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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 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 -
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