Posts Tagged review

[Abstract] Additional physical therapy services reduce length of stay and improve health outcomes in people with acute and sub-acute conditions: an updated systematic review and meta-analysis

Abstract

Objective

To update a previous review on whether additional physical therapy services reduce length of stay, improve health outcomes, are safe and cost effective for patients with acute or sub-acute conditions.

Data sources

Electronic database (AMED, CINAHL, EMBASE, MEDLINE, PEDro, PubMed) searches were updated from 2010 through June 2017.

Study selection

Randomized controlled trials evaluating additional physical therapy services on patient health outcomes, length of stay or cost effectiveness were eligible. Searching identified 1524 potentially relevant articles, of which 11 new articles from 8 new randomized controlled trials with 1563 participants were selected. In total, 24 randomized controlled trials with 3262 participants are included in this review.

Data extraction

Data were extracted using the form used in the original systematic review. Methodological quality was assessed using the PEDro scale and The Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach was applied to each meta-analysis.

Data synthesis

Post intervention data were pooled with an inverse variance, random effects model to calculate standardized mean differences (SMDs) and 95% confidence intervals (CIs). There is moderate quality evidence that additional physical therapy services reduced length of stay by 3 days in sub-acute settings (MD-2.8, 95%CI -4.6 to -0.9, I20%) and low quality evidence that it reduced length of stay by 0.6 days in acute settings (MD -0.6, 95%CI -1.1 to 0.0, I2 65%). Additional physical therapy led to small improvements in self-care (SMD 0.11, 95%CI 0.03 to 0.19, I2 0%), activities of daily living (SMD 0.13, 95%CI 0.02 to 0.25, I2 15%) and health-related quality of life (SMD 0.12, 95%CI 0.03 to 0.21, I2 0%), with no increases in adverse events. There was no significant change in walking ability. One trial reported that additional physical therapy was likely to be cost-effective in sub-acute rehabilitation.

Conclusions

Additional physical therapy services improve patient activity and participation outcomes, while reducing hospital length of stay for adults. These benefits are likely safe and there is preliminary evidence to suggest they may be cost effective.

via Additional physical therapy services reduce length of stay and improve health outcomes in people with acute and sub-acute conditions: an updated systematic review and meta-analysis – Archives of Physical Medicine and Rehabilitation

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[Abstract] Rehabilitation Interventions for Upper Limb Function in the First Four Weeks Following Stroke: A Systematic Review and Meta-Analysis of the Evidence

Abstract

Objective

To investigate the therapeutic interventions reported in the research literature and synthesize their effectiveness in improving upper limb (UL) function in the first 4 weeks poststroke.

Data Sources

Electronic databases and trial registries were searched from inception until June 2016, in addition to searching systematic reviews by hand.

Study Selection

Randomized controlled trials (RCTs), controlled trials, and interventional studies with pre/posttest design were included for adults within 4 weeks of any type of stroke with UL impairment. Participants all received an intervention of any physiotherapeutic or occupational therapeutic technique designed to address impairment or activity of the affected UL, which could be compared with usual care, sham, or another technique.

Data Extraction

Two reviewers independently assessed eligibility of full texts, and methodological quality of included studies was assessed using the Cochrane Risk of Bias Tool.

Data Synthesis

A total of 104 trials (83 RCTs, 21 nonrandomized studies) were included (N=5225 participants). Meta-analyses of RCTs only (20 comparisons) and narrative syntheses were completed. Key findings included significant positive effects for modified constraint-induced movement therapy (mCIMT) (standardized mean difference [SMD]=1.09; 95% confidence interval [CI], .21–1.97) and task-specific training (SMD=.37; 95% CI, .05–.68). Evidence was found to support supplementary use of biofeedback and electrical stimulation. Use of Bobath therapy was not supported.

Conclusions

Use of mCIMT and task-specific training was supported, as was supplementary use of biofeedback and electrical simulation, within the acute phase poststroke. Further high-quality studies into the initial 4 weeks poststroke are needed to determine therapies for targeted functional UL outcomes.

