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Musculoskeletal (MSK) conditions are the leading cause of disability, resulting in up to 40% of visits to family physicians. Current primary care workforce shortages in Canada require other providers to maximize scopes of practice. Few MSK providers have been trained in team-based primary care settings. Study objectives included: (1) educating participating primary care teams through synchronous education, (2) educating Canadian primary care providers through asynchronous education, and (3) integrating chiropractors into primary care teams, whilst evaluating team MSK care knowledge/attitudes and integration experience. Results indicated improvements in collaborative competency, improved understanding and attitudes to chiropractic, and the importance of providing MSK care within funded primary care. Teams employed unique approaches to integrating chiropractors and indicated high demand for their services by patients and providers. Provision of MSK care without economic barrier is desirable and highly valued by teams. Chiropractors are well suited to participate in funded primary care teams in Canada.
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Quiropráctica , Competencia Clínica , Enfermedades Musculoesqueléticas , Grupo de Atención al Paciente , Atención Primaria de Salud , Humanos , Atención Primaria de Salud/organización & administración , Quiropráctica/educación , Canadá , Enfermedades Musculoesqueléticas/terapia , Grupo de Atención al Paciente/organización & administración , Femenino , Masculino , Adulto , Atención Integral de Salud/organización & administración , Relaciones Interprofesionales , Persona de Mediana EdadRESUMEN
Introduction: Understanding healthcare utilization by Canadians with back problems informs healthcare planning nationally. Research question: What is the prevalence of utilization of healthcare providers (medical doctors, chiropractors, physiotherapists, nurses), and associated characteristics among Canadians with chronic back problems (2001-2016)? Material and methods: This population-based study used Canadian Community Health Survey data (2001-2016) restricted to respondents with chronic back problems (aged ≥12 years). We used self-reported consultation with healthcare providers (medical doctors, chiropractors, physiotherapists, nurses) from 2001-2010, and self-reported regular healthcare provider from 2015-2016. We calculated the 12-month prevalence of utilization with providers, and used modified Poisson regression to assess sociodemographic, health-related and behavioural factors associated with utilization of different providers. Results: From 2001 to 2010 and 2015/2016, respectively, prevalence of utilization of medical doctors was 87.9% (95% CI 87.6-88.2) and 86.7% (95% CI 85.9-87.5); chiropractors 24.0% (95% CI 23.6-24.4) and 14.5% (95% CI 13.8-15.3); physiotherapists 17.2% (95% CI 16.9-17.6) and 10.7% (95% CI 10.0-11.4); nurses 14.0% (95% CI 13.7-14.2) and 6.6% (95% CI 6.1-7.0). Females were more likely to see any provider than males. Persons of lower socioeconomic status were less likely to consult chiropractors or physiotherapists (2001-2016), or nurses (2001-2010). Immigrants were less likely to consult chiropractors or nurses. Persons aged >65 years were less likely to consult chiropractors or physiotherapists, and those with fair/poor general health were less likely to consult chiropractors, but more likely to consult other providers. Discussion and conclusion: Medical doctors were most commonly consulted by Canadians with back problems, then chiropractors and physiotherapists. Characteristics of healthcare utilization varied by provider. Findings inform the need to strengthen healthcare delivery for Canadians with back problems.
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OBJECTIVES: To estimate the one-month prevalence of problematic psychological symptoms among Canadian postsecondary students, and to compare the prevalence by student characteristics. PARTICIPANTS: Three samples of students from two postsecondary institutions. METHODS: In a cross-sectional study conducted in 2017, we measured self-reported problems related to symptoms of depression, anxiety, and stress using questions from the functioning module of the WHO Model Disability Survey. We used modified Poisson regression modeling to compute prevalence ratios (95%CI) to compare the prevalence by student characteristics. RESULTS: Our study included 1392 students (participation rate 35%-77%). Across samples, the one-month prevalence of moderate-extreme problems ranged from 50.8%-64.7% for anxiety, 41.2%-60.8% for stress, and 29.4%-43.6% for depression. Such problems were consistently more prevalent among females, poor-quality sleepers, students with food insecurity and those with insufficient social support. CONCLUSIONS: Significant burden of problems related to psychological symptoms exists within the postsecondary student population and varies by student characteristics.
