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Medicine Jun 2024Dyskinesia is one of the most common complications of stroke. Acupuncture therapy (AT) and mirror therapy (MT) are promising rehabilitation measures for the treatment of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Dyskinesia is one of the most common complications of stroke. Acupuncture therapy (AT) and mirror therapy (MT) are promising rehabilitation measures for the treatment of post-stroke dyskinesia. Although some studies suggested that AT and MT are effective and safe for dyskinesia, the effects, and safety remain uncertain due to lacking strong evidence. The purpose of this study is to investigate the efficacy and safety of AT combined with MT in the treatment of post-stroke dyskinesia.
METHODS
We searched the following databases: PubMed, Web of Science, Cochrane Library, EMBASE, Medline, China Knowledge Network, WANFANG, and China Biomedical Literature Database, from inception to 1 January 2023 to identify eligible studies. Total effective rate, the Fugl-Meyer assessment scale (FMA) upper and lower limb scores, modified Barthel index scores, Berg balance scale, modified Ashworth scale, and adverse reactions were adopted as outcome indicators. The Grading of Recommendations Assessment Development and Evaluation system was used by 2 independent reviewers to assess the quality of evidence for the outcome indicators included in the study. The statistical analysis was conducted by RevMan V.5.4 software.
RESULTS
A total of 24 randomized controlled studies included 2133 patients with post-stroke dyskinesia were included. The total effective rate of AT combined with MT was more advantageous in the treatment of post-stroke dyskinesia (relative risk = 1.31, 95% confidence interval [CI] [1.22-1.42], Z = 6.96, P < .0001). AT combined with MT was more advantageous for FMA upper limb score (mean difference [MD] = 6.67, 95% CI [5.21-8.13], Z = 8.97, P < .00001) and FMA lower limb score (MD = 3.72, 95% CI [2.81-4.63], Z = 7.98, P < .00001). Meta-analysis showed that AT combined with MT for post-stroke dyskinesia had a more advantageous modified Barthel index score (MD = 9.51, 95% CI [7.44-11.58], Z = 9.01, P < .00001).
CONCLUSION
AT combined with MT is effective in improving motor function and daily living ability of patients, especially in improving muscle spasms. However, these results should be regarded with caution given the low quality of evidence for the evaluation results.
Topics: Humans; Acupuncture Therapy; Stroke; Dyskinesias; Stroke Rehabilitation; Randomized Controlled Trials as Topic; Combined Modality Therapy; Treatment Outcome
PubMed: 38941386
DOI: 10.1097/MD.0000000000038733 -
Frontiers in Nutrition 2024Physical exertion during exercise often leads to increased oxidative stress and inflammatory responses, significantly affecting physical performance. Current strategies...
BACKGROUND
Physical exertion during exercise often leads to increased oxidative stress and inflammatory responses, significantly affecting physical performance. Current strategies to mitigate these effects are limited by their effectiveness and potential side effects. Molecular hydrogen (H₂) has gained attention for its antioxidant and anti-inflammatory properties. Studies have suggested that H supplementation contributes to antioxidant potential and anti-fatigue during exercise, but the variance in the observations and study protocols is presented across those studies.
OBJECTIVE
This systematic review and meta-analysis aimed to comprehensively characterize the effects of H₂ supplementation on physical performance (i.e., endurance, muscular strength, and explosive power), providing knowledge that can inform strategies using H for enhancing physical performance.
METHODS
We conducted a literature search of six databases (PubMed, Web of Science, Medline, Sport-Discus, Embase, and PsycINFO) according to the PRISMA guidelines. The data were extracted from the included studies and converted into the standardized mean difference (SMD). After that, we performed random-effects meta-analyses and used the statistic to evaluate heterogeneity. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess the quality of the evidence obtained from this meta-analysis.
RESULTS
In total, 27 publications consisting of 597 participants were included. The search finally included aerobic endurance, anaerobic endurance, muscular strength, lower limb explosive power, rating of perceived exertion (RPE), blood lactate (BLA), and average heart rate (HR) in the effect size (ES) synthesis. The ES of H on aerobic endurance, including V̇O (SMD = 0.09, = 0.394; = 0%) and aerobic endurance exercise (SMD = 0.04, = 0.687; = 0%), were not significant and trivial; the ES of H on 30 s maximal anaerobic endurance (SMD = 0.19, = 0.239; = 0%) was not significant and trivial; the ES of H on muscular strength (SMD = 0.19, = 0.265; = 0%) was not significant and trivial; but the ES of H on lower limb explosive power (SMD = 0.30, = 0.018; = 0%) was significant and small. In addition, H reduces RPE (SMD = -0.37, = 0.009; = 58.0%) and BLA (SMD = -0.37, = 0.001; = 22.0%) during exercise, but not HR (SMD = -0.27, = 0.094; = 0%).
