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Are non-pharmacological interventions delivered through synchronous telehealth as effective and safe as in-person interventions for the management of patients with non-acute musculoskeletal conditions? A systematic rapid review

Corso, Melissa; Cancelliere, Carol; Mior, Silvano; Salmi, Louis Rachid; Cedraschi, Christine; Nordin, Margareta; Taylor-Vaisey, Anne; Côté, Pierre
OBJECTIVE:To determine whether non-pharmacological interventions delivered through synchronous telehealth are as effective and safe compared to in-person interventions for the management of patients with musculoskeletal conditions in improving pain, functioning, self-reported recovery, psychological outcomes or health-related quality of life using rapid review methods. DATA SOURCES/METHODS:We searched MEDLINE, CINAHL, Embase and Cochrane Central Register of Controlled Trials from 2010 to August 2020 for randomized controlled trials (RCTs) published in English or French and updated our search in January 2021. STUDY SELECTION/METHODS:One reviewer screened citations in two phases (phase-one: title/abstract, phase-two: full-text) selecting RCTs comparing synchronous telehealth to in-person care for the management of musculoskeletal conditions. A random 10% sample was screened by two independent reviewers with minimum 95% agreement prior to full screening. One reviewer critically appraised and one reviewer validated appraisal for eligible RCTs. DATA EXTRACTION/METHODS:One author extracted participant characteristics, setting, sample size, interventions, comparisons, follow-up period and outcome data. A second author validated data extraction. DATA SYNTHESIS/RESULTS:We summarized the findings narratively. Low to moderate quality evidence suggests that synchronous telehealth (i.e. videoconference or telephone calls) alone or in combination with in-person care leads to similar outcomes as in-person care alone for non-specific low back pain, generalized osteoarthritis, hip and/or knee osteoarthritis and non-acute headaches in adults. CONCLUSIONS:Synchronous telehealth may be an option for the management of non-acute musculoskeletal conditions in adults. However, our results may not be generalized to rural or low socioeconomic populations. Future research should investigate the outcomes associated the use of new technologies, such as videoconference.
PMID: 34736919
ISSN: 1532-821x
CID: 5038402

Noninvasive management of soft tissue disorders of the shoulder: A clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) collaboration

Yu, Hainan; Côté, Pierre; Wong, Jessica J; Shearer, Heather M; Mior, Silvano; Cancelliere, Carol; Randhawa, Kristi; Ameis, Arthur; Carroll, Linda J; Nordin, Margareta; Varatharajan, Sharanya; Sutton, Deborah; Southerst, Danielle; Jacobs, Craig; Stupar, Maja; Taylor-Vaisey, Anne; Gross, Douglas P; Brison, Robert J; Paulden, Mike; Ammendolia, Carlo; Cassidy, J David; Marshall, Shawn; Bohay, Richard N; Stapleton, John; Lacerte, Michel
OBJECTIVES/OBJECTIVE:Objective of this study is to develop an evidence-based guideline for the noninvasive management of soft tissue disorders of the shoulder (shoulder pain), excluding major pathology. METHODS:This guideline is based on high-quality evidence from seven systematic reviews. Multidisciplinary experts considered the evidence of effectiveness, safety, cost-effectiveness, societal and ethical values, and patient experiences when formulating recommendations. Target audience is clinicians; target population is adults with shoulder pain. RESULTS:When managing patients with shoulder pain, clinicians should (a) rule out major structural or other pathologies as the cause of shoulder pain and reassure patients about the benign and self-limited nature of most soft tissue shoulder pain; (b) develop a care plan in partnership with the patient; (c) for shoulder pain of any duration, consider low-level laser therapy; multimodal care (heat/cold, joint mobilization, and range of motion exercise); cervicothoracic spine manipulation and mobilization for shoulder pain when associated pain or restricted movement of the cervicothoracic spine; or thoracic spine manipulation; (d) for shoulder pain >3-month duration, consider stretching and/or strengthening exercises; laser acupuncture; or general physician care (information, advice, and pharmacological pain management if necessary); (e) for shoulder pain with calcific tendinitis on imaging, consider shock-wave therapy; (f) for shoulder pain of any duration, do not offer ultrasound; taping; interferential current therapy; diacutaneous fibrolysis; soft tissue massage; or cervicothoracic spine manipulation and mobilization as an adjunct to exercise (i.e., range of motion, strengthening and stretching exercise) for pain between the neck and the elbow at rest or during movement of the arm; (g) for shoulder pain >3-month duration, do not offer shock-wave therapy; and (h) should reassess the patient's status at each visit for worsening of symptoms or new physical, mental, or psychological symptoms, or satisfactory recovery. CONCLUSIONS:Our evidence-based guideline provides recommendations for non-invasive management of shoulder pain. The impact of the guideline in clinical practice requires further evaluation. SIGNIFICANCE/CONCLUSIONS:Shoulder pain of any duration can be effectively treated with laser therapy, multimodal care (i.e., heat/cold, joint mobilization, range of motion exercise), or cervicothoracic manipulation and mobilization. Shoulder pain (>3 months) can be effectively treated with exercises, laser acupuncture, or general physician care (information, advice, and pharmacological pain management if necessary).
PMID: 33942459
ISSN: 1532-2149
CID: 4872292