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Introduction: The effectiveness of post-surgical rehabilitation following lumbar disc herniation (LDH) surgery is unclear. Research question: To investigate the effectiveness and safety of rehabilitation interventions initiated within three months post-surgery for adults treated surgically for LDH. Material and methods: This systematic review searched seven databases from inception to November 2023. Independent reviewers screened studies, assessed and extracted data, and rated the certainty of the evidence using the GRADE approach. Results: This systematic review retrieved 20,531 citations and included 25 randomized controlled trials. The high certainty evidence suggests that adding Pilates exercise to routine care and cognitive behavioral therapy may improve function immediately post-intervention (1 RCT), and that adding whole-body magnetic therapy to exercise, pharmacological and aquatic therapy may reduce low back pain intensity (1 RCT) immediately post-intervention. Compared to placebo, pregabalin did not reduce low back pain or leg pain intensity (1 RCT) (moderate to high certainty evidence). We found no differences between: 1) behavioral graded activity vs. physiotherapy (1 RCT); 2) exercise and education vs. neck massage or watchful waiting (1 RCT); 3) exercise, education, and in-hospital usual care vs. in-hospital usual care (1 RCT); 4) functional or staged exercise vs. usual post-surgical care including exercise (2 RCTs); and 5) supervised exercise with education vs. education (1 RCT). No studies assessed adverse events. Discussion and conclusion: Evidence on effective and safe post-surgical rehabilitation interventions is sparse. This review identified two interventions with potential short-term benefits (Pilates exercises, whole-body magnetic therapy) but safety is unclear, and one with an iatrogenic effect (pregabalin).
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This review sought to identify, critically appraise, compare, and summarize the literature on the reliability, discriminative validity and responsiveness of the flexion relaxation ratio (FRR) in adults (≥ 18 years old) with or without spine pain (any duration), in either a clinical or research context. The review protocol was registered on Open Science Framework ( https://doi.org/10.17605/OSF.IO/27EDF ) and follows COSMIN, PRISMA, and PRESS guidelines. Six databases were searched from inception to June 1, 2022. The search string was developed by content experts and a health services librarian. Two pairs of reviewers independently completed titles/abstracts and full text screening for inclusion, data extraction, and risk of bias assessment (COSMIN RoB Toolkit). At all stages, discrepancies were resolved through consensus meetings. Data were pooled where possible with a three-level random effects meta-analyses and a modified GRADE assessment was used for the summary of findings. Following duplicate removal, 728 titles/abstracts and 219 full texts were screened with 23 included in this review. We found, with moderate certainty of evidence, that the cervical FRR has high test-retest reliability and lumbar FRR has moderate to high test-retest reliability, and with high certainty of evidence that the cervical and lumbar FRR can discriminate between healthy and clinical groups (standardized mean difference - 1.16 [95% CI - 2.00, - 0.32] and - 1.21 [- 1.84, - 0.58] respectively). There was not enough evidence to summarize findings for thoracic FRR discriminative validity or the standard error of measurement for the FRR. Several studies used FRR assuming responsiveness, but no studies were designed in a way that could confirm responsiveness. The evidence supports adequate reliability of FRR for the cervical and lumbar spine, and discriminative validity for the cervical and lumbar spine only. Improvements in study design and reporting are needed to strengthen the evidence base to determine the remaining measurement properties of this outcome.
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Enfermedades Óseas , Región Lumbosacra , Adulto , Humanos , Adolescente , Reproducibilidad de los Resultados , Vértebras Lumbares , DolorRESUMEN
STUDY OBJECTIVES: Sleep quality is important during childhood and adolescence. Given the high prevalence of pain in children/youth with cerebral palsy, we aimed to measure the association between short-term pain trajectories and sleep disturbance in these individuals. METHODS: We accrued the cohort between November 2019 and October 2020 and recruited children/youth who (1) were 8-18 years old; (2) had cerebral palsy with any Gross Motor Function Classification System level; and (3) could self-report pain and sleep disturbance. We collected self-reported baseline and weekly follow-up data using electronic questionnaires completed every week for 5 weeks. Sleep disturbance at 5 weeks was the primary outcome (pediatric Patient-Reported Outcomes Measurement Information System short form, v1.0-4a). We used general linear regression to assess the association between pain intensity trajectory group and sleep disturbance controlling for confounders. RESULTS: A total of 190 individuals were eligible; 102 were enrolled and 89 were included in our final analysis. Pain trajectory groups had estimated crude mean sleep disturbance scores at 5 weeks ranging from 56.0 (95% confidence interval, 51.8, 60.8) to 61.8 (55.7, 67.9). Compared to those with stable, no/very mild pain, those in the stable, high-pain group had the greatest sleep disturbance (adjusted ß = 5.7; 95% confidence interval, 1.2, 10.2). CONCLUSIONS: Irrespective of pain trajectory, children and youth with cerebral palsy reported sleep disturbances. Those with a stable, high pain intensity in the previous 5 weeks reported the greatest sleep disturbance. The results highlight the importance of considering pain trajectories and their impact on sleep in children with cerebral palsy. CITATION: Shearer HM, Côté P, Hogg-Johnson S, Fehlings DL. A good night's sleep: pain trajectories and sleep disturbance in children with cerebral palsy. J Clin Sleep Med. 2024;20(5):719-726.
