Posts Tagged systematic review

[Abstract+References] Self-directed therapy programmes for arm rehabilitation after stroke: a systematic review

To investigate the effectiveness of self-directed arm interventions in adult stroke survivors.

A systematic review of Medline, EMBASE, CINAHL, SCOPUS and IEEE Xplore up to February 2018 was carried out. Studies of stroke arm interventions were included where more than 50% of the time spent in therapy was initiated and carried out by the participant. Quality of the evidence was assessed using the Cochrane risk of bias tool.

A total of 40 studies (n = 1172 participants) were included (19 randomized controlled trials (RCTs) and 21 before–after studies). Studies were grouped according to no technology or the main additional technology used (no technology n = 5; interactive gaming n = 6; electrical stimulation n= 11; constraint-induced movement therapy n = 6; robotic and dynamic orthotic devices n = 8; mirror therapy n = 1; telerehabilitation n = 2; wearable devices n = 1). A beneficial effect on arm function was found for self-directed interventions using constraint-induced movement therapy (n = 105; standardized mean difference (SMD) 0.39, 95% confidence interval (CI) −0.00 to 0.78) and electrical stimulation (n = 94; SMD 0.50, 95% CI 0.08–0.91). Constraint-induced movement therapy and therapy programmes without technology improved independence in activities of daily living. Sensitivity analysis demonstrated arm function benefit for patients >12 months poststroke (n = 145; SMD 0.52, 95% CI 0.21–0.82) but not at 0–3, 3–6 or 6–12 months.

Self-directed interventions can enhance arm recovery after stroke but the effect varies according to the approach used and timing. There were benefits identified from self-directed delivery of constraint-induced movement therapy, electrical stimulation and therapy programmes that increase practice without using additional technology.

References

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via Self-directed therapy programmes for arm rehabilitation after stroke: a systematic review – Ruth H Da-Silva, Sarah A Moore, Christopher I Price, 2018

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[ARTICLE] Progressive resistance training increases strength after stroke but this may not carry over to activity: a systematic review – Full Text

Article Outline

  1. Introduction
  2. Method
    1. Identification and selection of studies
    2. Assessment of characteristics of the studies
      1. Quality
      2. Participants
      3. Intervention
      4. Outcome measures
    3. Data analysis
  3. Results
    1. Flow of trials through the review
    2. Characteristics of included trials
      1. Quality
      2. Participants
      3. Intervention
      4. Outcome measures
    3. Effect of intervention
      1. Strength
      2. Activity
  4. Discussion
  5. Appendix 1. Supplementary data
  6. References

Abstract

Question

Does progressive resistance training improve strength and activity after stroke? Does any increase in strength carry over to activity?

Design

Systematic review of randomised trials with meta-analysis.

Participants

Adults who have had a stroke.

Intervention

Progressive resistance training compared with no intervention or placebo.

Outcome measures

The primary outcome was change in strength. This measurement had to be of maximum voluntary force production and performed in muscles congruent with the muscles trained in the intervention. The secondary outcome was change in activity. This measurement had to be a direct measure of performance that produced continuous or ordinal data, or with scales that produced ordinal data.

Results

Eleven studies involving 370 participants were included in this systematic review. The overall effect of progressive resistance training on strength was examined by pooling change scores from six studies with a mean PEDro score of 5.8, representing medium quality. The effect size of progressive resistance training on strength was 0.98 (95% CI 0.67 to 1.29, I2 = 0%). The overall effect of progressive resistance training on activity was examined by pooling change scores from the same six studies. The effect size of progressive resistance training on activity was 0.42 (95% CI –0.08 to 0.91, I2 = 54%).

Conclusion

After stroke, progressive resistance training has a large effect on strength compared with no intervention or placebo. There is uncertainty about whether these large increases in strength carry over to improvements in activity.

via Progressive resistance training increases strength after stroke but this may not carry over to activity: a systematic review – Journal of Physiotherapy

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[Abstract] Interventions for Improving Upper Limb Function after Stroke – Cochrane Database Syst Rev.