SPINE20 A global advocacy group promoting evidence-based spine care of value

AlEissa, Sami I; Tamai, Koji; Konbaz, Faisal; Alturkistany, Ahmed; Blattert, Thomas R; Chhabra, Harvinder S; Costanzo, Giuseppe; Dohring, Edward J; Kandziora, Frank; Kothe, Ralph; Misaggi, Bernardo; Muehlbauer, Eric J; Pereira, Paulo; Rajasekaran, Shanmuganathan; Sullivan, William J; Truumees, Eeric; Alqahtani, Yahya; Alsobayel, Hana I; Franke, Joerg; Teli, Marco G A; Wang, Jeffrey C; Al-Hazzaa, Hazzaa M; Alosaimi, Majed Nasser; Berven, Sigurd; Brayda-Bruno, Marco; Briggs, Andrew M; Busari, Jamiu O; Caserta, Antonello-Valerio; Côté, Pierre; Crostelli, Marco; Fehlings, Michael G; Gunzburg, Robert; Haddadin, Sami; Ihm, Joseph; Hilibrand, Alan S; Luca, Andrea; Osvaldo, Mazza; Pigott, Tim; Rothenfluh, Dominique A; Ruosi, Carlo; Salmi, Louis-Rachid; Shetty, Ajoy P; Singh, Kern; Vaccaro, Alexander R; Wong, David A; Zileli, Mehmet; Nordin, Margareta
PURPOSE/OBJECTIVE:The Global Burden of Diseases (GBD) Studies have estimated that low back pain is one of the costliest ailments worldwide. Subsequent to GBD publications, leadership of the four largest global spine societies agreed to form SPINE20. This article introduces the concept of SPINE20, the recommendations, and the future of this global advocacy group linked to G20 annual summits. METHODS:The founders of SPINE20 advocacy group coordinated with G20 Saudi Arabia to conduct the SPINE20 summit in 2020. The summit was intended to promote evidence-based recommendations to use the most reliable information from high-level research. Eight areas of importance to mitigate spine disorders were identified through a voting process of the participating societies. Twelve recommendations were discussed and vetted. RESULTS:The areas of immediate concern were "Aging spine," "Future of spine care," "Spinal cord injuries," "Children and adolescent spine," "Spine-related disability," "Spine Educational Standards," "Patient safety," and "Burden on economy." Twelve recommendations were created and endorsed by 31/33 spine societies and 2 journals globally during a vetted process through the website and during the virtual inaugural meeting November 10-11, 2020 held from the G20 platform. CONCLUSIONS:This is the first time that international spine societies have joined to support actions to mitigate the burden of spine disorders across the globe. SPINE20 seeks to change awareness and treatment of spine pain by supporting local projects that implement value-based practices with healthcare policies that are culturally sensitive based on scientific evidence.
PMID: 34106349
ISSN: 1432-0932
CID: 4936672

Health systems strengthening to arrest the global disability burden: Empirical development of prioritised components for a global strategy for improving musculoskeletal health

