Meta-analysis of Cognitive Function Following Non-severe SARS-CoV-2 Infection.

To effectively diagnose and treat subjective cognitive symptoms in post-acute sequalae of COVID-19 (PASC), it is important to understand objective cognitive impairment across the range of acute COVID-19 severity. Despite the importance of this area of research, to our knowledge, there are no current meta-analyses of objective cognitive functioning following non-severe initial SARS-CoV-2 infection. The aim of this meta-analysis is to describe objective cognitive impairment in individuals with non-severe (mild or moderate) SARS-CoV-2 cases in the post-acute stage of infection. This meta-analysis was pre-registered with Prospero (CRD42021293124) and utilized the PRISMA checklist for reporting guidelines, with screening conducted by at least two independent reviewers for all aspects of the screening and data extraction process. Fifty-nine articles (total participants = 22,060) with three types of study designs met our full criteria. Individuals with non-severe (mild/moderate) initial SARS-CoV-2 infection demonstrated worse objective cognitive performance compared to healthy comparison participants. However, those with mild (nonhospitalized) initial SARS-CoV-2 infections had better objective cognitive performance than those with moderate (hospitalized but not requiring ICU care) or severe (hospitalized with ICU care) initial SARS-CoV-2 infections. For studies that used normative data comparisons instead of healthy comparison participants, there was a small and nearly significant effect when compared to normative data. There were high levels of heterogeneity (88.6 to 97.3%), likely reflecting small sample sizes and variations in primary study methodology. Individuals who have recovered from non-severe cases of SARS-CoV-2 infections may be at risk for cognitive decline or impairment and may benefit from cognitive health interventions.

Meta-analysis of Cognitive Rehabilitation Interventions in Veterans and Service Members With Traumatic Brain Injuries.

MAIN OBJECTIVE: Cognitive difficulties are some of the most frequently experienced symptoms following mild-to-moderate traumatic brain injuries (TBIs). There is meta-analytic evidence that cognitive rehabilitation improves cognitive functioning after TBI in nonveteran populations but not specifically within the veteran and service member (V/SM) population. The purpose of the current meta-analysis was to examine the effect of cognitive rehabilitation interventions for V/SMs with a history of mild-to-moderate TBI. DESIGN AND MAIN MEASURES: This meta-analysis was preregistered with PROSPERO (CRD42021262902) and used the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist for reporting guidelines. Inclusion criteria required studies to have (1) randomized controlled trials; (2) used adult participants (aged 18 years or older) who were US veterans or active-duty service members who had a history of mild-to-moderate TBI; (3) cognitive rehabilitation treatments designed to improve cognition and/or everyday functioning; (4) used objective neuropsychological testing as a primary outcome measure; and (5) been published in English. At least 2 reviewers independently screened all identified abstracts and full-text articles and coded demographic and effect size data. The final search was run on February 24, 2023, using 4 databases (PubMed, PsycINFO, Web of Science, and Google Scholar). Study quality and bias were examined using the revised Cochrane Risk-of-Bias Tool for Randomized Trials. RESULTS: We identified 8 articles meeting full criteria (total participants = 564; 97% of whom had a history of mild TBI). Compared with control groups, participants showed a small, but significant, improvement in overall objective neuropsychological functioning after cognitive rehabilitation interventions. Interventions focusing on teaching strategies had a larger effect size than did those focusing on drill-and-practice approaches for both objective neuropsychological test performance and performance-based measures of functional capacity. CONCLUSION: There is evidence of cognitive improvement in V/SMs with TBI histories after participation in cognitive rehabilitation. Clinician-administered interventions focusing on teaching strategies may yield the greatest cognitive improvement in this population.

Moral Injury during the COVID-19 pandemic: A delphi model survey of family medicine residents.

OBJECTIVES: The objective is to investigate the primary factors that created experiences leading to moral injury in family medicine residents during the COVID-19 pandemic and also to identify any barriers keeping these residents from seeking or receiving help when they experienced moral injury. METHOD: A DELPHI model study utilizing three rounds of surveys was conducted at four family medicine residency programs in the United States. Resident responses to Survey 1 generated factors perceived to be causing them moral injury or constituting barriers to their seeking help. Thematic analysis identified common themes which were presented to residents in Survey 2 for rating and justification. Results and feedback from Survey 2 were shared with residents in Survey 3, where residents were prompted to reevaluate their ratings for factors and barriers for the purpose of generating consensus among themselves. A ranked list of factors and barriers was thereby created for the participating sites. RESULTS: Residents shared several stories about the factors that most pressured them to violate their moral values. The most severe and frequent factors contributing to moral injury involved disruptions to doctor-patient relationships, patient-family relationships, and relationships with other healthcare professionals. Time was the major barrier to residents seeking help. CONCLUSION: During times of crisis, moral injury among residents may be minimized by protecting and promoting important clinical and professional relationships with patients, colleagues, and other medical professionals. While residents report that lack of time was the most significant barrier to seeking help, it is unclear how this complicated and ubiquitous problem would be resolved or mitigated.

Do musculoskeletal physiotherapists believe the NICE guidelines for the management of non-specific LBP are practical and relevant to their practice? A cross sectional survey.

BACKGROUND: Evidence-based practice has become fundamentally important in the field of musculoskeletal physiotherapy, which include clinical practice guidelines, such as those developed by National Institute for Health and Clinical Excellence (NICE) for low back pain. OBJECTIVES: To gauge whether musculoskeletal physiotherapist working in the UK are compliant with the NICE guidelines for back pain, and if they believe them to be practical and relevant to their current practice. DESIGN: Descriptive cross-sectional voluntary electronic survey. METHODS: A survey of musculoskeletal physiotherapists currently working in the UK was conducted through an anonymous online data collection website over a two month data collection period. Data was collected about demographic details of participants, and their views about the NICE guidelines through a specially designed questionnaire, and are presented descriptively. RESULTS: Two hundred and twenty-three therapists participated. Following a thematic content analysis seven key themes were identified about the guidelines: they facilitated evidence-based practice; they were unrealistic and idealistic; they did not facilitate a multimodal approach; they promoted largely a passive approach; they challenged therapist autonomy; they were outdated; they lacked relevance and specificity. CONCLUSION: Musculoskeletal physiotherapists strongly believe in the principles of EBP, and thought the NICE back pain guidelines were relevant to their practice. However the recommendations made within the guidelines were not realistic in day to day practice and they impacted negatively on the practice in a number of ways.