This repeat systematic reviews and meta-analysis should never have to occur if we had a decent database of all stroke research and protocols, updated as new research comes in. But our fucking failures of stroke associations can't see the need and create one.
rhythmic auditory cueing (8 posts to April 2016)
bilateral leg training with rhythmic auditory cueing (1 post to June 2020)
The latest here:
Effects of rhythmic auditory stimulation on motor function and balance ability in stroke: A systematic review and meta-analysis of clinical randomized controlled studies
Lei Wang
Jin-lin Peng2, 
Wu Xiang
Yi-jie Huang- 1Department of Rehabilitation Medicine, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
- 2Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
- 3Department of Rehabilitation, Beibei Traditional Chinese Medical Hospital, Chongqing, China
- 4Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
Objective: Rhythmic auditory stimulation (RAS) belongs to neurologic music therapy, which has attracted clinical attention because of its efficacy in motor function after stroke. This study aimed to summarize the effectiveness of rhythmic auditory stimulation (RAS) for the treatment of motor function and balance ability in stroke through a systematic review and meta-analysis.
Methods: All studies were retrieved from six databases. The effects of RAS on stroke were determined using the following indicators: motor function including step length, step cadence, velocity, Fugl–Meyer assessment (FMA); and balance ability including overall balance index (OBI) and Berg Balance Scale (BBS). The risk map of bias of the quality of the studies and the meta-analysis results of the indicators was prepared using RevMan 5.2 software.
Results: A total of 1,363 abstracts were retrieved. Among them, 325 duplicate studies were eliminated, and 971 studies were excluded after reading the titles and abstracts. In addition, by downloading the full text for further reading and screening, 47 studies were excluded. A total of 22 studies were included in the systematic review, and 18 studies were included in the meta-analysis. Assessment of quality, based on the PEDro scale, two studies had low quality, three studies had excellent quality, and the other studies had good quality; based on the Cochrane Collaborative Network Bias Risk Assessment Scale. A total of 15 studies specifically explained the random methods used. Meanwhile, seven studies did not report random sequence generation. A total of 10 studies reported that the evaluation of experimental results was blinded. In the meta-analysis, the results of motor function [namely, velocity (SMD = 0.99, 95% CI (0.43, 1.55)), step length (SMD = 0.97, 95% CI (0.74, 1.20)), and step cadence (MD = 5.16, 95% CI (4.17, 6.14)), FMA (MD = 2.93, 95% CI (2.04, 3.83))], were statistically significant (P < 0.01). The results of balance ability [OBI (MD = −0.51, 95% CI (−0.86, −0.16)) and BBS (MD = 2.93, 95% CI (1.67, 4.20))], were also statistically significant (P < 0.01). Among all the outcome indicators, three indicators were included in more than 10 studies: these are step length, step cadence, and velocity. The results showed that the two sides of the funnel chart were asymmetrical, thus these results all showed heterogeneity. The GRADEpro GDT online tool was used to evaluate the quality of evidence for the outcome indicators in the included studies. Five outcome indicators were included, of which three were low-quality indicators and two were moderate-quality indicators.
Conclusions: RAS could improve gait parameters, walking function, and balance ability of individuals with stroke. However, studies or samples of outcome indicators for balance ability of stroke patients is relatively insufficient, which also requires further research in the future.
Systematic review registration: PROSPERO, identifier: CRD42021225102.
Introduction
Stroke is the second leading cause of death and the third leading cause of disability worldwide (Feigin et al., 2022), with more than 13 million new stroke cases annually (GBD 2016 Neurology Collaborators, 2019). In the 2022 World Stroke Organization (WSO) report, from 1990 to 2019, stroke events and stroke-related deaths increased by 70.0 and 43.0%, respectively (Feigin et al., 2022). Recently, stroke mortality has declined with improved medical care and preventive measures, however, the absolute number of new stroke cases annually has increased, thereby leading to a growing burden of stroke-related disability (Feigin et al., 2014; Platz, 2019). One-third of patients with stroke are permanently disabled, and more than half of stroke survivors aged 65 years and older have mobility impairment (Virani et al., 2020). Thus, these trends will continue with the development of the population on average as people are growing older (Platz, 2019).
