The Role of Selective Peripheral Neurectomy in the Treatment of Upper Limb Spasticity

Background: Management of upper limb spasticity remains challenging. Selective peripheral neurectomy (SPN) is a relatively recent intervention for cases refractory to medical therapy. The aim of this study was to conduct a systematic review looking at the efficacy and outcomes of SPN, in order to clarify the patient selection criteria and surgical technique. Methods: A search of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science Core Collection, Open Grey and CINAHL was conducted. Inclusion criteria included studies comparing pre- and post-operative outcomes for SPN, neurectomy, fasciculotomy and upper limb spasticity. Results: Only case series were reported with no randomised controlled trials found. 7 studies met the inclusion criteria with a total of 174 patients. A meta-analysis was not possible due to the degree of baseline heterogeneity. All studies had no control arm for comparison of outcomes, with a high risk of bias due to poor internal and external validity, as well as design and performance bias. Surgical techniques differ vastly between studies, with percentage of fascicles ablated between 30–80% and length of neurectomy between 5–10 mm. Some advocated removing end branches while others performed fascicular SPN proximally. 13 patients underwent orthopaedic or neurosurgical procedures, which are both confounding factors. All studies reported an improvement in spasticity although functional outcomes were reported with non-standardized measures. Recurrence rates were reported to be 0–16.1% (mean 3.72%). Conclusions: From this systematic review, SPN appeared to be a useful technique in selected cases, but overall no firm conclusions can be drawn regarding the best surgical technique, or the extent of functional improvement.

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Mirror therapy simultaneously combined with electrical stimulation for upper limb motor function recovery after stroke: a systematic review and meta-analysis of randomized controlled trials

Clinical Rehabilitation ◽

10.1177/0269215520951935 ◽

2020 ◽

pp. 026921552095193

Author(s):

Alberto Saavedra-García ◽

Jose A Moral-Munoz ◽

David Lucena-Anton

Keyword(s):

Systematic Review ◽

Electrical Stimulation ◽

Motor Function ◽

Upper Limb ◽

Meta Analysis ◽

Mean Difference ◽

Current Evidence ◽

Controlled Trials ◽

Cochrane Central Register ◽

Mirror Therapy

Objective: To evaluate the current evidence on the effectiveness of simultaneous combination of mirror therapy and electrical stimulation in the recovery of upper limb motor function after stroke, compared with conventional therapy, mirror therapy or electrical stimulation isolated. Data sources: Articles published in PubMed, Web of Science, Scopus, Physiotherapy Evidence Database (PEDro), Cochrane Central register of controlled trials and ScienceDirect up to July 2020. Review methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Methodological quality was assessed using the PEDro tool. The RevMan 5.4 statistical software was used to obtain the meta-analysis, through the standardized mean difference and 95% confidence intervals (CI), and to evaluate the risk of bias. The GRADE approach was employed to assess the certainty of evidence. Results: Eight articles were included in this systematic review, seven were included in the meta-analysis. A total of 314 participants were analyzed. The overall quality of the articles included in this review was good. There was no overall significant mean difference on upper limb motor function after stroke using the Upper-Extremity Fugl-Meyer Assessment by 1.56 (95% CI = –2.08, 5.20; P = 0.40; moderate-certainty evidence) and the Box and Block Test results by 1.39 (95% CI = –2.14, 4.92; P = 0.44; high-certainty evidence). There was overall significant difference in the Action Research Arm Test by 3.54 (95% CI = 0.18, 6.90; P = 0.04; high-certainty evidence). Conclusion: Direct scientific evidence about the effectiveness of the combined therapy of mirror therapy and electrical stimulation simultaneously for the improvement of the upper limb motor function after stroke is lacking. Further high-quality and well-designed research is needed.

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Interpersonal Psychotherapy to Reduce Psychological Distress in Perinatal Women: A Systematic Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17228421 ◽

2020 ◽

Vol 17 (22) ◽

pp. 8421

Author(s):

Katherine S. Bright ◽

Elyse M. Charrois ◽

Muhammad Kashif Mughal ◽

Abdul Wajid ◽

Deborah McNeil ◽

...

