ABSTRACT
Background: For more than two decades, the surgical treatment of post-stroke spastic hands has been displaced by botulinum toxin therapy and is currently underutilized. Objectives: This article aimed to assess the potential of surgery for treating a post-stroke spastic upper extremity through a systematic review of the literature on surgical approaches that are adopted in different profiles of patients and on their outcomes and complications. Methods: Medline PubMed, Web of Science, SCOPUS, and Cochrane Library databases were searched for observational and experimental studies published in English up to November 2022. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluations (GRADE) system. Results: The search retrieved 501 abstracts, and 22 articles were finally selected. The GRADE-assessed quality of evidence was low or very low. The results of the reviewed studies suggest that surgery is a useful, safe, and enduring treatment for post-stroke spastic upper extremities, although most studied patients were candidates for hygienic improvements alone. Patients usually require an individualized combination of techniques. Over the past ten years, interest has grown in procedures that act on the peripheral nerve. Conclusions: Despite the lack of comparative studies on the effectiveness, safety, and cost of the treatments, botulinum toxin has displaced surgery for these patients. Studies to date have found surgery to be an effective and safe approach, but their weak design yields only poor-quality evidence, and clinical trials are warranted to compare these treatment options.
ABSTRACT
Introducción y objetivos: Realizamos una revisión bibliográfica para determinar la relación entre el estrés laboral y la obesidad en el ámbito laboral. Material y métodos: Revisión sistemática. Bases de datos: Medline (Medlars Online International Literature a través de Pubmed), Web Of Science, LILACS, IBECS, Embase, SCOPUS y Cochrane. Se han utilizado los niveles de evidencia STROBE y CONSORT para evaluar la calidad de los artículos. Resultados: Se han obtenido 177 referencias. Sólo 12 cumplieron con los criterios de inclusión y exclusión. Obtuvimos 1 estudio de casos y controles, 3 estudios de cohortes y 8 estudios transversales. Conclusiones: Aún no se dispone de evidencia científica suficiente que apoye una relación directa entre el estrés laboral y el aumento del índice de masa corporal, por lo cual, resulta necesario realizar estudios a más largo plazo que aporten evidencia sobre este tema, en vista del aumento del estrés en el trabajo, así como de la obesidad en los últimos años. (AU)
Introduction and objectives: We carried out a literature review to determine the relationship between exposure to occupational stress and obesity among workers. Material and methods: Systematic Review. Databases: Medline (Medlars Online International Literature through Pubmed), Web of Science, LILACS, IBECS, Embase, SCOPUS and Cochrane. We used STROBE and CONSORT evidence levels to evaluate the quality of the articles. Results: 177 references have been obtained. Only 12 satisfied the inclusion and exclusion criteria. We obtained one case-control study, three cohort studies and eight cross-sectional studies. Conclusions: There is not enough scientific evidence to support a direct relationship between occupational stress and the increase of the body max index, therefore, it is necessary to conduct more long-term studies that provide evidence on this subject, in the view of the increase in job stress and obesity in the last years. (AU)
