Prevalence of pain in amyotrophic lateral sclerosis: A systematic review and meta-analysis

Objectives: Physical pain is a known symptom in amyotrophic lateral sclerosis (ALS), but no systematically derived prevalence estimate is available. The aim of this study was to determine the pooled prevalence of pain in ALS, relative to its method of measurement and pain characteristics. Methods: A systematic search across multiple databases was conducted on January 16, 2020. Random-effects meta-analyses of single proportions were performed on prevalence data. Heterogeneity was determined using the I2 statistic. Where available, pain location, intensity, and type or source were compared. Results: 2552 articles were identified. Twenty-one eligible studies were included. All studies used observational designs (14 cross-sectional, 6 cohort, 1 case-control). Pooled prevalence of pain in ALS across all studies was 60% (95% CI = 50–69%), with a high degree of heterogeneity (I2 = 94%, p < .001). Studies that used only validated measures had lower heterogeneity (I2 = 82%, p = 0.002), compared to those that used tailored measures, or tailored supplemented with validated measures (I2 = 90%, p < 0.001 and I2 = 83%, p < 0.001, respectively). In a subset of studies (N = 9), the most commonly reported pain location was the upper limbs including shoulders/extremities (41.5%). A further study subset (N = 7) showed moderate-severe intensity pain was most frequently reported. Type of pain was commonly related to cramp or spasm. Conclusions: Experiencing physical pain in ALS occurs with high prevalence. Deriving consensus on which specific tools should be used to assess, monitor and compare symptoms of pain in this population will reduce current heterogeneity in approaches and increase the likelihood of ameliorating distressing experiences more effectively

Experiencing mental health diagnosis: a systematic review of service user, clinician, and carer perspectives across clinical settings

Receiving a mental health diagnosis can be pivotal for service users, and it has been described in both positive and negative terms. What influences service-user experience of the diagnostic process is unclear; consequently, clinicians report uncertainty regarding best practice. This Review aims to understand and inform diagnostic practice through a comprehensive synthesis of qualitative data on views and experiences from key stakeholders (service users, clinicians, carers, and family). We searched five databases and identified 78 papers for inclusion, originating from 13 countries and including 2228 participants. Eligible papers were assessed for quality, and data were coded and then developed into themes, which generated a model representing factors to consider for clinicians conveying, and individuals receiving, mental health diagnoses. Themes included disclosure, information provision, collaboration, timing, stigma, and functional value of diagnosis for recovery. Variations between different stakeholders and clinical contexts are explored. Findings support an individualised, collaborative, and holistic approach to mental health diagnosis

Factors predicting incidence of post-operative delirium in older people following hip fracture surgery: a systematic review and meta-analysis

Objective: Delirium is one of the most common complications following hip fracture surgery in older people. This study identified pre- and peri-operative factors associated with the development of post-operative delirium following hip fracture surgery. Methods: Published and unpublished literature were searched to identify all evidence reporting variables on patient characteristics, on-admission, intra-operative and post-operative management assessing incident delirium in older people following hip fracture surgery. Pooled odds ratio (OR) and mean difference (MD) of those who experienced delirium compared to those who did not were calculated for each variable. Evidence was assessed using the Downs and Black appraisal tool and interpreted using the GRADE approach. Results: 6704 people (2090 people with post-operative delirium) from 32 studies were analysed. There was moderate evidence of nearly a two-times greater probability of post-operative delirium for those aged 80 years and over (OR: 1.77; 95% CI: 1.09, 2.87), whether patients lived in a care institution pre-admission (OR: 2.65; 95% CI: 1.79, 3.92), and a six-times greater probability of developing post-operative delirium with a pre-admission diagnosis of dementia (OR: 6.07, 95% CI: 4.84, 7.62). There was no association with intra-operative variables and probability of delirium. Conclusion: Clinicians treating people with a hip fracture should be vigilant towards post-operative delirium if their patients are older, have pre-existing cognitive impairment and poorer overall general health. This is also the case for those who experience post-operative complications such as pneumonia or a urinary tract infection

Perspectives and experiences of the process of mental health diagnosis: a systematic review:Protocol

Published in PROSPERO International prospective register of systematic review

Orientation and verbal fluency in the English Longitudinal Study of Ageing: modifiable risk factors for falls?

Objectives:To determine the relationship between falls and deficits in specific cognitive domains in older adults.Design:An analysis of the English Longitudinal Study of Ageing (ELSA) cohort.Setting:United Kingdom community-based.Participants:5197 community-dwelling older adults recruited to a prospective longitudinal cohort study.Measurements:Data on the occurrence of falls and number of falls, which occurred during a 12-month follow-up period, were assessed against the specific cognitive domains of memory, numeracy skills, and executive function. Binomial logistic regression was performed to evaluate the association between each cognitive domain and the dichotomous outcome of falls in the preceding 12 months using unadjusted and adjusted models.Results:Of the 5197 participants included in the analysis, 1308 (25%) reported a fall in the preceding 12 months. There was no significant association between the occurrence of a fall and specific forms of cognitive dysfunction after adjusting for self-reported hearing, self-reported eyesight, and functional performance. After adjustment, only orientation (odds ratio [OR]: 0.80; 95% confidence intervals [CI]: 0.65-0.98, p = 0.03) and verbal fluency (adjusted OR: 0.98; 95% CI: 0.96-1.00; p = 0.05) remained significant for predicting recurrent falls.Conclusions:The cognitive phenotype rather than cognitive impairment per se may predict future falls in those presenting with more than one fall

