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JAMA Oct 2023There are ongoing concerns about the benefits of intensive vs standard blood pressure (BP) treatment among adults with orthostatic hypotension or standing hypotension. (Comparative Study)
Comparative Study Meta-Analysis
IMPORTANCE
There are ongoing concerns about the benefits of intensive vs standard blood pressure (BP) treatment among adults with orthostatic hypotension or standing hypotension.
OBJECTIVE
To determine the effect of a lower BP treatment goal or active therapy vs a standard BP treatment goal or placebo on cardiovascular disease (CVD) or all-cause mortality in strata of baseline orthostatic hypotension or baseline standing hypotension.
DATA SOURCES
Individual participant data meta-analysis based on a systematic review of MEDLINE, EMBASE, and CENTRAL databases through May 13, 2022.
STUDY SELECTION
Randomized trials of BP pharmacologic treatment (more intensive BP goal or active agent) with orthostatic hypotension assessments.
DATA EXTRACTION AND SYNTHESIS
Individual participant data meta-analysis extracted following PRISMA guidelines. Effects were determined using Cox proportional hazard models using a single-stage approach.
MAIN OUTCOMES AND MEASURES
Main outcomes were CVD or all-cause mortality. Orthostatic hypotension was defined as a decrease in systolic BP of at least 20 mm Hg and/or diastolic BP of at least 10 mm Hg after changing position from sitting to standing. Standing hypotension was defined as a standing systolic BP of 110 mm Hg or less or standing diastolic BP of 60 mm Hg or less.
RESULTS
The 9 trials included 29 235 participants followed up for a median of 4 years (mean age, 69.0 [SD, 10.9] years; 48% women). There were 9% with orthostatic hypotension and 5% with standing hypotension at baseline. More intensive BP treatment or active therapy lowered risk of CVD or all-cause mortality among those without baseline orthostatic hypotension (hazard ratio [HR], 0.81; 95% CI, 0.76-0.86) similarly to those with baseline orthostatic hypotension (HR, 0.83; 95% CI, 0.70-1.00; P = .68 for interaction of treatment with baseline orthostatic hypotension). More intensive BP treatment or active therapy lowered risk of CVD or all-cause mortality among those without baseline standing hypotension (HR, 0.80; 95% CI, 0.75-0.85), and nonsignificantly among those with baseline standing hypotension (HR, 0.94; 95% CI, 0.75-1.18). Effects did not differ by baseline standing hypotension (P = .16 for interaction of treatment with baseline standing hypotension).
CONCLUSIONS AND RELEVANCE
In this population of hypertension trial participants, intensive therapy reduced risk of CVD or all-cause mortality regardless of orthostatic hypotension without evidence for different effects among those with standing hypotension.
Topics: Aged; Female; Humans; Male; Blood Pressure; Blood Pressure Determination; Cardiovascular Diseases; Hypertension; Hypotension, Orthostatic; Middle Aged
PubMed: 37847274
DOI: 10.1001/jama.2023.18497 -
Pediatrics Jun 2020The World Health Organization recommends tummy time for infants because of the benefits of improved motor development and reduced likelihood of plagiocephaly. Because of...
CONTEXT
The World Health Organization recommends tummy time for infants because of the benefits of improved motor development and reduced likelihood of plagiocephaly. Because of poor uptake of these recommendations, the association of tummy time with other health outcomes requires further investigation.
OBJECTIVE
To review existing evidence regarding the association of tummy time with a broad and specific range of infant health outcomes.
DATA SOURCES
Electronic databases were searched between June 2018 and April 2019.
STUDY SELECTION
Peer-reviewed English-language articles were included if they investigated a population of healthy infants (0 to 12 months), using an observational or experimental study design containing an objective or subjective measure of tummy time which examined the association with a health outcome (adiposity, motor development, psychosocial health, cognitive development, fitness, cardiometabolic health, or risks/harms).
DATA EXTRACTION
Two reviewers independently extracted data and assessed their quality.
RESULTS
Sixteen articles representing 4237 participants from 8 countries were included. Tummy time was positively associated with gross motor and total development, a reduction in the BMI- score, prevention of brachycephaly, and the ability to move while prone, supine, crawling, and rolling. An indeterminate association was found for social and cognitive domains, plagiocephaly, walking, standing, and sitting. No association was found for fine motor development and communication.
