Systematic Review
As the body of knowledge is growing in the field of OH management for SCI, it is becoming increasingly important to review the literature and ensure that the information used both in research and clinical practice is current and evidence based. The aim of this section of the OH chapter is to provide an overview of the current systematic reviews available for in areas related to OH management in SCI population.
Authors; Country Date included in the review Number of articles Level of evidence Type of study Score |
Methods Databases |
Evidence |
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Krassioukov et al. 2009; Canada Reviewed published articles from 1950 to July 2008 N=26 n=251 Level of evidence: PEDRo Scale – RCTs (9–10: excellent; 6–8: good; 4–5: fair; 0-4: poor) Modified Downs & Black scale – non RCTs (0 to 28) Type of study: 2 case reports, 1 case series, 2 observational, 1 pre-post, 1 RCT AMSTAR: 6 |
Methods: Key word literature search for (original) articles, previous practice guidelines, and review articles was conducted to identify literature evaluating the effectiveness of any treatment or therapy for OH in the SCI population. |
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Gillis et al. 2008; Belgium Reviewed published articles from 1966 to April 2007 N=13 n=138 Level of evidence: Downs & Black scale Type of study: Parallel group, cross-over, quasi-random assignment AMSTAR: 5 |
Methods: Key word literature search for non-pharmacological management of OH during early rehab in SCI. |
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Discussion
We found only one systematic review on OH management for individuals with SCI by Krassioukov et al. (2009). Although the authors found that the overall quality of the literature was poor and that higher quality research assessing the treatments for OH in the SCI population is needed, there is level 2 evidence that pressure from elastic stockings and abdominal binders may improve cardiovascular physiologic responses during submaximalupper-extremity exercises. In addition, FES is an important adjunct treatment to minimize cardiovascular changes during postural orthostatic stress and that simultaneous upper-extremity exercises may increase orthostatic tolerance during a progressive tilt exercise in subjects with paraplegia.