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Head & Neck Apr 2017Thyroid cancer is the fastest growing cancer in the United States. A small portion of differentiated thyroid cancers (DTCs; 2% to 13%) develop bone metastases, which can... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Thyroid cancer is the fastest growing cancer in the United States. A small portion of differentiated thyroid cancers (DTCs; 2% to 13%) develop bone metastases, which can decrease a patient's survival rate by more than 60%.
METHODS
A systematic literature search of studies, including patients with DTC with bone metastases, was conducted by following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A case series of patients with DTC diagnosed with bone metastases seen at our institution was also included.
RESULTS
A total of 616 bone metastases sites in 317 patients were identified in 14 case series. Ten patients were identified in our institutional case series. The most common sites of metastases are spine (34.6%), pelvis (25.5%), sternum and ribs (18.3%), extremities (10.2%), shoulder girdle (5.4%), and craniomaxillofacial (5.4%).
CONCLUSION
The axial skeleton is the primary target of bone metastases in DTC. The relative distribution of bone metastases and red marrow content follow a similar rank. © 2017 Wiley Periodicals, Inc. Head Neck 39: 812-818, 2017.
Topics: Adult; Aged; Bone Neoplasms; Carcinoma; Female; Humans; Incidence; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Prognosis; Risk Assessment; Skeleton; Survival Analysis; Thyroid Neoplasms
PubMed: 28079945
DOI: 10.1002/hed.24655 -
European Spine Journal : Official... Jun 2016Although pain is generally regarded as originating in the lumbar spine, it has been estimated that in 15-30 % of patients, LBP originates from the sacroiliac joint (SIJ). (Meta-Analysis)
Meta-Analysis Review
BACKGROUND CONTEXT
Although pain is generally regarded as originating in the lumbar spine, it has been estimated that in 15-30 % of patients, LBP originates from the sacroiliac joint (SIJ).
PURPOSE
To determine whether sacroiliac joint fusion (SIJF) for LBP is effective in reducing pain when the SIJ is known to be the pain generator.
STUDY DESIGN/SETTING
Systematic review and meta-analysis.
METHODS
A systematic literature review and meta-analysis was performed of observational studies describing outcome of SIJF in patients with LBP. Outcome measures were VAS pain, ODI, SF-36 PCS/MCS and Majeed score. The following databases were searched: PubMed, Web of Science, Embase, Medline and Google scholar. The methodological quality of selected studies was assessed using the National Heart Lung and Blood Institute case series quality assessment tool. Meta-analysis was used to combine the studies for each outcome and forest plots were prepared. Outcomes were expressed as mean difference (MD).
RESULTS
Six studies were included in the meta-analysis with a mean follow-up of 17.6 months. All outcomes showed statistical and clinical improvement (VAS pain MD: 54.8; 95 % CI 48.6, 61.0; n = 380; p < 0.001, ODI MD: 14.5; 95 % CI 8.4, 20.6; n = 102; p < 0.001, SF-36 PCS MD: -19.5; 95 % CI -24.7, -14.2; n = 140; p < 0.001, SF-36 MCS MD: -8.5; 95 % CI -12.9, -4.1; n = 198; p < 0.001 and Majeed score MD: -35.4; 95 % CI -48.5, -22.2; n = 140; p < 0.001).
CONCLUSIONS
SIJF appears to be a satisfactory procedure for alleviating pelvic girdle pain.
Topics: Arthrodesis; Humans; Low Back Pain; Pelvic Girdle Pain; Sacroiliac Joint; Visual Analog Scale
PubMed: 26957096
DOI: 10.1007/s00586-016-4490-8 -
Journal of Rehabilitation Research and... 2015Symphysis pubis diastasis (SPD) is an infrequent complication of labor that can impair womens' general health through failure of the passive stability of the pelvic... (Review)
Review
Symphysis pubis diastasis (SPD) is an infrequent complication of labor that can impair womens' general health through failure of the passive stability of the pelvic girdle. Although conservative approaches are often used to decrease symptoms and interpubic separation, notably few studies have analyzed the effect of these methods on managing the symptoms of women with SPD. The purpose of this study was to review the available literature on the conservative treatment of SPD during pregnancy and labor. A computer-based search using PubMed, PEDro, and CINAHL was performed up to November 2014. We selected all studies that considered women with SPD during pregnancy or labor and treated them with conservative methods and excluded those that included surgical intervention. Eighteen studies were selected, most of which were case reports. Although the overall results of conservative treatment were unclear because of the type and design of the obtained studies, most of the studies reported bed rest in the lateral decubitus position and a pelvic girdle as basic treatments. Additionally, the few clinical trials reported recommended additional physiotherapy, including strengthening and stabilizing exercises, to reduce SPD symptoms.
