Untitled

THE COCHRANE CORNER
EJPRM systematic continuous update on Cochrane reviews
in rehabilitation: news from the 3rd Issue 2009
Aim. Since 2007 we have been focusing our attention to
ISICO (Italian Scientific Spine Institute), Milan, Italy EJPRM as the best available clinical evidence as offered
by the Cochrane Collaboration. Due to the absence of a
specific Rehabilitation Group (only a Field does exist),
some reviews in the field of PRM are not easy to find.
Consequently, the EJPRM lists and presents all these
reviews systematically. The aim of the present paper is
to systematically review all the new papers in the field
of rehabilitation published in the 3rd Issue of 2009 from
Knowledge and papers about rehabilitation topics have been growing during the last few years.
the Cochrane Library in order to provide physicians a
Some results are discordant, others are based on a summary of the best updated evidence.
Methods. The authors systematically searched all the
small population, thus limiting the validity of the find- new papers of on rehabilitation from the 3rd Issue 2009
ings. The best way to deal with these problems and of the Cochrane Library. The retrieved papers have been
to synthesize the results driving to clinical indications divided in subgroups on the base of theirs topic and the
is to order systematically reviews according to their Cochrane Groups.
Results. The number of included papers was 18, 14 of
topic. This is the main aim of the Cochrane them being new reviews, 7 new reviews dealing with neu-
Collaboration, so that today the Cochrane reviews rological rehabilitation, 4 dealing with musculoskeletal dis-
are considered the most reliable synthesis instruments.
orders, 3 dealing with pain management. In addition, 4
In order to provide our readers with the best available reviews have been updated, 1 in the field of muscu-
evidence in the field of Rehabilitation, we continuously loskeletal disorders, 2 on neuromuscular disorders, and
1 on elderly rehabilitation. The Cochrane Collaboration
perform systematic reviews of the articles regularly and the Cochrane Library are two important instruments
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to improve evidence-based medicine (EBM) in medical
In the present article readers can find a list of papers practice and in the field of rehabilitation.
of rehabilitative interest systematically researched and Conclusion. The present paper can help rehabilitation
specialists to retrieve the findings of the most relevant
reviewed from the 3rd Issue of 2009. At the end of and updated reviews in order to better their clinical
the paper, a list of all the existing systematic reviews practice.
of rehabilitation interested is reported.
KEY WORDS: Nervous system disorders - Rehabilitation -
Physician's practice patterns.
Materials and methods
Accepted for publication on November 25, 2009.
The author systematically searched all the new reviews of rehabilitative interest from the 3rd Issue Corresponding author: F. Zaina, ISICO (Italian Scientific Spine 2009 of the Cochrane Library. We present the papers Institute), Via Roberto Bellarmino 13/1, Milan, Italy. E-mail: [email protected] divided in subgroups on the base of the topic. From EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE EJPRM SYSTEMATIC CONTINUOUS UPDATE ON COCHRANE REVIEWS IN REHABILITATION this review we also started a continuous update of ferent durations of antibiotic treatment for chronic the list of reviews of interest for PRM specialists in osteomyelitis, or adjusted the remission rate for bac- Appendix 1, which was first published in 2007.1 All teria species or severity of disease.
new papers have been added to the list of Cochrane Limited evidence suggests that the method of antibi- reviews of PRM interest, while the withdrawn reviews otic administration (oral versus parenteral) does not affect the rate of disease remission if the bacteria aresensitive to the antibiotic used. However, this and thelack of statistically significant differences in adverse effects need confirmation. No or insufficient evidenceexists for other aspects of antibiotic therapy for chron- The number of included papers was 18, 14 of these were new reviews. 7 new review dealing with neu-rological rehabilitation, 4 dealing with musculoskeletal disorders, 3 dealing with pain management.
Corticosteroid injection for de Quervain's tenosyn- Moreover, 4 reviews have been updated, 1 in the ovitis.—One controlled clinical trial of 18 participants field of musculoskeletal disorders, 2 on neuromus- (all pregnant or lactating women) comparing one cular disorders, and 1 on elderly rehabilitation. Allthese are listed in the other papers. steroid injection with methylprednisolone and bupi- vacaine to splinting with a thumb spica was found.3All patients in the steroid injection group (9/9)achieved complete relief of pain whereas none of the New reviews
patients in the thumb spica group (0/9) had completerelief of pain, 1 to 6 days after intervention (number needed to treat to benefit [NNTB]=1.95% CI 0.8 to1.2). No side effects or local complications of steroid COCHRANE BONE, JOINT AND MUSCLE TRAUMA VA MEDICA
Antibiotics for treating chronic osteomyelitis in The efficacy of corticosteroid injections for de aults.—iEight small trials were included (257 par- Quervain's tenosynovitis has been studied in only ticipants in total, with data available from 228).2 one small controlled clinical trial, which found steroid Study quality was often inadequate: in particular, injections to be superior to thumb spica splinting.
