Efeitos do uso de palmilhas nas funções da marcha, equilíbrio e controle postural de indivíduos pós Acidente Vascular Cerebral: uma Revisão Sistemática com meta-análise

Abstract

Introduction: The use of insoles can increase the activation of the somatosensory system of the support base, improve postural control of individuals with hemiparesis post-stroke, and consequently, balance and gait. However, there is no clarity on how effective these technologies can be in improving related outcomes. Objective: To investigate the effects of the use of insoles (plantar orthoses) on gait, balance, and postural control functions of post-stroke individuals. Methodology: A Systematic Review (PROSPERO ID = CRD42022352629) of Randomized Clinical Trials was conducted, which analyzed the effects of the use of insoles on gait functions, balance, and postural control, and of Cross-Sectional Studies that evaluated the immediate responses of the patient to the use of technology. We included studies that presented at least one outcome measure for the use of insoles, with adult individuals affected by stroke, able to walk with or without the assistance of devices and presented as intervention insoles designed to meet their demands compared to a sham insole or base intervention without the use of an insole; and for cross-sectional studies the absence of an insole. The outcomes were the modification in gait and balance performance and the immediate changes in the spatiotemporal parameters of gait and in the symmetry of the support base after the use of the insole. Results: The review consisted of 9 RCTs and 4 cross-sectional studies with a total of 337 participants, of which 66.7% (n = 225) were in the chronic phase. Four types of insoles were identified: postural, textured, elevation, and auditory feedback. Only one study standardized participants' footwear. The findings of the RCTs showed little or no difference between the groups, however, the insole with auditory feedback presented the best effect size for increasing balance performance. The results of the meta-analysis showed that the use of this insole promoted changes in functional mobility and increased the BBS score with a moderate confidence level. In cross-sectional studies, the results of adding an insole showed slight variations. Regarding the certainty of the evidence, except for the insole with auditory feedback, the studies showed low or very low confidence levels. Conclusion: Although insoles with auditory feedback are promising, further studies with shoe standardization are needed to investigate the effects of their use.