Abstract: BACKGROUND: Dystonia is the third common motor disorder; deep brain stimulation (DBS) has been reported as beneficial in selected dystonia patients. OBJECTIVE: To assess the effects of DBS in adults with dystonia. METHODS: Cochrane Review conducted by Rodrigues et al. searching for RCTs with a parallel design, comparing DBS versus placebo, sham intervention, or best medical/surgical treatment was summarized and discussed from a rehabilitation perspective. RESULTS: Only two RCTs, at high risk of bias, and comparing DBS with sham intervention, were selected; low quality evidence was found that DBS may improve specific symptoms and functionality in adults with cervical or…segmental/generalized dystonia; no conclusion was reached on DBS safety and tolerability. CONCLUSIONS: High quality studies are needed to verify DBS effects in dystonia; more types of dystonia and other control interventions also need to be addressed.
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Abstract: BACKGROUND: Cognitive Impairment (CI) after stroke is frequent and often persistent, and is associated with poor functional outcome. Occupational therapy (OT) is aimed at restoring functioning also by addressing CI. OBJECTIVE: Commentary on the review by Gibson et al. (2022) updating a previous Cochrane Review (Hoffmann et al., 2010 ) to investigate the effectiveness of OT on CI after stroke. METHODS: This review included randomised and quasi-randomised controlled trials evaluating OT for adults with clinically defined stroke and confirmed CI. Outcomes included basic activities of daily living (BADL) (primary), instrumental ADL (IADL), community integration and participation, global cognitive function and…specific cognitive abilities. RESULTS: Overall, 24 trials from 11 countries including 1142 participants. For BADL, a small effect below the minimal clinically important difference (MCID) was found immediately after intervention and at six months’ follow-up (low certainty evidence), but not at three months follow-up (insufficient evidence). For IADL, the evidence was very uncertain about an effect, while for community integration, there was insufficient evidence of an effect. For global cognitive performance, there was an improvement of clinical importance after the intervention (low-certainty). There was some effect for attention overall, and for executive functional performance overall (very low-certainty). Of the cognitive subdomains, there was evidence of effect of possible clinical importance, immediately after intervention, only for sustained visual attention (moderate certainty), for working memory (low certainty), and thinking flexibly (low certainty), while there was only low or very low certainty or insufficient evidence of an effect for other cognitive domains/subdomains; CONCLUSION: The authors concluded that the body of evidence for the effectiveness of OT interventions has improved since their first review. However, although their findings provide some support for the potential benefits of OT (mostly based on low certainty evidence), OT effectiveness for stroke patients remains unclear.
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Abstract: Background: Researchers may be tempted to favorably distort the interpretation of their findings when reporting the abstract (i.e., spin). Spin bias overemphasizes the beneficial effects of the intervention compared with the results shown in the full text. Objective: To assess the occurrence of spin bias and incompleteness in reporting abstracts in post-stroke upper limb (UL) rehabilitation randomized clinical trials (RCTs). Methods: A sample of 120 post-stroke UL rehabilitation RCTs (indexed in PEDro database), published in English between 2012 and 2020, was included. The completeness of reporting and spin were assessed using the Consolidated Standards of Reporting Trials for Abstracts (CONSORT-A)…and the spin checklist. The relationship between CONSORT-A and spin checklist scores with RCT and journal characteristics was assessed. Results: CONSORT-A and spin checklist scored 5.3±2.4 (max 15-points, higher scores indicating better reporting) and 5.5±2.0 (max 7-points, higher scores indicating presence of spin), respectively; Significant differences were detected between abstract and full-text scores in the CONSORT-A checklist (p < 0.01) and the spin checklist (p < 0.01). Items of the CONSORT-A checklist in the abstracts and full text showed a fair agreement (k = 0.31), while a moderate agreement (k = 0.59) for the spin checklist was detected. Completeness of abstract was associated (R2 = 0.46) with journal Impact Factor (p < 0.01), CONSORT Guideline endorsement (p = 0.04), and abstract word number (p = 0.02). A lower spin was associated with a higher journal Impact Factor (p = 0.01) and CONSORT Guideline endorsement (p = 0.01). Conclusions: Post-stroke UL rehabilitation RCTs abstracts were largely incomplete showing spin. Authors, reviewers, publishers, and stakeholders should be aware of this phenomenon. Publishers should consider allowing more words in abstracts to improve the completeness of reporting abstracts. Although we have investigated only stroke rehabilitation, our results suggest that health care professionals of all disciplines should avoid clinical decision-making based solely upon abstracts.
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Keywords: Data accuracy, stroke, abstracting and indexing, neurological rehabilitation, spin bias, randomized controlled trials
Abstract: BACKGROUND: Robot-based treatments are developing in neurorehabilitation settings. Recently, the Italian National Health Systems recognized robot-based rehabilitation as a refundable service. Thus, the Italian neurorehabilitation community promoted a national consensus on this topic. OBJECTIVE: To conceptualize undisclosed perspectives for research and applications of robotics for neurorehabilitation, based on a qualitative synthesis of reference theoretical models. METHODS: A scoping review was carried out based on a specific question from the consensus Jury. A foreground search strategy was developed on theoretical models (context) of robot-based rehabilitation (exposure), in neurological patients (population). PubMed and EMBASE® databases were searched and studies on theoretical models…of motor control, neurobiology of recovery, human-robot interaction and economic sustainability were included, while experimental studies not aimed to investigate theoretical frameworks, or considering prosthetics, were excluded. RESULTS: Overall, 3699 records were screened and finally 9 papers included according to inclusion and exclusion criteria. According to the population investigated, structured information on theoretical models and indications for future research was summarized in a synoptic table. CONCLUSION: The main indication from the Italian consensus on robotics in neurorehabilitation is the priority to design research studies aimed to investigate the role of robotic and electromechanical devices in promoting neuroplasticity.
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