Evaluating repetitive transcranial magnetic stimulation for neurogenic overactive bladder management in stroke survivors: A randomized sham-controlled trial protocol.

BACKGROUND: Neurogenic overactive bladder (OAB) is a distressing condition in stroke. Existing neurogenic OAB management is expensive, unstandardized regimens, or invasive. Evaluating the effectiveness of repetitive transcranial magnetic stimulation (rTMS) remains crucial. We aimed to (1) compare the effectiveness of active-rTMS with sham-rTMS on neurogenic OAB symptoms, (2) analyze whether rTMS is cost-effective, and (3) explore the rTMS's experiences on participants' symptoms. METHODS: This is a randomized, sham-controlled, double-blinded trial with embedded qualitative and cost-effectiveness studies. A total of 110 stroke survivors with neurogenic OAB symptoms were screened for eligibility; 60 participants were eligible for inclusion and were randomly assigned to either the active (n = 30) or sham-rTMS (n = 30) groups using a computer-generated randomization schedule. The active-rTMS group received low-frequency rTMS of 1200 pulses per session lasting 20 min thrice weekly to pelvic floor muscle representation at the contralesional primary motor cortex. The sham-rTMS group received low-frequency stimulation at a 20 % resting motor threshold using the same coil as the active-rTMS but was configured to reduce the TMS-induced electrical fields significantly. The primary and secondary outcome measures were assessed at baseline, post-intervention (week 4) and follow-up (week 8). The analysis of covariance (ANCOVA) analysis compared changes in the study groups. Quality-adjusted life-years (QALY) were measured to evaluate the cost-effectiveness while EQ-5D-5L estimated QALY changes. Additionally, the focus group discussion data were thematically analyzed. CONCLUSIONS: The findings from this rTMS intervention study will be useful in alleviating neurogenic OAB symptoms and enhancing patient satisfaction in a cost-effective way.

Association between fear of falling and falls following acute and chronic stroke: a systematic review with meta-analysis.

OBJECTIVES: To examine the association between falls and fear of falling in people with stroke and to evaluate the differences between patients with acute stroke and those with chronic stroke with regard to any such association. METHODS: Articles were searched in Medline, CINAHL, AMED, Embase, PsycINFO, Cochrane Library of Reviews and PEDro from inception until March 2023. Experimental, observational or explorative studies investigating the association between fear of falling and falls in people with stroke were included. Articles were screened by 2 independent reviewers. Data were extracted by an independent reviewer. RESULTS: A total of 26 reports were included in this review (n = 2863). Fear of falling, assessed by a single-question survey, was significantly associated with falls (relative risk = 1.44; 95% confidence interval (95% CI) = 1.22, 1.70; I2 = 0%) in people with acute stroke. Significant mean differences in fear of falling, based on the Falls Efficacy Scale (mean difference = 12.80; 95% CI = 1.81, 23.78; I² = 28%) and Activities-specific Balance Confidence Scale (mean difference = -9.99; 95% CI = -15.36, -4.62; I² = 57%), were also reported between fallers and non-fallers in people with chronic stroke. CONCLUSION: A small, but significant, association exists between falls and fear of falling in both acute and chronic stroke patients.

Clinical tools for evaluating the severity of overactive bladder: A systematic review of psychometric properties.

OBJECTIVES: To systematically evaluate the evidence describing the psychometric properties of clinical measures for assessing overactive bladder symptoms (urinary urgency with or without urge urinary incontinence, urinary frequency and nocturia). To evaluate the quality of this evidence-base using the COnsensus-based Standards for selecting health status Measurement INstruments (COSMIN) checklist and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tools. DATA SOURCES: Five electronic databases (CINAHL, EMBASE, MEDLINE, Scopus and Web of Science) were searched from dataset inception to August 2023. REVIEW METHODS: Study screening, data extraction and quality appraisal were performed by two independent authors. Inclusion criteria were studies testing one or more psychometric properties of clinical tools for the assessment of overactive bladder symptoms among adults aged 18 years and older for both sexes. The methodological quality and quality of the evidence were evaluated using the COSMIN checklist and GRADE tools, respectively. RESULTS: The search identified 40 studies totalling 10,634 participants evaluating the psychometric properties of 15 clinical tools. The COSMIN methodological quality was rated good for most measures, and the GRADE quality of evidence ranged from low (13%) to high (33%). The Overactive Bladder Symptom Score, Overactive Bladder Questionnaire and Neurogenic Bladder Symptom Score were of good methodological and high-GRADE evidence qualities. CONCLUSION: Overactive Bladder Symptom Score, the Overactive Bladder Questionnaire and the Neurogenic Bladder Symptoms Score are promising psychometrically sound measures. The Overactive Bladder Symptom Score has been applied to the most culturally diverse populations supported by studies of good methodological and high-GRADE evidence quality.

