Query: stroke

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Source: Cochrane Database of Systematic Reviews

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Total 228 results found since Jan 2013.

Transcranial Doppler sonography for detecting stenosis or occlusion of intracranial arteries in people with acute ischaemic stroke.
CONCLUSIONS: This review provides evidence that TCD or TCCD, administered by professionals with adequate experience and skills, can provide useful diagnostic information for detecting stenosis or occlusion of intracranial vessels in people with acute ischaemic stroke, or guide the request for more invasive vascular neuroimaging, especially where CT or MR-based vascular imaging are not immediately available. More studies are needed to confirm or refute the results of this review in a larger sample of stroke patients, to verify the role of contrast medium and to evaluate the clinical advantage of the use of ultrasound. ...
Source: Cochrane Database of Systematic Reviews - February 19, 2020 Category: General Medicine Authors: Mattioni A, Cenciarelli S, Eusebi P, Brazzelli M, Mazzoli T, Del Sette M, Gandolfo C, Marinoni M, Finocchi C, Saia V, Ricci S Tags: Cochrane Database Syst Rev Source Type: research

Anticoagulant treatment for subsegmental pulmonary embolism.
CONCLUSIONS: There is no evidence from randomised controlled trials to assess the effectiveness and safety of anticoagulation therapy versus control in patients with isolated subsegmental pulmonary embolism (SSPE) or incidental SSPE. Well-conducted research is required before informed practice decisions can be made. PMID: 32030721 [PubMed - in process]
Source: Cochrane Database of Systematic Reviews - February 7, 2020 Category: General Medicine Authors: Yoo HH, Nunes-Nogueira VS, Fortes Villas Boas PJ Tags: Cochrane Database Syst Rev Source Type: research

Telerehabilitation services for stroke.
CONCLUSIONS: While there is now an increasing number of RCTs testing the efficacy of telerehabilitation, it is hard to draw conclusions about the effects as interventions and comparators varied greatly across studies. In addition, there were few adequately powered studies and several studies included in this review were at risk of bias. At this point, there is only low or moderate-level evidence testing whether telerehabilitation is a more effective or similarly effective way to provide rehabilitation. Short-term post-hospital discharge telerehabilitation programmes have not been shown to reduce depressive symptoms, improv...
Source: Cochrane Database of Systematic Reviews - January 31, 2020 Category: General Medicine Authors: Laver KE, Adey-Wakeling Z, Crotty M, Lannin NA, George S, Sherrington C Tags: Cochrane Database Syst Rev Source Type: research

Motor neuroprosthesis for promoting recovery of function after stroke.
CONCLUSIONS: Current evidence indicates that MN is no more beneficial than another assistive technology device for improving activities involving limbs measured by Timed Up and Go, balance (moderate-certainty evidence), activities involving limbs measured by walking speed and modified Emory Functional Ambulation Profile, exercise capacity (low-certainty evidence), and participation scale of HRQoL (very low-certainty evidence). Evidence was insufficient to estimate the effect of MN on independence in ADL. In comparison to other assistive devices, MN does not appear to increase the number of falls (moderate-certainty evidenc...
Source: Cochrane Database of Systematic Reviews - January 14, 2020 Category: General Medicine Authors: Mendes LA, Lima IN, Souza T, do Nascimento GC, Resqueti VR, Fregonezi GA Tags: Cochrane Database Syst Rev Source Type: research

Transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis in people with low surgical risk.
CONCLUSIONS: Our meta-analysis indicates that, in the short term, TAVI probably has little or no mortality difference compared to SAVR for severe AS in individuals with low surgical risk. Similarly, there is probably little or no difference in risk of stroke, MI, and cardiac death between the two approaches. TAVI may reduce the risk of rehospitalisation, but we are uncertain about the effects on LOS. TAVI reduces the risk of atrial fibrillation, AKI, and bleeding. However, this benefit is offset by the increased risk of PPM implantation. Long-term follow-up data are needed to further assess and validate these outcomes, esp...
Source: Cochrane Database of Systematic Reviews - December 20, 2019 Category: General Medicine Authors: Kolkailah AA, Doukky R, Pelletier MP, Volgman AS, Kaneko T, Nabhan AF Tags: Cochrane Database Syst Rev Source Type: research

