Top

BMC Musculoskeletal Disorders

Published in:

Open Access 01-12-2015 | Research article

Systematic review and clinical recommendations for dosage of supported home-based standing programs for adults with stroke, spinal cord injury and other neurological conditions

Authors: Ginny Paleg, Roslyn Livingstone

Published in: BMC Musculoskeletal Disorders | Issue 1/2015

Abstract

Background

Sitting for more than 8 h a day has been shown to negatively impact health and mortality while standing is the recommended healthier alternative. Home-based standing programs are commonly recommended for adults who cannot stand and/or walk independently. The aim of this systematic review is to review effectiveness of home-based standing programs for adults with neurological conditions including stroke and spinal cord injury; and to provide dosage guidelines to address body structure and function, activity and participation outcomes.

Methods

Eight electronic databases were searched, including Cochrane Library databases, MEDLINE, CINAHL and EMBASE. From 376 articles, 36 studies addressing impact of a standing intervention on adults with sub-acute or chronic neurological conditions and published between 1980 and September 2015 were included. Two reviewers independently screened titles, reviewed abstracts, evaluated full-text articles and rated quality and strength of evidence. Evidence level was rated using Oxford Centre for Evidence Based Medicine Levels and quality evaluated using a domain-based risk-of-bias rating. Outcomes were divided according to ICF components, diagnoses and dosage amounts from individual studies. GRADE and the Evidence-Alert Traffic-Lighting system were used to determine strength of recommendation and adjusted in accordance with risk-of-bias rating.

Results

Stronger evidence supports the impact of home-based supported standing programs on range of motion and activity, primarily for individuals with stroke or spinal cord injury while mixed evidence supports impact on bone mineral density. Evidence for other outcomes and populations is weak or very weak.

Conclusions

Standing should occur 30 min 5 times a week for a positive impact on most outcomes while 60 min daily is suggested for mental function and bone mineral density.

Available only for authorised users

Van der Ploeg HP, Chey T, Korda RJ, Banks E, Bauman A. Sitting time and all-cause mortality risk in 222 497 Australian Adults. Arch Intern Med. 2012;172(6):494–500. doi:10.1001/archinternmed.2011.2174.CrossRefPubMed

Van der Ploeg HP, Chey T, Ding D, Chau JY, Stamatakis E, Bauman AE. Standing time and all-cause mortality in a large cohort of Australian adults. Prev Med (Baltim). 2014;69(Dec):187–91. doi:10.1016/j.ypmed.2014.10.004.CrossRef

Katzmarzyk PT. Standing and mortality in a prospective cohort of canadian Adults. Med Sci Sports Exerc. 2014;46(5):940–6. doi:10.1249/MSS.0000000000000198.CrossRefPubMed

Arva J, Paleg G, Lange M, Lieberman J, Schmeler M, Dicianno B, et al. RESNA position on the application of wheelchair standing devices. Assist Technol. 2009;21(3):161–8. doi:10.1080/10400430903175622. quiz 169–171.CrossRefPubMed

World Health Organization. International Classification of Functioning, Disability & Health (ICF). Geneva: World Health Organization; 2001.

Sackley C, Brittle N, Patel S, Ellins J, Scott M, Wright C, et al. The prevalence of joint contractures, pressure sores, painful shoulder, other pain, falls, and depression in the year after a severely disabling stroke. Stroke. 2008;39(12):3329–34. doi:10.1161/STROKEAHA.108.518563.CrossRefPubMed

Giangregorio L, McCartney N. Bone loss and muscle atrophy in spinal cord injury: epidemiology, fracture prediction, and rehabilitation strategies. J Spinal Cord Med. 2006;29(5):489–500. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1949032&tool=pmcentrez&rendertype=abstract.PubMedCentralPubMed

Hoang PD, Gandevia SC, Herbert RD. Prevalence of joint contractures and muscle weakness in people with multiple sclerosis. Disabil Rehabil. 2013:1–6. doi:10.3109/09638288.2013.854841.

