Reliability of activity monitors for physical activity assessment in patients with musculoskeletal disorders: A systematic review

BACKGROUND: Activity monitors have been introduced in the last years to objectively measure physical activity to help physicians in the management of musculoskeletal patients. OBJECTIVE: This systematic review aimed at describing the assessment of physical activity by commercially available portable activity monitors in patients with musculoskeletal disorders. METHODS: PubMed, Embase, PEDro, Web of Science, Scopus and CENTRAL databases were systematically searched from inception to June 11th, 2020. We considered as eligible observational studies with: musculoskeletal patients; physical activity measured by wearable sensors based on inertial measurement units; comparisons performed with other tools; outcomes consisting of number of steps/day, activity/inactivity time, or activity counts/day. RESULTS: Out of 595 records, after removing duplicates, title/abstract and full text screening, 10 articles were included. We noticed a wide heterogeneity in the wearable devices, that resulted to be 10 different types. Patients included suffered from rheumatoid arthritis, osteoarthritis, juvenile idiopathic arthritis, polymyalgia rheumatica, and fibromyalgia. Only 3 studies compared portable activity trackers with objective measurement tools. CONCLUSIONS: Taken together, this systematic review showed that activity monitors might be considered as useful to assess physical activity in patients with musculoskeletal disorders, albeit, to date, the high device heterogeneity and the different algorithms still prevent their standardization

Asymptomatic and symptomatic deep venous thrombosis in hospitalized acutely ill medical patients: risk factors and therapeutic implications

Background Acutely ill medical patients experience deep venous thrombosis (DVT) during the hospitalization, however the time course of DVT is still unclear. Objectives To evaluate risk factors in acutely ill hospitalized medical patients for proximal asymptomatic DVT (ADVT) and symptomatic DVT (SDVT) at admission and discharge. Patients/Methods In this prospective observational study, consecutive acutely ill medical patients (hospitalized mainly for acute medical disease as infections, neoplasm, anemia, heart failure) underwent compression ultrasonography (CUS) of proximal lower limb veins within 48 h from admission and at discharge to diagnose ADVT and SDVT. Covid-19 patients, anticoagulant therapy, surgical procedures, acute SDVT, and acute pulmonary embolism, were exclusion criteria. Biographical characteristics at hospitalization, D-Dimer (assessed by ELISA)) and DD-improve score. Results Of 2,100 patients (1002 females, 998 males, age 71 +/- 16 years) 58 (2.7%) had proximal ADVT at admission. Logistic regression analysis showed that age, and active cancer were independently associated with ADVT at admission. The median length of hospitalization was 10 days [interquartile range: 6-15]. During the hospital stay, 6 patients (0.3%) with a negative CUS at admission experienced DVT (2 SDVT and 4 ADVT). In the subgroup of patients (n = 1118), in whom D-dimer was measured at admission, D-Dimer and IMPROVE-DD score were associated with ADVT at admission (n = 37) and with all DVT (n = 42) at discharge. ROC curve defined an IMPROVE-DD score of 2.5 as the optimal cut-off for discriminating patients with and without thrombotic events. Conclusions We provide evidence of early development of ADVT in unselected acutely ill medical patients suggesting the need of investigating patients by CUS immediately after hospital admission (within 48 h). Advanced age, active cancer, known thrombophilia and increased IMPROVE-DD score may identify patients at risk. The benefit of anticoagulation needs to be investigated in patients with these specific risk factors and negative CUS at admission

The use of language methodology for disseminating Cochrane Evidence through Cochrane Corners : Cochrane Rehabilitation experience.

Background. Health literacy has been recognized for a long time as an important factor both for understanding health information and prediction of health status. There are many efforts to translate health information in different languages, but particular challenge for achieving appropriate health literacy are systematic reviews of health interventions, because they summarize evidence from individual studies to help doctors and patients make informed choices about health treatments. One of these efforts are Cochrane Corners, a knowledge translation tool to disseminate Cochrane Evidence to make sure that all health professionals can make use of the best available evidence in their clinical work. Objectives. The aim of this work is to highlight the use of qualitative statements, in Cochrane Corners, produced by Cochrane rehabilitation, to communicate the clinical implications of rehabilitation interventions to the clinicians, founded on the certainty of evidence. Methods. Cochrane Corners have a specific structure: they are authored by one author who is rehabilitation professional to make comments from a rehabilitation perspective, the main section is founded on the summary of Cochrane Review contents and the last section is dedicated to \u201cclinical implication for rehabilitation professionals\u201d. It is founded on the use of qualitative statements, proposed by Cochrane Norway, to communicate the magnitude of rehabilitation intervention effects on specific outcome, based on the certainty of evidence. Results. We published 8 Cochrane Corners on neurorehabilitation, rheumatology, musculoskeletal diseases and pain conditions. In each Cochrane Corner, it has been provided the clinical implications of each rehabilitation intervention in traumatic brain injury, stroke, fibromyalgia, migraine in adults and in older people living in community. Conclusion. The use of qualitative statement is a good instrument to improve the applicability of evidence to clinical practice. Patient or healthcare consumer involvement. Not applicable. Relevance to diversity. The research addressed to rehabilitation clinicians to use short summary of Cochrane Systematic Reviews in rehabilitation field and to inform clinical and public health decisions on better evidence

