-
Neurological Sciences : Official... May 2022In the last decade, there is a growing interest in the use of virtual reality for rehabilitation in clinical and home settings. The aim of this systematic review is to... (Meta-Analysis)
Meta-Analysis Review
Effect of home-based virtual reality training and telerehabilitation on balance in individuals with Parkinson disease, multiple sclerosis, and stroke: a systematic review and meta-analysis.
OBJECTIVE
In the last decade, there is a growing interest in the use of virtual reality for rehabilitation in clinical and home settings. The aim of this systematic review is to do a summary of the current evidence on the effect of home-based virtual reality training and telerehabilitation on postural balance in individuals with central neurological disorders.
METHODS
Literature was searched in PubMed, Web of Science, PEDro, ScienceDirect, and MEDLINE. Randomized controlled trials (RCTs) evaluating the effect of home-based virtual reality (VR) training and telerehabilitation (TR) on postural balance in patients with Parkinson's disease, Multiple sclerosis or stroke. Studies were imported to EndNote and Excel to perform two screening phases by four reviewers. Risk of bias was assessed using PEDro scale and Cochrane assessment tool for risk of bias. Synthesis of the data on comparative outcomes was performed using RevMan software.
RESULTS
Seven RCTs were included, with all three pathologies represented. VR and TR consisted of a training device (e.g., Nintendo Wii or Xbox 360) and a monitoring device (e.g., Skype or Microsoft Kinect). Five studies used the Berg Balance Scale (BBS) for measuring postural balance. Across studies, there was an improvement in BBS scores over time in both experimental and control groups, and the effect remained at follow-up for both groups. However, there was no significant difference between groups post-intervention (MD = 0.74, p = 0.45).
CONCLUSION
Home-based VR and TR can be used as prolongation to conventional therapy.
Topics: Humans; Multiple Sclerosis; Parkinson Disease; Postural Balance; Stroke; Stroke Rehabilitation; Telerehabilitation; Virtual Reality
PubMed: 35175439
DOI: 10.1007/s10072-021-05855-2 -
Journal of Intellectual Disability... Aug 2019Down syndrome is the most common chromosomal abnormality, with a worldwide incidence of around 0.1% in live births. It is related to several conditions in which the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Down syndrome is the most common chromosomal abnormality, with a worldwide incidence of around 0.1% in live births. It is related to several conditions in which the physical therapy could take action-preventing co-morbidities. This study aims to evaluate the effectiveness of physical therapy in Down syndrome, to know and compare the effectiveness of different physical therapy interventions in this population.
METHODS
A systematic review and a meta-analysis of randomised controlled trials were conducted. The search was performed during June 2018 in the following databases: PubMed, Web of Science, Physiotherapy Evidence Database and Scopus. The studies were selected using predefined inclusion and exclusion criteria. The Physiotherapy Evidence Database scale evaluated the quality of the methods used in the studies. Subsequently, the data were extracted, and statistical analysis was performed when possible.
RESULTS
A total of 27 articles were included, of which nine contributed information to the meta-analysis. Statistical analysis showed favourable results for the strength of upper and lower limbs [standardised mean difference (SMD) = 1.46; 95% confidence interval (CI): (0.77-2.15); and SMD = 2.04; 95% CI: (1.07-3.01)] and mediolateral oscillations of balance [SMD = -3.30; 95% CI: (-5.34 to -1.26)].
CONCLUSIONS
The results show the potential benefit of certain types of physical therapy interventions, specifically in strength and balance, in people with Down syndrome. There are still many aspects to clarify and new lines of research.
Topics: Down Syndrome; Humans; Physical Therapy Modalities
PubMed: 30788876
DOI: 10.1111/jir.12606 -
International Journal of Environmental... Jan 2021the main objective of this study was to analyze the potential short-, medium- and long-term effects of a therapeutic physical exercise (TFE) programme on the... (Review)
Review
BACKGROUND
the main objective of this study was to analyze the potential short-, medium- and long-term effects of a therapeutic physical exercise (TFE) programme on the functionality of amyotrophic lateral sclerosis (ALS) patients, measured with the Revised Amyotrophic Lateral Sclerosis Functional Scale (ALSFRS-R) scale.
