazil. kelson_fisio@hotmail.com. kelson.silva@unifesp.br.

Publication History

  1. Publication Status: New
  2. Published Online: 12 MAY 2010

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Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Andersson 1996Randomised controlled trial. Intervention was directed at strength training.

Bearne 2002Randomised controlled trial. Duration of intervention less than 6 weeks. Balance training less than 30 minutes per exercise session.

Patients: 93 randomised (47 - Intervention Group / 46 - Control Group) + 25 healthy subjects.

61 patients completed rehabilitation regime - 34.41% drop-out.

Rehabilitation intervention: Warm-up exercises (e.g. 5 min cycling on a static bicycle, stretching/range of movement); 24 isometric MVCs (four sets of six contractions) at 90° knee flexion; three functional exercise (e.g. sit-to-stand, step-ups, etc.); balance exercises (e.g. wobble-board). "The functional and balance exercise were each performed for 1-5 min".

Duration of the exercise program: 5 weeks (10 exercise sessions / twice a week)

Bilberg 2005Randomised controlled trial. Intervention: Moderately intensive exercise. Intervention did not target balance training.

Patients: 43 randomised (20 - Intervention Group / 23 - Control Group).

Rehabilitation intervention: Exercises in a temperate pool of moderate aerobic intensity. Exercises for aerobic capacity, dynamic (eccentric and concentric) and static muscle strength, and muscle endurance for upper and lower extremities, flexibility, coordination and relaxation.

Duration of the exercise program: 12 weeks (twice a week) / Each session - 45 min.

Brodin 2008Multicenter, randomized controlled study. Intervention did not target balance training.

Author (Nina Brodin): "No specific exercises were suggested. Most patients engaged in hydrotherapy, walking, bicycling, swimming, aerobics or strength training."

Ekdahl 1990Randomised controlled trial. Balance training less than 30 minutes per exercise session. Balance training combined with exercise to promote muscle strength.

Patients: 67 randomised in four training groups.

Rehabilitation intervention:

Group I: Dynamic program: 12 scheduled visits twice a week for a period of 6 weeks.
Group II: Dynamic program: 4 visits (twice the first week, one at the middle and one at the end of the
6-week period).
Group Ill : Static program: 12 visits (same as Group I).
Group IV: Static program: 4 visits (same as Group II).

Duration of the exercise program: 6 weeks.

Eversden 2007Randomised controlled trial. Intervention: Hydrotherapy and land exercises. Intervention did not target balance training. "Participants, in groups, received either a weekly 30-minute session of hydrotherapy or land based exercises for 6 weeks".

Patients: 115 randomised (58 - Land Group / 57 - Hydrotherapy Group)

85 patients completed the study - loss 26.09%.

Rehabilitation intervention: the exercise in each group was similar - Warm-up exercises (mobilising and stretching); core exercises.

Duration of the exercise program: 6 weeks (once a week).

Giraudet-Le 2007Randomised controlled trial. Intervention did not target balance training.

Patients: 208 randomised (104 - Intervention Group / 104 - Control Group).

Rehabilitation intervention: The educational intervention consisted of 8 weekly ambulatory sessions, each lasting 6 hours.

Duration of the exercise program: 8 weeks (once a week).

Hansen 1993Randomised controlled trial. Intervention did not target balance training. Conditioning training (swimming, cycling, running or jogging).

Patients: 75 randomised.

Groups: (15 patients per group):

A - Self training after instruction in the training program.
B - As A plus training with a physiotherapist in general practice once a week.
C - As A plus weekly group training in the hospital.
D - As C but including training in a hot water.
E - No instruction in training.

Häkkinen 1994Randomised controlled trial. Intervention: progressive dynamic strength training. Patients with recent onset rheumatoid or psoriatic arthritis.

Patients: 39 randomised (21 - Intervention Group / 18 - Control Group).

Rehabilitation intervention: Strength training program (altogether 9 different exercises for the upper and lower extremities and for the trunk); Control Group (walking, biking and swimming).

Duration of the exercise program: 6 months (Rehabilitation Group - 2 to 3 times a week / Control Group - 3 to 4 times a week).

