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

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. 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). 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. 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. 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. [ABSTRACT FROM AUTHOR]