Exercise therapy is effective at improving short- and long-term mobility, ADL and balance in older patients following hip fracture: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Signe Hulsbæk ◽  
Carsten Juhl ◽  
Alice Røpke ◽  
Thomas Bandholm ◽  
Morten Tange Kristensen
Keyword(s):  
Hip Fracture ◽  
Exercise Therapy ◽  
Lower Limb ◽  
Older Patients ◽  
Meta Analysis ◽  
Term Effect ◽  
Short Term ◽  
Short And Long Term ◽  
Moderate Effect

Abstract Background A systematic review and meta-analysis was performed to evaluate the short- and long-term effect of exercise therapy on physical function, independence and wellbeing in older patients following hip fracture, and secondly, whether the effect was modified by trial level characteristics such as intervention modality, duration and initiation timepoint. Methods Medline, CENTRAL, Embase, CINAHL and PEDro was searched up-to November 2020. Eligibility criteria was randomized controlled trials investigating the effect of exercise therapy on physical function, independence and wellbeing in older patients following hip fracture, initiated from time of surgery up-to 1-year. Results Forty-nine studies involving 3905 participants showed a small to moderate effect of exercise therapy at short term (end of intervention) on mobility (Standardized mean difference, SMD 0.49, 95%CI 0.22-0.76); Activities of Daily Living (ADL) (SMD 0.31, 95%CI 0.16-0.46); lower limb muscle strength (SMD 0.36, 95%CI 0.13-0.60); balance (SMD 0.34, 95%CI 0.14-0.54). At long term (closest to 1-year), small to moderate effects were found for mobility (SMD 0.74, 95%CI 0.15-1.34); ADL (SMD 0.42, 95%CI 0.23-0.61); balance (SMD 0.50, 95%CI 0.07-0.94) and Health related Quality of Life (HRQoL) (SMD 0.31, 95%CI 0.03-0.59). Certainty of evidence was evaluated using GRADE ranging from moderate to very low, due to study limitation and inconsistency. Conclusion We found low certainty of evidence for a moderate effect of exercise therapy on mobility in older patients following hip fracture at end-of-treatment and follow-up. Further, low evidence was found for small to moderate short-term effect on ADL, lower limb muscle strength and balance.

scholarly journals Comparison of Prognostic Accuracy of the quick Sepsis-Related Organ Failure Assessment between Short- & Long-term Mortality in Patients Presenting Outside of The Intensive Care Unit - A Systematic Review & Meta-analysis

2018 ◽  
Author(s):  
TOH LEONG TAN ◽  
Ying Jing Tang ◽  
Ling Jing Ching ◽  
Noraidatulakma Abdullah ◽  
Hui-min Neoh
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Short Term ◽  
Suspected Infection ◽  
Failure Assessment ◽  
Short Term Mortality ◽  
Short And Long Term ◽  
Qsofa Score ◽  
Long Term Mortality

Objective: In year 2016, quick Sepsis-Related Organ Failure Assessment (qSOFA) was introduced as a better sepsis screening tool compared to systemic inflammatory response syndrome (SIRS). The purpose of this systematic review and meta-analysis is to evaluate the ability of the qSOFA in predicting short- and long-term mortality among patients outside the intensive care unit setting. Method: Studies reporting on the qSOFA and mortality from MEDLINE (published between 1946 and 15th December 2017) and SCOPUS (published before 15th December 2017). Hand-checking of the references of relevant articles was carried out. Studies were included if they involved inclusion of patients presenting to the ED; usage of Sepsis-3 definition with suspected infection; usage of qSOFA score for mortality prognostication; and written in English. Study details, patient demographics, qSOFA scores, short-term (<30 days) and long-term (≥30 days) mortality were extracted. Two reviewers conducted all reviews and data extraction independently. Results and Discussion: A total of 39 studies met the selection criteria for full text review and only 36 studies were inclided. Data on qSOFA scores and mortality rate were extracted from 36 studies from 15 countries. The pooled odds ratio was 5.5 and 4.7 for short-term and long-term mortality respectively. The overall pooled sensitivity and specificity for the qSOFA was 48% and 85% for short-term mortality and 32% and 92% for long-term mortality, respectively. Studies reporting on short-term mortality were heterogeneous (Tau=24%, I2=94%, P<0.001), while long-term mortality studies were homogenous (Tau=0%, I2<0.001, P=0.52). The factors contributing to heterogeneity may be wide age group, various clinical settings, variation in the timing of qSOFA scoring, and broad range of clinical diagnosis and criteria. There was no publication bias for short-term mortality analysis. Conclusion: qSOFA score showed a poor sensitivity but moderate specificity for both short and long-term mortality prediction in patients with suspected infection. qSOFA score may be a cost-effective tool for sepsis prognostication outside of the ICU setting.

