scholarly journals Adolescents’ experiences of fluctuating pain in musculoskeletal disorders: A qualitative systematic review and thematic synthesis

2020 ◽  
Author(s):  
Sonia Khanom ◽  
Janet E McDonagh ◽  
Michelle Briggs ◽  
Ebru Bakir ◽  
John McBeth
Keyword(s):  
Musculoskeletal Disorders ◽  
Musculoskeletal Pain ◽  
Grey Literature ◽  
Background Level ◽  
Chronic Musculoskeletal Pain ◽  
Future Research ◽  
Symptom Experience ◽  
Health Service Provision ◽  
Pain Experience ◽  
Thematic Synthesis

Abstract Background Adolescents with chronic musculoskeletal pain experience daily fluctuations in pain. Although not all fluctuations are bothersome, pain flares are a distinct type of symptom fluctuation with greater impact. Since literature on the experience of pain flares is non-existent, the aim of this review was to (i) synthesise the qualitative literature on adolescents’ experiences of fluctuating pain in musculoskeletal disorders in order to (ii) identify knowledge gaps to inform future research on pain flares. Methods Electronic databases (CINAHL, MEDLINE, EMBASE, PsycINFO), grey literature and reference lists were searched from inception to June 2018 for qualitative studies reporting adolescents’ experiences of pain. Comprehensiveness of reporting was assessed using the Consolidated Criteria for Reporting Qualitative Health Research. Studies were analysed using thematic synthesis.Results Of the 3787 records identified, 32 studies (n= 536) were included. Principal findings were synthesised under three key themes: 1) symptom experience, 2) disruption and loss, and 3) regaining control. The first theme (symptom experience) describes adolescent’s perception and interpretation of pain fluctuations. The second theme (disruption and loss) describes the physical, social and emotional constraints faced as a result of changes in pain. The third theme (regaining control) describes coping strategies used to resist and accommodate unpredictable phases of pain. Each theme was experienced differently depending on adolescents’ characteristics such as their developmental status, pain condition, and the duration of the pain experience.Conclusions Adolescents with chronic musculoskeletal pain live with a daily background level of symptoms which frequently fluctuate and are associated with functional and emotional difficulties. It was not clear whether these symptoms and challenges were experienced as part of ‘typical’ fluctuations in pain, or whether they reflect symptom exacerbations classified as ‘flares’. Further research is needed to explore the frequency and characteristics of pain flares, and how they differ from their typical fluctuations in pain. The review also highlights areas relating to the pain experience, symptom management and health service provision that require further exploration to support more personalised, tailored care for adolescents with chronic musculoskeletal pain.

scholarly journals Adolescents’ experiences of fluctuating pain in musculoskeletal disorders: a qualitative systematic review and thematic synthesis

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Sonia Khanom ◽  
Janet E. McDonagh ◽  
Michelle Briggs ◽  
Ebru Bakir ◽  
John McBeth
Keyword(s):  
Musculoskeletal Disorders ◽  
Musculoskeletal Pain ◽  
Grey Literature ◽  
Background Level ◽  
Chronic Musculoskeletal Pain ◽  
Future Research ◽  
Symptom Experience ◽  
Health Service Provision ◽  
Pain Experience ◽  
Thematic Synthesis

