The Efficacy and Treatment Fidelity of Kinesiology Taping in Conjunction With Conservative Treatment Interventions Among Individuals With Shoulder Pain: A Systematic Review with Meta-Analysis

PurposeKinesiology taping is a common intervention used to treat individuals with shoulder pain. While there have been several studies published to date evaluating the effectiveness of this intervention, a systematic review with meta-analysis synthesizing the collective effectiveness of kinesiology taping is not available. Therefore, the purpose of this study was to perform a systematic review with meta-analysis investigating the efficacy and treatment fidelity of kinesiology taping (KT) in combination with conservative interventions for shoulder pain.MethodsDatabases (PubMed, EMBASE, SportDiscus, CINAHL) of studies published in English meeting criteria were searched to October 2019. Methodologic quality was assessed utilizing the Modified Downs and Black checklist. Treatment fidelity was evaluated using a modified fidelity tool. Random effects meta-analyses were performed when an outcome (disability, pain, range of motion (ROM)) was reported by two or more studies. Overall effect size (pooled random effects) was estimated for studies with acceptable clinical homogeneity.ResultsWhen KT was used with conservative treatments, meta-analysis revealed large effect sizes for improvements in disability (standard mean difference (SMD) = -1.35; 95% CI, -2.09 to -0.60) and ROM (SMD = 0.96; 95% CI, 0.60-1.33) with no significant effects for pain. The average Modified Downs & Black score for bias was 11.5 ± 3.9. Of 10 retained studies, only two had good treatment fidelity.ConclusionsAdding KT to interventions performed in clinical settings appears to demonstrate efficacy regarding disability and ROM when compared to conservative interventions alone. However, despite reasonably good methodologic quality, fidelity was lacking in a majority of studies. Because of its impact on the implementation of evidence-based practice, lower fidelity should be considered when interpreting results.     

The Verbal Numeric Pain Scale: Effects of Patient Education on Self-reports of Pain

Background: Emergency department (ED) patients are frequently asked to provide a self‐report of the level of pain experienced using a verbal numeric rating scale. Objectives: To determine the effects of patient education regarding the verbal numeric rating scale on self‐reports of pain among ED patients. Methods: In this prospective, interventional study, 310 eligible ED patients with pain, aged 18 years and older, were randomized to view either a novel educational video (n= 155) or a novel print brochure (n= 155) as an educational intervention, both developed to deliver educational information about the verbal numeric pain scale and its use. Participants initially rated their pain on a scale from 0 to 10 and then were administered the educational intervention. Following the educational intervention, participants completed a survey that included demographic information, postinterventional pain score, prior pain experience, and subjective rating of the helpfulness of the educational intervention. Fifty‐five consecutive participants were enrolled as controls and received no educational intervention but gave a self‐reported triage pain score and a second pain score at an equivalent time interval. Clinical significance was defined as a decrease in pain of 2 or more points following the education. Results: Following the educational interventions, there were statistically significant, although not clinically significant, decreases in mean pain scores within each intervention group (video: mean change, 1 point [95% confidence interval [CI] = 0.7 to 1.2]; printed brochure: mean change, 0.6 points [95% CI = 0.4 to 0.8]). For participants in the control group (no intervention), there was no significant change (mean change, 0.2 points [95% CI =?0.2 to 0.5]). A clinically significant decrease in pain was seen in 28% of the video group, 23% of the brochure group, and 5% of controls. Most patients had no change (71% of the video group, 73% of the brochure group, and 89% of controls). Participants rated the helpfulness of the video educational intervention as 7.1 (95% CI = 6.7 to 7.5) and the print educational intervention as 6.7 (95% CI = 6.2 to 7.1) on a scale from 0 (least effective) to 10 (most helpful). Conclusions: Among ED participants with pain, both educational interventions (video and printed brochure) resulted in statistically and clinically significant decreased self‐reported pain scores by 2 or more points in 26% of participants compared with 5% of controls. The educational interventions were rated as helpful by participants, with no appreciable difference between the two intervention groups.     

