Cifu - Revision history

M.bennett at 01:42, 13 November 2020

2020-11-13T01:42:38Z

M.bennett at 06:15, 6 May 2020

2020-05-06T06:15:28Z

M.bennett at 06:12, 6 May 2020

2020-05-06T06:12:14Z

M.bennett at 02:02, 4 May 2020

2020-05-04T02:02:10Z

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Gordoben: Imported from Wikispaces

2018-11-23T06:53:53Z

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==Hyperbaric oxygen therapy no better than sham for the treatment of postconcussion syndrome==
==Clinical Bottom Line:==
{|
| '''1. No effect on postconcussion syndrome of either HBOT regimen compared to a sham treatment.''' ** 2. Some minor improvements in all groups compared to baseline but did not reach pre-defined clinical significance.''' **3, No improvement in eye tracking abnormailities with HBOT'''
|-
|}
**Citation/s:'''
 1. Cifu DX, Hart BB, West SL, Walker W, Carne W. The effect of hyperbaric oxygen on persistent postconcussion symptoms. Journal of Head Trauma and Rehabilitation 2014;29(1):11-20.
 2. Cifu DX, Walker WC, West SL, Hart BB, Franke LM, Sima A, Graham CW, Carne W. Hyperbaric oxygen for blast-related postconcussion syndrome: three-month outcomes. Annals of Neurology 2014;75:277-286.

3. Cifu DX, Hole KW, Wetzel PA, Wares JR, Gitchel G, Carne W. Effects of hyperbaric oxygen on eye tracking abnormalities in males after mild traumatic brain injury. Journal of Rehabilitation Research and Development 2014;51(7):1047-1056

'''Lead author's name and fax:''' William Carne William.Carne@va.gov 
**Three-part Clinical Question:''' For patients with postconcussion syndrome following blast injury, does HBOT compared to a sham therapy result in any improvement in symptoms?

 '''Search Terms:''' postconcussion syndrome; blast injury; post-truamatic stress disorder
**The Study: '''Double-blinded concealed randomised controlled trial with intention-to-treat.

 '''The Study Patients:''' Patients diagnosed with mild traumatic brain injury 3 months to 3 years in the past and with postconcussion symptoms.

 '''Control group''' (N = 21; 21 analysed): Sham treatment using compression to 2 ATA breathing 10.5% oxygen for 40 daily exposures for 60 minutes

 '''Experimental group''' (N = 40; 39 analysed): 1. 100% oxygen breathing at 1.5 ATA on the same schedule as control. 2. 100% oxygen breathing at 2 ATA on the same schedule as control.
**The Evidence:'''

{|
| '''Measure''' |||| '''Control Group''' |||| '''HBOT Groups''' || '''Difference''' || '''P-value'''
|-
|^ || '''Mean''' || '''SD''' || '''Mean''' || '''SD''' ||^ ||^
|-
| '''RPQ-16 at end of treatment''' || 32.86 || || 28.62 || || 4.24 || NS
|-
| '''PCL-M at end treatment''' || 43.9 || || 42.93 || || 0.970 || NS
|-
|}
RPQ-16: Rivermead Postconcussion Questionnaire-16. PCL-M: Posttraumatic Disorder Checklist – Military Version.

Mixed model ANOVA for tracking variables - Interaction of oxygen level and time:
**Vertical''' Mean of non-normalized primary position error: P = 0.44
**Horizontal''' Mean of normalized primary position error: P = 0.68

**Comments:'''

 1. Well conducted study with rigorous design including blinding, allocation concealment and two regimens for HBOT. 

 2. Sham here unusual in that there was pressure exposure at a PIO2 identical with air at 1 ATA.

 3. Improvements noted were ascribed most likely due to placebo or Hawthorne effects.

 4. Three month outcomes were analysed by repeated measure mixed effects modelling - no difference was found due to the group allocation.

