scholarly journals The association between early MRI and length of disability in acute lower back pain: a systematic review and narrative synthesis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Bara A. Shraim ◽  
Muath A. Shraim ◽  
Ayman R. Ibrahim ◽  
Mohamed E. Elgamal ◽  
Basem Al-Omari ◽  
...  
Keyword(s):  
Systematic Review ◽  
Back Pain ◽  
Clinical Guidelines ◽  
Methodological Quality ◽  
Significant Proportion ◽  
Bibliographic Databases ◽  
Narrative Synthesis ◽  
Red Flags ◽  
Acute Low Back Pain ◽  
Retrospective Cohort Studies

Abstract Background Clinical guideline recommendations are against early magnetic resonance imaging (eMRI) within the first 4 to 6 weeks of conservative management of acute low back pain (LBP) without “clinical suspicion” of serious underlying conditions (red flags). There is some limited evidence that a significant proportion of patients with LBP receive eMRI non- indicated by clinical guidelines, which could be associated with increased length of disability (LOD). The aim of this systematic review was to investigate whether eMRI for acute LBP without red flags is associated with increased LOD. The LOD was defined as the number of disability days (absence from work). Methods Medline, EMBASE, and CINAHL bibliographic databases were searched from inception until June 5, 2021. Two reviewers independently assessed the methodological quality of included studies using the Newcastle–Ottawa scale and extracted data for the review. The search identified 324 records, in which seven studies met the inclusion criteria. Three of the included studies used the same study population. Owing to between-study heterogeneity, a narrative synthesis of results was used. Results All included studies were of good methodological quality and consistently reported that patients with acute LBP without red flags who received eMRI had increased LOD compared to those who did not receive eMRI. Three retrospective cohort studies reported that the eMRI groups had a higher mean LOD than the no eMRI groups ranging from 9.4 days (95% CI 8.5, 10.2) to 13.7 days (95% CI 13.0, 14.5) at the end of 1-year follow-up period. The remaining studies reported that the eMRI groups had a higher hazard ratio of work disability ranging between 1.75 (95% CI 1.23, 2.50) and 3.57 (95% CI 2.33, 5.56) as compared to the no eMRI groups. Conclusion eMRI is associated with increased LOD in patients with acute LBP without red flags. Identifying reasons for performing non-indicated eMRI and addressing them with quality improvement interventions may improve adherence to clinical guidelines and improve disability outcomes among patients with LBP.

scholarly journals Isokinetic Trunk Strength in Acute Low Back Pain Patients Compared to Healthy Subjects: A Systematic Review

2021 ◽  
Vol 18 (5) ◽  
pp. 2576
Author(s):  
Waleska Reyes-Ferrada ◽  
Luis Chirosa-Rios ◽  
Angela Rodriguez-Perea ◽  
Daniel Jerez-Mayorga ◽  
Ignacio Chirosa-Rios
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Reference Values ◽  
Healthy Subjects ◽  
Isokinetic Strength ◽  
Low Back ◽  
Acute Low Back Pain ◽  
Trunk Strength

Background: The purpose of this systematic review was to: (I) determine the quality of evidence from studies assessing trunk isokinetic strength in subjects with acute low back pain (ALBP) compared to healthy subjects and (II) establish reference values of isokinetic trunk strength in subjects with ALBP. Methodology: Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statements were followed using keywords associated with trunk, strength and low back pain. Four databases were used: PubMed, Web of Science, Scopus and SPORTDiscus. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS). Results: A total of 1604 articles were retrieved, four included in this review. All were evaluated as high risk of bias (Rob). Due to the high Rob and the diversity of protocols, instruments and variables used, it was not possible to determine reference values for subjects with ALBP, we can only establish a range of flexion peak torque (PT) between 175.1 and 89.7 Nm at 60°/s and between 185 and 81.5 Nm at 120°/s, and for extension PT between 240.0 and 91.5 Nm at 60°/s and between 217.5 and 69.2 Nm at 120°/s in subjects with ALBP. Conclusions: Due to the low quality of the evidence and the diversity of protocols used when measuring trunk isokinetic strength, it is necessary to carry out new high-quality research to establish reference values of trunk strength in subjects with ALBP.

Longitudinal outcomes of patients with pseudodementia: a systematic review

2018 ◽  
Vol 49 (5) ◽  
pp. 727-737 ◽  
Author(s):  
Michael H. Connors ◽  
Lena Quinto ◽  
Henry Brodaty
Keyword(s):  
Systematic Review ◽  
Significant Proportion ◽  
Conversion Disorder ◽  
Bibliographic Databases ◽  
Clinical Value ◽  
Trial Methodology ◽  
Longitudinal Outcomes ◽  
Increased Risk ◽  
Wide Range

