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Current Pain and Headache Reports Jun 2024The present investigation evaluates clinical uses and roles of platelet rich plasma in the management of vetrebrogenic and discogenic mediated pain states. (Review)
Review
PURPOSE OF REVIEW
The present investigation evaluates clinical uses and roles of platelet rich plasma in the management of vetrebrogenic and discogenic mediated pain states.
RECENT FINDINGS
Back pain is a common and significant condition that affects millions of people around the world. The cause of back pain is often complex and multifactorial, with discogenic and vertebrogenic pain being two subtypes of back pain. Currently, there are numerous methods and modalities in which back pain is managed and treated such as physical therapy, electrical nerve stimulation, pharmacotherapies, and platelet-rich plasma. To conduct this systematic review, the authors used the keywords "platelet-rich plasma", "vertebrogenic pain", and "discogenic pain", on PubMed, EuroPMC, Who ICTRP, and clinicaltrials.gov to better elucidate the role of this treatment method for combating vertebrogenic and discogenic back pain. In recent decades, there has been a rise in popularity of the use of platelet-rich plasma for the treatment of numerous musculoskeletal conditions. Related to high concentration of platelets, growth factors, cytokines, and chemokines, platelet-rich plasma is effective in reducing pain related symptoms and in the treatment of back pain. Platelet-rich plasma use has evolved and gained popularity for pain related conditions, including vertebrogenic and discogenic back pain. Additional well-designed studies are warranted in the future to better determine best practice strategies to provide future clinicians with a solid foundation of evidence to make advancements with regenerative medical therapies such as platelet-rich plasma.
PubMed: 38850492
DOI: 10.1007/s11916-024-01274-y -
ESC Heart Failure Jun 2024Heart failure (HF) and malnutrition exhibit overlapping risk factors, characterized by increased levels of natriuretic peptides and an inflammatory profile. The aim of...
BACKGROUND
Heart failure (HF) and malnutrition exhibit overlapping risk factors, characterized by increased levels of natriuretic peptides and an inflammatory profile. The aim of this study was to compare the differences in plasma brain natriuretic peptide (BNP), N-terminal-pro B-type natriuretic peptide (NT-proBNP), and C-reactive protein (CRP) in patients with HF and malnutrition versus normal nutrition.
METHODS
From inception until July 2023, the databases, PubMed, Scopus, Web of Science, and Cochrane Library were searched. To examine the association among malnutrition [controlling nutritional status (CONUT) score ≥2; Geriatric Nutritional Risk Index (GNRI) score <92] with BNP, NT-proBNP and CRP in patients with HF, a meta-analysis using a random-effects model was conducted (CRD42023445076).
RESULTS
A significant association of GNRI with increased levels of BNP were demonstrated [mean difference (MD): 204.99, 95% confidence interval (CI) (101.02, 308.96, I = 88%, P < 0.01)], albeit no statistically significant findings were shown using CONUT [MD: 158.51, 95% CI (-1.78 to 318.79, I = 92%, P = 0.05)]. GNRI [MD: 1885.14, 95% CI (1428.76-2341.52, I = 0%, P < 0.01)] and CONUT [MD: 1160.05, 95% CI (701.04-1619.07, I = 0%, P < 0.01)] were associated with significantly higher levels of NT-proBNP. Patients with normal GNRI scores had significantly lower levels of CRP [MD: 0.50, 95% CI (0.12-0.88, I = 87%, P = 0.01)] whereas significantly higher levels of CRP were observed in those with higher CONUT [MD: 0.40, 95% CI (0.08-0.72, I = 88%, P = 0.01)]. Employing meta-regression, age was deemed a potential moderator between CRP and GNRI.
CONCLUSIONS
Normal nutrition scores in patients with HF are linked to lower BNP, NT-proBNP, and CRP levels compared with malnourished counterparts. Despite the significant link between CRP and malnutrition, their relationship may be influenced in older groups considering the sensitivity of GNRI due to ageing factors.
PubMed: 38850122
DOI: 10.1002/ehf2.14851 -
European Heart Journal. Cardiovascular... Jun 2024Direct oral anticoagulants (DOACs) are increasingly used off-label to treat patients with left ventricular thrombus (LVT). We analyzed available meta-data comparing...
AIMS
Direct oral anticoagulants (DOACs) are increasingly used off-label to treat patients with left ventricular thrombus (LVT). We analyzed available meta-data comparing DOACs and vitamin K antagonists (VKAs) for efficacy and safety.
