title: Hyperbaric oxygen therapy for stroke: a systematic review of the evidence.
abstract: 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.
authors.affiliation: Oregon Evidence-based Practice Center, Oregon Health & Science University, Department of Medical Informatics & Clinical Epidemiology, Portland, OR 97239, USA. carsons@ohsu.edu
authors.forename: Susan
authors.initials: S
authors.lastname: Carson
authors.forename: Marian
authors.initials: M
authors.lastname: McDonagh
authors.forename: Barry
authors.initials: B
authors.lastname: Russman
authors.forename: Mark
authors.initials: M
authors.lastname: Helfand
mesh_terms: 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