LIMITATIONS
Most studies were observational in design and lacked the robustness of a randomized controlled trial. High selection and performance bias were also present.
CONCLUSIONS
These findings guide the prioritization of interventions aimed at assisting parents meet the global and national physical activity guidelines.
Topics: Child Development; Humans; Infant; Infant Health; Infant, Newborn; Observational Studies as Topic; Plagiocephaly; Prone Position
PubMed: 32371428
DOI: 10.1542/peds.2019-2168 -
The Cochrane Database of Systematic... Nov 2019The prevalence of musculoskeletal symptoms among sedentary workers is high. Interventions that promote occupational standing or walking have been found to reduce... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The prevalence of musculoskeletal symptoms among sedentary workers is high. Interventions that promote occupational standing or walking have been found to reduce occupational sedentary time, but it is unclear whether these interventions ameliorate musculoskeletal symptoms in sedentary workers.
OBJECTIVES
To investigate the effectiveness of workplace interventions to increase standing or walking for decreasing musculoskeletal symptoms in sedentary workers.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, OSH UPDATE, PEDro, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal up to January 2019. We also screened reference lists of primary studies and contacted experts to identify additional studies.
SELECTION CRITERIA
We included randomised controlled trials (RCTs), cluster-randomised controlled trials (cluster-RCTs), quasi RCTs, and controlled before-and-after (CBA) studies of interventions to reduce or break up workplace sitting by encouraging standing or walking in the workplace among workers with musculoskeletal symptoms. The primary outcome was self-reported intensity or presence of musculoskeletal symptoms by body region and the impact of musculoskeletal symptoms such as pain-related disability. We considered work performance and productivity, sickness absenteeism, and adverse events such as venous disorders or perinatal complications as secondary outcomes.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened titles, abstracts, and full-text articles for study eligibility. These review authors independently extracted data and assessed risk of bias. We contacted study authors to request additional data when required. We used GRADE considerations to assess the quality of evidence provided by studies that contributed to the meta-analyses.
MAIN RESULTS
We found ten studies including three RCTs, five cluster RCTs, and two CBA studies with a total of 955 participants, all from high-income countries. Interventions targeted changes to the physical work environment such as provision of sit-stand or treadmill workstations (four studies), an activity tracker (two studies) for use in individual approaches, and multi-component interventions (five studies). We did not find any studies that specifically targeted only the organisational level components. Two studies assessed pain-related disability. Physical work environment There was no significant difference in the intensity of low back symptoms (standardised mean difference (SMD) -0.35, 95% confidence interval (CI) -0.80 to 0.10; 2 RCTs; low-quality evidence) nor in the intensity of upper back symptoms (SMD -0.48, 95% CI -.096 to 0.00; 2 RCTs; low-quality evidence) in the short term (less than six months) for interventions using sit-stand workstations compared to no intervention. No studies examined discomfort outcomes at medium (six to less than 12 months) or long term (12 months and more). No significant reduction in pain-related disability was noted when a sit-stand workstation was used compared to when no intervention was provided in the medium term (mean difference (MD) -0.4, 95% CI -2.70 to 1.90; 1 RCT; low-quality evidence). Individual approach There was no significant difference in the intensity or presence of low back symptoms (SMD -0.05, 95% CI -0.87 to 0.77; 2 RCTs; low-quality evidence), upper back symptoms (SMD -0.04, 95% CI -0.92 to 0.84; 2 RCTs; low-quality evidence), neck symptoms (SMD -0.05, 95% CI -0.68 to 0.78; 2 RCTs; low-quality evidence), shoulder symptoms (SMD -0.14, 95% CI -0.63 to 0.90; 2 RCTs; low-quality evidence), or elbow/wrist and hand symptoms (SMD -0.30, 95% CI -0.63 to 0.90; 2 RCTs; low-quality evidence) for interventions involving an activity tracker compared to an alternative intervention or no intervention in the short term. No studies provided outcomes at medium term, and only one study examined outcomes at long term. Organisational level No studies evaluated the effects of interventions solely targeted at the organisational level. Multi-component approach There was no significant difference in the proportion of participants