The effect of rehabilitation interventions on physical function and immobility-related complications in severe stroke-protocol for a systematic review

Impact of COVID-19 on brain connectivity and rehabilitation outcome after stroke

Background

Coronavirus disease (COVID-19) may induce neurological issues, impacting brain structure and stroke recovery. Limited studies have explored its effects on post-stroke rehabilitation. Our study compares brain structure and connectivity, assessing rehabilitation outcomes based on pre-stroke COVID-19 infection.

Methods

A retrospective analysis of 299 post-stroke rehabilitation cases from May 2021 to January 2023 included two groups: those diagnosed with COVID-19 at least two weeks before stroke onset (COVID group) and those without (control group). Criteria involved first unilateral supratentorial stroke, <3 months post-onset, initial MR imaging, and pre- and post-rehabilitation clinical assessments. Propensity score matching ensured age, sex, and initial clinical assessment similarities. Using lesion mapping, tract-based statistical analysis, and group-independent component analysis MRI scans were assessed for structural and functional differences.

Results

After propensity score matching, 12 patients were included in each group. Patient demographics showed no significant differences. Analyses of MR imaging revealed no significant differences between COVID and control groups. Post-rehabilitation clinical assessments improved notably in both groups, however the intergroup analysis showed no significant difference.

Conclusions

Previous COVID-19 infection did not affect brain structure or connectivity nor outcomes after rehabilitation.

Using of Hot Red Bean Bag on the Symptoms of Depression, Sleep, and Fatigue in Stroke Patients

Background

Symptoms of depression, sleep, and fatigue in stroke patients are associated with each other, and intervention development for improving of these symptoms is needed. This study aimed to examine the effects of hot red bean bag on depression, sleep state, sleep satisfaction, and fatigue among Korean stroke patients.

Methods

A quasi-experimental pretest-posttest control group design was employed. The study participants included 57 stroke patients (Intervention: n=28, Control: n=29) in a hospital in Seoul, South Korea from Aug 2017 to Mar 2018. Hot red bean bag, as an intervention, was heated in a 2,450 MHz microwave oven for 3 min, and applied for 30 min at 41±6 °C in the lower limbs of the intervention group for 5 days.

Results

There were statistically significant differences on depression (P<0.001), sleep state (P<0.001), sleep satisfaction (P<0.001), and total fatigue (P<0.001) between the two groups.

Conclusion

Hot red bean bag was an effective intervention for decreasing depression and total/subcategories fatigue, and for improving sleep state and sleep satisfaction of Korean stroke patients. Research on complementary and alternative therapies for stroke patients needs be studied continuously.

Effect of spiritual care on the quality of life in patients who underwent intracranial hemorrhage surgery: a randomized controlled trial

INTRODUCTION

One of the most important complications of stroke after intracranial haemorrhage surgery is impaired quality of life. This study was conducted to determine the impact of spiritual care on the quality of life of stroke patients.

METHODS

This single-blind clinical trial with a pre-test and post-test design was conducted on 100 stroke patients. Participants were recruited and randomly assigned to a control group and an intervention group. The stroke-specific quality of life (SS -QoL) scale was used to assess the quality of life of stroke patients. The intervention group received four sessions of spiritual care.

RESULTS

The independent t -test showed no significant difference between the two groups in the mean quality of life score ( t =-0.120, P =0.281) and its dimensions before the intervention. However, after the intervention, the results showed a significant difference between the two groups in terms of the mean quality of life score ( t =1.984, P <0.001) and its dimensions. In addition, the results of the paired t -test showed that in the intervention group, the mean score of quality of life ( t =5.161, P <0.001) and its dimensions were significantly different before and after the intervention. Furthermore, the results showed that before and after the intervention in the control group, the mean score of quality of life ( t =1.109, P =0.614) and its dimensions were not significantly different.

CONCLUSIONS

Based on this results, the authors strongly recommend the use of spiritual care as a holistic care and complementary method to improve the symptoms and quality of life of stroke patients.

