Table 1 Characteristics of included primary studies

Adams & Hicks 2011 [28]

Randomized crossover

Serious risk (low quality)

7

Chronic SCI

Tilt table angle 68.6° ± 11.3

45 mins, 3 × wk × 4 weeks (135 mins/week)

Extensor spasms were reduced to a greater degree with standing than BWSTT. Flexor spasms, clonus, self-reported mobility, and QOL tended to benefit more from 4 weeks of BWSTT than standing alone

Alekna et al. 2008 [29]

Longitudinal

Serious risk (low quality)

54 total–27 matched pairs

Sub-acute SCI followed for 18 mos

Upright standing frame

60 mins, 5 × wk (300 mins/week)

No SS difference between standing and non-standing groups in yr 1. After 2 years those standing >/=1 h daily, 5 days/week had SS higher leg BMD than non-standing group

Allison & Dennett 2007 [30]

RCT

Moderate risk (moderate quality)

17

Sub-acute stroke

Upright stander

45 mins, 5 × wk (225 mins/week)

Intervention group: SS improvement Berg Balance score between wk 1 and 12, in intervention group. Non SS higher scores on all motor measures wk 12

Bagley et al. 2005 [31]

RCT

Moderate risk (moderate quality)

167 total–71 intervention, 69 controls

Sub-acute stroke

Upright standing frame

26 mins × 14 sessions (182 mins/week)

No SS difference between groups on any outcome measure or decrease in resource use

Baker et al. 2007 [32]

Randomized crossover

Moderate risk (moderate quality)

6

Chronic MS

Upright standing frame

30 mins daily × 3 weeks (210 mins/week)

SS improvement in hip and ankle ROM in standing vs exercise phase for both groups. No SS differences in spasticity or spasm although downward trend seen

Ben et al. 2001 [33]

RCT

Moderate risk (moderate quality)

20

Sub-acute SCI

Tilt-table, vertical

30 mins, 3× wk × 12 weeks (90 mins/week)

Mean treatment effect on ankle ROM of 4° and on femur BMD of 0.005

Bohannon & Larkin 1985 [34]

Case series

Moderate risk (moderate quality)

20

Sub-acute and chronic SCI

Tilt table, 70°

30 mins × 2.3–6.4 × wk (69–192 mins/week)

Passive ankle dorsiflexion ROM increases in all subjects of between 3 and 17° at a calculated rate of 0.11 to 1.0° a day

Bohannon 1993 [35]

Case study

N/A (low quality)

1

Chronic SCI

Tilt table, 80°

30 mins × 5 sessions (150 mins/week)

Each day’s standing trial followed by immediate reduction in lower extremity spasticity (modified Ashworth scale and pendulum testing). Spasms reduced until following morning-helpful for performance of car transfers

Cotie et al. 2010 [36]

Randomized crossover

Moderate risk (moderate quality)

7

Chronic SCI

Tilt table, to maximum angle tolerated or 80°

30 mins, 3 × wk × 4 weeks (90 mins/week)

Resting skin temperature decreased at 4 sites after 4 weeks BWSTT. Resting skin temp decreased at right thigh only after 4 weeks standing. Both BWSTT and standing training altered reactivity of skin temperature at all sites except the right calf following single session. 1 session BWSTT skin temperature decreased at 6 sites

I session standing skin temperature decreased 2/6 sites

De Bruin et al. 1999 [37]

SSRD—MBD

Serious risk (low quality)

19

Sub-acute SCI

Upright stander

60 mins, 5 × wk (300 mins/week)

Marked decrease trabecular bone in the nonintervention subjects. Subjects beginning standing program early showed no or insignificant loss of trabecular bone

Dunn et al. 1998 [38]

Cross-sectional survey

N/A (low quality)

99

Chronic SCI

Upright stander

30–60 min 1–6×/week (30–360 mins/week)

Less than 10 % experienced side effects e.g. nausea or headaches 21 % reported being able to empty their bladder more completely. Favorable response on effects of the standing on bowel regularity, reduction of urinary tract infections, leg spasticity, and number of bed sores. 79 % of subjects highly recommended standing devices

Edwards & Layne 2007 [39]

Case series

Serious risk (low quality)

4

Chronic SCI

Upright stander

60 mins, 2 × wk × 12 weeks (120 mins/week)

Subjects actively responded to exercise in the standing device, as measured by EMG, HR, and BP

Eng et al. 2001 [20]

Cross-sectional survey

N/A (low quality)

126

Chronic SCI

Upright stander or walker and long-leg braces

40 min 3.8 ×/week (152 mins/week)