Briggs, Andrew M.; Huckel Schneider, Carmen; Slater, Helen; Jordan, Joanne E.; Parambath, Sarika; Young, James J.; Sharma, Saurab; Kopansky-Giles, Deborah; Mishrra, Swatee; Akesson, Kristina E.; Ali, Nuzhat; Belton, Joletta; Betteridge, Neil; Blyth, Fiona M.; Brown, Richard; Debere, Demelash; Dreinhofer, Karsten E.; Finucane, Laura; Foster, Helen E.; Gimigliano, Francesca; Haldeman, Scott; Haq, Syed A.; Horgan, Ben; Jain, Anil; Joshipura, Manjul; Kalla, Asgar A.; Lothe, Jakob; Matsuda, Shuichi; Mobasheri, Ali; Mwaniki, Lillian; Nordin, Margareta C.; Pattison, Marilyn; Reis, Felipe J.J.; Soriano, Enrique R.; Tick, Heather; Waddell, James; Wiek, Dieter; Woolf, Anthony D.; March, Lyn
Introduction Despite the profound burden of disease, a strategic global response to optimise musculoskeletal (MSK) health and guide national-level health systems strengthening priorities remains absent. Auspiced by the Global Alliance for Musculoskeletal Health (G-MUSC), we aimed to empirically derive requisite priorities and components of a strategic response to guide global and national-level action on MSK health. Methods Design: mixed-methods, three-phase design. Phase 1: qualitative study with international key informants (KIs), including patient representatives and people with lived experience. KIs characterised the contemporary landscape for MSK health and priorities for a global strategic response. Phase 2: scoping review of national health policies to identify contemporary MSK policy trends and foci. Phase 3: informed by phases 1-2, was a global eDelphi where multisectoral panellists rated and iterated a framework of priorities and detailed components/actions. Results Phase 1: 31 KIs representing 25 organisations were sampled from 20 countries (40% low and middle income (LMIC)). Inductively derived themes were used to construct a logic model to underpin latter phases, consisting of five guiding principles, eight strategic priority areas and seven accelerators for action. Phase 2: of the 165 documents identified, 41 (24.8%) from 22 countries (88% high-income countries) and 2 regions met the inclusion criteria. Eight overarching policy themes, supported by 47 subthemes, were derived, aligning closely with the logic model. Phase 3: 674 panellists from 72 countries (46% LMICs) participated in round 1 and 439 (65%) in round 2 of the eDelphi. Fifty-nine components were retained with 10 (17%) identified as essential for health systems. 97.6% and 94.8% agreed or strongly agreed the framework was valuable and credible, respectively, for health systems strengthening. Conclusion An empirically derived framework, co-designed and strongly supported by multisectoral stakeholders, can now be used as a blueprint for global and country-level responses to improve MSK health and prioritise system strengthening initiatives.
ISSN: 2059-7908
CID: 4923562

Distance Management of Spinal Disorders During the COVID-19 Pandemic and Beyond: Evidence-Based Patient and Clinician Guides From the Global Spine Care Initiative