Abstract

Impairment of the upper limbs is quite frequent after stroke, making rehabilitation an essential step towards clinical recovery and patient empowerment. This review aimed to synthetize existing evidence regarding interventions for upper limb function improvement after Stroke and to assess which would bring some benefit. The Cochrane Database of Systematic Reviews, the Database of Reviews of Effects and PROSPERO databases were searched until June 2013 and 40 reviews have been included, covering 503 studies, 18 078 participants and 18 interventions, as well asdifferent doses and settings of interventions. The main results were:

  1. Information currently available is insufficient to assess effectiveness of each intervention and to enable comparison of interventions;
  2. Transcranial direct current stimulation brings no benefit for outcomes of activities of daily living;
  3. Moderate-quality evidence showed a beneficial effect of constraint-induced movement therapy, mental practice, mirror therapy, interventions for sensory impairment, virtual reality and repetitive task practice;
  4. Unilateral arm training may be more effective than bilateral arm training;
  5. Moderate-quality evidence showed a beneficial effect of robotics on measures of impairment and ADLs;
  6. There is no evidence of benefit or harm for technics such as repetitive transcranial magnetic stimulation, music therapy, pharmacological interventions, electrical stimulation and other therapies.

Currently available evidence is insufficient and of low quality, not supporting clear clinical decisions. High-quality studies are still needed.

 

via [Analysis of the Cochrane Review: Interventions for Improving Upper Limb Function after Stroke. Cochrane Database Syst Rev. 2014,11:CD010820]. – PubMed – NCBI

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[Systematic Review] Complementary and alternative interventions for fatigue management after traumatic brain injury: a systematic review – Full Text

We systematically reviewed randomized controlled trials (RCTs) of complementary and alternative interventions for fatigue after traumatic brain injury (TBI).

We searched multiple online sources including ClinicalTrials.gov, the Cochrane Library database, MEDLINE, CINAHL, Embase, the Web of Science, AMED, PsychINFO, Toxline, ProQuest Digital Dissertations, PEDro, PsycBite, and the World Health Organization (WHO) trial registry, in addition to hand searching of grey literature. The methodological quality of each included study was assessed using the Jadad scale, and the quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. A descriptive review was performed.

Ten RCTs of interventions for post-TBI fatigue (PTBIF) that included 10 types of complementary and alternative interventions were assessed in our study. There were four types of physical interventions including aquatic physical activity, fitness-center-based exercise, Tai Chi, and aerobic training. The three types of cognitive and behavioral interventions (CBIs) were cognitive behavioral therapy (CBT), mindfulness-based stress reduction (MBSR), and computerized working-memory training. The Flexyx Neurotherapy System (FNS) and cranial electrotherapy were the two types of biofeedback therapy, and finally, one type of light therapy was included. Although the four types of intervention included aquatic physical activity, MBSR, computerized working-memory training and blue-light therapy showed unequivocally effective results, the quality of evidence was low/very low according to the GRADE system.

The present systematic review of existing RCTs suggests that aquatic physical activity, MBSR, computerized working-memory training, and blue-light therapy may be beneficial treatments for PTBIF. Due to the many flaws and limitations in these studies, further controlled trials using these interventions for PTBIF are necessary

Fatigue is a common phenomenon following traumatic brain injury (TBI), with a reported prevalence ranging from 21% to 80% [Ouellet and Morin, 2006Bushnik et al. 2007Dijkers and Bushnik, 2008Cantor et al. 2012Ponsford et al. 2012], regardless of TBI severity [Ouellet and Morin, 2006Ponsford et al. 2012]. Post-TBI fatigue (PTBIF) refers to fatigue that occurs secondary to TBI, which is generally viewed as a manifestation of ‘central fatigue’. Associated PTBIF symptoms include mental or physical exhaustion and inability to perform voluntary activities, and can be accompanied by cognitive dysfunction, sensory overstimulation, pain, and sleepiness [Cantor et al. 2013]. PTBIF appears to be persistent, affects most TBI patients daily, negatively impacts quality of life, and decreases life satisfaction [Olver et al. 1996Cantor et al.20082012Bay and De-Leon, 2010]. Given the ubiquitous presence of PTBIF, treatment or management of fatigue is important to improve the patient’s quality of life after TBI. However, the effectiveness of currently available treatments is limited.

