The effects of active rehabilitation on symptoms associated with tau pathology: an umbrella review. Implications for Chronic Traumatic Encephalopathy symptom management

Hearn, Rachael, Selfe, James ORCID: https://orcid.org/0000-0001-9931-4998, Cordero Campa�a, Maria ORCID: https://orcid.org/0000-0003-0692-8064 and Dobbin, Nicholas ORCID: https://orcid.org/0000-0001-7508-1683 (2022) The effects of active rehabilitation on symptoms associated with tau pathology: an umbrella review. Implications for Chronic Traumatic Encephalopathy symptom management. PLoS One, 17 (7). e0271213. ISSN 1932-6203

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Abstract

Objective This review sought to address an evidence gap and lay a foundation for future Chronic Traumatic Encephalopathy (CTE) management studies by evaluating and appraising the literature which reports the effect that active rehabilitation has on other tauopathies, a group of conditions with hyperphosphorylation and aggregation of tau protein that can lead to neurodegeneration. Design Umbrella review. Data source Meta-analyses and systematic reviews were identified using CINAHL, Medline, Cochrane, Web of Science, PubMed, and SPORTDiscus. Eligibility Systematic review or meta-analyses that examine the effect active rehabilitation has on outcome measures of symptoms associated with CTE. Studies with men and women diagnosed with Alzheimer’s disease, Parkinson’s disease, Lewy Body dementia, Frontotemporal degeneration/dementia or Corticobasal degeneration. All types of active rehabilitation were included. Control group was usual care, no intervention, or light-intensity physical activity. Results Twelve reviews were included. A large pooled standardized mean difference (SMD) was observed for balance (SMD=0.88, P<0.001) and motor function (SMD=0.83, P<0.001). A moderate pooled SMD was observed for cognitive function (SMD=0.66, P<0.116). A small pooled SMD was observed for mobility (SMD=0.45, P=0.002). A trivial pooled SMD was observed for gait speed/velocity (SMD=0.11, P=0.372). No findings for mood/behavioral symptoms. All pooled effects demonstrated substantial to considerable heterogeneity (74.3% to 91.9%, P<0.001). Conclusions A positive effect of active rehabilitation was observed in patients with tau pathologies suffering from motor, vestibular and cognitive impairments supporting the use of active rehabilitation for CTE management; however, the findings need to be considered with caution given the limited research in some of the tau pathologies, large between-study heterogeneity and wide 95% prediction intervals.