scholarly journals Changes in Dorsiflexion and Dynamic Postural Control After Mobilizations in Individuals With Chronic Ankle Instability: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 54 (4) ◽  
pp. 403-417 ◽  
Author(s):  
Robert A. Vallandingham ◽  
Stacey L. Gaven ◽  
Cameron J. Powden
Keyword(s):  
Systematic Review ◽  
Postural Control ◽  
Ankle Instability ◽  
Meta Analysis ◽  
Intervention Group ◽  
Chronic Ankle Instability ◽  
Control Group ◽  
Quality Level ◽  
Methodologic Quality ◽  
Evidence Database

Objective To conduct a systematic review with meta-analysis assessing the effectiveness of joint mobilizations for improving dorsiflexion range of motion (DFROM) and dynamic postural control in individuals with chronic ankle instability. Data Sources Electronic databases (PubMed, MEDLINE, CINAHL, and SPORTDiscus) were searched from inception to January 2017. Study Selection Included studies examined the isolated effects of joint mobilizations to enhance DFROM and dynamic postural control in individuals with chronic ankle instability and provided adequate data to calculate effect sizes (ESs) and 95% confidence intervals (CIs). Data Extraction Two investigators independently assessed the methodologic quality, level of evidence, and strength of recommendation using the Physiotherapy Evidence Database scale and the Strength of Recommendation Taxonomy. We extracted the sample sizes, means, and standard deviations for DFROM and dynamic postural control and filtered the data based on control-to-intervention and preintervention-to-postintervention (pre-post) comparisons. Data Synthesis We included 7 level 1 and 3 level 2 studies that had a median Physiotherapy Evidence Database score of 60% (range = 40%–80%). The magnitudes of control-to-intervention and pre-post differences were examined using bias-corrected Hedges g ESs. Random-effects meta-analyses were conducted for each outcome measure and comparison. Positive ESs indicated better outcome scores in the intervention group than in the control group and at postintervention than at preintervention. The α level was set at .05. Meta-analysis revealed weak and moderate ESs for overall control-to-intervention (ES = 0.41; 95% CI = 0.14, 0.68; P = .003) and pre-post (ES = 0.34; 95% CI = 0.20, 0.48; P < .001) DFROM analyses. Overall, dynamic postural control meta-analysis revealed moderate control-to-intervention (ES = 0.42; 95% CI = −0.14, 0.98; P = .14) and weak and moderate ESs for pre-post (ES = 0.37; 95% CI = −0.12, 0.87; P = .14) analyses. Conclusions We observed grade A evidence that joint mobilizations can mildly improve DFROM among individuals with chronic ankle instability compared with controls and preintervention. We observed grade B evidence that indicated conflicting effects of joint mobilizations on dynamic postural control compared with controls and preintervention.

scholarly journals Dynamic Balance Measures in Healthy and Chronic Ankle Instability Participants While Wearing Ankle Braces: Systematic Review With Meta-Analysis

2020 ◽  
pp. 1-8
Author(s):  
Robert J. Reyburn ◽  
Cameron J. Powden
Keyword(s):  
Systematic Review ◽  
Ankle Instability ◽  
Dynamic Balance ◽  
Meta Analysis ◽  
Chronic Ankle Instability ◽  
Balance Test ◽  
Ankle Brace ◽  
Time To Stabilization ◽  
Evidence Database ◽  
Healthy Participants

