Effect of Time-Dose-Matched Virtual Reality Therapy on Upper Limb Dysfunction in Patients Poststroke: A Meta-Analysis of Randomized Controlled Trials

ObjectiveTo investigate the efficacy and acceptability of virtual reality (VR) with time-dose-matched conventional therapy (CT) in patients poststroke with upper limb dysfunction.Data SourcesCochrane, PubMed, Web of Science, Embase, and ProQuest were systematically searched up to May 24, 2021.Study SelectionRandomized controlled trials comparing VR with time-dose-matched CT in patients poststroke with upper limb dysfunction were included.Data ExtractionThe extracted data included efficacy (mean change in structure/function, activity, and participation scores), acceptability (dropouts for all reasons), adverse events, and characteristics of the included studies. The Cochrane risk of bias assessment tool was used to assess the risk of bias.Data SynthesisThirty-one randomized controlled trails were included. VR was superior to time-dose-matched CT in terms of the World Health Organization's International Classification of Functioning, Disability and Health structure/function, with a standardized mean difference (SMD) of 0.35, but not activity and participation. Subgroup analyses demonstrated that virtual environment was superior to CT in structure/function (SMD=0.38) and activity (SMD=0.27), whereas there were no significant differences between commercial gaming and CT in any World Health Organization International Classification of Functioning, Disability and Health domain. VR mixed with CT was more effective than time-dose-matched CT in structure/function (SMD=0.56), whereas VR only was not significantly different from CT. There were no significant differences in the incidence of adverse events and dropout rates between VR and CT.ConclusionsThe results suggest that VR is superior to time-dose-matched CT in terms of recovery of upper extremity motor function, especially when a virtual environment is used or VR is mixed with CT. However, VR (VR only or mixed with CT) does not improve patients’ daily activity performance and participation compared with CT. Overall, VR appears to be safe and acceptable as CT. Large-scale definitive trials are needed to verify or refute these findings.     

Efficacy of Robot-Assisted Training on Rehabilitation of Upper Limb Function in Patients With Stroke: A Systematic Review and Meta-analysis

ObjectiveTo systematically evaluate the effect of robot-assisted training (RAT) on upper limb function recovery in patients with stroke, providing the evidence-based medical basis for the clinical application of RAT.Data SourcesWe searched online electronic databases up to June 2022, including PubMed, The Cochrane Library, Scopus, Web of Science, EMBASE, WanFang Data, CNKI, and VIP full-text databases.Study SelectionRandomized controlled trials of the effect of RAT on upper extremity functional recovery in patients with stroke.Data ExtractionThe Cochrane Collaboration Tool for Assessing the Risk of Bias was used to assess study quality and risk of bias.Data SynthesisFourteen randomized controlled trials involving 1275 patients were included for review. Compared with the control group, RAT significantly improved upper limb motor function and daily living ability. The overall differences were statistically significant, Fugl-Meyer Assessment for the Upper Extremity (FMA-UE; standard mean difference=0.69; 95% confidence interval, 0.34, 1.05; P=.0001), modified Barthel Index (standard mean difference=0.95; 95% confidence interval, 0.75, 1.15; P<.00001), whereas the differences in modified Ashworth Scale, FIM, and Wolf Motor Function Test scores were not statistically significant.Subgroup AnalysisCompared with the control group, the differences between FMA-UE and modified Barthel Index at 4 and 12 weeks of RAT, there were statistically significant, the differences of FMA-UE and modified Ashworth Scale in patients with stroke in the acute and chronic phases were statistically significant.ConclusionThe present study showed that RAT can significantly enhance the upper limb motor function and activities of daily life in patients with stroke undergoing upper limb rehabilitation.     