Pre-Clinical Mobility Limitation (PCML) Outcomes in Rehabilitation Interventions for Middle-Aged and Older Adults: A Scoping Review

Individuals with pre-clinical mobility limitation (PCML) are at a high risk of future functional loss and progression to disability. The purpose of this scoping review was to provide a comprehensive understanding of PCML intervention studies in middle-aged and older adults. We present the interventions that have been tested or planned, describe how they have been conducted and reported, identify the knowledge gaps in current literature, and make recommendations about future research directions. An initial search of 2,291 articles resulted in 14 articles that met criteria for inclusion. Findings reveal that: (1) there is limited published work on PCML interventions, especially in middle-aged populations; and (2) the complexity and variety of PCML measures make it difficult to compare findings across PCML studies. Despite the diversity of measures, this review provides preliminary evidence that rehabilitation interventions on PCML help to delay or prevent disability progression.

Oxidative stress as a bridge between age and stroke: A narrative review

Stroke is the third most common cause of death globally and a leading cause of disability. The cellular and molecular changes following stroke and causes of neuronal death are not fully understood, and there are few effective treatments currently available. A rapid increase in the levels of reactive oxygen species (ROS) post stroke can overwhelm antioxidant defenses and trigger a series of pathophysiologic events including the inflammatory response, blood-brain barrier (BBB) disruption, apoptosis, and autophagy, ultimately leading to neuron degeneration and apoptosis. It is thought that beyond a certain age, the ROS accumulation resulting from stroke increases the risk of morbidity and mortality. In the present review, we summarize the role of oxidative stress (OS) as a link between aging and stroke pathogenesis. We also discuss how antioxidants can play a beneficial role in the prevention and treatment of stroke by eliminating harmful ROS, delaying aging, and alleviating damage to neurons.

Influence of Robotic Therapy on Severe Stroke Patients

Robotic rehabilitation has emerged as a promising approach to enhance motor recovery after stroke, but there is limited knowledge about its efficacy in individuals who have experienced severe stroke. The study presented in this paper aims to analyze the effect of robotic therapy on the recovery of patients with severe stroke when combined with conventional rehabilitation therapies, and we want to observe whether there is a relationship between the clinical assessment provided by the therapist and the data recorded by the robotic device. Participants were divided into an experimental group and a control group, both receiving 15 sessions of conventional therapy in three consecutive weeks, but the experimental group underwent three out of five sessions per week with a robotic device. Both groups were evaluated using clinical scales, and in addition the experimental group was evaluated using an assessment game incorporated in the robotic device that provides session data such as the level of assistance needed by each user to complete the activity, or the score obtained in the game. These preliminary results showed that patients who received robot-assisted therapy had better motor function recovery compared to those who only received conventional therapy. In addition, it is also observed that the robot assistance needed by patients in the experimental group decreased as the sessions progressed, suggesting that robot-assisted therapy could be an effective tool for severe stroke patients.

Association between volume of patients undergoing stroke rehabilitation at acute care hospitals and improvement in activities of daily living

BACKGROUND

This study aimed to determine the relationship between the annual volume of patients undergoing rehabilitation per hospital and the outcomes of patients admitted for acute stroke.

METHODS

This observational study used nationwide administrative data. Data on stroke patients aged ≥ 20 years who underwent rehabilitation were extracted from 1,182 acute care hospitals in Japan. The exclusion criteria were extended hospital stay exceeding 180 days and death during hospitalization. Hospital volumes were divided into four quartiles of total patients per hospital. The primary outcome was an improvement in activities of daily living from admission to discharge measured using the Barthel index. Poisson regression analysis of activities of daily living improvement was performed using inverse probability of treatment weighting.

RESULTS

High rehabilitation volume was significantly correlated with improvements in activities of daily living using the "very low group" as a reference (risk ratio [95% confidence interval]): 1.06 [1.05-1.08], P<0.001). Low volume was also significantly associated with activities of daily living improvement (risk ratio [95% confidence interval]: 1.04 [1.03-1.06], P<0.001).

CONCLUSIONS

The annual volume of stroke patients undergoing multidisciplinary rehabilitation at a specific hospital may be a factor in the degree of patient improvement in activities of daily living.

