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22. European Stroke Conference 911 Meta-analysis and reviews Stroke and visual problems: a comprehensive set of Cochrane reviews to investigate effective interventions A. Pollock1, C. Hazelton2, A. Bowen3 on behalf of the authors of the four Cochrane reviews Glasgow Caledonian University, Glasgow, UNITED KINGDOM1, Glasgow Caledonian Uni-versity, Glasgow, UNITED KINGDOM2, University of Manchester, Manchester, UNITED KING-DOM3 INTRODUCTION Visual problems in stroke patients result from visual field deficits (VFD), eye movement deficits (EMD), visual neglect (VN) and concurrent age-related eye conditions (ARC) and impact on func-tional abilities, quality of life and participation. The evidence base for best treatments is currently inconsistent. METHODS We conducted three new Cochrane reviews and updated a fourth. We searched the Cochrane Central Register of controlled Trials, MEDLINE, EMBASE, CINAHL, AMED, PsycINFO, reference lists, trials registers, hand-searched relevant journals and contacted experts. We included RCTs of adults with stroke which evaluated interventions which targeted improved vision or compensation for a visual problem. Two authors independently screened abstracts, extracted data and assessed method-ological 828 © 2013 S. Karger AG, Basel Scientific Programme quality. RESULTS Thirteen RCTs (n=285) investigated VFD, six of which had a control/placebo group. Meta-analysis of three RCTs (n=129) demonstrated that scanning training is more effective than control/placebo at improving ability to scan (SMD 1.140.29, 2.00) and read (SMD 0.790.29, 1.29). Two RCTs investigated EMD, but only included a total of five stroke patients. Twenty-three RCTs (n=628) investigated VN, nineteen of which compared cognitive rehabilitation with a placebo, control or no treatment. Meta-analysis of 11 RCTs (n=355) demonstrated that cognitive rehabilitation is more ef-fective than control for immediate effects on activities of daily living (SMD 0.24 0.01, 0.48), but data from 7 RCTs (259 participants) showed that this effect was no longer significant at long-term follow-up. No RCTs investigated ARC specifically in a stroke population. CONCLUSIONS Our four reviews provide a comprehensive overview of the effectiveness of interventions for visual problems after stroke. No rehabilitation approach for VFD or VN can be supported or refuted based on current evidence from RCTs. There is an absence of evidence relating to EMD or ARC. 912 Meta-analysis and reviews Meta-Analysis of the Efficacy of Training Therapies in Animal Models of Focal Cerebral Isch-emia A. Schmidt1, J. Wellmann2, W.R. Schäbitz3, K. Diederich4, J. Minnerup5 Department of Neurology, University of Münster, Münster, GERMANY1, Institute of Epide-miology and Social Medicine, University of Münster, Münster, GERMANY2, Department of Neu-rology, EVK Bielefeld, Bethel, Bielefeld, GERMANY3, Department of Neurology, University of Münster, Münster, GERMANY4, Department of Neurology, University of Münster, Münster, GER-MANY5 Background: Although several studies have shown beneficial effects of physical training in animal models of stroke, the most effective training strategy has not been identified. Moreover, the optimal time to initiate training remains unclear. The present meta-analysis was performed to compare the efficacy of different training strategies with respect to infarct size and functional outcome, and to de-termine the optimal time window for training therapies. Methods: We searched the literature for studies analysing the efficacy of physical training in animal models of focal cerebral ischemia. Training consisted of either forced exercise or voluntary exercise (i.e. animals had free access to running wheels) or forced arm use. Two reviewers independently extracted data on study quality, training strategy, infarct size and neurological outcome (cognitive function, running function and limb function). Data were pooled by means of a meta-analysis. Results: Thirty-six studies with more than 880 animals were included. A pooled meta-analysis of all treatments showed that training therapies reduced the infarct volume by 14% (95% CI, 2% to 25%), and improved the cognitive function by 33% (95% CI, 8% to 50%), the neuroscore by 13.4% (95% CI, 1.5% to 25.3%) and the running function by 6.64% (95% CI, 1.35% to 11.93). Among the differ-ent training strategies, forced exercise most effectively reduced the infarct volume (30% reduction of infarct volume compared to untreated controls (95% CI, 17% to 42%)) and forced exercise most effectively improved the running function (17.84%; 95% CI, 8.40% to 27.90%). Conclusion: The meta-analysis confirms that training therapies reduce the infarct volume and en-hance the functional recovery in animal models of stroke. Among three different training strategies, forced exercise reduced the infarct volume and improved the running function most effectively. A meta-regression will be performed to determine the optimal time window to initiate training.


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