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Healthcare (Basel, Switzerland) Jun 2024To determine whether allied health interventions delivered using telehealth provide similar or better outcomes for patients compared with traditional face-to-face... (Review)
Review
To determine whether allied health interventions delivered using telehealth provide similar or better outcomes for patients compared with traditional face-to-face delivery modes. A rapid systematic review using the Cochrane methodology to extract eligible randomized trials. Trials were eligible for inclusion if they compared a comparable dose of face-to-face to telehealth interventions delivered by a neuropsychologist, occupational therapist, physiotherapist, podiatrist, psychologist, and/or speech pathologist; reported patient-level outcomes; and included adult participants. MEDLINE, CENTRAL, CINAHL, and EMBASE databases were first searched from inception for systematic reviews and eligible trials were extracted from these systematic reviews. These databases were then searched for randomized clinical trials published after the date of the most recent systematic review search in each discipline (2017). The reference lists of included trials were also hand-searched to identify potentially missed trials. The risk of bias was assessed using the Cochrane Risk of Bias Tool Version 1. Fifty-two trials (62 reports, = 4470) met the inclusion criteria. Populations included adults with musculoskeletal conditions, stroke, post-traumatic stress disorder, depression, and/or pain. Synchronous and asynchronous telehealth approaches were used with varied modalities that included telephone, videoconferencing, apps, web portals, and remote monitoring, Overall, telehealth delivered similar improvements to face-to-face interventions for knee range, Health-Related Quality of Life, pain, language function, depression, anxiety, and Post-Traumatic Stress Disorder. This meta-analysis was limited for some outcomes and disciplines such as occupational therapy and speech pathology. Telehealth was safe and similar levels of satisfaction and adherence were found across modes of delivery and disciplines compared to face-to-face interventions. Many allied health interventions are equally as effective as face-to-face when delivered via telehealth. Incorporating telehealth into models of care may afford greater access to allied health professionals, however further comparative research is still required. In particular, significant gaps exist in our understanding of the efficacy of telehealth from podiatrists, occupational therapists, speech pathologists, and neuropsychologists. PROSPERO (CRD42020203128).
PubMed: 38921331
DOI: 10.3390/healthcare12121217 -
Frontiers in Bioengineering and... 2024Musculoskeletal simulations can be used to estimate biomechanical variables like muscle forces and joint torques from non-invasive experimental data using inverse and...
Musculoskeletal simulations can be used to estimate biomechanical variables like muscle forces and joint torques from non-invasive experimental data using inverse and forward methods. Inverse kinematics followed by inverse dynamics (ID) uses body motion and external force measurements to compute joint movements and the corresponding joint loads, respectively. ID leads to residual forces and torques (residuals) that are not physically realistic, because of measurement noise and modeling assumptions. Forward dynamic simulations (FD) are found by tracking experimental data. They do not generate residuals but will move away from experimental data to achieve this. Therefore, there is a gap between reality (the experimental measurements) and simulations in both approaches, the sim2real gap. To answer (patho-) physiological research questions, simulation results have to be accurate and reliable; the sim2real gap needs to be handled. Therefore, we reviewed methods to handle the sim2real gap in such musculoskeletal simulations. The review identifies, classifies and analyses existing methods that bridge the sim2real gap, including their strengths and limitations. Using a systematic approach, we conducted an electronic search in the databases Scopus, PubMed and Web of Science. We selected and included 85 relevant papers that were sorted into eight different solution clusters based on three aspects: how the sim2real gap is handled, the mathematical method used, and the parameters/variables of the simulations which were adjusted. Each cluster has a distinctive way of handling the sim2real gap with accompanying strengths and limitations. Ultimately, the method choice largely depends on various factors: available model, input parameters/variables, investigated movement and of course the underlying research aim. Researchers should be aware that the sim2real gap remains for both ID and FD approaches. However, we conclude that multimodal approaches tracking kinematic and dynamic measurements may be one possible solution to handle the sim2real gap as methods tracking multimodal measurements (some combination of sensor position/orientation or EMG measurements), consistently lead to better tracking performances. Initial analyses show that motion analysis performance can be enhanced by using multimodal measurements as different sensor technologies can compensate each other's weaknesses.
