Risultati per: Il dolore neuropatico: review

Stroke, Volume 56, Issue Suppl_1, Page AWP278-AWP278, February 1, 2025. Background:The elevation of high-sensitivity cardiac troponin T (hsTnT) in patients with atrial fibrillation (AF) is associated with adverse outcomes. However, the extent of this association for risk stratification is not clear.Hypothesis:This study aims to evaluate the association between hsTnT elevation and cardiovascular outcomes.Methods:We conducted a thorough literature search for relevant articles available until March 2024 on PubMed, Google Scholar, and Embase. Outcomes were pooled using the random effects DerSimonian-Laird model and reported as hazard ratio (HR) with a 95% confidence interval. A p-value of

Stroke, Volume 56, Issue Suppl_1, Page ATP58-ATP58, February 1, 2025. Background:Stroke is a leading cause of disability and death. The use of intravenous (IV) thrombolytics, such as alteplase and tenecteplase (TNKase), for acute ischemic stroke (AIS) is a standard of care. Tenecteplase has been recommended as an alternative agent to alteplase. In November 2020, the use of IV TNKase for AIS at a standard 0.25mg/kg dose was implemented at a small community hospital within a large integrated healthcare system. The use of TNKase without the required infusion may expedite admission to the intensive care unit (ICU).Purpose:The aim of this retrospective comparative review was to ascertain the effects of IV TNKase, compared to IV alteplase, on average length of stay (LOS) in the emergency department (ED) and time of ED to admission to the ICU (ED to floor).Methods:A total of 155 electronic patient charts were reviewed from January 2018 to June 2024. An unpaired t-test was used to determine thepvalue. Thepvalue of < 0.05 was considered statistically significant.Results:There were no significant differences in the age and sex between the alteplase and TNKase patients. The average LOS and ED to floor measure were also not significant between the two groups (3.24 versus 2.87 hours,p= 0.11; 79.7 versus 63.4 minutes,p= 0.20, respectively). When examining the ED to floor measure from a different perspective, there was a significant improvement in the percentage of patients admitted to the ICU within 60 minutes – 54.3% (2018 – 2020) to 72.7% (2021 – 2023) to 85.7% in 2024.Conclusion:There have been numerous trials and studies published on the use of IV TNKase for AIS with promising results. The single bolus IV TNKase dose given over 5 seconds is an attractive nursing workflow. Without the use an infusion, post-TNKase patients may be admitted sooner to ICU. Reducing ED LOS improved throughput in a small often overcrowded ED. Additional in-depth reviews and data analysis would be needed to examine patient characteristics and clinical conditions, variations in workflow, operational needs, staffing, and documentation accuracy contributing to ED LOS and ED to floor measure.

Stroke, Volume 56, Issue Suppl_1, Page ATP10-ATP10, February 1, 2025. Introduction:Early neurological deterioration (END) is an adverse outcome of acute ischemic stroke that affects up to one-third of patients and is linked to poorer functional outcomes. Tirofiban, a nonpeptide glycoprotein IIb/IIIa receptor blocker, is widely used in the treatment of atherosclerotic heart disease and percutaneous coronary intervention. Herein, we sought to assess whether Tirofiban reduces the severity of outcomes and improves stroke patient recovery through a systematic review and meta-analysis.Methods:We systematically searched Pubmed, Cochrane, Web of Science and Scopus for randomized clinical trials and observational studies. The studies compared the effects on the administration of Tirofiban or control on END in individuals with acute ischemic stroke. Risk ratio (RR) was used for binary outcomes and mean difference (MD) for continuous endpoints with 95% confidence intervals (CIs). Heterogeneity was evaluated with I2statistics and p value < 0,05 were considered statistically significant. Statistical analysis was performed using R statistical software 4.4.1 version.Results:Seven studies and 2163 patients were included. Among them, 1132 (52,34%) were allocated to receive Tirofiban and 1031 (47,66%) received a placebo. The number of male patients was higher than females, with 1401 (64,80%), while 762 (35,20%) were women. The outcomes of END (RR 0.43; 95% CI 0.21 to 0.87; P=0.018715; I2=50%), 7th day National Institutes of Health Stroke Scale (NIHSS Score) (MD -1,03; 95% CI -2.03 to -0.02; P=0.045408; I2=72%) and score of 0 to 2 on the Modified Rankin Scale (mRS) for functional independence (MD -1.05; 95% CI -1.71 to -0.39; P=0.001916; I2=95%) presented statistical significance favoring the Tirofiban group. The following outcomes showed no statistical significance: mortality (RR 0.94; 95% CI 0.57 to 1.55; P=0.810315; I2=39%) and symptomatic intracerebral hemorrhage (RR 1.27; 95% CI 0.32 to 5.04; P=0.738112; I2=47%).Conclusion:Even though there was no significant difference between the groups in all outcomes, such as mortality and symptomatic intracerebral hemorrhage, Tirofiban induced a favorable impact on functional outcome and improved the prognosis in patients with acute ischemic stroke. This systematic review and meta-analysis suggest that Tirofiban is efficient in preventing early neurological deterioration and improving the mRS and NIHSS scores, however, new RCTs are needed to clarify our results.

