Difference between revisions of "Igor"
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− | | + | <span style="font-size:medium;">'''Citation/s: '''1, Igor S, Mirka T, Dalibor P, Milutin R, Dusica D, Vladimir Z, Vladimir J. Hyperbaric oxygenation accelerates prosthetic rehabilitation of lower limb amputees. Undersea and Hyperbaric Medicine 2013;40(3):289-287.</span> |
− | + | ---- | |
<span style="font-size:medium;">'''Lead author's name and fax: '''J Vladimir drvladakgbg@yahoo.com</span> | <span style="font-size:medium;">'''Lead author's name and fax: '''J Vladimir drvladakgbg@yahoo.com</span> | ||
− | '''Three-part Clinical Question: | + | '''<span style="font-size:medium;">Three-part Clinical Question:</span>''''' ''<span style="font-size: medium;">For patients undergoing rehabilitation and the fitting of prosthetic limbs after amputation, does the addition of hyperbaric oxygen therapy improve rehabilitation?</span> |
<span style="font-size:medium;">'''Search Terms:''' amputation; rehabilitation; prosthesis</span> | <span style="font-size:medium;">'''Search Terms:''' amputation; rehabilitation; prosthesis</span> | ||
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− | <span style="font-size: | + | <span style="font-size:large;">'''The Evidence:'''</span> |
− | {| class="Table" style="border: | + | {| class="Table" style="width:659.25pt; border:solid windowtext 1.0pt" width="0" |
|- | |- | ||
− | | style="width: | + | | style="width:100.85pt; border:solid windowtext 1.0pt" width="137" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''Outcome'''</p> |
− | | style="width: | + | | style="width:86.3pt; border:solid windowtext 1.0pt" width="117" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''Time to Outcome'''</p> |
− | | style="width: | + | | style="width:83.55pt; border:solid windowtext 1.0pt" width="113" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''Control Group'''</p> |
− | | style="width: | + | | style="width:90.6pt; border:solid windowtext 1.0pt" width="123" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''Hyperbaric Group'''</p> |
− | | style="width: | + | | style="width:104.85pt; border:solid windowtext 1.0pt" width="142" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''Relative risk reduction'''</p> |
− | | style="width: | + | | style="width:97.5pt; border:solid windowtext 1.0pt" width="132" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''Absolute risk reduction'''</p> |
− | | style="width: | + | | style="width:83.6pt; border:solid windowtext 1.0pt" width="114" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''NNT'''</p> |
|- | |- | ||
− | | style="width: | + | | rowspan="2" style="width:100.85pt; border:solid windowtext 1.0pt" width="137" | |
− | + | '''Complications (e.g. dehiscence, phantom pain, haematoma)''' | |
− | | style="width: | + | | style="width:86.3pt; border:solid windowtext 1.0pt" width="117" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">Discharge</p> |
− | | style="width: | + | | style="width:83.55pt; border:solid windowtext 1.0pt" width="113" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">1.00</p> |
− | | style="width: | + | | style="width:90.6pt; border:solid windowtext 1.0pt" width="123" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">0.87</p> |
− | | style="width: | + | | style="width:104.85pt; border:solid windowtext 1.0pt" width="142" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">13%</p> |
− | | style="width: | + | | style="width:97.5pt; border:solid windowtext 1.0pt" width="132" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">0.13</p> |
− | | style="width: | + | | style="width:83.6pt; border:solid windowtext 1.0pt" width="114" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">8</p> |
|- | |- | ||
− | | | + | | colspan="3" style="width:263.45pt; border:solid windowtext 1.0pt" width="353" | <p align="right" style="text-align:right; padding:.75pt .75pt .75pt .75pt">95% CIs:</p> |
− | + | | style="width:104.85pt; border:solid windowtext 1.0pt" width="142" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">1% to 25%</p> | |
− | + | | style="width:97.5pt; border:solid windowtext 1.0pt" width="132" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">0.01 to 0.26</p> | |
− | + | | style="width:83.6pt; border:solid windowtext 1.0pt" width="114" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">4 to 87</p> | |
− | | style="width: | ||
− | | style="width: | ||
− | | style="width: | ||
|- | |- | ||
− | | style="width: | + | | rowspan="2" style="width:100.85pt; border:solid windowtext 1.0pt" width="137" | |
− | + | '''Stump contracture''' | |
− | | style="width: | + | | style="width:86.3pt; border:solid windowtext 1.0pt" width="117" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">Discharge</p> |
− | | style="width: | + | | style="width:83.55pt; border:solid windowtext 1.0pt" width="113" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">0.20</p> |
