Jo-Anne Aubut

Does a relationship exist between body weight, concerns about weight, and smoking among adolescents? An integration of the literature with an emphasis on gender.

It has been speculated that body weight and concern about body weight are important factors in initiation of tobacco use among adolescents, particularly females. An examination of studies that have explored these relationships can provide important information on possible underlying mechanisms that could be used for prevention interventions. This review summarizes recent studies examining weight concerns and youth smoking, with a focus on gender differences. These studies were integrated with the few studies that have examined the relationship between actual body weight and smoking among adolescents. A total of 55 primary research articles met inclusion criteria for the review. Of these, 19 studies assessed the relationship between body weight and smoking, and 50 studies addressed weight concerns and smoking. Some evidence indicated a positive relationship between smoking and body weight among adolescents, although not all studies found a positive association. In terms of the relationship between weight concerns and adolescent smoking, the amount of evidence supporting a positive association differed depending on the dimension of weight concern considered, with the strongest evidence for dieting behaviors. For dieting behaviors, disordered eating symptoms, and some aspects of general weight concerns, the positive relationship with smoking was more consistent among female adolescents than among male adolescents. Possible explanations for these findings are discussed, and priorities for future research are identified.

A systematic review of therapeutic interventions for pressure ulcers after spinal cord injury.

OBJECTIVE To systematically review evidence on the prevention and treatment of pressure ulcers in those with a spinal cord injury (SCI). DATA SOURCES For this evidence-based review, the following data sources were used: MEDLINE/PubMed, CINAHL, EMBASE, and PsycINFO. STUDY SELECTION To be selected for inclusion in the current review, there had to have been an intervention, studies had to have 3 or more subjects, and 50% or more of the participating group had to have an SCI. DATA EXTRACTION Data extracted included study design, subject demographics, inclusion and exclusion criteria, study type, sample size, outcome measures used, and study results. DATA SYNTHESIS Articles selected for this review were organized into 1 of 2 categories: prevention or treatment. Within each broad category, several smaller ones were created, and articles were grouped according to the prevention (direct or indirect) or treatment intervention discussed. CONCLUSIONS Of the 26 articles selected for inclusion in the systematic review, 7 were randomized controlled trials (RCTs) that dealt with treatment for pressure ulcers, and there was 1 RCT on prevention. Despite the cost-effectiveness of prevention, little research exists on preventative interventions, and what does exist is mostly level 4 evidence. More research is needed for both prevention and treatment, but especially the former.

A systematic review of the rehabilitation of moderate to severe acquired brain injuries

Objective: To conduct a systematic review of the rehabilitation literature of moderate to severe acquired brain injuries (ABI) from traumatic and non-traumatic causes. Methods: A review of the literature was conducted for studies looking at interventions in ABI rehabilitation. The methodological quality of each study was determined using the Downs and Black scale for randomized controlled trials (RCTs) and non-RCTs as well as the Physiotherapy Evidence Database (PEDro) scale for RCTs only. Results: Almost 14 000 references were screened from which 1312 abstracts were selected. A total of 303 articles were chosen for careful review of which 275 were found to be interventional studies but only 76 of these interventional studies were RCTs. From this, 5 levels of evidence were determined with 177 conclusions drawn; however of the 177 conclusions only 7 were supported by two or more RCTs and 41 were supported by one RCT. Conclusion: Only 28% of the interventional studies were RCTs. Over half of the 275 interventional studies were single group interventions, pointing to the need for studies of improved methodological quality into ABI rehabilitation.

A systematic review of the therapeutic interventions for heterotopic ossification after spinal cord injury

Study design:Systematic review.Objective:To conduct a systematic review of the effectiveness of interventions used to prevent and treat heterotopic ossification (HO) after spinal cord injury (SCI).Setting:St Josephs Parkwood Hospital, London, Ontario, Canada.Methods:MEDLINE, CINAHL, EMBASE and PsycINFO databases were searched for articles addressing the treatment of HO after SCI. Studies were selected by two reviewers and were only included for analysis if at least 50% of the subjects had an SCI, there were at least three SCI subjects and if the study subjects participated in a treatment or intervention. Study quality was assessed by two independent reviewers using the Downs and Black evaluation tool for all studies, as well as the PEDro assessment scale for randomized control trials only. Levels of evidence were assigned using a modified Sackett scale.Results:A total of 13 studies met the inclusion criteria. The selected articles were divided into prevention or treatment of post-SCI HO. Nonsteroidal anti-inflammatory drugs (NSAIDs), warfarin, and pulse low-intensity electrogmagnetic field (PLIMF) therapy were reviewed as prophylactic measures. Bisphosphonates, radiotherapy and excision were reviewed as treatments of post-SCI HO.Conclusions:Pharmacological treatments of HO after SCI had the highest level of research evidence supporting their use. Of these, NSAIDs showed greatest efficacy in the prevention of HO when administered early after an SCI, whereas bisphosphonates were the intervention with strongest supportive evidence once HO had developed. Of the non-pharmacological interventions, PLIMF was supported by the highest level of evidence; however, more research is needed to fully understand its role.

