Labour Q1 pain - poorly analysed and reported: a systematic review

Psychometric Properties of the Turkish Version of the Rating Scale of Pain Expression during Childbirth Scale (ESVADOPA-TR)

BACKGROUND

Evaluation of a specific and dynamic pain, such as labor pain, with a situation-specific measurement tool will increase the quality of care given during childbirth. The Rating Scale of Pain Expression during Childbirth (ESVADOPA) is a situation-specific measurement tool for labor pain. The aim was to examine the psychometric properties of a Turkish version of the ESVADOPA scale.

METHODS

This study utilized a methodological design. Participants were 158 pregnant women at term and in spontaneous labor. Two measurements were performed during the passive and active phases of labor. To avoid bias between the raters, all the evaluations were performed by a single midwife. Validity analyses of the scale were performed using exploratory factor analysis and confirmatory factor analysis.

RESULTS

The scale was composed of a one-factor structure that had an eigenvalue of over 1 and explained 71.79% of the variance. Cronbach's alpha internal consistency coefficient of the scale is 0.92. An analysis of the factor structure showed that the item factor loads ranged between 0.729 and 0.897. In the confirmatory factor analysis, the results showed that the data had a good fit with the model.

CONCLUSIONS

The Turkish version of the ESVADOPA was found to have high reliability and validity for determining the expression of pain during childbirth.

Adjuvant use of melatonin for pain management in endometriosis-associated pelvic pain-A randomized double-blinded, placebo-controlled trial

Considering the pharmacological treatment options for endometriosis-associated pain are confined to hormonal therapy and analgesics, we studied the analgesic effect of 20 mg melatonin as an adjuvant therapy in women with endometriosis-associated pain. This randomized double-blinded, placebo-controlled trial was conducted at the Research Center for Womens' Health at Södersjukhuset, a university hospital in Stockholm, Sweden. Forty women from 18 to 50 years of age with endometriosis and severe dysmenorrhea with or without chronic pelvic pain were given 20 mg Melatonin or placebo orally daily for two consecutive menstrual cycles or months. The level of pain was recorded daily on the 11-point numeric rating scale, a difference of 1.3 units was considered clinically significant. Clincaltrials.gov nr NCT03782740. Sixteen participants completed the study in the placebo group and 18 in the melatonin group. The difference in endometriosis-associated pain between the groups showed to be non-significant statistically as well as clinically, 2.9 (SD 1.9) in the melatonin group and 3.3 (SD 2.0) in the placebo group, p = 0.45. This randomized, double-blinded, placebo-controlled trial could not show that 20 mg of melatonin given orally at bedtime had better analgesic effect on endometriosis-associated pain compared with placebo. No adverse effects were observed.

Outcomes to measure the effects of pharmacological interventions for pain management for women during labour and birth: a review of systematic reviews and randomised trials

BACKGROUND

Pharmacological pain management options can relieve women's pain during labour and birth. Trials of these interventions have used a wide variety of outcomes, complicating meaningful comparisons of their effects. To facilitate better assessment of the effectiveness of labour pain management in trials and meta-analyses, consensus about key outcomes and the development of a core outcome set is essential.

OBJECTIVE

To identify all outcomes used in studies of pharmacological pain management interventions during labour and birth.

DESIGN

A review of systematic reviews and their included randomised controlled trials was undertaken.

SEARCH STRATEGY

Cochrane CENTRAL was searched to identify all Cochrane systematic reviews describing pharmacological pain management options for labour and birth. Search terms included 'pain management', 'labour' and variants, with no limits on year of publication or language.

SELECTION CRITERIA

Cochrane reviews and randomised controlled trials contained within these reviews were included, provided they compared a pharmacological intervention with other pain management options, placebo or no treatment.

DATA COLLECTION AND ANALYSIS

All outcomes reported by reviews or trials were extracted and tabulated, with frequencies of individual outcomes reported.

MAIN RESULTS

Nine Cochrane reviews and 227 unique trials were included. In total, 146 unique outcomes were identified and categorised into maternal, fetal, neonatal, child, health service, provider's perspective or economic outcome domains.