Effectiveness of virtual reality in children and young adults with cerebral palsy: a systematic review of randomized controlled trial

BackgroundCerebral palsy (CP) is one of the main causes of disability in childhood. Virtual reality (VR) has been used as a treatment option in this population, however its effectiveness is unclear.ObjectiveTo evaluate the effectiveness of VR in patients with CP.MethodsWe conducted electronic searches in EMBASE, MEDLINE, Cochrane library, PEDro, AMED, PsycoINFO, and LILACS databases and trial site registries such as ClinicalTrials.gov and ICTRP. We included randomized controlled trials that tested the use of VR alone or in combination with other interventions compared to more conventional rehabilitation or usual care in individuals with CP. The primary outcomes were upper and lower limb function, postural control, and balance. The secondary outcomes included global motor function, perception, cognition and spatial functions, motivation, motor learning, and adverse events. Two independent reviewers extracted and assessed included articles for risk of bias using the Cochrane risk of bias tool. We use a meta-analysis with random effect model whenever possible. We analyzed the quality of evidence using theGRADE approach.ResultsWe included 38 trials (pooled n = 1233 participants) in this review. There is very low quality of evidence that VR plus conventional rehabilitation is better than conventional rehabilitation for upper limb function. There is also very low quality evidence that VR alone is no better than conventional rehabilitation for upper and lower limb function. No adverse events were observed among the 10 trials that provided information on this outcome.ConclusionAt present we have very limited to limited confidence in effect estimation for utilization of VR in this population. Future studies may change our confidence in results and effect estimates.Protocol registrationPROSPERO CRD 42018102759.     

Noninvasive Brain Stimulation for Rehabilitation of Pediatric Motor Disorders Following Brain Injury: Systematic Review of Randomized Controlled Trials

ObjectiveTo assess the evidence of the effectiveness of noninvasive brain stimulation (NIBS) for rehabilitation of pediatric motor disorders after brain injury.Data SourcesOvid, Cochrane, Science Direct, Web of Science, EBSCOhost, PubMed, and Google Scholar databases were searched up to August 2017 by 2 independent reviewers.Study SelectionRandomized controlled trials (RCTs) published in English were included if they met the following criteria. Population: Pediatric patients with motor disorders following brain injury. Intervention: NIBS, including transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS). Outcomes: Measures related to motor disorders (upper limb functional abilities, gait, balance, and spasticity). Fourteen RCTs were included (10 studies used tDCS, while 4 studies used rTMS).Data ExtractionPredefined data were tabulated by 1 reviewer and verified by another reviewer. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale; also levels of evidence adapted from Sackett were used.Data SynthesisA grouped meta-analysis was performed on balance, gait parameters, and upper limb function. Data were pooled using a random-effects model to assess the immediate effect and 1-month follow-up of NIBS. According to the PEDro scale, 3 studies were excellent, 8 studies were good, and 3 studies were fair. The level of evidence of all of the included studies was 1b, except for 3 studies with grade 2a. There were significant improvements in all upper limb functions (standardized mean differences [SMDs] ranging from 0.94 to 1.83 [P values=.0001]), balance (SMDs ranging between -0.48 to 0.83 [P values<.05]) and some gait variables.ConclusionPediatric patients with brain injury can be safely stimulated by NIBS, and there is evidence for the efficacy of rTMS in improving upper limb function, and tDCS in improving balance and majority of gait variables with persisted effects for 1 month. The efficacy of spasticity is uncertain.     

Effect of Resistance Exercise on Body Structure and Function,Activity, and Participation in Individuals With Parkinson Disease: A Systematic Review

ObjectiveTo investigate the effects of resistance exercise (RE) on body structure and function, activity, and participation in individuals with Parkinson Disease (PD) in the mild to moderate stages.Data SourcesMedline, Embase, Web of Science, The Cochrane Library, Lilacs, and PEDro were searched from inception until June 2020 using the terms “Parkinson Disease,” “Exercise,” “Resistance Training,” “Muscle Strength,” “Cardiorespiratory Fitness,” “Postural Balance,” “Gait,” and “Quality of Life.”Study SelectionWe included studies conducted in individuals with PD involving RE compared with a control group. Two independent reviewers performed the selection process based on titles, abstracts, and full-text reading. In total, 270 individuals with PD were included from 10 selected studies.Data extractionTwo reviewers independently extracted characteristics related to participants, intervention and control types, and results. The PEDro scale was used to assess the methodological quality, and the level of evidence was analyzed and synthesized using the Grading of Recommendation, Assessment, Development, and Evaluations approach.Data SynthesisThe level of evidence for body structure and function was low and without effect for lower limb muscle strength; very low and with effect for upper limb muscle strength, cardiorespiratory fitness, and postural balance; and very low and without effect for flexibility after RE training. For activity, the evidence was very low and with effect for gait and very low and without effect for mobility. For participation (ie, quality of life) the evidence was very low and without effect.ConclusionsAlthough the level of evidence was low to very low, RE was shown to promote improvements in body structure and function (upper limb muscle strength, cardiovascular function, postural balance) and activity (gait). In contrast, RE did not significantly improve participation (quality of life). However, based on the present findings, the practice of RE can be recommended for individuals with PD in the mild to moderate stages.     

