Timing and Dose of Upper Limb Motor Intervention After Stroke: A Systematic Review

Stroke ◽  
2021 ◽  
Author(s):  
Kathryn S. Hayward ◽  
Sharon F. Kramer ◽  
Emily J. Dalton ◽  
Gemma R. Hughes ◽  
Amy Brodtmann ◽  
...  
Keyword(s):  
Systematic Review ◽  
Sample Size ◽  
Upper Limb ◽  
Risk Of Bias ◽  
Timing Recovery ◽  
Stroke Recovery ◽  
Data Sets ◽  
Subacute Stroke ◽  
Online Databases ◽  
And Control

This systematic review aimed to investigate timing, dose, and efficacy of upper limb intervention during the first 6 months poststroke. Three online databases were searched up to July 2020. Titles/abstracts/full-text were reviewed independently by 2 authors. Randomized and nonrandomized studies that enrolled people within the first 6 months poststroke, aimed to improve upper limb recovery, and completed preintervention and postintervention assessments were included. Risk of bias was assessed using Cochrane reporting tools. Studies were examined by timing (recovery epoch), dose, and intervention type. Two hundred and sixty-one studies were included, representing 228 (n=9704 participants) unique data sets. The number of studies completed increased from one (n=37 participants) between 1980 and 1984 to 91 (n=4417 participants) between 2015 and 2019. Timing of intervention start has not changed (median 38 days, interquartile range [IQR], 22–66) and study sample size remains small (median n=30, IQR 20–48). Most studies were rated high risk of bias (62%). Study participants were enrolled at different recovery epochs: 1 hyperacute (<24 hours), 13 acute (1–7 days), 176 early subacute (8–90 days), 34 late subacute (91–180 days), and 4 were unable to be classified to an epoch. For both the intervention and control groups, the median dose was 45 (IQR, 600–1430) min/session, 1 (IQR, 1–1) session/d, 5 (IQR, 5–5) d/wk for 4 (IQR, 3–5) weeks. The most common interventions tested were electromechanical (n=55 studies), electrical stimulation (n=38 studies), and constraint-induced movement (n=28 studies) therapies. Despite a large and growing body of research, intervention dose and sample size of included studies were often too small to detect clinically important effects. Furthermore, interventions remain focused on subacute stroke recovery with little change in recent decades. A united research agenda that establishes a clear biological understanding of timing, dose, and intervention type is needed to progress stroke recovery research. Prospective Register of Systematic Reviews ID: CRD42018019367/CRD42018111629.

scholarly journals β-Oscillations Reflect Recovery of the Paretic Upper Limb in Subacute Stroke

2020 ◽  
Vol 34 (5) ◽  
pp. 450-462 ◽  
Author(s):  
Chih-Wei Tang ◽  
Fu-Jung Hsiao ◽  
Po-Lei Lee ◽  
Yun-An Tsai ◽  
Ya-Fang Hsu ◽  
...  
Keyword(s):  
Motor Function ◽  
Upper Limb ◽  
Primary Motor Cortex ◽  
Hand Movement ◽  
Stroke Recovery ◽  
Stroke Survivors ◽  
Healthy Controls ◽  
Functional Changes ◽  
Post Stroke ◽  
Subacute Stroke

Background. Recovery of upper limb function post-stroke can be partly predicted by initial motor function, but the mechanisms underpinning these improvements have yet to be determined. Here, we sought to identify neural correlates of post-stroke recovery using longitudinal magnetoencephalography (MEG) assessments in subacute stroke survivors. Methods. First-ever, subcortical ischemic stroke survivors with unilateral mild to moderate hand paresis were evaluated at 3, 5, and 12 weeks after stroke using a finger-lifting task in the MEG. Cortical activity patterns in the β-band (16-30 Hz) were compared with matched healthy controls. Results. All stroke survivors (n=22; 17 males) had improvements in action research arm test (ARAT) and Fugl-Meyer upper extremity (FM-UE) scores between 3 and 12 weeks. At 3 weeks post-stroke the peak amplitudes of the movement-related ipsilesional β-band event-related desynchronization (β-ERD) and synchronization (β-ERS) in primary motor cortex (M1) were significantly lower than the healthy controls (p<0.001) and were correlated with both the FM-UE and ARAT scores (r=0.51-0.69, p<0.017). The decreased β-ERS peak amplitudes were observed both in paretic and non-paretic hand movement particularly at 3 weeks post-stroke, suggesting a generalized disinhibition status. The peak amplitudes of ipsilesional β-ERS at week 3 post-stroke correlated with the FM-UE score at 12 weeks (r=0.54, p=0.03) but no longer significant when controlling for the FM-UE score at 3 weeks post-stroke. Conclusions. Although early β-band activity does not independently predict outcome at 3 months after stroke, it mirrors functional changes, giving a potential insight into the mechanisms underpinning recovery of motor function in subacute stroke.

