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Ocular Immunology and Inflammation Jul 2021: Anterior chamber (AC) flare is a key sign for anterior uveitis. New instrument-based techniques for measuring AC flare can offer automation and objectivity. This...
: Anterior chamber (AC) flare is a key sign for anterior uveitis. New instrument-based techniques for measuring AC flare can offer automation and objectivity. This review aims to identify objective instrument-based measures for AC flare.: In this systematic review, we identified studies reporting correlation between instrument-based tests versus clinician AC flare grading, and/or aqueous protein concentration, as well as test reliability.: Four index tests were identified in 11 studies: laser-flare photometry (LFP), optical coherence tomography, ocular flare analysis meter (OFAM) and the double-pass technique. The correlation between LFP and clinician grading was 0.40-0.93 and 0.87-0.94 for LFP and protein concentration. The double-pass technique showed no correlation with clinician grading and insufficient information was available for OFAM.: LFP shows moderate to strong correlation with clinician grading and aqueous protein concentration. LFP could be a superior reference test compared to clinician AC flare grading for validating new index tests.
Topics: Anterior Chamber; Aqueous Humor; Diagnostic Techniques, Ophthalmological; Eye Proteins; Humans; Photometry; Tomography, Optical Coherence; Uveitis, Anterior
PubMed: 32255392
DOI: 10.1080/09273948.2019.1709650 -
Journal of Advanced Nursing Sep 2019To determine the impact of strategies to promote mobilization on physical function in hospitalized adults with medical conditions. (Comparative Study)
Comparative Study Meta-Analysis
AIM
To determine the impact of strategies to promote mobilization on physical function in hospitalized adults with medical conditions.
BACKGROUND
Slow progress is noted on the promotion of mobilization during hospitalization for adult patients admitted for medical conditions. This may reflect the limited evidence on the evaluation of the impact of progressive mobilization activities on clinical endpoints in adult patients throughout hospitalization.
DESIGN
A systematic review and meta-analysis of published randomized controlled trials in any language.
DATA RESOURCES
The literature search was performed in the MEDLINE, CINAHL online, HealthStar, EMBASE, the Cochrane Library Controlled Trials Registry and LILACS databases (January 2000-February 2017).
REVIEW METHODS
Two authors independently identified randomized trials meeting inclusion criteria, assessed their quality and extracted relevant data. Outcomes assessed were the changes in physical function evaluated by scales measuring either the aerobic (metres walked/second) or the balance domain (using the Time Up and Go test, in seconds), length of hospital stay (days), and adverse clinical events. We calculated pooled mean differences or Mantel-Haenszel odds ratios and 95% confidence intervals for continuous or dichotomous outcome data and obtained heterogeneity statistics across studies.
RESULTS
Thirteen studies, including in total 2,703 participants, met our eligibility criteria. Patients in the intervention group showed significant improvement in physical function (aerobic domain), reduced length of stay, and a reduction of pulmonary embolism.
CONCLUSION
Patients and health providers should consider a course of therapy that enhances the functional capacity of medical patients during hospitalization.
Topics: Adult; Aged; Aged, 80 and over; Exercise; Exercise Therapy; Female; Hospitalization; Humans; Male; Middle Aged; Mobility Limitation; Postural Balance; Practice Guidelines as Topic; Standard of Care
PubMed: 30672011
DOI: 10.1111/jan.13958 -
Scientific Reports Jun 2020Treatment options for chronic thromboembolic pulmonary hypertension (CTEPH) that is not amenable to thromboendarterectomy or is recurrent/persistent after... (Meta-Analysis)
Meta-Analysis
Comparison of Balloon Pulmonary Angioplasty and Pulmonary Vasodilators for Inoperable Chronic Thromboembolic Pulmonary Hypertension: A Systematic Review and Meta-Analysis.