Effect of Core Stability Training on Unstable Support Surfaces in Postoperative Rehabilitation of Thoracolumbar Vertebral Compression Fractures in the Elderly

Objective

Thoracolumbar vertebral compression fractures (TVCF) are caused by anterior flexion or vertical downward violence to the spine (Sezer et al. 2021). This study is aimed at investigating the effect of core stability training (CST) on unstable support surfaces in the postoperative rehabilitation of TVCF in the elderly. Methods. Ninety-eight patients with TVCF who underwent surgical treatment in our hospital from July 2021 to April 2022 were selected as study subjects. Then, they were divided into a research group receiving unstable support surface CST and a control group with conventional rehabilitation training according to the random number table method. Before and after the training, the X-ray machine was positioned and the anterior margin and middle height ratio and the posterior convex Cobb angle of the injured vertebrae were observed, and the balance detector was used to detect patients' eye opening and closing trajectory length, Romberg rate, and to perform gait test. Patients' pain, lumbar spine function, and quality of life were subsequently assessed using the Visual Analogue Scale (VAS), Oswestry Dysfunction Index (ODI), Generic Quality of Life Inventory-74 (GQOL-74), and patient satisfaction with rehabilitation was investigated. Results. After rehabilitation training, there was no statistically marked difference in eye-opening trajectory length between both groups (P > 0.05). The research group had higher scores than the control group in all dimensions of the anterior border of the injured vertebra, middle height ratio, and GQOL-74, while the posterior convex Cobb angle, closed-eye trajectory length, Romberg rate, VAS, and ODI were lower than the control group (P < 0.05). The research group also revealed better gait improvement and higher rehabilitation satisfaction than the control group after training (P < 0.05).

Conclusion

Unstable support surface CST can effectively improve postoperative vertebral body rehabilitation, balance function, gait, pain conditions, and lumbar spine function in elderly TVCF patients, and enhance their quality of life and rehabilitation satisfaction. This trial is registered with ChiCTR2000014547.

Integrative and complementary practices to control nausea and vomiting in pregnant women: a systematic review

OBJECTIVE

to synthesize the evidence available in the literature on the effects of integrative and complementary practices in nausea and vomiting treatment in pregnant women.

METHOD

a systematic review, reported according to PRISMA and registered in PROSPERO. The search for studies was carried out in 11 databases. To assess risk of bias in randomized clinical trials, the Cochrane Collaboration Risk of Bias Tool (RoB 2) was used.

RESULTS

the final sample consisted of 31 articles, divided into three categories: aromatherapy, phytotherapy and acupuncture. It was observed that aromatherapy with lemon essential oil, ginger capsules, pericardial 6 point acupressure were the interventions that proved to be effective. Less than half of studies reported adverse effects, with mild and transient symptoms predominating. Most articles were classified as "some concern" in risk of bias assessment.

CONCLUSION

the three most effective interventions to control gestational nausea and vomiting were aromatherapy, herbal medicine and acupuncture, with significant results in the assessment of individual studies.

Práticas integrativas e complementares para controle de náuseas e vômitos em gestantes: revisão sistemática

RESUMO Objetivo: sintetizar as evidências disponíveis na literatura sobre os efeitos das práticas integrativas e complementares no tratamento de náusea e vômito em gestantes. Método: revisão sistemática, relatada conforme o PRISMA e registrada no PROSPERO. A busca pelos estudos foi realizada em 11 bases/bancos de dados. Para avaliação do risco de viés dos ensaios clínicos randomizados, utilizou-se a ferramenta Cochrane Collaboration Risk of Bias Tool (RoB 2). Resultados: a amostra final foi composta por 31 artigos, divididos em três categorias: aromaterapia, fitoterapia e acupuntura. Observou-se que a aromaterapia com óleo essencial de limão, cápsulas de gengibre, acupressão no ponto pericárdio 6 foram as intervenções que se provaram eficazes. Menos da metade dos estudos relatou efeitos adversos, sendo que predominaram sintomas de leve intensidade e transitórios. A maioria dos artigos foi classificada como “alguma preocupação” na avaliação do risco de viés. Conclusão as três intervenções mais eficazes para controle de náusea e vômito gestacional foram aromaterapia, fitoterapia e acupuntura, com resultados significativos na avaliação dos estudos individuais.