concealment of allocation was not confirmed and However, the applicability of these findings to daily there was an absence of blinding of outcome assess- clinical practice is limited, as they are based on only ment. The antibiotic regimens, duration of treat- one trial with a small number of included participants, ment and follow-up varied between trials. Five tri- the methodological quality was poor and only preg- als compared oral versus parenteral antibiotics.
nant and lactating women participated in the study. No There was no statistically significant difference between the two groups in the remission rate 12 Exercise for osteoarthritis of the hip.—Combining COPYRIGHT
or more months after treatment (risk ratio 0.94, 95% the results of the 5 included randomized controlled tri- confidence interval [CI] 0.78 to 1.13; 3 trials).
als (RCTs) demonstrated a small treatment effect for Antibiotic treatment for osteomyelitis was associat- pain, but no benefit in terms of improved self-report- ed with moderate or severe adverse events in 4.8% of patients allocated oral antibiotics and 15.5% Only one of these five RCTs exclusively recruited patients allocated parenteral antibiotics (risk ratio: 0.40, 95% confidence interval 0.13 to 1.22; 4 trials).
The limited number and small sample size of the Single trials with very few participants found no included RCTs restricts the confidence that can be attrib- statistical significant differences for remission or uted to these results. Adequately powered RCTs evalu- adverse events for the following three comparisons:parenteral plus oral versus parenteral only admin- ating exercise programs specifically designed for peo- istration; two oral antibiotic regimens; and two par- ple with symptomatic hip OA need to be conducted.
enteral antibiotic regimens. No trials compared dif- Topical glyceryl trinitrate for rotator cuff disease.—Τοπι EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE EJPRM SYSTEMATIC CONTINUOUS UPDATE ON COCHRANE REVIEWS IN REHABILITATION αThree small studies, one at moderate risk of bias and The selected interventions were found to be generally two at high risk of bias, were included.5 Meta-analy- sis was precluded due to different interventions and Only pharmacological interventions were included outcome measures. Study participants also had dif- and none proved to be effective as a disease-modi- fering durations of symptoms and data for pain and fying therapy for HD. Further trials with greater function could only be extracted from one study. One methodological quality should be conducted using placebo-controlled trial (20 participants) tested 5 mg more sensitive biological markers. Pre-symptomatic glyceryl trinitrate patches, used daily for three days, mutation carriers should be included in future studies.
among participants with 'acute supraspinatus ten- Therapeutic interventions for symptomatic treat- dinitis' of less than seven days duration. Treatment ment in Huntington's disease.—Twenty-two trials (1 resulted in reduced pain intensity (adjusted MD -3.50, 254 participants) were included. Nine trials had a 95% CI -3.96 to -3.04). Function was not measured.
cross-over design and 13 were conducted in parallel.7 One trial (53 participants) compared one quarter of a Study duration ranged from 2 to 80 weeks. Various 5 mg glyceryl trinitrate patch used daily for up to 24 pharmacological interventions were studied, mostly, weeks combined with rehabilitation to placebo patch- they were anti-dopaminergic drugs (N=5), glutamate es and rehabilitation among participants with receptor antagonists (N=5) and energy metabolites 'supraspinatus tendinopathy' for longer than six (N=5). Only tetrabenazine showed a clear efficacy months. A third trial (48 participants) tested 5 mg for the control of chorea. The remaining pharmaco- glyceryl trinitrate patches, used daily for three days, logical interventions revealed no clear effectiveness.
compared to corticosteroid injection among partici- No intervention proved to have a consistent symp- pants with 'rotator cuff tendinitis' of less than six- tomatic control in HD. Tetrabenazine is the anti-chor- VA MEDICA
weeks duration. Fifteen out of 24 participants in the eic drug with the best quality data available. Other glyceryl trinitrate treatment reported headache (RR symptomatic areas should be explored by well- designed randomised placebo-controlled studies.
