Posts Tagged meta-analysis

[ARTICLE] Virtual rehabilitation of upper extremity function and independence for stoke: a meta-analysis – Full Text

Abstract

We aimed to conduct a systematic literature review with a meta-analysis to investigate whether virtual reality (VR) approaches have beneficial effects on the upper extremity function and independent activities of stroke survivors. Experimental studies published between 2007 and 2017 were searched from two databases (EBSCOhost and PubMed). This study reviewed abstracts and assessed full articles to obtain evidence on qualitative studies. For the meta-analysis, the studies that estimated the standardized mean between the two groups analyzed the statistical values necessary for calculating the effect size. The present study also evaluated the statistical heterogeneity. In total, 34 studies with 1,604 participants were included, and the number of participants in each study ranged from 10 to 376. Nine studies were assessed to evaluate the quantitative statistical analysis for 698 patients with hemiparetic stroke. The results of the meta-analysis were as follows: The overall effect size was moderate (0.41, P<0.001). The 95% confidence interval ranged from 0.25 to 0.57. However, no significant heterogeneity and publication bias were observed. The results of this study showed that VR approaches are effective in improving upper extremity function and independent activities in stroke survivors.

 

INTRODUCTION

Stroke has varying severity and subsequent functional impact, which depends on the recovery process of an individual and the extent of neurological damage (Chollet et al., 1991). Several stroke survivors experience physical, cognitive, perceptual, and mental impairments that require a period of intensive rehabilitation and may develop permanent disabilities (Teasell et al., 2005). Some stroke survivors can undergo a short period of inpatient rehabilitation program for recovery of function, and others continue to recover for a long period or throughout their lifetimes (Cramer, 2011). Therefore, in the intensive rehabilitation of individuals with neurological diseases, extremely important considerations must be made because of the reintegration of family and social roles and recreational activities (French et al., 2016West and Bernhardt, 2012).
In rehabilitation settings, functional and task-specific trainings are the key elements of therapy and designed to assist stroke survivors in restoring their motor control to attain more-normal functional movement patterns (Teasell et al., 2005). Stroke survivors must have significant changes in the motor control and strength of the trunk and limbs, with an emphasis on the more-affected side and bilateral symmetric movement; these may be achieved using specific reeducation strategies (Veerbeek et al., 2014West and Bernhardt, 2012). In terms of stroke rehabilitation settings, most previous studies were performed in laboratory or clinical settings that are less complex than the outdoor environment (Cho and Lee, 2013). Laboratory and clinical settings are not appropriate for establishing some complex personal space and community surroundings to meet the demands of multiple tasks for stroke survivors (Demain et al., 2013Fung et al., 2012).
Virtual reality (VR) is a computer-generated environment that simulates a realistic experience for practicing functional tasks at intensities higher than those in traditional rehabilitation programs for stroke survivors (Chen et al., 2016). VR may help engage stroke survivors in a repetitive, intensive, and goal-oriented therapy to improve their functional disabilities, activity limitations, and participation restrictions, without considering the cost and burden associated with increasing the number of therapeutic sessions (Merians et al., 2002). Furthermore, VR provides real-time visual feedback for movements, thereby increasing engagement in enjoyable rehabilitation tasks. VR provides rehabilitative clinicians with new and effective therapeutic tools that can help treat various disabilities and enables remote therapy. VR-based interventions lead to clinical improvement and cortical reorganization through repetitive, adaptive, task-oriented, meaningful, and challenging exercises for stroke survivors (Laver et al., 2012).
As mentioned earlier, several virtual realities in rehabilitation interventions have been applied in the stroke population. However, the efficacy of VR rehabilitation interventions remains to be fully elucidated. In particular, studies on the qualitative and quantitative beneficial effects of VR on upper extremity function and independence in performing activities of daily living among patients with stroke are limited. The objectives of the present study were as follows: (a) to investigate the effectiveness of VR-based interventions in rehabilitation programs for restoring the upper extremity function of stroke survivors through a systematic review and (b) to examine the efficacy of VR-based interventions as part of a therapeutic rehabilitation program to improve upper limb function and independence in performing activities of daily living in stroke survivors by conducting a meta-analysis. Then, the VR-based interventions that are effective for improving upper limb function and independence in performing activities of daily living in stroke survivors were identified.[…]

