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Healthcare (Basel, Switzerland) Mar 2024The aim of this study was to evaluate the clinical effectiveness of craniosacral therapy (CST) in the management of any conditions. (Review)
Review
OBJECTIVES
The aim of this study was to evaluate the clinical effectiveness of craniosacral therapy (CST) in the management of any conditions.
METHODS
Two independent reviewers searched the PubMed, Physiotherapy Evidence Database, Cochrane Library, Web of Science, and Osteopathic Medicine Digital Library databases in August 2023, and extracted data from randomized controlled trials (RCT) evaluating the clinical effectiveness of CST. The PEDro scale and Cochrane Risk of Bias 2 tool were used to assess the potential risk of bias in the included studies. The certainty of the evidence of each outcome variable was determined using GRADEpro. Quantitative synthesis was carried out with RevMan 5.4 software using random effect models.
DATA SYNTHESIS
Fifteen RCTs were included in the qualitative and seven in the quantitative synthesis. For musculoskeletal disorders, the qualitative and quantitative synthesis suggested that CST produces no statistically significant or clinically relevant changes in pain and/or disability/impact in patients with headache disorders, neck pain, low back pain, pelvic girdle pain, or fibromyalgia. For non-musculoskeletal disorders, the qualitative and quantitative synthesis showed that CST was not effective for managing infant colic, preterm infants, cerebral palsy, or visual function deficits.
CONCLUSIONS
The qualitative and quantitative synthesis of the evidence suggest that CST produces no benefits in any of the musculoskeletal or non-musculoskeletal conditions assessed. Two RCTs suggested statistically significant benefits of CST in children. However, both studies are seriously flawed, and their findings are thus likely to be false positive.
PubMed: 38540643
DOI: 10.3390/healthcare12060679 -
The Lancet. Psychiatry Sep 2023People with intellectual disability show a high prevalence of behaviours that challenge. Clinical guidelines recommend that such behaviour should first be treated with... (Meta-Analysis)
Meta-Analysis
Non-pharmacological and pharmacological interventions for the reduction or prevention of topographies of behaviours that challenge in people with intellectual disabilities: a systematic review and meta-analysis of randomised controlled trials.
BACKGROUND
People with intellectual disability show a high prevalence of behaviours that challenge. Clinical guidelines recommend that such behaviour should first be treated with non-pharmacological interventions, but research suggests off-label pharmaceuticals are commonly used. We aimed to evaluate the efficacy of non-pharmacological and pharmacological interventions for topographies of behaviours that challenge drawn from randomised controlled trials (RCTs).
METHODS
In this systematic review and meta-analysis, we searched PsycINFO, MEDLINE, Embase, CINAHL, and CENTRAL databases for RCT studies assessing an intervention (pharmacological or non-pharmacological) for behaviours that challenge (self-injury behaviour, aggression, destruction of property, irritability, and a composite overall measure) in participants with intellectual disability. The primary aim was to assess the efficacy of non-pharmacological and pharmacological interventions on behaviours that challenge. Secondary aims were to evaluate how effects varied over time and whether intervention, methodological, and participant characteristics moderate efficacy. We extracted standard mean difference (SMD) effect sizes (Cohen's d) from eligible studies and meta-analysed the data using a series of random effects models and subgroup analyses. This study was registered with PROSPERO 2021, CRD4202124997.
FINDINGS
Of 11 912 reports identified, 82 studies were included. 42 (51%) studies assessed non-pharmacological interventions and 40 (49%) assessed pharmacological interventions. Across all studies, 4637 people with intellectual disability aged 1-84 years (mean age 17·2 years) were included. 2873 (68·2%) were male, 1339 (28·9%) were female, and for 425 (9·2%) individuals, data on gender were not available. Data on ethnicity were unavailable. Small intervention effects were found for overall behaviours that challenge at post-intervention (SMD -0·422, 95% CI -0·565 to -0·279), overall behaviours that challenge at follow-up (-0·324, -0·551 to -0·097), self-injury behaviour at post-intervention (-0·238, -0·453 to -0·023), aggression at post-intervention (-0·438, -0·566 to -0·309), and irritability at post-intervention (-0·255, -0·484 to -0·026). No significant differences between non-pharmacological and pharmacological interventions were found for any topography of behaviours that challenge (all p>0·05).