AbstractDepression and a number of other psychiatric conditions can impair cognition and give the appearance of neurodegenerative disease. Collectively, this group of disorders is known as ‘pseudodementia’ and are important to identify given their potential reversibility with treatment. Despite considerable interest historically, the longitudinal outcomes of patients with pseudodementia remain unclear. We conducted a systematic review of longitudinal studies of pseudodementia. Bibliographic databases were searched using a wide range of search terms. Two reviewers independently assessed papers for inclusion, rated study quality, and extracted data. The search identified 18 studies with follow-up varying from several weeks to 18 years. Overall, 284 patients were studied, including 238 patients with depression, 18 with conversion disorder, 14 with psychosis, and 11 with bipolar disorder. Irrespective of diagnosis, 33% developed irreversible dementia at follow-up, 53% no longer met criteria for dementia, and 15% were lost to follow-up. Considerable variability was identified, with younger age at baseline, but not follow-up duration, associated with better outcomes. ECT and pharmacological interventions were also reported to be beneficial, though findings were limited by the poor quality of the studies. Overall, the findings suggest that pseudodementia may confer an increased risk of irreversible dementia in older patients. The findings also indicate, however, that a significant proportion improve, while many remain burdened with their psychiatric condition, independent of organic dementia. The findings support the clinical value of the construct and the need for its re-examination in light of developments in neuroimaging, genomics, other investigative tools, and trial methodology.

Persian participation measures for adolescents: A systematic review

2020 ◽  
pp. 030802262091040
Author(s):  
Ghodsiyeh Joveini ◽  
Armin Zareiyan ◽  
Laleh Lajevardi ◽  
Mitra Khalafbeigi ◽  
Afsoon Hassani Mehraban
Keyword(s):  
Systematic Review ◽  
Methodological Quality ◽  
Leisure Activities ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Bibliographic Databases ◽  
Patient Reported ◽  
Age Features ◽  
Adolescent Participation

Introduction Enhancing participation is the focus of occupational therapy. Comprehensive and accurate assessment ensures that clinicians can tailor an intervention to the client’s needs. This systematic review was completed to identify Persian adolescents’ participation measures and critically appraise them. It would be helpful in the selection of the most appropriate instrument to use in adolescent-related research and clinical practice. Method Ten bibliographic databases, four Iranian and six international, without year limits were searched up to June 2019. A systematic search was directed according to COSMIN guidelines for systematic reviews of patient-reported outcome measures and PRISMA guidelines (Systematic review registration: CRD42017073581). Results Seven measures were extracted from the articles. Reviewing the content and psychometric properties of the measures as well as the methodological quality of the studies indicated that the Modified Activity Questionnaire is the only measure with consistent and moderately reliable results. It measures adolescent participation in leisure activities but not all domains of participation. Conclusion There may be a growing need for adapting existing Persian measures or developing new ones based on specific age features related to puberty-stage alongside cultural, social and academic demands, which have a significant effect on adolescents’ participation in meaningful occupations. High methodological quality in designing such studies also has great importance.

scholarly journals Effects Of Transcutaneous Electrical Nerve Stimulation (Tens) On Patients With Acute Low Back Pain

2012 ◽  
Vol 7 (2) ◽  
pp. 29-32
Author(s):  
B Ahmed ◽  
S Alam ◽  
I Rashid ◽  
N Rahman ◽  
A Rahman ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Nerve Stimulation ◽  
Transcutaneous Electrical Nerve Stimulation ◽  
Significant Proportion ◽  
Low Back ◽  
Electrical Nerve Stimulation ◽  
Acute Low Back Pain ◽  
Group A ◽  
Group B

Background: Acute low back pain (LBP) affects a significant proportion of the population. Transcutaneous electrical nerve stimulation (TENS) was introduced more than 30 years ago as an adjunct to the pharmacological management of pain. However, despite its widespread use, the usefulness of TENS in LBP is still controversial. Introduction: LBP is a common problem in Bangladesh. Acute LBP is usually defined by a period of complaints of LBP of six weeks or shorter. TENS may improve acute LBP. Objective: To evaluate the effectiveness of TENS on acute LBP and also to ensure the patients wellbeing by shortening recovery time who have acute LBP. Methods: A prospective study was carried out in the Department of Physical Medicine and Rehabilitation, Bangubandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from July 2008 to December 2008. The patients were divided into two groups (A and B). Patients of Group A (30 patients) were treated with TENS, Non-steroidal anti-inflammatory drugs (NSAIDs) and activities of daily living (ADLs) instruction. Patients of group B (28 patients) were treated with NSAIDs and ADLs instructions. Results: A total of 58 Patients of acute LBP were included in this study. The mean age of the patients was 38.5 ± 9.01 years. Main causes of pain were muscle strain (39.65%), nonspecific LBP (22.41%), prolapsed lumber intervertebral disc (17.24%), lumbar spondylosis (13.79%) and sciatica (6.91%). After treatment the result was compared and student's 't' test was done to see the level of significance. Method was found significant after treatment (p<0.05). Twenty four (80%) patients were improved in group A and 18 (64.28%) patients in group B. Patient compliances of group A were better than that in group B. Conclusion: Effect of TENS on patients with acute low back pain is beneficial. DOI: http://dx.doi.org/10.3329/jafmc.v7i2.10393 JAFMC 2011; 7(2): 29-32

