Kristen E. D'Anci, PhD; Stacey Uhl, MS; Jeffrey Oristaglio, PhD; Nancy Sullivan, BA; Amy Y. Tsou, MD, MSc
Acknowledgment: The authors thank Evelyn Kuserk, MA, MLS, for designing and conducting the original searches for this systematic review, and Laura Koepfler, MLS, and Kristina McShea, MSLIS, for conducting targeted searches for newly published systematic reviews of relevance to this topic.
Disclosures: Dr. D'Anci reports grants from the U.S. Department of Veterans Affairs during the conduct of the study. Dr. Oristaglio reports grants from the VA/DoD during the conduct of the study. Dr. Tsou reports that ECRI Institute received funding from the VA/DoD, which supported the work presented in the manuscript. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-2414.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor, Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Corresponding Author: Kristen E. D'Anci, PhD, ECRI Institute Center for Clinical Evidence and Guidelines, ECRI Institute, 5200 Butler Pike, Plymouth Meeting, PA 19462-1298; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. D'Anci, Oristaglio, and Tsou; Ms. Uhl; and Ms. Sullivan: ECRI Institute Center for Clinical Evidence and Guidelines, ECRI Institute, 5200 Butler Pike, Plymouth Meeting, PA 19462-1298.
Author Contributions: Conception and design: K.E. D'Anci, S. Uhl, A.Y. Tsou.
Analysis and interpretation of the data: K.E. D'Anci, S. Uhl, J. Oristaglio, N. Sullivan, A.Y. Tsou.
Drafting of the article: K.E. D'Anci, S. Uhl, A.Y. Tsou.
Critical revision of the article for important intellectual content: K.E. D'Anci, S. Uhl, J. Oristaglio, A.Y. Tsou.
Final approval of the article: K.E. D'Anci, N. Sullivan, A.Y. Tsou.
Statistical expertise: K.E. D'Anci.
Collection and assembly of data: K.E. D'Anci, S. Uhl, J. Oristaglio, N. Sullivan, A.Y. Tsou.
Early rehabilitation after stroke is essential to help reduce disability.
To summarize evidence on the benefits and harms of nonpharmacologic and pharmacologic treatments for motor deficits and mood disorders in adults who have had stroke.
English-language searches of multiple electronic databases from April 2009 through July 2018; targeted searches to December 2018 for studies of selective serotonin reuptake inhibitors (SSRIs) or serotonin–norepinephrine reuptake inhibitors.
19 systematic reviews and 37 randomized controlled trials addressing therapies for motor deficits or mood disorders in adults with stroke.
One investigator abstracted the data, and quality and GRADE assessment were checked by a second investigator.
Most interventions (for example, SSRIs, mental practice, mirror therapy) did not improve motor function. High-quality evidence did not support use of fluoxetine to improve motor function. Moderate-quality evidence supported use of cardiorespiratory training to improve maximum walking speed and repetitive task training or transcranial direct current stimulation to improve activities of daily living (ADLs). Low-quality evidence supported use of robotic arm training to improve ADLs. Low-quality evidence indicated that antidepressants may reduce depression, whereas the frequency and severity of antidepressant-related adverse effects was unclear. Low-quality evidence suggested that cognitive behavioral therapy and exercise, including mind–body exercise, may reduce symptoms of depression and anxiety.
Studies were of poor quality, interventions and comparators were heterogeneous, and evidence on harms was scarce.
Cardiorespiratory training, repetitive task training, and transcranial direct current stimulation may improve ADLs in adults with stroke. Cognitive behavioral therapy, exercise, and SSRIs may reduce symptoms of poststroke depression, but use of SSRIs to prevent depression or improve motor function was not supported.
U.S. Department of Veterans Affairs, Veterans Health Administration.
D'Anci KE, Uhl S, Oristaglio J, et al. Treatments for Poststroke Motor Deficits and Mood Disorders: A Systematic Review for the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Guidelines for Stroke Rehabilitation. Ann Intern Med. 2019;171:906–915. [Epub ahead of print 19 November 2019]. doi: https://doi.org/10.7326/M19-2414
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Published: Ann Intern Med. 2019;171(12):906-915.
Published at www.annals.org on 19 November 2019
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