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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 -
Ophthalmic Epidemiology Apr 2022Age-related macular degeneration (AMD), a leading cause of irreversible blindness, increases fall risk through impaired central vision. Falls place an enormous economic...
PURPOSE
Age-related macular degeneration (AMD), a leading cause of irreversible blindness, increases fall risk through impaired central vision. Falls place an enormous economic burden on healthcare systems. We hypothesized that AMD treatments may reduce patients' falls risk. This systematic review (ID #: 172623) synthesized the current understanding of wet and dry AMD treatments' impact on patient falls and mobility, connecting these two public health issues.
METHODS
On April 17, 2020, PubMed, Scopus, CINAHL, and the Cochrane Central Register of Controlled Trials were queried. Clinical trials and observational studies were included, while non-English and non-primary studies were excluded. Two authors screened, extracted data, and assessed bias using RoB-2 and ROBINS-I. A third author served as a tie breaker.
RESULTS
This database search resulted in 3,525 studies, with an additional 112 identified through bibliography review. Ten articles met eligibility criteria. Most studies featured the outcome of interest as a secondary outcome (n = 4) and patient-reported adverse events (n = 5), rather than a primary focus (n = 2). Ten out of the 11 outcomes had a moderate to serious risk of bias. No two studies used the same instrument to measure falls or mobility.
CONCLUSION
Despite the potential positive impact of AMD treatments on patient falls and mobility, quality data on this relationship are lacking. This work underscores the need to broaden ophthalmologic research outcomes beyond visual parameters to include patient-centred, functional measures. Incorporating standardized methods to track falls and screen for difficulty with walking and balance would enable evaluation of AMD treatments on functional outcomes, potentially helping guide management.
Topics: Accidental Falls; Geographic Atrophy; Humans; Macular Degeneration; Visual Acuity
PubMed: 33993827
DOI: 10.1080/09286586.2021.1921227 -
International Journal of Nursing Studies Jun 2021Impaired physical mobility refers to a limitation in independent and purposeful physical movement of the body or one or more extremities. Physical restrictions result in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Impaired physical mobility refers to a limitation in independent and purposeful physical movement of the body or one or more extremities. Physical restrictions result in negative consequences on an individual's physical and psychosocial functions. Sitting Tai Chi, a derivative form of traditional Tai Chi, has been found to increase the flexibility of all joints involved and enhance the ability to perform physical activity. However, the evidence of sitting Tai Chi on physical and psychosocial health outcomes on individuals with impaired physical mobility is limited.
OBJECTIVES
To critically synthesize evidence that evaluates the effects of sitting Tai Chi on health outcomes among individuals with impaired physical mobility and to identify implementation strategies for the sitting Tai Chi intervention.
METHODS
Searches were performed across 11 English and two Chinese databases systematically from inception to January 2020. Randomised controlled trials and non-randomised controlled trials, written in English or Chinese were included. Two independent reviewers screened all eligible studies, appraised risk of bias, and extracted the data. Meta-analyses were conducted using Review Manager 5.4 and narrative syntheses were performed where meta-analysis was inappropriate. The certainty of evidence was assessed using Grades of Recommendation, Assessment, Development and Evaluation profiler Guideline Development Tool. This study was registered in PROSPERO.
RESULTS
A total of 1,446 records were generated and 11 studies were eligible for inclusion. Meta-analysis reported a statistically significant effect size favouring sitting Tai Chi on depressive symptoms (SMD: -1.53, 95% CI: -2.81 to -0.21, 2 studies; very low quality), heart rate (MD: -5.72, 95% CI: -11.16 to -0.29, 2 studies; low quality) and social domain of quality of life (MD: 1.42, 95% CI: 0.66 to 2.19, 3 studies; low quality).
CONCLUSIONS
Sitting Tai Chi was found to have favourable effects on depressive symptoms, heart rate, and social domain of quality of life of individuals with impaired physical mobility. Very low to low quality evidence does not support the effectiveness of sitting Tai Chi on dynamic sitting balance, handgrip strength, and the physical and psychological domains of quality of life. There was limited evidence to suggest the best implementation strategies for the sitting Tai Chi intervention. It is anticipated that more well-designed studies will continue developing high quality evidence in this field.
Topics: Exercise; Hand Strength; Humans; Outcome Assessment, Health Care; Quality of Life; Tai Ji
PubMed: 33751992
DOI: 10.1016/j.ijnurstu.2021.103911 -
International Journal of Rheumatic... May 2021Patients with spondyloarthritis (SpA) may have a greater risk of falling due to poor postural balance and decreased mobility. To our best knowledge, there are no...
OBJECTIVE
Patients with spondyloarthritis (SpA) may have a greater risk of falling due to poor postural balance and decreased mobility. To our best knowledge, there are no published reviews that study falls in patients with SpA. Therefore, we aim to systematically review the literature and identify the prevalence and risk factors of falls in patients with SpA.