scholarly journals Surgically accelerated orthodontic techniques and periodontal response: a systematic review

2020 ◽  
Vol 42 (6) ◽  
pp. 635-642 ◽  
Author(s):  
Umar Rekhi ◽  
Raisa Queiroz Catunda ◽  
Monica Prasad Gibson
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Sample Size ◽  
Orthodontic Treatment ◽  
Small Sample Size ◽  
Small Sample ◽  
Risk Of Bias ◽  
Long Term Follow Up

Summary Background Reduction in orthodontic treatment time is gaining popularity due to patient demands. Several new techniques of acceleratory orthodontic treatment have been introduced to effectively treat the malocclusion in a shorter time period with minimal adverse effects. Objective The objective of this systematic review is to critically evaluate the potential effect of accelerated surgically assisted orthodontic techniques on periodontal tissues. Materials and methods Electronic databases used to perform the search were Medline (Ovid), EMBASE, PubMed, Scopus, Cochrane, Google Scholar, and hand searching of the literature was also performed. Selection criteria Only randomized control trials (RCTs) that assessed the relationship between accelerated surgically assisted orthodontic techniques and its effects on periodontium were included. Data collection and analysis The Joanna Briggs Institute (JBI) critical appraisal checklist tool (2016) was used to assess the finally selected studies. Among these studies, five evaluated corticotomy-facilitated orthodontics, two tested accelerated tooth movement with piezocision, one compared corticotomy-facilitated orthodontics with piezocision, and one studied the effects of periodontally accelerated osteogenic orthodontics. The duration of these studies was relatively short and had moderate to high risk of bias. Results Literature search identified 225 records from 5 databases and 50 articles from the partial grey literature (Google scholar) search. Finally, nine eligible RCTs were included in the review. Limitations Most of the included studies were of a high risk of bias due to high experimental heterogeneity and small sample size. Long-term follow-up of the periodontal response to these interventions was also lacking. Conclusions There is an absence of evidence considering the lack of long-term follow-up and small sample size therefore, the results of this review should be carefully interpreted. Implications Due to the need for more studies with less risk of bias, these techniques should be implemented in dental practice with caution. With stronger evidence, the study may be confirmed to provide quicker desired results for orthodontic patients. Registration This study protocol was not registered. Funding No funding was obtained for this systematic review.

scholarly journals Effectiveness of technological interventions to improve upper limb motor function in people with stroke in low- and middle-income countries: Protocol for a systematic review and meta-analysis

2020 ◽  
Author(s):  
Meiling Milagros Carbajal-Galarza ◽  
Nathaly Olga Chinchihualpa-Paredes ◽  
Sergio Alejandro Abanto-Perez ◽  
María Lazo-Porras
Keyword(s):  
Systematic Review ◽  
Upper Extremity ◽  
Motor Function ◽  
Upper Limb ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Middle Income ◽  
Middle Income Countries ◽  
Technological Interventions ◽  
Low And Middle Income

ABSTRACTIntroductionStroke is one of the main causes of disability in low- and middle-income countries (LMIC), frequently presenting with upper extremity paresis and causing major functional dependence. It requires high dose and intense rehabilitation which implies high economic costs, consequently limiting this therapy in LMIC. There are multiple technological interventions that facilitate rehabilitation either in intensity, adherence and motor evaluation; or enable access to rehabilitation such as robots, games or virtual reality, sensors, electronic devices and tele-rehabilitation. Their efficacy has been mainly evaluated in high-income countries, hence the importance of conducting a systematic review in LMIC settings.ObjectivesTo measure the efficacy of technological interventions vs. classical physical rehabilitation in the upper extremity motor function in people who had suffered a first or recurrent episode of stroke in LMIC.Methods and analysisThis protocol is consistent with the methodology recommended by the PRISMA-P and the Cochrane handbook for systematic reviews of interventions. We propose to do a systematic review and meta-analysis. In order to do so, we will perform an electronic search in PubMed, Global Index Medicus and Physiotherapy Evidence Database. No date range parameters will be used. Randomized controlled trials (RCT) published in English, Spanish, French and Portuguese, with the primary outcome focusing on upper limb motor function, will be included. Two reviewers will screen all retrieved titles, abstracts and full texts, perform the evaluation of the risk of bias and extract all data independently. The risk of bias of the included RCT will be evaluated by the Cochrane Collaboration’s tool. A qualitative synthesis will be provided in text and tables, to summarize the main results of the selected publications.The heterogeneity between studies will be assessed through the I2 statistic. If there is sufficient homogeneity across outcomes, a meta-analysis will be considered. The outcomes to be evaluated will be motor functionality of the upper extremity, performance for activities of daily living and quality of life, through measurement scales.ConclusionsThis systematic review will provide evidence regarding the efficacy of multiple technological interventions to improve motor function of upper extremity in individuals with stroke in LMIC. Based on this analysis, we will be able to assess whether these interventions are also effective and feasible in the recovery of functionality after stroke in low- and middle-income countries, and thus offer recommendations in these areas.

