Saudi Cultural Missions Theses & Dissertations
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Item Restricted Is there a Relationship between the Number of Consultations with a Clinician or Exercise Provider and Outcomes of Pain and Physical Function Following an Exercise Program for People with Knee Osteoarthritis?(Saudi Digital Library, 2025) Alhjjaji, Nouf; Lawford, Belinda1. Abstract 1.1 Background Knee osteoarthritis (OA) is a common disease that presents a significant health burden, causing chronic joint pain and physical function limitation. Given that there is no cure, exercise therapy is recommended as the first-line treatment by all current international clinical guidelines. 1.2 Objectives This systematic review aimed to investigate whether the number of consultations with a clinician or exercise provider is associated with changes in pain and physical function following an exercise intervention in individuals with knee OA. 1.3 Methods We conducted a systematic review with meta-regression and subgroup meta- analyses. A comprehensive literature search was performed using three electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase, from inception until 26 February 2025, with no language restrictions. We included randomised controlled trials (RCTs) comparing exercise interventions for knee OA to no treatment, usual care, attention control/placebo, or co- interventions. The primary outcomes were changes in self-reported pain and physical function. Meta-regression were used to evaluate associations between the number of consultations and outcome changes. Additionally, subgroup meta-analyses were conducted across eight consultation-frequency groups (0, 1–3, 4–6, 7–9, 10–15, 16– 20, 21–25, and 26+ sessions). Sensitivity analyses were conducted to address potential outliers and reduce heterogeneity. 1.4 Results A total of 145 RCTs involving 12,633 participants were included. The number of consultations across studies ranged from zero to over 26 sessions. Meta-regression analyses revealed no statistically significant association between the number of consultations and changes in pain (slope coefficient = −0.003 standardised mean difference [SMD], 95% CI: −0.008 to 0.002; p = 0.203) or physical function (slop coefficient = −0.003 SMD, 95% CI: −0.008 to 0.002; p = 0.250). Subgroup meta- analyses similarly found no meaningful differences in outcomes across the different consultation-frequency groups. Substantial between-study heterogeneity was observed, and evidence of publication bias was detected. Sensitivity analyses, which excluded outliers (20 trials for pain and 24 for function with SMD > ±2), did not alter the overall findings. 1.5 Conclusion There was no association between the number of consultations and changes in pain or function following an exercise program for people with knee osteoarthritis (OA). Given the overall poor quality of the included studies, as well as the heterogeneity among studies, the findings should be interpreted with caution.15 0Item Restricted Pain Management in Adult Intensive Care Unit in Saudi Arabia(University of Newcastle, 2024) Alotni, Majid Ali Saleh; Fernandez, Ritin; Guilhermino, MichelleThesis Abstract The prevalence of pain among patients in the intensive care unit (ICU) resulting from invasive procedures and medical interventions remains high. This issue is particularly complex for ICU patients unable to self-report their pain, leading to undetected and untreated pain and affecting quality of life. The specific aims were to: 1. Identify the barriers to nurse-led pain management in adult ICUs through an integrative review. 2. Implement the Critical Care Pain Observation Tool (CPOT) in Saudi Arabia to improve pain assessment in patients unable to self-report pain, with the goal of improving nurse practice and patient outcomes. 3. Develop and investigate the psychometric properties of an instrument designed to measure nurses’ readiness for implementing the CPOT, in ICUs in Saudi Arabia. Method An integrative review was conducted to identify the barriers to nurse-led pain management. Which were mapped to the COM-B model. This model suggested specific strategies to address the barriers. A stepped-wedge trial was conducted to assess the effect of the implementation of the CPOT on pain assessment. Finally, nurses’ readiness to implement was tested using the cross-sectional method with validity and psychometric analysis. Results The integrative review revealed several barriers to nurse-led pain management and informed the intervention. The intervention resulted in a significant increase in the number of pain assessments (Rate Ratio: 1.77, 95% confidence interval [CI]:1.45, 2.16, p < 0.001) and re-assessment (Rate Ratio: 13.99, 95% CI: 8.14, 24.02, p < 0.001) between the intervention and control groups. There was no significant effect on patient outcomes. The content validity of the mAFt. resulted in two factors: acceptability (10 items) and feasibility (five items). Conclusion Identifying barriers to nurse-led pain management in the ICU is crucial. Selecting the most effective interventions is essential to achieving optimal outcomes for both nurses and patients.19 0Item Restricted Nurses' knowledge and attitudes towards non-pharmacological interventions for managing pain in the Intensive care unit: an extend literature review.