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Subacute stroke physical rehabilitation evidence in activities of daily living outcomes: A systematic review of meta-analyses of randomized controlled trials.

ABSTRACT: BACKGROUND:Stroke is a leading cause of disabilities worldwide. One of the key disciplines in stroke rehabilitation is physical therapy which is primarily aimed at restoring and maintaining activities of daily living (ADL). Several meta-analyses have found different interventions improving functional capacity and reducing disability. OBJECTIVES:To systematically evaluate existing evidence, from published systematic reviews of meta-analyses, of subacute physical rehabilitation interventions in (ADLs) for stroke patients. METHODS:Umbrella review on meta-analyses of RCTs ADLs in MEDLINE, Web of Science, Scopus, Cochrane, and Google Scholar up to April 2018. Two reviewers independently applied inclusion criteria to select potential systematic reviews of meta-analyses of randomized controlled trials (RCTs) of physical rehabilitation interventions (during subacute phase) reporting results in ADLs. Two reviewers independently extracted name of the 1st author, year of publication, physical intervention, outcome(s), total number of participants, and number of studies from each eligible meta-analysis. The number of subjects (intervention and control), ADL outcome, and effect sizes were extracted from each study. RESULTS:Fifty-five meta-analyses on 21 subacute rehabilitation interventions presented in 30 different publications involving a total of 314 RCTs for 13,787 subjects were identified. Standardized mean differences (SMDs), 95% confidence intervals (fixed and random effects models), 95% prediction intervals, and statistical heterogeneity (I and Q test) were calculated. Virtual reality, constraint-induced movement, augmented exercises therapy, and transcranial direct current stimulation interventions resulted statistically significant (P??0.8) but with considerable heterogeneity (I2?>?75%). Only acupuncture reached "suggestive" level of evidence. CONCLUSION:Despite the range of interventions available for stroke rehabilitation in subacute phase, there is lack of high-quality evidence in meta-analyses, highlighting the need of further research reporting ADL outcomes.

SUBMITTER: Garcia-Rudolph A

PROVIDER: S-EPMC6408050 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Subacute stroke physical rehabilitation evidence in activities of daily living outcomes: A systematic review of meta-analyses of randomized controlled trials.

García-Rudolph Alejandro A Sánchez-Pinsach David D Salleras Eloy Opisso EO Tormos Josep María JM

Medicine 20190201 8

<h4>Background</h4>Stroke is a leading cause of disabilities worldwide. One of the key disciplines in stroke rehabilitation is physical therapy which is primarily aimed at restoring and maintaining activities of daily living (ADL). Several meta-analyses have found different interventions improving functional capacity and reducing disability.<h4>Objectives</h4>To systematically evaluate existing evidence, from published systematic reviews of meta-analyses, of subacute physical rehabilitation inte ...[more]

PMID: 30813152

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Project description:BackgroundUpper limb recovery is one of the main goals of post-stroke rehabilitation due to its importance for autonomy in Activities of Daily Living (ADL). Although the efficacy of upper limb Robot-assisted Therapy (RT) is well established in literature, the impact of the initial status of the patient on the effects of RT is still understudied. This paper aims to identify whether demographic, clinical and motor characteristics of stroke patients may influence the ability to independently perform ADL after RT.MethodsA retrospective study was conducted on sixty stroke patients who conducted planar upper limb goal-directed tasks with the InMotion 2.0 robot. The RT was administered 5 days/week for 4 weeks and each session lasted 45 minutes. The primary outcome measure was the Modified Barthel Index (BI), dichotomized into favourable (BI ≥75) and unfavourable (BI<75) outcomes. The potential predictors were the demographic and clinical records, and the following clinical assessment scores: Modified Ashworth Scale-Shoulder (MAS-S); Modified Ashworth Scale-Elbow (MAS-E); Fugl-Meyer Assessment Upper Extremity (FMA-UE); upper limb section of the Motricity Index (MIul); total passive Range Of Motion (pROM); and Box and Block Test (BBT).ResultsStatistical analysis showed that the BBT, FMA-UE and MIul scores were significant predictors of a favourable outcome in ADL. The cut-off scores of the independent variables were calculated (FMA-UE = 32; MIul = 48; BBT = 3) with respect to the dichotomic BI outcome. Their robustness was assessed with the Fragility Index (FMA-UE = 2; MIul = 3; BBT = 7), showing that BBT is the most robust predictor of favourable BI outcome. Moreover, subjects with all predictors higher than the cut-off scores had higher probability to increase their independence in ADL at the end of the therapy. Demographic records, spasticity and pROM were not identified as predictors.ConclusionStroke patients with greater manual dexterity and less impairment appear to have a higher probability of achieving clinically significant ADL outcomes after upper limb RT. The obtained results can help to optimise the management of RT treatment planning. Further studies on a larger number of patients with a long-term follow up are recommended in order to evaluate other potential predictors and to validate the results.

Project description:Background and aimTo report the six-month safety analyses among patients enrolled in the "Physical Fitness Training in Subacute Stroke-PHYS-STROKE" trial and identify underlying risk factors associated with serious adverse events.MethodsWe performed a pre-specified safety analysis of a multicenter, randomized controlled, endpoint-blinded trial comprising 200 patients with moderate to severe subacute stroke (days 5-45 after stroke) that were randomly assigned (1:1) to receive either aerobic, bodyweight supported, treadmill-based training (n = 105), or relaxation sessions (n = 95, control group). Each intervention session lasted for 25 min, five times weekly for four weeks, in addition to standard rehabilitation therapy. Serious adverse events defined as cerebro- and cardiovascular events, readmission to hospital, and death were assessed during six months of follow-up. Incident rate ratios (IRR) were calculated, and Poisson regression analyses were conducted to identify risk factors for serious adverse events and to test the association with aerobic training.ResultsSix months after stroke, 50 serious adverse events occurred in the trial with a higher incidence rate (per 100 patient-months) in the training group compared to the relaxation group (6.31 vs. 3.22; IRR 1.70, 95% CI 0.96 to 3.12). The association of aerobic training with serious adverse events incidence rates were modified by diabetes mellitus (IRR for interaction: 7.10, 95% CI 1.56 to 51.24) and by atrial fibrillation (IRR for interaction: 4.37, 95% CI 0.97 to 31.81).ConclusionsSafety analysis of the PHYS-STROKE trial found a higher rate of serious adverse events in patients randomized to aerobic training compared to control within six months after stroke. Exploratory analyses found an association between serious adverse events occurrence in the aerobic training group with pre-existing diabetes mellitus and atrial fibrillation which should be further investigated in future trials.Data access statementThe raw data and analyses scripts are provided by the authors on a secure online repository for reproduction of reported findings.

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Subacute stroke physical rehabilitation evidence in activities of daily living outcomes: A systematic review of meta-analyses of randomized controlled trials.

Publications

Subacute stroke physical rehabilitation evidence in activities of daily living outcomes: A systematic review of meta-analyses of randomized controlled trials.

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