Effects of hyperbaric oxygen therapy on patients with spinal cord injury: A systematic review and meta-analysis of Randomized Controlled Trials.

BACKGROUND: The effects of hyperbaric oxygen therapy (HBO) for spinal cord injury (SCI) are controversial. OBJECTIVE: The purpose of this study was to evaluate the effects of HBO therapy on motor function, sensory function, and psychology after SCI. METHOD: We searched the following databases: Medline, Embase, PubMed, Ovid, Cochrane library, China National Knowledge Infrastructure (CNKI), Wan Fang, and VIP up to May 2020. We included Randomized Controlled Trials (RCTs) which investigated patients with SCI received HBO during hospitalization. Motor function, sensory function, and psychology status were measured by commonly used scales including American Spinal Injury Association (ASIA) motor score, Modified Barthel Index (MBI), ASIA sensory score, Hamilton Depression Scale (HAMD), and Hamilton Anxiety Scale (HAMA). We performed a meta-analysis by calculating mean difference (MD) to determine the effect of HBO on three levels of function on patients with SCI. We evaluated heterogeneity by I2 test, and I2> 50% was significant. RESULTS: A total of 1746 studies were identified initially, and 11 studies were included, involving 875 participants. HBO therapy significantly improved the ASIA motor score (MD 15.84, 95% CI 9.04 to 22.64, I2= 87%). Six trails suggested that HBO therapy statistically promoted ASIA sensory score (MD 66.30, 95% CI 53.44 to 79.16, I2= 95%). The other four trails suggested that HBO therapy statistically increased the light touch score (MD 9.27, 95% CI 3.89 to 14.65, I2= 91%) and needling score (MD 10.01, 95% CI 8.60 to 11.43, I2= 95%), respectively. HBO therapy was implicated in the significant improvement of MBI (MD 13.80, 95% CI 10.65 to 16.94, I2= 0%). HBO therapy also decreased the HAMA (MD -2.37, 95% CI -2.72 to -2.02, I2= 0%) and HAMD (MD -3.74, 95% CI -5.82 to -1.65, I2= 90%). CONCLUSIONS: HBO therapy may improve motor function, sensory function and psychology after SCI compared to conventional treatments. More high-quality, large sample size RCTs are needed to support these perspectives.

The Effect of Pulsed Electromagnetic Fields on Angiogenesis.

A pulsed electromagnetic field (PEMF) has been used to treat inflammation-based diseases such as osteoporosis, neurological injury, and osteoarthritis. Numerous animal experiments and in vitro studies have shown that PEMF may affect angiogenesis. For ischemic diseases, in theory, blood flow may be richer by increasing the number of blood vessels which supply blood to ischemic tissue. PEMF plays a role in enhancing angiogenesis, and their clinical application may go far beyond the current scope. In this review, we analyzed and summarized the effects and possible mechanisms of PEMF on angiogenesis. Most studies have shown that PEMF with specific parameters can promote angiogenesis, which is manifested by an increased vascular growth rate and increased capillary density. The potential mechanisms consist of promoting vascular endothelial cell proliferation, migration, and tube formation, and increasing the expression level of vascular endothelial growth factor (VEGF), fibroblast growth factor 2 (FGF2), angiopoietin-2 (Ang-2), and other angiogenic growth factors. Additionally, PEMF has an impact on the activation of voltage-gated calcium channels (VGCC). Bioelectromagnetics. © 2021 Bioelectromagnetics Society.

Effects of water therapy on disease activity, functional capacity, spinal mobility and severity of pain in patients with ankylosing spondylitis: a systematic review and meta-analysis.

PURPOSE: To evaluate the efficacy of water therapy for disease activity, functional capacity, spinal mobility, and pain in patients with ankylosing spondylitis. METHODS: PubMed, Ovid, web of science, Cochrane library, Physiotherapy Evidence Database, CNKI, VIP, Wan Fang, and Open Grey were searched for randomized controlled trials that investigated the effects of water therapy on patients with ankylosing spondylitis. Two researchers independently screened the literature databases and then assessed methodological qualities using the Physiotherapy Evidence Database scale and extracted data. Outcomes included were disease activity, functional capacity, spinal mobility, and pain. RESULTS: A total of eight studies (n = 383) met the inclusion criteria. Analysis demonstrated that water therapy had a significant effect on disease activity and pain, but not on spinal mobility, or functional capacity in patients with ankylosing spondylitis. CONCLUSION: Water therapy can benefit patients with ankylosing spondylitis by reducing disease activity and alleviating pain. More well-designed randomized controlled trials are needed to confirm the results.IMPLICATIONS FOR REHABILITATIONWater therapy can reduce disease activity and pain in patients with ankylosing spondylitis, but cannot improve functional capacity or spinal mobility.Due to its analgesic effect both during and after treatment, water therapy remains an alternative for patients with ankylosing spondylitis when land-based therapy is not well tolerated.