Although pharmacological interventions such as piracetam, creatine, monoaminergic stabilizer OSU6162, and methylphenidate can alleviate fatigue, adverse effects limit their usage and further research is needed to clarify their effects [Hakkarainen and Hakamies, 1978Sakellaris et al.2008Johansson et al. 2012b2014]. Therefore, many researchers have attempted to identify complementary and alternative interventions to relieve PTBIF [Bateman et al. 2001Hodgson et al. 2005Gemmell and Leathem, 2006Hassett et al. 2009Johansson et al. 2012aBjörkdahl et al. 2013Sinclair et al. 2014]. In this study, we aimed to systematically review randomized controlled trials (RCTs) that evaluated treatment of PTBIF using complementary and alternative medicine (CAM) to provide practical recommendations for this syndrome. […]

 

Continue —>  Complementary and alternative interventions for fatigue management after traumatic brain injury: a systematic review – Gang-Zhu Xu, Yan-Feng Li, Mao-De Wang, Dong-Yuan Cao, 2017

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[Abstract] The Effects of Timing and Intensity of Neurorehabilitation on Functional Outcome after Traumatic Brain Injury: a Systematic Review & Meta-Analysis

Abstract

Objective

To systematically review evidence on the effects of timing and intensity of neurorehabilitation on the functional recovery of patients with moderate to severe traumatic brain injury (TBI) and aggregate the available evidence using meta-analytic methods.

Data sources

Pubmed, Embase, PsycINFO and Cochrane Database.

Data selection

Electronic databases were searched for prospective controlled clinical trials assessing the effect of timing or intensity of multidisciplinary neurorehabilitation programs on functional outcome of patients with moderate or severe TBI. A total of 5,961 unique records were screened for relevance, of which 58 full-text articles were assessed for eligibility by two independent authors. Eleven articles were included for systematic review and meta-analysis.

Data extraction

Two independent authors performed data extraction and risk of bias analysis using the Cochrane Collaboration Tool. Discrepancies between authors were resolved by consensus.

Data synthesis

Systematic review of a total of six randomized controlled trials, one quasi-randomized trails and four controlled trials revealed consistent evidence for a beneficial effect of early onset neurorehabilitation in the trauma center and intensive neurorehabilitation in the rehabilitation facility on functional outcome, as compared to usual care. Meta-analytic quantification revealed a large-sized positive effect for early onset rehabilitation programs (d = 1.02, p < .001, 95%-confidence interval [CI]: 0.56-1.47) and a medium-sized positive effect for intensive neurorehabilitation programs (d = 0.67, p < .001. 95%-CI: 0.38-0.97) as compared to usual care. These effects were replicated based on solely studies with a low overall risk of bias.

Conclusions

The available evidence indicates that early onset neurorehabilitation in the trauma center and more intensive neurorehabilitation in the rehabilitation facility promote functional recovery of patients with moderate to severe TBI as compared to usual care. These findings support the integration of early onset and more intensive neurorehabilitation in the chain of care for patients with TBI.

via The Effects of Timing and Intensity of Neurorehabilitation on Functional Outcome after Traumatic Brain Injury: a Systematic Review & Meta-Analysis – Archives of Physical Medicine and Rehabilitation

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[Abstract] Effectiveness of Neuromuscular Electrical Stimulation on Lower Limb Hemiplegic Patients following Chronic Stroke: A Systematic Review

Abstract

Objective

To investigate the effectiveness of neuromuscular electrical stimulation (NMES) with or without other interventions in improving lower limb activity after chronic stroke.

Data Source

Electronic databases including PubMed, EMBase, Cochrane Library, PEDro (Physiotherapy Evidence Database) and PsycINFO were searched from the inception to January, 2017.