Cochrane Rehabilitation prioritisation exercise based on an external framework reference system

Background. Cochrane did not have a representation of Rehabilitation stakeholders till the launch of Cochrane Rehabilitation at the end of 2016. We found that 1 out of 11 Cochrane Systematic Reviews (CSR) are related to Cochrane Rehabilitation (Levack et al, 2019), and that more than 50% of Review Groups produced CSR relevant to rehabilitation professionals. Nevertheless, there are not data about the coverage of rehabilitation relevant topics and if there are gaps in the current CSR production. Objectives. To present the results of the prioritisation process. Methods. Consensus gathering through Delphi Process via online surveys. Sixty-seven national Physical and Rehabilitation Medicine (PRM) Scientific Societies members of the International and European PRM Societies have been asked to participate through one medical delegate. Each delegate was asked to involve at least one other rehabilitation professional from his country. We started from an external reference framework provided by the Cochrane Rehabilitation ebook project: an inclusive index drafted from treatises and educational curricula in rehabilitation. This has been validated by the delegates. Then we have mapped the existing Cochrane evidence to the general index. Delegates have finally been asked to define the priorities for Cochrane Reviews production among these gaps. Results. We recruited 100 rehabilitation practitioners of 9 different professions from 39 countries. The response rate to all surveys was between 50% and 60%. The ebook index has been refined according to the suggestions received and four chapters have been added to the original nine. The gaps have been identified and the list of priorities defined. Discussion. The Delphi Rounds performed allowed Cochrane Rehabilitation to upgrade the original version of the index, providing a validated external reference framework to map the existing Cochrane Evidence. The prioritisation of gaps will be provided to Networks for future Reviews production. Patient or healthcare consumer involvement. Healthcare consumers have not been directly involved. Relevance to diversity. The research addressed to rehabilitation stakeholders. The results of prioritization process are important for all rehabilitation stakeholders to produce better evidence that inform clinical and public health decisions

Overview of Cochrane Systematic Reviews as a methodological tool to introduce Cochrane evidence in WHO guidelines: the Cochrane Rehabilitation experience

Background. The World Health Organization (WHO), following its \u201cRehabilitation 2030: a call for action\u201d, launched a process to develop the Package of Rehabilitation Intervention (PRI), a minimum set to be proposed to all Health Ministries to achieve Universal Health Coverage, a WHO strategic priority. Cochrane Rehabilitation has been involved in developing the methodology of the PRI, and in providing the relevant Cochrane Evidence. Overviews of systematic reviews are a new methodology to synthesise the results of multiple systematic reviews. Since PRI is produced for different health intervention, overviews of Cochrane Systematic Reviews are a good tool to introduce Cochrane Evidence in the PRI. Objectives. The aim is to present the methodology developed to answer to the requests of WHO in the development of PRI. Methods. The main health condition studied has been stroke. The literature search used was the \u201ctagging process\u201d of Cochrane Rehabilitation as reported by Levack et al (Arch Phys Med Rehabil, 2019). The search was limited to the last 10 years. The reviewers collected for each CSR author, publication year, title, date of search, n\ub0 of included studies (n\ub0 of participants), population, setting, intervention, control, outcome, corresponding risk (95% CI), relative effect (95% CI), quality of evidence (GRADE), statistical method, heterogeneity, upgrade or downgrade motivation. Where not available in the original CSR, the Table of Findings with GRADE evaluation has been performed. Results. We found 62 CSRs (to September 2018): 33 had GRADE evaluation and 29 did not. The study is still ongoing: final results will be provided to the WHO in April 2019 and will be reported at the Colloquium. Conclusions. This study will provide recommendations on stroke rehabilitation, for different outcomes, based on Cochrane Evidence. Patient or healthcare consumer involvement. Not applicable. Relevance to diversity. The research addressed to rehabilitation stakeholders. The recommendations on stroke rehabilitation are important for all rehabilitation stakeholders to use better evidence that inform clinical and public health decisions

Cytosolic calcium levels in spermatozoa are modulated differently in healthy subjects and patients with varicocele