Using a storytelling intervention in schools to explore death, dying, and loss

Purpose: Experiencing bereavement in childhood can cause profound changes to developmental trajectories. This paper aims to evaluate the feasibility of implementing a public health intervention in schools to encourage pupils aged 12-15 years to independently explore ideas of death, dying, loss and end of life care in a structured and creative format. Design/methodology/approach: A co-produced storytelling intervention was implemented in an independent school in Norwich, UK. Pupils wrote up to 1,000 words in response to the title, “I Wish We’d Spoken Earlier”. Their participation was voluntary and extra-curricular. Stakeholder feedback was used in addition to the submissions as a measure of acceptability, appropriateness, adoption and feasibility. Findings: In total, 24 entries were submitted. Pupils demonstrated their ability to engage thoughtfully and creatively with the subject matter. Feasibility for the storytelling intervention was demonstrated. Importantly, the intervention also prompted family conversations around preferences and wishes for end of life care. Research limitations/implications: To determine whether the intervention has psychological and social benefits will require further study. Practical implications: Educational settings can be considered as anchor institutions to support a public health approach to end of life care. Originality/value: The positive response from all stakeholders in delivering and supporting the intervention indicates that schools are a community asset that could be further empowered to support children and families affected by death, dying and loss

Psychedelics and mindfulness: A systematic review and meta-analysis

Background and aims: The benefits of classic serotonergic psychedelics (e.g. psilocybin, LSD, DMT, ayahuasca) are becoming more widely known with the resurgence in research in the past decade. Furthermore, the benefits of mindfulness are well documented. However, no systematic reviews have examined linkage of mindfulness and psychedelics use. The aim of this systematic review is to explore the link between psychedelics and characteristics of mindfulness. Methods: We conducted a systematic search across multiple databases, inclusive of grey literature and backwards/forward-citation tracking, on the 18 January 2021. The search strategy included terms relating to mindfulness and psychedelics, with no restriction on clinical or non-clinical conditions. Study quality was assessed. An exploratory random-effects meta-analysis was conducted on pre-post mindfulness data relative to psychedelic ingestion. Results: Of 1805 studies screened, 13 were included in the systematic review. There was substantial variability in participant characteristics, psychedelic administration method and measurement of mindfulness. The ingestion of psychedelics is associated with an increase in mindfulness, specifically relating to domains of acceptance, which encompasses non-judgement of inner experience and non-reactivity. The meta-analysis of a subset of studies (N = 6) showed small effects overall relative to ayahuasca ingestion, increasing mindfulness facets of non-judgement of inner experience and non-reactivity, as well as acting with awareness. Conclusions: Further methodologically robust research is needed to elucidate the relationship between psychedelics and mindfulness. However, mindfulness and specific facets relating to acceptance have been shown to increase following ingestion of psychedelics in a number of studies

The effects of music listening interventions on cognition and mood post-stroke: a systematic review

Introduction: Music listening may have beneficial psychological effects but there has been no comprehensive synthesis of the available data describing efficacy of music listening in stroke. Areas covered: We performed a systematic review examining the effects of music listening interventions on cognition and mood post-stroke. We found five published trials (n=169 participants) and four ongoing trials. All studies demonstrated benefits of music listening on at least one measure of cognition or mood. Heterogeneity precluded meta-analysis and all included studies had potential risk of bias. Common reporting or methodological issues including lack of blinding, lack of detail on the intervention and safety reporting. Expert commentary: It is too early to recommend music listening as routine treatment post-stroke, available studies have been under-powered and at risk of bias. Accepting these caveats, music listening may have beneficial effects on both mood and cognition and we await the results of ongoing controlled studies

The association between registration status and reported outcomes in physiotherapy randomised controlled trials

Background/Aims:  Clinical trial registration has been proposed as a method of mitigating selective reporting in scientific research. It remains unknown whether trial registration is associated with reported outcomes in physiotherapy trials. This study aimed to analyse the association between registration status and outcome (the rejection or acceptance of a primary null hypothesis) for physiotherapy randomised controlled trials. Methods:  All randomised controlled trials reporting a physiotherapy intervention in publications listed in PubMed between 1 January 2017 and 30 June 2017 were included. Trial registration was determined based on the reporting of a registration number in the primary article or by identifying trials through trial registries. Results:  Of the 291 trials analysed, 176 (60.5%) were registered; 115 (39.5%) were not. There was no significant association between trial registration and outcome on multivariate analyses (Odds Ratio 1.65; 95% Confidence Interval (0.92–2.96); P=0.09). Only 22% of trials were prospectively registered. Conclusions:  Registration status and trial outcome are not associated in randomised controlled trials of physiotherapy interventions. The rate of physiotherapy trial registration remains low