There is some evidence from one study at high risk of bias that topical glyceryl trinitrate is more effective than placebo for rotator cuff disease among Oral versus Intravenous Steroids for Treatment of patients with acute symptoms (< seven-days dura- Relapses in Multiple Sclerosis.—Four eligible studies tion), but there is insufficient evidence to be certain (167 patients) were identified.8 Only one outcome, about their longer-term effects. Headache was a the proportion of patients with EDSS improvement common side effect in one trial and any benefits of at 4 weeks, was common to three trials. Otherwise out- treatment need to be balanced against the risk of comes were too heterogeneous to pool. Only one tri- headache. Further high quality research is needed to al employed an equivalence design, but all reported determine the effectiveness and safety of this new no statistically significant difference in outcomes between groups. Namely, there was no significantdifference in the degree of recovery 4 weeks follow- COPYRIGHT
ing treatment. No difference was found in subsequent relapse rate, disability, hospitalization, ambulation, bioavailability, or in magnetic resonance imaging Therapeutic interventions for disease progression (MRI). Due to methodological limitations, heteroge- in Huntington's disease.—Eight trials were included neous treatment regimens and limited data, formal involving a total of 1366 HD patients.6 The duration conclusions about equivalence of oral and intravenous of the studies ranged between 30 and 144 weeks (median: 52 weeks). The following interventions were Corticosteroid Therapy of Acute Exacerbations of selected: vitamin E, Idebenone, Baclofen, Lamotrigine, Multiple Sclerosis (OMEGA) trial, designed to address creatine, coenzyme Q10 + Remacemide, ethyl-eicos- such limitations, is currently underway.
apentanoic acid and Riluzole. No trials produced pos- The trials reviewed support the hypothesis that no itive results for the selected efficacy outcome mea- significant differences in clinical, radiological or phar- sures. A descriptive summary of the trials is provided.
macological outcomes oral and intravenous steroids EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE EJPRM SYSTEMATIC CONTINUOUS UPDATE ON COCHRANE REVIEWS IN REHABILITATION for MS relapses exist. However, with the small num- available for follow-up. There was no difference in ber of patients and methodological limitations, con- fatigue between the two groups. The third trial inves- clusions of equivalence are premature.
tigated a chronic disease self-management programmein 1 150 patients with chronic diseases, of whom 125 had had a stroke. There was no difference in fatigueat follow up between the treatment and control in Treatment for idiopathic and hereditary neuralgic amyotrophy (brachial neuritis).—No randomized or There is insufficient evidence available to guide quasi-randomized trials were identified.9 In 30 arti- the management of fatigue after stroke. Further trials cles anecdotal evidence was found on treatment for neuralgic amyotrophy. Only three of these articlescontained more than 10 treated cases, with one pro- Overground physical therapy gait training for chron- viding sufficient details to calculate the primary and ic stroke patients with mobility deficits.—Nine studies secondary outcome measures for this review.
involving 499 participants were included.12 We found At this moment there is no evidence from ran- no evidence for a benefit on the primary variable, domized trials on any form of treatment for neuralgic post-test gait function, based on three studies with amyotrophy. Evidence from one open-label retro- 269 participants. Uni-dimensional performance vari- spective series suggests that oral prednisone given in ables did show significant effects post-test. Gait speed the first month after onset can shorten the duration of increased by 0.07 metres per second (95% CI 0.05 to the initial pain and leads to earlier recovery in some 0.10) based on seven studies with 396 participants, patients. RCTs are needed to establish the efficacy of timed up-and-go (TUG) test improved by 1.81 seconds treatment with corticosteroids or other immune-mod- (95% CI -2.29 to -1.33), and six-minute-walk test (6MWT) increased by 26.06 metres (95% CI 7.14 to44.97) based on four studies with 181 participants.
We found no significant differences in deaths/dis- abilities or in adverse effects, based on published Acanthopanax for acute ischaemic stroke. VA MEDICA
reports or personal communication from all of the trials (962 participants) were included; the period of follow up in all included trials ranged from 10 to 30 It was found insufficient evidence to determine if days.10 None of the trials reported the pre-specified pri- overground physical therapy gait training benefits gait mary outcome death or dependency during the follow- function in patients with chronic stroke, though lim- up period. The outcome measure in all included tri- ited evidence suggests small benefits for uni-dimen- als was the improvement of neurological deficit after sional variables such as gait speed or 6MWT. These treatment; acanthopanax was associated with a sig- findings must be replicated by large, high quality stud- nificant increase in the number of participants whose neurological impairment improved (risk ratio [RR]1.22, 95% CI 1.15 to 1.29). Two trials reported adverse events; 5 trials reported no adverse events.