Mortality among older adults after a traumatic brain injury: A meta-analysis

Primary objective: To examine mortality rates among older adults (≥60 years) post-traumatic brain injury (TBI). Research design: Systematic review and meta-analysis. Methods and procedures: Using multiple databases, a literature search was conducted for articles on mortality after TBI published up to July 2011. Information on patient characteristics (age, Glasgow Coma Scale (GCS), injury aetiology, etc.), mortality rates, time to death and study design was extracted and pooled. Main outcomes and results: Twenty-four studies had an overall mortality rate of 38.3% (CI 27.1–50.9%). The odds of mortality for those over 75 years compared to those of 65–74 years was 1.734 (CI = 1.311–2.292; p < 0.0001). Pooled mortality rates for mild (GCS 13–15), moderate (GCS 9–12) and severe (GCS 3–8) head injuries were 12.3% (CI = 6.1–23.3%), 34.3% (CI = 19.5–53.0%) and 65.3% (CI = 53.1–75.9), respectively. Odds ratios comparing severe to mild and moderate to mild head injuries were 12.69 (CI = 5.29–30.45; p < 0.0001) and 5.31 (CI = 3.41-8.29; p < 0.0001), respectively. There was no significant difference in the odds of death between severe and moderate injuries (p = 0.116). Conclusions: These mortality rates associated with moderate and severe injuries may be attributed to complications, chronic disease prevalence, conservative management techniques or the consequences of biological ageing.

Venous Thromboembolism After Spinal Cord Injury

OBJECTIVE To review systematically the published literature on the treatment of deep venous thromboembolism after spinal cord injury (SCI). DATA SOURCES MEDLINE/PubMed, CINAHL, EMBASE, and PsycINFO databases were searched for articles addressing the treatment of deep venous thromboembolism post-SCI. Randomized controlled trials (RCTs) were assessed for methodologic quality using the Physiotherapy Evidence Database Scale, while non-RCTs were assessed using the Downs and Black evaluation tool. STUDY SELECTION Studies included RCTs, non-RCTS, cohort, case-control, case series, pre-post, and postinterventional studies. Case studies were included only when no other studies were available. DATA EXTRACTION Data extracted included demographics, the nature of the study intervention, and study results. DATA SYNTHESIS Levels of evidence were assigned to the interventions using a modified Sackett scale. CONCLUSIONS Twenty-three studies met inclusion criteria. Thirteen studies examined various pharmacologic interventions for the treatment or prevention of deep venous thrombosis in patients with SCI. There was strong evidence to support the use of low-molecular-weight heparin in reducing venous thrombosis events, and a higher adjusted dose of unfractionated heparin was found to be more effective than 5000 units administered every 12 hours, although bleeding complications were more common. Nonpharmacologic treatments were also reviewed, but again limited evidence was found to support these treatments.

An evidence-based review of the effectiveness of cognitive behavioral therapy for psychosocial issues post-spinal cord injury

STUDY DESIGN Systematic review. OBJECTIVE To examine the evidence supporting the effectiveness of cognitive behavioral therapy (CBT) for improving psychosocial outcomes in individuals with spinal cord injury (SCI). METHOD Electronic databases (MEDLINE, CINAHL, EMBASE, and PsycINFO) were searched for studies published between 1990 and October 2010. Randomized control trials (RCTs) and nonrandomized control trials (non-RCTs) utilizing a CBT intervention to improve psychosocial outcomes (depressive symptomatology, anxiety, coping, and adjustment to disability) in outpatient persons with SCI were included for review. Levels of evidence were assigned to each study using a modified Sackett scale. Effect size calculations for the interventions were provided where possible. RESULTS Nine studies met the inclusion criteria. The studies reviewed included two RCTs, six prospective controlled trials (PCTs) and one cohort study. All studies examined at least two groups. There is Level 1 and Level 2 evidence supporting the use of specialized CBT protocols in persons with SCI for improving outcomes related to depression, anxiety, adjustment, and coping. CONCLUSIONS CBT holds promise as an effective approach for persons with SCI experiencing depression, anxiety, adjustment, and coping problems. As CBT may involve many different components, it is important in the future to determine which of these elements alone or in combination is most effective in treating the emotional consequences of SCI.