Keyword(s):

Systematic Review ◽

Psychological Distress ◽

Full Text ◽

Postpartum Period ◽

Interpersonal Psychotherapy ◽

Controlled Trials ◽

Cochrane Central Register ◽

Inclusion Criteria ◽

Prevention And Treatment ◽

Perinatal Women

Background: Interpersonal psychotherapy (IPT) is a psychological intervention with established efficacy in the prevention and treatment of depressive disorders. Previous systematic reviews have not evaluated the effectiveness of IPT on symptoms of stress, anxiety, depression, quality of life, relationship satisfaction/quality, social supports, and an improved psychological sense of wellbeing. There is limited information regarding moderating and mediating factors that impact the effectiveness of IPT such as the timing of the intervention or the mode of delivery of IPT intervention. The overall objective of this systematic review was to evaluate the effectiveness of IPT interventions to treat perinatal (from pregnancy up to 12 months postpartum) psychological distress. Methods: MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily (Ovid), EMBASE (Ovid), PsycINFO (Ovid), Cochrane Central Register of Controlled Trials (OVID), CINAHL with Full Text (Ebsco), Social Work Abstracts (Ebsco), SocINDEX with Full Text (Ebsco), Academic Search Complete (Ebsco), Family & Society Studies Worldwide (Ebsco), Family Studies Abstracts (Ebsco), and Scopus databases were searched from inception until 31 January 2019. Two researchers independently screened articles for eligibility. Of the 685 screened articles, 43 met the inclusion criteria. The search was re-run on 11 May 2020. An additional 204 articles were screened and two met the inclusion criteria, resulting in a total of 45 studies included in this review. There were 25 Randomized Controlled Trials, 10 Quasi-experimental studies, eight Open Trials, and two Single Case Studies. All included studies were critically appraised for quality. Results: In most studies (n = 24, 53%), the IPT intervention was delivered individually; in 17 (38%) studies IPT was delivered in a group setting and two (4%) studies delivered the intervention as a combination of group and individual IPT. Most interventions were initiated during pregnancy (n = 27, 60%), with the remaining 18 (40%) studies initiating interventions during the postpartum period. Limitations: This review included only English-language articles and peer-reviewed literature. It excluded government reports, dissertations, conference papers, and reviews. This limited the access to grassroots or community-based recruitment and retention strategies that may have been used to target smaller or marginalized groups of perinatal women. Conclusions: IPT is an effective intervention for the prevention and treatment of psychological distress in women during their pregnancy and postpartum period. As a treatment intervention, IPT is effective in significantly reducing symptoms of depression and anxiety as well as improving social support, relationship quality/satisfaction, and adjustment. Systematic Review Registration: PROSPERO CRD42019114292.

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Surgical Technique in Distal Pancreatectomy: A Systematic Review of Randomized Trials

BioMed Research International ◽

10.1155/2014/482906 ◽

2014 ◽

Vol 2014 ◽

pp. 1-9 ◽

Cited By ~ 13

Author(s):

Filip Čečka ◽

Bohumil Jon ◽

Zdeněk Šubrt ◽

Alexander Ferko

Keyword(s):

Systematic Review ◽

Surgical Technique ◽

Distal Pancreatectomy ◽

Meta Analysis ◽

Surgical Techniques ◽

Controlled Trials ◽

Eligibility Criteria ◽

Pancreatic Remnant ◽

Study Selection ◽

Central Registry

Despite recent improvements in surgical technique, the morbidity of distal pancreatectomy remains high, with pancreatic fistula being the most significant postoperative complication. A systematic review of randomized controlled trials (RCTs) dealing with surgical techniques in distal pancreatectomy was carried out to summarize up-to-date knowledge on this topic. The Cochrane Central Registry of Controlled Trials, Embase, Web of Science, and Pubmed were searched for relevant articles published from 1990 to December 2013. Ten RCTs were identified and included in the systematic review, with a total of 1286 patients being randomized (samples ranging from 41 to 450). The reviewers were in agreement for application of the eligibility criteria for study selection. It was not possible to carry out meta-analysis of these studies because of the heterogeneity of surgical techniques and approaches, such as varying methods of pancreas transection, reinforcement of the stump with seromuscular patch or pancreaticoenteric anastomosis, sealing with fibrin sealants and pancreatic stent placement. Management of the pancreatic remnant after distal pancreatectomy is still a matter of debate. The results of this systematic review are possibly biased by methodological problems in some of the included studies. New well designed and carefully conducted RCTs must be performed to establish the optimal strategy for pancreatic remnant management after distal pancreatectomy.

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Efficacy and safety of manual acupuncture for the treatment of upper limb motor dysfunction after stroke: Protocol for a systematic review and meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0258921 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0258921

Author(s):

Di Cao ◽

Xiaolin Zhang ◽

Mingjun Liu ◽

Qiguang Yang ◽

Shuhong Gu ◽

...