Fergusson D, Hutton B, Drodge A. The epidemiology of major joint contractures: a systematic review of the literature. Clin Orthop Relat Res. 2007;456(456):22–9. doi:10.1097/BLO.0b013e3180308456.CrossRefPubMed

10.

Kwah LK, Harvey LA, Diong JHL, Herbert RD. Half of the adults who present to hospital with stroke develop at least one contracture within six months: an observational study. J Physiother. 2012;58(1):41–7. doi:10.1016/S1836-9553(12)70071-1.CrossRefPubMed

11.

Singer BJ, Jegasothy GM, Singer KP, Allison GT, Dunne JW. Incidence of ankle contracture after moderate to severe acquired brain injury. Arch Phys Med Rehabil. 2004;85(9):1465–9. doi:10.1016/j.apmr.2003.08.103.CrossRefPubMed

12.

Glickman L, Geigle P, Paleg G. A systematic review of supported standing programs. J Pediatr Rehabil Med. 2010;3(3):197–213.PubMed

13.

Newman M, Barker K. The effect of supported standing in adults with upper motor neurone disorders: a systematic review. Clin Rehabil. 2012;26(12):1059–77. doi:10.1177/0269215512443373.CrossRefPubMed

14.

Abramson A, Delagi E. Influence of weight-bearing and muscle contraction on disuse osteoporosis. Arch Phys Med Rehabil. 1961:147–51. http://europepmc.org/abstract/MED/13681127. Accessed April 21, 2014.

15.

Climo S. The erect position as an aid in the care of the paraplegic. Plast Reconstr Surg. 1954;13(1):65–9.CrossRef

16.

Kim K. The Kim self-stander for wheelchair patients. Arch Phys Med Rehabil. 1961;42:599–601.PubMed

17.

Machek O. A new standing table. Am J Occup Ther. 1955;9(4):158–63.PubMed

18.

Rogers E. The care of paraplegic patients in general hospitals. Can Med Assoc J. 1948;59(8):338–43. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1591168&tool=pmcentrez&rendertype=abstract.PubMedCentralPubMed

19.

Willhite C. The quadriplegic standing frame. Arch Phys Med Rehabil. 1954;35(4):236–9.PubMed

20.

Eng J, Levins S, Townson A, Mah-Jones D, Bremner J, Huston G. Use of prolonged standing for individuals with spinal cord injuries. Phys Ther. 2001;81(8):1392–9. http://physther.net/content/81/8/1392.short. Accessed December 31, 2012.PubMed

21.

Warren B, Brewer J, Herrara E, Perkash I. The frequency of standing frame use in a spinal cord injured outpatient population. In: American Corrective Therapy Association National Conference, New York. Palo Alto: VAMC; 1985.

22.

Walter J, Sola P, Sacks J, Lucero Y, Langbein E, Weaver F. Implications for a home standing program for individuals with spinal cord injury. J Spinal Cord Med. 1999;22(3):152–8.PubMed

23.

Moher D, Liberati A, Tetzlaff J, Altman D. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med. 2009;6(6):e1000097.CrossRefPubMedCentralPubMed

24.

Higgins J, Green S. Cochrane handbook for systematic reviews of interventions 5.1.0, The Cochrane Collaboration. 2011.

25.

OCEBM Levels of Evidence Working Group. The Oxford Levels of Evidence 2. Oxford Cent Evid Based Med. 2011;1. www.cebm.net/index.aspx?o=5653.

26.

Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64(4):383–94. doi:10.1016/j.jclinepi.2010.04.026.CrossRefPubMed

27.

Novak I. Evidence to practice commentary: the evidence alert traffic light grading system. Phys Occup Ther Pediatr. 2012;32(3):256–9. doi:10.3109/01942638.2012.698148.CrossRefPubMed

28.

