1.
Effects of early mobilization on short-term blood pressure variability in acute intracerebral hemorrhage patients: A protocol for randomized controlled non-inferiority trial
Yen HC, Jeng JS, Cheng CH, Pan GS, Chen WS
Medicine. 2021;100(21):e26128
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Abstract
BACKGROUND Early out-of-bed mobilization may improve acute post-intracerebral hemorrhage (ICH) outcomes, but hemodynamic instability may be a concern. Some recent studies have showed that an increase in mean systolic blood pressure (SBP) and high blood pressure variability (BPV), high standard deviation of SBP, may lead to negative ICH outcomes. Therefore, we investigated the impact of an early mobilization (EM) protocol on mean SBP and BPV during the acute phase. METHODS The study was an assessor-blinded, randomized controlled non-inferiority study. The participants were in An Early Mobilization for Acute Cerebral Hemorrhage trial and were randomly assigned to undergo EM or a standard early rehabilitation (SER) protocol within 24 to 72 hour after ICH onset at the stroke center. The EM and SER groups each had 30 patients. 24-measurement SBP were recorded on days 2 and 3 after onset, and SBP were recorded three times daily and during rehabilitation on days 4 through 7. The two groups' mean SBP and BPV under three different time frames (days 2 and 3 during the acute phase, and days 4 through 7 during the late acute phase) were calculated and compared. RESULTS At baseline, the two groups' results were similar, with the exception being that the mean time to first out-of-bed mobilization after symptom onset was 51.60 hours (SD 14.15) and 135.02 hours (SD 33.05) for the EM group and SER group, respectively (P < .001). There were no significant differences in mean SBP and BPV during the acute and late acute phase between the two groups for the three analyses (days 2, 3, and 4 through 7) (P > .05). CONCLUSIONS It is safe to implement the EM protocol within 24 to 72 hour of onset for mild-moderate ICH patients during the acute phase.
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The Comparative Effectiveness of Autologous Blood-derived Products vs Steroids Injection in Plantar Fasciitis: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Tseng WC, Uy J, Yi-Hsiang Chiu MD, Chen WS, Vora A
Pm r. 2020
Abstract
OBJECTIVE Plantar fasciitis is one of the most common musculoskeletal diseases, and nearly 90% of patients can be successfully treated by non-surgical options. However, it is yet to be determined which non-surgical treatment has the best efficacy. The present study investigated for differences between autologous blood-derived products and corticosteroid injections in the treatment of plantar fasciitis. LITERATURE SURVEY We searched PubMed, EMBASE, CINAHL, and Web of Science for relevant articles up to November 2019. There was no language restriction, and unpublished trials were excluded. This systematic review included only randomized controlled trials. METHODOLOGY The primary outcomes were Visual Analogue Scale and American Orthopedic Foot and Ankle Score. The follow-up times were divided into short term (3 to 6 wk), intermediate term (3 mo or 12 wk), and long term (6 mo or 24 wk). The random-effects model was utilized, and weighted mean difference was calculated as the pool estimates. SYNTHESIS 13 randomized controlled trials s and 640 patients were included. No significant difference in Visual Analog Scale reduction was observed between autologous blood-derived product and corticosteroid injections in the short term (WMD = -0.84, 95% CI: -1.71 to 0.03, P = 0.057), intermediate term (WMD = -0.24, 95% CI: -0.90 to 0.42, P = 0.475), and long term (WMD = 0.47, 95% CI: -0.72 to 1.65, P = 0.44). No significant difference in AOFAS was observed between autologous blood-derived products and corticosteroids in the short term (WMD = -0.65, 95% CI: -5.40 to 4.10, P = 0.79), intermediate term (WMD = 0.17, 95% CI: -8.07 to 8.41, P = 0.97), and long term (WMD = 1.16, 95% CI: -4.54 to 6.86, P = 0.69). CONCLUSIONS This systematic review and meta-analysis of autologous blood-derived products vs corticosteroids for plantar fasciitis is the first that includes only randomized controlled trials. Our meta-analysis found no significant difference between autologous blood-derived products and corticosteroids, as measured by Visual Analog Scale or American Orthopedic Foot and Ankle Scores. These findings applied whether followed up in short, intermediate or long term. Our results differ from previous studies that showed superior efficacy of autologous blood-derived products compared with corticosteroids in the long term. This article is protected by copyright. All rights reserved.
