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Archives of Dermatological Research Aug 2022Calcinosis cutis is a deposition of calcium in the skin and subcutaneous tissue, often accompanied by pain, reduced mobility, and chronic infections. Limited evidence is... (Review)
Review
Calcinosis cutis is a deposition of calcium in the skin and subcutaneous tissue, often accompanied by pain, reduced mobility, and chronic infections. Limited evidence is available about the feasibility and efficacy of therapies alternative to systemic treatment and surgical excision, both of which often lead to unsatisfactory results or complications. We conducted a systematic review to evaluate the efficacy and safety of topical and intralesional sodium thiosulfate, extracorporeal shock-wave lithotripsy (ESWL), and laser for calcinosis cutis. PubMed, Embase, and Web of Science were searched. Reports of calciphylaxis and treatment combined with systemic medications were excluded. A total of 40 studies including 136 patients were analysed. Partial or complete remission after monotherapy was observed in 64% to 81% of cases. Self-applied topical sodium thiosulfate required patient's adherence (mean treatment duration, 4.9 months; range 2-24). Laser therapy enabled complete remission of microcalcifications after a single procedure (57%; 12/21). ESWL and intralesional sodium thiosulfate injections decreased calcinosis-associated pain (median reduction in VAS score, 3; range 0-9 and 1; range 0-5, respectively). The most common adverse event was scarring and hyperkeratosis, observed after CO laser (56%; 10/18). Intralesional sodium thiosulfate injections caused transient pain in over 11% of patients. Recurrences within the follow-up were rare (2%; 3/136). This study provides an overview of minimally invasive and local therapies that in selected cases might transcend conventional treatment. The limitation of this study is the poor level of evidence, which emerges mainly from non-randomized studies at high risk of bias.
Topics: Administration, Cutaneous; Calcinosis; Humans; Immunotherapy; Pain; Remission Induction
PubMed: 34165603
DOI: 10.1007/s00403-021-02264-5 -
Pediatrics Sep 2013Neuroplasticity evidence from animals favors an early enriched environment for promoting optimal brain injury recovery. In infants, systematic reviews show environmental... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND OBJECTIVES
Neuroplasticity evidence from animals favors an early enriched environment for promoting optimal brain injury recovery. In infants, systematic reviews show environmental enrichment (EE) improves cognitive outcomes but the effect on motor skills is less understood. The objective of this review was to appraise the effectiveness evidence about EE for improving the motor outcomes of infants at high risk of cerebral palsy (CP).
METHODS
A systematic review was conducted. Cochrane Central Register of Controlled Trials (PubMed), Cumulative Index to Nursing and Allied Health Literature, Education Resource Information Center, SocINDEX, and PsycINFO databases were searched for literature meeting inclusion criteria: randomized controlled trials; high risk of /diagnosis of CP; >25% participants ≤2 years; parent or infant interventions postdischarge; and motor outcomes reported. Data were extracted using the Cochrane protocol regarding participants, intervention characteristics, and outcomes. Methodological quality was assessed using risk of bias assessment and GRADE.
RESULTS
A total of 226 studies were identified. After removing duplicates and unrelated studies, 16 full-text articles were reviewed, of which 7 studies met inclusion criteria. The risk of bias varied between studies with the more recent studies demonstrating the lowest risk. Enrichment interventions varied in type and focus, making comparisons difficult. A meta-analysis was conducted of studies that compared enrichment to standard care (n = 5), and totaled 150 infants. A small positive effect for enrichment was found; standardized mean difference 0.39 (95% confidence interval 0.05-0.72; I(2) = 3%; P = .02) CONCLUSIONS: EE looks promising for CP, and therefore high-quality studies with well-defined EE strategies are urgently required.