Continue —> Virtual rehabilitation of upper extremity function and independence for stoke: a meta-analysis

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[ARTICLE] The Effects of Virtual Reality Training on Function in Chronic Stroke Patients: A Systematic Review and Meta-Analysis – Full Text

Abstract

Objective. The aim of this study was to perform a meta-analysis to examine whether virtual reality (VR) training is effective for lower limb function as well as upper limb and overall function in chronic stroke patients. Methods. Three databases, OVID, PubMed, and EMBASE, were used to collect articles. The search terms used were “cerebrovascular accident (CVA),” “stroke”, and “virtual reality”. Consequently, twenty-one studies were selected in the second screening of meta-analyses. The PEDro scale was used to assess the quality of the selected studies. Results. The total effect size for VR rehabilitation programs was 0.440. The effect size for upper limb function was 0.431, for lower limb function it was 0.424, and for overall function it was 0.545. The effects of VR programs on specific outcomes were most effective for improving muscle tension, followed by muscle strength, activities of daily living (ADL), joint range of motion, gait, balance, and kinematics.Conclusion. The VR training was effective in improving the function in chronic stroke patients, corresponding to a moderate effect size. Moreover, VR training showed a similar effect for improving lower limb function as it did for upper limb function.

1. Introduction

Stroke is a major cause of death in the modern world; it also causes sensory, motor, cognitive, and visual impairments and restricts performance of activities of daily living (ADL) [1]. Motor impairments are observed in 80% of stroke patients, and these can include loss of balance and gait [2]. These problems are important targets of rehabilitation, because they reduce the ability of individuals to perform ADL and this result in impaired community activities [34].

Most studies on balance and gait rehabilitation have shown positive effects. However, training-based methods often become tiresome are resource-intensive and require specialized facilities or equipment. Therefore, there is a demand for economical and safe methods of rehabilitation [2].

Virtual reality (VR) is defined by “the use of interactive simulations created with computer hardware and software to present users with opportunities to engage in environments that appear and feel similar to real world objects and events.” Participants interact with projected images, maneuver virtual objects and perform activities programmed into the task, giving the user a sense of immersion in the simulated environment. Various forms of feedback are provided through the environment, the most common being visual and auditory, to enhance enjoyment and motor learning through real-time feedback and immediate results [5]. VR training using these features has recently been widely used in the field of stroke rehabilitation [3]. VR training aims to improve neural plasticity by providing a safe and enriched environment to perform functional task-specific activities with increased repetitions, intensity of practice, and motivation to comply with the intervention [1].

In the field of stroke rehabilitation, VR training is reported to be mostly effective at increasing upper limb joint range of motion, improving sensation, muscle strengthening, reducing pain, and improving functional processesRecently, various VR programs have been developed and implemented for the lower limbs as well as the upper limbs, and their effects are being tested. VR training for stroke patients has been shown to be safe and cost-effective at improving lower limb function, specifically improving balance, stair climbing speed, ankle muscle strength, range of motion, and gait speed [1]. Compared with existing treatment methods, it may be more effective at improving dynamic balance control and preventing falls in subacute and chronic stroke patients [6].

Treatment methods using VR provide a virtual environment for ADLs that are difficult to perform in a hospital, and therefore, it could be very effective at improving both upper limb and lower limb function. However, because the lower limbs have to support the weight of the body, various elements are required, including muscle strength and balance to control body weight, joint movements, and cognitive ability to integrate these other elements. Although studies related to VR training have been increasing in recent years, VR intervention has been used more extensively to improve upper limb function, which is relatively easier to apply than lower limb function.