 5. Males only studied and all were military personnel.May affect generalizability

**Appraised by:''' Mike Bennett, University of NSW ; Thursday, 30 October 2014 Email: m.bennett@unsw.edu.au

 '''Kill or Update By:''' November 2021

[[File:sumhorsa.gif|center]]

[[Head Injury | BACK ]]

@@ Line 19: / Line 19: @@
 <span style="font-size: 10pt;">2. Cifu DX, Walker WC, West SL, Hart BB, Franke LM, Sima A, Graham CW, Carne W. Hyperbaric oxygen for blast-related postconcussion syndrome: three-month outcomes. Annals of Neurology 2014;75:277-286.</span>
-. Cifu DX, Hole KW, Wetzel PA, Wares JR, Gitchel G, Carne W. Effects of hyperbaric oxygen on eye tracking abnormalities in males after mild traumatic brain injury. Journal of Rehabilitation Research and Development 2014;51(7):1047-1056
+. Wares D, Cifu DX, Hole KW, Wetzel PA, Wares JR, Gitchel G, Carne W. Effects of hyperbaric oxygen on eye tracking abnormalities in males after mild traumatic brain injury. Journal of Rehabilitation Research and Development 2014;51(7):1047-1056
 .&nbsp;Walker WC, Franke LM, Cifu DX, Hart BB. Randomized, Sham-controlled, feasibility trial of hyperbaric oxygen for service members with postconcussion syndrome: cognitive and psychomotor outcomes 1 week postintervention. Neurorehabilitation and neural repair. 2014 Jun;28(5):420-32.
@@ Line 29: / Line 29: @@
 <span style="font-size: 10pt;">'''Search Terms:''' postconcussion syndrome; blast injury; post-truamatic stress disorder</span>
 <span style="font-size: 10pt;">'''The Study:''' Double-blinded concealed randomised controlled trial with intention-to-treat.</span>
 <span style="font-size: 10pt;">'''The Study Patients:''' Patients diagnosed with mild traumatic brain injury 3 months to 3 years in the past and with postconcussion symptoms.</span>

