Mohammad Alwardat

Constraint-induced movement therapy as a rehabilitation intervention for upper extremity in stroke patients: Systematic review and meta-analysis

Constraint-induced movement therapy (CIMT) is a neurorehabilitation technique designed to improve upper extremity motor functions after stroke. This review aimed to investigate evidence of the effect of CIMT on upper extremity in stroke patients and to identify optimal methods to apply CIMT. Four databases (MEDLINE, EMBASE, CINHAL, and PEDro) and reference lists of relevant articles and reviews were searched. Randomized clinical trials that studied the effect of CIMT on upper extremity outcomes in stroke patients compared with other rehabilitative techniques, usual care, or no intervention were included. Methodological quality was assessed using the PEDro score. The following data were extracted for each trial: patients’ characteristics, sample size, eligibility criteria, protocols of CIMT and control groups, outcome measurements, and the PEDro score. A total of 38 trials were identified according to the inclusion criteria. The trials included were heterogeneous in CIMT protocols, time since stroke, and duration and frequency of treatment. The pooled meta-analysis of 36 trials found a heterogeneous significant effect of CIMT on upper extremity. There was no significant effect of CIMT at different durations of follow-up. The majority of included articles did not fulfill powered sample size and quality criteria. The effect of CIMT changed in terms of sample size and quality features of the articles included. These meta-analysis findings indicate that evidence for the superiority of CIMT in comparison with other rehabilitative interventions is weak. Information on the optimal dose of CIMT and optimal time to start CIMT is still limited.

Assessment of serum uric acid as risk factor for tauopathies

Low levels of serum uric acid (UA) are a risk factor for many neurodegenerative diseases but the role of UA in tauopathies has not been yet fully evaluated. In this study, we assessed the risk associated with serum UA levels in a large group of patients with tauopathies, either primary or secondary. The mean serum UA concentrations of 111 patients with tauopathies (TAU), including 41 with progressive supranuclear palsy (PSP), 45 with Alzheimer’s disease (AD) and 25 with frontotemporal dementia (FTD) were compared to that of 130 controls (CTL). The association between serum UA and TAU condition, PSP, AD and FTD was calculated as odd ratio (OR) adjusted for age and gender. A cut-off value of serum UA was finally obtained to predict subjects at risk for TAU. The serum UA levels in TAU and PSP, AD and FTD subgroups were similar, and significantly lower than CTL. Linear regression revealed inverse relationships between UA and TAU (ORxa0=xa00.610), PSP (ORxa0=xa00.626), AD (ORxa0=xa00.685) and FTD (ORxa0=xa00.577). The cut-off value of 4.35xa0mg/dl (AUCxa0=xa00.655) discriminates TAU from CTL, although with poor specificity and sensitivity. Low concentrations of serum UA represent a common risk factor for different tauopathies (PSP, FTD and AD). These findings may represent a starting point for preventive strategies or novel therapeutic approaches in this group of severe neurodegenerative diseases.

Does Pisa syndrome affect upper limb function in patients with Parkinson's disease? An observational cross-sectional study

BACKGROUNDnTrunk alignment is thought to contribute to upper limb (UL) function. However, this common assumption is not clear in patients with Parkinsons Disease (PD) suffering from Pisa syndrome (PS). PS is a postural abnormality, characterized by revisable lateral trunk flexion more than 10 degrees.nnnOBJECTIVEnTo investigate the UL functioning and activities of daily living in PD patients with PS.nnnMETHODSnForty-five participants distributed equally in three groups PD patients with PS, PD patients without PS and age/sex matched healthy controls (HC). The function and disability of UL was assessed by Arm Shoulder and Hand (DASH) questionnaire for all groups. PD groups then completed clinical assessments by the Unified Parkinsons Disease Rating Scale (UPDRS) part II-III, Modified Hoenh & Yahr (mH&Y) staging and the Levodopa Equivalent Daily Dose (LEDD).nnnRESULTSnThree groups showed significant differences in DASH questionnaire (pu200a<u200a0.001) with higher scores for PS group, intermediate for PD group and lower for HC group. PS group also showed higher score in UPDRS-II and mH&Y (pu200a=u200a0.019), while no differences emerged between PD and PS in UPDRS-III score and LEDD.nnnCONCLUSIONnOur results demonstrated that PS is associated with major impairment of both UL functioning and activities of daily living in PD patients.

