A randomized, double-blind study to assess if vitamin D treatment affects the outcomes of rehabilitation and balance in hemiplegic patients

Sarı, Aylin; Durmuş, Bekir; Karaman, Çiğdem Arifoğlu; Öğüt, Evrim; Aktaş, İlknur

doi:10.1589/jpts.30.874

Cited by 23 publications

(37 citation statements)

References 22 publications

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“…28,29 One study reported that vitamin D supplementation exerted a positive effect on the balance score of stroke patients. 30 Because impaired sensations are associated with balance disorder in stroke patients, our results are coherent with the available literature. Electrophysiological data suggest that the time needed to document the changes in Berg balance test scores is >8 weeks, which corresponds to axonal regeneration time.…”

Section: Discussionsupporting

confidence: 90%

<p>Does Vitamin D Affect Diabetic Neuropathic Pain and Balance?</p>

Sarı¹,

Altun²,

Karaman³

et al. 2020

JPR

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Purpose: This randomized, placebo-controlled study examined the effect of vitamin D replacement therapy on neuropathic symptoms and balance in patients with diabetic neuropathic pain and low vitamin D levels. Patients and Methods: Among the 258 patients, the results in a total of 57 volunteers (32 in the treatment and 25 in the control arm) meeting the inclusion criteria are reported. Symptoms of neuropathic pain were assessed using Douleur Neuropathique 4 (DN4) questionnaire, and presence of polyneuropathy (PNP) was determined by performing electromyography (EMG). Balance was assessed using Berg balance test (BBT). After undergoing these examinations, the patients in the treatment group were intramuscularly (IM) injected with 300,000 IU vitamin D in a liquid formulation and those in the placebo group were IM injected with physiological saline. The DN4 and BBT were repeated after 12 weeks, and the results were compared. Results: The patients in the treatment group showed a significant decrease in total DN4 scores from baseline to the study endpoint compared with the patients in the placebo group (p=0.008). The patients in the treatment group also showed a significant increase in BBT scores from baseline to the study endpoint compared with the patients in the placebo group (p=0.001). Furthermore, in subgroup analysis, these patients showed a significant decrease in electric shock and burning sensation scores from baseline to the study endpoint compared with the patients in the placebo group (p=0.006, p=0.001, respectively). Conclusion: In patients with diabetic neuropathic pain, vitamin D levels should be measured and vitamin D replacement therapy should be administered as required to resolve neuropathic symptoms and to improve balance.

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Section: Discussionsupporting

confidence: 90%

<p>Does Vitamin D Affect Diabetic Neuropathic Pain and Balance?</p>

Sarı¹,

Altun²,

Karaman³

et al. 2020

JPR

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“…Vitamin D was the most commonly used self-care product in our study and while there is evidence that Vitamin D 40 and omega 3 41 levels may have an inverse relationship with stroke risk, the evidence that they each improve rehabilitation outcomes remains promising but preliminary. [42][43][44] Interestingly, while the self-care products used by stroke survivors in our study have limited clinical evidence for such use, clinical research does support the use of tai chi by chronic stroke patients to improve balance, gait and quality of life 45 but not stroke prevention. 46 Small-scale studies suggest yoga may improve anxiety and depression in chronic stroke patients, but the improvements on balance and overall quality of life have been consistently nonsignificant.…”

Section: Discussionmentioning

confidence: 65%

“…St John's Wort ( Hypericum perforatum ), a self‐care product reported to be used by stroke survivors in our study, has high level evidence of effectiveness in the treatment of mild to moderate depression 39 but has not yet been studied or assessed in stroke patients. Vitamin D was the most commonly used self‐care product in our study and while there is evidence that Vitamin D 40 and omega 3 41 levels may have an inverse relationship with stroke risk, the evidence that they each improve rehabilitation outcomes remains promising but preliminary 42‐44 . Interestingly, while the self‐care products used by stroke survivors in our study have limited clinical evidence for such use, clinical research does support the use of tai chi by chronic stroke patients to improve balance, gait and quality of life 45 but not stroke prevention 46 .…”