METHODS
We conducted a systematic review using 5 electronic databases: PubMed, EMBASE, Scopus, Web of Science and Google Scholar using controlled vocabulary terms (eg MeSH terms) in the search strategy for the concepts: falls, fall risk, SpA and its subtypes.
RESULTS
We identified 7279 articles, of which 3 studies with a total of 441 patients were included. Prevalence of falls ranged from 13% to 25%. We identified 16 main factors across 5 categories. Under socio-demographic factors, functional limitation, decreased quality of life, advanced age and job loss were associated with an increased risk of falls. Poor balance and mobility and fear of falling were associated with increased risk of falls. Active disease and symptoms of SpA were medical factors that were associated with increased risk of falls. Medication factors including polypharmacy, myorelaxants and antidepressants were not associated with increased fall risk.
CONCLUSION
We identified potentially modifiable risk factors associated with increased risk of falls in patients with SpA, including functional limitation, poor balance and mobility, fear of falling and active disease. Clinicians should recognize these factors and address them in the holistic management of patients with SpA, thereby reducing falls and their complications.
Topics: Accidental Falls; Aged; Fear; Female; Humans; Male; Middle Aged; Postural Balance; Prevalence; Quality of Life; Risk Factors; Spondylitis, Ankylosing
PubMed: 33704897
DOI: 10.1111/1756-185X.14092 -
Health Technology Assessment... Feb 2021A rotator cuff tear is a common, disabling shoulder problem. Symptoms may include pain, weakness, lack of shoulder mobility and sleep disturbance. Many patients require...
BACKGROUND
A rotator cuff tear is a common, disabling shoulder problem. Symptoms may include pain, weakness, lack of shoulder mobility and sleep disturbance. Many patients require surgery to repair the tear; however, there is a high failure rate. There is a need to improve the outcome of rotator cuff surgery, and the use of patch augmentation (on-lay or bridging) to provide support to the healing process and improve patient outcomes holds promise. Patches have been made using different materials (e.g. human/animal skin or tissue and synthetic materials) and processes (e.g. woven or mesh).
OBJECTIVES
The aim of the Patch Augmented Rotator Cuff Surgery (PARCS) feasibility study was to determine the design of a definitive randomised controlled trial assessing the clinical effectiveness and cost-effectiveness of a patch to augment surgical repair of the rotator cuff that is both acceptable to stakeholders and feasible.
DESIGN
A mixed-methods feasibility study of a randomised controlled trial.
DATA SOURCES
MEDLINE, EMBASE and the Cochrane Library databases were searched between April 2006 and August 2018.
METHODS
The project involved six stages: a systematic review of clinical evidence, a survey of the British Elbow and Shoulder Society's surgical membership, a survey of surgeon triallists, focus groups and interviews with stakeholders, a two-round Delphi study administered via online questionnaires and a 2-day consensus meeting. The various stakeholders (including patients, surgeons and industry representatives) were involved in stages 2-6.
RESULTS
The systematic review comprised 52 studies; only 15 were comparative and, of these, 11 were observational (search conducted in August 2018). These studies were typically small (median number of participants 26, range 5-152 participants). There was some evidence to support the use of patches, although most comparative studies were at a serious risk of bias. Little to no published clinical evidence was available for a number of patches in clinical use. The membership survey of British Elbow and Shoulder surgeons [105 (21%) responses received] identified a variety of patches in use. Twenty-four surgeons (77%) completed the triallist survey relating to trial design. Four focus groups were conducted, involving 24 stakeholders. Differing views were held on a number of aspects of trial design, including the appropriate patient population (e.g. patient age) to participate. Agreement on the key research questions and the outline of two potential randomised controlled trials were achieved through the Delphi study [29 (67%)] and the consensus meeting that 22 participants attended.
LIMITATIONS
The main limitation was that the findings were influenced by the participants, who are not necessarily representative of the views of the relevant stakeholder groups.
CONCLUSION
The need for further clinical studies was clear, particularly given the range and number of different patches available.
FUTURE WORK
Randomised comparisons of on-lay patch use for completed rotator cuff repairs and bridging patch use for partial rotator cuff repairs were identified as areas for further research. The value of an observational study to assess safety concerns of patch use was also highlighted. These elements are included in the trial designs proposed in this study.
STUDY REGISTRATION
The systematic review is registered as PROSPERO CRD42017057908.
FUNDING
This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in ; Vol. 25, No. 13. See the NIHR Journals Library website for further project information.