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Parálisis Cerebral , Trastornos del Sueño-Vigilia , Humanos , Parálisis Cerebral/complicaciones , Parálisis Cerebral/fisiopatología , Femenino , Masculino , Niño , Adolescente , Trastornos del Sueño-Vigilia/complicaciones , Trastornos del Sueño-Vigilia/epidemiología , Dolor/complicaciones , Dolor/fisiopatología , Dolor/epidemiología , Encuestas y Cuestionarios , Calidad del Sueño , Estudios de Cohortes , AutoinformeRESUMEN
Driving posture can lead to musculoskeletal pain. Most work focuses on the lower back; therefore, we know little about automobile seat design and neck posture. This study evaluated an automobile driver seat that individualized upper back support to improve head and neck posture. Specifically, we examined the system's impact on anterior head translation with secondary outcomes of spine posture and perceptions of comfort/well-being compared with a control. Forty participants were block randomized to experience either the activated or deactivated version of the same seating system first. Participants completed two 30-minute simulated driving trials, separated by washout, with continuous measures of anterior head translation, spine posture, and pelvis orientation. Perceptions of comfort/well-being were assessed by survey and open-ended questions immediately following each condition. Small, but statistically significant decreases in anterior head translation and posterior pelvic tilt occurred with the activated seat system. Participants reported lower satisfaction with the activated seat system. Order of the 2 seat conditions affected differences in pelvis orientation and participant perceptions of comfort/well-being. An anthropometric-based seat system targeting upper back support can significantly affect head and pelvic posture but not satisfaction during simulated driving. Future work should examine long-term impacts of these posture changes on health outcomes.
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Conducción de Automóvil , Diseño de Equipo , Humanos , Cuello , Postura , Sedestación , Estudios CruzadosRESUMEN
BACKGROUND: Chronic health conditions impact worker outcomes but are challenging to measure using administrative workers' compensation (WC) data. The Functional Comorbidity Index (FCI) was developed to predict functional outcomes in community-based adult populations, but has not been validated for WC settings. We assessed a WC-based FCI (additive index of 18 conditions) for identifying chronic conditions and predicting work outcomes. METHODS: WC data were linked to a prospective survey in Ohio (N = 512) and Washington (N = 2,839). Workers were interviewed 6 weeks and 6 months after work-related injury. Observed prevalence and concordance were calculated; survey data provided the reference standard for WC data. Predictive validity and utility for control of confounding were assessed using 6-month work-related outcomes. RESULTS: The WC-based FCI had high specificity but low sensitivity and was weakly associated with work-related outcomes. The survey-based FCI suggested more comorbidity in the Ohio sample (Ohio mean = 1.38; Washington mean = 1.14), whereas the WC-based FCI suggested more comorbidity in the Washington sample (Ohio mean = 0.10; Washington mean = 0.33). In the confounding assessment, adding the survey-based FCI to the base model moved the state effect estimates slightly toward null (<1% change). However, substituting the WC-based FCI moved the estimate away from null (8.95% change). CONCLUSIONS: The WC-based FCI may be useful for identifying specific subsets of workers with chronic conditions, but less useful for chronic condition prevalence. Using the WC-based FCI cross-state appeared to introduce substantial confounding. We strongly advise caution-including state-specific analyses with a reliable reference standard-before using a WC-based FCI in studies involving multiple states.
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Indemnización para Trabajadores , Adulto , Humanos , Estudios Prospectivos , Washingtón/epidemiología , Enfermedad Crónica , ComorbilidadRESUMEN
ABSTRACT: Degenerative cervical radiculopathy (DCR) can lead to severe pain, paraesthesia, and/or motor weakness, resulting in significant morbidity, disability, and reduced quality of life. Typically, individuals suffer from prolonged symptoms, with time to complete recovery spanning months to years. Little is known about the impact DCR has on peoples' lives. Therefore, this study aimed to explore the everyday experiences of individuals living with DCR. A qualitative study was conducted through an interpretivist lens exploring the experiences of participants. Participants were purposefully recruited and interviewed with 2 research team members. Transcripts were independently analyzed by 2 reviewers and coding was finalized by consensus. Analysis was performed using an interpretative phenomenological approach, with emergent themes mapped onto the 5 domains of the International Classification of Functioning, Disability and Health framework. Eleven participants were interviewed between December 2021 and April 2022. Three themes emerged: the biopsychosocial impact of DCR, role of the health care provider, and uncertainty surrounding DCR. Pain and paraesthesia were the most common symptoms experienced by participants, leading to significant psychological distress and impact to daily activities, most notably driving, housecleaning, sleep, and ability to work. Participants described the uncertainty they experienced as a result of the unpredictable nature of DCR and the important role that health care providers play in their journey with DCR. Health care providers were seen acting as either a facilitator or a barrier to their recovery. The findings from this study can be used by clinicians providing patient-centered care to better understand the experiences of people with DCR.