CONCLUSION
These findings suggest that H supplementation is favorable in healthy adults to improve lower limb explosive power, alleviate fatigue, and boost BLA clearance, but may not be effectively improving aerobic and anaerobic endurance and muscular strength. Future studies with more rigorous designs are thus needed to examine and confirm the effects of H on these important functionalities in humans.
SYSTEMATIC REVIEW REGISTRATION
http://www.crd.york.ac.uk/PROSPERO.
PubMed: 38903627
DOI: 10.3389/fnut.2024.1387657 -
Journal of Clinical Medicine May 2024Upper body pain, particularly in the limbs and shoulders, is a common symptom among patients with spinal cord injury (SCI) and wheelchair users. Despite the focus on... (Review)
Review
Upper body pain, particularly in the limbs and shoulders, is a common symptom among patients with spinal cord injury (SCI) and wheelchair users. Despite the focus on resistance muscle training as a suitable intervention for SCI individuals, findings across different populations and conditions have been inconsistent. We conducted a systematic review to elucidate the correlations among exercise interventions, muscle strength enhancement, and pain reduction. A comprehensive literature search was performed using the keywords "spinal cord injury," "pain," "exercise," "disability," "paraplegia," and "tetraplegia" across the DBpia, EMBASE, PubMed, and Science Direct databases. From 191 identified articles, 13 studies (1 from Korea and 12 from other countries) were selected for analysis. The results indicate that exercise interventions are effective in reducing pain in patients with SCI, with a particular emphasis on alleviating shoulder pain. Exercise is essential for pain reduction in patients with SCI, especially those experiencing shoulder pain. However, there is a notable lack of experimental research focusing primarily on pain. The development of appropriate measurement instruments is crucial for the prevention and relief of pain in this patient population.
PubMed: 38892777
DOI: 10.3390/jcm13113066 -
PloS One 2024Core strength training (CST) has been shown to improve performance in several sports disciplines. CST is recognized as one of the crucial elements that enhance athletic... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Core strength training (CST) has been shown to improve performance in several sports disciplines. CST is recognized as one of the crucial elements that enhance athletic performance, particularly impacting badminton skills. Despite its popularity as a strength training method among badminton players, there is a lack of comprehensive studies examining the effectiveness of CST on the performance of these athletes.
OBJECTIVE
This study aims to ascertain CST's effects on badminton players' performance.
METHOD
This study followed PRISMA principles and conducted comprehensive searches in well-known academic databases (SCOPUS, Pubmed, CNKI, Web of Science, Core Collection, and EBSCOhost) up to August 2023. The inclusive criteria were established using the PICOS framework. Following their inclusion based on PICOS criteria, the selected studies underwent literature review and meta-analysis. The methodological quality of the assessments was evaluated using Cochrane Collaboration's risk of bias tools bias risk tools and recommendations for a graded assessment, development, and evaluation.
RESULTS
The analysis included participants aged 10-19 years from 13 studies of moderate quality, totaling 208 individuals. The CST intervention s lasted between 4 to 16 weeks, with a frequency of 1 to 4 sessions per week and each session lasting 20 to 120 minutes. Sample sizes across these studies ranged from 8 to 34 participants. According to the meta-analysis, CST significantly influenced badminton performance, particularly in areas of explosive power (ES = 0.03 P = 0.04), front-court skill (ES = 2.53, P = 0.003), and back-court skill (ES = 2.33, P = 0.002).
CONCLUSION
CST enhances badminton players' fitness (strength, power, balance, and stability), in situ (front/back-court) skills, and movement position hitting. However, its effects on speed, endurance, agility, flexibility, and coordination are unclear, revealing a research gap. The precise benefits of CST, especially on flexibility and specific hitting skills (smashes, clears, drives, net shots, crosscourt, push, and lift shots), need more investigation. Additionally, research on CST's impact on female athletes is significantly lacking.
Topics: Humans; Athletes; Athletic Performance; Muscle Strength; Racquet Sports; Resistance Training; Child; Adolescent; Young Adult
PubMed: 38865415
DOI: 10.1371/journal.pone.0305116 -
European Journal of Physical and... Jun 2024Fibromyalgia is characterized by chronic widespread pain accompanied by reduced levels of physical activity and associated comorbidities such as overweight and obesity...