METHODS
We conducted a systematic search and meta-analysis of observational and randomized data comparing DOACs versus VKAs in patients with LVT. Endpoints of interest were stroke or systemic embolism, thrombus resolution, all-cause death, and a composite bleeding endpoint. Estimates were pooled using a random-effect model meta-analysis, and their robustness was investigated using sensitivity and influential analyses.
RESULTS
We identified 22 articles (18 observational studies, 4 small randomized clinical trials) reporting on a total of 3,587 patients (2,489 VKA vs. 1,098 DOAC therapy). The pooled estimates for stroke or systemic embolism (OR 0.81; 95% CI [0.57, 1.15]) and thrombus resolution (OR 1.12; 95% CI [0.86; 1.46]) were comparable, and there was low heterogeneity overall across the included studies. DOAC use was associated with lower odds of all-cause death (OR 0.65; 95%CI [0.46; 0.92]) and a composite bleeding endpoint (OR 0.67; 95%CI [0.47; 0.97]). A risk of bias was evident particularly for observational reports, with some publication bias suggested in funnel plots.
CONCLUSION
In this comprehensive analysis of mainly observational data, the use of DOACs was not associated with a significant difference in stroke or systemic embolism, or thrombus resolution compared to VKA therapy. The use of DOACs was associated with a lower rate of all-cause death and fewer bleeding events. Adequately sized randomized clinical trials are needed to confirm these findings, which could allow a wider adoption of DOACs in patients with LVT.
PubMed: 38845369
DOI: 10.1093/ehjcvp/pvae042 -
Physical Therapy in Sport : Official... Jun 2024The aim of this review is to synthesise qualitative studies examining adolescents' experience with pain and injury arising from sports participation.
OBJECTIVE
The aim of this review is to synthesise qualitative studies examining adolescents' experience with pain and injury arising from sports participation.
METHODS
This review was registered on Open Science Framework prior to data extraction. A systematic search of PubMed, Embase, and SPORTDiscus was conducted. Studies were appraised using the CASP (critical appraisal skills programme) checklist. Data was synthesised using a meta aggregation.
STUDY SELECTION CRITERIA
Inclusion criteria included studies related to adolescents aged 14-19yrs with sports related pain/injury, employed a qualitative design, full text publications in English.
RESULTS
Sixteen studies of 216 participants were included. Studies investigated severe knee injuries, concussion, or other musculoskeletal injuries. Synthesised findings show that, regardless of injury type, adolescents experience a mix of positive (motivation to rehab and return to sport, optimism) and negative emotions (fear of re-injury, isolation, depressive responses) throughout recovery. Common coping strategies were to ignore symptoms, modify activity levels, or seek support.
CONCLUSION
Sports-related pain and injury has a multifaceted effect on the adolescent athlete. There is a pervasive fear of re-injury and social isolation, but the desire to return to sports is facilitated through motivation and support. Peer motivation effects the willingness of the adolescent to persist with rehabilitation.
PubMed: 38843686
DOI: 10.1016/j.ptsp.2024.05.003 -
International Journal of Nursing Studies May 2024Work-related musculoskeletal disorders significantly impact the job performance and quality of life of nursing personnel in China, necessitating an understanding of...
BACKGROUND
Work-related musculoskeletal disorders significantly impact the job performance and quality of life of nursing personnel in China, necessitating an understanding of their prevalence and risk factors to enhance occupational health and improve medical safety.
OBJECTIVE
To systematically evaluate the prevalence and risk factors of work-related musculoskeletal disorders among clinical nurses in China.
DESIGN
Systematic literature review and meta-analysis.
METHODS
A computerized search was conducted on databases, including the China Knowledge Resource Integrated Database, Wanfang Database, China Biomedical Literature Database, Weipu Database, Embase, PubMed, Web of Science, the Cochrane Library, and CINAHL, covering studies from inception to February 28, 2024, addressing the risk factors for work-related musculoskeletal disorders among clinical nursing professionals in China. The meta-analysis was performed using Review Manager 5.4 and Stata 14 software.