INTERPRETATION
A broad range of interventions for behaviours that challenge are efficacious with small effect sizes for people with intellectual disability. These findings highlight the importance of precision in the measurement of behaviours that challenge, and when operationalising intervention components and dosages.
FUNDING
Cerebra.
Topics: Female; Male; Humans; Adolescent; Intellectual Disability; Aggression; Self-Injurious Behavior; Databases, Factual; Ethnicity; Randomized Controlled Trials as Topic
PubMed: 37595996
DOI: 10.1016/S2215-0366(23)00197-9 -
Frontiers in Neuroscience 2023In recent years, pain neuroscience education (PNE) has been the focus of extensive research in the scientific literature in the field of physical therapy, but the...
INTRODUCTION
In recent years, pain neuroscience education (PNE) has been the focus of extensive research in the scientific literature in the field of physical therapy, but the results obtained are controversial and its clinical application remains unclear. The main aim of this umbrella review was to assess the effectiveness of PNE in patients with chronic musculoskeletal pain (CMP).
METHODS
We searched systematically in PubMed (Medline), PEDro, EMBASE, CINAHL and PsycINFO. Methodological quality was analyzed using AMSTAR-2 scale and overlapping analysis using GROOVE tool.
RESULTS
16 systematic reviews were included. A qualitative synthesis was performed for the following sets of patients with CMP: overall CMP, chronic spinal pain, patients with fibromyalgia and patients with osteoarthritis. In general terms, it seems that the addition of the PNE-based intervention to other treatments, mostly exercise-based interventions although we might refer to it in terms of a multimodal approach, leads to greater clinical improvements than the multimodal approach alone. We have found this especially in the reduction of the influence of psychosocial variables. However, it seems that studies testing the effectiveness of PNE in isolation, systematic reviews with or without meta-analysis did not show statistically significant improvements overall in terms of pain intensity, disability levels or psychosocial variables.
DISCUSSION
There is a great heterogeneity in the results obtained and the PNE protocols used, a critically low quality in the reviews included and a very high overlap, so there is a need to improve the studies in this field before clinical application.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO (CRD42022355634).
PubMed: 38075271
DOI: 10.3389/fnins.2023.1272068 -
Injury Epidemiology Aug 2023Globally, drowning is a leading cause of unintentional injury and death among children. Teaching aquatic competencies (swimming skills and water safety knowledge) to... (Review)
Review
BACKGROUND
Globally, drowning is a leading cause of unintentional injury and death among children. Teaching aquatic competencies (swimming skills and water safety knowledge) to children has been proposed as a prevention strategy. In Australia, however, many children are not meeting standard aquatic competency benchmarks. Exploration of the connection between demographic and background factors and aquatic competencies could provide insight into why differences in acquisition of aquatic knowledge and skills occur.
MAIN BODY
A systematic literature review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was performed to identify studies that reported on the association between demographic and background factors and aquatic competencies. Nine databases were searched for English language peer-reviewed studies published since 2000. Fourteen studies fulfilled all inclusion criteria. Studies were quasi-experimental or cross-sectional in design, which is considered quality level III-2 or IV, respectively, on the National Health and Medical Research Council Evidence Hierarchy. Study quality was moderate, and risk of bias was high. While aquatic competencies can be taught, this review found that factors including age, gender, geographic residence, medical conditions/disabilities, socioeconomic status, and swimming frequency were significantly associated with the demonstration and/or acquisition of aquatic competencies.
CONCLUSION
This review provides insight into demographic and background factors that are significantly associated with the development of aquatic competence. Whilst further investigation is required to increase the evidence base, these findings may assist in tailoring swimming and water safety programs to accommodate those at-risk of not achieving age-appropriate aquatic competencies.
