OBJECTIVE: This study aimed to evaluate the comparative effectiveness and ranking of robot-assisted training, virtual reality, and robot-assisted rehabilitation combined with virtual reality in improving balance, gait, and daily function in patients with stroke.
DATA SOURCES: PubMed, EMBASE, the Cochrane Library, Physiotherapy Evidence Database, CINAHL, Web of Science, and ProQuest Dissertations and Theses A&I databases were comprehensively searched to include randomized controlled trials published through August 31, 2022.
STUDY SELECTION: Randomized controlled trials (RCTs) comparing between robot-assisted training, virtual reality, robot-assisted rehabilitation combined with virtual reality, and conventional therapy to assess the effects on balance, gait, and daily function of patients with stroke.
DATA EXTRACTION: The risk of bias was assessed using the Cochrane Risk of Bias tool (RoB 2.0) and the methodological quality of the studies was assessed using the Physiotherapy Evidence Database (PEDro) Scale. The network meta-analysis of random-effects models was performed for direct and indirect. Data were analyzed using Stata SE 17.0 and R 4.2.1.
DATA SYNTHESIS: A total of 52 randomized controlled trials involving 1,559 participants were included in this study. Based on the ranking probabilities, the robot-assisted rehabilitation combined with virtual reality was most effective in improving balance (surface under cumulative ranking curve values [SUCRCV]: 82.0%, mean difference [MD]: 4.10, 95% confidence interval [CI]: 0.43 to 7.67). Virtual reality was most effective in improving velocity (SUCRCV: 97.8%, MD= -0.15, 95%CI -0.24 to -0.06) and daily function (SUCRCV: 92.1%, MD= -7.85, 95%CI -15.18 to -1.07).
CONCLUSIONS: Compared to robot-assisted training and conventional therapy, robot-assisted training combined virtual reality was most likely the best intervention in balance, and virtual reality might be the most helpful in improving daily function for stroke patients. Further studies are needed to clarify the specific efficacy of robot-assisted training combined virtual reality and virtual reality on gait.
Although patient centredness is part of providing high-quality health care, little is known about the effectiveness of care transition interventions that involve patients and their families on readmissions to the hospital or emergency visits post-discharge. This systematic review (SR) aimed to examine the evidence on patient- and family-centred (PFC) care transition interventions and evaluate their effectiveness on adults’ hospital readmissions and emergency department (ED) visits after discharge. Searches of Medline, CINAHL, and Embase databases were conducted from the earliest available online year of indexing up to and including 14 March 2021. The studies included: (i) were about care transitions (hospital to home) of ≥18-year-old patients; (ii) had components of patient-centred care and care transition frameworks; (iii) reported on one or more outcomes were among hospital readmissions and ED visits after discharge; and (iv) were cluster-, pilot- or randomized-controlled trials published in English or French. Study selection, data extraction, and risk of bias assessment were completed by two independent reviewers. A narrative synthesis was performed, and pooled odd ratios, standardized mean differences, and mean differences were calculated using a random-effects meta-analysis. Of the 10,021 citations screened, 50 trials were included in the SR and 44 were included in the meta-analyses. Care transition intervention types included health assessment, symptom and disease management, medication reconciliation, discharge planning, risk management, complication detection, and emotional support. Results showed that PFC care transition interventions significantly reduced the risk of hospital readmission rates compared to usual care [incident rate ratio (IRR), 0.86; 95% confidence interval (CI), 0.75–0.98; I² = 73%] regardless of time elapsed since discharge. However, these same interventions had minimal impact on the risk of ED visit rates compared to usual care group regardless of time passed after discharge (IRR, 1.00; 95% CI, 0.85–1.18; I² = 29%). PFC care transition interventions containing a greater number of patient-centred care (IRR, 0.73; 95% CI, 0.57–0.94; I² = 59%) and care transition components (IRR, 0.76; 95% CI, 0.64–0.91; I² = 4%) significantly decreased the risk of patients being readmitted. However, these interventions did not significantly increase the risk of patients visiting the ED after discharge (IRR, 1.54; CI 95%, 0.91–2.61). Future interventions should focus on patients’ and families’ values, beliefs, needs, preferences, race, age, gender, and social determinants of health to improve the quality of adults’ care transitions. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
BACKGROUND: Depression is an important morbidity associated with stroke that impacts on recovery, yet is often undetected or inadequately treated.