 

via Rehabilitation Interventions for Upper Limb Function in the First Four Weeks Following Stroke: A Systematic Review and Meta-Analysis of the Evidence – Archives of Physical Medicine and Rehabilitation

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[ARTICLE] Systematic Review of Appropriate Robotic Intervention for Gait Function in Subacute Stroke Patients – Full Text

Abstract

The purpose of this study was to critically evaluate the effects of robot-assisted gait training (RAGT) on gait-related function in patients with acute/subacute stroke. We conducted a systematic review of randomized controlled trials published between May 2012 and April 2016. This search included 334 articles (Cochrane, 51 articles; Embase, 175 articles; PubMed, 108 articles). Based on the inclusion and exclusion criteria, 7 studies were selected for this review. We performed a quality evaluation using the PEDro scale. In this review, 3 studies used an exoskeletal robot, and 4 studies used an end-effector robot as interventions. As a result, RAGT was found to be effective in improving walking ability in subacute stroke patients. Significant improvements in gait speed, functional ambulatory category, and Rivermead mobility index were found with RAGT compared with conventional physical therapy . Therefore, aggressive weight support and gait training at an early stage using a robotic device are helpful, and robotic intervention should be applied according to the patient’s functional level and onset time of stroke.

1. Introduction

Stroke is a common disease [1]. In most patients, disabilities remain after stroke, and long-lasting disability requires continuous management and intensive rehabilitation [12]. Furthermore, the economic burden on the patient increases because of the prolonged rehabilitation period. Therefore, the application of intensive and efficient rehabilitation programs and techniques is an urgent need after stroke [3].

Gait impairment is one of the most important problems after stroke and is associated with activities of daily living and mobility issues [4]. Therefore, recovery of gait function is an important goal of rehabilitation for independent living [5]. Interventions to enhance gait function require repetitive task training with high intensity, and extensive effort by physical therapists is essential [5]. Moreover, the most effective rehabilitation intervention, including gait training, must be performed shortly after stroke and in an intensive and task-oriented manner and should include multisensory stimulation [3].

Robot-assisted gait training (RAGT) for patients in the acute/subacute stage who are nonambulatory is effective at reeducating motor control function through repetitive training of a specific task [6]; RAGT provides intensive therapy, which reduces the burden on therapists, and enhances motor reeducation with multisensory stimulation [3]. Several previous studies reported that gait training using robotic devices is effective at enhancing muscular activity patterns [7], muscle tone, joint range of motion [8], gait speed, functional gait capability [79], gait independence, and mobility in the community [1011]. Moreover, patients who received RAGT and conventional physical therapy had a higher chance of regaining independent gait function than those who received only conventional gait training [12]. However, owing to studies that suggested RAGT is ineffective [13], the effect on gait and gait-related function in subacute stroke remains unclear. In a previous review of effectiveness in stroke patients, the RAGT group showed significant improvement in balance and balance-related activity function, but the comparison between the groups was not significant [14]. These results show that RAGT is effective, but whether it is more effective than other gait-related rehabilitation interventions is still unclear. In this context, the effect of RAGT is still not clearly demonstrated, and reviews that have recently demonstrated the effect of RAGT on gait-related outcome measures in patients with acute/subacute stroke are also limited.

Therefore, the aim of this systematic review was to investigate the effects of RAGT on acute/subacute stroke. The specific goals included identifying the effects of RAGT using assessment tools associated with gait and gait-related function in patients with acute/subacute stroke.[…]

Continue —>  Systematic Review of Appropriate Robotic Intervention for Gait Function in Subacute Stroke Patients

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[ARTICLE] Cannabinoids in the Treatment of Epilepsy: Hard Evidence at Last? – Full Text PDF