Furthermore, doubts could be raised as to whether VR treatment methods for the lower limbs can improve these elements; these doubts related to lack of VR equipment or programs, as well as safety issues or dizziness during treatment. For this reason, we aimed to perform a meta-analysis as a scientific method to test the effects of uncertain treatment methods using statistical methods, in order to examine whether VR training is effective for lower limb function as well as upper limb function. […]

Continue —>  The Effects of Virtual Reality Training on Function in Chronic Stroke Patients: A Systematic Review and Meta-Analysis

 

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[Webcast] KTDRR Research Evidence Training: An Overview of Meta-Analysis and Effect Size

Webcast

Date:
Time: 3:00 – 4:00 p.m. Eastern
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https://www.surveygizmo.com/s3/4871669/Registration-Meta-Analysis-Effect-Size

About the Webcast

The KTDRR Center and the international Campbell Collaboration are working together to offer a five-part training course that focuses on high-quality methods for synthesis of evidence, including the procedures and methods for conducting systematic reviews/research syntheses as well as software, tools, and strategies for analyzing and reporting data. The training materials are developed by representatives of the Campbell Collaboration. Online resources from various national and international organizations will be provided for each session.

This fifth and final webcast in the series is a pre-recorded session that provides an overview of the foundation of meta-analysis: an effect size (a quantitative indicator of a treatment effect or relation between two variables) and discusses the basic processes of a meta-analysis and how the technique can be used to answer complex questions asked by policymakers and practitioners. (NOTE: This session was previously aired live on September 20, 2018.)

How to Participate

  1. On Wednesday, June 19, 2019 at 3 p.m. Eastern this pre-recorded webcast will be aired via YouTube. Detailed instructions will be provided to all who register.
  2. Tips for Optimal Viewing on YouTube:
    • To increase volume, turn up the volume on your computer and use the volume bar on bottom left side of the YouTube video window.
    • Captioning is available by selecting the “CC” option on the bottom right side of the video window. Click on “Options” to change the font, size, and color of the captions.
    • Additional tools on the bottom right side: “Settings” increase the video quality; “Theater mode” (default)/”Full screen.”
  3. Presentation materials: Coming soon!
  4. Evaluation: Please fill out the brief evaluation after viewing the webcast. Once the webcast is completed, all who register will receive an email with a link to the evaluation. There are no pre-approved CRC-CEUs for this webcast.

About the Presenters

Photo of Ryan Williams

Ryan Williams, PhD, is a principal researcher at AIR and leads large-scale evaluations and research syntheses. Dr. Williams’ work focuses on improving generalizations in education research through research synthesis. He is currently the Principal Investigator (PI) on an Institute for Educational Sciences (IES) meta-analysis that is exploring sources of heterogeneity in mathematics intervention effects. He also is a co-PI of an IES methods training institute for advanced meta-analysis. Dr. Williams is Associate Methods Editor of The Campbell Collaboration Education Coordinating Group.

 

Photo of Joshua Polanin

Joshua Polanin, PhD, is a principal researcher at AIR who has experience in the application and use of quantitative methodology in criminal justice, education, and behavioral health. He is the PI of two National Institute of Justice–funded systematic reviews and meta-analyses and the co-PI of one IES-funded systematic review and meta-analysis. In addition, he currently serves as the project director for the What Works Clearinghouse’s Statistics, Website, and Training (SWAT) contract and is co-PI of an IES methods training institute for advanced meta-analysis. Dr. Polanin is also active in The Campbell Collaboration and served as an Associate Editor of the Methods Group.

via KTDRR Research Evidence Training: An Overview of Meta-Analysis and Effect Size

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[Abstract] Use of Kinesio taping in lower-extremity rehabilitation of post-stroke patients: A systematic review and meta-analysis.

Abstract

BACKGROUND:

and purpose: The benefits of Kinesio taping (KT) in post-stroke rehabilitation have not been determined. This study aimed to evaluate its effects on lower-extremity rehabilitation in patients after a stroke.

METHODS:

A literature search was performed using EBSCOhost, Embase, Physiotherapy Evidence Database (PEDro), PubMed, Cochrane, Web of Science, China National Knowledge Infrastructure (CNKI), SinoMed, and Wanfang Data through June 2018. Randomized controlled trials (RCTs) on the use of KT during lower-extremity, post-stroke rehabilitation were selected. Meta-analysis was conducted.