Impact of Specialized Pediatric Palliative Care: A Systematic Review

ContextSpecialized pediatric palliative care (SPPC) is increasingly involved in the care of seriously ill children, yet the evidence on its impact has not been comprehensively reviewed.ObjectiveThe objective of this study was to assess the effects of providing SPPC to seriously ill children on patient-, caregiver-, and systems-level outcomes.MethodsWe performed a Systematic Review following Cochrane methods. Data sources: Medline, Embase, PsycINFO, Global Health, The Cochrane Central Register of Controlled Trials, LILACS, and Web of Science were searched from January 1996 to June 2018. Study selection/data extraction: We included randomized controlled, cohort, case-control, and before-after studies in which exposure to SPPC services was the intervention of interest. All outcomes reported in these studies were included. Two investigators independently selected articles, extracted data, and assessed risk of bias of included studies using standardized criteria.ResultsTwenty-four studies were included in qualitative synthesis: one nonrandomized controlled trial, 16 cohort studies, and seven before-after studies. Evidence certainty was low. Twenty-one studies had one or more area with high risk of bias, most commonly selection bias, low group comparability, risk for confounding, and inadequate statistical reporting. Studies analyzed 46 domains, operationalized as 136 distinct outcomes. SPPC was associated with better child quality of life scores in all four studies that assessed this outcome. No other outcome showed this consistency.ConclusionReceiving SPPC was associated with better child quality of life. However, the paucity and low certainty of the evidence precluded any firm recommendations about SPPC practice. Larger collaborative networks and greater consensus regarding SPPC research standards are needed.     

The Effect of Music Listening on Pain in Adults Undergoing Colonoscopy: A Systematic Review and Meta-Analysis

PurposeTo investigate the role of music listening in reducing pain in adults undergoing colonoscopy.DesignThis is a systematic review and meta-analysis of randomized control trials (RCTs) that evaluated the effect of music in reducing pain in adults undergoing colonoscopy.MethodsWe searched CINAHL, Embase, MEDLINE, PsycINFO, and PubMed for RCTs that reported on the effects of music listening in reducing pain in adult patients undergoing colonoscopy from database inception to March 15, 2020, when the search was completed. Studies published in English with adult participants testing the efficacy of music during colonoscopy were eligible for inclusion. Studies reporting the results of combined nonpharmacological interventions were excluded. The methodological quality of each included RCT was assessed using the Cochrane Collaboration tool for assessing the risk of bias. Two authors independently abstracted data and assessed risks of bias.FindingsSeven RCTs with a total of 622 adult participants fulfilled our inclusion criteria and were, therefore, included. A random-effects model estimated the summary effect of the 7 included studies as −1.83 ± 0.98, P = 0.06.ConclusionsAlthough our meta-analysis demonstrated a small treatment effect, this effect was clinically not statistically significant. Substantial heterogeneity among the included trials limits the certainty of our findings. Additional trials investigating the effects of listening to music on pain in adults undergoing colonoscopy are needed to generate further evidence to establish the analgesic effect of music in adults undergoing colonoscopy.     

Trunk and lower extremity biomechanics during sit-to-stand after stroke: A systematic review

