Objective To evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) for treating dysfunction in patients with Parkinson’s disease (PD). Methods We searched the Cochrane Library (Issue 1, 2010), MEDLINE, EMbase, CBMdisc, and CNKI from the date of the database establishment to April 2010. Randomized controlled trials (RCTs) of rTMS for patients with PD were collected. The quality of the included RCTs was critically appraised and data were extracted by two reviewers independently. Meta-analyses were conducted for the eligible RCTs. Results Eight RCTs were included. The pooled results of the first 2 RCTs showed that, there was no significant difference compared with control group about treating PD patients with clinical motor dysfunction by high-frequency rTMS 10 days later (WMD= –4.75, 95%CI –13.73 to 4.23). The pooled analysis of another 3 studies showed that, no significant difference were found about improving symptoms with treatment of low-frequency rTMS for 1 month compared with control group (WDM= –8.51, 95%CI –18.48 to 1.46). The pooled analysis of last 3 studies showed that, patient with treatment of low-frequency rTMS for 3 months, had been significantly improved in clinical symptoms such as neurological, behavior and emotional state, clinical motor function, and activities of daily living (WDM= –5.79, 95%CI –8.44 to –1.13). The frontal or motor cortex rTMS manifested as low frequency (≤1Hz), high intensity (≥90% RMT), multi-frequency (≥3 times) and long time (≥3 months) had a positive effect on the clinical symptoms of patients with PD and also had a long-term effect. Conclusions rTMS can improve clinical symptoms and dysfunction of the patients with PD.
This paper is aimed to introduce the definition and application of Population Impact Measures (PIMs). The PIMs use Number Need to Treat (NNT) for reference and generalize the variables of clinical research to interest population, which then can be used to measure the effectiveness of interventions and the harmfulness of risk factors, so as to provide evidence for making public health policy. Of the PIMs, the variables used for measuring the effectiveness of interventions include Disease Impact Number (DIN), Population Impact Number (PIN) and Number of Events Prevented in your Population (NEPP); The variables used for measuring the harmfulness of risk factors include Exposure Impact Number (EIN), Exposed Cases Impact Number (ECIN), Population Impact Number (PIN), Case Impact Number (CIN) and Population Impact Number of Eliminating a Risk factor (PIN-ER-t).
Objective To systematically review the efficacy of low-frequency repetitive transcranial magnetic stimulation (rTMS) compared with sham therapy for the treatment of major depressive disorder. Methods The Cochrane Library, Medline, EMbase, CBMdisk, CNKI and VIP were searched through computer from 1985 to 2011. The review included RCTs comparing the treatment efficacy of low-frequency rTMS located on right dorsolateral prefrontal cortex (DLPFC) with sham stimulation in the patients suffering major depressive disorder. The quality of the included RCTs was strictly evaluated and the data were extracted by two reviewers independently. The extracted data were analyzed by RevMan 4.2. Results Among seven double-blinded RCTs involving 234 patients included, 1 was A level in quality, 5 were B level, and 1 was C level according to the outcomes of quality evaluation. The results of Meta-analysis indicated that low frequency rTMS was superior to sham stimulation in remission rates after two weeks’ treatment (RR=3.11, 95%CI 1.56 to 6.19). Additionally, low frequency rTMS was lower than the sham stimulation in the scores of HDRS and MADRS (WMD= –6.41, 95%CI –9.32 to –3.50, and WMD= –5.27, 95%CI –9.08 to –1.46, respectively). But no significant difference in response rates between the low prequency rTMS group and the sham group was found (RR=1.72, 95%CI 0.74 to 4.01). There were no severe and intolerable side effects reported in these seven studies. Conclusion The low frequency rTMS as a non-invasive and safe technique may appear to be effective for the treatment of major depressive disorder according to the positive results but the conclusion is not definite because of negative results. This review suggests that parameters could be sited as frequency: 1 Hz, intensity: 90%-110% motor threshold (MT), location: right DLPFC and duration: 2 weeks. Nevertheless, further multicenter and high quality studies are needed before it is used as a first-line treatment for major depressive disorder.
