The efficacy of rehabilitation in people with Guillain-Barrè syndrome: a systematic review of randomized controlled trials

Sulli, Sara; Scala, Luca; Berardi, Anna; Conte, Antonella; Baione, Viola; Belvisi, Daniele; Leodori, Giorgio

doi:10.1080/14737175.2021.1890034

Cited by 10 publications

(6 citation statements)

References 20 publications

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“…On the other hand, many of the data for outcome assessment stem from clinical trial cohorts, which may result in an overestimate of good recovery. Additionally, intensive rehabilitation may improve outcome [ 25 , 26 ], but the role of rehabilitation in most outcomes studies has not been evaluated. Similarly, impact of factors such as nutrition may play a role that is yet to be elucidated [ 27 ].…”

Section: Methodsmentioning

confidence: 99%

“…Patients and surrogates should also receive counseling and advice related to navigation of the health care system, particularly the transition from the acute phase to subacute and chronic phases, as well as health care costs [ 28 , 96 ]. Because intensive rehabilitation may improve outcome [ 25 , 26 ], future studies should further examine the impact of rehabilitation on outcomes [ 26 , 97 ]. Similarly, factors such as nutrition may play a role that is yet to be elucidated [ 27 ].…”

Section: Methodsmentioning

confidence: 99%

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Guidelines for Neuroprognostication in Adults with Guillain–Barré Syndrome

et al. 2023

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Background Guillain–Barré syndrome (GBS) often carries a favorable prognosis. Of adult patients with GBS, 10–30% require mechanical ventilation during the acute phase of the disease. After the acute phase, the focus shifts to restoration of motor strength, ambulation, and neurological function, with variable speed and degree of recovery. The objective of these guidelines is to provide recommendations on the reliability of select clinical predictors that serve as the basis of neuroprognostication and provide guidance to clinicians counseling adult patients with GBS and/or their surrogates. Methods A narrative systematic review was completed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Candidate predictors, including clinical variables and prediction models, were selected based on clinical relevance and presence of appropriate body of evidence. The Population/Intervention/Comparator/Outcome/Time frame/Setting (PICOTS) question was framed as follows: “When counseling patients or surrogates of critically ill patients with Guillain–Barré syndrome, should [predictor, with time of assessment if appropriate] be considered a reliable predictor of [outcome, with time frame of assessment]?” Additional full-text screening criteria were used to exclude small and lower quality studies. Following construction of an evidence profile and summary of findings, recommendations were based on four GRADE criteria: quality of evidence, balance of desirable and undesirable consequences, values and preferences, and resource use. In addition, good practice recommendations addressed essential principles of neuroprognostication that could not be framed in PICOTS format. Results Eight candidate clinical variables and six prediction models were selected. A total of 45 articles met our eligibility criteria to guide recommendations. We recommend bulbar weakness (the degree of motor weakness at disease nadir) and the Erasmus GBS Respiratory Insufficiency Score as moderately reliable for prediction of the need for mechanical ventilation. The Erasmus GBS Outcome Score (EGOS) and modified EGOS were identified as moderately reliable predictors of independent ambulation at 3 months and beyond. Good practice recommendations include consideration of both acute and recovery phases of the disease during prognostication, discussion of the possible need for mechanical ventilation and enteral nutrition during counseling, and consideration of the complete clinical condition as opposed to a single variable during prognostication. Conclusions These guidelines provide recommendations on the reliability of predictors of the need for mechanical ventilation, poor functional outcome, and independent ambulation following GBS in the context of counseling patients and/or surrogates and suggest broad principles of neuroprognostication. Few predictors were considered moderately reliable based on the available body of evidence, and higher quality data are needed.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Guidelines for Neuroprognostication in Adults with Guillain–Barré Syndrome

et al. 2023

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“…Although they opined from their study that exercise programmes improve physical outcomes in patients with GBS, they concluded that making confident conclusions about the effects of exercise interventions on physical outcomes in patients with GBS is not possible because of insufficient high-quality literature. Sulli et al, [34] in their systematic review asserted that the analysis of three randomized controlled trials (RCTs) showed that various types of rehabilitation interventions are correlated to an improvement in the well-being of patients with GBS. They also concluded that it is difficult to draw definite conclusions on the effectiveness of rehabilitation treatment in patients with GBS, and recommended that high-quality future studies are needed to confirm these hypotheses.…”

Section: Discussionmentioning

confidence: 99%

Physiotherapy Management of Guillain-Barré Syndrome in a Tertiary Hospital in South-South Nigeria: A Case Report.

