Outcome measures to assess walking ability following stroke: a systematic review of the literature

Objectives

The recovery of independent walking is an important goal in stroke rehabilitation. The objective of this systematic review was to identify all outcome measures used in the stroke research literature that included an evaluation of walking ability and evaluate the concepts contained in these measures with reference to the International Classification of Functioning, Disability and Health (ICF) framework.

Data sources

Searches were conducted of MEDLINE, CINAHL, EMBASE and PsycINFO databases for the time period January 1990-December 2005 using appropriate keywords.

Review methods

Studies were selected for further analysis if they used one or more standardized outcome measure incorporating an aspect of walking defined by the ICF. The outcome measure had to have published psychometric properties and specifically measure walking rather than mobility. The content of each outcome measure was classified with reference to the ICF subcategories for walking. The number of times each outcome measure was used was calculated.

Results

Three hundred and fifty-seven studies met the selection criteria. Sixty-one different outcome measures were used a total of 848 times to measure walking ability. Six of the outcome measures reflected impairment and 52 reflected limitations of activity and participation. The other three outcome measures showed overlap between domains, reflecting aspects of both impairment and limitations in activity and participation. The three most frequently used measures (self-paced gait speed measured over a short distance, spatiotemporal parameters and fast gait speed) were used 350 times but only assessed one ICF subcategory. The Rivermead Mobility Index and the Adapted Patient Evaluation Conference System assessed the greatest number of ICF subcategories but were used only 19 times and once respectively.

Conclusions

The most frequently used outcome measures reflect only one aspect of walking ability: walking short distances. Mobility tasks related to function in the community, like walking long distances, around obstacles and over uneven ground, and moving around outside or in buildings other then the home are not well represented by outcome measures used in most studies.     

The effects of added prosthetic mass on physiologic responses and stride frequency during multiple speeds of walking in persons with transtibial amputation

OBJECTIVES: To determine the effect of 3 prosthetic mass conditions on selected physiologic responses during multiple speed treadmill walking in persons with transtibial amputation. DESIGN: A repeated-measures design for 3 prosthetic mass conditions and 5 walking speeds. SETTING: University research laboratory. PARTICIPANTS: Eight ambulatory men with unilateral traumatic transtibial amputation. INTERVENTIONS: The 3 prosthetic mass conditions were 60%, 80%, and 100% of the estimated intact limb below-knee mass. The multiple-speed treadmill walking test (4min at each speed: 54, 67, 80, 94, 107m/min) was performed on an instrumented treadmill according to randomly assigned mass conditions. MAIN OUTCOME MEASURES: Oxygen consumption, gait efficiency, relative exercise intensity (percentage of age-predicted maximal heart rate), and stride frequency. RESULTS: Prosthetic mass did not significantly alter oxygen consumption or gait efficiency (P>.05). From the 60% to the 100% prosthetic mass conditions, relative exercise intensity significantly increased and stride frequency significantly decreased (P<.05). CONCLUSIONS: A heavier prosthesis (up to 100% of estimated intact limb below-knee mass) did not significantly increase the energy costs of walking for the 5 speeds examined. Further study of gait symmetry with the use of a heavier prosthesis is warranted.     

Cardiovascular effects of dipeptidyl peptidase-4 inhibitor in diabetic patients with and without established cardiovascular disease: a meta-analysis and systematic review

Objectives: We aim to conduct a meta-analysis, by stratifying diabetic patients with or without clinical cardiovascular diseases (CVD), to explore whether there are different cardiovascular effects of dipeptidyl peptidase-4 inhibitors (DPP-4is) on these two different classes of diabetic patients.

Methods: We searchedMedline,Embase, theCochrane Libraryand ClinicalTrials.gov for relevant randomized controlled trials (RCTs). The included trials are divided into CVD (+) trials (subjects with established CVD), and CVD (-) trials (subjects with no CVD). We use all-cause mortality and cardiovascular outcomes as primary endpoints.

Results: (1) Three CVD (+) trials were included and 36,895 subjects were enrolled with a mean follow-up duration of 127.1 weeks. The pooled results showed that DPP-4is treatment, compared with the placebo, did not significantly affect all-cause mortality (RR, 1.03; 95% CI, 0.95 to 1.11), cardiovascular death (1.01, 0.91 to 1.12), myocardial infarction (0.98, 0.88 to 1.08) or stroke (1.02, 0.88 to 1.18) in diabetic patients with coexisting CVD history; however, it significantly increased the risk of heart failure (1.14, 1.01 to 1.27) in this population. 2) Thirty-five CVD (-) trials were included, and 29,600 patients were enrolled with a mean follow-up duration of 77.8 weeks. The analysis comparing DPP-4is with the placebo control showed that DPP-4is treatment did not significantly affect the risk of all-cause mortality or cardiovascular outcomes in diabetic patients free of CVD history. However, when compared with the active control, the pooling data showed that DPP-4is had a significant reduction on the risk of stroke (0.58, 0.34 to 0.99) but did not significantly affect the risk of all-cause mortality and other cardiovascular outcomes.