INTRODUCTION
Fibromyalgia is characterized by chronic widespread pain accompanied by reduced levels of physical activity and associated comorbidities such as overweight and obesity which have been associated to sarcopenia development. The aim of this systematic review is to ascertain whether Europeans with fibromyalgia show a reduction in sarcopenia determinants compared to apparently-healthy controls and to determine the risk of sarcopenia and its possible risk factors (PROSPERO: CRD42023439839).
EVIDENCE ACQUISITION
Systematic searches were conducted on six databases (Academic-Search-Ultimate, CENTRAL, PubMed, SciELO, WOS-Core Collection, and ClinicalTrials.gov last-search February-2024) looking for original studies developed in European countries which assessed any of the sarcopenia determinants proposed by the EWGSOP2-guidelines (handgrip strength, five sit-to-stand, appendicular skeletal mass [ASM], skeletal muscle index [SMI]) and included fibromyalgia and healthy-control individuals. Studies mixing fibromyalgia with other diagnoses were excluded. Random-effects meta-analyses and meta-regressions were used to analyze possible differences and associated risk factors. The risk of bias was assessed using the Cochrane-Rob tool and the Quality Assessment Tool for Observational Studies, and the certainty of the evidence using GRADE-approach.
EVIDENCE SYNTHESIS
A total of 25 studies (6393 individuals; 97% women; 20-65 years) were included. Fibromyalgia individuals showed reduced muscle strength ([handgrip] SMD: -1.16 [-1.29, -1.03]; high-certainty; [five sit-to-stand] not-assessed) and muscle quantity ([ASM] mean-difference: -0.83 kg [-1.41, -0.37]; [SMI] mean-difference: -0.26 kg/m [-0.41, -0.10]; both low-certainty) compared to healthy-controls. Fibromyalgia individuals had nine-times greater risk for probable sarcopenia (OR: 9.23 [6.85, 12.45]; high-certainty), but not for confirmed sarcopenia ([ASM] OR: 0.91 [0.49, 1.67]; [SMI] OR: 0.67 [0.19, 2.33]; both low-certainty) according to the EWGSOP2 cut-off points. Reduced muscle strength was strongly associated to fibromyalgia-severity (β=-0.953 [-0.069, -0.038]). Studies were rated as high-risk of bias overall because did not account for some potential confounders (physical activity, sedentary time, Body Mass Index) which could influence the estimated effect.
CONCLUSIONS
Europeans with fibromyalgia have a large reduction in muscle strength and may have a reduction in muscle quantity. The risk of probable sarcopenia according to the EWGSOP2 cut-off points was nine-times higher, but may have no difference in risk of reduced muscle quantity relative to healthy-controls. Muscle strength was strongly associated to disease severity.
PubMed: 38860694
DOI: 10.23736/S1973-9087.24.08348-5 -
Journal of Orthopaedic Translation May 2024The neuromuscular junction (NMJ) is a specialized chemical synapse that converts neural impulses into muscle action. Age-associated NMJ degeneration, which involves... (Review)
Review
The neuromuscular junction (NMJ) is a specialized chemical synapse that converts neural impulses into muscle action. Age-associated NMJ degeneration, which involves nerve terminal and postsynaptic decline, denervation, and loss of motor units, significantly contributes to muscle weakness and dysfunction. Although physical training has been shown to make substantial modifications in NMJ of both young and aged animals, the results are often influenced by methodological variables in existing studies. Moreover, there is still lack of strong consensus on the specific effects of exercise on improving the morphology and function of the ageing NMJ. Consequently, the purpose of this study was to conduct a systematic review to elucidate the effects of exercise training on NMJ compartments in the elderly. We conducted a systematic review using PubMed, Embase, and Web of Science databases, employing relevant keywords. Two independent reviewers selected studies that detailed NMJ changes during exercise in ageing, written in English, and available in full text. In total, 20 papers were included. We examined the altered adaptation of the NMJ to exercise, focusing on presynaptic and postsynaptic structures and myofibers in older animals or humans. Our findings indicated that aged NMJs exhibited different adaptive responses to physical exercise compared to younger counterparts. Endurance training, compared with resistance and voluntary exercise regimens, was found to have a more pronounced effect on NMJ structural remodeling, particularly in fast twitch muscle fibers. Physical exercise was observed to promote the formation and maintenance of acetylcholine receptor (AChR) clusters by increasing the recombinant docking protein 7 (Dok7) expression and stabilizing Agrin and lipoprotein receptor-related protein 4 (LRP4). These insights suggest that research on exercise-related therapies could potentially attenuate the progression of neuromuscular degeneration. Translational potential of this article: This systematic review provides a detailed overview of the effects of different types of physical exercise on improving NMJ in the elderly, providing scientific support for the timely intervention of muscle degeneration in the elderly by physical exercise, and providing help for the development of new therapeutic interventions in the future.