Abstract Background Adolescents with chronic musculoskeletal pain experience daily fluctuations in pain. Although not all fluctuations are bothersome, pain flares are a distinct type of symptom fluctuation with greater impact. Since literature on the experience of pain flares is non-existent, the aim of this review was to (i) synthesise the qualitative literature on adolescents’ experiences of fluctuating pain in musculoskeletal disorders in order to (ii) identify knowledge gaps to inform future research on pain flares. Methods Electronic databases (CINAHL, MEDLINE, EMBASE, PsycINFO), grey literature and reference lists were searched from inception to June 2018 for qualitative studies reporting adolescents’ experiences of pain. Comprehensiveness of reporting was assessed using the Consolidated Criteria for Reporting Qualitative Health Research. Studies were analysed using thematic synthesis. Results Of the 3787 records identified, 32 studies (n = 536) were included. Principal findings were synthesised under three key themes: 1) symptom experience, 2) disruption and loss, and 3) regaining control. The first theme (symptom experience) describes adolescent’s perception and interpretation of pain fluctuations. The second theme (disruption and loss) describes the physical, social and emotional constraints faced as a result of changes in pain. The third theme (regaining control) describes coping strategies used to resist and accommodate unpredictable phases of pain. Each theme was experienced differently depending on adolescents’ characteristics such as their developmental status, pain condition, and the duration of the pain experience. Conclusions Adolescents with chronic musculoskeletal pain live with a daily background level of symptoms which frequently fluctuate and are associated with functional and emotional difficulties. It was not clear whether these symptoms and challenges were experienced as part of ‘typical’ fluctuations in pain, or whether they reflect symptom exacerbations classified as ‘flares’. Further research is needed to explore the frequency and characteristics of pain flares, and how they differ from their typical fluctuations in pain. The review also highlights areas relating to the pain experience, symptom management and health service provision that require further exploration to support more personalised, tailored care for adolescents with chronic musculoskeletal pain.

scholarly journals Adolescents’ experiences of fluctuating pain in musculoskeletal disorders: A qualitative systematic review and thematic synthesis

2020 ◽  
Author(s):  
Sonia Khanom ◽  
Janet E McDonagh ◽  
Michelle Briggs ◽  
Ebru Bakir ◽  
John McBeth
Keyword(s):  
Musculoskeletal Disorders ◽  
Musculoskeletal Pain ◽  
Grey Literature ◽  
Background Level ◽  
Distinct Type ◽  
Chronic Musculoskeletal Pain ◽  
Future Research ◽  
Symptom Experience ◽  
Pain Experience ◽  
Thematic Synthesis

Abstract Objectives Adolescents with chronic musculoskeletal pain experience daily fluctuations in pain. Although not all fluctuations are bothersome, pain flares are a distinct type of symptom fluctuation with greater impact. Since literature on the experience of pain flares is non-existent, the aim of this review was to (i) synthesise the qualitative literature on adolescents’ experiences of fluctuating pain in musculoskeletal disorders in order to (ii) identify knowledge gaps to inform future research on pain flares. Methods Electronic databases (CINAHL, MEDLINE, EMBASE, PsycINFO), grey literature and reference lists were searched from inception to June 2018 for qualitative studies reporting adolescents’ experiences of pain. Comprehensiveness of reporting was assessed using the Consolidated Criteria for Reporting Qualitative Health Research. Studies were analysed using thematic synthesis. Results Of the 3787 records identified, 32 studies (n= 536) were included. Principal findings were synthesised under three themes: 1) symptom experience, 2) disruption and loss, and 3) regaining control. Each theme was experienced differently depending on adolescents’ characteristics such as their developmental status, pain condition, and the duration of the pain experience. Conclusions Adolescents with chronic musculoskeletal pain live with a daily background level of symptoms which frequently fluctuate and are associated with functional and emotional difficulties. It was not clear whether these symptoms and challenges were experienced as part of ‘typical’ fluctuations in pain, or whether they reflect symptom exacerbations classified as ‘flares’. Further research is needed to explore the frequency and characteristics of pain flares, and how they differ from their typical fluctuations in pain.

scholarly journals P36 Adolescents’ experiences of fluctuating pain in musculoskeletal disorders: a qualitative systematic review and thematic synthesis

Rheumatology ◽  
2019 ◽  
Vol 58 (Supplement_4) ◽  
Author(s):  
Sonia Khanom ◽  
John McBeth ◽  
Michelle Briggs ◽  
Ebru Bakir ◽  
Janet McDonagh
Keyword(s):  
Musculoskeletal Disorders ◽  
Musculoskeletal Pain ◽  
Conflicts Of Interest ◽  
Chronic Musculoskeletal Pain ◽  
Future Research ◽  
Daily Fluctuation ◽  
Pain Experience ◽  
Thematic Synthesis ◽  
Normal Fluctuations ◽  
The Impact