Conclusion: DPP-4is may have no cardiovascular protective effects in diabetic patients with coexisting CVD, while there is a lack of definitive evidence supporting the cardiovascular benefits of DPP-4is treatment among diabetic patients free of CVD history.     

The effects of instrument-assisted soft tissue mobilization compared to other interventions on pain and function: a systematic review

Background: Instrument-assisted soft tissue mobilization (IASTM) is an emerging intervention in physical therapy. With the increasing prevalence of pain and disability associated with musculoskeletal impairments, it is essential to identify the most effective treatment strategies.

Objective: To systematically examine evidence on the effectiveness of IASTM, compared to other interventions on patients with pain and disability resulting from musculoskeletal impairments.

Methods: Numerous databases were searched using the terms Instrument Assisted Soft Tissue, Pain, Function, Graston, and soft tissue mobilization (STM). Inclusion criteria included: randomized clinical trials on patients with musculoskeletal impairments, STM had to be a treatment intervention, performed on human subjects, and had to capture a measure of pain or function. Articles were excluded if they were not published in English or if the subjects were of the pediatric or geriatric populations. Included articles were appraised using the Physiotherapy Evidence Database (PEDro) scale.

Results: Seven studies met the inclusion criteria. All seven articles scored a minimum 4/10 on the PEDro scale. The studies involved treatment of numerous anatomical locations and the majority of the studies demonstrated significant improvements in pain and/or range of motion when compared to control or other conservative treatment groups.

Conclusions: These outcomes support the idea that IASTM may have an impact on physiological changes by providing an increase in blood flow, reduction in tissue viscosity, myofascial release, interruption of pain receptors, and improvement of flexibility of underlying tissue. It is suggested that IASTM is an effective treatment intervention for reducing pain and improving function in less than a three-month period.     

Exoskeletons' design and usefulness evidence according to a systematic review of lower limb exoskeletons used for functional mobility by people with spinal cord injury

Purpose: Rehabilitation professionals have little information concerning lower limb exoskeletons for people with paraplegia. This study has four objectives: (1) Outline the characteristics of the exoskeletons’ design and their usefulness evidence as assistive mobility devices in the community for the Rewalk?, Mina, Indego®, Ekso? (previously known as the eLEGS?) and Rex®; (2) document functional mobility outcomes of using these exoskeletons; (3) document secondary skills and benefits achieved with these exoskeletons, safety, user satisfaction and applicability in the community; and (4) establish level of scientific evidence of the selected studies. Method: A systematic review of the literature (January 2004 to April 2014) was done using the databases PubMed, CINAHL and Embase and groups of keywords associated with “exoskeleton”, “lower limb” and “paraplegia”. Results: Seven articles were selected. Exoskeleton use is effective for walking in a laboratory but there are no training protocols to modify identified outcomes over the term usage (ReWalk?: 3 months, Mina: 2 months and Indego®: 1 session). Levels of evidence of selected papers are low. Conclusions: The applicability and effectiveness of lower limb exoskeletons as assistive devices in the community have not been demonstrated. More research is needed on walking performance with these exoskeletons compared to other mobility devices and other training contexts in the community.

• Implications for rehabilitation

• Characteristics of the exoskeletons’ design and their usefulness evidence as assistive mobility devices in the community are addressed for the Rewalk?, Mina, Indego®, Ekso? and Rex® ReWalk?, Indego® and Mina lower limb exoskeletons are effective for walking in a laboratory for individuals with complete lower-level SCI.

• The ReWalk? has the best results for walking, with a maximum speed of 0.51 m/s after 45 sessions lasting 60 to 120 min; it is comparable to the average speed per day or per week in a manual wheelchair.

• The level of scientific evidence is low. Other studies are needed to provide more information about performance over the longer term when walking with an exoskeleton, compared to wheelchair mobility, the user’s usual locomotion, the use of different exoskeletons or the training context in which the exoskeleton is used.

