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BMC Family Practice Jan 2021Postural hypotension (PH), the reduction in blood pressure when rising from sitting or lying 0to standing, is a risk factor for falls, cognitive decline and mortality.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Postural hypotension (PH), the reduction in blood pressure when rising from sitting or lying 0to standing, is a risk factor for falls, cognitive decline and mortality. However, it is not often tested for in primary care. PH prevalence varies according to definition, population, care setting and measurement method. The aim of this study was to determine the prevalence of PH across different care settings and disease subgroups.
METHODS
Systematic review, meta-analyses and meta-regression. We searched Medline and Embase to October 2019 for studies based in primary, community or institutional care settings reporting PH prevalence. Data and study level demographics were extracted independently by two reviewers. Pooled estimates for mean PH prevalence were compared between care settings and disease subgroups using random effects meta-analyses. Predictors of PH were explored using meta-regression. Quality assessment was undertaken using an adapted Newcastle-Ottawa Scale.
RESULTS
One thousand eight hundred sixteen studies were identified; 61 contributed to analyses. Pooled prevalences for PH using the consensus definition were 17% (95% CI, 14-20%; I = 99%) for 34 community cohorts, 19% (15-25%; I = 98%) for 23 primary care cohorts and 31% (15-50%; I = 0%) for 3 residential care or nursing homes cohorts (P = 0.16 between groups). By condition, prevalences were 20% (16-23%; I = 98%) with hypertension (20 cohorts), 21% (16-26%; I = 92%) with diabetes (4 cohorts), 25% (18-33%; I = 88%) with Parkinson's disease (7 cohorts) and 29% (25-33%, I = 0%) with dementia (3 cohorts), compared to 14% (12-17%, I = 99%) without these conditions (P < 0.01 between groups). Multivariable meta-regression modelling identified increasing age and diabetes as predictors of PH (P < 0.01, P = 0.13, respectively; R = 36%). PH prevalence was not affected by blood pressure measurement device (P = 0.65) or sitting or supine resting position (P = 0.24), however, when the definition of PH did not fulfil the consensus description, but fell within its parameters, prevalence was underestimated (P = 0.01) irrespective of study quality (P = 0.04).
CONCLUSIONS
PH prevalence in populations relevant to primary care is substantial and the definition of PH used is important. Our findings emphasise the importance of considering checking for PH, particularly in vulnerable populations, to enable interventions to manage it. These data should contribute to future guidelines relevant to the detection and treatment of PH.
PROSPERO
CRD42017075423.
Topics: Blood Pressure; Blood Pressure Determination; Humans; Hypertension; Hypotension, Orthostatic; Prevalence
PubMed: 33388038
DOI: 10.1186/s12875-020-01313-8 -
International Journal of Environmental... Dec 2020Active design is an emerging concept to incorporate physical activity into daily life through thoughtful design, and is often implemented in new building designs. It is,...
Active design is an emerging concept to incorporate physical activity into daily life through thoughtful design, and is often implemented in new building designs. It is, however, not known what evidence base there is to support the claims. Through this systematic review, the current evidence for active design was investigated. Seven databases were searched. A range of search terms relating to active design, physical activity, sitting, performance and wellbeing were used. After title and abstract screening of 1174 papers and full-text screening, 17 were selected for inclusion. The papers provided promising evidence of active design aiding a reduction in sitting and increase in standing time. Limited evidence was found for physical activity; a few studies reported an increase in step counts. Musculoskeletal effects were investigated in few studies, but there is some evidence of benefits to lower back pain. There was consistent evidence for better light and air quality, but no evidence for other features of the workplace environment. No conclusive evidence was found on associations between active design features and work performance. There is hence some evidence to support the benefit of active design on physical health; however, the dearth and heterogeneity of the study designs, measures and findings warrant further research.
Topics: Adult; Aged; Cross-Sectional Studies; Exercise; Humans; Interior Design and Furnishings; Sitting Position; Workplace
PubMed: 33321818
DOI: 10.3390/ijerph17249228 -
Bone & Joint Open Aug 2020To analyze outcomes reported in studies of Ponseti correction of idiopathic clubfoot.
AIMS
To analyze outcomes reported in studies of Ponseti correction of idiopathic clubfoot.
