Non-Pharmacological Interventions for Preventing Secondary Vascular Events After Stroke or Transient Ischemic Attack.

Non-pharmacological interventions for preventing secondary vascular events after stroke or transient ischemic attack.

Cochrane Database Syst Rev. 2013; 3: CD008656
Mackay-Lyons M, Thornton M, Ruggles T, Che M

Stroke is the second leading cause of death among adults worldwide. Individuals who have suffered a stroke are at high risk of having another stroke likely leading to greater disability and institutionalization. Non-pharmacological interventions may have a role to play in averting a second stroke.To determine the effectiveness of multi-modal programs of non-pharmacological interventions compared with usual care in preventing secondary vascular events and reducing vascular risk factors after stroke or transient ischemic attack (TIA).We searched the Cochrane Stroke Group Trials Register (September 2012); The Cochrane Library databases CENTRAL, CDSR, DARE, HTA and NHS EED (2012 Issue 2); MEDLINE (1950 to February 2012); EMBASE (1974 to February 2012); CINAHL (1982 to February 2012); SPORTDiscus (1800 to February 2012); PsycINFO (1887 to February 2012) and Web of Science (1900 to February 2012). We also searched PEDro, OT Seeker, OpenSIGLE, REHABDATA and Dissertation Abstracts (February 2012). In an effort to identify further published, unpublished and ongoing trials we searched trials registers, scanned reference lists, and contacted authors and researchers.We included randomized controlled trials evaluating the use of non-pharmacological interventions that included components traditionally used in cardiac rehabilitation (CR) programs in adults with stroke or TIA. Primary outcomes were a cluster of second stroke or myocardial infarction or vascular death. Secondary outcomes were (1) secondary vascular events: second stroke, myocardial infarction, and vascular death, as well as (2) vascular risk factors: blood pressure, body weight, lipid profile, insulin resistance and tobacco use. We also recorded adverse events such as exercise-related musculoskeletal injuries or cardiovascular events.Two review authors independently scanned titles and abstracts and independently screened full reports of studies that were potentially relevant. At each stage, we compared results. The two review authors resolved disagreements through discussion or by involving a third review author.We identified one study, involving 48 participants, of a 10-week CR program for patients post-stroke that met the inclusion criteria. The results of this completed pilot trial show that patients post-stroke had significantly greater improvement in cardiac risk score in the CR group (13.4 ± 10.1 to 12.4 ± 10.5, P value < 0.05) when compared with usual care (9.4 ± 6.7 to 15.0 ± 6.1, P value < 0.05). In addition, five trials, which are ongoing, will likely meet the inclusion criteria for this review once completed.There is limited applicable evidence. Therefore, no implications for practice can be drawn. Further research is required and several trials are underway, the findings of which are anticipated to contribute to the body of evidence. HubMed – rehab


Multidimensional rehabilitation programmes for adult cancer survivors.

Cochrane Database Syst Rev. 2013; 3: CD007730
Scott DA, Mills M, Black A, Cantwell M, Campbell A, Cardwell CR, Porter S, Donnelly M

Multidimensional rehabilitation programmes (MDRPs) have developed in response to the growing number of people living with and surviving cancer. MDRPs comprise a physical component and a psychosocial component. Studies of the effectiveness of these programmes have not been reviewed and synthesised.To conduct a systematic review of studies examining the effectiveness of MDRPs in terms of maintaining or improving the physical and psychosocial well-being of adult cancer survivors.We conducted electronic searches in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL and PsychINFO up to February 2012.Selection criteria focused on randomised controlled trials (RCTs) of multidimensional interventions for adult cancer survivors. Interventions had to include a physical component and a psychosocial component and to have been carried out on two or more occasions following completion of primary cancer treatment. Outcomes had to be assessed using validated measures of physical health and psychosocial well-being. Non-English language papers were included.Pairs of review authors independently selected trials, rated their methodological quality and extracted relevant data. Although meta-analyses of primary and secondary endpoints were planned there was a high level of study heterogeneity and only one common outcome measure (SF-36) could be statistically synthesised. In addition, we conducted a narrative analysis of interventions, particularly in terms of inspecting and identifying intervention components, grouping or categorising interventions and examining potential common links and outcomes.Twelve RCTs (comprising 1669 participants) met the eligibility criteria. We judged five studies to have a moderate risk of bias and assessed the remaining seven as having a high risk of bias. It was possible to include SF-36 physical health component scores from five studies in a meta-analysis. Participating in a MDRP was associated with an increase in SF-36 physical health component scores (mean difference (MD) 2.22, 95% confidence interval (CI) 0.12 to 4.31, P = 0.04). The findings from the narrative analysis suggested that MDRPs with a single domain or outcome focus appeared to be more successful than programmes with multiple aims. In addition, programmes that comprised participants with different types of cancer compared to cancer site-specific programmes were more likely to show positive improvements in physical outcomes. The most effective mode of service delivery appeared to be face-to-face contact supplemented with at least one follow-up telephone call. There was no evidence to indicate that MDRPs which lasted longer than six months improved outcomes beyond the level attained at six months. In addition, there was no evidence to suggest that services were more effective if they were delivered by a particular type of health professional.There is some evidence to support the effectiveness of brief, focused MDRPs for cancer survivors. Rigorous and methodologically sound clinical trials that include an economic analysis are required. HubMed – rehab


