Therapeutic effect of traditional Chinese exercise in stroke patients: An umbrella review of systematic reviews and meta-analyses of clinical trials

Abstract

Introduction

Numerous published systematic reviews have examined the effects of traditional Chinese exercise (TCE) on post-stroke rehabilitation. The results of these studies are often contradictory, so there is an urgent need for a hierarchical synthesis of the evidence and a review of the credibility of previous meta-analyses. To determine the robustness of these findings, we conducted an umbrella review to summarize the effects of TCE on stroke patients.

Methods

We searched PubMed, Embase, Web of Science, and Scopus for meta-analyses published between inception and June 2023, and subsequently updated the search to February 2024. We included meta-analyses involving the effects of TCE, including Tai Chi, Baduanjin, Liuzijue, and Yijinjing, on at least one outcome of interest in stroke patients. Primary outcomes included balance function and activities of daily living (ADL), and secondary outcomes included depression, anxiety, sleep quality, and walking ability. Meta-analyses were assessed using "A Measure Tool to Assess Systematic Reviews." We recalculated standardized mean difference (SMD), 95 % confidence intervals (95 % CI), 95 % prediction intervals, assessment of inconsistency/heterogeneity (I²) based on the "metaumbrella" package of R software. Finally, we rated the evidence according to Grading of Recommendations Assessment Development and Evaluation (GRADE).

Results

There were 17 systematic reviews and meta-analyses, containing 93 randomized controlled trials, included in the umbrella review. TCE had a significant effect on improving balance function (Tai Chi: SMD=1.661; 95 % CI 1.074 to 2.247; Baduanjin: SMD=1.697; 95 % CI 1.223 to 2.172) and ADL (Tai Chi: SMD=1.216; 95 % CI 0.811 to 1.620), and reducing depression (Tai Chi: SMD=-0.327; 95 % CI -0.618 to -0.035) and anxiety (Tai Chi: SMD=-0.592; 95 % CI -0.862 to -0.321) in stroke patients, with a very low certainty of evidence. However, the impact of TCE on walking ability and sleep quality was insignificant.

Conclusion

Among 93 study estimates covering six different outcomes in stroke patients, while some findings suggest potential benefits of TCE (especially Tai Chi) on depression, anxiety, and balance function, all evidence was rated as very low certainty according to GRADE assessment.