METHODS
A systematic review of the literature was performed to identify a list of outcomes and outcome tools reported in the literature. A total of 865 studies were screened following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and 124 trials were included in the analysis. Data extraction was completed by two researchers for each trial. Each outcome tool was assigned to one of the five core areas defined by the Outcome Measures Recommended for use in Randomized Clinical Trials (OMERACT). Bias assessment was not deemed necessary for the purpose of this paper.
RESULTS
In total, 20 isolated outcomes and 16 outcome tools were identified representing five OMERACT domains. Most outcome tools were appropriately designed for children of walking age but have not been embraced in the literature. The most commonly reported isolated outcomes are subjective and qualitative. The quantitative outcomes most commonly used are ankle range of motion (ROM), foot position in standing, and muscle function.
CONCLUSIONS
There is a diverse range of outcomes reported in studies of Ponseti correction of clubfoot. Until outcomes can be reported unequivocally and consistently, research in this area will be limited. Completing the process of establishing and validating COS is the much-needed next step.Cite this article: 2020;1-8:457-464.
PubMed: 33215139
DOI: 10.1302/2633-1462.18.BJO-2020-0109.R1 -
Sports Medicine (Auckland, N.Z.) Feb 2021Perineal pressure associated with bicycle riding is the cause of several genitourinary pathologies, most notably Alcock's syndrome and subsequent perineal numbness. The... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Perineal pressure associated with bicycle riding is the cause of several genitourinary pathologies, most notably Alcock's syndrome and subsequent perineal numbness. The possible link between cycling-induced perineal numbness and erectile dysfunction makes the development of strategies for perineal protection in bicycle users critical.
OBJECTIVE
To assess the effectiveness of strategies for reducing the impact of cycling on the perineum in healthy males.
METHODS
We have conducted a systematic review and a meta-analysis of studies examining various means of reducing the impact of cycling on the perineum under the PRISMA guidelines.
RESULTS
Out of 2217 screened studies, 22 met our inclusion criteria, and 6 qualified for meta-analysis. The strategies included various designs of saddles, changes in the cycling position, seat shock absorber, shorts with different padding, using the recumbent bike. Using the no-nose saddle and recumbent bike resulted in a significant reduction of perineal pressure and higher penile oxygen pressure compared with a standard saddle. Indirect evidence supports the protective effect of standing on the pedals every few minutes during cycling. More evidence is needed to support-or dismiss-other strategies.
CONCLUSIONS
Current evidence supports the use of no-nose saddles as a mean to reduce the negative impact of cycling on the perineum in healthy males at the cost of worse stability and increase of posterior seat pressure. Standing on the pedals every ten minutes might be an effective and potentially widely applicable strategy. The use of a recumbent bike appears to protect the perineum, but several concerns prevent its widespread use.
Topics: Bicycling; Erectile Dysfunction; Humans; Male; Oxygen; Penis; Perineum
PubMed: 33074460
DOI: 10.1007/s40279-020-01363-z -
Annals of Internal Medicine Jan 2021Although intensive blood pressure (BP)-lowering treatment reduces risk for cardiovascular disease, there are concerns that it might cause orthostatic hypotension (OH). (Meta-Analysis)
Meta-Analysis
BACKGROUND
Although intensive blood pressure (BP)-lowering treatment reduces risk for cardiovascular disease, there are concerns that it might cause orthostatic hypotension (OH).
PURPOSE
To examine the effects of intensive BP-lowering treatment on OH in hypertensive adults.
DATA SOURCES
MEDLINE, EMBASE, and Cochrane CENTRAL from inception through 7 October 2019, without language restrictions.
STUDY SELECTION
Randomized trials of BP pharmacologic treatment (more intensive BP goal or active agent) that involved more than 500 adults with hypertension or elevated BP and that were 6 months or longer in duration. Trial comparisons were groups assigned to either less intensive BP goals or placebo, and the outcome was measured OH, defined as a decrease of 20 mm Hg or more in systolic BP or 10 mm Hg or more in diastolic BP after changing position from seated to standing.
DATA EXTRACTION
2 investigators independently abstracted articles and rated risk of bias.
DATA SYNTHESIS
5 trials examined BP treatment goals, and 4 examined active agents versus placebo. Trials examining BP treatment goals included 18 466 participants with 127 882 follow-up visits. Trials were open-label, with minimal heterogeneity of effects across trials. Intensive BP treatment lowered risk for OH (odds ratio, 0.93 [95% CI, 0.86 to 0.99]). Effects did not differ by prerandomization OH ( for interaction = 0.80). In sensitivity analyses that included 4 additional placebo-controlled trials, overall and subgroup findings were unchanged.