Häkkinen 2001Randomised controlled trial. Intervention did not target balance training. Intervention: Strength training.

Patients: 70 randomised.

62 patients completed the study (31 - Intervention Group / 31 - Control Group).

Rehabilitation intervention: Strength training program (different exercises for the upper and lower extremities and for the trunk); Control Group (walking, biking and swimming).

Duration of the exercise program: 24 months - examined at 6 month intervals. (Rehabilitation Group - twice a week - 45 minutes / Control Group - twice a week).

Lineker 2001Randomised controlled trial. Intervention did not target balance training. Intervention: Home-based physical therapy.

Patients: 127 protocol completers.

* 117 patients were available for one year follow-up - the design was a prospective uncontrolled cohort study.

Duration of the exercise program: 6 week (mean 4 hours).

Mayoux-Benhamou 2008Randomised controlled trial. Intervention did not target balance training.

Patients: 208 randomised (104 - Intervention Group / 104 - Control Group).

189 patients completed the study.

Rehabilitation intervention: The home-based exercise program included 10 exercises - 3 hand and
wrist range-of-motion exercises; 5 isometric strengthening exercises to reinforce limb muscles with elastic bands; a foot-roll exercise involving a tennis ball; and 1 towel-grabbing exercise to recruit plantar muscles.

Munneke 2001Randomised controlled trial. Intervention did not target balance training.

Patients: 300 patients were included; 41 randomised (19 - Intervention Group / 22 - Control Group).

Rehabilitation intervention: intensive weight-bearing exercise.

Duration of the exercise program: 2 years (twice a week).

Munneke 2003Randomised controlled trial. Intervention did not target balance training. Each session was divided into 3 parts: bicycle training (20 minutes), exercise circuit (20 minutes), and sport or game (20 minutes).

Study described results on the same 300 patients participating in the study cited above (Munneke 2001). The descriptions of participants, interventions, research design and outcomes, are the same.

Nordemar 1981aControlled trial, not randomised. Intervention did not target balance training.

Patients: 46 randomised (23 - Intervention Group / 23 - Control Group).

Rehabilitation intervention: training on bicycle ergometer, swimming, skiing, cycling, dancing, gymnastics, golf, fast walking, jogging, and various other organized training sports.

Duration of the study: 4 to 8 years.

Nordemar 1981bControlled trial, not randomised. Intervention did not target balance training.

Study described results on the same 46 patients participating in the study cited below (Nordemar 1981a). The descriptions of participants, interventions, research design and outcomes, are the same.

Suomi 2003Randomised controlled trial. Intervention did not target balance training.

Patients: 32 randomised (11 - Aquatic exercise group / 11 - On-land exercise group / 10 - Control group). Only 8 patients with rheumatoid arthritis.

30 patients completed the study.

Duration of the exercise program: 8 weeks (twice a week / session - 45 minutes).

 MVCs = maximum voluntary contractions


 
Summary of findings for the main comparison. Balance training (proprioceptive training) for rheumatoid arthritis

Balance training (proprioceptive training) for rheumatoid arthritis

Patient or population: patients with rheumatoid arthritis
Settings:
Intervention: Balance training (proprioceptive training)

OutcomesIllustrative comparative risks* (95% CI)Relative effect
(95% CI)
No of Participants
(studies)
Quality of the evidence
(GRADE)
Comments

Assumed riskCorresponding risk

ControlBalance training (proprioceptive training)

ACR-50See commentSee commentNot estimable0
(0)
See commentNo included study, so no data available.

PainSee commentSee commentNot estimable0
(0)
See commentNo included study, so no data available.

DAS (low or remission)See commentSee commentNot estimable0
(0)
See commentNo included study, so no data available.

HAQ for functionSee commentSee commentNot estimable0
(0)
See commentNo included study, so no data available.

GaitSee commentSee commentNot estimable0
(0)
See commentNo included study, so no data available.

Adverse effectsSee commentSee commentNot estimable0
(0)
See commentNo included study, so no data available.

Discontinuation ratesSee commentSee commentNot estimable0
(0)
See commentNo included study, so no data available.

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.