M.bennett at 04:30, 20 July 2021

2021-07-20T04:30:24Z

M.bennett at 04:28, 20 July 2021

2021-07-20T04:28:41Z

M.bennett: Created page with " '''The addition of hyper..."

2021-07-20T04:17:30Z

Created page with " '''The addition of hyper..."

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'''The addition of hyperbaric oxygen to standard treatment for incomplete spinal injury at altitude reduced the grade of injury after treatment.'''

{| class="Table" style="width: 888px;" width="623"
|- style="height:77.7pt"
| style="width: 876px;" |
'''Clinical Bottom Line:'''

'''1. The addition of HBOT resulted in a higher proportion of patients with better ASIA grade of injury (normal or incomplete) than with standard treatment alone. 2. Improvements in quality of life and both sensory and motor scores were not statistically significant.'''

|}

'''Citation/s:'''1. Sun Q, Bao JF, An YL, Lei H, Ma J. Hyperbaric oxygen therapy and comprehensive orthopedic treatment for incomplete traumatic spinal cord injury on the qinghai-tibet plateau: Study protocol for an open-label randomized controlled clinical trial. Asia Pacific Journal of Clinical Trials: Nervous System Diseases. 2017 Apr 1;2(2):50. '''Corresponding author:'''  Jun Ma majunqh75@163.com

'''Three-part Clinical Question:'''For patients with incomplete spinal cord injury and living at high altitude, does the application of hyperbaric oxygen compared to air breathing, result in any improvement in recovery? '''Search Terms:''' Spinal cord trauma; hypoxia; healing

'''The Study:'''Non-blinded concealed randomised controlled trial with intention-to-treat. '''The Study Patients:''' Adult patients with incomplete spinal cord injury and who had lived at altitude for at least two years. '''Control group''' (N = 82; 82 analysed): Standard treatment with pedicle screw and laminectomy as indicated '''Experimental group''' (N = 82; 82 analysed): As above plus forty daily sessions breathing 100% oxygen for 60 minutes at 2.0 ATA given in four sets of 10 treatments with 5 to 7 days intervals.

'''The Evidence:'''

{| class="Table" style="border:solid windowtext 1.0pt"
|-
| style="width:118.0pt; border:solid windowtext 1.0pt" width="157" | '''Outcome'''
| style="width:66.95pt; border:solid windowtext 1.0pt" width="89" | '''Time to Outcome'''
| style="border:solid windowtext 1.0pt" | '''Control group'''
| style="border:solid windowtext 1.0pt" | '''Hyperbaric group'''
| style="border:solid windowtext 1.0pt" | '''Relative risk reduction'''
| style="border:solid windowtext 1.0pt" | '''Absolute risk reduction'''
| style="border:solid windowtext 1.0pt" | '''NNT'''
|-
| rowspan="2" style="width:118.0pt; border:solid windowtext 1.0pt" width="157" |
'''American Spinal Injury Ass Grade D or E (best)'''

| style="width:66.95pt; border:solid windowtext 1.0pt" width="89" | At completion of treatment
| style="border:solid windowtext 1.0pt" | 0.65
| style="border:solid windowtext 1.0pt" | 0.90
| style="border:solid windowtext 1.0pt" | 40%
| style="border:solid windowtext 1.0pt" | 0.26
| style="border:solid windowtext 1.0pt" | 4
|-
| colspan="3" style="width:175.55pt; border:solid windowtext 1.0pt" width="234" | 95% CIs:
| style="border:solid windowtext 1.0pt" | 21% to 58%
| style="border:solid windowtext 1.0pt" | 0.13 to 0.38
| style="border:solid windowtext 1.0pt" | 3 to 7
|}

 

{| class="Table" style="border:solid windowtext 1.0pt"
|-
| rowspan="2" style="width:167.6pt; border:solid windowtext 1.0pt" width="223" | '''Measure'''
| colspan="2" style="width:83.55pt; border:solid windowtext 1.0pt" width="111" | '''Control Group'''
| colspan="2" style="width:83.55pt; border:solid windowtext 1.0pt" width="111" | '''Hyperbaric  Group'''
| rowspan="2" style="width:48.15pt; border:solid windowtext 1.0pt" width="64" | '''Difference'''
| rowspan="2" style="width:58.95pt; border:solid windowtext 1.0pt" width="79" | '''95% CI'''
|-
| style="width:41.05pt; border:solid windowtext 1.0pt" width="55" | Mean
| style="width:41.0pt; border:solid windowtext 1.0pt" width="55" | SD
| style="width:41.05pt; border:solid windowtext 1.0pt" width="55" | Mean
| style="width:41.0pt; border:solid windowtext 1.0pt" width="55" | SD
|-
| style="width:167.6pt; border:solid windowtext 1.0pt" width="223" |
'''Mod. Barthel Index (0 to 100). Higher is better. End of treatment'''