Keyword(s):

Systematic Review ◽

Randomized Controlled Trials ◽

Upper Extremity ◽

Upper Limb ◽

Motor Dysfunction ◽

Controlled Trials ◽

Cochrane Central Register ◽

Efficacy And Safety ◽

Manual Acupuncture ◽

Randomized Controlled

Introduction The incidence of stroke sequelae among patients is as high as 70%–80%. Flexor spasm is the most common stroke sequela, presenting a heavy burden to the patients and their families. This study will evaluate the results of randomized controlled trials to determine the efficacy and safety of hand manipulation acupuncture for the treatment of upper limb motor dysfunction after stroke. Methods Eight databases, including China National Knowledge Infrastructure, Chinese Scientific Journal Database, Cochrane Central Register of Controlled Trials, Embase, MEDLINE, PubMed, Wanfang Database, and Web of Science, will be searched using English and Chinese search strategies. In addition, manual retrieval of research papers, conference papers, ongoing experiments, and internal reports, among others, will supplement electronic retrieval. All eligible studies published on or before January 15, 2021 will be selected. To enhance the effectiveness of the study, only clinical randomized controlled trials related to the use of manual acupuncture for the treatment of upper limb motor dysfunction after stroke will be included. Analysis The Fugl-Meyer upper extremity assessment will be the primary outcome measure, whereas the Wolf Motor Function Test, Modified Ashworth Scale, arm movement survey test table, and upper extremity freehand muscle strength assessment scores will be the secondary outcomes. Side effects and adverse events will be included as safety evaluations. To ensure the quality of the systematic evaluation, study selection, data extraction, and quality assessment will be independently performed by two authors, and a third author will resolve any disagreement. Ethics and dissemination This systematic review will evaluate the efficacy and safety of manual acupuncture for the treatment of upper limb motor dysfunction after stroke. Since all included data will be obtained from published articles, it does not require ethical approval and will be published in a peer-reviewed journal. INPLASY registration number: INPLASY202110071.

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Abstract TP143: Sensor-based Assistive Technology to Aid Arm Recovery in Stroke and Its Effectiveness: A Systematic Review

Stroke ◽

10.1161/str.48.suppl_1.tp143 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Aneel Kumar Maheshwari ◽

Paulette van Vliet ◽

Irene Hudson ◽

James Welsh

Keyword(s):

Systematic Review ◽

Motor Control ◽

Assistive Technology ◽

Upper Limb ◽

Cochrane Library ◽

Controlled Trials ◽

Review Author ◽

Cochrane Central Register ◽

Limb Function ◽

Upper Limb Function

Background: Improving upper limb function is a core element of stroke rehabilitation, needed to maximise recovery and reduce disability. There is an increasing number of medical devices available to improve motor control of the upper limb following stroke, but yet there is no systematic review combining information about these devices and to evaluate the effectiveness in improving upper limb motor control. Objective: (1) identify all existing sensor-based assistive technology targeted at improving motor control of the upper limb following stroke, and (2) investigate the effectiveness of current sensor-based assistive technology for improving the motor control of the upper limb following stroke. Search Methods: The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); MEDLINE; EMBASE; CINAHL; AMED; IEEE Explorer; ProQuest Dissertations and Theses (International), ISI Proceedings (Conference) databases, and occupational therapy (OT Seeker) and physiotherapy (PEDRO) databases. Data collection and analysis: Following exclusion of irrelevant titles by one review author, two review authors independently screened abstracts according to inclusion and exclusion criteria. The quality of evidence was determined independently by two authors using the Pedro levels of evidence scale. We systematically tabulated data and performed meta-analysis where studies used the same outcome measures. Results: 2364 records were screened, and 221 full-text articles were evaluated for eligibility. Finally, 65 studies for objective 1, and 29 randomized controlled trials for objective 2 were included. Studies were divided into 7 groups for objective 2. Results were statistically significant for EMG and Electrical Simulation (standardised mean difference (SMD) 0.46, 95% confidence intervals (CI) -0.03 to 0.96, based on 2 studies with 65 participants). However, results were not statistically significant for the other device groups. Authors’ Conclusions: EMG and Electrical Stimulation showed a significant effect in improving upper limb function, but it is unknown whether effects are sustained in the longer term. Further studies are needed to investigate the effectiveness of sensor-based devices to improve upper limb motor control.