− | | style="width: | + | | style="width:90.6pt; border:solid windowtext 1.0pt" width="123" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">0.13</p> |
− | | style="width: | + | | style="width:104.85pt; border:solid windowtext 1.0pt" width="142" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">34%</p> |
− | | style="width: | + | | style="width:97.5pt; border:solid windowtext 1.0pt" width="132" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">0.07</p> |
− | | style="width: | + | | style="width:83.6pt; border:solid windowtext 1.0pt" width="114" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">15</p> |
|- | |- | ||
− | | | + | | colspan="3" style="width:263.45pt; border:solid windowtext 1.0pt" width="353" | <p align="right" style="text-align:right; padding:.75pt .75pt .75pt .75pt">95% CIs:</p> |
− | + | | style="width:104.85pt; border:solid windowtext 1.0pt" width="142" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">-60% to 100%</p> | |
− | + | | style="width:97.5pt; border:solid windowtext 1.0pt" width="132" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">-0.12 to 0.26</p> | |
− | + | | style="width:83.6pt; border:solid windowtext 1.0pt" width="114" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">NNT 4 to INF;</p> <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">NNH8 to INF</p> | |
− | | style="width: | ||
− | | style="width: | ||
− | | style="width: | ||
|- | |- | ||
− | | style="width: | + | | rowspan="2" style="width:100.85pt; border:solid windowtext 1.0pt" width="137" | |
− | + | '''Return of palpable peripheral pulses''' | |
− | | style="width: | + | | style="width:86.3pt; border:solid windowtext 1.0pt" width="117" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">Discharge</p> |
− | | style="width: | + | | style="width:83.55pt; border:solid windowtext 1.0pt" width="113" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">0</p> |
− | | style="width: | + | | style="width:90.6pt; border:solid windowtext 1.0pt" width="123" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">0.27</p> |
− | | style="width: | + | | style="width:104.85pt; border:solid windowtext 1.0pt" width="142" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">INF</p> |
− | | style="width: | + | | style="width:97.5pt; border:solid windowtext 1.0pt" width="132" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">0.27</p> |
− | | style="width: | + | | style="width:83.6pt; border:solid windowtext 1.0pt" width="114" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">4</p> |
|- | |- | ||
− | | | + | | colspan="3" style="width:263.45pt; border:solid windowtext 1.0pt" width="353" | <p align="right" style="text-align:right; padding:.75pt .75pt .75pt .75pt">95% CIs:</p> |
− | + | | style="width:104.85pt; border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" width="142" | | |
− | + | | style="width:97.5pt; border:solid windowtext 1.0pt" width="132" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">0.11 to 0.43</p> | |
− | + | | style="width:83.6pt; border:solid windowtext 1.0pt" width="114" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">2 to 9</p> | |
− | | style="width: | ||
− | | style="width: | ||
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|} | |} | ||
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{| class="Table" style="border:solid windowtext 1.0pt" | {| class="Table" style="border:solid windowtext 1.0pt" | ||
|- | |- | ||
− | | style="border:solid windowtext 1.0pt" | <p align="center" style=" | + | | style="width:217.0pt; border:solid windowtext 1.0pt" width="225" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''Measure'''</p> |
− | | style=" | + | | colspan="2" style="width:126.05pt; border:solid windowtext 1.0pt" width="138" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''Control Group'''</p> |
− | + | | colspan="2" style="width:111.9pt; border:solid windowtext 1.0pt" width="128" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''Hyperbaric Group'''</p> | |
− | + | | style="width:86.5pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''Difference'''</p> | |
− | | style="border:solid windowtext 1.0pt | + | | style="width:108.2pt; border:solid windowtext 1.0pt" width="112" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''95% CI'''</p> |
− | |||
− | | style="border:solid windowtext 1.0pt" | <p align="center" style=" | ||
− | | style="border:solid windowtext 1.0pt" | <p align="center" style=" | ||
|- | |- | ||
− | | style="border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" | | + | | style="width:217.0pt; border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" width="225" | |
− | | style="border:solid windowtext 1.0pt" | <p align="center" style=" | + | | style="width:83.55pt; border:solid windowtext 1.0pt" width="92" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">Mean</p> |
− | | style="border:solid windowtext 1.0pt" | <p align="center" style=" | + | | style="width:41.0pt; border:solid windowtext 1.0pt" width="46" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">SD</p> |
