scholarly journals Acupuncture for Improving Cognitive Impairment After Stroke: A Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Vol 11 ◽  
Author(s):  
Liang Zhou ◽  
Yao Wang ◽  
Jun Qiao ◽  
Qing Mei Wang ◽  
Xun Luo
Keyword(s):  
Cognitive Impairment ◽  
Randomized Controlled Trials ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Sham Acupuncture ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Post Stroke ◽  
Randomized Controlled ◽  
Therapeutic Benefits

Objective: This meta-analysis evaluated the efficacy of acupuncture in improving cognitive impairment of post-stroke patients.Design: Randomized controlled trials (RCTs) investigating the effects of acupuncture compared with no treatment or sham acupuncture on post-stroke cognitive impairment (PSCI) before December 2019 were identified from databases (PubMed, EMBASE, Ovid library, Cochrane Library, Chinese National Knowledge Infrastructure, VIP Chinese Periodical Database, Wanfang Database, and SinoMed). The literature searching and data extracting were independently performed by two investigators. Study quality was assessed using the Cochrane Handbook for Systematic Reviews of Interventions. Meta-analyses were performed for the eligible RCTs with Revman 5.3 software.Results: Thirty-seven RCTs (2,869 patients) were included in this meta-analysis. Merged Random-effects estimates of the gain of MMSE (Mini-Mental State Examination) or MoCA (Montreal Cognitive Assessment) were calculated for the comparison of acupuncture with no acupuncture or sham acupuncture. Following 2–8 weeks of intervention with acupuncture, pooled results demonstrated significant effects of acupuncture in improving PSCI assessed by MMSE (MD [95% CI] = 2.88 [2.09, 3.66], p < 0.00001) or MoCA (MD [95% CI] = 2.66 [1.95, 3.37], p < 0.00001).Conclusion: The results suggest that acupuncture was effective in improving PSCI and supported the needs of more rigorous design with large-scale randomized clinical trials to determine its therapeutic benefits.

scholarly journals Cognitive rehabilitation interventions after stroke: protocol for a systematic review and meta-analysis of randomized controlled trials

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Qing Zhao ◽  
Xue Wang ◽  
Tao Wang ◽  
Adam A. Dmytriw ◽  
Xiao Zhang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Cognitive Impairment ◽  
Randomized Controlled Trials ◽  
Cognitive Rehabilitation ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Post Stroke ◽  
Randomized Controlled

Abstract Background Stroke is the second leading cause of death worldwide, and 53.4% of stroke survivors suffer from post-stroke cognitive impairment. Post-stroke cognitive impairment can increase hospitalization rate and cost of care and decrease the quality of life of stroke patients. To date, multiple cognitive rehabilitation interventions have been tested in stroke populations with post-stroke cognitive impairment. However, the most efficacious intervention has not been established. This systematic review aims to compare the efficacy of cognitive rehabilitation interventions for patients with post-stroke cognitive impairment. Methods We will search MEDLINE, EMBASE, CENTRAL, PsycINFO, CINAHL, PubMed, and clinical trial registries to identify eligible randomized clinical trials with no restrictions in the date of publication and language. Studies conducted with patients aged 18 or over, with the presence of cognitive impairment after being diagnosed with stroke will be included. Studies will be restricted to randomized controlled trials comparing a cognitive rehabilitation intervention with another intervention. The primary outcome is any clinical changes in the general or specific cognitive domain (e.g., executive function, attention, memory, or perception). The secondary outcomes that will be collected include adverse effects (e.g., stroke, disability, or mortality) and quality of life. Two independent reviewers will assess articles to identify trials eligible for inclusion. Data extraction and risk of bias assessment of the included studies will also be done independently. Any discrepancies will be solved by discussion, or a third reviewer will be consulted if necessary. A meta-analysis will be carried out if appropriate. Discussion This systematic review for patients with post-stroke cognitive impairment will assess the efficacy of cognitive rehabilitation interventions. And our results will help clinical decision-making and support the development of clinical practice guidelines. Trial registration Systematic review registration: PROSPERO CRD42020173988

The Impact of Immersive and Non-Immersive Virtual Reality Trends in Sensorimotor Recovery of Post-Stroke Patients-A Meta-Analysis