Section: Discussionmentioning

confidence: 67%

Utilisation of self‐care products and practices and its associated factors among stroke survivors

et al. 2020

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This study explored the characteristics associated with the use of self‐care products and practices by people rehabilitating from stroke. A cross‐sectional sub‐study of the Sax Institute's 45 and Up Study in which 1300 participants who had indicated a doctor had diagnosed them as having had a stroke were mailed a sub‐study survey. The survey instrument included questionnaire items on demographics, self‐care products and practices, health status and stroke status. The survey was completed by 576 (44.3%) of those eligible. At least one self‐care product or practice was used by 39.9% of participants. Female participants were more likely than males to use self‐care products (P ≤ .001) and self‐care practices (P = .021). Self‐care product use was higher amongst those with higher levels of fatigue (OR = 1.07) and/or those reporting slight (OR = 2.05) or moderate disability (OR = 2.28), compared with those who had no symptoms at all. As the burden of stroke survivorship increases because of improved acute stroke care in an ageing population, a stronger focus is needed by researchers, clinicians and policy makers on the self‐care strategies used by stroke survivors and the ability for health professionals to appropriately support stroke survivors’ in their rehabilitation and long‐term management.

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“…For example, two small unblinded studies among individuals with vitamin D insufficiency or deficiency who experienced an ischemic stroke suggested that vitamin D supplementation after stroke may result in larger improvements in the Scandinavian Stroke Scale [25] or lower modified Rankin Scale scores [26] than individuals assigned to no supplementation. A blinded trial among 132 individuals with hemiplegia due to ischemic stroke observed that an intramuscular injection of 300 000 IU vitamin D resulted in increased activity levels and accelerated balance recovery but did not affect ambulation or motor recovery compared with a saline injection [27]. In contrast, a blinded trial among 100 hospitalized patients undergoing rehabilitation after acute stroke observed no significance differences in the gain in Barthel Index score between those randomized to receive 2000 IU/day of vitamin D3 and those randomized to placebo [28].…”

Section: Discussionmentioning

confidence: 99%

Effect of vitamin D and/or omega‐3 fatty acid supplementation on stroke outcomes: A randomized trial

Rist

Buring

Cook

et al. 2020

Euro J of Neurology

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Background and purpose Among stroke patients, low serum 25‐hydroxyvitamin D predicts poor outcomes. In mice, higher omega‐3 (n‐3) fatty acid intake diminishes brain damage after stroke. In this study, we tested whether vitamin D or n‐3 fatty acids supplementation prior to stroke reduces the risk of functional limitations and physical disability after stroke. Methods We used data from VITAL (the VITamin D and OmegA‐3 TriaL) which randomized middle‐aged and older men and women without cardiovascular disease to vitamin D3 (2000 IU/day) and/or marine n‐3 fatty acids (1 g/day) and followed them for incident stroke events. Individuals experiencing a non‐fatal stroke were mailed questionnaires assessing functional limitations (the physical performance scale adapted from Nagi) and physical disability (the modified Katz Activities of Daily Living and Rosow‐Breslau Functional Health scales). We used logistic regression to analyze associations between randomized treatment and limitations on each scale. Results A total of 290 individuals experienced their first stroke during the trial, of whom 197 stroke survivors completed the stroke outcomes questionnaire a median of 1.4 years after diagnosis. We observed no associations between randomized treatment to vitamin D and functional limitations (odds ratio [OR] 1.01, 95% confidence interval [CI] 0.52, 1.97) or physical disability (Rosow‐Breslau scale: OR 0.92, 95% CI 0.50, 1.67; Katz scale: OR 1.03, 95% CI 0.31, 3.42). Those randomized to n‐3 fatty acids had a non‐significantly lower risk of functional limitations (OR 0.55, 95% CI 0.28, 1.09) and physical disability (Rosow‐Breslau scale: OR 0.56, 95% CI 0.31, 1.02; Katz sclae: OR 0.32, 95% CI 0.50, 1.67). Conclusion Vitamin D or omega‐3 fatty acid supplementation prior to stroke did not result in significantly improved post‐stroke outcomes.

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A randomized, double-blind study to assess if vitamin D treatment affects the outcomes of rehabilitation and balance in hemiplegic patients

Cited by 23 publications

References 22 publications

<p>Does Vitamin D Affect Diabetic Neuropathic Pain and Balance?</p>

<p>Does Vitamin D Affect Diabetic Neuropathic Pain and Balance?</p>

Utilisation of self‐care products and practices and its associated factors among stroke survivors

Effect of vitamin D and/or omega‐3 fatty acid supplementation on stroke outcomes: A randomized trial

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