Non-vitamin K antagonist oral anticoagulants (NOACs) post-percutaneous coronary intervention: a network meta-analysis.
CONCLUSIONS: Very low- to moderate-certainty evidence suggests no meaningful difference in efficacy outcomes between non-vitamin K antagonist oral anticoagulants (NOAC) and vitamin K antagonists following percutaneous coronary interventions (PCI) in people with non-valvular atrial fibrillation. NOACs probably reduce the risk of recurrent hospitalisation for adverse events compared with vitamin K antagonists. Low- to moderate-certainty evidence suggests that dabigatran may reduce the rates of major and non-major bleeding, and apixaban and rivaroxaban probably reduce the rates of non-major bleeding compared with vitamin K an...
Source: Cochrane Database of Systematic Reviews - December 19, 2019 Category: General Medicine Authors: Al Said S, Alabed S, Kaier K, Tan AR, Bode C, Meerpohl JJ, Duerschmied D Tags: Cochrane Database Syst Rev Source Type: research

Community pharmacy interventions for health promotion: effects on professional practice and health outcomes.
CONCLUSIONS: Health-promotion interventions in the community pharmacy context probably improve pharmacy workers' behaviour and probably have a slight beneficial effect on health-related behaviour, intermediate clinical outcomes, and quality of life for pharmacy users. Such interventions are likely to be cost-effective and the effects are seen across a range of clinical conditions and health-related behaviours. Nevertheless the magnitude of the effects varies between conditions, and more effective interventions might be developed if greater consideration were given to the theoretical basis of the intervention and mechanisms...
Source: Cochrane Database of Systematic Reviews - December 6, 2019 Category: General Medicine Authors: Steed L, Sohanpal R, Todd A, Madurasinghe VW, Rivas C, Edwards EA, Summerbell CD, Taylor SJ, Walton RT Tags: Cochrane Database Syst Rev Source Type: research

Corticosteroids for treating sepsis in children and adults.
CONCLUSIONS: Moderate-certainty evidence indicates that corticosteroids probably reduce 28-day and hospital mortality among patients with sepsis. Corticosteroids result in large reductions in ICU and hospital length of stay (high-certainty evidence). There may be little or no difference in the risk of major complications; however, corticosteroids increase the risk of muscle weakness and hypernatraemia, and probably increase the risk of hyperglycaemia. The effects of continuous versus intermittent bolus administration of corticosteroids are uncertain. PMID: 31808551 [PubMed - in process]
Source: Cochrane Database of Systematic Reviews - December 6, 2019 Category: General Medicine Authors: Annane D, Bellissant E, Bollaert PE, Briegel J, Keh D, Kupfer Y, Pirracchio R, Rochwerg B Tags: Cochrane Database Syst Rev Source Type: research

Metformin for prevention or delay of type 2 diabetes mellitus and its associated complications in persons at increased risk for the development of type 2 diabetes mellitus.
CONCLUSIONS: Metformin compared with placebo or diet and exercise reduced or delayed the risk of T2DM in people at increased risk for the development of T2DM (moderate-quality evidence). However, metformin compared to intensive diet and exercise did not reduce or delay the risk of T2DM (moderate-quality evidence). Likewise, the combination of metformin and intensive diet and exercise compared to intensive diet and exercise only neither showed an advantage or disadvantage regarding the development of T2DM (very low-quality evidence). Data on patient-important outcomes such as mortality, macrovascular and microvascular diabe...
Source: Cochrane Database of Systematic Reviews - December 3, 2019 Category: General Medicine Authors: Madsen KS, Chi Y, Metzendorf MI, Richter B, Hemmingsen B Tags: Cochrane Database Syst Rev Source Type: research

Repetitive peripheral magnetic stimulation for impairment and disability in people after stroke.
CONCLUSIONS: Available trials provided insufficient evidence to permit any conclusions about routine use of rPMS for people after stroke. Additional trials with large sample sizes are needed to provide robust evidence for rPMS after stroke. PMID: 31784991 [PubMed - in process]
Source: Cochrane Database of Systematic Reviews - November 30, 2019 Category: General Medicine Authors: Sakai K, Yasufuku Y, Kamo T, Ota E, Momosaki R Tags: Cochrane Database Syst Rev Source Type: research

Higher versus lower fraction of inspired oxygen or targets of arterial oxygenation for adults admitted to the intensive care unit.
CONCLUSIONS: We are very uncertain about the effects of higher versus lower fraction of inspired oxygen or targets of arterial oxygenation for adults admitted to the ICU on all-cause mortality, serious adverse events, and lung injuries at the time point closest to three months due to very low-certainty evidence. Our results indicate that oxygen supplementation with higher versus lower fractions or oxygenation targets may increase mortality. None of the trials reported the proportion of participants with one or more serious adverse events according to the ICH-GCP criteria, however we found that the trials reported an increa...
Source: Cochrane Database of Systematic Reviews - November 27, 2019 Category: General Medicine Authors: Barbateskovic M, Schjørring OL, Russo Krauss S, Jakobsen JC, Meyhoff CS, Dahl RM, Rasmussen BS, Perner A, Wetterslev J Tags: Cochrane Database Syst Rev Source Type: research

