Is traditional Chinese exercise effective in improving gait and balance among patients with stroke?
Date of publication of the systematic review: August 2015
Design
Systematic review of 9 randomized controlled trials (RCTs) and meta-analysis of 8 RCTs.
Participants
704 patients diagnosed with stroke (mean age: 68.2 years in treatment group, 65.6 years in control group). The reviewers did not report gender proportion of the participants.
Intervention
Traditional Chinese exercise was provided with a range of 2 weeks to 12 weeks. The duration of each session was not reported. Three trials used Tai Chi, two trials used baduanjin and one used YiJinjing.
Comparator
Comparison: Traditional Chinese exercise versus no intervention, conservative treatment or sham acupuncture.
Major Outcomes
Outcome 1: Balance as measured by the Berg balance scale (BBS) at the end of intervention. Higher score indicated better quality of balance.
Settings
The included trials were performed in outpatient settings.
Comparison    Traditional Chinese exercise versus no intervention, conservative treatment or sham acupuncture
Main Results
Compared to no intervention, conservative treatment or sham acupuncture, traditional Chinese exercise showed significant improvement for balance by increasing the scores in BBS (pooled mean difference (pooled MD): 11.85, 95% CI: 5.41 to 18.30).
Comparison: Traditional Chinese exercise versus no intervention, conservative treatment or sham acupuncture in patients with stroke
Outcomes No. of studies (Total no. of participants) Mean score / No. of participants Heterogeneity test (I2) Pooled MD (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 6 (534) 21.62 /271 9.77 /258 99% 11.85 (5.41 to18.30) 0.0003 Moderate
Keys: MD = mean difference; CI = confidence interval.
Comparison    Traditional Chinese exercise versus no intervention, conservative treatment or sham acupuncture
Main Results
Compared to no intervention, conservative treatment or sham acupuncture, traditional Chinese exercise showed significant improvement for balance by increasing the scores in BBS (pooled mean difference (pooled MD): 11.85, 95% CI: 5.41 to 18.30).
Comparison: Traditional Chinese exercise versus no intervention, conservative treatment or sham acupuncture in patients with stroke
Outcomes 1
No. of studies (Total no. of participants) 6 (534)
Mean score / No. of participants Intervention 21.62 /271
Comparator 9.77 /258
Pooled MD (95% CI) 11.85 (5.41 to18.30)
p value 0.0003
Overall quality of evidence* Moderate
Keys: MD = mean difference; CI = confidence interval.
Conclusion
Benefits
Compared to no intervention, conservative treatment or sham acupuncture, traditional Chinese exercise showed significant improvement on the balance ability for stroke patients by increasing the scores in BBS. For outcome 1, the overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
Harms
No adverse events were reported in the included trials.
Link to Original Article
http://www.ncbi.nlm.nih.gov/pubmed/26291978
The synopsis is based on the following article:
Chen BL, Guo JB, Liu MS, Li X, Zou J, Chen X, et al. Effect of Traditional Chinese Exercise on Gait and Balance for Stroke: A Systematic Review and Meta-Analysis. [Review] PLoS ONE [Electronic Resource].2015; 10(8):e0135932.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.