Friday, April 29, 2011

CONSORT Statement for Ehealth randomized controlled trials

www.consort-statement.org/ CONSORT stands for Consolidated Standards of Reporting Trials. The group exists to encourage good reporting of randomized controlled trials (RCTs) by offering recommendations on a standard way to report findings.

CONSORT has recently created a checklist for reporting Ehealth trials as a draft version. www.jmir.org/ojs/public/journals/1/CONSORT-EHEALTH-v1-5.pdf

The opportunity exists to comment on the CONSORT items as this document evolves.
tinyurl.com/consort-ehealth-v1-5

CONSORT seeks “to improve the reporting of different types of health research, and indeed, to improve the quality of research used in decision-making in healthcare”.

Wednesday, April 13, 2011

Does Virtual Reality improve Upper Extremity Function: Systematic Review


Galvin, J., McDonald, R., Catroppa, C. & Anderson, V. (2011). Brain Injury, 1-8, Early Online

Objective: One randomized control trial (RCT) and four case studies were found that fit the criteria of the literature search; research articles that “specifically refer to upper limb interventions and outcomes of the use of virtual reality (VR) with children who had neurological impairment.”

Process: Studies were rated for level of evidence using the Australian National Health and Medical Research Council scale (1) and for study quality using the Downs and Black Checklist (2). The Downs and Black scale assesses internal validity, generalizability, bias, confounders and power. The instruments used within the studies were the Quality of Upper Extremity Skills Test, the Melbourne Assessment, the Pediatric Motor Activity Log and the Canadian Occupational Performance Measure. Three of the studies used one item of one sub-test of the Bruininks-Oseretsky Test of Motor Proficiency.

Results: The RCT showed an evidence level of II (n = 34) and the remaining articles are all case studies (n =1-5) with an evidence level of IV. The studies scored from 9 to 22 of a possible 32 points on the Downs and Black scale, with only the RCT scoring more than 50% on each of the sub-scales. The case studies are weak in the areas of reporting and analysis which limits their external validity. Power is limited due to sample size.

Conclusion: “Small sample sizes and inconsistencies in outcome measures limit the ability to generalize findings.” There is a continuing need to establish evidence for the clinical utility of VR as a treatment medium.


References: (1) NHMRC. (1999) A guide to the development, implementation and evaluation of clinical practice guidelines. In: Council NNHaMR, editor. Canberra: Australian Government. (2) Downs, S.H. & Black, N. (1998). The feasibility of creating a checklist for the assessment of the methodological quality both of randomized and non-randomized studies of health care interventions. Journal of Epidemiology and Community Health, 52: 377- 384.

Tuesday, April 5, 2011

Systematic review: VR for children with motor impairment

Virtual reality in the assessment and treatment of children with motor impairment: a Systematic review
Laufer, Y. & Weiss, P.L. (2011) Journal of Physical Therapy Education, 25 (1), Winter 2011, 59-71.

The objective of this article is to present a systematic review of publications where virtual reality (VR) has been used to provide rehabilitation to children with sensorimotor deficits. Articles were chosen from research reported in English, peer-reviewed journals.

Process: 26 studies were first classified by study design to reveal strength of evidence. Of them, 20 had sufficient strength of evidence to be evaluated using the American Academy for Cerebral Palsy and Developmental Medicine conduct questions. Based on positive responses to 10 study characteristics (such as adequate description of randomization, exclusion criteria and power calculations); the studies ranged from 3-10 positive responses with an average score of 5.25.

Results: Most studies reported positive outcomes with fair to poor evidence quality. Research of a higher quality is necessary for stronger assessment of the claims of VR. As noted, evaluation is limited by poor research design and methodology, but also by the “diversity of research objectives, outcome measures and treatment intensity presented in the different studies.”

Link to abstract: www.library.nhs.uk/booksandjournals/details.aspx?t=*systematic+review&stfo=True&sc=bnj.ovi.amed,bnj.ovi.bnia,bnj.ebs.cinahl,bnj.ovi.emez,bnj.ebs.heh,bnj.ovi.hmic,bnj.pub.MED,bnj.ovi.psyh&p=1&sf=srt.publicationdate&sfld=fld.title&sr=bnj.ebs&did=2010897080&pc=2295&id=6