Change in Function, Pain, and Quality of Life following Structured Nonoperative Treatment in Patients with Degenerative Cervical Myelopathy: A Systematic Review
Notice bibliographique
Résumé
Introduction The role of structured nonoperative treatment for the management of DCM is not well defined, and surgery is typically recommended as the default treatment option for patients with moderate and severe myelopathy. This study aims to conduct a systematic review of the literature to determine (1) the change in function, pain and quality of life following structured nonoperative treatment for degenerative cervical myelopathy (DCM); (2) the variability of change in function, pain and quality of life following different types of structured nonoperative treatment; (3) the differences in outcomes observed between certain subgroups (i.e baseline severity score, duration of symptoms); and (4) negative outcomes and harms resulting from structured nonoperative treatment. Material and Methods A systematic search was conducted in Embase, PubMed, and the Cochrane Collaboration for articles published between January 1, 1950 and February 9, 2015. Studies were included if they evaluated outcomes following structured nonoperative treatment, including therapeutic exercise, manual therapy, cervical bracing and/or traction. Outcomes of interest were functional status (Japanese Orthopedic Association (JOA), Nurick), pain in upper extremities and neck, quality of life (Neck Disability Index), and/or conversion to surgery. The quality of each study was evaluated using the Newcaste-Ottawa Scale and the strength of the overall body of evidence was rated using guidelines outlined by the Grading of Recommendation Assessment, Development and Evaluation Working Group. Results Of the 570 retrieved citations, eight met the inclusion criteria and were included in this review. There is very low evidence to suggest that structured nonoperative treatment for DCM results in a positive or negative change in function, pain and quality of life as evaluated by the JOA score. There is also limited evidence from three studies indicating that early structured nonoperative treatment (duration of symptoms < 1 year) may be associated with positive clinical outcomes. There were no studies that directly compared structured nonoperative treatment types and no studies that explored outcomes based on patient subgroups. The rate of conversion to surgery was reported to be between 23-54% in mostly cases of mild or moderate myelopathy (JOA≥12). Conclusion There is a lack of evidence to determine the role of nonoperative treatment in patients with DCM. However, in the majority of studies, patients did not achieve clinically significant gains in functional status following structured nonoperative treatment. Furthermore, rates of failed conservative treatment were between 23-54%.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,005 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».