Cycling using functional electrical stimulation therapy to improve motor function and activity in post-stroke individuals in early subacute phase: a systematic review with meta-analysis

BACKGROUND

Stroke necessitates interventions to rehabilitate individuals with disabilities, and the application of functional electrical stimulation therapy (FEST) has demonstrated potential in this regard. This study aimed to analyze the efficacy and effectiveness of cycling using FEST to improve motor function and lower limb activity in post-stroke individuals.

METHODS

We performed a systematic review according to the recommendations of the PRISMA checklist, searching MEDLINE, Cochrane, EMBASE, LILACS, and PEDro databases by July 2022, without any date or language limitations. Studies were selected using the following terms: stroke, electrical stimulation therapy, cycling, and clinical trials. Randomized or quasi-randomized clinical trials that investigated the effectiveness of cycling using FEST combined with exercise programs and cycling using FEST alone for motor function and activity in subacute post-stroke individuals were included. The quality of included trials was assessed using the PEDro scores. Outcome data were extracted from eligible studies and combined in random-effects meta-analyses. The quality of evidence was determined according to the Grading of Recommendations Assessment, Development, and Evaluation system.

RESULTS

Five randomized clinical trials involving 187 participants were included. Moderate-quality evidence indicates that cycling using FEST combined with exercise programs promotes relevant benefits in trunk control (MD 9 points, 95% CI 0.36-17.64) and walking distance (MD 94.84 m, 95% CI 39.63-150.05, I = 0%), the other outcomes had similar benefits. Cycling using FEST alone compared to exercise programs promotes similar benefits in strength, balance, walking speed, walking distance, and activities of daily living.

CONCLUSION

This systematic review provides low- to moderate-quality evidence that cycling using FEST may be an effective strategy to consider in improving motor function and activity outcomes for post-stroke individuals in the early subacute phase.

REVIEW REGISTRATION

PROSPERO (CRD42022345282).

Child sleep: assessment of the knowledge of parents of children aged zero to two years

Changes in sleep behavior are considered a public health problem, since they interfere with the health of the individual, especially in early childhood, and can impair growth and development. The objective of this study was to evaluate the knowledge about children's sleep in parents of children aged 0 to 24 months. Quasi-experimental study, of the type before and after, with a single group, developed in a pediatric outpatient clinic in northeastern Brazil. Convenience sample of 60 parents of children discharged from the neonatal unit, who represent preliminary data from a larger study. Data collected between November / 2019 and January / 2020, using the CAP survey (Knowledge, Attitude and Practice). A child sleep instrument was used in the pre-test (first time with the parents) and post-test (15 days after the first application). After the pre-test, the parents read an educational booklet containing the information to which they were asked. The knowledge about sleep was assessed including, time, place and sleeping clothes, position in the crib, prevention of sudden infant death syndrome and total sleep time. Scores ≤ 3 represented inadequate knowledge; 4-7 adequate knowledge. Only 5 parents had inadequate knowledge in the pre-test. In the post-test, everyone demonstrated adequate knowledge. The average of points in the pre-test was 4.3, median of 4. In the post-test, the average of points (6.15), median (6). In the pre-test, less correct questions were total sleep time, adequate sleeping position, with 12 and 20 errors, respectively. After the application of the booklet, the question regarding the total sleep time remained with an equal number of errors, however only 7 parents were wrong about the position of the child at the time of sleep. It is concluded that there is a need for guidance to parents on sleep, and it is pertinent to evaluate their previous knowledge, contributing to the strengthening of public policies aimed at children's sleep.

Key messages

Parents should receive guidance on infant sleep hygiene. Strengthening the promotion of children's sleep by health professionals.