ABSTRACT
INTRODUCTION: Falls among older adults are associated with adverse sequelae including fractures, chronic pain and disability, which can lead to loss of independence and increased risks of nursing home admissions. The COVID-19 pandemic has significantly increased the uptake of telehealth, but the effectiveness of virtual, home-based fall prevention programmes is not clearly known. We aim to synthesise the trials on telerehabilitation and home-based falls prevention programmes to determine their effectiveness in reducing falls and adverse outcomes, as well as to describe the safety risks associated with telerehabilitation. METHODS AND ANALYSIS: This protocol was developed using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Database searches from inception to August 2022 will be conducted without language restrictions of MEDLINE, EMBASE, Ovid HealthSTAR, CINAHL, SPORTDiscus, Physiotherapy EvidenceDatabase (PEDro) and the Cochrane Library. Grey literature including major geriatrics conference proceedings will be reviewed. Using Covidence software, two independent reviewers will in duplicate determine the eligibility of randomised controlled trials (RCTs). Eligible RCTs will compare telerehabilitation and home-based fall prevention programmes to usual care among community-dwelling older adults and will report at least one efficacy outcome: falls, fractures, hospitalisations, mortality or quality of life; or at least one safety outcome: pain, myalgias, dyspnoea, syncope or fatigue. Secondary outcomes include functional performance in activities of daily living, balance and endurance. Risk of bias will be assessed using the Cochrane Collaboration tool. DerSimonian-Laird random effects models will be used for the meta-analysis. Heterogeneity will be assessed using the I2 statistic and Cochran's Q statistic. We will assess publication bias using the Egger's test. Prespecified subgroup analyses and univariate meta-regression will be used. ETHICS AND DISSEMINATION: Ethics approval is not required. The results will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER: CRD42022356759.
Subject(s)
COVID-19 , Fractures, Bone , Telerehabilitation , Humans , Aged , Independent Living , COVID-19/prevention & control , Systematic Reviews as Topic , Meta-Analysis as TopicABSTRACT
OBJECTIF: Résumer 10 études ou lignes directrices de grande qualité publiées en 2021 qui présentent un intérêt marqué pour les médecins qui ont une pratique familiale complète. SÉLECTION DES DONNÉES PROBANTES: L'équipe PEER (Patients, Experience, Evidence, Research), un groupe de professionnels de la santé dont la recherche s'intéresse à la médecine fondée sur les données probantes et à la médecine de première ligne, a systématiquement surveillé les résumés publiés dans les revues savantes importantes et dans EvidenceAlerts. L'équipe PEER a passé au crible, sélectionné et placé les résumés en ordre d'importance. MESSAGE PRINCIPAL: Les articles publiés en 2021 qui influeront le plus probablement sur la pratique de première ligne traitent des sujets suivants : empagliflozine contre l'insuffisance cardiaque avec fraction d'éjection préservée; sémaglutide pour perdre du poids; arrêter les antidépresseurs en première ligne; budésonide par inhalation contre la COVID-19; acide acétylsalicylique en prévention de la prééclampsie; quart de dose d'antihypertenseurs contre l'hypertension; contrôle énergique de la tension artérielle chez les patients âgés; méthode kangourou pour les nouveau-nés de faible poids; chaussures pour la gonarthrose; et report de l'antibiothérapie pour les infections respiratoires pédiatriques. On jette également un coup d'Åil rapide à deux « mentions honorables ¼. CONCLUSION: En 2021, la recherche a produit plusieurs études de grande qualité dans le domaine des soins cardiovasculaires, mais elle a également porté sur une gamme d'affections présentant un intérêt pour les soins de première ligne, dont la perte pondérale, la dépression et la COVID-19.
Subject(s)
Peer Group , Primary Health Care , HumansABSTRACT
OBJECTIVE: To summarize 10 high-quality studies or guidelines from 2021 that have strong relevance to physicians in comprehensive family practice. SELECTING THE EVIDENCE: Routine literature surveillance of abstracts in high-impact journals and EvidenceAlerts was completed by the PEER (Patients, Experience, Evidence, Research) team, a group of health care professionals with a research interest in evidence-based medicine and primary care. Abstracts were screened, selected, and ranked by the PEER team. MAIN MESSAGE: The articles from 2021 that are most likely to impact primary care practice discuss the following topics: empagliflozin for heart failure with preserved ejection fraction; semaglutide for weight loss; stopping antidepressants in primary care; inhaled budesonide for COVID-19; acetylsalicylic acid for preeclampsia prevention; quarter-dose blood pressure medications for hypertension; aggressive blood pressure control for elderly patients; kangaroo care for low-birth-weight infants; footwear for knee osteoarthritis; and delayed antibiotics for pediatric respiratory infections. Two "honourable mention" studies are also briefly reviewed. CONCLUSION: Research from 2021 produced several high-quality studies in cardiovascular care but also addressed a variety of conditions relevant to primary care including weight loss, depression, and COVID-19.
Subject(s)
COVID-19 , Hypertension , Aged , Child , Humans , Primary Health Care , Research , Weight LossABSTRACT
Korownyk examines the revolution of primary care prevention. The COVID-19 pandemic has seemingly reversed the trend toward working away from home. Indeed, COVID-19 has challenged many of people's societal norms which is particularly evident in primary care. The desire to keep patients and staff safe has resulted in increased use of virtual visits. These visits, while not funded in many provinces just months ago, are becoming recognized as valid for the provision of care. Inherent in this situation, many family physicians are delaying less urgent visits such as annual physical examinations. Restricted access to screening services in many provinces means that screening tests are being delayed. Perhaps most meaningfully, the proliferation of false and misleading evidence on treatment for COVID-19 has reminded us to be skeptical and demand high-level evidence to guide our care. As we see, once again many apparent "good ideas" are later disproved by well-conducted randomized controlled trials. Primary care is no stranger to good ideas based on limited evidence. Prevention is a good example. In theory, the more disease is prevented, the less it will need to be treated down the road.