Difference between revisions of "Efrati"

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=='''<span style="font-size: 120%;">There is some weak evidence to support the benefit of hyperbaric oxygen in patients more than six months after stroke</span>'''==
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'''<span style="font-size:16.0pt"><span style="line-height:107%">Some weak evidence to support the benefit of hyperbaric oxygen in patients more than six months after stroke</span></span>'''
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| '''Clinical bottom line:'''<br>**1. There is some limited evidence that HBO improves disability more than six months after stroke'''
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{| class="Table" style="border:undefined"
 
|-
 
|-
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|
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'''<span style="font-size:14.0pt"><span style="line-height:107%">Clinical bottom line:</span></span>'''<br/> 1. There is some limited evidence that HBO improves disability more than six months after stroke
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|}
 
|}
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**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
 
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**Lead author's name and email:''' Shai Efrati: efratishai@013.net
 
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**T''''''hree-part Clinical Question:''' Does hyperbaric oxygen improve disability in post stroke patients?
 
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**Search Terms:''' stroke, neuroplasticity
 
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**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.
 
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**The Evidence:'''
 
  
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{|
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'''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
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| <span style'''"display: block; font-size: 90%; text-align: center;">Measure</span> |||| <span style'''"display: block; font-size: 90%; text-align: center;">Control Group</span> |||| <span style'''"display: block; font-size: 90%; text-align: center;">HBO Group</span> || <span style'''"display: block; font-size: 90%; text-align: center;">Difference</span> || <span style="display: block; font-size: 90%; text-align: center;">95% CI</span>
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 +
'''Lead author's name and email: '''Shai Efrati: efratishai@013.net
 +
 
 +
'''Three-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.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
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'''The Study Patients: '''Adult patients at least six months after stroke and at least one motor deficit.'''&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;''''''Control group '''(N = 37; 29 analysed): Usual physiotherapy for 8 weeks, then cross over to hyperbaric oxygen.&nbsp;&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; '''Experimental group '''(N = 37; 30 analysed): Standard care plus 40 sessions of HBO at 2ATA for 90 minutes daily for 8 weeks.
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 +
'''The Evidence:'''
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 +
{| class="Table" style="border:solid windowtext 1.0pt"
 
|-
 
|-
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|^  || <span style'''"display: block; font-size: 90%; text-align: center;">Mean</span> || <span style'''"display: block; font-size: 90%; text-align: center;">SD</span> || <span style'''"display: block; font-size: 90%; text-align: center;">Mean</span> || <span style'''"display: block; font-size: 90%; text-align: center;">SD</span> ||^  ||^ 
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| rowspan="2" style="width:206.5pt; border:solid windowtext 1.0pt" width="278" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''Measure'''</p>
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| colspan="2" style="width:69.9pt; border:solid windowtext 1.0pt" width="95" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''Control Group'''</p>  
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| colspan="2" style="width:58.7pt; border:solid windowtext 1.0pt" width="80" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''HBO Group'''</p>  
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| rowspan="2" style="width:48.65pt; border:solid windowtext 1.0pt" width="71" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''Difference'''</p>  
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| rowspan="2" style="width:58.05pt; border:solid windowtext 1.0pt" width="80" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''95% CI'''</p>  
 
|-
 
|-
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| <span style'''"font-size: 90%;">'''National Institutes of Health Stroke Scale''' (0'''normal, 42'''most severe deficit) </span><br><span style'''"font-size: 90%;">at 8 weeks</span> || <span style'''"display: block; text-align: center;">8.3</span> || <span style'''"display: block; text-align: center;">4.3</span> || <span style'''"display: block; text-align: center;">5.5</span> || <span style'''"display: block; text-align: center;">3.6</span> || <span style'''"display: block; text-align: center;">2.8</span> || <span style'''"display: block; text-align: center;">0.77 to 4.87</span>  
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| style="width:35.7pt; border:solid windowtext 1.0pt" width="50" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''Mean'''</p>  
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| style="width:32.7pt; border:solid windowtext 1.0pt" width="46" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''SD'''</p>  
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| style="width:29.95pt; border:solid windowtext 1.0pt" width="42" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''Mean'''</p>  
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| style="width:27.25pt; border:solid windowtext 1.0pt" width="38" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''SD'''</p>  
 
|-
 
|-
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| <span style'''"font-size: 90%;">'''Activity of Daily Living''' (scale unknown)</span> || <span style'''"display: block; font-size: 90%; text-align: center;">17.6</span> || <span style'''"display: block; font-size: 90%; text-align: center;">9.5</span> || <span style'''"display: block; font-size: 90%; text-align: center;">12.8</span> || <span style'''"display: block; font-size: 90%; text-align: center;">7.3</span> || <span style'''"display: block; font-size: 90%; text-align: center;">4.7</span> || <span style="display: block; font-size: 90%; text-align: center;">0.27 to 9.09</span>  
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| style="width:206.5pt; border:solid windowtext 1.0pt" width="278" |
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'''National Institutes of Health Stroke Scale''' (0= normal, 42=most severe deficit) '''at 8 weeks'''
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| style="width:35.7pt; border:solid windowtext 1.0pt" width="50" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">8.3</p>  
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| style="width:32.7pt; border:solid windowtext 1.0pt" width="46" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">4.3</p>  
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| style="width:29.95pt; border:solid windowtext 1.0pt" width="42" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">5.5</p>  
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| style="width:27.25pt; border:solid windowtext 1.0pt" width="38" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">3.6</p>  
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| style="width:48.65pt; border:solid windowtext 1.0pt" width="71" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">2.8</p>  
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| style="width:58.05pt; border:solid windowtext 1.0pt" width="80" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">0.77 to 4.87</p>  
 
