scholarly journals Robotic-Assisted Gait Training Effect on Function and Gait Speed in Subacute and Chronic Stroke Population: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2019 ◽  
Vol 81 (3-4) ◽  
pp. 103-111 ◽  
Author(s):  
Jaya Shanker Tedla ◽  
Snehil Dixit ◽  
Kumar Gular ◽  
Mohammed Abohashrh
Keyword(s):  
Systematic Review ◽  
Effect Size ◽  
Gait Speed ◽  
Meta Analysis ◽  
Gait Training ◽  
Chronic Stroke ◽  
Total Effect ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Subacute Stroke

Background: The review is intended to provide the effectiveness of robotic-assisted gait training (RAGT) for functional gait recovery in poststroke survivors through a systematic review and to provide evidence for gait speed improvements through the meta-analysis of randomized controlled trials (RCTs). Summary: In this systematic review, PubMed, Web of Science, Wiley Online Library, Science Direct, Science Robotics, Scopus, UpToDate, MEDLINE, Google Scholar, ­CINHAL, EMBASE, and EBSCO were reviewed to identify relevant RCTs. Articles included in the study were thoroughly examined by 2 independent reviewers. The included RCTs were having a PEDro score between 6 and 8 points. The initial database review yielded 1,371 studies and, following further screening; 9 studies finally were selected for systematic review and meta-analysis. Out of the 9 studies, 4 were on chronic stroke and 5 were on subacute stroke. The meta-analysis of gait speed showed an effect size value ranging between –0.91 and 0.64, with the total effect size of all the studies being –0.12. During subgroup analysis, the subacute stroke total effect size was identified as –0.48, and the chronic stroke total effect size was noted as 0.04. Meta-analysis revealed no significant differences between RAGT and conventional gait training (CGT). Key Messages: Our systematic review revealed that the RAGT application demonstrated a better or similar effect to that of CGT in a poststroke population. A meta-analysis of gait speed involving all the studies identified here indicated no significant differences between RAGT and CGT. However, the subanalysis of chronic stroke survivors showed a slight positive effect of RAGT on gait speed.

scholarly journals Effects of Virtual Reality-Based Intervention on Cognition, Motor Function, Mood, and Activities of Daily Living in Patients With Chronic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 13 ◽  
Author(s):  
Yong Gao ◽  
Lu Ma ◽  
Changsheng Lin ◽  
Shizhe Zhu ◽  
Lingling Yao ◽  
...  
Keyword(s):  
Systematic Review ◽  
Virtual Reality ◽  
Activities Of Daily Living ◽  
Motor Function ◽  
Daily Living ◽  
Meta Analysis ◽  
Chronic Stroke ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Global Cognition

Background: The efficacy of virtual reality (VR)-based intervention for improving cognition in patients with the chronic stage of stroke is controversial. The aims of this meta-analysis were to evaluate the effect of VR-based training combined with traditional rehabilitation on cognition, motor function, mood, and activities of daily living (ADL) after chronic stroke.Methods: The search was performed in the Cochrane Library (CENTRAL), EBSCO, EMBASE, Medline (OVID), Web of Science databases, PubMed, CINAHL Ovid, and Scopus from inception to May 31, 2021. All included studies were randomized controlled trials (RCTs) examining VR-based intervention combined with traditional rehabilitation for chronic stroke. The main outcomes of this study were cognition, including overall cognition (combined with all cognitive measurement results), global cognition (measured by the Montreal Cognitive Assessment, MoCA, and/or Mini-Mental State Examination, MMSE), and attention/execution. The additional outcomes were motor function, mood, and ADL. Subgroup analyses were conducted to verify the potential factors for heterogeneity.Results: Six RCTs including 209 participants were included for systematic review, and five studies of 177 participants were included in meta-analyses. Main outcome analyses showed large and significant effect size (ES) of VR-based training on overall cognition (g = 0.642; 95% CI = 0.134–1.149; and P = 0.013) and attention/execution (g = 0.695; 95% CI = 0.052–1.339; and P = 0.034). Non-significant result was found for VR-based intervention on global cognition (g = 0.553; 95% CI = −0.273–1.379; and P = 0.189). Additional outcome analyses showed no superiority of VR-based intervention over traditional rehabilitation on motor function and ADL. The ES of VR-based intervention on mood (g = 1.421; 95% CI = 0.448–2.393; and P = 0.004) was large and significant. In the subgroup analysis, large effects for higher daily intensity, higher weekly frequency, or greater dose of VR intervention were found.Conclusion: Our findings indicate that VR-based intervention combined with traditional rehabilitation showed better outcomes for overall cognition, attention/execution, and depressive mood in individuals with chronic stroke. However, VR-based training combined with traditional rehabilitation showed a non-significant effect for global cognition, motor function, and ADL in individuals with chronic stroke.

