共查询到20条相似文献，搜索用时 11 毫秒
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Jean-Sébastien Bourseul Anais Molina Mael Lintanf Laetitia Houx Emmanuelle Chaléat-Valayer Christelle Pons Sylvain Brochard 《Archives of physical medicine and rehabilitation》2018,99(6):1160-1176.e5
Objective
To report current evidence regarding the safety of intramuscular botulinum toxin injection (BTI) in children with orthopedic- and neurologic-related musculoskeletal disorders >2 years of age.Data Sources
PubMed, Cochrane Library, and ScienceDirect, Google Scholar, and Web of Science.Study Selection
Two reviewers independently selected studies based on predetermined inclusion criteria.Data Extraction
Data relating to the aim were extracted. Methodologic quality was graded independently by 2 reviewers using the Physiotherapy Evidence Database scale for randomized controlled trials (RCTs) and the Downs and Black evaluation tool for non-RCTs. Level of evidence was determined using the modified Sackett scale.Data Synthesis
Data of 473 infants were analyzed. Fifty-five infants had cerebral palsy, 112 had obstetric brachial plexus palsy, 257 had clubfoot, and 44 had congenital torticollis. No studies reported any severe adverse event that could be attributed to the BTI. The rate of mild to moderate adverse events reported varied from 5% to 25%. Results regarding efficacy were preliminary, dependent on the pathology, and limited by the small number of studies and their low levels of evidence.Conclusions
BTI is already widely used as an early treatment for this age group. The safety profile of BTI in infants appears similar to that of older children and risks appear more related to the severity of the pathology and the location of the injections than to the toxin itself. Regarding effectiveness, other studies with higher levels of evidence should be carried out for each specific pathology. 相似文献4.
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Martin J. Tenniglo Marc J. Nederhand Erik C. Prinsen Anand V. Nene Johan S. Rietman Jaap H. Buurke 《Archives of physical medicine and rehabilitation》2014
Objective
To determine the effect of motor branch block (MBB) or neuromuscular block (NMB) of the rectus femoris on knee kinematics during swing, functional outcome, and energy cost in adults with spastic paresis presenting a stiff knee gait.Data Sources
PubMed, Embase, CINAHL, and Cochrane Library were searched. Studies were collected up to February 26, 2013. Reference lists were additionally scrutinized.Study Selection
No restrictions were applied regarding study design. Patients were adults suffering from a central neurological disorder. Interventions had to include MBB or NMB. Outcome measures had to include knee kinematics during the swing phase. Study selection was independently performed by 2 reviewers.Data Extraction
Two reviewers independently assessed the methodological quality of included studies. Data on kinematics, functional outcome, and energy cost from patients with stroke were extracted from the total population and when possible pooled.Data Synthesis
A total of 9 articles describing 12 different studies were included. Knee kinematics (peak knee flexion or knee range) during swing improved significantly in all the included studies. The average increase in peak knee flexion varied from 1.9° to 15.4°. Data pooling of peak knee flexion in patients with stroke showed a significant improvement of 7.37° (P=.000) in NMB studies and of 9.35° (P=.002) in MBB studies. Data pooling of knee velocity at toe-off showed a significant improvement of 53.01°/s in NMB studies. In MBB studies, this improvement was not significant. Data pooling of knee range of motion, functional outcomes, and energy cost showed no significant difference.Conclusions
According to this review, chemodenervation of the rectus femoris shows a significant improvement in peak knee flexion during swing. The effect on functional outcomes and energy cost is still unclear. 相似文献6.
