Ahmad J. Abdulsalam, Kübranur Demirel, Mahmud Fazıl Aksakal, Murat Kara, Bayram Kaymak, Levent Özçakar
{"title":"Ultrasound imaging and guidance in Bell's palsy","authors":"Ahmad J. Abdulsalam, Kübranur Demirel, Mahmud Fazıl Aksakal, Murat Kara, Bayram Kaymak, Levent Özçakar","doi":"10.1002/pmrj.13181","DOIUrl":"https://doi.org/10.1002/pmrj.13181","url":null,"abstract":"","PeriodicalId":20287,"journal":{"name":"Pm & R","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140798382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cristian Caparrós‐Manosalva, Jessica Espinoza, Paula M. Caballero, Maira J. da Cunha, Feng Yang, Sujay Galen, Aline S. Pagnussat
ObjectiveNavigating obstacles involves adjusting walking patterns, particularly when stepping over them. This task may be particularly challenging for people with Parkinson disease (PD) for several reasons. This review aims to compare the spatiotemporal gait parameters of people with and without PD while stepping over obstacles.Literature SurveyA systematic literature search was conducted in six databases (PubMed, Scopus, Web of Science, EBSCO, Embase, and SciELO) from inception to September 2023.MethodologyStudies were selected that evaluated gait parameters of people with and without PD while walking over obstacles. Two independent researchers evaluated the eligibility and extracted gait parameters during obstacle crossing. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Heterogeneity was assessed using I2‐tests. Random effects models were determined for effect sizes as standardized mean differences (SMD).SynthesisTwenty‐five studies were included in the review and 17 in the meta‐analysis. Most of the studies (58%) showed a low risk of bias. People with PD exhibit a shorter step when landing after crossing an obstacle (SMD = −0.50 [−0.69 to −0.31]). Compared to people without PD, people with PD also widen their support base (SMD = 0.27 [0.07–0.47]) and reduce gait velocity (SMD = −0.60 [−0.80 to −0.39]) when crossing the obstacle.ConclusionsPeople with PD adopt a more conservative motor behavior during obstacle crossing than those without PD, with a shorter step length when landing after crossing an obstacle, greater step width and lower crossing speed.
目标导航障碍物需要调整行走方式，尤其是在跨过障碍物时。由于多种原因，这项任务对帕金森病（PD）患者来说尤其具有挑战性。本综述旨在比较帕金森病患者和非帕金森病患者跨过障碍物时的时空步态参数。文献调查从开始到 2023 年 9 月，在六个数据库（PubMed、Scopus、Web of Science、EBSCO、Embase 和 SciELO）中进行了系统的文献检索。两名独立研究人员对研究资格进行评估，并提取跨越障碍物时的步态参数。偏倚风险采用乔安娜-布里格斯研究所的关键评估清单进行评估。异质性采用 I2 检验进行评估。以标准化均值差异（SMD）确定效应大小的随机效应模型。综述25项研究被纳入综述，17项研究被纳入荟萃分析。大多数研究（58%）的偏倚风险较低。帕金森氏症患者在跨越障碍物后落地时步幅较短（SMD = -0.50 [-0.69 to -0.31]）。与非帕金森氏症患者相比，帕金森氏症患者在跨越障碍时还会加宽支撑基础（SMD = 0.27 [0.07-0.47]）并降低步速（SMD = -0.60 [-0.80 to -0.39]）。
{"title":"Movement strategies during obstacle crossing in people with Parkinson disease: A systematic review with meta‐analysis","authors":"Cristian Caparrós‐Manosalva, Jessica Espinoza, Paula M. Caballero, Maira J. da Cunha, Feng Yang, Sujay Galen, Aline S. Pagnussat","doi":"10.1002/pmrj.13166","DOIUrl":"https://doi.org/10.1002/pmrj.13166","url":null,"abstract":"ObjectiveNavigating obstacles involves adjusting walking patterns, particularly when stepping over them. This task may be particularly challenging for people with Parkinson disease (PD) for several reasons. This review aims to compare the spatiotemporal gait parameters of people with and without PD while stepping over obstacles.Literature SurveyA systematic literature search was conducted in six databases (PubMed, Scopus, Web of Science, EBSCO, Embase, and SciELO) from inception to September 2023.MethodologyStudies were selected that evaluated gait parameters of people with and without PD while walking over obstacles. Two independent researchers evaluated the eligibility and extracted gait parameters during obstacle crossing. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Heterogeneity was assessed using <jats:italic>I</jats:italic><jats:sup>2</jats:sup>‐tests. Random effects models were determined for effect sizes as standardized mean differences (SMD).SynthesisTwenty‐five studies were included in the review and 17 in the meta‐analysis. Most of the studies (58%) showed a low risk of bias. People with PD exhibit a shorter step when landing after crossing an obstacle (SMD = −0.50 [−0.69 to −0.31]). Compared to people without PD, people with PD also widen their support base (SMD = 0.27 [0.07–0.47]) and reduce gait velocity (SMD = −0.60 [−0.80 to −0.39]) when crossing the obstacle.ConclusionsPeople with PD adopt a more conservative motor behavior during obstacle crossing than those without PD, with a shorter step length when landing after crossing an obstacle, greater step width and lower crossing speed.","PeriodicalId":20287,"journal":{"name":"Pm & R","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140798384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joshua Cassinat, Joseph Nygaard, Collin Hoggard, Michael Hoffmann
IntroductionTraumatic brain injury (TBI) is a leading cause of death and disability, often resulting in prolonged coma and disordered consciousness. There are currently gaps in understanding the factors affecting rehabilitation location and outcome after TBI.ObjectiveTo identify the impact of demographics, comorbidities, and complications on discharge disposition in adults with prolonged coma following TBI.DesignRetrospective cohort study.SettingTertiary care hospitals and trauma centers in the United States.ParticipantsPatients 18 years of age or older with TBI and prolonged coma during the years 2008 to 2015.InterventionNot applicable.Main Outcome MeasuresDemographics, clinical injury data, comorbidities, and complications were collected, and odds ratios (ORs) and descriptive analysis were calculated for mortality, long‐term rehabilitation, and home discharge without services.ResultsA total of 6929 patients with TBI and prolonged coma were included in the final analysis; 3318 (47.9%) were discharged to rehabilitation facilities, 1859 (26.8%) died, and 1752 (25.3%) were discharged home. Older patients and those with higher injury severity scores had significantly higher ORs for mortality and rehab discharge. A total of 58.3% of patients presented with at least one comorbidity. Non‐White ethnicities and self‐pay/uninsured patients were significantly less likely to be discharged to a rehab facility. Furthermore, comorbidities including congestive heart failure (CHF) and diabetes were associated with a significantly increased OR for mortality and rehab discharge compared to home discharge without services.ConclusionsComorbidities, age, and injury severity were the most significant risk factors for increased mortality and acute rehab discharge. Maximizing the treatment of comorbidities including CHF and diabetes has the potential to decrease mortality and adverse outcomes following TBI with prolonged coma.
{"title":"Predictors of mortality and rehabilitation location in adults with prolonged coma following traumatic brain injury","authors":"Joshua Cassinat, Joseph Nygaard, Collin Hoggard, Michael Hoffmann","doi":"10.1002/pmrj.13177","DOIUrl":"https://doi.org/10.1002/pmrj.13177","url":null,"abstract":"IntroductionTraumatic brain injury (TBI) is a leading cause of death and disability, often resulting in prolonged coma and disordered consciousness. There are currently gaps in understanding the factors affecting rehabilitation location and outcome after TBI.ObjectiveTo identify the impact of demographics, comorbidities, and complications on discharge disposition in adults with prolonged coma following TBI.DesignRetrospective cohort study.SettingTertiary care hospitals and trauma centers in the United States.ParticipantsPatients 18 years of age or older with TBI and prolonged coma during the years 2008 to 2015.InterventionNot applicable.Main Outcome MeasuresDemographics, clinical injury data, comorbidities, and complications were collected, and odds ratios (ORs) and descriptive analysis were calculated for mortality, long‐term rehabilitation, and home discharge without services.ResultsA total of 6929 patients with TBI and prolonged coma were included in the final analysis; 3318 (47.9%) were discharged to rehabilitation facilities, 1859 (26.8%) died, and 1752 (25.3%) were discharged home. Older patients and those with higher injury severity scores had significantly higher ORs for mortality and rehab discharge. A total of 58.3% of patients presented with at least one comorbidity. Non‐White ethnicities and self‐pay/uninsured patients were significantly less likely to be discharged to a rehab facility. Furthermore, comorbidities including congestive heart failure (CHF) and diabetes were associated with a significantly increased OR for mortality and rehab discharge compared to home discharge without services.ConclusionsComorbidities, age, and injury severity were the most significant risk factors for increased mortality and acute rehab discharge. Maximizing the treatment of comorbidities including CHF and diabetes has the potential to decrease mortality and adverse outcomes following TBI with prolonged coma.","PeriodicalId":20287,"journal":{"name":"Pm & R","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140798385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
IntroductionCorticosteroid injection effectively treats de Quervain disease, and due to the high prevalence of the intracompartmental septum in the first extensor compartment, ultrasound guidance improves injection accuracy.ObjectiveTo compare the effectiveness, adverse events, and the recurrence rate between ultrasound‐guided and palpation‐guided injection in patients with de Quervain disease.DesignProspective, single‐blind, randomized controlled trial.SettingRehabilitation department of a private teaching hospital.ParticipantsWe enrolled 49 patients, ≥20 years of age, clinically diagnosed with de Quervain disease based on their medical history and physical examination.InterventionsPatients were randomized into two groups: ultrasound‐guided and palpation‐guided injection. Both groups received a mixture of 10 mg triamcinolone acetonide (10 mg/1 mL) and 0.3 mL 1% lidocaine.Main Outcome MeasuresThe primary outcome measure was the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score at 1 week. The secondary outcome measures were visual analog scale for pain (pain VAS) score, patient satisfaction, and adverse events or complications from the interventions at 1 week, 3 months, and 6 months.ResultsBoth groups showed improvement over time in QuickDASH scores and pain VAS (p < .001); however, no statistically significant differences were noted between the groups for either QuickDASH scores (p = .22) or pain VAS (p = .30). In addition, no statistically significant differences were found between the groups in terms of patient satisfaction (p = .76) and adverse events (p = .47, .33, .58) at the 1‐week, 3‐month, and 6‐month follow‐ups.ConclusionsBoth ultrasound‐guided and palpation‐guided injections effectively treated de Quervain disease. During a 6‐month follow‐up, there were no statistically significant differences between the groups in pain relief, upper limb function, or patient satisfaction. However, the palpation‐guided group showed a tendency for more recurrence and skin side effects.
{"title":"Ultrasound versus palpation‐guided corticosteroid injection for de Quervain disease: A randomized controlled trial","authors":"Ying‐Chen Kuo, Lin‐Fen Hsieh, Ya‐Fang Liu, Chia‐Sung Chang","doi":"10.1002/pmrj.13144","DOIUrl":"https://doi.org/10.1002/pmrj.13144","url":null,"abstract":"IntroductionCorticosteroid injection effectively treats de Quervain disease, and due to the high prevalence of the intracompartmental septum in the first extensor compartment, ultrasound guidance improves injection accuracy.ObjectiveTo compare the effectiveness, adverse events, and the recurrence rate between ultrasound‐guided and palpation‐guided injection in patients with de Quervain disease.DesignProspective, single‐blind, randomized controlled trial.SettingRehabilitation department of a private teaching hospital.ParticipantsWe enrolled 49 patients, ≥20 years of age, clinically diagnosed with de Quervain disease based on their medical history and physical examination.InterventionsPatients were randomized into two groups: ultrasound‐guided and palpation‐guided injection. Both groups received a mixture of 10 mg triamcinolone acetonide (10 mg/1 mL) and 0.3 mL 1% lidocaine.Main Outcome MeasuresThe primary outcome measure was the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score at 1 week. The secondary outcome measures were visual analog scale for pain (pain VAS) score, patient satisfaction, and adverse events or complications from the interventions at 1 week, 3 months, and 6 months.ResultsBoth groups showed improvement over time in QuickDASH scores and pain VAS (<jats:italic>p</jats:italic> < .001); however, no statistically significant differences were noted between the groups for either QuickDASH scores (<jats:italic>p</jats:italic> = .22) or pain VAS (<jats:italic>p</jats:italic> = .30). In addition, no statistically significant differences were found between the groups in terms of patient satisfaction (<jats:italic>p</jats:italic> = .76) and adverse events (<jats:italic>p</jats:italic> = .47, .33, .58) at the 1‐week, 3‐month, and 6‐month follow‐ups.ConclusionsBoth ultrasound‐guided and palpation‐guided injections effectively treated de Quervain disease. During a 6‐month follow‐up, there were no statistically significant differences between the groups in pain relief, upper limb function, or patient satisfaction. However, the palpation‐guided group showed a tendency for more recurrence and skin side effects.","PeriodicalId":20287,"journal":{"name":"Pm & R","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140798383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Megan E. Narad, Kaelynn Knestrick, Shari L. Wade, Brad G. Kurowski, Allen R. McConnell, Catherine C. Quatman‐Yates
IntroductionChildren with acquired brain injury (ABI) are at risk for poor therapeutic engagement due to cognitive impairment, affect lability, pain, and fatigue. Animal‐assisted therapy (AAT) has the potential to improve patient engagement in rehabilitation therapies; however, the feasibility of integrating AAT into the rigorous therapy schedule of inpatient clinical care or its reception by patients, families, and staff is unknown.ObjectiveTo examine the feasibility and acceptability of incorporating dogs into physical therapy and occupational therapy sessions with pediatric patients being treated on an inpatient rehabilitation unit for acquired brain injury.DesignA feasibility study of AAT within the context of a within‐subjects crossover study.SettingPediatric inpatient rehabilitation unit.ParticipantsSixteen patients, aged 7–28 years (mean = 13.6 years, standard deviation [SD] = 5.2 years; 50% male), being treated on the inpatient rehabilitation unit following ABI.InterventionAAT – the integration of dogs into inpatient physical therapy and occupational therapy sessions.Main Outcome MeasuresFeasibility measures: enrollment rate, the proportion of AAT sessions a dog attended, adverse events, instances where therapist or handler ended session early, patient animal closeness, and utilization of dog in session. Satisfaction measures: parent satisfaction questionnaires and therapist feedback.ResultsFeasibility was supported by high enrollment rate (88.9%) and dog attendance rate of 93%–95%; 84.3% of sessions used the dog in multiple ways and patients reported a high level of closeness with the dog in session, indicating that the dogs were integrated in meaningful ways. No adverse events were noted, therapists reported that intervention was convenient, and clinical care was not negatively impacted. A high level of satisfaction was reported by families and therapists.ConclusionsFindings suggest that AAT is feasible and acceptable, and it may be a valuable tool for therapists working with patients with ABI on an inpatient rehabilitation unit.
导言：后天性脑损伤（ABI）患儿由于认知障碍、情绪不稳定、疼痛和疲劳等原因，有可能无法很好地参与治疗。目标研究在后天性脑损伤住院康复病房接受治疗的儿科患者的物理疗法和作业疗法中加入狗的可行性和可接受性。设计在受试者内交叉研究的背景下进行动物辅助治疗的可行性研究。干预AAT--将狗融入住院物理治疗和职业治疗疗程中。主要结果测量可行性测量：入院率、狗参加的AAT疗程比例、不良事件、治疗师或驯养师提前结束疗程的情况、患者与动物的亲近程度以及疗程中狗的使用情况。满意度测量：家长满意度问卷和治疗师反馈。结果高注册率（88.9%）和狗的出席率（93%-95%）证明了可行性；84.3%的疗程以多种方式使用狗，患者报告说在疗程中与狗的亲近程度很高，这表明狗以有意义的方式融入了疗程。没有发现不良事件，治疗师表示干预很方便，临床护理也没有受到负面影响。结论研究结果表明，AAT 是可行的，也是可以接受的，对于在住院康复病房工作的 ABI 患者治疗师来说，它可能是一种有价值的工具。
{"title":"The feasibility and acceptability of integrating dogs into inpatient rehabilitation therapy with children with acquired brain injury","authors":"Megan E. Narad, Kaelynn Knestrick, Shari L. Wade, Brad G. Kurowski, Allen R. McConnell, Catherine C. Quatman‐Yates","doi":"10.1002/pmrj.13176","DOIUrl":"https://doi.org/10.1002/pmrj.13176","url":null,"abstract":"IntroductionChildren with acquired brain injury (ABI) are at risk for poor therapeutic engagement due to cognitive impairment, affect lability, pain, and fatigue. Animal‐assisted therapy (AAT) has the potential to improve patient engagement in rehabilitation therapies; however, the feasibility of integrating AAT into the rigorous therapy schedule of inpatient clinical care or its reception by patients, families, and staff is unknown.ObjectiveTo examine the feasibility and acceptability of incorporating dogs into physical therapy and occupational therapy sessions with pediatric patients being treated on an inpatient rehabilitation unit for acquired brain injury.DesignA feasibility study of AAT within the context of a within‐subjects crossover study.SettingPediatric inpatient rehabilitation unit.ParticipantsSixteen patients, aged 7–28 years (mean = 13.6 years, standard deviation [SD] = 5.2 years; 50% male), being treated on the inpatient rehabilitation unit following ABI.InterventionAAT – the integration of dogs into inpatient physical therapy and occupational therapy sessions.Main Outcome MeasuresFeasibility measures: enrollment rate, the proportion of AAT sessions a dog attended, adverse events, instances where therapist or handler ended session early, patient animal closeness, and utilization of dog in session. Satisfaction measures: parent satisfaction questionnaires and therapist feedback.ResultsFeasibility was supported by high enrollment rate (88.9%) and dog attendance rate of 93%–95%; 84.3% of sessions used the dog in multiple ways and patients reported a high level of closeness with the dog in session, indicating that the dogs were integrated in meaningful ways. No adverse events were noted, therapists reported that intervention was convenient, and clinical care was not negatively impacted. A high level of satisfaction was reported by families and therapists.ConclusionsFindings suggest that AAT is feasible and acceptable, and it may be a valuable tool for therapists working with patients with ABI on an inpatient rehabilitation unit.","PeriodicalId":20287,"journal":{"name":"Pm & R","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140623656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mollie Andreae, James M. Shultz, J. Marshall Shepherd, Zelde Espinel, Lauren T. Shapiro
Climate‐driven disasters have disproportionate and often devastating consequences on individuals with disabilities. Warming ocean and air temperatures are fueling more extreme tropical cyclones, further endangering those living in at‐risk regions. Although hurricane preparedness is particularly critical for those with functional impairments and/or special medical needs, studies show such persons are less ready for disasters than the general population. This review calls attention to the time‐urgent need to improve hurricane readiness among persons with disabilities. It summarizes evidence that climate change is resulting in cyclonic storms that are increasingly jeopardizing the health and safety of affected persons and reflects on how this trend may compound the particular hardships those with disabilities experience during times of disaster. It identifies unique storm‐related challenges faced by patient populations commonly cared for by physiatrists, including those with stroke, traumatic brain injury, multiple sclerosis, spinal cord injury, and limb loss. Available research pertaining to the gaps in emergency preparedness practices among persons with disabilities is reviewed as are potential strategies to mitigate barriers to achieving disaster readiness and resilience. Lastly, the review provides physiatrists with a comprehensive guide for optimally safeguarding their patients before, during, and after catastrophic hurricanes.
{"title":"Weathering the storms of climate change: Preparing persons with disabilities and the physiatrists who provide their care for extreme hurricanes","authors":"Mollie Andreae, James M. Shultz, J. Marshall Shepherd, Zelde Espinel, Lauren T. Shapiro","doi":"10.1002/pmrj.13159","DOIUrl":"https://doi.org/10.1002/pmrj.13159","url":null,"abstract":"Climate‐driven disasters have disproportionate and often devastating consequences on individuals with disabilities. Warming ocean and air temperatures are fueling more extreme tropical cyclones, further endangering those living in at‐risk regions. Although hurricane preparedness is particularly critical for those with functional impairments and/or special medical needs, studies show such persons are less ready for disasters than the general population. This review calls attention to the time‐urgent need to improve hurricane readiness among persons with disabilities. It summarizes evidence that climate change is resulting in cyclonic storms that are increasingly jeopardizing the health and safety of affected persons and reflects on how this trend may compound the particular hardships those with disabilities experience during times of disaster. It identifies unique storm‐related challenges faced by patient populations commonly cared for by physiatrists, including those with stroke, traumatic brain injury, multiple sclerosis, spinal cord injury, and limb loss. Available research pertaining to the gaps in emergency preparedness practices among persons with disabilities is reviewed as are potential strategies to mitigate barriers to achieving disaster readiness and resilience. Lastly, the review provides physiatrists with a comprehensive guide for optimally safeguarding their patients before, during, and after catastrophic hurricanes.","PeriodicalId":20287,"journal":{"name":"Pm & R","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140608843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Morgan R. Price, Kaelyn E. Mead, Diana M. Cowell, Alyssa M. Troutner, Tyler E. Barton, Sheryl A. Walters, Clinton J. Daniels
ObjectiveThe purpose of this systematic review was to ascertain guideline‐recommended pharmaceutical approaches to lumbosacral radicular symptoms, assess the quality of the clinical practice guidelines (CPGs) with the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool, and qualitatively synthesize the guideline recommendations.Literature SurveyLiterature searches were performed in PubMed, Cochrane Database of Systematic Reviews, Index to Chiropractic Literature, Allied and Complementary Medicine Database (AMED), Cumulative Index for Nursing and Allied Health Literature (CINAHL), and Physiotherapy Evidence Database (PEDro). We included guidelines published between January 1, 2017, and January 9, 2022, written in the English language, related to radiculopathy, sciatica, and/or low back pain with leg pain, and that provided recommendations on oral medication.MethodologyThe review was performed in accordance with Preferred Reporting Items for Systemic Reviews and Meta‐Analyses (PRISMA) and the protocol was pre‐registered with the International Prospective Register of Systematic Reviews (PROSPERO). Eligibility screening, full‐text review, extraction of information pertaining to pharmacological management, and synthesis of results were performed independently by two authors and a third investigator was recruited to arbitrate any disagreements. The AGREE II tool was administered by four authors to appraise CPG quality.SynthesisAfter screening 413 citations and assessing 37 full‐text articles, 11 CPGs met the inclusion criteria. They represented seven countries (Belgium, Canada, England, France, Japan, Korea, and United States) and three continents (Asia, Europe, and North America), as well as the Global Spine Care Initiative aimed at a worldwide presence. The mean overall AGREE II score was 87.1% (standard deviation [SD] 12.6%), generally reflecting high‐quality CPGs. The highest domain mean score was for Clarity of Presentation (96.7%, SD 4.4%), and the lowest was Applicability (75.6%, SD 22.8%). Five classes of medications were recommended by at least one CPG: anticonvulsants, antidepressants, oral corticosteroids, nonsteroidal anti‐inflammatory drugs (NSAIDs), and opioids.ConclusionsThe most common medication class recommended by the CPGs for lumbar radiculopathy was antidepressants. No CPGs recommended prescribing acetaminophen, benzodiazepines, muscle relaxants, or antibiotics. There was very little agreement between the CPGs, and all the medication classes had at least one CPG recommended against its use. Three guidelines reviewed did not recommend any medications due to lack of supporting literature, and instead recommended nonpharmacologic therapy.
{"title":"Medication recommendations for treatment of lumbosacral radiculopathy: A systematic review of clinical practice guidelines","authors":"Morgan R. Price, Kaelyn E. Mead, Diana M. Cowell, Alyssa M. Troutner, Tyler E. Barton, Sheryl A. Walters, Clinton J. Daniels","doi":"10.1002/pmrj.13142","DOIUrl":"https://doi.org/10.1002/pmrj.13142","url":null,"abstract":"ObjectiveThe purpose of this systematic review was to ascertain guideline‐recommended pharmaceutical approaches to lumbosacral radicular symptoms, assess the quality of the clinical practice guidelines (CPGs) with the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool, and qualitatively synthesize the guideline recommendations.Literature SurveyLiterature searches were performed in PubMed, Cochrane Database of Systematic Reviews, Index to Chiropractic Literature, Allied and Complementary Medicine Database (AMED), Cumulative Index for Nursing and Allied Health Literature (CINAHL), and Physiotherapy Evidence Database (PEDro). We included guidelines published between January 1, 2017, and January 9, 2022, written in the English language, related to radiculopathy, sciatica, and/or low back pain with leg pain, and that provided recommendations on oral medication.MethodologyThe review was performed in accordance with Preferred Reporting Items for Systemic Reviews and Meta‐Analyses (PRISMA) and the protocol was pre‐registered with the International Prospective Register of Systematic Reviews (PROSPERO). Eligibility screening, full‐text review, extraction of information pertaining to pharmacological management, and synthesis of results were performed independently by two authors and a third investigator was recruited to arbitrate any disagreements. The AGREE II tool was administered by four authors to appraise CPG quality.SynthesisAfter screening 413 citations and assessing 37 full‐text articles, 11 CPGs met the inclusion criteria. They represented seven countries (Belgium, Canada, England, France, Japan, Korea, and United States) and three continents (Asia, Europe, and North America), as well as the Global Spine Care Initiative aimed at a worldwide presence. The mean overall AGREE II score was 87.1% (standard deviation [SD] 12.6%), generally reflecting high‐quality CPGs. The highest domain mean score was for Clarity of Presentation (96.7%, SD 4.4%), and the lowest was Applicability (75.6%, SD 22.8%). Five classes of medications were recommended by at least one CPG: anticonvulsants, antidepressants, oral corticosteroids, nonsteroidal anti‐inflammatory drugs (NSAIDs), and opioids.ConclusionsThe most common medication class recommended by the CPGs for lumbar radiculopathy was antidepressants. No CPGs recommended prescribing acetaminophen, benzodiazepines, muscle relaxants, or antibiotics. There was very little agreement between the CPGs, and all the medication classes had at least one CPG recommended against its use. Three guidelines reviewed did not recommend any medications due to lack of supporting literature, and instead recommended nonpharmacologic therapy.","PeriodicalId":20287,"journal":{"name":"Pm & R","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140608849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：