Topics: Analgesics; Bed Rest; Braces; Female; Humans; Patient Positioning; Physical Therapy Modalities; Pregnancy; Pubic Symphysis Diastasis
PubMed: 26560443
DOI: 10.1682/JRRD.2014.12.0302 -
Acta Obstetricia Et Gynecologica... Nov 2015To explore the effect of physiotherapeutic interventions on pregnancy-related lumbopelvic pain. (Review)
Review
OBJECTIVE
To explore the effect of physiotherapeutic interventions on pregnancy-related lumbopelvic pain.
MATERIAL AND METHODS
Data sources: MEDLINE, Cochrane Central Register of Controlled Trials, PEDro, CINAHL, AMED, and SCOPUS databases were searched up to December 2014 for studies written in English, French, German or Scandinavian languages that evaluated physiotherapeutic modalities for preventing and treating pregnancy-related lumbopelvic pain.
RESULTS
For lumbopelvic pain during pregnancy, the evidence was strong for positive effects of acupuncture and pelvic belts. The evidence was low for exercise in general and for specific stabilizing exercises. The evidence was very limited for efficacy of water gymnastics, progressive muscle relaxation, a specific pelvic tilt exercise, osteopathic manual therapy, craniosacral therapy, electrotherapy and yoga. For postpartum lumbopelvic pain, the evidence was very limited for clinic-based treatment concepts, including specific stabilizing exercises, and for self-management interventions for women with severe disabilities. No specific adverse events were reported for any intervention. No meta-analysis could be performed because of study heterogeneity.
CONCLUSIONS
The levels of evidence were strong for a positive effect of acupuncture and pelvic belts, but weak for an effect of specific exercises. Caution should prevail in choosing other interventions for pregnancy-related lumbopelvic pain.
Topics: Acupuncture Therapy; Female; Humans; Low Back Pain; Patient Education as Topic; Pelvic Pain; Physical Therapy Modalities; Pregnancy; Pregnancy Complications; Puerperal Disorders; Self Care
PubMed: 26018758
DOI: 10.1111/aogs.12681 -
International Urogynecology Journal Nov 2015Several studies have described the evidence of prenatal physiotherapy for one symptom, but none has made an overview. We provided a systematic review on the... (Review)
Review
Several studies have described the evidence of prenatal physiotherapy for one symptom, but none has made an overview. We provided a systematic review on the effectiveness of prenatal physiotherapy. A full search was conducted in three electronic databases (Embase, PubMed/MEDLINE and PEDro), selecting randomized controlled trials concerning prenatal physiotherapy. Methodological quality was assessed using the PEDro scale. We identified 1,249 studies and after exclusions 54 studies were included concerning the evidence of prenatal physiotherapy. The majority of studies indicated a preventative effect for low back pain/pelvic girdle pain, weight gain, incontinence, and perineal massage. For leg edema, fear, and prenatal depression, the efficacy was only based on one study per symptom. No preventative effect was found for gestational diabetes, while literature concerning gestational hypertensive disorders was inconclusive. Regarding the treatment of low back pain/pelvic girdle pain and weight gain, most therapies reduced pain and weight respectively. Evidence regarding exercises for diabetes was contradictory and only minimally researched for incontinence. Foot massage and stockings reduced leg edema and leg symptoms respectively. Concerning gestational hypertensive disorders, perineal pain, fear, and prenatal depression no treatment studies were performed. The majority of studies indicated that prenatal physiotherapy played a preventative role for low back pain/pelvic girdle pain, weight gain, incontinence, and pelvic pain. Evidence for the remaining symptoms was inclusive or only minimally investigated. Regarding treatment, most studies indicated a reduction of low back pain/pelvic girdle pain, weight gain, incontinence, and the symptoms of leg edema.