Efficacy of biofeedback, repetitive transcranial magnetic stimulation and pelvic floor muscle training for female neurogenic bladder dysfunction after spinal cord injury: a study protocol for a randomised controlled trial.

INTRODUCTION: Neurogenic bladder dysfunction is prevalent in female patients with spinal cord injury (SCI), and previous guidelines have recommended pelvic floor muscle training (PFMT) for first-line conservative treatment. However, the actual regimen of PFMT varies widely and the single treatment does not satisfy the need of some patients. Therefore, this study aims to provide a detailed rationale and methodology for comparing the effectiveness of PFMT, biofeedback and repetitive transcranial magnetic stimulation (rTMS) as adjunct treatments for neurogenic bladder dysfunction. METHODS AND ANALYSIS: This trial is a single-centre randomised controlled trial for female patients with urinary incontinence (UI) in phase of chronic SCI. Eligible participants will be randomised to one of four arms: (1) PFMT, (2) PFMT with biofeedback, (3) PFMT and rTMS and (4) PFMT with biofeedback and rTMS. There will be 44 participants in each arm and all the subjects will undergo 20 treatment sessions, five times a week for 4 weeks. The outcomes will be evaluated at 4 weeks, 3 months and 6 months after randomisation. The primary outcome is the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, and the secondary outcomes include bladder diary, pelvic floor muscle function and the International Spinal Cord Injury Quality of Life Basic Data Set. ETHICS AND DISSEMINATION: The Clinical Research and Biomedical Ethics Committee of the West China Hospital, Sichuan University has approved this trial and the approval number is 2019-885. All participants will be provided written informed consent after verification of the eligibility criteria. The results of this study will be accessible in peer-reviewed publications and be presented at academic conferences. TRIAL REGISTRATION NUMBER: Chinese Clinical Trial Registry (ChiCTR1900026126).

Effectiveness of Pulsed Electromagnetic Fields on Bone Healing: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

The effect of pulsed electromagnetic field (PEMF) on bone healing is still uncertain and it has not been established as a standardized treatment. The aim of this systematic review and meta-analysis is to evaluate the effect of PEMF on bone healing in patients with fracture. We searched CNKI, Wan Fang, VIP, EMbase, PubMed, CENTRAL, Web of Science, Physiotherapy Evidence Database, and Open Grey websites for randomized controlled trials (published before July 2019 in English or Chinese) comparing any form of PEMF to sham. Reference lists were also searched. Related data were extracted by two investigators independently. The bias risk of the articles and the evidence strength of the outcomes were evaluated. Twenty-two studies were eligible and included in our analysis (n = 1,468 participants). The pooled results of 14 studies (n = 1,131 participants) demonstrated that healing rate in PEMF group was 79.7% (443/556), and that in the control group was 64.3% (370/575). PEMF increased healing rate (RR = 1.22; 95% confidence interval [CI] = 1.10-1.35; I2 = 48%) by the Mantel-Haenszel analysis, relieved pain (standardized mean difference (SMD) = -0.49; 95% CI = -0.88 to -0.10; I2 = 60%) by the inverse variance analysis, and accelerated healing time (SMD = -1.01; 95% CI = -2.01 to -0.00; I2 = 90%) by the inverse variance analysis. Moderate quality evidence suggested that PEMF increased healing rate and relieved pain of fracture, and very low-quality evidence showed that PEMF accelerated healing time. Larger and higher quality randomized controlled trials and pre-clinical studies of optimal frequency, amplitude, and duration parameters are needed. © 2020 Bioelectromagnetics Society.

Efficacy of Extracorporeal Shockwave Therapy on Pain and Function in Myofascial Pain Syndrome of the Trapezius: A Systematic Review and Meta-Analysis.