Abstract Background Adolescents with chronic musculoskeletal pain experience pain that fluctuates within and across days. The aim of this review was to (i) synthesise the qualitative literature on adolescents’ experiences of fluctuating pain in musculoskeletal disorders, (ii) identify the concept of pain flare and how this may differ from daily fluctuation of pain, and (ii) identify knowledge gaps to inform the design of future research. Methods Six electronic databases (MEDLINE, EMBASE, PsycINFO, CINAHL, OpenGrey and Scopus) and reference lists of relevant articles were searched from inception to June 2018. Articles were eligible for inclusion if they were qualitative studies exploring the experiences of pain in adolescents, aged between 10–19 years, diagnosed with juvenile idiopathic arthritis (JIA) and chronic idiopathic pain syndromes (CIPS). Comprehensiveness of reporting was assessed using the Consolidated Criteria for Reporting Qualitative Health Research (COREQ) framework, and studies were analysed using thematic synthesis. Results Of the 3,787 records identified, 32 studies were included from 11 countries. 536 young people with JIA or CIPS participated in the studies, of which 509 had a diagnosis of JIA, and 27 with CIPS. Interviews were conducted in 29 studies, with 9 studies also combining interviews with focus groups, observations, questionnaires, researcher journaling, visual depictions and diaries. Although all included studies reported adolescent’s experience of pain, only 19 studies provide insight into the impact of fluctuating pain on an individual’s life and lived experience. 21 studies included data from parents, siblings, health professionals and/or individuals with other chronic illnesses, but efforts were made to only extract data referring to or expressed by adolescents with JIA or CIPS. Ages of patients ranged from 3 to 23 years, but all studies averaged within the adolescent range. Principal findings were synthesised under three themes: 1) symptom experience, 2) disruption and loss, and 3) regaining control. These themes can be seen to describe a journey through which the adolescent experiences fluctuating pain and associated symptoms, encounters the challenges to lifestyle that fluctuating pain presents, followed by employing coping strategies to regain a sense of control of their lives and pain. Each stage is experienced differently depending on individual factors such as adolescents’ developmental status, pain condition, and duration of the pain experience. Conclusion Adolescents with chronic musculoskeletal pain live with a daily background level of symptoms which frequently fluctuate and are associated with functional and emotional difficulties. It is not clear whether these symptoms and challenges are experienced as part of normal fluctuations in pain, or whether they reflect symptom exacerbations classified as flares. Further research is needed to explore the frequency and characteristics of pain flares, and how they differ from their normal fluctuations in pain. Conflicts of Interest The authors declare no conflicts of interest.

scholarly journals How pain neuroscience education is performed in patients with chronic musculoskeletal pain: a scoping review protocol

2021 ◽  
Author(s):  
Roberta Giovinazzi ◽  
Andrea Tamborrino ◽  
Michele Marelli ◽  
Leonardo Pellicciari ◽  
Tiziano Innocenti
Keyword(s):  
Musculoskeletal Pain ◽  
Scoping Review ◽  
Grey Literature ◽  
Chronic Musculoskeletal Pain ◽  
Future Research ◽  
Publication Type ◽  
Comprehensive Overview ◽  
Neuroscience Education ◽  
Review Protocol ◽  
Collection Form

AbstractBackgroundPain Neuroscience Education (PNE) is an effective widely used strategy in the field of chronic pain management. The objective of this scoping review is to summarize the literature to identify how PNE is performed in patients with chronic musculoskeletal pain.MethodsThis scoping review will be performed in accordance with the Joanna Briggs Institute methodology. Studies will be included if they meet the following population, concept, and context criteria: any patient with chronic musculoskeletal pain aged over 18 years old, any PNE delivery method, any context. No study design, publication type, and data restrictions will be applied. MEDLINE, Cochrane Central, Scopus, PsycInfo and PEDro databases will be searched up to March 2021. Additional records will be identified through searching in grey literature and reference lists of all relevant and included studies. Two reviewers will independently screen all title, abstracts and full-text studies for inclusion. A data collection form will be developed by the research team to extract the characteristics of the studies included. A tabular and accompanying narrative summary of the information will be provided.ConclusionsThis will be the first scoping review to provide a comprehensive overview of the topic. The results will add meaningful information for future research and clinical practice. Furthermore, any knowledge gaps on the topic will be identified. The results of this research will be published in a peer-reviewed journal and will be presented at relevant (inter)national scientific events.

scholarly journals Musculoskeletal pain in professional symphony orchestra musicians

