Immobilization protocols for the treatment of cervical spine fracture: a scoping review.

BACKGROUND: Current protocols on cervical immobilization postcervical spine fracture are widely accepted in the acute rehabilitation of older adults, however consensus on its overall effectiveness remains lacking. PURPOSE: Summarize information from original studies on available cervical immobilization protocols following a cervical fracture and to answer the questions; Which types of study designs have been used to assess the effectiveness of these protocols? What are the currently reported cervical immobilization protocols following cervical fracture in adults? What is the effectiveness of these protocols? What adverse events are associated with these protocols? STUDY DESIGN: Scoping review was performed. PATIENT SAMPLE: Searches were performed on the following online databases from inception to February 23, 2023: EMBASE, MEDLINE, CINAHL, and CENTRAL. Databases were searched for articles pertaining to collar use post cervical spine fracture. OUTCOME MEASURES: Effectiveness of the cervical fracture immobilization protocols was the primary outcome, examined by various measures including union rates and disability indexes. METHODS: 4 databases were searched; EMBASE, MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Cochrane Central Register of Controlled Trials (CENTRAL) beginning on February 23, 2023, where 5,127 studies were yielded and 32 were extracted based on studies of adults (≥18 years) with a diagnosis of a cervical fracture (C0-C7) managed with a rigid external orthosis to prevent instability and surgery (collar, or cervicothoracic orthosis). Risk of bias was assessed using the guidelines set out by the Joanna Briggs Institute. RESULTS: This scoping review yielded low-level prospective (18%) and retrospective (69%) cohort studies, case-control studies (3%), and case series (6%) from 1987 to 2022, patient age ranged from 14 to 104 years. Findings were difficult to summarize based on the lack of randomized controlled trials, leading to no clear conclusions drawn on the presence of standardized cervical immobilization protocols with no information on the duration of treatment or transition in care. Most included articles were retrospective cohort studies of poor to moderate quality, which have significant risk of bias for intervention questions. The effectiveness of these protocols remains unclear as most studies evaluated heterogeneous outcomes and did not present between-group differences. Mortality, musculoskeletal (MSK) complications, and delayed surgery were common adverse events associated with cervical collar use. CONCLUSION: This scoping review highlights the need for higher levels of evidence as there is currently no standardized immobilization protocol for cervical spine fractures as a primary treatment, the effectiveness of cervical immobilization protocols is unclear, and mortality, MSK complications, and delayed surgery are common adverse events. No sources of funding were used for this scoping review.

Balance measures for fall risk screening in community-dwelling older adults with COPD: A longitudinal analysis.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) increases fall risk, but consensus is lacking on suitable balance measures for fall risk screening in this group. We aimed to evaluate the reliability and validity of balance measures for fall risk screening in community-dwelling older adults with COPD. METHODS: In a secondary analysis of two studies, participants, aged ≥60 years with COPD and 12-month fall history or balance issues were tracked for 12-month prospective falls. Baseline balance measures - Brief Balance Evaluation Systems Test (Brief BESTest), single leg stance (SLS), Timed Up and Go (TUG), and TUG Dual-Task (TUG-DT) test - were assessed using intra-class correlation (ICC2,1) for reliability, Pearson/Spearman correlation with balance-related factors for convergent validity, t-tests/Wilcoxon rank-sum tests with fall-related and disease-related factors for known-groups validity, and area under the receiver operator characteristic curve (AUC) for predictive validity. RESULTS: Among 174 participants (73 ± 8 years; 86 females) with COPD, all balance measures showed excellent inter-rater and test-retest reliability (ICC2,1 = 0.88-0.97) and moderate convergent validity (r = 0.34-0.77) with related measures. Brief BESTest and SLS test had acceptable known-groups validity (p < 0.05) for 12-month fall history, self-reported balance problems, and gait aid use. TUG test and TUG-DT test discriminated between groups based on COPD severity, supplemental oxygen use, and gait aid use. All measures displayed insufficient predictive validity (AUC<0.70) for 12-month prospective falls. CONCLUSION: Though all four balance measures demonstrated excellent reliability, they lack accuracy in prospectively predicting falls in community-dwelling older adults with COPD. These measures are best utilized within multi-factorial fall risk assessments for this population.

Loneliness and resilience are associated with nutrition risk after the first wave of COVID-19 in community-dwelling older Canadians.

