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  • 1. Berg, Katarina
    et al.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköpings universitet, Ersta Sköndal University College .
    Kjellgren, Karin
    Postoperative recovery from the perspective of day surgery patients: A phenomenographic study.2013In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 50, no 12, p. 1630-1638Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Today, many patients undergo surgical procedures in a day surgery setting. The shift from inpatient care to care at the patients' own home following discharge places various demands on patients and their families during the recovery process. There is a need for knowledge of how the postoperative recovery process is perceived, as research indicates a lack of support for patients managing recovery at home. OBJECTIVE: To explore day surgery patients' different perceptions of postoperative recovery. DESIGN: A qualitative design with a phenomenographic approach was used. METHODS AND SETTINGS: Semi-structured interviews with 31 patients undergoing an orthopaedic, general or urologic day surgical procedure were carried out face to face at the patients' homes, 11-37 days post-discharge. Patients were recruited from two day surgery settings: one private unit and one unit associated with a local county hospital. RESULTS: The patients perceived postoperative recovery as comprising internal and external prerequisites and implying changes in ordinary life with varying levels of support. The effective production at the day surgery unit was perceived as having an impact on patients' prerequisites for recovery. The results are elucidated in three descriptive categories: 'Conditions for recovery at home', 'The rollback to ordinary life' and 'Being a cog in a flow of care'. CONCLUSIONS: The postoperative phase seems to be a weak link in day surgery care. From the patients' perspective, postoperative recovery following day surgery implies extensive responsibility at home. Patients need knowledge and understanding concerning what constitutes the normal range in recovery and how to manage self-care following their specific surgical procedure.

  • 2.
    Blomqvist, Kerstin
    et al.
    University of Kalmar, School of Human Sciences.
    Hallberg, Ingalill R
    Recognising pain in older adults living in sheltered accommodation: the views of nurses and older adults2001In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 38, no 3, p. 305-318Article in journal (Refereed)
  • 3.
    Brüggemann, A. Jelmer
    et al.
    Linköpings universitet.
    Swahnberg, Katarina
    Linköpings universitet.
    What contributes to abuse in health care?: A grounded theory of female patients’ stories2013In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 50, no 3, p. 404-412Article in journal (Refereed)
    Abstract [en]

    Background

    In Sweden, 20% of female patients have reported lifetime experiences of abuse in any health care setting. Corresponding prevalence among male patients is estimated to be 8%. Many patients report that they currently suffer from these experiences. Few empirical studies have been conducted to understand what contributes to the occurrence of abuse in health care.

    Objectives

    To understand what factors contribute to female patients’ experiences of abuse in health care.

    Design

    Constructivist grounded theory approach.

    Settings

    Women's clinic at a county hospital in the south of Sweden.

    Participants

    Twelve female patients who all had reported experiences of abuse in health care in an earlier questionnaire study.

    Methods

    In-depth interviews.

    Results

    The analysis resulted in the core category, the patient loses power struggles, building on four categories: the patient's vulnerability, the patient's competence, staff's use of domination techniques, and structural limitations. Participants described how their sensitivity and dependency could make them vulnerable to staff's domination techniques. The participants’ claim for power and the protection of their autonomy, through their competence as patients, could catalyze power struggles.

    Conclusions

    Central to the participants’ stories was that their experiences of abuse in health care were preceded by lost power struggles, mainly through staff's use of domination techniques. For staff it could be important to become aware of the existence and consequences of such domination techniques. The results indicate a need for a clinical climate in which patients are allowed to use their competence.