METHODS
a systematic review of the PubMed, SCOPUS, Cochrane, Scientific Electronic Library Online (Scielo), Physiotherapy Evidence Database (PEDro), Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Medical Literature Analysis and Retrieval System Online (MEDline) databases was carried out. The information was filtered using the following Medical Subjects Heading (MeSH) terms: "Amyotrophic lateral sclerosis", "Physical Therapy", and "Physical and Rehabilitation Medicine". The internal validity of the selected documents was evaluated using the PEDro scale. The study included clinical trials published in the last 5 years in which one of the interventions was therapeutic physical exercise in patients with ALS, using the ALSFRS-R as the main outcome variable and functional variables as secondary variables.
RESULTS
10 clinical trials were analyzed, with an internal validity of 5-7 points. The TFE groups showed significant short-, medium- and long-term differences, obtaining a mean difference of 5.8 points compared to the 7.6 points obtained by the control groups, at six months, measured with ALSFRS-R. In addition, the participants showed significant improvements in functional abilities in the short, medium and long terms.
CONCLUSIONS
Therapeutic physical exercise could contribute to slowing down the deterioration of the musculature of patients with ALS, thus facilitating their performance in activities of daily living, based on the significant differences shown by these individuals in the short, medium and long term both in subjective perception, measured with ALSFRS-R, and functional capacities.
Topics: Activities of Daily Living; Amyotrophic Lateral Sclerosis; Exercise; Exercise Therapy; Humans; Physical Therapy Modalities
PubMed: 33530383
DOI: 10.3390/ijerph18031074 -
Clinical Rehabilitation Sep 2020This systematic review and meta-analysis investigates the effects of resistance training in supporting the recovery in stroke patients. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This systematic review and meta-analysis investigates the effects of resistance training in supporting the recovery in stroke patients.
DATA SOURCES
PubMed, the Cochrane Central Register of Controlled Trials and the PEDro databases were reviewed up to 30 April 2020.
REVIEW METHODS
Randomized controlled trials were included, who compared: (i) resistance training with no intervention, (ii) resistance training with other interventions and (iii) different resistance training protocols in stroke rehabilitation.
RESULTS
Overall 30 trials ( = 1051) were enrolled. The parameters evaluated were: (1) gait, (2) muscular force and motor function, (3) mobility, balance and postural control, (4) health related quality of life, independence and reintegration, (5) spasticity and hypertonia, (6) cardiorespiratory fitness, (7) cognitive abilities and emotional state and (8) other health-relevant physiological indicators. The data indicates that: (i) resistance training is beneficial for the majority of parameters observed, (ii) resistance training is superior to other therapies on muscular force and motor function of lower and upper limbs, health related quality of life, independence and reintegration and other health-relevant physiological indicators, not significantly different from other therapies on walking ability, mobility balance and postural control and spasticity and hypertonia, and inferior to ergometer training on cardiorespiratory fitness and (iii) the type of resistance training protocol significantly impacts its effect; leg press is more efficient than knee extension and high intensity training is superior than low intensity training.
CONCLUSION
Current data indicates that resistance training may be beneficial in supporting the recovery of stroke patients. However, the current evidence is insufficient for evidence-based rehabilitation.
Topics: Humans; Resistance Training; Stroke Rehabilitation
PubMed: 32527148
DOI: 10.1177/0269215520932964 -
Sports Medicine and Arthroscopy Review Jun 2021Rotator cuff tears are the most common cause of shoulder disability and can cause significant pain and dysfunction. This systematic review summarizes the latest research...