RESULTS:

A total of 14 RCTs of low to moderate quality were reviewed and included 783 participants. Results indicated that KT significantly improved patients’ lower extremity spasticity, motor function, balance, ambulation, gait parameters, and daily activities, with few adverse effects.

CONCLUSION:

KT may have positive effects on lower-extremity, post-stroke rehabilitation. Due to the limited number and quality of the research, additional studies are needed to identify KT benefits.

via Use of Kinesio taping in lower-extremity rehabilitation of post-stroke patients: A systematic review and meta-analysis. – PubMed – NCBI

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[Abstract] Action observation therapy for improving arm function, walking ability, and daily activity performance after stroke: a systematic review and meta-analysis

This study was to investigate the effectiveness of action observation therapy on arm and hand motor function, walking ability, gait performance, and activities of daily living in stroke patients.

Systematic review and meta-analysis of randomized controlled trials.

Searches were completed in January 2019 from electronic databases, including PubMed, Scopus, the Cochrane Library, and OTseeker.

Two independent reviewers performed data extraction and evaluated the study quality by the PEDro scale. The pooled effect sizes on different aspects of outcome measures were calculated. Subgroup analyses were performed to examine the impact of stroke phases on treatment efficacy.

Included were 17 articles with 600 patients. Compared with control treatments, the action observation therapy had a moderate effect size on arm and hand motor outcomes (Hedge’s g = 0.564; P < 0.001), a moderate to large effect size on walking outcomes (Hedge’s g = 0.779; P < 0.001), a large effect size on gait velocity (Hedge’s g = 0.990; P < 0.001), and a moderate to large effect size on activities of daily function (Hedge’s g = 0. 728; P = 0.004). Based on subgroup analyses, the action observation therapy showed moderate to large effect sizes in the studies of patients with acute/subacute stroke or those with chronic stroke (Hedge’s g = 0.661 and 0.783).

This review suggests that action observation therapy is an effective approach for stroke patients to improve arm and hand motor function, walking ability, gait velocity, and daily activity performance.

via Action observation therapy for improving arm function, walking ability, and daily activity performance after stroke: a systematic review and meta-analysis – Tzu-Hsuan Peng, Jun-Ding Zhu, Chih-Chi Chen, Ruei-Yi Tai, Chia-Yi Lee, Yu-Wei Hsieh, 2019

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[Abstract] Effectiveness of electrical stimulation therapy in improving arm function after stroke: a systematic review and a meta-analysis of randomised controlled trials

The aim of this study is to investigate the effectiveness of electrical stimulation in arm function recovery after stroke.

Data were obtained from the PubMed, Cochrane Library, Embase, and Scopus databases from their inception until 12 January 2019. Only randomized controlled trials (RCTs) reporting the effects of electrical stimulation on the recovery of arm function after stroke were selected.

Forty-eight RCTs with a total of 1712 patients were included in the analysis. The body function assessment, Upper-Extremity Fugl-Meyer Assessment, indicated more favorable outcomes in the electrical stimulation group than in the placebo group immediately after treatment (23 RCTs (n = 794): standard mean difference (SMD) = 0.67, 95% confidence interval (CI) = 0.51–0.84) and at follow-up (12 RCTs (n = 391): SMD = 0.66, 95% CI = 0.35–0.97). The activity assessment, Action Research Arm Test, revealed superior outcomes in the electrical stimulation group than those in the placebo group immediately after treatment (10 RCTs (n = 411): SMD = 0.70, 95% CI = 0.39–1.02) and at follow-up (8 RCTs (n = 289): SMD = 0.93, 95% CI = 0.34–1.52). Other activity assessments, including Wolf Motor Function Test, Box and Block Test, and Motor Activity Log, also revealed superior outcomes in the electrical stimulation group than those in the placebo group. Comparisons between three types of electrical stimulation (sensory, cyclic, and electromyography-triggered electrical stimulation) groups revealed no significant differences in the body function and activity.