Interventions to reduce moral distress in clinicians working in intensive care: A systematic review

ObjectiveTo evaluate the effectiveness of interventions to mitigate the harmful effects of moral distress experienced by nursing and medical clinicians working in the intensive care setting.DesignEligible studies were identified from searches of PubMed, EBSCO (Academic Search Complete, CINAHL and Medline) and Scopus. Included studies were published prior to 20 August 2020.ResultsTwelve studies were included in this review comprising three randomised controlled trials, seven quasi-randomised trials and two observational studies. Nine studies reported interventions targeting only nurses while three included both nurses and doctors. The types of interventions identified included: moral empowerment programs, end-of-life educational programs, reflective exercises through individual narrative writing or group reflective debriefing, multidisciplinary case debriefing meetings integrated into clinical practice and moral resiliency training. Due to the overall low methodological quality and high risk of bias, no single intervention may be considered efficacious in managing moral distress.ConclusionsThere is weak evidence that some currently available interventions reduce the moral distress experienced by intensive care health care providers. Larger randomised trials involving all intensive healthcare clinicians are required to evaluate multifaceted interventions.     

Mindfulness intervention in the management of chronic pain and psychological comorbidity: A meta-analysis

ObjectiveTo review trials on mindfulness intervention for chronic pain in primary care to clarify the evidence base and establish whether mindfulness is an important intervention for relieving pain and improving psychological comorbidity.MethodsWe performed a literature search using PubMed, the Cochrane Database, EBSCOhost, Elsevier, Wiley, Springer, and the references of retrieved articles. We included articles written in English and that were published up to January 2012. We found 428 empirical studies, but only eight were included as randomized controlled trials of mindfulness intervention for chronic pain in our meta-analysis. After extracting and synthesizing data from these eight trials, we analyzed the data extracted and synthesized from these eight trials.ResultsCompared with control intervention, mindfulness intervention had no specific effect on reducing pain intensity (weighted mean difference 3.24, 95% confidence interval [CI]: −8.92 to 2.45). Mindfulness intervention led to greater improvement in psychological comorbidity with chronic pain, such as depression (weighted mean difference −3.91, 95% CI −5.94 to −2.32) and trait anxiety (weighted mean difference −4.07, 95% CI −4.48 to −3.65).ConclusionThere is insufficient evidence that mindfulness intervention relieves pain intensity. However, it improves depression and trait anxiety in patients with chronic pain. Further research in larger, properly powered, and better-designed studies is warranted.     

Virtual reality intervention as a support method during wound care and rehabilitation after burns: A systematic review and meta-analysis

ObjectiveThis systematic review and meta-analysis aimed to analyze and synthesize the evidence on the effectiveness of virtual reality (VR) interventions in the prevention of pain, fear and anxiety during burn wound care procedures.MethodsIn September and October 2021, PubMed, Scopus, Cochrane Library and Web of Science were searched for relevant randomized controlled and crossover studies. Two independent authors described the following inclusion criteria for the search: patients undergoing burn wound care with applied VR treatment compared to any other or non-VR intervention. From a total of 1171 records, 25 met the inclusion criteria. After full-text screening, seven publications were excluded. The risk of bias was assessed for 18 studies by two independent authors. RevMan 5.4 was used for the statistical analysis, meta-analysis and visual presentation of the results.ResultsThe meta-analysis showed a significant difference between VR treatment and standard care when analyzing pain outcome during wound care procedures (SMD = −0.49; 95% CI [−0.78, −0.15]; I² = 41%) and in subgroup analysis when immersive VR was incorporated (SMD = −0.71; 95% CI [−1.07, −0.36]; I² = 0%). No significant differences were found between VR treatment and standard care for range of motion outcome (SMD = 0.44; 95% CI [−0.23, 1.11]; I² = 50%).ConclusionsVR seems to be an effective therapeutic support in burn wound care procedures for reducing pain. However, this systematic review and meta-analysis highlights the need for more research into the use of VR as a distraction method. Studies on larger groups using similar conditions can provide unequivocal evidence of the effectiveness of VR and enable the inclusion of such intervention in standard medical procedures.     