RESULTS
The analysis included 23 articles, involving a total of 21,042 cases, and revealed a prevalence rate of 79 % (95 % CI: 73 %-84 %) for work-related musculoskeletal disorders among clinical nursing staff in China. Subgroup analysis revealed that the prevalence of work-related musculoskeletal disorders was highest among those with length of service >15 years, at 87 %; the 31-40 age group had a higher prevalence than other age groups, at 85 %; female nurses exhibited a prevalence rate of 80 %, surpassing male nurses at 77 %, while surgical nurses had a higher prevalence rate (83 %) than those in other departments. The most affected body parts were the neck (58 %), waist (57 %), shoulders (49 %), and back (35 %). Identified risk factors for work-related musculoskeletal disorders among clinical nurses in China included age >35 years (OR = 1.69, 95 % CI: 1.16-2.45), length of service ≥10 years (OR = 3.30, 95 % CI: 1.84-5.92), marital status (married) (OR = 2.19, 95 % CI: 1.91-2.50), heavy workload (OR = 2.46, 95 % CI: 1.25-4.83), weekly work hours >40 h (OR = 1.50, 95 % CI: 1.34-1.67), daily work hours >8 h (OR = 1.71, 95 % CI: 1.32-2.21), strong sense of work fatigue (OR = 1.47, 95 % CI: 1.22-1.76), and high night shift frequency (OR = 1.81, 95 % CI: 1.62-2.02). Regular physical exercise was found to be a protective factor (OR = 0.68, 95 % CI: 0.56-0.82).
CONCLUSION
The overall prevalence of work-related musculoskeletal disorders among clinical nursing staff in China was 79 %. Age >35 years, length of service ≥10 years, marital status (married), heavy workload, weekly work hours >40 h, daily work hours >8 h, strong sense of work fatigue, and night shift frequency were identified as risk factors. Nursing administrators and staff can take proactive measures against the aforementioned factors to reduce the risk of illness and ensure the safety of medical care.
REGISTRATION
PROSPERO: CRD42023479433.
PubMed: 38843644
DOI: 10.1016/j.ijnurstu.2024.104826 -
Frontiers in Sports and Active Living 2024Unstable surfaces are commonly utilized to enhance the flexibility of the musculoskeletal system for achieving training or rehabilitation goals. However, their effects...
Electromyography of shoulder muscles in individuals without scapular dyskinesis during closed kinetic chain exercises on stable and unstable surfaces: a systematic review and meta-analysis.
INTRODUCTION
Unstable surfaces are commonly utilized to enhance the flexibility of the musculoskeletal system for achieving training or rehabilitation goals. However, their effects on shoulder muscle activation during various push-up (PU) exercises have not been thoroughly investigated. Therefore, the purpose of this study was to synthesize electromyography (EMG) data of shoulder muscles in individuals without scapular dyskinesis performing different PU exercises on both stable and unstable surfaces.
METHODS
A systematic online search was conducted in electronic databases, including Web of Science, PubMed, Scopus, and Google Scholar, up to January 16, 2024, using predefined sets of keywords. Out of the 1,971 titles and abstracts screened, 80 articles were reviewed in detail by two independent researchers to check the eligibility, of which 28 eligible studies were ultimately included. Following assessment of the quality and risk of bias, the studies were categorized based on exercises and muscle groups, and a meta-analysis using a random-effects model was performed to estimate the overall effect size.
RESULTS
The use of unstable surfaces led to a decrease in anterior deltoid activity during PU [ = 0.032; = 91.34%; SMD = -0.630 (95% CI -1.205, -0.055)], an increase in pectoralis major activity during PU [ = 0.006; = 63.72%; SMD = 0.282 (95% CI 0.079, 0.484)], as well as during knee PU [ = 0.018; = 32.29%; SMD = 0.309 (95% CI 0.052, 0.565)], and an increase in triceps brachii activity during PU [ = 0.000; = 85.05%; SMD = 0.813 (95% CI 0.457, 1.168)], knee PU [ = 0.000; = 0.00%; SMD = 0.589 (95% CI 0.288, 0.891)], as well as during push-up plus [ = 0.006; = 13.16%; SMD = 0.563 (95% CI 0.161, 0.965)]. However, the use of unstable surfaces did not show a significant effect on the EMG activity of the pectoralis major during push-up plus [ = 0.312; = 22.82%; SMD = 0.207 (95% CI -0.194, 0.609)].
CONCLUSIONS
Unstable surfaces can modulate muscle activity in different PU exercises, while the effects on the targeted muscles depend on the type of exercise. The findings of this review provide a framework based on the level of activity of each shoulder muscle during different PU exercises, which can help coaches, trainers, and sports therapists select the most suitable type of PU for designing training or rehabilitation programs. Particularly, the most suitable exercise for increasing anterior deltoid activity is PU on a stable surface. To concurrently increase activity of the pectoralis major and triceps brachii, adding unstable surfaces under hands during knee PU and standard PU is recommended.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, identifier CRD42021268465.
PubMed: 38840951
DOI: 10.3389/fspor.2024.1385693 -
Frontiers in Psychiatry 2024We conducted a systematic review to evaluate the quality and extent of evidence on associations between personality disorders (PDs) and musculoskeletal disorders (MSDs)...