2021 ◽  
Vol 9 (5) ◽  
pp. 555-564
Author(s):  
Jaza Rizvi ◽  
◽  
Abid Khan ◽  
Sumaira Imran Farooqui ◽  
Bashir Ahmed Soomro ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Stroke Patients ◽  
Post Stroke ◽  
Randomized Controlled ◽  
Sensorimotor Recovery ◽  
The Impact

Virtual Reality (VR) is an approach in stroke rehabilitation with ever-improving technological advancement for targeted motor rehabilitation by providing a user interface in a simulated environment with proprioceptive and visual feedback. This meta-analysis intended to evaluate the impact of immersive and non-immersive VR-based interventions compared to conventional rehabilitation in sensorimotor recovery following stroke. Randomized Controlled Trials based on the impact of VR, either immersive or non-immersive type in comparison to conventional rehabilitation on post-stroke patients (>18 years) sensorimotor recovery were searched on six databases including Google Scholar, PEDro, MEDLINE, Cochrane Library, EMBASE, and Web of Science from August to November 2020. A total of 17 randomized controlled trials on VR based intervention showed significant improvement in sensorimotor recovery following a stroke in overall FMA outcomes in comparison to the control group with pool effects in terms of SMD in a random effect model showed an impact of 0.498 at 95% CI (p<0.001) depicts a moderate effect size. An immersive and non-immersive emerging VR trend appears to be a promising therapeutic tool in sensorimotor recovery following stroke.

scholarly journals Is Fluoxetine Good for Subacute Stroke? A Meta-Analysis Evidenced From Randomized Controlled Trials

2021 ◽  
Vol 12 ◽  
Author(s):  
Guangjie Liu ◽  
Xingyu Yang ◽  
Tao Xue ◽  
Shujun Chen ◽  
Xin Wu ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Compulsive Disorder ◽  
Post Stroke ◽  
Randomized Controlled ◽  
Subacute Stroke

Background and Purpose: Fluoxetine is a drug commonly used to treat mental disorders, such as depression and obsessive–compulsive disorder, and some studies have shown that fluoxetine can improve motor and function recovery after stroke. Therefore, we performed a meta-analysis to investigate the efficacy and safety of fluoxetine in the treatment of post-stroke neurological recovery.Methods: PubMed, Embase, and Cochrane Library were searched for randomized controlled trials (RCTs) that were performed to assess the efficacy and safety of fluoxetine for functional and motor recovery in subacute stroke patients up to October 2020. Review Manager 5.3 software was used to assess the data. The risk ratio (RR) and standardized mean difference (SMD) were analyzed and calculated with a fixed effects model.Results: We pooled 6,788 patients from nine RCTs. The primary endpoint was modified Rankin Scale (mRS). Fluoxetine did not change the proportion of mRS ≤ 2 (P = 0.47). The secondary endpoints were Fugl-Meyer Motor Scale (FMMS), Barthel Index (BI), and National Institutes of Health Stroke Scale (NIHSS). Fluoxetine improved the FMMS (P &lt; 0.00001) and BI(P &lt; 0.0001) and showed a tendency of improving NIHSS (P = 0.08). In addition, we found that fluoxetine reduced the rate of new-onset depression (P &lt; 0.0001) and new antidepressants (P &lt; 0.0001).Conclusion: In post-stroke treatment, fluoxetine did not improve participants' mRS and NIHSS but improved FMMS and BI. This difference could result from heterogeneities between the trials: different treatment duration, clinical scales sensitivity, patient age, delay of inclusion, and severity of the deficit.

scholarly journals Hydroxychloroquine plus standard care compared with the standard care alone in COVID-19: a meta-analysis of randomized controlled trials

2020 ◽  
Author(s):  
Bahman Amani ◽  
Ahmad Khanijahani ◽  
Behnam Amani
Keyword(s):  
Clinical Trials ◽  
Randomized Controlled Trials ◽  
Standard Care ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Randomized Controlled ◽  
Significant Difference