The interest in cannabis-based products for the treatment of refractory epilepsy has skyrocketed in recent years. Marijuana and other cannabis products with high content in Δ(9) –tetrahydrocannabinol (THC), utilized primarily for recreational purposes, are generally unsuitable for this indication, primarily because THC is associated with many undesired effects. Compared with THC, cannabidiol (CBD) shows a better defined anticonvulsant profile in animal models and is largely devoid of adverse psychoactive effects and abuse liability. Over the years, this has led to an increasing use of CBD-enriched extracts in seizure disorders, particularly in children. Although improvement in seizure control and other benefits on sleep and behavior have been often reported, interpretation of the data is made difficult by the uncontrolled nature of these observations. Evidence concerning the potential anti-seizure efficacy of cannabinoids reached a turning point in the last 12 months, with the completion of three high-quality placebo-controlled adjunctive-therapy trials of a purified CBD product in patients with Dravet syndrome and Lennox-Gastaut syndrome. In these studies, CBD was found to be superior to placebo in reducing the frequency of convulsive (tonic-clonic, tonic, clonic, and atonic) seizures in patients with Dravet syndrome, and the frequency of drop seizures in patients with Lennox-Gastaut syndrome. For the first time, there is now class 1 evidence that adjunctive use of CBD improves seizure control in patients with specific epilepsy syndromes. Based on currently available information, however, it is unclear whether the improved seizure control described in these trials was related to a direct action of CBD, or was mediated by drug interactions with concomitant medications, particularly a marked increased in plasma levels of N-desmethylclobazam, the active metabolite of clobazam. Clarification of the relative contribution of CBD to improved seizure outcome requires re-assessment of trial data for the subgroup of patients not comedicated with clobazam, or the conduction of further studies controlling for the confounding effect of this interaction. (2017;7:61-76) […]

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[ARTICLE] User Acceptance of Computerized Cognitive Behavioral Therapy for Depression: Systematic Review – Full Text

ABSTRACT

Background: Computerized cognitive behavioral therapy (cCBT) has been proven to be effective in depression care. Moreover, cCBT packages are becoming increasingly popular. A central aspect concerning the take-up and success of any treatment is its user acceptance.

Objective: The aim of this study was to update and expand on earlier work on user acceptance of cCBT for depression.

Methods: This paper systematically reviewed quantitative and qualitative studies regarding the user acceptance of cCBT for depression. The initial search was conducted in January 2016 and involved the following databases: Web of Science, PubMed, the Cochrane Library, and PsycINFO. Studies were retained if they described the explicit examination of the user acceptance, experiences, or satisfaction related to a cCBT intervention, if they reported depression as a primary outcome, and if they were published in German or English from July 2007 onward.

Results: A total of 1736 studies were identified, of which 29 studies were eligible for review. User acceptance was operationalized and analyzed very heterogeneously. Eight studies reported a very high level of acceptance, 17 indicated a high level of acceptance, and one study showed a moderate level of acceptance. Two qualitative studies considered the positive and negative aspects concerning the user acceptance of cCBT. However, a substantial proportion of reviewed studies revealed several methodical shortcomings.

Conclusions: In general, people experience cCBT for depression as predominantly positive, which supports the potential role of these innovative treatments. However, methodological challenges do exist in terms of defining user acceptance, clear operationalization of concepts, and measurement.

 

Introduction

Depressive disorders are among the most common and serious mental illnesses [1]. Globally, 350 million people of all ages are estimated to suffer from depression. If depressive disorders are detected at an early stage, they are highly treatable in the majority of cases [2]. There are known effective psychological treatments, for example, cognitive behavioral therapy (CBT) [3]. However, individuals suffering from depression often find themselves confronted with barriers to receiving appropriate care such as social stigma associated with mental disorders, long waiting times, or the logistical difficulties of appearing in person for treatment [4,5]. For these reasons, computerized programs present an innovative approach to improving access to psychological treatments for depression. There is evidence that computerized cognitive behavioral therapy (cCBT) is effective in the treatment of various mental disorders, including depression [610]. There are a number of advantages that are associated with cCBT such as anonymity, wide availability, or location-independent and around-the-clock access [9,11]. Well-known cCBT programs such as Beating The Blues and MoodGYM have been shown to provide a promising option for the treatment of mental health problems [9,12,13]. A prerequisite for cCBT programs to be effective is its user acceptance, as the implementation of an innovative intervention such as cCBT can be affected negatively because of individuals being unwilling to use it. For example, the absence of a contact person and the resulting anonymity can have a negative impact on the user’s motivation to start or keep up with a cCBT program. Therefore, it is of utmost importance to consider user acceptance when developing and implementing a cCBT program for the treatment of depression.

