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PM & R : the Journal of Injury,... Aug 2023To summarize the recommendations on the interventional management of subacute and chronic nonradicular low back pain (LBP) from the 21 quality-appraised clinical... (Review)
Review
OBJECTIVE
To summarize the recommendations on the interventional management of subacute and chronic nonradicular low back pain (LBP) from the 21 quality-appraised clinical practice guidelines (CPGs) identified in a previously published paper: "Quality of Clinical Practice Guidelines on Interventional Management of Low Back Pain: A Systematic Review." By disseminating this information, we aimed to facilitate the implementation of these recommendations into clinical practice. TYPE: Systematic Review LITERATURE SURVEY: Electronic bibliographic databases, guideline databases, and gray literature were searched from January 2016 to January 2020 to identify CPGs that met study criteria.
METHODOLOGY
A total of 21 CPGs were quality appraised and interventional management recommendations were extracted and organized into several treatment categories including epidural steroid injections, radiofrequency procedures (RF), facet injections, sacroiliac injections, and prolotherapy. Within each treatment category, the recommendations were organized based on two factors: quality of CPG and strength of recommendation.
SYNTHESIS
Overall, there was no consistency in recommendations for or against any interventional procedure, even when accounting for the quality of the CPG. In all of the CPGs reviewed, the most common strength of recommendation was weakly for. The second, third, and fourth most common strength of recommendations were inconclusive, weakly against, and strongly against, respectively, and the least common was strongly for. The treatment categories with the greatest number of recommendations were RF procedures (most common strength of recommendation was weakly for) and facet procedures. Among the high-quality CPGs, the most common strength of recommendation was inconclusive.
CONCLUSIONS
Most of the interventional management recommendations for management of nonradicular LBP in the 21 CPGs appraised in this review were either weakly for, weakly against, or inconclusive, with several recommendations within each treatment category contradicting each other. Appraisal of Guidelines for Research & Evaluation Instrument quality appraisals of CPGs on interventional management of LBP were of unclear utility in guiding clinical implementation.
Topics: Humans; Low Back Pain; Pain Management; Databases, Factual
PubMed: 36507598
DOI: 10.1002/pmrj.12930 -
Journal of Neurosurgery Jun 2023Stroke remains the leading cause of disability in the United States. Even as acute care for strokes advances, there are limited options for improving function once the...
OBJECTIVE
Stroke remains the leading cause of disability in the United States. Even as acute care for strokes advances, there are limited options for improving function once the patient reaches the subacute and chronic stages. Identification of new therapeutic approaches is critical. Deep brain stimulation (DBS) holds promise for these patients. A number of case reports and small case series have reported improvement in movement disorders after strokes in patients treated with DBS. In this systematic review, the authors have summarized the patient characteristics, anatomical targets, stimulation parameters, and outcomes of patients who have undergone DBS treatment for poststroke movement disorders.
METHODS
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The PubMed, Scopus, and SpringerLink databases were searched for the keywords "DBS," "stroke," "movement," and "recovery" to identify patients treated with DBS for movement disorders after a stroke. The Joanna Briggs Institute Critical Appraisal checklists for case reports and case series were used to systematically analyze the quality of the included studies. Data collected from each study included patient demographic characteristics, stroke diagnosis, movement disorder, DBS target, stimulation parameters, complications, and outcomes.
RESULTS
The authors included 29 studies that described 53 patients who underwent placement of 82 total electrodes. Movement disorders included tremor (n = 18), dystonia (n = 18), hemiballism (n = 6), spastic hemiparesis (n = 1), chorea (n = 1), and mixed disorders (n = 9). The most common DBS targets were the globus pallidus internus (n = 32), ventral intermediate nucleus of thalamus (n = 25), and subthalamic area/subthalamic nucleus (n = 7). Monopolar stimulation was reported in 43 leads and bipolar stimulation in 13. High-frequency stimulation was used in 57 leads and low-frequency stimulation in 6. All patients but 1 had improvement in their movement disorders. Two complications were reported: speech impairment in 1 patient and hardware infection in another. The median (interquartile range) duration between stroke and DBS treatment was 6.5 (2.1-15.8) years.
CONCLUSIONS
This is the first systematic review of DBS for poststroke movement disorders. Overall, most studies to date have been case reports and small series reporting heterogeneous patients and surgical strategies. This review suggests that DBS for movement disorders after a stroke has the potential to be effective and safe for diverse patients, and DBS may be a feasible option to improve function even years after a stroke.