Topics: Brain; Cerebral Palsy; Child, Preschool; Cognition Disorders; Education; Female; Humans; Infant; Male; Mobility Limitation; Neuronal Plasticity; Physical Therapy Modalities; Psychomotor Disorders; Randomized Controlled Trials as Topic; Social Environment; Treatment Outcome
PubMed: 23958771
DOI: 10.1542/peds.2012-3985 -
Topics in Stroke Rehabilitation Apr 2018Background Stroke is the leading cause of severe disability and many survivors report long-term physical or cognitive impairments that may impact their ability to... (Review)
Review
UNLABELLED
Background Stroke is the leading cause of severe disability and many survivors report long-term physical or cognitive impairments that may impact their ability to achieve community mobility (CM).
PURPOSE
To determine the extent to which people with chronic stroke achieve CM compared to age-matched norms or non-neurologically impaired controls. Methods The StrokEDGE outcome measures were searched to identify validated tools that included >25% of items addressing CM. MEDLINE, CINAHL, Google Scholar, PubMed, PEDro and the Cochrane databases were searched from 2001 to 2015 with the identified outcome measures cross-referenced against search terms related to stroke and CM.
INCLUSION CRITERIA
utilized a validated CM outcome measure, chronic (>3 months post) stroke survivors, and randomized controlled trial, observational or cohort study design. One reviewer screened the studies and performed data extraction and three performed quality appraisal. Fourteen studies met all inclusion criteria. Results Stroke survivors have impaired CM as demonstrated by 30-83% of normative or non-stroke subject CM scores. As time post-stroke increased, CM improved only slightly. Factors found to correlate with the CM were age, education, general well-being, emotional state, motor function and coordination, independence in activities of daily living, balance, endurance and driving status. Limitations of this review include a relatively high functioning cohort, no meta-analysis and reliance on outcome measures not specifically designed to measure CM. Conclusion Survivors of stroke may experience a significant decrease in CM compared to people without neurological injury. Rehabilitation addressing motor function, coordination, independence in activities of daily living, balance and endurance may be important for achieving higher levels of CM. Outcome measures directly addressing CM are needed.
Topics: Community Participation; Humans; Mobility Limitation; Stroke Rehabilitation
PubMed: 29322861
DOI: 10.1080/10749357.2017.1419617 -
Journal of Alternative and... Nov 2011The objectives of this study were to systematically review the literature available on the complementary approach to healing known as Bowenwork(®) and to examine... (Review)
Review
OBJECTIVES
The objectives of this study were to systematically review the literature available on the complementary approach to healing known as Bowenwork(®) and to examine reported research methods.
METHODS
To the authors' knowledge, an exhaustive search of the computerized databases from the known scientific community on all available published literature on Bowenwork(®) was conducted. Databases included Medline Ovid, PubMed, PsychINFO, and CINAHL(®). The literature search included English language studies (1985-September 5, 2009) using the following search terms: Bowen Technique, Bowen Therapy, Bowtech, and Bowenwork(®). In addition, a hand search of individual journals noted to publish complementary and alternative medicine articles was done (1997-2009). Abstracts of all studies were reviewed. Studies were included if (1) they referenced the original Bowenwork, (2) provided health-related outcomes, and (3) provided quantitative or qualitative data. Excluded articles included testimonials, duplicates, unrelated topics, literature reviews, articles lacking verifiable sources, and studies from proprietary resources.
RESULTS
Of the 309 citations obtained, only 15 articles met the inclusion criteria (randomized clinical trial, n=1; quasi-experimental, n=2; mixed methods, n=3; cross-sectional, n=2; case study, n=7). Over half of these studies (53%) reported that Bowenwork was effective for pain reduction and 33% reported improved mobility. In addition, several studies (n=5) reported the effectiveness of Bowenwork(®) on the relief of symptoms experienced by persons living with a chronic illness, such as multiple sclerosis.
CONCLUSIONS
Bowenwork(®) may provide a noninvasive and affordable complementary approach to improvements in health. This intervention may offer improvements in pain reduction for various conditions such as frozen shoulder and migraines. While Bowenwork is recognized internationally, scientific evidence is not well documented. Further research is needed to systematically test this modality, before widespread recommendations can be given.
