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Reutimann, Stefan; Hill-Strathy, Maryjane; Krewer, Carmen; Bergmann, Jeannine; Mueller, Friedemann; Jahn, Klaus and Rauen, Katrin (2022): Influence of footwear on postural sway: A systematic review and meta-analysis on barefoot and shod bipedal static posturography in patients and healthy subjects. In: Gait & Posture, Vol. 92: pp. 302-314

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Abstract

Background: Bipedal static posturography is widely used to assess postural control. However, standardized methods and evidence on the influence of footwear on balance in comparison to barefoot stance is sparse.& nbsp;Research questions: Is bipedal static posturography applied in a standardized way with respect to demographics and the experimental set-up (systematic review)? Does habitual footwear influence postural control in comparison to barefoot condition during bipedal static posturography in adult patients and healthy subjects (meta analysis)?& nbsp;Methods: For this systematic review and meta-analysis, a comprehensive follow-up literature search was conducted from March 2009 until January 2020 according to the PRISMA guidelines. Original, research articles reporting on bipedal, unsupported, static posturography in adults (>= 18 years) were included according to inclusion criteria (age, sex, height, weight, duration, repetitions, visual/foot condition, sampling frequency). Studies comparing habitual footwear with barefoot condition during bipedal static posturography were included for the meta-analysis. Center of pressure parameters (sway velocity, range, root mean square, paths lengths) with subjects having eyes closed (EC) or open (EO) were analyzed using random effects models.& nbsp;Results: For this systematic review and meta-analysis, 207 and eight out of 5189 studies with 12'341 and 156 subjects, respectively, were eligible. Most studies (89%) reported barefoot, 5% shod, and 6% barefoot and shod measurements. Less than half of studies (44%) included patients of which the minority (13%) suffered from neurological disease. Sway velocity in the anterior-posterior direction was higher in habitual shoes compared to barefoot with EC (SMD: 1.08;95% CI: 0.68-1.48;p < 0.01;I-2 = 0%), with EO (SMD: 0.68;95% CI: 0.11-1.26;p = 0.02;I-2 = 1%), and in the medio-lateral direction with EC (SMD: 1.30;95% CI: 0.76-1.85, p < 0.01;I-2 = 37%).& nbsp;Significance: Methodical heterogeneity of bipedal static posturography hampers studies' comparability. Thus, we provide a standardized approach to increase knowledge whether habitual footwear decrease postural control in comparison to barefoot stance.

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