     

步行运动对高血压合并糖尿病患者糖代谢、动态血压及生活质量的影响

目的 观察在常规药物治疗基础上辅以步行运动对高血压合并2型糖尿病患者糖代谢、动态血压及生活质量的影响.方法 应用计步器筛选出62例在我科门诊或住院治疗且步行运动量＜5000步/d的高血压合并2型糖尿病患者,采用随机数字表法将其分为运动组(32例)及对照组(30例).2组患者均给予常规药物(包括缬沙坦、二甲双胍、阿卡波糖)治疗,运动组患者在此基础上每天步行10000步以上(对其运动持续时间及运动强度不作限定),对照组仍按照日常习惯生活.于入选时、干预3个月后观察2组患者空腹血糖(FPG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、胰岛素敏感性(HOMA-IS)、动态血压参数及生活质量变化情况.结果 2组患者分别经3个月干预后,发现运动组患者FPG[(5.41±1.23) mmol/L]、HbA1c[(6.16 ±0.87)％]、FINS[(8.72±2.43) mIU/L]、HOMA-IR[(2.27±1.41)、HOMA-IS[(0.0182 ±0.0034)]、动态血压参数[24h收缩压为(126±13) mmHg,24h舒张压为(72±8) mmHg,白天收缩压为(132±8)mmHg,白天舒张压为(74.4 ±8.3)mmHg,夜间收缩压为(123.1±8.7) mmHg,夜间舒张压为(70.5±6.1) mmHg]及生活质量评分[生理功能为(87.2±11.5)分,生理职能为(73.0±14.3)分,总体健康为(78.6±15.5)分,生命活力为(68.4 ±18.8)分,情感职能为(68.7 ±20.4)分,精神健康为(78.6 ±19.4)分]均较入选时及对照组明显改善(P＜0.05),其间差异均具有统计学意义(P＜0.05).结论 在常规药物治疗基础上每天步行10000步以上可进一步改善缺乏运动的轻度高血压合并2型糖尿病患者糖代谢及动态血压参数,对提高患者生活质量具有重要意义.     

The effects of assistive technology service delivery processes and factors associated with positive outcomes – a systematic review

Abstract

Purpose: The objective of this systematic review was to investigate effects of different assistive technology service delivery processes (AT-SDPs) for people with functional limitations, including investigation of factors associated with positive outcomes.

Materials and methods: The study was registered in PROSPERO, registration number CRD42018097030. Included were quantitative studies published in peer reviewed journals: randomized controlled trials, cohort, case-control and analytical cross-sectional studies investigating effects of different AT-SDPs or factors associated with the AT-SDP and with n?≥?10 participants. A systematic literature search was carried out in the databases PsycINFO, CINAHL, SSCI and Medline from 1 January 2008 to 25 July 2018. Besides, four journals were hand searched. The Joanna Briggs Institute MAStARI Critical Appraisal Tools were utilized to assess the risk of bias.

Results: The search resulted in a total of 2947 references of which 12 articles representing 10 studies were included. Five studies were experimental, two were cohort, and five were cross-sectional studies.

Conclusions: This systematic review confirms previous findings that assistive technology users should be involved in the AT-SDP in order to achieve positive outcomes. The level of evidence is, however, low, and it is not clear which of the applied methods are most effective. The review also gives some indication that new technologies could be used to improve the AT-SDP and reduce costs and that training in using the assistive devices seems to be useful. Even though some evidence of effective AT-SDP methods has been identified, more research is still needed to give valid recommendations to AT-SDP practice.

• Implications for rehabilitation

• Assistive technology users should be involved in the AT-SDP in order to achieve positive outcomes, but it cannot be determined which methods are the most effective.

• New digital technologies could be used to improve the AT-SDP and reduce costs.

• Training of the users in using their devices is probably useful, but since no specific methods nor extent or dose can be recommended, the professionals still need to use their clinical experience and reasoning to assess the user’s needs for training.

     

Effect of dexmedetomidine on hemodynamics in patients undergoing hysterectomy: a meta-analysis and systematic review

ObjectiveWe conducted a meta-analysis and systematic review to evaluate the effects of dexmedetomidine on the hemodynamics of patients undergoing hysterectomy.MethodsWe searched the Medline, Embase, and Cochrane Central Register of Controlled Trials databases for clinical randomized controlled trials (RCTs) that allowed direct or indirect comparisons of hemodynamic indicators. We also searched nine English-language databases up to April 2021 to identify relevant research. The Cochrane risk-of-bias tool for RCTs was applied to assess the methodological quality of the eligible studies. The meta-analysis was conducted using RevMan 5.4 software.ResultsNine trials were included in this systematic review. The effect of dexmedetomidine on heart rate during surgery was significantly smaller than that of other sedatives. Intraoperative systolic and diastolic blood pressure and mean arterial pressure were more stable in the dexmedetomidine group compared with the control group. The postoperative modified Observer’s Assessment of Alertness Score was also better in the dexmedetomidine compared with the control group.ConclusionsDexmedetomidine increases hemodynamic stability in patients undergoing hysterectomy, reduces the cardiovascular stress response during surgery, and effectively prevents postoperative adverse reactions, with good safety.     

