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Wirksamkeit und Nebenwirkungen eines vierwöchigen aeroben Gangtrainings im Vergleich zu einer Entspannungstherapie bei Patienten nach subakutem Schlaganfall
Full text linkIntroduction: Despite ongoing research no pharmaceutical means has proven efficacious to improve functional recovery in stroke patients. One promising therapeutic intervention is aerobic gait training as it is hypothesized to improve systemic oxygenation and cerebral recovery processes while being functional. For the early subacute phase after stroke, first exploratory studies could show an increase in mobility and improved functionality through aerobic training but feasibility in this high-risk population remains unclear. In this study we aimed to address the effect of an aerobic gait training compared to an active control intervention in the subacute phase after stroke and assess its feasibility, including safety, training adherence and treatment fidelity.
Methods: The multicenter, randomized controlled, endpoint-blinded trial ‘Physical Fitness Training in Patients with Subacute Stroke – Phys-Stroke’ recruited 200 patients in the subacute phase (5 – 45 days) after moderate to severe stroke. Participants were randomized (1:1) to receive either a four week aerobic, bodyweight supported gait training (n = 105) with five sessions per week á 25 minutes or a progressive muscle relaxation therapy (n = 95) of equal amount. Co-primary efficacy endpoints were changes in maximal walking speed and in Barthel index score at three months post stroke. Secondary endpoints included six minute walking distance, gait energy cost and change in lesion volume. Safety measures were assessed until six months post stroke and included the serious adverse events (SAE) recurrent cerebro- or cardiovascular event, referral to an acute hospital or death. Adjusted analysis of co-variance were used to analyze both primary endpoints independently in the full analysis set. Poisson regression analysis were performed to assess incidence rate ratios (IRR) of SAE between both intervention groups.
Results: Compared to relaxation therapy, aerobic training did not improve maximal walking speed (adjusted treatment effect 0.1 m/s (95% confidence interval 0.0 to 0.2 m/s), p=0.23) or Barthel index score (0, 95% CI −5 to 5, p=0.99) significantly at three months post stroke. Exploratory findings revealed an interaction effect of female sex with training (0.3 m/s, 95% CI 0.1 to 0.5) and a treatment effect of change in lesion volume (-21.8 ml, 95% CI -40.4 to -3.2). Incidence rates (per 100 patient months) were higher in the training group compared to relaxation for all SAE combined (6.31 vs 3.22; IRR 1.70, 95% CI 0.96 to 3.12).
Discussion: Aerobic training delivered in the subacute phase after moderate to severe stroke was not found to be superior on maximal walking speed or activities of daily living compared to relaxation therapy. Additionally, a higher rate of SAE in the training group questions feasibility of aerobic exercise in this stroke population. Results are in contrast to previous smaller studies and should be considered in future guidelines.Einleitung: Bisher hat sich kein pharmazeutisches Mittel zur Verbesserung der
funktionellen Erholung bei Schlaganfallpatient:innen als wirksam erwiesen. Eine
vielversprechende therapeutische Intervention ist das aerobe Gangtraining. Für die
frühe subakute Phase nach Schlaganfall konnten erste explorative Studien eine
Steigerung der Mobilität und eine verbesserte Funktionalität durch aerobes Training
zeigen, aber die sichere Durchführung in dieser Hochrisikopopulation bleibt unklar. Ziel
dieser Studie war es, den Effekt eines aeroben Gangtrainings im Vergleich zu einer
aktiven Kontrollintervention in der subakuten Phase nach Schlaganfall zu untersuchen
und dessen Durchführbarkeit, einschließlich der Sicherheit, Trainings- und
Therapietreue zu bewerten.
Methoden: Die multizentrische, randomisierte, kontrollierte, Studie 'Physical Fitness
Training in Patients with Subacute Stroke - Phys-Stroke' rekrutierte 200 Patient:innen in
der subakuten Phase (5 - 45 Tage) nach moderatem bis schwerem Schlaganfall. Die
Teilnehmer:innen wurden randomisiert (1:1), um entweder ein vierwöchiges aerobes,
körpergewichtsunterstütztes Gangtraining (n = 105) mit fünf Sitzungen pro Woche á 25
Minuten oder eine gleichwertige progressive Muskelentspannungstherapie (n = 95) zu
erhalten. Ko-primäre Endpunkte waren Veränderungen in der maximalen
Ganggeschwindigkeit und im Barthel-Index drei Monate nach dem Schlaganfall. Zu den
sekundären Endpunkten gehörten die sechs Minuten Gehstrecke, der Energieaufwand
beim Gehen und die Veränderung des Läsionsvolumens. Sicherheitsendpunkte wurden
bis sechs Monate nach dem Schlaganfall erhoben und umfassten die schwerwiegenden
unerwünschten Ereignisse (SUE) rezidivierendes zerebro- oder kardiovaskuläres
Ereignis, Einweisung in ein Akutkrankenhaus oder Tod.
Ergebnisse: Im Vergleich zur Entspannung verbesserte das aerobe Training bis drei
Monate nach dem Schlaganfall weder die maximale Ganggeschwindigkeit (adjustierter
Behandlungseffekt 0,1 m/s (95% Konfidenzintervall 0,0 bis 0,2 m/s), p=0,23) noch den
Barthel-Index (0 (-5 bis 5), p=0,99) signifikant. Explorative Ergebnisse zeigten einen
Interaktionseffekt des weiblichen Geschlechts mit dem Training (0,3 m/s, 95% CI 0,1 bis
0,5) und einen Behandlungseffekt auf die Veränderung des Läsionsvolumens (-21,8 ml,
95% CI -40,4 bis -3,2). Die Inzidenzraten (pro 100 Patientenmonate) waren in der
Trainingsgruppe im Vergleich zur Entspannungsgruppe für alle SUE zusammen höher
(6,31 vs. 3,22; IRR 1,70, 95% CI 0,96 bis 3,12).
Diskussion: Aerobes Training in der subakuten Phase nach mittelschwerem bis
schwerem Schlaganfall erwies sich im Vergleich zur Entspannungstherapie nicht als
überlegen in Bezug auf die maximale Ganggeschwindigkeit oder Aktivitäten des
täglichen Lebens. Zusätzlich stellt eine höhere Rate an SUE in der Trainingsgruppe die
Durchführbarkeit von aerobem Training in dieser Population in Frage
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
Applying time series analyses on continuous accelerometry data – Dataset
No full textData and analysis script accompanying the study:
Applying time series analyses on continuous accelerometry data – a clinical example in older adults with and without cognitive impairmen
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
Author-wise bibliometric analysis based on entropy.
No full textAuthor-wise bibliometric analysis based on entropy.</p
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