Measures of quality of life of people with neurogenic overactive bladder: A systematic review of psychometric properties.

OBJECTIVE: To identify psychometrically robust quality-of-life (QOL) outcome measures for evaluating QOL among people with neurogenic overactive bladder (OAB). STUDY DESIGN: Electronic databases (CINAHL, EMBASE, MEDLINE, Scopus and Web of Science) were searched from inception to January 2023. Two independent reviewers participated in study screening, data extraction and quality appraisal. Studies were included if they validated at least one psychometric property of a QOL outcome measure among adults (age ≥ 18 years) with neurogenic OAB. The COnsensus-based Standards for selecting health status Measurement INstruments (COSMIN) checklist and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool were used to evaluate the methodological quality and quality of evidence, respectively, for each included study. RESULTS: Database searches identified 47 studies that tested the psychometric properties of 15 QOL measures in a total of 19,994 participants with stroke, spinal cord injury, Parkinson's disease or multiple sclerosis. The Incontinence Quality of Life Questionnaire (I-QOL), King's Health Questionnaire, Overactive Bladder Questionnaire and Qualiveen were the best validated measures, with strong reliability, validity and responsiveness. I-QOL was the most robust, cross-culturally administered and psychometrically strong measure. The COSMIN checklist indicated sufficient methodological quality for 70% of measures, and the modified GRADE tool indicated quality of evidence ranging from moderate (67%) to high (33%). CONCLUSIONS: This review identified the I-QOL as a culturally diverse measure with robust reliability, validity and responsiveness for assessing QOL among people with neurogenic OAB. These findings are supported by studies with good methodological quality (COSMIN) and high-quality evidence (GRADE).

Using ultrasound elastography to assess non-invasive, non-pharmacological interventions for musculoskeletal stiffness: a systematic review and meta-analysis.

PURPOSE: To evaluate the current evidence regarding the use of ultrasound elastography for assessing non-invasive, non-pharmacological interventions for eliciting changes in musculoskeletal stiffness. METHODS: A systematic search of MEDLINE, CINAHL, EMBASE, and Web of Science databases was performed in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Information on measurement and intervention procedures was extracted. Bias was assessed using Cochrane Risk of Bias or Risk of Bias In Non-randomised Studies of Interventions (ROBINS-I) tools for studies with true or quasi-experimental designs, respectively. Analyses were conducted for adequately powered subgroups based on intervention type, measurement site, and population assessed. RESULTS: Twenty-one studies were included in the review. Overall risk of bias was low for true experimental studies and moderate for quasi-experimental studies. Subgroup analyses indicated a large overall effect for interventions involving manual physiotherapy and taping/splinting for reducing masseter muscle stiffness in patients with masticatory muscle disorders (g = 1.488, 95% CI = 0.320-2.655, p = 0.013). Analyses for other intervention types and patient groups were underpowered. CONCLUSION: Ultrasound elastography demonstrates clinical applicability for assessing non-invasive, non-pharmacological interventions for musculoskeletal stiffness. However, the comparative efficacy of these interventions for modulating tissue stiffness remains inconclusive.

Elastography demonstrates clinical applicability for assessing non-invasive, non-pharmacological interventions for musculoskeletal stiffnessInterventions involving manual physiotherapy and taping/bracing showed a large overall effect for reducing masseter muscle stiffnessThe comparative efficacy of other interventions remains inconclusive.

Effects of therapeutic exercise on disease severity, balance, and functional Independence among individuals with cerebellar ataxia: A systematic review with meta-analysis.

