Posts Tagged systematic review

[Abstract] Contraceptive knowledge and use among women with intellectual, physical, or sensory disabilities: A systematic review

Abstract

Background

Women spend most of their reproductive years avoiding pregnancy. However, we know little about contraceptive knowledge and use among women with disabilities, or about strategies to improve contraceptive knowledge and decision-making in this population.

Objective

To systematically review published literature on women with disabilities and: 1) contraceptive knowledge; 2) attitudes and preferences regarding contraception; 3) contraceptive use; 4) barriers and facilitators to informed contraceptive use; and 5) effectiveness of interventions to improve informed contraceptive decision-making and use.

Methods

We searched MEDLINE, PsychINFO, the Cochrane Library, CINAHL, and ERIC databases from inception through December 2017. Two reviewers independently reviewed studies for eligibility, abstracted study data, and assessed risk of bias following PRISMA guidance.

Results

We reviewed 11,659 citations to identify 62 publications of 54 unique studies (total n of women with disabilities = 21,246). No standard definition of disability existed across studies. The majority of studies focused on women with intellectual disabilities (ID). Women with ID and those who were deaf or hard-of-hearing had lower knowledge of contraceptive methods than women without disabilities. Estimates of contraceptive use varied widely, with some evidence that women with disabilities may use a narrower range of methods. Five of six studies evaluating educational interventions to increase contraceptive knowledge or use reported post-intervention improvements.

Conclusions

Women with disabilities may use a more narrow mix of contraceptive methods and are often less knowledgeable about contraceptives than women without disabilities. Interventions to improve knowledge show some promise. A lack of data exists on contraceptive preferences among women with disabilities.

 

via Contraceptive knowledge and use among women with intellectual, physical, or sensory disabilities: A systematic review – ScienceDirect

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[ARTICLE] The effects of ankle-foot orthoses on walking speed in patients with stroke: a systematic review and meta-analysis of randomized controlled trials – Full Text

The aim of this study was to evaluate the effects of ankle-foot orthoses on speed walking in patients with stroke.

PubMed, Embase, Web of Science, Scopus, CENTRAL, PEDro, RehabData, RECAL, and ProQuest were searched from inception until 30 September 2019.

This study was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline statement. Risk of bias assessment was performed using the Cochrane Risk of Bias Tool. Begg’s test and Egger’s regression method were used to assess the publication bias. Trim and fill analysis was also used to adjust any potential publication bias. Sensitivity analysis was performed to evaluate the effect of individual studies. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria.

Overall, 14 studies were included with a total of 1186 participants. A small-to-moderate and non-significant improvement in favor of the ankle-foot orthosis versus without ankle-foot orthosis (standardized mean difference (SMD) = 0.41, 95% confidence interval = −0.15 to 0.96), similar effects of ankle-foot orthosis and functional electrical stimulation (SMD = 0.00, 95% confidence interval = −0.16 to 0.16), and a small and non-significant improvement in favor of ankle-foot orthosis versus another type of ankle-foot orthosis (SMD = 0.22, 95% confidence interval = −0.05 to 0.49) in walking speed were found. However, the quality of evidence for all comparisons was low or very low.

Despite reported positive effects in some studies, there is no firm evidence of any benefit of ankle-foot orthoses on walking speed.

A total of 50% of patients with stroke suffer from diminished mobility due to hemiparesis.1 Impaired walking is one of the major problems occurring for stroke patients;2 although 70% of patients regain their ability for walking, they experience functional constraints due to spasticity, muscle weakness, and poor balance.3 Foot drop is among main causes of improper walking related to affected individuals. In response to this abnormality, clearance in swing phase and stability in stance phase are impaired, resulting in reduced walking speed and increased risk of falling.4

The use of ankle-foot orthosis and functional electrical stimulation as two major rehabilitation interventions is propounded to improve walking speed of individuals with stroke.5 An ankle-foot orthosis contributes to stabilization of the foot and ankle in stance phase, keeping the toes up while taking steps, and improving heel strike.6,7 Ankle-foot orthoses are used in different models and designs such as articulated, non-articulated, rigid, and dynamic.8 Functional electrical stimulation refers to the usage of musculoskeletal electrical stimulation to activate the muscles while performing functional tasks,9 which has been established as an alternative to ankle-foot orthoses for patients with stroke.