THE EFFECTS OF TRAINING ON DIFFERENT SURFACES, ON BALANCE AND GAIT PERFORMANCE IN STROKE HEMIPLEGIA

ABSTRACT Although many studies have focused on balance exercises for elderly or stroke patients, no comprehensive studies have investigated the use of training on different surfaces (TDS) with analysis of gait performance in elderly male stroke patients. The active properties of balance and subjective reporting of functional gait ability were used to identify the effects of TDS. Static balance (SB), dynamic balance (DB) and gait analysis was measured in 30 elderly stroke patients. The patients were divided into the TDS group (n=15) and a control group (CG, n=15). Fifteen elderly stroke patients underwent TDS five times a week for 12 weeks. The data was analyzed using repeated measures analysis of variance. Significant differences were observed between the two groups (TDS and Control): SB (p < 0.0001), DB (OSI: p < 0.0001, APSI: p < 0.001, MLSI: p < 0.004) and gait analysis (right: temporal step time: p < 0.0001, temporal cycle time: p < 0.001, temporal double support time: p < 0.0001; left: temporal step time: p < 0.0001, temporal cycle time: p < 0.0001, temporal double support time: p < 0.0001). TDS in elderly male stroke patients suggests that the characteristics of gait performance in these patients may be improved by increasing static balance, dynamic balance and gait velocity. It is hoped that the results of this trial will provide new information on the effects of TDS on balance stability and gait ability in stroke patients, through changes in stability of the lower extremities. Level III, Case-control Study.

Psychometric properties of the Persian version of the Physical Activity Scale for the Elderly (PASE)

Background

Old age is associated with reduced physical ability. It is necessary to measure and evaluate the physical activity of older people. Implementing appropriate requires a valid and reliable tool. Physical Activity Scale for the Elderly (PASE) is the frequently used self-reported physical activity assessment for older adults. Therefore, this study aimed to determine the translation validity and reliability of the Persian version of the Physical Activity Scale for the Elderly.

Methods

This study is a methodological, descriptive applied research was conducted on 300 older people. The translation process of the English version of PASE into Persian was carried out according to the process of translation and adaptation of scale recommended by the World Health Organization. The reliability of the scale was examined by calculating the Cronbach’s alpha, Pearson, and intraclass correlation coefficient (ICC). The reliability and validity of the scale were evaluated by following the “Consensus-Based Standards for the Selection of Health Status Measurement Instruments” (COSMIN) checklist. To assess the face and content validity, impact score (IS), the content validity ratio (CVR), and the content validity index (CVI) were determined. A confirmatory factor analysis was also performed.

Results

The experts approved the quality of the Persian version of PASE. The reliability was calculated with a Cronbach’s alpha of 0.94, an ICC of 0.99, and a test-retest correlation coefficient of 0.94. The qualitative and quantitative face validity of all questions by expert judgment and IS of greater than 1.5 was considered. Also, CVR and CVI scores of all questions were higher than 0.6 and 0.79, respectively. Confirmatory factor analysis revealed a good fit for the original three-factor structure.

Conclusions

The Persian or Farsi version of PASE was shown to have acceptable validity and reliability. This tool is suitable for measuring the physical activity level in the Persian elderly language special in clinical environments and therapeutic interventions.

Utilisation of follow-up rehabilitation services for stroke survivors: a scoping review protocol

INTRODUCTION

Stroke is a leading cause of death and disability and has been identified as a significant public health problem. Residual functional deficits negatively affect the stroke survivor's functional independence and quality of life. Rehabilitation is necessary for them to regain lost skills, relearn tasks and be independent again.

METHODOLOGY AND ANALYSIS

A scoping review will be conducted to map available literature on factors influencing utilisation of follow-up rehabilitation services for stroke survivors. Databases including PubMed, LISTA(EBSCO), Web of Science (Clarivate), Google Scholar, Scopus and Science Direct will be searched using keyword searches for articles. The review will include studies presenting evidence on outpatient stroke rehabilitation services, studies undertaken and published in English, including grey literature. Title and abstract screening will be done simultaneously. Two reviewers will independently conduct the abstract and full-text article screening as well as pilot the data extraction form. Thematic analysis will be used to analyse the findings.

ETHICS AND DISSEMINATION

This scoping review is part of a larger study approved by the University of KwaZulu Natal Biomedical Research Ethics Committee (Reference no. BREC/00000660/2019). The results will be disseminated through publication.

Posttraumatic stress disorder prevalence in medical populations: A systematic review and meta-analysis

OBJECTIVE

PTSD is increasingly recognized following medical traumas although is highly heterogeneous. It is difficult to judge which medical contexts have the most traumatic potential and where to concentrate further research and clinical attention for prevention, early detection and treatment. The objective of this study was to compare PTSD prevalence in different medical populations.