Topics: Female; Humans; Low Back Pain; Pelvic Floor Disorders; Pelvic Girdle Pain; Physical Therapy Modalities; Pregnancy; Pregnancy Complications; Prenatal Care
PubMed: 25822028
DOI: 10.1007/s00192-015-2684-y -
International Journal of Sports... Oct 2013Patellofemoral pain syndrome is a common disorder of the knee with multifactorial aetiology. Multimodal treatment, including exercise therapy, has been shown to be...
BACKGROUND
Patellofemoral pain syndrome is a common disorder of the knee with multifactorial aetiology. Multimodal treatment, including exercise therapy, has been shown to be effective in the treatment of patellofemoral pain, although some patients continue to experience pain and dysfunction despite treatment. To address this, recent research has started to investigate the lumbo-pelvic and hip girdle in patellofemoral pain.
PURPOSE
The aim of this systematic review was to investigate the effectiveness of proximal exercises, compared with knee exercises, for patients with patellofemoral pain, in improving pain and function.
METHODS
A computer-based search (population: patients with patellofemoral pain, intervention: proximal [hip or lumbo-pelvic] exercises, comparator: knee exercises, outcome: self-reported pain and/or functional questionnaire) was undertaken. Medline, Embase, CINAHL, SportsDiscus, Cochrane Library and PEDro were searched for studies published between January 2011 and January 2013. The included studies were appraised independently using the McMaster Critical Review Form for Quantitative Studies. Data was extracted for the exercise prescription and applicable outcome measures, and a descriptive analysis undertaken.
RESULTS
Eight studies (three randomized controlled trials, one clinical controlled trial, three cohort studies and one case series) of moderate to high methodological quality met the inclusion criteria. Proximal exercise programs showed a consistent reduction of pain and function in the treatment of patellofemoral pain. Knee exercise programs had variable outcomes.
CONCLUSION
Proximal interventions provide relief of pain and improved function in the short and long term and therefore physical therapists should consider using proximal interventions for treatment of patellofemoral pain.
LEVEL OF EVIDENCE
3a.
PubMed: 24175148
DOI: No ID Found -
Physiotherapy Theory and Practice Aug 2013The aim of this work was to investigate the effectiveness of physical therapy for the treatment of low back pain (LBP) and pelvic girdle pain (PGP) related to pregnancy... (Review)
Review
The aim of this work was to investigate the effectiveness of physical therapy for the treatment of low back pain (LBP) and pelvic girdle pain (PGP) related to pregnancy after delivery. A systematic review of studies published since 1985 in the databases Medline, PEDro, SciELO, SCOPUS, LILACS, and the Cochrane Library was made. Studies that focused on postpartum LBP or PGP, without being related to pregnancy or in other non-pregnant patients, were excluded, as were papers addressing LBP or PGP indicating radiculopathy, rheumatism, or any other serious disease or pathologic condition. In accordance with the exclusion criteria and duplicate articles, of the 105 articles retrieved only six were considered for quality assessment with the PEDro Scale. Among these six papers, two were follow-ups, such that only four trials were included in this review. All trials used exercise for motor control and stability of the lumbopelvic region, but with different intervention approaches. The study affording the best evidence used individual guidance and adjustments given by the physiotherapists. Nevertheless, this systematic review was inconclusive and showed that more randomized clinical trials, with good quality, are needed.
Topics: Female; Humans; Low Back Pain; Pelvic Pain; Physical Therapy Modalities; Pregnancy; Pregnancy Complications; Treatment Outcome
PubMed: 23244038
DOI: 10.3109/09593985.2012.748114 -
European Spine Journal : Official... Sep 2012To determine the level of evidence for altered mechanical and motor control of the pelvis being associated with pregnancy-related pelvic girdle pain (PPGP). (Review)
Review
PURPOSE
To determine the level of evidence for altered mechanical and motor control of the pelvis being associated with pregnancy-related pelvic girdle pain (PPGP).
METHODS
This systematic review was undertaken by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six different databases were used for the electronic search. Observational cohorts, cross sectional or case-control studies focused on the association between altered kinematic/kinetic and motor control of the pelvis and PPGP during pregnancy were included. Study selection was conducted by two reviewers who firstly screened for titles, then for abstracts and finally for full articles. The Newcastle-Ottawa scale and the guidelines proposed by the Cochrane back review group were used to assess risk of bias and quality of evidence, respectively.