(The Queen’s University of Belfast, 2024-03-22) Almatrafi, Rehab; Martin, DaphneBackground: Effective pain management in critical care units is crucial for patient outcomes and satisfaction. Although pharmacological approaches are commonly used, they can have adverse effects. Non-pharmacological interventions (NPIs) offer alternative methods for pain management and reduce reliance on medications. Aim: This literature review aimed to explore nurses’ knowledge of and attitudes towards NPIs for pain management in intensive care units (ICUs). It also sought to identify factors hindering nurses from using NPIs in the ICU. Search strategy: A total of 20 keywords were used, and six databases were consulted: CINAHL, MEDLINE, PsycINFO, Embase, Scopus and Web of Science. They were selected for their relevance to the research topic. The search strategy was verified by a subject librarian and a supervisor, and a systematic approach was followed. Additionally, the reference lists of relevant articles were hand-searched. The quality of the included studies was assessed using appropriate tools. Results: The review included six studies: two qualitative studies, three cross-sectional studies and one mixed-methods study. These studies examined nurses’ knowledge and attitudes concerning NPIs for pain management in the ICU. Overall, the results indicated that nurse training, education and policy support are crucial for enhancing the use of NPIs and improving nurse knowledge. Conclusions: Nurses’ knowledge of NPIs in the ICU was low to moderate, with a positive attitude towards their use. This lack of understanding may hinder the development of educational programmes for nurses, which could increase the use of NPIs. Barriers affecting nurses’ knowledge and attitudes concerning NPIs include professional barriers, ICU setting barriers and hospital policy barriers. Therefore, healthcare systems should establish a supportive environment, equip nurses with knowledge and skills, and encourage patient and family engagement in treatment plans.40 0Item Restricted Investigation into Inappropriately Prescribed Analgesia and Patient Care: Focus on Gabapentinoids, Neuropathic Pain and the Role of Community Pharmacy.(Saudi Digital Library, 2023-12-21) Alotaibi, Jawza; Obara, IlonaIn 2019, gabapentinoids were reclassified as a controlled substance in the United Kingdom to tackle their misuse. The focus of this thesis was to assess the safety of gabapentinoids in the management of neuropathic pain for adults and to clarify community pharmacists’ (CPs) role in tackling gabapentinoid misuse. Firstly, a systematic review and meta-analysis were conducted to investigate the safety of gabapentinoids. Fifty studies were included. Most adverse events (AEs) pertained to the nervous system or psychiatric disorders. Pregabalin had more AEs than gabapentin. There was no evidence of addiction to gabapentinoids found. Euphoria was the adverse event of pregabalin that may correlate with addiction. Literature suggests that gabapentinoids are commonly misused concurrently with opioid use. An in-vivo study was conducted to investigate pregabalin reinforcing efficacy after exposure to morphine self-administration. Twelve naïve rats went through three phases: acquisition, extinction, and reinstatement. A significant difference was observed between the number of active levers in the reinstatement compared to the extinction phase. Results showed that pregabalin might have a reinforcing efficacy. A second systematic review was conducted to investigate CPs‐led interventions in analgesia misuse. Six studies were included. The identified interventions were mapped to Behaviour Change Wheel. Then, a qualitative study was conducted to explore CPs’ perspectives about addressing inappropriately prescribed analgesia (IPA). Semi-structured interviews were conducted with 12 CPs. Nine Theoretical Domains Framework were identified. Seventeen behaviour change techniques were identified that could