M.bennett at 03:28, 17 May 2021

2021-05-17T03:28:32Z

Gordoben: Imported from Wikispaces

2018-10-11T03:57:59Z

Imported from Wikispaces

New page

=='''There is some weak evidence to support the benefit of hyperbaric oxygen in patients more than six months after stroke'''==
{|
| '''Clinical bottom line:''' **1. There is some limited evidence that HBO improves disability more than six months after stroke'''
|-
|}
**Citation:''' Efrati S, Fishlev G, Bechor Y et al. Hyperbaric oxygen induces late neuroplasticity in post stroke patients-Randomized prospective trial. PLoS ONE 2013;8 (1): e53716.doi:10.1371/journal.pone.0053716
**Lead author's name and email:''' Shai Efrati: efratishai@013.net
**T''''''hree-part Clinical Question:''' Does hyperbaric oxygen improve disability in post stroke patients?
**Search Terms:''' stroke, neuroplasticity
**The Study:'''Single-blinded randomised controlled trial without intention-to-treat.'''The Study Patients:''' Adult patients at least six months after stroke and at least one motor deficit. '''Control group''' (N = 37; 29 analysed): Usual physiotherapy for 8 weeks, then cross over to hyperbaric oxygen.'''Experimental group''' (N = 37; 30 analysed): Standard care plus 40 sessions of HBO at 2ATA for 90 minutes daily for 8 weeks.
**The Evidence:'''

{|
| Measure |||| Control Group |||| HBO Group || Difference || 95% CI
|-
|^ || Mean || SD || Mean || SD ||^ ||^
|-
| '''National Institutes of Health Stroke Scale''' (0'''normal, 42'''most severe deficit) at 8 weeks || 8.3 || 4.3 || 5.5 || 3.6 || 2.8 || 0.77 to 4.87
|-
| '''Activity of Daily Living''' (scale unknown) || 17.6 || 9.5 || 12.8 || 7.3 || 4.7 || 0.27 to 9.09
|-
| '''Quality of Life''' (EQ-5D) (scale unknown) || 8.6 || 1.7 || 7.7 || 1.3 || 1.0 || 0.18 to 1.76
|-
| '''Quality of Life''' (EQ-VAS) (sclae unknown) || 5.3 || 2.3 || 6.5 || 1.5 || 1.3 || 0.2 to 2.2
|-
|}

**Comments:'''
1. The unblinded study design may have contributed to positive bias from patient and staff perception. Chamber confinement is accepted as a powerful placebo.
2.There was no neurologist involved in the trial which seems unusual.
3. Assessment of the clinical benefit of a mean improvement of 2.8 in NIHSS score requires specialist interpretation, but seems unlikely to be a signficant gain.
4. The outcomes are very short term and may not persist.
5. There is patient data missing from each graph in Figure 2.
6. The EQ-VAS mean improvement of 4.9 to 6.5 is extremely small on a scale of 1-100. Probably mis-reported and is actually a scale from 1 to 10.

**Appraised by:'''
Alan Bourke and Michael bennett; Sunday, 11th April 2013
Email: alan.bourke@sesiahs.health.nsw.gov.au

**Kill or Update By:''' July 2022

[[File:http://www.hboevidence.com/_themes/copy-of-sumi-painting/sumhorsa.gif]]

[[File:sumhorsa.gif|center]]

[[Stroke | BACK]]

Efrati - Revision history

M.bennett at 03:28, 17 May 2021

Gordoben: Imported from Wikispaces