OBJECTIVES: To evaluate the benefits and harms of pharmacological intervention, non-invasive brain stimulation, psychological therapy, or combinations of these to treat depression after stroke.
SEARCH METHODS: This is a living systematic review. We search for new evidence every two months and update the review when we identify relevant new evidence. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review. We searched the Specialised Registers of Cochrane Stroke, and Cochrane Depression Anxiety and Neurosis, CENTRAL, MEDLINE, Embase, five other databases, two clinical trials registers, reference lists and conference proceedings (February 2022). We contacted study authors.
SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing: 1) pharmacological interventions with placebo; 2) non-invasive brain stimulation with sham stimulation or usual care; 3) psychological therapy with usual care or attention control; 4) pharmacological intervention and psychological therapy with pharmacological intervention and usual care or attention control; 5) pharmacological intervention and non-invasive brain stimulation with pharmacological intervention and sham stimulation or usual care; 6) non-invasive brain stimulation and psychological therapy versus sham brain stimulation or usual care and psychological therapy; 7) pharmacological intervention and psychological therapy with placebo and psychological therapy; 8) pharmacological intervention and non-invasive brain stimulation with placebo and non-invasive brain stimulation; and 9) non-invasive brain stimulation and psychological therapy versus non-invasive brain stimulation and usual care or attention control, with the intention of treating depression after stroke.
DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, assessed risk of bias, and extracted data from included studies. We calculated mean difference (MD) or standardised mean difference (SMD) for continuous data, and risk ratio (RR) for dichotomous data, with 95% confidence intervals (CIs). We assessed heterogeneity using the I² statistic and certainty of the evidence according to GRADE.
MAIN RESULTS: We included 65 trials (72 comparisons) with 5831 participants. Data were available for: 1) 20 comparisons; 2) nine comparisons; 3) 25 comparisons; 4) three comparisons; 5) 14 comparisons; and 6) one comparison. We found no trials for comparisons 7 to 9. Comparison 1: Pharmacological interventions Very low-certainty evidence from eight trials suggests pharmacological interventions decreased the number of people meeting the study criteria for depression (RR 0.70, 95% CI 0.55 to 0.88; P = 0.002; 8 RCTs; 1025 participants) at end of treatment and very low-certainty evidence from six trials suggests that pharmacological interventions decreased the number of people with inadequate response to treatment (RR 0.47, 95% CI 0.32 to 0.70; P = 0.0002; 6 RCTs; 511 participants) compared to placebo. More adverse events related to the central nervous system (CNS) (RR 1.55, 95% CI 1.12 to 2.15; P = 0.008; 5 RCTs; 488 participants; very low-certainty evidence) and gastrointestinal system (RR 1.62, 95% CI 1.19 to 2.19; P = 0.002; 4 RCTs; 473 participants; very low-certainty evidence) were noted in the pharmacological intervention than in the placebo group. Comparison 2: Non-invasive brain stimulation Very low-certainty evidence from two trials show that non-invasive brain stimulation had little to no effect on the number of people meeting the study criteria for depression (RR 0.67, 95% CI 0.39 to 1.14; P = 0.14; 2 RCTs; 130 participants) and the number of people with inadequate response to treatment (RR 0.84, 95% CI 0.52, 1.37; P = 0.49; 2 RCTs; 130 participants) compared to sham stimulation. Non-invasive brain stimulation resulted in no deaths. Comparison 3: Psychological therapy Very low-certainty evidence from six trials suggests that psychological therapy decreased the number of people meeting the study criteria for depression at end of treatment (RR 0.77, 95% CI 0.62 to 0.95; P = 0.01; 521 participants) compared to usual care/attention control. No trials of psychological therapy reported on the outcome inadequate response to treatment. No differences in the number of deaths or adverse events were found in the psychological therapy group compared to the usual care/attention control group. Comparison 4: Pharmacological interventions with psychological therapy No trials of this combination reported on the primary outcomes. Combination therapy resulted in no deaths. Comparison 5: Pharmacological interventions with non-invasive brain stimulation Non-invasive brain stimulation with pharmacological intervention reduced the number of people meeting study criteria for depression at end of treatment (RR 0.77, 95% CI 0.64 to 0.91; P = 0.002; 3 RCTs; 392 participants; low-certainty evidence) but not the number of people with inadequate response to treatment (RR 0.95, 95% CI 0.69 to 1.30; P = 0.75; 3 RCTs; 392 participants; very low-certainty evidence) compared to pharmacological therapy alone. Very low-certainty evidence from five trials suggest no difference in deaths between this combination therapy (RR 1.06, 95% CI 0.27 to 4.16; P = 0.93; 487 participants) compared to pharmacological therapy intervention and sham stimulation or usual care. Comparison 6: Non-invasive brain stimulation with psychological therapy No trials of this combination reported on the primary outcomes.
