Efrati

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 (0normal, 42most 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

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