2021 ◽  
Vol 15 (2) ◽  
pp. 1-6
Author(s):  
Antonina Kaczorowska ◽  
Agata Mroczek ◽  
Ewelina Lepsy ◽  
Magdalena Kornek ◽  
Agnieszka Kaczorowska ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Musculoskeletal Disorders ◽  
Musculoskeletal Pain ◽  
Body Mass ◽  
Musculoskeletal System ◽  
Symphony Orchestra ◽  
Body Height ◽  
Future Research ◽  
Professional Musicians ◽  
Positive Correlations

Background: A musician’s many years of professional experience may contribute to the development of pain and musculoskeletal disorders. There are a few studies in Poland on gender differences in musculoskeletal pain among adult professional musicians. Aim of the study: This study aimed to assess and compare pain in Polish women and men who are professional musicians, as well as to analyze the relationships between the intensity and frequency of pain and the time spent playing each week and the experience of playing the instrument in years. Material and methods: Sixty professional musicians were examined (26 men and 34 women). Pain intensity was assessed using the visual analog scale (VAS). Participants reported the frequency of musculoskeletal system ailments, the location of the pain, the number of hours of playing the instrument per week, and the playing experience in years. In addition, body weight and height were measured and body mass index (BMI) was calculated. Results: Most of the participants (94% of women and 69% of men) reported pain in the musculoskeletal system (p=0.010). Women experienced significantly greater pain in the musculoskeletal system assessed using the VAS (p=0.036), and also declared pain significantly more often compared to men (p=0.002). Significant positive correlations were found between frequency of symptoms per week with the number of hours of playing per week (r=0.28), year of playing the instrument (r=0.38), and pain assessment on the VAS (r=0.57). Moreover, negative correlations were found between frequency of symptoms per week with body height (r=–0.45) and body mass (r=–0.36). Conclusions: Musculoskeletal disorders are very common among professional musicians, especially among women. In general, the greater the number of hours playing per week and the longer the history of playing, the greater the pain intensity. Future research should aim to evaluate the prevalence and risk factors of musculoskeletal disorders associated with playing an instrument in different groups of musicians.

CHARACTERISTICS OF WORK RELATED MUSCULOSKELETAL DISORDERS IN COMANDOS

2021 ◽  
Vol 62 (6) ◽  
Author(s):  
Nguyen Huu Ben ◽  
Phan Van Manh ◽  
Bui Duy Hoan ◽  
Vu Quang Phong ◽  
Nguyen Van Khoi ◽  
...  
Keyword(s):  
Musculoskeletal Disorders ◽  
Musculoskeletal Pain ◽  
Descriptive Study ◽  
Chronic Musculoskeletal Pain ◽  
Cross Sectional ◽  
Work Related ◽  
Lower Back ◽  
Work Related Musculoskeletal Disorders ◽  
Low Rate

Objective: To describe the characteristics of work related musculoskeletal disorders in commandos. Subjects and methods: A cross-sectional descriptive study on 1,500 servicemen of the comando forces participating in the investigation of musculoskeletal disorders. Results: The prevalence of chronic musculoskeletal pain (in 12 months) was 60% of which the pain was mainly found in the nape, shoulder and lower back. Chronic musculoskeletal pain having to leave work only had a low rate (17,73%), most in the lower back with 9.40%. The nape and lower back had the highest rate of acute musculoskeletal pain, 21.40% and 21.27%, respectively. The Comandos soldiers worked mainly in standing and sitting positions. High REBA scores associated with musculoskeletal pain in the neck, elbows, wrists or hands, upper and lower back, thighs, and knees. Conclusion: The rate of musculoskeletal disorders in the commandos was 60%, of which the nape, shoulder, and lower back are the areas with the highest rate of musculoskeletal pain. Standing and sitting are the two main working positions of commandos. High REBA scores are associated with musculoskeletal pain in commandos.

scholarly journals Prevalence, burden of disease, and lost in health state utilities attributable to chronic musculoskeletal disorders and pain in Chile