AUTHORS' CONCLUSIONS: Very low-certainty evidence suggests that pharmacological, psychological and combination therapies can reduce the prevalence of depression while non-invasive brain stimulation had little to no effect on the prevalence of depression. Pharmacological intervention was associated with adverse events related to the CNS and the gastrointestinal tract. More research is required before recommendations can be made about the routine use of such treatments.
The growing understanding of the importance of involving patients with neurological diseases in their healthcare routine either for at-home management of their chronic conditions or after the hospitalization period has opened the research for new rehabilitation strategies to enhance patient engagement in neurorehabilitation. In addition, the use of new digital technologies in the neurorehabilitation field enables the implementation of telerehabilitation systems such as virtual reality interventions, video games, web-based interventions, mobile applications, web-based or telephonic telecoach programs, in order to facilitate the relationship between clinicians and patients, and to motivate and activate patients to continue with the rehabilitation process at home. Here we present a systematic review that aims at reviewing the effectiveness of different engagement strategies and the different engagement assessments while using telerehabilitation systems in patients with neurological disorders. We used PICO's format to define the question of the review, and the systematic review protocol was designed following the Preferred Reported Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Bibliographical data was collected by using the following bibliographic databases: PubMed, EMBASE, Scopus, and Web of Science. Eighteen studies were included in this systematic review for full-text analyses. Overall, the reviewed studies using engagement strategies through telerehabilitation systems in patients with neurological disorders were mainly focused on patient self-management and self-awareness, patient motivation, and patient adherence subcomponents of engagement, that are involved in by the behavioral, cognitive, and emotional dimensions of engagement. Conclusion: The studies commented throughout this systematic review pave the way for the design of new telerehabilitation protocols, not only focusing on measuring quantitative or qualitative measures but measuring both of them through a mixed model intervention design (1). The future clinical studies with a mixed model design will provide more abundant data regarding the role of engagement in telerehabilitation, leading to a possibly greater understanding of its underlying components.
BACKGROUND: People with stroke or transient ischaemic attack (TIA) are at increased risk of future stroke and other cardiovascular events. Stroke services need to be configured to maximise the adoption of evidence-based strategies for secondary stroke prevention. Smoking-related interventions were examined in a separate review so were not considered in this review. This is an update of our 2014 review.
OBJECTIVES: To assess the effects of stroke service interventions for implementing secondary stroke prevention strategies on modifiable risk factor control, including patient adherence to prescribed medications, and the occurrence of secondary cardiovascular events.
SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register (April 2017), the Cochrane Effective Practice and Organisation of Care Group Trials Register (April 2017), CENTRAL (the Cochrane Library 2017, issue 3), MEDLINE (1950 to April 2017), Embase (1981 to April 2017) and 10 additional databases including clinical trials registers. We located further studies by searching reference lists of articles and contacting authors of included studies.
SELECTION CRITERIA: We included randomised controlled trials (RCTs) that evaluated the effects of organisational or educational and behavioural interventions (compared with usual care) on modifiable risk factor control for secondary stroke prevention.
DATA COLLECTION AND ANALYSIS: Four review authors selected studies for inclusion and independently extracted data. The quality of the evidence as 'high', 'moderate', 'low' or 'very low' according to the GRADE approach (GRADEpro GDT).Three review authors assessed the risk of bias for the included studies. We sought missing data from trialists.The results are presented in 'Summary of findings' tables.
