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Muscle relaxation is required to facilitate some surgical procedures. If it is not completely reversed after surgery, the muscle relaxation effects might lead to remaining muscle weakness, breathing problems, lung infection and delayed recovery. Neostigmine and other medications from the same drug family are currently used to restore muscle function after surgery. These medications, however, are not effective in all situations and may cause complications as well. Complications include changes in the heart and lung function, and nausea and vomiting after surgery. Sugammadex is a new medication that is used after surgery in order to reverse the effects of muscle relaxation medications. In this review article we have included 18 trials on the efficacy and safety of sugammadex. The trials included a total of 1321 patients. Sugammadex was shown to be more effective than placebo (no medication) or neostigmine in reversing muscle relaxation caused by neuromuscular blockade during surgery and is relatively safe. Serious complications occurred in less than 1% of the patients who received sugammadex. The results of this review article (specially the safety results) need to be confirmed by future trials on larger patient populations.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Individual studies suggest that neuromuscular electrical stimulation, or NMES, may help improve the muscle weakness that people often experience as a consequence of a progressive disease. NMES uses a lightweight stimulator unit and skin electrodes to produce a controlled and comfortable muscle contraction. Being a passive form of exercise, NMES allows patients to exercise their leg muscles at home whilst seated. This may be particularly helpful for people who are unable to take part in more strenuous forms of exercise, for example because of shortness of breath or fatigue.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

This book aims to help consumers and practitioners develop the skills to assess health advice – and hopefully to make decisions that will improve the quality of their care. For some people, making better-informed decisions could be life saving. We hope that it will be useful if you are struggling to come to terms with an illness or injury, and the best ways of managing it. Or you may simply want to lead a healthier life, and may be wondering how to make sense of the often conflicting flood of health information that deluges us every day, through the media, and from our friends and health practitioners.

Hammersmith Press.

Version: 2008

Therapists use a variety of techniques to help the arm to get better following stroke. However, the details of what they doing are unclear, are not well described in studies, and are used in various combinations. It is not known which elements of these techniques are effective. This review therefore attempted to identify which, if any, of the techniques used are beneficial. However, we found only three studies giving clear descriptions of the techniques used. In addition, each of these studies used different techniques with different types of patients in different environments and the success of these interventions was measured differently. It was therefore difficult to draw clear conclusions. In light of this, it is suggested that this review has demonstrated that the limited evidence of benefit of stretching, passive exercises and mobilization, when applied to the hemiplegic upper limb following stroke, merits further research.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Muscle weakness is very common in people with amyotrophic lateral sclerosis (ALS), which is also known as motor neuron disease (MND). A weak muscle can be damaged if overworked because it is already functioning close to its maximal limits. Because of this, some experts have discouraged exercise programs for people with ALS. However, if a person with ALS is not active, deconditioning (loss of muscle performance) and weakness from lack of use occurs, on top of the deconditioning and weakness caused by the disease itself. If the reduced level of activity persists, many organ systems can be affected and a person with ALS can develop further deconditioning and muscle weakness, and muscle and joint tightness may occur leading to contractures (abnormal distortion and shortening of muscles) and pain. These all make daily activities harder to do. This review found only two randomised studies of exercise in people with ALS. The trials compared an exercise program with usual care (stretching exercises). Combining the results from the two trials (43 participants), exercise produced a greater average improvement in function (measured using an ALS‐specific measurement scale) than usual care. There were no other differences between the two groups. There were no reported adverse events due to exercise. The studies were too small to determine to what extent exercise for people with ALS is beneficial or whether exercise is harmful. We found no new trials when we updated the searches in 2012. More research is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Older people generally lose muscle strength as they age. This reduction in muscle strength and associated weakness means that older people are more likely to have problems carrying out their daily activities and to fall. Progressive resistance training (PRT) is a type of exercise where participants exercise their muscles against some type of resistance that is progressively increased as their strength improves. The exercise is usually conducted two to three times a week at moderate to high intensity by using exercise machines, free weights, or elastic bands.This review sets out to examine if PRT can help to improve physical function and muscle strength in older people.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

This summary of a Cochrane review presents what we know about the effect of electrical stimulation as a treatment to improve the strength of the thigh muscles before and after  knee replacement surgery.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