PubMed: 36308482
DOI: 10.3171/2022.8.JNS221334 -
Frequency and Characteristics of Medical Complications in Rehabilitation Settings: A Scoping Review.Journal of Rehabilitation Medicine Dec 2022To synthesize the available evidence on medical complications occurring in adult patients in subacute inpatient rehabilitation, and to describe the impact on subacute... (Review)
Review
OBJECTIVE
To synthesize the available evidence on medical complications occurring in adult patients in subacute inpatient rehabilitation, and to describe the impact on subacute length of stay and readmission to acute care.
DESIGN
Scoping review.
SUBJECTS
Adult patients, within the inpatient rehabilitation environment, who experienced medical complications, clinical deterioration and/or the requirement of transfer to acute care.
METHODS
A systematic search of MEDLINE and CINAHL electronic databases was undertaken to identify primary research studies published in English and French during the period 2000-2021. Study reporting followed the standards indicated by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist (PRISMA-ScR).
RESULTS
A total of 47 studies were identified for inclusion. Key results included differences in the type and frequency of complications according to admission type, the proportion of patients experiencing at least 1 complication, and complications associated with transfer to acute care.
CONCLUSION
Patients admitted for inpatient rehabilitation are at high risk of medical complications and may not be medically stable during their admission, requiring care by clinicians with expertise in functional rehabilitation, and ongoing management by members of the multidisciplinary team with expertise in acute general medicine, infectious diseases and recognition and response to clinical deterioration.
Topics: Adult; Humans; Clinical Deterioration; Hospitalization; Inpatients
PubMed: 36287186
DOI: 10.2340/jrm.v54.2752 -
PloS One 2022Guidelines recommend patient education materials (PEMs) for low back pain (LBP), but no systematic review has assessed PEMs on their own. We investigated the... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Guidelines recommend patient education materials (PEMs) for low back pain (LBP), but no systematic review has assessed PEMs on their own. We investigated the effectiveness of PEMs on process, clinical, and health system outcomes for LBP and sciatica.
METHODS
Systematic searches were performed in MEDLINE, EMBASE, CINAHL, PsycINFO, SPORTDiscus, trial registries and grey literature through OpenGrey. We included randomized controlled trials of PEMs for LBP. Data extraction, risk of bias, and quality of evidence gradings were performed independently by two reviewers. Standardized mean differences or risk ratios and 95% confidence intervals were calculated, and effect sizes pooled using random-effects models. Analyses of acute/subacute LBP were performed separately from chronic LBP at immediate, short, medium, and long-term (6, 12, 24, and 52 weeks, respectively).
RESULTS
27 studies were identified. Compared to usual care for chronic LBP, we found moderate to low-quality evidence that PEMs improved pain intensity at immediate (SMD = -0.16 [95% CI: -0.29, -0.03]), short (SMD = -0.44 [95% CI: -0.88, 0.00]), medium (SMD = -0.53 [95% CI: -1.01, -0.05]), and long-term (SMD = -0.21 [95% CI: -0.41, -0.01]), medium-term disability (SMD = -0.32 [95% CI: -0.61, -0.03]), quality of life at short (SMD = -0.17 [95% CI: -0.30, -0.04]) and medium-term (SMD = -0.23 [95% CI: -0.41, -0.04]) and very low-quality evidence that PEMs improved global improvement ratings at immediate (SMD = -0.40 [95% CI: -0.58, -0.21]), short (SMD = -0.42 [95% CI: -0.60, -0.24]), medium (SMD = -0.46 [95% CI: -0.65, -0.28]), and long-term (SMD = -0.43 [95% CI: -0.61, -0.24]). We found very low-quality evidence that PEMs improved pain self-efficacy at immediate (SMD = -0.21 [95% CI: -0.39, -0.03]), short (SMD = -0.25 [95% CI: -0.43, -0.06]), medium (SMD = -0.23 [95% CI: -0.41, -0.05]), and long-term (SMD = -0.32 [95% CI: -0.50, -0.13]), and reduced medium-term fear-avoidance beliefs (SMD = -0.24 [95% CI: -0.43, -0.06]) and long-term stress (SMD = -0.21 [95% CI: -0.39, -0.03]). Compared to usual care for acute LBP, we found high to moderate-quality evidence that PEMs improved short-term pain intensity (SMD = -0.24 [95% CI: -0.42, -0.06]) and immediate-term quality of life (SMD = -0.24 [95% CI: -0.42, -0.07]). We found low to very low-quality evidence that PEMs increased knowledge at immediate (SMD = -0.51 [95% CI: -0.72, -0.31]), short (SMD = -0.48 [95% CI: -0.90, -0.05]), and long-term (RR = 1.28 [95% CI: 1.10, 1.49]) and pain self-efficacy at short (SMD = -0.78 [95% CI: -0.98, -0.58]) and long-term (SMD = -0.32 [95% CI: -0.52, -0.12]). We found moderate to very low-quality evidence that PEMs reduced short-term days off work (SMD = -0.35 [95% CI: -0.63, -0.08]), long-term imaging referrals (RR = 0.60 [95% CI: 0.41, 0.89]), and long-term physician visits (SMD = -0.16 [95% CI: -0.26, -0.05]). Compared to other interventions (e.g., yoga, Pilates), PEMs had no effect or were less effective for acute/subacute and chronic LBP.
