Biomedical subjects

Sanjit K Bhogal

Publications and source records attributed to Sanjit K Bhogal.

12 recordsLinked to original sources

PubMed2004

Lesion location and poststroke depression: systematic review of the methodological limitations in the literature.

BACKGROUND: It has been hypothesized that poststroke depression (PSD) results from left hemisphere lesions. However, attempts to systematically review the data investigating lesion location and PSD have yielded conflicting results. We sought to investigate the methodological differences across the literature studying the relationship between lesion location and PSD. SUMMARY OF REVIEW: A MEDLINE literature search to retrieve articles investigating the association between PSD and lesion location was performed. Information sought included source population of samples, definition of depression, standardized measurement of stroke and depression, blinding, time since stroke onset, and study design. Odds ratios (ORs) and 95% CIs were calculated with the use of Review Manager and MetaView statistical software. Twenty-six original articles were reviewed. Much of the heterogeneity across studies reflected differences in methodology. The direction of association between left hemisphere lesion location and PSD varied depending on whether patients were sampled as inpatients (OR, 1.36; 95% CI, 1.05 to 1.76) or from the community (OR, 0.60; 95% CI, 0.39 to 0.92). Change in the direction of association was also observed across assessment interval from the acute stroke (OR, 2.14; 95% CI, 1.50 to 3.04) to the chronic stroke (OR, 0.53; 95% CI, 0.30 to 0.93) phase. Differences in the measurement of depression, study design, and presentations of results also may have contributed to the heterogeneity of the findings. CONCLUSIONS: Several key initiatives should be addressed before future research is undertaken, including the development of a comprehensive measure of PSD, optimal poststroke assessment intervals, and determination of a representative population reference.

Depression↗

PubMed2003

Intensity of aphasia therapy, impact on recovery.

BACKGROUND: It has been speculated that the conflicting results demonstrated across poststroke aphasia therapy studies might be related to differences in intensity of therapy provided across studies. The aim of this study is to investigate the relationship between intensity of aphasia therapy and aphasia recovery. METHODS: A MEDLINE literature search was conducted to retrieve clinical trials investigating aphasia therapy after stroke. Changes in mean scores from each study were recorded. Intensity of therapy was recorded in terms of length of therapy, hours of therapy provided per week, and total hours of therapy provided. Pearson correlation was used to assess the relationship between changes in mean scores of outcome measures and intensity of therapy. RESULTS: Studies that demonstrated a significant treatment effect provided 8.8 hours of therapy per week for 11.2 weeks versus the negative studies that only provided approximately 2 hours per week for 22.9 weeks. On average, positive studies provided a total of 98.4 hours of therapy, whereas negative studies provided 43.6 hours of therapy. Total length of therapy time was found to be inversely correlated with hours of therapy provided per week (P=0.003) and total hours of therapy provided (P=0.001). Total length of therapy was significantly inversely correlated with mean change in Porch Index of Communicative Abilities (PICA) scores (P=0.0001). The number of hours of therapy provided in a week was significantly correlated to greater improvement on the PICA (P=0.001) and the Token Test (P=0.027). Total number of hours of therapy was significantly correlated with greater improvement on the PICA (P<0.001) and the Token Test (P<0.001). CONCLUSIONS: Intense therapy over a short amount of time can improve outcomes of speech and language therapy for stroke patients with aphasia.

Aphasia↗

PubMed2003

Treatment of visual perceptual disorders post stroke.

Visual perceptual disorders are a common clinical consequence of stroke. They include unilateral neglect, which has a major impact on rehabilitation outcome. The nature of the behavioral deficits associated with neglect has suggested that behavioral modification strategies may improve performance. This article presents a critical review and synthesis of published research evidence for the effectiveness of treatments for visual perceptual disorders after stroke. The strongest evidence for rehabilitation effectiveness was for the following: (a) specific treatment for perceptual disorders; and (b) specific training for neglect (including visual scanning). Findings also suggest that more research is needed into how the assessment of specific features of visual perceptual disorders might lead to improved methods for rehabilitation, including the use of assistive devices for mobility and activities of daily living.

Humans↗

PubMed2003

Quality of the stroke rehabilitation research.

The Stroke Rehabilitation Evidence-Based Review revealed a wide range of quality scores across primary studies. The aim of this section is to determine what differences there are across studies and to provide a detailed examination of methodological issues in the stroke rehabilitation literature. Methodology of each article was assessed using the Physiotherapy Evidence Database (PEDro) quality scale. Mean PEDro scores and percentage of studies meeting individual PEDro criteria were determined for all studies, for therapy-based studies only, and for drug-based studies only. It was noted that the stroke rehabilitation literature lacked rigor in the area of concealed allocation, blinding of the assessor, and intention-to-treat analysis. Investigation of the methodological quality of stroke rehabilitation literature emphasizes the need for improved treatment protocols, taking into account previous deficits, during research.

Clinical Trials as Topic↗

PubMed2003

An evidence-based review of stroke rehabilitation.