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The risk of bias in all the included trials was high, COCHRANE PAIN, PALLIATIVE AND SUPPORTIVE CARE GROUP and hence the data were not adequate to draw reliable Cyclobenzaprine for the treatment of myofascial conclusions about the efficacy of acanthopanax in pain in adults.—Two studies with a total of 79 par-
acute stroke. Much larger trials of greater method- ticipants were identified.13 One study, with 41 partic- ipants, compared cyclobenzaprine with clonazepam Interventions for post-stroke fatigue.—Three trials and with placebo. Participants taking cyclobenzaprine were identified.11 One randomized 83 patients with had some improvement of pain intensity compared to emotional disturbance after stroke to fluoxetine or those on clonazepam, mean difference (MD) -0.25 placebo. After correcting for differences in fatigue (95% CI, -0.41 to -0.09; P value 0.002) and placebo, MD severity at baseline, there was no significant difference -0.25 (95% CI, 0.41 to -0.09; P value 0.002). The oth- in fatigue between groups at follow up. The second er study, with 38 participants, compared cyclobenza- trial randomized 31 women with subarachnoid hem- prine with lidocaine infiltration. Thirty days after treat- orrhage to tirilazad or placebo, of whom 18 were ment there were statistically non-significant differ- EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE EJPRM SYSTEMATIC CONTINUOUS UPDATE ON COCHRANE REVIEWS IN REHABILITATION ences between comparison groups, favoring lidocaine For moderate and substantial benefit on any outcome infiltration, for the mean for global pain, MD 0.90 NNTs for the former were generally six and below (95% CI -0.35 to 2.15, P value 0.16), and for the mean for 300 mg and 600 mg daily; for fibromyalgia NNTs for pain at digital compression, MD 0.60 (95% CI - were much higher, and generally seven and above.
0.55 to 1.75, P value 0.30). There were no life-threat- Pregabalin has proven efficacy in neuropathic pain ening adverse events associated with the medications.
conditions and fibromyalgia. A minority of patients will There was insufficient evidence to support the use have substantial benefit with pregabalin, and more of cyclobenzaprine in the treatment of MP. Only two will have moderate benefit. Many will have no or triv- small studies in which a total of 35 participants were ial benefit, or will discontinue because of adverse given cyclobenzaprine, and it was not possible to events. Individualisation of treatment is needed to estimate risks for benefits or harms. Further high qual- maximise pain relief and minimise adverse events.
ity RCTs of cyclobenzaprine for treating MP need to There is no evidence to support the use of prega- be conducted before firm conclusions on its effec- tiveness and safety can be made. Experts in this area Topical rubefacients for acute and chronic pain in should elect cut-off points for participants to identify adults.—Six placebo and one active controlled stud- whether a patient has achieved a clinically relevant ies (560 and 137 participants) in acute pain, and 7 reduction of pain (primary outcome), so that their placebo and 2 active controlled studies (489 and 90 results can be combined easily into future versions of participants) in chronic pain were included.15 All used topical salicylates. The evidence in acute conditions Pregabalin for acute and chronic pain in adults.—
was not robust; using only better quality, valid stud- There was no clear evidence of beneficial effects of cient and topical control, though overall, including VA MEDICA
pregabalin in established acute postoperative pain.14No studies evaluated pregabalin in chronic nocicep- lower quality studies, the NNT for clinical success compared with placebo was 3.2 (95% CI: 2.4 to 4.9).
Pregabalin at doses of 300 mg, 450 mg, and 600 In chronic conditions the NNT was 6.2 (95% CI: 4.0 to mg daily was effective in patients with postherpetic 13) compared with topical placebo. Adverse events neuralgia, painful diabetic neuropathy, central neu- and withdrawals occurred more often with rubefa- ropathic pain, and fibromyalgia (19 studies, 7003 par- cients than placebo, but analyses were sensitive to ticipants). Pregabalin at 150 mg daily was generally inclusion of individual studies, so not robust. There ineffective. Efficacy was demonstrated for dichoto- were insufficient data to draw conclusions against mous outcomes equating to moderate or substantial pain relief, alongside lower rates for lack of efficacy The evidence does not support the use of topical discontinuations with increasing dose. The best (low- rubefacients containing salicylates for acute injuries, est) NNT for each condition for at least 50% pain relief and suggests that in chronic conditions their efficacy over baseline (substantial benefit) for 600 mg prega- compares poorly with topical non-steroidal antiin- balin daily compared with placebo were 3.9 (95% flammatory drugs (NSAIDs). Topical salicylates seem confidence interval 3.1 to 5.1) for postherpetic neu- to be relatively well tolerated in the short-term, based COPYRIGHT
ralgia, 5.0 (4.0 to 6.6) for painful diabetic neuropathy, on limited data. There is no evidence at all for topi- 5.6 (3.5 to 14) for central neuropathic pain, and 11 (7.1 cal rubefacients with other components.
