Midazolam for sedation before procedures in adults and children: a systematic review update

Abstract Background Midazolam is used for sedation before diagnostic and therapeutic medical procedures by several routes including oral, intravenous, intranasal and intramuscular. This is an update of a Cochrane review published in 2016, which aimed to determine the evidence on the effectiveness of midazolam for sedation when administered before a diagnostic or therapeutic procedure in adults and children. Methods We searched CENTRAL, MEDLINE, Embase and two trials registers up to May 2020 together with reference checking to identify additional studies. We imposed no language restrictions. Randomized controlled trials of midazolam in comparison with placebo or other medications used for sedation were included. Two authors independently extracted data and assessed risk of bias for each included study. Results Eight new trials were included in this update, which resulted in changed conclusions for the intravenous midazolam versus placebo, oral midazolam versus chloral hydrate and oral midazolam versus placebo comparisons. Effect estimates for all outcomes within the intravenous midazolam versus placebo (7 trials; 633 adults and 32 children) are uncertain due to concerns about imprecision and risk of bias. Midazolam resulted in a higher level of sedation than placebo (mean difference (MD) 1.05; 95% confidence interval (95% CI) 0.69 to 1.41; 1 study; 100 adults). There was no difference in anxiety (RR 0.43, 95% CI 0.09 to 1.99; I2 = 75%; 2 studies; 123 adults). Risk of difficulty performing procedures was lower in the midazolam group (RR 0.5; 95% CI 0.29 to 0.86; I2 = 45%; 3 studies; 191 adults and 32 children). There was no difference in discomfort (RR 0.51; 95% CI 0.25 to 1.04; I2 = 0%; 2 studies; 190 adults). Five trials with 336 children were included in the oral midazolam versus chloral hydrate comparison. Midazolam was less likely to result in moderate sedation (RR 0.30, 95% CI 0.11 to 0.82; I2 = 64%; 2 studies, 228 participants). This effect estimate is highly uncertain due to concerns about the risk of bias, imprecision and inconsistency. There was no difference in ratings of anxiety (SMD − 0.26; 95% CI − 0.75 to 0.23; I2 = 0%; 2 studies; 68 participants). Midazolam increased risk of incomplete procedures (RR 4.01; 95% CI 1.92 to 8.40; I2 = 0%; 4 studies, 268 participants). This effect estimate is uncertain due to concerns about the risk of bias. There were four trials with 359 adults and 77 children included in the oral midazolam versus placebo comparison. Midazolam reduced ratings of anxiety (SMD − 1.01; 95% CI − 1.86 to − 0.16; I2 = 92%; 4 studies; 436 participants). It is unclear if midazolam has an effect on difficulty performing procedures. Meta-analysis was not performed because there was only one incomplete procedure in the midazolam group in one of the trials. Midazolam reduced pain in one study with 99 adults (MD − 2; 95% CI − 2.5 to − 1.6; moderate quality). The effect estimate is uncertain due to concerns about the risk of bias. Conclusion The additional evidence arising from inclusion of new studies in this updated review has not produced sufficient high-quality evidence to determine whether midazolam produces more effective sedation than other medications or placebo in any specific population included in this review. For adults, there was low-quality evidence that intravenous midazolam did not reduce the risk of anxiety or discomfort/pain in comparison to placebo, but the sedation level was higher. By combining results from adults and children, there was low-quality evidence of a large reduction in the risk of procedures being difficult to perform with midazolam in comparison to placebo. The effect estimates for this comparison are uncertain because there was concern about risk of bias and imprecision. There is moderate-quality evidence suggesting that oral midazolam produces less-effective sedation than chloral hydrate for completion of procedures for children undergoing non-invasive diagnostic procedures. Ratings of anxiety were not different between oral midazolam and chloral hydrate. The extent to which giving oral midazolam to adults or children decreases anxiety during procedures compared with placebo is uncertain due to concerns about risk of bias and imprecision. There was moderate-quality evidence from one study that oral midazolam reduced the severity of discomfort/pain for adults during a brief diagnostic procedure in comparison with placebo.