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Calidad de Vida , Radiculopatía , Humanos , Calidad de Vida/psicología , Parestesia , Investigación Cualitativa , DolorRESUMEN
OBJECTIVE: We aimed to describe the prevalence of unmet rehabilitation needs among a sample of Canadians living with long-term conditions or disabilities during the first wave of the COVID-19 pandemic. DESIGN: Cross-sectional survey. SETTING: Individuals residing in Canada during the first wave of the COVID-19 pandemic. PARTICIPANTS: Eligible participants were Canadians living with long-term conditions or disabilities, 15 years or older living in 1 of the 10 provinces or 3 territories (n=13,487). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: We defined unmet rehabilitation needs as those who reported needing rehabilitation (ie, physiotherapy/massage therapy/chiropractic, speech, or occupational therapy, counseling services, support groups) but did not receive it because of the COVID-19 pandemic. We calculated the national, age, gender, and province/territory-specific prevalence and 95% confidence interval of unmet rehabilitation needs. RESULTS: During the first wave of the pandemic, the prevalence of unmet rehabilitation needs among Canadians with long-term conditions or disabilities was 49.3% (95% confidence interval [CI]; 48.3, 50.3]). The age-specific prevalence was higher among individuals 15-49 years old (55.6%; 95% CI [54.2, 57.1]) than those 50 years and older (46.0%; 95% CI [44.5, 47.4]). Females (53.7%; 95% CI [52.6, 54.9]) had higher unmet needs than males (44.1%; 95% CI [42.3, 45.9]). Unmet rehabilitation needs varied across provinces and territories. CONCLUSIONS: In this sample, almost 50% of Canadians living with long-term conditions or disabilities had unmet rehabilitation needs during the first wave of the COVID-19 pandemic. This suggests that a significant gap between the needs for and delivery of rehabilitation care existed during the early phase of the pandemic.
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COVID-19 , Necesidades y Demandas de Servicios de Salud , Pandemias , Rehabilitación , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Canadá/epidemiología , COVID-19/epidemiología , Estudios Transversales , Pueblos de América del Norte , PrevalenciaRESUMEN
OBJECTIVE: This study aimed to describe the characteristics associated with unmet rehabilitation needs in a sample of Canadians with long-term health conditions or disabilities during the first wave of the COVID-19 pandemic. DESIGN: We used data from the Impacts of COVID-19 on Canadians Living With Long-Term Conditions and Disabilities, a national cross-sectional survey with 13,487 respondents. Unmet needs were defined as needing rehabilitation (ie, physiotherapy/massage/chiropractic, speech therapy, occupational therapy, counseling services, or support groups) but not receiving due to the pandemic. We used multivariable modified Poisson regression to examine the association between demographic, socioeconomic, and health-related characteristics and unmet rehabilitation needs. RESULTS: More than half of the sample were 50 years and older (52.3%), female (53.8%), and 49.3% reported unmet rehabilitation needs. Those more likely to report unmet needs were females, those with lower socioeconomic status (receiving disability benefits or social assistance, job loss, increased work hours, decreased household income or earnings), and those with lower perceived general health or mental health status. CONCLUSIONS: Among Canadians with disabilities or chronic health conditions, marginalized groups are more likely to report unmet rehabilitation needs. Understanding the systemic and upstream determinants is necessary to develop strategies to minimize unmet rehabilitation needs and facilitate the delivery of equitable rehabilitation services.