Topics: Chronic Disease; Humans; Mobility Limitation; Multiple Sclerosis; Musculoskeletal Manipulations; Musculoskeletal Pain; Outcome Assessment, Health Care
PubMed: 22087611
DOI: 10.1089/acm.2010.0023 -
Clinical Rheumatology Jul 2023The objective of this systematic review and meta-analysis is to clarify the effect of exercise therapy on the first peak knee adduction moment (KAM), as well as other... (Meta-Analysis)
Meta-Analysis Review
The objective of this systematic review and meta-analysis is to clarify the effect of exercise therapy on the first peak knee adduction moment (KAM), as well as other biomechanical loads in patients with knee osteoarthritis (OA), and identify physical characteristics that influence differences in biomechanical load after exercise therapy. The data sources are PubMed, PEDro, and CINAHL, from study inception to May 2021. The eligibility criteria include studies evaluating the first peak (KAM), peak knee flexion moment (KFM), maximal knee joint compression force (KCF), or co-contraction during walking before and after exercise therapy in patients with knee OA. The risk of bias was independently assessed by two reviewers using PEDro and NIH scales. Among 11 RCTs and nine non-RCTs, 1119 patients with knee OA were included (average age: 63.7 years). As the results of meta-analysis, exercise therapy tended to increase the first peak KAM (SMD 0.11; 95% CI: -0.03-0.24), peak KFM (SMD 0.13; 95% CI: -0.03-0.29), and maximal KCF (SMD 0.09; 95% CI -0.05-0.22). An increased first peak KAM was significantly associated with a larger improvement in knee muscle strength and WOMAC pain. However, the quality of evidence regarding the biomechanical loads was low-to-moderate according to the GRADE approach. The improvement in pain and knee muscle strength may mediate the increase in first peak KAM, suggesting difficulty in balancing symptom relief and biomechanical load reduction. Therefore, exercise therapy may satisfy both aspects simultaneously when combined with biomechanical interventions, such as a valgus knee brace or insoles. Registration: PROSPERO (CRD42021230966).
Topics: Humans; Middle Aged; Osteoarthritis, Knee; Knee Joint; Walking; Exercise Therapy; Pain; Biomechanical Phenomena; Gait
PubMed: 36879173
DOI: 10.1007/s10067-023-06553-4 -
Arthritis Care & Research Apr 2021To identify whether rheumatoid arthritis (RA) is associated with driving ability and/or the use of assistive devices or modifications to improve driving ability.
OBJECTIVE
To identify whether rheumatoid arthritis (RA) is associated with driving ability and/or the use of assistive devices or modifications to improve driving ability.
METHODS
We conducted a systematic literature review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines of RA and driving ability/adaptations by searching multiple databases from inception to April 2018. Eligible studies were original articles in the English language that had quantitative data regarding the study objective and at least 5 RA patients. Similar outcomes were extracted across studies and grouped into categories for review.
RESULTS
Our search yielded 1,935 potential reports, of which 22 fulfilled eligibility criteria, totaling 6,285 RA patients. The prevalence of driving issues in RA was highly variable among the studies. Some of the shared themes addressed in these publications included RA in association with rates of motor vehicle crashes, self-reported driving difficulty, inability to drive, use of driving adaptations, use of assistance by other people for transport, and difficulty with general transportation.
CONCLUSION
Despite variability among individual reports, driving difficulties and the use of driving adaptations are relatively common in individuals with RA. Given the central importance of automobile driving for the quality of life of RA patients, further investigations of driving ability and potential driving adaptations that can help overcome barriers to safe driving are needed.