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Predictors of adherence to prescribed exercise programs for older adults with non-musculoskeletal indications for exercise: a systematic review

10.21203/rs.3.rs-43573/v2 ◽

2020 ◽

Author(s):

Julia F Shaw ◽

Sophie Pilon ◽

Matthieu Vierula ◽

Daniel I McIsaac

Keyword(s):

Older Adults ◽

Experimental Studies ◽

Risk Of Bias ◽

Adherence Rate ◽

Exercise Programs ◽

Assessment Development ◽

Moderate Quality ◽

Adverse Health Outcomes ◽

Predictors Of Adherence ◽

Quality Evidence

Abstract BACKGROUND AND OBJECTIVES: Prescribed exercise to treat medical conditions and to prepare for surgery is a promising intervention to prevent adverse health outcomes for older adults; however, adherence to exercise programs may be low. Our objective was to identify and grade the quality of predictors of adherence to prescribed exercise in older adults.METHODS: After registration (CRD42018108242), prospective experimental studies were identified using a peer-reviewed search strategy applied to MEDLINE, EMBASE, Cochrane and CINAHL from inception until April 23, 2019. Following independent and duplicate review of titles, abstracts and full texts, we included prospective studies with an average population age >65 years, where exercise was formally prescribed for a medical or surgical condition. We excluded studies where exercise was prescribed for a chronic musculoskeletal condition. Risk of bias was assessed using the Quality in Prognostic studies tool or Cochrane risk of bias tool, as appropriate. Predictors of adherence were identified, pooled, and graded for quality using an adaptation of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework for predictor studies.RESULTS: We included 19 observational studies and 4 randomized controlled trials (n=5785) Indications for exercise included cardiac (n=6), pulmonary rehabilitation (n=7), or other (n=10; surgical, medical, and neurologic). Overall adherence rate was reported in 20 studies (range 21%-93%; mean 68%, standard deviation 23%). Moderate-quality evidence suggested that positive predictors of adherence were self-efficacy and good self-rated mental health; negative predictors were depression (high quality) and distance from the exercise facility. Moderate-quality evidence suggested that comorbidity and age were not predictive of adherence.CONCLUSIONS: These findings can inform design of future exercise programs as well as identification of individuals who may require extra support to benefit from prescribed exercise.

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Periodontitis Impact in Interleukin-6 Serum Levels in Solid Organ Transplanted Patients: A Systematic Review and Meta-Analysis

Diagnostics ◽

10.3390/diagnostics10040184 ◽

2020 ◽

Vol 10 (4) ◽

pp. 184 ◽

Cited By ~ 7

Author(s):

Vanessa Machado ◽

João Botelho ◽

Joana Lopes ◽

Mariana Patrão ◽

Ricardo Alves ◽

...

Keyword(s):

Systematic Review ◽

Serum Levels ◽

Case Control ◽

Risk Of Bias ◽

Solid Organ ◽

Systemic Complications ◽

Moderate Quality ◽

Meta Analyses ◽

The Impact ◽

Quality Evidence

This systematic review aimed to investigate the influence of periodontitis on post-transplant IL-6 serum levels of solid organ transplanted patients as compared to healthy subjects. Four databases (PubMed, Scholar, EMBASE, and CENTRAL) were searched up to February 2020 (PROSPERO CRD42018107817). Case-control and cohort studies on the association of IL-6 serum levels with a periodontal status of patients after solid organ transplantation were included. The risk of bias of observational studies was assessed through the Newcastle-Ottawa Scale (NOS). Random effects meta-analyses were thoroughly conducted. GRADE assessment provided quality evidence. Four case-control studies fulfilled the inclusion criteria (274 transplant recipients and 146 healthy controls), all of low risk of bias. Meta-analyses revealed significantly higher IL-6 levels in transplanted patients than healthy individuals with low-quality evidence (Mean Difference (MD): 2.55 (95% confidence interval (CI): 2.07, 3.03)). Transplanted patients with periodontitis have higher serum IL-6 levels than transplanted patients without periodontitis with moderate quality evidence (MD: 2.20 (95% CI: 1.00, 3.39)). We found low-quality evidence of higher IL-6 levels than healthy patients in patients with heart and kidney transplant. In these transplanted patients, there was moderate quality evidence that periodontitis is associated with higher IL-6 serum levels. Future research should consider the impact of such a difference in organ failure and systemic complications.

