Featured Articles #007: Stroke, Cervical Spondylotic Radiculopathy and Obstetric Anal Sphincter Injury
Previously featured articles #007: March 31,2022 – April 25 2022
Effectiveness of Constraint-Induced Movement Therapy (CIMT) on Balance and Functional Mobility in the Stroke Population: A Systematic Review and Meta-Analysis
Abstract
Constraint-induced movement therapy (CIMT) is one of the most popular treatments for enhancing upper and lower extremity motor activities and participation in patients following a stroke. However, the effect of CIMT on balance is unclear and needs further clarification. The aim of this research was to estimate the effect of CIMT on balance and functional mobility in patients after stroke. After reviewing 161 studies from search engines including Google Scholar, EBSCO, PubMed, PEDro, Science Direct, Scopus, and Web of Science, we included eight randomized controlled trials (RCT) in this study. The methodological quality of the included RCTs was verified using PEDro scoring. This systematic review showed positive effects of CIMT on balance in three studies and similar effects in five studies when compared to the control interventions such as neuro developmental treatment, modified forced-use therapy and conventional physical therapy. Furthermore, a meta-analysis indicated a statistically significant effect size by a standardized mean difference of 0.51 (P = 0.01), showing that the groups who received CIMT had improved more than the control groups. However, the meta-analysis results for functional mobility were statistically insignificant, with an effect size of −4.18 (P = 0.16), indicating that the functional mobility improvements in the investigated groups were not greater than the control group. This study’s findings demonstrated the superior effects of CIMT on balance; however, the effect size analysis of functional mobility was statistically insignificant. These findings indicate that CIMT interventions can improve balance-related motor function better than neuro developmental treatment, modified forced-use therapy and conventional physical therapy in patients after a stroke.
Abstract
Objective
To examine the effects of high-intensity interval training on the functioning and health-related quality of life of post-stroke patients.
Methods
TWe searched the following electronic databases: MEDLINE/Pubmed, Cochrane Central Register of Controlled Trials, PEDro database, and Scielo up to January 2022 for randomized controlled trials that investigated the effects of high-intensity interval training in post-stroke patients. Two reviewers selected the studies independently. Study quality was evaluated using the PEDro scale. The mean difference (MD), standard mean difference (SMD), and 95% confidence intervals (CIs) were calculated.
Results
Nine studies met the study criteria (375 patients). The age of the participants ranged from 55.8 to 72.1 years. The studies included patients within 2 weeks of stroke onset to patients longer than 1 month of stroke. High-intensity interval training resulted in improvement in cardiorespiratory fitness (peak oxygen uptake) MD (3.8 mL/kg/min, 95% CI: 2.62, 5.01, n = 91), balance MD 5.7 (95% CI: 3.50, 7.91; N = 64), and gait speed SMD (0.2 m/s; 95% CI: 0.05, 0.27; N = 100) compared with continuous aerobic training. The health-related quality of life did not differ between the groups. Compared to usual care, high-intensity interval training improved the cardiorespiratory fitness SMD (0.5 95% CI: 0.14, 0.81, n = 239). No serious adverse events were observed.
Conclusion
The findings of this systematic review show that high-intensity interval training was more efficient than continuous aerobic training to gain cardiorespiratory fitness, balance and gait speed in post-stroke patients. In addition, compared to usual care, high-intensity interval training improved cardiorespiratory fitness.
Management of Cervical Spondylotic Radiculopathy: A Systematic review
Abstract
Objective
(1) To evaluate the effects of surgery and conservative treatments for cervical spondylotic radiculopathy and (2) provide reference for choosing the time and method of treatment
Methods
A literature search was performed using PubMed, EMbase, The Cochrane Library, Web of Science, and ClinicalTrials from inception to September 2021. Randomized controlled trials (RCTs) on the use of surgery or conservative Treatments in Cervical Spondylotic Radiculopathy (CSR) were selected. The primary outcomes were the neck and arm visual analog scale (VAS) and Neck Disability Index (NDI). Secondary outcomes included active range of cervical motion (ROM) and Mental Health. Two reviewers proceeded study selection and quality assessment.
