Evidence for Allied Health: new evidence and resources – January 2022

The latest evidence and resources for allied health professionals and clinical support staff. You can either scroll through this page or click on any of the links below to jump to the relevant section.

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COVID-19

This year, Cochrane is continuing to produce new and updated reviews in response to the pandemic. We have blogged about many of them and this blog COVID-19 evidence: a Cochrane round-up brings together a large collection of evidence and resources, starting from when this evidence was first being produced in spring 2020. Like the reviews themselves, all our blogs are updated to reflect new evidence.

There is a Cochrane news item about Ivermectin: Cochrane’s most talked about review so far, ever. Why?

The impact of measures intended to prevent or reduce the spread of Covid-19 in long-term care facilities have been explored in Non‐pharmacological measures implemented in the setting of long‐term care facilities to prevent SARS‐CoV‐2 infections and their consequences: a rapid review. There is evidence that a number of strategies may reduce the number of infections and related outcomes, but more robust evidence is needed. You can read more in the news item Can non-pharmacological measures prevent or reduce Covid-19 (SARS-CoV-2) infections in long term care facilities? and there are a number of related Cochrane Clinical Answers (see reference list).

Cochrane Special Collections

Cochrane Special Collections assemble Cochrane Reviews on important topics for the prevention and treatment of COVID-19. They are developed with experts from our global Cochrane network. They are based on World Health Organization interim guidance, and continuously updated. You can find Coronavirus (COVID-19) Special Collections here.

Cochrane Podcasts

Cochrane COVID-19 Podcasts offer short summaries of Cochrane COVID-19 reviews from the authors themselves. A good way to hear the latest Cochrane evidence in under 5 minutes each.

Cochrane Clinical Answers

Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically-focused entry point to rigorous research from Cochrane Reviews. They are designed to be actionable and to inform point-of-care decision-making. Each CCA contains a clinical question, a short answer, and data for the outcomes from the Cochrane Review deemed most relevant to practising healthcare professionals.

You can find Cochrane Clinical Answers related to COVID-19 here.

Cardiac rehabilitation

Cochrane Clinical Answer: What are the effects of exercise‐based cardiac rehabilitation for people with coronary heart disease? 

Communication for adults with an artificial airway

The Cochrane Review Interventions to enable communication for adult patients requiring an artificial airway with or without mechanical ventilator support (October 2021) has highlighted a lack of evidence to guide practice on choice of communication aid and when to use them.

COPD

Chronic non‐invasive ventilation 

The Cochrane Review Chronic non‐invasive ventilation for chronic obstructive pulmonary disease was published in August 2021. The authors concluded: “Regardless of the timing of initiation, chronic NIV [non-invasive ventilation] improves daytime hypercapnia. In addition, in stable COPD, survival seems to be improved and there might be a short term HRQL [health-related quality of life] benefit. In people with persistent hypercapnia after a COPD exacerbation, chronic NIV might prolong admission‐free survival without a beneficial effect on HRQL.”

Integrated disease management

Cochrane Clinical Answer: What are the effects of integrated disease management (IDM) interventions for people with chronic obstructive pulmonary disease (COPD)?

Delirium prevention

Delirium is common in hospitalised patients. The authors of a Cochrane Review on Non‐pharmacological interventions for preventing delirium in hospitalised non‐ICU patients (November 2021) have concluded:

  • “There is moderate‐certainty evidence regarding the benefit of multicomponent non‐pharmacological interventions for the prevention of delirium in hospitalised adults, estimated to reduce incidence by 43% compared to usual care.
  • We found no evidence of an effect on mortality.
  • There is emerging evidence that these interventions may reduce hospital length of stay, with a trend towards reduced delirium duration, although the effect on delirium severity remains uncertain.”

Dementia

Cochrane Clinical Answers:

Dietary salt for people with chronic kidney disease

The authors of a Cochrane Review Altered dietary salt intake for people with chronic kidney disease (June 2021) found high-certainty evidence that salt reduction reduced blood pressure in people with chronic kidney disease (CKD), and albuminuria in people with earlier stage CKD in the short‐term. They state that “if such reductions could be maintained long‐term, this effect may translate to clinically significant reductions in CKD progression and cardiovascular events. Research into the long‐term effects of sodium‐restricted diet for people with CKD is warranted.”

Cochrane Clinical Answer: What are the effects of altered dietary salt intake for adults with chronic kidney disease?

Exercise therapy for chronic low back pain

Life-threatening conditions and emergency care

Cochrane Clinical Answer: What are the benefits and harms of interventions to increase patient and family involvement in the escalation of care for community health and hospital settings?

Music interventions for people with cancer

In adults with cancer, music interventions may lead to a reduction in anxiety, depression, and pain, and may lead to an increase in hope and quality of life, although the evidence is very uncertain. Music interventions may also lead to a reduction in fatigue (low-certainty evidence). There may be little or no effect on mood but the evidence is very uncertain. In children with cancer, music interventions may lead to a reduction in anxiety, but the evidence is very uncertain. The evidence about other effects in children is very uncertain. No unwanted effects of music interventions were reported. Cochrane Review (published October 2021): 81 studies with 5576 people with cancer in either inpatient or outpatient settings (74 of the studies included adults and 7 included children). The studies compared music intervention plus standard care compared with standard care alone.