Study Selection

We selected the randomized controlled trials (RCTs) involving chronic stroke survivors with lower limb dysfunction and comparing NMES or combined with other interventions with control of no electrical-stimulated treatment.

Data Extraction

The primary outcome was defined as lower limb motor function, and the secondary outcomes included gait speed, Berg Balance scale, Timed Up and Go, Six-Minute Walk Test, Modified Ashworth Scale and Range of Motion .

Data Synthesis

Twenty-one RCTs involving 1,481 participants were identified from 5,759 retrieved articles. Pooled analysis showed that NMES had a moderate but statistically significant benefits on lower limb motor function (SMD 0.42, 95% CI 0.26 to 0.58), especially when NMES combined with other interventions or treatment time within either 6 or 12 weeks. NMES also had significant benefits on gait speed, balance, spasticity and range of motion but had no significant difference in walking endurance after NMES.

Conclusion

NMES combined with or without other interventions has beneficial effects in lower limb motor function in chronic stroke survivors. These data suggest that NMES should be a promising therapy to apply in chronic stroke rehabilitation to improve the capability of lower extremity in performing activities.

via Effectiveness of Neuromuscular Electrical Stimulation on Lower Limb Hemiplegic Patients following Chronic Stroke: A Systematic Review – Archives of Physical Medicine and Rehabilitation

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[ARTICLE] Attitudes, barriers and enablers to physical activity in pregnant women: a systematic review – Full Text

Abstract

Question

What are the attitudes, barriers and enablers to physical activity perceived by pregnant women?

Design

In a systematic literature review, eight electronic databases were searched: AMED, CINAHL, Embase, Joanna Briggs Institute, Medline, PsycInfo, SPORTDiscus (from database inception until June 2016) and PubMed (from 2011 until June 2016). Quantitative data expressed as proportions were meta-analysed. Data collected using Likert scales were synthesised descriptively. Qualitative data were analysed thematically using an inductive approach and content analysis. Findings were categorised as intrapersonal, interpersonal or environmental, based on a social-ecological framework.

Participants

Pregnant women.

Intervention

Not applicable.

Outcome measures

Attitudes and perceived barriers and enablers to physical activity during pregnancy.

Results

Forty-nine articles reporting data from 47 studies (7655 participants) were included. Data were collected using questionnaires, interviews and focus groups. Meta-analyses of proportions showed that pregnant women had positive attitudes towards physical activity, identifying it as important (0.80, 95% CI 0.52 to 0.98), beneficial (0.71, 95% CI 0.58 to 0.83) and safe (0.86, 95% CI 0.79 to 0.92). This was supported by themes emerging in 15 qualitative studies that reported on attitudes (important, 12 studies; beneficial, 10 studies). Barriers to physical activity were predominantly intrapersonal such as fatigue, lack of time and pregnancy discomforts. Frequent enablers included maternal and foetal health benefits (intrapersonal), social support (interpersonal) and pregnancy-specific programs. Few environmental factors were identified. Little information was available about attitudes, barriers and enablers of physical activity for pregnant women with gestational diabetes mellitus who are at risk from inactivity.

Conclusion

Intrapersonal themes were the most frequently reported barriers and enablers to physical activity during pregnancy. Social support also played an enabling role. Person-centred strategies using behaviour change techniques should be used to address intrapersonal and social factors to translate pregnant women’s positive attitudes into increased physical activity participation.

Introduction

Physical activity has substantial benefits for women with uncomplicated pregnancies, minimal risks, and is recommended in pregnancy guidelines.1, 2, 3 The benefits of physical activity during pregnancy include improved physical fitness,3, 4, 5 reduced risk of excessive weight gain,6 reduced risk of pre-eclampsia and pre-term birth,7reduced low back pain,8, 9 improved sleep,10 reduced anxiety and depressive symptoms,11, 12 and improved health perception13 and self-reported body image.14

