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

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.

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

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.

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

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

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

Diagnostics ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. 184 ◽  
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.

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

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.

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

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e033248 ◽  
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.

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

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Aaron Conway ◽  
Kristina Chang ◽  
Sebastian Mafeld ◽  
Joanna Sutherland
Keyword(s):  
Chloral Hydrate ◽  
Risk Of Bias ◽  
Effect Estimate ◽  
Moderate Quality ◽  
Midazolam Group ◽  
Increased Risk ◽  
Oral Midazolam ◽  
Adults And Children ◽  
Effective Sedation ◽  
Quality Evidence

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.

scholarly journals Influenza Vaccination in Pregnant Women: A Systematic Review

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Tais F. Galvao ◽  
Marcus T. Silva ◽  
Ivan R. Zimmermann ◽  
Luiz Antonio B. Lopes ◽  
Eneida F. Bernardo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Influenza Vaccination ◽  
Pregnant Women ◽  
Influenza Virus Vaccine ◽  
Upper Respiratory Infection ◽  
Influenza Like Illness ◽  
Assessment Development ◽  
Moderate Quality ◽  
Quality Evidence

Objective. To assess the effects of the inactivated influenza virus vaccine on influenza outcomes in pregnant women and their infants. Methods. We performed a systematic review of the literature. We searched for randomized controlled trials and cohort studies in the MEDLINE, Embase, and other relevant databases (inception to September 2013). Two researchers selected studies and extracted the data independently. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the quality of the evidence. Results. We included eight studies out of 1,967 retrieved records. Influenza vaccination in pregnant women significantly reduced the incidence of influenza-like illness in mothers and their infants when compared with control groups (high-quality evidence) and reduced the incidence of laboratory-confirmed influenza in infants (moderate-quality evidence). No difference was found with regard to influenza-like illness with fever higher than 38°C (moderate-quality evidence) or upper respiratory infection (very-low-quality evidence) in mothers and infants. Conclusions. Maternal vaccination against influenza was shown to prevent influenza-like illness in women and infants; no differences were found for other outcomes. As the quality of evidence was not high overall, further research is needed to increase confidence and could possibly change these estimates.

scholarly journals Systematic review of aquatic physical exercise programs on functional fitness in older adults

2021 ◽  
Author(s):  
Jose Fuentes-Lopez ◽  
Ruben Vidal-Espinoza ◽  
Fernando Alvear-Vasquez ◽  
Lucila Sanchez-Macedo ◽  
Dony Mamani Velasquez ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Physical Exercise ◽  
Experimental Studies ◽  
Exercise Program ◽  
Aquatic Exercise ◽  
Functional Fitness ◽  
Exercise Programs ◽  
Exercise Frequency ◽  
Pubmed Database

The practice of physical exercise is recommended in the prevention of the deterioration of neuromuscular functions in aging. The objectives of this systematic review were to describe the protocols used and the functional fitness indicators evaluated in aquatic exercise programs in adults aged 50 to 80 years. The Pubmed database was used. The keywords were: 1) Physical exercise program or protocols or duration or type of exercise or aquatic exercise, frequency or intensity or indicators; 2) Adults or older adults; 3) Training or indicators, functional fitness, physical fitness. The search strategy considered the components of the Population, Interventions, Comparators, Outcomes, and Study design (PICOS) tool. Nine experimental studies were identified. These studies developed protocols to improve functional fitness in adults aged 50 to 80 years. They were based on sessions of 2 to 5 per week, the work time per session was 30 to 60min, intensities varied between 50 to 95% and totaled between 4 to 24 weeks of intervention. The activities were based on aquatic gymnastic exercises aimed at muscular strengthening of the upper and lower extremities, as well as coordination, balance, agility, cycling and walking exercises submerged in water. The protocols developed to improve functional fitness in adults aged 50 to 80 years were based on general physical exercise prescription guidelines (frequency, duration, intensity and type of activity). The application of aquatic exercises based on gymnastic exercises can provoke positive responses on functional fitness if worked at least 2 to 5 times per week, 30 to 60min/day and at intensities of 50 to 95%. These systematized indicators can be used by professionals working with adults to create and promote aquatic programs to improve functional fitness.

scholarly journals Falls efficacy instruments for community-dwelling older adults: A COSMIN-based systematic review

2020 ◽  
Author(s):  
Shawn Leng-Hsien Soh ◽  
Judith Lane ◽  
Tim Tianma Xu ◽  
Nigel Gleeson ◽  
Chee-Wee Tan
Keyword(s):  
Older Adults ◽  
Content Validity ◽  
Community Dwelling ◽  
High Quality ◽  
Structural Validity ◽  
Balance Confidence ◽  
Moderate Quality ◽  
High Quality Evidence ◽  
Community Dwelling Older Adults ◽  
Quality Evidence

Abstract Background: Falls efficacy is a widely-studied latent construct in community-dwelling older adults. Various self-reported instruments have been used to measure falls efficacy. In order to be informed of the choice of the best measurement instrument for a specific purpose, empirical evidence of the development and measurement properties of falls efficacy related instruments is needed.Methods: The Consensus-based Standards for the Selection of Health Measurement Intruments (COSMIN) checklist was used to summarise evidence on the development, content validity, and structural validity of instruments measuring falls efficacy in community-dwelling older adults. Databases including MEDLINE, Web of Science, PsychINFO, SCOPUS, CINAHL were searched (May 2019). Records on the development of instruments and studies assessing content validity or structural validity of falls efficacy related scales were included. COSMIN methodology was used to guide the review of eligible studies and in the assessment of their methodological quality. Evidence of content validity: relevance, comprehensiveness and comprehensibility and unidimensionality for structural validity were synthesised. A modified GRADE approach was applied to evidence synthesis.Results: 35 studies, of which 18 instruments had been identified, were included in the review. High-quality evidence showed that the Modified Falls Efficacy Scale (FES)-13 items (MFES-13) has sufficient relevance, yet insufficient comprehensiveness for measuring falls efficacy. Moderate quality evidence supporting the FES-10 has sufficient relevance, and MFES-14 has sufficient comprehensibility. Activities-specific Balance Confidence (ABC) Scale–Simplified (ABC-15) has sufficient relevance in measuring balance confidence supported by moderate-quality evidence. Low to very low-quality evidence underpinned the content validity of other instruments. High-quality evidence supported sufficient unidimensionality for eight instruments (FES-10, MFES-14, ABC-6, ABC-15, ABC-16, Iconographical FES (Icon-FES), FES–International (FES-I) and Perceived Ability to Prevent and Manage Fall Risks (PAPMFR)). Conclusion: Content validity of instruments to measure falls efficacy is understudied. Structural validity is sufficient for a number of widely-used instruments. Measuring balance confidence is a subset of falls efficacy. Further work is needed to investigate a broader construct for falls efficacy.

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

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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