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Pedro Zitko ◽  
Norberto Bilbeny ◽  
Carlos Balmaceda ◽  
Tomas Abbott ◽  
Cesar Carcamo ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Musculoskeletal Disorders ◽  
Musculoskeletal Pain ◽  
Chronic Low Back Pain ◽  
Population Level ◽  
Chronic Musculoskeletal Pain ◽  
Health State ◽  
Low Back ◽  
Health State Utilities

Abstract Background Musculoskeletal disorders are a leading cause of disability adjusted life years (DALY) in the world. We aim to describe the prevalence and to compare the DALYs and loss of health state utilities (LHSU) attributable to common musculoskeletal disorders in Chile. Methods We used data from the Chilean National Health Survey carried out in 2016–2017. Six musculoskeletal disorders were detected through the COPCOPRD questionnaire: chronic musculoskeletal pain, chronic low back pain, chronic shoulder pain, osteoarthritis of hip and knee, and fibromyalgia. We calculated the DALY for each disorder for 18 sex and age strata, and LHSU following an individual and population level approaches. We also calculated the fraction of LHSU attributable to pain. Results Chronic musculoskeletal pain disorder affects a fifth of the adult population, with a significant difference between sexes. Among specific musculoskeletal disorders highlights chronic low back pain with the highest prevalence. Musculoskeletal disorders are a significant cause of LHSU at the individual level, especially in the case of fibromyalgia. Chronic musculoskeletal pain caused 503,919 [283,940 - 815,132] DALYs in 2017, and roughly two hundred thousand LSHU at population level, which represents 9.7% [8.8–10.6] of the total LSHU occurred in that year. Discrepancy in the burden of musculoskeletal disorders was observed according to DALY or LSHU estimation. The pain and discomfort domain of LHSU accounted for around half of total LHSU in people with musculoskeletal disorders. Conclusion Chronic musculoskeletal pain is a major source of burden and LHSU. Fibromyalgia should deserve more attention in future studies. Using the attributable fraction offers a straightforward and flexible way to explore the burden of musculoskeletal disorders.

scholarly journals The Perspectives of Patients with Parkinson's Disease: A Systematic Review and Thematic Synthesis

2021 ◽  
Author(s):  
Birgitte Nørgaard ◽  
Signe Beck Titlestad ◽  
Charlotte Abrahamsen ◽  
Michael Marcussen
Keyword(s):  
Systematic Review ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Grey Literature ◽  
Healthcare Delivery ◽  
Bibliographic Databases ◽  
Future Research ◽  
Patient Centered ◽  
Thematic Synthesis ◽  
Centered Care

Abstract Background: Parkinson’s disease has considerable impact on the quality of life of both patients and their caregivers. Patients’ perspectives are a source of vital knowledge that informs health professionals’ ability to provide individualised and patient-centered care. The aim of this systematic review was to identify the perspectives of patients with Parkinson’s disease on treatment, care and rehabilitation.Methods: We conducted a systematic review and searched the following electronic bibliographic databases: MEDLINE, EMBASE, CINAHL, PsycInfo and Scopus for original studies published before June 2020. Grey literature was searched at www.parkinson.org, http://www.epda.eu.com, www.apdaparkinson.org and in the OpenSIGLE and HMIC databases. We included studies focusing on patients with Parkinson’s disease aged 18 or older that reported patients’ perspectives on treatment, care and rehabilitation. Results were analysed using thematic synthesis. Results: Ten studies were included, each of them applying qualitative methods and including between 1 and 28 patients. A total of 156 codings led to 17 descriptive themes which resulted in three analytic themes: Significance of self, Significance of informal caregivers and peers, and Significance of professionals.Conclusions: Our findings could be important in helping healthcare professionals plan and deliver treatment, care and rehabilitation based on patients’ priorities in the context of suffering from a chronic disease. The results might also guide future research regarding patient perspectives, as well as how and why to incorporate patients’ perspectives in healthcare delivery. Systematic review registration: The protocol was registered in Prospero (183551).

scholarly journals Prevalence, Burden of Disease, and Lost in Health State Utilities Attributable to Chronic Musculoskeletal Disorders and Pain in Chile

2020 ◽  
Author(s):  
Pedro Zitko ◽  
Norberto Bilbeny ◽  
Carlos Balmaceda ◽  
Tomas Abbott ◽  
Cesar Carcamo ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Musculoskeletal Disorders ◽  
Musculoskeletal Pain ◽  
Population Level ◽  
Attributable Fraction ◽  
Chronic Musculoskeletal Pain ◽  
Health State ◽  
Low Back ◽  
Health State Utilities