reporting low back symptoms (risk ratio (RR) 0.93, 95% CI 0.69 to 1.27; 3 RCTs; low-quality evidence), neck symptoms (RR 1.00, 95% CI 0.76 to 1.32; 3 RCTs; low-quality evidence), shoulder symptoms (RR 0.83, 95% CI 0.12 to 5.80; 2 RCTs; very low-quality evidence), and upper back symptoms (RR 0.88, 95% CI 0.76 to 1.32; 3 RCTs; low-quality evidence) for interventions using a multi-component approach compared to no intervention in the short term. Only one RCT examined outcomes at medium term and found no significant difference in low back symptoms (MD -0.40, 95% CI -1.95 to 1.15; 1 RCT; low-quality evidence), upper back symptoms (MD -0.70, 95% CI -2.12 to 0.72; low-quality evidence), and leg symptoms (MD -0.80, 95% CI -2.49 to 0.89; low-quality evidence). There was no significant difference in the proportion of participants reporting low back symptoms (RR 0.89, 95% CI 0.57 to 1.40; 2 RCTs; low-quality evidence), neck symptoms (RR 0.67, 95% CI 0.41 to 1.08; two RCTs; low-quality evidence), and upper back symptoms (RR 0.52, 95% CI 0.08 to 3.29; 2 RCTs; low-quality evidence) for interventions using a multi-component approach compared to no intervention in the long term. There was a statistically significant reduction in pain-related disability following a multi-component intervention compared to no intervention in the medium term (MD -8.80, 95% CI -17.46 to -0.14; 1 RCT; low-quality evidence).
AUTHORS' CONCLUSIONS
Currently available limited evidence does not show that interventions to increase standing or walking in the workplace reduced musculoskeletal symptoms among sedentary workers at short-, medium-, or long-term follow up. The quality of evidence is low or very low, largely due to study design and small sample sizes. Although the results of this review are not statistically significant, some interventions targeting the physical work environment are suggestive of an intervention effect. Therefore, in the future, larger cluster-RCTs recruiting participants with baseline musculoskeletal symptoms and long-term outcomes are needed to determine whether interventions to increase standing or walking can reduce musculoskeletal symptoms among sedentary workers and can be sustained over time.
Topics: Adult; Ergonomics; Humans; Musculoskeletal Diseases; Occupational Diseases; Randomized Controlled Trials as Topic; Sedentary Behavior; Standing Position; Walking; Workplace
PubMed: 31742666
DOI: 10.1002/14651858.CD012487.pub2 -
Journal of Back and Musculoskeletal... 2022A validated method to assess sitting and standing posture in a clinical setting is needed to guide diagnosis, treatment and evaluation of these postures. At present, no... (Review)
Review
BACKGROUND
A validated method to assess sitting and standing posture in a clinical setting is needed to guide diagnosis, treatment and evaluation of these postures. At present, no systematic overview of assessment methods, their clinimetric properties, and usability is available.
OBJECTIVE
The objective of this study was to provide such an overview and to interpret the results for clinical practice.
METHODS
A systematic literature review was performed according to international guidelines. Two independent reviewers assessed risk of bias, clinimetric values of the assessment methods, and their usability. Quality of evidence and strength of recommendations were determined according to the Grading of Recommendations Assessment, Development and Evaluation working group (GRADE).
RESULTS
Out of 27,680 records, 41 eligible studies were included. Thirty-two assessment instruments were identified, clustered into five categories. The methodological quality of 27 (66%) of the articles was moderate to good. Reliability was most frequently studied. Little information was found about validity and none about responsiveness.
CONCLUSIONS
Based on a moderate level of evidence, a tentative recommendation can be made to use a direct visual observation method with global posture recorded by a trained observer applying a rating scale.
Topics: Humans; Posture; Reproducibility of Results; Sitting Position
PubMed: 34366318
DOI: 10.3233/BMR-200073 -
Occupational and Environmental Medicine Jan 2021The individual peripheral vascular disease risk factors are well documented, but the role of work conditions remains equivocal. This systematic review aims to assess...
OBJECTIVES
The individual peripheral vascular disease risk factors are well documented, but the role of work conditions remains equivocal. This systematic review aims to assess relationships between lower limb peripheral venous diseases (lower limb varicose veins (LLVV), venous thromboembolism (VTE) comprising deep vein thrombosis and pulmonary embolism), peripheral arterial disease (intermittent claudication, aortic dissection, aortic aneurysm) and occupational constraints among working adults.