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COVID-19 , Personas con Discapacidad , Necesidades y Demandas de Servicios de Salud , SARS-CoV-2 , Humanos , COVID-19/epidemiología , COVID-19/rehabilitación , Femenino , Masculino , Canadá/epidemiología , Estudios Transversales , Persona de Mediana Edad , Personas con Discapacidad/rehabilitación , Personas con Discapacidad/estadística & datos numéricos , Adulto , Enfermedad Crónica/rehabilitación , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Anciano , Evaluación de Necesidades , Pandemias , Factores Socioeconómicos , Adulto Joven , Pueblos de América del NorteRESUMEN
BACKGROUND: The World Health Organization Disability Assessment Schedule 2.0 12-item survey (WHODAS-12) is a questionnaire developed by the WHO to measure functioning across health conditions, cultures, and settings. WHODAS-12 consists of a subset of the 36 items of WHODAS-2.0 36-item questionnaire. Little is known about the minimal important difference (MID) of WHODAS-12 in persons with chronic low back pain (LBP), which would be useful to determine whether rehabilitation improves functioning to an extent that is meaningful for people experiencing the condition. Our objective was to estimate an anchor-based MID for WHODAS-12 questionnaire in persons with chronic LBP. METHODS: We analyzed data from two cohort studies (identified in our previous systematic review) conducted in Europe that measured functioning using the WHODAS-36 in adults with chronic LBP. Eligible participants were adults with chronic LBP with scores on another measure as an anchor to indicate participants with small but important changes in functioning over time [Short-form-36 Physical Functioning (SF36-PF) or Oswestry Disability Index (ODI)] at baseline and follow-up (study 1: 3-months post-treatment; study 2: 1-month post-discharge from hospital). WHODAS-12 scores were constructed as sums of the 12 items (scored 0-4), with possible scores ranging from 0 to 48. We calculated the mean WHODAS-12 score in participants who achieved a small but meaningful improvement on SF36-PF or ODI at follow-up. A meaningful improvement was an MID of 4-16 on ODI or 5-16 on SF36-PF. RESULTS: Of 70 eligible participants in study 1 (mean age = 54.1 years, SD = 14.7; 69% female), 18 achieved a small meaningful improvement based on SF-36 PF. Corresponding mean WHODAS-12 change score was - 3.22/48 (95% CI -4.79 to -1.64). Of 89 eligible participants in study 2 (mean age = 65.5 years, SD = 11.5; 61% female), 50 achieved a small meaningful improvement based on ODI. Corresponding mean WHODAS-12 change score was - 5.99/48 (95% CI - 7.20 to -4.79). CONCLUSIONS: Using an anchor-based approach, the MID of WHODAS-12 is estimated at -3.22 (95% CI -4.79 to -1.64) or -5.99 (95% CI - 7.20 to -4.79) in adults with chronic LBP. These MID values inform the utility of WHODAS-12 in measuring functioning to determine whether rehabilitation or other health services achieve a minimal difference that is meaningful to patients with chronic LBP.
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Dolor de la Región Lumbar , Adulto , Humanos , Femenino , Persona de Mediana Edad , Anciano , Masculino , Dolor de la Región Lumbar/terapia , Cuidados Posteriores , Alta del Paciente , Evaluación de la Discapacidad , Organización Mundial de la SaludRESUMEN
PURPOSE: The aim of our study is to inform the development of a rehabilitation program of care from the perspectives of those suffering from degenerative cervical radiculopathy (DCR). MATERIAL AND METHODS: We conducted a qualitative study, purposefully recruiting individuals with DCR. Transcripts from virtual semi-structured interviews were iteratively analyzed using interpretative phenomenological methods. RESULTS: Eleven participants were recruited and depicted their ideal rehabilitation program of care. Participants described the importance of a patient centered-approach, health care providers who were validating, reassuring and attentive, easier access to health services, a supportive and collaborative team environment, and receiving peer support. Furthermore, participants expressed that they would expect the program of care to result in their symptoms being less intense and intermittent. In consideration of the participant perspectives, the ideal rehabilitation program of care can be conceptualized by the enactive-biopsychosocial model, which provides a theoretical framework for developing and implementing the program of care. CONCLUSION: We obtained valuable information from individuals living with DCR regarding their preferences and expectations of a rehabilitation program of care. The participant descriptions will provide the groundwork for its development to meet patient needs and expectations. Future research to guide implementation will also be explored.
The lives of those suffering from cervical radiculopathy are significantly impacted.Incorporating patient perspectives in the development of care plans can lead to the inclusion of interventions considered patient-centered and may improve implementation, adherence, and outcomes.Participants described their preferences and expectations of a rehabilitation program of care that may assist in its future development to meet patient needs and expectations.From participants' perspectives, the ideal rehabilitation program of care would be framed by the enactive-biopsychosocial model, thus providing a theoretical context for its development and implementation.
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OBJECTIVE: This study investigated the moderating role of baseline depressive symptoms on the association between baseline pain severity and time to recovery in individuals with acute grade I-II whiplash-associated disorders. DESIGN: This is a secondary analysis of a randomized controlled trial investigating the effectiveness of a government-regulated rehabilitation guideline for the management of grade I-II whiplash-associated disorders. Participants who completed baseline questionnaires for neck pain intensity and depressive symptoms and follow-up questionnaire on self-reported recovery were included in the analysis. Cox proportional hazards models were built, and hazard rate ratios were reported to describe the association between baseline neck pain intensity and time to self-reported recovery and to assess the effect modification of baseline depressive symptoms. RESULTS: Three hundred three participants provided data for this study. Despite baseline level of depressive symptoms and neck pain intensity being independently associated with delayed recovery, the association between baseline neck pain intensity and time to recovery was not stronger for individuals with significant postcollision depressive symptoms (hazard rate ratio = 0.91; 95% confidence interval = 0.79-1.04) than for those without depressive symptoms (hazard rate ratio = 0.92; 95% confidence interval = 0.83-1.02). CONCLUSIONS: Baseline depressive symptoms are not an effect modifier of the association between baseline neck pain intensity and time to self-reported recovery in acute whiplash-associated disorders.