Electrical stimulation therapy can effectively improve the arm function in stroke patients.

via Effectiveness of electrical stimulation therapy in improving arm function after stroke: a systematic review and a meta-analysis of randomised controlled trials – Jheng-Dao Yang, Chun-De Liao, Shih-Wei Huang, Ka-Wai Tam, Tsan-Hon Liou, Yu-Hao Lee, Chia-Yun Lin, Hung-Chou Chen, 2019

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[Abstract] Upper limb tendon/ muscle vibration in persons with subacute and chronic stroke: a systematic review and meta-analysis

 

INTRODUCTION: Results of several recent studies suggest that tendon/muscle vibration treatment may improve motor performance and reduce spasticity in individuals with stroke. We performed a systematic review and meta-analysis to assess the efficacy of tendon/muscle vibration treatment for upper limb functional movements in persons with subacute and chronic stroke.
EVIDENCE ACQUISITION: We searched MEDLINE (Ovid), EMBASE (Ovid), and the Cochrane Central Register of Controlled Trials (Wiley) from inception to September 2017. We included randomized controlled trials comparing upper limb tendon/muscle vibration to sham treatment/rest or conventional interventions in persons with subacute and chronic stroke. Our primary outcome was upper limb functional movement at the end of the treatment period.
EVIDENCE SYNTHESIS: We included eight trials enrolling a total of 211 participants. We found insufficient evidence to support a benefit for upper limb functional movement (standard mean difference -0.32, 95% confidence interval (CI) -0.74 to 0.10, I2 25%, 6 trials, 135 participants). Movement time for reaching tasks significantly decreased after using tendon/muscle vibration (standard mean difference -1.20, 95% CI -2.05 to -0.35, I2 65%, 2 trials, 74 participants). We also found that tendon/muscle vibration was not associated with a significant reduction in spasticity (4 trials).
CONCLUSIONS: Besides shorter movement time for reaching tasks, we did not identify evidence to support clinical improvement in upper limb functional movements after tendon/muscle vibration treatment in persons with subacute and chronic stroke. A small number of trials were identified; therefore, there is a need for larger, higher quality studies and to consider the clinical relevance of performance-based outcome measures that focus on time tocomplete a functional movement such as a reach.

via Upper limb tendon/ muscle vibration in persons with subacute and chronic stroke: a systematic review and meta-analysis – European Journal of Physical and Rehabilitation Medicine 2019 Mar 11 – Minerva Medica – Journals

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[Abstract] Repetitive transcranial magnetic stimulation of lower limb motor function in patients with stroke: a systematic review and meta-analysis of randomized controlled trials

The aim of this study was to evaluate the effects of repetitive transcranial magnetic stimulation (rTMS) on the post-stroke recovery of lower limb motor function.

We searched the databases of PubMed, Cochrane Library, and Embase. The randomized controlled trials were published by 25 January 2019.

We included randomized controlled trials that evaluated the effects of rTMS on lower limb motor recovery in patients with stroke. Two reviewers independently screened the searched records, extracted data, and assessed the risk of bias. The treatment effect sizes were pooled in a meta-analysis by using the RevMan 5.3 software. The internal validity was assessed using topics suggested by the Physiotherapy Evidence Database (PEDro).

Eight studies with 169 participants were included in the meta-analysis. Pooled estimates demonstrated that rTMS significantly improved the body function of the lower limbs (standardized mean difference (SMD) = 0.66; P < 0.01), lower limb activity (SMD = 0.66; P < 0.01), and motor-evoked potential (SMD = 1.13; P < 0.01). The subgroup analyses results also revealed that rTMS improved walking speed (SMD = 1.13) and lower limb scores on the Fugl-Meyer Assessment scale (SMD = 0.63). We found no significant differences between the groups in different mean post-stroke time or stimulation mode over lower limb motor recovery. Only one study reported mild adverse effects.

rTMS may have short-term therapeutic effects on the lower limbs of patients with stroke. Furthermore, the application of rTMS is safe. However, this evidence is limited by a potential risk of bias.

 

via Repetitive transcranial magnetic stimulation of lower limb motor function in patients with stroke: a systematic review and meta-analysis of randomized controlled trials – Yi-Chun Tung, Chien-Hung Lai, Chun-De Liao, Shih-Wei Huang, Tsan-Hon Liou, Hung-Chou Chen, 2019

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[Abstract] Effectiveness of botulinum toxin treatment for upper limb spasticity after stroke over different ICF domains: a systematic review and meta-analysis.

