Association between functional social support and cognitive function in middle-aged and older adults: a protocol for a systematic review

IntroductionMaintenance of cognitive function into old age is important for ageing populations. Researchers seek to identify modifiable risk and protective factors for cognitive function. One such modifiable factor is functional social support, that is, one’s perception of whether their social network can provide resources such as material help, companionship, information and emotional contact, if needed. While the literature generally reports positive associations between functional social support and cognitive function, results vary according to study methods such as the tool used to measure functional social support or the specific cognitive domain under investigation. Our review will summarise the association between functional social support and cognitive function in middle-aged and older-aged adults who reside in any setting (eg, community dwelling, long-term care facilities). We will also identify sources of discrepant findings between studies.Methods and analysisThis protocol was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guideline. PubMed, PsycINFO, Sociological Abstracts, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Scopus will be searched from inception to the present using a search strategy developed with a medical librarian’s help. We will supplement the database searches with a grey literature search. English-language or French-language studies with a comparison group will be subject to inclusion, regardless of the measures used to assess functional social support or cognitive function. We will assess risk of bias with the Cochrane Risk of Bias Tool-Version 2 or the Newcastle-Ottawa Scale, narratively synthesise the extracted data and conduct a meta-analysis of studies with similar characteristics (eg, sample age and sex, cognitive function outcomes). Two independent raters will screen articles and assess risk of bias.Ethics and disseminationThis review is timely given the push toward early diagnosis and treatment of dementia/major neurocognitive disorder and other types of cognitive impairment. This protocol does not require a formal ethics review. We will publish our findings in a peer-reviewed journal.

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The effect of hearing aids on cognitive function: A systematic review

PLoS ONE ◽

10.1371/journal.pone.0261207 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0261207

Author(s):

Maxime E. Sanders ◽

Ellen Kant ◽

Adriana L. Smit ◽

Inge Stegeman

Keyword(s):

Systematic Review ◽

Hearing Loss ◽

Cognitive Function ◽

Hearing Aids ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Grey Literature ◽

Cognitive Domain ◽

Cochrane Library ◽

Beneficial Impact

Rationale Dementia currently affects 50 million people globally with this expected to triple by 2050. Even though hearing loss is associated with cognitive decline, the underlying mechanisms are not fully understood. Considering hearing loss is the largest modifiable risk factor for developing dementia, it is essential to study the effect of hearing aids on cognitive function. Objective To systematically review the existing literature to examine the evidence for using hearing aids intervention as a treatment for deteriorating cognitive function. Design A search of PubMed, Cochrane Library, Embase and grey literature was conducted revealing 3060 unique records between 1990–2020. Two reviewers independently selected longitudinal studies observing the effects of hearing aids on cognitive function in persons without dementia at onset of the study. Due to the heterogeneity of the data, a meta-analysis could not be performed. Outcomes are described in a summary of findings table and portrayed diagrammatically. Results We identified 17 unique studies, spanning 30 years of research and 3526 participants. The included studies made use of 50 different cognitive function tests. These tests were grouped into separate cognitive domains according to the DSM-V classification for further analysis. The most beneficial impact of hearing aids seems to be in the cognitive domain of executive function, with six studies showing improvement, two studies being inconclusive and three studies not demonstrating a significant effect. Three of five studies demonstrated significant improvement when screening for brief mental status. The least beneficial impact is seen in domain of complex attention, with eight studies showing no significant effects, compared with one demonstrating improvement with intervention. Conclusions Based on this systematic review, we conclude that there is controversy about the effects of hearing aids on cognition. Additional research through randomized clinical trials with standardized cognitive assessment and longer follow-up is warranted to further elucidate this relationship.