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Nutritional supplements for people with non‐alcohol‐related fatty liver disease

Cochrane Clinical Answer: For people with non‐alcohol‐related fatty liver disease (NAFLD), how do nutritional supplements compare?

Patient questionnaires

Using patient questionnaires for improving clinical management and outcomes – an interview with Cochrane review author Christopher Gibbons about their recent Cochrane Review to find out whether healthcare workers who receive information from questionnaires completed by their patients give better health care and whether their patients have better health.

Rehabilitation after hip fracture

Care and rehabilitation after hip fracture surgery are increasingly in the hands of a multidisciplinary team, and this was explored in a Cochrane Review Multidisciplinary rehabilitation for older people with hip fractures (updated November 2021). There is now evidence that, in hospital settings, rehabilitation after hip fracture surgery delivered by a multidisciplinary team and supervised by an appropriate medical specialist, probably results in fewer cases of ‘poor outcome’. It may also reduce the number of people with poor mobility at 12 months. Its effects (if any) on other outcomes, such as long-term hip-related pain, quality of life, and activities of daily living pain, are uncertain. The impact of supported discharge and multidisciplinary home rehabilitation is also unclear.

Cochrane Clinical Answer: What are the benefits and harms of multidisciplinary rehabilitation (MDR) for older people with hip fracture?

This is one of several reviews included in our blog After hip fracture: how best to help people get back on their feet.

In hospital settings, rehabilitation after hip fracture surgery, delivered by a multidisciplinary team and supervised by an appropriate medical specialist, probably results in fewer cases of 'poor outcome’. There is a need for better evidence to guide care for people with dementia after hip fracture. Exercise programmes, especially those involving balance and functional exercises, reduce the rate of falls and the number of people experiencing falls in older people living in the community. Tai chi may also help prevent falls in this population.  

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Smoking cessation

E-cigarettes

The Cochrane Review Electronic cigarettes for smoking cessation was updated in September 2021.

Here is a summary of the review:

More people probably stop smoking for at least six months using nicotine e-cigarettes than using nicotine replacement therapy (NRT) or nicotine-free e‑cigarettes (moderate-certainty evidence). Nicotine e-cigarettes may help more people to stop smoking than no support or behavioural support only, but the evidence is very uncertain. There is not enough reliable information about possible serious unwanted effects. Minor unwanted effects (such as throat/mouth irritation, headache, cough, and nausea) may be more common in people using e-cigarettes than people receiving no support or behavioural support only (low-certainty evidence). There may be little or no difference between NRT and nicotine e-cigarettes (low-certainty evidence) and there is probably little or no difference between non-nicotine cigarettes and nicotine e-cigarettes (moderate-certainty evidence). Cochrane Review (published September 2021); 61 studies with 16,759 adults who smoke, comparing e‑cigarettes with: nicotine replacement therapy (such as patches or gum); varenicline; nicotine-free e-cigarettes; behavioural support (such as advice or counselling); or no support.

Cochrane Clinical Answer: How effective and safe are electronic cigarettes (ECs) for smoking cessation?

Preventing weight gain

Stroke

Reducing sedentary behaviour

Cochrane Clinical Answer: For people with stroke, what are the effects of interventions to reduce sedentary behavior? 

Screening for dysphagia

A new Cochrane Review Screening for aspiration risk associated with dysphagia in acute stroke has been published and reveals an evidence gap. The authors conclude “we were unable to identify a tool that could accurately identify everyone with food and drink entering their airway, as well as detect all those who definitely did not.”

Vegan diet for primary prevention of cardiovascular disease

Cochrane Clinical Answer: What are the effects of a vegan dietary pattern for primary prevention of cardiovascular disease (CVD)?

Opportunities and events

On this page, Important Cochrane Links, you can find opportunities to get involved, including how to join Cochrane, find volunteer tasks, or jump into the Cochrane Library.

Hundreds of health leaders and experts met on October 14 to recommend the international community urgently mount stronger evidence-based responses to global health emergencies. Recordings from this event are now available on this page: Cochrane Convenes recordings available: the world must learn from pandemic lessons to avoid future catastrophes.

Please note that this page includes a round-up of materials mainly published within the last two months, and is not updated after it’s posted.

References (pdf)

Join in the conversation on Twitter with @SarahChapman30 and @CochraneUK or leave a comment on the blog.

Please note, we cannot give medical advice and do not publish comments that link to individual pages requesting donations or to commercial sites, or appear to endorse commercial products. We welcome diverse views and encourage discussion but we ask that comments are respectful and reserve the right to not publish any we consider offensive. Cochrane UK does not fact check – or endorse – readers’ comments, including any treatments mentioned.

Sarah and Selena have nothing to disclose.



Evidence for Allied Health: new evidence and resources – January 2022 by Sarah Chapman and Selena Ryan-Vig

is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International

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