CONCLUSIONS
There was a high degree of variability across outcomes and time points, but providing PEMs appears favorable to usual care as we observed many small, positive patient and system impacts for acute/subacute and chronic LBP. PEMs were generally less effective than other interventions; however, no cost effectiveness analyses were performed to weigh the relative benefits of these interventions to the likely less costly PEMs.
Topics: Acute Pain; Humans; Low Back Pain; Patient Education as Topic; Quality of Life; Sciatica
PubMed: 36223377
DOI: 10.1371/journal.pone.0274527 -
BMJ Open Aug 2022Major organ complications have been reported in patients hospitalised for COVID-19; most studies lacked controls.
BACKGROUND
Major organ complications have been reported in patients hospitalised for COVID-19; most studies lacked controls.
OBJECTIVE
Examine major organ damage postdischarge among adults hospitalised for COVID-19 versus non-COVID-19 controls.
DATA SOURCES
MEDLINE, Embase and Cochrane Library from 1 January 2020 to 19 May 2021.
STUDY ELIGIBILITY CRITERIA
English language studies of adults discharged from hospital for COVID-19; reporting major organ damage. Single review of abstracts; independent dual review of full text.
STUDY APPRAISAL AND SYNTHESIS METHODS
Study quality was assessed using the Joanna Briggs Institute Appraisal Checklist for Cohort Studies. Outcome data were not pooled due to heterogeneity in populations, study designs and outcome assessment methods; findings are narratively synthesised.
RESULTS
Of 124 studies in a full evidence report, 9 included non-COVID controls and are described here. Four of the nine (three USA, one UK) used large administrative databases. Four of the remaining five studies enrolled <600 COVID-19 patients. Mean or median age ranged from 49 to 70 years with 46%-94% male and 48%-78% White race; 10%-40% had been in intensive care units. Follow-up ranged from 4 weeks to 22 weeks postdischarge. Four used hospitalised controls, three non-hospitalised controls and two were unclear. Studies used various definitions of, and methods to assess, major organ damage outcomes. While the magnitude of effect differed across studies, incident cardiac, pulmonary, liver, acute and chronic kidney, stroke, diabetes, and coagulation disorders were consistently greater in adults hospitalised for COVID-19 compared with non-COVID-19 controls.
LIMITATIONS
Applicability to subgroups (age, gender, COVID-19 severity, treatment, vaccination status) and non-hospitalised patients is unknown.
CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS
Postacute COVID-19 major organ damage is common and likely higher than controls. However, there is substantial uncertainty. More consistent reporting of clinical outcomes and pre-COVID health status along with careful selection of control groups are needed to address evidence gaps.
PROSPERO REGISTRATION NUMBER
CRD42020204788.
Topics: Adult; Aftercare; Aged; COVID-19; Female; Humans; Intensive Care Units; Male; Middle Aged; Patient Discharge; Subacute Care
PubMed: 36002211
DOI: 10.1136/bmjopen-2022-061245 -
JBI Evidence Synthesis Jan 2023The objective of this review was to examine the available evidence on the experiences and perceptions of nurses working the night shift within any specialty in the acute... (Review)
Review
OBJECTIVE
The objective of this review was to examine the available evidence on the experiences and perceptions of nurses working the night shift within any specialty in the acute care, subacute, or long-term care setting.
INTRODUCTION
Nurses are required for around-the-clock patient care. Night shift nurses can experience detrimental effects because of their work hours, which disrupt their normal circadian rhythm. Understanding nurses' experiences and perceptions when working night shift will facilitate the development of strategies to minimize the potential negative effects of working at night. In examining nurses' experiences and perceptions of working night shift, there is scope to explore how to improve night shift nurses' practice environment and job satisfaction, which will then translate to improved nurse and patient outcomes.
INCLUSION CRITERIA
This review included qualitative studies focused on the experiences and perceptions of registered nurses and licensed practical nurses who work the night shift or rotate between day and night shift.