AbstractBackground & ObjectiveThe efficacy and safety of Hydroxychloroquine (HCQ) in treating coronavirus disease COVID-19 pandemic is disputed. This study aimed to examine the efficacy and safety of HCQ plus the standard of care in COVID-19 patients.MethodsPubMed, The Cochrane Library, Embase, and web of sciences were searched up to June 1, 2020. The references list of the key studies was reviewed for additional relevant resources. Clinical studies registry databases were searched for identifying potential clinical trials. The quality of the included studies was evaluated using the Cochrane Collaboration’s tool. Meta-analysis was performed using RevMan software (version 5.3).ResultsThree randomized controlled trials with total number of 242 patients were identified eligible for meta-analysis. No significant differences were observed between HCQ and standard care in terms of viral clearance (Risk ratio [RR] = 1.03; 95% confidence interval [CI] = 0.91, 1.16; P = 0.68), disease progression (RR = 0.92; 95% CI = 0.10, 0.81; P = 0.94), Chest CT (RR = 1.40; 95% CI = 1.03, 1.91; P = 0.03). There is a significant difference between HCQ and standard care for adverse events (RR = 2.88; 95% CI = 1.50, 5.54; P = 0.002).ConclusionAlthough the current meta-analysis failed to confirm the efficacy and safety of HCQ in the treatment of COVID-19 patients, further rigorous randomized clinical trials are necessary to evaluate conclusively the efficacy and safety of HCQ against COVID-19.

scholarly journals Effectiveness of Acupuncture for Lateral Epicondylitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Vol 2020 ◽  
pp. 1-10 ◽  
Author(s):  
Yumei Zhou ◽  
Yuebao Guo ◽  
Rui Zhou ◽  
Ping Wu ◽  
Fanrong Liang ◽  
...  
Keyword(s):  
Acupuncture Therapy ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Lateral Epicondylitis ◽  
Sham Acupuncture ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Efficacy Rate ◽  
Randomized Controlled

Objective. This study aimed at assessing the clinical effectiveness of acupuncture for lateral epicondylitis (LE). Methods. The following databases were systematically searched: China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, Wan Fang database, Chinese Biomedicine Literature, PubMed, EMBASE, and Cochrane Library from inception to May 2019. Randomized controlled trials (RCTs) meeting the inclusion criteria were included. RevMan 5.3 software was used to conduct meta-analyses. The study quality was evaluated with the Cochrane risk of bias. Results. Ten RCTs involving 796 individuals were included in this meta-analysis. Three studies reported randomized methods with a specific description. For the analyses of the clinical efficacy rate, acupuncture outperformed sham acupuncture (two RCTs, n = 130, P=0.15), medicine therapy (two RCTs, n = 124, P=0.02), and blocking therapy (four RCTs, n = 427, P=0.0001). For the analyses of the visual analog scale, acupuncture outperformed sham acupuncture (two RCTs, n = 92, P=0.18), medicine therapy (two RCTs, n = 144, P<0.00001), and blocking therapy (two RCTs, n = 132, P=0.03). The subgroup analyses comparing acupuncture with sham acupuncture therapy revealed heterogeneities. The follow-up information and adverse reactions were not analyzed because of the insufficient number of studies. Conclusions. Acupuncture appears to be superior to drug or blocking therapy or sham acupuncture therapy for LE. However, considering the low quality of the available trials, further large-scale RCTs with a low risk of bias are needed in the future.

scholarly journals Acupuncture for Essential Hypertension: A Meta-Analysis of Randomized Sham-Controlled Clinical Trials

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Dong-Ze Li ◽  
Yu Zhou ◽  
Yi-Ning Yang ◽  
Yi-Tong Ma ◽  
Xiao-Mei Li ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Essential Hypertension ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Sham Acupuncture ◽  
Mean Difference ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Antihypertensive Medications ◽  
Randomized Controlled

Background. Acupuncture is frequently advocated as an adjunct treatment for essential hypertension. The aim of this review was to assess its adjunct effectiveness in treating hypertension.Methods. We searched PubMed, the Cochrane Library, EMBASE, and the Chinese databases Sino-Med, CNKI, WanFang, and VIP through November, 2012, for eligible randomized controlled trials that compared acupuncture with sham acupuncture. Outcome measures were changes in diastolic (DBP) and systolic blood pressure (SBP).Results. A total of 4 randomized controlled trials were included. We found no evidence of an improvement with the fact that acupuncture relative to sham acupuncture in SBP change (n=386; mean difference = −3.80 mmHg, 95% CI = −10.03–2.44 mmHg;I2=99%), and an insignificant improvement in DBP change (n=386; mean difference = −2.82 mmHg, 95% CI = −5.22–(−0.43) mmHg;I2=97%). In subgroup analyses, acupuncture significantly improved both SBP and DBP in patients taking antihypertensive medications. Only minor acupuncture-related adverse events were reported.Conclusions. Our results are consistent with acupuncture significantly lowers blood pressure in patients taking antihypertensive medications. We did not find that acupuncture without antihypertensive medications significantly improves blood pressure in those hypertensive patients.