Clinical Guidelines for the Management of Acute Low Back Pain

Physiotherapy ◽  
1996 ◽  
Vol 82 (11) ◽  
pp. 644
Author(s):  
Michael J Rose ◽  
Gillian M Beattie
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Guidelines ◽  
Low Back ◽  
Acute Low Back Pain

scholarly journals Do clinical guidelines for whole body computerised tomography in trauma improve diagnostic accuracy and reduce unnecessary investigations? A systematic review and narrative synthesis

Trauma ◽  
2017 ◽  
Vol 19 (3) ◽  
pp. 163-174 ◽  
Author(s):  
Nicholas P Hare ◽  
Alistair W Macdonald ◽  
James P Mellor ◽  
Maaz Younus ◽  
Hridesh Chatha ◽  
...  
Keyword(s):  
Systematic Review ◽  
Diagnostic Accuracy ◽  
Clinical Guidelines ◽  
De Novo ◽  
Whole Body ◽  
Routine Practice ◽  
Significant Finding ◽  
Narrative Synthesis ◽  
Computerised Tomography ◽  
Manual Search

Introduction Whole body computerised tomography has become a standard of care for the investigation of major trauma patients. However, its use varies widely, and current clinical guidelines are not universally accepted. We undertook a systematic review of the literature to determine whether clinical guidelines for whole body computerised tomography in trauma increase its diagnostic accuracy. Materials and methods A systematic review of Medline, Cinhal and the Cochrane database, supplemented by a manual search of relevant papers was undertaken, with narrative synthesis. Studies comparing clinical guidelines to physician gestalt for the use of whole body computerised tomography in adult trauma were included. Results A total of 887 papers were identified from the electronic databases, and 1 from manual searches. Of these, seven papers fulfilled the inclusion criteria. Two papers compared clinical guidelines with routine practice: one found increased diagnostic accuracy while the other did not. Two papers investigated the performance of established clinical guidelines and demonstrated moderate sensitivity and low specificity. Two papers compared different components of established triage tools in trauma. One paper devised a de novo clinical decision rule, and demonstrated good diagnostic accuracy with the tool. The outcome criteria used to define a ‘positive’ scan varied widely, making direct comparisons between studies impossible. Conclusions Current clinical guidelines for whole body computerised tomography in trauma may increase the sensitivity of the investigation, but the evidence to support this is limited. There is a need to standardise the definition of a ‘clinically significant’ finding on CT to allow better comparison of diagnostic studies.

scholarly journals Summarizing the Effects of Different Exercise Types in Chronic Low Back Pain – A Systematic Review of Systematic Reviews

2021 ◽  
Author(s):  
Wilhelmus JA Grooten ◽  
Carina Boström ◽  
Åsa Stephansson Dedering ◽  
Marie Halvorsen ◽  
Roman P Kuster ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Resistance Training ◽  
Exercise Therapy ◽  
Systematic Reviews ◽  
Low Back ◽  
Moderate Evidence ◽  
Acute Low Back Pain ◽  
Review Of Reviews

Abstract Background Recently, a review of reviews concluded that exercise therapy of any type makes no difference to the effect on pain or disability in adult patients with acute low back pain (LBP). Whether this is also the case for exercise therapy in chronic LBP is still unknown. Objectives To summarize and synthesize systematic reviews (SR) and meta-analyses (MA) investigating the effects on pain and disability of common exercise types used in chronic LBP. Methods We included systematic reviews from several databases in which ≥ 75% of the studies were RCTs on adults between 18 and 70 years of age suffering from chronic or recurrent LBP for a period of at least 12 weeks. These were grouped into nine exercise types: Aerobic training, Aquatic exercises, Motor control exercises (MCE), Resistance training, Pilates, Sling exercises, Traditional Chinese Exercises (TCE), Walking, and Yoga. The study quality was assessed with AMSTAR-2. For each type of exercise, a narrative analysis was performed, and the levels of evidence for the effects of exercise were assessed through GRADE. Results The wide search resulted in 2,345 studies, and out of the 246 full texts that were screened, 41 SR/MA were included. Of these, 10 SR/MA were of high quality, 15 of moderate, 14 of low, and two of critically low quality. We found low to moderate evidence of mainly short-term and small beneficial effects on pain and disability for MCE, Resistance training, Pilates, TCE, and Yoga compared to no intervention. Few reviews were found for Aerobic, Aquatic, Sling, and Walking exercises, but with promising results. Aquatic exercises seem to be more beneficial compared to land exercises (low level of evidence). Conclusions In line with previous studies but in a broader perspective, this systematic review of reviews showed that there is low to moderate evidence that exercises are effective for reducing pain and disability compared to no or minimal interventions, but that no exercise type is more effective than other conservative interventions (very low to moderate evidence). Systematic review registration number PROSPERO: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=190409

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