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|-
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| <span style'''"font-size: 90%;">'''Quality of Life''' (EQ-5D) (scale unknown)</span> || <span style'''"display: block; font-size: 90%; text-align: center;">8.6</span> || <span style'''"display: block; font-size: 90%; text-align: center;">1.7</span> || <span style'''"display: block; font-size: 90%; text-align: center;">7.7</span> || <span style'''"display: block; font-size: 90%; text-align: center;">1.3</span> || <span style'''"display: block; font-size: 90%; text-align: center;">1.0</span> || <span style="display: block; font-size: 90%; text-align: center;">0.18 to 1.76</span>  
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| style="width:206.5pt; border:solid windowtext 1.0pt" width="278" |
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'''Activity of Daily Living''' (scale unknown)
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| style="width:35.7pt; border:solid windowtext 1.0pt" width="50" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">17.6</p>  
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| style="width:32.7pt; border:solid windowtext 1.0pt" width="46" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">9.5</p>  
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| style="width:29.95pt; border:solid windowtext 1.0pt" width="42" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">12.8</p>  
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| style="width:27.25pt; border:solid windowtext 1.0pt" width="38" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">7.3</p>  
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| style="width:48.65pt; border:solid windowtext 1.0pt" width="71" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">4.7</p>  
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| style="width:58.05pt; border:solid windowtext 1.0pt" width="80" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">0.27 to 9.09</p>  
 
|-
 
|-
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| <span style'''"font-size: 90%;">'''Quality of Life''' (EQ-VAS) (sclae unknown)</span> || <span style'''"display: block; font-size: 90%; text-align: center;">5.3</span> || <span style'''"display: block; font-size: 90%; text-align: center;">2.3</span> || <span style'''"display: block; font-size: 90%; text-align: center;">6.5</span> || <span style'''"display: block; font-size: 90%; text-align: center;">1.5</span> || <span style'''"display: block; font-size: 90%; text-align: center;">1.3</span> || <span style="display: block; font-size: 90%; text-align: center;">0.2 to 2.2</span>  
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| style="width:206.5pt; border:solid windowtext 1.0pt" width="278" |
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'''Quality of Life''' (EQ-5D) (scale unknown)
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| style="width:35.7pt; border:solid windowtext 1.0pt" width="50" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">8.6</p>  
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| style="width:32.7pt; border:solid windowtext 1.0pt" width="46" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">1.7</p>  
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| style="width:29.95pt; border:solid windowtext 1.0pt" width="42" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">7.7</p>  
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| style="width:27.25pt; border:solid windowtext 1.0pt" width="38" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">1.3</p>  
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| style="width:48.65pt; border:solid windowtext 1.0pt" width="71" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">1.0</p>  
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| style="width:58.05pt; border:solid windowtext 1.0pt" width="80" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">0.18 to 1.76</p>  
 
|-
 
|-
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| style="width:206.5pt; border:solid windowtext 1.0pt" width="278" |
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'''Quality of Life''' (EQ-VAS) (scale unknown)
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| style="width:35.7pt; border:solid windowtext 1.0pt" width="50" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">5.3</p>
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| style="width:32.7pt; border:solid windowtext 1.0pt" width="46" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">2.3</p>
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| style="width:29.95pt; border:solid windowtext 1.0pt" width="42" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">6.5</p>
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| style="width:27.25pt; border:solid windowtext 1.0pt" width="38" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">1.5</p>
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| style="width:48.65pt; border:solid windowtext 1.0pt" width="71" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">1.3</p>
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| style="width:58.05pt; border:solid windowtext 1.0pt" width="80" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">0.2 to 2.2</p>
 
|}
 
|}
  
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**Comments:'''
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&nbsp;
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'''Comments:'''
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1. The unblinded study design may have contributed to positive bias from patient and staff perception. Chamber confinement is accepted as a powerful placebo.
 
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.
 
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.
 
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.
 
4. The outcomes are very short term and may not persist.
 +
 
5. There is patient data missing from each graph in Figure 2.
 
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.
 
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.
  
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**Appraised by:'''
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'''Appraised by: '''Alan Bourke and Michael Bennett; Sunday, 11th April 2013 Email: alan.bourke@sesiahs.health.nsw.gov.au
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Alan Bourke and Michael bennett; Sunday, 11th April 2013
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Email: alan.bourke@sesiahs.health.nsw.gov.au
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'''Kill or Update By: '''July 2022
  
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**Kill or Update By:''' July 2022
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[[File:Sumhorsa.gif|center|Sumhorsa.gif]]
  
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<span style="display: block; text-align: center;"><span style="color: #7c00ff; font-size: 140%;">[[Stroke|BACK]]</span></span>
  
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<span style="display: block; text-align: center;"><span style="color: #7c00ff; font-size: 140%;">[[Stroke  |  BACK]]</span></span>
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[[Category:Pages with broken file links]]

Latest revision as of 23:28, 16 May 2021

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

Three-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) (scale 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

 

Sumhorsa.gif

BACK

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