With 600 mg pregabalin daily somnolence typically occurred in 15% to 25% and dizziness occurred in 27% Updated reviews
to 46%. Treatment was discontinued due to adverseevents in 18% to 28%. The proportion of participants reporting at least one adverse event was not affected by COCHRANE BONE, JOINT AND MUSCLE TRAUMA GROUP dose, nor was the number with a serious adverse event,which was not more than with placebo.
Progressive resistance strength training for improv- Higher rates of substantial benefit were found in ing physical function in older adults.—One hundred postherpetic neuralgia and painful diabetic neuropa- and twenty one trials with 6700 participants were thy than in central neuropathic pain and fibromyalgia.
included.16 In most trials, PRT was performed two to EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE EJPRM SYSTEMATIC CONTINUOUS UPDATE ON COCHRANE REVIEWS IN REHABILITATION three times per week and at a high intensity. PRT tivity analyses, which varied the risk of bias allowed resulted in a small but significant improvement in for inclusion in the meta-analyses to allow data from physical ability (33 trials, 2 172 participants; SMD 0.14, 95% CI 0.05 to 0.22). Functional limitation mea- There is no clear evidence that antidepressants are sures also showed improvements: e.g. there was a more effective than placebo in the management of modest improvement in gait speed (24 trials, 1179 patients with chronic low-back pain. These findings participants, MD 0.08 m/s, 95% CI 0.04 to 0.12); and do not imply that severely depressed patients with a moderate to large effect for getting out of a chair (11 back pain should not be treated with antidepressants; trials, 384 participants, SMD -0.94, 95% CI -1.49 to - furthermore, there is evidence for their use in other 0.38). PRT had a large positive effect on muscle strength (73 trials, 3059 participants, SMD 0.84, 95% CI0.67 to 1.00). Participants with osteoarthritis reported a reduction in pain following PRT(6 trials, 503 par-ticipants, SMD -0.30, 95% CI -0.48 to -0.13). There was no evidence from 10 other trials (587 partici- Multi-disciplinary rehabilitation for acquired brain pants) that PRT had an effect on bodily pain. Adverse injury in adults of working age.—The authors identi- events were poorly recorded but adverse events relat- fied 11 trials of good methodological quality and five ed to musculoskeletal complaints, such as joint pain of lower quality.18 Within the subgroup of predomi- and muscle soreness, were reported in many of the nantly mild brain injury, 'strong evidence' suggested studies that prospectively defined and monitored these that most patients made a good recovery with provi- events. Serious adverse events were rare, and no seri- sion of appropriate infor®
ous events were reported to be directly related to the specific intervention. For moderate to severe injury, there was 'strong evidence' of benefit from formal T is an ef A MEDICA
intervention. For patients with moderate to severe tive intervention for improving physical functioning in acquired brain injury already in rehabilitation, there older people, including improving strength and the was strong evidence that more intensive programmes performance of some simple and complex activities.
are associated with earlier functional gains, and 'mod- However, some caution is needed with transferring erate evidence' that continued outpatient therapy these exercises for use with clinical populations could help to sustain gains made in early post-acute because adverse events are not adequately reported.
rehabilitation. There was 'limited evidence' that spe-cialist in-patient rehabilitation and specialist multi- disciplinary community rehabilitation may provideadditional functional gains, but the studies serve to highlight the particular practical and ethical restraints Antidepressants for non-specific low back pain.—Ten on randomisation of severely affected individuals for trials that compared antidepressants with placebo whom there are no realistic alternatives to specialist were included in this review.17 The pooled analyses COPYRIGHT
showed no difference in pain relief (6 trials [one tri- Problems following acquired brain injury vary.
al with two treatment arms and a second trial with 3 Consequently, different interventions and combina- treatment arms]; standardized mean difference [SMD] tions of interventions are required to suit the needs of -0.04 [95% CI -0.25 to 0.17]) or depression (two trials; patients with different problems. Patients presenting SMD 0.06 [95% CI -0.29 to 0.40]) between antide- acutely to hospital with moderate to severe brain pressant and placebo treatments. The qualitative analy- injury should be routinely followed up to assess their ses found conflicting evidence on the effect of anti- needs for rehabilitation. Intensive intervention appears depressants on pain intensity in chronic low-back to lead to earlier gains. The balance between intensity pain, and no clear evidence that antidepressants and cost-effectiveness has yet to be determined.
reduce depression in chronic low-back pain patients.