BACKGROUND: Balance impairments are common in cerebellar ataxia. Exercises are beneficial in this population. OBJECTIVE: Explore the benefits of therapeutic exercises on disease severity, balance and functional independence in cerebellar ataxia. METHODS: Databases were searched from inception until July 2021. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale and the Newcastle-Ottawa Scale (NOS); and quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. RESULTS: Twenty-six studies were included and eight studies of low to high PEDro methodological quality were meta-analyzed. 'Low' to 'moderate' GRADE quality evidence supports the use of therapeutic exercises to reduce disease severity, assessed using the Scale for the Assessment and Rating of Ataxia [weighted mean difference (WMD): -3.3; 95% confidence interval (95%CI): -3.7, -2.8; p < .01]; and improve balance, assessed using the Berg Balance Scale (WMD: 2.6; 95%CI: 1.1, 4.2; p < .01). The effect of therapeutic exercises on functional independence was insignificant (WMD: 1.6; 95%CI: -1.5, 4.6; p = .31). CONCLUSION: Low to moderate evidence from studies of low to high methodological quality provides some support for therapeutic exercises for reducing disease severity among non-hereditary degenerative cerebellar ataxia and improving balance among acquired cerebellar ataxia. Exercises did not benefit functional independence. Additional studies of large sample size and high methodological quality are necessary to substantiate these findings.

Validity of balance measures in cerebellar ataxia: A prospective study with 12-month follow-up.

INTRODUCTION: Balance deficits are common in cerebellar ataxia. Determining which balance outcome measures are psychometrically strong for this population remains an unmet need. OBJECTIVE: To evaluate the validity and responsiveness of two clinic-based balance measures (Berg Balance Scale [BBS] and balance sub-component of the Scale for the Assessment and Rating of Ataxia [SARA-bal]) and two laboratory-based balance measures (Sensory Organization Test [SOT] and Limits of Stability [LOS]) in cerebellar ataxia. DESIGN: Prospective cohort study. SETTING: Institutional study assessing 40 participants with cerebellar ataxia at baseline, and 6 and 12 months. MAIN OUTCOME MEASURES: Balance was assessed using the BBS, SARA-bal, SOT, and LOS; disease severity was assessed using the SARA; and Patients' Global Impression of Change (PGIC) was used to estimate responsiveness to disease progress at 6 and 12 months. RESULTS: BBS and SARA-bal (Spearman's correlation coefficient, ρS = -0.89, p < .01) demonstrated strong criterion validity. Convergent validity was moderate to high (ρS range: -0.75 to 0.92) and external validity was low (ρS range: -0.75 to 0.11). Composite SOT scores (SOT-COM; ρS = 0.29, p < .01) and maximal excursion (MXE-LOS) in the forward (F) and right (R) directions of the LOS (ρS = 0.18, p < .01) demonstrated moderate to low criterion and convergent validity. The area under the receiver-operating characteristic curve (AUCROC ) and its effect size (standard response mean [SRM]) for categorizing "stable" and "worsened" patients at 6 and 12 months were satisfactory for the BBS (AUCROC : 0.75; SRM-Stable: 1.06; SRM-Worsened: 1.16), SARA-bal (AUCROC : 0.76; SRM-Stable: 0.86; SRM-Worsened: 0.85), and MXE-LOS(R) (AUCROC : 0.29; SRM-Stable: 0.41; SRM-Worsened: 1.39). CONCLUSION: BBS and SARA-bal have moderate to strong criterion and convergent validity and adequate responsiveness to balance changes. Both laboratory-based measures (SOT and LOS) demonstrated a high floor effect. The SOT-COM and MXE-LOS(R) demonstrated moderate to low criterion validity, with only the MXE-LOS(R) displaying adequate responsiveness to balance changes after 6 and 12 months.

Physiotherapy interventions for pain relief in individuals with peripheral neuropathic pain: A systematic review and meta-analyses of randomized controlled trials.

