Yoga for stroke rehabilitation
Background Stroke is a major health issue and cause of long‐term disability and has a major emotional and socioeconomic impact. There is a need to explore options for long‐term sustainable interventions that support stroke survivors to engage in meaningful activities to address life challenges after...
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| Veröffentlicht in: | Cochrane database of systematic reviews 2017-12, Vol.2017 (12), p.CD011483-CD011483 |
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| creator | Lawrence, Maggie Celestino Junior, Francisco T Matozinho, Hemilianna HS Govan, Lindsay Booth, Jo Beecher, Jane Lawrence, Maggie |
| description | Background
Stroke is a major health issue and cause of long‐term disability and has a major emotional and socioeconomic impact. There is a need to explore options for long‐term sustainable interventions that support stroke survivors to engage in meaningful activities to address life challenges after stroke. Rehabilitation focuses on recovery of function and cognition to the maximum level achievable, and may include a wide range of complementary strategies including yoga.
Yoga is a mind‐body practice that originated in India, and which has become increasingly widespread in the Western world. Recent evidence highlights the positive effects of yoga for people with a range of physical and psychological health conditions. A recent non‐Cochrane systematic review concluded that yoga can be used as self‐administered practice in stroke rehabilitation.
Objectives
To assess the effectiveness of yoga, as a stroke rehabilitation intervention, on recovery of function and quality of life (QoL).
Search methods
We searched the Cochrane Stroke Group Trials Register (last searched July 2017), Cochrane Central Register of Controlled Trials (CENTRAL) (last searched July 2017), MEDLINE (to July 2017), Embase (to July 2017), CINAHL (to July 2017), AMED (to July 2017), PsycINFO (to July 2017), LILACS (to July 2017), SciELO (to July 2017), IndMED (to July 2017), OTseeker (to July 2017) and PEDro (to July 2017). We also searched four trials registers, and one conference s database. We screened reference lists of relevant publications and contacted authors for additional information.
Selection criteria
We included randomised controlled trials (RCTs) that compared yoga with a waiting‐list control or no intervention control in stroke survivors.
Data collection and analysis
Two review authors independently extracted data from the included studies. We performed all analyses using Review Manager (RevMan). One review author entered the data into RevMan; another checked the entries. We discussed disagreements with a third review author until consensus was reached. We used the Cochrane 'Risk of bias' tool. Where we considered studies to be sufficiently similar, we conducted a meta‐analysis by pooling the appropriate data. For outcomes for which it was inappropriate or impossible to pool quantitatively, we conducted a descriptive analysis and provided a narrative summary.
Main results
We included two RCTs involving 72 participants. Sixty‐nine participants were included in one meta‐analysis ( |
| doi_str_mv | 10.1002/14651858.CD011483.pub2 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6486003</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1975033165</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4732-2f202cf9c321f6bf47da2614fc39ac25f4e50ff1f1a636d44fd10b8e120a52983</originalsourceid><addsrcrecordid>eNqFkEtPwzAQhC0EolD4C1WPXFLsje0kFyQoT6kSFzhwshzHbg1pXOwU1H-Poz5UuHCypfl2ZncQGhA8IhjDJaGckZzlo_EtJoTm6WixLOEAnXRC0imHe_8eOg3hHeOUF5Adox4UAJhRcoIGb24qh8b5YWi9-9BDr2eytLVtZWtdc4aOjKyDPt-8ffR6f_cyfkwmzw9P4-tJomiWQgIGMChTqBSI4aWhWSWBE2pUWkgFzFDNsDHEEMlTXlFqKoLLXBPAkkGRp310tfaNV8x1pXTTelmLhbdz6VfCSSt-K42dian7EpzmPN4VDS42Bt59LnVoxdwGpetaNtotgyBFxiJGOIsoX6PKuxC8NrsYgkVXrtiWK7blduEQBwf7S-7Gtm1G4GYNfNtar4RyauZj_j--f1J-AOJ9iXw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1975033165</pqid></control><display><type>article</type><title>Yoga for stroke rehabilitation</title><source>MEDLINE</source><source>Cochrane Library</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Lawrence, Maggie ; Celestino Junior, Francisco T ; Matozinho, Hemilianna HS ; Govan, Lindsay ; Booth, Jo ; Beecher, Jane ; Lawrence, Maggie</creator><creatorcontrib>Lawrence, Maggie ; Celestino Junior, Francisco T ; Matozinho, Hemilianna HS ; Govan, Lindsay ; Booth, Jo ; Beecher, Jane ; Lawrence, Maggie</creatorcontrib><description>Background
Stroke is a major health issue and cause of long‐term disability and has a major emotional and socioeconomic impact. There is a need to explore options for long‐term sustainable interventions that support stroke survivors to engage in meaningful activities to address life challenges after stroke. Rehabilitation focuses on recovery of function and cognition to the maximum level achievable, and may include a wide range of complementary strategies including yoga.