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Acupuncture for ulcerative colitis: a systematic review and meta-analysis of randomized clinical trials

BMC Complementary Medicine and Therapies ◽

10.1186/s12906-020-03101-4 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Xiao Wang ◽

Nan-qi Zhao ◽

Yu-xin Sun ◽

Xue Bai ◽

Jiang-tao Si ◽

...

Keyword(s):

Ulcerative Colitis ◽

Clinical Trials ◽

Clinical Effect ◽

Conventional Medicine ◽

Risk Of Bias ◽

Cochrane Library ◽

Stool Examination ◽

Moderate Quality ◽

Significant Difference ◽

Quality Evidence

Abstract Background Ulcerative colitis, characterized by diarrhea, bloody stools and abdominal pain, is a chronic, idiopathic inflammatory disease of the colonic mucosa. In recent years, the incidence of ulcerative colitis presents an increasing trend year by year. Acupuncture, as a potential effective treatment for ulcerative colitis, is widely used in clinical practice. Methods We searched PubMed, the Cochrane Library, Chinese CBM Database, China National Knowledge Infrastructure, Chinese VIP Information, and Wanfang Database from the date of the establishment of each database up to March, 2019. We included randomized controlled clinical trials (RCT) comparing acupuncture versus conventional conventional medicine or comparing acupuncture combined with conventional medicine versus conventional medicine in participants with ulcerative colitis. Two authors screened all references, assessed the risk of bias and extracted data independently. We summarized data using risk ratios (RR) with 95% confidence intervals (CI) for binary outcomes. We performed meta-analyses using random effects model. We assessed overall quality of evidence using GRADE. Results We included 13 RCTs (1030 participants, 515 in the acupuncture group and 515 in the control group). Only one study tested head acupuncture, and the other 12 tested body acupuncture. The treatment duration ranged from 14 to 60 days. Seven trials compared acupuncture alone versus conventional medicine, and six compared acupuncture combined with conventional medicine versus conventional medicine. Acupuncture combined with mesalazine showed better clinical effect (improved clinical symptoms, colonoscopy results and stool examination results) (RR 1.25, 95% CI 1.19 to 1.41; 232 participants; 4 trials; low quality evidence) and better colonoscopy curative effect (RR 1.33, 95% CI 1.04 to 1.71; 108 participants; 2 trials; moderate quality evidence) compared to mesalazine. Acupuncture showed better clinical effect compared to the combination of metronidazole and sulfasalazine (RR 1.21, 95%CI 1.10, 1.34; 318 participants; 3 trials; moderate quality evidence). There was no significant difference in the incidence of adverse events between groups. Conclusions Both acupuncture alone and acupuncture combined with conventional medicine may be effective in treating ulcerative colitis compared to conventional medicine. Our findings must be interpreted with caution due to high or unclear risk of bias of the included trials.

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Effects of presurgical interventions on chronic pain after total knee replacement: a systematic review and meta-analysis of randomised controlled trials

BMJ Open ◽

10.1136/bmjopen-2019-033248 ◽

2020 ◽

Vol 10 (1) ◽

pp. e033248 ◽

Cited By ~ 1

Author(s):

Jane Dennis ◽

Vikki Wylde ◽

Rachael Gooberman-Hill ◽

AW Blom ◽

Andrew David Beswick

Keyword(s):

