TABLE 3.
Improvement of symptoms of syncope and presyncope with counter pressure maneuvers.
| Paper | N | Population | Setting | Follow Up (Mo) | Endpoint | Description | Maneuver | Improvement (%) |
| Privett et al., (57) | 6 | Control | Post-exercise | – | OI Reoccurrence | Control: 6/6 (100%) had OI CPM: 2/6 (33%) had OI |
Calf raises | 67 |
| Krediet et al., (56) | 13 | VVS | Sit-stand | – | Presyncope | Control: 13/18 (72%) reported presyncope CPM: 2/18 (11%) reported presyncope |
Lower body tensing | 89 |
| Tutaj et al., (62) | 15 | FD | Standing | – | Presyncope | 14/15 (93%) verbally reported reduced symptoms with CPM | Squat, leg cross, abdominal compression, bend forward | 93 |
| Kim et al., (73) | 13 | VVS | Tilt (Passive) | – | Tilt Endpoint | Control tilt: 13/13 (100%) positive Tilt + CPM: 6/13 (46%) positive |
Leg crossing | 54 |
| Brignole et al., (67) | 19 | VVS | Tilt (Passive) | – | Tilt Endpoint | Control tilt: 19/19 (100%) positive Tilt + CPM: 12/19 (63%) positive |
Hand grip | 37 |
| Krediet et al., (72) | 21 | VVS | Tilt (Passive) | – | Tilt Endpoint | Reaction averted with CPM in 5/21 patients (24%), 15/21 (71%) had delayed syncope by median 2.5 min (30 s–11 min) | Leg crossing and tensing | 24 |
| van Lieshout et al., (65) | 5 | OH | Sit-stand | – | Presyncope | Control: 5/5 (100%) reported presyncope Stand + CPM: 0/5 (0%) reported presyncope |
Leg crossing | 100 |
| Smith et al., (58) | 8 | Control | Tilt (LBNP) |
– | Tilt Endpoint | Control tilt: 6/8 (75%) positive Tilt + CPM: 0/8 (0%) positive |
Lower body tensing | 100 |
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| Weighted Mean: | 62 ± 4 | |||||||
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| Tomaino et al., (90) | 95 | VVS | Community | 16 | Syncopal Reoccurrence | Reoccurred in 15/40 (37%, CPM), 24/45 (53%, control at follow up | Leg crossing, lower body tensing, arm tensing | 63 |
| Romme et al., (96) | 100 | VVS | Community | 12 | Syncopal Reoccurrence | 63/100 (63%) using CPM experienced a decreased syncope burden (episodes/year) at follow up | Squatting, leg-crossing, lower body tensing, arm tensing | 63 |
| Krediet et al., (36) | 10 | OH | Community | 2 | Presyncope | 8/10 (80%) patients reported reduced symptoms with CPM | Lower body tensing | 80 |
| van Dijk et al., (35) | 85 | VVS | Community | 12 | Syncopal Reoccurrence | Reoccurred in 31/98 (32%, CPM), 56/110 (51%, control) at follow up | Leg crossing, lower body tensing, arm tensing | 68 |
| Croci et al., (89) | 19 | VVS | Community | 14 | Syncopal Reoccurrence | 5/29 (17%) patients experienced syncopal reoccurrence at follow up | Arm tensing | 74 |
| Krediet et al., (72) | 16 | VVS | Community | 10 | Syncopal Reoccurrence | 13/16 (81%) with recurrence experienced fewer episodes than in previous year | Leg crossing and tense | 81 |
| Brignole et al., (67)* | 97 | VVS | Community | 9 | Presyncope | Among 11 patients (median 3 syncopal episodes/year), 94/97 (97%) cases of presyncope resolved. | Arm tensing | 97 |
| Weighted Mean: | 72 ± 9 | |||||||
Reports from studies evaluating counter pressure maneuvers (CPM) in the laboratory (top) and community setting (bottom, employment of counter pressure maneuvers in daily living) are summarized. The weighted mean ± standard deviation (%) of participants improved is reported under each respective list. These assessments considered populations of healthy controls (control), as well as patients with vasovagal syncope (VVS), orthostatic hypotension (OH, included initial OH and classical OH), and familial dysautonomia (FD). The follow up periods of community-based studies are given in months (Mo). Improvement was characterized by reports of the onset and subsequent alleviation of symptoms via counter pressure maneuvers, as indicated by the endpoint of the study. The endpoint for improvement varied across studies: OI reoccurrence, symptoms of orthostatic intolerance detected; presyncope, detected with cardiovascular cut-offs or patient reports; tilt endpoint, detected as per experimental protocol; syncopal reoccurrence, episode of syncope reported by patient over follow up period. Individuals that did not experience symptom onset initially or over the trial period were excluded from analyses. Individuals that were unable to employ counter pressure maneuvers for any reason were included in the analysis. Because most studies did not incorporate a control, or crossover design, improvement was calculated based on intervention group only. *Denotes study that used pseudo-replication in reporting of results; episodes of syncope experienced by 11 participants were pooled, and the improvement of individual participants was not evaluated.