INTRODUCTION
We conducted a systematic review to evaluate the quality and extent of evidence on associations between personality disorders (PDs) and musculoskeletal disorders (MSDs) in population-based studies, since these disorders are leading causes of disease burden worldwide.
METHODS
A search strategy of published, peer-reviewed and gray literature was developed in consultation with a liaison librarian and implemented for Embase, CINAHL Complete, Medline Complete, and PsycINFO via the EBSCOhost platform from 1990 to the present and CORDIS and ProQuest Dissertations & Theses Global, respectively. The inclusion criteria were as follows: I) general population participants aged ≥15 years; II) self-report, probable PD based on positive screen, or threshold PD according to the DSM-IV/5 (groupings: any, Clusters A/B/C, specific PD) or ICD-10/11; III) MSDs identified by self-report or ICD criteria (arthritis, back/neck conditions, fibromyalgia, osteopenia/osteoporosis) and III) cohort, case-control, and cross-sectional study designs. Two reviewers independently screened articles and extracted the data. Critical appraisal was undertaken using the Joanna Briggs Institute checklists for systematic reviews of etiology and risk. A descriptive synthesis presents the characteristics of included studies, critical appraisal results, and descriptions of the main findings. This review adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.
RESULTS
There were 11 peer-reviewed, published articles included in this review (n = 9 cross-sectional and n = 2 case-control studies); participants were ≥18 years in these studies. No published gray literature was identified. Semi-structured interviews were the most common method to ascertain PDs; all studies utilized self-reported measures to identify MSDs. Overall, we detected limited and conflicting evidence for associations between PDs and MSDs.
DISCUSSION
The main result may be explained by lack of population-based longitudinal evidence, heterogenous groupings of PD, and few comparable cross-sectional and case-control studies. Strengths of the review include a comprehensive search strategy and a discussion of mechanisms underlying possible associations between PDs and MSDs.
CONCLUSIONS
The quality of most studies included in this review that examined associations between PD and MSDs in general population adults was high. However, the results demonstrated limited and conflicting evidence for these associations, in part, due to lack of comparable evidence, which should be addressed in future research.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier CRD42021243094.
PubMed: 38835544
DOI: 10.3389/fpsyt.2024.1288874 -
Sports Medicine - Open Jun 2024Abnormal posture (e.g. loss of lordosis) has been associated with the occurrence of musculoskeletal pain. Stretching tight muscles while strengthening the antagonists...
BACKGROUND
Abnormal posture (e.g. loss of lordosis) has been associated with the occurrence of musculoskeletal pain. Stretching tight muscles while strengthening the antagonists represents the most common method to treat the assumed muscle imbalance. However, despite its high popularity, there is no quantitative synthesis of the available evidence examining the effectiveness of the stretch-and-strengthen approach.
METHODS
A systematic review with meta-analysis was conducted, searching PubMed, Web of Science and Google Scholar. We included controlled clinical trials investigating the effects of stretching or strengthening on spinal and lumbopelvic posture (e.g., pelvic tilt, lumbar lordosis, thoracic kyphosis, head tilt) in healthy individuals. Effect sizes were pooled using robust variance estimation. To rate the certainty about the evidence, the GRADE approach was applied.
RESULTS
A total of 23 studies with 969 participants were identified. Neither acute (d = 0.01, p = 0.97) nor chronic stretching (d=-0.19, p = 0.16) had an impact on posture. Chronic strengthening was associated with large improvements (d=-0.83, p = 0.01), but no study examined acute effects. Strengthening was superior (d = 0.81, p = 0.004) to stretching. Sub-analyses found strengthening to be effective in the thoracic and cervical spine (d=-1.04, p = 0.005) but not in the lumbar and lumbopelvic region (d=-0.23, p = 0.25). Stretching was ineffective in all locations (p > 0.05).
CONCLUSION
Moderate-certainty evidence does not support the use of stretching as a treatment of muscle imbalance. In contrast, therapists should focus on strengthening programs targeting weakened muscles.
