Are clinical practice guidelines for low back pain interventions of high quality and updated? A systematic review using the AGREE II instrument.

BACKGROUND: Clinical practice guidelines (CPGs) provide recommendations for practice, but the proliferation of CPGs issued by multiple organisations in recent years has raised concern about their quality. The aim of this study was to systematically appraise CPGs quality for low back pain (LBP) interventions and to explore inter-rater reliability (IRR) between quality appraisers. The time between systematic review search and publication of CPGs was recorded. METHODS: Electronic databases (PubMed, Embase, PEDro, TRIP), guideline organisation databases, websites, and grey literature were searched from January 2016 to January 2020 to identify GPCs on rehabilitative, pharmacological or surgical intervention for LBP management. Four independent reviewers used the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool to evaluate CPGs quality and record the year the CPGs were published and the year the search strategies were conducted. RESULTS: A total of 21 CPGs met the inclusion criteria and were appraised. Seven (33%) were broad in scope and involved surgery, rehabilitation or pharmacological intervention. The score for each AGREE II item was: Editorial Independence (median 67%, interquartile range [IQR] 31-84%), Scope and Purpose (median 64%, IQR 22-83%), Rigour of Development (median 50%, IQR 21-72%), Clarity and Presentation (median 50%, IQR 28-79%), Stakeholder Involvement (median 36%, IQR 10-74%), and Applicability (median 11%, IQR 0-46%). The IRR between the assessors was nearly perfect (interclass correlation 0.90; 95% confidence interval 0.88-0.91). The median time span was 2 years (range, 1-4), however, 38% of the CPGs did not report the coverage dates for systematic searches. CONCLUSIONS: We found methodological limitations that affect CPGs quality. In our opinion, a universal database is needed in which guidelines can be registered and recommendations dynamically developed through a living systematic reviews approach to ensure that guidelines are based on updated evidence. LEVEL OF EVIDENCE: 1 TRIAL REGISTRATION: REGISTRATION PROSPERO DETAILS: CRD42019127619 .

Exercise-induced Acute Abdominal Haemorrhage due to Iliopsoas Trauma in Racing Greyhounds.

Post-mortem examination of 74 racing greyhounds with sudden, unexpected death was undertaken at the Veterinary School, University of Nottingham, UK, from 2015 to 2019. These investigations revealed severe, acute haemoabdomen with extensive retroperitoneal haemorrhage and an underlying severe, unilateral iliopsoas tear in four cases (5.4%). In all four cases, unilateral trauma and haemorrhage affecting the right iliopsoas muscle was common near the caudal insertion. Despite the acute clinical event, three cases demonstrated histological evidence of previous muscle damage with muscular regeneration, fibrosis and evidence of chronic haemorrhage. To our knowledge, this is the first detailed description of exercise-induced trauma to the iliopsoas muscle leading to extensive haemoretroperitoneum and haemoabdomen with subsequent hypovolaemic shock and death in racing greyhounds.

Pulmonary Basaloid Squamous Cell Carcinoma in a Dog.

A 9-year-old neutered male crossbred dog with a 4-week history of progressive vestibulocerebellar signs was presented for necropsy examination. Gross examination revealed neoplastic growth in the lungs, thoracic lymph nodes, left kidney and cerebellum. Microscopically, the tumour consisted of an infiltrative, densely cellular, basaloid epithelial neoplastic growth with extensive areas of abrupt keratinization. Immunohistochemically, neoplastic cells expressed p63 and partially expressed cytokeratins 5/6. Based on these findings, the tumour was diagnosed as a primary pulmonary basaloid squamous cell carcinoma (BSSC) with metastasis to regional lymph nodes, kidney and brain. As far as the authors are aware, this is the first description of BSCC in an animal species.

Symptomatic sensorineural hearing loss in patients with ulcerative colitis.

BACKGROUND: Sensorineural hearing loss has been reported as an extraintestinal manifestation of inflammatory bowel disease, especially in adult patients with ulcerative colitis. However, to date only a few series have been reported in the literature, and none from Italy. The aim of the present investigation was to assess the prevalence of symptomatic sensorineural hearing loss in Italian patients with ulcerative colitis. METHODS: We retrospectively assessed the charts of all patients with ulcerative colitis who underwent otolaryngologic investigation in a 10-year period. RESULTS: Complete charts of 57 patients were available for the observation period. Reasons for head and neck investigation were transient, mild hearing loss and sporadic vertigo. Clinical and instrumental head and neck examination was unremarkable in all but one woman who complained of mild hearing loss without vertigo or tinnitus, in whom sensorineural hearing loss was diagnosed. CONCLUSIONS: In our series, sensorineural hearing loss was found in less than 2 % of adult patients with ulcerative colitis evaluated in a department of otolaryngology. Systematic evaluation for this extraintestinal manifestation should not be carried out unless hearing loss is present.

Constraint-induced movement therapy in stroke patients: systematic review and meta-analysis.