The concept of user acceptance arose as a key term in the scientific discourse. Definitions of the term differ widely depending on the intended use [14]. One of the most popular approaches is the technology acceptance model (TAM) developed by Davis [15]. TAM illustrates user acceptance determined by two factors: perceived usefulness and perceived ease of use. According to Davis [15], both have a significant impact on a person’s attitude toward using a new technology. Kollmann [16] and Rogers [17] went one step further and combined different phases in their acceptance models. Therefore, the user passes through phases from getting to know a new technology, to forming an attitude toward it, to a decision whether to use or not to the confirmation of the decision. On this basis, user acceptance can be defined as the willingness of individuals to employ information technology for the tasks it is designed to support, the realization, and approval of the decision to employ. All of these models have one thing in common: user acceptance is considered to be a process beginning with an attitude toward the innovation and developing into satisfaction with the innovation; it is not an instantaneous act. Accordingly, we have conceived acceptance as the act of accepting, experiencing, and being satisfied.

Since the emergence of the first cCBT programs, there have been a number of reviews addressing the user acceptance of cCBT; however, they have utilized different approaches. In their reviews, Titov [18], Andrews et al [8], and Vallury et al [19] focused broadly on effectiveness and user acceptance of cCBT for several mental disorders, including depression and anxiety disorders. Waller and Gilbody [20] reviewed quantitative and qualitative studies examining adverse consequences, accessibility, and acceptability of cCBT programs for treating anxiety and depression. However, Kaltenthaler et al [21] provide the only review with a very comprehensive and focused insight into the user acceptance of cCBT for depression, including research up to June 2007. They systematically reviewed sources of information on acceptability to patients of cCBT for depression. As a result, they documented several studies reporting positive expectancies and high satisfaction in routine care cCBT services for those completing the treatment and argued that studies should reveal more detailed information on patient recruitment methods, dropout rates, and reasons for dropping out. Furthermore, they drafted well-designed surveys and qualitative studies included alongside trials to determine levels of patient acceptability as implications for further research.

On this basis, we provide a systematic overview on user acceptance of cCBT for depression over the last 10 years and widen the perspective to include the notion that the process of user acceptance spans a number of phases, including accepting, experiencing, and being satisfied with cCBT. We intend to answer the following research questions: (1) which measures were used to examine the user acceptance of cCBT for depression? and (2) to what degree do users accept cCBT for depression? […]

Continue —> JMIR-User Acceptance of Computerized Cognitive Behavioral Therapy for Depression: Systematic Review | Rost | Journal of Medical Internet Research

Figure 2. Recommended examination of user acceptance.

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[ARTICLE] Agent-based systems for telerehabilitation: strengths, limitations and future challenges (PDF Download Available) – Full Text

