title: Nonpharmacologic management of orthostatic hypotension: a systematic review.
abstract: OBJECTIVE
  To systematically review the literature on nonpharmacologic treatment of orthostatic hypotension.
  
  
  METHODS
  MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, Cochrane Central Register of Controlled Trials, and SPORTDiscus were searched for human studies written in the English language between January 1980 and April 2013. Reference lists of relevant articles were reviewed for citations to expand the data set.
  
  
  METHODS
  Prospective experimental studies assessing nonpharmacologic interventions for management of orthostatic drop in blood pressure in various patient populations were included. All studies identified through the literature search were reviewed independently in duplicate. Of the 642 studies, 23 met the selection criteria.
  
  
  METHODS
  Two reviewers independently extracted data for analysis, including systolic and diastolic blood pressure and orthostatic symptoms in response to postural challenge before and after the intervention. All 23 studies were assessed in duplicate for risk of bias using the Physiotherapy Evidence Database scale for randomized controlled trials and the Downs and Black tool for nonrandomized trials.
  
  
  RESULTS
  There were 8 identified nonpharmacologic interventions for management of orthostatic hypotension under 2 general categories: physical modalities (exercise, functional electrical stimulation, compression, physical countermaneuvers, compression with physical countermaneuvers, sleeping with head up) and dietary measures (water intake, meals). Owing to the clinically diverse nature of the studies, statistical comparison (meta-analysis) was deemed inappropriate. Instead, descriptive comparisons were drawn. Levels of evidence were assigned.
  
  
  CONCLUSIONS
  Strong levels of evidence were found for 4 of the 8 interventions: functional electrical stimulation in spinal cord injury, compression of the legs and/or abdomen, physical countermaneuvers in various patient populations, and eating smaller and more frequent meals in chronic autonomic failure. However, this conclusion is based on a limited number of studies with small sample sizes. Further research into all interventions is warranted.
authors.affiliation: Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada; Department of Medicine, International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada; GF Strong Rehabilitation Center, Vancouver, British Columbia, Canada; Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver Coastal Health, Vancouver, British Columbia, Canada. Electronic address: patricia.mills@vch.ca.
authors.forename: Patricia Branco
authors.initials: PB
authors.lastname: Mills
authors.affiliation: Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada; Department of Medicine, International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Carlen K
authors.initials: CK
authors.lastname: Fung
authors.affiliation: Faculty of Arts and Science, Queens University, Vancouver, British Columbia, Canada.
authors.forename: Angelique
authors.initials: A
authors.lastname: Travlos
authors.affiliation: Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada; Department of Medicine, International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada; GF Strong Rehabilitation Center, Vancouver, British Columbia, Canada; Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver Coastal Health, Vancouver, British Columbia, Canada.
authors.forename: Andrei
authors.initials: A
authors.lastname: Krassioukov
mesh_terms: D058128:Compression Bandages; D004327:Drinking Behavior; D004599:Electric Stimulation Therapy; D015444:Exercise; D006801:Humans; D007024:Hypotension, Orthostatic / Q000209:etiology / Q000628:therapy*; D062407:Meals; D009119:Muscle Contraction; D011187:Posture
keywords: Diet therapy; Hypotension, orthostatic; Orthostatic intolerance; Physical therapy modalities; Rehabilitation