Gordoben: Imported from Wikispaces

2018-04-09T07:46:27Z

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'''Weak evidence that hyperbaric oxygenation may improve the rate at which strength recovers following unaccustomed eccentric exercise.''' 

'''Clinical Bottom Line:''' 
1. There may be some improvement in the speed of strength recovery after unaccustomed eccentric exercise with a five day course of HBOT. 
2. No improvement in pain with hyperbaric oxygen. 

'''Appraised by:''' Mike Bennett, Dept. of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney, Monday, 3 April 2000 

'''Clinical Scenario:''' An athlete in training presents for management of muscle soreness following training. 
'''Three-part Question:''' In subjects likely to develop delayed onset of muscle soreness (DOMS) after exercise, does treatment with hyperbaric oxygen, compared with no specific therapy, result in any reduction in pain or improvement in muscle strength during recovery? 
'''Search Terms:''' DOMS, injuries, musculoskeletal 

'''The Study:''' 
Double-blinded concealed randomised controlled trial without intention-to-treat. 
Healthy volunteer, untrained, college students. All had undergone a standard eccentric exercise protocol involving the quadriceps of the non-dominant leg. The study was run in two phases with sham and 'early' HBOT groups in both phases. 
'''Control group''' (N = 30; 28 analysed): 10 subjects had no specific intervention, 20 had sham HBOT by exposure to 1.2ATA breathing air at 0, 24, 48, 72 and 96 hours for one hour on each occasion. 
'''Experimental group''' (N = 40; 38 analysed): 20 subjects had 100% oxygen at 2ATA for 1 hour at 0, 24 and 48 hours after exercise, followed by two sham treatments at 72 and 96 hours. 10 subjects had sham at 0 and 24 hours, followed by HBOT at 48, 72 and 96 hours, while 10 further subjects had HBOT on five occasions at 0, 24, 48, 72 and 96 hours. 

'''The Evidence:'''
{|
| '''Non-event outcomes''' || '''Time to outcome''' || '''Control group''' || '''HBO group''' || '''P-value'''
|-
| '''Muscle pain (VAS 0-10)''' || 24 hrs || 4.3 || 4.3 || NS
|-
| '''Strength (Nm)''' || 48 hrs || 158 || 153 || Unknown
|-
| '''Strength recovered (Nm)''' || 0 to 96 hrs || 34 || 46 || Unknown
|-
|}

'''Comments:''' 
1. Study design in two phases makes interpretation difficult as two arms with the same treatment yield quite different results. 
2. All numbers in the evidence table above were read from figures in the paper and averaged as required. 
3. Authors report a significant improvement in strength recovery in HBO group in phase I compared to all other groups. May be due to greater reduction in strength on exercise. 
4. Authors report a significant improvement in strength recovery in 5 HBOT group compared to sham. This may be due to a greater drop in strength following exercise. 
5. This study does not allow firm conclusions. 
6. Any findings may only apply to non-athletes. 

'''Expiry date:''' March 2021

'''References:''' 
1. Staples JR, Clement DB, Taunton JE, McKenzie DC. Effects of hyperbaric oxygen on a human model of injury. Am Journal of Sports Medicine 1999; 27:600-605

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Gordoben: Imported from Wikispaces