ObjectivesThis systematic review aimed to pool available evidence of differences in trunk and lower extremity biomechanics during the different phases of a sit-to-stand (STS) task between persons with stroke and to healthy controls.MethodsFour electronic databases (Medline, Web of Science, EMBASE, and Cochrane Library) were systematically searched up to, and including, December 2021. Studies were included if they investigated kinematic, kinetic and/or electromyographic outcome measures of adults with stroke during STS and compared results with healthy controls. Data from eligible studies were categorized according to STS subphases if reported (Phase I: Movement onset to seat-off; Seat-off; Phase II: Seat-off to movement termination; Whole task [if no subtasks reported]). The Newcastle-Ottawa Scale was used to assess risk of bias.ResultsTwenty-one studies were included in this systematic review. Methodological quality ranged from 13% to 75%; mean score was 55%. The findings of this systematic review suggest that after stroke, people rise to stand (phase I) with increased lateral trunk flexion and displacement of the center of pressure (COP) towards the non-paretic side, decreased anterior pelvic tilt, decreased hip flexion and altered timing of lower limb muscle activation. In addition, during phase II, lateral pelvic translation and weight distribution asymmetry was increased, knee extension velocity was decreased and delayed, stabilization was decreased and COP velocity was increased compared with healthy subjects.ConclusionsThis systematic review clearly showed changes in kinematics, kinetics and muscle recruitment after stroke, with differences between the different phases of STS. Therapeutic interventions should focus on subphases of this functional task to optimize performance in daily living.     

Effects of Cognitive and Mental Health Factors on the Outcomes Following Carpal Tunnel Release: A Systematic Review and Meta-analysis

ObjectiveTo determine the effects of the cognitive and mental health factors on the outcomes after carpal tunnel release (CTR).Data SourcesEmbase, PubMed/MEDLINE, Web of Science, Cumulative Index to Nursing and Allied Health, and Cochrane Central Register of Controlled Trials databases from inception to August 14, 2021.Study SelectionRandomized controlled trials and observational studies of patients with CTR were included. The included studies aimed to determine the effect of the cognitive (catastrophic thinking, kinesiophobia, self-efficacy) or mental health factors (symptoms of anxiety and depression) on the outcomes at least 3 months post CTR.Data ExtractionTwo independent reviewers performed data extraction and assessed the risk of bias. Data were extracted using a standardized protocol and reporting forms. The risk of bias of the included studies was assessed using the Quality in Prognosis Studies risk-of-bias tool. Random-effects models were used for meta-analysis.Data SynthesisA total of 15 studies involving 2599 patients were included in this systematic review. The majority of studies indicate a significant association between the cognitive or mental health factors and outcomes after CTR. Quantitative analysis showed a moderate association of symptoms of depression on symptom severity (n=531; r=0.347; 95% CI, 0.205-0.475; P≤.0001), function (n=386; r=0.307; 95% CI, 0.132-0.464; P=.0008), and pain (n=344; r=0.431; 95% CI, 0.286-0.558; P≤.0001). In general, the risk of bias in the included studies was low.ConclusionsThis systematic review and meta-analysis showed that symptoms of depression have a moderate association with symptom severity, function, and pain after CTR. Symptoms of anxiety, catastrophic thinking, and self-efficacy are also important indicators of poor postsurgery outcomes. Physicians, physical therapists, and occupational therapists should consider evaluating these variables in patients undergoing CTR.     

Predictors of upper limb spasticity after stroke? A systematic review and meta-analysis

ObjectiveTo determine the predictive markers for the occurrence of upper limb spasticity in the first 12 months after stroke.Data sourcesA systematic review was undertaken of the databases MEDLINE, EMBASE, CINAHL and PEDRO to 31st December 2017.Study selectionNon-experimental or experimental studies that included a control group with spasticity who did not receive an experimental intervention which investigated at least one variable (explanatory variable) measured at baseline against the development (or not) of spasticity at a future time point within 12 months post stroke were selected independently by two reviewers. Eleven papers met the selection criteria.Study appraisalData were extracted into tabular format using predefined data fields by two reviewers. Study quality was evaluated using the modified Downs and Black tool. Data were analysed using a meta-analysis or narrative review.ResultsTen studies, including 856 participants were analysed. The predictive markers of upper limb spasticity at one month post stroke were: motor 11.25 (odds ratio, OR); [95% CI:2.48, 51.04] and sensory impairments 4.91 (OR); [1.24, 19.46]; haemorrhagic stroke 3.70 (OR); [1.05, 12.98] and age 0.01 (OR) [0.00, 69.89]. Only motor impairment was found as a significant predictor at six months post stroke 30.68 (OR); [1.60, 587.06].LimitationsLow number of studies exploring biomechanical and neurophysiological in addition to behavioural predictors of spasticity were included.Conclusion and implications of key findingsUsing the results, the identified predictive markers have potential to better inform clinical decision-making and to plan specific rehabilitation interventions by physiotherapists for stroke survivors with upper limb spasticity.
Systematic Review Registration Number PROSPERO (ID: CRD42016027642).     