Abstract
Telerehabilitation in older adults is most needed in the patient environments, rather than in formal ambulatories or hospitals. Supporting such practices brings significant advantages to patients, their family, formal and informal caregivers, clinicians, and researchers. Several techniques and technologies have been developed aiming at facilitating and enhancing the effectiveness of telerehabilitation. This paper gives a quick overview of the state of the art, investigating video-based, wear-able, robotic, distributed, and gamified telerehabilitation solutions. In particular, agent-based solutions are analyzed and discussed addressing strength, limitations, and future challenges. Elaborating on functional requirements expressed by professional physiotherapists and researchers, the need for extending multi-agent systems (MAS) peculiarities at the sensing level in wearable solutions establishes new research challenges. Employed in cyber-physical scenarios with users-sensors and sensors-sensors interactions, MAS are requested to handle timing constraints, scarcity of resources and new communication means, which are crucial for providing real-time feedback and coaching.
1 Introduction
Healthcare institutions are facing the strain of a significantly larger elderly population [1]. Lengthening life expectancy is met by an increasing demand for medical and technological contributions to extend the ”good-health”, and disability free period.
The major factor catalyzing the elderly’s impairing process is the progres-
sive reduction of mobility, due to the natural aging process, inactivity, dis-
eases such as osteoarthritis, stroke or other neurological conditions, falls with its consequences, such as fear of falls (leading to inactivity), or fractures (needing surgery).Despite the emergence of less-invasive surgical techniques, post-intervention rehabilitation still requires extended periods and tailored therapies, which usually involve complications. Performing traditional rehabilitative practices is leading to a significant increase in public-health costs and, in some cases a lack of resources, thus worsening the services’ quality. Rehabilitation is often a long process and needs to be sustained long after the end of the acute care. Simplifying the access to health services [2] can raise the number of patients, maintaining (or even increasing) the quality of care. For example, patients requiring support, such as continuous or selective monitoring, can benefit from systems that automatically transmit the information gathered in their domestic environment to the health clinics, thus enabling telemonitoring on their health conditions [3].
Although in traditional solutions telemonitoring is a self-contained practice
limited to passively observing the patients, the need for remote sensing is crucially coupled with the need for coaching older adults in their daily living [4,5].
For example, a critical activity such as telerehabilitation cannot be limited
to observing the patients’ behaviors. Indeed, patient adherence and acceptability of rehabilitative practices need to be actively enhanced, overcoming pitfalls due to motor (e.g., endurance), non-motor (e.g., fatigue, pain, dysautonomic symptoms, and motivational), and cognitive deficits. According to Rodriguez et al. [6], telerehabilitation can be formally defined as:
“the application of telecommunication, remote sensing and operation tech-
nologies, and computing technologies to assist with the provision of med-
ical rehabilitation services at a distance.”
Patients, physiotherapists, and health institutes can gain several benefits
from an extensive adoption of telerehabilitation systems [7]. Considering the
economical point of view, Mozaffarian et al. [8] figured out that the total cost
of stroke in the US was estimable to be 34.3 billion dollars in 2008, rising up to 69.1 billion dollars in 2016.
Even though to date they are not precisely quantifiable due to insufficient evidence [9], Mutingi et al. [10] presented as “inevitable advantages”
(i) a substantial cost saving primarily due to the reduction of specialized human resources,
(ii) an enhancement of patient comfort and lifestyle, and (iii) improvements of therapy and decision making processes. Moreover, Morreale et al. [11] mentioned one of the most appreciated benefits: the increase of adherence to rehabilitation protocols.
The multitude of scientific contributions fostering telerehabilitation exploits
new technologies and various architectures to better understand and serve user requirements. However, due to technological or technical limitations, physiotherapists’ needs have not yet been completely satisfied. To fill this gap, a system evolution is required. For example, telerehabilitation systems cannot offer the same behavior to users with diverse conditions. Viceversa, according to the environment condition, they must rather be able to adapt themselves to the user needs [6].
Telerehabilitation is characterized by a very delicate equilibrium between
environment, devices, and users. Thus, the capabilities such as self adaptation, flexibility, and ubiquity are crucial to facilitate and promote the usability and then the actual practices.
Agent-based systems for telerehabilitation: strengths, limitations and future challenges (PDF Download Available). Available from: https://www.researchgate.net/publication/316790326_Agent-based_systems_for_telerehabilitation_strengths_limitations_and_future_challenges [accessed May 26, 2017].

Continue —> Agent-based systems for telerehabilitation: strengths, limitations and future challenges (PDF Download Available)

Fig. 2. Agent-based sensing: future challenge for telerehabilitation MAS. 

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[ARTICLE] Visual Impairment Following Stroke – The Impact on Quality of Life: A Systematic Review – Full Text PDF

ABSTRACT

Background: The visual impairments caused by stroke have the potential to affect the ability of an individual to perform activities of daily living. An individual with visual impairment may also have reduced level of independence. The purpose of this review was to investigate the impact on quality of life from stroke related visual impairment, using subjective patient reported outcome measures.