After an injury at a high point on the spinal cord (a cervical injury), the muscles responsible for breathing are paralysed or weakened. This weakness reduces the volume of the lungs (lung capacity), the ability to take a deep breath and cough, and puts them at greater risk of lung infection. Just like other muscles of the body, it is possible to train the breathing (respiratory) muscles to be stronger; however, it is not clear if such training is effective for people with a cervical spinal cord injury. This review compared any type of respiratory muscle training with standard care or sham treatments. We reviewed 11 studies (including 212 people with cervical spinal cord injury) and suggested that for people with cervical spinal cord injury there is a small beneficial effect of respiratory muscle training on lung volume and on the strength of the muscles used to take a breath in and to breathe air out and cough. No effect was seen on the maximum amount of air that can be pushed out in one breath, or shortness of breath. An insufficient number of studies had examined the effect of respiratory muscle training on the frequency of lung infections or quality of life, so we could not assess these outcomes in the review. We identified no adverse effects of training the breathing muscles for people with a cervical spinal cord injury.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Mental practice is a process through which an individual repeatedly mentally rehearses an action or task without actually physically performing the action or task. The goal of the mental practice is to improve performance of those actions or tasks. Mental practice has been proposed as a potential adjunct to the physical practice procedures that are commonly performed by survivors of stroke undergoing rehabilitation.  Our review of six studies involving 119 participants provided limited evidence that mental practice, when added to traditional physical rehabilitation treatment, produced improved outcomes compared with the use of traditional rehabilitation treatment alone. The evidence to date shows the improvements are limited to measures of performance of real‐life tasks appropriate to the upper limb (e.g. drinking from a cup, manipulating a door knob). It is not clear if mental practice added to physical practice produces improvements in the motor capacity of the upper limb (i.e. the ability to perform selected movements of the upper limb with strength, speed and/or co‐ordination). Finally, there is no evidence available detailing either the components of the mental practice (e.g. How long should the mental practice sessions be? How many mental practice sessions are necessary?, etc) or the qualities of the survivor of a stroke (How long since onset of stroke? How much recovery is required?, etc) that are required to obtain a positive outcome. However, there is reason for optimism that some of the questions will be answered as there are several large trials currently ongoing.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Paralysis of the arm or leg is common after stroke and frequently causes problems with activities of daily living such as walking, dressing or eating. Mirror therapy is a rehabilitation therapy in which a mirror is placed between the arms or legs so that the image of the non‐affected limb gives the illusion of normal movement in the affected limb. We found 14 relevant studies involving 567 participants. At the end of treatment, mirror therapy improved movement of the affected limb and the ability to carry out daily activities. Mirror therapy reduced pain after stroke, but only in patients with a complex regional pain syndrome. The beneficial effects on movement were maintained for six months, but not in all study groups. No adverse side effects were reported. Further research is needed with larger studies in natural clinical settings, and with a comparison of mirror therapy with more routine treatments.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

After a stroke, arm problems are common and their recovery is often limited. This review of 18 studies with 549 relevant participants looked at whether performing identical activities with both arms at the same time (simultaneous bilateral training) could improve performance in daily (or extended daily) activities, movement of the arm and/or reduce arm impairments. In comparison with usual care, bilateral training had no effect on performance in activities of daily living, functional movement of the arm or hand, performance in extended activities of daily living or motor impairment outcomes. In comparison with other arm interventions, bilateral training had no effect on performance in activities of daily living, functional movement of the arm or hand or motor impairment outcomes. One study found that people who undertook bilateral training showed less improvement in performance in extended activities of daily living than people doing another arm intervention. The evidence in this area is limited. Further research is needed to determine the effects of bilateral training.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

We wanted to assess the effects of constraint‐induced movement therapy (CIMT) on ability to manage daily activities and on the recovery of movement in paralysed arms after a stroke.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

Heart failure is a term used to describe the state that develops when the heart cannot maintain adequate cardiac output or can do so only at the expense of overfilling the heart chambers. People with heart failure commonly experience a relapsing and remitting disease course, with periods of stability and episodes of decompensation (failure to cope with heart damage) leading to worsening symptoms that necessitate hospitalisation. Treatment options for heart failure range from drugs to heart transplantation, with each having its own limitations. Coenzyme Q10 (or ubiquinone) has been suggested as a treatment option in some trials. Coenzyme Q10 is a non‐prescription nutritional supplement. It is a fat‐soluble molecule that has a role in energy production within the cells of the body. It may also have antioxidant properties. Low levels of conequme Q10 may be related to the severity of heart failure. Coenzyme Q10 has been found in all tissues and organs in the body, with the highest concentrations in the heart. Emerging data have suggested that the harmful effects of reactive oxygen species are increased in patients with heart failure and coenzyme Q10, given its antioxidant activity, may help to reduce these toxic effects, which damage the components of the cardiac cells and disrupt cellular signalling. Coenzyme Q10 also has a role in stabilising myocardial calcium‐dependent ion channels and preventing the consumption of metabolites essential for adenosine‐5'‐triphosphate (ATP) synthesis. The concentration of coenzyme Q10 has been inversely related to the severity of heart failure. Supplementation with coenzyme Q10 may improve heart failure. Coenzyme Q10 is sometimes used because it is thought to have an acceptable safety profile with no significant side effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

We reviewed the evidence about the effects of exercise rehabilitation on functional exercise capacity and health‐related quality of life for patients who have been critically unwell in the intensive care unit (ICU). Functional exercise capacity is a term used to express how well individuals perform activities such as walking or climbing the stairs.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

