Objective: To systematically assess the effectiveness of core-based exercise for correcting a spinal deformity and improving quality of life in people with scoliosis. Data sources: The PubMed, Embase, Cochrane Library, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Web of Science databases were searched from inception up to September 30, 2020. Methods: Clinical controlled trials were eligible if they compared the effectiveness of core-based exercise to other nonsurgical interventions in people with scoliosis. The revised Cochrane risk of bias assessment tool for randomized trials and the methodological index for non-randomized studies scale were used to assess the risk of bias. The outcomes included the Cobb angle, the angle of trunk rotation and quality of life. RevMan 5.3 was used, and intergroup differences were determined by calculating mean differences (MD) and 95% confidence intervals (CIs). Results: After screening 1348 studies, nine studies with 325 participants met the inclusion criteria. The exercise group had significantly lower Cobb angles (MD = −2.08, 95% CI: −3.89 to −0.28, P = 0.02) and significantly better quality of life as measured by the Scoliosis Research Society-22 questionnaire (MD = 0.25, 95% CI: 0.02 to 0.49, P = 0.03) than the control groups. However, no significant difference was observed regarding the angle of trunk rotation between groups (MD = −0.69, 95% CI: −2.61 to 1.22, P = 0.48). Furthermore, no serious adverse events were reported. The overall quality of evidence ranged from low to very low. Conclusion: Core-based exercise may have a beneficial role in reducing the Cobb angle and improving quality of life in people with scoliosis in the short term. PROSPERO registration number: CRD42020160509 (Available at http://www.crd.york.ac.uk/prospero/ )
Neuropathic pain and neuropsychiatric symptoms are common complications reported by the traumatic brain injury (TBI) population. Although a growing body of research has indicated the effectiveness of repetitive transcranial magnetic stimulation (rTMS) for the management of neurological and psychiatric disorders, little evidence has been presented to support the effects of rTMS on neuropathic pain and neuropsychiatric symptoms in patients with TBI in all age groups. In addition, a better understanding of the potential factors that might influence the therapeutic effect of rTMS is necessary. The objective of this preregistered systematic review and meta-analysis was to quantify the effects of rTMS on physical and psychological symptoms in individuals with TBI. We systematically searched six databases for randomized controlled trials (RCTs) of rTMS in TBI patients reporting pain and neuropsychiatric outcomes published until March 20, 2022. The mean difference (MD) with 95% confidence intervals (CIs) was estimated separately for outcomes to understand the mean effect size. Twelve RCTs with 276 TBI patients were ultimately selected from 1605 records for systematic review, and 11 of the studies were included in the meta-analysis. Overall, five of the included studies showed a low risk of bias. The effects of rTMS on neuropathic pain were statistically significant ( MD = − 1.00 , 95% CI -1.76 to -0.25, P = 0.009 ), with high heterogeneity ( I 2 = 76 % ). A significant advantage of 1 Hz rTMS over the right dorsolateral prefrontal cortex (DLPFC) in improving depression ( MD = − 6.52 , 95% CI -11.58 to -1.46, P = 0.01 ) was shown, and a significant improvement was noted in the Rivermead Post-Concussion Symptoms Questionnaire-13 (RPQ-13) scores of mild TBI patients after rTMS ( MD = − 5.87 , 95% CI -10.63 to -1.11, P = 0.02 ). However, no significance was found in cognition measurement. No major adverse events related to rTMS were reported. Moderate evidence suggests that rTMS can effectively and safely improve neuropathic pain, while its effectiveness on depression, postconcussion symptoms, and cognition is limited. More trials with a larger number of participants are needed to draw firm conclusions. This trial is registered with PROSPERO (PROSPERO registration number: CRD42021242364.
The aim of the study is to quantify the effects of virtual reality-based exercise on balance after stroke. Design: The PubMed, Embase, Cochrane Library, Cumulative Index of Nursing and Allied Health Literature, and Web of Science databases were searched until December 31, 2021. Independent investigators abstracted data, assessed the quality of the evidence, and rated the certainty of the evidence. The intergroup differences were determined by calculating mean difference and 95% confidence interval by RevMan 5.3 software. Results: Fourteen randomized controlled trials involving 423 stroke patients were included. Patients who received virtual reality-based exercise illustrated marked improvements in the Berg Balance Scale (mean difference, 1.35; 95% confidence interval, 0.58 to 1.86; P < 0.00001; I 2 = 44%), Timed Up and Go test (mean difference, −0.81; 95% confidence interval, −1.18 to −0.44; P < 0.0001; I 2 = 0%), Functional Reach Test (mean difference, 3.06; 95% confidence interval, 1.31-4.80; P = 0.0006; I 2 = 0%), 10-Meters Walking Test (mean difference, −1.53; 95% confidence interval, −2.92 to −0.13; P = 0.03; I 2 = 33%), and Modified Barthel Index (mean difference, 5.26; 95% confidence interval, 1.70 to 8.82; P = 0.004; I 2 = 0%) compared with the control group. Conclusions: Existing low-evidence analyses showed that virtual reality-based exercise could effectively and safely improve balance in chronic stroke. Longer-term virtual reality-based exercise was more effective on functional ability of stroke.
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