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Madhuvrata P.,Sheffield Teaching Hospital NHS Foundation Trust | Singh M.,Sheffield Teaching Hospital NHS Foundation Trust | Hasafa Z.,Grampian NHS | Abdel-Fattah M.,University of Aberdeen
European Urology | Year: 2012

Context: There is a lack of evidence about the efficacy and safety of anticholinergic drugs and about the optimal anticholinergic drug, if any, for the treatment of adult neurogenic detrusor overactivity (NDO). Objective: Review the current evidence on the efficacy, safety, and tolerability of anticholinergic drugs in the treatment of adult NDO. Evidence acquisition: A literature search was conducted from 1966 to May 2011. Meta-analysis of all published randomised controlled trials (RCTs) comparing anticholinergic drugs with placebo and comparing different types, doses, and routes of administration of anticholinergic drugs, in adults with NDO, was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. The primary outcome was patient-reported cure/improvement of overactive bladder symptoms. Secondary outcomes were quality of life (QoL) changes, bladder diary events, urodynamic outcomes, adverse events, and costs to health services. Evidence synthesis: A total of 960 patients from 16 RCTs with mean follow-up of 3.8 wk were included. Anticholinergic drugs were associated with statistically significantly better patient-reported cure/improvement (risk ratio: 2.80; 95% confidence interval [CI], 1.64 to 4.77), higher maximum cystometric capacity (weighted mean difference [WMD]: 49.49; 95% CI, 15.38 to 84.20), higher volume at first contraction (WMD: 49.92; 95% CI, 20.06 to 79.78), and lower maximum detrusor pressure (WMD: -38.30; 95% CI, -53.17 to -23.43) when compared with placebo. The dry-mouth rates were statistically significantly higher with anticholinergics, with no difference in withdrawals because of adverse events. There was no statistically significant difference in any of the outcomes between oxybutynin and other anticholinergics or among different doses and preparations of anticholinergic drugs. No study reported QoL changes or costs to health services. Conclusions: Compared with placebo, anticholinergic treatment in patients with NDO is associated with better patient-reported cure/improvement and significant reduction of maximum detrusor pressure; however, there is a higher incidence of adverse events. None of the anticholinergic drugs or different dosages assessed in this review was superior to another. © 2012 European Association of Urology. Source

Jackson A.E.,University of Leeds | Culmer P.R.,University of Leeds | Levesley M.C.,University of Leeds | Makower S.G.,NHS Leeds Community Healthcare | And 2 more authors.
IEEE International Conference on Rehabilitation Robotics | Year: 2011

iPAM (intelligent Pneumatic Arm Movement) is a dual robotic system that aims to assist in the recovery of upper-limb movement in people with all severities of motor impairment after stroke. This paper presents effector force data gathered during the course of a pilot clinical study. It identifies the forces and workspace required to facilitate reach-retrieve exercises in a range of patients as part of rehabilitation treatments. These findings have been used in further refinements of the iPAM system. © 2011 IEEE. Source

Jackson A.E.,University of Leeds | Levesley M.C.,Leeds Community Healthcare NHS Trust | Makower S.G.,Grampian NHS | Cozens J.A.,University of Leeds | O'Connor R.J.,University of Leeds
IEEE International Conference on Rehabilitation Robotics | Year: 2015

This paper presents some findings from a randomised controlled trial in patients with upper-limb weakness in acute stroke services within the UK's National Health Service. Three patients were selected from the robot arm of the trial; one who exhibited a large increase in Fugl-Meyer score (change > 30); one who exhibited a moderate change (10 < change < 20) and a subject who demonstrated no change between baseline and follow-up. The results from robot assistance level and target achievement over the course of the treatment are presented for the three patients, demonstrating the system's ability to automatically alter the assistance level as patients progress. © 2015 IEEE. Source

Weightman A.,University of Leeds | Preston N.,University of Leeds | Levesley M.,University of Leeds | Holt R.,University of Leeds | And 4 more authors.
Journal of Rehabilitation Medicine | Year: 2011

Objective: We developed a home-based rehabilitation exercise system incorporating a powered joystick linked to a computer game, to enable children with arm paresis to participate in independent home exercise. We investigated the feasibility and impact of using the system in the home setting. Methods: Eighteen children with cerebral palsy (median age 7.5 years, age range 5-16 years) were recruited from local National Health Service and the exercise system was installed in their home for approximately 4 weeks. Baseline and post-intervention assessments were taken: Canadian Occupational Performance Measure (COPM); kinematic measurement of movement quality (indexed by duration and smoothness) measured using a motion tracking system when performing a standardized computer task. Results: The system was used for a median time of 75 min (interquartile range (IQR) 17-271), equating to 606 outward and 734 inward movements. Pre-COPM, (median 4.2); post-COPM (median 6.0); obs = 34; z = 3.62, p < 0.01). Kinematic analysis of pre-and post-intervention movements on the standardized task showed decreased duration and increased smoothness. Conclusion: Some improvements in self-reported function and quality of movement are observed. This pilot study suggests that the system could be used to augment home-based arm exercise in an engaging way for children with cerebral palsy, although a controlled clinical trial is required to establish clinical efficacy. The feasibility of this technology has been demonstrated. © 2011 Foundation of Rehabilitation Information. Source

Abdel-Fattah M.,University of Aberdeen | Ford J.A.,University of Aberdeen | Lim C.P.,Grampian NHS | Madhuvrata P.,Sheffield Teaching Hospitals NHS Foundation Trust
European Urology | Year: 2011

Context: Single-incision mini-slings (SIMS) have been introduced for the treatment of female stress urinary incontinence (SUI); however, concerns have been raised regarding their efficacy. No systematic reviews or meta-analyses have previously assessed these relatively new procedures. Objective: To assess the current evidence of effectiveness and safety of SIMS compared with standard midurethral slings (SMUS) (retropubic and transobturator tension-free vaginal tapes) in the management of female SUI. Evidence acquisition: We conducted a literature search from 1996 to January 2011. Meta-analysis of all randomised controlled trials (RCTs) comparing SIMS versus SMUS was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data were analysed using Rev-Man 5. Primary outcomes were patient-reported and objective cure rates. Secondary outcomes included perioperative complications, quality of life (QoL) changes, and costs to health services. Evidence synthesis: A total of 758 women in nine RCTs with a mean follow-up of 9.5 mo were included. The mean age (52.3 vs 52.1 yr), body mass index (27.4 vs 27.7), and parity (2.4 and 2.4) were comparable for both groups. SIMS were associated with significantly lower patient-reported and objective cure rates at 6-12 mo compared with SMUS (risk ratio [RR]: 0.83; 95% confidence interval [CI], 0.70-0.99, and RR: 0.85; 95% CI, 0.74-0.97, respectively). SIMS were associated with significantly shorter operative time (weighed mean difference [WMD]: 8.67 min; 95% CI, 17.32 to -0.02), lower day 1 pain scores (WMD: 1.74; 95% CI, -2.58 to -0.09), and less postoperative groin pain (RR: 0.18; 95% CI, 0.04-0.72). Repeat continence surgery (RR: 6.72; 95% CI, 2.39-18.89) and de novo urgency incontinence (RR: 2.08; 95% CI, 1.01-4.28) were significantly higher in the SIMS group. There was no significant difference in the QoL scores between the groups (WMD: 33.46; 95% CI, -20.62 to 87.55). No studies compared cost to health services. Conclusions: SIMS are associated with inferior patient-reported and objective cure rates on the short-term follow-up, as well as higher reoperation rates for SUI when compared with SMUS. © 2011 European Association of Urology. Source

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