The Effect of Music on Pain in the Adult Intensive Care Unit: A Systematic Review of Randomized Controlled Trials

ContextMultimodal analgesic approaches are recommended for intensive care unit (ICU) pain management. Although music is known to reduce pain in acute and chronic care settings, less is known about its effectiveness in the adult ICU.ObjectivesDetermine the effects of music interventions on pain in the adult ICU, compared with standard care or noise reduction.MethodsThis review was registered on PROSPERO (CRD42018106889). Databases were searched for randomized controlled trials of music interventions in the adult ICU, with the search terms [“music*” and (“critical care” or “intensive care”)]. Pain scores (i.e., self-report rating scales or behavioral scores) were the main outcomes of this review. Data were analyzed using a DerSimonian-Laird random-effects method with standardized mean difference (SMD) of pain scores. Statistical heterogeneity was determined as I² > 50% and explored via subgroup analyses and meta-regression.ResultsEighteen randomized controlled trials with a total of 1173 participants (60% males; mean age 60 years) were identified. Ten of these studies were included in the meta-analysis based on risk of bias assessment (n = 706). Music was efficacious in reducing pain (SMD −0.63 [95% CI −1.02, −0.24; n = 10]; I² = 87%). Music interventions of 20–30 minutes were associated with a larger decrease in pain scores (SMD −0.66 [95% CI −0.94, −0.37; n = 5]; I² = 30%) compared with interventions of less than 20 minutes (SMD 0.10 [95% CI −0.10, 0.29; n = 4]; I² = 0%). On a 0–10 scale, 20–30 minutes of music resulted in an average decrease in pain scores of 1.06 points (95% CI −1.56, −0.56).ConclusionMusic interventions of 20–30 minutes are efficacious to reduce pain in adult ICU patients able to self-report.     

Effectiveness of mechanical diagnosis and therapy in patients with non-specific chronic low back pain: a literature review with meta-analysis

ObjectiveTo determine the effectiveness of mechanical diagnosis and therapy (MDT) in patients with chronic low back pain (CLBP) compared to other traditional physical therapy interventions.MethodsRandomized controlled trials investigating the effect of MDT compared to other traditional physical therapy interventions in individuals with CLBP were considered eligible. For the purpose of this review, MDT was compared to active and passive physical therapy interventions. Independent reviewers assessed the eligibility of studies, extracted data, and assessed the risk of bias. The primary outcomes investigated were pain and disability.ResultsFourteen studies were included in the review. Of these, 11 provided data to be included in the meta-analyses. Our findings showed that MDT was no more effective in decreasing pain (standardized mean difference [SMD] = 0.01, 95% confidence interval [CI]: ?0.44, 0.46) and disability (SMD = 0.08, 95% CI: ?0.53, 0.68) than other active treatments. Similar results were found when comparing MDT to other passive treatments for pain (SMD = ?0.39, 95% CI: ?0.90, 0.11) and disability (SMD = ?0.13, 95% CI: ?0.29, 0.03).ConclusionThere is low to moderate quality evidence that MDT is not superior than other traditional physical therapy interventions in improving pain and disability in people with CLBP.     

Star-Shape Kinesio Taping Is Not Better Than a Minimal Intervention or Sham Kinesio Taping for Pain Intensity and Postural Control in Chronic Low Back Pain: A Randomized Controlled Trial