Liye Zou Jeffer Eidi Sasaki Nan Zeng Chaoyi Wang Li Sun 《Archives of physical medicine and rehabilitation》2018,99(11):2355-2364
Objective
To critically evaluate the rehabilitative effects of mindful exercises for poststroke patients.Data Sources
Six databases (PubMed, Physiotherapy Evidence Database, Cochrane Library, Web of Science, Wanfang, Chinese National Knowledge Infrastructure) and reference lists of relevant articles were searched.Study Selection
Randomized controlled trials on the effects of mindful exercises on rehabilitative outcomes such as sensorimotor function, gait speed, leg strength, aerobic endurance, cognitive function, and overall motor function.Data Extraction
Two investigators independently screened eligible studies according to the eligible criteria, extracted data, and assessed risk of bias.Data Synthesis
A total of 20 studies that satisfied the eligibility criteria were finally included. The sum scores of 5-9 points in the adapted Physiotherapy Evidence Database scale indicates low-to-medium risk of bias. The study results of meta-analysis indicate that mindful exercise intervention was significantly associated with improved sensorimotor function on both lower limb (standardized mean difference=0.79; 95% confidence interval, 0.43-1.15; P<.001; I2=62.67%) and upper limb (standardized mean difference=0.7; 95% confidence interval, 0.39-1.01; P<.001; I2=32.36%).Conclusions
This review suggests that mindful exercises are effective in improving sensorimotor function of lower and upper limbs in poststroke patients. The effects on gait speed, leg strength, aerobic endurance, overall motor function, and other outcomes (eg, cognitive function, gait parameters) require further investigation for allowing evidence-based conclusions. 相似文献7.
Amreen Mahmood Sundar Kumar Veluswamy Aditi Hombali Aditi Mullick Manikandan N John M. Solomon 《Archives of physical medicine and rehabilitation》2019,100(4):751-768
Objectives
(1) To determine the effect of transcutaneous electrical nerve stimulation (TENS) on poststroke spasticity. (2) To determine the effect of different parameters (intensity, frequency, duration) of TENS on spasticity reduction in adults with stroke. (3) To determine the influence of time since stroke on the effectiveness of TENS on spasticity.Data Sources
PubMed, PEDro, CINAHL, Web of Science, CENTRAL, and EMBASE databases were searched from inception to March 2017.Study Selection
Randomized controlled trial (RCT), quasi-RCT, and non-RCT were included if (1) they evaluated the effects of TENS for the management of spasticity in participants with acute or subacute or chronic stroke using clinical and neurophysiological tools; and (2) TENS was delivered either alone or as an adjunct to other treatments.Data Extraction
Two authors independently screened and extracted data from 15 of the 829 studies retrieved through the search using a pilot tested pro forma. Disagreements were resolved through discussion with other authors. Quality of studies was assessed using Cochrane risk of bias criteria.Data Synthesis
Meta-analysis was performed using a random-effects model that showed (1) TENS along with other physical therapy treatments was more effective in reducing spasticity in the lower limbs compared to placebo TENS (SMD ?0.64; 95% confidence interval [95% CI], ?0.98 to ?0.31; P=.0001; I2=17%); and (2) TENS, when administered along with other physical therapy treatments, was effective in reducing spasticity when compared to other physical therapy interventions alone (SMD ?0.83; 95% CI, ?1.51 to ?0.15; P=.02; I2=27%). There were limited studies to evaluate the effectiveness of TENS for upper limb spasticity.Conclusion
There is strong evidence that TENS as an adjunct is effective in reducing lower limb spasticity when applied for more than 30 minutes over nerve or muscle belly in chronic stroke survivors (review protocol registered at PROSPERO: CRD42015020151). 相似文献8.
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Zhongqiu Hong Minghong Sui Zhiqiang Zhuang Huihua Liu Xiuyuan Zheng Chuanping Cai Dongmei Jin 《Archives of physical medicine and rehabilitation》2018,99(5):1011-1022.e1
Objective
To investigate the effectiveness of neuromuscular electrical stimulation (NMES) with or without other interventions in improving lower limb activity after chronic stroke.Data Sources
Electronic databases, including PubMed, EMBase, Cochrane Library, PEDro (Physiotherapy Evidence Database), and PsycINFO, were searched from the inception to January 2017.Study Selection
We selected the randomized controlled trials (RCTs) involving chronic stroke survivors with lower limb dysfunction and comparing NMES or combined with other interventions with a control group of no electrical stimulation treatment.Data Extraction
The primary outcome was defined as lower limb motor function, and the secondary outcomes included gait speed, Berg Balance Scale, timed Up and Go, 6-minute walk test, Modified Ashworth Scale, and range of motion.Data Synthesis
Twenty-one RCTs involving 1481 participants were identified from 5759 retrieved articles. Pooled analysis showed that NMES had a moderate but statistically significant benefit on lower limb motor function (standard mean difference 0.42, 95% confidence interval 0.26–0.58), especially when NMES was combined with other interventions or treatment time within either 6 or 12 weeks. NMES also had significant benefits on gait speed, balance, spasticity, and range of motion but had no significant difference in walking endurance after NMES.Conclusions
NMES combined with or without other interventions has beneficial effects in lower limb motor function in chronic stroke survivors. These data suggest that NMES should be a promising therapy to apply in chronic stroke rehabilitation to improve the capability of lower extremity in performing activities. 相似文献10.
