ABSTRACT
Hypertension is a prevalent condition that is associated with lower health status in patients with lumbar spinal stenosis. The study determined whether hypertension is a prognostic factor associated with functional recovery after spine surgery for lumbar spinal stenosis. This was a secondary analysis of the Alberta Lumbar Spinal Stenosis Study in which patients were identified as participants at the time of lumbosacral magnetic resonance imaging or computed tomography in Calgary, Alberta, Canada. Multivariable linear regression analyses were performed to examine hypertension as a prognostic factor of functional recovery after surgery (Oswestry Disability Index, the Swiss Spinal Stenosis (SSS)-Symptom Severity and SSS-Physical Function scales). Of the 97 surgical participants, 49 who were hypertensive were older (76.8, SD 11.4 years) than the 48 non-hypertensive participants (66.7, SD 12.4 years) (p < 0.001). No significant associations between hypertension and post-operative function in any of the three multivariable models were seen. The Oswestry Disability Index mean score improved after surgery (effect size: 1.73; 95%CI: 1.39, 2.06), with no differences seen between those with and without hypertension (p = 0.699). Large changes were seen after surgery for the SSS-Symptom Severity (effect size: 1.0, 95%CI 0.7, 1.3) and SSS-Physical Function (effect size: 0.9, 95%CI 0.6, 1.2) scales. Hypertension alone does not negatively impact functional recovery following surgery.
ABSTRACT
BACKGROUND: Clinicians are faced with using the current best evidence to make treatment decisions, yet synthesis of knowledge translation (KT) strategies that influence professional practice behaviors in rehabilitation disciplines remains largely unknown. PURPOSE: The purposes of this study were: (1) to examine the state of science for KT strategies used in the rehabilitation professions (physical therapy, occupational therapy, speech-language pathology), (2) to identify the methodological approaches utilized in studies exploring KT strategies, and (3) to report the extent that KT interventions are described. DATA SOURCES: Eight electronic databases (MEDLINE, CINAHL, ERIC, PASCAL, EMBASE, IPA, Scopus, and CENTRAL) were searched from January 1985 to May 2013 using language (English) restriction. STUDY SELECTION: Eligibility criteria specified articles evaluating interventions or strategies with a primary purpose of translating research or enhancing research uptake into clinical practice. DATA EXTRACTION: Two reviewers independently screened the titles and abstracts, reviewed full-text articles, performed data extraction, and performed quality assessment. The published descriptions of the KT interventions were compared with the Workgroup for Intervention Development and Evaluation Research's (WIDER) Recommendations to Improve the Reporting of the Content of Behaviour Change Interventions. DATA SYNTHESIS: Of a total of 2,793 articles located and titles and abstracts screened, 26 studies were included in the systematic review. Eighteen articles reported interventions that used a multicomponent KT strategy. Education-related components were the predominant KT intervention regardless of whether it was a single or multicomponent intervention. Few studies used reminders or audit and feedback intervention (n=3). Only one study's primary outcome measure was an economic evaluation. No clear delineation of the effect on KT strategies was seen. LIMITATIONS: Diverse studies were included; however, the heterogeneity of the studies was not conducive to pooling the data. CONCLUSIONS: The modest-to-low methodological quality assessed in the studies underscores the gaps in KT strategies used in rehabilitation and highlights the need for rigorously designed studies that are well reported.