scholarly journals Correlation between neutrophil-to-lymphocyte ratio and postoperative mortality in elderly patients with hip fracture: a meta-analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yu-Hang Chen ◽  
Ching-Hsin Chou ◽  
Hsin-Hsien Su ◽  
Yu-Ting Tsai ◽  
Ming-Hsiu Chiang ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
Geriatric Patients ◽  
Meta Analysis ◽  
Postoperative Mortality ◽  
Short Term ◽  
Term Survival ◽  
Lymphocyte Ratio ◽  
Long Term Mortality

Abstract Introduction The neutrophil-to-lymphocyte ratio (NLR) is a crucial prognosis predictor following several major operations. However, the association between NLR and the outcome after hip fracture surgery is unclear. In this meta-analysis, we investigated the correlation between NLR and postoperative mortality in geriatric patients following hip surgery. Method PubMed, Embase, Cochrane library, and Google Scholar were searched for studies up to June 2021 reporting the correlation between NLR and postoperative mortality in elderly patients undergoing surgery for hip fracture. Data from studies reporting the mean of NLR and its 95% confidence interval (CI) were pooled. Both long-term (≥ 1 year) and short-term (≤ 30 days) mortality rates were included for analysis. Result Eight retrospective studies comprising a total of 1563 patients were included. Both preoperative and postoperative NLRs (mean difference [MD]: 2.75, 95% CI: 0.23–5.27; P = 0.03 and MD: 2.36, 95% CI: 0.51–4.21; P = 0.01, respectively) were significantly higher in the long-term mortality group than in the long-term survival group. However, no significant differences in NLR were noted between the short-term mortality and survival groups (MD: − 1.02, 95% CI: − 3.98 to 1.93; P = 0.5). Conclusion Higher preoperative and postoperative NLRs were correlated with a higher risk of long-term mortality following surgery for hip fracture in the geriatric population, suggesting the prognostic value of NLR for long-term survival. Further studies with well-controlled confounders are warranted to clarify the predictive value of NLR in clinical practice in geriatric patients with hip fracture.

scholarly journals Surgery versus conservative management for lumbar disc herniation with radiculopathy: A systematic review and meta-analysis

2018 ◽  
Vol 8 (1) ◽  
pp. 42-53 ◽  
Author(s):  
Musa Sani Dan-Azumi ◽  
Bashir Bello ◽  
Salim Ahmad Rufai ◽  
Mamuda Alhaji Abdulrahman
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Conservative Management ◽  
Lumbar Disc ◽  
Meta Analysis ◽  
Term Effect ◽  
Early Surgery ◽  
Short Term ◽  
Conservative Care

Introduction: Lumbar Disk Herniation with Radiculopathy (LDHR) appears to be a large and costly problem. The paradigm regarding the best treatment for LDHR has being between surgery and conservative management. The aim of this study was to compare and summarize evidence regarding the effectiveness of surgery and conservative treatment for individuals with sciatica due to lumbar disc herniation. Methods: This study reviewed all literatures published on individuals with LDHR, who were managed either via surgery or conservative method. Pain and functional disability were the main outcome measures analyzed. A comprehensive search of PubMed, TRIP, PEDro and CINAHL was conducted from October, 2011 to June 2017. Two independent researchers selected the studies, and extracted the data. Methodological quality was assessed using the PEDro scale. Meta-analysis was carried out where suitable. Results: Eight studies involving (n=1,507) were included in the review. Meta-analysis was conducted for only 4 studies (n=784). The meta-analysis showed significant benefit for early surgery than conservative care -8.01(95% CI, -9.27 to -6.72) in the short-term effect -0.49 (95% CI, -0.7 to -0.28). However, the result for long-term effect did not show any significant difference between surgery and conservative care 1.60 (95% CI, -6.85 to 10.05). Conclusion: This current evidence suggest that early surgery for individuals with lumbar disc herniation with radiculopathy is better than conservative care in the short-term without any long-term difference. The results of this review should be interpreted with caution as the populations of the included studies were largely heterogeneous.