scholarly journals Quality of life in cancer patients treated with mistletoe: a systematic review and meta-analysis

2019 ◽  
Author(s):  
Martin Loef ◽  
Harald Walach
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Cancer Patients ◽  
Positive Impact ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Sensitivity Analyses ◽  
Data Sets ◽  
Mistletoe Extracts

AbstractBackgroundMistletoe extracts are used as an adjunct therapy for cancer patients, but there is dissent as to whether this therapy has a positive impact on quality of life (QoL).MethodsWe conducted a systematic review searching in several databases (Medline, Embase, CENTRAL, CINAHL, PsycInfo, Science Citation Index, clinicaltrials.gov, opengrey.org) by combining terms that cover the fields of “neoplasm”, “quality of life” and “mistletoe”. We included prospective controlled trials that compared mistletoe extracts with a control in cancer patients and reported QoL or related dimensions. The quality of the studies was assessed with the Cochrane Risk of Bias tool version 2.We conducted a quantitative meta-analysis.ResultsWe included 26 publications with 30 data sets. The studies were heterogeneous. The pooled standardized mean difference (random effects model) for global QoL after treatment with mistletoe extracts vs. control was d = 0.61 (95% CI 0.41-0.81; p<0,00001). The effect was stronger for younger patients, with longer treatment, in studies with lower risk of bias, in randomized and blinded studies. Sensitivity analyses support the validity of the finding. 50% of the QoL subdomains (e.g. pain, nausea) show a significant improvement after mistletoe treatment. Most studies have a high risk of bias or at least raise some concern.ConclusionMistletoe extracts produce a significant, medium-sized effect on QoL in cancer. Risk of bias in the analyzed studies is likely due to the specific type of treatment, which is difficult to blind; yet this risk is unlikely to affect the outcome.PROSPERO registration numberCRD42019137704

scholarly journals A systematic review of the efficacy of antibiotics for the prevention of swine respiratory disease

2019 ◽  
Vol 20 (2) ◽  
pp. 291-304
Author(s):  
Jan M. Sargeant ◽  
Michele D. Bergevin ◽  
Katheryn Churchill ◽  
Kaitlyn Dawkins ◽  
Bhumika Deb ◽  
...  
Keyword(s):  
Systematic Review ◽  
Respiratory Disease ◽  
Antibiotic Use ◽  
Prophylactic Antibiotics ◽  
Risk Of Bias ◽  
Comparative Efficacy ◽  
Quality Of Reporting ◽  
Nursery Pigs ◽  
And Control

AbstractPrevention and control of respiratory disease is a major contributor to antibiotic use in swine. A systematic review was conducted to address the question, ‘What is the comparative efficacy of antimicrobials for the prevention of swine respiratory disease?’ Eligible studies were controlled trials published in English evaluating prophylactic antibiotics in swine, where clinical morbidity, mortality, or total antibiotic use was assessed. Four databases and the gray literature were searched for relevant articles. Two reviewers working independently screened titles and abstracts for eligibility followed by full-text articles, and then extracted data and evaluated risk of bias for eligible trials. There were 44 eligible trials from 36 publications. Clinical morbidity was evaluated in eight trials where antibiotics were used in nursery pigs and 10 trials where antibiotics were used in grower pigs. Mortality was measured in 22 trials in nursery pigs and 12 trials in grower pigs. There was heterogeneity in the antibiotic interventions and comparisons published in the literature; thus, there was insufficient evidence to allow quantification of the efficacy, or relative efficacy, of antibiotic interventions. Concerns related to statistical non-independence and quality of reporting were noted in the included trials.

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