Systematic Review ◽

Chronic Pain ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Risk Of Bias ◽

Controlled Trials ◽

Moderate Quality ◽

Total Knee ◽

Randomised Controlled ◽

Quality Evidence

ObjectiveNearly 100 000 primary total knee replacements (TKR) are performed in the UK annually. The primary aim of TKR is pain relief, but 10%–34% of patients report chronic pain. The aim of this systematic review was to evaluate the effectiveness of presurgical interventions in preventing chronic pain after TKR.DesignMEDLINE, Embase, CINAHL,The Cochrane Libraryand PsycINFO were searched from inception to December 2018. Screening and data extraction were performed by two authors. Meta-analysis was conducted using a random effects model. Risk of bias was assessed using the Cochrane tool and quality of evidence was assessed by Grading of Recommendations Assessment, Development and Evaluation.Primary and secondary outcomesPain at 6 months or longer; adverse events.InterventionsPresurgical interventions aimed at improving TKR outcomes.ResultsEight randomised controlled trials (RCTs) with data from 960 participants were included. The studies involved nine eligible comparisons. We found moderate-quality evidence of no effect of exercise programmes on chronic pain after TKR, based on a meta-analysis of 6 interventions with 229 participants (standardised mean difference 0.20, 95% CI −0.06 to 0.47, I2=0%). Sensitivity analysis restricted to studies at overall low risk of bias confirmed findings. Another RCT of exercise with no data available for meta-analysis showed no benefit. Studies evaluating combined exercise and education intervention (n=1) and education alone (n=1) suggested similar findings. Adverse event data were reported by most studies, but events were too few to draw conclusions.ConclusionsWe found low to moderate-quality evidence to suggest that neither preoperative exercise, education nor a combination of both is effective in preventing chronic pain after TKR. This review also identified a lack of evaluations of other preoperative interventions, such as multimodal pain management, which may improve long-term pain outcomes after TKR.PROSPERO registration numberCRD42017041382.

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Predictors of adherence to prescribed exercise programs for older adults with non-musculoskeletal indications for exercise: a systematic review

10.21203/rs.3.rs-43573/v1 ◽

2020 ◽

Author(s):

Julia F Shaw ◽

Sophie Pilon ◽

Matthieu Vierula ◽

Daniel I McIsaac

Keyword(s):

Older Adults ◽

Experimental Studies ◽

Risk Of Bias ◽

Adherence Rate ◽

Exercise Programs ◽

Assessment Development ◽

Moderate Quality ◽

Adverse Health Outcomes ◽

Predictors Of Adherence ◽

Quality Evidence

Abstract BACKGROUND AND OBJECTIVES: Prescribed exercise to treat medical conditions and to prepare for surgery is a promising intervention to prevent adverse health outcomes for older adults; however, adherence to exercise programs may be low. Our objective was to identify and grade the quality of predictors of adherence to prescribed exercise in older adults. METHODS After registration (CRD42018108242), prospective experimental studies were identified using a peer-reviewed search strategy applied to MEDLINE, EMBASE, Cochrane and CINAHL from inception until April 23, 2019. Following independent and duplicate review of titles, abstracts and full texts, we included prospective studies with an average population age ≥ 65 years, where exercise was formally prescribed for a medical or surgical condition. We excluded studies where exercise was prescribed for a chronic musculoskeletal condition. Risk of bias was assessed using the Quality in Prognostic studies tool or Cochrane risk of bias tool, as appropriate. Predictors of adherence were identified, pooled, and graded for quality using an adaptation of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework for predictor studies. RESULTS We included 19 observational studies and 4 randomized controlled trials (n = 5785) Indications for exercise included cardiac (n = 6), pulmonary rehabilitation (n = 7), or other (n = 10; surgical, medical, and neurologic). Overall adherence rate was reported in 20 studies (range 21%-93%; mean 68%, standard deviation 23%). Moderate-quality evidence suggested that positive predictors of adherence were self-efficacy and good self-rated mental health; negative predictors were depression (high quality) and distance from the exercise facility. Moderate-quality evidence suggested that comorbidity and age were not predictive of adherence. CONCLUSIONS These findings can inform design of future exercise programs as well as identification of individuals who may require extra support to benefit from prescribed exercise.