Comment on: “Effects of interventions with a physical activity component on bone health in obese children and adolescents: a systematic review and meta-analysis”

We have read the article [1] published in your respected journal. It is impressive to see how much obesity affects bone health and how it impacts structured intervention in obese children and adolescents. Evaluating the effectiveness of obesity and structured interventions, such as the physical activity, can enhance the awareness of these factors on bone health for both children and adolescents. However, we have some comments with respect to the procedures and results of this study. First, the authors employed a non-systematic review of articles with wide and heterogeneous methodological designs, such as randomized control trials and observational studies (cross-sectional and longitudinal), but there were no clear selection criteria regarding the methodological designs of the studies included. Moreover, the evidence of the qualities of the included studies has been assessed by the PEDro scale, which fails to determine the level of evidence, and is why we believe that adapting the GRADE approach is highly recommended and more efficient. Second, the authors reported Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) in their study, but did not adequately follow the PICO format (P: participants, I: intervention, C: comparison, O: outcomes), and the inclusion criteria did not follow the previous format. Furthermore, the inclusion criteria did not include or measure structured interventions, such as physical activity, as the included articles were experimental and observational studies that measured the bone minerals and mass in healthy children and adolescents. Third, the study excluded any outcome measurements, which is an essential part of the inclusion criteria. They also used different studies with heterogeneous outcomes and mixed results for their systematic review and meta-analysis. Running a systematic review without full knowledge about the inclusion criteria can lead to problems in assessing the validity, applicability, and comprehensiveness of the systematic review [2]. Finally, the authors included both cross-sectional and longitudinal studies in the review and analysis, which is biased with short outcomes and lacks the random allocation to an intervention in the experimental element [3]. We highly believe that if they had used sub group analysis that it would significantly reduce any chance of bias in the study.

Comments on “Transcutaneous electrical nerve stimulation improves walking capacity and reduces spasticity in stroke survivors: a systematic review and meta-analysis”

Kwong et al.1 recently conducted a systematic review and meta-analysis to evaluate the influence of transcutaneous nerve electrical stimulation (TENS) on spasticity and walking capacity in stroke patients. The review includes 11 randomized clinical trials (RCTs). I wish to comment on some procedures and findings in this review. First, the authors assessed the quality of the included RCTs using the PEDro scale. In a RCT, a score of 6 or higher was considered to be high quality of evidence, whereas a score of less than 6 was considered to be low quality of evidence. A score of 6 on PEDro is not sufficient to consider high quality of evidence especially for the RCTs that compared TENS with other TENS, placebo TENS, pharmacological intervention, or no interventions. Those articles have better possibility to match blinding patients and therapists. The adapting of more precise approaches such as Grade approach is highly required to determine the level of evidence. Second, the inclusion criteria are ambiguous. The authors do not sufficiently follow the PICO format (P: participants, I: intervention, C: comparison, O: outcomes). The authors state the inclusion criteria as stroke survivors used repetitive TENS/electrical somatosensory stimulation applied the stimulation to lower extremity and included at least one outcome measure on lower extremity motor function, and the study design was a RCT. The authors state that the review aims to evaluate the effects of TENS and its parameters on lower extremity motor recovery in stroke survivors, including its effects on spasticity, muscle strength, balance, and walking capacity. Surprisingly, the inclusion criteria do not demand that the studies measure spasticity, muscle strength, balance, and walking capacity. The included articles were RCTs that compared the effect of different types of electrical stimulation as a single intervention or adjunctive therapy in comparison with placebo electrical stimulation. Third, one of the included articles applied different forms of electrical stimulation other than TENS. Chen et al. applied surface electrical stimulation.5 Finally, the review does not consider ankle muscle force measurements. Ankle muscle strength is correlated strongly with balance, walking endurance, gait symmetry, and walking speed in stroke patients.2–4

Comments on: “Transcranial Direct Current Stimulation for Obsessive-Compulsive Disorder: A Systematic Review”

Dear Editor, Brunelin et al. [1] recently conducted a systematic review that evaluated the effect of applied transcranial direct current stimulation (tDCS) on patients with obsessive compulsive disorder (OCD).[...].