Yoga is a mind‐body practice that originated in India, and which has become increasingly widespread in the Western world. Recent evidence highlights the positive effects of yoga for people with a range of physical and psychological health conditions. A recent non‐Cochrane systematic review concluded that yoga can be used as self‐administered practice in stroke rehabilitation.
Objectives
To assess the effectiveness of yoga, as a stroke rehabilitation intervention, on recovery of function and quality of life (QoL).
Search methods
We searched the Cochrane Stroke Group Trials Register (last searched July 2017), Cochrane Central Register of Controlled Trials (CENTRAL) (last searched July 2017), MEDLINE (to July 2017), Embase (to July 2017), CINAHL (to July 2017), AMED (to July 2017), PsycINFO (to July 2017), LILACS (to July 2017), SciELO (to July 2017), IndMED (to July 2017), OTseeker (to July 2017) and PEDro (to July 2017). We also searched four trials registers, and one conference s database. We screened reference lists of relevant publications and contacted authors for additional information.
Selection criteria
We included randomised controlled trials (RCTs) that compared yoga with a waiting‐list control or no intervention control in stroke survivors.
Data collection and analysis
Two review authors independently extracted data from the included studies. We performed all analyses using Review Manager (RevMan). One review author entered the data into RevMan; another checked the entries. We discussed disagreements with a third review author until consensus was reached. We used the Cochrane 'Risk of bias' tool. Where we considered studies to be sufficiently similar, we conducted a meta‐analysis by pooling the appropriate data. For outcomes for which it was inappropriate or impossible to pool quantitatively, we conducted a descriptive analysis and provided a narrative summary.
Main results
We included two RCTs involving 72 participants. Sixty‐nine participants were included in one meta‐analysis (balance). Both trials assessed QoL, along with secondary outcomes measures relating to movement and psychological outcomes; one also measured disability.
In one study the Stroke Impact Scale was used to measure QoL across six domains, at baseline and post‐intervention. The effect of yoga on five domains (physical, emotion, communication, social participation, stroke recovery) was not significant; however, the effect of yoga on the memory domain was significant (mean difference (MD) 15.30, 95% confidence interval (CI) 1.29 to 29.31, P = 0.03), the evidence for this finding was very low grade. In the second study, QoL was assessed using the Stroke‐Specifc QoL Scale; no significant effect was found.
Secondary outcomes included movement, strength and endurance, and psychological variables, pain, and disability.
Balance was measured in both studies using the Berg Balance Scale; the effect of intervention was not significant (MD 2.38, 95% CI ‐1.41 to 6.17, P = 0.22). Sensititivy analysis did not alter the direction of effect. One study measured balance self‐efficacy, using the Activities‐specific Balance Confidence Scale (MD 10.60, 95% CI ‐7.08,= to 28.28, P = 0.24); the effect of intervention was not significant; the evidence for this finding was very low grade.
One study measured gait using the Comfortable Speed Gait Test (MD 1.32, 95% CI ‐1.35 to 3.99, P = 0.33), and motor function using the Motor Assessment Scale (MD ‐4.00, 95% CI ‐12.42 to 4.42, P = 0.35); no significant effect was found based on very low‐grade evidence.
One study measured disability using the modified Rankin Scale (mRS) but reported only whether participants were independent or dependent. No significant effect was found: (odds ratio (OR) 2.08, 95% CI 0.50 to 8.60, P = 0.31); the evidence for this finding was very low grade.
