Lateropulsion Prevalence After Stroke: A Systematic Review and Meta-analysis

Lateropulsion is a deficit of active body orientation with respect to gravity in the frontal plane, mostly observed after a stroke. It magnifies mobility limitations and represents an emerging target in rehabilitation. Efforts to design specific interventional studies require some basic knowledge of epidemiology, which is insufficient today because many studies have focused on a few severe forms in individuals called pushers. The objectives of this study were to bridge this gap.

We systematically searched MEDLINE, EMBASE, CINAHL, and Cochrane Clinical Trials up to 31 May 2021 for original research reporting a prevalence or incidence of poststroke lateropulsion. We followed MOOSE and PRISMA guidelines. Eligibility for inclusion, data extraction, and study quality (Joanna Briggs Institute guidelines) were evaluated by 2 reviewers who used a standardized protocol (PROSPERO; CRD42020175037). A random-effects meta-analysis was used to obtain the pooled prevalence, whose heterogeneity was investigated by subgroup analysis (stroke locations and poststroke phases) and metaregression.

We identified 22 studies (5,125 individuals; mean age 68.5 years; 42.6% female; assessed 24 days, on average, after stroke), most published after 2000. The studies' quality was adequate, with only 8 (36.4%) showing risk of bias. The pooled lateropulsion prevalence was 55.1% (95% CI 35.9-74.2) and was consistent across assessment tools. After supratentorial stroke, lateropulsion prevalence was 41% (95% CI 33.5-48.5), and only 12.5% (95% CI 9.2-15.9) in individuals with severe lateropulsion, called pushers. Metaregression did not reveal any effect of age, sex, geographic region, publication year, or study quality. Lateropulsion prevalence progressively decreased from 52.8% (95% CI 40.7-65) in the acute phase to 37% (95% CI 26.3-47.7) in the early subacute phase and 22.8% (95% CI 0-46.3) in the late subacute phase. The ratio of right to left hemispheric stroke with lateropulsion increased as a function of time: 1.7 in the acute phase to 7.7 in the late subacute phase. After infratentorial stroke, lateropulsion prevalence was very high, reaching 83.2% (95% CI 63.9-100.3).

Poststroke lateropulsion prevalence is high, which appeals for its systematic detection to guide early interventions. Uprightness is predominantly controlled from the right hemisphere.