MAIN RESULTS: The updated review included 16 new studies involving 25,819 participants, resulting in a total of 42 studies including 33,840 participants. We used the Cochrane risk of bias tool and assessed three studies at high risk of bias; the remainder were considered to have a low risk of bias. We included 26 studies that predominantly evaluated organisational interventions and 16 that evaluated educational and behavioural interventions for participants. We pooled results where appropriate, although some clinical and methodological heterogeneity was present.Educational and behavioural interventions showed no clear differences on any of the review outcomes, which include mean systolic and diastolic blood pressure, mean body mass index, achievement of HbA1c target, lipid profile, mean HbA1c level, medication adherence, or recurrent cardiovascular events. There was moderate-quality evidence that organisational interventions resulted in improved blood pressure control, in particular an improvement in achieving target blood pressure (odds ratio (OR) 1.44, 95% confidence interval (CI) 1.09 to1.90; 13 studies; 23,631 participants). However, there were no significant changes in mean systolic blood pressure (mean difference (MD), -1.58 mmHg 95% CI -4.66 to 1.51; 16 studies; 17,490 participants) and mean diastolic blood pressure (MD -0.91 mmHg 95% CI -2.75 to 0.93; 14 studies; 17,178 participants). There were no significant changes in the remaining review outcomes.
AUTHORS' CONCLUSIONS: We found that organisational interventions may be associated with an improvement in achieving blood pressure target but we did not find any clear evidence that these interventions improve other modifiable risk factors (lipid profile, HbA1c, medication adherence) or reduce the incidence of recurrent cardiovascular events. Interventions, including patient education alone, did not lead to improvements in modifiable risk factor control or the prevention of recurrent cardiovascular events.
BACKGROUND: Virtual reality and interactive video gaming have emerged as recent treatment approaches in stroke rehabilitation with commercial gaming consoles in particular, being rapidly adopted in clinical settings. This is an update of a Cochrane Review published first in 2011 and then again in 2015.
OBJECTIVES: Primary objective: to determine the efficacy of virtual reality compared with an alternative intervention or no intervention on upper limb function and activity.Secondary objectives: to determine the efficacy of virtual reality compared with an alternative intervention or no intervention on: gait and balance, global motor function, cognitive function, activity limitation, participation restriction, quality of life, and adverse events.
SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register (April 2017), CENTRAL, MEDLINE, Embase, and seven additional databases. We also searched trials registries and reference lists.
SELECTION CRITERIA: Randomised and quasi-randomised trials of virtual reality ("an advanced form of human-computer interface that allows the user to 'interact' with and become 'immersed' in a computer-generated environment in a naturalistic fashion") in adults after stroke. The primary outcome of interest was upper limb function and activity. Secondary outcomes included gait and balance and global motor function.
DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials based on pre-defined inclusion criteria, extracted data, and assessed risk of bias. A third review author moderated disagreements when required. The review authors contacted investigators to obtain missing information.
MAIN RESULTS: We included 72 trials that involved 2470 participants. This review includes 35 new studies in addition to the studies included in the previous version of this review. Study sample sizes were generally small and interventions varied in terms of both the goals of treatment and the virtual reality devices used. The risk of bias present in many studies was unclear due to poor reporting. Thus, while there are a large number of randomised controlled trials, the evidence remains mostly low quality when rated using the GRADE system. Control groups usually received no intervention or therapy based on a standard-care approach.
PRIMARY OUTCOME: results were not statistically significant for upper limb function (standardised mean difference (SMD) 0.07, 95% confidence intervals (CI) -0.05 to 0.20, 22 studies, 1038 participants, low-quality evidence) when comparing virtual reality to conventional therapy. However, when virtual reality was used in addition to usual care (providing a higher dose of therapy for those in the intervention group) there was a statistically significant difference between groups (SMD 0.49, 0.21 to 0.77, 10 studies, 210 participants, low-quality evidence).
