Evidence-based Practice

Key Findings While chest x-ray is readily available and may precede RT-PCR test, chest x-ray has low sensitivity early in the COVID-19 disease and shows non-specific lung abnormalities in COVID-19 patients. Chest x-ray is part of the initial diagnostic tool used on COVID-19 patients in some hospitals as it yields fast results compared with reverse transcription-polymerase chain reaction (RT-PCR). Chest Computed Tomography (CT) has been reported to be more sensitive than chest x-ray in determining the presence of COVID-19. Chest x-ray findings in confirmed COVID-19 patients show: Normal lung findings early in the illness and in mildly symptomatic patients. Typical ground-glass opacities and consolidation in the lung periphery. Lung abnormalities are non-specific and may likewise be present in other infections and coronavirus-types of pneumonia. The American College of Radiology (ACR), Center for Disease Control and Prevention (CDC), Canadian Association of Radiologists (CAR), Canadian Society of Thoracic Radiology (CSTR), and British Society of Thoracic Imaging do not recommend the use of chest x-ray to diagnose COVID-19. The Fleisher Society, composed of radiologists and pulmonologists in ten countries, does not recommend a chest x-ray for patients suspected of mild COVID-19. A chest x-ray is recommended for patients with moderate to severe COVID-19 needing immediate triage and patients at high risk for disease progression. Despite presence of chest x-ray findings suggesting COVID-19, RT-PCR test remains the standard diagnostic procedure.
Covid-19

Introduction: COVID-19 infection spreads through respiratory droplets, contact, and airborne transmission. During aerosol-generating procedures (AGPs), the risk of spreading SARS-CoV-2 via aerosols is increased significantly. This rapid review determined the association between using personal protective equipment (PPE) during AGPs, including those during surgery, among confirmed or suspected patients with COVID-19 and the risk of infection among healthcare workers. Method: A systematic search of electronic databases MEDLINE, EBSCO, Science Direct, Google Scholar, and Cochrane CENTRAL base was performed last March 21, 2021, using the Boolean combination of keywords for SARS-CoV-2, PPE, and surgery. Two reviewers screened the articles for relevance and extracted the data from the included studies. We critically appraised the included studies using criteria from the Painless Evidence-Based Medicine Evaluation of Articles on Harm. We used RevMan for data pooling, with a 40% heterogeneity cut-off score. GRADEpro guideline development tool determined the quality of evidence of the included studies. Results: Five observational studies investigated the effectiveness of PPE use in reducing SARS-CoV-2 transmission among healthcare workers during any AGPs. The use of N95 masks (OR 0.37 [95% CI 0.21, 0.67], 1 study, n=195), surgical gown (OR 0.59 [95% CI 0.46, 0.77] I2= 0%, 2 studies, n= 941) and gloves (OR 0.42 [95% CI 0.43, 0.55] I2=34%, 3 studies, n=978) versus their non-use significantly reduced the odds of SARS-COV-2 transmission among healthcare workers involved in AGP. Albeit inconclusive due to the very low quality of evidence, using face shields or goggles was not associated with a significant reduction in the odds of SARS-CoV-2 transmission (OR 0.70 [95% CI 0.31, 1.59]) than the non-use of face shields or goggles. The certainty of the overall body of evidence on PPE use in reducing SARS-CoV-2 transmission during AGP procedures was rated very low. In addition, confounders in the assessment could have been using individual PPE with the other standard PPE, compliance of healthcare worker on properly wearing it, and observing other preventive measures. Conclusion There were lower odds of COVID-19 infection among healthcare workers using appropriate PPE, including N95 respirators, surgical gowns, and gloves during AGPs in suspected or confirmed COVID-19 patients. Several guidelines recommended using enhanced PPE among healthcare workers during surgery despite limited and low-quality evidence. The findings should help in developing recommendations in reducing SARS-CoV-2 transmission in the Philippines. The findings should provide the information needed for healthcare policy decision-making.
Personal Protective Equipment ; Methods ; COVID-19 ; SARS-CoV-2