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Effective Parental intervention strategies to reduce screen time among preschool-aged children: A systematic review (Preprint)

10.2196/preprints.25774 ◽

2020 ◽

Author(s):

Diana Raj ◽

Halimatus Sakdiah Minhat ◽

Nor Afiah Mohd. Zulkefli ◽

Norliza Ahmad

Keyword(s):

Systematic Review ◽

Preschool Children ◽

Young Children ◽

Screen Time ◽

Mode Of Delivery ◽

Intervention Strategies ◽

Controlled Trials ◽

Cochrane Central Register ◽

Negative Consequences ◽

Parental Intervention

BACKGROUND The increasing screen time exposure among young children in general and the reported negative consequences associated with excessive ST, calls for focused strategies to reduce ST, especially among young children. OBJECTIVE This systematic review aimed to identify effective parental intervention strategies to reduce ST among preschool children. METHODS A total of five databases, namely Cochrane Central Register of Controlled Trials, CINAHL, Medline Complete, PubMed, and Scopus, were searched for randomised controlled trials that involved intervention strategies in ST reduction among preschool children. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines were used. RESULTS A total of nine studies were assessed. The results showed that besides providing knowledge and awareness regarding ST, having restrictive practices, offering alternative activities to parents, and removal of screen from child’s bedroom were the most common strategies used by studies that reported successful intervention. Intervention duration of between six to eight weeks was sufficient to produce ST reduction. Face-to-face method was the commonest mode of delivery. Theoretical constructs that aimed at increasing parental self-efficacy, listing outcome expectations, and offering reinforcement of strategies that targeted both the parents and home environment were beneficial in reducing ST. CONCLUSIONS By offering appropriate strategies to parents, a reduction in the amount of ST was observed among the children. Future intervention studies could benefit in exploring culturally adapted strategies, especially in developing countries. Trials of higher quality would also facilitate the drawing of conclusions in future research. CLINICALTRIAL PROSPERO No: CRD42020199398

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Effect of gut microbiota modulation on feeding tolerance of enterally fed critically ill adult patients: a systematic review

Systematic Reviews ◽

10.1186/s13643-021-01633-5 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Najmeh Seifi ◽

Ali Jafarzadeh Esfahani ◽

Alireza Sedaghat ◽

Reza Rezvani ◽

Majid Khadem-Rezaiyan ◽

...

Keyword(s):

Systematic Review ◽

Gut Microbiota ◽

Beneficial Effect ◽

Critically Ill ◽

Energy Intake ◽

Adult Patients ◽

Controlled Trials ◽

Cochrane Central Register ◽

Clinical Endpoints ◽

Feeding Tolerance

Abstract Purpose The objective of this systematic review was to evaluate the effect of pre-, pro-, and synbiotics on feeding tolerance of enterally fed critically ill adult patients. Methods MEDLINE, Science Direct, Web of Knowledge, and the Cochrane Central Register of Controlled Trials were searched up to November 2019. English language randomized controlled trials reporting the effect of pre, pro or synbiotics on the feeding tolerance of enterally fed critically ill adult patients were included. Results Overall, 15 papers were selected for review. Among six studies reporting the energy intake, only two studies showed significantly higher energy intake in the prebiotic-receiving groups. Among four RCTs reporting frequency or time to achieve the target calorie, only one found a significant effect of probiotics to reduce the time to achieve a target dose of calorie. About the prevalence or duration of diarrhea, 7 out of 12 RCTs reported a beneficial effect. All but one study found no beneficial effects for gut microbiota manipulation on clinical endpoints including length of stay (LOS) in hospital and intensive care unit (ICU). Conclusion It should be noticed that the heterogeneity in study designs, product format, and ICU patient populations makes it difficult to draw any general conclusion. Overall, it seems that pre, pro, or synbiotics have no significant beneficial effect on feeding tolerance and clinical endpoints in critically ill adults, but they may reduce the prevalence or duration of diarrhea.

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Efficacy and safety of inulin supplementation for functional constipation: a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2020-042597 ◽

2021 ◽

Vol 11 (4) ◽

pp. e042597

Author(s):

Xinyuan Liu ◽

Qing Yang ◽

Zhongning He ◽

Shukun Yao

Keyword(s):