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Emergency department interventions for adult patients with low back pain: a systematic review of randomised controlled trials

Emergency Medicine Journal ◽

10.1136/emermed-2020-209588 ◽

2020 ◽

Vol 38 (1) ◽

pp. 59-68

Author(s):

Crystian B Oliveira ◽

Hugo E Amorim ◽

Danielle M Coombs ◽

Bethan Richards ◽

Marco Reedyk ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Risk Of Bias ◽

Low Back ◽

Pharmacological Treatments ◽

Moderate Quality ◽

Intravenous Paracetamol ◽

Randomised Controlled ◽

Quality Evidence

BackgroundMost low back pain trials have limited applicability to the emergency department (ED) because they provide treatment and measure outcomes after discharge from the ED. We investigated the efficacy and safety of pharmacological and non-pharmacological interventions delivered in the ED to patients with non-specific low back pain and/or sciatica on patient-relevant outcomes measured during the emergency visit.MethodsLiterature searches were performed in MEDLINE, EMBASE and CINAHL from inception to week 1 February 2020. We included all randomised controlled trials investigating adult patients (≥18 years) with non-specific low back pain and/or sciatica presenting to ED. The primary outcome of interest was pain intensity. Two reviewers independently screened the full texts, extracted the data and assessed risk of bias of each trial using the Physiotherapy Evidence Database (PEDro) scale. The overall quality of evidence, or certainty, provided by a set of trials evaluating the same treatment was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, which considers imprecision, inconsistency, indirectness and bias in the evidence.ResultsFifteen trials (1802 participants) were included with 12 of 15 at low risk of bias (ie, PEDro score >6). Based on results from individual trials and moderate quality evidence, ketoprofen gel was more effective than placebo for non-specific low back pain at 30 min (mean difference (MD) −15.0, 95% confidence interval (CI) −21.0 to −9.0). For those with sciatica (moderate quality evidence), intravenous paracetamol (acetaminophen) (MD −15.7, 95% CI −19.8 to −11.6) and intravenous morphine (MD −11.4, 95% CI −21.6 to −1.2) were both superior to placebo at 30 min. Based on moderate quality of evidence, corticosteroids showed no benefits against placebo at emergency discharge for non-specific low back pain (MD 9.0, 95% CI −0.71 to 18.7) or sciatica (MD −6.8, 95% CI −24.2 to 10.6). There were conflicting results from trials comparing different pharmacological options (moderate quality evidence) or investigating non-pharmacological treatments (low quality evidence).ConclusionKetoprofen gel for non-specific low back pain and intravenous paracetamol or morphine for sciatica were superior to placebo, whereas corticosteroids were ineffective for both conditions. There was conflicting evidence for comparisons of different pharmacological options and those involving non-pharmacological treatments. Additional trials measuring important patient-related outcomes to EDs are needed.

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Early and frequent exposure to antibiotics in children and the risk of obesity: systematic review and meta-analysis of observational studies

F1000Research ◽

10.12688/f1000research.24553.1 ◽

2020 ◽

Vol 9 ◽

pp. 711

Author(s):

Archita Srivastava ◽

Kim Chau ◽

Henry Kwon ◽

Qin Guo ◽

Bradley C. Johnston

Keyword(s):

Observational Studies ◽

Meta Analysis ◽

Overweight And Obesity ◽

Risk Of Bias ◽

Early Infancy ◽

Antibiotic Exposure ◽

Increased Risk ◽

Comprehensive Search ◽

Quality Evidence

Background: This study aimed to systematically evaluate the available evidence on prenatal and early infancy antibiotic exposure and the association with overweight and obesity in later childhood. Methods: We conducted a comprehensive search of Embase, MEDLINE, and Web of Science for observational studies assessing prenatal and early antibiotic exposure on the risk of overweight and obesity. We independently assessed the risk of bias using the ROBINS instrument and the overall quality of evidence using the GRADE approach. Results: Our search identified thirteen observational studies including 554,983 participants; most studies were at moderate risk of bias. We found a statistically significant impact of early antibiotic exposure and the risk of being overweight later in childhood (OR 1.18; 95% CI 1.05 to 1.34) (very low quality evidence). We also found that early childhood antibiotic exposure was associated with the risk for childhood obesity (OR 1.14; 95% CI 1.04 to 1.24) (very low quality evidence). Conclusions: Very low quality evidence suggests that exposure to antibiotics early in life may be associated with an increased risk of being overweight and obese in later childhood. However, very low quality evidence raises serious questions about the plausibility of prenatal and early infancy antibiotic exposure being causally related to weight in children. PROSPERO registration: CRD42016050011 (14/12/2016)