Nutrition risk is linked to hospitalization, frailty, depression, and death. Loneliness during the coronavirus disease 2019 (COVID-19) pandemic may have heightened nutrition risk. We sought to determine prevalence of high nutrition risk and whether loneliness, mental health, and assistance with meal preparation/delivery were associated with risk in community-dwelling older adults (65+ years) after the first wave of COVID-19 in association analyses and when adjusting for meaningful covariates. Data were collected from 12 May 2020 to 19 August 2020. Descriptive statistics, association analyses, and linear regression analyses were conducted. For our total sample of 272 participants (78 ± 7.3 years old, 70% female), the median Seniors in the Community: Risk evaluation for Eating and Nutrition (SCREEN-8) score (nutrition risk) was 35 [1st quartile, 3rd quartile: 29, 40], and 64% were at high risk (SCREEN-8 < 38). Fifteen percent felt lonely two or more days a week. Loneliness and meal assistance were associated with high nutrition risk in association analyses. In multivariable analyses adjusting for other lifestyle factors, loneliness was negatively associated with SCREEN-8 scores (-2.92, 95% confidence interval [-5.51, -0.34]), as was smoking (-3.63, [-7.07, -0.19]). Higher SCREEN-8 scores were associated with higher education (2.71, [0.76, 4.66]), living with others (3.17, [1.35, 4.99]), higher self-reported health (0.11, [0.05, 0.16]), and resilience (1.28, [0.04, 2.52]). Loneliness, but not mental health and meal assistance, was associated with nutrition risk in older adults after the first wave of COVID-19. Future research should consider longitudinal associations among loneliness, resilience, and nutrition.

Prevalence, Incidence, and Factors Associated With Non-Specific Chronic Low Back Pain in Community-Dwelling Older Adults Aged 60 Years and Older: A Systematic Review and Meta-Analysis.

Chronic low back pain (CLBP) is common among older adults. This systematic review aimed to summarize: (1) the prevalence and incidence of CLBP in older adults, and (2) demographic, psychological, and clinical factors positively/negatively associated with prevalence/incidence of CLBP among older adults. Four databases were searched to identify relevant publications. Ten studies (31,080 older adults) were included after being screened by 5 independent reviewers using predetermined criteria. The methodological quality of these studies was evaluated by standardized tools. The quality of evidence for all factors were appraised by modified GRADE for cohort studies. Twenty-eight and 1 factors were associated with a higher prevalence and a lower 5-year cumulative incidence of CLBP, respectively. No prognostic factor was identified. There was very limited to limited evidence that females, obesity, anxiety, depression, mental disorders, self-expectation of recovery, self-perceived health status, lifestyle (smoking, daily fluoride consumption), previous falls or lower body injury, retirement/disability due to ill health, family history of body pain, comorbidity (knee osteoarthritis, or chronic obstructive pulmonary disease with/without hypertension), weak abdominal muscles, leg pain, leg pain intensity, widespread pain, pain interference on functioning, use of pain medication, occupational exposure (driving for >20 years, or jobs involving bending/twisting for >10 years), disc space narrowing and severe facet osteoarthritis were significantly related to a higher prevalence of CLBP in older adults. However, very limited evidence suggested that intermediate level of leisure-time physical activity was associated with a lower prevalence of CLBP in older adults. Given the aging population and limited information regarding risk factors for CLBP in older adults, future high-quality prospective studies should identify relevant risk factors to help develop proper preventive and treatment strategies. PERSPECTIVE: Despite the high prevalence of non-specific chronic low back pain among older adults, there is only very limited to limited evidence regarding factors associated with a higher prevalence of chronic low back pain in this population. Given the aging population, high-quality prospective studies are warranted to address this gap.

Which Exercise for Low Back Pain? (WELBack) trial predicting response to exercise treatments for patients with low back pain: a validation randomised controlled trial protocol.