@@ Line 7: / Line 7: @@
 |-
+|
-'''<span>1. No effect on postconcussion syndrome of either HBOT regimen compared to a sham treatment.</span>'''<br/> <br/> <span>'''2. Some minor improvements in all groups compared to baseline but did not reach pre-defined clinical significance'''.</span><br/> <br/> '''<span style="font-size: 10pt;">3.</span>''''''<span style="font-size: 10pt;">No improvement in eye tracking abnormailities with HBOT</span>'''
+'''<span>1. No effect on postconcussion syndrome of either HBOT regimen compared to a sham treatment.</span><br/> <br/> 2. Some minor improvements in all groups compared to baseline but did not reach pre-defined clinical significance''''''.'''<br/> <br/> ''<span style="font-size: 10pt;">3.</span>''''''<span style="font-size: 10pt;">No improvement in eye tracking abnormailities with HBOT</span>'''
 '''<span style="font-size: 10pt;">4. No improvements in multiple cognitive and psychomotor assessments</span>'''
@@ Line 25: / Line 25: @@
 <span style="font-size: 10pt;">'''Lead author's name and fax:''' William Carne William.Carne@va.gov</span>
 '''<span style="font-size: 10pt;">Three-part Clinical Question:&nbsp;</span>'''<span style="font-size: 10pt;">For patients with postconcussion syndrome following blast injury, does HBOT compared to a sham therapy result in any improvement in symptoms?</span>
 <span style="font-size: 10pt;">'''Search Terms:''' postconcussion syndrome; blast injury; post-truamatic stress disorder</span>
@@ Line 39: / Line 39: @@
 '''<span style="font-size: 10pt;">The Evidence:</span>'''
-{|
+{| class="Table" style="border:solid windowtext 1.0pt"
 |-
-| <span><span>'''<span>Measure</span>'''</span></span>
+| style="border:solid windowtext 1.0pt" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''Measure'''</p>
-| &nbsp;
+| style="width:36.85pt; border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" width="51" | &nbsp;
-| <span><span>'''<span>Control Group</span>'''</span></span>
+| style="width:59.8pt; border:solid windowtext 1.0pt" width="82" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''Control Group'''</p>
-| &nbsp;
+| style="width:43.55pt; border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" width="60" | &nbsp;
-| <span><span>'''<span>HBOT Groups</span>'''</span></span>
+| style="width:49.5pt; border:solid windowtext 1.0pt" width="68" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''HBOT Groups'''</p>
-| <span><span>'''<span>Difference</span>'''</span></span>
+| style="border:solid windowtext 1.0pt" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''Difference'''</p>
-| <span><span>'''<span style="font-size: 10pt;">P-value</span>'''</span></span>
+| style="border:solid windowtext 1.0pt" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''P-value'''</p>
 |-
-| &nbsp;
+| style="border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" | &nbsp;
-| <span><span>'''<span>Mean</span>'''</span></span>
+| style="width:36.85pt; border:solid windowtext 1.0pt" width="51" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''Mean'''</p>
-| <span><span>'''<span>SD</span>'''</span></span>
+| style="width:59.8pt; border:solid windowtext 1.0pt" width="82" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''SD'''</p>
-| <span><span>'''<span>Mean</span>'''</span></span>
+| style="width:43.55pt; border:solid windowtext 1.0pt" width="60" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''Mean'''</p>
-| <span><span>'''<span>SD</span>'''</span></span>
+| style="width:49.5pt; border:solid windowtext 1.0pt" width="68" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''SD'''</p>
-| &nbsp;
+| style="border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" | &nbsp;
-| &nbsp;
+| style="border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" | &nbsp;
 |-
-| '''<span>RPQ-16 at end of treatment</span>'''
+| style="border:solid windowtext 1.0pt" |
-| <span><span>32.86</span></span>
+'''RPQ-16 at end of treatment'''
 | &nbsp;
-| <span><span>28.62</span></span>
+| style="width:36.85pt; border:solid windowtext 1.0pt" width="51" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">32.86</p>
-| &nbsp;
+| style="width:59.8pt; border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" width="82" | &nbsp;
-| <span><span>4.24</span></span>
+| style="width:43.55pt; border:solid windowtext 1.0pt" width="60" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">28.62</p>
-| <span><span style="display: block; font-size: 10pt; text-align: center;">NS</span></span>
+| style="width:49.5pt; border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" width="68" | &nbsp;
 |-
-| '''<span>PCL-M at end treatment</span>'''
+| style="border:solid windowtext 1.0pt" |
-| <span><span>43.9</span></span>
+'''PCL-M at end treatment'''
 | &nbsp;
-| <span><span>42.93</span></span>
+| style="width:36.85pt; border:solid windowtext 1.0pt" width="51" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">43.9</p>
-| &nbsp;
+| style="width:59.8pt; border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" width="82" | &nbsp;
-| <span><span>0.970</span></span>
+| style="width:43.55pt; border:solid windowtext 1.0pt" width="60" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">42.93</p>
-| <span><span style="display: block; font-size: 10pt; text-align: center;">NS</span></span>
+| style="width:49.5pt; border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" width="68" | &nbsp;
 |}
 <span style="font-size: 10pt;">RPQ-16: Rivermead Postconcussion Questionnaire-16. PCL-M: Posttraumatic Disorder Checklist – Military Version.</span>
 &nbsp;

