Appendix I. Levels of evidence and conclusion according to the Dutch CBO guidelines
Levels of evidence according to the Dutch CBO guidelines
Systematic review containing at least 2 independent trials of level A2
Randomized comparative double-blind study of good quality and sufficient size
Comparative trials, but not all characteristic of A2 (also patient control studies and cohort studies)
Level of conclusion according to the Dutch CBO guidelines
Conclusion based on:
Research on level A1 of at least 2 independent trials of level A2
1 trial of level A2 of at least 2 independent trials of level B
1 trial of level B or C
CBO: Institute for Healthcare Improvement.
ContentList volumes - List articles in this issue
Outcome of motor training programmes on arm and hand functioning in patients with cervical spinal cord injury according to different levels of the ICF: A systematic review
OBJECTIVE: To investigate the outcome of motor training programmes on arm and hand functioning in patients with
cervical spinal cord injury according to different levels of
the International Classification of Functioning, Disability and Health (ICF).
DESIGN: Systematic review.
METHODS: A search of the following databases: Medline,
Cochrane, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Physiotherapy Evidence Database (PEDro) and Database of Abstracts of Reviews of Effects (DARE) from 1976 to August 2008 was performed using the following MeSH terms: Spinal Cord Injuries, Quadriplegia, Rehabilitation, Physical Education and Training, Exercise, Patient-Centered Care, Upper Extremity, Activities of Daily Living, Motor Skills, Motor Activity, Intervention Studies, Clinical Trial. The methodological quality of the selected articles was scored with the Van Tulder Checklist. Descriptive analyses were performed using the PICO principle (Patient characteristics, Intervention, Comparison, Outcome & results) along the ICF function and activity level.
RESULTS: Twelve studies were included in the analyses. Overall, the methodological quality of the studies was acceptable, with a mean Van Tulder score of 9.58. Interventions included motor training programmes at the level of function, activity or a combined programme. Most studies reported improvements in arm and hand functioning at the level that was trained for.
CONCLUSION: Motor training programmes may improve arm and hand functioning at function and/or activity level in cervical spinal cord injured patients. However, no general conclusion based on a meta-analysis can be drawn due to the wide variety of approaches.
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