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Exercise interventions for cognitive function in adults older than 50: a systematic review with meta-analysis

British Journal of Sports Medicine ◽

10.1136/bjsports-2016-096587 ◽

2017 ◽

Vol 52 (3) ◽

pp. 154-160 ◽

Cited By ~ 261

Author(s):

Joseph Michael Northey ◽

Nicolas Cherbuin ◽

Kate Louise Pumpa ◽

Disa Jane Smee ◽

Ben Rattray

Keyword(s):

Systematic Review ◽

Cognitive Function ◽

Physical Exercise ◽

Meta Analysis ◽

Cognitive Status ◽

Community Dwelling ◽

Cognitive Domain ◽

Moderate Intensity ◽

Eligibility Criteria ◽

Exercise Interventions

BackgroundPhysical exercise is seen as a promising intervention to prevent or delay cognitive decline in individuals aged 50 years and older, yet the evidence from reviews is not conclusive.ObjectivesTo determine if physical exercise is effective in improving cognitive function in this population.DesignSystematic review with multilevel meta-analysis.Data sourcesElectronic databases Medline (PubMed), EMBASE (Scopus), PsychINFO and CENTRAL (Cochrane) from inception to November 2016.Eligibility criteriaRandomised controlled trials of physical exercise interventions in community-dwelling adults older than 50 years, with an outcome measure of cognitive function.ResultsThe search returned 12 820 records, of which 39 studies were included in the systematic review. Analysis of 333 dependent effect sizes from 36 studies showed that physical exercise improved cognitive function (0.29; 95% CI 0.17 to 0.41; p<0.01). Interventions of aerobic exercise, resistance training, multicomponent training and tai chi, all had significant point estimates. When exercise prescription was examined, a duration of 45–60 min per session and at least moderate intensity, were associated with benefits to cognition. The results of the meta-analysis were consistent and independent of the cognitive domain tested or the cognitive status of the participants.ConclusionsPhysical exercise improved cognitive function in the over 50s, regardless of the cognitive status of participants. To improve cognitive function, this meta-analysis provides clinicians with evidence to recommend that patients obtain both aerobic and resistance exercise of at least moderate intensity on as many days of the week as feasible, in line with current exercise guidelines.

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Comparative efficacy and safety of interventions for treating head lice: a protocol for systematic review and network meta-analysis

BMJ Paediatrics Open ◽

10.1136/bmjpo-2021-001129 ◽

2021 ◽

Vol 5 (1) ◽

pp. e001129

Author(s):

Bill Stevenson ◽

Wubshet Tesfaye ◽

Julia Christenson ◽

Cynthia Mathew ◽

Solomon Abrha ◽

...

Keyword(s):

Systematic Review ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Grey Literature ◽

Risk Of Bias ◽

Controlled Trials ◽

Head Lice ◽

Efficacy And Safety ◽

Randomised Controlled ◽

Meta Analyses

BackgroundHead lice infestation is a major public health problem around the globe. Its treatment is challenging due to product failures resulting from rapidly emerging resistance to existing treatments, incorrect treatment applications and misdiagnosis. Various head lice treatments with different mechanism of action have been developed and explored over the years, with limited report on systematic assessments of their efficacy and safety. This work aims to present a robust evidence summarising the interventions used in head lice.MethodThis is a systematic review and network meta-analysis which will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement for network meta-analyses. Selected databases, including PubMed, Embase, MEDLINE, Web of Science, CINAHL and Cochrane Central Register of Controlled Trials will be systematically searched for randomised controlled trials exploring head lice treatments. Searches will be limited to trials published in English from database inception till 2021. Grey literature will be identified through Open Grey, AHRQ, Grey Literature Report, Grey Matters, ClinicalTrials.gov, WHO International Clinical Trials Registry and International Standard Randomised Controlled Trials Number registry. Additional studies will be sought from reference lists of included studies. Study screening, selection, data extraction and assessment of methodological quality will be undertaken by two independent reviewers, with disagreements resolved via a third reviewer. The primary outcome measure is the relative risk of cure at 7 and 14 days postinitial treatment. Secondary outcome measures may include adverse drug events, ovicidal activity, treatment compliance and acceptability, and reinfestation. Information from direct and indirect evidence will be used to generate the effect sizes (relative risk) to compare the efficacy and safety of individual head lice treatments against a common comparator (placebo and/or permethrin). Risk of bias assessment will be undertaken by two independent reviewers using the Cochrane Risk of Bias tool and the certainty of evidence assessed using the Grading of Recommendations, Assessment, Development and Evaluations guideline for network meta-analysis. All quantitative analyses will be conducted using STATA V.16.DiscussionThe evidence generated from this systematic review and meta-analysis is intended for use in evidence-driven treatment of head lice infestations and will be instrumental in informing health professionals, public health practitioners and policy-makers.PROSPERO registration numberCRD42017073375.