Systematic Review ◽

Lifestyle Intervention ◽

Functional Constipation ◽

Biomedical Literature ◽

Basic Material ◽

Economic Losses ◽

Controlled Trials ◽

Cochrane Central Register ◽

Efficacy And Safety ◽

Clinical Trial Registry

IntroductionFunctional constipation (FC) is a common digestive system disease, with an uptrend in morbidity and mortality, resulting in huge social and economic losses. Although the guidelines recommend lifestyle intervention as a first-line treatment, lifestyle intervention is not widely used in clinic. Inulin can be used as the basic material of functional food. Clinical studies have shown that inulin supplementation is associated with increased frequency of bowel movements, but has certain side effects. Therefore, the efficacy and safety of inulin in the treatment of FC need to be further evaluated.Methods and analysisWe will search Medline, Web of Science, Embase, China National Knowledge Infrastructure Database, Wanfang Database and China Biomedical Literature Database. We will also search the China Clinical Trial Registry, the Cochrane Central Register of Controlled Trials and related conference summaries. This systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RevMan V.5.3.5 will be used for analysis.Ethics and disseminationThis systematic review will evaluate the efficacy and safety of inulin supplementation for the treatment of FC. All included data will be obtained from published articles, there is no need for the ethical approval, and it will be published in a peer-reviewed journal. Due to lack of a new systematic review in this field, this study will combine relevant randomised controlled trials to better explore the evidence of inulin supplementation in the treatment of FC and guide clinical practice and clinical research.PROSPERO registration numberCRD42020189234.

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Functional cortical changes associated with shoulder instability – a systematic review

Shoulder & Elbow ◽

10.1177/17585732211019016 ◽

2021 ◽

pp. 175857322110190

Author(s):

Morissa F Livett ◽

Deborah Williams ◽

Hayley Potter ◽

Melinda Cairns

Keyword(s):

Systematic Review ◽

Joint Instability ◽

Glenohumeral Joint ◽

Controlled Trials ◽

Cochrane Central Register ◽

Cortical Function ◽

High Quality Research ◽

Central Register ◽

Rehabilitative Measures ◽

Randomised Controlled

Background Glenohumeral joint instability is associated with structural deficits and/or alterations in sensory and motor processing; however, a proportion of patients with glenohumeral joint instability fail to respond to surgical and rehabilitative measures. This systematic review aimed to establish if functional cortical changes occur in patients with glenohumeral joint instability. Methods AMED, CINAHL, Cochrane Central Register of Controlled Trials, Embase, Medline, PEDro, Pubmed, PsychINFO and Scopus were searched from inception to 17 March 2021. Randomised controlled trials and non-randomised trials were included and quality was appraised using the Downs and Black tool. Results One thousand two hundred seventy-nine records were identified of which five were included in the review. All studies showed altered cortical function when comparing instability patients with healthy controls and included areas associated with higher cortical functions. Discussion The findings of this systematic review offer some insight as to why interventions addressing peripheral pathoanatomical factors in patients with glenohumeral joint instability may fail in some cases due to functional cortical changes. However, data are of moderate to high risk of bias. Further high-quality research is required to ascertain the degree of functional cortical changes associated with the type and duration of glenohumeral joint instability.

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Interventional radiology versus operative management for splenic injuries: a study protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2018-028172 ◽

2019 ◽

Vol 9 (8) ◽

pp. e028172

Author(s):

Masahiro Kashiura ◽

Noritaka Yada ◽

Kazuma Yamakawa

Keyword(s):

Systematic Review ◽

Interventional Radiology ◽

Meta Analysis ◽

Operative Management ◽

Sensitivity Analyses ◽

Definitive Treatment ◽

Controlled Trials ◽

Cochrane Central Register ◽

Statistical Heterogeneity ◽

Non Operative Management

IntroductionOver the past decades, the treatment for blunt splenic injuries has shifted from operative to non-operative management. Interventional radiology such as splenic arterial embolisation generally increases the success rate of non-operative management. However, the type of intervention, such as the first definitive treatment for haemostasis (interventional radiology or surgery) in blunt splenic injuries is unclear. Therefore, we aim to clarify whether interventional radiology improves mortality in patients with blunt splenic trauma compared with operative management by conducting a systematic review and meta-analysis.Methods and analysisWe will search the following electronic bibliographic databases to retrieve relevant articles for the literature review: Medline, Embase and the Cochrane Central Register of Controlled Trials. We will include controlled trials and observational studies published until September 2018. We will screen search results, assess the study population, extract data and assess the risk of bias. Two review authors will extract data independently, and discrepancies will be identified and resolved through a discussion with a third author where necessary. Data from eligible studies will be pooled using a random-effects meta-analysis. Statistical heterogeneity will be assessed by using the Mantel-Haenszel χ² test and the I² statistic, and any observed heterogeneity will be quantified using the I² statistic. We will conduct sensitivity analyses according to several factors relevant for the heterogeneity.Ethics and disseminationOur study does not require ethical approval as it is based on the findings of previously published articles. This systematic review will provide guidance on selecting a method for haemostasis of splenic injuries and may also identify knowledge gaps that could direct further research in the field. Results will be disseminated through publication in a peer-reviewed journal and presentations at relevant conferences.PROSPERO registration numberCRD42018108304.

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