Methods: A systematic search of the literature was performed. The inclusion criteria required studies to have adult participants (aged 18 years or over) with a diagnosis of a visual impairment directly resulting from a stroke. Studies which included visual impairment as a result of other intracranial aetiology, were included if over half of the participants were stroke survivors. Multiple scholarly online databases and registers of published, unpublished and ongoing trials were searched, in addition articles were hand searched. MESH terms and alternatives in relation to stroke and visual conditions were used. Study selection was performed by two authors independently. Data was extracted by one author and verified by a second. The quality of the evidence was assessed using a quality appraisal tool and reporting guidelines.

Results: This review included 11 studies which involved 5646 participants, the studies used a mixture of generic and vision-specific instruments. The seven instruments used by the included studies were the EQ-5D, LIFE-H, SF-36, NEI VFQ-25, VA LV VFQ-48, SRA-VFP and DLTV.

Conclusion: A reduction in quality of life was reported by all studies in stroke survivors with visual impairment. Some studies used generic instruments, therefore making it difficult to extract the specific impact of the visual impairment as opposed to the other deficits caused by stroke. The majority of studies (8/11) primarily had participants with visual field loss. This skew towards visual field loss and no studies investigating the impact ocular motility prevented a comparison of the effects on quality of life due to different visual impairments caused by stroke. In order to fully understand the impact of visual impairment following stroke on quality of life, further studies need to use an appropriate vision-specific outcome measure and include all types of visual impairment which can result from a stroke.

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[Abstract] Functional Electrical Stimulation Improves Activity After Stroke: A Systematic Review With Meta-Analysis

Abstract

Objective

To investigate the effect of functional electrical stimulation (FES) in improving activity and to investigate whether FES is more effective than training alone.

Data Sources

Cochrane Central Register of Controlled Trials, Ovid Medline, EBSCO Cumulative Index to Nursing and Allied Health Literature, Ovid EMBASE, Physiotherapy Evidence Database (PEDro), and Occupational Therapy Systematic Evaluation of Effectiveness.

Study Selection

Randomized and controlled trials up to June 22, 2014, were included following predetermined search and selection criteria.

Data Extraction

Data extraction occurred by 2 people independently using a predetermined data collection form. Methodologic quality was assessed by 2 reviewers using the PEDro methodologic rating scale. Meta-analysis was conducted separately for the 2 research objectives.

Data Synthesis

Eighteen trials (19 comparisons) were eligible for inclusion in the review. FES had a moderate effect on activity (standardized mean difference [SMD], .40; 95% confidence interval [CI], .09–.72) compared with no or placebo intervention. FES had a moderate effect on activity (SMD, .56; 95% CI, .29–.92) compared with training alone. When subgroup analyses were performed, FES had a large effect on upper-limb activity (SMD, 0.69; 95% CI, 0.33–1.05) and a small effect on walking speed (mean difference, .08m/s; 95% CI, .02–.15) compared with control groups.

Conclusions

FES appears to moderately improve activity compared with both no intervention and training alone. These findings suggest that FES should be used in stroke rehabilitation to improve the ability to perform activities.

Source: Functional Electrical Stimulation Improves Activity After Stroke: A Systematic Review With Meta-Analysis – Archives of Physical Medicine and Rehabilitation

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[Abstract] Effect of electrical stimulation as an adjunct to botulinum toxin type A in the treatment of adult spasticity: a systematic review

Objective: To investigate whether electrical stimulation (ES) as an adjunct to BTX-A boosts botulinum activity and whether the combined therapeutic procedure is more effective than BTX-A alone in reducing spasticity in adult subjects.

Data sources: A search was conducted in PubMed, EMBASE, Cochrane Central Register, and CINAHL from January 1966 to January 2016.

Study selection: Only randomized controlled studies (RCT) involving the combination of BTX-A and ES were considered. RCTs were excluded if BTX plus ES was investigated in animals or healthy subjects; certain techniques were used as an adjunct to BTX-A, but ES was not used; BTX-A or ES were compared but were not used in combination. ES was divided into neuromuscular stimulation (NMS), functional electrical stimulation (FES), and transcutaneous electrical nerve stimulation (TENS). Two authors independently screened all search results and reviewed study characteristics using the Physiotherapy Evidence Database (PEDro) scale.

