Pharma Focus Asia

Non-pharmacological Interventions for Bone Health after Stroke: A Systematic Review

Hakimah Sallehuddin, Terence Ong, Salmiah Md. Said, Noor Azleen Ahmad Tarmiz, Siew Ping Loh, Wan Chieh Lim, Reena Nadarajah, Hong Tak Lim, Nurul Huda Mohd Zambri, Yun Ying Ho, Sazlina Shariff Ghazali

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

Introduction
The risk for hip fracture is quadrupled in stroke survivors compared to healthy individuals, attributable mainly to falls and disuse osteoporosis in the paretic side. A study by Ramnemark et al. showed that fracture risk increased from 4% in the first year after stroke to 15% and 24% after 5 and 10 years, respectively. Among stroke patients with unilateral persisting paresis at the time of fracture, up to two-thirds had their fractures on the paretic side.

Methods:
Search strategy and selection of studies

A systematic review of the literature was carried out. The following online databases were searched for articles published from inception to 31st August 2021: Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database for Systematic Reviews, MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ScienceDirect, Scopus, PubMed and PeDRO.

Evaluation of methodological quality
Two review authors (HMS, YYH) independently assessed the risk of bias for each study using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions.

Effect measures
Synthesis without meta-analysis (SWiM) was carried out because the interventions and outcome measures were too diverse to yield a meaningful summary effect estimate.

Discussion
From the low to moderate-quality evidence that we gathered, we could not make a firm recommendation on the best approach to prevent bone loss in post-stroke patients. The positive and significant findings of bone loss reduction were found in the bone mineral density, bone mineral content and cortical thickness of the lower extremities among those who underwent upright weight-bearing, balance and aerobic exercises.

Citation: Sallehuddin H, Ong T, Md. Said S, Ahmad Tarmizi NA, Loh SP, Lim WC, et al. (2022) Non-pharmacological interventions for bone health after stroke: A systematic review. PLoS ONE 17(2): e0263935. https://doi.org/10.1371/journal.pone.0263935

Editor: Gausal A. Khan, Fiji National University, FIJI

Received: November 13, 2021; Accepted: January 30, 2022; Published: February 23, 2022.

Copyright: © 2022 Sallehuddin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting information files.

Funding: There is no financial support or funding for this review. The publication of this manuscript is partially funded by the Universiti Putra Malaysia Publication Fund. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

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