Josette Bettany-Saltikov

A comparison of outcomes with and without a tourniquet in total knee arthroplasty: A systematic review and meta-analysis of randomized controlled trials

A tourniquet is often used in total knee arthroplasty resulting in improved visualization of structures, reduced intraoperative bleeding and better cementation. The risks include deep vein thrombosis and pulmonary embolism. To quantify the case for or against tourniquet use, we carried out a systematic review and meta-analysis of selected randomized controlled trials. Ten studies were included in the meta-analysis. Of the 8 outcomes analyzed (surgery duration; total, intraoperative, and postoperative blood losses; deep vein thrombosis; pulmonary embolism; and minor/major complications), the total and intraoperative blood losses were less using a tourniquet. Minor complications were more common in the tourniquet group. The remaining outcomes showed no difference between the groups. Using a tourniquet may be beneficial, but long-term studies of outcome are needed.

Braces for idiopathic scoliosis in adolescents

Study Design. A Cochrane systematic review. Objective. To evaluate the efficacy of bracing for adolescents with AIS versus no treatment or other treatments, on quality of life, disability, pulmonary disorders, progression of the curve, psychological, and cosmetic issues. Summary of Background Data. Idiopathic scoliosis is a three-dimensional deformity of the spine. The most common form is diagnosed in adolescence. Although adolescent idiopathic scoliosis (AIS) can progress during growth and cause a surface deformity, it is usually not symptomatic. Methods. We searched CENTRAL, MEDLINE, EMBASE, five other databases, and two trials registers up to February 2015. We also checked reference lists and hand searched grey literature. Randomized controlled trials (RCTs) and prospective controlled cohort studies comparing braces with no treatment, other treatment, surgery, and different types of braces for adolescent with AIS. We used standard methodological procedures expected by the Cochrane Collaboration. Results. We included seven studies. Five were planned as RCTs, two as prospective controlled clinical trials. One RCT failed completely, another was continued as an observational study. There was very low quality evidence from one small RCT that quality of life (QoL) during treatment did not differ significantly between rigid bracing and observation. Conclusion. Two studies showed that bracing did not change QoL during treatment, and QoL, back pain psychological and cosmetic issues in the long term (16 years.) All articles showed that bracing prevented curve progression. The high rate of failure of RCTs demonstrates the huge difficulties in performing RCTs in a field where parents reject randomization of their children. Level of Evidence: 1

SOSORT 2012 consensus paper: reducing x-ray exposure in pediatric patients with scoliosis.

This 2012 Consensus paper reviews the literature on side effects of x-ray exposure in the pediatric population as it relates to scoliosis evaluation and treatment. Alternative methods of spinal assessment and imaging are reviewed, and strategies for reducing the number of radiographs are developed. Using the Delphi technique, SOSORT members developed consensus statements that describe how often radiographs should be taken in each of the pediatric and adolescent sub-populations.

Selecting the most appropriate inferential statistical test for your quantitative research study

AIMS AND OBJECTIVES To discuss the issues and processes relating to the selection of the most appropriate statistical test. A review of the basic research concepts together with a number of clinical scenarios is used to illustrate this. BACKGROUND Quantitative nursing research generally features the use of empirical data which necessitates the selection of both descriptive and statistical tests. Different types of research questions can be answered by different types of research designs, which in turn need to be matched to a specific statistical test(s). DESIGN Discursive paper. METHODS This paper discusses the issues relating to the selection of the most appropriate statistical test and makes some recommendations as to how these might be dealt with. CONCLUSION When conducting empirical quantitative studies, a number of key issues need to be considered. Considerations for selecting the most appropriate statistical tests are discussed and flow charts provided to facilitate this process. RELEVANCE TO CLINICAL PRACTICE When nursing clinicians and researchers conduct quantitative research studies, it is crucial that the most appropriate statistical test is selected to enable valid conclusions to be made.