PubMed: 37553586
DOI: 10.1186/s40621-023-00447-4 -
Journal of Clinical Medicine Sep 2023Dysfunctions of the lumbosacral area and related pain syndromes, such as chronic low back pain (CLBP), are among the most common musculoskeletal problems in modern... (Review)
Review
Dysfunctions of the lumbosacral area and related pain syndromes, such as chronic low back pain (CLBP), are among the most common musculoskeletal problems in modern society. The purpose of this study was to evaluate the effectiveness of isolated myofascial release techniques (MFR) in the treatment of CLBP in adults. PubMed, Web of Science, Scopus, and Cochrane Library databases were searched for studies published from 1 January 2013 to 1 March 2023. We included English-language randomized controlled trials evaluating the effect of isolated MFR performed by a specialist on adults with CLBP. Only studies with a comparison group without treatment or with sham MFR were included. A total of 373 studies were detected, of which 6 studies were finally included in this review. There was a total of 397 CLBP patients aged 18-60 in all study groups. The studies evaluated the effects of a series of MFR treatments as well as a single intervention. After applying a series of treatments, a statistically significant reduction in pain intensity, improvement in the range of motion, reduction in the level of functional disability and fear-avoidance beliefs, as well as a decrease in the activity of paraspinal muscles at maximum trunk flexion were demonstrated. A single, 40-min complex intervention involving tissues at various depths significantly reduced the level of pain, improved the range of motion, and reduced the resting activity of paraspinal muscles in the standing position, but did not affect postural stability. The use of a single 5 min MFR technique did not affect pain intensity and sensitivity and functional disability. The findings suggest that the use of a series of isolated MFR improves the condition of patients with CLBP by reducing the intensity of pain, improving functional efficiency, and reducing the activity of the paraspinal muscles in the position of maximum forward bend. The use of a single intervention containing a set of techniques covering superficial and deep tissue also reduces the intensity of pain, improves mobility, and reduces the resting activity of the paraspinal muscles in a standing position. Given the small number of eligible studies with limitations, conclusions should be interpreted with caution and avoid overgeneralizing the benefits of isolated MFR based on limited or mixed evidence.
PubMed: 37834787
DOI: 10.3390/jcm12196143 -
Frontiers in Human Neuroscience 2023Bowel dysfunction is a common consequence of neurological diseases and has a major impact on the dignity and quality of life of patients. Evidence on neurogenic bowel is...
UNLABELLED
Bowel dysfunction is a common consequence of neurological diseases and has a major impact on the dignity and quality of life of patients. Evidence on neurogenic bowel is focused on spinal cord injury and multiple sclerosis; few studies have focused on patients with acquired brain injury (ABI). Neurogenic bowel dysfunction is related to a lifelong condition derived from central neurological disease, which further increases disability and social deprivation. The manifestations of neurogenic bowel dysfunction include fecal incontinence and constipation. Almost two out of three patients with central nervous system disorder have bowel impairment. This scoping review aims to comprehend the extent and type of evidence on bowel dysfunction after ABI and present conservative treatment. For this scoping review, the PCC (population, concept, and context) framework was used: patients with ABI and bowel dysfunction; evaluation and treatment; and intensive/extensive rehabilitation path. Ten full-text articles were included in the review. Oral laxatives are the most common treatment. The Functional Independence Measure (FIM) subscale is the most common scale used to assess neurogenic bowel disease (60%), followed by the Rome II and III criteria, and the colon transit time is used to test for constipation; however, no instrumental methods have been used for incontinence. An overlapping between incontinence and constipation, SCI and ABI increase difficulties to manage NBD. The need for a consensus between the rehabilitative and gastroenterological societies on the diagnosis and medical care of NBD.
SYSTEMATIC REVIEW REGISTRATION
Open Science Framework on August 16, 2022 https://doi.org/10.17605/OSF.IO/NEQMA.