− | | style="border:solid windowtext 1.0pt | + | | style="width:55.2pt; border:solid windowtext 1.0pt" width="67" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">Mean</p> |
− | + | | style="width:55.2pt; border:solid windowtext 1.0pt" width="60" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">SD</p> | |
− | | style="border:solid windowtext 1.0pt" | <p align="center" style=" | + | | style="width:86.5pt; border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" width="104" | |
− | | style="border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" | | + | | style="width:108.2pt; border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" width="112" | |
− | | style="border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" | | ||
|- | |- | ||
− | | style="border:solid windowtext 1.0pt" | + | | style="width:217.0pt; border:solid windowtext 1.0pt" width="225" | |
− | + | '''Locomotor capability index at discharge''' | |
− | | style="border:solid windowtext 1.0pt" | <p align="center" style=" | + | | style="width:83.55pt; border:solid windowtext 1.0pt" width="92" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">34</p> |
− | | style="border:solid windowtext 1.0pt" | <p align="center" style=" | + | | style="width:41.0pt; border:solid windowtext 1.0pt" width="46" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">9</p> |
− | | style="border:solid windowtext 1.0pt | + | | style="width:55.2pt; border:solid windowtext 1.0pt" width="67" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">38</p> |
− | + | | style="width:55.2pt; border:solid windowtext 1.0pt" width="60" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">11</p> | |
− | | style="border:solid windowtext 1.0pt" | <p align="center" style=" | + | | style="width:86.5pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">4</p> |
− | | style="border:solid windowtext 1.0pt" | <p align="center" style=" | + | | style="width:108.2pt; border:solid windowtext 1.0pt" width="112" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">1.2 to 9.2</p> |
− | | style="border:solid windowtext 1.0pt" | <p align="center" style=" | ||
|- | |- | ||
− | | style="border:solid windowtext 1.0pt" | + | | style="width:217.0pt; border:solid windowtext 1.0pt" width="225" | |
− | + | '''Two minute walking test at discharge (feet)''' | |
− | | style="border:solid windowtext 1.0pt" | <p align="center" style=" | + | | style="width:83.55pt; border:solid windowtext 1.0pt" width="92" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">74</p> |
− | | style="border:solid windowtext 1.0pt" | <p align="center" style=" | + | | style="width:41.0pt; border:solid windowtext 1.0pt" width="46" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">21</p> |
− | | style="border:solid windowtext 1.0pt | + | | style="width:55.2pt; border:solid windowtext 1.0pt" width="67" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">90</p> |
− | + | | style="width:55.2pt; border:solid windowtext 1.0pt" width="60" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">32</p> | |
− | | style="border:solid windowtext 1.0pt" | <p align="center" style=" | + | | style="width:86.5pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">16</p> |
− | | style="border:solid windowtext 1.0pt" | <p align="center" style=" | + | | style="width:108.2pt; border:solid windowtext 1.0pt" width="112" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">2.0 to 30.0</p> |
− | | style="border:solid windowtext 1.0pt" | <p align="center" style=" | ||
|} | |} | ||
− | <span style="font-size: | + | |
+ | |||
+ | <span style="font-size:large;">'''Comments:'''</span> | ||
<span style="font-size:medium;">1. Functional outcome using an 'adapted Narang Scale' is not explained so omitted here.</span> | <span style="font-size:medium;">1. Functional outcome using an 'adapted Narang Scale' is not explained so omitted here.</span> | ||
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<span style="font-size:medium;">'''Appraised by:''' Mike Bennett m.bennett@unsw.edu.au ; Sunday, 1 October 2017</span> | <span style="font-size:medium;">'''Appraised by:''' Mike Bennett m.bennett@unsw.edu.au ; Sunday, 1 October 2017</span> | ||
− | <span style="font-size:medium;">'''Kill or Update By:''' July | + | <span style="font-size:medium;">'''Kill or Update By:''' July 2023</span> |
[[File:Sumhorsa.gif|center|Sumhorsa.gif]] | [[File:Sumhorsa.gif|center|Sumhorsa.gif]] | ||
<span style="color: #7c00ff; display: block; font-size: 26px; text-align: center;">[[Flaps_and_grafts|'''BACK''']]</span> | <span style="color: #7c00ff; display: block; font-size: 26px; text-align: center;">[[Flaps_and_grafts|'''BACK''']]</span> |
Revision as of 03:36, 17 August 2022
Hyperbaric oxygen therapy may improve mobility, reduce complications and return circulation in post-amputation patients have rehabilitation for prosthesis fitting.