Effects of Complex Physical Therapy and Multimodal Approaches on Lymphedema Secondary to Breast Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials

ObjectiveWhat are the immediate, short-term, and long-term effects of complex physical therapy and multimodal approaches on lymphedema secondary to breast cancer?Data SourcesFour electronic databases (MEDLINE, Embase, Cochrane Library, Physiotherapy Evidence Database) were searched from inception up to August 2020.Study SelectionRandomized controlled trials comparing complex physical therapy and multimodal approaches to the conservative treatment of lymphedema secondary to breast cancer.Data ExtractionTwo independent researchers performed data extraction and assessed the risk of bias, respectively, using the predefined form and Cochrane Collaboration of Risk of Bias. The determination of evidence quality was carried out using the Grading of Recommendations Assessment, Development, and Evaluation tools.Data SynthesisFourteen studies were identified for the systematic review and 11 studies for the meta-analysis with standardized mean difference (SMD), 95% CI, and random-effect model. The common outcomes involved total volume, pain, and physical function of the upper limb. Complex physical therapy has shown a favorable tendency to control outcomes in the short- and long-term. The meta-analysis indicated a small effect for volume reduction (SMD, ?0.18; 95% confidence interval [CI], ?0.35 to 0.00) and a moderate effect for short-term pain reduction (SMD, ?0.61; 95% CI, ?1.19 to –0.02).ConclusionsHigh-quality evidence suggests a more significant effect of complex physical therapy on multimodal approaches to the control of the upper limb total volume, substantiating the absence of changes in the current clinical practice in the management of lymphedema secondary to breast cancer. Future research should aim to identify concrete effect of therapeutic modalities in the immediate-, short-, and long-term.     

Systematic Review of Functional Outcomes in Cancer Rehabilitation

ObjectiveTo systematically review the evidence regarding rehabilitation interventions targeting optimal physical or cognitive function in adults with a history of cancer and describe the breadth of evidence as well as strengths and limitations across a range of functional domains.Data SourcesPubMed, Cumulative Index to Nursing and Allied Health Plus, Scopus, Web of Science, and Embase. The time scope was January 2008 to April 2019.Study SelectionProspective, controlled trials including single- and multiarm cohorts investigating rehabilitative interventions for cancer survivors at any point in the continuum of care were included, if studies included a primary functional outcome measure. Secondary data analyses and pilot/feasibility studies were excluded. Full-text review identified 362 studies for inclusion.Data ExtractionExtraction was performed by coauthor teams and quality and bias assessed using the American Academy of Neurology (AAN) Classification of Evidence Scheme (class I-IV).Data SynthesisStudies for which the functional primary endpoint achieved significance were categorized into 9 functional areas foundational to cancer rehabilitation: (1) quality of life (109 studies), (2) activities of daily living (61 studies), (3) fatigue (59 studies), (4) functional mobility (55 studies), (5) exercise behavior (37 studies), (6) cognition (20 studies), (7) communication (10 studies), (8) sexual function (6 studies), and (9) return to work (5 studies). Most studies were categorized as class III in quality/bias. Averaging results found within each of the functional domains, 71% of studies reported statistically significant results after cancer rehabilitation intervention(s) for at least 1 functional outcome.ConclusionsThese findings provide evidence supporting the efficacy of rehabilitative interventions for individuals with a cancer history. The findings should be balanced with the understanding that many studies had moderate risk of bias and/or limitations in study quality by AAN criteria. These results may provide a foundation for future work to establish clinical practice guidelines for rehabilitative interventions across cancer disease types.     