Topics: Accidents, Traffic; Arthritis, Rheumatoid; Automobile Driving; Cost of Illness; Female; Functional Status; Humans; Independent Living; Male; Middle Aged; Mobility Limitation; Quality of Life; Risk Assessment; Risk Factors
PubMed: 31909890
DOI: 10.1002/acr.24137 -
Gait & Posture Feb 2023Trips and slips increase fall risk for young and older adults. To examine recovery responses, studies utilized treadmill and/or over-ground methods to simulate... (Review)
Review
BACKGROUND
Trips and slips increase fall risk for young and older adults. To examine recovery responses, studies utilized treadmill and/or over-ground methods to simulate real-world perturbations. However, differences in the recovery response between treadmill and over-ground perturbations remain unexamined.
RESEARCH QUESTION
To assess the current literature on the reactive recovery responses between over-ground- and split-belt treadmill trips and slips as well as the effect of aging on these responses.
METHODS
PubMed, Medline, Web of Science, SCOPUS, and Cochrane databases were searched for publications examining trips and slips in healthy young, healthy older adults, and older adults who fall. Included articles were in English, full-text accessible, and biomechanically quantified the reactive recovery responses for slips and trips during either over-ground or split-belt treadmill protocols. The initial database search yielded 1075 articles and 31 articles were included after title, abstract, and full-text screening.
RESULTS
For slips, 7 articles utilized lubricated surfaces while 5 articles used treadmills. Further, 3 studies examined differences between older and younger adults. For trips, 9 articles utilized obstacles and 7 used treadmills. Further, 4 articles examined differences between older and young adults and 1 article only examined older adults during over-ground trips. For both perturbations, treadmill and over-ground protocols demonstrated similar anteroposterior destabilization on the center of mass. In the mediolateral direction, over-ground slips consistently found a lateral destabilization while treadmill articles did not examine this direction. Foot placement recovery responses varied less for both perturbation directions on a treadmill compared to over-ground.
SIGNIFICANCE
Although treadmill and over-ground perturbations destabilize the center of mass similarly, the recovery response to these perturbations were different on treadmills. Specifically, recovery responses were more consistent for both slips and trips on treadmills. As older adults have difficulty in perturbation recovery scaling, treadmills may be limited in their ability to investigate the variety of aging impairments on perturbation recovery responses.
Topics: Young Adult; Humans; Aged; Postural Balance; Aging; Foot; Exercise Test; Walking; Gait
PubMed: 36603326
DOI: 10.1016/j.gaitpost.2022.12.015 -
Occupational Medicine (Oxford, England) Dec 2011Although various occupational physical activities are suspected of contributing to low back pain (LBP), causal relationships have not been confirmed, complicating... (Review)
Review
BACKGROUND
Although various occupational physical activities are suspected of contributing to low back pain (LBP), causal relationships have not been confirmed, complicating adjudication of work injuries, return to work instructions and preventive efforts.
AIMS
To summarize eight systematic review (SR) reports that examined evidence supporting causal relationships between bending/twisting, awkward postures, sitting, standing/walking, carrying, pushing/pulling, lifting and manual handling/assisting patients and LBP.
METHODS
A literature search was conducted to identify eligible studies. Methodological quality was assessed using a modified Newcastle-Ottawa Scale (NOS). Levels of evidence supporting factors for causation were examined using a Bradford Hill framework. Results were presented in eight SR reports, each focused on one or more related physical activities. This study summarizes findings from those reports and offers clinicians an overview.
RESULTS
Collectively, the eight SR reports included 99 studies. None found strong evidence supporting a causal relationship between any occupational physical activity considered and LBP. Conflicting evidence was found between LBP and bending, twisting, lifting or pushing/pulling, but only for statistical association, not causation. Strong evidence against a causal relationship was found between LBP and manual handling/assisting patients, awkward postures, carrying, sitting, standing or walking.
CONCLUSIONS
Although occupational physical activities are suspected of causing LBP, findings from the eight SR reports did not support this hypothesis. This may be related to insufficient or poor quality scientific literature, as well as the difficulty of establishing causation of LBP. These population-level findings do not preclude the possibility that individuals may attribute their LBP to specific occupational physical activities.