Adams MM, Hicks AL. Comparison of the effects of body-weight-supported treadmill training and tilt-table standing on spasticity in individuals with chronic spinal cord injury. J Spinal Cord Med. 2011;34(5):488–94. doi:10.1179/2045772311Y.0000000028.CrossRefPubMedCentralPubMed

29.

Alekna V, Tamulaitiene M, Sinevicius T, Juocevicius A. Effect of weight-bearing activities on bone mineral density in spinal cord injured patients during the period of the first two years. Spinal Cord. 2008;46(11):727–32. doi:10.1038/sc.2008.36.CrossRefPubMed

30.

Allison R, Dennett R. Pilot randomized controlled trial to assess the impact of additional supported standing practice on functional ability post stroke. Clin Rehabil. 2007;21(7):614–9. doi:10.1177/0269215507077364.CrossRefPubMed

31.

Bagley P, Hudson M, Forster A, Smith J, Young J. A randomized trial evaluation of the Oswestry Standing Frame for patients after stroke. Clin Rehabil. 2005;19:354–64.CrossRefPubMed

32.

Baker K, Cassidy E, Rone-Adams S. Therapeutic standing for people with multiple sclerosis: efficacy and feasibility. Int J Ther Rehabil. 2007;14(3):104–9.CrossRef

33.

Ben M, Harvey L, Denis S, Glinsky J, Goehl G, Chee S, et al. Does 12 weeks of regular standing prevent loss of ankle mobility and bone mineral density in people with recent spinal cord injuries ? Aust J Physiother. 2001;51:251–6.CrossRef

34.

Bohannon R, Larkin P. Passive ankle dorsiflexion increases in patients after a regimen of tilt table-wedge board standing a clinical report. Phys Ther. 1985;65(11):1676–8. http://physther.net/content/65/11/1676.short. Accessed January 2, 2013.PubMed

35.

Bohannon R. Tilt table standing for reducing spasticity after spinal cord injury. Arch Phys Med Rehabil. 1993;74:1121–2.CrossRefPubMed

36.

Cotie LM, Geurts CLM, Adams MME, MacDonald MJ. Leg skin temperature with body-weight-supported treadmill and tilt-table standing training after spinal cord injury. Spinal Cord. 2010;49(1):149–53. doi:10.1038/sc.2010.52.CrossRefPubMed

37.

De Bruin ED, Frey-Rindova P, Herzog RE, Deitz V, Dambacher MA, Stüssi E. Changes of tibia bone properties after spinal cord injury : effects of early intervention. Arch Phys Med Rehabil. 1999;80(February):214–20.CrossRefPubMed

38.

Dunn R, Walter J, Lucero Y. Follow-up assessment of standing mobility device users. Assist Technol. 1998;10:84–93. http://www.tandfonline.com/doi/abs/10.1080/10400435.1998.10131966. Accessed December 31, 2012.CrossRefPubMed

39.

Edwards LC, Layne CS. Effect of dynamic weight bearing on neuromuscular activation after spinal cord injury. Am J Phys Med Rehabil. 2007;86(6):499–506. doi:10.1097/PHM.0b013e31805b764b.CrossRefPubMed

40.

Eser P, de Bruin ED, Telley I, Lechner HE, Knecht H, Stüssi E. Effect of electrical stimulation-induced cycling on bone mineral density in spinal cord-injured patients. Eur J Clin Invest. 2003;33(5):412–9. http://www.ncbi.nlm.nih.gov/pubmed/12713456.CrossRefPubMed

41.

Frey-Rindova P, De Bruin E, Stüssi E, Dumbacher M, Dietz V. Bone mineral density in upper and lower extremities during 12 months after spinal cord injury measured by peripheral quantitative computed tomography. Spinal Cord. 2000;38:26–32. http://ukpmc.ac.uk/abstract/MED/10762194. Accessed December 31, 2012.CrossRefPubMed

42.