  • 4.
    Eriksson, Kerstin
    et al.
    Jönköping University;Ryhov County Hospital.
    Wikström, Lotta
    Jönköping University;Ryhov County Hospital.
    Fridlund, Bengt
    Jönköping University.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköping University;Linköping University Hospital.
    Brostrom, Anders
    Jönköping University;Linköping University Hospital.
    Patients' experiences and actions when describing pain after surgery - A critical incident technique analysis2016In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 56, p. 27-36Article in journal (Refereed)
    Abstract [en]

    Background: Postoperative pain assessment remains a significant problem in clinical care despite patients wanting to describe their pain and be treated as unique individuals. Deeper knowledge about variations in patients' experiences and actions could help healthcare professionals to improve pain management and could increase patients' participation in pain assessments. Objective: The aim of this study was, through an examination of critical incidents, to describe patients' experiences and actions when needing to describe pain after surgery. Methods: An explorative design involving the critical incident technique was used. Patients from one university and three county hospitals in both urban and rural areas were included. To ensure variation of patients a strategic sampling was made according to age, gender, education and surgery. A total of 25 patients who had undergone orthopaedic or general surgery was asked to participate in an interview, of whom three declined. Findings: Pain experiences were described according to two main areas: "Patients' resources when in need of pain assessment" and "Ward resources for performing pain assessments". Patients were affected by their expectations and tolerance for pain. Ability to describe pain could be limited by a fear of coming into conflict with healthcare professionals or being perceived as whining. Furthermore, attitudes from healthcare professionals and their lack of adherence to procedures affected patients' ability to describe pain. Two main areas regarding actions emerged: "Patients used active strategies when needing to describe pain" and "Patients used passive strategies when needing to describe pain". Patients informed healthcare professionals about their pain and asked questions in order to make decisions about their pain situation. Selfcare was performed by distraction and avoiding pain or treating pain by themselves, while others were passive and endured pain or refrained from contact with healthcare professionals due to healthcare professionals' large work load. (C) 2015 Elsevier Ltd. All rights reserved.

  • 5.
    Fagerström, Cecilia
    et al.
    Blekinge Institute of Technology.
    Palmqvist, Roger
    Blekinge Institute of Technology.
    Carlsson, Johanna
    Blekinge Institute of Technology.
    Hellström, Ylva
    Blekinge Institute of Technology.
    Malnutrition and cognitive impairment among people 60 years of age and above living in regular housing and in special housing in Sweden: a population-based cohort study2011In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 48, no 7, p. 863-871Article in journal (Refereed)
    Abstract [en]

    Background: Malnutrition is a common problem among older people and associated with reduced functional and cognitive ability. Furthermore, malnutrition among people living in special housing, i.e. in nursing homes or sheltered accommodation, appears to be more common than among those living in regular housing, i.e. in their own homes. However, it is still unclear if the relationship between malnutrition and impaired cognitive ability is connected to living arrangement, i.e. if the relationship is stronger among those who live alone compared to those who cohabit in regular housing.

    Objectives: The purpose with the present study was to describe the relationship between nutritional status and cognitive ability among people 60 years of age and above in Sweden, with a focus on housing and living arrangement.

    Design: Population-based cohort study.

    Setting and participants: The study focused on people living in regular or in special housing and comprised 1402 randomly selected individuals (60-96 years of age) who lived in one municipality in south-eastern Sweden and participated in SNAC-B (the Swedish study on Aging and Care - Blekinge), 2001-2003.

    Methods: Data regarding demography, nutrition and functional and cognitive ability were collected through questionnaires, medical examinations and structured interviews.

    Results: The relationship was the strongest between cognitive ability and nutritional status among those living in special housing. Regardless of housing and living arrangement, older people with a moderate or severe cognitive impairment risked (OR 2.59-16.00) being malnourished, irrespective of functional ability.

    Conclusion: This study highlights that those with a moderate and severe cognitive impairment suffer a risk of developing malnutrition, irrespective of living and housing arrangement. The findings suggest that nurses in the social service and health care system need to consider changes in weight and nutritional intake as well as the individual needs of older people with cognitive impairment to avoid malnutrition.