Results
A total of 6 studies, which comprised a total of 464 participants were included in the final meta-analysis. Compared with conservative treatment, surgical treatment was more effective in lowering Neck-VAS (<3 m: MD = −29.44, 95% CI = (–41.62,–17.27), P < .00001; 3–6 M: MD = −20.97, 95% CI = (–26.36,–15.57), P < .00001; 6 M: MD = −13.40, 95% CI = (–19.39, −7.41), P<.0001; 12 M: MD=−15.53, 95% CI=(-28.38, −2.68), P=.02), Arm-VAS(<3 m: MD = −33.52, 95% CI = (–39.89, −27.16), P < .00001; 3-6 M: MD = −20.97, 95% CI = (–26.36, −15.57), P < .00001; 6 M: MD = −17.52, 95% CI=(–23.94, −11.11), P < .0001; 12 M: MD = −21.91, 95% CI=(–27.09, −16.72), P < .00001) and NDI (<3 m: MD = −8.89, 95% CI = (–11.17, −6.61), P < .00001; 6 M: MD = −5.14, 95% CI = (–7.60, −2.69), P < .0001). No significant difference was observed in NDI at 12-month time point (MD = −5.17, 95% CI = (–12.33, 2.00), P = .16), ROM(MD = 2.91, 95% CI = (–4.51, 10.33), P = .77) and Mental Health (MD = .05, 95% CI=(–.24, .33), P = .74).
Conclusion
The 6 included studies that had low risk of bias, providing high-quality evidence for the surgical efficacy of CSR. The evidence indicates that surgical treatment is better than conservative treatment in terms of VAS score and NDI score, and superior to conservative treatment in less than one year. There was no evidence of a difference between surgical and conservative care in ROM and mental health. A small sample study with a follow-up of 5 to 8 years showed that surgical treatment was still better than conservative treatment, but the sample size was small and the results should be carefully interpreted.
Compared with conservative treatment, surgical treatment had a faster onset of response, especially in pain relief, but did not have a significant advantage in range of motion or NDI. This seems to mean that for patients with severe or even unbearable pain, the benefits of surgery as soon as possible will be significant. Although it is not clear whether the short-term risks of surgery are outweighed by the long-term benefits, rapid pain relief is necessary. Conservative treatment (including medical exercise therapy, mechanical cervical tractions, transcutaneous electrical nerve stimulation, pain management education, and cervical collar) once or twice a week for 3 months is beneficial in the long term and avoids the risks of surgery. In consideration of the good natural history of CSR and the relatively good outcome of conservative treatment (although symptom relief is slow), we think that surgery is not necessary for patients who do not need rapid pain relief.
Women’s experiences of obstetric anal sphincter injury and physical therapy interventions – A qualitative study
Abstract
Background
During childbirth, women may suffer perineal injuries that can lead to persistent disorders. No interview study has investigated women’s experience of obstetric anal sphincter injuries (OASIS) and physical therapy rehabilitation process after the injury.
Objective: To describe women’s experiences of OASIS and the physical therapy rehabilitation process.
Methods
A qualitative study with an inductive approach based on semi-structured interviews was performed with 14 primi- and multi-parous women affected by OASIS. They had been sutured within 24 h and were recruited from a university hospital in Sweden. The interviews lasted between 35 and 66 min. Data were processed and analyzed using qualitative content analysis.
Results
Three main categories emerged from the analysis: The categories described experiences of a difficult time after the injury and physical therapy rehabilitation but also experiences of a safe follow-up. Moreover, experiences of that it wasn´t that bad after all when looking back.
Conclusion
Regardless of the extent of the injury, some women experienced a long and troublesome recovery with intense physical therapy rehabilitation, while other women felt that they fortunately got away lightly. Factors that can influence a woman’s confidence in safely beginning pelvic floor muscle training at an early stage include individualizing when and how information about OASIS is provided. Meeting each woman’s needs and wishes is emphasized by this study.