PubMed: 37900728
DOI: 10.3389/fnhum.2023.1146054 -
International Journal of Spine Surgery Dec 2023Sacroiliac (SI) joint fusion is increasingly used to treat chronic SI joint pain. Multiple surgical approaches are now available.
BACKGROUND
Sacroiliac (SI) joint fusion is increasingly used to treat chronic SI joint pain. Multiple surgical approaches are now available.
METHODS
Data abstraction and random effects meta-analysis of safety and efficacy outcomes from published patient cohorts. Patient-reported outcomes (PROs) and safety measures were stratified by surgical technique: transiliac, including lateral transiliac (LTI) and posterolateral transiliac (PLTI), and posterior interpositional (PI) procedures.
RESULTS
Fifty-seven cohorts of 2851 patients were identified, including 43 cohorts (2126 patients) for LTI, 6 cohorts (228 patients) for PLTI, and 8 cohorts (497 patients) for PI procedures. Randomized trials were only available for LTI. PROs were available for pain (numeric rating scale) in 57 cohorts (2851 patients) and disability (Oswestry Disability Index [ODI]) in 37 cohorts (1978 patients).All studies with PROs showed improvement from baseline after surgery. Meta-analytic improvements in pain scores were highest for LTI (4.8 points [0-10 scale]), slightly lower for PLTI (4.2 points), and lowest for PI procedures (3.8 points, = 0.1533). Mean improvements in ODI scores were highest for LTI (25.9 points), lowest for PLTI procedures (6.8 points), and intermediate for PI (16.3 points, = 0.0095).For safety outcomes, acute symptomatic implant malposition was 0.43% for LTI, 0% for PLTI, and 0.2% for PI procedures. Wound infection was reported in 0.15% of LTI, 0% of PLTI, and 0% of PI procedures. Bleeding requiring surgical intervention was reported in 0.04% of LTI procedures and not reported for PLTI or PI. Breakage and migration were not reported for any device. Radiographic imaging evaluation reporting implant placement accuracy and fusion was only available for LTI.
DISCUSSION
Literature support for SI joint fusion is growing. The LTI procedure contains the largest body of available evidence and shows the largest improvements in pain and ODI. Only LTI procedures have independent radiographic evidence of fusion and implant placement. The adverse event rate for all procedures was low.
PubMed: 37798076
DOI: 10.14444/8543 -
BMC Neurology Nov 2023Fatigue is the most disabling symptom for individuals with multiple sclerosis (MS), which can significantly affect postural control (PC) by impairing the ability of the...
BACKGROUND
Fatigue is the most disabling symptom for individuals with multiple sclerosis (MS), which can significantly affect postural control (PC) by impairing the ability of the central nervous system to modulate sensory inputs and coordinate motor responses. This systematic review aimed to investigate the effect of fatigue on PC in individuals with MS..
METHODS
This systematic review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline and registered in PROSPERO with ID CRD42022376262. A systematic search was performed in the Web of Science, PubMed, Scopus, and Google Scholar until January 2023, and a manual search was performed using the reference lists of included studies. Two authors independently selected the studies, extracted data, and evaluated their methodological quality using the Downs and Black checklist. The process was later discussed with a third author..
RESULTS
Five studies were included in this review, of which consistent evidence investigating a direct relationship between fatigue and PC in individuals with MS. All the studies reported negative effects on PC. Four studies employed walking tests as their primary protocol for inducing fatigue, while one study implemented a strength testing protocol for both legs, serving as a fatigue-inducing activity.
CONCLUSIONS
The evidence suggests that individuals with MS may experience PC deficits due to fatigue. However, the present body of literature exhibits limitations regarding its quality and methodology. Gender differences, balance, fatigue task, and muscle function are essential factors that need to be considered when investigating the relationship between fatigue and PC deficits in MS. Further high-quality research is necessary to comprehend the complex interplay between MS-related fatigue and PC deficits after physical activity.