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Depresión , Lesiones por Latigazo Cervical , Humanos , Depresión/etiología , Lesiones por Latigazo Cervical/complicaciones , Cuello , Dolor de Cuello/etiología , Encuestas y CuestionariosRESUMEN
STUDY DESIGN: Systematic review. OBJECTIVE: The aim of this study was to evaluate the inclusion and exclusion criteria for participants in randomized control trials (RCTs) assessing conservative management for cervical radiculopathy (CR), to determine if any consensus exists within the literature. SUMMARY OF BACKGROUND DATA: A 2012 systematic review identified a lack of uniformity for the eligibility criteria of participants in RCTs evaluating conservative interventions for CR. Since then, a large number of RCTs have been published, signaling the need for an updated evaluation of this topic. MATERIALS AND METHODS: We electronically searched MEDLINE, CENTRAL, CINAHL, Embase, and PsycINFO from inception to June 15, 2022, to identify RCTs assessing conservative management of CR. Information extracted was analyzed to determine the level of homogeneity and/or heterogeneity of the inclusion and exclusion criteria across studies. RESULTS: Seventy-six RCTs met our inclusion criteria with 68 distinct trials identified. The inclusion of arm pain with or without another symptom ( i.e. numbness, paresthesia, or weakness) was required in 69.12% of trials, 50% of trials required participants to exhibit neck symptoms, and 73.53% of studies required some form of clinical examination findings, but inconsistencies existed for the number and type of tests used. Furthermore, 41.18% of trials included imaging, with 33.82% of trials requiring magnetic resonance imaging findings. The most common exclusion criteria included were the presence of red flags and cervical myelopathy in 66.18% and 58.82% of trials, respectively. CONCLUSIONS: Overall, there is still a lack of uniformity for the inclusion/exclusion criteria of trials assessing the conservative management of CR, with some improvements noted compared with the 2012 review. Based on the current literature assessing the diagnostic utility of clinical symptoms and confirmatory tests, we proposed inclusion criteria for trials assessing conservative interventions. Future research should aim to develop standardized classification criteria to improve consistency among studies.
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Radiculopatía , Humanos , Radiculopatía/diagnóstico , Radiculopatía/terapia , Tratamiento Conservador , Ensayos Clínicos Controlados Aleatorios como Asunto , DolorRESUMEN
OBJECTIVE: The purpose of this systematic review was to assess the effectiveness and safety of conservative interventions compared with other interventions, placebo/sham interventions, or no intervention on disability, pain, function, quality of life, and psychological impact in adults with cervical radiculopathy (CR). METHODS: We searched MEDLINE, CENTRAL, CINAHL, Embase, and PsycINFO from inception to June 15, 2022 to identify studies that were randomized controlled trials, had at least one conservative treatment arm, and diagnosed participants with CR through confirmatory clinical examination and/or diagnostic tests. Studies were appraised using the Cochrane Risk of Bias 2 tool and the quality of the evidence was rated using the Grades of Recommendations, Assessment, Development, and Evaluation approach. RESULTS: Of the 2561 records identified, 59 trials met our inclusion criteria (n = 4108 participants). Due to clinical and statistical heterogeneity, the findings were synthesized narratively. There is very-low certainty evidence supporting the use of acupuncture, prednisolone, cervical manipulation, and low-level laser therapy for pain and disability in the immediate to short-term, and thoracic manipulation and low-level laser therapy for improvements in cervical range of motion in the immediate term. There is low to very-low certainty evidence for multimodal interventions, providing inconclusive evidence for pain, disability, and range of motion. There is inconclusive evidence for pain reduction after conservative management compared with surgery, rated as very-low certainty. DISCUSSION: There is a lack of high-quality evidence, limiting our ability to make any meaningful conclusions. As the number of people with CR is expected to increase, there is an urgent need for future research to help address these gaps.
