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A Systematic Review of the Management of Autonomic Dysreflexia After Spinal Cord Injury
Authors:Andrei Krassioukov  Darren E. Warburton  Robert Teasell  Janice J. Eng  Spinal Cord Injury Rehabilitation Evidence Research Team
Affiliation:a International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
b Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada
c Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
d Cardiovascular Physiology and Rehabilitation Laboratory and Experimental Medicine, University of British Columbia, Vancouver, BC, Canada
e Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, ON, Canada
f Rehabilitation Research Laboratory, G.F. Rehabilitation Centre, Vancouver, BC, Canada
Abstract:Krassioukov A, Warburton DE, Teasell R, Eng JJ, Spinal Cord Injury Rehabilitation Evidence Research Team. A systematic review of the management of autonomic dysreflexia after spinal cord injury.

Objective

To review systematically the clinical evidence on strategies to prevent and manage autonomic dysreflexia (AD).

Data Sources

A key word search of several databases (Medline, CINAHL, EMBASE, and PsycINFO), in addition to manual searches of retrieved articles, was undertaken to identify all English-language literature evaluating the efficacy of interventions for AD.

Study Selection

Studies selected for review included randomized controlled trials (RCTs), prospective cohort studies, and cross-sectional studies. Treatments reviewed included pharmacologic and nonpharmacologic interventions for the management of AD in subjects with spinal cord injury. Studies that failed to assess AD outcomes (eg, blood pressure) or symptoms (eg, headaches, sweating) were excluded.

Data Extraction

Studies were critically reviewed and assessed for their methodologic quality by 2 independent reviewers.

Data Synthesis

Thirty-one studies were assessed, including 6 RCTs. Preventative strategies to reduce the episodes of AD caused by common triggers (eg, urogenital system, surgery) primarily were supported by level 4 (pre-post studies) and level 5 (observational studies) evidence. The initial acute nonpharmacologic management of an episode of AD (ie, positioning the patient upright, loosening tight clothing, eliminating any precipitating stimulus) is supported by clinical consensus and physiologic data (level 5 evidence). The use of antihypertensive drugs in the presence of sustained elevated blood pressure is supported by level 1 (prazosin) and level 2 evidence (nifedipine and prostaglandin E2).

Conclusions

A variety of options are available to prevent AD (eg, surgical, pharmacologic) and manage the acute episode (elimination of triggers, pharmacologic); however, these options are predominantly supported by evidence from noncontrolled trials, and more rigorous trials are required.
Keywords:Autonomic dysreflexia   Rehabilitation   Spinal cord injuries
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