To the best of our knowledge, a limited systematic review and meta-analysis has also been performed in 2013,10 aimed at investigating the effects of ankle-foot orthosis on balance and gait after stroke. In that review, different study designs were included with heterogeneous methodologies, and short-term effects were only assessed. Although the study was published in 2013, the authors only included the studies published until 2011. In recent years, two meta-analyses11,12 have been carried out which aimed at comparing the therapeutic effects of ankle-foot orthoses and functional electrical stimulation on drop foot in central nervous system (CNS) diseases. In these reviews, stroke was considered along with other CNS diseases, and ankle-foot orthoses and functional electrical stimulation were found to have the same effects. Lack of publication bias assessment, quality of evidence evaluation, and combined different types of interventions resulted in inconclusive findings in these meta-analyses.

The primary objective of this up-to-date study is systematically reviewing the literature with regard to the effects of ankle-foot orthoses on walking speed of patients with stroke.[…]

 

Continue —->  The effects of ankle-foot orthoses on walking speed in patients with stroke: a systematic review and meta-analysis of randomized controlled trials – Saeed Shahabi, Hosein Shabaninejad, Mohammad Kamali, Maryam Jalali, Ahmad Ahmadi Teymourlouy,

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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 to complete 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 October;55(5):558-69 – Minerva Medica – Journals

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[Abstract] A systematic review of personal smart technologies used to improve outcomes in adults with acquired brain injuries

This review aimed to determine the effectiveness of personal smart technologies on outcomes in adults with acquired brain injury.

A systematic literature search was conducted on 30 May 2019. Twelve electronic databases, grey literature databases, PROSPERO, reference list and author citations were searched.

Randomised controlled trials were included if personal smart technology was used to improve independence, goal attainment/function, fatigue or quality of life in adults with acquired brain injury. Data were extracted using a bespoke form and the TIDieR checklist. Studies were graded using the PEDro scale to assess quality of reporting. Meta-analysis was conducted across four studies.

Six studies met the inclusion criteria, generating a total of 244 participants. All studies were of high quality (PEDro ⩾ 6). Interventions included personal digital assistant, smartphone app, mobile phone messaging, Neuropage and an iPad. Reporting of intervention tailoring for individual needs was inconsistent. All studies measured goal attainment/function but none measured independence or fatigue. One study (n = 42) reported a significant increase in memory-specific goal attainment (p = 0.0001) and retrospective memory function (p = 0.042) in favour of the intervention. Another study (n = 8) reported a significant increase in social participation in favour of the intervention (p = 0.01). However, our meta-analyses found no significant effect of personal smart technology on goal attainment, cognitive or psychological function.

At present, there is insufficient evidence to support the clinical benefit of personal smart technologies to improve outcomes in acquired brain injury. Researchers need to conduct more randomised studies to evaluate these interventions and measure their potential effects/harms.

 

via A systematic review of personal smart technologies used to improve outcomes in adults with acquired brain injuries – Jade Kettlewell, Roshan das Nair, Kate Radford,

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[Abstract] Functional Balance and Postural Control Improvements in Patients with Stroke after Non-Invasive Brain Stimulation: A Meta-Analysis

Highlights

  • NIBS improved deficits in functional balance and postural control post stroke.
  • The treatment effects on postural imbalance were significant following rTMS.
  • The improvements after rTMS appeared in acute, subacute, and chronic patients.
  • A higher number of rTMS sessions significantly increased the treatment effects.

Abstract

Objectives

The postural imbalance post stroke limits individual’s walking abilities as well as increase the risk of falling. We investigated the short-term treatment effects of non-invasive brain stimulation (NIBS) on functional balance and postural control in patients with stroke.

Data Sources

We started the search via PubMed and ISI’s Web of Science on March 1, 2019 and concluded the search on April 30, 2019.

Study Selection

The meta-analysis included studies that used either repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) for the recovery of functional balance and postural control post stroke. All included studies used either randomized control trial or crossover designs with a sham control group.

Data Extraction

Three researchers independently performed data extraction and assessing methodological quality and publication bias. We calculated overall and individual effect sizes using random effects meta-analysis models.

Data Synthesis

The random effects meta-analysis model on the 18 qualified studies identified the significant positive effects relating to NIBS in terms of functional balance and postural control post stroke. The moderator variable analyses revealed that these treatment effects were only significant in rTMS across acute/subacute and chronic stroke patients whereas tDCS did not show any significant therapeutic effects. The meta-regression analysis showed that a higher number of rTMS sessions was significantly associated with more improvements in functional balance and postural control post stroke.