Patients discharged from in-patient rehabilitation Two pooled analyses showed no difference in pain should have access to out-patient or community-based relief between different types of antidepressants and services appropriate to their needs. Those with milder placebo. Our findings were not altered by the sensi- brain injury benefit from follow up and appropriate EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE EJPRM SYSTEMATIC CONTINUOUS UPDATE ON COCHRANE REVIEWS IN REHABILITATION information and advice. Not all questions in rehabil- nificant positive effect of strength training. No effect itation can be addressed by randomised controlled of strength training was found in people with either trials or other experimental approaches. Some ques- myotonic dystrophy or facioscapulohumeral muscu- tions include which treatments work best for which lar dystrophy. Surgery had no significant effect in chil- patients over the long term, and which models of ser- dren with Duchenne muscular dystrophy and night vice represent value for money in the context of life- splinting of the ankle had no significant effect in peo- long care. In future, such questions will need to be set ple with Charcot-Marie-Tooth disease. More evidence alongside practice-based evidence gathered from large generated by methodologically sound trials is required.
systematic, longitudinal cohort studies conducted inthe context of routine clinical practice.
Discussion
Rehabilitation interventions for foot drop in neu- From the musculoskeletal group, that included 3 romuscular disease.—Early surgery did not signifi- reviews, we had some indications of efficacy of top- cantly affect walking speed in a trial including 20 chil- ical glyceryl trinitrate for rotator cuff disease,5 a weak dren with Duchenne muscular dystrophy.19 Both evidence of efficacy of corticosteroid injection for de groups deteriorated during the 12 months follow-up.
Quervain's tenosynovitis 3 and a weak evidence about After one year, the mean difference (MD) of the 28 feet the pain relief efficacy for exercise osteoarthritis of the walking time was 0.00 seconds (95% CI -0.83 to 0.83) and the MD of the 150 feet walking time was -2.88 sec- wo reviews dealt with the Huntington disease, onds, favouring the control group (95% CI -8.18 to VA MEDICA
2.42). Night splinting of the ankle did not significant- but none o the studied drugs reached significant ly affect muscle force or range of movement about the ankle in a trial of 26 participants with Charcot-Marie- Stroke is a main topic in the rehabilitation field.
Tooth disease. Improvements were observed in both Three systematic reviews in the 3rd Issue of 2009 of the the splinting and control groups. In a trial of 26 par- Cochrane Library dealt with this, both regarding its ticipants with Charcot-Marie-Tooth disease and 28 acute phase and the outcome phase.10-12 Despite this, participants with myotonic dystrophy, 24 weeks of evidence regarding the interventions investigated is still strength training significantly improved six-metre timed walk in the Charcot-Marie-Tooth group com- Among updated review, there weren’t any change pared to the control group (MD 0.70 seconds, favour- for the review about antidepressants for non-specif- ing strength training, 95% CI 0.23 to 1.17), but not in ic low back pain.17 Exercise proved to be effective in the myotonic dystrophy group (MD -0.20 seconds, improving foot drop in Charcot-Marie-Tooth Disease favouring the control group, 95% CI -0.79 to 0.39).
19 and for improving physical functioning in older No significant differences were observed for the 50 people, including improving strength and the per- metre timed walk in the Charcot-Marie-Tooth disease formance of some simple and complex activities.16 COPYRIGHT
group (MD 1.90 seconds, favouring the training group,95% CI -0.29 to 4.09) or the myotonic dystrophy group(MD -0.80 seconds, favouring the control group, 95%CI -5.29 to 3.69). In a trial of 65 participants with Conclusions
facioscapulohumeral muscular dystrophy, 26 weeks ofstrength training did not significantly affect ankle The Cochrane Collaboration and the Cochrane strength. After one year, the mean difference in max- Library are two important instruments to improve imum voluntary isometric contraction was -0.43 kg, EBM in medical practice and thus also in the favouring the control group (95%CI -2.49 to 1.63) and Rehabilitation Field. The present paper can help reha- the mean difference in dynamic strength was 0.44 kg, bilitation specialists to easily retrieve the findings of the favouring the training group (95%CI -0.89 to 1.77).
