Therapeutisches Klettern für Kindern mit ADHS

Abstract

Objectives: To investigate the effectiveness and safety of non-pharmacological interventions for the management of spasticity in people with MS in improving patient outcomes. Design: Systematic review. Settings: Inpatient and ambulatory rehabilitation settings. Methods: A comprehensive literature search was performed using the Cochrane MS Group Trials Register which among other sources contains Cochrane Central, Medline, Embase, Cinahl, Lilacs Pedro in June 2012. All randomised controlled trials (RCTs) that reported non-pharmacological intervention/ s for treatment of spasticity in adults with MS and compared them with some form of control intervention were included. Four review authors independently selected the studies, extracted data, and assessed the methodological quality of the studies for best-evidence synthesis. Results: Nine RCTs (n = 341 participants 301 included in analyses) investigated various types and intensities of non-pharmacological interventions for treating spasticity in adults with MS. All studies scored "low" on the methodological quality assessment implying high risk of bias. The included trials were heterogeneous in terms of: type of intervention, outcome measures, and study quality. Hence quantitative synthesis was not possible and a qualitative synthesis of "best evidence" was provided. There is "low level" evidence for: addition of active physiotherapy after BONT injection in reducing spasticity up to 12 weeks; "intermittent theta burst stimulation" as a single intervention or in combination with exercise therapy reduced spasticity after 2 weeks of treatment; short-term benefits of "repetitive transcranial magnetic stimulation" and "pulsing magnetic fields" for improved spasticity. There was no evidence of benefit to support the use of transcutaneous electrical nerve stimulation, sports climbing, and vibration therapy for treating spasticity. Conclusions: A range of nonpharmacological interventions are used for the treatment of spasticity in people with MS. More robust trials are needed to build evidence for these interventions.