OBJECTIVE: To evaluate the effectiveness of physiotherapy interventions on peripheral neuropathic pain (pNeP) due to any underlying cause. METHODS: Multiple databases were searched from database inception until Dec 2021. Studies on physiotherapy interventions for pain relief assessed using the visual analogue scale among individuals with pNeP of any underlying cause were included. Methodological quality was assessed using the PEDro scale and the quality of the evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. RESULTS: The searches yielded 1498 articles. Seventeen studies met the inclusion criteria and were included in the review. Meta-analysis revealed a significant benefit for laser therapy compared to sham laser on pNeP (weighted mean difference [WMD] -1.27; 95% CI: -2.29 to -0.25; p = 0.01) in people with carpal tunnel syndrome. The pooled analyses revealed a significant effect of spinal cord stimulation compared to control for failed back syndrome (standardised mean difference [SMD; Hedges'g] -0.73; 95% CI: -1.17 to -0.30; p = 0.001) and diabetic neuropathy (SMD -1.63; 95% CI -2.06--1.21; p < 0.001). The effect of acupuncture on chemotherapy-induced pain (SMD - 2.09; 95% CI: -4.27-0.09; p = 0.06) and electromagnetic stimulation on diabetic neuropathic pain (Hedges' g - 0.77; 95% CI: -1.82-0.27; p = 0.15) were insignificant. CONCLUSION: Evidence supports the use of spinal cord stimulation for the treatment of pNeP secondary to failed back surgery syndrome and diabetic neuropathy. Laser therapy was more effective than sham laser for alleviating pain due to carpal tunnel syndrome. The efficacy of acupuncture and electromagnetic therapy for chemotherapy-induced pain and diabetic neuropathy, respectively remains inconclusive.

Effectiveness and cost of integrated cognitive and balance training for balance and falls in cerebellar ataxia: a blinded two-arm parallel group RCT.

Background: In patients with cerebellar ataxia (CA), dual-tasking deteriorates the performance of one or both tasks. Objective: Evaluate the effects of 4 weeks of cognitive-coupled intensive balance training (CIBT) on dual-task cost, dynamic balance, disease severity, number of falls, quality of life, cognition and cost among patients with CA. Methods: This RCT compared CIBT (Group 1) to single-task training (Group 2) among 32 patients with CA. The intervention included either dual-task (CIBT) or single-task training for 4 weeks followed by 6 months of unsupervised home exercises. Dual-task timed up-and-go test (D-TUG) assessed dual-task cost of the physical and cognitive tasks. Assessment time points included baseline 1 (Week 0:T1), baseline 2 (Week 6:T2), post-intervention (Week 10:T3), and follow-up (Week 34:T4). Results: Compared to single-task training CIBT improved the dual-task cost of physical task [MD -8.36 95% CI (-14.47 to -2.36, p < 0.01), dual-tasking ability [-6.93 (-13.16 to -0.70); p = 0.03] assessed using D-TUG, balance assessed using the scale for the assessment and rating of ataxia (SARAbal) [-2.03 (-4.04 to -0.19); p = 0.04], visual scores of the SOT (SOT-VIS) [-18.53 (-25.81 to -11.24, p ≤ 0.01] and maximal excursion [13.84 (4.65 to 23.03; p ≤ 0.01] of the Limits of Stability (LOS) in the forward direction and reaction time in both forward [-1.11 (-1.42 to -0.78); p < 0.01] and right [-0.18 (0.05 to 0.31); p < 0.01] directions following 4 weeks of training. CIBT did not have any additional benefits in reducing the number of falls, or improving disease severity, quality of life and cognition. The mean cost of intervention and healthcare costs for 7 months was HKD 33,380 for CIBT group and HKD 38,571 for single-task training group. Conclusion: We found some evidence to support the use of CIBT for improving the dual-tasking ability, dual-task cost of physical task and dynamic balance in CA. Future large fully-powered studies are needed to confirm this claim. Clinical trial registration: https://clinicaltrials.gov/study/NCT04648501, identifier [Ref: NCT04648501].

A Systematic Review Exploring the Theories Underlying the Improvement of Balance and Reduction in Falls Following Dual-Task Training among Older Adults.

BACKGROUND: Balance impairment causes frequent falls in older adults, and preventing falls remains challenging. Dual-task (DT) training reduces falls by improving balance, but the precise theory is not fully understood. This review aims to explore the theories underlying the effectiveness of DT in improving balance and reducing falls in older adults. METHODS: Eleven electronic databases were searched from database inception to June 2022. Two reviewers independently performed study screening and data extraction. The risk of bias (RoB) in the included studies was assessed using the Cochrane Collaboration RoB 2 tool. RESULTS: The searches yielded 1478 citations, of which 30 studies met the inclusion criteria and were included in the review. Twenty-two of the 30 included studies utilized the motor-cognitive type of DT for training, while six used motor-motor and two utilized cognitive-cognitive DT. The included studies reported 20 different theories to explain the effectiveness of DT for improving balance and reducing falls in older adults. The predominant theory identified in the included studies was attention theory (n = 14). Overall, 26 studies reported improved balance and five studies found a reduction in fall incidence following DT training. Balance and falls improved significantly in 15 motor-cognitive DT intervention studies. CONCLUSION: Attention shifting between two tasks is reported to occur following DT training. Motor-cognitive DT training improves balance and reduces fall incidence in older adults by shifting attention based on the difficulty and priority of a task from the motor to the cognitive task.