Physical activity is also important for pregnant women with comorbidities and complications such as obesity1 or gestational diabetes mellitus (GDM).15, 16, 17 Physical activity assists with weight control and reduces the risk of GDM in obese pregnant women.1 In women diagnosed with GDM (a common pregnancy-related complication occurring in 3.5 to 12% of pregnancies),15, 16 physical activity is beneficial as an adjunctive intervention in the management of glycaemic control.15, 17, 18, 19, 20 Managing glycaemic control is critical for reducing adverse effects associated with poorly controlled GDM.21 Consequently, aerobic exercise performed at moderate intensity for 30 minutes on most days of the week is recommended for healthy pregnant women,1, 3 those with GDM15, 22,23 and those who are overweight or obese.24

Despite well-documented health benefits,1, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 24, 25, 26, 27 60 to 80% of pregnant women28, 29, 30, 31 – including those who are overweight or obese31 – and more than 60% of women with GDM32 do not participate in physical activity as recommended. Pregnant women from backgrounds other than Caucasian are also less likely to engage in physical activity.29 However, to improve pregnant women’s participation in physical activity (ie, leisure time physical activities or structured exercise programs), we need to understand their attitudes to it, the reasons why they do not engage in physical activity, and enablers that could be harnessed to design effective physical activity interventions or programs that facilitate behaviour change and thereby improve their participation in physical activity during pregnancy.

The inclusion of behaviour change techniques into physical activity interventions has been reported as helpful in improving physical activity levels during pregnancy.33 Behaviour change techniques such as goal setting, planning and education to shape knowledge appear most effective when delivered with face-to-face feedback about goal achievement.33 However, to facilitate uptake of these effective physical activity interventions, clinicians need to know which barriers, enablers and attitudes are common among pregnant women, so they can effectively target their education and evidence-based behaviour change strategies. A systematic review of barriers, enablers and attitudes of pregnant women to physical activity would provide valuable information to enable clinicians to effect a positive behaviour change of increased physical activity in this group.

Identification of women’s attitudes and perceptions of barriers and enablers to physical activity in pregnancy could be informed by quantitative or qualitative research approaches. A review that collates data from studies using either method would benefit from the advantages of each: improving generalisability and providing deeper insights into pregnant women’s beliefs and perceptions about physical activity during pregnancy. Inclusion of qualitative findings may assist in better understanding the factors that can influence women’s attitudes and perceptions. Such deeper understanding would provide valuable insight that clinicians can use to plan strategies to encourage pregnant women – in particular at-risk groups of women such as those with GDM – to participate in physical activity. It would also inform the design of realistic and acceptable interventions to be tested in an effectiveness study. No systematic review has collated quantitative data or provided a meta-summary of attitudes and perceptions of barriers and enablers to physical activity in pregnant women.

Therefore, the research question for this review was:

What are the attitudes, barriers and enablers to physical activity perceived by pregnant women, including women diagnosed with gestational diabetes mellitus?

Continue —> Attitudes, barriers and enablers to physical activity in pregnant women: a systematic review – Journal of Physiotherapy

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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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[Abstract] Determining the potential benefits of yoga in chronic stroke care: a systematic review and meta-analysis

Abstract

Background: Survivors of stroke have long-term physical and psychological consequences that impact their quality of life. Few interventions are available in the community to address these problems. Yoga, a type of mindfulness-based intervention, is shown to be effective in people with other chronic illnesses and may have the potential to address many of the problems reported by survivors of stroke.

Objectives: To date only narrative reviews have been published. We sought to perform, the first systematic review with meta-analyses of randomized controlled trials (RCTs) that investigated yoga for its potential benefit for chronic survivors of stroke.

Methods: Ovid Medline, CINHAL plus, AMED, PubMed, PsychINFO, PeDro, Cochrane database, Sport Discuss, and Google Scholar were searched for papers published between January 1950 and August 2016. Reference lists of included papers, review articles and OpenGrey for Grey literature were also searched. We used a modified Cochrane tool to evaluate risk of bias. The methodological quality of RCTs was assessed using the GRADE approach, results were collated, and random effects meta-analyses performed where appropriate.