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Bionka M. Huisstede Manon S. Randsdorp Janneke van den Brink Thierry P.C. Franke Bart W. Koes Peter Hoogvliet 《Archives of physical medicine and rehabilitation》2018,99(8):1609-1622.e10
Objective
To present an evidence-based overview of the effectiveness of oral pain medication and corticosteroid injections to treat carpal tunnel syndrome (CTS).Data Sources
The Cochrane Library, PubMed, Embase, CINAHL, and Physiotherapy Evidence Database were searched for relevant systematic reviews and randomized controlled trials (RCTs).Study Selection
Two reviewers independently applied the inclusion criteria to select potential studies.Data Extraction
Two reviewers independently extracted the data on pain (visual analog scale), function or recovery, and assessed the methodologic quality.Data Synthesis
A best-evidence synthesis was performed to summarize the results of the included studies. Four reviews and 9 RCTs were included. For oral pain medication, strong and moderate evidence was found for the effectiveness of oral steroids versus placebo in the short term. Moderate evidence was found in favor of oral steroids versus splinting in the short term. No evidence was found for the effectiveness of oral steroids in the long term. For corticosteroid injections, strong evidence was found in favor of a corticosteroid injection versus a placebo injection and moderate evidence was found in favor of corticosteroid injection versus oral steroids in the short term. Also, in the short term, moderate evidence was found in favor of a local versus a systematic corticosteroid injection. Higher doses of corticosteroid injections seem to be more effective in the midterm; however, the benefits of corticosteroid injections were not maintained in the long term.Conclusions
The reviewed evidence supports that oral steroids and corticosteroid injections benefit patient with CTS particularly in the short term. Although a higher dose of steroid injections seems to be more effective in the midterm, the benefits of oral pain medication and corticosteroid injections were not maintained in the long term. 相似文献12.
Karen P.Y. Liu Jessica Hanly Paul Fahey Shirley S.M. Fong Rosalind Bye 《Archives of physical medicine and rehabilitation》2019,100(5):956-979
Objective
To evaluate the effectiveness of activity-based, nonactivity-based, and combined activity- and nonactivity-based rehabilitative interventions for individuals presenting with unilateral spatial neglect (USN) and hemianopia.Data Sources
We searched CINAHL, Cochrane Library, EMBASE, MEDLINE, and PubMed from 2006 to 2016.Study Selection
Randomized controlled trials (RCTs) with a score of 6 or more in the Physiotherapy Evidence Database Scale that examined the effects of activity-based and nonactivity-based rehabilitation interventions for people with USN or hemianopia. Two reviewers selected studies independently.Data Extraction
Extracted data from the published RCTs. Mean differences (MD) or standardized mean differences (SMD), and 95% confidence intervals (CIs) were calculated. Heterogeneity was assessed using the I2 statistic.Data Synthesis
A total of 20 RCTs for USN and 5 for hemianopia, involving 594 and 206 stroke participants respectively, were identified. Encouraging results were found in relation to activity-based interventions for visual scanning training and compensatory training for hemianopia (MD=5.11; 95% confidence intervals [95% CI], 0.83-9.4; P=.019; I2=25.16% on visual outcomes), and optokinetic stimulation and smooth pursuit training for USN (SMD=0.49; 95% CI, 0.01-0.97; P=.045; I2=49.35%) on functional performance in activities of daily living, (SMD=0.96; 95% CI, 0.09-1.82; P=.031; I2=89.57%) on neglect.Conclusions
Activity-based interventions are effective and commonly used in the treatment of USN and hemianopia. Nonactivity-based and combined approaches, for both impairments, have not been refuted, because more studies are required for substantiated conclusions to be drawn. 相似文献13.