Abstract

Objective

To provide a comprehensive overview of reported effects and scientific robustness of botulinum toxin (BoNT) treatment regarding the main clinical goals related to post-stroke upper limb spasticity, using the ICF classification.

Data sources

Embase.com, PubMed, Wiley/Cochrane Library, and Ebsco/CINAHL were searched from inception up to 16 May 2018.

Study Selection

Randomized controlled trials comparing upper limb BoNT injections with a control intervention in stroke patients were included. A total of 1212 unique records were screened by two independent reviewers. Forty trials were identified, including 2718 stroke patients.

Data Extraction

Outcome data were pooled according to assessment timing (i.e. 4-8 and 12 weeks after injection), and categorized into six main clinical goals (i.e. spasticity-related pain, involuntary movements, passive joint motion, care ability, arm and hand use, and standing and walking performance). Sensitivity analyses were performed for the influence of study and intervention characteristics, involvement of pharmaceutical industry, and publication bias.

Data Synthesis

Robust evidence is shown for the effectiveness of BoNT in reducing resistance to passive movement, as measured with the (Modified) Ashworth Score, and improving self-care ability for the affected hand and arm after intervention (p<0.005) and at follow-up (p<0.005). In addition, robust evidence is shown for the absence of effect on ‘arm-hand capacity’ at follow-up. BoNT significantly reduced ‘involuntary movements’, ‘spasticity-related pain’, and ‘carer burden’, and improved ‘passive range of motion’, while no evidence was found for ‘arm and hand use’ after intervention.

Conclusions

In view of the robustness of current evidence, no further trials are needed to investigate BoNT for its favourable effects on resistance to passive movement of the spastic wrist and fingers, and on self-care. No trials are needed to further confirm the lack of effects of BoNT on arm-hand capacity, whereas additional trials are needed to establish the suggested favourable effects of BoNT on other ‘body functions’ which may result in clinically meaningful outcomes at ‘activity’ and ‘participation’ levels.

via Effectiveness of botulinum toxin treatment for upper limb spasticity after stroke over different ICF domains: a systematic review and meta-analysis – Archives of Physical Medicine and Rehabilitation

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[Abstract] Mental practice for upper limb motor restoration after stroke: an updated meta-analysis of randomized controlled trials

Abstract

OBJECTIVES:

Stroke is a common refractory disease that may cause dysfunctions in the motor system. The study aimed to evaluate the effects of mental practice (MP) compared with other methods on upper limb motor restoration after stroke.

METHODS:

Eligible studies were identified from Pubmed, Embase, and The Cochrane Library. The study quality was assessed with the Cochrane risk assessment tool and heterogeneity test was performed using I2 statistic and Q test. Random- and fixed-effects models were used and data were reported as weighted mean difference (WMD) and 95% confidence intervals (CIs). The publication bias was examined by Egger’s test and the sensitivity analysis was conducted by ignoring one literature at a time to observe whether this document could reverse the merged results.

RESULTS:

Total of 12 randomized controlled trials were identified. No evidence of publication bias was found. In a fixed-effect model, MP (experimental group) resulted in a significantly larger increase in Fugl-Meyer assessment (FMA) compared with other exercise methods (control group) (WMD = 2.0702, 95% CI: 1.2354-2.905, Z = 4.8606, P < 0.001). In a random-effect model, a significant pooled outcome was obtained for action research arm test (ARAT) (WMD = 4.0936, 95% CI: 1.9900-6.1971, Z = 3.8141, P < 0.001). Sensitivity analysis revealed that the merged WMDs of FMA and ARAT were not reversed.

CONCLUSIONS:

Mental practice is effective on upper limb motor restoration after stroke. It is recommended to treat with MP to improve the outcome of stroke.

 

via Mental practice for upper limb motor restoration after stroke: an updated meta-analysis of randomized controlled trials. – PubMed – NCBI

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