Biomechanical differences at the hemiparetic knee in people with stroke: a systematic review and meta-analysis protocol

Abstract

Background

Understanding the effect of stroke on knee biomechanics in gait is important for clinicians and practitioners who work with people with stroke. Biomechanical differences have been established between the hemiparetic knee, and the unaffected knee and healthy controls during gait. These data have not yet been systematically summarised and analysed. This protocol describes the background and methods for a systematic review and meta-analysis of three-dimensional biomechanics of the hemiparetic knee whilst walking overground, based on data collected using optical motion capture systems.

Methods/Design

The review will be directed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two authors will independently carry out searches using Web of Science, MEDLINE, Embase, CINAHL and Scopus. The reference list of included studies will be screened for further studies by one reviewer. Observational studies and baseline data from randomised control trials will be included. Two reviewers will screen the studies, extract data and assess for bias using a modified Downs and Black quality index. Meta-analyses will be performed if sufficient data are available, and the level of evidence assessed using confidence intervals and effects sizes, and displayed in forest plots.

Discussion

Findings of the review will provide further insight into the biomechanical differences at the hemiparetic knee, which may assist with outcome measurements and planning of post-stroke rehabilitation. The findings may also be used to inform future research into the biomechanical assessment of gait in people with stroke. Trial registration: Prospero registration number CRD42019137058.

Keywords:

• Stroke
• gait
• mobility
• biomechanics
• knee

Acknowledgement

We thank Dr Gisela Sole, Associate Professor and Associate Dean (Undergraduate Studies), School of Physiotherapy, University of Otago, for her guidance in developing this protocol; and her advice and support as the first author’s (CW) primary supervisor between November 2018 and February 2020. We thank Mrs Thelma Fisher, Physiotherapy Subject Librarian, University of Otago Library, for her advice and assistance with database selection and development of the search strategy. We would also like to thank Professor Leigh Hale, Dean, and Dr Ally Calder, Lecturer, School of Physiotherapy, University of Otago, for their advice and guidance in finalising this protocol.

Contributions by authors

The first author, Clifford Waller (CW) developed the current protocol in conjunction with the listed authors. This protocol was piloted by CW and further refined as guided by the listed authors, Associate Professor Gisela Sole, and Mrs Thelma Fisher (see ‘Acknowledgements’ below). The listed authors have had an active role in the development and progression of the protocol; and the guarantors of this review are the first author’s supervisors: Professor Leigh Hale, Dr Allyson Calder, Assoc. Professor Stephanie Woodley, and Dr Peter Lamb.

Declaration of interest statement

The authors declare no conflicts of interest.

Funding

The completion of this protocol contributes to the first author’s, Cliff Waller’s, Doctoral studies at the University of Otago. As such, this protocol was supported by the University of Otago Doctoral Scholarship.

Additional information

Notes on contributors

Clifford Waller

Mr Clifford Waller is a PhD student at the Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy at the University of Otago. His research interests include neurorehabilitation, with a specific interest in stroke rehabilitation.

Bahram Sangelaji

Dr Bahram Sangelaji is a Tutor at the Department of Anatomy at the University of Otago. His research interests include clinical neurorehabilitation, with a specific interest in multiple sclerosis and stroke rehabilitation.

Peter Lamb

Dr Peter Lamb is a Senior Lecturer of biomechanics at the University of Otago. His research interests are focused on multi-limb coordination and the application of novel analyses required to study coordination.

Suzanne Kuys

Professor Suzanne Kuys is the National Head of School of Allied Health (Faculty of Health Sciences) at the Australian Catholic University. Her research interests include stroke rehabilitation, gait and balance rehabilitation, ageing, outcome measures, cardiorespiratory fitness and physical activity in chronic disease populations.

Stephanie J. Woodley

Dr Stephanie Woodley is an Associate Professor in the Department of Anatomy, University of Otago. Her research encompasses clinical anatomy and physiotherapy, with her main area of interest being musculoskeletal conditions, particularly relating to the pelvis, hip and lower limb.