INTRODUCTION: Exercise therapy is the most recommended treatment for chronic low back pain (LBP). Effect sizes for exercises are usually small to moderate and could be due to the heterogeneity of people presenting with LBP. Thus, if patients could be better matched to exercise based on individual factors, then the effects of treatment could be greater. A recently published study provided evidence of better outcomes when patients are matched to the appropriate exercise type. The study demonstrated that a 15-item questionnaire, the Lumbar Spine Instability Questionnaire (LSIQ), could identify patients who responded best to one of the two exercise approaches for LBP (motor control and graded activity). The primary aim of the current study isill be to evaluate whether preidentified baseline characteristics, including the LSIQ, can modify the response to two of the most common exercise therapies for non-specific LBP. Secondary aims include an economic evaluations with a cost-effectiveness analysis. METHODS AND ANALYSIS: Participants (n=414) will be recruited by primary care professionals and randomised (1:1) to receive motor control exercises or graded activity. Participants will undergo 12 sessions of exercise therapy over an 8-week period. The primary outcome will be physical function at 2 months using the Oswestry Disability Index. Secondary outcomes will be pain intensity, function and quality of life measured at 2, 6 and 12 months. Potential effect modifiers will be the LSIQ, self-efficacy, coping strategies, kinesiophobia and measures of nociceptive pain and central sensitisation. We will construct linear mixed models with terms for participants (fixed), treatment group, predictor (potential effect modifier), treatment group×predictor (potential effect modifier), physiotherapists, treatment group×physiotherapists and baseline score for the dependent variable. ETHICS AND DISSEMINATION: This study received ethics approval from the Hamilton Integrate Research Ethics Board. Results will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT04283409.

A systematic review of the role of inflammatory biomarkers in acute, subacute and chronic non-specific low back pain.

BACKGROUND: Low back pain (LBP) is one of the greatest contributors to disability in the world and there is growing interest on the role of biomarkers in LBP. To purpose of this review was to analyze available evidence on the relationship between inflammatory biomarkers, clinical presentation, and outcomes in patients with acute, subacute and chronic non-specific low back pain (NSLBP). METHODS: A search was performed in Medline, Embase, Cinahl and Amed databases. Studies which measured levels of inflammatory biomarkers in participants with NSLBP were included. Two reviewers independently screened titles and abstracts, full-texts, and extracted data from included studies. Methodological quality was assessed using the Newcastle Ottawa Quality Assessment Scale. Level of evidence was assessed using the modified GRADE approach for prognostic studies. RESULTS: Seven primary studies were included in this review. All results assessed using the modified GRADE demonstrated low to very low quality evidence given the small number of studies and small sample. Three studies examined C-reactive protein (CRP), one of which found significantly higher CRP levels in an acute NSLBP group than in controls and an association between high pain intensity and elevated CRP. Three studies examined tumor necrosis factor alpha (TNF-α), two of which found elevated TNF-α in chronic NSLBP participants compared to controls. Two studies examined interleukin 6 (IL-6), none of which found a significant difference in IL-6 levels between NSLBP groups and controls. Two studies examined interleukin 1 beta (IL-ß), none of which found a significant difference in IL-ß levels between NSLBP groups and controls. CONCLUSIONS: This review found evidence of elevated CRP in individuals with acute NSLBP and elevated TNF-Α in individuals with chronic NSLBP. There are a limited number of high-quality studies evaluating similar patient groups and similar biomarkers, which limits the conclusion of this review.

Antiemetics for Postoperative Nausea and Vomiting in Patients Undergoing Elective Arthroplasty: Scheduled or As Needed?

BACKGROUND: Postoperative nausea and vomiting (PONV) is one of the most commonly reported adverse experiences after surgery. PONV is a major risk factor for delayed patient mobilization and consequently increased length of hospital stay. OBJECTIVES: The primary objective was to compare the effectiveness of scheduled versus as-needed administration of antiemetic for the prevention and treatment of PONV in the first 48 h after elective hip or knee arthroplasty. The secondary objective was to determine whether PONV affected mobilization on either postoperative day 0 or postoperative day 1 in each study group. METHODS: This retrospective cohort study used chart reviews for collection of patient data. PONV and mobilization were compared for patients who received antiemetics on a scheduled or as-needed basis following elective hip or knee arthroplasty performed between January and September 2016. RESULTS: Of the 132 patients included in the study, 65 received antiemetics on an as-needed basis and 67 had scheduled antiemetic therapy. Thirty-one (46%) of the patients in the "scheduled" group received antiemetics as intended; the others missed one or more of the scheduled doses. There was no statistical difference in PONV between treatment groups with either intention-to-treat or as-treated analysis. Furthermore, there was no statistically significant difference in mobilization, on either POD 0 or POD 1, between patients who received scheduled antiemetic and those who received antiemetic on an as-needed basis. CONCLUSIONS: Scheduled use of antiemetics did not significantly affect PONV, nor did it positively influence mobilization in the postoperative period for patients undergoing elective arthroplasty. Further high-quality prospective studies are needed to confirm these results.