Anxiety and depression were measured in one study. Three measures were used: the Geriatric Depression Scale‐Short Form (GCDS15), and two forms of State Trait Anxiety Inventory (STAI, Form Y) to measure state anxiety (i.e. anxiety experienced in response to stressful situations) and trait anxiety (i.e. anxiety associated with chronic psychological disorders). No significant effect was found for depression (GDS15, MD ‐2.10, 95% CI ‐4.70 to 0.50, P = 0.11) or for trait anxiety (STAI‐Y2, MD ‐6.70, 95% CI ‐15.35 to 1.95, P = 0.13), based on very low‐grade evidence. However, a significant effect was found for state anxiety: STAI‐Y1 (MD ‐8.40, 95% CI ‐16.74 to ‐0.06, P = 0.05); the evidence for this finding was very low grade.
No adverse events were reported.
Quality of the evidence
We assessed the quality of the evidence using GRADE. Overall, the quality of the evidence was very low, due to the small number of trials included in the review both of which were judged to be at high risk of bias, particularly in relation to incompleteness of data and selective reporting, and especially regarding the representative nature of the sample in one study.
Authors' conclusions
Yoga has the potential for being included as part of patient‐centred stroke rehabilitation. However, this review has identified insufficient information to confirm or refute the effectiveness or safety of yoga as a stroke rehabilitation treatment. Further large‐scale methodologically robust trials are required to establish the effectiveness of yoga as a stroke rehabilitation treatment.</description><identifier>ISSN: 1465-1858</identifier><identifier>EISSN: 1465-1858</identifier><identifier>EISSN: 1469-493X</identifier><identifier>DOI: 10.1002/14651858.CD011483.pub2</identifier><identifier>PMID: 29220541</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Anxiety ; Anxiety - diagnosis ; Communication ; Complementary & alternative medicine ; Depression ; Depression - diagnosis ; Difficulties in activities of daily living (ADL) ; Disability ; Emotions ; Gait ; Heart & circulation ; Humans ; Medicine General & Introductory Medical Sciences ; Memory ; Neurology ; Postural Balance ; Prevention & treatment of complications ; PREVENTION AND TREATMENT OF COMPLICATIONS FOLLOWING STROKE ; Quality of Life ; Randomized Controlled Trials as Topic ; Recovery of Function ; Social Participation ; Stroke ; Stroke Rehabilitation ; Stroke Rehabilitation - methods ; Stroke Rehabilitation - psychology ; Yoga</subject><ispartof>Cochrane database of systematic reviews, 2017-12, Vol.2017 (12), p.CD011483-CD011483</ispartof><rights>Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4732-2f202cf9c321f6bf47da2614fc39ac25f4e50ff1f1a636d44fd10b8e120a52983</citedby><cites>FETCH-LOGICAL-c4732-2f202cf9c321f6bf47da2614fc39ac25f4e50ff1f1a636d44fd10b8e120a52983</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27922,27923</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29220541$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lawrence, Maggie</creatorcontrib><creatorcontrib>Celestino Junior, Francisco T</creatorcontrib><creatorcontrib>Matozinho, Hemilianna HS</creatorcontrib><creatorcontrib>Govan, Lindsay</creatorcontrib><creatorcontrib>Booth, Jo</creatorcontrib><creatorcontrib>Beecher, Jane</creatorcontrib><creatorcontrib>Lawrence, Maggie</creatorcontrib><title>Yoga for stroke rehabilitation</title><title>Cochrane database of systematic reviews</title><addtitle>Cochrane Database Syst Rev</addtitle><description>Background
Stroke is a major health issue and cause of long‐term disability and has a major emotional and socioeconomic impact. There is a need to explore options for long‐term sustainable interventions that support stroke survivors to engage in meaningful activities to address life challenges after stroke. Rehabilitation focuses on recovery of function and cognition to the maximum level achievable, and may include a wide range of complementary strategies including yoga.
Yoga is a mind‐body practice that originated in India, and which has become increasingly widespread in the Western world. Recent evidence highlights the positive effects of yoga for people with a range of physical and psychological health conditions. A recent non‐Cochrane systematic review concluded that yoga can be used as self‐administered practice in stroke rehabilitation.
Objectives
To assess the effectiveness of yoga, as a stroke rehabilitation intervention, on recovery of function and quality of life (QoL).