METHODS

A systematic review of the literature on PTSD following medical traumas was conducted as well as a meta-analysis with final pooled result and 95% confidence intervals presented. A meta-regression was used to investigate the impact of potential effect modifiers (PTSD severity, age, sex, timeline) on study effect size between prevalence studies.

RESULTS

From 3278 abstracts, the authors extracted 292 studies reporting prevalence. Using clinician-administered reports, the highest 24 month or longer PTSD prevalence was found for intraoperative awareness (18.5% [95% CI=5.1%-36.6%]) and the lowest was found for epilepsy (4.5% [95% CI=0.2%-12.6%]). In the overall effect of the meta-regression, only medical events or procedures emerged as significant (p = 0.006) CONCLUSION: This review provides clinicians with greater awareness of medical contexts most associated with PTSD, which may assist them in the decision to engage in more frequent, earlier screening and referral to mental health services.

Care for Patients with Stroke During the COVID-19 Pandemic: Physical Therapy and Rehabilitation Suggestions for Preventing Secondary Stroke

Infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes the development of the novel 2019 coronavirus disease (COVID-19) and associated clinical symptoms, which typically presents as an upper respiratory syndrome such as pneumonia. Growing evidence indicates an increased prevalence of neurological involvement (e.g., in the form of stroke) during virus infection. COVID-19 has been suggested to be more than a lung infection because it affects the vasculature of the lungs and other organs and increases the risk of thrombosis. Patients with stroke are vulnerable to secondary events as a result not only of their poor vascular condition but also of their lack of access to rehabilitation resources. Herein, we review current knowledge regarding the pathophysiology of COVID-19, its possible association with neurological involvement, and current drug therapies. Suggestions are also offered regarding the potential for current neurorehabilitation therapies to be taught and practiced at home.

Effectiveness of extracorporeal shock wave for post-stroke shoulder-hand syndrome: A protocol for systematic review and meta analysis

BACKGROUND

Post-stroke shoulder-hand syndrome (PSSHS) is one of the most common sequelae in patients with stroke. Previous studies have reported that extracorporeal shock wave (EPSW) has been used to treat this condition effectively. However, its conclusions are still inconsistent. Therefore, this study will provide evidence to systematically assess the effectiveness and safety of EPSW for the treatment of PSSHS.

METHODS

We will comprehensively search relevant randomized controlled trials (RCTs) assessing the effectiveness and safety of EPSW for the treatment of PSSHS in the following databases from their start to February 1, 2020 without language and publication date limitations: Cochrane Library, MEDLINE, EMBASE, CINAHL, Web of Science, PsycINFO, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. For trials that meet all inclusion criteria, 2 researchers will independently extract the data from them and appraise study quality by Cochrane risk of bias. Any differences will be solved by discussion with the help of another researcher. All data will be performed and analyzed using RevMan 5.3 software.

RESULTS

We will summarize up-to-date high quality RCTs to evaluate the effectiveness and safety of EPSW for the treatment of PSSHS.

CONCLUSIONS

This study will provide a comprehensive evidence summary to determine whether EPSW is effective and safety for the treatment of PSSHS or not.

PROSPERO REGISTRATION NUMBER

PROSPERO CRD42020175630.

Can cervical vascular ultrasound combined with transcranial Doppler ultrasound accurately diagnose cerebral infarction?: A protocol for a systematic review and meta-analysis

BACKGROUND

The purpose of this study is to investigate the impact of cervical vascular ultrasound (CVU) combined transcranial Doppler ultrasound (TDU) in the diagnosis of cerebral infarction (CI).

METHODS

The following electronic databases will be sought from PUBMED, EMBASE, Cochrane Library, PSYCINFO, Web of Science, Allied and Complementary Medicine Database, WANGFANG, VIP database, and China National Knowledge Infrastructure. The search period will cover from the initial indexing to March 1, 2020 without restrictions of language and publication status. All case-controlled studies which identifying the impact of CVU combined TDU in the diagnosis of CI will be considered. Two authors will independently perform the whole process of study selection, data extraction, and quality assessment, respectively. If any disagreements occur between two authors, we will invite a third experienced author to help solve them through discussion. Quality Assessment of Diagnostic Accuracy Studies tool will be used to check study quality, and RevMan V.5.3 software and Stata V.12.0 software will be utilized to carry out statistical analysis.