OTI,

OKONKWO,

AYERITE

et al. 2024

ijmsdh

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Background: Guillain-Barré Syndrome (GBS) is a potentially life-threatening post infectious disease characterized by rapidly progressive, symmetrical weakness of the extremities. It can cause life-threatening complications, particularly if the breathing muscles are affected or if there is dysfunction of the autonomic nervous system. Case Presentation: This is a case report of Physiotherapy management of a 51-year old female patient with Guillain-Barré Syndrome (GBS). Patient was referred from the neurology unit, department of Internal Medicine, University of Port Harcourt Teaching Hospital (UPTH) to the neurology clinic of the physiotherapy department, UPTH as a case GBS after series of investigations. Appropriate physiotherapy intervention was given for a period of 36 weeks after a thorough assessment of the patient. The Guillain-Barre Syndrome Disability Score was used to assess the overall functional status of the patient while the Oxford Muscle Grading Scale was used to assess for muscle strength. The Numerical Pain Rating Scale (NPRS) was used to assess the level of pain in the limbs while the Berge Balance Scale (BBS) was used to assess the patient’s balance. The case report was presented in line with the CARE: Case Report Guideline for case reports. All ethical procedures were followed. Treatment outcome: Treatment outcome revealed that the Guillain-Barré Syndrome Disability Score reduced from 4 to 2 while that of Berg Balance Scale increased from 3 to 42 after 36 weeks of intervention. Pain level on range of motion of the limbs based on the Numerical Pain Rating Scale reduced from 6/10 to 1/10 on the upper limb and from 8/10 to 2/10 on the lower limbs. Conclusion: Physiotherapy is effective in the management of patients with Guillain-Barré Syndrome. Early referral to Physiotherapy is key to pain management, balance control and overall functional status of the patients.

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“…A United Kingdom (UK) national study of functional outcomes and efficiency of in-hospital rehabilitation in a national cohort of patients with inflammatory polyneuropathies that included 118 GBS patients found IR cost effective and efficient, albeit with an average LOS of 72 days [ 16 ]. A recent systematic review of randomized controlled trials also suggests efficacy of rehabilitation interventions including IR for GBS patients [ 17 ]. Our study showed that gender was the only factor that did not have a significant association with discharge disposition.…”

Section: Discussionmentioning

confidence: 99%

Predictors of discharge to home/community following inpatient-rehabilitation in a US national sample of Guillain-Barre-Syndrome patients

et al. 2023

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Background Guillain-Barre-Syndrome (GBS), an autoimmune polyneuropathy causing acute flaccid paralysis, is a rare condition with1-2 cases per 100,000 annually (approximately 5000 cases/year) in the United States (US). There is a paucity of published data regarding patient outcomes in association with discharge destinations following inpatient-rehabilitation (IR) in this patient population, thus this study. Objectives To analyze IR efficacy, and possible predictors of discharge to home/community in a US-national-sample of GBS patients. Methods Retrospective-observational-cohort study of 1304 GBS patients admitted to IR comparing discharge disposition destinations (community/home, skilled-nursing-facility [SNF], or return to acute-care) by demographic (age, gender) and clinical variables (length-of-stay [LOS], case-mix-index [CMI], and Functional-Independence-Measure [FIM] score changes). Multinomial-logistic-regression and discriminant-function-analysis were performed to determine model fit in predicting discharge destination. Results 81.8% were discharged to home/community- average LOS 19-days, total-FIM-gain 43.2; 9.8% discharged to SNFs- average LOS 27.5-days, total-FIM-gain 27.2; and 8.4% discharged to acute-care- average LOS 15.4-days and total-FIM-gain 16.5, (F = 176, p < .001). Stepwise-linear-regression for prediction of community discharge showed change in FIM-Bed/chair/wheelchair-Transfers was the most significant predictor (Wald = 42.2; p < .001), followed by CMI (Wald = 26.9; p < .001), change in FIM-walking/wheelchair (Wald = 14.9; p < .001), and age (Wald = 9.5; p < .002). Using discriminant-function-analysis to test model validity for predicting discharge disposition, FIM-change for Bed/chair/wheelchair Transfers, Walking, and Self-Care as predictors resulted in a classification rate of 78.1%, 92% of variance explained, and Eigenvalue of .53 (p < .001). Conclusions Total-FIM scores improved in all groups, and most patients were discharged to home/community suggesting IR efficacy. The ability to transfer bed/chair/wheelchair was the most important predictive factor associated with discharge destination.

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The efficacy of rehabilitation in people with Guillain-Barrè syndrome: a systematic review of randomized controlled trials

Cited by 10 publications

References 20 publications

Guidelines for Neuroprognostication in Adults with Guillain–Barré Syndrome

Guidelines for Neuroprognostication in Adults with Guillain–Barré Syndrome

Physiotherapy Management of Guillain-Barré Syndrome in a Tertiary Hospital in South-South Nigeria: A Case Report.

Predictors of discharge to home/community following inpatient-rehabilitation in a US national sample of Guillain-Barre-Syndrome patients

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