A comprehensive evidence-based review of stroke rehabilitation was created to be an up-to-date review of the current evidence in stroke rehabilitation and to provide specific conclusions based on evidence that could be used to help direct stroke care at the bedside and at home. A literature search using multiple data-bases was used to identify all trials from 1968 to 2001. Methodological quality of the individual randomized controlled trials was assessed using the Physiotherapy Evidence Database (PEDro) quality assessment scale. A five-stage level-of-evidence approach was used to determine the best practice in stroke rehabilitation. Over 403 treatment-based articles investigating of various areas of stroke rehabilitation were identified. This included 272 randomized controlled trials.

Clinical Trials as Topic↗

PubMed2003

The efficacy of stroke rehabilitation: a qualitative review.

A systematic review of randomized controlled trials published from 1970-2002 was conducted to assess whether specialized inpatient stroke rehabilitation is associated with improved outcomes compared to conventional care. Twelve studies involving 2,813 patients were included for detailed review. The methodological quality of the studies was assessed using the PEDro Scale. The outcomes of death, functional outcome, length of hospital stay, and rates of institutionalization were compared between the intervention and control group(s). Improved functional outcomes and reduced length of hospital stays were reported among patients receiving specialized rehabilitation in the majority of studies (7/12 and 5/8, respectively), while no differences in mortality or institutionalization were reported between the groups.

Health Facilities↗

PubMed2003

Community reintegration after stroke.

A systematic review of the literature from 1970-2002 was conducted to highlight the issues facing stroke survivors and their families upon integration into the community. Areas of interests were social support, caregiver burden and depression, family interactions, family education intervention, social and leisure activities post stroke, and leisure therapy. Four studies were selected for detailed reviews of the effectiveness of social support, 10 studies for family education intervention, and 3 studies for leisure therapy post stroke. There was evidence that improved social support as an intervention improves outcomes and that an active educational-counseling approach has a positive impact on family functioning post stroke. However, consensus regarding leisure therapy was not achieved. This article also stresses the impact of caring for a stroke survivor and the effect it has on family functioning and caregiver burden.

Caregivers↗

PubMed2003

Research gaps in stroke rehabilitation.

The Stroke Rehabilitation Evidence-Based Review was designed to be a comprehensive review of the stroke rehabilitation literature. Despite a wealth of research, which included 272 randomized controlled trials (RCTs), many research questions remained unanswered. In the absence of strong evidence (at least two RCTs confirming the efficacy of a treatment), a research gap was identified. These gaps, in areas of research rehabilitation research considered to be of clinical significance, are presented in this article as unanswered research questions.

Clinical Trials as Topic↗

PubMed2003

Early supported discharge in stroke rehabilitation.

A systematic review of the randomized controlled trials published from 1970-2002 was conducted to assess the effectiveness of early supported discharge programs in the context of stroke rehabilitation. Ten studies, including 1,286 patients, were selected for detailed review. The methodological quality of the studies was assessed using the PEDro Scale. The outcome assessed included functional outcomes, cost analysis, and length of hospital stay. Although the majority of studies reported no statistically significant differences in functional outcomes between the two groups, there was a reduction in hospital stays for patients receiving home-based therapy. These results suggest that patients with milder strokes who receive home-based therapies have similar functional outcomes to patients who receive traditional inpatient rehabilitation.

Activities of Daily Living↗

PubMed2003

Rehabilitation of aphasia: more is better.

Although the most effective means of treating aphasia post stroke has not been determined, several areas of aphasia therapy have proven to be more effective than others. A recent study had determined that intense aphasia therapy over a short period of time has greater impact on recovery than less intense therapy over a longer period of time. Building upon the idea that more is better, this article examines other spects of aphasia therapy that may be combined to facilitate recovery.

Aphasia↗

PubMed2003

Gait retraining post stroke.

A major component of stroke rehabilitation focuses on gait restoration. The purpose of this review is to examine the efficacy of a variety of gait retraining techniques currently in clinical use, including strength training, functional electrical stimulation, treadmill training, partial body-weight support, EMG biofeedback, and splinting of the lower extremity. Forty-eight studies evaluating six gait enhancement techniques were reviewed. There is either strong or moderate evidence to support the use of strength training, EMG/biofeedback, and functional electrical stimulation as an adjunctive therapy in gait training, and there is either limited or conflicting evidence to support the use of ankle-foot orthosis, treadmill training, and partial body-weight support.

Gait Disorders, Neurologic↗

PubMed2003

Stroke Rehabilitation Evidence-Based Review: methodology.

The Stroke Rehabilitation Evidence-Based Review was intended to be an up-to-date review of all therapies associated with stroke rehabilitation including both therapeutic interventions and medications. This section describes the literature search strategy, the data abstraction process, and the scale used to evaluate the methodological quality of randomized controlled trials included in the review and the system upon which the levels of evidence were based.

Evidence-Based Medicine↗