The effects of Prickly Pear fruit and cladode (Opuntia spp.) consumption on blood lipids: A systematic review

BackgroundThe current dietary recommendations for cardiovascular disease (CVD) risk reduction include increased fruit and vegetable consumption. The Opuntia spp., Prickly Pear (PP) fruit is rich in dietary fiber and may have lipid-lowering effects but it is often confused with the PP stem/leaf (Cladode (CLD)), or not identified. The efficacy of the PP fruit and CLD in reducing CVD risk is a growing area of research.MethodsThis systematic review (PROSPERO: CRD42018110643), examined the effects of consuming the Opuntia spp. components (PP or CLD) on CVD risk factors, specifically total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG). The review, performed from February through September 2019, used resources available through Food Science and Technology Abstracts (EBSCO), Medline, Scopus, CINAHL, Web of Science and Cochrane databases.Results and DiscussionEleven articles met the inclusion criteria, which characterised Opuntia spp. products as either PP (n = 6), CLD (n = 4) or commercial products’ (n=1). Effects were investigated in healthy and obese populations as well as those with metabolic illnesses, specifically type 2 diabetes and metabolic syndrome. PP consumption was associated with significant reductions in TC (p < 0.05) in all but one included study, whereas in the remaining studies (n=6), LDL-C levels decreased (p < 0.05). Separately, the effect of CLD consumption on lipids was small with one study reporting a significant increase in plasma HDL-C in a subgroup of participants (>45 years of age) following consumption of a patented CLD powder product. It is plausible, that differences in overall effect may be due to compositional distinctions between CLD and PP, such as fiber composition. Care must be taken in future studies to accurately report the identity of the selected components of Opuntia spp.     

Cardiovascular and renal effects of carperitide and nesiritide in cardiovascular surgery patients: a systematic review and meta-analysis

Introduction  

Acute kidney injury (AKI) following cardiovascular surgery is a common disease process and is associated with both morbidity and mortality. The aim of our study was to evaluate the cardiovascular and renal effects of an atrial natriuretic peptide (ANP, carperitide) and a B-type (or brain) natriuretic peptide (BNP, nesiritide) for preventing and treating AKI in cardiovascular surgery patients.     

Effect of combined interval training on the cardiorespiratory fitness in heart failure patients: a systematic review and meta-analysis

BackgroundThe combination of interval training and resistance training has showed interesting results in chronic heart failure patients, corroborating the benefits of physiological adaptations of both protocols.ObjectiveTo evaluate the effect of the combination of interval training and resistance training program when compared to interval training alone and/or without intervention group on cardiorespiratory fitness in patients with chronic heart failure.MethodsWe search MEDLINE via PubMed, ScienceDirect, Sportdiscus, BIREME and Scielo, from their inception to December 2018. Were included both randomized and non-randomized controlled trials comparing the effect of combined training, interval training alone and/or WI group on VO_2peak (expressed in ml/kg/min), in people with chronic heart failure patients. The meta-analysis was conducted via Review Manager v 5.3 software, using random effect model.ResultsTen articles were selected (nine randomized controlled trial), involving 401 participants. Six studies compared combined training with interval training and six studies compared combined training with the without intervention group. Eighty percent of the trials presented moderate risk of bias and twenty percent low risk of bias. Data showed significant difference and major increase in VO_2peak in favor to combined training group compared to interval training group (SMD = 0.25; CI = 0.04–0.46) and without intervention group (SMD = 0.46; CI = 0.29–0.64), respectively.ConclusionThe combination of interval training and resistance training showed more effective in increasing cardiorespiratory fitness in patients with heart failure than interval training alone and non-exercise therapy. However, further studies should be conducted to increase the understanding of this combined training method.     