METHODS
Several databases were systematically searched until February 2019 for observational studies and clinical trials. Preferred Reporting Items for Systematic Reviews and Meta-Analyses method was used for article selection. Quality assessment and risk of bias were evaluated using Strengthening the Reporting of Observational Studies in Epidemiology and Newcastle-Ottawa scales.
RESULTS
Among the 720 screened articles, 37 remained after full-text evaluation. Among the 21 studies on LLVV, prolonged standing was significantly associated to a higher risk of varicose veins with a threshold probably around >3 to 4 hours/day but exposure duration in years was not sufficiently considered. Seated immobility was often observed in workers, with no sufficient evidence to prove that prolonged sitting at work is related to VTE. Carrying heavy loads, stress at work and exposure to high temperatures have emerged more recently notably in relation to varicose veins but need to be better explored. Only three studies discussed the potential role of work on peripheral arterial disease development.
CONCLUSIONS
Although some observational studies showed that prolonged standing can be related to varicose veins and that seated immobility at work could be linked to VTE, very little is known about peripheral arterial disease and occupational constraints. Clinical trials to determine preventive strategies at work are needed.
PROSPERO REGISTRATION NUMBER
CRD42019127652.
Topics: Humans; Occupational Exposure; Peripheral Arterial Disease; Risk Factors; Sitting Position; Standing Position; Varicose Veins; Venous Thromboembolism
PubMed: 32439829
DOI: 10.1136/oemed-2019-106375 -
BMC Geriatrics Jul 2022After a fall, more than half of older people living alone are unable to get up or get help independently. Fall-related recumbency makes affected individuals aware of... (Review)
Review
BACKGROUND
After a fall, more than half of older people living alone are unable to get up or get help independently. Fall-related recumbency makes affected individuals aware of functional status limitations and increased vulnerability. Patient-centered therapy is needed to manage physical, psychological, and social needs. This review summarizes the current evidence on care options for the special patient population.
METHODS
The scoping review used the six-step framework proposed by Arksey and O´Malley and was conducted in accordance with the modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework for scoping reviews. The literature searches were conducted in five databases and ten online archives. Articles were screened, assessed and selected using defined inclusion and exclusion criteria. Articles were included if they were published in either German or English and related to the care of long lies. Thematic synthesis was based on the literature review.
RESULTS
The search yielded 1047 hits, of which 19 research papers were included. Two themes were identified: (1) acute therapy, focused on prolonged recumbency and pronounced physical effects; and (2) preventive therapy, which examined standing up training, technical aids, and social control systems in the context of fall management.
CONCLUSIONS
There are a limited number of interventions that relate to the patient population. The interventions are predominantly presented independently, so there is a lack of structuring of the interventions in the form of a treatment pathway. In addition to pooling professional expertise and an interprofessional approach, it is important to continue inpatient treatment in the home setting, even though the effectiveness of interventions in a home setting has hardly been verified thus far. The solution for a missing treatment process is first of all a planned, interprofessional and intersectoral approach in therapy.
Topics: Accidental Falls; Aged; Hospitalization; Humans
PubMed: 35840883
DOI: 10.1186/s12877-022-03258-2 -
Heliyon Apr 2024Sagittal imbalance can be caused by various etiologies and is among the most important indicators of spinal deformity. Sagittal balance can be restored through surgical... (Review)
Review
BACKGROUND
Sagittal imbalance can be caused by various etiologies and is among the most important indicators of spinal deformity. Sagittal balance can be restored through surgical intervention based on several radiographic measures. The purpose of this study is to review the normal parameters in the sitting position, which are not well understood and could have significant implications for non-ambulatory patients.
METHODS
A systematic review was performed adhering to PRISMA Guidelines. Using R-software, the weighted means and 95% confidence intervals of the radiographic findings were calculated using a random effect model and significance testing using unpaired t-tests.
RESULTS
10 articles with a total of 1066 subjects reported radiographic measures of subjects with no spinal deformity in the sitting and standing position. In the healthy individual, standing sagittal vertical axis -16.8°was significantly less than sitting 28.4° (p < 0.0001), while standing lumbar lordosis 43.3°is significantly greater than sitting 21.3° (p < 0.0001). Thoracic kyphosis was not significantly different between the two groups (p = 0.368). Standing sacral slope 34.3° was significantly greater than sitting 19.5° (p < 0.0001) and standing pelvic tilt 14.0° was significantly less than sitting 33.9° (p < 0.0001).