Search methods
We searched the Cochrane Stroke Group Trials Register (last searched July 2017), Cochrane Central Register of Controlled Trials (CENTRAL) (last searched July 2017), MEDLINE (to July 2017), Embase (to July 2017), CINAHL (to July 2017), AMED (to July 2017), PsycINFO (to July 2017), LILACS (to July 2017), SciELO (to July 2017), IndMED (to July 2017), OTseeker (to July 2017) and PEDro (to July 2017). We also searched four trials registers, and one conference s database. We screened reference lists of relevant publications and contacted authors for additional information.
Selection criteria
We included randomised controlled trials (RCTs) that compared yoga with a waiting‐list control or no intervention control in stroke survivors.
Data collection and analysis
Two review authors independently extracted data from the included studies. We performed all analyses using Review Manager (RevMan). One review author entered the data into RevMan; another checked the entries. We discussed disagreements with a third review author until consensus was reached. We used the Cochrane 'Risk of bias' tool. Where we considered studies to be sufficiently similar, we conducted a meta‐analysis by pooling the appropriate data. For outcomes for which it was inappropriate or impossible to pool quantitatively, we conducted a descriptive analysis and provided a narrative summary.
Main results
We included two RCTs involving 72 participants. Sixty‐nine participants were included in one meta‐analysis (balance). Both trials assessed QoL, along with secondary outcomes measures relating to movement and psychological outcomes; one also measured disability.
In one study the Stroke Impact Scale was used to measure QoL across six domains, at baseline and post‐intervention. The effect of yoga on five domains (physical, emotion, communication, social participation, stroke recovery) was not significant; however, the effect of yoga on the memory domain was significant (mean difference (MD) 15.30, 95% confidence interval (CI) 1.29 to 29.31, P = 0.03), the evidence for this finding was very low grade. In the second study, QoL was assessed using the Stroke‐Specifc QoL Scale; no significant effect was found.
Secondary outcomes included movement, strength and endurance, and psychological variables, pain, and disability.
Balance was measured in both studies using the Berg Balance Scale; the effect of intervention was not significant (MD 2.38, 95% CI ‐1.41 to 6.17, P = 0.22). Sensititivy analysis did not alter the direction of effect. One study measured balance self‐efficacy, using the Activities‐specific Balance Confidence Scale (MD 10.60, 95% CI ‐7.08,= to 28.28, P = 0.24); the effect of intervention was not significant; the evidence for this finding was very low grade.
One study measured gait using the Comfortable Speed Gait Test (MD 1.32, 95% CI ‐1.35 to 3.99, P = 0.33), and motor function using the Motor Assessment Scale (MD ‐4.00, 95% CI ‐12.42 to 4.42, P = 0.35); no significant effect was found based on very low‐grade evidence.
One study measured disability using the modified Rankin Scale (mRS) but reported only whether participants were independent or dependent. No significant effect was found: (odds ratio (OR) 2.08, 95% CI 0.50 to 8.60, P = 0.31); the evidence for this finding was very low grade.
Anxiety and depression were measured in one study. Three measures were used: the Geriatric Depression Scale‐Short Form (GCDS15), and two forms of State Trait Anxiety Inventory (STAI, Form Y) to measure state anxiety (i.e. anxiety experienced in response to stressful situations) and trait anxiety (i.e. anxiety associated with chronic psychological disorders). No significant effect was found for depression (GDS15, MD ‐2.10, 95% CI ‐4.70 to 0.50, P = 0.11) or for trait anxiety (STAI‐Y2, MD ‐6.70, 95% CI ‐15.35 to 1.95, P = 0.13), based on very low‐grade evidence. However, a significant effect was found for state anxiety: STAI‐Y1 (MD ‐8.40, 95% CI ‐16.74 to ‐0.06, P = 0.05); the evidence for this finding was very low grade.
No adverse events were reported.
Quality of the evidence
We assessed the quality of the evidence using GRADE. Overall, the quality of the evidence was very low, due to the small number of trials included in the review both of which were judged to be at high risk of bias, particularly in relation to incompleteness of data and selective reporting, and especially regarding the representative nature of the sample in one study.