PubMed: 38919383
DOI: 10.3389/fbioe.2024.1386874 -
Pain Jun 2024This systematic review and meta-analysis critically examined the evidence for peer support interventions to reduce pain and improve health outcomes in community-dwelling...
The effectiveness of peer support interventions for community-dwelling adults with chronic musculoskeletal pain: a systematic review and meta-analysis of randomised trials.
This systematic review and meta-analysis critically examined the evidence for peer support interventions to reduce pain and improve health outcomes in community-dwelling adults with chronic musculoskeletal pain (PROSPERO CRD42022356850). A systematic search (inception-January 2023) of electronic databases and grey literature was undertaken to identify relevant randomised controlled trials, with risk of bias and GRADE assessments performed on included studies. Meta-analyses used a generic, inverse-variance, random-effects model, calculating mean difference (MD) or standardised mean difference (SMD). Of 16,445 records identified, 29 records reporting on 24 studies (n = 6202 participants) were included. All evidence had unclear/high risk of bias and low-very low certainty. Peer support interventions resulted in small improvements in pain (medium-term: MD -3.48, 95% CI -6.61, -0.35; long-term: MD -1.97, 95% CI -3.53, -0.42), self-efficacy (medium-term: SMD 0.26, 95% CI 0.16, 0.36; long-term: SMD 0.21, 95% CI 0.07, 0.36), and function (long-term: SMD -0.10, 95% CI -0.19, -0.00) relative to usual care and greater self-efficacy (medium-term: SMD 0.36, 95% CI 0.20, 0.51) relative to waitlist control. Peer support interventions resulted in similar improvement as active (health professional led) interventions bar long-term self-efficacy (MD -0.41, 95% CI -0.77, -0.05), which favoured active interventions. No point estimates reached minimal clinically important difference thresholds. Pooled health service utilisation outcomes showed unclear estimates. Self-management, quality of life, and social support outcomes had mixed evidence. Despite low-very low evidence certainty, peer support interventions demonstrated small improvements over usual care and waitlist controls for some clinical outcomes, suggesting that peer support may be useful as an adjunct to other treatments for musculoskeletal pain.
PubMed: 38916521
DOI: 10.1097/j.pain.0000000000003293 -
Revista Brasileira de Ortopedia Jun 2024To investigate the epidemiology of injury types among jiu-jitsu practitioners, as well as the incidence regarding different skill and experience levels, through the...
To investigate the epidemiology of injury types among jiu-jitsu practitioners, as well as the incidence regarding different skill and experience levels, through the question: "What are the characteristics and prevalence of musculoskeletal injuries in Jiu-Jitsu practitioners?". Since the beginning of the study, in August 2020, we conducted a search on the MEDLINE, LILACS, and SciELO electronic databases. We included cross-sectional studies published between 2018 and 2023 on the epidemiology of the types of injuries among jiu-jitsu practitioners that compared their incidence regarding different levels of ability and experience. Two independent researchers performed the data extraction and assessed the risk of bias. Seven studies were included. The common outcomes involved 2,847 jiu-jitsu practitioners. A high prevalence in the knee joint and chest and rib areas was reported. Considering the difference in experience level among the practitioners, we could observe that most of the individuals included were beginners. Among the age groups observed, male practitioners older than 30 years of age were the ones who presented the highest rate of musculoskeletal injury, especially during training sessions. There is a high prevalence of musculoskeletal injuries among jiu-jitsu practitioners. The most affected anatomical segments are the knee joint, the chest, and the rib region, followed by the shoulder joint. The related factors change according to certain variables, being more common during training in male individuals over 30 years of age and beginners in the sport.