Results: The search yielded five eligible papers from four RCTs with small sample sizes (n = 17–47). Quality of RCTs was rated as low to moderate. Yoga is beneficial in reducing state anxiety symptoms and depression in the intervention group compared to the control group (mean differences for state anxiety 6.05, 95% CI:−0.02 to 12.12; p = 0.05 and standardized mean differences for depression: 0.50, 95% CI:−0.01 to 1.02; p = 0.05). Consistent but nonsignificant improvements were demonstrated for balance, trait anxiety, and overall quality of life.

Conclusions: Yoga may be effective for ameliorating some of the long-term consequences of stroke. Large well-designed RCTs are needed to confirm these findings.

Source: Determining the potential benefits of yoga in chronic stroke care: a systematic review and meta-analysis: Topics in Stroke Rehabilitation: Vol 24, No 4

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[ARTICLE] Markerless motion capture systems as training device in neurological rehabilitation: a systematic review of their use, application, target population and efficacy  – Full Text

 

Abstract

Background

Client-centred task-oriented training is important in neurological rehabilitation but is time consuming and costly in clinical practice. The use of technology, especially motion capture systems (MCS) which are low cost and easy to apply in clinical practice, may be used to support this kind of training, but knowledge and evidence of their use for training is scarce. The present review aims to investigate 1) which motion capture systems are used as training devices in neurological rehabilitation, 2) how they are applied, 3) in which target population, 4) what the content of the training and 5) efficacy of training with MCS is.

Methods

A computerised systematic literature review was conducted in four databases (PubMed, Cinahl, Cochrane Database and IEEE). The following MeSH terms and key words were used: Motion, Movement, Detection, Capture, Kinect, Rehabilitation, Nervous System Diseases, Multiple Sclerosis, Stroke, Spinal Cord, Parkinson Disease, Cerebral Palsy and Traumatic Brain Injury. The Van Tulder’s Quality assessment was used to score the methodological quality of the selected studies. The descriptive analysis is reported by MCS, target population, training parameters and training efficacy.

Results

Eighteen studies were selected (mean Van Tulder score = 8.06 ± 3.67). Based on methodological quality, six studies were selected for analysis of training efficacy. Most commonly used MCS was Microsoft Kinect, training was mostly conducted in upper limb stroke rehabilitation. Training programs varied in intensity, frequency and content. None of the studies reported an individualised training program based on client-centred approach.

Conclusion

Motion capture systems are training devices with potential in neurological rehabilitation to increase the motivation during training and may assist improvement on one or more International Classification of Functioning, Disability and Health (ICF) levels. Although client-centred task-oriented training is important in neurological rehabilitation, the client-centred approach was not included. Future technological developments should take up the challenge to combine MCS with the principles of a client-centred task-oriented approach and prove efficacy using randomised controlled trials with long-term follow-up.

Background

People with central nervous system diseases such as multiple sclerosis (MS), stroke and spinal cord injury (SCI), demonstrate among others loss of motor and sensory function in the upper and lower limbs. Due to motor impairment in upper limbs, the performance of activities of daily life, sports and leisure activities is affected. Motor impairment in the lower limbs, affects mobility in general and balance control during reaching movement. The impairments of both upper and lower limbs reduce functional independence and thus the quality of life of the individual [1, 2, 3, 4, 5, 6]. Exercise therapy has proven to improve impairments [7, 8, 9], therefore rehabilitation is very important for these patients.

In neurological rehabilitation, training should be challenging, repetitive, task-specific, motivating, salient and intensive to activate neuroplasticity [4]. Moreover, studies have shown the importance and benefits of client-centred task-oriented rehabilitation [10, 11]. The concept of client-centredness not only incorporates patient’s wishes and needs in their rehabilitation, but also actively involves the patient in selecting goals for their own rehabilitation process. Definitions of task-oriented training are still very diverse, but it incorporates that training is directed to a specific, functional, task [10, 12]. Task-oriented training has been proven to be effective in arm-hand skilled performance in stroke patients [12, 13], spinal cord [10] and MS [14]. Spooren et al. [14] demonstrated the importance of specificity of training and inclusion of ‘client-centred training’ and ‘exercise progression’. Timmermans et al. [12] concluded that training components, such as random and distributed practice, together with feedback and clear functional goals, should be incorporated in order to enhance the outcomes of task-oriented training. Despite the advantages of a client-centred task-oriented approach with regard to training outcome and motor learning, this approach requires individualised training schemes and guidance of a therapist. Therefore a client-centred and task-oriented approach is more time consuming and costly for therapists and rehabilitation centres. Hence a new approach is needed where client-centred task-oriented rehabilitation can be administered without extra costs and effort of therapists.