ObjectiveThis study investigated the effects of star-shape Kinesio taping (KT) compared with both sham KT and minimal intervention (MI) on pain intensity and postural control.DesignRandomized controlled trial.SettingOutpatient physical therapy.ParticipantsA total of 120 people with chronic low back pain (CLBP) aged 18-60 years (N=120).InterventionsStar-shape KT, sham KT (no tension), and MI (educational booklet for self-management counseling).Main Outcome MeasuresThe primary outcome measures were pain intensity and center of pressure (COP) mean sway speed, and disability score (Oswestry Disability Index) was a secondary outcome. The outcomes were obtained immediately after initial KT application, on the seventh day of intervention and at the 1-month follow-up. Linear mixed-model analyses using Bonferroni post hoc analyses were applied to investigate between-group differences. The model included treatment, time, and treatment×time interaction as fixed effects.ResultsPain intensity was significantly lower for the star-shape KT group than for the MI group (mean difference [MD], ?1.35; 95% confidence interval [CI], ?2.63 to ?0.07) immediately after the intervention and on the seventh day of intervention (MD, ?1.32; 95% CI, ?2.56 to ?0.07). No difference in pain intensity between star-shape KT vs sham-KT groups was observed. In addition, no significant between-group differences were observed for the COP mean sway speed and disability score at any of the follow-up times.ConclusionsOur results showed no meaningful effect of star-shape KT intervention on pain intensity and postural control in people with CLBP compared with MI or sham KT. The observed reduction of 1.3 units between star-shape KT and MI groups was statistically different, but it could not be considered clinically relevant. The results of this trial suggest that benefits from KT are more likely attributable to contextual factors rather than specific taping parameters.     

Effect of an educational program on physical activity in individuals undergoing their first percutaneous coronary intervention: A randomized clinical trial

BackgroundEducational programs designed for specific populations to improve regular physical activity need to be tested.ObjectivesTo evaluate the effectiveness of an educational program, when compared to usual care, on improving physical activity 5 to 7 months after hospital discharge in adult patients undergoing their first percutaneous coronary intervention.MethodsRandomized controlled trial with two groups: usual care (n = 56) and educational program (n = 53) interventions. Data on sociodemographic and clinical characteristics were collected and the Baecke-Habitual Physical Activity Questionnaire, Self-efficacy Scale for Physical Activity, and Hospital Anxiety and Depression Scale were administered at baseline and follow-up. Participants in the educational program received an intervention based on Social Cognitive Theory, focused on physical activity, followed by three telephone calls. The usual care group received the hospital routine information. Unadjusted and adjusted differences between the two groups in mean score changes (with 95% confidence intervals [CI]) were calculated for all outcomes.ResultsAt follow-up, the educational program group showed higher mean ± standard deviation scores than the usual care group for practice of physical activity (7.94 ± 1.84 vs. 6.90 ± 1.89) and for self-efficacy (3.98 ± 3.75 vs. 2.52 ± 3.12). Adjusting for baseline outcome, the difference in mean change between groups was 0.89 (95% CI: 0.32, 1.46) for physical activity and 2.30 (95% CI: 1.12, 3.49) for self-efficacy. There were no statistical differences between groups in symptoms of anxiety and depression.ConclusionThe educational program may be an effective intervention in increasing habitual physical activity and self-efficacy for physical activity in individuals with coronary artery disease.     

Health Care Provider Attitudes,Beliefs, and Perceived Confidence in Managing Patients With Cancer Pain and Nonmedical Opioid Use

ContextHealth care provider education is an effective strategy to improve knowledge and competencies in opioid-prescribing practices. However, there are very few studies regarding this among providers of patients with cancer pain and nonmedical opioid use (NMOU). The aim of our study was to assess participants' attitudes, beliefs, and self-perceived confidence in caring for patients with cancer pain and NMOU before and after attending an opioid educational seminar on the use and nonmedical use of opioids in patients with cancer.MethodsAn anonymous cross-sectional survey was conducted among health care providers who attended an opioid educational event in April 2018 and May 2019.ResultsThe overall response rate was 63% (129 of 206). Approximately 72% of participants had concerns about NMOU in patients with cancer, 69% felt that such patients are frequently underdetected, and 63% felt that cancer pain is frequently undertreated. At baseline, only 23% reported adequate knowledge and 35% reported confidence in caring for patients with cancer with NMOU-related issues. Among those who completed both the preseminar and postseminar surveys, these numbers improved significantly at the end of the seminar (26% vs. 71% and 43% vs. 84%, respectively; all P < 0.001).ConclusionMost health care providers expressed concerns about underdetection of NMOU and undertreatment of pain among patients with cancer. Many self-reported knowledge and confidence deficits in caring for patients with cancer with NMOU. Seminar participation was associated with an increase in the number of participants with self-perceived knowledge and confidence. Future studies are needed to ascertain the impact of such opioid educational events on patient care practices.     