Goemaere S, Laere M Van. Bone mineral status in paraplegic patients who do or do not perform standing. Osteoporos Int. 1994;4:138–43. http://www.springerlink.com/index/X72N6T6G5L18G0LQ.pdf. Accessed December 31, 2012.

43.

Goktepe A, Tugcu I, Yilmaz B. Does standing protect bone density in patients with chronic spinal cord injury. J Spinal Cord Med. 2008;31:197–201. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2565474/. Accessed January 1, 2013.

44.

Hoenig H, Murphy T. Case study to evaluate a standing table for managing constipation. SCI Nurs. 2001;18(2):74–7. http://ukpmc.ac.uk/abstract/MED/12035465. Accessed January 2, 2013.

45.

Kunkel C, Scremin A, Eisenberg B, Garcia J, Roberts S, Martinez S. Effect of “standing” on spasticity, contracture, and osteoporosis in paralyzed males. Arch Phys Med Rehabil. 1993;74:73–8. http://ukpmc.ac.uk/abstract/MED/8420525. Accessed January 2, 2013.

46.

Kuznetsov AN, Rybalko NV, Daminov VD, Luft AR. Early poststroke rehabilitation using a robotic tilt-table stepper and functional electrical stimulation. Stroke Res Treat. 2013;2013(Article ID 946056):1–9. doi:10.1155/2013/946056.CrossRef

47.

Lee M, Wong M, Tang F. Clinical evaluation of a new biofeedback standing balance training device. J Med Eng. 1996;20(2):60–6. http://informahealthcare.com/doi/abs/10.3109/03091909609008381. Accessed February 27, 2013.

48.

Matjacić Z, Hesse S, Sinkjaer T. BalanceReTrainer: a new standing-balance training apparatus and methods applied to a chronic hemiparetic subject with a neglect syndrome. NeuroRehabilitation. 2003;18(3):251–9. http://www.ncbi.nlm.nih.gov/pubmed/14530590.PubMed

49.

Nelson D, Schau E. Effects of a standing table on work productivity and posture in an adult with developmental disabilities. Work. 1997;9:13–20. http://www.ingentaconnect.com/content/els/10519815/1997/00000009/00000001/art00019. Accessed February 4, 2013.

50.

Netz Y, Argov E, Burstin A, Brown R, Heyman SN, Dunsky A, et al. Use of a device to support standing during a physical activity program to improve function of individuals with disabilities who reside in a nursing home. Disabil Rehabil Assist Technol. 2007;2(1):43–9. doi:10.1080/17483100601143371.CrossRefPubMed

51.

Odeen I, Knutsson E. Evaluation of the effects of muscle stretch and weight load in patients with spastic paraplegia. Scand J Rehabil Med. 1981;13(4):117–21. http://ukpmc.ac.uk/abstract/MED/7347432. Accessed March 4, 2013.

52.

Richardson D. The use of the tilt-table to effect passive tendo-achilles stretch in a patient with head injury. Physiother Theory Pract. 1991;7:45–50.CrossRef

53.

Robinson W, Smith R, Aung O, Ada L. No difference between wearing a night splint and standing on a tilt table in preventing ankle contracture early after stroke: a randomised trial. Aust J Physiother. 2008;54:33–8. http://svc019.wic048p.server-web.com/ajp/vol_54/1/AustJPhysiotherv54i1Robinson.pdf. Accessed December 31, 2012.

54.

Shields RK, Dudley-Javoroski S. Monitoring standing wheelchair use after spinal cord injury: a case report. Disabil Rehabil. 2005;27(3):142–6. doi:10.1080/09638280400009337.CrossRefPubMedCentralPubMed

55.

Singer B, Dunne J, Singer K, Jegasothy G, Allison G. Non-surgical management of ankle contracture following acquired brain injury. Disabil Rehabil. 2004;26(6):335–45. doi:10.1080/0963828032000174070.CrossRefPubMed

56.