Acupuncture for acute management and rehabilitation of traumatic brain injury.

Cochrane Database Syst Rev. 2013; 3: CD007700
Wong V, Cheuk DK, Lee S, Chu V

Traumatic brain injury (TBI) can be life threatening depending on the severity of the insult to the brain. It can also cause a range of debilitating sequelae which require cognitive, motor, communication, emotional, or behavioral rehabilitation of varying intensity and duration. A number of studies conducted and published in China have suggested that acupuncture may be beneficial in the acute treatment and rehabilitation of TBI.To determine the efficacy and safety of acupuncture in the acute management or rehabilitation (or both) of patients with a TBI, including cognitive, neurological, motor, communication, emotional, or behavioral complications, or a combination of such complications.We searched the Cochrane Injuries Group Specialised Register, Cochrane Central Register of Controlled Trials (The Cochrane Library), MEDLINE, EMBASE, CINAHL, AMED, PsycINFO and others. We also searched the Chinese Acupuncture Studies Register, the Studies Register of the Cochrane Complementary Medicine Field, NCCAM, and NIH Clinical Studies Database. Three major Mainland Chinese academic literature databases (CNKI, VIP and Wang Fang Data) were also searched using keywords in simplified Chinese. We searched all databases through December 2009, and some searches have been updated to October 2012.Randomized controlled studies evaluating different variants of acupuncture and involving participants of any age who had suffered a TBI. Included trials compared acupuncture with placebo or sham treatment, or acupuncture plus other treatments compared with the same other treatments. We excluded trials that only compared different variants of acupuncture or compared acupuncture alone against other treatments alone, as they did not yield the net effect of acupuncture.Two review authors identified potential articles from the literature search and extracted data independently using a data extraction form. We performed methodological assessment of included studies using the Cochrane Collaboration’s tool for assessing risk of bias. We were unable to perform quantitative data analysis due to insufficient included studies and available data.Four RCTs, including 294 participants, reported outcomes specified by this review. Three investigated electro-acupuncture for TBI while one investigated acupuncture for acute TBI. The results seem to suggest that acupuncture is efficacious for these indications, however the low methodological quality of these studies renders the results questionable. No adverse effects of acupuncture were reported in any of the studies.The low methodological quality of the included studies does not allow us to make conclusive judgments on the efficacy and safety of acupuncture in either the acute treatment and/or rehabilitation of TBI. Its beneficial role for these indications remains uncertain. Further research with high quality trials is required. HubMed – rehab


Are crutches required after hip arthroscopy? A case-control study.

Hip Int. 2013 Mar 25; 0
Jayasekera N, Aprato A, Villar RN

Hip arthroscopy provides a less invasive alternative to arthrotomy and has the potential for more rapid rehabilitation. Few guidelines exist for rehabilitation after hip arthroscopic surgery. However, these are not corroborated with evidence of objective outcome measures. In particular, the period for which crutches should be used is imprecisely explained, if explained at all. The purpose of this study was to determine whether or not crutch use is required after hip arthroscopic surgery, and if so, for how long.? We compare a postoperative regimen of four weeks partial weight bearing on crutches (Group 1, n = 85) with a regimen that permitted patients to fully weight bear immediately after surgery if comfort allowed (Group 2, n = 80). We used the modified Harris hip score (mHHS) as an outcome measure at six weeks and six months after surgery. For Group 1, the mean duration of crutch use was 28.2 days and the mean postoperative mHHS at six weeks and six months showed significant improvement compared with preoperatively. For Group 2 the mean duration of crutch use was 13.4 days and the mean postoperative mHHS at six weeks and six months also showed significant improvement compared with preoperatively. The results demonstrated no significant difference in postoperative mHHS between the two groups at six weeks and six months after surgery.? There thus appears to be no need to enforce a defined period of partial weight bearing on crutches after hip arthroscopic surgery, irrespective of the procedure undertaken. HubMed – rehab