Selective serotonin reuptake inhibitors (SSRIs) for stroke recovery.
CONCLUSIONS: We found no reliable evidence that SSRIs should be used routinely to promote recovery after stroke. Meta-analysis of the trials at low risk of bias indicate that SSRIs do not improve recovery from stroke. We identified potential improvements in disability only in the analyses which included trials at high risk of bias. A further meta-analysis of large ongoing trials will be required to determine the generalisability of these findings. PMID: 31769878 [PubMed - in process]
Source: Cochrane Database of Systematic Reviews - November 26, 2019 Category: General Medicine Authors: Legg LA, Tilney R, Hsieh CF, Wu S, Lundström E, Rudberg AS, Kutlubaev MA, Dennis M, Soleimani B, Barugh A, Hackett ML, Hankey GJ, Mead GE Tags: Cochrane Database Syst Rev Source Type: research

Cognitive rehabilitation for attention deficits following stroke.
CONCLUSIONS: The effectiveness of cognitive rehabilitation for attention deficits following stroke remains unconfirmed. The results suggest there may be an immediate effect after treatment on attentional abilities, but future studies need to assess what helps this effect persist and generalise to attentional skills in daily life. Trials also need to have higher methodological quality and better reporting. PMID: 31706263 [PubMed - in process]
Source: Cochrane Database of Systematic Reviews - November 10, 2019 Category: General Medicine Authors: Loetscher T, Potter KJ, Wong D, das Nair R Tags: Cochrane Database Syst Rev Source Type: research

Peroxisome proliferator-activated receptor gamma agonists for preventing recurrent stroke and other vascular events in people with stroke or transient ischaemic attack.
CONCLUSIONS: Peroxisome proliferator-activated receptor gamma agonists probably reduce recurrent stroke and total events of cardiovascular death, non-fatal myocardial infarction or non-fatal stroke, and may improve insulin sensitivity and the stabilisation of carotid plaques. Their effects on adverse events are uncertain. Our conclusions should be interpreted with caution considering the small number and the quality of the included studies. Further well-designed, double-blind RCTs with large samples are required to assess the efficacy and safety of PPAR-γ agonists in the secondary prevention of stroke and related vascular...
Source: Cochrane Database of Systematic Reviews - October 9, 2019 Category: General Medicine Authors: Liu J, Wang LN Tags: Cochrane Database Syst Rev Source Type: research

Interventions for preventing falls in people after stroke.
CONCLUSIONS: At present there exists very little evidence about interventions other than exercises to reduce falling post stroke. Low to very low quality evidence exists that this population benefits from exercises to prevent falls, but not to reduce number of fallers.Fall research does not in general or consistently follow methodological gold standards, especially with regard to fall definition and time post stroke. More well-reported, adequately-powered research should further establish the value of exercises in reducing falling, in particular per phase, post stroke. PMID: 31573069 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - October 1, 2019 Category: General Medicine Authors: Denissen S, Staring W, Kunkel D, Pickering RM, Lennon S, Geurts AC, Weerdesteyn V, Verheyden GS Tags: Cochrane Database Syst Rev Source Type: research

Marine-derived n-3 fatty acids therapy for stroke.
CONCLUSIONS: We are very uncertain of the effect of marine-derived n-3 PUFAs therapy on functional outcomes and dependence after stroke as there is insufficient high-quality evidence. More well-designed RCTs are needed, specifically in acute stroke, to determine the efficacy and safety of the intervention.Studies assessing functionality might consider starting the intervention as early as possible after the event, as well as using standardised clinically-relevant measures for functional outcomes, such as the modified Rankin Scale. Optimal doses remain to be determined; delivery forms (type of lipid carriers) and mode of ad...
Source: Cochrane Database of Systematic Reviews - June 26, 2019 Category: General Medicine Authors: Alvarez Campano CG, Macleod MJ, Aucott L, Thies F Tags: Cochrane Database Syst Rev Source Type: research