scholarly journals Cognitive rehabilitation interventions after stroke: protocol for a systematic review and meta-analysis of randomized controlled trials

2021 ◽  
Author(s):  
Qing Zhao ◽  
Xue Wang ◽  
Tao Wang ◽  
Adam A. Dmytriw ◽  
Xiao Zhang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Cognitive Impairment ◽  
Randomized Controlled Trials ◽  
Cognitive Rehabilitation ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Post Stroke ◽  
Randomized Controlled

Abstract Background: Stroke is the second leading cause of death worldwide, and 53.4% of stroke survivors suffer from post-stroke cognitive impairment. Post-stroke cognitive impairment can increase hospitalization rate and cost of care, and decrease the quality of life of stroke patients. To date, multiple cognitive rehabilitation interventions have been tested in stroke populations with post-stroke cognitive impairment. However, the most efficacious intervention has not been established. This systematic review aims to compare the efficacy of cognitive rehabilitation interventions for patients with post-stroke cognitive impairment.Methods: We will search MEDLINE, EMBASE, CENTRAL, PsycINFO, CINAHL, PubMed, and clinical trial registries to identify eligible randomized clinical trials with no restrictions in the date of publication and language. Studies conducted with patients aged 18 or over, with the presence of cognitive impairment after being diagnosed with stroke will be included. Studies will be restricted to randomized controlled trials comparing a cognitive rehabilitation intervention with another intervention. The primary outcome is any clinical changes in the general or specific cognitive domain (e.g. executive function, attention, memory, or perception). The secondary outcomes that will be collected include adverse effects (e.g. stroke, disability, or mortality) and quality of life. Two independent reviewers will assess articles to identify trials eligible for inclusion. Data extraction and risk of bias assessment of the included studies will also be done independently. Any discrepancies will be solved by discussion, or a third reviewer will be consulted if necessary. A meta-analysis will be carried out if appropriate.Discussion: This systematic review for patients with post-stroke cognitive impairment will assess the efficacy of cognitive rehabilitation interventions. And our results will help clinical decision-making and support the development of clinical practice guidelines.Systematic review registration: PROSPERO CRD42020173988

scholarly journals Cognitive Rehabilitation Interventions After Stroke: Protocol for a Systematic Review and Meta-analysis of Randomized Controlled Trials

2020 ◽  
Author(s):  
Qing Zhao ◽  
Xue Wang ◽  
Tao Wang ◽  
Adam A. Dmytriw ◽  
Xiao Zhang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Cognitive Impairment ◽  
Randomized Controlled Trials ◽  
Cognitive Rehabilitation ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Post Stroke ◽  
Randomized Controlled

Abstract Background: Stroke is the second leading cause of deaths worldwide, and 53.4% of the stroke survivors suffer from post-stroke cognitive impairment. Post-stroke cognitive impairment can increase hospitalization rate and cost of care, and decrease the quality of life of stroke patients. To date, multiple cognitive rehabilitation interventions have been tested in stroke populations with post-stroke cognitive impairment. However, the most efficacious intervention has not been established. This systematic review aims to compare the efficacy of cognitive rehabilitation interventions for patients with post-stroke cognitive impairment.Methods: We will search MEDLINE, EMBASE, CENTRAL, PsycINFO, CINAHL, PubMed and clinical trial registries to identify eligible randomized clinical trials with no restrictions in the date of publication and language. Studies conducted with patient aged 18 or over, with the presence of cognitive impairment after being diagnosed with stroke will be included. Studies will be restricted to randomized controlled trials comparing a cognitive rehabilitation intervention with another intervention. The primary outcome is any clinical changes in general or specific cognitive domain (e.g. executive function, attention, memory or perception). The secondary outcomes that will be collected include adverse effects (e.g. stroke, disability or mortality) and quality of life. Two independent reviewers will assess articles to identify trials eligible for inclusion. Data extraction and risk of bias assessment of the included studies will also be done independently. Any discrepancies will be solved by discussion, or a third reviewer will be consulted if necessary. A meta-analysis will be carried out if appropriate.Discussion: This systematic review for patients with post-stroke cognitive impairment will assess efficacy of cognitive rehabilitation interventions. And our results will help clinical decision-making and support the development of clinical practice guidelines.Systematic review registration: PROSPERO CRD42020173988

scholarly journals Perioperative immunonutrition in esophageal cancer patients undergoing esophagectomy: the first meta-analysis of randomized clinical trials

