The Effect of Telehealth Interventions on Mobility for Individuals with Lower Limb Loss: A Systematic Review and Meta-Analysis

Author(s):  
Elham Esfandiari
2020 ◽  
Vol 10 (1) ◽  
pp. 86
Author(s):  
Emanuela Elena Mihai ◽  
Luminita Dumitru ◽  
Ilie Valentin Mihai ◽  
Mihai Berteanu

The purpose of this systematic review and meta-analysis is to evaluate the long-term efficacy of Extracorporeal Shock Wave Therapy (ESWT) on reducing lower limb post-stroke spasticity in adults. A systematic electronic search of PubMed/ MEDLINE, Physiotherapy Evidence Database (PEDro), Scopus, Ovid MEDLINE(R), and search engine of Google Scholar was performed. Publications that ranged from January 2010 to August 2020, published in English, French, Spanish, Portuguese, and Italian language and available as full texts were eligible for inclusion and they were searched without any restrictions of country. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and followed the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. Two authors screened the references, extracted data, and assessed the risk of bias. The primary outcome was spasticity grade mainly assessed by the Modified Ashworth Scale (MAS). Secondary outcomes were passive range of motion (PROM), pain intensity, electrophysiological parameters, gait assessment, and adverse events. A total of seven recent randomized controlled trials (RCTs) were included in the systematic review and meta-analysis, and a beneficial effect on spasticity was found. The high level of evidence presented in this paper showed that ESWT ameliorates spasticity considering the parameters: MAS: standardized mean difference (SMD) = 0.53; 95% confidence interval (95% CI): (0.07–0.99); Modified Tardieu Scale (MTS): SMD = 0.56; 95% CI: (0.01–1.12); Visual Analogue Scale (VAS): SMD = 0.35; 95% CI: (−0.21–0.91); PROM: SMD = 0.69; 95% CI: (0.20–1.19). ESWT presented long-term efficacy on lower limb post-stroke spasticity, reduced pain intensity, and increased range of motion. The effect of this novel and non-invasive therapy was significant and the intervention did not present adverse events, proving a satisfactory safety profile.


2019 ◽  
Vol 100 (6) ◽  
pp. 1102-1113 ◽  
Author(s):  
Liye Zou ◽  
Jia Han ◽  
Chunxiao Li ◽  
Albert S. Yeung ◽  
Stanley Sai-chuen Hui ◽  
...  

2021 ◽  
Author(s):  
Derek Roberts ◽  
Hannah Dreksler ◽  
Sudhir K. Nagpal ◽  
Allen Li ◽  
Jeanna Parsons Leigh ◽  
...  

BACKGROUND Patients undergoing lower limb revascularization surgery for peripheral artery disease (PAD) have a high-risk of perioperative morbidity and mortality and often have long hospital stays. Use of neuraxial or regional anesthesia instead of general anesthesia may represent one approach to improving outcomes and reducing resource use among these patients. OBJECTIVE To conduct a systematic review and meta-analysis to determine whether receipt of neuraxial or regional anesthesia instead of general anesthesia in adults undergoing lower limb revascularization surgery for PAD results in improved health outcomes and costs and a shorter length of hospitalization. METHODS We will search electronic bibliographic databases (MEDLINE, EMBASE, and the seven databases in Evidence-Based Medicine Reviews), review articles identified during the search, and included article bibliographies. We will include randomized and non-randomized studies comparing use of neuraxial or regional anesthesia instead of general anesthesia in adults undergoing lower limb revascularization surgery for PAD. Two investigators will independently evaluate risk of bias. The primary outcome will be short-term mortality (in-hospital or 30-day). Secondary outcomes will include longer-term mortality; major adverse cardiovascular, pulmonary, and renal events; delirium; deep vein thrombosis or pulmonary embolism; major adverse limb events; neuraxial or regional anesthesia-related complications; graft-related outcomes; length of operation and hospital stay; costs; and patient-reported or functional outcomes. We will calculate summary odds ratios and standardized mean differences using random-effects models. Heterogeneity will be explored using stratified meta-analyses and meta-regression. We will assess for publication bias using Begg’s and Egger’s tests and use the trim-and-fill method to estimate the potential influence of this bias on summary estimates. Finally, we will use Grading of Recommendations, Assessment, Development, and Evaluation methodology to make an overall rating of the quality of evidence in our effect estimates. RESULTS The protocol was registered in PROSPERO, the international register of systematic reviews. CONCLUSIONS This study will synthesize existing evidence regarding whether receipt of neuraxial or regional anesthesia instead of general anesthesia in adults undergoing lower limb revascularization surgery for PAD results in improved health outcomes, graft patency, and costs, and a shorter length of hospital stay. Study results will be used to inform practice and future research, including creation of a pilot and then multicenter randomized controlled trial. CLINICALTRIAL PROSPERO CRD42021237060.


2019 ◽  
Vol 44 (3) ◽  
pp. 389-412 ◽  
Author(s):  
Ardalan Shariat ◽  
Mahboubeh Ghayour Najafabadi ◽  
Noureddin Nakhostin Ansari ◽  
Joshua A. Cleland ◽  
Maria A. Fiatarone Singh ◽  
...  

2020 ◽  
Vol 315 ◽  
pp. 81-92
Author(s):  
Ángel Herraiz-Adillo ◽  
Iván Cavero-Redondo ◽  
Celia Álvarez-Bueno ◽  
Diana P. Pozuelo-Carrascosa ◽  
Montserrat Solera-Martínez

2020 ◽  
Vol 50 (5) ◽  
pp. 965-985
Author(s):  
Manuela Besomi ◽  
Liam Maclachlan ◽  
Rebecca Mellor ◽  
Bill Vicenzino ◽  
Paul W. Hodges

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