Interventions for visual field defects in people with stroke.
CONCLUSIONS: There is a lack of evidence relating to the effect of interventions on our primary outcome of functional ability in activities of daily living. There is limited low-quality evidence that compensatory scanning training may be more beneficial than placebo or control at improving quality of life, but not other outcomes. There is insufficient evidence to reach any generalised conclusions about the effect of restitutive interventions or substitutive interventions (prisms) as compared to placebo, control, or no treatment. There is low-quality evidence that prisms may cause minor adverse events. PMID: 31120142 [...
Source: Cochrane Database of Systematic Reviews - May 23, 2019 Category: General Medicine Authors: Pollock A, Hazelton C, Rowe FJ, Jonuscheit S, Kernohan A, Angilley J, Henderson CA, Langhorne P, Campbell P Tags: Cochrane Database Syst Rev Source Type: research

Transcranial direct current stimulation (tDCS) for improving aphasia in adults with aphasia after stroke.
CONCLUSIONS: Currently there is no evidence of the effectiveness of tDCS (anodal tDCS, cathodal tDCS and Dual-tDCS) versus control (sham tDCS) for improving functional communication in people with aphasia after stroke (low quality of evidence). However, there is limited evidence that tDCS may improve naming performance in naming nouns (moderate quality of evidence), but not verbs (very low quality of evidence) at the end of the intervention period and possibly also at follow-up. Further methodologically rigorous RCTs with adequate sample size calculation are needed in this area to determine the effectiveness of this interv...
Source: Cochrane Database of Systematic Reviews - May 21, 2019 Category: General Medicine Authors: Elsner B, Kugler J, Pohl M, Mehrholz J Tags: Cochrane Database Syst Rev Source Type: research

Stem cell transplantation for ischemic stroke.
CONCLUSIONS: Overall, in participants with ischemic stroke, stem cell transplantation was associated with a reduced neurological impairment, but not with a better functional outcome. No obvious safety concerns were raised. However, these conclusions came mostly from small RCTs with high risk of bias, and the certainty of the evidence ranged from low to very low. More well-designed trials are needed. PMID: 31055832 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - May 5, 2019 Category: General Medicine Authors: Boncoraglio GB, Ranieri M, Bersano A, Parati EA, Del Giovane C Tags: Cochrane Database Syst Rev Source Type: research

Prehospital stroke scales as screening tools for early identification of stroke and transient ischemic attack.
CONCLUSIONS: In the field, CPSS had consistently the highest sensitivity and, therefore, should be preferred to other scales. Further evidence is needed to determine its absolute accuracy and whether alternatives scales, such as MASS and ROSIER, which might have comparable sensitivity but higher specificity, should be used instead, to achieve better overall accuracy. In the ER, ROSIER should be the test of choice, as it was evaluated in more studies than FAST and showed consistently high sensitivity. In a cohort of 100 people of whom 62 have stroke/TIA, the test will miss on average seven people with stroke/TIA (ranging fr...
Source: Cochrane Database of Systematic Reviews - April 9, 2019 Category: General Medicine Authors: Zhelev Z, Walker G, Henschke N, Fridhandler J, Yip S Tags: Cochrane Database Syst Rev Source Type: research

Pharmaceutical interventions for emotionalism after stroke.
CONCLUSIONS: Antidepressants may reduce the frequency and severity of crying or laughing episodes based on very low quality evidence. Our conclusions must be qualified by several methodological deficiencies in the studies and interpreted with caution despite the effect being very large. The effect does not seem specific to one drug or class of drugs. More reliable data are required before appropriate conclusions can be made about the treatment of post-stroke emotionalism. Future trialists investigating the effect of antidepressants in people with emotionalism after stroke should consider developing and using a standardised...
Source: Cochrane Database of Systematic Reviews - March 19, 2019 Category: General Medicine Authors: Allida S, Patel K, House A, Hackett ML Tags: Cochrane Database Syst Rev Source Type: research

Calcium antagonists for acute ischemic stroke.
CONCLUSIONS: We found no evidence to support the use of calcium antagonists in people with acute ischemic stroke. PMID: 30758052 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - February 13, 2019 Category: General Medicine Authors: Zhang J, Liu J, Li D, Zhang C, Liu M Tags: Cochrane Database Syst Rev Source Type: research

