Patient positioning (mobilisation) and bracing for pain relief and spinal stability in metastatic spinal cord compression in adults
Abstract
Background
Many patients with metastatic spinal cord compression (MSCC) have spinal instability but are determined, by their clinician, to be unsuitable for surgical internal fixation due to their advanced disease. Mobilisation may be hazardous in the presence of spinal instability as further vertebral collapse can occur. Current guidance on positioning (or mobilisation) and spinal bracing is contradictory.
Objectives
To investigate the correct positioning (or mobilisation) and examine the effects of spinal bracing to relieve pain or to prevent further vertebral collapse in patients with MSCC.
Search methods
The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, CANCERLIT, NICE, SIGN, AMED, TRIP, National Guideline Clearinghouse and PEDro database were searched; the last search was run in February 2012.
Selection criteria
We selected randomised controlled trials (RCTs) of adults with MSCC of interventions on positioning or mobilisation and bracing.
Data collection and analysis
Two review authors independently assessed each possible study for inclusion and quality.
Main results
One thousand, six hundred and eleven potentially relevant studies were screened. No studies met the inclusion criteria. Many papers identified the importance of mobilisation but no RCTs have been undertaken. No RCTs of bracing in MSCC were identified.
Authors' conclusions
There is lack of evidence based guidance around how to correctly position and when to mobilise patients with MSCC or if spinal bracing is an effective technique for reducing pain or improving quality of life. RCTs are required in this important area.
PICOs
Plain language summary
Patient positioning or mobilisation and bracing for pain relief and spinal stability in adults with metastatic spinal cord compression
People with advanced cancer may develop metastatic spinal cord compression (MSCC), a serious complication which can cause pain and mobility problems and possibly paralysis. MSCC is the spread of the cancer to the spinal column. A diagnosis of MSCC normally indicates advanced disease and for many patients the final stages of their illness. Knowing how to manage this condition is challenging for healthcare professionals who may need to decide what interventions are appropriate. Some existing guidelines suggest strategies such as bed rest, avoiding mobility and the use of braces as ways of managing this condition. However, this needs to be balanced against the wishes of the patient, ensuring their comfort and individual preferences. If life expectancy is short then a palliative care approach, which focuses on patient preferences and priorities, is appropriate. This review tried to establish what evidence exists to help healthcare professionals and patients decide what treatment (positioning or mobilisation, bracing) is best for them. Unfortunately little research exists which can tell us the best way to manage this condition. Therefore our suggestions are twofold. Firstly there needs to be more research undertaken to find out what treatment approaches can help. Secondly, in the absence of clear evidence, healthcare professionals and patients need to discuss the options and precedence be given to the expressed wishes of patients.