Evidence is the core of Evidence-Based Medcine; the Grades of Recommendations Assessment, Development and Evaluation (GRADE System) is a milestone in the history of evidence development. This paper outlines the GRADE System and GRADEpro 3.2 software, and briefly explores the right and wrong application which was published in the Chinese Journal of Evidence-Based Medicine. The GRADEpro 3.2 software is easy to operate, but for evaluating the reasons of upgrade and downgrade, and the importance of the parameters of outcomes, it needs to comprehensively and systematically understand the knowledge of relevant background, and to construct a solid foundation in clinical epidemiology and systematic review. In view of this paper based on the current GRADE System, there may be some discrepancy to the later content with the GRADE System constant improvement. Therefore, it is bly recommended that readers should keep constant learning and improving.
ObjectiveTo explore the effects of rehabilitation therapy on postoperative pulmonary function and exercise capacity of patients with lung cancer during the hospitalization in the setting of enhanced recovery after surgery (ERAS) protocols.MethodsA total of 110 lung cancer patients undergoing thoracoscopic lobectomy in the Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from September 2017 to December 2018 were randomly divided into the rehabilitation treatment group (the trial group, n=54) and the non-rehabilitation treatment group (the control group, n=56). The trial group got out of bed within 24 hours after surgery and performed respiratory rehabilitation training. The control group did not receive rehabilitation after surgery. Pulmonary function and 6-minute walking distance (6MWD) were evaluated preoperatively and prior to discharge in both groups to compare the differences in pulmonary function and exercise capacity between the two groups.ResultsThe preoperative forced vital capacity (FVC) in the trial group and the control group were (2.45±0.57) and (2.47±0.61) L, respectively; the forced expiratory volume in the first second (FEV1) were (2.29±0.55) and (2.22±0.55) L, respectively; 6MWD were (592±51) and (576±57) m, respectively; the differences between the two groups were not statistically significant (P>0.05). Prior to discharge, the FVC in the trial group and the control group were (1.43±0.36) and (1.19±0.33) L, respectively; FEV1 were (1.28±0.32) and (1.06±0.61) L, respectively; 6MWD were (264±43) and (218±37) m, respectively. The results of pre-discharge evaluation were significantly lower than those of preoperative evaluation (P<0.01). The pre-discharge FVC, FEV1, and 6MWD in the trial group were significantly superior to those in the control group (P<0.01).ConclusionIn the setting of ERAS protocols, postoperative rehabilitation therapy during hospitalizations can improve pulmonary function and promote the recovery of exercise capacity in lung cancer patients more effectively.
Spasm is a common complication of stroke with high morbidity and a high disability rate. Spasticity continues to impair the patient’s motor function, and symptoms such as muscle shortening and joint deformity may occur, which seriously affects the patient’s physical and mental health. Systemic therapy is a key part to control spasticity clinically. However, systematic treatment is conducted on the basis of proper assessment. The tools for assessing spasticity are divided into two categories: subjective and objective, and the subjective assessment tools mainly include some scales, which are subjectively assessed and judged by the therapist. Objective methods mainly include electrophysiology testers, ultrasonic measurement techniques, robots, three-dimensional motion analysis systems, isokinetic muscle strength testers, etc. This paper analyzes and summarizes the methods of post-hemiplegic spasticity assessment through a literature review, reviews the advantages, disadvantages and practicability of various assessment methods, and puts forward prospects for future research directions.
Objective To evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in treating stroke patients with motor dysfunction. Methods The Cochrane Library, MEDLINE, EMbase, CBM, CNKI and WanFang Data were searched from inception to January 2012, and the references of the included studies were also retrieved to collect the randomized controlled trials (RCTs) on rTMS in treating stroke patients with motor dysfunction. Two reviewers independently screened articles according to the inclusion and exclusion criteria, extracted data and evaluated the quality of the included studies. Then meta-analysis was performed using RevMan 5.0.2 software, and evidence quality and recommendation level were assessed using the GRADE system. Results A total of 11 RCTs involving 376 patients were included. The results of meta-analysis (including 3 RCTs, low quality) showed that, compared with the routine rehabilitation treatment, 2 to 4 weeks of rTMS was much beneficial to stroke patients with motor dysfunction, with significant differences (WMD=11.02, 95%CI 2.56 to 19.47). The other 8 studies only adopted descriptive analysis accordingly. Conclusion It is still uncertain of the effectiveness of rTMS in improving motor dysfunction of stroke patients, so rTMS should be applied with caution in clinic.