scholarly journals Comparison of Clinical Efficacy Between Transforaminal and Interlaminar Epidural Injections in Lumbosacral Disc Herniation: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 1 (21;1) ◽  
pp. 433-447 ◽  
Author(s):  
Jung Hwan Lee
Keyword(s):  
Systematic Review ◽  
Clinical Efficacy ◽  
Pain Control ◽  
Meta Analysis ◽  
Epidural Injection ◽  
Functional Improvement ◽  
Low Grade ◽  
Short Term ◽  
Short And Long Term

Background: Epidural injection (EI) is used to treat back or radicular pain from lumbosacral disc herniation (LDH). Although several reports have stated that the transforaminal approach in EI (TFEI) has an advantage in target specificity and yields better clinical efficacy than the interlaminar approach in EI (ILEI), other studies have indicated that the clinical efficacy of ILEI was not inferior to that of TFEI and that ILEI also has the ability to spread medication into the ventral space to a degree similar to that of TFEI. There has been controversy about whether TFEI is superior to ILEI in clinical efficacy. Objectives: This systematic review and meta-analysis aimed to investigate whether TFEI is more useful than ILEI for achieving clinical outcomes in patients with LDH. Study design: A systematic review and meta-analysis using a random effects model on randomized controlled studies (RCT). Methods: A literature search was performed in MEDLINE, EMBASE, Cochrane review, and KoreaMed for studies published from January 1996 until July 2017. From those found fulfilling the search criteria, manuscripts that compared the clinical efficacy of steroids and control agents, such as local anesthetics or saline, in terms of pain control and functional improvement were included in this study. Exclusion criteria included a previous history of lumbosacral surgery, nonspecific low back pain, severe spinal stenosis, and severe disc degeneration. After reviewing titles, abstracts, and the full text of 6,711 studies; 12 studies were included in the qualitative synthesis. Data including pain scores, functional scores, and follow-up period were extracted from 10 studies and analyzed using a random effects model to obtain effect size and its statistical significance. The quality and level of evidence were analyzed in accordance with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Results: In terms of pain control, TFEI showed significantly better short-term (2 weeks to 1 month) outcomes and slightly favorable long-term (4 - 6 month) outcomes, but without significance, in comparison with ILEI. In terms of functional improvement, TFEI also showed favorable short- and long-term outcomes, but without significance, in comparison with ILEI. TFEI had target specificity, required no additional cost and resources, and had equal applicability to ILEI. However, TFEI was more associated with a higher frequency of discomfort or adverse events during the procedure. Overall, better results were reported with TFEI over ILEI, but with low-grade evidence due to the inconsistency and imprecision of the selected studies. Limitation: Analyses of safety or adverse effects could not be performed due to a lack of available data from the included studies. Conclusions: Based on low-grade evidence, TFEI showed significantly better short-term pain control and slightly favorable outcomes in long-term pain reduction and short- and long-term functional improvement in comparison with ILEI. Key words: Epidural injection, interlaminar, transforaminal, meta-analysis, systemic review, pain, function

scholarly journals Association Between Out-of-Hour Admission and Short- and Long-Term Mortality in Acute Myocardial Infarction: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Yue-Yan Yu ◽  
Bo-Wen Zhao ◽  
Lan Ma ◽  
Xiao-Ce Dai
Keyword(s):  
Myocardial Infarction ◽  
Systematic Review ◽  
Acute Myocardial Infarction ◽  
Publication Bias ◽  
Meta Analysis ◽  
Short Term ◽  
Short Term Mortality ◽  
Short And Long Term ◽  
Long Term Mortality

