London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 823 901 Meta-analysis and reviews The effectiveness of conservative treatment modalities in right hemisphere stroke patients with hemineglect, measured by neuropsychological and/or functional tests: a systematic review L. Pernet1, A. Juchters2, E. Kerckhofs3 Vrije Universiteit Brussel, Brussels, BELGIUM1, Vrije Universiteit Brussel, Brussels, BEL-GIUM2, Brussels, BELGIUM3 Background: Patients suffering from unilateral neglect syndrome (UNS) are not able to respond to stimuli administered to the side of the body opposite to the lesion. They experience more prob-lems with ADL-activities and recovery after stroke is delayed. UNS is most commonly seen after right-hemisphere lesions. Many treatments have already been developed, but it is unclear which treatment modalities achieve the best results. The aim of this systematic review is to investigate which treatment modalities can alleviate the symptoms of UNS and determine the effectiveness. Methods: Databases PubMed, Web of knowledge and PEDro have been searched using keywords as ‘stroke’, ‘unilateral neglect’, ‘therapeutic strategies’, ‘physical therapy’, ‘treatment effect’. Qual-ity assessment was conducted using the Delphi list. Levels of evidence were assigned according to CBO-guidelines. Data extraction was performed by the author. Effect sizes have been calculated us-ing Cohen’s d. Results: 13 studies have been included. A variety of treatment options are discussed, including mirror therapy, feedback glasses, visuomotor imagery, trunk rotation, eye-patching, arm activation, prism adaptation, somatosensory stimulation, transcranial magnetic stimulation, optokinetic stimu-lation and TENS. Most studies used add-on therapies. Almost all trials found improvements within groups. 7 trials showed significant between group differences in favor of the intervention. Conclusion: Although the discussed articles are all RCT’s, study designs are heterogeneous and UNS is defined in different ways. This makes it difficult to compare the studies. Large variations of quality of the assessed trials and small sample sizes are also important limiting factors. All the in-terventions discussed in this review can reduce the symptoms of UNS. No firm conclusions can be made about the effectiveness because of the differences in quality of the studies. 902 Meta-analysis and reviews Palliative end of life care in hospital for acute stroke – a systematic review C. Moshona1, J. Sobesky2, I. Wellwood35 Centre for Stroke Research Berlin, Charité-Universitätsmedizin, Berlin, GERMANY1, Centre for Stroke Research Berlin, Charité-Universitätsmedizin, Berlin, GERMANY2, Centre for Stroke Research Berlin, Charité-Universitätsmedizin, Berlin, GERMANY3 Background Despite advances in knowledge about effective treatments for acute stroke, estimates continue to show early case fatality from stroke to be 17–30% in the first 30 days after stroke. Previous reviews of palliative care at end of life after stroke have raised questions about the optimal type and avail-ability of care for these patients. We aimed to update and extend these reviews, addressing a fo-cussed research question: What is the optimal process of care for adult patients with acute stroke of any aetiology requiring end of life palliative care within the acute stage (up to 1 month) after stroke in the hospital setting? Methods A systematic review following recognised methods, including all observational, interventional, qualitative and quantitative studies on the process of end of life care specifically featuring adult in-patients with acute stroke (World Health Organisation definition) in English, German, and French language. We excluded individual case studies. Search terms included: “palliative” OR “ end of life” AND “stroke” applied to the PubMed, Embase, PsycINFO, CINHAL, AHMED and Cochrane data-bases from 1982 to end 2012. Reviews and reference lists were checked for relevant studies. Quality assessment was conducted independently by 2 researchers with standardised appraisal tools and re-ported according to PRISMA guidelines. Results 383 potentially relevant studies were identified. 17 studies including 1445 patients were selected. Studies varied substantially in terms of type, perspective, scope, size and methodological quality. Common themes of care needs for patients e.g. symptom control, hydration and feeding, and carers e.g. communication were identified. We found few studies comparing care processes. Conclusion Further research and comparative studies for interventional models are warranted to address the lack of clear evidence guiding end of life care practices for the substantial number of patients with acute stroke who die in hospital.
Karger_ESC London_2013
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