LIMITATIONS
Assessments of OH were done while participants were seated (not supine) and did not include the first minute after standing. Data on falls and syncope were not available.
CONCLUSION
Intensive BP-lowering treatment decreases risk for OH. Orthostatic hypotension, before or in the setting of more intensive BP treatment, should not be viewed as a reason to avoid or de-escalate treatment for hypertension.
PRIMARY FUNDING SOURCE
National Heart, Lung, and Blood Institute, National Institutes of Health. (PROSPERO: CRD42020153753).
Topics: Antihypertensive Agents; Blood Pressure; Blood Pressure Determination; Humans; Hypertension; Hypotension, Orthostatic
PubMed: 32909814
DOI: 10.7326/M20-4298 -
Clinical Rehabilitation Jan 2021This systematic review analysed the evidence for the effect of head-up tilt (passive-standing) on consciousness among persons in prolonged disorders of consciousness.
OBJECTIVE
This systematic review analysed the evidence for the effect of head-up tilt (passive-standing) on consciousness among persons in prolonged disorders of consciousness.
DATA SOURCES
Articles were identified through primary database searching (Medline, CINAHL, AMED, The Cochrane Library) and post-citation searching (Scopus).
REVIEW METHODS
This review followed the PRISMA statement. The search strategy was created to find articles that combined any conceivable passive standing device, any measure of consciousness and disorders of consciousness of any origin. Inclusion criteria were any papers that evaluated the use of head-up tilt in adults in defined disorders of consciousness. Exclusion criteria included active stand studies, paediatric studies and animal studies.The search was completed independently by two researchers. Data collection and risk of bias assessment was completed using the Downs and Black tool.
RESULTS
6867 titles were retrieved (last search completed 21/6/20). Ten papers met the inclusion criteria: five examined the effects of a single head-up tilt treatment, and five the effects of head-up tilt regimes. Eighty-seven participants were randomised in three randomised controlled trials. In the remaining preliminary studies or case series, 233 participants were analysed. Quality was low, with only two high-quality studies available. Four studies were suitable for effect size analysis, where medium to large effect sizes were found. The two high-quality studies found head-up tilt had a large effect on consciousness.
CONCLUSION
Overall there is some evidence that repeated passive standing on a tilt-table can improve consciousness, but the relevant studies provoke further questions.
Topics: Adult; Consciousness; Consciousness Disorders; Humans; Patient Positioning; Standing Position
PubMed: 32734772
DOI: 10.1177/0269215520946696 -
International Journal of Occupational... Sep 2020The head is an important element of the biokinetic chain. Under physiological conditions, it should extend along the midline of the body. Due to its location and the...
The head is an important element of the biokinetic chain. Under physiological conditions, it should extend along the midline of the body. Due to its location and the fact that it constitutes approx. 6% of the total body weight, many authors believe it has a significant impact on its functioning. The aim of this study was to conduct a systematic literature search and to synthesize the evidence of the impact of the head posture on the functioning of the human body. A systematic review was conducted within 3 databases: PubMed, Medline OVID, and EBSCO, using the following terms: "forward head," "posture," "position," and "neck." For the analysis, scientific articles published after 2013 were selected. A total of 16 studies matched the inclusion criteria of this systematic review. Their results have proven that the position of the head has a significant effect on the human body. Research findings show that abnormal head position changes affect muscle activity, proprioception, the pattern of breathing and neck pain. This is the first systematic review of the relationship between the head posture, and the functioning of the human body. The results of this study seem to be promising if used in therapeutic practice. Int J Occup Med Environ Health. 2020;33(5):559-68.
Topics: Head; Human Body; Humans; Neck; Postural Balance; Standing Position
PubMed: 32713947
DOI: 10.13075/ijomeh.1896.01585 -
Neurosciences (Riyadh, Saudi Arabia) Jul 2020To find out new assessment tools for sitting, in patients with neurological and neuromuscular conditions, to be recommended for rehabilitation practice locally in Saudi...
OBJECTIVE
To find out new assessment tools for sitting, in patients with neurological and neuromuscular conditions, to be recommended for rehabilitation practice locally in Saudi Arabia and internationally.