METHODS
This review followed the JBI methodology for systematic reviews of qualitative evidence. The methodology used was consistent with the a priori protocol. Studies included in this review were those published in full text, English, and between 1983 (when the seminal work on hospitals that attract and retain nurses was published) and February 2021, when the search was completed. The main databases searched for published and unpublished studies included MEDLINE, CINAHL, Embase, PsycINFO, and Web of Science.From the search, two reviewers independently screened the studies against the inclusion criteria, and then papers selected for inclusion were assessed for methodological quality. Qualitative data were extracted from the included papers independently by the four reviewers. Results from each reviewer were discussed and clarified to reach agreement. The extracted findings were pooled and examined for shared meaning, coded, and grouped into categories. Common categories were grouped into meta-synthesis to produce a comprehensive set of synthesized findings. The final synthesized findings were graded using the ConQual approach to determine the level of confidence (trust) users may have in the value of the synthesized findings.
RESULTS
Thirty-four papers, representing 33 studies, met the criteria for inclusion. The studies were conducted in 11 countries across six continents, with a total of 601 participants. From these, a total of 220 findings were extracted and combined to form 11 categories based on similarity in meaning, and three syntheses were derived: i) The "Other" Shift: the distinctiveness of night nursing; ii) Juggling sleep and all aspects of life when working nights; and iii) Existing in the Twilight Zone: battling the negative impact of sleep deprivation consumes nurses who strive to keep patients, self, and others safe.
CONCLUSIONS
The major conclusions from this review are the uniqueness of working the night shift and the sleep deprivation of night nurses. Organizational strategies and support are needed for those working this shift, which will enhance nurse and patient safety.
SYSTEMATIC REVIEW REGISTRATION NUMBER
PROSPERO CRD42019135294.
Topics: Humans; Sleep Deprivation; Qualitative Research; Clinical Competence; Nurses
PubMed: 35975311
DOI: 10.11124/JBIES-21-00472 -
Occupational Therapy in Health Care Oct 2023Occupational therapy is beneficial among adults with chronic pain; however, occupational therapy interventions addressing earlier phases of pain have not been clearly...
Occupational therapy is beneficial among adults with chronic pain; however, occupational therapy interventions addressing earlier phases of pain have not been clearly explicated. This systematic review characterized acute and subacute interventions billable by occupational therapy after hip or knee replacement to improve pain and function. Seven articles met inclusion criteria. Six articles had a low risk of bias. Three intervention types were found: task-oriented exercise, water-based, and modalities. Only task-oriented interventions improved both pain and function one-year after surgery. There are long-term benefits to early task-oriented exercise. Further research is needed to contextualize occupational therapy's role in early pain interventions.
Topics: Adult; Humans; Occupational Therapy; Pain; Exercise; Arthroplasty, Replacement, Knee; Lower Extremity
PubMed: 35654087
DOI: 10.1080/07380577.2022.2066239 -
European Journal of Clinical Nutrition Jan 2023Despite advances in identifying malnutrition at hospital admission, decline in nutritional status of well-nourished patients can be overlooked. The aim of this... (Review)
Review
Despite advances in identifying malnutrition at hospital admission, decline in nutritional status of well-nourished patients can be overlooked. The aim of this systematic review was to investigate the incidence of hospital-acquired malnutrition (HAM), diagnostic criteria and health-related outcomes. PubMed, CINAHL, Embase and Cochrane Library were searched up to July 2021. Studies were included if changes in nutritional status was assessed with a validated nutrition assessment tool in acute and subacute adult (≥18 yrs) hospitalised patients. A random-effects method was used to pool the incidence proportion of HAM in prospective studies. The certainty of evidence was appraised using the Grading of Recommendation Assessment, Development and Evaluation system. We identified 12 observational cohort studies (10 prospective and 2 retrospective), involving 35,324 participants from acute (9 studies) and subacute settings (3 studies). Retrospective studies reported a lower incidence of HAM (<1.4%) than prospective studies (acute: 9-38%; subacute: 0-7%). The pooled incidence of HAM in acute care was 25.9% (95% confidence interval (CI): 17.3-34.6). Diagnostic criteria varied, with use of different nutrition assessment tools and timeframes for assessment (retrospective studies: >14 days; prospective studies: ≥7 days). Nutritional decline is probably associated with longer length of stay and higher 6-month readmission (moderate certainty of evidence) and may be association with higher complications and infections (low certainty of evidence). The higher incidence of HAM in the acute setting, where nutritional assessments are conducted prospectively, highlights the need for consensus regarding diagnostic criteria and further studies to understand the impact of HAM.