PubMed: 38911890
DOI: 10.1055/s-0044-1785662 -
Probiotics and Antimicrobial Proteins Jun 2024The aim of this systematic review is to evaluate musculoskeletal changes in response to prebiotics, probiotics, or synbiotics supplementation in older adults or in...
The aim of this systematic review is to evaluate musculoskeletal changes in response to prebiotics, probiotics, or synbiotics supplementation in older adults or in animal models of aging musculoskeletal disorders. A comprehensive search was conducted on electronic databases, including PubMed/Medline, Cochrane, and Web of Science until April 2024. The quality assessment of clinical trials was conducted using the Cochrane Collaboration tool and for animal studies, the SYRCLE's tool was used. Our literature search resulted in 652 studies. After removing duplicates and screening the articles based on their titles and abstracts, we assessed the full text of 112 articles, which yielded 20 clinical trials and 30 animal studies in our systematic review. Most of human and animal studies reported an improvement in physical performance, a decrease in frailty index, and a lower reduction in bone mineral density in the intervention groups. Body composition tends to increase in muscle ratio, muscle mass, and reduce in appendicular lean mass and muscle atrophy. Also, the intervention induced bone turnover and mineral absorption, significantly increasing Ca, P, and Mg absorption and short-chain fatty acid concentration. Additionally, levels of inflammatory markers such as IL1, IL6, IL17, T helper 17, and TNF-α exhibited a decreasing trend, while an increase in IL10 and IFN-γ was observed. Prebiotics, probiotics, or synbiotics supplementations could effectively improve the physical performance and muscle strength and reduce the risk of bone loss and frailty in the elderly.
PubMed: 38907826
DOI: 10.1007/s12602-024-10306-3 -
Journal of Back and Musculoskeletal... Jun 2024Fibromyalgia is a debilitating condition marked by persistent pain and reduced functionality. Various therapeutic methods have been suggested to alleviate symptoms in... (Review)
Review
BACKGROUND
Fibromyalgia is a debilitating condition marked by persistent pain and reduced functionality. Various therapeutic methods have been suggested to alleviate symptoms in individuals with fibromyalgia, yet the impact of diverse rehabilitation strategies remains unclear.
OBJECTIVE
This systematic review and meta-analysis aimed at assessing the efficacy of rehabilitation interventions in improving functioning in fibromyalgia patients.
METHODS
We conducted a comprehensive literature search of multiple international databases (PubMed, Scopus, and Web of Science) from their inception until November 22nd, 2023. We identified 23 randomized controlled trials (RCTs) assessing multiple rehabilitation strategies. The primary outcome was the Fibromyalgia Impact Questionnaire (FIQ). Study quality was assessed using the Cochrane Risk-of-Bias Tool for Randomized Trials (RoB 2). The study protocol was registered in PROSPERO (CRD42020197666).
RESULTS
Our meta-analysis rehabilitation interventions significantly reduce FIQ scores (MD =-11.74, 95% CI: -16.88 to -6.59, p< 0.0001). Notably, the subgroup analysis showed that different rehabilitation modalities seem to induce different therapeutic responses.
CONCLUSIONS
Rehabilitation strategies hold promise in addressing the functional impairments and improving the overall well-being of individuals with fibromyalgia. The study underscores the need for further research to determine the optimal rehabilitation approach and its potential impact on the multilevel disability characterizing patients with fibromyalgia.