Adherence to Exercise Programs in Community-Dwelling Older Adults Postdischarge for Hip Fracture: A Systematic Review and Meta-analysis

ObjectiveTo determine whether older adults adhere to exercise programs after discharge for hip fracture and how adherence relates to exercise program characteristics and intervention efficacy.Data SourcesCochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health, Embase, Physiotherapy Evidence Database, Web of Science, SPORTDiscus, PsycINFO, PubMed, and Ovid MEDLINE were searched from inception to August 2020.Study SelectionRandomized controlled trials of exercise interventions in adults older than 60 years with a surgically managed hip fracture that provided a measure of adherence were selected by 2 independent reviewers.Data ExtractionData were extracted independently by 1 reviewer and cross-checked by a second reviewer for accuracy. Risk of bias was assessed with 2 tools: a customized checklist was used to examine sources of bias and ambiguity for adherence data, and the Cochrane Risk of Bias tool was used to assess the interval validity of studies.Data SynthesisSeventeen trials with 1850 participants (mean age, 78.8 years) were included in the review. The pooled estimate of adherence to exercise programs post hip fracture was 0.88 (95% CI, 0.78-0.95). Programs that were more than 6 months in duration were associated with a decrease in adherence (odds ratio, 0.29; 95% CI, 0.11-0.77). However, increased adherence was not associated with improvements in functional outcomes. None of the other program characteristics were associated with improvements in functional outcomes.ConclusionsAdherence to exercise programs after hip fracture appears to be high and may be related to program duration. However, there is a need for a standardized approach to measure and report adherence data in future studies to determine whether exercise adherence is associated with improvements in function for this population.     

Supervised Training Compared With No Training or Self-training in Patients With Subacromial Pain Syndrome: A Systematic Review and Meta-analysis

ObjectiveTo study the effects of supervised training in adults with subacromial pain syndrome.Data SourcesEmbase, MEDLINE, Cochrane Library, Cumulative Index to Nursing and Allied Health, and Physiotherapy Evidence Database were searched from inception to March 2020.Study SelectionIndependent reviewers selected randomized controlled trials comparing supervised training with (1) no training or (2) self-training in adults with subacromial pain syndrome lasting for at least 1 month. Critical outcomes were shoulder pain, function, and patient-perceived effect. Important outcomes included other potential benefits and adverse events at 3-month follow-up.Data ExtractionTwo independent reviewers extracted data for the meta-analysis. Risk of bias was assessed using the Cochrane Risk of Bias tool 1, and certainty of evidence was evaluated using the Grades of Recommendation Assessment, Development, and Evaluation (GRADE).Data SynthesisTen studies (n=597, 43% female) were included. Supervised training resulted in larger improvements than no training on pain (at rest: n=286; mean difference [MD], 1.68; 95% confidence interval [CI], 0.31-3.06 on 0-10 scale; during movement: n=353; MD, 1.84; 95% CI,0.91-2.76), function (n=396; standardized MD, 0.30; 95% CI, 0.07-0.52), and patient-perceived effect (n=118; risk ratio, 1.43; 95% CI, 0.87-2.34). Supervised training had potential benefits regarding quality of life, return to work, dropout, and training adherence, albeit more patients reported mild, transient pain after training. Supervised training and self-training showed equal improvements on pain (n=44) and function (n=76), with no data describing patient-perceived effect. Certainty of evidence was low for critical outcomes and low-moderate for other outcomes.ConclusionsSupervised training might be superior to no training and equally effective as self-training on critical and important outcomes. Based on low-moderate certainty of evidence, these findings support a weak recommendation for supervised training in adults with subacromial pain syndrome.     

Combined somatosensory and motor training to improve upper limb function following stroke: a systematic scoping review

Purpose: The purpose of this systematic scoping review was to (1) identify combined somatosensory and motor training interventions for the upper limb and their training components, and (2) review the efficacy of the combined interventions.

Methods: Participants were adults post-stroke with somatosensory and/or movement deficits in the upper limb. All studies with interventions combining somatosensory and motor training and targeting the affected upper limb were included. Outcome measures were assessments of somatosensory and/or motor impairment and upper limb function.

Results: Ten studies (n?=?219) were included, comprising three randomized controlled trials, two pre-post studies with non-randomized comparison groups, three single-case experimental studies, and two case reports. There was heterogeneity across studies with regards to intervention contents and dosage, participant characteristics, and outcome measures. The interventions included combinations of tactile stimulation/discrimination, proprioceptive stimulation/discrimination, haptic object discrimination/recognition, movement training, and functional training. Only one group study, a non-randomized controlled study with multiple active components and the largest dose of treatment, found significant improvements in fine motor and somatosensory measures. Some improvements were found in case studies.

