Effectiveness of physiotherapy interventions on disease-specific and generic outcomes for individuals with cardiovascular diseases in India – a systematic review and Meta-analysis

Abstract

Background

The incidence of cardiovascular diseases (CVDs) is rising in India and there is a need for a systematic review to corroborate the effects of physiotherapy interventions and their cultural adaptations on CVDs in India.

Objectives

To summarize the level of evidence for the effects of physiotherapy interventions on disease-specific and generic outcome measures in individuals with CVDs and assess cultural adaptations of these interventions in India (PROSPERO registration: CRD42019128342).

Methods

Eight databases were searched from inception to March 2019. Two reviewers extracted data and assessed risk of bias of the eligible studies (controlled/randomized clinical trials [RCTs]) using the Cochrane RoB2 tool. A meta-analysis was conducted using a fixed-effects model. Overall evidence was synthesized using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria.

Results

Of 1349 citations retrieved, only 4 RCTs including 165 individuals (130 men) with CVDs (post-myocardial infarction, left ventricular failure, and stable/congestive heart failure) met the inclusion criteria. The results demonstrated a significant improvement in 6-minute walk distance, blood pressure, anxiety and quality of life following physiotherapy interventions in individuals with CVDs. However, there was a high risk of bias for all outcomes. There were critical weaknesses in all domains of GRADE criteria for all outcomes which resulted in a very low evidence. The cultural adaptations of interventions were inadequately reported.

Conclusions

Owing to a small number of studies with a high risk of bias and heterogeneous results, methodologically-robust RCTs are warranted for finding a more conclusive evidence on physiotherapy interventions for CVDs in India.

Keywords:

• Physical therapy
• heart
• 6-minute walk test
• blood pressure
• functional capacity
• quality of life

Disclosure statement

There are no conflicts of interest that could have either influenced the study or preparation of the manuscript.

Contributors

AA, KKS and HD conceived the idea of the project. RR, AA, KKS and HD were responsible for designing the review and conceptualizing the initial review protocol. RR led the writing of the manuscript. AA, KKS and HD contributed to critical appraisal of the findings and drafting the manuscript. All authors have reviewed and revised the manuscript for important content and approved the final version of it. AA is the guarantor of this work.

Additional information

Funding

No funding was received to conduct and report this systematic review.

Notes on contributors

Raja Regan

Mr Raja Regan is a Professor at PSG College of Physiotherapy, Tamilnadu, India. He had completed his bachelor and master degrees in physiotherapy under the Tamilnadu Dr. MGR Medical university in 2008 and 2012 respectively. He has more than seven years of academic experience and, currently, he is the Head of Department of clinical physiotherapy subjects. He teaches physiotherapy in neurological conditions and electrophysiology for both bachelor and master students in Physiotherapy. His publications and research interest include stroke rehabilitation and motor control.

Kesava Kovanur Sampath

Dr Kesava Kovanur Sampath is a lecturer/clinic lead at the Department of Allied Health and Social Practice, Ara Institute of Canterbury, Christchurch, New Zealand. His research work focuses on mechanisms underpinning manual therapy practice. Currently, he leads a research project investigating the usage of bio-psycho-social model of care by New Zealand osteopaths while treating people with persistent musculoskeletal pain.

Hemakumar Devan

Dr Hemakumar Devan is a New Zealand registered physiotherapist currently working as a postdoctoral fellow at the Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago in Wellington, New Zealand. His primary research interest is to foster self-management support to empower people with persistent pain and their whānau (family and significant others). Dr Devan is currently leading a programme of work – Behavioral intervention technologies for pain self-management support (Pain BITS). He is also a key researcher of a Health Research Council funded project evaluating the clinical and cost-effectiveness of an online-delivered self-management program (iSelfhelp). He is a steering group member of the Social Aspects of Pain Special Interest Group (Soc SIG), International Society for the Study of Pain (IASP) and a council member (Social media) of the New Zealand Pain Society (NZPS). Dr Devan has presented his work in national and international conferences and news media.

Ashokan Arumugam

Dr Ashokan Arumugam is an Assistant Professor of Physiotherapy at the College of Health Sciences, University of Sharjah, United Arab Emirates. He is an Orthopedic Manual Physiotherapist and his research to date primarily focuses on biomechanical analyses of the lower limbs and associated brain activation patterns in individuals with and without anterior cruciate ligament injuries, systematic reviews and meta-analyses, and physical activity analysis at work. He received his PhD under the supervision of Associate Professor Gisela Sole at the School of Physiotherapy, University of Otago, New Zealand. He completed his postdoctoral fellowship under the mentorship of Professor Charlotte Häger at Umeå University, Sweden. He had worked as a clinician and/or an academic in various professional capacities in India, New Zealand, Sweden, and Saudi Arabia.