NEUROLOGICAL EVIDENCE

The impact of increased duration of exercise therapy on functional recovery following stroke: what is the evidence?
Author's objectives
To examine the effect of increased duration of exercise therapy compared to routine formal exercise on functional recovery after stroke.
Author's conclusions
The authors concluded that increased duration of exercise therapy, when compared to standard exercise regimes, improved functional outcome, as measured by the Barthel Index, in patients with stroke both post-treatment and at six months follow-up. They also indicated that their findings supported a positive effect on lower extremity impairment and walking speed.
Bibliographic details
Galvin R, Murphy B, Cusack T, Stokes E. The impact of increased duration of exercise therapy on functional recovery following stroke: what is the evidence? Topics in Stroke Rehabilitation, 2008; 15(4): 365-377
Status
This record is a structured abstract written by CRD reviewers. The original has met a set of quality criteria.
CRD commentary
This review had a clear aim and inclusion criteria and adequate details of studies included were provided. The literature search covered several databases but no attempt was made to uncover unpublished or non-English language studies, leaving the review open to possible publication and language bias. Only one reviewer assessed the references for retrieval, but full papers were screened by two reviewers, limiting possible reviewer bias. Quality assessment was performed independently by two reviewers, but it was not clear whether data extraction was performed in the same way. A relatively thorough quality assessment appeared to have been performed, although details of the process and criteria used to assess studies for the PEDro database would have added to this. The choice of statistical synthesis and method used was appropriate. Only results for trials reporting the same outcome measure were pooled, but given that results using different scales were converted to standardised mean differences, results could have been pooled across scales giving the analyses greater power, although this might have been at the expense of meaningful results if the scales were not assessing sufficiently similar outcomes. No details of the heterogeneity assessment were provided and no graphical presentation of trial results was given to allow the reader to assess the similarity of included trials. This was a reasonable well-conducted review and the authors' conclusions with respect to functional outcome are an accurate and reliable reflection of the results of the review, although the authors did not indicate that the actual observed effect was small in magnitude. The conclusions relating to lower extremity impairment and walking speed are not based on the results of the review and cannot be regarded as reliable.
Publication Date: 23 Dec 2009
Publication Type: Structured Abstract
Publisher: Centre for Reviews and Dissemination
Source: Database of Abstracts of Reviews of Effects
Creator: Centre for Reviews and Dissemination

Botulinum toxin treatment for spasticity following stroke
Bibliographic details
Botulinum toxin treatment for spasticity following stroke. HAYES, Inc, 2008; Directory Publication
URL of original report http://www.hayesinc.com/
Status
The HTA database is produced by the Centre for Reviews and Dissemination (CRD), York and the International Network of Agencies for Health Technology Assessment (INAHTA), Sweden. The HTA database contains information on publications and projects from nationally funded health technology assessment organisations. The abstracts in this database are descriptive only, and the original reports have not been evaluated by reviewers from the CRD
Publication Date: 23 Dec 2009
Publication Type: Review
Source: CRD Health Technology Assessment Database

Antidepressants and stroke
“Postmenopausal women who take antidepressants may be increasing their chance of suffering a stroke and dying prematurely,” reported the Daily Mail. It said a six-year study found a 45% increase in risk of strokes for women who used antidepressants compared to women who did not use them.
As the newspaper also reported, the absolute increase in risk of stroke (the number of women who might be affected) was small, equating to an increase of about 13 additional women in every 10,000 (0.43% of women on antidepressants compared to 0.3% of women not on them). In addition, depression itself is a known risk factor for stroke, so it is not clear how much of the increase was due to depression rather than the drugs.
Overall, this increase in risk was small and may not be attributable solely to the drugs themselves. Taking any medication involves weighing up the pros and cons of taking the drug compared to the prospects of leaving the disease untreated. As the British Heart Foundation said, “it is important to weigh up any small increase in the risk of stroke with the benefits of treating depression".
What does NHS Choices make of this study?
This study has collected and pooled a large amount of data from several studies of postmenopausal women. In the full journal article, the researchers are cautious in their interpretations of their results, discussing the issue of residual confounding and other limitations in four pages of comments.
See the entire NHS Choices commentary on this news item.
Citation of original study
Smoller JW, Allison M, Cochrane BB, et al. Antidepressant Use and Risk of Incident Cardiovascular Morbidity and Mortality Among Postmenopausal Women in the Women's Health Initiative Study. Arch Intern Med 2009; 169: 2128-2139