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Enhancing Our Understanding of Transitional Care Programs

Innovation in Aging ◽

10.1093/geroni/igaa057.448 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 136-137

Author(s):

Katherine McGilton ◽

Shirin Vellani ◽

Alexandra Krassikova ◽

Alexia Cumal ◽

Sheryl Robertson ◽

...

Keyword(s):

Older Adults ◽

Transitional Care ◽

Discharge Planning ◽

Grey Literature ◽

Occupational Therapists ◽

Community Dwelling ◽

Bibliographic Databases ◽

Multidisciplinary Teams ◽

Term Care ◽

Hospitalized Older Adults

Abstract Many hospitalized older adults experience delayed discharge. Transitional care programs (TCPs) provide short-term care to these patients to prepare them for transfer to nursing homes or back to the community. There are knowledge gaps related to the processes and outcomes of TCPs. We conducted a scoping review following Arksey & O’Malley’s framework to identify the: 1) characteristics of older patients served by TCPs, 2) services provided within TCPs, and 3) outcomes used to evaluate TCPs. We searched bibliographic databases and grey literature. We included papers and reports involving community-dwelling older adults aged ≥ 65 years and examined the processes and/or outcomes of TCPs. The search retrieved 4828 references; 38 studies and 2 reports met the inclusion criteria. Most studies were conducted in Europe (n=19) and America (n=13). Patients admitted to TCPs were 59-86 years old, had 2-10 chronic conditions, 26-74% lived alone, the majority were functionally dependent and had mild cognitive impairment. Most TCPs were staffed by nurses, physiotherapists, occupational therapists, social workers and physicians, and support staff. The TCPs provided 5 major types of services: assessment, care planning, treatment, evaluation/care monitoring and discharge planning. The outcomes most frequently assessed were discharge destination, mortality, hospital readmission, length of stay, cost and functional status. TCPs that reported significant improvement in older adults’ functions (which was the main goal of the TCPs) included multiple services delivered by multidisciplinary teams. There is a wide variation in the operationalization of TCPs within and between countries.

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What Types of Exercise Are More Effective in Reducing Obesity and Blood Pressure for Middle-Aged Women? A Systematic Review With Meta-Analysis

Biological Research For Nursing ◽

10.1177/10998004211015424 ◽

2021 ◽

pp. 109980042110154

Author(s):

Seong-Hi Park ◽

Chul-Gyu Kim

Keyword(s):

Systematic Review ◽

Blood Pressure ◽

Metabolic Syndrome ◽

Body Weight ◽

Waist Circumference ◽

Meta Analysis ◽

Physical Activities ◽

Risk Of Bias ◽

Cochrane Library ◽

Middle Aged

Background: A systematic review was performed to identify the types of physical activities effective as interventions in preventing metabolic syndrome in middle-aged women. Methods: Electronic databases (MEDLINE, EMBASE, the Cochrane Library, and CINAHL) served as the data sources. Cochrane’s Risk of Bias 2 was applied to assess the risk of bias of the randomized controlled trials. Meta-analyses were performed on selected studies using Review Manager 5.3. Thirty-one trials enrolling 2,202 participants were included. Results: Compared to controls, the effects of physical activity were indicated by pooled mean differences, which were −0.57 kg for body weight, −0.43 kg/m2 for body mass index, −1.63 cm for waist circumference, −4.89 mmHg for systolic blood pressure (BP), and −2.71 mmHg for diastolic BP. The effects were greater on the measurements of waist circumference and BP than on body weight and BMI. The types of physical activities were further analyzed according to sub-groups. Only aerobic exercise did not affect body weight and resistance exercise did not significantly change any results. Contrarily, combined exercises significantly reduced measurements of waist circumference and BP. Conclusion: This review can provide valuable information for research and implementation of measures to prevent metabolic syndrome in middle-aged women.