Conclusions

Our systematic review and meta-analysis confirmed that NIBS may be an effective option for restoring functional balance and postural control for patients with stroke.

via Functional Balance and Postural Control Improvements in Patients with Stroke after Non-Invasive Brain Stimulation: A Meta-Analysis – Archives of Physical Medicine and Rehabilitation

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[Abstract + References] Motor stroke recovery after tDCS: a systematic review

Abstract

The purpose of the present study was to investigate the effects of transcranial direct current stimulation (tDCS) on motor recovery in adult patients with stroke, taking into account the parameters that could influence the motor recovery responses. The second aim was to identify the best tDCS parameters and recommendations available based on the enhanced motor recovery demonstrated by the analyzed studies. Our systematic review was performed by searching full-text articles published before February 18, 2019 in the PubMed database. Different methods of applying tDCS in association with several complementary therapies were identified. Studies investigating the motor recovery effects of tDCS in adult patients with stroke were considered. Studies investigating different neurologic conditions and psychiatric disorders or those not meeting our methodologic criteria were excluded. The main parameters and outcomes of tDCS treatments are reported. There is not a robust concordance among the study outcomes with regard to the enhancement of motor recovery associated with the clinical application of tDCS. This is mainly due to the heterogeneity of clinical data, tDCS approaches, combined interventions, and outcome measurements. tDCS could be an effective approach to promote adaptive plasticity in the stroke population with significant positive premotor and postmotor rehabilitation effects. Future studies with larger sample sizes and high-quality studies with a better standardization of stimulation protocols are needed to improve the study quality, further corroborate our results, and identify the optimal tDCS protocols.

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[Abstract] Effectiveness of home-based virtual reality on vestibular rehabilitation outcomes: a systematic review

Background: A 2015 systematic review evaluated the efficacy of utilizing virtual reality in vestibular rehabilitation programs. However, the biggest limitation with most of the included virtual reality systems was the associated cost of the equipment. In addition, home-based exercises are the preferred method of vestibular rehabilitation treatments.

Objectives: The purpose of this systematic review was to examine the effectiveness of home-based virtual reality systems on vestibular rehabilitation outcomes.

Methods: The following databases were examined: CINAHL Complete, ProQuest Medical Database, and PubMed. The following search terms were utilized: ‘video OR computer’ AND ‘vestibular’ AND ‘home’. The evidence level for all of the included articles was evaluated using the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence and the methodological rigor for all of the included articles was evaluated using a 10-item tool created by Medlicott and Harris.

Results: Based on the inclusion and exclusion criteria, seven articles were selected for inclusion in this systematic review. This systematic review found that home-based virtual reality interventions were able to effectively achieve the primary objectives of vestibular rehabilitation and that the use of these interventions was equally as effective as the use of a traditional vestibular rehabilitation program. In addition, it may be most beneficial to combine virtual reality with traditional vestibular rehabilitation.

Conclusions: Clinicians should consider using a combination of virtual reality and traditional vestibular rehabilitation when treating individuals who have been diagnosed with a vestibular dysfunction.

 

via Effectiveness of home-based virtual reality on vestibular rehabilitation outcomes: a systematic review: Physical Therapy Reviews: Vol 0, No 0

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[ARTICLE] A Systematic Review of International Clinical Guidelines for Rehabilitation of People With Neurological Conditions: What Recommendations Are Made for Upper Limb Assessment? – Full Text

Background: Upper limb impairment is a common problem for people with neurological disabilities, affecting activity, performance, quality of life, and independence. Accurate, timely assessments are required for effective rehabilitation, and development of novel interventions. International consensus on upper limb assessment is needed to make research findings more meaningful, provide a benchmark for quality in clinical practice, more cost-effective neurorehabilitation and improved outcomes for neurological patients undergoing rehabilitation.

Aim: To conduct a systematic review, as part of the output of a European COST Action, to identify what recommendations are made for upper limb assessment.

Methods: We systematically reviewed published guidance on measures and protocols for assessment of upper limb function in neurological rehabilitation via electronic databases from January 2007–December 2017. Additional records were then identified through other sources. Records were selected for inclusion based on scanning of titles, abstracts and full text by two authors working independently, and a third author if there was disagreement. Records were included if they referred to “rehabilitation” and “assessment” or “measurement”. Reasons for exclusion were documented.

