Balance training (proprioceptive training) for rheumatoid arthritis.

This summary of a Cochrane review presents what we know from research about the effect of balance training on rheumatoid arthritis.

The review shows that in people with rheumatoid arthritis:

We are unsure of the effects of balance training because no studies met the review's inclusion criteria. Further randomised controlled trials are required to evaluate the effectiveness and safety of balance exercises (proprioceptive training) alone in patients with rheumatoid arthritis

What is rheumatoid arthritis and what is balance training?

When you have rheumatoid arthritis, your immune system, which normally fights infection, attacks the lining of your joints. This makes your joints swollen, stiff and painful. The small joints of your hands and feet are usually affected first. There is no cure for rheumatoid arthritis at present, so the treatments aim to relieve pain and stiffness and improve your ability to move. Patients with rheumatoid arthritis may have an increased risk of falls due to impairments in the legs and feet which can lead to instability.

Balance training is a set of exercises in which participants use their muscles against an external force as a planned movement or in response to an unexpected movement or changes in order to maintain their balance. Balance exercises and positions can include feet together, semi and tandem position, one leg stance, unstable platforms or foams, eyes opened and closed. In addition, balance training can include some coordination and agility exercises such as: shuttle walk, tandem walk, crossover walk, side-to-side walk and figure of eight. 

Authors' conclusions: 

There is no research available examining the efficacy of balance training alone in patients with rheumatoid arthritis. The effectiveness and safety of balance training to improve functional capacity of these patients remains unclear. We suggest that future research should give more importance to balance training by either increasing the number and duration of sessions or investigating its efficacy alone.

Read the full abstract...
Background: 

Patients with rheumatoid arthritis may have an increased risk of falls due to impairments in lower-extremity joints, which may result in either mobility, or postural stability problems. There is evidence in the literature suggesting that balance, agility and coordination training techniques can induce changes in lower-extremity muscle activity patterns that result in improvement in dynamic joint stability.

The mechanoreceptors present in and around the joints are responsible for maintaining postural control and joint position sense. These receptors are integrated to compose the somatosensorial system. In combination with visual and auditory inputs, which improve our spatial perception even further, the systems are able to maintain a stable body posture.

However, there is a lack of information on the efficacy of balance training alone in patients with rheumatoid arthritis.

Objectives: 

To assess the effectiveness and safety of balance training (proprioceptive training) to improve functional capacity in patients with rheumatoid arthritis.

Search strategy: 

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 4), MEDLINE via PubMed (January 1966 to December 2008), EMBASE (January 1980 to December 2008), LILACS (January 1982 to December 2008), CINAHL (January 1982 to December 2008), PEDro and Scirus (inception to 2008). We also handsearched conference abstracts.

Selection criteria: 

All eligible randomised controlled trials (RCT) or controlled clinical trials (CCT) comparing balance training (proprioceptive training) with any other intervention or with no intervention.

Data collection and analysis: 

Two review authors independently assessed titles or abstracts, or both, for inclusion criteria.

Main results: 

The electronic search identified 864 studies. From this search, 17 studies described general exercises in rheumatoid arthritis patients as the main topic.  After analysing them, we observed that the main interventions were exercises to improve muscle strength, endurance, and dynamic exercises (swimming, walking, etc). As we did not find any studies investigating the effects of balance training alone or in combination with other therapies in patients with rheumatoid arthritis, it was not possible to include any data regarding the chosen topic in this systematic review.

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