be considered in designing future interventions. Overall, the thesis findings provide a comprehensive safety profile of gabapentinoids in neuropathic pain. There was no evidence of gabapentinoid use causing addiction. Further investigations are required to confirm pregabalin reinforcing properties when substituted for morphine. There is limited evidence of CPs‐led interventions to tackle IPA, this thesis provides an in-depth explanation of the determinants to address IPA from CPs’ perspectives.51 0Item Restricted The relationship between Musculoskeletal Disorders and Pain, and Smartphone use amongst adolescents: systematic review(Saudi Digital Library, 2023-11-19) Alanazi, Basmah; Evans, TraceyIntroduction: Over the last few years, smartphone usage, particularly amongst adolescents, has risen exponentially. This has led to concern regarding the link between smartphone utilisation and musculoskeletal issues. The latter could have a detrimental impact on the growth, normal development and well-being of adolescents. Currently, there are few reviews which have investigated the influence of using smartphones on the musculoskeletal system, and specifically, in the adolescent population. Aim: The aim of this research was to perform a systematic review with respect to contemporary publications on musculoskeletal pain and disorder related to the usage of smartphones in adolescents. Methods: A literature search was carried out in a number of electronic databases in order to recognise publications that could be identified using keywords relating to the use of smartphone, musculoskeletal symptoms, such as pain or discomfort, and exposures. The identified publications underwent screening, pertinent information was retrieved and an evaluation of the quality of the study methods used was performed. Narrative synthesis was presented of the study findings owing to the lack of uniformity between studies. Results: Eight quantitative studies were included and were rated as moderate (n=7) and high (n=1) quality. The findings of the review indicated that long durations of smartphone utilisation are linked with musculoskeletal system pain and disorder; this was a consensus opinion amongst all the included studies. The greater the number of hours a smartphone was used for; the more anatomical sites were determined to be impacted by musculoskeletal pain. Reviewed studies indicated that the neck was the most frequent source of discomfort, but that the shoulder, back, arm, elbow and wrist were also affected. Discussion: It was determined from this systematic review that there was only limited evidence and low number of studies linking the use of smartphones, together with a number of parameters relating to their utilisation, such as degree of use, length of time used and tasks performed, with symptoms and discomfort in the musculoskeletal system. To some extent, these findings were attributed to the predominantly moderate quality of evidence presented in the single case-control study, and in the seven cross-sectional studies encompassed within the review. The review did not include any longitudinal epidemiological publications. Nevertheless, the results obtained from this systematic review offer an improved comprehension of the relationships between musculoskeletal pain and disorder and the use of smartphones, an activity which has become a component of the daily life of most adolescents. The data presented could be incorporated into recommendations and interventions in order encourage the judicious usage of smartphones within this population, and could be of value to scientists, policy-makers, teachers, parents and the adolescents per se.19 0Item Restricted Nurses’ perspectives on the barriers to and facilitators of effective paediatric pain assessment and management: A systematic review(Saudi Digital Library, 2023-11-21) Gadi, Amirah Dawood M; Wilson, IseultBackground: Children’s pain is a universal problem that has far-reaching negative consequences. Despite the recognition that effective pain management is a fundamental human right, some children are still suffering from unrelieved pain. Nurses have a pivotal role in paediatric pain management; however, they are confronted by many barriers. It is therefore of value to explore the barriers and facilitators that nurses experience when caring for children in pain. Aim: This study aims to explore nurses’ perspectives regarding the barriers and facilitators related to the effective assessment and management of pain in children, infants, and neonates. Methodology: A search strategy was formulated, and five databases were searched for relevant articles including