The effects of pole walking on arm lymphedema and cardiovascular fitness in women treated for breast cancer: a pilot and feasibility study

Abstract

The benefit of exercise for breast cancer-treated women is well documented. However, studies of cardiovascular fitness training for women with breast cancer-related arm lymphedema are rare. The purpose of this study was to investigate the effects of intensive pole walking on arm lymphedema in women treated for breast cancer. Thirty-five women with unilateral lymphedema were included and twenty-three completed an eight-week exercise intervention consisting of pole walking 3–5 times per week, for 30–60?min, at 70%–80% of their maximum heart rate, preceded by a two-week control period. Measurements of arm lymphedema (water displacement method), body weight, cardiovascular fitness (sub-maximal bicycle ergometer test) and subjective assessments (disability of the arm, shoulder and hand (DASH) questionnaire; heaviness and tightness using a visual analogue scale (VAS); and well-being) were performed before the control period and before and after the exercise intervention. The results indicated a significant reduction in total arm volume of the lymphedema arm (p?=?0.001), in lymphedema absolute volume (p?=?0.014) and lymphedema relative volume (p?=?0.015). Significant decreases of heart rate (p?=?0.004), DASH score (p?=?0.053) and rating of tightness in the arm (p?=?0.043) were found. Positive and negative influences on well-being were reported. The conclusion of this study is that pole walking is feasible for breast cancer-treated women with arm lymphedema.     

Analgesic efficacy and adverse effects of epidural morphine compared to parenteral opioids after elective caesarean section: A systematic review

BackgroundThe optimal effective dose of epidural morphine that provides postoperative analgesia after caesarean section with minimal side effects remains debated.AimsWe performed a systematic review to assess the analgesic efficacy and the incidence of adverse effects of epidural morphine after caesarean section compared to systemic analgesia with opioids.MethodsWe searched Medline, Embase and Cochrane Collaboration Library databases. Studies were evaluated with the Modified Oxford Scale. Prospective randomized studies comparing analgesic efficacy and/or adverse effects of a single epidural morphine administration versus systemic opioids after elective caesarean section were included.ResultsTen studies (n = 431) were selected. Epidural morphine increases the time until the first request for a rescue analgesic (Emax, 29.7 h; 95% confidence interval, 25.2–33.9) and decreases pain scores and postoperative morphine request during the first 24 h compared to systemic opioid analgesia. However, epidural morphine increases the incidence of pruritus (relative risk, 2.7; 95% CI, 2.1–3.6) and nausea (relative risk, 2.0; 95% CI, 1.2–3.3).ConclusionsA single bolus of epidural morphine provides better analgesia than parenteral opioids but with an effect limited to the first postoperative day after caesarean section and with an increase in morphine side effects.     

6分钟步行运动训练对射血分数正常的心力衰竭患者运动耐力及左室舒张功能的影响

目的 探讨6 min步行运动训练对射血分数正常心力衰竭患者运动耐力及左室舒张功能的影响.方法 采用随机数字表法将90例射血分数正常心力衰竭患者分为训练组及对照组,每组45例患者.2组患者均给予常规药物治疗(包括利尿剂、血管紧张素转换酶抑制剂或血管紧张素受体阻断剂、CC钙离子阻断剂及控制高血压、房颤、糖尿病、冠心病等药物),治疗组在上述治疗基础上辅以6 min步行运动训练.2组患者治疗时间均为6个月.于治疗前、后分别检测2组患者血浆脑钠肽前体N末段(NT-proBNP)水平,采用彩超测定心脏左房容积指数(LAVI),同时观察2组患者治疗前、后6 min步行距离变化情况.结果 2组患者分别经6个月治疗后,发现训练组NT-proBNP浓度[心功能Ⅱ级患者运动后为(331.9±107.3) pg/ml,心功能Ⅲ级患者运动后为(442.7±124.1)pg/ml]、6 min步行距离[心功能Ⅱ级患者为(493.0 ±56.8)m,心功能Ⅲ级患者为(385.0 ±48.7)m],对照组NT-proBNP浓度[心功能Ⅱ级患者运动后为(398.2±111.7) pg/ml,心功能Ⅲ级患者运动后为(534.1±124.9) pg/ml]、6 min步行距离[心功能Ⅱ级患者为(369.0±48.9)m,心功能Ⅲ级患者为(306.0±40.4)m],均较治疗前显著改善(P＜0.05),并且训练组6 min步行运动距离、LAVI[心功能Ⅱ级患者为(25.1±8.1)ml/m2,心功能Ⅲ级患者为(28.5±9.0) ml/m2]及NT-proBNP表达均显著优于对照组水平(均P ＜0.05).结论 6 min步行运动训练能显著改善射血分数正常心衰患者的运动耐力及左室舒张功能,有益于延缓病情进展及提高生活质量.