Topics: Adult; Humans; Incidence; Prospective Studies; Retrospective Studies; Malnutrition; Hospitals
PubMed: 35501387
DOI: 10.1038/s41430-022-01141-2 -
Pain Medicine (Malden, Mass.) Aug 2022Total knee arthroplasty (TKA) and total hip arthroplasty (THA) surgeries are among the most common elective procedures. Moderate to severe postoperative pain during the... (Review)
Review
Effectiveness of Pharmacological-Based Interventions, Including Education and Prescribing Strategies, to Reduce Subacute Pain After Total Hip or Knee Arthroplasty: A Systematic Review of Randomized Controlled Trials.
BACKGROUND
Total knee arthroplasty (TKA) and total hip arthroplasty (THA) surgeries are among the most common elective procedures. Moderate to severe postoperative pain during the subacute period (defined here as the period from hospital discharge to 3 months postoperatively) is a predictor of persistent pain 12 months postoperatively. This review aimed to examine the available postdischarge pharmacological interventions, including educational and prescribing strategies, and their effect on reducing pain during the subacute period after TKA or THA.
METHODS
We searched seven electronic databases from inception to April 22, 2021. Published randomized controlled trials of adults who underwent TKA or THA and received a pharmacological-based intervention commencing within 1 week after hospital discharge and conducted for up to 3 months postoperatively were compared with any treatment. Two reviewers independently extracted data on the primary outcome, pain intensity. This review was registered prospectively on PROSPERO (ID: CRD42021250384).
RESULTS
Four trials involving 660 participants were included. Interventions included changing analgesic prescribing practices upon hospital discharge and education on analgesic use. Providing multimodal non-opioid analgesia in addition to reduced opioid quantity was associated with lower subacute pain (coefficient -0.81; 95% confidence interval -1.33 to -0.29; P = 0.003). Education on analgesic use during multidisciplinary home visits was effective for reducing pain intensity during the subacute period (6.25 ± 10.13 vs 35.67 ± 22.05; P < 0.001) compared with usual care.
CONCLUSIONS
Interventions involving the provision of multimodal non-opioid analgesia and education on analgesic use show positive effects on reducing pain intensity during the subacute period after TKA and THA.
Topics: Adult; Aftercare; Analgesics; Analgesics, Opioid; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Humans; Pain, Postoperative; Patient Discharge; Randomized Controlled Trials as Topic
PubMed: 35325201
DOI: 10.1093/pm/pnac052 -
Frontiers in Neurology 2021Malnutrition is common after stroke and can affect rehabilitation and healthcare costs. A comprehensive overview of stroke patients' nutritional condition from the...
BACKGROUND
Malnutrition is common after stroke and can affect rehabilitation and healthcare costs. A comprehensive overview of stroke patients' nutritional condition from the hyperacute to the chronic phase is lacking. This systematic review aimed to investigate the prevalence of impaired nutritional condition (INC) across the continuum of care in specific phases after stroke.
METHODS
CAB ABSTRACTS, Embase, MEDLINE, were used to collect studies published between 01-01-1999 and 26-08-2020. Primary and secondary outcomes were prevalence of INC and prevalence of malnutrition, respectively. Exploratory outcomes were prevalence of INC at follow-up, nutritional examination methods, prevalence of dysphagia, stroke severity, adverse events, and continent-specific prevalence of INC. A random-effects meta-analysis model was used to estimate the phase-specific pooled prevalence of INC and malnutrition.
RESULTS
The dataset consisted of 78 study groups selected over a total of 1,244 identified records. The pooled prevalence of INC and malnutrition were 19% (95%CI:7-31) ( = 4) and 19% (95%CI:9-29) ( = 3), 34% (95%CI:25-43) ( = 34) and 26% (95%CI:18-35) ( = 29), 52% (95%CI:43-61) ( = 34) and 37% (95%CI:28-45) ( = 31), 21% (95%CI:12-31) ( = 3) and 11% (95%CI:0-24) ( = 3) and 72% (95%CI:41-100) ( = 3) and 30% (95%CI:0-76) ( = 2) in the hyperacute, acute, early subacute, late subacute, and chronic phase, respectively.
CONCLUSION
INC and malnutrition are highly prevalent in all stages of stroke care. Since malnutrition has been shown to negatively affect clinical outcomes, mortality, and overall healthcare expenditure in stroke survivors, it is essential to examine and monitor the nutritional status of stroke patients throughout their care journey to guide and plan, timely nutritional support and dietary modification.
PubMed: 35178021
DOI: 10.3389/fneur.2021.780080