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Comparative effectiveness of platelet-rich plasma injections for treating knee joint cartilage degenerative pathology: a systematic review and meta-analysis
Chang KV, Hung CY, Aliwarga F, Wang TG, Han DS, Chen WS
Archives of Physical Medicine & Rehabilitation. 2014;95((3):):562-75.
Abstract
OBJECTIVE To explore the effectiveness of platelet-rich plasma (PRP) in treating cartilage degenerative pathology in knee joints. DATA SOURCES Electronic databases, including PubMed and Scopus, were searched from the earliest record to September 2013. STUDY SELECTION We included single-arm prospective studies, quasi-experimental studies, and randomized controlled trials that used PRP to treat knee chondral degenerative lesions. Eight single-arm studies, 3 quasi-experimental studies, and 5 randomized controlled trials were identified, comprising 1543 participants. DATA EXTRACTION We determined effect sizes for the selected studies by extracting changes in functional scales after the interventions and compared the PRP group pooled values with the pretreatment baseline and the groups receiving placebo or hyaluronic acid (HA) injections. DATA SYNTHESIS PRP injections in patients with knee degenerative pathology showed continual efficacy for 12 months compared with their pretreatment condition. The effectiveness of PRP was likely better and more prolonged than that of HA. Injection doses <2, the use of a single-spinning approach, and lack of additional activators led to an uncertainty in the treatment effects. Patients with lower degrees of cartilage degeneration achieved superior outcomes as opposed to those affected by advanced osteoarthritis. CONCLUSIONS PRP application improves function from basal evaluations in patients with knee joint cartilage degenerative pathology and tends to be more effective than HA administration. Discrepancy in the degenerative severity modifies the treatment responses, leading to participants with lower degrees of degeneration benefiting more from PRP injections. Copyright 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
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The blood-saving effect of tranexamic acid in minimally invasive total knee replacement: is an additional pre-operative injection effective?
Lin PC, Hsu CH, Huang CC, Chen WS, Wang JW
Journal of Bone & Joint Surgery - British Volume. 2012;94((7):):932-6.
Abstract
Tranexamic acid (TEA), an inhibitor of fibrinolysis, reduces blood loss after routine total knee replacement (TKR). However, controversy persists regarding the dosage and timing of administration of this drug during surgery. We performed a prospective randomised controlled study to examine the optimum blood-saving effect of TEA in minimally invasiveTKR. We randomly assigned 151 patients who underwent unilateral minimally invasive TKR to three groups: 1) a placebo group (50 patients); 2) a one-dose TEA group (52 patients), who received one injection of TEA (10 mg/kg) intra-operatively on deflation of the tourniquet; and 3) a two-dose TEA group (49 patients), who received two injections of TEA (10 mg/kg) given pre-operatively and intra-operatively. Total blood loss was calculated from the maximum loss of haemoglobin. All patients were followed clinically for the presence of venous thromboembolism (VTE). The mean total blood loss was significantly higher in the placebo group than in the other two groups (1222ml (845 to 2043) versus 1035ml (397 to 1934) and 986ml (542 to 1811), respectively (both p < 0.0001)). The mean blood loss was not significantly different between the one- and two-TEA groups (p = 0.148). The mean transfusion rate was higher in the placebo group than in the other two groups (22% versus 3.8% (p = 0.006) and 6.1% (p=0.041), respectively) and there was no statistically significant difference in the mean transfusion rate between the one- and two-TEA groups (p = 0.672). Only one patient, in the two-dose group, had a radiologically confirmed deep venous thrombosis. Our prospective randomised controlled study showed that one intra-operative injection of TEA is effective for blood conservation after minimally invasive TKR