Objectives: Out-of-hour admission (on weekends, holidays, and weekday nights) has been associated with higher mortality in patients with acute myocardial infarction (AMI). We conducted a meta-analysis to verify the association between out-of-hour admission and mortality (both short- and long-term) in AMI patients.Design: This Systematic review and meta-analysis of cohort studies.Data Sources: PubMed and EMBASE were searched from inception to 27 May 2021.Eligibility Criteria for Selected Studies: Studies of any design examined the potential association between out-of-hour admission and mortality in AMI.Data Extraction and Synthesis: In total, 2 investigators extracted the data and evaluated the risk of bias. Analysis was conducted using a random-effects model. The results are shown as odds ratios [ORs] with 95% confidence intervals (CIs). I2 value was used to estimate heterogeneity. Grading of Recommendations Assessment, Development, and Evaluation was used to assess the certainty of the evidence.Results: The final analysis included 45 articles and 15,346,544 patients. Short-term mortality (defined as either in-hospital or 30-day mortality) was reported in 42 articles (15,340,220 patients). Out-of-hour admission was associated with higher short-term mortality (OR 1.04; 95%CI 1.02–1.05; I2 = 69.2%) but there was a significant statistical indication for publication bias (modified Macaskill's test P &lt; 0.001). One-year mortality was reported in 10 articles (1,386,837 patients). Out-of-hour admission was also associated with significantly increased long-term mortality (OR 1.03; 95%CI 1.01–1.04; I2 = 66.6%), with no statistical indication of publication bias (p = 0.207). In the exploratory subgroup analysis, the intervention effect for short-term mortality was pronounced among patients in different regions (p = 0.04 for interaction) and socio-economic levels (p = 0.007 for interaction) and long-term mortality was pronounced among patients with different type of AMI (p = 0.0008 for interaction) or on different types of out-to-hour admission (p = 0.006 for interaction).Conclusion: Out-of-hour admission may be associated with an increased risk of both short- and long-term mortality in AMI patients.Trial Registration: PROSPERO (CRD42020182364).

The Impact of Business Communication Education on Students’ Short- and Long-Term Performances

2004 ◽  
Vol 67 (1) ◽  
pp. 24-40 ◽  
Author(s):  
Jensen J. Zhao ◽  
Melody W. Alexander
Keyword(s):  
Business Communication ◽  
Performance Outcomes ◽  
Term Effect ◽  
Communication Education ◽  
Short Term ◽  
Communication Course ◽  
Short And Long Term ◽  
Long Term Impact ◽  
The Impact

The purpose of this longitudinal study was to identify the short- and long-term impact of business communication education on students’ skill developments and performance outcomes. Nearly 400 students at an AACSC International–accredited business college participated in the study during their sophomore and senior years. The findings indicate that the business communication course helped students develop good skills in writing reports, solving problems, working in teams, communicating orally, and using Internet technologies for both the short term (sophomore year) and the long term (senior year). More than 95% of the students reported achieving As and Bs on written assignments, company-analysis reports, problem-solving assignments, and oral presentations in their sophomore, junior, and senior years. However, the long-term effect was statistically less significant than was the short-term effect, although both were within the same positive range.

scholarly journals Correlation Between Neutrophil-to-lymphocyte Ratio and Postoperative Mortality in Elderly Patients With Hip Fracture: a Meta-analysis

2021 ◽  
Author(s):  
Ching-Hsin Chou ◽  
Yu-Hang Chen ◽  
Hsin-Hsien Su ◽  
Yu-Ting Tsai ◽  
Ming-Hsiu Chiang ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
Geriatric Patients ◽  
Meta Analysis ◽  
Postoperative Mortality ◽  
Short Term ◽  
Term Survival ◽  
Lymphocyte Ratio ◽  
Long Term Mortality

Abstract Introduction: The neutrophil-to-lymphocyte ratio (NLR) is a crucial prognosis predictor following several major operations. However, the association between NLR and the outcome after hip fracture surgery is unclear. In this meta-analysis, we investigated the correlation between NLR and postoperative mortality in geriatric patients following hip surgery. Method: PubMed, Embase, Cochrane library, and Google Scholar were searched for studies up to June 2021 reporting the correlation between NLR and postoperative mortality in elderly patients undergoing surgery for hip fracture. Data from studies reporting the mean of NLR and its 95% confidence interval (CI) were pooled. Both long-term (≥1 year) and short-term (≤30 days) mortality rates were included for analysis.Result: Eight retrospective studies comprising a total of 1563 patients were included. Both preoperative and postoperative NLRs (mean difference [MD]: 2.75, 95% CI: 0.23–5.27; P = 0.03 and MD: 2.36, 95% CI: 0.51–4.21; P = 0.01, respectively) were significantly higher in the long-term mortality group than in the long-term survival group. However, no significant differences in NLR were noted between the short-term mortality and survival groups (MD: −1.02, 95% CI: −3.98 to 1.93; P = 0.5).Conclusion: Higher preoperative and postoperative NLRs were correlated with a higher risk of long-term mortality following surgery for hip fracture in the geriatric population, suggesting the prognostic value of NLR for long-term survival. Further studies with well-controlled confounders are warranted to clarify the predictive value of NLR in clinical practice in geriatric patients with hip fracture.Trial registration: no registration needed

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