2020 ◽  
Vol 33 (4) ◽  
Author(s):  
Wang Mingliang ◽  
Ke Zhangyan ◽  
Fan Fangfang ◽  
Wang Huizhen ◽  
Li Yongxiang
Keyword(s):  
Esophageal Cancer ◽  
Randomized Controlled Trials ◽  
Anastomotic Leakage ◽  
Large Scale ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Significant Difference

Summary Although several randomized controlled trials have been published in recent years, the effect of perioperative immunonutrition in esophageal cancer (EC) patients remains unclear. This initial meta-analysis was conducted to assess whether perioperative enteral immunonutrition reduces postoperative complications in patients undergoing esophagectomy for EC. Relevant randomized controlled trials published before 1st September 2019 were retrieved from the Cochrane Library, PubMed, and EMBASE databases. After the literature was screened, two researchers extracted the information and data from eligible studies according to predefined selection criteria. Obtained data were pooled and analyzed by RevMan 5.3 software. The results were presented as risk ratios (RRs) with 95% confidence intervals (CIs). The heterogeneity among studies was tested by I2 test. Seven high-quality randomized controlled trials were included, with a total of 606 patients, 311 of whom received immunonutrition before and after surgery, while 295 received perioperative standard nutrition. No significant difference was observed between the two groups in the incidence of postoperative infection complications, including total infection complications (RR = 0.97, CI: 0.78–1.20, P = 0.76), pneumonia (RR = 0.97, CI: 0.71–1.33, P = 0.84), wound infection (RR = 0.80, CI: 0.46–1.40, P = 0.44), sepsis (RR = 1.35, CI: 0.67–2.71, P = 0.40), and urinary tract infection (RR = 0.87, CI: 0.54–1.40, P = 0.56). The prevalence of anastomotic leakage in the two groups was 9.4 and 5.4%, but the difference was not statistically significant (RR = 0.59, CI: 0.33–1.04, P = 0.07). Perioperative enteral immunonutrition provided no benefit in terms of the incidence of infection complications and anastomotic leakage in EC patients undergoing esophagectomy. Further large-scale randomized controlled trials are needed to confirm this conclusion.

Pharmacological and Psychotherapeutic Interventions for Management of Post-stroke Depression: A Bayesian Network Meta-analysis of 27 Randomized Controlled Trials

2017 ◽  
Vol 41 (S1) ◽  
pp. S69-S70
Author(s):  
L. Deng
Keyword(s):  
Randomized Controlled Trials ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Meta Analysis ◽  
Indirect Evidence ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Post Stroke ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Post Stroke Depression

BackgroundPost-stroke depression (PSD) constitutes an important complication of stroke, leading to great disability as well as increased mortality. Since which treatment for PSD should be preferred are still matters of controversy, we aimed to compare and rank these treatments.MethodsWe did a network meta-analysis to incorporate both direct and indirect evidence from relevant trials by Bayesian random effects model. We searched PubMed, the Cochrane Library Central Register of Controlled Trials, Scopus, Embase for randomized controlled trials of different PSD treatments. The primary outcomes were efficacy and tolerability. We assessed the quality of evidence using the GRADE framework.ResultFrom 1347 citations, 27 randomised trials with a total of 1620 participants were included in this network meta-analysis. In terms of primary outcome, only for reboxetione (standardised mean difference [SMD] −12.84, 95% credible interval [CrI] −23.13 to −2.65) and nortriptyline (SMD −7.95, 95% CrI −14.85 to −1.75) enough evidence existed to support superiority compared with placebo. No significant difference was observed in terms tolerability. Considering patient response rate, repetitive transcranial magnetic stimulation (rTMS) was statistically more effective than sertraline plus nimodipine (Relative risk [RR] 5.53, 95% CrI 1.36 to 23.86) and fluoxetine (RR 10.74, 95% CrI 3.55 to 35.97)ConclusionCompared with placebo, reboxetione and nortriptyline offered a clear advantage for PSD patients. rTMS is probably the best option to consider in addition of pharmacological treatment. Nevertheless, doctors need to consider our results together with all known safety and economy information when selecting the strategy for individual patients.Disclosure of interestThe author has not supplied his declaration of competing interest.

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