Rotator cuff tears are the most common cause of shoulder disability and can cause significant pain and dysfunction. This systematic review summarizes the latest research on rehabilitation following arthroscopic rotator cuff repair. Studies were eligible for inclusion if they pertained to postoperative rehabilitation following arthroscopic rotator cuff repair and were published between 2003 and 2019 with a level of evidence of 1 or 2. Two blinded reviewers screened, graded, and extracted data from articles and recommendations on various aspects of rehabilitation were summarized. A total of 4067 articles were retrieved from the database search and 22 studies were included for data extraction. We noted similar outcomes between early and delayed mobilization following surgery. Reviewed articles support the use of supervised physical therapy, bracing in 15 degrees external rotation, and adjunctive transcutaneous electrical nerve stimulation for pain management. Early isometric loading improved outcomes in 1 study. Evidence is lacking for exercise prescription parameters and postoperative rehabilitation of the subscapularis.
Topics: Braces; Combined Modality Therapy; Humans; Pain Management; Physical Therapy Modalities; Postoperative Care; Rotator Cuff Injuries
PubMed: 33972488
DOI: 10.1097/JSA.0000000000000310 -
Annals of Palliative Medicine Feb 2022Limb hemiplegia is one of the common sequelae of stroke. Physical therapy-based rehabilitation training can rapidly improve limb functioning and muscle strength. This... (Meta-Analysis)
Meta-Analysis
Effects of physical therapy-based rehabilitation on recovery of upper limb motor function after stroke in adults: a systematic review and meta-analysis of randomized controlled trials.
BACKGROUND
Limb hemiplegia is one of the common sequelae of stroke. Physical therapy-based rehabilitation training can rapidly improve limb functioning and muscle strength. This study investigated the effect of physical therapy on the recovery of upper limb motor function by employing a literature search and meta-analysis.
METHODS
We searched Embase, The Cochrane Central Register of Controlled Trials library, Wiley online library, PubMed, Ovid, and Clinicaltrials.org for randomized controlled trial (RCT) studies and performed an electronic search with the keyword combinations 'physical therapy/rehabilitation' & 'stroke/post-stroke' & 'upper extremity/upper limb'. After screening the literature for inclusion criteria and assessing the risk of bias, Revman 5.4 software was used for the analysis and to obtain forest and funnel plots.
RESULTS
A total of 15 RCTs with 1,081 patients were included in the quantitative analysis for this study. The meta-analysis results showed that compared with conventional therapy, physical therapy improved the upper limb Fugl-Meyer Assessment for Upper Extremity (FMA) scores in convalescent stroke patients (MD =7.27, 95% CI: 4.23-10.32, Z=4.68, P<0.00001), and increased the Functional Independence Measure (FIM) scores (MD =18.82, 95% CI: 6.34-31.30, Z=2.96, P=0.003), the Action Research Arm Test (ARAT) scores (MD =8.84, 95% CI: 6.53-11.15, Z=7.50, P<0.00001), and the Box and Block Test (BBT) scores (MD =6.11, 95% CI: 1.18-11.04, Z=2.43, P=0.02) of patients during the rehabilitation period.
DISCUSSION
The use of physical therapy-based rehabilitation training in the recovery period for stroke patients with hemiplegia can improve upper limb movement ability, increase muscle strength, reduce limb pain, and improve the quality of life.
Topics: Adult; Humans; Physical Therapy Modalities; Randomized Controlled Trials as Topic; Stroke; Stroke Rehabilitation; Upper Extremity
PubMed: 35249330
DOI: 10.21037/apm-21-3710 -
Multiple Sclerosis and Related Disorders Jan 2023To assess the benefits of neurological rehabilitation and the dose-response relationship for the treatment of mobility and balance in multiple sclerosis. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To assess the benefits of neurological rehabilitation and the dose-response relationship for the treatment of mobility and balance in multiple sclerosis.
METHODS
We included studies investigating the effects of neurological rehabilitation on mobility and balance with the following eligibility criteria for inclusion: Population, People with Multiple Sclerosis (PwMS); Intervention, method of rehabilitation interventions; Comparison, experimental (specific balance intervention) vs control (no intervention/no specific balance intervention); Outcome, balance clinical scales; Study Design, randomised controlled trials. We conducted a random effects dose-response meta-analysis to assess linear trend estimations and a one stage linear mixed effects meta-regression for estimating dose-response curves.