Are Fear of COVID-19 and Vaccine Hesitancy Associated with COVID-19 Vaccine Uptake? A Population-Based Online Survey in Nigeria.

This study examined the association between COVID-19 and fear of contracting COVID-19 and reasons for vaccination refusal. A population-based online survey was conducted via social media in Nigeria using the Fear of COVID-19 scale and items related to vaccination refusal/hesitancy items. Individuals aged 13 years and older were invited to participate. Data were analysed using binary logistic regression to calculate odds ratios (ORs) and associated 95% confidence intervals (CIs) at a p-value of less than 0.05. The study enrolled 577 individuals with a mean age of 31.86 years, 70% of whom were male and 27.7% of whom had received at least one dose of the vaccine against COVID-19. None of the variables on the Fear of COVID-19 scale significantly predicted vaccine uptake in multivariate analysis. However, individuals who were fearful of COVID-19 were more likely to be vaccinated in bivariate analysis (OR: 1.7, 95% CI: 1.06-2.63). The most significant factors among the vaccination refusal items associated with COVID-19 vaccination were doubts about vaccination (adjusted OR: 2.56, 95% CI: 1.57-4.17) and misconceptions about vaccine safety/efficacy (adjusted OR: 2.15, 95% CI: 1.24-3.71). These results suggest that uptake of the vaccine against COVID-19 in Nigeria can be predicted by factors associated with vaccination refusal, but not by fear of COVID-19. To contain the pandemic COVID-19 in Nigeria, efforts should be made to educate people about the efficacy of the vaccine and to increase their confidence in vaccination.

Prevalence of Anxiety and Depression Among the General Population in Africa During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis.

Background: Medical and socio-economic uncertainties surrounding the COVID-19 pandemic have had a substantial impact on mental health. This study aimed to systematically review the existing literature reporting the prevalence of anxiety and depression among the general populace in Africa during the COVID-19 pandemic and examine associated risk factors. Methods: A systematic search of the following databases African Journal Online, CINAHL, PubMed, Scopus, and Web of Science was conducted from database inception until 30th September 2021. Studies reporting the prevalence of anxiety and/or depression among the general populace in African settings were considered for inclusion. The methodological quality of included studies was assessed using the Agency for Healthcare Research and Quality (AHRQ). Meta-analyses on prevalence rates were conducted using Comprehensive Meta-analysis software. Results: Seventy-eight primary studies (62,380 participants) were identified from 2,325 studies via electronic and manual searches. Pooled prevalence rates for anxiety (47%, 95% CI: 40-54%, I2 = 99.19%) and depression (48%, 95% CI: 39-57%, I2 = 99.45%) were reported across Africa during the COVID-19 pandemic. Sex (female) and history of existing medical/chronic conditions were identified as major risk factors for anxiety and depression. Conclusions: The evidence put forth in this synthesis demonstrates the substantial impact of the pandemic on the pervasiveness of these psychological symptoms among the general population. Governments and stakeholders across continental Africa should therefore prioritize the allocation of available resources to institute educational programs and other intervention strategies for preventing and ameliorating universal distress and promoting psychological wellbeing. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021228023, PROSPERO CRD42021228023.

Physiotherapy interventions may relieve pain in individuals with central neuropathic pain: a systematic review and meta-analysis of randomised controlled trials.