Context: Ankle braces have been theorized to augment dynamic balance. Objectives: To complete a systematic review with meta-analysis of the available literature assessing the effect of ankle braces on dynamic balance in individuals with and without chronic ankle instability (CAI). Evidence Acquisition: Electronic databases (PubMed, MEDLINE, CINAHL, and SPORTDiscus) were searched from inception to October 2019 using combinations of keywords related to dynamic balance, ankle braces, Star Excursion Balance Test (SEBT), Y-Balance Test (YBT), and Time to Stabilization. Inclusion criteria required that studies examined the effects of ankle braces on dynamic balance. Studies were excluded if they evaluated other conditions besides CAI, did not access dynamic balance, or did not use an ankle brace. Methodological quality was assessed using the Physiotherapy Evidence Database scale. The level of evidence was assessed using the Strength of Recommendation Taxonomy. The magnitude of brace effects on dynamic balance was examined using Hedges g effect sizes (ESs) and 95% confidence intervals (CIs). Random-effects meta-analysis was performed to synthesize SEBT/YBT and Time to Stabilization data separately. Data Synthesis: Seven studies were included with a median Physiotherapy Evidence Database score of 60% (range 50%–60%), and 4 were classified as high quality. Overall meta-analysis indicated a weak to no effect of braces on SEBT/YBT (ES = 0.117; 95% CI, −0.080 to 0.433; P = .177) and Time to Stabilization (ES = −0.064; 95% CI, −0.211 to 0.083, P = .083). Subanalysis of SEBT/YBT measures indicated a weak negative effect in healthy participants (ES = −0.116; 95% CI, −0.209 to −0.022, P = .015) and a strong positive effect in individuals with CAI (ES = 0.777; 95% CI, 0.418 to 1.136; P < .001). Conclusion: The current literature supports a strong effect of ankle braces on the SEBT/YBT in those with CAI. However, little to no dynamic balance changes were noted in healthy participants. Future research should include consistent ankle brace types, pathologic populations, and the examination of dynamic balance changes contribution to injury risk reduction.

scholarly journals Changes in Spinal and Corticospinal Excitability in Patients with Chronic Ankle Instability: A Systematic Review with Meta-Analysis

2019 ◽  
Vol 8 (7) ◽  
pp. 1037 ◽  
Author(s):  
Kyung-Min Kim ◽  
Joo-Sung Kim ◽  
David Cruz-Díaz ◽  
Seungho Ryu ◽  
Minsoo Kang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ankle Instability ◽  
Meta Analysis ◽  
Chronic Ankle Instability ◽  
H Reflex ◽  
Corticospinal Excitability ◽  
Spinal Reflex ◽  
Control Group ◽  
Neural Excitability ◽  
Ankle Muscles

The objective of this systematic review with meta-analysis was to determine alterations in spinal and corticospinal excitability of ankle muscles in patients with chronic ankle instability (CAI) compared to uninjured controls. Independent researchers performed comprehensive literature searches of electronic databases and included studies that compared groups with and without CAI and investigated neural excitability with Hoffmann reflex (H-reflex) and/or transcranial magnetic stimulation (TMS). A fixed-effect meta-analysis was conducted to determine group differences for (1) soleus and fibularis maximal H-reflex (Hmax)/maximal M-wave (Mmax)-ratios, and (2) soleus and fibularis longus cortical motor thresholds (CMTs). Seventeen studies were included in the current meta-analysis. They showed that the Hmax/Mmax-ratios of the soleus and the fibularis longus in the CAI group were significantly lower than those in the uninjured control group (soleus: d = −0.41, p < 0.001; fibularis longus: d = −0.27, p = 0.04). There was no evidence for changes in the CMT. This systematic review is the first to demonstrate evidence that patients with CAI present decreased spinal reflex excitability in the soleus and fibularis longus. However, there is no evidence of changes in supraspinal excitability when considering only the CMT. The latter result needs to be interpreted with caution as all except one study demonstrate some changes at the supraspinal level with CAI.

Effects of 12 Weeks of Tai Chi Intervention in Patients With Chronic Ankle Instability: A Randomized Controlled Trial

2020 ◽  
Vol 29 (3) ◽  
pp. 326-331
Author(s):  
David Cruz-Díaz ◽  
Kyung-Min Kim ◽  
Fidel Hita-Contreras ◽  
Marco Bergamin ◽  
Agustin Aibar-Almazán ◽  
...  
Keyword(s):  
Postural Control ◽  
Tai Chi ◽  
Ankle Instability ◽  
Controlled Trial ◽  
Intervention Group ◽  
Chronic Ankle Instability ◽  
Control Group ◽  
Balance Test ◽  
Randomized Controlled ◽  
Cumberland Ankle Instability Tool

