Systematic Review and Meta-Analysis of Constraint-Induced Movement Therapy in the Hemiparetic Upper Extremity More Than Six Months Post Stroke.
Systematic review and meta-analysis of constraint-induced movement therapy in the hemiparetic upper extremity more than six months post stroke.
Filed under: Rehab Centers
Top Stroke Rehabil. 2012 Nov-Dec; 19(6): 499-513
McIntyre A, Viana R, Janzen S, Mehta S, Pereira S, Teasell R
Objective: To conduct a systematic review and meta-analysis of the available evidence on the effectiveness of constraint-induced movement therapy (CIMT) in the hemiparetic upper extremity (UE) among individuals who were more than 6 months post stroke. Methods: A literature search of multiple databases (PubMed, CINAHL, and EMBASE) was conducted to identify articles published in the English language up to and including July 2012. Studies were included for review if (1) ?50% of the sample had sustained a stroke, (2) the research design was a randomized controlled trial (RCT), (3) the mean time since stroke was ?6 months for both the treated and control groups, (4) the treatment group received CIMT, (5) the control group received a form of traditional rehabilitation, and (6) functional improvement was assessed both pre and posttreatment. Methodological quality was assessed using the PEDro tool with a score out of 10. Results: Sixteen RCTs (PEDro scores 4-8) met inclusion criteria and included a pooled sample size of 572 individuals with a mean age of 58.2 years (range, 30-87). The meta-analysis revealed a significant treatment effect on the amount of use and quality of movements subscales of the Motor Activity Log ( P < .001, for both), Fugl-Meyer Assessment ( P = .014), and Action Research Arm Test ( P = .001); however, there was no significant treatment effect demonstrated by the Wolf Motor Function Test ( P = .120) or FIM ( P = .070). Conclusions: CIMT to improve UE function is an appropriate and beneficial therapy for individuals who have sustained a stroke more than 6 months previously. HubMed – rehab
Functional electrical stimulation for improving gait in persons with chronic stroke.
Filed under: Rehab Centers
Top Stroke Rehabil. 2012 Nov-Dec; 19(6): 491-8
Pereira S, Mehta S, McIntyre A, Lobo L, Teasell RW
Background: The long-term management of stroke is an area of increasing clinical interest, and it is important to identify therapeutic interventions that are effective in the chronic phase post stroke. Objective: To conduct a systematic review on the effectiveness of functional electrical stimulation (FES) in improving lower extremity function in chronic stroke. Methods: Multiple databases (PubMed, CINAHL, EMBASE, and Scopus) were searched for relevant articles. Studies were included for review if (1) ?50% of the study population has sustained a stroke, (2) the study design was a randomized controlled trial (RCT), (3) the mean time since stroke was ?6 months, (4) FES or neuromuscular electrical stimulation (NMES) was compared to other interventions or a control group, and (5) functional lower extremity outcomes were assessed. Methodological quality was assessed using the PEDro tool. A standardized mean difference (SMD ± SE and 95% confidence interval [CI]) was calculated for the 6-minute walk test (6MWT). Pooled analysis was conducted for treatment effect of FES on the 6MWT distance using a fixed effects model. Results: Seven RCTs (PEDro scores 5-7) including a pooled sample size of 231 participants met inclusion criteria. Pooled analysis revealed a small but significant treatment effect of FES (0.379 ± 0.152; 95% CI, 0.081 to 0.677; P = .013) on 6MWT distance. Conclusion: FES may be an effective intervention in the chronic phase post stroke. However, its therapeutic value in improving lower extremity function and superiority over other gait training approaches remains unclear.
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Systematic review of the effectiveness of pharmacological interventions in the treatment of spasticity of the hemiparetic lower extremity more than six months post stroke.
Filed under: Rehab Centers
Top Stroke Rehabil. 2012 Nov-Dec; 19(6): 479-90
McIntyre A, Lee T, Janzen S, Mays R, Mehta S, Teasell R
Background: The long-term management of lower limb spasticity after stroke is an important aspect of an individual’s physical recovery and quality of life. Objective: To examine the effectiveness of pharmacological interventions in reducing spasticity of the lower limb in chronic stroke survivors. Methods: PubMed, CINAHL, and EMBASE were searched for studies in which (1) ?50% of the sample size had sustained a stroke; (2) the research design was a randomized controlled trial (RCT); (3) the mean time since stroke was ?6 months for both the treatment and control groups, at the time treatment was initiated; (4) the treatment group received a pharmacological intervention aimed at treating lower limb spasticity; and (5) spasticity was assessed pre and post treatment. Methodological quality of each study was assessed using the PEDro tool. Results: Nine RCTs (PEDro scores, 4-9) met inclusion criteria and included a pooled sample size of 605 individuals with a mean age of 54.8 years (range, 14-86). Four RCTs provided evidence that botulinum toxin type A was effective in reducing spasticity compared to persons receiving placebo or a phenol neurolytic. One study provided evidence that both alcohol and phenol neurolytics were effective in reducing spasticity. Finally, 4 studies provided evidence that oral and intrathecal medications were effective in reducing lower limb spasticity compared to placebo. Conclusions: Pharmacological treatment initiated 6 months post stroke reduced lower limb spasticity. Relevant areas of exploration for future research could include the period of effectiveness, long-term complications, and a cost-benefit analysis of such treatments.
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