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Terapia por Acupuntura , Radiculopatía , Adulto , Humanos , Tratamiento Conservador , Calidad de Vida , Dolor , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
OBJECTIVE: To determine the measurement properties and minimal important change (MIC) of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) short (12 questions) and full (36 questions) versions in persons with nonspecific low back pain (LBP). DATA SOURCES: MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, APA PsycInfo, and Cochrane Central Register of Controlled Trials (inception to May 2021). STUDY SELECTION: Eligible studies assessed measurement properties or MIC of WHODAS 2.0 in persons with LBP. DATA EXTRACTION: Paired reviewers screened articles, extracted data, and assessed risk of bias using Consensus-Based Standards for Selection of Health Measurement Instruments (COSMIN) and COSMIN-Outcome Measures in Rheumatology checklists. DATA SYNTHESIS: We descriptively synthesized results stratified by measurement property and LBP duration (subacute: 6 weeks to 3 months; chronic: ≥3 months). RESULTS: We screened 297 citations and included 14 studies (reported in 15 articles). Methodological quality of studies was very good for internal consistency and varied between very good and doubtful for construct validity, doubtful for responsiveness, and adequate for all other properties assessed. Evidence suggests that WHODAS 2.0 full version has adequate content validity (2 studies); WHODAS 2.0 short and full versions have adequate structural validity (3 studies), but construct validity is indeterminate (9 studies). WHODAS 2.0 short and full versions have adequate internal consistency (10 studies), and the full version has adequate test-retest and interrater reliability (3 studies) in persons with LBP. Minimal detectable change (MDC) was 10.45-13.99 of 100 for the full version and 8.6 of 48 for the short version in persons with LBP (4 studies). WHODAS 2.0 full version has no floor or ceiling effects, but the short version has potential floor effects in persons with chronic LBP (3 studies). One study estimated MIC for the full version as 4.87 of 100 or 9.74 of 100 (corresponding to 1- and 2-point change on 0- to 10-cm visual analog scale for pain, respectively), and 1 study estimated 3.09-4.68 of 48 for the short version. CONCLUSIONS: In persons with LBP, WHODAS 2.0 full version has adequate content validity, structural validity, internal consistency, and reliability. WHODAS 2.0 short version has adequate structural validity and internal consistency. Construct validity of the short and full versions is indeterminate. Since MDC is estimated to be larger than MIC, users may consider both MIC and MDC thresholds to measure change in functioning for LBP.
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Dolor de la Región Lumbar , Humanos , Evaluación de la Discapacidad , Reproducibilidad de los Resultados , Psicometría , Organización Mundial de la Salud , Encuestas y CuestionariosRESUMEN
AIM: To describe the clinical course of pain intensity in individuals with cerebral palsy (CP) resulting from usual care or specific interventions. METHOD: We conducted an exploratory prognostic systematic review searching electronic databases from inception to 31st December 2021. Evidence from low and moderate risk-of-bias studies was synthesized. RESULTS: We retrieved 2275 citations; 18 studies met the inclusion criteria and 10 were synthesized. The course of pain intensity in children with CP receiving usual care was stable over 15 weeks (χ2 [2] = 1.8, p = 0.5). Children who received continuous intrathecal baclofen (CITB) reported significant pain intensity reduction (visual analogue scale [VAS] = -4.2 out of 10, 95% confidence interval [CI] = -6.3 to -2.1]) 6 months postinsertion but similar children receiving usual care had no significant change over 6 months (VAS = 1.3 out of 10, 95% CI = -1.3 to 3.6). Children receiving botulinum neurotoxin A (BoNT-A) injections had significant decreases in pain after 1 month (numeric rating scale = -6.5, 95% CI = -8.0 to -5.0). Adults with chronic pain receiving usual care reported stable pain intensity over time; pain intensity improved in ambulatory adults exercising and those treated surgically for cervical myelopathy. INTERPRETATION: The course of pain intensity in individuals with CP is unclear. Evidence suggests that children and adults receiving usual care had stable pain intensity over the short or long term. Interventions (CITB and BoNT-A in children and exercise and surgical treatment for cervical myelopathy in adults) had pain intensity reduction. Larger study samples are needed to confirm these results. WHAT THIS PAPER ADDS: Pain intensity was stable in children with cerebral palsy (CP) receiving usual care. Adults with CP and chronic pain receiving usual care had stable, persistent pain intensity. Children receiving continuous intrathecal baclofen via pump and botulinum neurotoxin A reported significantly lower pain intensities. Adults with chronic pain and dyskinetic CP and cervical myelopathy reported significantly lower pain intensity with exercise or cervical decompression. Limited high-quality evidence exists describing non-procedural pain changes in individuals with CP.
