AIM: The aim of this study was to classify the primary outcomes used in Cochrane Systematic Reviews (CSRs) into the ICF domains of functioning; to describe the differences in primary outcomes in reviews related to rehabilitation intervention and non-rehabilitation intervention; and to describe the trend of outcome selections according year of publication.
DESIGN: Methodological paper.
POPULATION: Adult stroke population.
METHODS: We analyzed the primary outcomes used in the CSRs published by the Cochrane Stroke Review Group up to December 2017. The primary outcomes were extracted and classified into the ICF domains of functioning (body functions, body structures and activity and participation).
RESULTS: One hundred and seventy-four papers with 216 primary outcomes were included in this analysis. Less than half (102/216, 47.2%) of the outcomes could be classified into the ICF domains of functioning. For the outcomes that could be classified into the ICF domains, the majority (72/102, 70.5%) were in the activity and participation domain, followed by body functions (26/102, 25.5%) and body structures (4/102, 4.0%). Of the outcomes that could not be classified into the ICF domains (N.=114), death (81/114, 71.1%) and recurrent stroke (21/114,18.4%) formed the majority of the outcome. There were 75 CSRs on rehabilitation related interventions; the majority of the outcomes (75/97, 77.3%) used in rehabilitation related CSRs could be classified into the ICF framework with more than half (49/75, 65.3%) in the activity and participation domain.
CONCLUSIONS: The majority of the primary outcomes selected by the Cochrane Stroke Review Group in their CSRs could not be classified into the ICF domains of functioning. Death and recurrence of vascular events remains the major outcome of interest. In rehabilitation related interventions, activity and participation domain is the functioning domain most commonly used.
CLINICAL REHABILITATION IMPACT: The systematic use of patients-centered ICF-based outcomes in CSRs could help the application of evidence in clinical decision making.
EVIDENCE ACQUISITION: Searches were conducted with the Web of Science, Google Scholar, IEEE Xplore, and PubMed databases from inception up to September 2020. Articles that employed virtual reality in the rehabilitation of individual with upper limb loss were included in the research if it is written in English, the keyword exists in the title and abstract; it uses visual feedback in non-immersive, semiimmersive, or fully immersive virtual environments. Data extraction was carried out by two independent researchers. The study was drafted using the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA).
EVIDENCE SYNTHESIS: A total of 38 articles met the inclusion criteria. Most studies were published between 2010 and 2020. 39% of the studies (n=15), originates from North America; 55% of the studies (n=21), were publicly funded; 61% of the studies (n=24), was without disclosure of conflict of interest; 82% of the studies (n=31), were cited in other studies. All the studies were published in journals and conference proceedings. 66% of the studies (n=25), has come out with positive outcome. The design studies were mostly case reports, case series, and poorly designed cohort studies that made up 55% (n=21) of all the studies cited here.
CONCLUSIONS: The research conducted on the use of virtual reality in individual with upper limb loss rehabilitation is of very low quality. The improvements to the research protocol are much needed. It is not necessary to develop new devices, but rather to assess existing devices with well-conducted randomized controlled trials.
AIM: To compare the physiological responses and user preferences between conventional heavy-bag boxing against a novel form of video game boxing, known as exergaming boxing.
DESIGN: Cross-sectional study.
SETTING: Exercise laboratory setting in a university medical center.
POPULATION: Seventeen participants with SCI were recruited, of which sixteen were male and only one female. Their mean age was 35.6±10.2 years.
METHODS: All of them performed a 15-minute physical exercise session of exergaming and heavy-bag boxing in a sitting position. The study assessed physiological responses in terms of oxygen consumption, metabolic equivalent (MET) and energy expenditure between exergaming and heavy-bag boxing derived from open-circuit spirometry. Participants also rated their perceived exertion using Borg's category-ratio ratings of perceived exertion.
RESULTS: Both exergaming (MET: 4.3±1.0) and heavy-bag boxing (MET: 4.4±1.0) achieved moderate exercise intensities in these participants with SCI. Paired t-test revealed no significant differences (P>0.05, Cohen's d: 0.02-0.49) in the physiological or perceived exertional responses between the two modalities of boxing. Post session user survey reported all the participants found exergaming boxing more enjoyable.
CONCLUSIONS: Exergaming boxing, was able to produce equipotent physiological responses as conventional heavy-bag boxing. The intensity of both exercise modalities achieved recommended intensities for health and fitness benefits.
CLINICAL REHABILITATION IMPACT: Exergaming boxing have the potential to provide an enjoyable, self-competitive environment for moderate-vigorous exercise even at the comfort of their homes.
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