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Multifactorial interventions for preventing falls in older people living in the community: a systematic review and meta-analysis of 41 trials and almost 20 000 participants

British Journal of Sports Medicine ◽

10.1136/bjsports-2019-100732 ◽

2019 ◽

Vol 54 (22) ◽

pp. 1340-1350 ◽

Cited By ~ 11

Author(s):

Sally Hopewell ◽

Bethan Copsey ◽

Philippa Nicolson ◽

Busola Adedire ◽

Graham Boniface ◽

...

Keyword(s):

Systematic Review ◽

Older People ◽

Usual Care ◽

Meta Analysis ◽

Risk Of Bias ◽

Moderate Quality ◽

Recurrent Falls ◽

Meta Regression ◽

Quality Evidence

ObjectiveTo assess the longer term effects of multifactorial interventions for preventing falls in older people living in the community, and to explore whether prespecific trial-level characteristics are associated with greater fall prevention effects.DesignSystematic review with meta-analysis and meta-regression.Data sourcesMEDLINE, EMBASE, CINHAL, CENTRAL and trial registries were searched up to 25 July 2018.Study selectionWe included randomised controlled trials (≥12 months’ follow-up) evaluating the effects of multifactorial interventions on falls in older people aged 65 years and over, living in the community, compared with either usual care or usual care plus advice.Review methodsTwo authors independently verified studies for inclusion, assessed risk of bias and extracted data. Rate ratios (RaR) with 95% CIs were calculated for rate of falls, risk ratios (RR) for dichotomous outcomes and standardised mean difference for continuous outcomes. Data were pooled using a random effects model. The Grading of Recommendations, Assessment, Development and Evaluation was used to assess the quality of the evidence.ResultsWe included 41 trials totalling 19 369 participants; mean age 72–85 years. Exercise was the most common prespecified component of the multifactorial interventions (85%; n=35/41). Most trials were judged at unclear or high risk of bias in ≥1 domain. Twenty trials provided data on rate of falls and showed multifactorial interventions may reduce the rate at which people fall compared with the comparator (RaR 0.79, 95% CI 0.70 to 0.88; 20 trials; 10 116 participants; I2=90%; low-quality evidence). Multifactorial interventions may also slightly lower the risk of people sustaining one or more falls (RR 0.95, 95% CI 0.90 to 1.00; 30 trials; 13 817 participants; I2=56%; moderate-quality evidence) and recurrent falls (RR 0.88, 95% CI 0.78 to 1.00; 15 trials; 7277 participants; I2=46%; moderate-quality evidence). However, there may be little or no difference in other fall-related outcomes, such as fall-related fractures, falls requiring hospital admission or medical attention and health-related quality of life. Very few trials (n=3) reported on adverse events related to the intervention. Prespecified subgroup analyses showed that the effect on rate of falls may be smaller when compared with usual care plus advice as opposed to usual care only. Overall, heterogeneity remained high and was not explained by the prespecified characteristics included in the meta-regression.ConclusionMultifactorial interventions (most of which include exercise prescription) may reduce the rate of falls and slightly reduce risk of older people sustaining one or more falls and recurrent falls (defined as two or more falls within a specified time period).Trial registration numberCRD42018102549.

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The Prevalence of Opioid Analgesic Use in People with Chronic Noncancer Pain: Systematic Review and Meta-Analysis of Observational Studies

Pain Medicine ◽

10.1093/pm/pnaa322 ◽

2020 ◽

Author(s):

Graeme Wertheimer ◽

Stephanie Mathieson ◽

Christopher G Maher ◽

Chung-Wei Christine Lin ◽

Andrew J McLachlan ◽

...