Context: Tai Chi is a physical activity modality which is widely practiced over the world. The effectiveness of Tai Chi on postural control and balance has been described in older population, but until recently there are no studies that include patients with chronic ankle instability. Objectives: The aim of this study was to evaluate the effectiveness of 12 weeks of Tai Chi intervention on dynamic balance and self-reported instability in patients with chronic ankle instability. Study Design: A randomized controlled trial was carried out. Setting: University physical therapy facility. Participants: Fifty-two participants were allocated to an intervention group (n = 26) based on Tai Chi training or a control group (n = 26) who received no intervention. Intervention: The participants completed 12 weeks of Tai Chi intervention (1 h session/2 times per week) or no intervention in the control group. Main Outcome Measures: Outcome measures included postural control and self-reported instability feeling assessed by the Star Excursion Balance Test and the Cumberland Ankle Instability Tool, respectively. Results: There was observed significant improvement in all Star Excursion Balance Test reach distances (anterior [F = 6.26, P < .01]; posteromedial [F = 9.58, P < .01], and posterolateral [F = 8.42, P < .01]) in the Tai Chi group with no change in the control group (P < .01). The intervention group demonstrated significant improvement on self-reported instability feeling assessed by the Cumberland Ankle Instability Tool questionnaire (F = 21.36, P < .01). Conclusion: The obtained results suggested that 12 weeks of Tai Chi intervention have positive effects on postural control and self-reported instability feeling in patients with chronic ankle instability.

scholarly journals Sofosbuvir with daclatasvir and the outcomes of patients with COVID-19: a systematic review and meta-analysis with GRADE assessment

2021 ◽  
pp. postgradmedj-2021-140287
Author(s):  
Ahmad Fariz Malvi Zamzam Zein ◽  
Catur Setiya Sulistiyana ◽  
Wilson Matthew Raffaello ◽  
Arief Wibowo ◽  
Raymond Pranata
Keyword(s):  
Systematic Review ◽  
Absolute Risk ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Invasive Mechanical Ventilation ◽  
Intervention Group ◽  
Control Group ◽  
Reduce Mortality Rate ◽  
Icu Admission ◽  
Clinical Recovery

PurposeThis systematic review and meta-analysis aimed to evaluate the effect of sofosbuvir/daclatasvir (SOF/DCV) on mortality, the need for intensive care unit (ICU) admission or invasive mechanical ventilation (IMV) and clinical recovery in patients with COVID-19.MethodsWe performed a systematic literature search through the PubMed, Scopus and Embase from the inception of databases until 6 April 2021. The intervention group was SOF/DCV, and the control group was standard of care. The primary outcome was mortality, defined as clinically validated death. The secondary outcomes were (1) the need for ICU admission or IMV and (2) clinical recovery. The pooled effect estimates were reported as risk ratios (RRs).ResultsThere were four studies with a total of 231 patients in this meta-analysis. Three studies were randomised controlled trial, and one study was non-randomised. SOF/DCV was associated with lower mortality (RR: 0.31 (0.12, 0.78); p=0.013; I2: 0%) and reduced need for ICU admission or IMV (RR: 0.35 (0.18, 0.69); p=0.002; I2: 0%). Clinical recovery was achieved more frequently in the SOF/DCV (RR: 1.20 (1.04, 1.37); p=0.011; I2: 21.1%). There was a moderate certainty of evidence for mortality and need for ICU/IMV outcome, and a low certainty of evidence for clinical recovery. The absolute risk reductions were 140 fewer per 1000 for mortality and 186 fewer per 1000 for the need for ICU/IMV. The increase in clinical recovery was 146 more per 1000.ConclusionSOF/DCV may reduce mortality rate and need for ICU/IMV in patients with COVID-19 while increasing the chance for clinical recovery.Protocol registrationPROSPERO: CRD42021247510.