Topics: Animals; Cost-Benefit Analysis; Feasibility Studies; Humans; Observational Studies as Topic; Randomized Controlled Trials as Topic; Rotator Cuff; Surveys and Questionnaires; Treatment Outcome
PubMed: 33646096
DOI: 10.3310/hta25130 -
Physiotherapy Jun 2021To establish the evidence for rehabilitation interventions tested in populations of patients admitted to ICU and critical care with severe respiratory illness, and...
OBJECTIVES
To establish the evidence for rehabilitation interventions tested in populations of patients admitted to ICU and critical care with severe respiratory illness, and consider whether the evidence is generalizable to patients with COVID-19.
METHODS
The authors undertook a rapid systematic review. Medline (via OvidSP), CINAHL Complete (via EBSCOhost), Cochrane Library, Cochrane Database of Systematic Reviews and CENTRAL (via Wiley), Epistemonikos (via Epistemonikos.org), PEDro (via pedro.org.au) and OTseeker (via otseeker.com) searched to 7 May 2020. The authors included systematic reviews, RCTs and qualitative studies involving adults with respiratory illness requiring intensive care who received rehabilitation to enhance or restore resulting physical impairments or function. Data were extracted by one author and checked by a second. TIDier was used to guide intervention descriptions. Study quality was assessed using Critical Skills Appraisal Programme (CASP) tools.
RESULTS
Six thousand nine hundred and three titles and abstracts were screened; 24 systematic reviews, 11 RCTs and eight qualitative studies were included. Progressive exercise programmes, early mobilisation and multicomponent interventions delivered in ICU can improve functional independence. Nutritional supplementation in addition to rehabilitation in post-ICU hospital settings may improve performance of activities of daily living. The evidence for rehabilitation after discharge from hospital following an ICU admission is inconclusive. Those receiving rehabilitation valued it, engendering hope and confidence.
CONCLUSIONS
Exercise, early mobilisation and multicomponent programmes may improve recovery following ICU admission for severe respiratory illness that could be generalizable to those with COVID-19. Rehabilitation interventions can bring hope and confidence to individuals but there is a need for an individualised approach and the use of behaviour change strategies. Further research is needed in post-ICU settings and with those who have COVID-19. Registration: Open Science Framework https://osf.io/prc2y.
Topics: Activities of Daily Living; COVID-19; Early Ambulation; Electric Stimulation Therapy; Exercise Therapy; Humans; Intensive Care Units; Mobility Limitation; Patient Discharge; SARS-CoV-2
PubMed: 33637294
DOI: 10.1016/j.physio.2021.01.007 -
International Journal of Health... Jan 2021Numerous studies have examined the association between safety and primary school-aged children's forms of active mobility. However, variations in studies' measurement... (Review)
Review
BACKGROUND
Numerous studies have examined the association between safety and primary school-aged children's forms of active mobility. However, variations in studies' measurement methods and the elements addressed have contributed to inconsistencies in research outcomes, which may be forming a barrier to advancing researchers' knowledge about this field. To assess where current research stands, we have synthesised the methodological measures in studies that examined the effects of neighbourhood safety exposure (perceived and measured) on children's outdoor active mobility behaviour and used this analysis to propose future research directions.
METHOD
A systematic search of the literature in six electronic databases was conducted using pre-defined eligibility criteria and was concluded in July 2020. Two reviewers screened the literature abstracts to determine the studies' inclusion, and two reviewers independently conducted a methodological quality assessment to rate the included studies.
RESULTS
Twenty-five peer-reviewed studies met the inclusion criteria. Active mobility behaviour and health characteristics were measured objectively in 12 out of the 25 studies and were reported in another 13 studies. Twenty-one studies overlooked spatiotemporal dimensions in their analyses and outputs. Delineations of children's neighbourhoods varied within 10 studies' objective measures, and the 15 studies that opted for subjective measures. Safety perceptions obtained in 22 studies were mostly static and primarily collected via parents, and dissimilarities in actual safety measurement methods were present in 6 studies. The identified schematic constraints in studies' measurement methods assisted in outlining a three-dimensional relationship between 'what' (determinants), 'where' (spatial) and 'when' (time) within a methodological conceptual framework.
CONCLUSIONS
The absence of standardised measurement methods among relevant studies may have led to the current diversity in findings regarding active mobility, spatial (locality) and temporal (time) characteristics, the neighbourhood, and the representation of safety. Ignorance of the existing gaps and heterogeneity in measures may impact the reliability of evidence and poses a limitation when synthesising findings, which could result in serious biases for policymakers. Given the increasing interest in children's health studies, we suggested alternatives in the design and method of measures that may guide future evidence-based research for policymakers who aim to improve children's active mobility and safety.
Topics: Child; Humans; Parents; Reproducibility of Results; Residence Characteristics; Schools
PubMed: 33413433
DOI: 10.1186/s12942-020-00254-w -
European Journal of Vascular and... Mar 2021Most major lower limb amputations are related to peripheral artery disease (PAD) or diabetes. Just 40% of patients who undergo major lower limb amputation will use a...