Authors' conclusions
Yoga has the potential for being included as part of patient‐centred stroke rehabilitation. However, this review has identified insufficient information to confirm or refute the effectiveness or safety of yoga as a stroke rehabilitation treatment. Further large‐scale methodologically robust trials are required to establish the effectiveness of yoga as a stroke rehabilitation treatment.</description><subject>Anxiety</subject><subject>Anxiety - diagnosis</subject><subject>Communication</subject><subject>Complementary & alternative medicine</subject><subject>Depression</subject><subject>Depression - diagnosis</subject><subject>Difficulties in activities of daily living (ADL)</subject><subject>Disability</subject><subject>Emotions</subject><subject>Gait</subject><subject>Heart & circulation</subject><subject>Humans</subject><subject>Medicine General & Introductory Medical Sciences</subject><subject>Memory</subject><subject>Neurology</subject><subject>Postural Balance</subject><subject>Prevention & treatment of complications</subject><subject>PREVENTION AND TREATMENT OF COMPLICATIONS FOLLOWING STROKE</subject><subject>Quality of Life</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Recovery of Function</subject><subject>Social Participation</subject><subject>Stroke</subject><subject>Stroke Rehabilitation</subject><subject>Stroke Rehabilitation - methods</subject><subject>Stroke Rehabilitation - psychology</subject><subject>Yoga</subject><issn>1465-1858</issn><issn>1465-1858</issn><issn>1469-493X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>RWY</sourceid><sourceid>EIF</sourceid><recordid>eNqFkEtPwzAQhC0EolD4C1WPXFLsje0kFyQoT6kSFzhwshzHbg1pXOwU1H-Poz5UuHCypfl2ZncQGhA8IhjDJaGckZzlo_EtJoTm6WixLOEAnXRC0imHe_8eOg3hHeOUF5Adox4UAJhRcoIGb24qh8b5YWi9-9BDr2eytLVtZWtdc4aOjKyDPt-8ffR6f_cyfkwmzw9P4-tJomiWQgIGMChTqBSI4aWhWSWBE2pUWkgFzFDNsDHEEMlTXlFqKoLLXBPAkkGRp310tfaNV8x1pXTTelmLhbdz6VfCSSt-K42dian7EpzmPN4VDS42Bt59LnVoxdwGpetaNtotgyBFxiJGOIsoX6PKuxC8NrsYgkVXrtiWK7blduEQBwf7S-7Gtm1G4GYNfNtar4RyauZj_j--f1J-AOJ9iXw</recordid><startdate>20171208</startdate><enddate>20171208</enddate><creator>Lawrence, Maggie</creator><creator>Celestino Junior, Francisco T</creator><creator>Matozinho, Hemilianna HS</creator><creator>Govan, Lindsay</creator><creator>Booth, Jo</creator><creator>Beecher, Jane</creator><creator>Lawrence, Maggie</creator><general>John Wiley & Sons, Ltd</general><scope>7PX</scope><scope>RWY</scope><scope>ZYTZH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20171208</creationdate><title>Yoga for stroke rehabilitation</title><author>Lawrence, Maggie ; Celestino Junior, Francisco T ; Matozinho, Hemilianna HS ; Govan, Lindsay ; Booth, Jo ; Beecher, Jane ; Lawrence, Maggie</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4732-2f202cf9c321f6bf47da2614fc39ac25f4e50ff1f1a636d44fd10b8e120a52983</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Anxiety</topic><topic>Anxiety - diagnosis</topic><topic>Communication</topic><topic>Complementary & alternative medicine</topic><topic>Depression</topic><topic>Depression - diagnosis</topic><topic>Difficulties in activities of daily living (ADL)</topic><topic>Disability</topic><topic>Emotions</topic><topic>Gait</topic><topic>Heart & circulation</topic><topic>Humans</topic><topic>Medicine General & Introductory Medical Sciences</topic><topic>Memory</topic><topic>Neurology</topic><topic>Postural Balance</topic><topic>Prevention & treatment of complications</topic><topic>PREVENTION AND TREATMENT OF COMPLICATIONS FOLLOWING STROKE</topic><topic>Quality of Life</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Recovery of Function</topic><topic>Social Participation</topic><topic>Stroke</topic><topic>Stroke Rehabilitation</topic><topic>Stroke Rehabilitation - methods</topic><topic>Stroke Rehabilitation - psychology</topic><topic>Yoga</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lawrence, Maggie</creatorcontrib><creatorcontrib>Celestino Junior, Francisco T</creatorcontrib><creatorcontrib>Matozinho, Hemilianna HS</creatorcontrib><creatorcontrib>Govan, Lindsay</creatorcontrib><creatorcontrib>Booth, Jo</creatorcontrib><creatorcontrib>Beecher, Jane</creatorcontrib><creatorcontrib>Lawrence, Maggie</creatorcontrib><collection>Wiley-Blackwell