Objectives: To evaluate the effectiveness of any form of physiotherapy intervention for the management of central neuropathic pain (cNeP) due to any underlying cause. Methods: Multiple databases were searched from inception until August 2021. Randomised controlled trials evaluating physiotherapy interventions compared to a control condition on pain among people with cNeP were included. Methodological quality and the quality of evidence were assessed using the Physiotherapy Evidence Database Scale and the Grading of Recommendations, Assessment, Development, and Evaluation tool, respectively. Results: The searches yielded 2661 studies, of which 23 randomised controlled trials met the inclusion criteria and were included in the meta-analyses. Meta-analyses of trials examining non-invasive neurostimulation revealed significant reductions in pain severity due to spinal cord injury (SCI; standardised mean difference (SMD): -0.59 (95% confidence interval [CI]: -1.07, -0.11), p = 0.02) and phantom limb pain (weighted mean difference (WMD): -1.57 (95% CI: -2.85, -0.29), p = 0.02). The pooled analyses of trials utilising acupuncture, transcutaneous electrical nerve stimulation (TENS), and mirror therapy showed significant reductions in pain severity among individuals with stroke (WMD: -1.46 (95% CI: -1.97, -0.94), p < 0.001), multiple sclerosis (SMD: -0.32 (95% CI: -0.57, -0.06), p = 0.01), and phantom limb pain (SMD: -0.74 (95% CI: -1.36, -0.11), p = 0.02), respectively. Exercise was also found to significantly reduce pain among people with multiple sclerosis (SMD: -1.58 (95% CI: -2.85, -0.30), p = 0.02). Conclusion: Evidence supports the use of non-invasive neurostimulation for the treatment of pain secondary to SCI and phantom limb pain. Beneficial pain management outcomes were also identified for acupuncture in stroke, TENS in multiple sclerosis, and mirror therapy in phantom limb pain.

Tai Chi for Dynamic Balance Training Among Individuals with Cerebellar Ataxia: An Assessor-Blinded Randomized-Controlled Trial.

Objective: To evaluate the immediate and long-term effects of 12 weeks of Tai Chi training on dynamic balance and disease severity among individuals with cerebellar ataxia (CA). Design: An assessor-blinded, two-arm, parallel-group randomized-controlled trial was conducted among 24 participants with CA. Participants were randomized to receive either Tai Chi intervention (n = 12) or usual care (n = 12). Dynamic balance was assessed using the Berg Balance Scale (BBS), Scale for the Assessment and Rating of Ataxia (SARA) balance sub-component of the SARA (SARAbal), Sensory Organization Test, and Limits of Stability test. Disease severity was assessed using the SARA and health-related quality of life using the EuroQol visual analog scale. Assessments were completed at baseline (week 0: T1), postintervention (week 12: T2), and at the end of the 24-week (week 36: T3) follow-up period. Interventions: The 8-form Tai Chi exercise was delivered in 60-min sessions, three times a week for 12 weeks. Participants were asked to complete an unsupervised home Tai Chi exercise program over the next 24 weeks. Participants in the usual care control group completed all study measures but did not receive any intervention. Results: Compared with the usual care control group, after 12 weeks of Tai Chi training, the experimental group demonstrated beneficial effects for dynamic balance assessed using the BBS (mean difference [MD]: 4, 95% confidence interval [CI]: -1.06 to 8.71) and the SARAbal (MD: -1.33, 95% CI: -2.66 to 2.33). The effect size ranged from small to large. The benefits gained were not sustained after 24 weeks during the follow-up assessment. Tai Chi did not benefit disease severity and health-related quality of life in this population. Conclusion: Some evidence supports the immediate beneficial effects of 12 weeks of Tai Chi training on the dynamic balance among individuals with CA. Australia New Zealand Clinical Trials Registry (ACTRN12617000327381).

Task Complexity and Image Clarity Facilitate Motor and Visuo-Motor Activities in Mirror Therapy in Post-stroke Patients.

Introduction: Mirror therapy is effective in the recovery of upper-limb function among post-stroke patients. An important component of mirror therapy is imagining finger movements. This study aimed to determine the influence of finger movement complexity and mirror image clarity on facilitating motor and visuo-motor activities in post-stroke patients. Methods: Fifteen post-stroke patients and 18 right-handed healthy participants performed simple or complex finger tapping while viewing mirror images of these movements at varying levels of clarity. The physical setup was identical to typical mirror therapy. Functional near infrared spectroscopy (fNIRS) was used to capture the brain activities elicited in the bilateral primary motor cortices (M1) and the precuneus using a block experimental design. Results: In both study groups, the "complex finger-tapping task with blurred mirror image" condition resulted in lower intensity (p < 0.01) and authenticity (p < 0.01) of the kinesthetic mirror illusion, and higher levels of perceived effort in generating the illusion (p < 0.01), relative to the "simple finger-tapping with clear mirror image" condition. Greater changes in the oxygenated hemoglobin (HbO) concentration were recorded at the ipsilesional and ipsilateral M1 in the "complex finger-tapping task with blurred mirror image" condition relative to that recorded in the "simple finger-tapping task with clear mirror image" condition (p = 0.03). These HbO concentration changes were not significant in the precuneus. Post-stroke patients showed greater changes than their healthy counterparts at the ipsilesional M1 (F = 5.08; p = 0.03; partial eta squared = 0.14) and the precuneus (F = 7.71; p < 0.01; partial eta squared = 0.20). Conclusion: The complexity and image clarity of the finger movements increased the neural activities in the ipsilesional motor cortex in the post-stroke patients. These findings suggest plausible roles for top-down attention and working memory in the treatment effects of mirror therapy. Future research can aim to corroborate these findings by using a longitudinal design to examine the use of mirror therapy to promote upper limb motor recovery in post-stroke patients.