@@ Line 6: / Line 6: @@
 {|
 |-
-| '''<span>1. No effect on postconcussion syndrome of either HBOT regimen compared to a sham treatment.</span>'''<br/> <br/> **<span>2. Some minor improvements in all groups compared to baseline but did not reach pre-defined clinical significance.</span><br/> <br/> '''**<span style="font-size: 10pt;">3, No improvement in eye tracking abnormailities with HBOT</span>'''
 |}
+'''<span style="font-size: 10pt;">Citation/s:</span>'''
 <span style="font-size: 10pt;">1. Cifu DX, Hart BB, West SL, Walker W, Carne W. The effect of hyperbaric oxygen on persistent postconcussion symptoms. Journal of Head Trauma and Rehabilitation 2014;29(1):11-20.</span>
@@ Line 17: / Line 20: @@
 . Cifu DX, Hole KW, Wetzel PA, Wares JR, Gitchel G, Carne W. Effects of hyperbaric oxygen on eye tracking abnormalities in males after mild traumatic brain injury. Journal of Rehabilitation Research and Development 2014;51(7):1047-1056
 <span style="font-size: 10pt;">'''Lead author's name and fax:''' William Carne William.Carne@va.gov</span>
+'''<span style="font-size: 10pt;">Three-part Clinical Question:&nbsp;</span>'''<span style="font-size: 10pt;">For patients with postconcussion syndrome following blast injury, does HBOT compared to a sham therapy result in any improvement in symptoms?</span>
 <span style="font-size: 10pt;">'''Search Terms:''' postconcussion syndrome; blast injury; post-truamatic stress disorder</span>
+<span style="font-size: 10pt;">'''The Study:''' Double-blinded concealed randomised controlled trial with intention-to-treat.</span>
 <span style="font-size: 10pt;">'''The Study Patients:''' Patients diagnosed with mild traumatic brain injury 3 months to 3 years in the past and with postconcussion symptoms.</span>
@@ Line 34: / Line 37: @@
 <span style="font-size: 10pt;">'''Experimental group''' (N = 40; 39 analysed): 1. 100% oxygen breathing at 1.5 ATA on the same schedule as control. 2. 100% oxygen breathing at 2 ATA on the same schedule as control.</span>
+'''<span style="font-size: 10pt;">The Evidence:</span>'''
 {|
@@ Line 47: / Line 49: @@
 | <span><span>'''<span style="font-size: 10pt;">P-value</span>'''</span></span>
 |-
-| ^
+| &nbsp;
 | <span><span>'''<span>Mean</span>'''</span></span>
 | <span><span>'''<span>SD</span>'''</span></span>
 | <span><span>'''<span>Mean</span>'''</span></span>
 | <span><span>'''<span>SD</span>'''</span></span>
-| ^
+| &nbsp;
-| ^
+| &nbsp;
 |-
 | '''<span>RPQ-16 at end of treatment</span>'''
@@ Line 74: / Line 76: @@
 <span style="font-size: 10pt;">RPQ-16: Rivermead Postconcussion Questionnaire-16. PCL-M: Posttraumatic Disorder Checklist – Military Version.</span>
-Mixed model ANOVA for tracking variables - Interaction of oxygen level and time:
+Mixed model ANOVA for tracking variables - Interaction of oxygen level and tim
+&nbsp;
+'''<span style="font-size: 10pt;">Comments:</span>'''
 <span style="font-size: 10pt;">1. Well conducted study with rigorous design including blinding, allocation concealment and two regimens for HBOT.</span>
@@ Line 93: / Line 92: @@
 <span style="font-size: 10pt;">5. Males only studied and all were military personnel.May affect generalizability</span>
+'''<span style="font-size: 10pt;">Appraised by:&nbsp;</span>'''<span style="font-size: 10pt;">Mike Bennett, University of NSW&nbsp;; Thursday, 30 October 2014 Email: m.bennett@unsw.edu.au</span>
 <span style="font-size: 10pt;">'''Kill or Update By:''' November 2021</span>
@@ Line 100: / Line 98: @@
 [[File:Sumhorsa.gif|center|Sumhorsa.gif]]
-<span style="display: block; text-align: center;"><span style="font-size: 26px;">[[Head_Injury|BACK]]</span></span><span style="display: block; text-align: center;"></span><span style="display: block; text-align: center;"></span>
+<span style="display: block; text-align: center;"><span style="font-size: 26px;">[[Head_Injury|BACK]]</span></span>
 &nbsp;