Background: Lateral epicondylalgia (LE) is a cumulative strain injury affecting the common extensor origin of the elbow, manifesting as lateral elbow pain. Tightness of the fascia connecting the lateral elbow area with the shoulder area was assumed as potential source of LE. Limitation in shoulder rotatory motions may be associated with painful LE elbows. Aim: To determine the difference on shoulder rotatory motions between sides of symptomatic and asymptomatic elbows. Methods: Eligible participants had at least one elbow that tested positive for Cozen, Mill, or Maudsley’s test. Using a universal goniometer, a blinded assessor measured the participants’ active and followed by passive shoulder internal and external rotation. The primary investigator tested the external rotation followed by internal rotation of the right upper extremity, then subsequently the left upper extremity of healthy participants both passively and actively Results: The assessor showed excellent intra-tester reliability in measuring active and passive shoulder rotatory motions of 20 asymptomatic right upper extremities (ICC=0.98). Twenty-seven (27) participants (3 males, 24 females) with a mean (95%CI) age of 54 (49-58) years old were enrolled in the study. The mean visual analogue scale of the patients was 6.53 (5.91- 7.13), with mean (95%CI) duration of 96 (50-142) weeks. Based on hand dominance and side of LE, significant difference was found in active and passive shoulder internal rotation (p>0.05). Conclusion Shoulder active and passive internal rotations were significantly associated with hand dominance in patients with LE. Tightness of the fascia and muscle in the shoulder and painful LE elbow may underpin the decreased shoulder rotatory motions.
Tennis Elbow ; Shoulder ; Fascia

Background and Objective: Mindfulness-based interventions (MBI), a novel treatment, and cognitive behavioral therapy (CBT), the standard treatment, are both effective in treating anxiety in adolescents. This study determined the effectiveness of mindfulness-based interventions versus cognitive behavioral therapy in reducing symptoms of anxiety among adolescents experiencing social anxiety through a systematic review and meta-analysis. Methods: A systematic approach was used to identify eligible studies. Electronic databases, reference lists of relevant articles, and gray literature were searched. Data was analyzed using RevMan to calculate standard mean differences with 95% confidence intervals and subgroups. Heterogeneity was measured using visual assessment, the I2 statistic, and chi-square test. Results: Randomized controlled trials comparing MBI to CBT for adolescents diagnosed with social anxiety or social phobia disorder were analyzed, with non-randomized studies being excluded. Structured searches in electronic databases, reference lists, and gray literature were conducted by four independent reviewers who initially identified potential articles through title and abstract screening. After a comprehensive review of full-text articles and a consensus-building process, the selection of included articles was finalized. Data was analyzed using RevMan to calculate standard mean differences with 95% confidence intervals and to examine subgroups, with heterogeneity being assessed through visual evaluation, the I² statistic, and chi-square tests. Total number of participants was 255; 101 were male and 158 were women. Mean age was 27.5 years old, and diagnosed with Social Anxiety Disorder, Social Phobia, or DSM-IV-Defined-Anxiety-Disorder. They were divided into two groups: 125 participated in 8- to 12-week MBI sessions lasting 2 hours each, while 130 underwent 2-hour CBT sessions spanning 8, 12, or 14 weeks. There is moderate quality of evidence reporting non-significant difference on MBI vs CBT's effectiveness in alleviating symptoms of social anxiety [mean (95% CI) = -0.04 (-0.58, 0.51)]. Conclusion Study found that there were no significant differences between Mindfulness-Based Interventions and Cognitive Behavioral Therapy in reducing social anxiety in adolescents. Mindfulness interventions have advantages in terms of cost-effectiveness for reducing symptoms of anxiety. Future research should include larger sample sizes and longer follow-up periods to further assess long-term effects of these interventions.
Adolescent ; Mindfulness ; Anxiety ; Cognitive Behavioral Therapy ; Occupational Therapy

