Efrati
Some weak evidence to support the benefit of hyperbaric oxygen in patients more than six months after stroke
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Clinical bottom line: |
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