SECONDARY OUTCOMES: when compared to conventional therapy approaches there were no statistically significant effects for gait speed or balance. Results were statistically significant for the activities of daily living (ADL) outcome (SMD 0.25, 95% CI 0.06 to 0.43, 10 studies, 466 participants, moderate-quality evidence); however, we were unable to pool results for cognitive function, participation restriction, or quality of life. Twenty-three studies reported that they monitored for adverse events; across these studies there were few adverse events and those reported were relatively mild.
AUTHORS' CONCLUSIONS: We found evidence that the use of virtual reality and interactive video gaming was not more beneficial than conventional therapy approaches in improving upper limb function. Virtual reality may be beneficial in improving upper limb function and activities of daily living function when used as an adjunct to usual care (to increase overall therapy time). There was insufficient evidence to reach conclusions about the effect of virtual reality and interactive video gaming on gait speed, balance, participation, or quality of life. This review found that time since onset of stroke, severity of impairment, and the type of device (commercial or customised) were not strong influencers of outcome. There was a trend suggesting that higher dose (more than 15 hours of total intervention) was preferable as were customised virtual reality programs; however, these findings were not statistically significant.
ANTECEDENTES: El entrenamiento centrado en el cliente y orientado a la tarea es importante en la rehabilitación neurológica, pero es muy costoso y requiere mucho tiempo en la práctica clínica. El uso de la tecnología, especialmente los sistemas de captura de movimiento (MCS), que son de bajo costo y fácil de aplicar en la práctica clínica, puede ser utilizado para apoyar este tipo de formación, pero el conocimiento y la evidencia de su uso para la formación es escasa. La presente revisión pretende investigar 1) qué sistemas de captura de movimiento se utilizan como dispositivos de entrenamiento en la rehabilitación neurológica, 2) cómo se aplican, 3) en qué población objetivo, 4) cuál es el contenido de la capacitación y 5) la eficacia de la capacitación con MCS es. MÉTODOS: Se realizó una revisión sistemática de la literatura sistemática en cuatro bases de datos (PubMed, Cinahl, Cochrane Database y IEEE). Se utilizaron los siguientes términos MeSH y palabras clave: Movimiento, Movimiento, Detección, Captura, Kinect, Rehabilitación, Enfermedades del Sistema Nervioso, Esclerosis Múltiple, Derrame Cerebral, Médula Espinal, Enfermedad de Parkinson, Parálisis Cerebral y Lesión Cerebral Traumática. La evaluación de calidad de Van Tulder se utilizó para puntuar la calidad metodológica de los estudios seleccionados. El análisis descriptivo es informado por MCS, población objetivo, parámetros de entrenamiento y eficacia del entrenamiento. Resultados Se seleccionaron dieciocho estudios (valor medio de Van Tulder = 8,06 ± 3,67). Sobre la base de la calidad metodológica, se seleccionaron seis estudios para el análisis de la eficacia del entrenamiento. MCS más comúnmente utilizado fue Microsoft Kinect, el entrenamiento se llevó a cabo principalmente en la rehabilitación de un derrame cerebral. Los programas de entrenamiento variaron en intensidad, frecuencia y contenido. Ninguno de los estudios informó de un programa de capacitación individualizado basado en el enfoque centrado en el cliente. CONCLUSIÓN: Los sistemas de captura de movimiento son dispositivos de entrenamiento con potencial de rehabilitación neurológica para aumentar la motivación durante el entrenamiento y pueden ayudar a mejorar uno o más niveles de Clasificación Internacional de Funcionamiento, Discapacidad y Salud (ICF). Aunque el entrenamiento centrado en el cliente y orientado a tareas es importante en la rehabilitación neurológica, no se incluyó el enfoque centrado en el cliente. Los futuros desarrollos tecnológicos deberían aceptar el reto de combinar MCS con los principios de un enfoque orientado a las tareas centrado en el cliente y probar la eficacia utilizando ensayos controlados aleatorios con seguimiento a largo plazo. REGISTRO DE PRUEBA: Número de registro Prospero 42016035582.
OBJETIVO: Este artículo es una revisión sistemática de los efectos de la intervención basada en la tecnología en los resultados relativos a los proveedores de atención para aquellos que sobrevivieron a un accidente cerebrovascular.