  • 6. Galvin, Kate
    et al.
    Emami, Azita
    Dahlberg, Karin
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work.
    Ekebergh, Margaretha
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work.
    Rosser, E
    Powell, J
    Bach, S
    Edlund, B
    Bondas, Terese
    Uhrefeldt, L
    Challenges for future caring science research: a response to providing evidence for health- care practice.2008In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 43, p. 923-927Article in journal (Refereed)
  • 7. Johansson, K
    et al.
    Ekebergh, Margaretha
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work.
    Dahlberg, Karin
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work.
    A lifeworld phenomenological study of the experience of falling ill with diabetes.2009In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, no 46, p. 193-203Article in journal (Refereed)
  • 8. Levesque, Louise
    et al.
    Ducharme, Francine
    Caron, Chantal
    Hanson, Elizabeth
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Magnusson, Lennart
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Nolan, Janet
    University of Sheffield.
    Nolan, Mike
    University of Sheffield.
    A partnership approach to service needs assessment with family caregivers of an aging relative living at home: A qualitative analysis of the experiences of caregivers and practitioners2010In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 47, no 7, p. 876-887Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    As the global population ages, support for family caregivers who provide the bulk of care to community-dwelling older people is becoming ever more important. However, in many countries, homecare-service practitioners currently do not follow a systematic approach to assessing and responding to caregiver needs.

    OBJECTIVES:

    The aim of this study was to explore the experiences of caregivers and practitioners who took part in a field test of the Family Caregivers Support Agreement (FCSA) tool, a modified version of the Carers Outcome Agreement Tool (COAT) initially developed as the result of an Anglo-Swedish study. Both the COAT and the FCSA are designed to facilitate partnerships between caregivers and practitioners so that needs assessment and subsequent support services are negotiated and agreed so as to meet caregiver expectations.

    DESIGN AND PARTICIPANTS:

    A qualitative design was adopted and data were collected through focus groups with six practitioners (nurses and social workers) working in two Local Community Service Centres in the province of Quebec (Canada). These practitioners had previously completed the FCSA tool with 17 primary caregivers of frail elderly relatives who were clients of homecare services. Individual interviews were conducted with the caregivers to explore their experiences. Data were analyzed to identify significant themes, from the perspectives of caregivers and practitioners, which provided insights into their experiences and the strategies used by practitioners to facilitate partnership working.

    FINDINGS:

    To facilitate meaningful exchanges, practitioners adopted strategies such as sensitive listening and the use of enabling questions to identify and contextualize caregiver needs and to highlight the ability of caregivers to find their own creative solutions to the challenges they face. The caregivers described experiencing a climate of trust that allowed them to express their concerns, to reflect upon their situation and to participate in the development of an action plan for their support.

    CONCLUSIONS:

    The study reaffirms findings from Sweden and UK that the use of a tool such as the FCSA enhances partnership working and creates a caregiver-practitioner relationship based on a genuine alliance. As a result, both parties gain new insights into the caring situation. The approach underpinning the FCSA tool has potential for a more widespread application in different contexts.

  • 9.
    Nordgren, Lena
    et al.
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work.
    Asp, Margareta
    Fagerberg, Ingegerd
    Support as experienced by men living with heart failure in middle age: A phenomenological study2008In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 45, no 9, p. 1344-1354Article in journal (Refereed)
    Abstract [en]

    Background

    Men living with heart failure (HF) in middle-age experience restrictions limiting their work capacity and/or social activities. To adjust to the life-situation they need support. The meaning of the phenomenon of support is not well known. Thus, formal carers may find it problematic to know how to support patients.

    Aim

    The aim of the current study was to uncover and describe the meaning of the phenomenon of support as experienced by men living with HF in middle age.

    Design

    The study used a caring science perspective and a reflective lifeworld approach based on phenomenological philosophy.

    Participants and settings

    Nine men, aged 49–64 years and diagnosed with HF, were recruited from two outpatient HF clinics in Sweden.

    Methods

    Interviews were used for data gathering. Data were analyzed by means of reflective lifeworld research.

    Findings

    The essence of support as experienced by men living with HF in middle age can be understood as security, and a sense of having control over body and situation. Support is realized in the men's relations to other people; there is however tension between what is supportive and what is not, meaning that even though intentions are good, intended support involves limitations, uncertainties or insecurity. The essence is illuminated by the following meaning constitutes: Support—a tenuous security; Medications—a support for life; Conditional support within the context of formal care; and, Information and knowledge.

    Conclusions

    The meaning of support as experienced by men living with HF in middle age is multi-dimensional, qualitative and contextual. When the men are supported they gain a sense of security and control, giving them strength to handle their life-situation. A lifeworld-led approach in the context of formal care can help formal carers support men living with HF in middle age.