CONCLUSIONS
There are key differences between standing and sitting postures, which could lead to undue stress on surgical implants and poor outcomes, especially for non-ambulatory populations. There is a need for more studies reporting sitting and standing radiographic measures in different postures and spinal conditions.
PubMed: 38590852
DOI: 10.1016/j.heliyon.2024.e28545 -
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 -
European Spine Journal : Official... Nov 2023Clinicians detect scoliosis worsening over time using frequent radiographs during growth. Arms must be elevated when capturing sagittal radiographs to visualize the... (Meta-Analysis)
Meta-Analysis Review
Systematic review of imaging comparisons of spinal alignment among standing positions in healthy adolescents or adolescents with idiopathic scoliosis: SOSORT 2023 award winner.
PURPOSE
Clinicians detect scoliosis worsening over time using frequent radiographs during growth. Arms must be elevated when capturing sagittal radiographs to visualize the vertebrae, and this may affect the sagittal angles. The aim was to systematically review the published evidence of the effect of arm positions used during radiography on spinal alignment parameters in healthy participants and those with AIS.
METHODS
Design was registered in PROSPERO (CRD42022347494). A search strategy was run in Medline, Embase, CINAHL, and Web of Science. Healthy participants ≥ 10 years old and participants with AIS between 10 and 18 years old, with Cobb angles > 10° were included. Study quality was assessed using the Appraisal tool for Cross-Sectional Studies (AXIS). Meta-analysis was performed where possible.
RESULTS
Overall, 1332 abstracts and 33 full texts were screened. Data was extracted from 7 included studies. The most common positions were habitual standing, fists on clavicle, and active (arms raised unsupported). Kyphosis, lordosis, and sagittal vertical axis (SVA) were most measured. Meta-analysis showed significantly decreased kyphosis (SMD = 0.78, 95%CI 0.48, 1.09) and increased lordosis (SMD = - 1.21, 95%CI - 1.58, - 0.85) when clavicle was compared to standing. Significant posterior shifts in SVA were shown in clavicle compared to standing (MD = 30.59 mm, 95%CI 23.91, 37.27) and active compared to clavicle (MD = - 2.01 mm, 95%CI - 3.38, - 0.64). Cobb angles and rotation were rarely studied (1 study).
CONCLUSION
Meta-analysis evidence showed elevated arm positions modify sagittal measurements compared to standing. Most studies did not report on all relevant parameters. It is unclear which position best represent habitual standing.
Topics: Adolescent; Humans; Child; Scoliosis; Lordosis; Standing Position; Cross-Sectional Studies; Thoracic Vertebrae; Kyphosis; Lumbar Vertebrae; Retrospective Studies
PubMed: 37393596
DOI: 10.1007/s00586-023-07815-0 -
International Journal of Impotence... Nov 2020A phalloplasty is a complex genital reconstruction procedure of creating a neophallus. Several techniques to create a neophallus are described, based on different... (Review)
Review
A phalloplasty is a complex genital reconstruction procedure of creating a neophallus. Several techniques to create a neophallus are described, based on different vascularized flaps, and each of them has its advantages and drawbacks. The aim of this study is to present musculocutaneous latissimus dorsi (MLD) flap as a viable option for total phalloplasty, with an interest in clinical outcomes and complications. A comprehensive literature review of all available reports about MLD flap phalloplasty was made. The following keywords were used on PubMed: latissimus dorsi musculocutaneous/myocutaneous free flap and phalloplasty. Research criteria revealed five articles and the results of 182 patients were analyzed. A total number of the patients, indications, operative technique, follow-up period, postoperative results, and complications were presented. In conclusion, MLD free flap presents a good choice for phalloplasty providing sufficient amount of tissue for safe implantation of penile prosthesis and successful penetrative sexual intercourse. The erogenous sensitivity is preserved with clitoris or glans penis incorporated into the base of the neophallus, and voiding in a standing position is achievable after urethral reconstruction. The main drawback is the lack of tactile sensation of the neophallus and the significant advantage is a well-concealed donor site.
Topics: Female; Humans; Male; Penile Prosthesis; Penis; Plastic Surgery Procedures; Surgical Flaps; Urethra
PubMed: 33184508
DOI: 10.1038/s41443-020-00371-x