PubMed: 38905029
DOI: 10.3233/BMR-230382 -
Clinical Psychology Review Jun 2024Perception has been conceptualised as an active and adaptive process, based upon incoming sensory inputs, which are modified by top-down factors such as cognitions.... (Review)
Review
Perception has been conceptualised as an active and adaptive process, based upon incoming sensory inputs, which are modified by top-down factors such as cognitions. Visuospatial perception is thought to be scaled based on threat, with highly threatening objects or contexts visually inflated to promote escape or avoidance behaviours. This meta-analytical systematic review quantified the effect and evidence quality of threat-evoked visuospatial scaling, as well as how visuospatial scaling relates to affordances (perceived action capabilities) and behavioural avoidance/escape outcomes. Databases and grey literature were systematically searched inclusive to 10/04/24. Studies were assessed with a customised Risk of Bias form and meta-analysis was performed using a random-effects model. 12,354 records were identified. Of these, 49 experiments (n = 3027) were included in the review. There was consistent evidence that threat the of height influenced contextual perception (g = 0.66, 95% CI: 0.45, 0.88) and affordances (g = -0.43, 95% CI: -0.84, -0.03). Threatening objects were viewed as larger (g = 0.76, 95% CI: 0.26, 1.26) and as closer (g = 0.30, 95% CI: 0.17, 0.42). Bodily threat (pain) yielded conflicting effects on visuospatial perception/affordances. We conclude that threat may influence visuospatial perception and affordances. However, since behavioural measures were poorly reported, their relationship with visuospatial perception/affordances remains elusive.
PubMed: 38901066
DOI: 10.1016/j.cpr.2024.102449 -
Diabetes, Obesity & Metabolism Jun 2024To evaluate the impact of denosumab on (i) the incidence of type 2 diabetes (T2D), and (ii) long-term health outcomes (microvascular [neuropathy, retinopathy,...
Denosumab, for osteoporosis, reduces the incidence of type 2 diabetes, risk of foot ulceration and all-cause mortality in adults, compared with bisphosphonates: An analysis of real-world, cohort data, with a systematic review and meta-analysis.
AIM
To evaluate the impact of denosumab on (i) the incidence of type 2 diabetes (T2D), and (ii) long-term health outcomes (microvascular [neuropathy, retinopathy, nephropathy] and macrovascular [cardiovascular disease, cerebrovascular accident] complications, and all-cause mortality) in patients with T2D, before (iii) combining results with prior studies using meta-analysis.
METHODS
A retrospective analysis of data in a large global federated database (TriNetX; Cambridge, MA) was conducted from 331 375 patients, without baseline T2D or cancer, prescribed either denosumab (treatment, n = 45 854) or bisphosphonates (control, n = 285 521), across 83 healthcare organizations. Propensity score matching (1:1) of confounders was undertaken that resulted in 45 851 in each cohort. Secondary analysis further evaluated the impact of denosumab on long-term health outcomes in patients with T2D. Additionally, we systematically searched prior literature that assessed the association between denosumab and T2D. Estimates were pooled using random-effects meta-analysis. Risk of bias and evidence quality were assessed using Cochrane-endorsed tools.
RESULTS
Denosumab (vs. bisphosphonates) was associated with a lower risk of incident T2D over 5 years (hazard ratio 0.83 [95% confidence interval {CI} 0.78-0.88]). Secondary analysis showed significant risk reduction in all-cause mortality (0.79 [0.72-0.87]) and foot ulceration (0.67 [0.53-0.86]). Also, pooled results from four studies (three observational, one randomized controlled trial) following meta-analysis showed a reduced relative risk (RR [95% CI]) for incident T2D in patients prescribed denosumab (0.83 [0.79-0.87]) (I = 10.76%).
CONCLUSIONS
This is the largest cohort study to show that denosumab treatment is associated with a reduced RR of incident T2D, as well as an associated reduced RR of all-cause mortality and microvascular complications, findings that may influence guideline development in the treatment of osteoporosis, particularly in patients who are at a high risk of T2D.
PubMed: 38899553
DOI: 10.1111/dom.15708 -
Journal of Experimental Orthopaedics Jul 2024The discoid meniscus (DM) is distinguished by its thickened, disc-shaped formation, which extends over the tibial plateau. The likelihood of developing osteoarthritis... (Review)
Review
PURPOSE
The discoid meniscus (DM) is distinguished by its thickened, disc-shaped formation, which extends over the tibial plateau. The likelihood of developing osteoarthritis escalates if a DM tear remains undiagnosed and untreated. While DM tears can be diagnosed through arthroscopy, the high cost, invasive nature and limited availability of this procedure highlight the need for a better diagnostic modality. This study aims to determine the accuracy of magnetic resonance imaging (MRI) in diagnosing DM tears.