Quality of life of stroke survivors in Africa: a systematic review and meta-analysis.

PURPOSE: Functional impairments and socioeconomic constraints associated with stroke affect quality of life (QoL). With limited care and social support resources, there is a greater anticipated decline in QoL among stroke survivors in Africa. This study aims to examine post-stroke QoL, properties of outcome measures adopted and predictors of the QoL among African stroke survivors. METHODS: African Journals Online, CINAHL, PsychINFO, PubMed and Web of Science databases were searched from inception to February 2020. Methodological quality was assessed using the Agency for Healthcare Research and Quality (ARHQ) methodology checklist for observational studies. RESULTS: Twenty-eight studies recruiting 2572 (76.4%) stroke survivors and 795 (23.6%) healthy volunteers were included. Studies were conducted in eight African countries between 2007 and 2019. Methodological quality of studies was good. Overall, stroke survivors reported a low QoL. Six studies comparing QoL between stroke survivors and healthy controls were pooled for meta-analysis. Results showed a biased-adjusted standardised mean difference (Hedges's g) of 1.13 (95% CI 0.71 to 1.56; p < 0.001), indicating better QoL among healthy controls. Only 4 (14.3%) studies used translated or cross-culturally adapted QoL assessment tools. The most commonly reported predictor of QoL was post-stroke disability (35.8% of studies) which is followed by depression (28.6%) and stroke severity (28.6%). CONCLUSIONS: Overall, African stroke survivors reported comparatively lower QoL as compared to age-matched healthy controls. This highlights the need for cross-culturally validated assessment tools and more robust post-stroke QoL evaluation across the African continent. To improve QoL of stroke survivors in Africa, early interventions should focus on reducing disability and depression associated with stroke. PROSPERO registration number: CRD42019137653.

Neural Processes Underlying Mirror-Induced Visual Illusion: An Activation Likelihood Estimation Meta-Analysis.

Introduction: Neuroimaging studies on neural processes associated with mirror-induced visual illusion (MVI) are growing in number. Previous systematic reviews on these studies used qualitative approaches. Objective: The present study conducted activation likelihood estimation (ALE) meta-analysis to locate the brain areas for unfolding the neural processes associated with the MVI. Method: We searched the CINAHL, MEDLINE, Scopus, and PubMed databases and identified eight studies (with 14 experiments) that met the inclusion criteria. Results: Contrasting with a rest condition, strong convergence in the bilateral primary and premotor areas and the inferior parietal lobule suggested top-down motor planning and execution. In addition, convergence was identified in the ipsilateral precuneus, cerebellum, superior frontal gyrus, and superior parietal lobule, clusters corresponding to the static hidden hand indicating self-processing operations, somatosensory processing, and motor control. When contrasting with an active movement condition, additional substantial convergence was revealed in visual-related areas, such as the ipsilateral cuneus, fusiform gyrus, middle occipital gyrus (visual area V2) and lingual gyrus, which mediate basic visual processing. Conclusions: To the best of our knowledge, the current meta-analysis is the first to reveal the visualization, mental rehearsal and motor-related processes underpinning the MVI and offers theoretical support on using MVI as a clinical intervention for post-stroke patients.

Role of kinaesthetic motor imagery in mirror-induced visual illusion as intervention in post-stroke rehabilitation.