Interventions for treating urinary incontinence after stroke in adults.
CONCLUSIONS: There is insufficient evidence to guide continence care of adults in the rehabilitative phase after stroke. As few trials tested the same intervention, conclusions are drawn from few, usually small, trials. CIs were wide, making it difficult to ascertain if there were clinically important differences. Only four trials had adequate allocation concealment and many were limited by poor reporting, making it impossible to judge the extent to which they were prone to bias. More appropriately powered, multicentre trials of interventions are required to provide robust evidence for interventions to improve urinary inco...
Source: Cochrane Database of Systematic Reviews - February 1, 2019 Category: General Medicine Authors: Thomas LH, Coupe J, Cross LD, Tan AL, Watkins CL Tags: Cochrane Database Syst Rev Source Type: research

Action observation for upper limb rehabilitation after stroke.
CONCLUSIONS: We found evidence that AO is beneficial in improving upper limb motor function and dependence in activities of daily living (ADL) in people with stroke, when compared with any control group; however, we considered the quality of the evidence to be low. We considered the effect of AO on hand function to be large, but it does not appear to be clinically relevant, although we considered the quality of the evidence as moderate. As such, our confidence in the effect estimate is limited because it will likely change with future research. PMID: 30380586 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - October 31, 2018 Category: General Medicine Authors: Borges LR, Fernandes AB, Melo LP, Guerra RO, Campos TF Tags: Cochrane Database Syst Rev Source Type: research

Swallowing therapy for dysphagia in acute and subacute stroke.
CONCLUSIONS: Moderate- and low-quality evidence suggests that swallowing therapy did not have a significant effect on the outcomes of death or dependency/disability, case fatality at the end of the trial, or penetration aspiration score. However, swallowing therapy may have reduced length of hospital stay, dysphagia, and chest infections, and may have improved swallowing ability. However, these results are based on evidence of variable quality, involving a variety of interventions. Further high-quality trials are needed to test whether specific interventions are effective. PMID: 30376602 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - October 30, 2018 Category: General Medicine Authors: Bath PM, Lee HS, Everton LF Tags: Cochrane Database Syst Rev Source Type: research

Gamma aminobutyric acid (GABA) receptor agonists for acute stroke.
CONCLUSIONS: This review provides moderate-quality evidence that fails to support the use of GABA receptor agonists (chlormethiazole or diazepam) for the treatment of people with acute stroke. More well-designed RCTs with large samples of participants with total anterior circulation syndrome are required to determine if there are benefits for this subgroup. Somnolence and rhinitis are frequent adverse events related to chlormethiazole. PMID: 30376593 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - October 30, 2018 Category: General Medicine Authors: Liu J, Zhang J, Wang LN Tags: Cochrane Database Syst Rev Source Type: research

Percutaneous vascular interventions versus intravenous thrombolytic treatment for acute ischaemic stroke.
CONCLUSIONS: The present review directly compared intravenous thrombolytic treatment with percutaneous vascular interventions for ischaemic stroke. We found no evidence from RCTs that percutaneous vascular interventions are superior to intravenous thrombolytic treatment with respect to functional outcome. Quality of evidence was low (outcome assessment was blinded, but not the treating physician or participants). New trials with adequate sample sizes are warranted because of the rapid development of new techniques and devices for such interventions. PMID: 30365156 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - October 26, 2018 Category: General Medicine Authors: Lindekleiv H, Berge E, Bruins Slot KM, Wardlaw JM Tags: Cochrane Database Syst Rev Source Type: research

Very early versus delayed mobilisation after stroke.
CONCLUSIONS: VEM, which usually involved first mobilisation within 24 hours of stroke onset, did not increase the number of people who survived or made a good recovery after their stroke. VEM may have reduced the length of stay in hospital by about one day, but this was based on low-quality evidence. Based on the potential hazards reported in the single largest RCT, the sensitivity analysis of trials commencing mobilisation within 24 hours, and the NMA, there was concern that VEM commencing within 24 hours may carry an increased risk, at least in some people with stroke. Given the uncertainty around these effect estimates,...
Source: Cochrane Database of Systematic Reviews - October 16, 2018 Category: General Medicine Authors: Langhorne P, Collier JM, Bate PJ, Thuy MN, Bernhardt J Tags: Cochrane Database Syst Rev Source Type: research

Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke.
CONCLUSIONS: People who receive electromechanical and robot-assisted arm training after stroke might improve their activities of daily living, arm function, and arm muscle strength. However, the results must be interpreted with caution although the quality of the evidence was high, because there were variations between the trials in: the intensity, duration, and amount of training; type of treatment; participant characteristics; and measurements used. PMID: 30175845 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - September 3, 2018 Category: General Medicine Authors: Mehrholz J, Pohl M, Platz T, Kugler J, Elsner B Tags: Cochrane Database Syst Rev Source Type: research

