The effects of suspension-supported training on dynamic balance capacity in stroke patients: a systematic review and...

Systematically evaluate the effectiveness of suspension-supported training (SST) on dynamic balance in stroke patients and determine its optimal training dose to establish an evidence-based foundation for clinical rehabilitation.

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, randomized controlled trials (RCTs) meeting Population, Intervention, Comparator, Outcome, Study design (PICOS) criteria were screened in PubMed, Web of Science, PsycINFO, and the Cochrane Library (search cutoff: 31 October 2025). Twelve studies comprising 584 patients were included. A restricted maximum likelihood (REML) random-effects model was used to pool standardized mean differences (SMDs). Heterogeneity was assessed using the I-squared (I²) statistic and Cochran's Q test. Publication bias and robustness were evaluated by sensitivity analysis, Egger's regression test, and the trim-and-fill method. Subgroup analyses and meta-regression were conducted to explore potential moderators; additionally, a Bayesian dose-response meta-analysis was performed to characterize the non-linear relationship between training dosage and dynamic balance outcomes. An exploratory extreme gradient boosting (XGBoost) model combined with SHapley Additive exPlanations (SHAP) analysis was further applied to investigate dose-response patterns and feature importance.

SST produced a significant improvement in dynamic balance (SMD = 0.87, 95% CI 0.49-1.26, p < 0.0001), with substantial heterogeneity across studies (I² = 76.6%). The overall quality of evidence was rated as moderate using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Larger effects were observed in interventions lasting 6-8 weeks, sessions of 40-150 min, patients in the subacute phase, combined intervention approaches, and protocols employing approximately 30% body-weight support. Exploratory XGBoost-SHAP analysis identified training duration and intervention mode as the most influential predictors of outcome. Preliminary dose-response modeling suggested that a regimen of ~90-100 min per session, six sessions per week for 8-9 weeks (total dose ≈ 34.6-37.6 h; ~36 h) might be associated with favorable dynamic-balance gains; however, these estimates should be regarded as hypothesis-generating.

SST effectively enhances dynamic balance in stroke patients. Preliminary models indicated that a regimen of 90-100 min per session, 6 times per week for 8-9 weeks (total duration: 34.6-37.6 h, ~36 h) might yield favorable results. However, given the heterogeneity and study-level limitations, these dosage findings were considered hypothesis-generating. Future research should prioritize high-quality, large-sample RCTs with long follow-up to verify clinical and long-term effectiveness.