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Approaches to multidrug-resistant organism prevention and control in long-term care facilities for older people: a systematic review and meta-analysis

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-021-01044-0 ◽

2022 ◽

Vol 11 (1) ◽

Author(s):

Valerie Wing Yu Wong ◽

Ying Huang ◽

Wan In Wei ◽

Samuel Yeung Shan Wong ◽

Kin On Kwok

Keyword(s):

Small Sample Size ◽

Meta Analysis ◽

Small Sample ◽

Risk Of Bias ◽

Source Control ◽

Resistant Organism ◽

Routine Practice ◽

Post Intervention ◽

Term Care ◽

Mrsa Colonization

Abstract Background Despite clear evidence of benefits in acute-care hospitals, controversy over the effectiveness of IPC measures for MDROs is perceptible and evidence-based practice has not been established. Objective To investigate the effects of IPC interventions on MDRO colonization and infections in LTCFs. Data sources Ovid MEDLINE, EMBASE, and CINAHL from inception to September 2020. Eligibility criteria Original and peer-reviewed articles examining the post-intervention effects on MDRO colonization and infections in LTCFs. Interventions (i) Horizontal interventions: administrative engagement, barrier precautions, education, environmental cleaning, hand hygiene, performance improvement, and source control; and (ii) vertical intervention: active surveillance plus decolonization. Study appraisal and synthesis We employed a random-effects meta-analysis to estimate the pooled risk ratios (pRRs) for methicillin-resistant Staphylococcus aureus (MRSA) colonization by intervention duration; and conducted subgroup analyses on different intervention components. Study quality was assessed using Cochrane risk of bias tools. Results Of 3877 studies identified, 19 were eligible for inclusion (eight randomized controlled trials (RCTs)). Studies reported outcomes associated with MRSA (15 studies), vancomycin-resistant Enterococci (VRE) (four studies), Clostridium difficile (two studies), and Gram-negative bacteria (GNB) (two studies). Eleven studies were included in the meta-analysis. The pRRs were close to unity regardless of intervention duration (long: RR 0.81 [95% CI 0.60–1.10]; medium: RR 0.81 [95% CI 0.25–2.68]; short: RR 0.95 [95% CI 0.53–1.69]). Vertical interventions in studies with a small sample size showed significant reductions in MRSA colonization while horizontal interventions did not. All studies involving active administrative engagement reported reductions. The risk of bias was high in all but two studies. Conclusions Our meta-analysis did not show any beneficial effects from IPC interventions on MRSA reductions in LTCFs. Our findings highlight that the effectiveness of interventions in these facilities is likely conditional on resource availability—particularly decolonization and barrier precautions, due to their potential adverse events and uncertain effectiveness. Hence, administrative engagement is crucial for all effective IPC programmes. LTCFs should consider a pragmatic approach to reinforce standard precautions as routine practice and implement barrier precautions and decolonization to outbreak responses only.

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Overuse and underuse of cardiovascular diagnostic and therapeutic procedures for community-dwelling adults: a protocol for a systematic review

HRB Open Research ◽

10.12688/hrbopenres.13330.1 ◽

2021 ◽

Vol 4 ◽

pp. 99

Author(s):

Dominic Quinn ◽

David Byrne ◽

Tom Fahey ◽

Rose Anne Kenny ◽

Christine McGarrigle ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Artery Bypass ◽

