A systematic review of head-up tilt to improve consciousness in people with a prolonged disorder of consciousness.
Harriet Ng, Andrew King
PMID 32734772WHAT IT FOUND
There is insufficient high-quality evidence to support using head-up tilt to improve consciousness in adults with prolonged disorders of consciousness.
While the Erigo device reduces treatment interruptions from low blood pressure compared to standard tilt-tables, neither device has been proven to enhance alertness.
Key findings
01The review found insufficient high-quality evidence to support the practice of using head-up tilt to increase consciousness in this population.
02The Erigo device reduces treatment interruptions due to orthostatic hypotension compared to traditional tilt-tables, which may allow for more consistent therapy delivery.
03Included studies were too heterogeneous in their protocols, devices, and outcome measures to allow for a meta-analysis.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The included studies had high methodological heterogeneity, preventing a meta-analysis. Many studies lacked control groups or had poor blinding, making it difficult to distinguish treatment effects from natural recovery. Outcome measures varied significantly, with some studies using unvalidated tools like percentage of time with eyes open. Concurrent therapies were not consistently reported, making it unclear if other interventions influenced consciousness scores.
Declared interests
Funding was provided by Health Education England and the National Institute of Health Research via a scholarship for the lead author. The funders did not participate in the creation or analysis of the review.
The easy way to misread this
Do not interpret the reduction in treatment interruptions with the Erigo device as evidence that it improves consciousness. The review found no consistent evidence that either device enhances alertness, and the Erigo's benefit is primarily in tolerability and continuity of care.