Wong A, Lee M. The development and clinical evaluation of a standing biofeedback trainer. J Rehabil Res Dev. 1997;34(3):322–27. http://www.rehab.research.va.gov/jour/97/34/3/pdf/wong.pdf. Accessed February 4, 2013.

57.

Kim C-Y, Lee J-S, Kim H-D, Kim J-S. The effect of progressive task-oriented training on a supplementary tilt table on lower extremity muscle strength and gait recovery in patients with hemiplegic stroke. Gait Posture. 2015;41(2):425–30. doi:10.1016/j.gaitpost.2014.11.004.CrossRefPubMed

58.

Kim C-Y, Lee J-S, Kim H-D, Kim J, Lee I-H. Lower extremity muscle activation and function in progressive task-oriented training on the supplementary tilt table during stepping-like movements in patients with acute stroke hemiparesis. J Electromyogr Kinesiol. 2015;25(3):522–30. doi:10.1016/j.jelekin.2015.03.004.CrossRefPubMed

59.

Kwok S, Harvey L, Glinsky J, Bowden JL, Coggrave M, Tussler D. Does regular standing improve bowel function in people with spinal cord injury? A randomised crossover trial. Spinal Cord. 2015;53(1):36–41. doi:10.1038/sc.2014.189.CrossRefPubMed

60.

Taveggia G, Ragusa I, Trani V, Cuva D, Angeretti C, Fontanella M, et al. Robotic tilt table reduces the occurrence of orthostatic hypotension over time in vegetative states. Int J Rehabil Res. 2015;38(2):162–6. doi:10.1097/MRR.0000000000000104.CrossRefPubMed

61.

Aukland K, Lombard I, Paleg G. Considerations in passive standing programs for clients who are medically fragile. Pediatr Phys Ther. 2004;16(1):49.CrossRef

62.

Hendrie W. Stand and deliver! How the use of an Owestry standing frame improved sitting balance and function in a case of secondary progressive MS. Synapse. 2005;Autumn/Win:20–2.

63.

Biering-Sørensen F, Hansen RB, Biering-Sørensen J. Mobility aids and transport possibilities 10–45 years after spinal cord injury. Spinal Cord. 2004;42(12):699–706. doi:10.1038/sj.sc.3101649.CrossRefPubMed

64.

Yaziciotiu. The effect of tilt table therapy on pulmonary functions in tetraplegic and high level paraplegic patients. Turkiye Fiz Ripve Rehabil Derg. 2013;59:490.

65.

Bernhardt KA, Beck LA, Lamb JL, Kaufman KR, Amin S, Wuermser L-A. Weight bearing through lower limbs in a standing frame with and without arm support and low-magnitude whole-body vibration in men and women with complete motor paraplegia. Am J Phys Med Rehabil. 2012;91(4):300–8. doi:10.1097/PHM.0b013e31824aab03.CrossRefPubMedCentralPubMed

66.

Gould DW, Hsieh ACL, Tinckler LF, Physiol J. The effect of posture on bladder pressure. J Physiol. 1955;129:448–53.CrossRefPubMedCentralPubMed

67.

Bakewell J. Choosing support equipment in children’s therapy. Int J Ther Rehabil. 2007;14(8):379–81.CrossRef

68.

Kreutz D. Standing frames and standing wheelchairs: Implications for standing. Top Spinal Cord Inj Rehabil. 2000;5(4):24–8. http://thomasland.metapress.com/index/P8YCWGEHC1VP2VC1.pdf. Accessed January 1, 2013.

69.

Sprigle S, Maurer C, Soneblum SE, Sorenblum SE. Load redistribution in variable position wheelchairs in people with spinal cord injury. J Spinal Cord Med. 2010;33(1):58–64. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2853329&tool=pmcentrez&rendertype=abstract.

70.

Chelvarajah R, Knight SL, Craggs MD, Middleton FR. Orthostatic hypotension following spinal cord injury: impact on the use of standing apparatus. NeuroRehabilitation. 2009;24(3):237–42. doi:10.3233/NRE-2009-0474.PubMed

71.

