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


Sallehuddin, Hakimah and Ong, Terence and Md. Said, Salmiah and Ahmad Tarmizi, Noor Azleen and Loh, Siew Ping and Wan, Chieh Lim and Nadarajah, Reena and Lim, Hong Tak and Mohd Zambri, Nurul Huda and Mohd Zambri, Nurul Huda and Shariff Ghazali, Sazlina (2022) Non-pharmacological interventions for bone health after stroke: a systematic review. PL o S One, 17. pp. 1-17. ISSN 1932-6203


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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Additional Metadata

Item Type: Article
Divisions: Faculty of Medicine and Health Science
Malaysian Research Institute on Ageing
DOI Number: https://doi.org/10.1371/journal.pone.0263935
Publisher: Public Library of Science
Keywords: Hip fracture; Stroke survivors; Paretic side; Fracture risk
Depositing User: Ms. Che Wa Zakaria
Date Deposited: 08 Jun 2023 02:14
Last Modified: 08 Jun 2023 02:14
Altmetrics: http://www.altmetric.com/details.php?domain=psasir.upm.edu.my&doi=10.1371/journal.pone.0263935
URI: http://psasir.upm.edu.my/id/eprint/102327
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