Technology-based rehabilitation systems such as robotics and virtual reality (VR) are promising and may be able to deliver a client-centred task-oriented rehabilitation without extra costs and effort of therapists. Several studies addressed the positive effects of robotics and VR systems as additional therapy in neurological rehabilitation [4, 15, 16, 17, 18, 19]. Robotics have shown positive effects such as the enhancement of function and activity of affected limb and increased motivation, but the costs of the devices is high [3, 20]. In addition, the devices are often uncomfortable as the user needs to wear apparatuses on the body and patients have difficulty using such devices [3]. Although a few studies include some aspects of a client-centred approach in robotic rehabilitation, it remains very difficult to incorporate a full client-centred approach because of the wide variety of choices that can be made (e.g. difficult to select individual parameters, specific movements or activities, to use objects, etc. [19, 20]. VR, on the other hand, is a computer-based technology that allows users to interact with simulated environments and receive feedback on performance. VR also stimulates the increase of intensity of movements, therefore it may facilitate motor learning and neuroplasticity through repetition and increased intensity during task-oriented training [2, 3, 4]. Compared to the traditional methods used in motor rehabilitation of patients with neurological disorders, VR has some advantages: 1) patients can perform different rehabilitation exercises, recreated in a virtual way (i.e. virtual rehabilitation exercises), 2) VR can set up the features of the exercises, control their performance and acquire relevant data from the patient’s performance, and 3) VR can facilitate the interaction between patient and system through a variety of available devices, such as MIT-Manus, RemoviEM, etc. [21, 22]. Non-immersive video games are also a form of VR. They are developed by the entertainment industry for healthy population and home use making it less costly and more acceptable. Markerless (i.e. without markers or sensors on the body) motion capture systems (MCS) such as Nintendo Wii and Playstation Move, make use of non-immersive video games and have been used in VR rehabilitation. Studies showed an increase in motivation for rehabilitation as well as improvement in motor function and correctness of movement after training. Although the results are positive, these commercially available MCS systems with VR have to date limited utility in rehabilitation for impaired populations [1, 3, 4]: the standard games are too difficult or progress too quickly, they do not provide impairment-focused training (e.g. no treatment towards flexion synergies), and do not specifically address independent home usability and safety [1]. Only a few studies have looked into customising Kinect games for stroke, but no specific focus was payed to the coordination patterns which are important in stroke recovery, reducing compensation strategies, or usability and safety for independent home use [1, 23]. At present, validity and accuracy of the Microsoft Kinect in clinical assessment is strong regarding postural control and standing balance [24, 25]. The reproducibility of Kinect when analysing planar motions is similar to traditional marker-based stereophotogrammetry systems [26]. Although there is an increasing number of studies involving markerless motion capture systems in neurological rehabilitation, the knowledge and evidence of training content and training efficacy with Kinect or other markerless motion capture systems is scarce [24, 27].

Because little is known about the various markerless MCS used in neurological rehabilitation, their implementation in rehabilitation training, and effectiveness as a potential device in client-centred task-oriented training, the present study aims to investigate 1) which (markerless) motion capture systems are used as training devices in neurological rehabilitation, 2) how they are applied, 3) in which target population, 4) what the content of the training is and 5) what the efficacy of training with MCS is.

Continue —> Markerless motion capture systems as training device in neurological rehabilitation: a systematic review of their use, application, target population and efficacy | Journal of NeuroEngineering and Rehabilitation | Full Text

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