PURPOSE OF THE STUDY This article presents the evidence and the rationale for the recommendations for surgical treatment of degenerative lumbar stenosis (DLS) and spondylolisthesis that were recently developed as a part of the Czech Clinical Practice Guideline (CPG) "The Surgical Treatment of the Degenerative Diseases of the Spine". MATERIAL AND METHODS The Guideline was drawn up in line with the Czech National Methodology of the CPG Development, which is based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. We used an innovative GRADE-adolopment method that combines adoption and adaptation of the existing guidelines with de novo development of recommendations. In this paper, we present three adapted recommendations on DLS and a recommendation on spondylolisthesis developed de novo by the Czech team. RESULTS Open surgical decompression in DLS patients has been evaluated in three randomized controlled trials (RCTs). A recommendation in favour of decompression was made based on a statistically significant and clinically evident improvement in the Oswestry Disability Index (ODI) and leg pain. Decompression may be recommended for patients with symptoms of DLS in the event of correlation of significant physical limitation and the finding obtained via imaging. The authors of a systematic review of observational studies and one RCT conclude that fusion has a negligible role in the case of a simple DLS. Thus, spondylodesis should only be chosen as an adjunct to decompression in selected DLS patients. Two RCTs compared supervised rehabilitation with home or no exercise, showing no statistically significant difference between the procedures. The guideline group considers the post-surgery physical activity beneficial and suggests supervised rehabilitation in patients who have undergone surgery for DLS for the beneficial effects of exercise in the absence of known adverse effects. Four RCTs were found comparing simple decompression and decompression with fusion in patients with degenerative lumbar spondylolisthesis. None of the outcomes showed clinically significant improvement or deterioration in favour of either intervention. The guideline group concluded that for stable spondylolisthesis the results of both methods are comparable and, when other parameters are considered (balance of benefits and risks, or costs), point in favour of simple decompression. Due to the lack of scientific evidence, no recommendation has been formulated regarding unstable spondylolisthesis. The certainty of the evidence was rated as low for all recommendations. DISCUSSION Despite the unclear definition of stable/unstable slip, the inclusion of apparently unstable cases of DS in stable studies limits the conclusions of the studies. Based on the available literature, however, it can be summarized that in simple degenerative lumbar stenosis and static spondylolisthesis, fusion of the given segment is not justified. However, its use in the case of unstable (dynamic) vertebral slip is undisputable for the time being. CONCLUSIONS The guideline development group suggests decompression in patients with DLS in whom previous conservative treatment did not lead to improvement, spondylodesis only in selected patients, and post-surgical supervised rehabilitation. In patients with degenerative lumbar stenosis and spondylolisthesis with no signs of instability, the guideline development group suggests simple decompression (without fusion). Key words: degenerative lumbar stenosis, degenerative spondylolisthesis, spinal fusion, Clinical Practice Guideline, GRADE, adolopment.
- MeSH
- bederní obratle chirurgie MeSH
- chirurgická dekomprese metody MeSH
- fúze páteře * MeSH
- lidé MeSH
- spinální stenóza * chirurgie MeSH
- spondylolistéza * komplikace chirurgie MeSH
- stenóza chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- systematický přehled MeSH
Music-based experiences were found to be effective in supporting and promoting purposeful communication by non-speaking people who use benefit from augmentative and alternative communication (AAC). However, this area is fragmented into several disciplines (e.g. speech and language therapy, special education, music therapy, etc.) and the possibilities of music-making for AAC training have not been systematically reviewed. The aim of the planned scoping review is to analyze the types of experiences that use music-making as a form of AAC and overview their effects for different groups of AAC users. The scoping review will be conducted according to JBI methodology. We will search in databases (BMC, CINAHL, EMBASE, ERIC, MEDLINE, ProQuest Central, PsycINFO, Scopus, and Web of Science), and the sources of unpublished and gray literature (Central, Clinical Trials, Current Controlled Trials, Google Scholar, and Open Dissertations) including the reference lists of relevant texts, language, location or publication period will not be limited. Study selection and charting of data from relevant studies will be done independently by two reviewers. The findings of the scoping review may enable classification of different types of music experiences and their effects in the context of AAC training, and propose recommendations for a more intentional usage of those experiences by AAC users, professionals (e.g. music therapists or special teachers), families, and other non-professionals.
This statement paper provides a brief and clear background to the evidence-based medicine concept, systematic reviews and the development of clinical practice guidelines using the Grading of Recommendations, Assessment, Development and Eva luation (GRADE) system and focuses on their application in the fi eld of special education.Its main objective is to suggest ways of applying clinical practice guidelines in the fi eld of special education. Th e paper presents the fi rst Czech national project for developing clinical practice guidelines mainly in the fi eld of medicine and clinical practice with the main investigator being the Czech Health Research Council (AZV ČR). Some of the guidelines prepared within the project are relevant to special educators and the paper suggests that special teachers use the recommendations in their practice and in higher education. Moreover, it proposes that it is possible and useful to develop guidelines using the rigor of the GRADE methodology as described above, for issues directly pertaining to the fi eld of special education, or education in general. In that process, it may be neces-sary to identify the challenges typical for the fi eld of education and to suggest possible solutions. Finally, recommendations for special educators, for future research and for policy-makers are formulated. Specifi cally, the paper suggests that policy-makers, such as the Ministry of Education, Youth and Sports, develop national strategies for spe -cial-edu cational diagnostics and intervention based on rigorous methodology as des cribed on the example of the Czech national project of guideline development in medi cine and place special focus on the ethical aspects, social impacts and values and preferences of target populations.
- Klíčová slova
- vzdělávací politika,
- MeSH
- integrovaná výuka MeSH
- interdisciplinární výzkum organizace a řízení MeSH
- lidé MeSH
- medicína založená na důkazech normy MeSH
- metody pro podporu rozhodování MeSH
- postižení výchova MeSH
- pravidla klinického rozhodování MeSH
- programy národního zdraví organizace a řízení MeSH
- speciální vzdělávání * etika normy MeSH
- vytváření politiky MeSH
- vzdělávací modely MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- Geografické názvy
- Česká republika MeSH
