Objective: To investigate the effect of body position on oxygen saturation in the acute stages post stroke.
Design: Systematic review.
Methods: Databases: PREMEDLINE and MEDLINE, Psychinfo, EMBASE, CINAHL, PEDro, all EBM Reviews and Scottish Intercollegiate Guidelines Network (SIGN). Keywords: combinations of cerebrovascular accident/stroke/hemiplegia/ cerbrovascular disorders and position or posture or sitting or standing/lying/supine/ side lying, with oxygen saturation/oxygen levels/blood gas analysis/hypoxia/sleep apnea syndrome/obstructive sleep disorder/Cheyne Stokes breathing. Limits: English language, human, adults and clinical trials. The quality of relevant papers was independently reviewed using criteria based on the SIGN guidelines for randomized controlled trials and methods described by Rywdik et al.
Results: There were four relevant studies involving 183 patients: three high quality and one poor quality. Heterogeneity in the testing positions, selection criteria, outcome measures and analysis methods prevented meta-analysis. There was strong evidence that body position did not affect oxygen saturation in acute stroke patients without relevant (respiratory) co-morbidities. There was limited evidence that sitting in a chair had a beneficial effect and lying positions had a deleterious effect on oxygen saturation in acute stroke patients with respiratory co-morbidities.
Conclusions: Acute stroke patients without respiratory co-morbidities can adopt any body position, people with respiratory co-morbidities should be positioned as upright as possible.
Get full access to this article
View all access options for this article.
References
1.
1 Sulter G, Elting JW, Stewart R, den Arend A, de Keyser J. Continuous pulse oximetry in acute hemiparetic stroke. J Neurol Sci2000; 179: 65–69.
2.
2 Walshaw MJ, Pearson M. Hypoxia in patients with acute hemiplegia. BMJ1984; 288:15–17.
3.
3 Roffe C. Hypoxaemia and stroke. Rev Clin Gerontol2002; 12: 323–335.
4.
4 Edwards S. Neurological physiotherapy; a problem solving approach. Edinburgh; Churchill Livingstone, 1996.
5.
5 Carr EK, Kenney FD. Positioning of the stroke patient; A review of the literature. Int J Nurs Stud1992; 29: 355–369.
6.
6 Bobath B. Adult hemiplegia: evaluation and treatment, third edition. Oxford: Butterworth Heinemann, 1990.
7.
7 Chatterton H, Pomeroy V, Gratton J. Positioning for stroke patients; A survey of physiotherapists aims and practices. Disabil Rehabil2001; 23: 413–421.
8.
8 Rowat A. What do nurses and therapists think about the positioning of stroke patients?JAdv Nurs2001; 34: 795–803.
9.
9 The Intercollegiate Working Party for Stroke. National clinical guidelines for stroke. London: Royal College of Physicians, 2000.
10.
10 Scottish Intercollegiate Guidelines Network. No. 64. Management of patients with stroke. Rehabilitation, prevention and management of complications and discharge planning; A National clinical guideline, 2002.
11.
11 Scottish Intercollegiate Guidelines Network No. 50. A guideline developer's handbook. Methodology checklist 2: randomised controlled trials. Accessed 6 July 2004 from www.sign.ac.uk/guidelines/fulltext/50/checklist2.html
12.
12 Rydwik E, Frandin K, Akner G. Effects of physical training on physical performance in institutionalised elderly patients (70) with multiple diagnosis. Age Ageing2004; 33: 13–23.
13.
13 Chatterton HJ, Pomeroy V, Connolly M, Faragher B, Clayton L, Tallis R. The effects of body position on arterial oxygen saturation in acute stroke. J Gerontol Med Sci2000; 55A: 239–244
14.
14 Rowat A, Wardlaw J, Dennis M, Warlow C. Patient positioning influences oxygen saturation in the acute phases of stroke. Cerebrovasc Dis2001; 12:66–72
15.
15 Pang JA, Yeung VFT, Zhang YG. Do postural changes affect gas exchange in acute hemiplegia. Br J Clin Pract1988; 42: 501–502.
16.
16 Elizabeth J, Singarayar J, Ellul J, Barer D, Lye M. Arterial oxygen saturation and posture in acute stroke. Age Ageing1993; 22: 269–272.
17.
17 Adams HP Jr, Brott TG, Crowell RM et al. Guidelines for the management of patients with acute ischaemic stroke. A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke1994; 25: 1901–1914.
18.
18 The European Ad Hoc Consensus Group. Optimizing intensive care in stroke: a European perspective. Cerebrovasc Dis1997; 7: 123–128.
19.
19 European Stroke Initiative. European Stoke Initiative Recommendations for Stroke Management. Cerebrovasc Dis2000; 10: 335–351.