A stroke is a medical emergency. The most important thing you can do if you think someone is having a stroke is to immediately make an emergency call (112 in Germany and many other countries, 911 in the U.S.). The earlier you act, the more likely it is that lasting damage will be prevented.Quick action can save lives in an emergency! Starting treatment for a stroke as soon as possible can stop brain cells from dying and prevent serious consequences.It’s important to recognize the typical signs of a stroke:Sudden weakness, numbness and signs of paralysis: People who are having a stroke can often no longer move their arm, hand and/or leg properly. As well as weakness, some people experience sensations like tingling and numbness. It can sometimes feel like your arm or foot has gone to sleep. Drooping on one side of the mouth is another typical sign of a stroke. These symptoms usually just affect one side of the body, and only rarely both sides.Speech and language problems: Many people suddenly have difficulties finding the right words during a stroke and speak in broken sentences. Sudden slurring of words or mumbling can also be signs of a stroke. Another possible sign of a stroke is difficulties understanding speech: – although they can hear the words, they can't make sense of them.Vision problems: A stroke can affect vision. Things on the affected side of the body are no longer perceived, and the field of vision in the left or right eye is limited. Many people have double vision. If they want to reach for something, such as a cup, they often miss it.Dizziness and trouble walking: People may have difficulty keeping their balance. They either feel like everything is spinning around, or swaying from side to side.Severe headache: A sudden, unusually strong headache can also be a sign of a stroke. These headaches are caused by acute blood supply problems in the brain or by bleeding in the brain due to a torn or burst blood vessel. Headaches may be the only symptom at first, followed a little later by other symptoms such as paralysis and confusion. Nausea and vomiting are also possible symptoms.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: July 13, 2017

In rheumatoid arthritis some joints in the body are permanently inflamed. The inflammatory processes that occur inside the body can lead to general physical weakness, drowsiness and exhaustion. This feeling of extreme tiredness is also called "fatigue." Some people find this to be the worst symptom to deal with.Other typical symptoms are joint pain and swelling, and also joint stiffness and physical weakness later on. Non-specific symptoms like exhaustion may start earlier. But rheumatoid arthritis can develop in many different ways. Also, people may deal with the condition in various ways. But as much as perception of symptoms and coping strategies differ, there are some things that many people with rheumatoid arthritis have in common.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: July 27, 2016

Many people who have rheumatoid arthritis avoid exercise because they worry that it might damage their joints or make their symptoms worse. But there are a number of different sports that are suitable for people with rheumatoid arthritis, as well as good reasons for staying physically active: Exercise and sports improve physical fitness and flexibility, and they can also help with disease-related exhaustion.Rheumatoid arthritis is the most common inflammatory rheumatic condition. It causes joint pain and swelling, inflexible joints and physical weakness. It's also associated with general weakness, tiredness and exhaustion. The fingers, wrists and feet are often affected first, but it can also cause symptoms in larger joints as well, such as the knees, hips or shoulders.Joint damage is a major problem associated with rheumatoid arthritis, so many people worry that a lot of exercise - or the wrong kind - could cause their condition to flare up, the exhaustion to get worse, or their joints to become even more damaged. Also, the pain and exhaustion can make it more difficult to do any sports. But there are a number of exercises that are well suited for people who have rheumatoid arthritis. The main ones include the following:Strengthening exercises: Exercises with light weights for strengthening your legs, arms and back, for example.Conditioning: Sports for strengthening your heart and lungs, such as brisk walking, bicycling, swimming and dancing.Aerobics and water aerobicsTai chi (shadowboxing): Originally a type of Chinese martial arts, these exercises are made up of slow, continuous movements.Yoga: Exercises for controlling your body and breathing to improve flexibility and coordination, as well as provide relaxation.In general, the activities that are suitable for people with rheumatoid arthritis are those that don't put too much stress on the joints. It's best to talk with your doctor about which exercises would be best for you personally. If you're doing occupational therapy or physiotherapy, you can also ask about what kinds of other, related exercises might be suitable for you. The important thing is to first rest your joints if you have an acute flare-up or if you have just had surgery, and then slowly increase the intensity of the exercises.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: August 11, 2016

People with diabetes mellitus are at a greater risk of cardiovascular disease – especially if their blood pressure is too high. Lowering blood pressure to especially low levels can have both advantages and disadvantages for people with diabetes and high blood pressure. 

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: June 4, 2014

Most people who smoke decide to quit at some point. But putting this plan into action isn’t that easy. You usually need to try a few times before you succeed. Preparing well – for instance by making use of self-help materials, websites, telephone services and courses to quit smoking – can help.Most smokers who try to quit do it without seeking help. They want to succeed through sheer willpower. And most of them manage to quit at some point. Accepting help isn’t a sign of weakness, though. Quitting smoking is always a remarkable achievement, regardless of how you do it.Personal motivation is a key factor in the decision to quit smoking and stick to it. Various types of support such as telephone counseling or courses to quit smoking can help to put the decision into practice.How you feel about quitting is important too: Someone who finds it liberating because they can now get by without cigarettes will have an easier time than someone who sees it as having to give something up.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: August 24, 2017

Inflamed joints, pain and reduced flexibility can be signs of rheumatoid arthritis, but they may also be caused by osteoarthritis. Here you can find an overview of the typical symptoms and causes of rheumatoid arthritis. You can also read about the usual course of this chronic condition and the different treatment options.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: August 11, 2016

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