Development and proof of concept of a blended physiotherapeutic intervention for patients with non-specific low back pain

ObjectiveTo develop a blended physiotherapeutic intervention for patients with non-specific low back pain (e-Exercise LBP) and evaluate its proof of concept.DesignFocus groups with patients, physiotherapists, and eHealth and LBP experts were conducted to investigate values according to the development of e-Exercise LBP. Proof of concept was evaluated in a multicentre study.SettingDutch primary care physiotherapy practices (n = 21 therapists).ParticipantsAdults with non-specific LBP (n = 41).Interventione-Exercise LBP was developed based on clinical LBP guidelines and the focus groups, using the Center for eHealth Research Roadmap. Face-to-face physiotherapy sessions were integrated with a web application consisting of 12 information lessons, video-supported exercises and a physical activity module with the option to gradually increase individuals’ level of physical activity. The intervention could be tailored to patients’ risk of persistent disabling LBP, according to the STarT Back Screening Tool.Main outcome measuresFunctional disability, pain, physical activity, sedentary behaviour and fear-avoidance beliefs, measured at baseline and 12 weeks.ResultsAfter 12 weeks, improvements were found in functional disability [Quebec Back Pain Disability Scale: mean difference (MD) ?12.2/100; 95% confidence interval (CI) 8.3 to 16.1], pain (Numeric Pain Rating Scale: MD ?2.8/10; 95% CI 2.1 to 3.6), subjective physical activity (Short Questionnaire to Assess Health Enhancing Physical Activity: MD 11.5 minutes/day; 95% CI ?47.8 to 24.8) and objective sedentary behaviour (ActiGraph: MD ?23.0 minutes/day; 95% CI ?8.9 to 55.0). Small improvements were found in objective physical activity and fear-avoidance beliefs. The option to gradually increase physical activity was activated for six patients (15%). On average, patients received seven face-to-face sessions alongside the web application.ConclusionsThe results of this study provide the first indication of the effectiveness of e-Exercise LBP, particularly for disability and pain among patients with LBP. Future studies will focus on end-user experiences and (cost-) effectiveness.     

Proprioceptive neuromuscular facilitation training improves pain-related and balance outcomes in working-age patients with chronic low back pain: a randomized controlled trial

BackgroundProprioceptive neuromuscular facilitation training and general trunk exercises have been applied to treat chronic low back pain patients. However, there is currently little study to support the use of one treated intervention over the other to improve clinical outcomes and balance ability.ObjectiveTo examine the effects of proprioceptive neuromuscular facilitation training on pain intensity, disability and static balance ability in working-age patients with chronic low back pain.MethodsForty-four chronic low back pain participants aged 18–50 years were randomized either to a three-week proprioceptive neuromuscular facilitation training or to a control group receiving general trunk exercises. Pain intensity, disability and static balance ability were measured before and after the three-week intervention.ResultsThe proprioceptive neuromuscular facilitation training intervention showed a statistically significantly greater reduction in pain intensity and improved functional disability than the controls at three weeks (between-group difference: pain intensity 1.22 score, 95% CI: 0.58 to 1.88, p < 0.001; disability 2.23 score, 95% CI: 1.22 to 3.24, p < 0.001. The proprioceptive neuromuscular facilitation training intervention also had statistically better parameters of static balance ability than the control group (between-group difference: ellipse sway area during eye opened and closed conditions 129.09 mm², 95% CI: 64.93 to 175.25, p < 0.01 and 336.27 mm², 95% CI: 109.67 to 562.87, p < 0.05, respectively; the centre of pressure velocity during eye opened and eye closed conditions 6.68 mm/s, 95% CI: 4.41 to 8.95, p < 0.01 and 6.77 mm/s, 95% CI: 4.01 to 9.54, p < 0.01, respectively).ConclusionThe three-week proprioceptive neuromuscular facilitation training provides better pain intensity, disability and static balance ability than general trunk exercises for working-age individuals with chronic low back pain but the effects do not reach the clinical meaningful level. The therapists should consider carefully when making recommendations regarding these interventions, taking into account effectiveness and costs.     