Biological effects of amniotic membrane on diabetic foot wounds: a systematic review

2018 ◽  
Vol 27 (Sup2) ◽  
pp. S19-S25 ◽  
Author(s):  
André Oliveira Paggiaro ◽  
Andriws Garcia Menezes ◽  
Alexandra Donizetti Ferrassi ◽  
Viviane Fernandes De Carvalho ◽  
Rolf Gemperli
Keyword(s):  
Systematic Review ◽  
Wound Healing ◽  
Amniotic Membrane ◽  
Diabetic Foot ◽  
Biological Effects ◽  
Meta Analysis ◽  
Healing Process ◽  
Intervention Group ◽  
Risk Of Bias ◽  
Control Group

Objective: The amniotic membrane has biological properties that are beneficial to the wound healing process of diabetic foot ulcers (DFU). Our aim is to analyse the scientific evidence found in literature on the use of the amniotic membrane to stimulate DFU healing. Method: A systematic review of amniotic membrane's influence was undertaken, using the search terms ‘placenta’ ‘diabetic foot’ ‘amnion’ and biological dressing’, assessing the outcomes ‘wound healing’ and ‘wound healing time’, in DFU. Following the inclusion and exclusion criteria, randomised controlled trials (RCT) were identified, and the risk of bias was analysed according to the Cochrane risk of bias tool. We conducted a meta-analysis of the two outcomes to evaluate the level of evidence. Results: We identified six clinical trials, with a total of 331 patients. The most common risks of bias in the studies were selection, attrition, and detection biases. From the meta-analysis, the difference of the intervention group (amnion) in relation to the control group was statistically significant. We found that wound healing in the group treated with amniotic membrane occurs 2.32 times more often and is 32 days faster in comparison with the group that used conventional dressings. Conclusion: There is statistical evidence to support the effectiveness of amniotic membrane in comparison with other conventional dressings. In addition, there is a clear tendency for the use of amniotic membrane treatment to result in a larger number of DFUs healing at a quicker rate.

Intra-articular Alpha-2 Agonists as an Adjunct to Local Anesthetic in Knee Arthroscopy: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 32 (02) ◽  
pp. 138-145 ◽  
Author(s):  
Rhys Holyoak ◽  
Ruan Vlok ◽  
Thomas Melhuish ◽  
Anthony Hodge ◽  
Matthew Binks ◽  
...  
Keyword(s):  
Systematic Review ◽  
Side Effects ◽  
Postoperative Pain ◽  
Local Anesthetic ◽  
Knee Arthroscopy ◽  
Meta Analysis ◽  
Intervention Group ◽  
Control Group ◽  
Antiinflammatory Drugs ◽  
Level Of Evidence

AbstractThe infiltration of local anesthetic has been shown to reduce postoperative pain in knee arthroscopy. Several studies have shown that the addition of agents such as magnesium and nonsteroidal antiinflammatory drugs (NSAIDs) result in an increased time to first analgesia and overall reduction in pain. The aim of this systematic review and meta-analysis was to determine whether the addition of an α-2 agonist (A2A) to intra-articular local anesthetic, results in a reduction in postoperative pain. Four major databases were systematically searched for relevant randomized controlled trials (RCTs) up to July 2017. RCTs containing a control group receiving a local anesthetic and an intervention group receiving the same with the addition of an A2A were included in the review. The included studies were assessed for level of evidence and risk of bias. The data were then analyzed both qualitatively and where appropriate by meta-analysis. We reviewed 12 RCTs including 603 patients. We found that the addition of an A2A resulted in a significant reduction in postoperative pain up to 24 hours. The addition of the A2A increased time to first analgesia request by 258.85 minutes (p < 0.00001). Total 24-hour analgesia consumption was analyzed qualitatively with all included studies showing a significant reduction in total analgesia requirement. Interestingly, none of the studies found an increase in side effects associated with the A2A. This study provides strong evidence for the use of A2As as a means to reduce postoperative pain post arthroscopic knee surgery, without a corresponding increase in side effects.

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