[article]
| Titre : |
Inconclusive efficacy of intervention on upper-limb function after tetraplegia : A systematic review and meta-analysis |
| Type de document : |
texte imprimé |
| Auteurs : |
Sébastien Mateo ; Julie Di Marco ; Michel Cucherat (1964-....) ; François Gueyffier |
| Année de publication : |
2020 |
| Article en page(s) : |
p. 230-240 |
| Note générale : |
doi.org/10.1016/j.rehab.2019.05.008 |
| Langues : |
Anglais (eng) |
| Mots-clés : |
Spinal cord injury Physical therapy Occupational therapy Evidence-based practice Increasing activity Neuromodulation |
| Résumé : |
Background
Rehabilitation aims to improve hand-arm function, upper-limb strength, and functional independence that has been impaired by tetraplegia. On the basis of evidence derived from stroke rehabilitation, interventions aiming to increase intensity (i.e., duration and/or number of movements practiced) or alter brain plasticity (including motor imagery, virtual reality, transcranial direct-current or magnetic stimulations; i.e., neuromodulation) are now used during tetraplegic rehabilitation. However, no meta-analysis has investigated the efficacy of these interventions.
Objective
This systematic review and meta-analysis investigated, separately, the efficacy of these interventions to alter hand-arm function, upper-limb strength, and functional independence of individuals with tetraplegia.
Methods
Two independent reviewers followed the PROSPERO protocol (CRD42018098506) for this systematic review. MEDLINE, PEDro CENTRAL, and SCOPUS databases were searched for reports of randomized controlled trials of individuals with tetraplegia that were published in English. We performed a meta-analysis of intensive versus less intensive interventions and neuromodulation versus sham interventions considering hand-arm function, strength, and functional independence.
Results
From 168 records identified, we included 29 studies (all but 1 were single-centre) in the systematic review (647 participants with C2 to T1 tetraplegia [American Spinal Injury Association impairment scale A to D]). Interventions lasted from 66 to 40,320 min. Five studies were retained in the intensity meta-analyses and 5 in the neuromodulation meta-analyses. Overall, 3/5 and 1/5 studies had adequate methodology (Cochrane Risk of Bias score ≥ 6/10). For each outcome, the p-values for the overall effect were > 0.05. Heterogeneity was low, but when analyzing intensity, it was moderate for functional independence and high for hand-arm function. Quality of evidence was very low to low.
Conclusions
We can provide no recommendations for using intensive versus less intensive interventions or neuromodulation versus sham during tetraplegia rehabilitation. Further multicentre studies of high methodological quality are required to reduce uncertainty about the efficacy of these interventions. |
| Permalink : |
./index.php?lvl=notice_display&id=90800 |
in Annals of physical and rehabilitation medicine > Vol. 63, n°3 (Mai-Juin 2020) . - p. 230-240
[article] Inconclusive efficacy of intervention on upper-limb function after tetraplegia : A systematic review and meta-analysis [texte imprimé] / Sébastien Mateo ; Julie Di Marco ; Michel Cucherat (1964-....) ; François Gueyffier . - 2020 . - p. 230-240. doi.org/10.1016/j.rehab.2019.05.008 Langues : Anglais ( eng) in Annals of physical and rehabilitation medicine > Vol. 63, n°3 (Mai-Juin 2020) . - p. 230-240
| Mots-clés : |
Spinal cord injury Physical therapy Occupational therapy Evidence-based practice Increasing activity Neuromodulation |
| Résumé : |
Background
Rehabilitation aims to improve hand-arm function, upper-limb strength, and functional independence that has been impaired by tetraplegia. On the basis of evidence derived from stroke rehabilitation, interventions aiming to increase intensity (i.e., duration and/or number of movements practiced) or alter brain plasticity (including motor imagery, virtual reality, transcranial direct-current or magnetic stimulations; i.e., neuromodulation) are now used during tetraplegic rehabilitation. However, no meta-analysis has investigated the efficacy of these interventions.
Objective
This systematic review and meta-analysis investigated, separately, the efficacy of these interventions to alter hand-arm function, upper-limb strength, and functional independence of individuals with tetraplegia.
Methods
Two independent reviewers followed the PROSPERO protocol (CRD42018098506) for this systematic review. MEDLINE, PEDro CENTRAL, and SCOPUS databases were searched for reports of randomized controlled trials of individuals with tetraplegia that were published in English. We performed a meta-analysis of intensive versus less intensive interventions and neuromodulation versus sham interventions considering hand-arm function, strength, and functional independence.
Results
From 168 records identified, we included 29 studies (all but 1 were single-centre) in the systematic review (647 participants with C2 to T1 tetraplegia [American Spinal Injury Association impairment scale A to D]). Interventions lasted from 66 to 40,320 min. Five studies were retained in the intensity meta-analyses and 5 in the neuromodulation meta-analyses. Overall, 3/5 and 1/5 studies had adequate methodology (Cochrane Risk of Bias score ≥ 6/10). For each outcome, the p-values for the overall effect were > 0.05. Heterogeneity was low, but when analyzing intensity, it was moderate for functional independence and high for hand-arm function. Quality of evidence was very low to low.
Conclusions
We can provide no recommendations for using intensive versus less intensive interventions or neuromodulation versus sham during tetraplegia rehabilitation. Further multicentre studies of high methodological quality are required to reduce uncertainty about the efficacy of these interventions. |
| Permalink : |
./index.php?lvl=notice_display&id=90800 |
|
Inconclusive efficacy of intervention on upper-limb function after tetraplegia : A systematic review and meta-analysis in Annals of physical and rehabilitation medicine, Vol. 63, n°3 (Mai-Juin 2020)
