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Background: A pronounced discrepancy exists between balance assessments for stroke survivors that are used for clinical purposes and those used for research. Clinical assessments like the Berg Balance Scale generally have stronger ecological validity, whereas research-based assessments like posturography are generally more reliable and precise. We developed a stabilometer balance test (SBT) that aims to couple measurement reliability and precision to clinical meaningfulness by means of a personalized and adaptive test procedure. Research question: To examine the validity, reliability, and measurement error of the stabilometer balance test in inpatient stroke patients. Methods: In this cross-sectional study, inpatient stroke patients (FAC > 2) were tested on a stabilometer with adjustable resistance to mediolateral movement. A modified staircase procedure was used to adapt task difficulty (i.e., rotational stiffness) on a trial-by-trial basis. The main outcome was the threshold stiffness at which a patient could just stay balanced. Threshold stiffness was correlated with the Berg Balance Scale and posturography measurements to determine concurrent validity (N = 86). Test-retest reliability (N = 23) was analyzed with the Intraclass Correlation Coefficient (ICC). Floor and ceiling effects were assessed. The minimal detectable change was determined at individual and group level. Results: Threshold rotational stiffness moderately correlated with the Berg Balance Scale (r=−0.559, p < 0.001), and the absolute path length of the center of pressure during posturography (r=0.348, p = 0.006). Test-retest reliability was good to excellent (ICC=0.869; 95%CI=0.696–0.944). There were no floor or ceiling effects. The minimal detectable change was sufficiently small to detect relevant changes in balance control both on individual and group level. Relevance: The SBT is both a valid and reliable balance assessment in stroke patients. It is at least as precise as current clinically preferred measures and does not suffer from ceiling effects. Therefore, it is suitable for use in clinical practice as well as research.

Aim: This meta-analysis aimed to determine the effect of aerobic training, compared to non-aerobic interventions, on vascular and metabolic risk factors for recurrent stroke. Method: This study was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines (PRISMA). Searches were performed in PubMed, Embase, Cochrane library and Cinahl up to May 8th 2019. Randomized clinical trials evaluating the effect of solely aerobic training on vascular and metabolic risk factors for recurrent stroke were included in a meta-analysis if relevant outcomes were reported in at least two articles. Results: Our search resulted in a total of 7381 hits. Eleven outcomes out of nine articles were included in the meta-analysis. A significant positive effect of aerobic training was found on systolic blood pressure (−3.59 mmHg, 95% CI −6.14 to −1.05) and fasting glucose (−0.12 mmol/l, 95% CI −0.23 to −0.02). The effect on systolic blood pressure further improved when only high-quality studies were included (−4.95 mmHg, 95% CI −8.24 to −1.66). Conclusion: Aerobic training results in a significant positive effect on systolic blood pressure and fasting glucose after stroke when compared to non-aerobic usual care or non-aerobic exercise.Implications for rehabilitationAerobic training has a positive effect on two of the most important vascular risk factors for recurrent stroke (i.e., systolic blood pressure and fasting glucose).The effect of solely aerobic training seems to be comparable to the effect of combined strength exercise and aerobic training for systolic blood pressure and fasting glucose.Since aerobic training has a significant effect on risk factors for recurrent stroke, implementation of aerobic training in daily life is important to reduce long term stroke risk.Previous research has showed that other metabolic risk factors can be altered by other interventions (e.g., strength exercise or lifestyle coaching), therefore, post-stroke prevention programs should be tailored in order to target specific risk-factors for individual patients. Aerobic training has a positive effect on two of the most important vascular risk factors for recurrent stroke (i.e., systolic blood pressure and fasting glucose). The effect of solely aerobic training seems to be comparable to the effect of combined strength exercise and aerobic training for systolic blood pressure and fasting glucose. Since aerobic training has a significant effect on risk factors for recurrent stroke, implementation of aerobic training in daily life is important to reduce long term stroke risk. Previous research has showed that other metabolic risk factors can be altered by other interventions (e.g., strength exercise or lifestyle coaching), therefore, post-stroke prevention programs should be tailored in order to target specific risk-factors for individual patients.