Efficacy of Micronized Progesterone for Sleep: A Systematic Review and Meta-analysis of Randomized Controlled Trial Data

2020 ◽  
Author(s):  
Brendan J Nolan ◽  
Bonnie Liang ◽  
Ada S Cheung
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Effect Size ◽  
Meta Analysis ◽  
Sleep Onset ◽  
Sleep Time ◽  
Controlled Trials ◽  
Sleep Onset Latency ◽  
Randomized Controlled ◽  
Micronized Progesterone

Abstract Context Preclinical data has shown progesterone metabolites improve sleep parameters through positive allosteric modulation of the γ-aminobutyric acid type A receptor. We undertook a systematic review and meta-analysis of randomized controlled trials to assess micronized progesterone treatment on sleep outcomes. Evidence Acquisition Using preferred reporting items for systematic review and meta-analysis guidelines, we searched MEDLINE, Embase, PsycInfo, and the Cochrane Central Register of Controlled Trials for randomized controlled trials of micronized progesterone treatment on sleep outcomes up to March 31, 2020. This study is registered with the International Prospective Register of Systematic Reviews, number CRD42020165981. A random effects model was used for quantitative analysis. Evidence Synthesis Our search strategy retrieved 9 randomized controlled trials comprising 388 participants. One additional unpublished trial was found. Eight trials enrolled postmenopausal women. Compared with placebo, micronized progesterone improved various sleep parameters as measured by polysomnography, including total sleep time and sleep onset latency, though studies were inconsistent. Meta-analysis of 4 trials favored micronized progesterone for sleep onset latency (effect size, 7.10; confidence interval [CI] 1.30, 12.91) but not total sleep time (effect size, 20.72; CI -0.16, 41.59) or sleep efficiency (effect size, 1.31; CI -2.09, 4.70). Self-reported sleep outcomes improved in most trials. Concomitant estradiol administration and improvement in vasomotor symptoms limit conclusions in some studies. Conclusions Micronized progesterone improves various sleep outcomes in randomized controlled trials, predominantly in studies enrolling postmenopausal women. Further research could evaluate the efficacy of micronized progesterone monotherapy using polysomnography or validated questionnaires in larger cohorts.

scholarly journals Efficacy and Safety of Botulinum Toxin vs. Placebo in Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Vol 11 ◽  
Author(s):  
Huan Qian ◽  
Fangjie Shao ◽  
Cameron Lenahan ◽  
Anwen Shao ◽  
Yingjun Li
Keyword(s):  
Systematic Review ◽  
Depressive Symptoms ◽  
Botulinum Toxin ◽  
Randomized Controlled Trials ◽  
Clinical Diagnosis ◽  
Effect Size ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Randomized Controlled

Background: Major depressive disorder (MDD) is a serious mental disorder that represents a substantial public health problem. Several trials have been undertaken to investigate the role of botulinum toxin type A (BTX-A) in the treatment of MDD, but the conclusions were controversial. To examine the efficacy and safety of BTX-A vs. placebo on patients with a clinical diagnosis of MDD, we conducted this systematic review and meta-analysis.Methods: A systematic search was conducted for all relevant randomized controlled trials (RCTs) in PubMed and Web of Science from inception to June 17, 2020. All published studies that investigated the efficacy and safety of BTX-A injections on patients with a clinical diagnosis of MDD were included. The overall effect size was summarized using a random-effects meta-analysis model. The primary outcomes of the present meta-analysis were the changes in depressive rating scale at week 6 after BTX-A injection compared with placebo. The safety of BTX-A injections also was assessed.Results: Five RCTs with a total of 417 participants (189 patients in the BTX-A group, 228 patients in placebo group) were eligible in this meta-analysis. The results indicated an overall positive effect of BTX-A injections for reducing the depressive symptoms of patients with MDD (Hedges' g, −0.82; 95% CI, −1.38 to −0.27) with large effect size. Differences are likely explained by the dose of BTX-As and the gender of the participants. Our findings also highlighted that BTX-A injections were generally well-tolerated, with only mild and temporary adverse events reported.Conclusions: The present meta-analysis provides evidence that BTX-A injections are associated with a statistically significant improvement in depressive symptoms. BTX-A injections are generally safe and may provide a new, alternative option for the treatment of depression.

scholarly journals Effect of Transcranial Direct Current Stimulation Combined with Rehabilitation on Arm and Hand Function in Stroke Patients: A Systematic Review and Meta-Analysis

Healthcare ◽  
2021 ◽  
Vol 9 (12) ◽  
pp. 1705
Author(s):  
Joo-Hyun Lee ◽  
Yu-Jin Jeun ◽  
Hae Yean Park ◽  
Young-Jin Jung
Keyword(s):  
Systematic Review ◽  
Virtual Reality ◽  
Effect Size ◽  
Meta Analysis ◽  
Hand Function ◽  
Reality Therapy ◽  
Controlled Trials ◽  
Stroke Patients ◽  
Randomized Controlled ◽  
Upper Extremity Function

Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that may enhance motor recovery after stroke. We performed a systematic review and meta-analysis to assess the efficacy of tDCS combined with rehabilitation on arm and hand function after stroke. Electronic databases were searched from their inception to September 2021. We performed a systematic review of selected randomized controlled trials, and methodological qualities were measured using the PEDro (Physiotherapy Evidence Database) scale. We calculated the standardized mean difference for effect size using the Comprehensive Meta-Analysis 3.0 software. We selected 28 studies for the systematic review and 20 studies for the meta-analysis. The overall effect size was 0.480 (95% CI [0.307; 0.653], p < 0.05), indicating a moderate effect size of tDCS combined with rehabilitation for upper extremity function in stroke survivors. The tDCS with occupational therapy/physical therapy (0.696; 95% CI [0.390; 1.003], p < 0.05) or virtual reality therapy (0.510; 95% CI [0.111; 0.909], p < 0.05) was also significantly more effective than other treatments. This meta-analysis of 20 randomized controlled trials provides further evidence that tDCS combined with rehabilitation, especially occupational therapy/physical therapy and virtual reality therapy, may benefit upper extremity function of the paretic upper limb in stroke patients.

scholarly journals Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2017 ◽  
Vol 98 (1) ◽  
pp. 63-77 ◽  
Author(s):  
Yuping Chen ◽  
HsinChen D Fanchiang ◽  
Ayanna Howard
Keyword(s):  
Systematic Review ◽  
Virtual Reality ◽  
Cerebral Palsy ◽  
Motor Function ◽  
Effect Size ◽  
Literature Search ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Children With Cerebral Palsy

Abstract Background Researchers recently investigated the effectiveness of virtual reality (VR) in helping children with cerebral palsy (CP) to improve motor function. A systematic review of randomized controlled trials (RCTs) using a meta-analytic method to examine the effectiveness of VR in children with CP was thus needed. Purpose The purpose of this study was to update the current evidence about VR by systematically examining the research literature. Data Sources A systematic literature search of PubMed, CINAHL, Cochrane Central Register of Controlled Trials, ERIC, PsycINFO, and Web of Science up to December 2016 was conducted. Study Selection Studies with an RCT design, children with CP, comparisons of VR with other interventions, and movement-related outcomes were included. Data Extraction A template was created to systematically code the demographic, methodological, and miscellaneous variables of each RCT. The Physiotherapy Evidence Database (PEDro) scale was used to evaluate the study quality. Effect size was computed and combined using meta-analysis software. Moderator analyses were also used to explain the heterogeneity of the effect sizes in all RCTs. Data Synthesis . The literature search yielded 19 RCT studies with fair to good methodological quality. Overall, VR provided a large effect size (d = 0.861) when compared with other interventions. A large effect of VR on arm function (d = 0.835) and postural control (d = 1.003) and a medium effect on ambulation (d = 0.755) were also found. Only the VR type affected the overall VR effect: an engineer-built system was more effective than a commercial system. Limitations The RCTs included in this study were of fair to good quality, had a high level of heterogeneity and small sample sizes, and used various intervention protocols. Conclusions Then compared with other interventions, VR seems to be an effective intervention for improving motor function in children with CP.

Interventions to Reduce Alcohol Harms in Low and Middle Income Countries: a Systematic Review and Meta Analysis

2018 ◽  
Author(s):  
Joao Ricardo Nickenig Vissoci
Keyword(s):  
Systematic Review ◽  
Alcohol Use ◽  
Randomized Controlled Trials ◽  
Brain Stimulation ◽  
Meta Analysis ◽  
World Health ◽  
Controlled Trials ◽  
Middle Income ◽  
Brief Motivational Intervention ◽  
Randomized Controlled

BackgroundHarmful alcohol use leads to a large burden of disease and disability which disportionately impacts LMICs. The World Health Organization and the Lancet have issued calls for this burden to be addressed, but issues remain, primarily due to gaps in information. While a variety of interventions have been shown to be effective at reducing alcohol use in HICs, their efficacy in LMICs have yet to be assessed. This systematic review describes the current published literature on alcohol interventions in LMICs and conducts a meta analysis of clinical trials evaluating interventions to reduce alcohol use and harms in LMICs.MethodsIn accordance with PRISMA guidelines we searched the electronic databases Pubmed, EMBASE, Scopus,Web of Science, Cochrane, and Psych Info. Articles were eligible if they evaluated an intervention targeting alcohol-related harm in LMICs. After a reference and citation analysis, we conducted a quality assessment per PRISMA protocol. A meta-analysis was performed on the 39 randomized controlled trials that evaluated an alcohol-related outcome.ResultsOf the 3,801 articles from the literature search, 87 articles from 25 LMICs fit the eligibility and inclusion criteria. Of these studies, 39 randomized controlled trials were included in the meta-analysis. Nine of these studies focused specifically on medication, while the others focused on brief motivational intervention, brain stimulation, AUDIT-based brief interventions, WHO ASSIST-based interventions, group based education, basic screening and interventions, brief psychological or counseling, dyadic relapse prevention, group counseling, CBT, motivational + PTSD based interview, and health promotion/awareness. Conclusion Issues in determining feasible options specific to LMICs arise from unstandardized interventions, unequal geographic distribution of intervention implementation, and uncertain effectiveness over time. Current research shows that brain stimulation, psychotherapy, and brief motivational interviews have the potential to be effective in LMIC settings, but further feasibility testing and efforts to standardize results are necessary to accurately assess their effectiveness.

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