  • 10.
    Pettersen, Trond R.
    et al.
    Haukeland Hosp, Norway.
    Fridlund, Bengt
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Haukeland Hosp, Norway.
    Bendz, Bjorn
    Oslo Univ Hosp, Norway;Univ Oslo, Norway.
    Nordrehaug, Jan Erik
    Stavanger Univ Hosp, Norway;Univ Bergen, Norway.
    Rotevatn, Svein
    Haukeland Hosp, Norway.
    Schjott, Jan
    Univ Bergen, Norway;Haukeland Hosp, Norway.
    Norekval, Tone M.
    Haukeland Hosp, Norway;Univ Bergen, Norway.
    Challenges adhering to a medication regimen following first-time percutaneous coronary intervention: A patient perspective2018In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 88, p. 16-24Article in journal (Refereed)
    Abstract [en]

    Background: Percutaneous coronary intervention is the most common therapeutic intervention for patients with narrowed coronary arteries due to coronary artery disease. Although it is known that patients with coronary artery disease often do not adhere to their medication regimen, little is known about what patients undergoing percutaneous coronary interventions find challenging in adhering to their medication regimen after hospital discharge. Objectives: To explore patients' experiences in adhering to medications following early post-discharge after first-time percutaneous coronary intervention. Design: An abductive qualitative approach was used to conduct in-depth interviews of patients undergoing first-time percutaneous coronary intervention. Settings: Participants were recruited from a single tertiary university hospital, which services a large geographical area in western Norway. Patients fulfilling the inclusion criteria were identified through the Norwegian Registry for Invasive Cardiology. Participants: Participants were patients aged 18 years or older who had their first percutaneous coronary intervention six to nine months earlier, were living at home at the time of study inclusion, and were prescribed dual antiplatelet therapy. Patients who were cognitively impaired, had previously undergone cardiac surgery, and/or were prescribed anticoagulation therapy with warfarin or novel oral anticoagulants were excluded. Purposeful sampling was used to include patients of different gender, age, and geographic settings. Twenty-two patients (12 men) were interviewed between December 2016 and April 2017. Methods: Face-to-face semi-structured interviews were conducted, guided by a set of predetermined open-ended questions to gather patient experiences on factors relating to medication adherence or non-adherence. Transcribed interviews were analysed by qualitative content analysis. Findings: Patients failed to adhere to their medication regimen for several reasons; intentional and unintentional reasons, multifaceted side effects from heart medications, scepticism towards generic drugs, lack of information regarding seriousness of disease after percutaneous coronary intervention, psychological impact of living with coronary artery disease, and these interacted. There were patients who felt that the medication information they received from physicians and nurses was uninformative and inadequate. Side effects from heart medications were common, ranging from minor ones to more disabling side effects, such as severe muscle and joint pain and fatigue. Patients found well established medication taking routines and aids to be necessary, and these improved adherence. Conclusion: Patients undergoing first-time percutaneous coronary intervention face multiple, interacting challenges in trying to adhere to prescribed medications following discharge. This study highlights the need for a more structured follow-up care in order to improve medication adherence and to maximise their self-care abilities.

  • 11.
    Sandlund, Christina
    et al.
    Karolinska Institutet;Stockholm County Council.
    Hetta, Jerker
    Karolinska Institutet.
    Nilsson, Gunnar H.
    Karolinska Institutet;Stockholm County Council.
    Ekstedt, Mirjam
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Karolinska Institutet.
    Westman, Jeanette
    Karolinska Institutet;Stockholm County Council.
    Impact of group treatment for insomnia on daytime symptomatology: analyses from a randomized controlled trial in primary care2018In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 85, no September, p. 126-135Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: People typically seek primary health care for daytime symptoms and impairments they experience in association with their insomnia. However, few studies address the question of whether insomnia treatment can improve such symptomatology.

    OBJECTIVES: To investigate whether a nurse-led group treatment program, based on the techniques of cognitive behavioral therapy for insomnia (CBT-I), improved daytime symptomatology in primary care patients with insomnia.