Conclusion: There was little consistency across ‘combined somatosensory and motor training’ interventions and few have been rigorously tested for efficacy across somatosensory, motor and functional outcomes.     

Effect of Baduanjin exercise on the cognitive function of middle-aged and older adults: A systematic review and meta-analysis

BackgroundAge-related cognitive decline is a pervasive problem in the ageing population. Baduanjin training is a mind-body exercise with the characteristics of traditional Chinese medicine, and increasing numbers of studies have reported its usefulness in modulating the cognitive performance of various populations. However, no systematic review has evaluated the effect of Baduanjin training on cognition in middle-aged and older adults.ObjectiveTo systematically evaluate the effects of Baduanjin on the global cognitive function and specific cognitive domains of middle-aged and elderly people.MethodsFour literature databases (PubMed, Cochrane library, EMBASE, and Web of Science) and four Chinese databases (Wanfang, China National Knowledge Infrastructure, Chinese Science and Technology Periodical and China Biology Medicine) were searched from inception through May 2020. Randomized controlled trials (RCTs) examining the effect of Baduanjin exercise on the cognitive function of middle-aged and elderly people were included. Assessment of the risk of bias for the included studies and data synthesis were conducted using the software Review Manager 5.3 based on the methods given in the Cochrane Handbook.ResultsBaduanjin training showed significant benefit for global cognitive function and parts of specific domains of cognition, including general memory and its sub-domains (i.e., immediate memory and delayed memory), executive function, and processing speed, but no significant difference was found in attention function, visual-spatial ability or long-term memory (a sub-domain of memory). No related adverse events were reported in the included studies.ConclusionsThe findings of this review suggest that Baduanjin is safe and effective in enhancing global cognitive function and memory in middle-aged and older adults and potentially beneficial to parts of the other specific domains of cognition, including executive function and processing speed. However, additional trials with larger sample sizes and a more rigorous design are needed before more definitive conclusions can be drawn.     

Effects of Whole-Body Vibration Training on Body Composition,Cardiometabolic Risk,and Strength in the Population Who Are Overweight and Obese: A Systematic Review With Meta-analysis

ObjectivesTo assess the effects of whole-body vibration training (WBVT) on body composition, metabolic and cardiovascular risk variables, and lower limb strength in participants who are overweight/obese.Data SourcesA systematic review with meta-analysis was conducted in 3 databases (PubMed-MEDLINE, Web of Science, and Cochrane Library) from inception through to January 26, 2020.Study Selection: Studies analyzing the effect of WBVT on body composition variables, metabolic profile, blood pressure, heart rate, and lower limb strength in the population who are overweight/obese, with interventions of a minimum length of 2 weeks were included.Data ExtractionAfter applying the inclusion and exclusion criteria, 23 studies involving 884 participants who were obese/overweight (experimental group: 543; weight=79.9 kg; body mass index (BMI) =31.3 kg/m², obesity class I according to World Health Organization) were used in the quantitative analysis. The sex of the participants involved in the studies were as follows: (1) 17 studies included only female participants; (2) 1 study included only boys, and (3) 5 studies included both sexes. Meta-analysis, subgroup analysis, and meta-regression methods were used to calculate the mean difference and standardized mean difference (SMD; ± 95% confidence intervals [CIs]) as well as to analyze the effects of pre-post intervention WBVT and differences from control groups.Data SynthesisWBVT led to a significant decrease in fat mass (−1.07 kg, not clinically significant). In addition, WBVT reduced systolic blood pressure (−7.01 mmHg, clinically significant), diastolic blood pressure (−1.83 mmHg), and heart rate (−2.23 bpm), as well as increased the lower extremity strength (SMD=0.63; range, 0.40-0.86). On the other hand, WBVT did not modify the weight, BMI, muscle mass, cholesterol, triglycerides, or glucose.ConclusionsWBVT could be an effective training modality to reduce blood pressure (clinically relevant) and resting heart rate. In addition, WBVT led to improved lower limb strength. However, these findings were not consistent with significant improvements on other variables associated with metabolic syndrome (body composition, cholesterol, triglycerides, glucose).