Mirror-induced visual illusion obtained through mirror therapy is widely used to facilitate motor recovery after stroke. Activation of primary motor cortex (M1) ipsilateral to the moving limb has been reported during mirror-induced visual illusion. However, the mechanism through which the mirror illusion elicits motor execution processes without movements observed in the mirrored limb remains unclear. This study aims to review evidence based on brain imaging studies for testing the hypothesis that neural processes associated with kinaesthetic motor imagery are attributed to ipsilateral M1 activation. Four electronic databases were searched. Studies on functional brain imaging, investigating the instant effects of mirror-induced visual illusion among stroke survivors and healthy participants were included. Thirty-five studies engaging 78 stroke survivors and 396 healthy participants were reviewed. Results of functional brain scans (n = 20) indicated that half of the studies (n = 10, 50%) reported significant changes in the activation of ipsilateral M1, which mediates motor preparation and execution. Other common neural substrates included primary somatosensory cortex (45%, kinaesthesia), precuneus (40%, image generation and self-processing operations) and cerebellum (20%, motor control). Similar patterns of ipsilateral M1 activations were observed in the two groups. These neural substrates mediated the generation, maintenance, and manipulation of motor-related images, which were the key processes in kinaesthetic motor imagery. Relationships in terms of shared neural substrates and mental processes between mirror-induced visual illusion and kinaesthetic motor imagery generate new evidence on the role of the latter in mirror therapy. Future studies should investigate the imagery processes in illusion training for post-stroke patients.

Does task complexity influence motor facilitation and visuo-motor memory during mirror therapy in post-stroke patients?

Stroke is one of the most common causes of mortality and reduced disability-adjusted life years worldwide. Hemiparesis due to reduced skeletal-muscle power is an effect of brain lesions. Mirror therapy can significantly improve motor performance among post-stroke patients. To determine if altering the complexity of the mirror task in the mirror therapy paradigm would enhance top-down motor facilitation and visuo-motor memory demand, we conducted a pilot study on four post-stroke patients. Our preliminary results showed that performing complex finger tapping task resulted in enhanced activities in the primary motor cortex and precuneus, ipsilateral to the moving hand in the mirror therapy paradigm. We hypothesise the following: (a) complex finger tapping would result in stronger top-down motor facilitation and higher demand on visuo-motor memory than simple finger tapping in the mirror therapy paradigm, and (b) observing a blurred mirror image would result in increased top-down motor facilitation and higher demand on visuo-motor memory than a clear mirror image. To confirm these hypotheses, we propose a cross-sectional observational study on a large sample of post-stroke patients. This paper reports the findings of the pilot study, the rationale for testing the hypotheses, the experimental set-up, the task design and the assessment protocol for functional near-infrared spectroscopy.

Dosage for cost-effective exercise-based falls prevention programs for older people: A systematic review of economic evaluations.

BACKGROUND: Falls in older people is a global public health concern. Physical exercise is a useful and potentially cost-saving treatment option to prevent falls in older people. OBJECTIVES: We aimed to (1) summarize the research literature regarding the cost-effectiveness of exercise-based programs for falls prevention in older people and (2) discuss the implications of the review's findings for clinical practice and future research on the dosage of cost-effective exercise-based falls prevention programs for older people. METHODS: Multiple databases were searched from inception until February 2019. Studies were included if they (1) were randomized controlled trials with an economic evaluation of exercise-based falls prevention programs for people ≥ 60 years old and (2) assessed the incremental cost-effectiveness ratios, cost per quality-adjusted life year, incremental cost per fall and benefit-to-cost ratio of programs. Methodological quality was assessed with the Physiotherapy Evidence Database scale and quality of economic evaluation with the Quality of Health Economic Studies. RESULTS: We included 12 studies (3668 older people). Interventions for falls prevention were either exercise-only or multifactorial programs. Five studies of high economic quality and 2 of high methodological quality provided evidence supporting exercise-only programs as cost-effective for preventing falls in older people. Specifically, a tailored exercise program including strengthening of lower extremities, balance training, cardiovascular exercise, stretching and functional training of moderate intensity performed twice per week with each session lasting 60min for ≥ 6 months delivered in groups of 3 to 8 participants with home-based follow-up appears to be cost-effective in preventing falls in older people. CONCLUSION: There is evidence to support exercise-based interventions as cost-effective treatment for preventing falls. Further research is needed to fully establish the cost-effectiveness of such programs, especially in both developing and underdeveloped countries. REVIEW REGISTRATION: PROSPERO CRD42018102892.