Haldeman, Scott; Nordin, Margareta; Tavares, Patricia; Mullerpatan, Rajani; Kopansky-Giles, Deborah; Setlhare, Vincent; Chou, Roger; Hurwitz, Eric; Treanor, Caroline; Hartvigsen, Jan; Schneider, Michael; Gay, Ralph; Moss, Jean; Haldeman, Joan; Gryfe, David; Wilkey, Adam; Brown, Richard; Outerbridge, Geoff; Eberspaecher, Stefan; Carroll, Linda; Engelbrecht, Reginald; Graham, Kait; Cashion, Nathan; Ince, Stefanie; Moon, Erin
BACKGROUND:The COVID-19 pandemic has greatly limited patients' access to care for spine-related symptoms and disorders. However, physical distancing between clinicians and patients with spine-related symptoms is not solely limited to restrictions imposed by pandemic-related lockdowns. In most low- and middle-income countries, as well as many underserved marginalized communities in high-income countries, there is little to no access to clinicians trained in evidence-based care for people experiencing spinal pain. OBJECTIVE:The aim of this study is to describe the development and present the components of evidence-based patient and clinician guides for the management of spinal disorders where in-person care is not available. METHODS:Ultimately, two sets of guides were developed (one for patients and one for clinicians) by extracting information from the published Global Spine Care Initiative (GSCI) papers. An international, interprofessional team of 29 participants from 10 countries on 4 continents participated. The team included practitioners in family medicine, neurology, physiatry, rheumatology, psychology, chiropractic, physical therapy, and yoga, as well as epidemiologists, research methodologists, and laypeople. The participants were invited to review, edit, and comment on the guides in an open iterative consensus process. RESULTS:The Patient Guide is a simple 2-step process. The first step describes the nature of the symptoms or concerns. The second step provides information that a patient can use when considering self-care, determining whether to contact a clinician, or considering seeking emergency care. The Clinician Guide is a 5-step process: (1) Obtain and document patient demographics, location of primary clinical symptoms, and psychosocial information. (2) Review the symptoms noted in the patient guide. (3) Determine the GSCI classification of the patient's spine-related complaints. (4) Ask additional questions to determine the GSCI subclassification of the symptom pattern. (5) Consider appropriate treatment interventions. CONCLUSIONS:The Patient and Clinician Guides are designed to be sufficiently clear to be useful to all patients and clinicians, irrespective of their location, education, professional qualifications, and experience. However, they are comprehensive enough to provide guidance on the management of all spine-related symptoms or disorders, including triage for serious and specific diseases. They are consistent with widely accepted evidence-based clinical practice guidelines. They also allow for adequate documentation and medical record keeping. These guides should be of value during periods of government-mandated physical or social distancing due to infectious diseases, such as during the COVID-19 pandemic. They should also be of value in underserved communities in high-, middle-, and low-income countries where there is a dearth of accessible trained spine care clinicians. These guides have the potential to reduce the overutilization of unnecessary and expensive interventions while empowering patients to self-manage uncomplicated spinal pain with the assistance of their clinician, either through direct in-person consultation or via telehealth communication.
PMID: 33471778
ISSN: 2369-2960
CID: 4788262

Postsurgical rehabilitation for adults with low back pain with or without radiculopathy who were treated surgically: protocol for a mixed studies systematic review

Cancelliere, Carol; Wong, Jessica J; Yu, Hainan; Nordin, Margareta; Mior, Silvano; Pereira, Paulo; Brunton, Ginny; Shearer, Heather; Connell, Gaelan; Verville, Leslie; Taylor-Vaisey, Anne; Côté, Pierre
INTRODUCTION/BACKGROUND:Surgical rates for low back pain (LBP) have been increasing in Europe, North America and Asia. Many patients treated surgically will require postsurgical rehabilitation. Little is known about the effectiveness of postsurgical rehabilitation interventions on health outcomes or about patients' experiences with these interventions. OBJECTIVES/OBJECTIVE:To conduct a mixed studies systematic review of quantitative and qualitative studies regarding: (1) the effectiveness and safety of postsurgical rehabilitation interventions for adults with LBP treated surgically and (2) the experiences of patients, healthcare providers, caregivers or others involved with the rehabilitation. METHODS AND ANALYSIS/UNASSIGNED:We will search MEDLINE, Embase, PsycINFO, CINAHL, the Index to Chiropractic Literature, the Cochrane Controlled Register of Trials and the Rehabilitation & Sports Medicine Source for peer-reviewed empirical studies published from inception in any language. Studies using quantitative, qualitative and mixed methodologies will be included. We will also search reference lists of all eligible articles. Data extraction will include type of presurgical pathology, indication for surgery, surgical procedure, how the intervention was delivered and by whom, context and setting. We will conduct a quality assessment of each study and consider study quality in our evidence synthesis. We will use a sequential approach at the review level to synthesise and integrate data. First, we will synthesise the quantitative and qualitative studies independently, conducting a meta-analysis of the quantitative studies if appropriate and thematic synthesis of the qualitative studies. Then, we will integrate the quantitative and qualitative evidence by juxtaposing the findings in a matrix. ETHICS AND DISSEMINATION/UNASSIGNED:Ethical approval is not required for this knowledge synthesis. Findings will be disseminated through knowledge translation activities including: (1) presentations at national and international conferences and scientific meetings; (2) presentations to local and international stakeholders; (3) publications in peer-reviewed journals and (4) posts on organisational websites. PROSPERO REGISTRATION NUMBER/UNASSIGNED:CRD42019134607.
PMID: 32229527
ISSN: 2044-6055
CID: 4371352