Rosie Richards Josien C. van den Noort Joost Dekker Jaap Harlaar 《Archives of physical medicine and rehabilitation》2017,98(1):137-150
Objective
To review the current literature regarding methods and effects of real-time biofeedback used as a method for gait retraining to reduce knee adduction moment (KAM), with intended application for patients with knee osteoarthritis (KOA).Data Sources
Searches were conducted in MEDLINE, Embase, CINAHL, SPORTDiscus, Web of Science, and Cochrane Central Register of Controlled Trials with the keywords gait, feedback, and knee osteoarthritis from inception to May 2015.Study Selection
Titles and abstracts were screened by 1 individual for studies aiming to reduce KAM. Full-text articles were assessed by 2 individuals against predefined criteria.Data Extraction
Data were extracted by 1 individual according to a predefined list, including participant demographics and training methods and effects.Data Synthesis
Electronic searches resulted in 190 potentially eligible studies, from which 12 met all inclusion criteria. Within-group standardized mean differences (SMDs) for reduction of KAM in healthy controls ranged from .44 to 2.47 and from .29 to .37 in patients with KOA. In patients with KOA, improvements were reported in pain and function, with SMDs ranging from .55 to 1.16. Methods of implementation of biofeedback training varied between studies, but in healthy controls increased KAM reduction was noted with implicit, rather than explicit, instructions.Conclusions
This review suggests that biofeedback gait training is effective primarily for reducing KAM but also for reducing pain and improving function in patients with KOA. The review was limited by the small number of studies featuring patients with KOA and the lack of controlled studies. The results suggest there is value and a need in further researching biofeedback training for reducing KAM. Future studies should include larger cohorts of patients, long-term follow-up, and controlled trials. 相似文献14.
Michelle L. Nelson Kaileah A. McKellar Sarah Munce Linda Kelloway Parminder Kaur Hans Martin Fortin Renee Lyons Mark Bayley 《Archives of physical medicine and rehabilitation》2018,99(6):1232-1241
Evidence suggests that a stroke occurs in isolation (no comorbid conditions) in less than 6% of patients. Multimorbidity, compounded by psychosocial issues, makes treatment and recovery for stroke increasingly complex. Recent research and health policy documents called for a better understanding of the needs of this patient population, and for the development and testing of models of care that meet their needs. A research agenda specific to complexity is required. The primary objective of the think tank was to identify and prioritize research questions that meet the information needs of stakeholders, and to develop a research agenda specific to stroke rehabilitation and patient complexity. A modified Delphi and World Café approach underpinned the think tank meeting, approaches well recognized to foster interaction, dialogue, and collaboration between stakeholders. Forty-three researchers, clinicians, and policymakers attended a 2-day meeting. Initial question-generating activities resulted in 120 potential research questions. Sixteen high-priority research questions were identified, focusing on predetermined complexity characteristics—multimorbidity, social determinants, patient characteristics, social supports, and system factors. The final questions are presented as a prioritized research framework. An emergent result of this activity is the development of a complexity and stroke rehabilitation research network. The research agenda reflects topics of importance to stakeholders working with stroke patients with increasingly complex care needs. This robust process resulted in a preliminary research agenda that could provide policymakers with the evidence needed to make improvements toward better-organized services, better coordination between settings, improved patient outcomes, and lower system costs. 相似文献
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Bionka M. Huisstede Peter Hoogvliet Thierry P. Franke Manon S. Randsdorp Bart W. Koes 《Archives of physical medicine and rehabilitation》2018,99(8):1623-1634.e23
Objective
To review scientific literature studying the effectiveness of physical therapy and electrophysical modalities for carpal tunnel syndrome (CTS).Data Sources
The Cochrane Library, PubMed, Embase, CINAHL, and Physiotherapy Evidence Database.Study Selection
Two reviewers independently applied the inclusion criteria to select potential eligible studies.Data Extraction