PubMed: 38817243
DOI: 10.1016/j.jot.2024.03.007 -
Clinical Nutrition ESPEN Jun 2024International guidelines recommend a target protein intake of ≥1.2 g/kg/day to all critically ill patients for optimal outcomes. There are however various conflicting... (Review)
Review
International guidelines recommend a target protein intake of ≥1.2 g/kg/day to all critically ill patients for optimal outcomes. There are however various conflicting data related to this recommendation. The primary objective of this review was to compare a protein intake group (≥1.2 g/kg/day) with a lower protein intake group (<1.2 g/kg/day) in critically ill adult patients on mortality, length of intensive care unit (ICU) and hospital stay. Secondly, the effect of protein intake on length of mechanical ventilation, adverse nutrition-related events and muscle mass and strength parameters were investigated. Sixteen randomised controlled trials (RCTs) of adult patients admitted to an intensive or high care unit and receiving nutrition support in the form of enteral- and/or parenteral nutrition were selected against prespecified eligibility criteria. Two independent reviewers extracted relevant data and assessed the risk of bias of the included studies. Review Manager 5.4.1 was used to analyse data and GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) was used to evaluate the certainty of the evidence. The higher protein group, when compared to the lower protein group, probably results in little to no difference in mortality (risk ratio [RR] 1.01; 95% confidence interval [CI]: 0.89 to 1.14; moderate-certainty evidence); with a probable slight increase in length of ICU stay (mean difference [MD] 0.33; 95% CI -0.57 to 1.23; moderate-certainty) and length of hospital stay (MD 1.72; 95% CI -0.58 to 4.01; moderate-certainty evidence), on average. For secondary outcomes, it was found that the higher protein group probably does not reduce the length of mechanical ventilation (MD 0.08; 95% CI -0.38 to 0.53; moderate-certainty evidence). Higher protein group probably reduces the occurrence of diarrhoea and high gastric residual volume and may reduce the occurrence of constipation. It may also increase nitrogen balance (MD 3.66; 95% CI 1.81 to 5.51; low-certainty evidence). Importantly, there does not seem to be harm associated with the higher protein group, though it should be mentioned that for many of the adverse events in this study, the certainty of evidence was low or very low.
Topics: Humans; Critical Illness; Intensive Care Units; Dietary Proteins; Length of Stay; Respiration, Artificial; Adult; Randomized Controlled Trials as Topic; Practice Guidelines as Topic; Enteral Nutrition; Critical Care; Parenteral Nutrition; Hospital Mortality
PubMed: 38777455
DOI: 10.1016/j.clnesp.2024.04.003 -
PloS One 2024To synthesize the impact of improvement interventions related to care coordination, discharge support and care transitions on patient experience measures.
AIM
To synthesize the impact of improvement interventions related to care coordination, discharge support and care transitions on patient experience measures.
METHOD
Systematic review. Searches were completed in six scientific databases, five specialty journals, and through snowballing. Eligibility included studies published in English (2015-2023) focused on improving care coordination, discharge support, or transitional care assessed by standardized patient experience measures as a primary outcome. Two independent reviewers made eligibility decisions and performed quality appraisals.
RESULTS
Of 1240 papers initially screened, 16 were included. Seven studies focused on care coordination activities, including three randomized controlled trials [RCTs]. These studies used enhanced supports such as improvement coaching or tailoring for vulnerable populations within Patient-Centered Medical Homes or other primary care sites. Intervention effectiveness was mixed or neutral relative to standard or models of care or simpler supports (e.g., improvement tool). Eight studies, including three RCTs, focused on enhanced discharge support, including patient education (e.g., teach back) and telephone follow-up; mixed or neutral results on the patient experience were also found and with more substantive risks of bias. One pragmatic trial on a transitional care intervention, using a navigator support, found significant changes only for the subset of uninsured patients and in one patient experience outcome, and had challenges with implementation fidelity.
CONCLUSION
Enhanced supports for improving care coordination, discharge education, and post-discharge follow-up had mixed or neutral effectiveness for improving the patient experience with care, compared to standard care or simpler improvement approaches. There is a need to advance the body of evidence on how to improve the patient experience with discharge support and transitional approaches.