Treatment options for chronic thromboembolic pulmonary hypertension (CTEPH) that is not amenable to thromboendarterectomy or is recurrent/persistent after thromboendarterectomy (inoperable CTEPH) include pulmonary vasodilators or balloon pulmonary angioplasty (BPA). We compared efficacy and safety outcomes of BPA with or without pulmonary vasodilators to pulmonary vasodilator therapy alone in patients with inoperable CTEPH. Observational and randomized trial data reporting outcomes for >5 patients with inoperable CTEPH were sought. Single-arm random effects meta-analyses were performed. The primary outcome was change in six-minute walk distance (6MWD). Secondary outcomes included safety; World Health Organization functional class (WHO FC); and change in mean pulmonary arterial pressure (mPAP), pulmonary vascular resistance (PVR), and cardiac index. Thirty-four studies with 1604 patients were eligible for analyses. Both treatments resulted in significant improvement in 6MWD (71.0 meters, 95% CI: 47.4-94.5 meters with BPA versus 47.8 meters, 95% CI: 34.5-61.2 meters with pulmonary vasodilators), PVR [-3.1 Wood Units (WU), 95% CI: -4.9 to -1.4 WU versus -1.6 WU, 95% CI: -2.4 to -0.8 WU] and mPAP (-14.8 mmHg, 95% CI: -18.2 to -11.5 mmHg versus -4.9 mmHg, 95% CI: -6.9 to -2.8 mmHg). Cardiac index was similar and most patients were WHO FC II and III after their respective interventions. More complications occurred in the BPA arm. In conclusion, BPA and pulmonary vasodilators both improve 6MWD and hemodynamics in patients with inoperable CTEPH. While BPA may offer greater functional and hemodynamic improvements, this technique carries the accompanying risks of an invasive procedure.
Topics: Angioplasty, Balloon; Chronic Disease; Exercise Test; Humans; Hypertension, Pulmonary; Pulmonary Embolism; Treatment Outcome; Vasodilator Agents
PubMed: 32483219
DOI: 10.1038/s41598-020-65697-4 -
American Journal of Physical Medicine &... Oct 2020The study aimed to evaluate the effect of virtual reality on balance, motor function, gait, and the ability to perform activities of daily living in patients with... (Meta-Analysis)
Meta-Analysis
The Effect of Virtual Reality on the Ability to Perform Activities of Daily Living, Balance During Gait, and Motor Function in Parkinson Disease Patients: A Systematic Review and Meta-Analysis.
OBJECTIVE
The study aimed to evaluate the effect of virtual reality on balance, motor function, gait, and the ability to perform activities of daily living in patients with Parkinson disease.
METHODS
We searched Cochran Central Register of Controlled Trials, Embase, PubMed, Wanfang Data, VIP Database, and China National Knowledge Infrastructure from their inception to June 2019. Two authors independently screened articles for inclusion, extracted data, and evaluated quality.
RESULTS
Twelve randomized clinical trials involving 360 patients were included. It demonstrated that virtual reality can improve balance, measured by the Berg Balance Scale (fixed model weighted mean difference = 2.28, 95% CI = 1.39 to 3.16, P < 0.00001); strengthen motor function, assessed by the Timed Up and Go test (fixed model weighted mean difference = -1.66, 95% CI = -2.74 to 0.58, P = 0.003); enhance gait ability, assessed by the 10-Meter Walk Test Time (fixed model weighted mean difference = 0.13, 95% CI = 0.02 to 0.24, P = 0.02) in patients with Parkinson disease. It also showed that virtual reality can improve individuals' ability to perform activities of daily living, assessed by modified Barthel Index (fixed model weighted mean difference = 2.93, 95% CI = 0.8 to 5.06, P = 0.007).
CONCLUSIONS
The findings suggest that virtual reality rehabilitation may be valuable in improving the balance, motor function, gait, and ability to perform activities of daily living in patients with Parkinson disease.
Topics: Activities of Daily Living; Humans; Motor Skills; Parkinson Disease; Postural Balance; Randomized Controlled Trials as Topic; Virtual Reality
PubMed: 32304383
DOI: 10.1097/PHM.0000000000001447 -
Journal of Neurology Sep 2019Late-onset Pompe disease (LOPD) is a rare, metabolic disease primarily affecting the musculoskeletal and respiratory systems. Forced vital capacity (FVC) is commonly... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Late-onset Pompe disease (LOPD) is a rare, metabolic disease primarily affecting the musculoskeletal and respiratory systems. Forced vital capacity (FVC) is commonly used to measure pulmonary function; however, associations between FVC and other LOPD outcomes remain unclear.