Results: Fifteen RCTs were pinpointed and nine studies were included. Trials varied in methodological quality, size, and outcome measures used. ES was used in the form of NMS and FES in seven and two studies, respectively. No study investigating BTX-A plus TENS was found. BTX-A plus ES produced significant reduction in spasticity on the Ashworth Scale (AS) and on the modified AS in seven studies, but only four showed high quality on the PEDro scale. Significant reduction in compound muscular action potential (CMAP) amplitude was detected after BTX-A plus ES in two studies.

Conclusions: ES as an adjunctive therapy to BTX-A may boost BTX-A action in reducing adult spasticity, but ES variability makes it difficult to recommend the combined therapy in clinical practice.

Implications for rehabilitation

  • Electrical stimulation (ES) as adjunct to botulinum toxin type A (BTX-A) injections may boost neurotoxin action in treating adult spasticity.

  • Given the variability of ES characteristics and the paucity of high-quality trials, it is difficult to support definitively the use of BTX-A plus ES to potentiate BTX-A effect in clinical practice.

  • A vast array of rehabilitation interventions combined with BTX-A have been provided in reducing spasticity, but the present evidence is not sufficient to recommend any combined therapeutic strategy.

Source: Effect of electrical stimulation as an adjunct to botulinum toxin type A in the treatment of adult spasticity: a systematic review: Disability and Rehabilitation: Vol 0, No 0

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[REVIEW] Screening methods for post-stroke visual impairment: a systematic review – Full Text

Purpose: To provide a systematic overview of the various tools available to screen for post-stroke visual impairment.

Methods: A review of the literature was conducted including randomised controlled trials, controlled trials, cohort studies, observational studies, systematic reviews and retrospective medical note reviews. All languages were included and translation was obtained. Participants included adults ≥18 years old diagnosed with a visual impairment as a direct cause of a stroke. We searched a broad range of scholarly online resources and hand-searched articles registers of published, unpublished and on-going trials. Search terms included a variety of MESH terms and alternatives in relation to stroke and visual conditions. Study selection was performed by two authors independently. The quality of the evidence and risk of bias were assessed using the STROBE, GRACE and PRISMA statements.

Results: A total of 25 articles (n = 2924) were included in this review. Articles appraised reported on tools screening solely for visual impairments or for general post-stroke disabilities inclusive of vision. The majority of identified tools screen for visual perception including visual neglect (VN), with few screening for visual acuity (VA), visual field (VF) loss or ocular motility (OM) defects. Six articles reported on nine screening tools which combined visual screening assessment alongside screening for general stroke disabilities. Of these, three included screening for VA; three screened for VF loss; three screened for OM defects and all screened for VN. Two tools screened for all visual impairments. A further 19 articles were found which reported on individual vision screening tests in stroke populations; two for VF loss; 11 for VN and six for other visual perceptual defects. Most tools cannot accurately account for those with aphasia or communicative deficits, which are common problems following a stroke.

Conclusion: There is currently no standardised visual screening tool which can accurately assess all potential post-stroke visual impairments. The current tools screen for only a number of potential stroke-related impairments, which means many visual defects may be missed. The sensitivity of those which screen for all impairments is significantly lowered when patients are unable to report their visual symptoms. Future research is required to develop a tool capable of assessing stroke patients which encompasses all potential visual deficits and can also be easily performed by both the patients and administered by health care professionals in order to ensure all stroke survivors with visual impairment are accurately identified and managed.

  • Implications for Rehabilitation
  • Over 65% of stroke survivors will suffer from a visual impairment, whereas 45% of stroke units do not assess vision.

  • Visual impairment significantly reduces the quality of life, such as being unable to return to work, driving and depression.

  • This review outlines the available screening methods to accurately identify stroke survivors with visual impairments.

  • Identifying visual impairment after stroke can aid general rehabilitation and thus, improve the quality of life for these patients.

Continue —> Screening methods for post-stroke visual impairment: a systematic review: Disability and Rehabilitation: Vol 0, No 0

Figure 1. Flowchart for the pathway of included articles.

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