Topics: Activities of Daily Living; Humans; Lifting; Low Back Pain; Motor Activity; Occupational Diseases; Occupational Exposure; Posture
PubMed: 21727180
DOI: 10.1093/occmed/kqr092 -
Cancer Treatment Reviews Dec 2017People with cancer frequently report limitation in Activities of Daily Living (ADLs); essential activities required to live independently within society. Although... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
People with cancer frequently report limitation in Activities of Daily Living (ADLs); essential activities required to live independently within society. Although several studies have assessed ADL related disability, variability in assessment, setting, and population means evidence is difficult to interpret. We aimed to determine the prevalence of ADL related disability, overall and by setting, and the most commonly affected ADLs in people living with cancer.
METHODS
We searched twelve databases to June 2016 for observational studies assessing ADL disability in adults with cancer. Data on study design, population, ADL instruments and disability (difficulty with or requiring assistance in ≥1 activity) were extracted, summarised, and pooled to estimate disability prevalence with 95% confidence intervals (95% CI) overall and by setting.
RESULTS
Forty-three studies comprising 19,246 patients were included. Overall, 36.7% (95% CI 29.8-44.3, 18 studies) and 54.6% (95% CI 46.5-62.3, 15 studies) of patients respectively reported disability relating to basic and instrumental ADLs. Disability was marginally more prevalent in inpatient compared to outpatient settings. The Katz Index (18 studies) and Lawton IADL Scale (11 studies) were the most commonly used instruments. Across the activities studied, the most frequently affected basic ADLs were personal hygiene, walking and transfers, and instrumental ADLs were housework, shopping and transportation.
CONCLUSIONS
About one-third and half of adults with cancer respectively have difficulty or require assistance to perform basic and instrumental ADLs. These findings highlight the need for rehabilitation focused on functional independence, and underscore the importance of professionals skilled in occupational assessment and therapy within cancer services.
Topics: Activities of Daily Living; Aged; Aged, 80 and over; Disability Evaluation; Disabled Persons; Humans; Middle Aged; Neoplasms
PubMed: 29125982
DOI: 10.1016/j.ctrv.2017.10.006 -
Pharmacological Research Dec 2022Widespread musculoskeletal pain characterizes fibromyalgia (FM), accompanied by sleep, fatigue, and mood problems. Chronic stress and depression play a crucial role in... (Review)
Review
Widespread musculoskeletal pain characterizes fibromyalgia (FM), accompanied by sleep, fatigue, and mood problems. Chronic stress and depression play a crucial role in the etiology and pathophysiology of FM. They may contribute to a dysregulation of the central pain mechanisms together with the neuroendocrine and immune systems. Pharmacological treatments are the first-line therapy to reduce the symptoms of FM. The US Food and Drug Administration (FDA) indicated gabapentinoid, pregabalin, duloxetine, and milnacipran for adult patients. An alternative approach is widely used, based on therapies including interventions in patient education, behavioral therapy, exercise, pain management, and a healthy diet. A systematic search was performed on PubMed, MEDLINE, EMBASE, and Web of Science databases. The authors established the selection, inclusion, and exclusion criteria. We found a total of 908 articles. This systematic review will include ten articles selected after excluding duplicates and reading the abstracts and full texts. All studies related the effect of drugs to various symptoms caused by fibromyalgia patients with depression, such as insomnia/sleepiness, depression, suicide, difficulty walking/working, pain, fatigue, and nervousness. Although, we concluded that antidepressant drugs are effective in treating depression and pain in fibromyalgia, further studies are needed to understand the etiology of this disease and to find a combination of therapies to increase tolerability and adherence of the patient to the drug, decreasing the adverse effects.
Topics: Adult; Humans; Fibromyalgia; Antidepressive Agents; Fatigue; Musculoskeletal Pain; Employment
PubMed: 36336218
DOI: 10.1016/j.phrs.2022.106547