METHODS
A systematic literature review was conducted on November 2015, updated September 2016 and supplemented with clinical trial data from the sponsor. Outcomes included: 6-min walk test distance (6MWT), FVC, maximal inspiratory/expiratory pressure (MIP/MEP), Medical Research Council-skeletal muscle strength score (MRC), 36-item short-form survey-physical component score (SF-36), Rotterdam Handicap Scale (RHS), Fatigue Severity Scale (FSS) and survival. Individual patient data meta-analysis was used for cross-sectional analyses and longitudinal analyses to determine associations between percent of predicted FVC and LOPD measures and outcomes.
RESULTS
Fifteen studies were selected. From cross-sectional analyses, FVC and MRC were most strongly associated. Specifically, patients with 10% higher FVC (a round number for illustrative purposes only) were associated with a 4.72% (95% confidence interval [CI]: 3.37, 6.07) higher MRC score, indicating a positive association. Similarly, slopes for the 6MWT and SF-36 relative to a 10% higher FVC were estimated at 33.2 meters (95% CI 24.0, 42.4) and 1.2% (95% CI 0.24, 2.16%), respectively. From longitudinal analyses, a 10% incremental increase in predicted FVC was associated with an average increase of 4.12% in MRC score (95% CI 1.29, 6.95), 35.6 m in the 6MWT (95% CI 19.9, 51.6), and 1.34% in SF-36 (95% CI 0.08, 2.60). There was insufficient data to conduct analyses for RHS, FSS and survival.
CONCLUSIONS
FVC is positively associated with LOPD measures and outcomes across multiple domains. Additionally, longitudinal changes in FVC are positively associated with changes in the 6MWT, MRC and SF-36.
Topics: Age of Onset; Cross-Sectional Studies; Glycogen Storage Disease Type II; Humans; Treatment Outcome; Vital Capacity
PubMed: 31187190
DOI: 10.1007/s00415-019-09401-1 -
PM & R : the Journal of Injury,... Aug 2019To evaluate the evidence on the effectiveness of high-intensity interval training (HIIT) in improving fitness and mobility post stroke. TYPE: Systematic review.
OBJECTIVE
To evaluate the evidence on the effectiveness of high-intensity interval training (HIIT) in improving fitness and mobility post stroke. TYPE: Systematic review.
LITERATURE SURVEY
Medline, Embase, CINAHL, PsycINFO, and Scopus were searched for articles published in English up to January 2018.
METHODOLOGY
Studies were included if the sample was adult human participants with stroke, the sample size was ≥3, and participants received >1 session of HIIT. Study and participant characteristics, treatment protocols, and results were extracted.
SYNTHESIS
Six studies with a total of 140 participants met inclusion criteria: three randomized controlled trials and three pre-post studies. HIIT protocols ranged 20 to 30 minutes per session, 2 to 5 times per week, and 2 to 8 weeks in total. HIIT was delivered on a treadmill in five studies and a stationary bicycle in one study. Regarding fitness measures, HIIT produced significant improvements in peak oxygen consumption compared to baseline, but the effect was not significant compared to moderate intensity continuous exercise (MICE). Regarding mobility measures, HIIT produced significant improvements on the 10-Meter Walk Test (10MWT), 6-Minute Walk Test (6MWT), Berg Balance Scale (BBS), Functional Ambulation Categories (FAC), Timed Up and Go Test, and Rivermead Motor Assessment compared to baseline. The effect of HIIT was significant compared to MICE on the 10MWT and FAC but not on the 6MWT or BBS.
CONCLUSIONS
There is preliminary evidence that HIIT may be an effective rehabilitation intervention for improving some aspects of cardiorespiratory fitness and mobility post stroke.
LEVEL OF EVIDENCE
I.
