OBJECTIVE: To conduct a systematic review of clinical trials that examined the effectiveness of interventions on balance self-efficacy among individuals with stroke. DESIGN: Systematic review. SUMMARY OF REVIEW: Searches of the following databases were completed in December 2014: Medline (1948 to present), CINAHL (1982 to present), Embase (1980 to present) and PsycINFO (1987 to present) for controlled clinical trials that measured balance self-efficacy in adults with stroke. Reference lists of selected articles were hand-searched to identify further relevant studies. REVIEW METHODS: Two independent reviewers performed data extraction and assessed the methodological quality of the studies using the Physical Therapy Evidence Database Scale. Standardized mean differences (SMD) were calculated. RESULTS: A total of 19 trials involving 729 participants used balance self-efficacy as a secondary outcome. Study quality ranged from poor (n = 3) to good (n = 8). In the meta-analysis of 15 trials that used intensive physical activity interventions, a moderate beneficial effect on balance self-efficacy was observed immediately following the programs (SMD 0.44, 95% CI 0.11 to 0.77, p = 0.009). In the studies that included follow-up assessments, there was no difference between groups across retention periods (eight studies, SMD 0.32, 95% CI -0.17 to 0.80, p = 0.20). In the four studies that used motor imagery interventions, there was no between-group difference in change in balance self-efficacy (fixed effects SMD 0.68, 95% CI -0.33 to 1.69, p = 0.18). CONCLUSIONS: Physical activity interventions appear to be effective in improving balance self-efficacy after stroke.

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