| style="width:41.05pt; border:solid windowtext 1.0pt" width="55" | 75.4
| style="width:41.0pt; border:solid windowtext 1.0pt" width="55" | 12.3
| style="width:41.05pt; border:solid windowtext 1.0pt" width="55" | 89.9
| style="width:41.0pt; border:solid windowtext 1.0pt" width="55" | 11.6
| style="width:48.15pt; border:solid windowtext 1.0pt" width="64" | 14.5
| style="width:58.95pt; border:solid windowtext 1.0pt" width="79" | -29.6 to 58.6
|-
| style="width:167.6pt; border:solid windowtext 1.0pt" width="223" |
'''ASIA tactile score. End of treatment'''

| style="width:41.05pt; border:solid windowtext 1.0pt" width="55" | 102.3
| style="width:41.0pt; border:solid windowtext 1.0pt" width="55" | 13.5
| style="width:41.05pt; border:solid windowtext 1.0pt" width="55" | 118.7*
| style="width:41.0pt; border:solid windowtext 1.0pt" width="55" | 15.4
| style="width:48.15pt; border:solid windowtext 1.0pt" width="64" | 16.4
| style="width:58.95pt; border:solid windowtext 1.0pt" width="79" | -48.3 to 81.1
|-
| style="width:167.6pt; border:solid windowtext 1.0pt" width="223" |
'''ASIA motor score. End fo treatment'''

| style="width:41.05pt; border:solid windowtext 1.0pt" width="55" | 86.3
| style="width:41.0pt; border:solid windowtext 1.0pt" width="55" | 12.3
| style="width:41.05pt; border:solid windowtext 1.0pt" width="55" | 99.2
| style="width:41.0pt; border:solid windowtext 1.0pt" width="55" | 17.0
| style="width:48.15pt; border:solid windowtext 1.0pt" width="64" | 12.9
| style="width:58.95pt; border:solid windowtext 1.0pt" width="79" | -55.0 to 80.8
|}

*Authors state max score is 112 ‘on each side’ in text. Meaning unclear.

'''Comments:''' 1. Recruitment completed 2016 and results published here in 2017. Further analysis reported for neuroinflammation in 2019 (See '[[Sun|Sun' here]]). 2. Randomization method sounds reliable and concealed. 3. Sample size calculation suggested 188 patients needed but funds ran out.

 
'''Appraised by:'''Mike Bennett m.bennett@unsw.edu.au; Tuesday, 20 July 2021 '''Kill or Update By:''' July 2025

← Older revision		Revision as of 04:30, 20 July 2021
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	'''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:"><span style="color:black">Appraised by:</span></span></span></span>'''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:"><span style="color:black">Mike Bennett m.bennett@unsw.edu.au; Tuesday, 20 July 2021<br/> '''Kill or Update By:''' July 2025</span></span></span></span>		'''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:"><span style="color:black">Appraised by:</span></span></span></span>'''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:"><span style="color:black">Mike Bennett m.bennett@unsw.edu.au; Tuesday, 20 July 2021<br/> '''Kill or Update By:''' July 2025</span></span></span></span>
−	<p style="text-align: center;"> </p> <p style="text-align: center;"></p> <p style="text-align: center;"> </p> <p style="text-align: center;"><span style="font-size:xx-large;">[http://hboevidence.wikis.unsw.edu.au/Neuro_-_miscellaneous BACK]</span></p>	+	<p style="text-align: center;"> </p> <p style="text-align: center;">[[File:Sumhorsa.gif\|center\|Sumhorsa.gif]]</p> <p style="text-align: center;"> </p> <p style="text-align: center;"><span style="font-size:xx-large;">[http://hboevidence.wikis.unsw.edu.au/Neuro_-_miscellaneous BACK]</span></p>

Sun2 - Revision history

M.bennett at 04:30, 20 July 2021

M.bennett at 04:28, 20 July 2021

M.bennett: Created page with " '''The addition of hyper..."