No abstract

AimThis overview of Cochrane systematic reviews (CSRs) reports on current evidence on the effectiveness of rehabilitation interventions for individuals with cerebral palsy (CP) and the quality of the evidence.MethodFollowing the inclusion criteria defined by the World Health Organization, all CSRs tagged in the Cochrane Rehabilitation database that were relevant for individuals with CP were included. A mapping synthesis was used to group outcomes and comparisons of included CSRs indicating the effect of rehabilitation interventions and the certainty of evidence.ResultsA total of eight CSRs were included in the evidence map. The effect of interventions varied across comparisons and the certainty of evidence was inconsistent, ranging from high to very low. The best evidence was found for botulinum neurotoxin A (BoNT‐A) combined with occupational therapy in the management of spasticity. However, the effect of BoNT‐A on drooling and salivation remains unclear. A paucity of randomized controlled trials studying treatments for both dystonia and postural deformities was noted.InterpretationThis review emphasizes the need to further investigate the effectiveness and cost–benefit of rehabilitation interventions for individuals with CP.

INTRODUCTION Currently, no evidence exists on specific treatments for post COVID-19 condition (PCC). However, rehabilitation interventions that are effective for similar symptoms in other health conditions could be applied to people with PCC. With this overview of systematic reviews with mapping, we aimed to describe the Cochrane evidence on rehabilitation interventions proposed for cognitive impairment, anxiety and depression in different health conditions that can be relevant for PCC. EVIDENCE ACQUISITION We searched the last five years’ Cochrane Systematic Review (CSRs) using the terms “cognitive impairment,” “depressive disorder,” “anxiety disorder,” their synonyms and variants, and “rehabilitation” in the Cochrane Library. We extracted and summarized the available evidence using a map. We grouped the included CSRs for health conditions and interventions, indicating the effect and the quality of evidence. EVIDENCE SYNTHESIS We found 3596 CSRs published between 2016 and 2021, and we included 17 on cognitive impairment and 37 on anxiety and depression. For cognitive impairment, we found 7 CSRs on participants with stroke, 3 with cancer, 2 with Parkinson’s disease, and one each for five other health conditions. Each intervention improved a different domain, and included exercises, cognitive and attention-specific training, and computerized cognition-based training (from very low to high-quality evidence). For anxiety and depression, we found 10 CSRs including participants with cancer, 8 with stroke, 3 with chronic obstructive pulmonary disease, and 2 or 1 each in 11 other health conditions. Exercise training, physical activity and yoga resulted effective in several pathologies (very low- to moderate-quality evidence). In specific diseases, we found effective acupuncture, animal-assisted therapy, aromatherapy, educational programs, home-based multidimensional survivorship programs, manual acupressure massage, memory rehabilitation, non-invasive brain stimulation, pulmonary rehabilitation, and telerehabilitation (very low- to moderate-quality evidence). CONCLUSIONS These results are the first step of indirect evidence able to generate helpful hypotheses for clinical practice and future research. They served as the basis for the three recommendations on treatments for these PCC symptoms published in the current WHO Guidelines for clinical practice.

Introduction Despite the recent Department of Defense emphasis on traumatic brain injury (TBI) education and improvements in treatment, social, and attitudinal beliefs instilled in the military community hinder seeking medical assistance at the time of injury. This survey research presents injury reporting and care seeking behavioral patterns of service members (SMs) stationed in the Landstuhl catchment area in the context of TBI. This descriptive study investigated whether sociocultural factors influence health decision-making among SMs stationed abroad and how these compare to the SMs stationed in Fort Bliss and Fort Hood. Materials and Methods A total of 969 of U.S. Army, Air Force, and Navy SMs completed a voluntary and anonymous 2- to 5-minute paper survey during the month of March 2019. As a result of illegibility and incompleteness, 15 survey responses were removed from the total sample. Results Data analyses show three main findings about SMs in the Landstuhl catchment area: (a) older population (25-34, ≥48%; 18-24, 26.1%; +35, 25.4%) when compared to Fort Hood and Fort Bliss (≥48%; 18-24); (b) more years in service (7-13 years; 30.2%) versus 6 years or less in both Fort Hood and Fort Bliss (≥69%); (c) 54.8% of participants did not think TBI requires care versus 63.5% in both Fort Bliss and Fort Hood. Conclusion Results suggest that TBI beliefs and influences are constant variables hindering health decision-making choices in the military population. Beliefs about thinking that the injury does not require care, fear to jeopardize the career, and knowledge about TBI and treatments vary among the respondents and all these components influence treatment-seeking behaviors. The findings provide a preliminary framework to further investigate the role of culture in reporting and seeking treatment behaviors among SMs.

Background: This review examined the effectiveness of behavioral interventions for adults with post-traumatic stress disorder (PTSD) triggered by physical injury or medical trauma. It discusses implications in support of rehabilitation management for COVID-19 survivors diagnosed with PTSD. Methods: This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Interim Guidance from the Cochrane Rapid Reviews Methods Group. The authors searched for randomized control trials in PubMed, Embase, and CENTRAL databases up to 31 March 2021. Results: Five studies (n = 459) met the inclusion criteria. Each study measured a different comparison of interventions. The certainty of the evidence was judged to be very low for all outcomes. Post-traumatic stress disorder symptom reduction was found to be in favor of trauma-focused cognitive-behavioral therapy, cognitive therapy, and cognitive-behavioral therapy. Cognitive function improvements were observed in favor of the cognitive processing therapy control intervention. Conclusions: Overall, there is uncertainty about whether behavioral interventions are effective in reducing PTSD symptoms and improving functioning and quality of life when the disorder is triggered by a physical or medical trauma rather than a psychological trauma. Further research should investigate their efficacy in the context of rehabilitation management and gather evidence on this population.