Topics: Humans; Exercise; Multiple Sclerosis; Fatigue; Postural Balance
PubMed: 37978449
DOI: 10.1186/s12883-023-03464-4 -
Anesthesiology and Pain Medicine Aug 2023Musculoskeletal disorders are among the main causes of death and disability and can impose high costs on individuals and countries. Considering the importance of pain,...
CONTEXT
Musculoskeletal disorders are among the main causes of death and disability and can impose high costs on individuals and countries. Considering the importance of pain, the present meta-analysis study aimed to investigate the prevalence of orthopedic pains in Iranian children and adolescents.
METHODS
The present study was reported in line with PRISMA. The searching process was carried out using keywords, including adolescents, pain, youth, school-age children, shoulder pain, neck pain, shoulder, and neck, AND/OR operators for the articles published during 2000 and 2022 in Scopus, Embase, PubMed, Scientific Information Database, Magiran, International Statistical Institute, and Islamic World Science Citation Center databases. This study reviewed the articles that reported the prevalence of orthopedic pains (i.e., wrists/hands, shoulders, elbows, and knees) among the 5-18-year age group in Iran and extracted their results. Two researchers conducted the search quite independently and extracted the necessary data using a researcher-made checklist. The collected data were analyzed using Comprehensive Meta-Analysis software (CMA3).
RESULTS
Initially, 418 articles were identified, and 14 articles were entered into the systematic review stage. The prevalence rates of pains related to wrists/hands, shoulders, elbows, and knees were 6.6 (95% confidence interval [CI]: 3.2 - 13.0), 26.9 (95% CI: 17.0 - 39.7), 2.9 (95% CI: 1.3 - 6.3), and 6.6 (95% CI: 3.0 - 14.2), respectively.
CONCLUSIONS
The prevalence of shoulder and knee pains in individuals under 18 years in Iran was high. Therefore, it is necessary to make necessary interventions and take preventive measures.
PubMed: 38024003
DOI: 10.5812/aapm-136616 -
Psychiatria Danubina Dec 2023Children with disabilities (CWDs) are often excluded from scientific research, but no precise data are available on their participation in Clinical Trials. The aim of... (Review)
Review
BACKGROUND
Children with disabilities (CWDs) are often excluded from scientific research, but no precise data are available on their participation in Clinical Trials. The aim of this study was to evaluate the rates of exclusion of CWDs from recent medical research.
SUBJECTS AND METHODS
The protocol of the study was designed according to Prisma-ScR guidelines. All completed interventional Clinical Trials registered on Clinicaltrials.gov between 2010 and 2020 related to the Leading 10 Level 3 causes of global Disability-adjusted life years (DALYs) for both sexes combined for all ages of the updated Global Burden of Disease Study 2019 were analysed. The exclusion criteria were considered explicit if related to the following categories: disability, physical impairment, cognitive impairment, behavioural or psychiatric disorders, language and communication impairment, sensory impairment. Any generic or poorly specified exclusion criteria or statements that left wide discretion to researchers were considered "implicit exclusion criteria". We assessed the appropriateness of explicit exclusion criteria in relation to the primary objectives of the trials and labelled them as "absolute", "relative", or "questionable".
RESULTS
The trials selected according to the inclusion criteria of the scoping review were 328; 166 (50.6%) were pediatric-only studies, and 162 (49.4%) trials comprising subjects of all ages. Explicit exclusion criteria were found in 82 trials (25%) and the disability category most frequently excluded was "Behavioural or psychiatric disorders" present in 46 trials (56.1%). Explicit exclusion criteria were considered "relative" in over 90% of the selected studies. Implicit exclusion criteria were present in 153 trials (46.6%) and the number and percentage of studies with at least one explicit or implicit exclusion criterion were 193 and 58.8% respectively.
CONCLUSIONS
This study highlights a high rate of exclusion of CWDs from medical research and the need for an inclusive approach that comprises the study design and any necessary adaptations for specific needs.
Topics: Male; Female; Humans; Child; Disabled Children; Biomedical Research; Cognitive Dysfunction; Research Design
PubMed: 37994056
DOI: No ID Found