OBJECTIVE: To study parameters connected to fertility in the semen of patients with varicocele. DESIGN: We examine the ability of spermatozoa obtained from patients with varicocele to respond with an increase of cytosolic Ca2+ ([Ca2+]i) to some stimuli that are connected with spermatozoa activation. SETTING: An academic research environment. PATIENT(S): Ten healthy volunteer donors and 10 patients affected by II or III grade left varicocele. INTERVENTION(S): Spermatozoa and prostasomes (vesicles of prostatic origin obtained from semen) were prepared according to standard procedures. Spermatozoa were stimulated with 1 microM P. The [Ca2+]i was evaluated with the FURA II method. MAIN OUTCOME MEASURE(S): The level of [Ca2+]i. RESULT(S): In resting cells, the level of [Ca2+]i was 120 +/-15 nmol/L (10 determinations). This value increases by > or =100 nmol/L upon stimulation with P. No difference was observed between spermatozoa obtained from healthy donors or from patients with varicocele. S-nitrosocysteine, a nitric oxide donor, and the fusion between spermatozoa and prostasomes increased the effect of P on [Ca2+]i in control spermatozoa but not in spermatozoa obtained from patients with varicocele. CONCLUSION(S): Different responsiveness of varicocele patients' spermatozoa to S-nitrosocysteine and/or to fusion with prostasomes may be among the possible causes of reduced fertility

Recovery of sexual function after nerve-sparing radical retropubic prostatectomy: is cavernous nitric oxide level a prognostic index?

The preservation of NANC nerve fibers (producing nitric oxide, NO) is necessary for erection recovery after retropubic radical prostatectomy (RRP). Yet, it is impossible to establish when and if a patient will recover erections; therefore, we investigate the prognostic value of cavernous blood NO levels on this parameter. Nerve-sparing RRP was performed on 14 patients for localized prostate cancer. We evaluated all patients 3 months after surgery by IIEF score: no patients had erections. A cavernous blood sample was also taken to determine NO levels (as nitrite). Patients were evaluated again 18 months after surgery. In six cases, erectile function was compromised, whereas in seven cases, potency was restored. Statistical analysis showed a relationship between nitrite levels in cavernous blood 3 months after surgery and the recovery or erectile function at 18 months. We propose that cavernous NO blood levels are a prognostic index of erection recovery

Methodological Issues in Rehabilitation Research: A Scoping Review

Objective To identify, synthesize, and categorize the methodological issues faced by the rehabilitation field

Methodological issues in rehabilitation research : a scoping review

Background. Rehabilitation interventions are usually complex and include different aspects that make difficult to accomplish with classical measures of methodological quality in clinical research. The aim of the present study was to identify, synthesize and categorize the main methodological issues in rehabilitation research to guide the development of methods for reporting and evaluating evidence in the rehabilitation field. Methods. A scoping review was conducted on PubMed, Cochrane Library, EMBASE, Web of Science, Scopus, Pedro and Google Scholar database up to August 2018. Methodological studies, special communications and literature reviews addressing any methodological issue in rehabilitation research were included. For each study, we identified the methodological issues addressed. Quantitative (frequencies of issues addressed in the studies) and qualitative (content analysis of the issues) synthesis have been conducted. Results. After removing duplicates, we screened 2,879 citations, and 71 studies were finally included. Of these, 69% (n=49) were narrative reviews, 14% (n=11) systematic reviews, 7% (n=5) editorials, 4% (n=3) meta-epidemiological studies, 3% (n=2) cross-sectional survey, 1% (n=1) mapping review and 1% (n=1) overview. The methodological problems in rehabilitation research included: poor data collection description and statistical analysis methods (56%); problematic application of randomized-controlled trials (38%); interventions description (35%); the definition of a core outcome sets for different clinical problems (31%); lack of blinding assessor (17%); clinical practice applicability (11%); randomization method description (10%); participants characteristics description and recruitment (8%); methodological and reporting quality (10% vs 8%). Studies also discussed other issues more related to the peer-review process, such as the methodology training need (7%), low-quality of the peer-review process (6%), funding (6%) and ethical statement (3%), lack of protocol registration (3%), and conflict of interest declaration (1%). Conclusion. This study highlights several methodological and reporting issues in rehabilitation research and in the peer review process. Research looking at methods to improve reporting as well as improving the conduct of trials in the rehabilitation field is needed. The first step moving forward would be to evaluate the influence of all these issues on the validity of trial results and the development of a specific check-list for the evaluation of rehabilitation research specifically. Patient or healthcare consumer involvement. Not applicable. Relevance to diversity. The research is targeted to authors and reviewers. Improving the quality of reporting and conduct in rehabilitation research allows to produce better evidence that inform clinical and public health decisions