RESULTS
We retrieved 196 studies from a list of 5020 for full text review and 71 studies (n subjects=3306) were included. One study was a cross-over and 70 studies were randomized controlled trials and the mean sample size per study was 46.5 ± 28.6 (mean±SD) with a mean age of 48.3 ± 7.8years, disease duration of 11.6 ± 6.1years, and EDSS of 4.4 ± 1.4points. Twenty-nine studies (40.8%) had the balance outcome as the primary outcome, while 42 studies (59.1%) had balance as secondary outcome or did not specify primary and secondary outcomes. Thirty-three trials (46.5%) had no active intervention as comparator and 38 trials (53.5%) had an active control group. Individual level data from 20 studies (n subjects=1016) were analyzed showing a medium pooled effect size for balance interventions (SMD=0.41; 95% CIs 0.22 to 0.59). Moreover, we analyzed 14 studies (n subjects=696) having balance as primary outcome and BBS as primary endpoint yielding a mean difference of 3.58 points (95% CIs 1.79 to 5.38, p<0.0001). Finally, we performed meta regression of the 20 studies showing an association between better outcome, log of intensity defined as minutes per session (β=1.26; SEβ=0.51; p = 0.02) and task-oriented intervention (β=0.38; SEβ=0.17; p = 0.05).
CONCLUSION
Our analyses provide level 1 evidence on the effect of balance intervention to improve mobility. Furthermore, according to principles of neurological rehabilitation, high intensity and task-specific interventions are associated with better treatment outcomes.
Topics: Humans; Adult; Middle Aged; Multiple Sclerosis; Exercise Therapy; Neurological Rehabilitation; Randomized Controlled Trials as Topic
PubMed: 36473240
DOI: 10.1016/j.msard.2022.104424 -
Archives of Physical Medicine and... Jul 2022To determine the effects of virtual reality (VR) rehabilitation training on the cognitive function and activities of daily living (ADL) of patients with poststroke... (Meta-Analysis)
Meta-Analysis Review
Effects of Virtual Reality Rehabilitation Training on Cognitive Function and Activities of Daily Living of Patients With Poststroke Cognitive Impairment: A Systematic Review and Meta-Analysis.
OBJECTIVE
To determine the effects of virtual reality (VR) rehabilitation training on the cognitive function and activities of daily living (ADL) of patients with poststroke cognitive impairment (PSCI).
DATA SOURCES
Four Chinese databases and 6 English databases were systematically searched for studies published until August 31, 2021, by using Medical Subject Headings of the National Library of Medicine terms such as virtual reality, cognition disorders, cognitive dysfunction, and stroke and free terms such as virtual environment, VR, cognition impairment, cerebrovascular accident, and PSCI.
STUDY SELECTION
Randomized controlled trials treating PSCI with VR training were included. The control groups received conventional treatments such as conventional rehabilitation training and drug therapy; the experimental groups received VR rehabilitation training. The outcome measures were cognitive function and ADL.
DATA EXTRACTION
Two researchers independently extracted key information from eligible studies. The methodological quality of the studies was evaluated using the Cochrane Handbook for Systematic Reviews of Interventions v5.1.0. Meta-analysis was performed using RevMan v5.4. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines.
DATA SYNTHESIS
Twenty-one studies (1149 participants) were included. Meta-analyses found that compared with the control group, VR rehabilitation training increased Mini-Mental State Examination, Montreal Cognitive Assessment, Loewenstein Occupational Therapy Cognitive Assessment, Rivermead Behavioral Memory Test Second Edition, Barthel Index, Modified Barthel Index, and FIM scores; event-related potential 300 (P300) amplitude; and the N-acetylaspartate/creatinine (Cr) ratio on proton magnetic resonance spectroscopy (H-MRS) and reduced P300 latency; Trail Making Test scores; and the choline-containing compounds/Cr ratio on H-MRS (all P<.05). These results indicated that VR training improved cognitive function and ADL in PSCI.
CONCLUSIONS
VR rehabilitation training promotes the rehabilitation of cognitive function and recovery of ADL in patients with PSCI and may be a good complementary approach to conventional cognitive interventions.