The effectiveness of spiritual intelligence educational interventions for nurses and nursing students: A systematic review and meta-analysis

AimTo synthesize the best available research evidence regarding the effectiveness of spiritual intelligence educational interventions on spiritual intelligence and professional outcomes in nurses and nursing students.BackgroundSpiritual intelligence is a form of intelligence with which individuals can deal with a crisis, alter situations, solve problems and achieve goals through a set of capacities and abilities. Possessing spiritual intelligence contributes to professional practice and competence in the workplace and has been seen to be beneficial for nurses and nursing students. Nursing interventions to teach and increase understanding of spiritual intelligence have been explored in the literature, but the effectiveness of spiritual intelligence training for nurses and nursing students remains uncertain.DesignA systematic review and meta-analysis.Data sourcesA three-step systematized search of sixteen electronic English and Persian databases was conducted to identify randomized and non-randomized trials published in English and Persian from January 2000 to November 2021.MethodsThe methodological quality of eligible studies was undertaken by two independent reviewers using the Medical Education Research Study Quality Instrument. Meta-analyses were undertaken where appropriate using STATA v16.ResultsSeven studies involving 512 participants were included. Pooled results demonstrated that those who received the educational intervention had significantly higher spiritual intelligence scores at 2 weeks (MD 13.38, 95 % CI: 5.76, 20.99) and one month follow up (MD 20.03, 95% CI: 6.61, 33.45) compared with those who did not. No difference in spiritual intelligence scores was observed among those who received spiritual intelligence education or life skills training (MD 7.52, 95 % CI −1.78, 16.82). Significantly higher communication skills (MD 5.41, 95 % CI: 2.16, 8.66), job satisfaction (MD; 11.30, 95 % CI: 8.63, 13.97) and spiritual care competence (MD; 28.55, 95 % CI: 26.08, 31.02) and decrease in overall stress (MD; 10.30, 95 % CI: 6.84, 13.76) among those who received the educational interventions were reported at the one-month follow-up. Significantly higher job satisfaction levels were also reported at 2-month follow-up among those who received the educational interventions (MD; 16, 95 % CI: 11.06, 20.94).ConclusionsThe evidence from this review demonstrates that spiritual intelligence educational interventions have a positive effect on spiritual intelligence and professional outcomes in nurses and nursing students. We noted that the outcomes in the studies included were mostly measured at one-month follow-up and with subjective measures. Longer trials with objective measures are required to provide higher levels of evidence. The results of this review are largely based on single trials and were limited in terms of the number of outcomes. Conducting further trials is warranted to identify the influence of such education on various professional outcomes in nursing practice.Tweetable AbstractSystematic review and meta-analysis shows spiritual intelligence educational interventions have a positive effect on nurses' and nursing students’ spiritual intelligence, work-related stress and professional practice.     