RESULTS
354 references were identified, and after excluding unwanted articles, 10 studies met the final inclusion criteria. Studies not related to motor control or pelvic mobility were the main reason for exclusion. Seven studies were case-control and three were prospective cohort studies. Seven studies were ranked as high while three were ranked as low quality. Among the high quality studies, six found association between PPGP and altered motor control and mobility of the pelvis.
CONCLUSIONS
The level of evidence for an association between PPGP and altered motor control and kinematic or kinetic parameters of the pelvis was found to be moderate.
Topics: Biomechanical Phenomena; Female; Humans; Pelvic Girdle Pain; Pregnancy; Pregnancy Complications
PubMed: 22718046
DOI: 10.1007/s00586-012-2401-1 -
European Spine Journal : Official... Sep 2012The present systematic review assessed the level of evidence for the association between relaxin levels and pregnancy-related pelvic girdle pain (PPGP) during pregnancy. (Review)
Review
PURPOSE
The present systematic review assessed the level of evidence for the association between relaxin levels and pregnancy-related pelvic girdle pain (PPGP) during pregnancy.
METHODS
PRISMA guidelines were followed to conduct this systematic review. Electronic search was carried out using six different databases. Observational cohorts, cross-sectional or case-control studies focused on the association between relaxin levels and PPGP during pregnancy were included. Studies selection was conducted by two reviewers who screened firstly for titles, then for abstracts and finally for full articles. Risk of bias was assessed using the Newcastle-Ottawa scale and the quality of evidence by the guidelines proposed by the Cochrane back review group.
RESULTS
731 references were identified. Six articles met the inclusion criteria and were considered for this systematic review. The main reason for the studies exclusion was PPGP related to gynaecological reasons. Five studies were case-control and one study was a prospective cohort. Four studies were ranked as high while two were ranked as low quality. Among the high quality studies, three found no association between PPGP and relaxin levels.
CONCLUSIONS
Based on these findings, the level of evidence for the association between PPGP and relaxin levels was found to be low. PPGP assessment and controlling for risk factors were found to increase bias leaving uncertainty in interpretation of these findings and a need for further research.
Topics: Female; Humans; Pelvic Girdle Pain; Pregnancy; Pregnancy Complications; Relaxin
PubMed: 22310881
DOI: 10.1007/s00586-012-2162-x -
Journal of Clinical Nursing Jun 2009This article aims to review the literature published to date on the types, current use, the biomechanical effects and adverse effects of maternity support belts for low... (Review)
Review
AIMS
This article aims to review the literature published to date on the types, current use, the biomechanical effects and adverse effects of maternity support belts for low back pain during pregnancy, to identify future research directions.
BACKGROUND
Lumbar/pelvic support belts are frequently recommended for the prevention and treatment of low back pain during pregnancy.
DESIGN
Systematic review.
METHODS
MEDLINE, CINAHL, the Cochrane Library and patents databases were electronically searched.
RESULTS
Maternity support belts belong to one of the four main types of maternity support garments, which are widely commercially-available. Current research showed limited evidence in support of the commercial maternity products regarding the effectiveness in the prevention and/or treatment of low back pain during pregnancy, other than that from the manufacturers. However, potential stabilisation effect of maternity support belt was demonstrated in some studies. Adverse effects reported include increased pain, fetal heart rate changes, skin irritation and discomfort.
CONCLUSIONS
There is insufficient scientific evidence to conclude that wearing maternity support belts reduces pregnancy-related low back pain and/or pelvic girdle pain. Future research directions in the area of biomechanics and physiology are recommended.
RELEVANCE TO CLINICAL PRACTICE
This review provides comprehensive understanding of the effectiveness of maternity support belts for the relief of low back pain during pregnancy which will facilitate healthcare professionals in providing evidence-based advice to their patients.
Topics: Equipment and Supplies; Female; Humans; Low Back Pain; Pregnancy; Pregnancy Complications
PubMed: 19490291
DOI: 10.1111/j.1365-2702.2008.02749.x