Recanalisation therapies for wake-up stroke.
CONCLUSIONS: There is insufficient evidence from randomised controlled trials for recommendations concerning recanalisation therapies for wake-up stroke. Results from ongoing trials will hopefully establish the efficacy and safety of such therapies. PMID: 30129656 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - August 21, 2018 Category: General Medicine Authors: Roaldsen MB, Lindekleiv H, Mathiesen EB, Berge E Tags: Cochrane Database Syst Rev Source Type: research

Activity monitors for increasing physical activity in adult stroke survivors.
CONCLUSIONS: Only four small RCTs with 274 participants (three in inpatient rehabilitation and one in the community) have examined the efficacy of activity monitors for increasing physical activity after stroke. Although these studies showed activity monitors could be incorporated into practice, there is currently not enough evidence to support the use of activity monitors to increase physical activity after stroke. PMID: 30051462 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - July 27, 2018 Category: General Medicine Authors: Lynch EA, Jones TM, Simpson DB, Fini NA, Kuys SS, Borschmann K, Kramer S, Johnson L, Callisaya ML, Mahendran N, Janssen H, English C, ACTIOnS Collaboration Tags: Cochrane Database Syst Rev Source Type: research

Blood pressure-lowering treatment for preventing recurrent stroke, major vascular events, and dementia in patients with a history of stroke or transient ischaemic attack.
CONCLUSIONS: Our results support the use of BPLDs in people with stroke or TIA for reducing the risk of recurrent stroke. Current evidence is primarily derived from trials studying an ACE inhibitor or a diuretic. No definite conclusions can be drawn from current evidence regarding an optimal systolic blood pressure target after stroke or TIA. PMID: 30024023 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - July 19, 2018 Category: General Medicine Authors: Zonneveld TP, Richard E, Vergouwen MD, Nederkoorn PJ, de Haan R, Roos YB, Kruyt ND Tags: Cochrane Database Syst Rev Source Type: research

Mirror therapy for improving motor function after stroke.
CONCLUSIONS: The results indicate evidence for the effectiveness of mirror therapy for improving upper extremity motor function, motor impairment, activities of daily living, and pain, at least as an adjunct to conventional rehabilitation for people after stroke. Major limitations are small sample sizes and lack of reporting of methodological details, resulting in uncertain evidence quality. PMID: 29993119 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - July 11, 2018 Category: General Medicine Authors: Thieme H, Morkisch N, Mehrholz J, Pohl M, Behrens J, Borgetto B, Dohle C Tags: Cochrane Database Syst Rev Source Type: research

Remote ischaemic conditioning for preventing and treating ischaemic stroke.
CONCLUSIONS: We found low-quality evidence that RIC may reduce the risk of recurrent stroke in participants with intracerebral artery stenosis and reduce stroke severity in participants undergoing carotid stenting, but it may increase death or dependence in participants with acute ischaemic stroke who are undergoing intravenous thrombolysis. However, there is considerable uncertainty about these conclusions because of the small number of studies and low quality of the evidence. PMID: 29974450 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - July 5, 2018 Category: General Medicine Authors: Zhao W, Zhang J, Sadowsky MG, Meng R, Ding Y, Ji X Tags: Cochrane Database Syst Rev Source Type: research

Interventions for improving modifiable risk factor control in the secondary prevention of stroke.
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. PMID: 29734470 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - May 7, 2018 Category: General Medicine Authors: Bridgwood B, Lager KE, Mistri AK, Khunti K, Wilson AD, Modi P Tags: Cochrane Database Syst Rev Source Type: research

Acupuncture for acute stroke.
CONCLUSIONS: This updated review indicates that apparently improved outcomes with acupuncture in acute stroke are confounded by the risk of bias related to use of open controls. Adverse events related to acupuncture were reported to be minor and usually did not result in stopping treatment. Future studies are needed to confirm or refute any effects of acupuncture in acute stroke. Trials should clearly report the method of randomization, concealment of allocation, and whether blinding of participants, personnel, and outcome assessors was achieved, while paying close attention to the effects of acupuncture on long-term funct...
Source: Cochrane Database of Systematic Reviews - March 30, 2018 Category: General Medicine Authors: Xu M, Li D, Zhang S Tags: Cochrane Database Syst Rev Source Type: research