most relevant and updated reviews in order to change Only one study, involving people with Charcot- their clinical practice in a more rapid and effective Marie-Tooth disease, demonstrated a statistically sig- EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE EJPRM SYSTEMATIC CONTINUOUS UPDATE ON COCHRANE REVIEWS IN REHABILITATION References
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COPYRIGHT
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APPENDIX 1
Exercise, manipulation, massage, multidisciplinary rehabil- Chest physiotherapy for brochiolitis in children aged 0-24 itation and work conditioning for neck disorders (5 Individual patient education for low back pain 45 Exercise and physical therapy for asthma (5 reviews) 20-24 Insoles for prevention and treatment of back pain 46Mechanical traction for neck pain with or without radicu- COPYRIGHT
Physical training for bronchiectasis 25Physical training for interstitial lung disease 26 Physical therapy and pulmonary rehabilitation for BPCO Multidisciplinary rehabilitation for sub acute low back pain Educational interventions for asthma in children 29 Patient education for low-back pain (1 review) 49 Rehabilitation after lumbar disk surgery (1 review) 50 Antidepressants for non-specific low back pain 17 Back school, traction, exercise, massage, neurore- Antibiotics for treating chronic osteomyelitis in adults 2 flexotherapy, spinal manipulation and heat or cold ther- Biospychological rehabilitation for repetitive upper limb apy for non specific low back pain (7 reviews) 30-36 Bed rest for acute low back pain (1 review) 37 Conservative interventions for treating middle third clavicle Behavioural treatment and TENS for chronic low back pain Exercise for anterior cruciate ligament injuries (1 review) 53 EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE EJPRM SYSTEMATIC CONTINUOUS UPDATE ON COCHRANE REVIEWS IN REHABILITATION Exercise for treating anterior cruciate ligament injuries in combination with collateral ligament and meniscal dam- Vestibular rehabilitation for unilateral peripheral vestibular Exercise for improving balance in older people 55 Interventions for preventing falls in older people living in Orientation and modility training and reading aids for peo- Multidisciplinary rehabilitation and mobilisation for hip frac- Multidisciplinary rehabilitation programmes following Exercise for coronary heart disease (1 review) 90 joint replacement at the hip and knee in chronic Aerobic exercise and progressive resistive interventions (2 Prosthesis after limb amputation (1 review) 60 Rehabilitation after surgery for flexor tendon injuries in the Pelvic floor muscle training for prevention and treatment of Rehabilitation for ankle fractures in adults 62 urinary and faecal incontinence in antenatal and postnatal Rehabilitation for distal radial fractures (1 review) 63 Stretching to prevent or reduce muscle soreness after exer- Botulinum toxin injections for adults with overactive blad- Physical therapy for limphoedema (1 review) 65 Interventions for apathy after traumatic brain injury 95 exercise for women receiving adjuvant therapy (1 Locomotor training for walking after spinal cord injury 96 Pharmacological interventions for spasticity following spinal Cystic fibrosis and genetic disorders group: VA MEDICA
Chest physiotherapy and physical training for cystic fibro- Sensory stimulation for brain injured individuals in coma or Spinal injuries centre for people with acute traumatic spinal Cognitive rehabilitation for Alzheimer disease (1 review) 71 Light therapy, music therapy, reminiscence therapy, snoeze- Multi-disciplinary rehabilitation for acquired brain injury in len, massage and touch,TENS, validation therapy for Pharmacological treatment for agitation and aggression on Physical activity and enhanced fitness to improve cogni- tive function in older people without known cognitive Workplace interventions for preventing work disability 101 Physical activity programs for persons with dementia Exercise and Group based training for self-management Developmental, Psychosocial and Learning Problems Group strategies for type 2 diabetes mellitus (2 reviews) 102, 103 Intervention for childhood apraxia of speech 9 Intervention for dysarthria associated with acquired brain COPYRIGHT
Menstrual Disorders and Subfertility Group Personal assistance for adults (19-64) with physical impair- Exercise for vasomotor menopausal symptoms 105 Personal assistance for adults (19-64) with both physical Botulinum toxin type A and B for cervical dystonia (4 Personal assistance for children and adolescents (0-18) with Botulinum toxin type A for lower and upper limb spastici- both physical and intellectual impairments 84 ty in cerebral palsy (2 reviews) 110, 111 Personal assistance for children and adolescents (0-18) with Bromocriptine versus levodopa in early Parkinson's dis- Personal assistance for children and adolescents (0-18) with Occupational therapy for Parkinson's disease 113 Physiotherapy for Parkinson’s disease (2 reviews) 114, 115 Personal assistance for adults (19-64) with both physical Speech and language therapy for Parkinson’s disease and EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE EJPRM SYSTEMATIC CONTINUOUS UPDATE ON COCHRANE REVIEWS IN REHABILITATION Non-pharmacological therapies for dysphagia in Parkinson's Orthotic devices, Shock wave therapy for lateral elbow pain Pimozide for tics in Tourette's