    OUTCOMES: Fatigue (Fatigue Severity Scale [FSS]; main outcome), mood (General Health Questionnaire and Montgomery-Asberg Depression Rating Scale), health-related quality of life (Short-Form Health Survey), general daytime functioning, specific daytime symptoms (individual items from the Insomnia Severity Index and Uppsala Sleep Inventory), and dysfunctional beliefs (Dysfunctional Beliefs and Attitudes about Sleep).

    DESIGN: A randomized controlled trial including baseline and post-treatment assessment and a 1-year post-treatment follow-up of the intervention group.

    SETTINGS: Seven primary health care centers (Stockholm, Sweden).

    PARTICIPANTS: One hundred and sixty-five primary care patients who meet the criteria for insomnia disorder (mean age 54 years, SD 16). Most were women (73%).

    EXCLUSION CRITERIA: severe untreated illness, bipolar disorder, current stressful life event, night shift work, and untreated sleep disorder other than insomnia.

    METHODS: Data came from a randomized controlled trial of a 10-week nurse-led group treatment for insomnia based on CBT-I (n = 90). The control condition was treatment as usual (n = 75). In accordance with intention-to-treat principles, analyses included data on patients who completed baseline assessments (intervention n = 82, and control group n = 71; post-treatment dropout rate 20%). Fifty-four patients were included in the 1-year follow-up.

    RESULTS: Fatigue severity improved significantly more (p < 0.001) in the intervention than in the control group (intervention, total FSS score 37.2 [SD 11.9] to 31.0 [SD 13.4] vs. control 35.9 [SD 12.1] to 35.7 [SD 12.8]). This was true also for measurements on mood (psychological distress and depressive symptoms), health-related quality of life (mental functioning), general daytime functioning, specific daytime symptoms (worry about sleep, sleepiness, bodily tiredness, and difficulty concentrating) and dysfunctional beliefs. All improvements were maintained one year after group treatment.

    CONCLUSIONS: Many aspects of the daytime symptomatology of insomnia were improved via nurse-led group treatment based on CBT-I in primary health care.

  • 12.
    Sandlund, Christina
    et al.
    Karolinska Institutet, Sweden; Stockholm County Council, Sweden.
    Hetta, Jerker
    Karolinska Institutet, Sweden.
    Nilsson, Gunnar H.
    Karolinska Institutet, Sweden;Stockholm County Council, Sweden.
    Ekstedt, Mirjam
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Karolinska Institutet, Sweden.
    Westman, Jeanette
    Karolinska Institutet, Sweden;Stockholm County Council, Sweden.
    Improving insomnia in primary care patients: A randomized controlled trial of nurse-led group treatment2017In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 72, p. 30-41Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Insomnia is a common health problem, and most people who seek help for insomnia consult primary care. In primary care, insomnia treatment typically consists of hypnotic drugs, although cognitive behavioral therapy for insomnia is the recommended treatment. However, such treatment is currently available to few primary care patients.

    OBJECTIVES: To evaluate the effects of a group treatment program for insomnia led by nurses in primary care.

    OUTCOMES: were the Insomnia Severity Index, a 2-week sleep diary, and a questionnaire on frequency of hypnotic drug use.

    DESIGN: A randomized controlled trial with pre- and post-treatment assessment and a 1-year post-treatment follow-up of the intervention group.

    SETTINGS: Routine primary health care; 7 primary care centers in Stockholm, Sweden.

    PARTICIPANTS: Patients consulting primary care for insomnia were assessed for eligibility. To be included, patients had to have insomnia disorder and be 18 years or older. Patients were excluded if they if they worked night shifts or had severe untreated somatic and/or mental illness, bipolar disorder, or untreated sleep disorder other than insomnia. One-hundred and sixty-five patients 20 to 90 years were included. Most were women, and many had co-existing somatic and/or mental health problems. The post-treatment dropout rate was 20%.

    METHODS: The intervention was a nurse-led group treatment for insomnia based on the techniques of cognitive behavioral therapy for insomnia. The nurses had 2days of training in how to deliver the program. Ninety patients were randomized to the intervention and 75 to the control group (treatment as usual). Data from 82 in the intervention and 71 in the control group were analyzed in accordance with intention-to-treat principles. Fifty-four of the 72 in the intervention group who participated in the group treatment program were followed up after 1year.

