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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 -
Journal of Sports Science & Medicine Sep 2020After lower extremity injury, only half of the injured athletes return to their pre-injury sports level. Even though functional performance tests are often used to make...
After lower extremity injury, only half of the injured athletes return to their pre-injury sports level. Even though functional performance tests are often used to make return to sport decisions, it is unknown whether functional performance is associated with return to performance after such injuries. The aim of this systematic review was to identify, critically appraise, and analyze studies that investigated the association of functional performance tests with return to performance after lower extremity injuries in athletes participating in high-impact sports. MEDLINE, Embase, Web of Science, and CINAHL were systematically searched for relevant studies. Articles were independently screened by two authors and data were obtained from each included study using a data extraction form. Two authors independently scored methodological quality using the Quality In Prognosis Studies tool. A qualitative best evidence synthesis was conducted. Eight studies reported the association of functional performance with return to performance after lower extremity injuries, involving 1,246 athletes after anterior or posterior cruciate ligament reconstruction. No studies were found on the association of functional performance with return to performance for lower extremity injuries other than after anterior or posterior cruciate ligament reconstruction. All included studies had a high risk of bias. Two studies found significant but small associations for selected hop tests after anterior cruciate ligament reconstruction. Low evidence of association between functional performance and return to performance was present after anterior cruciate ligament reconstruction for the triple hop for distance, the 6-meter timed hop, the side hop in female athletes, and for the combination of the single and crossover hop for distance. In athletes after posterior cruciate ligament reconstruction, the vertical jump showed a significant but small association with return to performance. There is no high-quality evidence that functional performance is associated with return to performance after lower extremity injuries in athletes practicing high-impact sports. Low quality evidence suggests small associations after anterior and posterior cruciate ligament reconstruction. No evidence exists for lower extremity injuries other than after anterior or posterior cruciate ligament reconstruction. Therefore, research on functional performance associated with return to performance is recommended in high-quality prospective cohort studies including athletes with any type of lower extremity injury.
Topics: Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Athletic Injuries; Exercise Test; Humans; Lower Extremity; Physical Functional Performance; Recovery of Function; Return to Sport
PubMed: 32874110
DOI: No ID Found -
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 -
Journal of Sport and Health Science May 2022Soccer match-play is typically contested over 90 min; however, in some cup and tournament scenarios, when matches are tied, they proceed to an additional 30 min, which... (Review)
Review
OBJECTIVE
Soccer match-play is typically contested over 90 min; however, in some cup and tournament scenarios, when matches are tied, they proceed to an additional 30 min, which is termed "extra-time" (ET). This systematic review sought to appraise the literature available on 120-min of soccer-specific exercise, with a view to identifying practical recommendations and future research opportunities.
METHODS
The review was conducted according to the PRISMA guidelines. Independent researchers performed a systematic search of PubMed, CINAHL, and PsycINFO in May 2019, with the following keywords entered in various combinations: "soccer", "football", "extra-time", "extra time", "extratime", "120 minutes", "120 min", "additional 30 minutes", and "additional 30 min".
RESULTS
The search yielded an initial 73 articles. Following the screening process, 11 articles were accepted for analyses. Articles were subsequently organized into the following 5 categories: movement demands of ET, performance responses to ET, physiological and neuromuscular response during ET, nutritional interventions, and recovery and ET. The results highlighted that during competitive match-play, players cover 5%-12% less distance relative to match duration (i.e., meters per minute) during ET compared to the preceding 90 min. Reductions in technical performance (i.e., shot speed, number of passes and dribbles) were also observed during ET. Additionally, carbohydrate provision may attenuate and improve dribbling performance during ET. Moreover, objective and subjective measures of recovery may be further compromised following ET when compared to 90 min.
CONCLUSION
Additional investigations are warranted to further substantiate these findings and identify interventions to improve performance during ET.
Topics: Athletic Performance; Movement; Soccer; Humans
PubMed: 32445903
DOI: 10.1016/j.jshs.2020.03.008 -
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 -
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 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 -
Journal of Rehabilitation Medicine Oct 2019To evaluate the effectiveness of over-ground robotic locomotor training in individuals with spinal cord injuries with regard to walking performance, cardiovascular...
Effectiveness of over-ground robotic locomotor training in improving walking performance, cardiovascular demands, secondary complications and user-satisfaction in individuals with spinal cord injuries: A systematic review.
OBJECTIVES
To evaluate the effectiveness of over-ground robotic locomotor training in individuals with spinal cord injuries with regard to walking performance, cardiovascular demands, secondary health complications and user-satisfaction.
DATA SOURCES
PubMed, Cochrane, Web of Science, Scopus, EBSCOhost and Engineering Village.
STUDY SELECTION
Trials in which robotic locomotor training was used for a minimum of 3 participants with spinal cord injury.
DATA EXTRACTION
Independent extraction of data by 2 reviewers using a pre-established data abstraction table. Quality of evidence assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE).
DATA SYNTHESIS
Total of 27 non-controlled studies representing 308 participants. Most studies showed decreases in exertion ratings, pain and spasticity and reported positive well-being post-intervention. Seven studies were included in meta-analyses on walking performance, showing significant improvements post-intervention (p < 0.05), with pooled effects for the 6-min walking test and 10-metre walking test of-0.94 (95% confidence interval (95% CI) -1.53,-0.36) and -1.22 (95% CI -1.87,-0.57), respectively. The Timed Up and Go Test showed a positive pooled effect of 0.74 (95% CI 0.36, 1.11). Improvements in walking parameters were seen with an increase in session number; however, no significant cardiovascular changes were found over time.
CONCLUSION
Robotic locomotor training shows promise as a tool for improving neurological rehabilitation; however, there is limited evidence regarding its training benefits. Further high-powered, randomized controlled trials, with homogenous samples, are required to investigate these effects.
Topics: Humans; Physical Therapy Modalities; Robotics; Spinal Cord Injuries; Walking
PubMed: 31511902
DOI: 10.2340/16501977-2601 -
NeuroRehabilitation 2019One of the leading causes of disability in the world with enormous economic burden is stroke. (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
One of the leading causes of disability in the world with enormous economic burden is stroke.
OBJECTIVE
To quantify the effectiveness of different protocols of cycling with/without functional electrical stimulation on functional mobility after stroke.
METHODS
Multiple databases were searched till 2018. Data extraction was performed using a pre-determined data collection form. The quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation.
RESULTS
A total of 14 trials satisfied eligibility criteria and were included. Cycling had a positive effect on the 6-meter walking test performance (SMD, 0.41; 95% CI, 0.11 -0.71; I2 = 0% ) compared with no or placebo intervention (control). Compared with control, cycling had a positive effect on 10-meter walking speed (SMD, 0.30; 95% CI, 0.05 -0.55; I2 = 0% ), and on balance based on the Berg score (SMD, 0.32; 95% CI, 0.06 -0.57; I2 = 49% ). Cycling with functional electrical stimulation had a positive effect on balance (SMD, 1.48; 95% CI, 0.99 -1.97; I2 = 91% ) compared with cycling alone.
CONCLUSIONS
It appears that cycling has a positive effect on walking speed, walking ability and balance. Functional electrical stimulation combined with cycling has positive effects on balance beyond cycling alone.
Topics: Bicycling; Clinical Trials as Topic; Combined Modality Therapy; Electric Stimulation Therapy; Humans; Lower Extremity; Range of Motion, Articular; Stroke; Stroke Rehabilitation; Walking; Walking Speed
PubMed: 31227660
DOI: 10.3233/NRE-182671 -
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