A comparison of heterotopic ossification treatment within the traumatic brain and spinal cord injured population: An evidence based systematic review

BACKGROUND To compare the treatment of heterotopic ossification (HO) within the traumatic brain and spinal cord injured populations. METHODS MEDLINE/Pubmed, CINAHL, EMBASE, and PsycINFO databases were searched for articles addressing treatment of HO post-injury. Articles were constrained to: English language and human subjects. Studies were included if: n ≥ 50% of the subjects had a spinal cord injury (SCI) or a traumatic brain injury (TBI), n ≥ 3 SCI or TBI subjects, and study subjects participated in a treatment or intervention. Study quality, for randomized control trials (RCTs), were assessed using the PEDro assessment scale, while non-RCTs was assessed using the Downs and Black evaluation tool. A modified Sackett scale was used to apply levels of evidence for each intervention. RESULTS In total 26 studies (NTBI = 12; NSCI = 14) met inclusion criteria. The majority of studies (10/12) conducted in the TBI population were surgical interventions. Studies conducted with the SCI population investigated diverse pharmacological treatments including: bisphosphonates, non-steroidal anti-inflammatory drugs (NSAIDs) and Warfarin. Non-pharmacological studies investigated the benefits of pulse low-intensity electromagnetic field therapy, surgical excision, and radiotherapy in the treatment of HO. CONCLUSIONS Within the SCI literature, NSAIDs showed the greatest efficacy in the prevention of HO when administered early after a SCI, and biphosphonates were found to be the most effective treatment strategy. In the TBI population, surgical excision was the most effective treatment.

A meta-analysis of functional outcome among older adults with traumatic brain injury

OBJECTIVE The objective of this study was to determine rates of functional outcomes, based on Glasgow Outcome Scale scores, among older adults (>60 years) after a traumatic brain injury. METHODS An extensive database search was conducted. To be included all articles were published in English, included individuals 60 years or older, explicitly stated in-hospital GCS scores and GOS scores within one year post-TBI. Data was pooled on patient characteristics, mortality rates, time to death, and study design. RESULTS A total of 11 studies were included in this review. Among individuals with severe TBI, favourable, unfavourable, and fatal outcomes were observed in 7.9% (CI 5.3%-11.8%), 13.8% (CI 10.0%-18.8%) and 79.3% (CI 73.2%-84.4%), respectively. Among those with moderate TBI, favourable, unfavourable, and fatal outcomes were observed in 32.2% (CI 18.0%-50.7%), 29.5% (CI 16.5%-47.0%), and 42.5% (CI 26.1%-60.7%), respectively. Among those with mild TBI, favourable, unfavourable, and fatal outcomes were observed in 80.5% (CI 53.2%-93.7%), 7.0% (CI 1.9%-22.7%), and 10.7% (CI 3.1%-30.9%), respectively. CONCLUSION This study has demonstrated the significant interaction between GCS and GOS among older adults. Although older adults may require aggressive and comprehensive treatment to achieve these favourable outcomes, high rates of unfavourable outcome should not justify the use of conservative treatment.

A comparison of the PEDro and Downs and Black quality assessment tools using the acquired brain injury intervention literature

OBJECTIVE The objective of this study was to examine the correlation between the Physiotherapy Evidence Database (PEDro) and the Downs and Black (D&B) quality assessment scale and the PEDro and a modified D&B assessment scores in a research synthesis of the ABI literature. METHODS AND MAIN OUTCOMES A systematic review of the literature from 1980-2007 was conducted looking at treatment interventions following an ABI published in peer-reviewed English language journals. Of the articles chosen for inclusion in the study, 165 were identified as randomised controlled trials (RCT). All RCTs were scored using two quality assessment tools: the PEDro and D&B quality assessment scales. Items from these two scales were compared to identify which questions addressed similar information. RESULTS The association between the overall PEDro and D&B scores was moderately high (r = 0.71, p < 0.01) indicating a significant relationship between these two quality assessment tools. When considering the modified D&B scores, which contained a subset of questions deemed most comparable to the PEDro scale, the correlation between the two was also moderately high (r = 0.68, p < 0.01). CONCLUSIONS Further analysis is required to investigate the strength of the relationship between these two scales in the assessment of RCTs.