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. 2022 Feb 23;17(2):e0263935.
doi: 10.1371/journal.pone.0263935. eCollection 2022.

Non-pharmacological interventions for bone health after stroke: A systematic review

Hakimah Sallehuddin  1   2 , Terence Ong  3 , Salmiah Md Said  4 , Noor Azleen Ahmad Tarmizi  5 , Siew Ping Loh  6 , Wan Chieh Lim  7 , Reena Nadarajah  8 , Hong Tak Lim  9 , Nurul Huda Mohd Zambri  10 , Yun Ying Ho  11 , Sazlina Shariff Ghazali  2   12
Affiliations

Non-pharmacological interventions for bone health after stroke: A systematic review

Hakimah Sallehuddin et al. PLoS One. .

Abstract

Objective: To examine the effectiveness and safety of non-pharmacological interventions to reduce bone loss among post-stroke adult patients.

Data sources: Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database for Systematic Reviews, MEDLINE, CINAHL, ScienceDirect, Scopus, PubMed and PeDRO databases were searched from inception up to 31st August 2021.

Methods: A systematic review of randomized controlled trials, experimental studies without randomization and prospective cohort studies with concurrent control of non-pharmacological interventions for adult stroke patients compared with placebo or other stroke care. The review outcomes were bone loss, fall and fracture. The Cochrane Risk of Bias Tools were used to assess methodological quality, and Grading of Recommendations, Assessment, Development and Evaluations Framework to assess outcome quality. Synthesis Without Meta-Analysis (SWiM) was used for result synthesis.

Results: Seven studies (n = 453) were included. The methodological and outcome qualities varied from low to moderate. There were statistically significant changes between the intervention and parallel/placebo group in bone mineral density, bone mineral content, cortical thickness and bone turnover markers with specific physical and vibration therapies (p<0.05). Falls were higher in the intervention group, but no fracture was reported.

Conclusion: There was low to moderate evidence that physical and vibration therapies significantly reduced bone loss in post-stroke patients at the expense of a higher falls rate. The sample size was small, and the interventions were highly heterogeneous with different duration, intensities and frequencies. Despite osteoporosis occurring with ageing and accelerated by stroke, there were no studies on vitamin D or protein supplementation to curb the ongoing loss. Effective, high-quality non-pharmacological intervention to improve post-stroke bone health is required.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA flow diagram for study selection.
Fig 2
Fig 2
(a). Risk of Bias (ROB) analysis for each study. (b). Summary of risk of bias across the studies.
See this image and copyright information in PMC

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