Cochrane Library</collection><collection>Cochrane Library</collection><collection>Cochrane Library (Open Aceess)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Cochrane database of systematic reviews</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lawrence, Maggie</au><au>Celestino Junior, Francisco T</au><au>Matozinho, Hemilianna HS</au><au>Govan, Lindsay</au><au>Booth, Jo</au><au>Beecher, Jane</au><au>Lawrence, Maggie</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Yoga for stroke rehabilitation</atitle><jtitle>Cochrane database of systematic reviews</jtitle><addtitle>Cochrane Database Syst Rev</addtitle><date>2017-12-08</date><risdate>2017</risdate><volume>2017</volume><issue>12</issue><spage>CD011483</spage><epage>CD011483</epage><pages>CD011483-CD011483</pages><issn>1465-1858</issn><eissn>1465-1858</eissn><eissn>1469-493X</eissn><abstract>Background
Stroke is a major health issue and cause of long‐term disability and has a major emotional and socioeconomic impact. There is a need to explore options for long‐term sustainable interventions that support stroke survivors to engage in meaningful activities to address life challenges after stroke. Rehabilitation focuses on recovery of function and cognition to the maximum level achievable, and may include a wide range of complementary strategies including yoga.
Yoga is a mind‐body practice that originated in India, and which has become increasingly widespread in the Western world. Recent evidence highlights the positive effects of yoga for people with a range of physical and psychological health conditions. A recent non‐Cochrane systematic review concluded that yoga can be used as self‐administered practice in stroke rehabilitation.
Objectives
To assess the effectiveness of yoga, as a stroke rehabilitation intervention, on recovery of function and quality of life (QoL).
Search methods
We searched the Cochrane Stroke Group Trials Register (last searched July 2017), Cochrane Central Register of Controlled Trials (CENTRAL) (last searched July 2017), MEDLINE (to July 2017), Embase (to July 2017), CINAHL (to July 2017), AMED (to July 2017), PsycINFO (to July 2017), LILACS (to July 2017), SciELO (to July 2017), IndMED (to July 2017), OTseeker (to July 2017) and PEDro (to July 2017). We also searched four trials registers, and one conference s database. We screened reference lists of relevant publications and contacted authors for additional information.
Selection criteria
We included randomised controlled trials (RCTs) that compared yoga with a waiting‐list control or no intervention control in stroke survivors.
Data collection and analysis
Two review authors independently extracted data from the included studies. We performed all analyses using Review Manager (RevMan). One review author entered the data into RevMan; another checked the entries. We discussed disagreements with a third review author until consensus was reached. We used the Cochrane 'Risk of bias' tool. Where we considered studies to be sufficiently similar, we conducted a meta‐analysis by pooling the appropriate data. For outcomes for which it was inappropriate or impossible to pool quantitatively, we conducted a descriptive analysis and provided a narrative summary.
Main results
We included two RCTs involving 72 participants. Sixty‐nine participants were included in one meta‐analysis (balance). Both trials assessed QoL, along with secondary outcomes measures relating to movement and psychological outcomes; one also measured disability.
In one study the Stroke Impact Scale was used to measure QoL across six domains, at baseline and post‐intervention. The effect of yoga on five domains (physical, emotion, communication, social participation, stroke recovery) was not significant; however, the effect of yoga on the memory domain was significant (mean difference (MD) 15.30, 95% confidence interval (CI) 1.29 to 29.31, P = 0.03), the evidence for this finding was very low grade. In the second study, QoL was assessed using the Stroke‐Specifc QoL Scale; no significant effect was found.