Topics: Aged; Exercise Therapy; Female; High-Intensity Interval Training; Humans; Male; Middle Aged; Oxygen Consumption; Physical Fitness; Postural Balance; Prognosis; Randomized Controlled Trials as Topic; Recovery of Function; Stroke; Stroke Rehabilitation; Treatment Outcome; Walking Speed
PubMed: 30859720
DOI: 10.1002/pmrj.12154 -
Journal of Traditional Chinese Medicine... Apr 2020To evaluate the efficacy and safety of tonifying kidney therapy (Bushen, TK) for stable chronic obstructive pulmonary disease (COPD). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the efficacy and safety of tonifying kidney therapy (Bushen, TK) for stable chronic obstructive pulmonary disease (COPD).
METHODS
Randomized controlled trials (RCTs) of TK use for treatment of stable COPD were searched in four databases including PubMed, the Cochrane Library, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure Database from inception to December 2017. Two reviewers independently screened the literature, extracted the data, and assessed the risk of bias in the included studies. RevMan 5.3 software was used for the Meta-analysis.
RESULTS
Eight RCTs involving 809 patients with stable COPD were included. Compared with the conventional Western Medicine (CWM) group, the TK group (TK combined with CWM) showed significant improvements in the effectiveness rates (RR = 1.37, 95% CI 1.22 to 1.53, P < 0.000 01) and 6-min walk distance in meters (MD 11.92, 95% CI 3.52 to 20.32, P = 0.005), this study also showed that the TK group can decrease The Traditional Chinese Medicine Syndrome Score (MD -8.01, 95% CI -12.89 to -3.13, P = 0.001). The lung function [forced expiratory volume in one second% (FEV1%), FEV1/forced vital capacity] showed no difference between the TK and control groups.
CONCLUSION
For patients with stable COPD, TK can improve the clinical effectiveness and exercise capacity but fail to improve the patient's symptoms. Because of the low methodological quality of the included trials, additional high-quality and large-scale RCTs are required.
Topics: Aged; Drugs, Chinese Herbal; Female; Humans; Kidney; Male; Medicine, Chinese Traditional; Middle Aged; Pulmonary Disease, Chronic Obstructive; Quality of Life; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 32242384
DOI: No ID Found -
Disability and Rehabilitation.... Nov 2019To assess the effects of lower limb robotic exoskeletons on outcomes in the rehabilitation of people with acquired brain injury. A systematic review of seven electronic... (Meta-Analysis)
Meta-Analysis
To assess the effects of lower limb robotic exoskeletons on outcomes in the rehabilitation of people with acquired brain injury. A systematic review of seven electronic databases was conducted. The primary outcome of interest was neuromuscular function. Secondary outcomes included quality of life, mood, acceptability and safety. Studies were assessed for methodological quality and recommendations were made using the GRADE system. Of 2469 identified studies, 13 ( = 322) were included in the review. Five contained data suitable for meta-analysis. When the data were pooled, there were no differences between exoskeleton and control for 6-Minute Walk Test, Timed Up and Go or 10-Meter Walk Test. Berg Balance Scale outcomes were significantly better in controls (MD = 2.74, CI = 1.12-4.36, = 0.0009). There were no severe adverse events but drop-outs were 11.5% ( = 37). No studies reported the effect of robotic therapy on quality of life or mood. Methodological quality was on average fair (15.6/27 on Downs and Black Scale). Only small numbers of people with acquired brain injury had data suitable for analysis. The available data suggests no more benefit for gait or balance with robotic therapy than conventional therapy. However, some important outcomes have not been studied and further well-conducted research is needed to determine whether such devices offer benefit over conventional therapy, in particular subgroups of those with acquired brain injury.Implications for RehabilitationThere is adequate evidence to recommend that powered over-ground lower limb robotic exoskeletons should not be used clinically in those with ABI, and that use should be restricted to research.Further research (controlled trials) with dependent ambulators is recommended.Research of other outcomes such as acceptability, spasticity, sitting posture, cardiorespiratory and psychological function, should be considered.
Topics: Brain Injuries; Exoskeleton Device; Gait Disorders, Neurologic; Humans; Lower Extremity; Outcome Assessment, Health Care; Postural Balance; Quality of Life; Robotics; Walk Test
PubMed: 30241453
DOI: 10.1080/17483107.2018.1499137 -
Journal of Stroke and Cerebrovascular... Nov 2020Patients with post-stroke hemiparesis have poor postural stability; nevertheless, it is unclear whether vestibular rehabilitation affects gait performance after a stroke...
