Clinical Research Oriented Workshop (CROW) Meeting: Mar 30 2023

 

Present:   Justine Dee, Nancy Gell, Emily Houston, Jennifer Oshita, Liliane Savard, Adam Sprouse Blum, Connie van Eeghen, Liz Winterbauer (8)

 1.                   Warm Up: Where’s the March “out like a lamb” by now?  Crocuses are on their way…

2.                   Justine's scoping review, focusing on Physical Therapy for survivors of torture (SOT), looking for feedback on the intro, methods and results

a.       Goal: PT Journal, but this is competitive.  Other journals are “torture” focused.

b.       Is “evidence-based” a binary condition or a scale of low to high?  If a scale, represent the evidence-based results that way.

                                                   i.      Consider a method of evaluating evidence: each study design has associated criteria

1.       Liliane: Evidence-Based Medicine How to Practice and Teach EBM Sackett, Strauss, Richardson…

                                                 ii.      A scoping review does not require assessment of evidence but is recommended

c.       Scoping reviews to not typically include outcomes, but this will help the field move

                                                   i.      Consider combining Tables 2 and 3

d.       Introduction

                                                   i.      Focuses on refugees; literature results are broader (SOT)

                                                 ii.      1^st para is great – really grabs attention

                                               iii.      2^nd para: separate what we know about torture vs PT

1.       Stronger bridge for last sentence: what is the gap in the literature being filled?

2.       Spell out SOT

                                               iv.      Differentiate more clearly: psychologically informed trauma vs trauma informed approach, which is also different from the bio-psycho-social model

                                                 v.      Remove unnecessary jargon: nociplastic, somatic…

e.       Methods

                                                   i.      Include med librarians and process included with them

1.       Reduce the terms to eligibility criteria; move the terms to an appendix

2.       Excluded SLR that referred to same papers being reviewed separately

                                                 ii.      Identify that protocol was pre-determined and not registered

                                               iii.      Analysis plan should match results reported, which can be organized around the article’s message

f.        Results

                                                   i.      Organize based on the message of the article, e.g. the use of evidence-based treatments

                                                 ii.      Table 2

1.       Organize by what the message is, e.g. strength of evidence, rather than alpha

2.       Consider power of study as well, which may be biased

3.                   Next week:  TBD

 Recorded by: CvE

FW: NHATS and NSOC Workshops

The National Health and Aging Trends Study (NHATS) and the National Study of Caregiving (NSOC) will host two hands-on virtual workshops this summer. The NHATS workshop will be held June 26 -28, 2023 and the NSOC workshop will be held July 31- August 2, 2023. Applications are due May 15, 2023. More details are available here.  

 

Sprouse-Blum on Migraine

Adam Sprouse-Blum, MD just published a review article on migraine headache based on his doctoral research. Congratulations!

Blum ASS, Riggins NY, Hersey DP, Atwood GS, Littenberg B. Left- vs right-sided migraine: a scoping review. J Neurol. 2023 Mar 7. doi: 10.1007/s00415-023-11609-1. Epub ahead of print. PMID: 36882660. https://link.springer.com/article/10.1007/s00415-023-11609-1

Abstract

Background

Migraine is a historically unilateral head pain condition, the cause of which is not currently known. A growing body of literature suggests individuals who experience migraine with left-sided headache (“left-sided migraine”) may be distinguished from those who experience migraine with right-sided headache (“right-sided migraine”).

Objective

In this scoping review, we explore migraine unilaterality by summarizing what is currently known about left- and right-sided migraine.

Methods

Two senior medical librarians worked with the lead authors to construct and refine a set of search terms to identify studies of subjects with left- or right-sided migraine published between 1988, which is the year of publication of the first edition of the International Classification of Headache Disorders (ICHD), and December 8, 2021 (the date the searches were conducted). The following databases were searched: Medline, Embase, PsycINFO, PubMed, Cochrane Library, and Web of Science. Abstracts were loaded into Covidence review software, deduplicated, then screened by two authors to determine study eligibility. Eligible studies were those involving subjects diagnosed with migraine (according to ICHD criteria) in which the authors either: a) compared left- to right-sided migraine; or b) described (with analysis) a characteristic that differentiated the two. Data were extracted by the lead author, including ICHD version, the definition of unilateral migraine used by the authors, sample size, whether the findings were collected during or between attacks, and their key findings. The key findings were grouped into the following themes: handedness, symptoms, psychiatric assessments, cognitive testing, autonomic function, and imaging.

Results

After deduplication, the search yielded 5428 abstracts for screening. Of these, 179 met eligibility criteria and underwent full text review. 26 articles were included in the final analysis. All of the studies were observational. One study was performed during attack, nineteen between attacks, and six both during and between attacks. Left- and right-sided migraine were found to differ across multiple domains. In several cases, reciprocal findings were reported in left- and right-migraine. For example, both left- and right-sided migraine were associated with ipsilateral handedness, tinnitus, onset of first Parkinson’s symptoms, changes in blood flow across the face, white matter hyperintensities on MRI, activation of the dorsal pons, hippocampal sclerosis, and thalamic NAA/Cho and NAA/Cr concentrations. In other cases, however, the findings were specific to one migraine laterality. For example, left-sided migraine was associated with worse quality of life, anxiety, bipolar disorder, PTSD, lower sympathetic activity, and higher parasympathetic activity. Whereas right-sided migraine was associated with poorer performance on multiple cognitive tests, a greater degree of anisocoria, changes in skin temperature, higher diastolic blood pressure, changes in blood flow through the middle cerebral and basilar arteries, and changes on EEG.

Conclusion

Left- and right-sided migraine differed across a wide range of domains, raising the possibility that the pathophysiology of left- and right-migraine may not be identical.