Cost Effective ◽

Risk Of Bias ◽

Community Dwelling ◽

Cochrane Library ◽

Healthcare Intervention ◽

Cross Sectional ◽

International Guidelines

Background: Potentially inappropriate care can result from overuse or underuse of treatments, tests, or procedures. Overuse is defined as the use of health services with no clear benefit to the recipient or where harms outweigh benefits and/or costs of care. Underuse is defined as failure to deliver an effective and cost-effective healthcare intervention. Cardiovascular procedures such as coronary artery bypass grafting, carotid endarterectomy, coronary angiography, and coronary angioplasty (with/without stenting) are potentially both underused and overused. This systematic review aims to identify rates of potential overuse and underuse of these cardiovascular procedures and explore any associated patient or healthcare system factors. Methods: A systematic review and meta-analysis will be conducted in accordance with the PRISMA guidelines. A systematic search of MEDLINE (via Ovid), Embase, Cumulative Index to Nursing and Allied Health Literature and the Cochrane library will be conducted using a predefined search strategy. Eligible studies for inclusion will examine rates of overuse and underuse of cardiovascular procedures, measured against national/international guidelines, for adults aged ≥18 years. Primary observational studies including cross-sectional and cohort studies will be included. Titles, abstracts, and full texts will be screened for inclusion by two reviewers. Data will be extracted using a standardised form. Risk of bias for all included studies will be assessed using a modified version of the Hoy risk of bias tool. Where adequate data exists, and if statistically appropriate, meta-analyses will be conducted. If statistical pooling of the data is not possible, the findings will be narratively summarised focusing on the review’s objectives. Conclusion: This systematic review will examine overuse and underuse of cardiovascular procedures for adults. The results will help inform policy makers, researchers, patients, and clinicians in the appropriate use of these procedures, in line with international guidelines. Registration: This protocol has been submitted for registration on PROSPERO (CRD42021239041).

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The effects of non-clinician guidance on effectiveness and process outcomes of digital mental health interventions: A systematic review and meta-analysis. (Preprint)

10.2196/preprints.36004 ◽

2021 ◽

Author(s):

Calista Leung ◽

Julia Pei ◽

Kristen Hudec ◽

Farhud Shams ◽

Richard Munthali ◽

...

Keyword(s):

Mental Health ◽

Systematic Review ◽

Psychosocial Support ◽

Meta Analysis ◽

Grey Literature ◽

Risk Of Bias ◽

Health Interventions ◽

Cochrane Central Register ◽

Process Outcomes ◽

Mental Health Interventions

BACKGROUND Digital mental health interventions are increasingly prevalent in the current context of rapidly evolving technology, and research indicates that they yield effectiveness outcomes comparable to in-person treatment. Integrating professionals (i.e. psychologists, physicians) into digital mental health interventions has been common, and the inclusion of guidance within programs can increase adherence to interventions. However, employing professionals to enhance mental health programs may undermine the scalability of digital interventions. Therefore, delegating guidance tasks to paraprofessionals (peer supporters, technicians, lay counsellors, or other non-clinicians) can help reduce costs and increase accessibility. OBJECTIVE This systematic review and meta-analysis evaluates the effectiveness, adherence, and other process outcomes of non-clinician guided digital mental health interventions. METHODS Four databases (MEDLINE, EMBASE, CINAHL, and PSYCInfo) were searched for randomized controlled trials published between 2010 and 2020 examining digital mental health interventions. Three journals focused on digital intervention were also hand searched and grey literature was searched using ProQuest and the Cochrane Central Register of Control Trials (CENTRAL). Two researchers independently assessed risk of bias using the Cochrane Risk of Bias Tool 2. Data were collected on effectiveness, adherence, and other process outcomes, and meta-analyses were conducted for effectiveness and adherence outcomes. Non-clinician guided interventions were compared with treatment as usual, clinician-guided interventions, and unguided interventions. RESULTS Thirteen studies qualified for inclusion. Results indicate that non-clinician guided interventions yielded higher post-treatment effectiveness outcomes when compared to conditions involving control programs (e.g. online psychoeducation, monitored attention control) or waitlist controls (k=7, Hedges g=-0.73 (95% CI -1.08 to -0.38)). There are significant differences between non-clinician guided interventions and unguided interventions as well (k=6, Hedges g=-0.17 (95% CI -0.23 to -0.11)). In addition, non-clinician guided interventions did not differ in effectiveness from clinician-guided interventions (k=3, Hedges g=0.08 (95% CI -0.01 to 0.17)). These results suggest that guided digital mental health interventions are helpful to improve mental health outcomes regardless of the qualification, and that the presence of a non-clinician guide improves effectiveness outcomes more than no guidance. Non-clinician guided interventions did not yield significantly different effects on adherence outcomes when compared with unguided interventions (k=3, OR 1.58 (95% CI 0.51 to 4.92)), although a general trend of improved adherence was observed within non-clinician guided interventions. CONCLUSIONS Integrating paraprofessionals and non-clinicians appear to improve outcomes of digital mental health interventions, and may also enhance adherence outcomes (though the trend was nonsignificant). Further research should focus on the specific types of tasks these paraprofessionals can successfully provide (i.e. psychosocial support, therapeutic alliance, technical augmentation) and their associated outcomes. CLINICALTRIAL The protocol is preregistered on PROSPERO (CRD42020191226).