Clinical bottom line:
1. Evidence of a number of benefits in mobility and return of peripheral circulation in patients undergoing a rehabilitation program for prosthesis fitting |
Citation/s: 1, Igor S, Mirka T, Dalibor P, Milutin R, Dusica D, Vladimir Z, Vladimir J. Hyperbaric oxygenation accelerates prosthetic rehabilitation of lower limb amputees. Undersea and Hyperbaric Medicine 2013;40(3):289-287.
Lead author's name and fax: J Vladimir drvladakgbg@yahoo.com
Three-part Clinical Question: For patients undergoing rehabilitation and the fitting of prosthetic limbs after amputation, does the addition of hyperbaric oxygen therapy improve rehabilitation?
Search Terms: amputation; rehabilitation; prosthesis
The Study: Non-blinded randomised controlled trial with intention-to-treat.
The Study Patients: Patients with unilateral lower limb amputation and where a rehabilitation program for fitting of a prosthetic limb is planned.
Control group (N = 30; 30 analysed): A standard prosthetic assessment and rehabilitation program including orthopaedic assessment, physiotherapy, laser therapy, magnetotherapy, electrotherapy, thermotherapy and electrical stimulation.
Experimental group (N = 30; 30 analysed): As above plus 15 sessions of HBOT at 1.7 ATA for 60 minutes
The Evidence:
Outcome |
Time to Outcome |
Control Group |
Hyperbaric Group |
Relative risk reduction |
Absolute risk reduction |
NNT |
Complications (e.g. dehiscence, phantom pain, haematoma) |
Discharge |
1.00 |
0.87 |
13% |
0.13 |
8 |
95% CIs: |
1% to 25% |
0.01 to 0.26 |
4 to 87 | |||
Stump contracture |
Discharge |
0.20 |
0.13 |
34% |
0.07 |
15 |
95% CIs: |
-60% to 100% |
-0.12 to 0.26 |
NNT 4 to INF; NNH8 to INF | |||
Return of palpable peripheral pulses |
Discharge |
0 |
0.27 |
INF |
0.27 |
4 |
95% CIs: |
0.11 to 0.43 |
2 to 9 |
Measure |
Control Group |
Hyperbaric Group |
Difference |
95% CI | ||
Mean |
SD |
Mean |
SD |
|||
Locomotor capability index at discharge |
34 |
9 |
38 |
11 |
4 |
1.2 to 9.2 |
Two minute walking test at discharge (feet) |
74 |
21 |
90 |
32 |
16 |
2.0 to 30.0 |
Comments:
1. Functional outcome using an 'adapted Narang Scale' is not explained so omitted here.
2. Locomotor capability index and thigh girth have been read from a graph.
3. Other benefits stated in the paper not quantified - only p-values given.
4. It is difficult to understand how HBOT can return palpable peripheral pulses as suggested here. Authors suggest "we can assume that HBO2 significantly affected peripheral vascularization of our patients". This is an extraordinary claim.
5. Many findings in this study have a high chance of bias due to the unblinded nature of the study.
Appraised by: Mike Bennett m.bennett@unsw.edu.au ; Sunday, 1 October 2017
Kill or Update By: July 2023