Two reviewers independently extracted the data and assessed the methodologic quality using the Cochrane Risk of Bias Tool.Data Synthesis
A best-evidence synthesis was performed to summarize the results of the included studies (2 reviews and 22 randomized controlled trials [RCTs]). For physical therapy, moderate evidence was found for myofascial massage therapy versus ischemic compression on latent, or active, trigger points or low-level laser therapy in the short term. For several electrophysical modalities, moderate evidence was found in the short term (ultrasound vs placebo, ultrasound as single intervention vs other nonsurgical interventions, ultrasound vs corticosteroid injection plus a neutral wrist splint, local microwave hyperthermia vs placebo, iontophoresis vs phonophoresis, pulsed radiofrequency added to wrist splint, continuous vs pulsed vs placebo shortwave diathermy, and interferential current vs transcutaneous electrical nerve stimulation vs a night-only wrist splint). In the midterm, moderate evidence was found in favor of radial extracorporeal shockwave therapy (ESWT) added to a neutral wrist splint, in favor of ESWT versus ultrasound, or cryo-ultrasound, and in favor of ultrasound versus placebo. For all other interventions studied, only limited, conflicting, or no evidence was found. No RCTs investigating the long-term effects of physical therapy and electrophysical modalities were found. Because of heterogeneity in the treatment parameters used in the included RCTs, optimal treatment parameters could not be identified.Conclusions
Moderate evidence was found for several physical therapy and electrophysical modalities for CTS in the short term and midterm. Future studies should concentrate on long-term effects and which treatment parameters of physical therapy and electrophysical modalities are most effective for CTS. 相似文献16.
机器人辅助训练改善脑卒中患者下肢功能障碍的系统评价 总被引：1，自引：0，他引：1
目的系统评价机器人辅助训练对脑卒中患者下肢功能障碍的康复效果。方法计算机检索PubMed、Medline、EM-base、Cochrane Central Register of Controlled Trials(CENTRAL)、ISI Web of Knowledge、Ovid、中国知网、万方和维普数据库中关于机器人辅助训练改善脑卒中患者下肢运动功能障碍的随机对照试验,同时检索已纳入文献的参考文献。检索时间从建库至2013年3月。2名独立的研究人员依据Cochrane协作网推荐的偏倚风险评估方法,对纳入文献的质量进行严格评估及资料提取,对符合标准的随机对照试验进行Meta合并分析。统计分析采用RevMan 5.1软件。结果共纳入12个随机对照试验。Meta分析显示,机器人辅助训练后,脑卒中患者的Fugl-Meyer评分法下肢部分评分(WED=3.97,95%CI:2.84~5.10,Z=6.89,P<0.00001)及Berg平衡量表评分(WED=3.13,95%CI:0.80~5.45,Z=2.63,P=0.008)与对照组比较,差异有统计学意义;但步频(WED=8.40,95%CI:-0.95~17.75,Z=1.76,P=0.08)及步速(WED=0.03,95%CI:-0.02~0.07,Z=1.18,P=0.24)与对照组比较,差异无统计学意义。纳入文献质量的Jadad评分,低质量4篇,高质量8篇。结论机器人辅助训练在一定程度上能改善脑卒中患者的下肢运动功能。 相似文献
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Meng-Ting Lin Ming-Yen Hsiao Yu-Kang Tu Tyng-Guey Wang 《Archives of physical medicine and rehabilitation》2018,99(7):1383-1394.e6
Objective
To compare the efficacy of intra-articular (IA) steroid injection and distension in patients with frozen shoulder.Data Sources
Databases, including MEDLINE (via PubMed), Embase, Scopus, and Cochrane Library, were searched for studies published up to November 2016.Study Selection
We included all published randomized controlled trials (RCTs), quasi-experimental studies, and observational studies investigating the effectiveness of IA steroid injection, distension, and physiotherapy in patients with frozen shoulder. Sixteen RCTs and 1 observational study were enrolled in meta-analysis.Data Extraction
Full texts were independently reviewed, and quality of RCTs was assessed with The Cochrane Collaboration's tool. The primary outcome was functional improvement; the secondary outcomes included pain reduction and external rotation (ER) improvement.Data Synthesis
In pairwise meta-analysis, pooled standardized mean difference (SMD) of functional improvement and pain reduction revealed equal efficacy at 3 follow-up time points. With respect to ER improvement, distension has a superior effect compared with IA steroid injection in the short term [(2–4wk; SMD, ?.36; 95% confidence interval [CI], ?.68 to ?.04) and medium term (6–16wk; SMD, ?0.80; 95% CI, ?1.32 to ?0.29). The network meta-analysis indicated a better efficacy for distension than for IA steroid injection in ER improvement only in the medium term (6–16wk; SMD, ?0.70; 95% CI, ?1.19 to ?0.21).Conclusions
IA steroid injection was as effective as distension in shoulder function improvement, pain reduction, and increasing ER of the shoulder. Distension yielded better ER improvement in the medium term but to a minor extent in the long term. For patients with predominant ER limitation, early distension could be considered the primary choice of treatment. 相似文献18.