Effect of System-Wide Interventions on the Assessment and Treatment of Pain by Emergency Medical Services Providers

Background: An estimated 20% of patients arriving by ambulance to the emergency department are in moderate to severe pain. However, the management of pain in the prehospital setting has been shown to be inadequate. Untreated pain may have negative physiologic and psychological consequences. The prehospital community has acknowledged this inadequacy and made treatment of pain a priority. Objectives: To determine if system-wide pain management improvement efforts (i.e. education and protocol implementation) improve the assessment of pain and treatment with opioid medications in the prehospital setting and to determine if improvements are maintained over time. Methods: This was a retrospective before and after study of a countywide prehospital patient care database. The study population included all adult patients transported by EMS between February 2004 and February 2012 with a working assessment of trauma or burn. EMS patient care records were searched for documentation of pain scores and opioid administration. Four time periods were examined: 1) before interventions, 2) after pediatric specific pain management education, 3) after pain management protocol implementation, and 4) maintenance phase. Frequencies and 95% confidence intervals were calculated for all patients meeting the inclusion criteria in each time period and Chi-square was used to compare frequencies between time periods. Results: 15,228 adult patients transported by EMS during the study period met the inclusion criteria. Subject demographics were similar between the four time periods. Pain score documentation improved between the time periods but was not maintained over time (13% [95%CI 12–15%] to 32% [95%CI 31–34%] to 29% [95 CI 27–30%] to 19% [95%CI 18–21%]). Opioid administration also improved between the time periods and was maintained over time (7% [95%CI 6–8%] to 18% [95%CI 16–19%] to 24% [95%CI 22–25%] to 23% [95% CI 22–24%]). Conclusions: In adult patients both pediatric-focused education and pain protocol implementation improved the administration of opioid pain medications. Documentation and assessment of pain scores was less affected by specific pain management improvement efforts.     

Educational interventions to promote respectful maternity care: A mixed-methods systematic review

AimThis systematic review critiqued the impact of educational interventions for midwives, nurses, or midwifery/nursing students to enhance respectful maternity care.BackgroundTreating women with respect during maternity care has gained considerable global attention. Although research has focused on raising awareness about respectful care among health care professionals, the effectiveness of educational interventions remains uncertain.MethodsA mixed-methods systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This review used a convergent segregated approach, and methodology recommended by Joanna Briggs Institute (JBI) mixed-methods systematic reviews, to synthesise and integrate research findings. Multiple databases were searched. JBI critical appraisal checklists for quasi-experimental studies, cross-sectional, and qualitative studies, as well as a mixed-methods appraisal tool were used.FindingsNine educational interventions studies met the inclusion criteria, and most were conducted in Africa. Quantitative evidence supported the effectiveness of interventions to improve knowledge/perceptions of midwives and/or nurses regarding respectful maternity care, and woman-provider communication, and reduce women’s experience of disrespect and abuse. However, variation in content, intervention delivery mode, duration, timing of pre and post-test, evaluation methods, and difficulty distilling findings from multi-pronged interventions hindered robust conclusions. Only one study used a valid and reliable tool to measure women’s experience of respectful care. Qualitative findings suggest continuous education rather than one-off interventions and inclusion of other health care providers as well as managerial staff working in maternity care would help promote respectful care.ConclusionThere is low level evidence that educational interventions can improve midwives’, nurses’, and students’ knowledge and attitudes towards RMC. Outcomes of education and training need to be monitored regularly with valid and reliable tools. There is a need for respectful maternity care education interventions in high as well as middle and low-income countries.     

Effects of Nurse-Led Pain Management Interventions for Patients with Total Knee/Hip Replacement

BackgroundA literature review was conducted to assess nurse-led nonpharmacologic pain management interventions intended for total knee/hip replacement patients.DesignThis was a systematic review and meta-analysis.Data SourcesThe PubMed, Embase, CINAHL, and Cochrane Library databases were searched to identify relevant studies.Review MethodsThe systematic review was conducted based on the Cochrane Handbook for Systematic Reviews of Interventions and all Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting guidelines. Two reviewers independently selected the studies and appraised their quality. Thereafter, the effects of all described nurse-led nonpharmacologic pain management interventions were estimated regarding pain, anxiety, and satisfaction through a meta-analysis.ResultsIn total, 219 relevant studies were found through a search. Finally, 23 studies were selected for review, with 17 included in the meta-analysis. Nurse-led nonpharmacologic pain management was effective for pain relief (effect size, −0.22; 95% confidence interval [CI], −0.42 to −0.02), and educational interventions were especially effective (effect size, −0.36; 95% CI, −0.69 to −0.03). Although interventions reduced anxiety and improved satisfaction, these results were not statistically significant based on the analysis.ConclusionOur findings support that nurse-led nonpharmacologic pain management interventions could help reduce pain in patients with total knee/hip replacement by supplementing pharmacologic pain management.Implications for NursingNurse-led nonpharmacologic pain interventions should be considered to reduce patient pain with total knee/hip replacement.     