MATERIAL Y MÉTODOS: Se identificó la literatura en las bases de datos PubMed, PsycINFO, Scopus, y Cochrane para las pruebas sobre las intervenciones basadas en la tecnología para los cuidadores supervivientes del accidente cerebrovascular. La búsqueda se restringió para todos los artículos en idioma Inglés desde 1970 hasta febrero de 2015 que implicaron intervenciones basadas en la tecnología. Esta revisión incluyó estudios que midieron el impacto de este tipo de enfoques en uno o más de los siguientes: la depresión y cualquiera de la capacidad, carga, estado de salud, el apoyo social, la preparación y la utilización de asistencia sanitaria por recipient- cuidado de la solución de siguiente-problema como resultados secundarios. Asesoramiento telefónico o cara a cara sesiones no eran de interés para esta revisión. La estrategia de búsqueda identificó cinco estudios que cumplieron los criterios de inclusión: dos ensayos clínicos aleatorios y tres estudios preliminares / piloto, con diversos enfoques y diseños.
RESULTADOS: Cuatro estudios han evaluado el resultado primario, dos de los cuales informó de una reducción significativa en los síntomas depresivos de los cuidadores. Dos estudios habían medido cada uno de los siguientes resultados de la carga, capacidad, estado de salud, sociales y de resolución de problemas de soporte y que no revelaron diferencias significativas después de la intervención. Sólo un estudio evaluó la preparación de los cuidadores y mostró una mejora en las puntuaciones post-test. uso de los servicios de salud por la que recibe los cuidados se evaluó mediante un estudio, y los resultados indicaron una reducción significativa en las visitas a urgencias y reingresos al hospital.
CONCLUSIONES: A pesar de diversos diseños de los estudios y los pequeños tamaños de muestra, los datos disponibles sugieren que una intervención que incorpora un modelo basado en la teoría y está diseñado para atacar los cuidadores tan pronto como sea posible es una estrategia prometedora. Por otra parte, existe la necesidad de incorporar un análisis de coste-beneficio en estudios futuros.
ANTECEDENTES: Telerehabilitación, un método emergente, se extiende más allá de la atención de rehabilitación del hospital, y facilita los enfoques multifacéticos, a menudo psicoterapéuticos para la gestión moderna de los pacientes que utilizan la tecnología de las telecomunicaciones en el hogar o en la comunidad. Aunque una amplia gama de intervenciones telerehabilitación se probó en las personas con esclerosis múltiple (esclerosis múltiple), la evidencia de su efectividad es incierta.
OBJETIVOS: Investigar la efectividad y seguridad de la intervención en personas con esclerosis múltiple telerehabilitación de mejorar los resultados del paciente. En concreto, esta revisión aborda las siguientes preguntas: ¿Qué telerehabilitación lograr mejores resultados en comparación con la tradicional intervención cara a cara; y qué tipos de intervenciones telerehabilitación son eficaces, en qué entorno y la influencia que los resultados específicos (deterioro, de limitación de la actividad y la participación)?
ESTRATEGIA DE BÚSQUEDA: Se realizó una búsqueda bibliográfica en la Cochrane de Esclerosis Múltiple y Enfermedades Raras del Sistema Nervioso Central Revisión Registro Especializado del Grupo (09 de julio de 2014.) Se realizaron búsquedas manuales en revistas relevantes y los revisaron las listas de referencias de los estudios identificados y se estableció contacto con los autores para obtener datos adicionales.
Ensayos controlados aleatorios (ECA) y ensayos clínicos controlados (ECC) que informaron intervención telerehabilitación / s en personas con esclerosis múltiple y los compararon con algún tipo de intervención de control (como el nivel más bajo o diferentes tipos de intervención, intervención mínima, lista de espera controles o ningún tratamiento (o la atención habitual); intervenciones dadas en diferentes contextos) en adultos con esclerosis múltiple.
Recopilación y análisis de datos: Dos revisores seleccionaron de forma independiente los estudios y extrajeron los datos. Tres autores de la revisión evaluaron la calidad metodológica de los estudios que utilizan el software GRADEpro (GRADEpro 2008) para la síntesis de las mejores pruebas. Un meta-análisis no fue posible debido a la marcada heterogeneidad metodológica, clínica y estadística entre los ensayos incluidos y entre los instrumentos de medición utilizados. Por lo tanto, se realizó una síntesis de mejor evidencia mediante un análisis cualitativo.