CONCLUSIONS

Outcomes of pharmacological pain management interventions during labour and birth vary widely between trials. The standardisation of trial outcomes would permit the assessment of meta-analyses for best clinical practice.

TWEETABLE ABSTRACT

Outcomes to measure pharmacological pain management options during labour are highly variable and require standardisation.

Should corticosteroids be administered for local infiltration analgesia in knee arthroplasty? A meta-analysis and systematic review

WHAT IS KNOWN AND OBJECTIVE

The benefits of local infiltration analgesia (LIA) in knee arthroplasty (KA) have been well-documented. However, it is unknown whether adding a corticosteroid to the composition of the LIA is beneficial. This study aimed to investigate the efficacy and safety of administering periarticular steroids intraoperatively in patients who underwent KA through a systematic review and meta-analysis.

METHODS

A systematic search was conducted to identify relevant randomized controlled trials in the PubMed, Embase, Web of Science and Cochrane databases up to January 19th, 2021 to perform a meta-analysis. Outcome variables included pain scores, total opioid consumption, knee range of motion (ROM) and postoperative complications.

RESULTS

Corticosteroid injections did not reduce pain scores at 6, 12, 24 or 72 h postoperatively, although a minimal degree of transient pain relief was achieved at 48 h postoperatively compared with those in the placebo group, nor was there a significant difference in total opioid consumption. However, patients receiving corticosteroids did exhibit a transient ROM increase on postoperative days 1, 2 and 3. Since the minimal clinically important difference (MCID) for ROM is unclear, it is unknown if the improvement in ROM is clinically significant.

WHAT IS NEW AND CONCLUSION

Our specific end-point analysis demonstrated that corticosteroid administration did not provide pain relief or reduce opioid consumption compared with placebo. However, corticosteroids might provide a statistically significant, though transient and minimal improvement in knee ROM after KA, although no firm conclusions about the benefits of administering corticosteroids in KA can be made based on the available evidence.

A smartphone application to facilitate adherence to home-based exercise after flexor tendon repair: A randomised controlled trial

OBJECTIVE

Evaluate the effect of a smartphone application on exercise adherence, range of motion and self-efficacy compared to standard rehabilitation after repair of the flexor digitorum profundus tendon.

DESIGN

Prospective multi-centre randomised controlled trial.

SETTING

Four hand surgery departments in Sweden.

SUBJECTS

A total of 101 patients (35 women) (mean age 37.5 ± 12.8) were randomised to control (n = 49) or intervention group (n = 52).

INTERVENTION

A smartphone application to facilitate rehabilitation.

MAIN OUTCOME MEASURES

Adherence assessed with the Sport Injury Rehabilitation Adherence Scale at two and six weeks (primary outcome). Secondary outcomes were self-reported adherence in three domains assessed at two and six weeks, self-efficacy assessed with Athlete Injury Self-Efficacy Questionnaire at baseline, two and six weeks. Range of motion and perceived satisfaction with rehabilitation and information were assessed at 12 weeks.

RESULTS

Twenty-five patients were lost to follow-up. There was no significant between group difference in Sport Injury Rehabilitation Adherence Scale at two or six weeks, mean scores (confidence interval, CI 95%) 12.5 (CI 11.8-13.3), 11.8 (CI 11.0-12.8) for the intervention group, and 13.3 (CI 12.6-14.0), 12.8 (CI 12.0-13.7) for the control group. Self-reported adherence for exercise frequency at six weeks was significantly better for the intervention group, 93.2 (CI 86.9-99.5) compared to the controls 82.9 (CI 76.9-88.8) (P = 0.02). There were no differences in range of motion, self-efficacy or satisfaction.

CONCLUSION

The smartphone application used in this study did not improve adherence, self-efficacy or range of motion compared to standard rehabilitation for flexor tendon injuries. Further research regarding smartphone applications is needed.

LEVEL OF EVIDENCE

I. Randomised controlled trial.