OBJECTIVE: To evaluate the effect of extracorporeal shockwave therapy (ESWT) on pain and function in myofascial pain syndrome (MPS) of the trapezius. DATA SOURCES: PubMed, EMBASE, Web of Science, Physiotherapy Evidence Database, and The Cochrane Central Register of Controlled Trials were systematically searched from the time of their inception to September 2019. STUDY SELECTION: Randomized controlled trials comparing the effects of ESWT on MPS of the trapezius were included in this review. DATA EXTRACTION: Data related to study participants, intervention, follow-up period, measure time, and outcomes were extracted. The Physiotherapy Evidence Database scale and the Cochrane Collaboration Tool for Assessing Risk of Bias were used to assess study quality and risk of bias. DATA SYNTHESIS: In total, 10 articles (n=477 patients) met our criteria and were included in this study. The overall effectiveness was calculated using a meta-analysis method. The meta-analysis revealed that ESWT exhibited significant improvement in pain reduction compared with sham ESWT or ultrasound treatment, but no significant effect when compared with conventional treatments (dry needling, trigger point injection, laser therapy) as for pain intensity and neck disability index. CONCLUSIONS: ESWT appears to benefit patients with MPS of the trapezius by alleviating pain. ESWT may not be an ideal therapeutic method to replace conventional therapies but could serve as an adjunct therapeutic method to those treatments.

Pulsed Electromagnetic Fields Increase Angiogenesis and Improve Cardiac Function After Myocardial Ischemia in Mice.

BACKGROUND: Previous studies have shown that pulsed electromagnetic fields (PEMF) stimulate angiogenesis and may be a potential treatment strategy to improve cardiac function after myocardial infarction (MI). This study explored the effects and its related mechanisms of PEMF in MI mice.Methods and Results:MI mice were used in PEMF treatment (15 Hz 1.5 mT PEMF or 30 Hz 3.0 mT PEMF) for 45 min per day for 2 weeks. Furthermore, an in vivo Matrigel plug assay was used to observe the effect of PEMF in promoting angiogenesis. Compared with the sham PEMF group, PEMF treatment with 30 Hz 3.0 mT significantly improved heart function. PEMF treatment with 15 Hz 1.5 mT and 30 Hz 3.0 mT both increased capillary density, decreased infarction area size, increased the protein expression of vascular endothelial growth factor (VEGF), vascular endothelial growth factor receptor 2 (VEGFR2), Ser473-phosphorylated Akt (pSer473-Akt) and S1177-phosphorylated endothelial nitric oxide synthase (pS1177-eNOS), and increased the mRNA level of VEGF and hypoxia inducible factor 1-alpha (HIF-1α) in the infarct border zone. Additionally, treatment with 30 Hz 3.0 mT also increased protein and mRNA level of fibroblast growth factor 2 (FGF2), and protein level of ß1 integrin, and shows a stronger therapeutic effect. CONCLUSIONS: PEMF treatment could promote angiogenesis of the infarct border zone and improve cardiac function in MI mice. A treatment parameter of 30 Hz 3.0 mT is remarkably effective in MI mice. The effect is associated with the proangiogenic signaling pathways of HIF-1α/VEGF/Akt/eNOS or HIF-1α/FGF2/Akt/eNOS.

The Effect of Different Acupuncture Therapies on Neurological Recovery in Spinal Cord Injury: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

Many acupuncture therapies were used to treat spinal cord injury (SCI) and its complications. The difference in efficacy among these therapies has not been assessed. To compare the efficacy of different acupuncture therapies for SCI, we searched databases (PubMed, Embase, Cochrane Library, CNKI, and WanFang) for relevant RCTs in both English and Chinese before June 2019 that reported the association between acupuncture therapies and SCI. The RCTs were categorized according to the location of the acupoints used in them. The neural function was assessed by American Spinal Injury Association (ASIA) motor score, and daily living ability was accessed by Modified Barthel Index (MBI) after SCI. In total, 22 trials involving 1644 participants were included. The pairwise meta-analysis and random effects model network meta-analysis were conducted. The results indicated that exercise combined with electro-acupuncture (EA) is superior to exercise without acupuncture in improving the ASIA motor score. EA was associated with a significantly higher improvement in the MBI score than exercise alone, except for EA of head + limbs and limbs. Additionally, EA on the head + back and back + front (chest and abdomen) rank the top in both increasing the ASIA motor score and the MBI score. Acupuncture can significantly increase motor function and daily living ability of individuals who suffer from SCI, especially acupuncture of the back + front or the head + back. The evidence supports acupuncture of the back + front or the head + back as an effective treatment for SCI.