METHODS
Four databases were used: PubMed, Web of Science, Ovid Medline, and Cochrane. Inclusion criteria were articles published between the years 2009-2019; sitting, not standing or walking; assessment not intervention; published in English and studies on adults only. Exclusion criteria were any assessment that measures the standing/walking ability or has items for that, and studies that include pediatric or adolescent or both.
RESULTS
Ten articles met our criteria including 464 patients and divided into 3 main neurological conditions (stroke, SCI, and MS). One assessment (Function in Sitting Test) showed promising potential being implemented with both stroke and multiple sclerosis, Cronbach`s alpha, alpha were 0.91 and 0.98 indicating high internal consistency. It was used with SCI patients, however, no access was available to include this study in this review.
CONCLUSION
This review indicates an extension of what was carried out by previous systematic reviews with neurological conditions. It seems that Function in Sitting Test is the most frequent assessment in this review with multiple neurological conditions (stroke, MS and SCI) with high internal consistency and high quality studies according to available data. However, this review showed that there is an absence of evidence for individuals with brain injury and muscular dystrophy. Further work needs to be carried out to address such groups of patients to extend the choices that clinicians can use in rehabilitation sittings.
Topics: Humans; Multiple Sclerosis; Neurologic Examination; Neuromuscular Diseases; Postural Balance; Sitting Position; Spinal Cord Injuries; Stroke
PubMed: 32683409
DOI: 10.17712/nsj.2020.3.20190592 -
The Cochrane Database of Systematic... Jul 2020Adults spend a majority of their time outside the workplace being sedentary. Large amounts of sedentary behaviour increase the risk of type 2 diabetes, cardiovascular... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Adults spend a majority of their time outside the workplace being sedentary. Large amounts of sedentary behaviour increase the risk of type 2 diabetes, cardiovascular disease, and both all-cause and cardiovascular disease mortality.
OBJECTIVES
Primary • To assess effects on sedentary time of non-occupational interventions for reducing sedentary behaviour in adults under 60 years of age Secondary • To describe other health effects and adverse events or unintended consequences of these interventions • To determine whether specific components of interventions are associated with changes in sedentary behaviour • To identify if there are any differential effects of interventions based on health inequalities (e.g. age, sex, income, employment) SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, Cochrane Database of Systematic Reviews, CINAHL, PsycINFO, SportDiscus, and ClinicalTrials.gov on 14 April 2020. We checked references of included studies, conducted forward citation searching, and contacted authors in the field to identify additional studies.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) and cluster RCTs of interventions outside the workplace for community-dwelling adults aged 18 to 59 years. We included studies only when the intervention had a specific aim or component to change sedentary behaviour.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened titles/abstracts and full-text articles for study eligibility. Two review authors independently extracted data and assessed risk of bias. We contacted trial authors for additional information or data when required. We examined the following primary outcomes: device-measured sedentary time, self-report sitting time, self-report TV viewing time, and breaks in sedentary time.
MAIN RESULTS
We included 13 trials involving 1770 participants, all undertaken in high-income countries. Ten were RCTs and three were cluster RCTs. The mean age of study participants ranged from 20 to 41 years. A majority of participants were female. All interventions were delivered at the individual level. Intervention components included personal monitoring devices, information or education, counselling, and prompts to reduce sedentary behaviour. We judged no study to be at low risk of bias across all domains. Seven studies were at high risk of bias for blinding of outcome assessment due to use of self-report outcomes measures. Primary outcomes Interventions outside the workplace probably show little or no difference in device-measured sedentary time in the short term (mean difference (MD) -8.36 min/d, 95% confidence interval (CI) -27.12 to 10.40; 4 studies; I² = 0%; moderate-certainty evidence). We are uncertain whether interventions reduce device-measured sedentary time in the medium term (MD -51.37 min/d, 95% CI -126.34 to 23.59; 3 studies; I² = 84%; very low-certainty evidence) We are uncertain whether interventions outside the workplace reduce self-report sitting time in the short term (MD -64.12 min/d, 95% CI -260.91 to 132.67; I² = 86%; very low-certainty evidence). Interventions outside the workplace may show little or no difference in self-report TV viewing time in the medium term (MD -12.45 min/d, 95% CI -50.40 to 25.49; 2 studies; I² = 86%; low-certainty evidence) or in the long term (MD 0.30 min/d, 95% CI -0.63 to 1.23; 2 studies; I² = 0%; low-certainty evidence). It was not possible to pool the five studies that reported breaks in sedentary time given the variation in definitions used. Secondary outcomes Interventions outside the workplace probably have little or no difference on body mass index in the medium term (MD -0.25 kg/m², 95% CI -0.48 to -0.01; 3 studies; I² = 0%; moderate-certainty evidence). Interventions may have little or no difference in waist circumference in the medium term (MD -2.04 cm, 95% CI -9.06 to 4.98; 2 studies; I² = 65%; low-certainty evidence). Interventions probably have little or no difference on glucose in the short term (MD -0.18 mmol/L, 95% CI -0.30 to -0.06; 2 studies; I² = 0%; moderate-certainty evidence) and medium term (MD -0.08 mmol/L, 95% CI -0.21 to 0.05; 2 studies, I² = 0%; moderate-certainty evidence) Interventions outside the workplace may have little or no difference in device-measured MVPA in the short term (MD 1.99 min/d, 95% CI -4.27 to 8.25; 4 studies; I² = 23%; low-certainty evidence). We are uncertain whether interventions improve device-measured MVPA in the medium term (MD 6.59 min/d, 95% CI -7.35 to 20.53; 3 studies; I² = 70%; very low-certainty evidence). We are uncertain whether interventions outside the workplace improve self-reported light-intensity PA in the short-term (MD 156.32 min/d, 95% CI 34.34 to 278.31; 2 studies; I² = 79%; very low-certainty evidence). Interventions may have little or no difference on step count in the short-term (MD 226.90 steps/day, 95% CI -519.78 to 973.59; 3 studies; I² = 0%; low-certainty evidence) No data on adverse events or symptoms were reported in the included studies.
AUTHORS' CONCLUSIONS
Interventions outside the workplace to reduce sedentary behaviour probably lead to little or no difference in device-measured sedentary time in the short term, and we are uncertain if they reduce device-measured sedentary time in the medium term. We are uncertain whether interventions outside the workplace reduce self-reported sitting time in the short term. Interventions outside the workplace may result in little or no difference in self-report TV viewing time in the medium or long term. The certainty of evidence is moderate to very low, mainly due to concerns about risk of bias, inconsistent findings, and imprecise results. Future studies should be of longer duration; should recruit participants from varying age, socioeconomic, or ethnic groups; and should gather quality of life, cost-effectiveness, and adverse event data. We strongly recommend that standard methods of data preparation and analysis are adopted to allow comparison of the effects of interventions to reduce sedentary behaviour.
Topics: Adult; Bias; Confidence Intervals; Counseling; Exercise; Female; Fitness Trackers; Health Education; Humans; Independent Living; Male; Middle Aged; Randomized Controlled Trials as Topic; Sedentary Behavior; Self Report; Sitting Position; Television; Time Factors; Young Adult
PubMed: 32678471
DOI: 10.1002/14651858.CD012554.pub2 -
Journal of Cerebral Blood Flow and... May 2020The effects of upright postures on the cerebral circulation early post-ischaemic stroke are not fully understood. We conducted a systematic review and meta-analysis to...
The effects of upright postures on the cerebral circulation early post-ischaemic stroke are not fully understood. We conducted a systematic review and meta-analysis to investigate the effects of head positioning on cerebral haemodynamics assessed by imaging methods post-ischaemic stroke. Of the 21 studies included ( = 529), 15 used transcranial Doppler. Others used near-infrared, diffuse correlation spectroscopy and nuclear medicine modalities. Most tested head positions between 0° and 45°. Seventeen studies reported changes in CBF parameters (increase at lying-flat or decrease at more upright) in the ischaemic hemisphere with position change. However, great variability was found and risk of bias was high in many studies. Pooled data of two studies ≤24 h ( = 28) showed a mean increase in cerebral blood flow (CBF) velocity of 8.5 cm/s in the ischaemic middle cerebral artery (95%CI,-2.2-19.3) from 30° to 0°. The increase found ≤48 h ( = 50) was of 2.3 cm/s (95%CI,-4.6-9.2), while ≤7 days ( = 38) was of 8.4 cm/s (95%CI, 1.8-15). Few very early studies (≤2 days) tested head positions greater than 30° and were unable to provide information about the response of acute stroke patients to upright postures (sitting, standing). These postures are part of current clinical practice and knowledge on their effects on cerebral haemodynamics is required.
PubMed: 32404023
DOI: 10.1177/0271678X20922457