Autism Spectrum Disorder ; Autistic Disorder ; Occupational Therapy

Cognitive Behavioral Therapy ; Child

BACKGROUND: The COVID-19 pandemic has led to innumerable challenges in the practice of physical therapy (PT) in both local and global settings. Healthcare settings often use Personal Protective Equipment (PPE) to prevent contamination. Despite its benefits, compliance is challenged by issues such as discomfort, availability, accessibility, and individual perception. OBJECTIVES: Considering the contrasting roles and nature of healthcare practitioners' work and the differences in the demands of PPE usage, this study aims to develop a profession-specific questionnaire on the perceptions of physical therapists on PPE usage in response to the COVID-19 pandemic with good face and content validity. METHODS: The study comprises Phase 1 for questionnaire development and Phase 2 for questionnaire validation. Five experts recruited using purposive sampling participated in three rounds of the validation process. Each expert evaluated the face and content validity through Google Forms. Consequently, an expert panel evaluation to reach a consensus on the final items. Google sheets were utilized for analysis. EXPECTED RESULTS The final questionnaire will have 35 items covering the Health Belief Theory domains. All items will receive FVI (overall agreement scores), I-CVI, S-CVI/Ave, and S-CVI/UA scores that meet the cut-off. The final questionnaire will be useful in evaluating physical therapists' perceptions of using PPE due to COVID-19 and may also be helpful to organizations, policymakers, and other entities in their decision-making for PPE protocols, guidelines, and implementation. Future researchers can use this study to conduct a pilot study that assesses other psychometric properties of the tool.

Background. The use of face shield in addition to face mask is thought to reduce the transmission of SARS-CoV-2 by blocking respiratory droplets and by preventing one from touching facial orifices.

Objective. To determine the effectiveness of face mask with face shield, compared to face mask alone, in reducing transmission of SARS-CoV-2.

Methods. We searched MEDLINE, Cochrane Library, as well as trial registers, preprint sites and COVID-19 living evidence sites as of 30 September 2021. We included studies that used face shield with face mask versus face mask alone to prevent COVID-19. We screened studies, extracted data, assessed the risk of bias and certainty of evidence using the GRADE approach. Review Manager 5.4 was used to estimate pooled effects.

Results. There is no available direct evidence for face shield plus face mask versus face mask alone in the general public. Five (5) observational studies with very low certainty of evidence due to serious risk of bias and indirectness were included. Participants in all the studies were health care workers (HCWs) who used the face shield with their standard personal protective equipment (PPE). Four (4) of the studies were in the hospital setting (three case control studies, one pre- and post-surveillance study); one was done in the community (one pre- and post-surveillance study) in which HCWs visited the residence of the contacts of SARS-CoV-2 positive patients. The case control studies done in the hospital setting showed a trend toward benefit with the use of face shield or goggle but this was inconclusive (OR 0.85, 95% CI 0.68-1.08) while the pre- and post-surveillance study showed significant benefit when face shield (OR 0.28, 95% CI 0.22-0.37) use became a requirement for HCWs upon hospital entry. In the study done in the community setting, significant protection for HCWs was noted with the use of face shield (OR 0.04, 95% CI 0.00-0.69) but the results were limited by serious risk of bias and imprecision.

Conclusion. In the hospital setting, there was a lower likelihood of COVID-19 infection in HCWs who used a face shield or goggles on top of their PPE. For the general public in the community, there is presently no study on the use of face shield in addition to the face mask to prevent COVID-19 infection.

BACKGROUND: Facemasks are used to minimize SARS-CoV-2 spread during the COVID-19 pandemic. However, facemask use during exercise is associated with possible adverse effects. OBJECTIVES: To compare the effects of facemask use vs. non-facemask use on subjective responses, COVID- 19 incidence, and physiologic changes in healthy adults during exercise. METHODS: The systematic review (PROSPERO registration number: CRD42022296247) will follow the PRISMA-P guidelines and use electronic databases Science Direct, PubMed, Google Scholar, Herdin, and EbscoHost. This will cover randomized parallel groups or randomized crossover studies investigating tolerability, physiologic effects, and the impact on SARS-COV2 incidence of commercially-available cloth, surgical, or FFR/N95 facemasks compared to no-facemask conditions during exercise among healthy adults, including studies published from the earliest date to January 31, 2022. Outcomes of interest will be facemask tolerability in 10 domains of comfort and objective cardiopulmonary, gas exchange, and metabolic responses. Mean differences (MD) or standardized mean differences (SMD) with a 95% confidence interval (CI) will be calculated overall and for subgroups using RevMan software (version 5.4.1). Pooled and subgroup estimates will be calculated using random-effects meta-analysis. The chi-squared test, I2 statistics, and visual analysis will assess heterogeneity. The GRADEpro will determine the certainty of the level of evidence. EXPECTED RESULTS An evidence-based recommendation using GRADE on the changes attributed to facemask use during exercise will be available. This will be useful for organizations when developing appropriate guidelines for exercising while mitigating the risk of SARS-CoV-2 transmission. Future researchers may use this study when redesigning comfortable facemasks without compromising filtration capability.