CONTEXTE: Les nausées et vomissements postopératoires sont parmi les réactions indésirables les plus fréquentes après une intervention chirurgicale. Elles représentent un facteur de risque important de retard de mobilisation et par conséquent de prolongation du séjour à l'hôpital. OBJECTIFS: L'objectif principal visait la comparaison de l'efficacité d'une administration régulière d'antiémétiques à une administration au besoin pour la prévention et le traitement des nausées et vomissements postopératoires au cours des 48 heures suivant une arthroplastie nonurgente de la hanche ou du genou. L'objectif secondaire était de déterminer si les nausées et vomissements postopératoires avaient des répercussions sur la mobilisation des patients durant la journée postopératoire 0 ou 1 dans chaque groupe à l'étude. MÉTHODES: Les données de la présente étude de cohorte rétrospective proviennent des analyses de dossiers des patients. La comparaison portait sur les nausées et vomissements postopératoires et la mobilisation de patients ayant reçu des antiémétiques prescrits régulièrement ou au besoin après avoir subi une arthroplastie non-urgente de la hanche ou du genou, réalisée entre janvier et septembre 2016. RÉSULTATS: Parmi les 132 patients admis à l'étude, 65 ont reçu des antiémétiques au besoin et 67 en ont pris régulièrement. Trente et un (46 %) patients du groupe auquel on avait prescrit une prise régulière ont reçu des antiémétiques comme prévu, les autres ont sauté une ou plusieurs doses prévues. Aucune différence statistique n'a été relevée quant aux nausées et vomissements postopératoires entre les groupes, que ce soit à l'aide d'une analyse selon l'intention de traiter ou selon le traitement reçu. De plus, il n'y avait aucune différence statistiquement significative du point de vue de la mobilisation, pour les jours postopératoires 0 et 1 entre les patients ayant pris régulièrement des antiémétiques et ceux en ayant pris au besoin. CONCLUSIONS: L'administration régulière d'antiémétiques n'a pas eu d'effet significatif sur les nausées et vomissements postopératoires tout comme elle n'a pas influencé positivement la mobilisation au cours de la période postopératoire des patients ayant subi une arthroplastie non-urgente. De plus amples études prospectives de grande qualité sont nécessaires pour confirmer ces résultats.

Motor control exercise for persistent, nonspecific low back pain: a systematic review.

BACKGROUND: Previous systematic reviews have concluded that the effectiveness of motor control exercise for persistent low back pain has not been clearly established. OBJECTIVE: The objective of this study was to systematically review randomized controlled trials evaluating the effectiveness of motor control exercises for persistent low back pain. METHODS: Electronic databases were searched to June 2008. Pain, disability, and quality-of-life outcomes were extracted and converted to a common 0 to 100 scale. Where possible, trials were pooled using Revman 4.2. RESULTS: Fourteen trials were included. Seven trials compared motor control exercise with minimal intervention or evaluated it as a supplement to another treatment. Four trials compared motor control exercise with manual therapy. Five trials compared motor control exercise with another form of exercise. One trial compared motor control exercise with lumbar fusion surgery. The pooling revealed that motor control exercise was better than minimal intervention in reducing pain at short-term follow-up (weighted mean difference=-14.3 points, 95% confidence interval [CI]=-20.4 to -8.1), at intermediate follow-up (weighted mean difference=-13.6 points, 95% CI=-22.4 to -4.1), and at long-term follow-up (weighted mean difference=-14.4 points, 95% CI=-23.1 to -5.7) and in reducing disability at long-term follow-up (weighted mean difference=-10.8 points, 95% CI=-18.7 to -2.8). Motor control exercise was better than manual therapy for pain (weighted mean difference=-5.7 points, 95% CI=-10.7 to -0.8), disability (weighted mean difference=-4.0 points, 95% CI=-7.6 to -0.4), and quality-of-life outcomes (weighted mean difference=-6.0 points, 95% CI=-11.2 to -0.8) at intermediate follow-up and better than other forms of exercise in reducing disability at short-term follow-up (weighted mean difference=-5.1 points, 95% CI=-8.7 to -1.4). CONCLUSIONS: Motor control exercise is superior to minimal intervention and confers benefit when added to another therapy for pain at all time points and for disability at long-term follow-up. Motor control exercise is not more effective than manual therapy or other forms of exercise.