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INTEREST GROUP SESSION—ORAL HEALTH: COGNITIVE FUNCTION, SOCIAL SUPPORT, AND ORAL HEALTH STATUS AMONG OLDER ADULTS IN THE U.S. AND ABROAD

Innovation in Aging ◽

10.1093/geroni/igz038.1265 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S349-S349

Author(s):

Bei Wu ◽

Stephen K Shuman ◽

Michele Saunders

Keyword(s):

Social Support ◽

Older Adults ◽

Oral Health ◽

Cognitive Function ◽

Health Problems ◽

Community Dwelling ◽

Reciprocal Relationship ◽

Control Group ◽

Chinese Adults ◽

The U.S

Abstract There is an increasing awareness of the importance of oral health and its associated risk factors among older adults. This symposium includes four papers that address cognitive function, social support and oral health problems and symptoms among older adults in the U.S. and China. Lu and his colleagues examined the reciprocal relationship between cognitive function and complete tooth loss Chinese adults age 50+ using the China Health and Retirement Longitudinal study. The results show that there is a reciprocal relationship between these two indicators. The second paper used the Population Study of Chinese Elderly in Chicago (PINE) and examined the associations between tooth/gums symptoms and changes in cognitive function in Chinese older immigrants. The results reveal that having teeth symptoms was associated with a decline in cognitive function. Using the same PINE data, the third paper examined the association between different characteristics of social relationships and the number of oral health problems among U.S. older Chinese adults. Wu and her colleagues conducted a partner-assisted pilot intervention to improve oral health for community-dwelling older adults with either mild cognitive impairment or mild dementia. The results of this 6-month intervention show that persons in the treatment group had more improvement in oral hygiene than those in the control group. Findings from these four papers illustrate that cognitive function, social support, and oral health are interrelated. This symposium highlights the importance of improving cognitive health, social support, and oral health for middle-aged and older adults.

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Measures of central sensitisation and their measurement properties in the adult musculoskeletal trauma population: a protocol for a systematic review and data synthesis

BMJ Open ◽

10.1136/bmjopen-2018-023204 ◽

2019 ◽

Vol 9 (3) ◽

pp. e023204 ◽

Cited By ~ 1

Author(s):

Nicola Middlebrook ◽

Alison B Rushton ◽

Nicola R Heneghan ◽

Deborah Falla

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Grey Literature ◽

Risk Of Bias ◽

Measurement Properties ◽

Measurement Instruments ◽

Health Measurement ◽

Central Sensitisation ◽

Trauma Population ◽

Musculoskeletal Trauma

IntroductionPain following musculoskeletal trauma is common with poor outcomes and disability well documented. Pain is complex in nature and can include the four primary mechanisms of pain: nociceptive, neuropathic, inflammatory and central sensitisation (CS). CS can be measured in multiple ways; however, no systematic review has evaluated the measurement properties of such measures in the musculoskeletal trauma population. This systematic review aims to evaluate the measurement properties of current measures of CS in this population.Methods/analysisThis protocol is informed and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-P. MEDLINE, EMBASE, CINAHL, ZETOC, Web of Science, PubMed and Google Scholar as well as key journals and grey literature will be searched in two stages to (1) identify what measures are being used to assess CS in this population and (2) evaluate the measurement properties of the identified measures. Two independent reviewers will conduct the search, extract the data, assess risk of bias for included studies and assess overall quality. The Consensus-based Standards for the selection of Health Measurement Instruments Risk of Bias Checklist and a modified Grading of Recommendations, Assessment, Development and Evaluation guidelines will be used. Meta-analysis will be conducted if deemed appropriate. Alternatively, a narrative synthesis will be conducted and summarised per measurement property per outcome measure.Ethics and disseminationThis review will aid clinicians in using the most appropriate tool for assessing central sensitisation in this population and is the first step towards a more standardised approach in pain assessment. The results of this study will be submitted to a peer reviewed journal and presented at conferences.PROSPERO registrationnumberCRD42018091531.

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