OBJECTIVE
Most major lower limb amputations are related to peripheral artery disease (PAD) or diabetes. Just 40% of patients who undergo major lower limb amputation will use a prosthesis yet measures of surgical success commonly focus on prosthesis use. Patient reported outcome measures (PROMs) are valuable to comprehensively evaluate health related quality of life (HRQL) after surgery. This systematic review aimed to identify and describe PROMs available to assess HRQL in patients after amputation for PAD or diabetes.
METHODS
A search was conducted based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) for systematic reviews of PROMs. Ovid MEDLINE, Ovid EMBASE, PsycINFO, CINAHL, and Cochrane CENTRAL were also searched from inception until August 2019. Included were articles describing the development, measurement properties, or evaluation of HRQL via a PROM in adult patients after amputation for PAD or diabetes. Studies of amputation exclusively for trauma or malignancy were excluded. Data were collected on study characteristics, PROM characteristics (generic/disease specific), and properties of amputation specific PROMs.
RESULTS
Of 3 317 abstracts screened, 111 full text articles were assessed for eligibility and 64 included. Fifty-six studies evaluated HRQL, with 23 (46%) of these using an amputation specific PROM to do so. Eleven different amputation specific PROMs were identified, 10 (91%) of which were developed only for prosthesis users. One measure was suitable for use in all patients after amputation. This "Amputee single item mobility measure" includes a single item evaluating mobility. Nine studies reported some psychometric testing of an amputation specific PROM.
CONCLUSION
A well tested, multidimensional PROM applicable to wheelchair and prosthetic users after amputation is lacking and urgently needed for studies in this field. Future work to develop an appropriate measure is required.
Topics: Amputation, Surgical; Amputees; Artificial Limbs; Dependent Ambulation; Diabetic Angiopathies; Health Status; Humans; Lower Extremity; Mobility Limitation; Patient Reported Outcome Measures; Peripheral Arterial Disease; Prosthesis Fitting; Quality of Life; Treatment Outcome; Wheelchairs
PubMed: 33388237
DOI: 10.1016/j.ejvs.2020.11.043 -
Journal of Applied Gerontology : the... May 2021Global positioning system (GPS) technology has been increasingly used in aging research as a tool for reliably capturing the level and patterns of mobility among older...
Global positioning system (GPS) technology has been increasingly used in aging research as a tool for reliably capturing the level and patterns of mobility among older adults. This article aims to systematically review the current state of GPS-based mobility research with community-dwelling older adults. Twenty-nine studies from 2008 to 2019 are included. Included studies examined various forms of temporal and spatial mobility measures. This review provides a synthesis of the current evidence on the risk factors or correlates of GPS-driven mobility limitations, such as demographic, cognitive, physical, psychological, and environmental factors. There is variability in types of GPS technology and GPS-derived mobility measures, GPS recording methods, data processing, and correlates of mobility limitation across studies. Future research should focus on identifying meaningful GPS-derived mobility measures and developing standardized protocols for GPS administration and data analytics for comparison across studies.
Topics: Aged; Geographic Information Systems; Humans; Independent Living; Mobility Limitation; Technology
PubMed: 33356769
DOI: 10.1177/0733464820979801 -
Hematology, Transfusion and Cell Therapy 2021Hematopoietic stem cell transplantation (HSCT) is a treatment that requires long periods of hospitalization. The mobility restrictions result in physical, functional and... (Review)
Review
Hematopoietic stem cell transplantation (HSCT) is a treatment that requires long periods of hospitalization. The mobility restrictions result in physical, functional and psychological impairments. Physical exercise is a therapy that can restore physical and functional capacities; however, it is necessary to understand the effects of its practice in post-HSCT individuals. The purpose of this systematic review (SR) was to assess the impact of physical exercise in children and adolescents undergoing HSCT. The SR was conducted following the PRISMA guidelines through search in the electronic databases Embase, Lilacs, PEDro, PubMed and SCOPUS, without limitation of dates and languages. Randomized or non-randomized clinical trials with children and adolescents who underwent HSCT, aged between 3 to 19 years old, who participated in a regular physical activity program, were assessed. After removing duplicates and selecting studies according to the eligibility criteria, seven parallel studies incorporating hospitalized and discharged participants undertaking aerobic and strengthening exercises were included in this study. The main outcomes analyzed were exercise capacity, quality-of-life, body composition and freedom. Five studies comprised the meta-analysis regarding the effects of the distance walked in the 6-min walk test and quality-of-life. Physical exercise is considered to be safe, feasible and efficacious to prevent the decline of the quality-of-life in children and adolescents undergoing HCST, as well as a considerable improvement in physical capacity.
PubMed: 33288491
DOI: 10.1016/j.htct.2020.07.013