Resultados principales: Nueve ECA, uno con dos informes, (N = 531 participantes, 469 incluidos en los análisis) investigaron una variedad de intervenciones telerehabilitación en adultos con esclerosis múltiple. La media de edad de los participantes varió desde 41 hasta 52 años (media 46,5 años) y la media de años desde el diagnóstico 7,7-19,0 años (media 12,3 años). La mayoría de los participantes eran mujeres (proporción que va del 56% al 87%, con una media del 74%) y con un curso de recaída-remisión de la EM. Estas intervenciones fueron complejas, con más de un componente de rehabilitación y se incluyen la actividad física, los programas de gestión de la educación, de comportamiento y síntomas.Todos los estudios se calificó como "baja" en la evaluación de la calidad metodológica. En general, la revisión encontró evidencia "de bajo nivel" para las intervenciones de telerehabilitación en la reducción de la discapacidad y los síntomas como la fatiga a corto plazo. También hubo evidencia "de bajo nivel" de apoyo telerehabilitación en el largo plazo para mejorar las actividades funcionales, impedimentos (como la fatiga, el dolor, el insomnio); y la participación mide por la calidad de vida y los resultados psicológicos. No hubo datos limitados sobre la evaluación del proceso (la satisfacción de los participantes / terapeutas ') y no hay datos disponibles para la rentabilidad. No hubo eventos adversos reportados como resultado de las intervenciones de telerehabilitación.
Conclusiones de los revisores: En la actualidad existe evidencia limitada sobre la eficacia de telerehabilitación en la mejora de las actividades funcionales, la fatiga y la calidad de vida en adultos con esclerosis múltiple. Una serie de intervenciones telerehabilitación podría ser un método alternativo de prestación de servicios en las poblaciones con EM. No hay pruebas suficientes para apoyar sobre qué tipos de intervenciones telerehabilitación son eficaces, y en el que ajuste. Se necesitan ensayos más sólidos para construir pruebas de la efectividad clínica y el coste de estas intervenciones.
This study aimed to evaluate the comparative effectiveness and ranking of robot-assisted training, virtual reality, and robot-assisted rehabilitation combined with virtual reality in improving balance, gait, and daily function in patients with stroke.
DATA SOURCES:
PubMed, EMBASE, the Cochrane Library, Physiotherapy Evidence Database, CINAHL, Web of Science, and ProQuest Dissertations and Theses A&I databases were comprehensively searched to include randomized controlled trials published through August 31, 2022.
STUDY SELECTION:
Randomized controlled trials (RCTs) comparing between robot-assisted training, virtual reality, robot-assisted rehabilitation combined with virtual reality, and conventional therapy to assess the effects on balance, gait, and daily function of patients with stroke.
DATA EXTRACTION:
The risk of bias was assessed using the Cochrane Risk of Bias tool (RoB 2.0) and the methodological quality of the studies was assessed using the Physiotherapy Evidence Database (PEDro) Scale. The network meta-analysis of random-effects models was performed for direct and indirect. Data were analyzed using Stata SE 17.0 and R 4.2.1.
DATA SYNTHESIS:
A total of 52 randomized controlled trials involving 1,559 participants were included in this study. Based on the ranking probabilities, the robot-assisted rehabilitation combined with virtual reality was most effective in improving balance (surface under cumulative ranking curve values [SUCRCV]: 82.0%, mean difference [MD]: 4.10, 95% confidence interval [CI]: 0.43 to 7.67). Virtual reality was most effective in improving velocity (
SUCRCV:
97.8%, MD= -0.15, 95%CI -0.24 to -0.06) and daily function (
SUCRCV:
92.1%, MD= -7.85, 95%CI -15.18 to -1.07).
CONCLUSIONS:
Compared to robot-assisted training and conventional therapy, robot-assisted training combined virtual reality was most likely the best intervention in balance, and virtual reality might be the most helpful in improving daily function for stroke patients. Further studies are needed to clarify the specific efficacy of robot-assisted training combined virtual reality and virtual reality on gait.
