Hyperbaric oxygen therapy for stroke: a systematic review of the evidence.
OBJECTIVE
To identify the benefits and harms of using hyperbaric oxygen therapy to treat acute or subacute stroke or the chronic effects of a stroke. We aimed to identify any gaps in the evidence to provide guidance for future research.


METHODS
A systematic review of the evidence.


METHODS
We searched MEDLINE, EMBASE, the Cochrane Library, HealthSTAR, CINAHL, MANTIS, bibliographic databases from professional societies and hyperbaric oxygen therapy practitioners, and reference lists. Databases were searched from inception to December 2003.


METHODS



METHODS
Controlled clinical trials and observational studies published in English.


METHODS
Patients with ischaemic stroke in any inpatient or outpatient setting.


RESULTS
Mortality, functional health outcomes and adverse events.


METHODS
Using predetermined criteria, two reviewers assessed each study for inclusion, and abstracted data about study design, population, interventions, and outcomes. We assigned an overall quality rating (good, fair, or poor) based on internal validity.


RESULTS
We identified only four randomized controlled trials and one controlled clinical trial. The best evidence shows no benefit to hyperbaric oxygen therapy in patients with stroke, but because the stage of patients enrolled (acute, subacute, or chronic), the documentation of type and severity of stroke, and the dosage of hyperbaric oxygen therapy given varied considerably, the generalizability of these results is limited. We identified 17 observational studies; all were poor quality.


CONCLUSIONS
The overall evidence is insufficient to determine the effectiveness of hyperbaric oxygen therapy in any subgroup of stroke patients. To determine if hyperbaric oxygen therapy for stroke provides any benefit and that these outweigh potential harms, good quality studies are needed.
Carson
Susan
S
Oregon Evidence-based Practice Center, Oregon Health & Science University, Department of Medical Informatics & Clinical Epidemiology, Portland, OR 97239, USA. carsons@ohsu.edu
McDonagh
Marian
M
Russman
Barry
B
Helfand
Mark
M
D002545:Brain Ischemia / Q000534:rehabilitation; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000009:adverse effects / Q000379:methods; D011786:Quality Control; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome