to critically appraise and synthesize the evidence on the effects of vitamin C-based regimens for patients with sepsis or septic shock.
a broad search was performed on May 2021 to identify randomized ...clinical trials (RCTs) assessing vitamin C-based regimens as adjuvant therapy for adults with sepsis or septic shock. We used the Cochrane Risk of Bias table to assess the methodological quality of the included RCTs and the GRADE approach to evaluate the evidence certainty.
We included 20 RCTs (2124 participants). Evidence from low to very low certainty showed that vitamin C compared to placebo may reduce all-cause mortality up to 28 days (relative risk RR 0.60, 95% confidence interval (CI) 0.45 to 0.80, 4 RCTs, 335 participants). Considering the other comparisons (vitamin C alone or combined with thiamine and/or hydrocortisone, compared to placebo, standard care or hydrocortisone), there were a little to no difference or very uncertain evidence for adverse events, SOFA score, ICU length of stay, acute kidney injury, mechanical ventilation- and vasoactive drugs-free days up to 28 days.
Further RCTs with higher methodological quality, an increased number of participants and assessing clinically relevant outcomes are needed to provide better decision-making guidance.
CRD42021251786.
•This systematic review aimed to appraise the available evidence on the effects of vitamin C-based regimens for sepsis or septic shock patients.•Twenty RCTs with 2124 hospitalized adults diagnosed with sepsis or septic shock.•The certainty of evidence ranged from low to very low.•The adjuvant treatment with vitamin C-based regimens presents a little to no difference for effectiveness and safety outcomes.
Background. Neuromuscular diseases present a set of clinical and pathological disabilities that include muscle weakness and atrophy, perception of fatigue, fatigability, and contracture. Motor ...fatigability compromises the ability of the individual to generate muscle strength and perform their daily activities. Quantitative measures of strength and motor fatigability are important to determine the clinical progression of the disease and the response to the proposed treatments. Thus, the aim of this study was to identify the equipment and protocols frequently used to assess upper limb motor fatigability in patients with neuromuscular disease. Methods. Information such as equipment used to induce motor fatigability, body segment or joint studied, movement analyzed, type of contraction, and protocol utilized for the test was analyzed. Joanna Briggs Scale and Newcastle-Ottawa Scale assessed the methodological quality of the studies. In addition, a checklist was prepared by the research group to assess the protocols presented in the referred studies. Results. The isokinetic and handgrip dynamometers were the most utilized equipment to induce motor fatigability. 83% of the studies had a design with low methodological rigor and half of them with high risk of bias. In the analysis of the protocols utilized to induce motor fatigability, one study was classified as regular and the other ones as good. Conclusion. The methodological topics to assess motor fatigability were incompletely described considering the electrophysiological and biomechanical approach. Although the motor fatigability in the upper limb was evaluated using isokinetic and handgrip equipment, the absence of a gold standard protocol still compromises the understanding of clinical progression and responses to the treatments in the neuromuscular diseases. This trial is registered with CRD42021206934.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, FZAB, GIS, IJS, KILJ, NUK, OILJ, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
Purpose
Low physical capacity is hypothesized to be associated with the presence of musculoskeletal symptoms. Therefore, our aim was to investigate whether physical capacity is associated with the ...presence of musculoskeletal symptoms in the neck, shoulders, and thoracic and lumbar spine among office workers.
Methods
Sixty-seven office workers, recruited at the university, were evaluated regarding the presence of musculoskeletal symptoms through the Nordic Musculoskeletal Questionnaire (NMQ). Measurements of muscle strength and endurance of shoulder abduction, endurance of trunk flexion and extension, and back and leg flexibility were obtained. Data were analysed through a binomial logistic regression model, considering physical capacity as the independent variable and symptoms as the dependent variable. An adjusted model was also applied that controlled for individual and occupational covariates.
Results
The basic model showed a significant association between reduced shoulder abduction strength and neck (OR: 0.87; 95% CI 0.78–0.98) and shoulder symptoms (OR: 0.88; 95% CI 0.78–0.99), and between reduced back and leg flexibility and thoracic spine symptoms (OR: 0.92; 95% CI 0.85–0.99). The adjusted model, after controlling for the covariates, demonstrated that reduced shoulder abduction strength (OR: 0.70; 95% CI 0.52–0.94) and reduced back and leg flexibility (OR: 0.81; 95% CI 0.66–0.99) were associated, instead, with the occurrence of neck and low back symptoms, respectively, in the last 12 months.
Conclusions
Physical capacity is associated with the presence of neck and low back symptoms in office workers. Furthermore, individual and occupational characteristics affect the relationship between physical capacity and musculoskeletal symptoms and should be considered for understanding and managing musculoskeletal symptoms among office workers.
Introduction and hypothesis
The literature presents controversial results regarding the role of delivery mode in pelvic floor muscle (PFM) function after birth. Some studies showed a greater ...impairment of PFM function after vaginal delivery compared with cesarean section, while others have not identified a significant difference between these two modes of delivery. This study aimed to investigate whether there was a difference in short-term PFM function after childbirth in primiparous women who underwent cesarean section compared with those who underwent vaginal delivery.
Methods
Up to December 2018, the PubMed-MEDLINE, CINAHL, Embase, Bireme, Scopus, Web of Science, and Science Direct databases were searched. Two independent reviewers performed the selection process based on titles, abstracts, and full-text reading. Observational studies comparing PFM function after cesarean section versus vaginal delivery in primiparous women were included. PRISMA guidelines and Cochrane recommendations were followed. Methodological quality of the primary studies was assessed through the checklist proposed by the Joanna Briggs Institute for cross-sectional studies. Random effects meta-analysis was performed to synthesize evidence regarding PFM strength in primiparous woman after vaginal delivery compared with cesarean section. The GRADE approach was applied to classify the quality of the evidence.
Results
Eleven studies met the inclusion criteria and were included in this review. A total of 1726 primiparous women were analyzed after childbirth. Five studies were included in the meta-analysis. No difference in PFM strength after childbirth was identified when cesarean section was compared with vaginal delivery standardized mean difference (SMD): −0.15, 95% confidence interval (CI): −0.85 to 0.56. Differences in PFM strength were identified when patients who underwent cesarean section were compared with those with an episiotomy or instrumented vaginal delivery (SMD: −12.51, CI 95%: −24.57 to −0.44), favoring the cesarean section group. In both cases, the quality of evidence was classified as very low because of the observational design of the included studies and population heterogeneity.
Conclusion
There was no difference in short-term PFM strength after childbirth between primiparous women who underwent cesarean section or vaginal delivery, as assessed through vaginal manometry. However, we identified reduced PFM strength in women who underwent an episiotomy or instrumented vaginal delivery compared with those who underwent cesarean section. Nevertheless, this conclusion should be cautiously considered as the observational design of the primary studies and possible heterogeneity among the primiparous women included in the studies contributed to reducing the quality of the evidence synthesized. Future primary studies with longitudinal designs and long-term follow-up periods are needed to strengthen the quality of evidence and provide more conclusive evidence to guide clinical practice.
Objective:
To investigate the effectiveness of cryotherapy on pain and physical function in knee osteoarthritis.
Data sources:
An electronic search was performed up to February 2019 on ...PubMed/MEDLINE, EMBASE, CINAHL, Lilacs, Cochrane, Web of Science, Ibecs, and Scielo databases with keywords knee osteoarthritis and cryotherapy.
Methods:
Two authors independently performed the study selection. All languages and publication dates were considered. The PEDro scale was used to assess the methodological quality of the studies, and the body of evidence was analyzed and synthesized using the Grading of Recommendations, Assessment, Development, and Evaluation approach. The clinical relevance of the included studies was evaluated using the criteria proposed in the Cochrane Handbook for Systematic Reviews of Interventions.
Results:
Of the five studies, 202 subjects were included. All studies included participants with established knee osteoarthritis. The mean PEDro score was 4.20/10, and meta-analysis was not possible due to heterogeneity among the studies. The mean clinical relevance was 3/5. Only two studies were considered for analysis based on the GRADE approach, and low level of evidence was synthesized regarding the effectiveness of cryotherapy for pain management, knee stiffness, knee range of motion, and physical function. Application techniques, frequency, and duration did not affect outcomes.
Conclusions:
There were insufficient primary studies to draw any conclusions about the effectiveness of cryotherapy on pain and physical function on individuals with knee osteoarthritis.
Aim
To synthesize clinical and scientific evidence regarding the instruments available to assess upper‐limb function in paediatric patients with neuromuscular disease (NMD).
Method
This systematic ...review followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses and COnsensus‐based Standards for the selection of health Measurement INstruments (COSMIN) guidelines (Prospective Registry of Systematic Reviews no. CRD42020140343). Two independent reviewers searched the PubMed/MEDLINE, LILACS, Embase, and Scopus databases. Inclusion criteria were cross‐sectional or longitudinal studies or randomized controlled trials that used scales or questionnaires to assess upper‐limb function in paediatric patients with NMDs. The COSMIN Risk of Bias checklist and criteria for good measurement properties were applied to assess the methodological quality of the instruments.
Results
In total, 34 articles and 12 instruments were included. The Brooke Upper Extremity (n=16) and Performance of Upper Limb (PUL) (n=12) instruments were the most used tools. The PUL and Duchenne muscular dystrophy (DMD) Upper Limb patient‐reported outcome measures (PROMs) tested more measurement properties and provided higher methodological quality scores for patients with DMD. Likewise, the Revised Upper Limb Module (RULM) was the most suitable instrument for patients with spinal muscular atrophy. No instrument has been devised to assess upper‐limb function in patients with Charcot–Marie–Tooth disease and no other disease‐specific instruments were found.
Interpretation
The PUL, DMD Upper Limb PROM, and RULM are the most suitable instruments to assess upper‐limb function in the two most prevalent paediatric NMDs. The identified gaps and methodological flaws of the available instruments indicate a need to develop high‐quality instruments to assess other types of paediatric NMDs.
What this paper adds
The most suitable observer–rater instrument to assess upper‐limb function in Duchenne muscular dystrophy (DMD) is the Performance of Upper Limb.
The most suitable observer–rater instrument to assess upper‐limb function in spinal muscular atrophy is the Revised Upper Limb Module.
The DMD Upper Limb patient‐reported outcome measure is recommended to assess the upper‐limb performance of patients with DMD.
Literature gaps and methodological flaws indicate the need to develop high‐quality instruments to assess other types of paediatric neuromuscular disease.
Instrumentos para evaluar la función de miembro superior en niños y adolescentes con enfermedades neuromusculares: una revisión sistemática
Objetivo
Sintetizar la evidencia clínica y científica sobre los instrumentos disponibles para evaluar la función de miembro superior en pacientes pediátricos con enfermedad neuromuscular (ENM).
Método
Esta revisión sistemática siguió los ítems informados principales para revisiones sistemáticas y meta‐análisis y los estándares basados en el consenso para la selección de instrumentos de medición de la salud (Registro prospectivo de Revisiones sistemáticas número CRD42020140343). Dos revisores independientes buscaron en las bases de datos PubMed/MEDLINE, LILACS, Embase, y Scopus. Los criterios de inclusión fueron estudios transversales o longitudinales o ensayos controlados aleatorizados que usaran escalas o cuestionarios para evaluar la función de miembro superior en pacientes pediátricos con ENMs. Se aplicaron la lista de comprobación de riesgo de sesgo de acuerdo a los estándares del consenso para la selección de instrumentos de medición de la salud y los criterios para las correctas propiedades de medición para evaluar la calidad metodológica de los instrumentos.
Resultados
En total, se incluyeron 34 artículos y 12 instrumentos. Los instrumentos de Extremidad Superior Brooke (n=16) y de destreza de miembro superior en inglés, Performance of Upper Limb (PUL) (n=12) fueron las herramientas más utilizadas. El PUL y el de medidas de resultado en miembro superior informadas por el paciente con distrofia muscular de Duchene (DMD), en inglés, Duchenne muscular dystrophy Upper Limb patient‐reported outcome measures (PROMs) evaluaron más propiedades de medida y proporcionaron puntuaciones de calidad metodológica más altas para pacientes con DMD. Igualmente, el módulo revisado de extremidad superior en inglés, Revised Upper Limb Module (RULM) fue el instrumento más apropiado para pacientes con atrofia muscular espinal. No se ha ideado ningún instrumento para evaluar la función del miembro superior en pacientes con la enfermedad de Charcot‐Marie‐Tooth y no se encontraron otros instrumentos específicos de acuerdo con la patología.
Interpretación
El PUL, el PROM de miembro superior en DMD, y el RULM son los instrumentos más apropiados para evaluar la función del miembro superior en las dos ENMs pediátricas más prevalentes. Las diferentes detectadas y los defectos metodológicos de los instrumentos disponibles indican la necesidad de desarrollar instrumentos de evaluación de alta calidad para evaluar otros tipos de ENMs pediátricas.
Instrumentos para avaliar função do membro superior em crianças e adolescentes com doenças neuromusculares: uma revisão sistemática
Objetivo
Sintetizar a evidência clínica sobre os instrumentos disponíveis para avaliar a função do membro superior em pacientes pediátricos com doença neuromuscular (DNM).
Método
Esta revisão sistemática seguiu as diretrizes dos Itens Preferencias para Relatar em Revisões Sistemáticas e Metanálises e os Padrões Baseados em Consenso para a Seleção de Instrumentos de medida em saúde ( Registro Prospectivo de Revisões Sistemáticas no. CRD42020140343). Dois revisores independentes buscaram as bases de dados PubMed/MEDLINE, LILACS, Embase, e Scopus. Os critérios de inclusão foram estudos transversais ou longitudinais ou estudos randomizados controlados que usaram escalas ou questionários para avaliar a função do membro superior em pacientes pediátricos com DNMs. O checklist dos Padrões Baseados em Consenso para a Seleção de Instrumentos de medida em saúde e seus critérios para boas propriedades de medida foram aplicados para avaliar a qualidade metodológica dos instrumentos.
Resultados
No total, 34 artigos e 12 instrumentos foram incluídos. Os instrumentos Brooke Membro Superior (n=16) e Desempenho do Membro Superior (DMS) em inglês Performance of Upper Limb (PUL) (n=12) foram as ferramentas mais usadas. O DMS e as medidas de resultados reportadas pelo paciente (MRRPs) para o membro superior em Distrofia Muscular de Duchenne (DMD) em inglés, Duchenne muscular dystrophy Upper Limb patient‐reported outcome measures (PROMs) testaram mais propriedades de medida e fornecerem escores com maior qualidade metodológica para os pacientes com DMD. Similarmente, o Módulo Revisado para membro superior (MRMS) em inglés, Revised Upper Limb Module (RULM) foi o instrumento mais adequado para pacientes com atrofia muscular espinhal. Nenhum instrumento foi desenvolvido para avaliar função do membro superior na doença de Charcot–Marie–Tooth e nenhum outro instrumento doença‐específico foi encontrado.
Interpretação
O PUL, as PROM para membro superior em DMD, e RULM são os instrumentos mais adequados para avaliar função do membro superior nas duas DNMs pediátricas mais prevalentes. As lacunas identificadas e falhas metodológicas dos instrumentos disponíveis apontam para a necessidade de desenvolver instrumentos de alta qualidade para avaliar outros tipos de DNMs pediátricas.
What this paper adds
The most suitable observer–rater instrument to assess upper‐limb function in Duchenne muscular dystrophy (DMD) is the Performance of Upper Limb.
The most suitable observer–rater instrument to assess upper‐limb function in spinal muscular atrophy is the Revised Upper Limb Module.
The DMD Upper Limb patient‐reported outcome measure is recommended to assess the upper‐limb performance of patients with DMD.
Literature gaps and methodological flaws indicate the need to develop high‐quality instruments to assess other types of paediatric neuromuscular disease.
This article's has been translated into Spanish and Portuguese.
Follow the links from the to view the translations.
This systematic review and meta-analysis aimed to investigate the effect of physiotherapeutic interventions in individuals with thumb primary CMC OA on the outcomes of pain, hand function, grip or ...pinch strength.
RCTs that used some type of physiotherapeutic intervention compared to a passive or active control group were included. The quality of the evidence was assessed using the GRADE approach and, for the calculation of the meta-analysis, the standardized difference of means (SMD) was used.
Nineteen studies (
= 1477) were included and eight studies (
= 568) underwent meta-analysis. Orthosis intervention was superior to passive control group for pain improvement (SMD = -1.02,
= 0.03, very low evidence), grip strength (SMD = 0.45,
= 0.02, very low evidence) and pinch strength (SMD = 1.78,
= 0.01, very low evidence), but there was no improvement in hand function (
= 0.54). The use of a neoprene orthosis was similar to the use of a thermoplastic orthosis in improving pain (
= 0.38), hand function (
= 0.50), grip strength (
= 0.42) and pinch strength (
= 0.14). The use of short thermoplastic orthosis was also similar to long thermoplastic orthosis in improving pain (
= 0.88) and hand function (
= 0.58).
The use of orthoses is superior to no intervention in all outcomes, exception hand function.IMPLICATIONS FOR REHABILITATIONThe use of orthosis is recommended for the treatment of patients with rhizoarthrosisUse of orthosis is better than no intervention in improving pain, grip and pinch strength.The type of orthosis (neoprene or thermoplastic, short or long thermoplastic) does not affect the clinical improvement of the individual to the outcomes of pain, hand physical function, grip and pinch strength.
Pregnancy in chronic kidney disease (CKD) women is relatively rare, and the less risky choice of hemodialysis is unknown. The objective of this systematic review was to identify, systematically ...evaluate and summarize the available evidence on the efficacy and safety of hemodialysis strategies for pregnant CKD women. Sensitive search strategies were applied to six databases without data or language restrictions. Comparative (randomized and non‐randomized) studies were prioritized. Two reviewers independently selected, extracted, and critically evaluated data from studies. The risk of bias assessment was performed using the ROBINS‐I tool, considering the study design (non‐randomized comparative observational studies). The certainty of the evidence was assessed using the GRADE approach. From 7210 references identified, six retrospective cohort studies were included (576 women). The effects of intensive hemodialysis (over 20 h/week) are uncertain for maternal and neonatal mortality (Peto odds ratio OR 0.85; 95% confidence interval 95% CI 0.26–2.80), miscarriage (Peto OR 0, 38; 95% CI 0.12–1.23), stillbirths (Peto OR 0, 56; 95% CI 0.13–2.31), preterm birth (Peto OR 0.87; 95% CI 0.33–2.28), low birth weight (Peto OR 0.71; 95% CI 0.20–2.50) and congenital anomalies rates. The certainty of the evidence was very low due to studies methodological limitations and effect estimates imprecision. The uncertainty about intensive versus conventional hemodialysis effects for pregnant women with CKD and the imprecision in the estimated effects precludes any recommendation. The strategy choice must consider treatment availability, costs, and maternal social aspects until future studies provide more reliable evidence. PROSPERO CRD42021259237.
To systematically review evidence of the effectiveness of sticky mittens training to improve reaching skills and manual exploration of full-term and at-risk infants and optimal training dosage.
The ...Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided this systematic review. The electronic search was performed from September 2017 to August 2021 on PubMed, Scopus, Science Direct, and Cochrane databases. Eligibility criteria followed PICO terms: clinical trials investigating the effects of sticky mittens training on reaching skills and manual exploration of full-term and at-risk infants. PEDro scale and GRADE assessed methodological quality and quality of evidence, respectively.
Eight studies (313 children) were included. Five studies found statistically significant differences between experimental and control groups (62.6%). One study presented high methodological quality. Evidence synthesis showed very low and low evidence of the beneficial effects of sticky mittens training in full-term and at-risk infants, respectively.
Findings suggest that sticky mittens training facilitates reaching skills and manual exploration. However, results should interpretation with caution because studies targeted full-term infants. Future research should focus on infants at risk or with motor impairments since sticky mittens training seems to show positive effects and is easy to apply.