Keyword(s):

Systematic Review ◽

Observational Studies ◽

Opioid Analgesic ◽

Risk Of Bias ◽

Opioid Use ◽

Chronic Noncancer Pain ◽

Moderate Quality ◽

Meta Regression ◽

Noncancer Pain ◽

Quality Evidence

Abstract Objective To review studies examining the proportion of people with chronic noncancer pain who report consuming opioids and characteristics associated with their use. Design Systematic review. Methods We searched databases from inception to February 8, 2020, and conducted citation tracking. We included observational studies reporting the proportion of adults with chronic noncancer pain who used opioid analgesics. Opioids were categorized as weak (e.g., codeine) or strong (e.g., oxycodone). Study risk of bias was assessed, and Grading of Recommendations Assessment, Development and Evaluations provided a summary of the overall quality. Results were pooled using a random-effects model. Meta-regression determined factors associated with opioid use. Results Sixty studies (N=3,961,739) reported data on opioid use in people with chronic noncancer pain from 1990 to 2017. Of these 46, 77% had moderate risk of bias. Opioid use was reported by 26.8% (95% confidence interval [CI], 23.1–30.8; moderate-quality evidence) of people with chronic noncancer pain. The use of weak opioids (17.3%; 95% CI 11.9–24.4; moderate-quality evidence) was more common than the use of strong opioids (9.8%; 95% CI, 6.8–14.0; low-quality evidence). Meta-regression determined that opioid use was associated with geographic region (P=0.02; lower in Europe than North America), but not sampling year (P=0.77), setting (P=0.06), diagnosis (P=0.34), or disclosure of funding (P=0.77). Conclusions Our review summarized data from over 3.9 million people with chronic noncancer pain reporting their opioid use. Between 1990 and 2017, one-quarter of people with chronic noncancer pain reported taking opioids, and this proportion did not change over time.

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Predictors of Adherence to Prescribed Exercise Programs for Older Adults With Medical or Surgical Indications for Exercise: a Systematic Review

10.21203/rs.3.rs-130918/v1 ◽

2020 ◽

Author(s):

Julia F Shaw ◽

Sophie Pilon ◽

Matthieu Vierula ◽

Daniel McIsaac

Keyword(s):

Systematic Review ◽

Older Adults ◽

Experimental Studies ◽

Risk Of Bias ◽

Exercise Programs ◽

Assessment Development ◽

Moderate Quality ◽

Adverse Health Outcomes ◽

Predictors Of Adherence ◽

Quality Evidence

Abstract BACKGROUND AND OBJECTIVES: Prescribed exercise to treat medical conditions and to prepare for surgery is a promising intervention to prevent adverse health outcomes for older adults; however, adherence to exercise programs may be low. Our objective was to identify and grade the quality of predictors of adherence to prescribed exercise in older adults. METHODS: Prospective experimental studies were identified using a peer-reviewed search strategy applied to MEDLINE, EMBASE, Cochrane and CINAHL from inception until October 6, 2020. Following independent and duplicate review of titles, abstracts and full texts, we included prospective studies with an average population age >65 years, where exercise was formally prescribed for a medical or surgical condition. We excluded studies where exercise was prescribed for a chronic musculoskeletal condition. Risk of bias was assessed using the Quality in Prognostic studies tool or Cochrane risk of bias tool, as appropriate. Predictors of adherence were identified, pooled, and graded for quality using an adaptation of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework for predictor studies.RESULTS: We included 19 observational studies and 4 randomized controlled trials (n=5785) Indications for exercise included cardiac (n=6), pulmonary rehabilitation (n=7), or other (n=10; surgical, medical, and neurologic). Of the 10 studies that reported adherence as the percent of prescribed sessions completed, average adherence was 80% (range 60%-98%; standard deviation (SD) 11%). Of the 10 studies that reported adherence as a categorical threshold demarking adherent vs not adherent, average adherence was 57.5% (range 21%-83%; SD 21%). Moderate-quality evidence suggested that positive predictors of adherence were self-efficacy and good self-rated mental health; negative predictors were depression (high quality) and distance from the exercise facility. Moderate-quality evidence suggested that comorbidity and age were not predictive of adherence.CONCLUSIONS: These findings can inform design of future exercise programs as well as identification of individuals who may require extra support to benefit from prescribed exercise.SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018108242

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