    RESULTS: Mean Insomnia Severity Index score decreased significantly from 18.4 to 10.7 after group treatment but remained unchanged after treatment as usual (17.0 to 16.6). The effect size was large (1.23). Group treatment also resulted in significant improvements in all sleep diary variables (sleep onset latency, total sleep time, time awake after sleep onset, number of awakenings, and sleep quality). It also reduced hypnotic drug use. Improvements were maintained 1-year post-treatment.

    CONCLUSIONS: Patients with insomnia can be treated successfully with a nurse-led group treatment program in primary health care. The results support implementation of the treatment program, particularly given the need for increased access to non-pharmacological insomnia treatments.

  • 13.
    Zheng, Qing-Xiang
    et al.
    Fujian University of Traditional Chinese Medicine, Peoples Republic of China.
    Ge, Li
    Fujian University of Traditional Chinese Medicine, Peoples Republic of China.
    Wang, Carol Chunfeng
    Edith Cowan University, Australia.
    Ma, Qi-Shou
    Fujian University of Traditional Chinese Medicine, Peoples Republic of China.
    Liao, Yan-Tan
    Fujian University of Traditional Chinese Medicine, Peoples Republic of China.
    Huang, Ping-Ping
    Fujian University of Traditional Chinese Medicine, Peoples Republic of China.
    Wang, Guan-Dong
    Fujian University of Traditional Chinese Medicine, Peoples Republic of China.
    Xie, Qiu-Lin
    Fujian University of Traditional Chinese Medicine, Peoples Republic of China.
    Rask, Mikael
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Robot-assisted therapy for balance function rehabilitation after stroke: A systematic review and meta-analysis2019In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 95, p. 7-18Article in journal (Refereed)
    Abstract [en]

    Objective: To identify the rehabilitative effects of robot-assisted therapy on balance function among stroke patients. Design: A systematic review and meta-analysis of randomized controlled trials. Data sources: Thirteen electronic databases were systematically searched from inception to March 2018: Web of Science, PubMed, EMBase, The Cochrane Library, Science Direct, CINAHL, MEDLINE, AMED, Physiotherapy Evidence Database, SPORTDiscus, WanFang Data, China National Knowledge Infrastructure and Chinese Scientific Journal Database. Review methods: Randomized controlled trials were retrieved for identifying the effects of robot-assisted therapy on balance function among stroke patients. Two authors independently searched databases, screened studies, extracted data, and evaluated the methodological quality and risk bias of each included study. A standardized protocol and data-collection form were used to extract information. Effect size was evaluated by mean difference with corresponding 95% confidence intervals. Methodological quality and risk bias evaluation for each included study followed the quality appraisal criteria for randomized controlled trials that were recommended by Cochrane Handbook. Meta-analysis was conducted by utilizing Review Manager 5.3, a Cochrane Collaboration tool. Data was synthesized with descriptive analysis instead of meta-analysis where comparisons were not possible to be conducted with a meta-analysis. Results: Thirty-one randomized controlled trials with a total of 1249 participants were included. The majority of the included studies contained some methodological flaws. The results of the meta-analysis indicated that robot-assisted therapy produced positive effects on balance function, as shown by an increase in the Berg balance scale score [random effects model, mean difference = 4.64, 95%CI = 3.22–6.06, P<0.01], as well as Fugl-Meyer balance scale scores [fixed effects model, mean difference = 3.57, 95%CI = 2.81–4.34, P<0.01]. After subgroup and sensitivity analyses, the positive effects were not influenced by different types of robotic devices, by whether robot-assisted therapy was combined with another intervention or not, or by differences in duration and intensity of intervention. Conclusion: Evidence in the present systematic review indicates that robot-assisted therapy may produce significantly positive improvements on balance function among stroke patients compared with those not using this method. More multi-center, high-quality and large-scale randomized controlled trials following the guidelines of CONSORT are necessary to generate high-quality evidence in further research. © 2019 Elsevier Ltd

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