Physiotherapy scoliosis-specific exercises – a comprehensive review of seven major schools

In recent decades, there has been a call for change among all stakeholders involved in scoliosis management. Parents of children with scoliosis have complained about the so-called “wait and see” approach that far too many doctors use when evaluating children’s scoliosis curves between 10° and 25°. Observation, Physiotherapy Scoliosis Specific Exercises (PSSE) and bracing for idiopathic scoliosis during growth are all therapeutic interventions accepted by the 2011 International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT). The standard features of these interventions are: 1) 3-dimension self-correction; 2) Training activities of daily living (ADL); and 3) Stabilization of the corrected posture. PSSE is part of a scoliosis care model that includes scoliosis specific education, scoliosis specific physical therapy exercises, observation or surveillance, psychological support and intervention, bracing and surgery. The model is oriented to the patient. Diagnosis and patient evaluation is essential in this model looking at a patient-oriented decision according to clinical experience, scientific evidence and patient’s preference. Thus, specific exercises are not considered as an alternative to bracing or surgery but as a therapeutic intervention, which can be used alone or in combination with bracing or surgery according to individual indication. In the PSSE model it is recommended that the physical therapist work as part of a multidisciplinary team including the orthopeadic doctor, the orthotist, and the mental health care provider - all are according to the SOSORT guidelines and Scoliosis Research Society (SRS) philosophy. From clinical experiences, PSSE can temporarily stabilize progressive scoliosis curves during the secondary period of progression, more than a year after passing the peak of growth. In non-progressive scoliosis, the regular practice of PSSE could produce a temporary and significant reduction of the Cobb angle. PSSE can also produce benefits in subjects with scoliosis other than reducing the Cobb angle, like improving back asymmetry, based on 3D self-correction and stabilization of a stable 3D corrected posture, as well as the secondary muscle imbalance and related pain. In more severe cases of thoracic scoliosis, it can also improve breathing function.This paper will discuss in detail seven major scoliosis schools and their approaches to PSSE, including their bracing techniques and scientific evidence. The aim of this paper is to understand and learn about the different international treatment methods so that physical therapists can incorporate the best from each into their own practices, and in that way attempt to improve the conservative management of patients with idiopathic scoliosis. These schools are presented in the historical order in which they were developed. They include the Lyon approach from France, the Katharina Schroth Asklepios approach from Germany, the Scientific Exercise Approach to Scoliosis (SEAS) from Italy, the Barcelona Scoliosis Physical Therapy School approach (BSPTS) from Spain, the Dobomed approach from Poland, the Side Shift approach from the United Kingdom, and the Functional Individual Therapy of Scoliosis approach (FITS) from Poland.

Non-Surgical Interventions for Adolescents with Idiopathic Scoliosis: An Overview of Systematic Reviews

Background Non-surgical interventions for adolescents with idiopathic scoliosis remain highly controversial. Despite the publication of numerous reviews no explicit methodological evaluation of papers labeled as, or having a layout of, a systematic review, addressing this subject matter, is available. Objectives Analysis and comparison of the content, methodology, and evidence-base from systematic reviews regarding non-surgical interventions for adolescents with idiopathic scoliosis. Design Systematic overview of systematic reviews. Methods Articles meeting the minimal criteria for a systematic review, regarding any non-surgical intervention for adolescent idiopathic scoliosis, with any outcomes measured, were included. Multiple general and systematic review specific databases, guideline registries, reference lists and websites of institutions were searched. The AMSTAR tool was used to critically appraise the methodology, and the Oxford Centre for Evidence Based Medicine and the Joanna Briggs Institute’s hierarchies were applied to analyze the levels of evidence from included reviews. Results From 469 citations, twenty one papers were included for analysis. Five reviews assessed the effectiveness of scoliosis-specific exercise treatments, four assessed manual therapies, five evaluated bracing, four assessed different combinations of interventions, and one evaluated usual physical activity. Two reviews addressed the adverse effects of bracing. Two papers were high quality Cochrane reviews, Three were of moderate, and the remaining sixteen were of low or very low methodological quality. The level of evidence of these reviews ranged from 1 or 1+ to 4, and in some reviews, due to their low methodological quality and/or poor reporting, this could not be established. Conclusions Higher quality reviews indicate that generally there is insufficient evidence to make a judgment on whether non-surgical interventions in adolescent idiopathic scoliosis are effective. Papers labeled as systematic reviews need to be considered in terms of their methodological rigor; otherwise they may be mistakenly regarded as high quality sources of evidence. Protocol registry number CRD42013003538, PROSPERO

An evaluation of web sites recommended by UK NHS consultants to patients with adolescent idiopathic scoliosis at the first point of diagnosis