Results: From the initial 552 records identified (after duplicates were removed), 34 satisfied our criteria for inclusion, and only six recommended specific outcome measures and /or protocols. Records were divided into National Guidelines and other practice guidelines published in peer reviewed Journals. There was agreement that assessment is critical, should be conducted early and at regular intervals and that there is a need for standardized measures. Assessments should be conducted by a healthcare professional trained in using the measure and should encompass body function and structure, activity and participation.

Conclusions: We present a comprehensive, critical, and original summary of current recommendations. Defining a core set of measures and agreed protocols requires international consensus between experts representing the diverse and multi-disciplinary field of neurorehabilitation including clinical researchers and practitioners, rehabilitation technology researchers, and commercial developers. Current lack of guidance may hold-back progress in understanding function and recovery. Together with a Delphi consensus study and an overview of systematic reviews of outcome measures it will contribute to the development of international guidelines for upper limb assessment in neurological conditions.

Introduction

Worldwide prevalence of stroke in 2010 was 33 million, with 16.9 million people having a first stroke, of which 795,000 were American and 1.1 million European (1). It has been estimated that approximately one third of people fail to regain upper limb capacity, despite receiving therapy (2). This has important implications for both individuals and the wider society as reduced upper limb function is associated with dependence and poor quality of life for both patients and carers (35) and impacts on national economies (6).

While stroke has the highest prevalence, other neurological conditions such as Multiple Sclerosis (MS), Spinal Cord Injury (SCI), and Traumatic Brian Injury, have a significant incidence and there are often similarities in presentation, and treatment and therefore assessment. The worldwide incidence of SCI is 40–80 cases per million population and the estimated European mean annual rate of MS incidence is 4.3 cases per 100,000 (7). Recently, Kister et al. (8) reported that 60% of people with MS have impaired hand function. The impact of upper limb dysfunction on ADL is higher than in stroke, as both sides are often affected (9). Although dysfunction after SCI depends on level of injury, upper limb function is consistently cited as a health priority. The incidence rate of TBI in Europe is about 235 per 100,000 population (10). Outcome data among European countries are very heterogeneous. From the US however, it is known that about 1.1% of the population suffer a TBI resulting in long term disability (11).

 

Continue —>  Frontiers | A Systematic Review of International Clinical Guidelines for Rehabilitation of People With Neurological Conditions: What Recommendations Are Made for Upper Limb Assessment? | Neurology

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[REVIEW] A review of international clinical guidelines for rehabilitation of people with neurological conditions: what recommendations are made for upper limb assessment?

Background: Upper limb impairment is a common problem for people with neurological disabilities, affecting activity, performance, quality of life and independence. Accurate, timely assessments are required for effective rehabilitation, and development of novel interventions. International consensus on upper limb assessment is needed to make research findings be more meaningful, provide a benchmark for quality in clinical practice, more cost-effective neurorehabilitation and improved outcomes for neurological patients undergoing rehabilitation.

Aim: To conduct a systematic review, as part of the output of a European COST Action, to identify what recommendations are made for upper limb assessment.

Methods: We systematically reviewed published guidance on measures and protocols for assessing upper limb function in neurological rehabilitation via electronic databases from January 2007 – December 2017. Additional records were then identified through other sources. Records were selected for inclusion based on scanning of titles, abstracts and full text by two authors working independently, and a third author if there was disagreement. Records were included if they referred to ‘rehabilitation’ and ‘assessment’ or ‘measurement’. Reasons for exclusion were documented.
Results: From the initial 552 records identified (after duplicates were removed), 34 satisfied our criteria for inclusion and only six recommended specific outcome measures and /or protocols. Records were divided into National Guidelines and other practice guidelines published in peer reviewed Journals. There was agreement that assessment is critical, should be conducted early and at regular intervals and that there is a need for standardised measures. Assessments should be conducted by a healthcare professional trained in using the measure and should encompass body function and structure, activity and participation.
Conclusions: We present a comprehensive, critical and original summary of current recommendations. Defining a core set of measures and agreed protocols requires international consensus between experts representing the diverse and multi-disciplinary field of neurorehabilitation including clinical researchers and practitioners, rehabilitation technology researchers and commercial developers. Current lack of guidance may hold-back progress in understanding function and recovery. Together with a Delphi consensus study and an overview of systematic reviews of outcome measures it will contribute to the development of international guidelines for upper limb assessment in neurological conditions.