Motor dysfunction is one of the most common consequences of stroke and includes impairment of coordination and postural control (Langhorne et al., 2009). About 60% of stroke patients have difficulty walking (Mehrholz et al., 2014) because of motor and sensory disturbances on the hemiplegic side, in addition to symptoms, such as spasticity and cognitive impairment that may further hinder walking. Therefore, gait recovery is often the focus of rehabilitation efforts to enhance not only physical activity but also autonomy and participation in daily life (Mainka et al., 2018). Therefore, gait recovery is the most important goal of rehabilitation programs for patients with stroke (Lee et al., 2018). In clinical practice, some therapeutic methods are used to treat motor dysfunction after stroke and show good efficacy, such as Neurologic music therapy, repetitive transcranial magnetic stimulation(rTMS) (Fan et al., 2021) and Virtual reality (Turolla et al., 2013).
Neurologic music therapy, a crucial complementary therapy, is currently used in the rehabilitation of movement, speech, and cognition and is accepted in the medical field (Thaut et al., 2014). Rhythmic auditory stimulation (RAS) is a technology in neurologic music therapy and is based on rhythmic and repetitive auditory stimuli (Yoo and Kim, 2016). RAS uses an external rhythm (music) to facilitate internally generated rhythmic movements, such as walking (Thaut, 2015). In addition, RAS can be used as auditory cues for walking and may facilitate internal neural timing among post-stroke patients from a neurophysiological perspective (Ghai and Ghai, 2019). One of the earliest and relevant studies about the use of RAS in stroke rehabilitation was conducted by Thaut et al. (1993): they observed that RAS can effectively reduce stride time variability and more balanced muscle activation patterns between hemiplegic and unaffected limbs. Moreover, RAS may lead to improved lower extremity and gait function after stroke and can easily be used as adjunctive therapy (Thaut, 2015). Suh et al. also confirmed that RAS with significant effects on improving balance as well as gait coordination and symmetry (Suh et al., 2014), Yang et al. also confirmed this conclusion (Yang et al., 2016). Furthermore, several studies support the use of gait training with RAS in the chronic phase of stroke because it improves walking speed and flexibility (Ko et al., 2016; Wright et al., 2017). In the last 20 years, the of RAS for stroke treatment has been widely investigated. Nascimento et al. (2015), which provided evidence that rhythm cue training can improve walking speed and stride length more than walking training alone. It can also benefit from the rhythm and symmetry of walking. This review includes only seven trials with a total of 211 participants, including randomized controlled trials (RCT) and clinical controlled trials (CCT). Yoo and Kim (2016) in a review obtained the beneficial effects of RAS through meta-analysis, which confirmed that RAS can improve the gait parameters and other motor functions of patients, thus supporting its application in widening the rehabilitation field of stroke patients. The study was published in 2016, and only 10 studies (RCT or CCT) were included in the meta-analysis, with a total of 356 subjects. However, the above two studies have some limitations in the number of articles, the number of participants, and the quality of studies (Nascimento et al., 2015; Yoo and Kim, 2016). In addition, those studies' systematic reviews did not involve research on the balance ability of stroke patients. Therefore, the scientific basis of the influence of RAS on gait should be based on high-quality evidence-based medicine by incorporating more high-quality literature.
Thus, this study aimed to determine the effect of rhythmic auditory stimulation on the rehabilitation of patients with stroke and movement disorders through a systematic review and meta-analysis of the literature. This study will include more RCT studies to further improve the quantity and quality of articles to improve the evidence of evidence-based medicine. This work also provides strong evidence for the use of RAS to treat stroke and analyze the deficiencies of previous studies.
Methods
Herein, a systematic review was planned and conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement (Cumpston et al., 2019) and was registered with PROSPERO (registration number CRD42021225102). A PRISMA checklist is provided in Supplementary material 1.
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