Study Design. An Internet-based evaluation of Web sites using a validated assessment tool. Objective. To evaluate the quality of information on scoliosis Web sites recommended by UK NHS consultants. Summary of Background Data. One of the most common sources of inquiry on the Web is for the purposes of health-related information. The number of Web sites in the field of scoliosis has increased, yet the quality of information is reported to continue to be of poor quality. The 2 previous studies in this area identified Web sites for evaluation through the use of a single search term, “scoliosis,” on the 5 most popular search engines. Methods. Seven Web sites were identified for inclusion in this study from the results of a survey of UK NHS consultants. These were independently evaluated by 3 reviewers using a validated information assessment tool, the DISCERN instrument. DISCERN scores were analyzed for correlation between reviewers. Web sites were also analyzed for the presence or absence of the quality assurance certification, Health On the Net code. Results. Significant correlations between the DISCERN scores were found for reviewers 1 and 2 (&tgr; = 0.878, P = 0.006) and reviewers 2 and 3 (&tgr; = 0.732, P = 0.029). The highest mean cumulative score for all items achieved by any of the Web sites evaluated was 49 (maximum = 80, minimum = 15). Only one Web site was found to display the Health On the Net code. Conclusion. Healthcare professionals should be aware of the content of Web sites that they recommend to patients. Web sites should be designed so the content suits patient needs. Web sites should be maintained such that content is up to date, evidence based, impartial, and written in plain language. Level of Evidence: N/A

Are current scoliosis school screening recommendations evidence-based and up to date? A best evidence synthesis umbrella review

PurposeRecommendations addressing school screening for adolescents with idiopathic scoliosis are contradictory. Consequently a critical evaluation of the methodological quality of available systematic reviews, including those upon which these recommendations are based, was conducted.MethodsArticles meeting the minimal criteria to be considered a systematic review were included for a best evidence synthesis, umbrella review of secondary studies. The primary outcome measure was “any recommendation addressing the continuation, or not, of school screening programs”. Multiple general bibliographic databases, guideline registries, as well as websites of institutions were searched. The AMSTAR tool was used to critically appraise the methodology of included reviews. Venn diagrams were created to examine potential overlaps across included papers within different reviews.ResultsSix reviews undertaken between 2002 and 2011, scored as moderate to low quality, were included. The 2012 US Preventive Services Task Force recommendation against screening was found to be based on an outdated (2004) low-quality review, whilst two higher quality and more recent (2009 and 2010) reviews support the continuation of school screening programs.ConclusionsAs the existing recommendations supporting screening are based on moderate quality evidence whilst the recommendations against screening are based on low-quality evidence, the latter recommendations appear to be both unconvincing and methodologically invalid.

Bones, Boys, Bombs and Booze: An Exploratory Study of the Reliability of Marking Dissertations across Disciplines.

The primary aim of this study was to evaluate the reliability of the University’s Masters’ level (M‐level) generic assessment criteria when used by lecturers from different disciplines. A further aim was to evaluate if subject‐specific knowledge was essential to marking these dissertations. Four senior lecturers from diverse disciplines participated in this study. The University of Teesside’s generic M‐level assessment criteria were used and formatted into a grid. The assessment criteria related to the learning outcomes, the depth of understanding, the complexity of analysis and synthesis and the structure and academic presentation of the work. As well as a quantitative mark, a qualitative statement for the reason behind the judgement was required. Each lecturer provided a dissertation that had previously been marked. All participants then marked each of the four projects using the M‐level grid and comments sheet. The study found very good inter‐rater reliability. For any one project, the variation in marks from the original mark was no more than 6% on average. This study also found that subject‐specific knowledge was not essential to marking when using generic assessment criteria in terms of the reliability of marks. The authors acknowledge the exploratory nature of these results and hope other lecturers will join in the exploration to test the robustness of generic assessment criteria across disciplines.

Information provided to patients with adolescent idiopathic scoliosis (AIS) at the first point of diagnosis in the hospital clinic: a survey of UK NHS scoliosis consultants

Results The response rate was 47%. The most common questions asked by service users related to aetiology (22.5%) prognosis (42.6%) general treatment (16.8%) surgery (12.4%) and parental guilt (5.6%). 78.6% of consultants said that patients were provided with written information provided by a member of staff and written by the Scoliosis Association UK in 61.5% of cases. 92% of consultants referred patients to relevant web sites. Surgeons stressed the importance for information to be evidence-based, address patients anxieties and counselling needs, provide clear natural history information and address ways of contacting other patients with AIS who have or have not undergone surgery.