Reported improved well-being, circulation, self-care, skin integrity, reflex activity, bowel and bladder function, digestion, sleep, pain, and fatigue. The most common reason preventing respondents from standing was cost of standing equipment

Eser et al. 2003 [40]

RCT

Serious risk (low quality)

38 (19 in each group)

Sub-acute SCI

Passive standing angle or device not stated

30 mins, 5 × wk (150 mins/week)

No SS difference between 30 mins FES cycling or 30 mins standing. Tibial cortical BMD decreased by 0–10 % of initial values within 3–10 mos. Mean decrease BMD 0.3 % per month FES group and 0.7 % in standing group

Frey-Rindova et al. 2000 [41]

Longitudinal

Serious risk (low quality)

29

Sub-acute SCI followed for 2 years

Upright stander

30 mins, 3 × wk (90 mins/week)

12 mos after SCI: tetraplegic - SS decrease BMD in trabecular bone of radius and tibia; paraplegic - decrease in tibia BMD only. No SS influence of physical activity intensity. Tilt table standing in early rehabilitation may attenuate decrease of BMD of tibia in some

Goemaere & Laere 1994 [42]

Cross-sectional

Moderate risk (moderate quality)

53

Chronic SCI

Upright stander

60 mins, 3–7 × wk × 52 weeks (180–420 mins/week)

Standing group better-preserved BMD at femoral shaft (p = 0.009), but not at proximal femur, than non-standing. BMD at lumbar spine (L3, L4) marginally higher in standing group (SS only for L3). Subgroup standing with long leg braces SS higher BMD at proximal femur than those using a standing frame or wheelchair

Goktepe et al. 2008 [43]

Cross-sectional

Moderate risk (moderate quality)

71

Chronic SCI

Upright stander

60 mins daily (420 mins/week)

No SS difference in BMD found among mean t-scores of lumbar and proximal femoral regions of those standing > 1 h, < 1 h or non-standing. Standing >1 h daily -slight tendency to higher t-scores

Hoenig & Murphy 2001 [44]

Case study

N/A (low quality)

1

Chronic SCI

Upright stander

60 min 5 × wk (300 min/week)

Significant increase in frequency of bowel movements and decrease in bowel care time with use of standing table 5 times/week vs baseline

Kim et al. 2015 [57]

RCT

Moderate risk (moderate quality)

30

Sub-acute stroke

Tilt table (subjects determined angle)

20 min 5×/week (100 min)

SS increase in the strength of all LE muscle groups, gait velocity, cadence, stride length, decrease in double limb support period, and improvement in gait symmetry in task-oriented training on a tilt table group vs standing only or standing on 1 leg only groups.

Kim et al. 2015 [58]

RCT

Moderate risk (moderate quality)

39

Sub-acute Stroke

Tilt table (subjects determined angle)

20 min 5×/week (100 min/week)

SS increase in EMG patterns of affected leg extensors and flexors and clinical scores in standing with task-oriented training group vs controls or standing alone. SS improvement in functional status and lower extremity movement in tilt table standing group vs controls

Kunkel et al. 1993 [45]

Case series

Serious risk (low quality)

6 (4 SCI, 2 MS)

Chronic SCI and MS

Upright stander

144 h over 135 days = 64 mins day × 7 (448 mins/week)

No important differences between initial and final scores for clinical assessment and ROM. 3 subjects for whom H-reflexes were found, latency and amplitude not altered by standing. BMD normal in lumbar spine but sig reduced in femoral neck. Standing did not modify BMD in any site. 67 % of subjects continued to “stand” and felt healthier because of it

Kuznetsov et al. 2013 [46]

RCT

Serious risk (low quality)

104 divided between 3 groups

Sub-acute stroke

31 controls used tilt table, 60°–80°

20–30 mins day × 30 days (140–210 mins/week)

Compared robotic tilt-table training (ROBO) plus FES vs ROBO vs tilt-table only (controls). 8 controls prematurely quit study due to orthostatic reactions. BP and cerebral blood flow dipped <10 % during ROBO. 52 % of controls - mean arterial pressure decreased by ≥20 %. ROBO-FES increased leg strength by 1.97 ± 0.88 points, ROBO by 1.50 ± 0.85 more than controls (1.03 ± 0.61, P < 0.05). Cerebral blood flow volume increased in ROBO groups more than controls (P < 0.05)

Kwok 2015 [59]

Randomized Crossover

Moderate quality (moderate risk)

17

Chronic SCI

Tilt-table, as upright as possible

30 mins day 5 × wk × 6 weeks (150 mins/week)

No difference in time to first stool or time for bowel care routine. 8/17 reported improved bowel function including decreased abdominal distention. Some participants reported decreased muscle tone, improved posture in wheelchair and sense of achievement.