Objectives
The aim of this study was to investigate the effectiveness and safety of aggressive statin versus moderate statin therapy on patients with saphenous vein grafts (SVGs) in randomized, controlled trials (RCTs).Methods
We searched MEDLINE (1980–June 2012), the Cochrane Controlled Trials Register, EMBASE, Science Citation Index, and PubMed (to June 2012), and found 10 relevant RCTs, including 7 substudy analyses from a Post-CABG trial, and 1 pooled analysis of the PROVE-IT TIMI 22 trial (Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 Investigators) and A to Z trial. Early intensive vs a delayed conservative simvastatin strategy in patients with acute coronary syndromes; phase Z of the A to Z trial.Results
A total of 6645 of participants, ages ranging from 21 to 75 years old, were treated with coronary artery bypass graft (CABG) and were followed for 2 to 5 years. Eight studies showed that aggressive statin therapy had lower LDL-C levels and a decrease of 39% in graft atherosclerotic progression, 12% in new occlusions, and 19% in new lesions more than moderate statin therapy. Three reports indicated that aggressive statin therapy lowered the risk of repeated myocardial infarction more than moderate statin therapy for coronary revascularization (95% CI, 0.66–0.95; risk ratio [RR] = 0.80; and 95% CI, 0.66–0.85; RR = 0.75) and lowered the risk of cardiac death as well (95% CI, 0.64–1.08; RR = 0.83). Aggressive statin therapy had safety similar to that of moderate statin therapy except for a slight increase in myopathic events and aminotransferase levels. Seventy percent to 90% of patients took statin treatment as prescribed in long-term.Conclusions
Compared with moderate statin therapy, long-term aggressive statin lowered the LDL-C level significantly, further decreased the atherosclerotic progression of SVG, reduced the risks of repeated myocardial infarction and coronary revascularization after CABG, and revealed similar patient compliance and statin-related adverse effects but slightly increased myopathy events and aminotransferase levels. 相似文献19.
目的系统评价功能性电刺激对脑卒中足下垂患者步行的矫正效果。方法计算机检索PubMed、WebofScience、The Cochrane Library（2013年第1期）、EMbase、CBM、CNKI、VIP和WanFangData等数据库,收集功能性电刺激对脑卒中患者足下垂矫正效果的随机对照试验（RCT）,检索时限均为2000年1月～2013年1月,并追溯纳入研究的参考文献。由2位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后,采用RevMan5．1软件进行Meta分析。结果共纳入8个RCT,255例患者。4个RCT的合并分析结果显示,与常规治疗相比,功能性电刺激能提高脑卒中足下垂患者的步行速度,两组差异有统计学意义[MD=0．09,95％CI（0．00,0．18）,P=0．04],其余指标因数据不全仅作相应的描述性分析。结论功能性电刺激能提高脑卒中足下垂患者步行速度,但其他指标疗效尚不能确定,尚需更多高质量、大样本、多中心的RCT结果证实。 相似文献
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Sana&#x;a A. Alsubheen Goris Nazari Pavlos Bobos Joy C. MacDermid Tom J. Overend Kenneth Faber 《Archives of physical medicine and rehabilitation》2019,100(2):350-365