BACKGROUND
Patients with post-stroke hemiparesis have poor postural stability; nevertheless, it is unclear whether vestibular rehabilitation affects gait performance after a stroke or not. We performed a systematic review of randomized controlled trials to investigate the effects of vestibular rehabilitation on gait performance in patients with post stroke.
METHODS
The Medline, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and Cumulative Index to Nursing and Allied Health Literature databases were comprehensively searched. All literature published from each source's earliest date to June 2019 was included. Study selection and data extraction were performed independently by paired reviewers. Outcomes of gait performance were the 10-Meter Walking Test, Timed Up and Go Test, and Dynamic Gait Index. We applied the Physiotherapy Evidence Database scale to evaluate the risk of bias and the Grading of Recommendations Assessment, Development and Evaluation system to evaluate the quality of a body of evidence.
RESULTS
Three studies were included, and two out of three trials showed beneficial effects of vestibular rehabilitation in post-stroke patients. Quality assessment using the Grading of Recommendations Assessment, Development and Evaluation criteria found very low-quality evidence of all included studies due to inadequate allocation concealment, low participant numbers, and lack of blinding.
CONCLUSION
This review found beneficial effects of vestibular rehabilitation on gait performance in patients with stroke. However, due to the very low-quality evidence of previous randomized controlled trials as assessed by the Grading of Recommendations Assessment, Development and Evaluation criteria, definitive conclusions on the effectiveness of vestibular rehabilitation cannot be made. Hence, more high-quality and large-scale randomized controlled trials of vestibular rehabilitation after stroke are needed.
Topics: Aged; Female; Gait; Gait Analysis; Humans; Male; Middle Aged; Postural Balance; Randomized Controlled Trials as Topic; Recovery of Function; Stroke; Stroke Rehabilitation; Treatment Outcome; Vestibule, Labyrinth
PubMed: 33066892
DOI: 10.1016/j.jstrokecerebrovasdis.2020.105214 -
American Heart Journal Nov 2021Soluble guanylate cyclase (sGC) stimulators are a novel class of medications with emerging role in heart failure (HF). The aim of this study is to evaluate the efficacy... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Soluble guanylate cyclase (sGC) stimulators are a novel class of medications with emerging role in heart failure (HF). The aim of this study is to evaluate the efficacy and safety of oral sGC stimulators in patients with HF with reduced and preserved ejection fraction (HFrEF and HFpEF) by pooling data from all available randomized control trials (RCT).
METHODS
A comprehensive search of electronic databases from 2000-2020 was performed. Seven RCTs, three HFrEF and four HFpEF studies, were identified. The follow-up duration ranged from 1 month to a median of 10.8 months. A random-effects meta-analysis was conducted to summarize the studies.
RESULTS
The study population included 7190 patients: 5707 HFrEF and 1483 HFpEF patients. In HFrEF, oral sGC stimulators reduced the composite incidence of HF hospitalization and cardiovascular death (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.78-0.97; I = 0%), primarily driven by lower HF hospitalization (HR 0.88, 95% CI 0.78-0.99; I = 0%). There was no significant reduction in all-cause death in HFrEF (HR 0.95, 95% CI 0.83-1.09; I = 0%). In HFpEF, there were no improvements in Kansas City Cardiomyopathy Questionnaire clinical summary scores (mean difference 0.81, 95% CI -2.16-3.77; I = 72%) or 6-minute walk distance (mean difference 3.34 meters, 95% CI -7.86-14.54; I = 28%). There was no difference in all-cause mortality in HFpEF (HR 1.94, 95% CI 0.92-4.09; I = 0%). Overall, oral sGC stimulators had low medication-related serious adverse events.
CONCLUSION
Oral sGC stimulators are well tolerated in HF and reduce the incidence of HF hospitalization but not cardiovascular death among patients with HFrEF. However, there are no apparent benefits in HFpEF.
Topics: Enzyme Activators; Heart Failure; Hospitalization; Humans; Mortality; Randomized Controlled Trials as Topic; Soluble Guanylyl Cyclase
PubMed: 34283990
DOI: 10.1016/j.ahj.2021.07.003