syndrome 120 Patient education for adults with rheumatoid arthritis 154 Therapeutic interventions for disease progression in Physiotherapy interventions for ankylosing spondylitis 155 Physiotherapy interventions for shoulder pain 156 Therapeutic interventions for symptomatic treatment in Therapeutic ultrasound for treating patellofemoral pain syn- Transcutaneous electrical nerve stimulation (TENS) for the Anti-spasticity agents for multiple sclerosis 121 treatment of rheumatoid arthritis in the hand 158 Exercise therapy, Occupational therapy for multiple sclerosis Chest physiotherapy for preventing morbidity in babies Multidisciplinary rehabilitation for adults with multiple scle- being extubated from mechanical ventilation 159 Chest physiotherapy for reducing respiratory morbidity in Oral versus Intravenous Steroids for Treatment of Relapses infants requiring ventilatory support 160 Treatment for ataxia in multiple sclerosis 125 Exercise for people with peripheral neuropathy 162 Physical therapy for Bell´s palsy (idiopathic facial paral- Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women 126 Rehabilitation interventions for foot drop in neuromuscular Balneotherapy, Occupational therapy, Splints and Orthosis for rheumatoid arthritis (3 reviews) 127-129 Strength training and aerobic exercise training for muscle dis- VA MEDICA
Bisphosphonate therapy for children and adolescents with Therapeutic exercise for people with amyotrophic lateral Braces and orthoses, Transcutaneous electrical nerve stim- Treatment for Charcot-Marie-Tooth disease 167 ulation, Therapeutic ultrasound for treating osteoarthri- Treatment for idiopathic and hereditary neuralgic amy- Continuous passive motion following total knee arthro- Treatment for spasticity in amyotrophic lateral sclerosis/ Corticosteroid injection for de Quervain's tenosynovitis 3 Custom-made foot orthoses for the treatment of foot pain 136 Treatment for swallowing difficulties (dysphagia) in chron- Deep transverse friction massage for treating tendinitis 137 Electrical stimulation, Low level laser therapy (Classes I, II Pain, Palliative and Supportive Care Group and III), Thermotherapy, Therapeutic ultrasound for the treatment of rheumatoid arthritis 138-141 (4 reviews) Antipsychotics for acute and chronic pain in adults 172 Electromagnetic fields, Thermotherapy for the treatment of Cyclobenzaprine for the treatment of myofascial pain in COPYRIGHT
Exercise for acutely hospitalised older medical patients 144 Exercise for the management of cancer-related fatigue in Exercise for osteoarthritis of the hip or knee 145 Exercise for preventing and treating osteoporosis in post- Non-invasive physical treatments for chronic/recurrent Exercise for treating fibromyalgia syndrome 147 Pregabalin for acute and chronic pain in adults 14 Exercise therapy in juvenile idiopathic arthritis 148 Psychological therapies for the management of chronic pain Home versus center based physical activity programs in Topical rubefacients for acute and chronic pain in adults 15 Intensity of exercise for the treatment of osteoarthritis 150 Touch therapies for pain relief in adults 177 Multidisciplinary rehabilitation for fibromyalgia and mus- Transcutaneous electrical nerve stimulation for acute culoskeletal pain in working age adults 151 EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE EJPRM SYSTEMATIC CONTINUOUS UPDATE ON COCHRANE REVIEWS IN REHABILITATION Transcutaneous electrical nerve stimulation (TENS) for Force platform feedback for standing balance training after Information provision for stroke patients and their care- Exercise for intermittent claudication 180 Low molecular weight heparin for prevention of venous Interventions for apraxia of speech following stroke 196 thromboembolism in patients with lower-leg immobi- Interventions for dysphagia in acute stroke 197 Interventions for motor apraxia following stroke 198 Transcutaneous electrical nerve stimulation (TENS) for pain Mailuoning for acute ischaemic stroke 199 Occupational therapy for patients with problems in activi- Organised inpatient (stroke unit) care for stroke 201 Acanthopanax for acute ischaemic stroke 10 Overground physical therapy gait training for chronic stroke Acupuncture for stroke rehabilitation 183 Acupuncture for dysphagia in acute stroke 184 Physical fitness training for stroke patients 202 Cognitive rehabilitation for attention deficits, memory deficits, Physiotherapy treatment approaches for the recovery of spatial neglect following stroke (3 reviews) 185-187 postural control and lower limb function following stroke Electrical stimulation and Supportive devices for preventing and treating post-stroke shoulder pain and subluxation(2 reviews) Speech and language therapy for aphasia and dysarthria Electromechanical-assisted training for walking after stroke due to non-progressive brain damage (2 reviews) 204, 205 Therapy-based rehabilitation services for stroke patients at VA MEDICA
improving arm function and activities of daily living after Therapy-based rehabilitation services for patients living at home more than one year after stroke. 207
Electrostimulation for promoting recovery of movement or Treadmill training and body weight support for walking EMG biofeedback for the recovery of motor function after Honey as a topical treatment for wounds 209 COPYRIGHT
EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE

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