METHODS
A systematic review was conducted to gather articles with at least 10 cases on the comparison of MRI and arthroscopy as the gold standard for DM tear diagnosis. Stata and MetaDisc were used to conduct the statistical analysis. The quality of the included studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool.
RESULTS
Five diagnostic performance studies, derived from four original research papers involving 305 patients, were evaluated. Based on the pooled data, the sensitivity, specificity, diagnostic odds ratio, positive limit of detection and negative limit of detection were found to be 0.87 (95% confidence interval [CI], 0.82-0.91) and 0.84 (95% CI, 0.75-0.90), 32.88 (95% CI, 5.81-186.02), 5.22 (95% CI, 1.71-15.92) and 0.18 (95% CI, 0.09-0.38), respectively. A hierarchical summary receiver operating characteristic curve with an area under the curve of 0.92 was generated.
CONCLUSION
This meta-analysis demonstrates that MRI has excellent sensitivity and specificity for diagnosing DM tears. Despite its lower accuracy compared to arthroscopy, MRI can be used in symptomatic patients as a viable alternative to arthroscopy due to its inherent advantages.
LEVEL OF EVIDENCE
Level IV.
PubMed: 38899047
DOI: 10.1002/jeo2.12051 -
Journal of Sport Rehabilitation Jul 2024Tendon injuries are common disorders in both workers and athletes, potentially impacting performance in both conditions. This is why the search for effective treatments... (Meta-Analysis)
Meta-Analysis
CONTEXT
Tendon injuries are common disorders in both workers and athletes, potentially impacting performance in both conditions. This is why the search for effective treatments is continuing.
OBJECTIVE(S)
The objective of this study was to analyze whether the ultrasound-guided percutaneous needle electrolysis technique may be considered a procedure to reduce pain caused by tendinosis.
EVIDENCE ACQUISITION
The search strategy included the PubMed, SCOPUS, CINAHL, Physiotherapy Evidence Database, SciELO, and ScienceDirect up to the date of February 25, 2024. Randomized clinical trials that assessed pain caused by tendinosis using the Visual Analog Scale and Numeric Rating Scale were included. The studies were evaluated for quality using the Cochrane Risk of Bias 2, and the evidence strength was assessed by the GRADEpro GDT.
EVIDENCE SYNTHESIS
Out of the 534 studies found, 8 were included in the review. A random-effects meta-analysis and standardized mean differences (SMD) were conducted. The ultrasound-guided percutaneous needle electrolysis proved to be effective in reducing pain caused by tendinosis in the overall outcome (SMD = -0.97; 95% CI, -1.26 to -0.68; I2 = 58%; low certainty of evidence) and in the short-term (SMD = -0.83, 95% CI, -1.29 to -0.38; I2 = 65%; low certainty of evidence), midterm (SMD = -1.28; 95% CI, -1.65 to -0.91; I2 = 0%; moderate certainty of evidence), and long-term (SMD = -0.94; 95% CI, -1.62 to -0.26; I2 = 71%; low certainty of evidence) subgroups.
CONCLUSION(S)
The application of the ultrasound-guided percutaneous needle electrolysis technique for reducing pain caused by tendinosis appears to be effective. However, due to the heterogeneity found (partially explained), more studies are needed to define the appropriate dosimetry, specific populations that may benefit more from the technique, and possible adverse events.
Topics: Humans; Tendinopathy; Needles; Electrolysis; Ultrasonography, Interventional; Randomized Controlled Trials as Topic; Pain Measurement; Pain Management
PubMed: 38897578
DOI: 10.1123/jsr.2024-0009