Objective?To evaluate Mental Imagery on rehabilitation of functions in patients with stroke. Methods?Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMbase, PEDro (www.pedro.org.au), OpenSIGLE, National Technical Information Service (NTIS), CNKI, VIP, Wanfang Data, and CBM were searched for the Randomized controlled trials (RCTs) of Mental Imagery on rehabilitation of functions in patients with stroke from the date of establishment of the databases to October 2010. The bibliographies of the included studies were searched, too. Three independent researchers evaluated the included studies using GRADE. The extracted data were analyzed by RevMan 5.0.25 and GRAEDprofiler 3.2.2. Results?A total 16 trials were discovered. Meta-analyses showed that at the end of 4th, 6th, and 8th, compared with conventional rehabilitation, the mental practice increased the score measured by FMA (WMD=7.81, 95%CI 1.96 to 13.65; WMD=13.89, 95%CI 4.53 to 23.25; and WMD=9.45, 95%CI 3.67 to 15.23, respectively) and ARAT (WMD=5.70, 95%CI 3.17 to 8.22, P=0.30). The 4 outcomes were all of low quality in the GRADE system. Conclusion?The current evidence shows mental practice could improve the upper limb function in patients after stroke, and the side effects of mental practice are not found in meta-analyses. Compared with other rehabilitative therapies, it is simper, of lower input costs, and of low operating costs. The clinicians should recommend it. Due to the limitations of the included studies, more large-sample, high-quality RCTs are required.
ObjectiveTo systematically review the effectiveness of Tai Chi for improving negative symptoms and activity participation in patients with schizophrenia. MethodsDatabases including PubMed, The Cochrane Library (Issue 3, 2016), EMbase, CBM, CNKI, VIP and WanFang Data were electronically searched to collect the randomized controlled trials (RCTs) and quasi-randomized controlled trials (quasi-RCT) about Tai Chi for improving negative symptoms and activity participation in patients with schizophrenia from inception to Apirl 1st 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software. ResultsA total of three RCTs and two quasi-RCTs were included. The result of meta-analyses showed that no significant difference was found in negative symptom scores (MD=–0.95, 95% CI –3.78 to –1.89, P=0.51) and positive symptoms scores of PANSS (MD=–0.02, 95% CI –0.50 to 0.46, P=0.94) between two groups. However, the Tai Chi group was superior to the control group in items including attention, avolition, anhedonia-asociality, alogia and affective flattening/blunting of SANS (all P values<0.05). ConclusionTai Chi may have positively influence on various negative symptoms in patients with schizophrenia, but no evidence to support the Tai Chi's effects for activities participation. Larger and higher quality studies are needed.
Objective To systematically review respiratory muscle training (RMT) on respiratory functions of patients with spinal cord injury (SCI). Methods PubMed, EMbase and The Cochrane Library were electronically searched to collect the randomized controlled trials (RCTs) about RMT on pulmonary functions in patients with SCI from inception to April, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software. Results A total of 11 RCTs involving 263 patients were included. The results of meta-analysis showed that, compared with conventional rehabilitation group, RMT effectively improved vital capacity (MD=0.41, 95%CI 0.12 to 0.69, P=0.005), inspiratory capacity (MD=0.35, 95%CI 0.05 to 0.65, P=0.02), maximal inspiratory pressure (MD=7.75, 95%CI 0.11 to 15.39, P=0.05) and maximal voluntary ventilation (MD=17.52, 95%CI 8.11 to 26.93, P=0.000 3). There were significant differences between two groups. Conclusion Current evidence shows that RMT can effectively improve the respiratory function of patients with SCI. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.