Abstract Background: Musculoskeletal disorders are a leading cause of disability adjusted life years (DALY) in the world. In addition to DALY, other approaches such as the attributable fraction have been proposed to estimate the burden of diseases. We aim to describe the prevalence and to compare the DALYs and loss of health state utilities (LHSU) attributable to common musculoskeletal disorders in Chile.Methods: We used data from the Chilean National Health Survey carried out in 2016-2017. Six musculoskeletal disorder were detected through the COPCOPRD questionnaire: chronic musculoskeletal pain, chronic low back pain, chronic shoulder pain, osteoarthritis of hip and knee, and fibromyalgia. We calculated the DALY for each disorder for 18 sex and age strata, and LHSU at individual and population level. We also calculated the fraction of LHSU attributable to pain.Results: Chronic musculoskeletal pain disorder affects a fifth of the adult population, with a significant difference between sexes. Among specific musculoskeletal disorders highlights chronic low back pain with the highest prevalence. Musculoskeletal disorders are a significant cause of LHSU at the individual level, especially in the case of fibromyalgia. Chronic musculoskeletal pain caused 503,919 [283,940 - 815,132] DALYs in 2017, and roughly two hundred thousand LSHU at population level, which represents 9.7% [8.8 - 10.6] of the total LSHU occurred in that year. Discrepancy in the burden of musculoskeletal disorders was observed according to DALY or LSHU estimation. The pain and discomfort domain of LHSU accounted for around half of total LHSU in people with musculoskeletal disorders. Conclusion: chronic musculoskeletal pain is a major source of burden and LHSU. Fibromyalgia should deserve more attention in future studies. Using the attributable fraction offers a straightforward and flexible way to explore the burden of musculoskeletal disorders.

scholarly journals Which biopsychosocial factors are associated with the development of chronic musculoskeletal pain? Protocol for an umbrella review of systematic reviews

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e053941
Author(s):  
Michael Dunn ◽  
Alison B Rushton ◽  
Jai Mistry ◽  
Andrew Soundy ◽  
Nicola R Heneghan
Keyword(s):  
Musculoskeletal Disorders ◽  
Musculoskeletal Pain ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Chronic Musculoskeletal Pain ◽  
Narrative Synthesis ◽  
Umbrella Review ◽  
Factors Associated ◽  
Meta Level

IntroductionRecent systematic reviews have identified many biopsychosocial factors associated with the development of chronic musculoskeletal pain (CMP). Despite often being specific to a particular musculoskeletal condition, findings are similar across systematic reviews. Research is needed to aggregate these findings to identify consistent factors across musculoskeletal disorders that are associated with the development of CMP. The objective of this study is to provide a meta-level synthesis of all biopsychosocial factors associated with the development of CMP.Methods and analysisAn umbrella review and meta-level narrative synthesis±meta-analysis has been designed informed by Joanna Briggs Institute and Cochrane guidance. This protocol is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-P. Sources will include Ovid Medline, Embase, Web of Science Core Collection, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, PsycINFO, CINAHL, PEDro, PROSPERO, Google Scholar and grey literature. Inclusion criteria: any systematic review which investigates biopsychosocial factors which may be associated with the development of CMP through prospective longitudinal methods. The outcome is musculoskeletal pain lasting beyond 3 months. Two independent reviewers will be involved in all stages; screening, selection, data extraction and risk of bias evaluation using the Assessing the Methodological Quality of Systematic Reviews-2 guidelines. A meta-level narrative synthesis will be conducted based on (a) factors associated with development of CMP, (b) the range of musculoskeletal disorders for which the same/similar findings have been established and (c) the quality of studies informing these findings. Where possible, meta-analysis will be performed. The Grading of Recommendations, Assessment, Development and Evaluation guidelines will be followed to determine the level of evidence for each biopsychosocial factor.Ethics and disseminationThis umbrella review does not require ethical approval. Findings will be presented at conferences and published in a peer reviewed journal.PROSPERO registration numberCRD42020193081.

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