AIM: Upper extremity paresis is a leading cause of disability after stroke. A Cochrane review found an impact on disability of Constraint-Induced Movement Therapy (CIMT), its modified forms (mCIMT) and Forced Use (FU), with a moderate significant effect and a large significant effect on arm motor function. This article aims to present an update of the Cochrane review and assess the effects of CIMT, mCIMT and FU on disability and arm motor function. METHODS: Electronic databases were searched for Randomised Controlled Trials (RCT) and quasi-RCTs comparing CIMT, mCIMT or FU with other rehabilitative techniques, or none, in adult stroke patients. The primary and secondary outcomes were disability and arm motor function. Two reviewers independently screened search results, documented the methodological quality and extracted data. RESULTS: Four new studies were added to the previous review, for a total of 18 studies. The updated meta-analyses no longer indicate a benefit of CIMT mCIMT and FU on disability (eight studies, 276 participants, Standardised Mean Difference (SMD) 0.21, 95% CI -0.08 to 0.50), and a moderate benefit on arm motor function (14 studies, 479 participants, SMD 0.44, 95% CI 0.03 to 0.93). CONCLUSION: New evidence pushes the overall estimate of benefit toward the null effect. The majority of studies were underpowered and imprecise, exposing these analyses to small-study bias. This may explain why accumulation of evidence makes overall estimates inconsistent. Larger randomised trials to resolve these uncertainties are needed.

Lateral biases and fluctuations in infants' spontaneous arm movements and reaching.

The development of hand preference in infant reaching is marked by several lateral fluctuations. This study investigated whether similar lateral fluctuations were present in infants' spontaneous, nonreaching, and freely performed movements. We collected reaching and nonreaching movements kinematics in 4 infants that we followed longitudinally during their 1st year. In their 4th year, we assessed the direction of their hand preference. We found that lateral biases in spontaneous, nonreaching movements in the 1st year showed several shifts that were similar to those observed in reaching. Despite these shifts, all 4 infants traversed a short period of right-handedness. This right-handedness matched the direction of their hand preference at 3 years of age. We propose that shifts in the development of hand preference in the 1st year are linked to successive reorganizations of the motor system. These reorganizations take place as infants learn to sit, crawl, and walk.

Development of reaching during the first year: role of movement speed.

When infants first learn to reach at about 4 months, their hand paths are jerky and tortuous, but their reaches become smoother and straighter over the first year. Here the authors consider the role of the underlying limb dynamics, which scale with movement speed, on the development of trajectory control. The authors observed 4 infants weekly and then biweekly from reach onset to 1 year. Improvements in trajectories were not linear, but showed plateaus and regressions in straightness and smoothness. When infants' nonreaching movements were fast, their reaches were also fast, and faster reaches were also less straight. This is consistent with an equilibrium trajectory form of control, where development involves the increasing ability to stabilize the trajectory against self-generated movement perturbations.

The developmental origins of bimanual coordination: a dynamic perspective.

Patterns of interlimb coordination associated with infant reaching fluctuate frequently over developmental time. This study investigated whether these fluctuations are related to coordination tendencies. Interlimb patterns were studied in reaching and nonreaching movements in 4 infants, which were followed through their 1st year. Each week, reaching and nonreaching endpoint kinematics were recorded in both arms during multiple 14-s trials. It was found that patterns of interlimb coordination in reaching matched coordination tendencies in nonreaching. Reaching fluctuated between uni- and bimanual periods. During the bimanual periods, nonreaching interlimb activity tended to be synchronous. During the unimanual periods, nonreaching activity revealed no predominant form of interlimb coordination. It is argued that changing coordination tendencies may influence the organization of specific goal-oriented behaviors from early in life.

A Method for Identifying the Initiation of Reaching Movements in Natural Prehension.

Identifying the start of a movement is critical for calculating variables such as movement duration, movement speed, or trajectory length and straightness. In most experiments, the problem is simplified by giving instructions to the subjects and by constraining the task. This is not possible in populations that are too young or disabled to understand and execute the task as instructed. In this article, a method is presented for reliably identifying the onset of reaches in infants, whose movements are embedded in their ongoing activities. A computer program prompts the user to choose reach initiation on the basis of comparison between hand kinematics and videotaped behavior and to code the reach as emerging from 1 of 4 movement contexts. The method is highly reliable in infants of all ages and captures expected age-related changes in reaching. It is suggested that researchers could use this or a similar method to study movements that are part of natural, ongoing activities in normal and in clinical populations

The transition to reaching: mapping intention and intrinsic dynamics.

The onset of directed reaching demarks the emergence of a qualitatively new skill. In this study we asked how intentional reaching arises from infants' ongoing, intrinsic movement dynamics, and how first reaches become successively adapted to the task. We observed 4 infants weekly in a standard reaching task and identified the week of first arm-extended reach, and the 2 weeks before and after onset. The infants first reached at ages ranging from 12 to 22 weeks, and they used different strategies to get the toy. 2 infants, whose spontaneous movements were large and vigorous, damped down their fast, forceful movements. The 2 quieter infants generated faster and more energetic movements to lift their arms. The infants modulated reaches in task-appropriate ways in the weeks following onset. Reaching emerges when infants can intentionally adjust the force and compliance of the arm, often using muscle coactivation. These results suggest that the infant central nervous system does not contain programs that detail hand trajectory, joint coordination, and muscle activation patterns. Rather, these patterns are the consequences of the natural dynamics of the system and the active exploration of the match between those dynamics and the task.