Figoni S. Cardiovascular and haemodynamic responses to tilting and to standing in tetraplegic patients: a review. Paraplegia. 1984;22:99–109. http://www.nature.com/sc/journal/v22/n2/abs/sc198418a.html. Accessed March 7, 2013.

72.

Chao CY, Cheing GL. The effects of lower-extremity functional electric stimulation on the orthostatic responses of people with Tetraplegia. Arch Phys Med Rehabil. 2005;86(7):1427–33. doi:10.1016/j.apmr.2004.12.033.CrossRefPubMed

73.

Faghri PD, Yount JP, Pesce WJ, Seetharama S, Votto JJ. Circulatory hypokinesis and functional electric stimulation during standing in persons with spinal cord injury. Arch Phys Med Rehabil. 2001;82(11):1587–95. doi:10.1053/apmr.2001.25984.CrossRefPubMed

74.

Faghri PD, Yount J. Electrically induced and voluntary activation of physiologic muscle pump: a comparison between spinal cord-injured and able-bodied individuals. Clin Rehabil. 2002;16(8):878–85. http://www.ncbi.nlm.nih.gov/pubmed/12501950.CrossRefPubMed

75.

Jacobs P, Johnson B, Mahoney E. Physiologic responses to electrically assisted and frame-supported standing in persons with paraplegia. J Spinal Cord Med. 2003;26:384–9. http://www.ncbi.nlm.nih.gov/pubmed/14992341. Accessed January 2, 2013.PubMed

76.

Craven CTD, Gollee H, Coupaud S, Purcell MA, Allan DB. Investigation of robotic-assisted tilt-table therapy for early-stage spinal cord injury rehabilitation. J Rehabil Res Dev. 2013;50(3):367–78. http://www.ncbi.nlm.nih.gov/pubmed/23881763.CrossRefPubMed

77.

Luther MS, Krewer C, Müller F, Koenig E. Comparison of orthostatic reactions of patients still unconscious within the first three months of brain injury on a tilt table with and without integrated stepping. A prospective, randomized crossover pilot trial. Clin Rehabil. 2008;22(12):1034–41. doi:10.1177/0269215508092821.CrossRefPubMed

78.

Yoshida T, Masani K, Sayenko DG, Miyatani M, Fisher JA, Popovic MR. Cardiovascular response of individuals with spinal cord injury to dynamic functional electrical stimulation under orthostatic stress. IEEE Trans Neural Syst Rehabil Eng. 2013;21(1):37–46. doi:10.1109/TNSRE.2012.2211894.CrossRefPubMed

79.

Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348(March):g1687. doi:10.1136/bmj.g1687.CrossRefPubMed

Title: Systematic review and clinical recommendations for dosage of supported home-based standing programs for adults with stroke, spinal cord injury and other neurological conditions
Authors: Ginny Paleg
Roslyn Livingstone
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2015
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-015-0813-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Systematic review and clinical recommendations for dosage of supported home-based standing programs for adults with stroke, spinal cord injury and other neurological conditions

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2015

Comparing parecoxib and ketorolac as preemptive analgesia in patients undergoing posterior lumbar spinal fusion: a prospective randomized double-blinded placebo-controlled trial

The disease-modifying effect of dehydroepiandrosterone in different stages of experimentally induced osteoarthritis: a histomorphometric study

Gait and lower limb muscle strength in women after triple innominate osteotomy

Relationship between probability of future shoulder arthroplasty and outcomes of arthroscopic debridement in patients with advanced osteoarthritis of glenohumeral joint

Comorbidities, intensity, frequency and duration of pain, daily functioning and health care seeking in local, regional, and widespread pain—a descriptive population-based survey (SwePain)

Does a minimal invasive approach reduce anterior chest wall numbness and postoperative pain in plate fixation of clavicle fractures?