PubMed: 38834878
DOI: 10.1186/s40798-024-00733-5 -
Scientific Reports Jun 2024Lumbar disc herniation (LDH) is often managed surgically. Enzymatic chemonucleolysis emerged as a non-surgical alternative. This systematic review and meta-analysis aims... (Meta-Analysis)
Meta-Analysis
Lumbar disc herniation (LDH) is often managed surgically. Enzymatic chemonucleolysis emerged as a non-surgical alternative. This systematic review and meta-analysis aims to assess the efficacy and safety of chemonucleolytic enzymes for LDH. The primary objective is to evaluate efficacy through "treatment success" (i.e., pain reduction) and severe adverse events (SAEs) rates. Additionally, differences in efficacy and safety trends among chemonucleolytic enzymes are explored. Following our PROSPERO registered protocol (CRD42023451546) and PRISMA guidelines, a systematic search of PubMed and Web of Science databases was conducted up to July 18, 2023. Inclusion criteria involved human LDH treatment with enzymatic chemonucleolysis reagents, assessing pain alleviation, imaging changes, and reporting on SAEs, with focus on allergic reactions. Quality assessment employed the Cochrane Source of Bias and MINORS tools. Meta-analysis utilized odds ratios (OR) with 95% confidence intervals (CI). Among 62 included studies (12,368 patients), chemonucleolysis demonstrated an 79% treatment success rate and significantly outperformed placebo controls (OR 3.35, 95% CI 2.41-4.65) and scored similar to surgical interventions (OR 0.65, 95% CI 0.20-2.10). SAEs occurred in 1.4% of cases, with slightly higher rates in chymopapain cohorts. No significant differences in "proceeding to surgery" rates were observed between chemonucleolysis and control cohorts. Limitations include dated and heterogeneous studies, emphasizing the need for higher-quality trials. Further optimization through careful patient selection and advances in therapy implementation may further enhance outcomes. The observed benefits call for wider clinical exploration and adoption. No funding was received for this review.
Topics: Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Treatment Outcome; Intervertebral Disc Chemolysis
PubMed: 38834631
DOI: 10.1038/s41598-024-62792-8 -
JAMA Jul 2024Falls are the most common cause of injury-related morbidity and mortality in older adults. (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Falls are the most common cause of injury-related morbidity and mortality in older adults.
OBJECTIVE
To systematically review evidence on the effectiveness and harms of fall prevention interventions in community-dwelling older adults.
DATA SOURCES
MEDLINE, Cumulative Index for Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Clinical Trials for relevant English-language literature published between January 1, 2016, and May 8, 2023, with ongoing surveillance through March 22, 2024.
STUDY SELECTION
Randomized clinical trials of interventions to prevent falls in community-dwelling adults 65 years or older.
DATA EXTRACTION AND SYNTHESIS
Critical appraisal and data abstraction by 2 independent reviewers. Random-effects meta-analyses with Knapp-Hartung adjustment.
MAIN OUTCOMES AND MEASURES
Falls, injurious falls, fall-related fractures, hospitalizations or emergency department visits, people with 1 or more falls, people with injurious falls, people with fall-related fractures, and harms.
RESULTS
Eighty-three fair- to good-quality randomized clinical trials (n = 48 839) examined the effectiveness of 6 fall prevention interventions in older adults. This article focuses on the 2 most studied intervention types: multifactorial (28 studies; n = 27 784) and exercise (37 studies; n = 16 117) interventions. Multifactorial interventions were associated with a statistically significant reduction in falls (incidence rate ratio [IRR], 0.84 [95% CI, 0.74-0.95]) but not a statistically significant reduction in individual risk of 1 or more falls (relative risk [RR], 0.96 [95% CI, 0.91-1.02]), injurious falls (IRR, 0.92 [95% CI, 0.84-1.01]), fall-related fractures (IRR, 1.01 [95% CI, 0.81-1.26]), individual risk of injurious falls (RR, 0.92 [95% CI, 0.83-1.02]), or individual risk of fall-related fractures (RR, 0.86 [95% CI, 0.60-1.24]). Exercise interventions were associated with statistically significant reductions in falls (IRR, 0.85 [95% CI, 0.75-0.96]), individual risk of 1 or more falls (RR, 0.92 [95% CI, 0.87-0.98]), and injurious falls (IRR, 0.84 [95% CI, 0.74-0.95]) but not individual risk of injurious falls (RR, 0.90 [95% CI, 0.79-1.02]). Harms associated with multifactorial and exercise interventions were not well reported and were generally rare, minor musculoskeletal symptoms associated with exercise.
CONCLUSIONS AND RELEVANCE
Multifactorial and exercise interventions were associated with reduced falls in multiple good-quality trials. Exercise demonstrated the most consistent statistically significant benefit across multiple fall-related outcomes.
Topics: Accidental Falls; Humans; Aged; Independent Living; Randomized Controlled Trials as Topic; Fractures, Bone; Exercise; Hospitalization; Wounds and Injuries; Aged, 80 and over
PubMed: 38833257
DOI: 10.1001/jama.2024.4166