Antibiotic therapy for preventing infections in people with acute stroke.
CONCLUSIONS: Preventive antibiotics had no effect on functional outcome or mortality, but significantly reduced the risk of 'overall' infections. This reduction was driven mainly by prevention of urinary tract infection; no effect for pneumonia was found. PMID: 29355906 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - January 22, 2018 Category: General Medicine Authors: Vermeij JD, Westendorp WF, Dippel DW, van de Beek D, Nederkoorn PJ Tags: Cochrane Database Syst Rev Source Type: research

Yoga for stroke rehabilitation.
CONCLUSIONS: Yoga has the potential for being included as part of patient-centred stroke rehabilitation. However, this review has identified insufficient information to confirm or refute the effectiveness or safety of yoga as a stroke rehabilitation treatment. Further large-scale methodologically robust trials are required to establish the effectiveness of yoga as a stroke rehabilitation treatment. PMID: 29220541 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - December 8, 2017 Category: General Medicine Authors: Lawrence M, Celestino Junior FT, Matozinho HH, Govan L, Booth J, Beecher J Tags: Cochrane Database Syst Rev Source Type: research

Peroxisome proliferator-activated receptor gamma agonists for preventing recurrent stroke and other vascular events in people with stroke or transient ischaemic attack.
CONCLUSIONS: Peroxisome proliferator-activated receptor gamma agonists probably reduce recurrent stroke and total events of cardiovascular death, non-fatal myocardial infarction or non-fatal stroke, and may improve insulin sensitivity and the stabilisation of carotid plaques. Their effects on adverse events are uncertain. Our conclusions should be interpreted with caution considering the small number and the quality of the included studies. Further well-designed, double-blind RCTs with large samples are required to assess the efficacy and safety of PPAR-γ agonists in the secondary prevention of stroke and related vascular...
Source: Cochrane Database of Systematic Reviews - December 2, 2017 Category: General Medicine Authors: Liu J, Wang LN Tags: Cochrane Database Syst Rev Source Type: research

Virtual reality for stroke rehabilitation.
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 ty...
Source: Cochrane Database of Systematic Reviews - November 20, 2017 Category: General Medicine Authors: Laver KE, Lange B, George S, Deutsch JE, Saposnik G, Crotty M Tags: Cochrane Database Syst Rev Source Type: research

Direct oral anticoagulants versus warfarin for preventing stroke and systemic embolic events among atrial fibrillation patients with chronic kidney disease.
CONCLUSIONS: Our findings indicate that DOAC are as likely as warfarin to prevent all strokes and systemic embolic events without increasing risk of major bleeding events among AF patients with kidney impairment. These findings should encourage physicians to prescribe DOAC in AF patients with CKD without fear of bleeding. The major limitation is that the results of this study chiefly reflect CKD stage G3. Application of the results to CKD stage G4 patients requires additional investigation. Furthermore, we could not assess CKD stage G5 patients. Future reviews should assess participants at more advanced CKD stages. Additio...
Source: Cochrane Database of Systematic Reviews - November 6, 2017 Category: General Medicine Authors: Kimachi M, Furukawa TA, Kimachi K, Goto Y, Fukuma S, Fukuhara S Tags: Cochrane Database Syst Rev Source Type: research

Antiplatelet and anticoagulant agents for secondary prevention of stroke and other thromboembolic events in people with antiphospholipid syndrome.
CONCLUSIONS: There is not enough evidence for or against NOACs or for high-intensity VKA compared to the standard VKA therapy in the secondary prevention of thrombosis in people with APS. There is some evidence of harm for high-intensity VKA regarding minor and any bleeding. The evidence was also not sufficient to show benefit or harm for VKA plus antiplatelet agent or dual antiplatelet therapy compared to a single antiplatelet drug. Future studies should be adequately powered, with proper adherence to treatment, in order to evaluate the effects of anticoagulants, antiplatelets, or both, for secondary thrombosis prevention...
Source: Cochrane Database of Systematic Reviews - October 2, 2017 Category: General Medicine Authors: Bala MM, Celinska-Lowenhoff M, Szot W, Padjas A, Kaczmarczyk M, Swierz MJ, Undas A Tags: Cochrane Database Syst Rev Source Type: research

Treadmill training and body weight support for walking after stroke.
CONCLUSIONS: Overall, people after stroke who receive treadmill training, with or without body weight support, are not more likely to improve their ability to walk independently compared with people after stroke not receiving treadmill training, but walking speed and walking endurance may improve slightly in the short term. Specifically, people with stroke who are able to walk (but not people who are dependent in walking at start of treatment) appear to benefit most from this type of intervention with regard to walking speed and walking endurance. This review did not find, however, that improvements in walking speed and en...
Source: Cochrane Database of Systematic Reviews - August 17, 2017 Category: General Medicine Authors: Mehrholz J, Thomas S, Elsner B Tags: Cochrane Database Syst Rev Source Type: research

