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. 2009 May;90(5):876-85.
doi: 10.1016/j.apmr.2009.01.009.

A systematic review of the management of orthostatic hypotension after spinal cord injury

Andrei Krassioukov  1 , Janice J Eng, Darren E Warburton, Robert Teasell; Spinal Cord Injury Rehabilitation Evidence Research Team
Affiliations

A systematic review of the management of orthostatic hypotension after spinal cord injury

Andrei Krassioukov et al. Arch Phys Med Rehabil. 2009 May.

Abstract

Objective: To review systematically the evidence for the management of orthostatic hypotension (OH) in patients with spinal cord injuries (SCIs).

Data sources: A key word literature search was conducted of original and review articles as well as practice guidelines using Medline, CINAHL, EMBASE, and PsycInfo, and manual searches of retrieved articles from 1950 to July 2008, to identify literature evaluating the effectiveness of currently used treatments for OH.

Study selection: Included randomized controlled trials (RCTs), prospective cohort studies, case-control studies, pre-post studies, and case reports that assessed pharmacologic and nonpharmacologic intervention for the management of OH in patients with SCI.

Data extraction: Two independent reviewers evaluated the quality of each study, using the Physiotherapy Evidence Database score for RCTs and the Downs and Black scale for all other studies. Study results were tabulated and levels of evidence assigned.

Data synthesis: A total of 8 pharmacologic and 21 nonpharmacologic studies were identified that met the criteria. Of these 26 studies (some include both pharmacologic and nonpharmacologic interventions), only 1 pharmacologic RCT was identified (low-quality RCT producing level 2 evidence), in which midodrine was found to be effective in the management of OH after SCI. Functional electrical stimulation was one of the only nonpharmacologic interventions with some evidence (level 2) to support its utility.

Conclusions: Although a wide array of physical and pharmacologic measures are recommended for the management of OH in the general population, very few have been evaluated for use in SCI. Further research needs to quantify the efficacy of treatment for OH in subjects with SCI, especially of the many other pharmacologic interventions that have been shown to be effective in non-SCI conditions.

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References

    1. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. The Consensus Committee of the American Autonomic Society and the American Academy of Neurology. Neurology. 1996;46:1470. - PubMed
    1. Mathias CJ. Orthostatic hypotension: causes, mechanisms, and influencing factors. Neurology. 1995;45:S6–11. - PubMed
    1. Cariga P, Ahmed S, Mathias CJ, Gardner BP. The prevalence and association of neck (coat-hanger) pain and orthostatic (postural) hypotension in human spinal cord injury. Spinal Cord. 2002;40:77–82. - PubMed
    1. Faghri PD, Yount JP, Pesce WJ, Seetharama S, Votto JJ. Circulatory hypokinesis and functional electric stimulation during standing in persons with spinal cord injury. Arch Phys Med Rehabil. 2001;82:1587–95. - PubMed
    1. Claydon VE, Steeves JD, Krassioukov A. Orthostatic hypotension following spinal cord injury: understanding clinical pathophysiology. Spinal Cord. 2006;44:341–51. - PubMed

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