Effect of 24-Hour Bed Rest versus Early Ambulation on Headache after Spinal Anesthesia: Systematic Review and Meta-analysis.

OBJECTIVES: We performed a systematic review of the evidence for the effectiveness of bed rest after dural puncture to update current evidence on the topic. DESIGN: The design was a systematic review and meta-analysis. DATA SOURCES: We searched 10 electronic databases in English (Medline, CINAHL, EMBASE, and the Cochrane Controlled Trial Register) and Korean (KISS, KMBASE, NDSL, and RISS) using the terms "post-dural puncture headache," "spinal anesthesia," "epidural anesthesia," and "bed rest" to identify reports discussing the effectiveness of bed rest in preventing post-dural puncture headache (PDPH) after spinal anesthesia from 1980 to 2014. Review/Analysis Methods: Original studies such as randomized and nonrandomized controlled trials, where participants were allocated to an intervention or control group, were included. A total of eight studies that met the inclusion criteria were independently reviewed and encoded by two review authors. To ensure the quality of the eight studies, levels of risk of bias were assessed by two different researchers. The main outcome was the prevalence of PDPH. RESULTS: The included studies indicated that PDPH prevalence did not differ between the group assigned to 24 hours of bed rest and the group assigned to early ambulation. In subgroup analysis, the effect size of clinical factors (severity of headache, day of onset, and needle gauge) and the study characteristics (language and sample size) did not differ between groups. CONCLUSION: This meta-analysis of studies suggested that long-term bed rest after spinal anesthesia may not be effective in preventing PDPH.

The Methodological Quality of Systematic Reviews and Meta-Analyses on the Effectiveness of Non-pharmacological Cancer Pain Management.

This study used the Assessment of Multiple Systematic Reviews (AMSTAR) to determine how the quality of methodologies in systematic reviews (SRs) and meta-analyses (MAs) impacts the effectiveness of nonpharmacological cancer pain management. The authors searched 11 electronic databases for published and unpublished studies (in English and Korean) on SRs and MAs relating to "cancer" and "pain management" that were released prior to May 7, 2014. The findings from 17 SRs and MAs were scored for quality using AMSTAR and coded by management type and value of effect size. Only one article was deemed high quality; five were considered to be of low quality. The mean score was 5.47 (SD = 2.03), indicating moderate quality. Among the items we tested via AMSTAR, zero studies stated whether they have a conflict of interest in their covered studies, but every study established the research question and inclusion criteria before constructing the review. Rigorous assessment of nonpharmacological cancer pain management using AMSTAR might contribute to healthcare providers making more informed clinical decisions when it comes to handling pain. Based on the finding, researchers should abide by reporting guidelines for SRs and MAs to ensure that research is more rigorously synthesized.