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Toxinas Botulínicas Tipo A , Parálisis Cerebral , Dolor Crónico , Enfermedades de la Médula Espinal , Adulto , Niño , Humanos , Baclofeno/uso terapéutico , Toxinas Botulínicas Tipo A/uso terapéutico , Parálisis Cerebral/complicaciones , Parálisis Cerebral/tratamiento farmacológico , Dimensión del Dolor , PronósticoRESUMEN
Objective: To identify, appraise and synthesize the evidence of autonomic nervous system (ANS) dysfunction following sport-related concussion in pediatric populations. Methods: A literature search was conducted using MEDLINE (Ovid), SportDiscus (EBSCO), CINAHL (EBSCO), EMBASE (Ovid) and PsycINFO (Ovid). Studies were selected and appraised using the Joanna Briggs Institute (JBI) critical appraisal tools. Data was extracted from the included studies and qualitatively synthesized. Results: Eleven studies were included in the synthesis. There was variability in the methods used to measure ANS function between studies, and sample populations and time to assessment following concussion varied considerably. There was also variability in the direction of change of ANS function between some studies. Conclusion: This systematic review identifies that concussion is associated with dysregulation of ANS function in pediatric athletes. We identified some weaknesses in the extant literature which may be due to existing logistical and financial barriers to implementing valid ANS measurements in clinical and sports settings.
Objectif: Identifier, évaluer et synthétiser les preuves du dysfonctionnement du système nerveux végétatif (SNV) à la suite d'une commotion cérébrale liée au sport dans les populations pédiatriques. Méthodes: Une recherche documentaire a été effectuée sur MEDLINE (Ovid), SportDiscus (EBSCO), CINAHL (EBSCO), EMBASE (Ovid) et PsycINFO (Ovid). Les études ont été sélectionnées et évaluées à l'aide des outils d'évaluation critique du JBI (Joanna Briggs Institute). Les données ont été extraites des études incluses et ont fait l'objet d'une synthèse qualitative. Résultats: Onze études ont été incluses dans la synthèse. Les méthodes utilisées pour mesurer la fonction du SNV varient d'une étude à l'autre, et les populations d'échantillons ainsi que le délai d'évaluation après une commotion cérébrale varient considérablement. La direction du changement de la fonction du SNV variait également d'une étude à l'autre. Conclusion: Cette étude systématique montre que les commotions cérébrales sont associées à une dysrégulation de la fonction du SNV chez les athlètes enfants. Nous avons identifié certaines faiblesses dans la littérature existante, qui peuvent être dues aux obstacles logistiques et financiers existants pour mettre en oeuvre des mesures valides du SNV dans les environnements cliniques et sportifs.
RESUMEN
Context: Sarcopenia is a prevalent syndrome that has seen increased awareness in the last twenty years. Objective: To systematically assess and evaluate the utility of bioelectrical impedance analysis (BIA) in the diagnosis of sarcopenia in adults over the age of 60. Methods: An electronic search strategy of databases was conducted, including Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, and SportDiscus. Included articles were evaluated using The Quality Appraisal for Reliability Studies (QAREL) checklist. Results: Seven articles (1336 participants) met the inclusion criteria of evaluating the diagnostic ability of BIA. Results indicate that that there is a high degree of heterogeneity in how BIA is used to diagnose sarcopenia. While BIA is an affordable and easy to use measurement tool, it does not consistently demonstrate high levels of diagnostic sensitivity. Conclusion: The current evidence does not consistently support the utility of BIA as an accurate diagnostic tool for sarcopenia in adults over 60. If utilizing BIA, clinicians should select a validated BIA equation for their patient's demographics. Clinicians should also consider the use of functional tests and validated screening questionnaires. This systematic review was registered at https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=211586.
Contexte: La sarcopénie est un syndrome répandu qui a suscité une attention accrue ces vingt dernières années. Objectif: Examiner et évaluer systématiquement l'utilité d'une analyse d'impédance bioélectrique dans le diagnostic de la sarcopénie chez des adultes âgés de plus de 60 ans. Méthodologie: Une stratégie de recherche électronique sur des bases de données a été appliquée, notamment le Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL et SportDiscus. Les articles en question ont été évalués grâce à la liste de vérification de l'instrument Quality Appraisal for Reliability Studies (QAREL). Résultats: Sept articles (1 336 participants) remplissaient les critères d'inclusion de l'évaluation de la capacité diagnostique de l'analyse d'impédance bioélectrique. Les résultats montrent un degré élevé d'hétérogénéité dans l'utilisation de l'analyse d'impédance bioélectrique pour diagnostiquer la sarcopénie. Si l'analyse d'impédance bioélectrique est un outil de mesure fiable et facile à utiliser, il ne démontre pas systématiquement de hauts niveaux de sensibilité diagnostique. Conclusion: Les données probantes actuelles ne justifient pas systématiquement l'utilité d'une analyse d'impédance bioélectrique comme outil diagnostic précis de la sarcopénie chez des adultes âgés de plus de 60 ans. S'ils utilisent l'analyse d'impédance bioélectrique, les cliniciens doivent choisir une équation de l'analyse validée pour les données démographiques de leurs patients. Les cliniciens doivent également envisager de recourir à des examens fonctionnels et à des questionnaires de dépistage validés.L'examen systématique a été consigné sur le site https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=211586.