ProQuest, Scopus, CINAHL, PsycINFO and PubMed. Each paper identified by the search underwent a quality assessment using a predetermined tool. Relevant information to the research question was extracted, and the major themes were then identified by thematic analysis. Findings: Eighteen studies were included in this review. Recognised barriers and facilitators were categorised into three main themes related to: (i) healthcare professionals; (ii) the child and their parents; and (iii) the organisation. Prominent barriers included nurses' inadequate knowledge of the uses and side effects of medication, limited pain assessment experience, low prioritisation of pain, time constraints, communication and language difficulties with children, as well as uncooperative children, insufficient parental involvement, lack of guidelines and resources shortages, and nurses’ distrust in pain assessment tools. Key facilitators comprised robust knowledge, adequate experience, higher education, in-service training, parental involvement, effective communication with children and parents, clear guidelines, adequate resources, and nurses’ trust in and utilisation of pain assessment tools. Conclusions: This review provides valuable insights into the barriers and facilitators faced by nurses with respect to the assessment and management of pain in the paediatric population. There is a need for targeted educational interventions and policy changes to support nurses’ ability to deliver high-quality pain care. Further research is needed in order to investigate these factors and to examine any other potentially associated determinants amongst paediatric nurses.23 0Item Restricted THE EFFECTIVENESS OF TRIGGER POINTS DRY NEEDLING IN THE QUADRICEPS MUSCLE ON PAIN INTENSITY AMONG PATELLOFEMORAL PAIN SYNDROME PATIENTS: A SYSTEMATIC REVIEW(Saudi Digital Library, 2023-03-06) Altaiyar, Asma; Altaiyar, AsmaBackground Patellofemoral pain syndrome (PFPS), a non-traumatic condition, is characterised by anterior knee pain and is frequently associated with functional activities. The quadriceps muscle plays a major role in the aetiology and progression of PFPS. The available evidence confirms the presence of overall quadriceps muscle weakness and activation delay in PFPS patients. Muscle activation is primarily affected by the presence of trigger points in the muscle. Systematic reviews of the effectiveness of trigger point dry needling (TDN) in mixed muscles or across multiple body regions are available; however, despite the quadriceps playing a significant role in the condition, to date, no studies have specifically addressed the effectiveness of the use of TDN on the quadriceps of patients with PFPS Objectives: To assess the effect of TDN of the quadriceps muscle on pain intensity among PFPS patients. Search method: Database PEDro, Medline, Web of Science, AMED, EMBASE, Scopus, and CINAHL were searched between 10th October and 20th October 2022. Selection criteria: Randomised control trials (RCT) that used the TDN technique on the quadriceps muscle in PFPS patients to measure its effect on pain intensity. Data collection and analysis: Two independent reviewers assessed the methodological quality of the included studies using the PEDro scale. Only one reviewer conducted the data extraction process using the JBI data extraction tool. Results: The review included six RCT studies of low-to-moderate quality which involved a total of 283 participants. All six studies showed statistically significant improvements in pain intensity level outcomes pre-post intervention across the quadriceps TDN intervention (p<0.05). Combined TDN with conventional physiotherapy treatments demonstrated a more significant effect than TDN alone for pain intensity (p<0.05). However, no statistically significant differences were detected between TDN and other physical therapy interventions such as manual therapy, Kinesio tape (KT) and ischemic compression (IC). Conclusion: Based on the low-to-moderate quality of evidence, TDN of the quadriceps muscle may improve pain intensity among PFPS patients over the short-term. It appears that combining the TDN technique in multimodal therapy is more effective for PFPS patients than using TDN alone. Furthermore, there is evidence to suggest that the TDN technique in the quadriceps of PFPS patients is not superior to manual therapy, IC or KT in terms of pain intensity; rather, TDN has a similar effect. The results of the current review, however, are based on heterogeneous studies which have methodological limitations. Further high-quality research with a standardised TDN application protocol is required to increase the homogeneity of the studies.11 0