Topics: Humans; Patient Discharge; Transitional Care; Patient-Centered Care; Patient Satisfaction; Continuity of Patient Care; Randomized Controlled Trials as Topic
PubMed: 38771768
DOI: 10.1371/journal.pone.0299176 -
Journal of Bodywork and Movement... Apr 2024Low back pain is a painful disorder that prevents normal mobilization, increases muscle tension and whose first-line treatment is usually non-steroidal anti-inflammatory... (Review)
Review
Low back pain is a painful disorder that prevents normal mobilization, increases muscle tension and whose first-line treatment is usually non-steroidal anti-inflammatory drugs, together with non-invasive manual therapies, such as deep oscillation therapy. This systematic review aims to investigate and examine the scientific evidence of the effectiveness of deep oscillation therapy in reducing pain and clinical symptomatology in patients with low back pain, through the use of motion capture technology. To carry out this systematic review, the guidelines of the PRISMA guide were followed. A literature search was performed from 2013 to March 2022 in the PubMed, Elsevier, Science Director, Cochrane Library, and Springer Link databases to collect information on low back pain, deep oscillation, and motion capture. The risk of bias of the articles was assessed using the Cochrane risk of bias tool. Finally, they were included 16 articles and 5 clinical trials which met the eligibility criteria. These articles discussed the effectiveness of deep oscillation therapy in reducing pain, eliminating inflammation, and increasing lumbar range of motion, as well as analyzing the use of motion capture systems in the analysis, diagnosis, and evaluation of a patient with low back pain before, during and after medical treatment. There is no strong scientific evidence that demonstrates the high effectiveness of deep oscillation therapy in patients with low back pain, using motion capture systems. This review outlines the background for future research directed at the use of deep oscillation therapy as a treatment for other types of musculoskeletal injuries.
Topics: Humans; Low Back Pain; Range of Motion, Articular; Physical Therapy Modalities; Motion Capture
PubMed: 38763561
DOI: 10.1016/j.jbmt.2024.01.010 -
Frontiers in Neurology 2024It is essential to link the theoretical framework of any neurophysiotherapy approach with a detailed analysis of the central motor control mechanisms that influence...
INTRODUCTION
It is essential to link the theoretical framework of any neurophysiotherapy approach with a detailed analysis of the central motor control mechanisms that influence motor behavior. Vojta therapy (VT) falls within interventions aiming to modify neuronal activity. Although it is often mistakenly perceived as exclusively pediatric, its utility spans various functional disorders by acting on central pattern modulation. This study aims to review the existing evidence on the effectiveness of VT across a wide range of conditions, both in the adult population and in pediatrics, and analyze common therapeutic mechanisms, focusing on motor control modulation.
AIM
The goals of this systematic review are to delineate the existing body of evidence concerning the efficacy of Vojta therapy (VT) in treating a broad range of conditions, as well as understand the common therapeutic mechanisms underlying VT with a specific focus on the neuromodulation of motor control parameters.
METHODS
PubMed, Cochrane Library, SCOPUS, Web of Science, and Embase databases were searched for eligible studies. The methodological quality of the studies was assessed using the PEDro list and the Risk-Of-Bias Tool to assess the risk of bias in randomized trials. Methodological quality was evaluated using the Risk-Of-Bias Tool for randomized trials. Random-effects meta-analyses with 95% CI were used to quantify the change scores between the VT and control groups. The certainty of our findings (the closeness of the estimated effect to the true effect) was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE).
RESULTS
Fifty-five studies were included in the qualitative analysis and 18 in the meta-analysis. Significant differences in cortical activity ( = 0.0001) and muscle activity ( = 0.001) were observed in adults undergoing VT compared to the control, as well as in balance in those living with multiple sclerosis ( < 0.03). Non-significant differences were found in the meta-analysis when evaluating gross motor function, oxygen saturation, respiratory rate, height, and head circumference in pediatrics.
CONCLUSION
Although current evidence supporting VT is limited in quality, there are indications suggesting its potential usefulness for the treatment of respiratory, neurological, and orthopedic pathology. This systematic review and meta-analysis show the robustness of the neurophysiological mechanisms of VT, and that it could be an effective tool for the treatment of balance in adult neurological pathology. Neuromodulation of motor control areas has been confirmed by research focusing on the neurophysiological mechanisms underlying the therapeutic efficacy of VT.https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=476848, CRD42023476848.
PubMed: 38711552
DOI: 10.3389/fneur.2024.1391448