The fidelity of comparison intervention in manual therapy trial for patients with low back pain: a systematic review

Abstract

Background: Comparison interventions for low back pain are described in the literature utilizing different treatment interventions with various terminology. The effectiveness of these comparison groups is not well defined.

Objectives: The objective of this systematic review is to assess the fidelity of comparison interventions within randomized controlled trials assessing the effect of manual therapy on low back pain.

Methods: This systematic review utilized PubMed, CINAHL, Scopus, Cochrane, and Pedro databases. Articles were screened by two authors for eligibility criteria and then extracted, reviewed, and cross-checked for data that included sample size, patient demographics, manual therapy intervention, the control group protocol, and outcomes. The Cochrane Risk of Bias tool was used to determine disagreement among authors. A qualitative synthesis of the evidence was completed.

Results: A total of 20 articles were included in this systematic review. The comparison interventions were categorized into themes based on the terminology used by the various studies. The themes consisted of “standard care”, “sham treatment”, “control groups”, and unnamed comparison interventions. These themes were then compared to the CPG based on the interventions utilized in each study.

Conclusions: There appears to be significant variability in comparison interventions within randomized controlled trials assessing manual therapy effects on patients with low back pain. This variability may lead to inconsistent published effect sizes. It is imperative to correctly follow evidence-based practice from resources, such as the CPG, to determine the effectiveness of treatment interventions.     

Mind-Body Exercise Performed by Physical Therapists for Reducing Pain and Disability in Low Back Pain: A Systematic Review With Meta-analysis

ObjectiveTo assess the effectiveness of mind-body (MB) exercise interventions provided by physical therapists for reducing pain and disability in people with low back pain (LBP).Data SourcesMEDLINE, Embase, CINAHL, and the Cochrane Library were searched for articles published in English between December 2010 and June 2020.Study SelectionRandomized controlled trials evaluating the effects of Pilates, yoga, and tai chi interventions performed by physical therapists on pain or disability outcomes in adults with musculoskeletal LBP were included.Data ExtractionData were extracted by 2 independent reviewers. Quality of evidence and risk of bias were assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework and Cochrane risk of bias tools, respectively.Data Synthesis21,230 exercise trials were identified; 161 progressed to full-text review. Eight trials, 7 reporting on Pilates and 1 reporting on yoga, were included. Short-term outcomes for pain (SMD: -0.93; 95% confidence interval [CI]: -1.65 to -0.021) and disability (SMD: -0.74 95% CI: -1.36 to -0.012) indicated MB exercise was more effective than control intervention. Tests for subgroup differences between studies with exercise vs non-exercise control groups revealed a moderating effect on short-term outcomes where larger effects were observed in studies with non-exercise comparators. Long-term outcomes for pain (SMD: -0.60; 95% CI:-1.43 to 0.23) and disability (SMD: -1.05; 95% CI:-3.51 to 1.41) suggested that MB exercise is not more effective than control interventions for pain or disability. Quality of the evidence ranged from very low to low.ConclusionsPhysical therapist-delivered MB exercise interventions, which overwhelmingly consisted of Pilates, were more effective than control in the short and long-term for pain and in the short-term for disability, with differences in the short-term effects lessened when compared with an active intervention. Pilates interventions delivered by physical therapists represent a viable tool for the clinical management of chronic LBP.