Secondary outcomes included movement, strength and endurance, and psychological variables, pain, and disability.
Balance was measured in both studies using the Berg Balance Scale; the effect of intervention was not significant (MD 2.38, 95% CI ‐1.41 to 6.17, P = 0.22). Sensititivy analysis did not alter the direction of effect. One study measured balance self‐efficacy, using the Activities‐specific Balance Confidence Scale (MD 10.60, 95% CI ‐7.08,= to 28.28, P = 0.24); the effect of intervention was not significant; the evidence for this finding was very low grade.
One study measured gait using the Comfortable Speed Gait Test (MD 1.32, 95% CI ‐1.35 to 3.99, P = 0.33), and motor function using the Motor Assessment Scale (MD ‐4.00, 95% CI ‐12.42 to 4.42, P = 0.35); no significant effect was found based on very low‐grade evidence.
One study measured disability using the modified Rankin Scale (mRS) but reported only whether participants were independent or dependent. No significant effect was found: (odds ratio (OR) 2.08, 95% CI 0.50 to 8.60, P = 0.31); the evidence for this finding was very low grade.
Anxiety and depression were measured in one study. Three measures were used: the Geriatric Depression Scale‐Short Form (GCDS15), and two forms of State Trait Anxiety Inventory (STAI, Form Y) to measure state anxiety (i.e. anxiety experienced in response to stressful situations) and trait anxiety (i.e. anxiety associated with chronic psychological disorders). No significant effect was found for depression (GDS15, MD ‐2.10, 95% CI ‐4.70 to 0.50, P = 0.11) or for trait anxiety (STAI‐Y2, MD ‐6.70, 95% CI ‐15.35 to 1.95, P = 0.13), based on very low‐grade evidence. However, a significant effect was found for state anxiety: STAI‐Y1 (MD ‐8.40, 95% CI ‐16.74 to ‐0.06, P = 0.05); the evidence for this finding was very low grade.
No adverse events were reported.
Quality of the evidence
We assessed the quality of the evidence using GRADE. Overall, the quality of the evidence was very low, due to the small number of trials included in the review both of which were judged to be at high risk of bias, particularly in relation to incompleteness of data and selective reporting, and especially regarding the representative nature of the sample in one study.
Authors' conclusions
Yoga has the potential for being included as part of patient‐centred stroke rehabilitation. However, this review has identified insufficient information to confirm or refute the effectiveness or safety of yoga as a stroke rehabilitation treatment. Further large‐scale methodologically robust trials are required to establish the effectiveness of yoga as a stroke rehabilitation treatment.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>29220541</pmid><doi>10.1002/14651858.CD011483.pub2</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1465-1858 |
| ispartof | Cochrane database of systematic reviews, 2017-12, Vol.2017 (12), p.CD011483-CD011483 |
| issn | 1465-1858 1465-1858 1469-493X |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6486003 |
| source | MEDLINE; Cochrane Library; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Anxiety Anxiety - diagnosis Communication Complementary & alternative medicine Depression Depression - diagnosis Difficulties in activities of daily living (ADL) Disability Emotions Gait Heart & circulation Humans Medicine General & Introductory Medical Sciences Memory Neurology Postural Balance Prevention & treatment of complications PREVENTION AND TREATMENT OF COMPLICATIONS FOLLOWING STROKE Quality of Life Randomized Controlled Trials as Topic Recovery of Function Social Participation Stroke Stroke Rehabilitation Stroke Rehabilitation - methods Stroke Rehabilitation - psychology Yoga |
| title | Yoga for stroke rehabilitation |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-13T16%3A47%3A42IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Yoga%20for%20stroke%20rehabilitation&rft.jtitle=Cochrane%20database%20of%20systematic%20reviews&rft.au=Lawrence,%20Maggie&rft.date=2017-12-08&rft.volume=2017&rft.issue=12&rft.spage=CD011483&rft.epage=CD011483&rft.pages=CD011483-CD011483&rft.issn=1465-1858&rft.eissn=1465-1858&rft_id=info:doi/10.1002/14651858.CD011483.pub2&rft_dat=%3Cproquest_pubme%3E1975033165%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1975033165&rft_id=info:pmid/29220541&rfr_iscdi=true |