The course and factors associated with recovery of whiplash-associated disorders: an updated systematic review by the Ontario protocol for traffic injury management (OPTIMa) collaboration

Shearer, Heather M.; Carroll, Linda J.; Côté, Pierre; Randhawa, Kristi; Southerst, Danielle; Varatharajan, Sharanya; Wong, Jessica J.; Yu, Hainan; Sutton, Deborah; van der Velde, Gabrielle; Nordin, Margareta; Gross, Douglas P.; Mior, Silvano; Stupar, Maja; Jacobs, Craig; Taylor-Vaisey, Anne
Purpose: To update the findings of the Bone and Joint Decade 2000"“2010 Task Force on Neck Pain and Its Associated Disorders (Neck Pain Task Force) on prognostic factors for whiplash-associated disorder (WAD) outcomes. Materials and methods: We conducted a systematic review and best-evidence synthesis. We systematically searched MEDLINE, EMBASE, CINAHL and PsycINFO from 2000"“2017. Random pairs of reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. Results: We retrieved 10,081 articles. Of those, 100 met inclusion criteria. After critical appraisal, 74 were judged to have low risk of bias. This adds to the 47 admissible studies found by the Neck Pain Task Force. Twenty-two related to course of recovery; 59 to prognostic factors in recovery; and 16 reported other WADs outcomes. Some studies related to more than one category. Findings suggest that half of those with WADs will experience substantial improvement within three months and cessation of symptoms within six months. Among factors associated with recovery are post-crash psychological factors, including expectations for recovery and coping. Conclusions: Our review adds to the Neck Pain Task Force by clarifying the role of prognostic factors. Evidence supports the important role of post-crash psychological factors in WADs recovery. Systematic Review Registration Number: CRD42013004610.
ISSN: 2167-9169
CID: 4420102

Non-pharmacological Management of Persistent Headaches Associated with Neck Pain: A Clinical Practice Guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

Côté, Pierre; Yu, Hainan; Shearer, Heather M; Randhawa, Kristi; Wong, Jessica J; Mior, Silvano; Ameis, Arthur; Carroll, Linda J; Nordin, Margareta; Varatharajan, Sharanya; Sutton, Deborah; Southerst, Danielle; Jacobs, Craig; Stupar, Maja; Taylor-Vaisey, Anne; Gross, Douglas P; Brison, Robert J; Paulden, Mike; Ammendolia, Carlo; Cassidy, J David; Loisel, Patrick; Marshall, Shawn; Bohay, Richard N; Stapleton, John; Lacerte, Michel
OBJECTIVES/OBJECTIVE:To develop an evidence-based guideline for the non-pharmacological management of persistent headaches associated with neck pain (i.e., tension-type or cervicogenic). METHODS:This guideline is based on systematic reviews of high-quality studies. A multidisciplinary expert panel considered the evidence of clinical benefits, cost-effectiveness, societal and ethical values, and patient experiences when formulating recommendations. Target audience includes clinicians; target population is adults with persistent headaches associated with neck pain. RESULTS:When managing patients with headaches associated with neck pain, clinicians should: 1) rule out major structural or other pathologies, or migraine as the cause of headaches; 2) classify headaches associated with neck pain as tension-type headache or cervicogenic headache once other sources of headache pathology has been ruled out; 3) provide care in partnership with the patient and involve the patient in care planning and decision-making; 4) provide care in addition to structured patient education; 5) consider low load endurance craniocervical and cervicoscapular exercises for tension-type headaches (episodic or chronic) or cervicogenic headaches >3 months duration; 6) consider general exercise, multimodal care (spinal mobilization, craniocervical exercise, and postural correction), or clinical massage for chronic tension-type headaches; 7) do not offer manipulation of the cervical spine as the sole form of treatment for episodic or chronic tension-type headaches; 8) consider manual therapy (manipulation with or without mobilization) to the cervical and thoracic spine for cervicogenic headaches >3 months duration. However, there is no added benefit in combining spinal manipulation, spinal mobilization, and exercises; and 9) reassess the patient at every visit to assess outcomes and determine whether a referral is indicated. CONCLUSIONS:Our evidence-based guideline provides recommendations for the conservative management of persistent headaches associated with neck pain. The impact of the guideline in clinical practice requires validation.
PMID: 30707486
ISSN: 1532-2149
CID: 3626962

