hot or not innen rehabiliteringsforskning regional ... · stein arne rimehaug rkr regional...
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Stein Arne Rimehaug RKR
Regional kompetansetjeneste for Rehabilitering, Helse Sørøst
Hot or notInnen rehabiliteringsforskning
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Cochrane rehabilitation rehabilitation.cochrane.org
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Cochrane rehabilitation
Standard Cochrane metode i utgangspunktet, men:
rehabilitering krever en annen tilnærming til rett evidensinnhenting:
Hva?
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Cochrane rehabilitation
be4rehab (best evidence 4 rehab)
Package of Rehabilitation Interventions (PRI)
Rehabilitation Competency Framework (RCF)
Samarbeider med WHO om å utvikle disse framover
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Cochrane rehabilitationThe 2018 DeLisa LectureEvidence in Rehabilitation Medicine : Between Facts and Prejudices Negrini, Stefano MD
Systematiske oversikter og RCT er ikke alltidgullstandarden.
Problemstillinger som ikkeegner seg for RCT: søk etterandre typer studier.
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BCT? «Benchmarking controlled trial»
• Antti
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Roboter og exoskjelett
Holder det hva det lover?Er forskningen å stole på?
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Roboter og exoskjelett
“Published SRs on exoskeletons have many weaknesses in design and execution; clinicians, researchers, and other stakeholders should be cautious in relying on them to make decisions on the use of this technology. “
Dijkers, et al. vurderte 17 systematiske oversikter
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Prosjektrapport på ny teknologiFølg med på MISSING!
•
200
45 sa nei takk
55 gikk lei
60 av 100 hadde god effekt
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Roboter og exoskjelettRCT: n=770
«In summary
…did not find evidence that a robot-assistedtraining programme … improved upper limbfunction after stroke.
…not cost effective»
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Hvorfor ikke?
Laziness principle?
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Intensiv fysisk trening og hjernen
• Trening – lenge et fyord innen deler av akademisk rehabforskning?
• På vei inn i varmen igjen?
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Ageing, Exercise and Brain Plasticity
Kirk I. Erickson, PhD
Professor
Department of Psychology
Centers for Neuroscience and for the Neural Basis of Cognition
University of Pittsburgh
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Students MRI group Cognitive group Exercise group
Administration
Visitors
Data management
Post-docs
FundingNIA (R01 AG053952)NCI (R01 CA196762NIDDK (R01 DK095172)Alzheimer’s Association (NPSASA-14-321093)NHLBI (P01 HL040962)NIA (R01 AG060741)
CollaboratorsArt Kramer Chuck Hillman Edward McAuleyJeff Burns John JakicicMichelle VossTim VerstynenPete Gianaros
CollaboratorsMaria MataroBrad Sutton Eric VidoniChaeryon KangAnna MarslandCathy Bender Belinda Brown
Dance Group
Phlebotomy
Professor Kirk I. Erickson, PhD, University of Pittsburgh
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Kobling mellom fysisk trening og hjernehelse
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Exercise training improves cognitive function in older adults
Executive Controlled Spatial Speed
Task Type
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8Ef
fect
Siz
e (
g)
Control
Exercise
Colcombe & Kramer, 2003
Professor Kirk I. Erickson, PhD, University of Pittsburgh
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Fitness and hippocampal volume
Erickson, Prakash, Voss, Chaddock, Hu, Morris, White, Wojcicki, McAuley, Kramer, 2009
Professor Kirk I. Erickson, PhD, University of Pittsburgh
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Erickson, Voss, Prakash, et al. (2011)
Professor Kirk I. Erickson, PhD, University of Pittsburgh
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Mechanisms
Stillman et al., 2016
Professor Kirk I. Erickson, PhD, University of Pittsburgh
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Hippocampus, exercise, and brain-derived neurotrophic factor
Increased volume was associated with increased BDNF levels.
Erickson, Voss, Prakash, et al. (2011).
Professor Kirk I. Erickson, PhD, University of Pittsburgh
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Many unanswered questions:1. How long are the effects of exercise retained?2. What types of exercise are most effective?3. What are the dose-response effects?4. What do volumetric differences reflect on a cellular level?
Professor Kirk I. Erickson, PhD, University of Pittsburgh
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Trening for hjernehelse og plastitisitet
• Uspesifikk fysisk trening har positive effect på hjernen
- økt volum på hippocampus, synapsebygging, plastisitet.
• Trening gjennom livet kan vise seg å beskytte mot Alzheimer og annen demensutvikling.
- I tillegg selvsagt til hjerte/kar og andre positive helseeffekter.
- Lovende resultater på Norsk høy-intensiv gangtreningetter slag forskning.
Professor Kirk I. Erickson, PhD, University of Pittsburgh
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NorVISForskningsrådet har bevilget fem millioner kroner til Norwegian Vision in Stroke (NorVIS) network.Synet får liten oppmerksomhet i behandling, rehabilitering og oppfølging av slagrammede. Mål: synsfunksjon skal bli en strukturert del av diagnostisering, behandling og rehabilitering etter hjerneslag.
60 partnere:kommunersykehusrehabiliteringsinstitusjonerbrukerorganisasjonernasjonale og internasjonale forskere Norges Blindeforbund Norges Optikerforbund
Prosjektleder Helle Falkenberg:
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What is not?
55 gikk lei
RCT baserte Systematic reviews Ukritisk rapportering av ny teknologi Ingen rapportering av MISSING
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What’s hot?
• Cochrane rehabilitation
• Antti M og BCT Benchmarking controlledstudies
• Fysisk trening for hjernen
• NorVIS
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Stein Arne Rimehaug RKR
Regional kompetansetjeneste for Rehabilitering, Helse Sørøst
Takk for meg!