 

via Frontiers | A review of international clinical guidelines for rehabilitation of people with neurological conditions: what recommendations are made for upper limb assessment? | Neurology

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[ARTICLE] Sensory retraining of the leg after stroke: systematic review and meta-analysis – Full Text

This systematic review aimed to investigate the effects of interventions intended for retraining leg somatosensory function on somatosensory impairment, and secondary outcomes of balance and gait, after stroke.

Databases searched from inception to 16 January 2019 included Cochrane Library, PubMed, MEDLINE, CINAHL, EMBASE, PEDro, PsycINFO, and Scopus. Reference lists of relevant publications were also manually searched.

All types of quantitative studies incorporating interventions that intended to improve somatosensory function in the leg post stroke were retrieved. The Quality Assessment Tool for Quantitative Studies was used for quality appraisal. Standardised mean differences were calculated and meta-analyses were performed using preconstructed Microsoft Excel spreadsheets.

The search yielded 16 studies, comprising 430 participants, using a diverse range of interventions. In total, 10 of the included studies were rated weak in quality, 6 were rated moderate, and none was rated strong. Study quality was predominantly affected by high risk of selection bias, lack of blinding, and the use of somatosensory measures that have not been psychometrically evaluated. A significant heterogeneous positive summary effect size (SES) was found for somatosensory outcomes (SES: 0.52; 95% confidence interval (CI): 0.04 to 1.01; I2 = 74.48%), which included joint position sense, light touch, and two-point discrimination. There was also a significant heterogeneous positive SES for Berg Balance Scale scores (SES: 0.62; 95% CI: 0.10 to 1.14; I2 = 59.05%). Gait SES, mainly of gait velocity, was not significant.

This review suggests that interventions used for retraining leg somatosensory impairment after stroke significantly improved somatosensory function and balance but not gait.

 

Somatosensory impairment is common after stroke, occurring in up to 89% of stroke survivors.1Proprioception and tactile somatosensation are more impaired in the leg than in the arm post stroke,2 with the frequency increasing with increasing level of weakness and stroke severity.2,3 Leg somatosensory impairment also has a significant impact on independence in daily activities3 and activity participation in stroke survivors,4 as well as predicts longer hospital stays and lower frequency of home discharges.5

Leg somatosensory impairment negatively influences balance and gait. Post-stroke plantar tactile deficits correlate with lower balance scores and greater postural sway in standing.6 Tactile and proprioceptive feedback provide critical information about weight borne through the limb.7 Accordingly, tactile and proprioceptive somatosensory deficits may hinder paretic limb load detection ability, potentially leading to reduced weight-bearing and contributing to balance impairment and falls post stroke.8 Indeed, stroke survivors with somatosensory impairment have a higher falls incidence compared to those without somatosensory impairment.3 In addition to reduced balance, impaired load detection may also contribute to gait asymmetry, particularly in the push-off phase.8 In addition, leg proprioception influences variance in stride length, gait velocity,9 and walking endurance in stroke survivors.10 In fact, leg somatosensory impairment has been shown to be the third most important independent factor for reduced gait velocity in stroke survivors.11

Two systematic reviews have previously investigated the effects of interventions for retraining somatosensory function after stroke.12,13 In the first review, published more than a decade ago, only four of the 14 included studies targeted the leg,12 while the second only included studies of the arm.13 Nevertheless, both reviews reported that there were insufficient data to determine the effectiveness of these interventions. A third systematic review evaluating the effectiveness of proprioceptive training14 only included 16 studies with stroke-specific populations, of which only two specifically addressed the leg. From these three reviews, the effects of interventions for post-stroke leg somatosensory impairment remain unclear. In addition, the first review12 was critiqued for including studies with participants without somatosensory impairment, and that did not report somatosensory outcomes.15 Therefore, a targeted systematic review, addressing the limitations of previous reviews, is required to elucidate the effects of interventions for post-stroke leg somatosensory impairment.

It is of interest to clinicians and researchers to evaluate the effects of leg somatosensory retraining on factors that may ultimately influence activity and participation, as this could change practice. Therefore, this systematic review aimed to examine the effects of post-stroke leg somatosensory retraining on somatosensory impairment, balance, gait, motor impairment, and leg function.[…]

 

Continue —> Sensory retraining of the leg after stroke: systematic review and meta-analysis – Fenny SF Chia, Suzanne Kuys, Nancy Low Choy, 2019

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