Topics: Activities of Daily Living; Cognition; Cognitive Dysfunction; Humans; Stroke; Stroke Rehabilitation; Telerehabilitation; Virtual Reality; Virtual Reality Exposure Therapy
PubMed: 35417757
DOI: 10.1016/j.apmr.2022.03.012 -
Brain Research Bulletin Dec 2021Available literature indicates that 30-66% of stroke survivors present persistent upper limb impairment. Considering the importance of upper limb function for activities... (Meta-Analysis)
Meta-Analysis Review
Available literature indicates that 30-66% of stroke survivors present persistent upper limb impairment. Considering the importance of upper limb function for activities of daily living, it is necessary to investigate neurorehabilitation therapies that could improve the upper limb function. Among stroke complementary therapies, mirror therapy has shown promising results. Thus, the aim of this systematic review and meta-analyses was to review and synthesize clinical evidence on the use of mirror therapy on motor recovery of the upper limb and activities of daily living, and its neural correlates in stroke patients. The literature search was carried out in PubMed, ISI Web of Science, and Scopus databases. Twenty-nine studies met all the inclusion criteria. Two meta-analyses were conducted to compare mirror therapy with sham therapy on two general measures, upper limb assessment and activities of daily living. Results suggest that mirror therapy was better than sham therapy, mainly in the subacute phase, but the meta-analyses were nonsignificant. In addition, mirror therapy and cortical reorganization showed potential neural correlates, such as the primary motor cortex, precuneus, and posterior cingulate cortex.
Topics: Activities of Daily Living; Humans; Mirror Movement Therapy; Recovery of Function; Stroke; Stroke Rehabilitation; Upper Extremity
PubMed: 34626693
DOI: 10.1016/j.brainresbull.2021.10.003 -
Annals of Physical and Rehabilitation... Sep 2019Exercise is an effective treatment for osteoarthritis. However, the effect may vary from one patient (or study) to another. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Exercise is an effective treatment for osteoarthritis. However, the effect may vary from one patient (or study) to another.
OBJECTIVE
To evaluate the efficacy of exercise and its potential determinants for pain, function, performance, and quality of life (QoL) in knee and hip osteoarthritis (OA).
METHODS
We searched 9 electronic databases (AMED, CENTRAL, CINAHL, EMBASE, MEDLINE Ovid, PEDro, PubMed, SPORTDiscus and Google Scholar) for reports of randomised controlled trials (RCTs) comparing exercise-only interventions with usual care. The search was performed from inception up to December 2017 with no language restriction. The effect size (ES), with its 95% confidence interval (CI), was calculated on the basis of between-group standardised mean differences. The primary endpoint was at or nearest to 8 weeks. Other outcome time points were grouped into intervals, from<1 month to≥18 months, for time-dependent effects analysis. Potential determinants were explored by subgroup analyses. Level of significance was set at P≤0.10.
RESULTS
Data from 77 RCTs (6472 participants) confirmed statistically significant exercise benefits for pain (ES 0.56, 95% CI 0.44-0.68), function (0.50, 0.38-0.63), performance (0.46, 0.35-0.57), and QoL (0.21, 0.11-0.31) at or nearest to 8 weeks. Across all outcomes, the effects appeared to peak around 2 months and then gradually decreased and became no better than usual care after 9 months. Better pain relief was reported by trials investigating participants who were younger (mean age<60 years), had knee OA, and were not awaiting joint replacement surgery.
CONCLUSIONS
Exercise significantly reduces pain and improves function, performance and QoL in people with knee and hip OA as compared with usual care at 8 weeks. The effects are maximal around 2 months and thereafter slowly diminish, being no better than usual care at 9 to 18 months. Participants with younger age, knee OA and not awaiting joint replacement may benefit more from exercise therapy. These potential determinants, identified by study-level analyses, may have implied ecological bias and need to be confirmed with individual patient data.
Topics: Adult; Aged; Exercise Therapy; Female; Humans; Male; Middle Aged; Osteoarthritis, Hip; Osteoarthritis, Knee; Pain Measurement; Quality of Life; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 31121333
DOI: 10.1016/j.rehab.2019.04.006