The Global Spine Care Initiative: a summary of guidelines on invasive interventions for the management of persistent and disabling spinal pain in low- and middle-income communities

Acaroğlu, Emre; Nordin, Margareta; Randhawa, Kristi; Chou, Roger; Côté, Pierre; Mmopelwa, Tiro; Haldeman, Scott
PURPOSE/OBJECTIVE:The purpose of this study was to synthesize recommendations on the use of common elective surgical and interventional procedures for individuals with persistent and disabling non-radicular/axial with or without myelopathy, radicular back pain, cervical myelopathy, symptomatic spinal stenosis, and fractures due to osteoporosis. This review was to inform a clinical care pathway on the patient presentations where surgical interventions could reasonably be considered. METHODS:We synthesized recommendations from six evidence-based clinical practice guidelines and one appropriate use criteria guidance for the surgical and interventional management of persistent and disabling spine pain. RESULTS:Lower priority surgery/conditions include fusion for lumbar/non-radicular neck pain and higher priority surgery/conditions include discectomy/decompressive surgery for cervical or lumbar radiculopathy, cervical myelopathy, and lumbar spinal stenosis. Epidural steroid injections are less expensive than most surgeries with fewer harms; however, benefits are small and short lived. Vertebroplasty should be considered over kyphoplasty as an option for patients with severe pain and disability due to osteoporotic vertebral compression fracture. CONCLUSION/CONCLUSIONS:Elective surgery and interventional procedures could be limited in medically underserved areas and low- and middle-income countries due to a lack of resources and surgeons and thus surgical and interventional procedures should be prioritized within these settings. There are non-invasive alternatives that produce similar outcomes and are a recommended option where surgical procedures are not available. These slides can be retrieved under Electronic Supplementary Material.
PMID: 29322309
ISSN: 1432-0932
CID: 2946552

The Global Spine Care Initiative: a review of reviews and recommendations for the non-invasive management of acute osteoporotic vertebral compression fracture pain in low- and middle-income communities

Ameis, Arthur; Randhawa, Kristi; Yu, Hainan; Côté, Pierre; Haldeman, Scott; Chou, Roger; Hurwitz, Eric L; Nordin, Margareta; Wong, Jessica J; Shearer, Heather M; Taylor-Vaisey, Anne
PURPOSE/OBJECTIVE:The purpose of this review was to develop recommendations for non-invasive management of pain due to osteoporotic vertebral compression fractures (OVCF) that could be applied in medically underserved areas and low- and middle-income countries. METHODS:We conducted a systematic review and best evidence synthesis of systematic reviews on the non-invasive management of OVCF. Eligible reviews were critically appraised using the Scottish Intercollegiate Guidelines Network criteria. Low risk of bias systematic reviews and high-quality primary studies that were identified in the reviews were used to develop recommendations. RESULTS:From 6 low risk of bias systematic reviews and 14 high-quality primary studies we established that for acute pain management, in addition to rest and analgesic medication, orthoses may provide temporary pain relief, in addition to early mobilization. Calcitonin can be considered as a supplement to analgesics; however, cost is of concern. Once acute pain control is achieved, exercise can be effective for improving function and quality of life. CONCLUSION/CONCLUSIONS:The findings from this study will help to inform the GSCI care pathway and model of care for use in medically underserved areas and low- and middle-income countries. Conservative management of acute pain and recovery of function in adults with OVCF should include early mobilization, exercise, spinal orthosis for pain relief, and calcitonin for analgesic-refractory acute pain. These slides can be retrieved under Electronic Supplementary Material.
PMID: 29038868
ISSN: 1432-0932
CID: 2945832