Lee et al. 1996 [47]

RCT

Serious risk (low quality)

60

Sub-acute stroke

Upright stander with/without biofeedback

20 mins day × 2–4 weeks (140 mins/week)

SS improvement in static standing steadiness (p < 0.002) in group using biofeedback

Matjacic et al. 2003 [48]

Case study

N/A (low quality)

1

Chronic stroke

Upright dynamic stander

20 mins, 10 sessions (100 mins/week)

Subject demonstrated substantial functional improvement and improved weight-shifting ability following 10 days balance training in a specialized standing frame with computer feedback

Nelson & Schau 1997 [49]

SSRD

Low risk (high quality)

1

Chronic CP

Upright stander

Work day

Small increase in work output when positioned in the standing table but dramatically improved posture

Netz et al. 2007 [50]

Case series

Low risk (high quality)

13

Chronic - various

Upright standing box

Mean 16 mins, 47 sessions in 12 weeks. (62 mins/week)

Significant post-intervention improvements in LE muscle strength. Improvements measured with FIM in sphincter control, locomotion, mobility, motor score, and total score. Over 60 % of those previously requiring assistance to stand were able to stand for an average of 1 min unassisted and walk an average of 14 m with a walker

Odeen & Knutsson 1981 [51]

Case series

Serious risk (low quality)

9

Chronic SCI

Tilt-table 85° Feet in 15° dorsal or plantar flexion

30 mins × 8 sessions, 4 consecutive days (120–210 mins/week)

Following weight-bearing stretch in standing with feet in dorsal or plantar flexion, average reduction in resistance to passive movement was 32 % and 26 %, respectively. Following un-weighted stretch in supine, average reduction was 17 %

Richardson 1991 [52]

SSRD

Serious risk (low quality)

1

Sub-acute TBI

Upright stander

10 mins daily × 7 days (70 mins/week)

Subject increased tolerance for standing and ankle ROM increased

Robinson et al. 2008 [53]

RCT

Low risk (high quality)

30

Sub-acute stroke

Upright stander

30–40 mins × 5 days a wk × 4 weeks (150–200 mins/week)

Same ankle ROM at 4 and 10 week for 2 interventions: splint with affected ankle plantargrade, 7 nights wk vs tilt table standing with ankle at maximum dorsiflexion, 5 × wk

Shields & Dudley-Javoroski 2005 [54]

Case study

N/A (low quality)

1

Chronic SCI

Standing wheelchair

30–40 mins × 5 days a wk (130.4 mins/week)

Data-logger indicated client chose to stand for multiple short bouts (mean = 11.57 min) at average angle of 61° and average of 3.86 ×/week. He achieved 130.4 % of goal (20 mins 5 ×/week) resulting in average of 130.4 min/week. Subjective reports of improved spasticity and bowel motility

Singer et al. 2004 [55]

Longitudinal

Unclear risk (low quality)

105

Acute TBI

Upright stander

30 mins daily (210 mins/week)

Ankle contracture identified in 40/105 patients studied. In 23/40 contracture resolved with PT including prolonged weight-bearing stretches. 17/40 contracture worsened. 10/17 required serial plaster casting (+/− injection of botulinum toxin type A). Remediation of ankle contracture not a priority in 7/40 due to disability severity. Dystonic extensor muscle over-activity major contributor to persistent or progressive ankle contracture

Taveggio et al. 2015 [60]

RCT

Moderate risk (moderate quality)

8

Sub-acute ABI in VS or MCS

Tilt table at 65°

30 mins 3×/week × 24 sessions

Robotic stepping reduced cardiovascular distress in 3 out of 4 patients. Orthostatic hypotension worsened in 3 out of 4 patients in the static standing only group

Walter et al. 1999 [22]

Cross-sectional Survey

N/A (low quality)

99

Chronic SCI

Upright stander

>30 min 7×/week (>210 mins/week)

Respondents (n = 99) who stood ≥30 min/day had sig improved QOL, fewer bed sores, fewer bladder infections, improved bowel regularity, and improved ability to straighten their legs compared with those who stood less time. Compliance with regular home standing (at least once per week) was high (74 %)

Wong & Lee 1997 [56]

RCT

Serious risk (low quality)

60

Sub-acute stroke and TBI

Upright stander with/without biofeedback

60 mins 5 × wk × 2–4 weeks (300 mins/week)

After 4 weeks, % postural asymmetry in intervention (with biofeedback) and controls was reduced from 17.2 +/− 10.8 % and 17.0 +/− 10.0 % to 3.5 +/− 2.2 % and 10.1 +/− 6.4%, respectively (p = 0.003)