Occupational therapy for adults with problems in activities of daily living after stroke.
CONCLUSIONS: We found low-quality evidence that occupational therapy targeted towards activities of daily living after stroke can improve performance in activities of daily living and reduce the risk of deterioration in these abilities. Because the included studies had methodological flaws, this research does not provide a reliable indication of the likely effect of occupational therapy for adults with stroke. PMID: 28721691 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - July 19, 2017 Category: General Medicine Authors: Legg LA, Lewis SR, Schofield-Robinson OJ, Drummond A, Langhorne P Tags: Cochrane Database Syst Rev Source Type: research

Early supported discharge services for people with acute stroke.
CONCLUSIONS: Appropriately resourced ESD services with co-ordinated multidisciplinary team input provided for a selected group of stroke patients can reduce long-term dependency and admission to institutional care as well as reducing the length of hospital stay. Results are inconclusive for services without co-ordinated multidisciplinary team input. We observed no adverse impact on the mood or subjective health status of patients or carers, nor on readmission to hospital. PMID: 28703869 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - July 13, 2017 Category: General Medicine Authors: Langhorne P, Baylan S, Early Supported Discharge Trialists Tags: Cochrane Database Syst Rev Source Type: research

Repetitive peripheral magnetic stimulation for activities of daily living and functional ability in people after stroke.
CONCLUSIONS: Available trials provided inadequate evidence to permit any conclusions about routine use of rPMS for people after stroke. Additional trials with large sample sizes are needed to determine an appropriate rPMS protocol as well as long-term effects. We identified three ongoing trials and will include these trials in the next review update. PMID: 28644548 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - June 23, 2017 Category: General Medicine Authors: Momosaki R, Yamada N, Ota E, Abo M Tags: Cochrane Database Syst Rev Source Type: research

Circuit class therapy for improving mobility after stroke.
CONCLUSIONS: There is moderate evidence that CCT is effective in improving mobility for people after stroke - they may be able to walk further, faster, with more independence and confidence in their balance. The effects may be greater later after the stroke, and are of clinical significance. Further high-quality research is required, investigating quality of life, participation and cost-benefits, that compares CCT with standard care and that also investigates the influence of factors such as stroke severity and age. The potential risk of increased falls during CCT needs to be monitored. PMID: 28573757 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - June 2, 2017 Category: General Medicine Authors: English C, Hillier SL, Lynch EA Tags: Cochrane Database Syst Rev Source Type: research

Antithrombotic treatment after stroke due to intracerebral haemorrhage.
CONCLUSIONS: There is insufficient evidence from RCTs to support or discourage the use of antithrombotic treatment after ICH. RCTs comparing starting versus avoiding antiplatelet or anticoagulant drugs after ICH appear justified and are needed in clinical practice. PMID: 28540976 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - May 25, 2017 Category: General Medicine Authors: Perry LA, Berge E, Bowditch J, Forfang E, Rønning OM, Hankey GJ, Villanueva E, Al-Shahi Salman R Tags: Cochrane Database Syst Rev Source Type: research

Interventions for treating anxiety after stroke.
CONCLUSIONS: Evidence is insufficient to guide the treatment of anxiety after stroke. Further well-conducted randomised controlled trials (using placebo or attention controls) are required to assess pharmacological agents and psychological therapies. PMID: 28535332 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - May 23, 2017 Category: General Medicine Authors: Knapp P, Campbell Burton CA, Holmes J, Murray J, Gillespie D, Lightbody CE, Watkins CL, Chun HY, Lewis SR Tags: Cochrane Database Syst Rev Source Type: research

Electromechanical-assisted training for walking after stroke.
CONCLUSIONS: People who receive electromechanical-assisted gait training in combination with physiotherapy after stroke are more likely to achieve independent walking than people who receive gait training without these devices. We concluded that seven patients need to be treated to prevent one dependency in walking. Specifically, people in the first three months after stroke and those who are not able to walk seem to benefit most from this type of intervention. The role of the type of device is still not clear. Further research should consist of large definitive pragmatic phase III trials undertaken to address specific que...
Source: Cochrane Database of Systematic Reviews - May 10, 2017 Category: General Medicine Authors: Mehrholz J, Thomas S, Werner C, Kugler J, Pohl M, Elsner B Tags: Cochrane Database Syst Rev Source Type: research