RESULTS

This study will summarize the most recent evidence that focusing on the impact of CVU combined TDU in the diagnosis of CI.

CONCLUSION

This study will provide helpful evidence to determine whether CVU combined TDU is an accurate diagnosis tool for CI or not.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020171367.

The effect of rehabilitation interventions on physical function and immobility-related complications in severe stroke: a systematic review

OBJECTIVE

To evaluate the effectiveness of rehabilitation interventions on physical function and immobility-related complications in severe stroke.

DESIGN

Systematic review of electronic databases (Medline, Excerpta Medica database, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Physiotherapy Evidence Database, Database of Research in Stroke, Cochrane Central Register of Controlled Trials) searched between January 1987 and November 2018.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement guided the review. Randomised controlled trials comparing the effect of one type of rehabilitation intervention to another intervention, usual care or no intervention on physical function and immobility-related complications for patients with severe stroke were included. Studies that recruited participants with all levels of stroke severity were included only if subgroup analysis based on stroke severity was performed. Two reviewers screened search results, selected studies using predefined selection criteria, extracted data and assessed risk of bias for selected studies using piloted proformas. Marked heterogeneity prevented meta-analysis and a descriptive review was performed. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess evidence strength.

RESULTS

28 studies (n=2677, mean age 72.7 years, 49.3% males) were included in the review. 24 studies were rated low or very low quality due to high risk of bias and small sample sizes. There was high-quality evidence that very early mobilisation (ie, mobilisation with 24 hours poststroke) and occupational therapy in care homes were no more effective than usual care. There was moderate quality evidence supporting short-term benefits of wrist and finger neuromuscular electrical stimulation in improving wrist extensor and grip strength, additional upper limb training on improving upper limb function and additional lower limb training on improving upper limb function, independence in activities of daily living, gait speed and gait independence.

CONCLUSIONS

There is a paucity of high-quality evidence to support the use of rehabilitation interventions to improve physical function and reduce immobility-related complications after severe stroke. Future research investigating more commonly used rehabilitation interventions, particularly to reduce poststroke complications, is required.

PROSPERO REGISTRATION NUMBER

CRD42017077737.

Auriculotherapy to control chemotherapy-induced nausea and vomiting in patients with cancer: protocol of a systematic review

BACKGROUND

Due to the worldwide rise in cancer incidence, and therefore the rise in the need for antineoplastic chemotherapy, it is important for both healthcare professionals and patients alike that the side effects of chemotherapy, such as chemotherapy-induced nausea and vomiting (CINV), are treated and prevented. Auriculotherapy is a type of acupuncture and may be a low-cost and safe antiemetic measure to control the side effects of chemotherapy. The goal of this systematic review is to synthesize the available evidence in the literature regarding the auriculotherapy effects to treat CINV in people with cancer.

METHODS

The review will only include randomized controlled trials (RCTs) that compare the clinical effects of the auriculotherapy intervention (used alone or as an add-on), with sham auriculotherapy, routine treatment with antiemetic drugs, or other non-pharmacological interventions in patients with cancer with CINV who are undergoing chemotherapy. The outcomes to be evaluated are nausea and vomiting: in acute, delayed, or anticipated stages, when induced by chemotherapy. A comprehensive search for studies will be carried out in these databases: MEDLINE via PubMed, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, ICTRP, LILACS, CUMED, IBECS, BVS MTCI Americas, Web of Science, Scopus, PEDro, CNKI, and CBMdisc up until December 31, 2018. Only articles in English, Portuguese, and Spanish will be selected. Two independent reviewers will evaluate full texts, extract data, and assess the risk of bias of eligible articles. The quality of evidence will be assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). A meta-analysis will be undertaken to assess the interventions and outcomes' homogeneity, assessing statistical heterogeneity using the Cochran's Q test and quantified using Higgins' inconsistency index. If there is insufficient data for a meta-analysis, a narrative synthesis will be presented. This protocol has been prepared according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines.

DISCUSSION

The results of this systematic review will summarize the strength of evidence for the use of auriculotherapy in the control of CINV of patients with cancer and will be used to identify evidence gaps.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018117513.