Stroke, Volume 56, Issue Suppl_1, Page ATP15-ATP15, February 1, 2025. Introduction:Argatroban, a direct thrombin inhibitor, is currently being investigated as a potential adjunct to the standard of care for the treatment of acute ischemic stroke (AIS). However, data regarding its impact on functional neurological outcomes have been inconclusive. Our objective was to compare neurological outcomes at 90 days among individuals with AIS randomized to argatroban with standard of care versus standard of care alone.Methods:We systematically searched MEDLINE, EMBASE, and Cochrane CENTRAL databases from their inception to July 2024 for randomized controlled trials of argatroban. The primary outcome was excellent functional outcome, as defined by a modified Rankin Scale (mRS) score of 0-1 at 90 days. The secondary endpoints were favorable functional outcome, defined by a mRS score of 0-2 at 90 days, and repeat stroke or other vascular events within 90 days. Safety endpoints included symptomatic intracranial hemorrhage and parenchymal hematoma at 90 days. Risk of bias was assessed using the Cochrane Risk of Bias Tool (RoB 2). Random-effects meta-analytic models were used to estimate pooled risk ratios (RRs) and 95% confidence intervals (CIs). Our protocol was preregistered on Open Science Framework (https://osf.io/tygwx/).Results:Four randomized controlled trials were included. A total of 1,595 participants were randomized to receive either argatroban with standard of care (n=807) or standard of care alone (n=788). Participants were mostly male (67.1%), and their median/mean age ranged from 57 to 69 years. When data were pooled across trials, the impact of argatroban on the likelihood to have a mRS score of 0-1 was inconclusive due to a wide CI (RR: 1.12; 95% CI: 0.88-1.41; I2: 63%) (Figure 1). Similar trends were observed for the other predefined outcomes. The RRs were 1.00 (95% CI: 0.87-1.14) for a mRS score of 0-2 (Figure 2) and 0.79 (95% CI: 0.44-1.44) for stroke or other vascular events. The pooled RRs for symptomatic intracranial hemorrhage and parenchymal hematoma were 1.09 (95% CI: 0.73-1.63) and 0.84 (95% CI: 0.48-1.47), respectively.Conclusions:Results were inconclusive due to small sample sizes. Currently, there is insufficient data to support the addition of argatroban to standard of care for the treatment of AIS. Evidence from available trials in this area supports the conduct of larger trials to determine the clinical value of argatroban.

Stroke, Volume 56, Issue Suppl_1, Page AWP279-AWP279, February 1, 2025. Introduction:Neurological complications in patients with infective endocarditis (IE), such as ischemic and hemorrhagic stroke, are well-described, serious complications of IE; however, predicting which patients are most likely to experience stroke remains uncertain. The objective of this systematic review was to identify the factors associated with risk of stroke in patients hospitalized with IE.Methods:A systematic search of Ovid MEDLINE, EMBASE, and Web of Science was conducted between January 1990 and to July 2024. Articles evaluating risk of acute ischemic stroke (AIS) and/or intracranial hemorrhage (ICH) in patients with IE were included. Meta-analysis was feasible for only some predictive factors due to study heterogeneity. (PROSPERO protocol CRD42024571058).Results:Of 3558 studies identified, 35 were included: The review included 9 prospective and 26 retrospective cohort studies.Staphylococcus aureusinfection (odds ratio, 3.05 [95% CI, 1.96-4.73]; I2=77.2%; 9 studies) and 1 mm longer in vegetation size, on average (odds ratio, 1.26 [95% CI, 1.02-1.55]; I2=90.1%; 3 studies) were associated with a higher risk of AIS, adjusting for other covariates. Due to high heterogeneity among the studies, a meta-analysis was not feasible for the other predictive factors. High intensity signals on transcranial doppler, and comorbidities such as hypertension, atrial fibrillation, and hyperlipidemia were also found to have a higher risk of AIS. Risk of ICH was heightened by thrombocytopenia, mycotic aneurysms, prior ICH and/or AIS, and cerebral microbleeds.Conclusion:Physicians need to monitor numerous, diverse features of patients hospitalized with IE to mitigate the risk of ensuing stroke. While the causative microorganism, echocardiographic and neuroimaging findings may be particularly informative, underlying comorbidities and various laboratory values may also contribute to predicting IE-associated ischemic and hemorrhagic stroke.

Stroke, Volume 56, Issue Suppl_1, Page AWP264-AWP264, February 1, 2025. Background:Medium vessel occlusion (MeVO) accounts for approximately one-third of all acute ischemic strokes and presents distinct management challenges, despite being less severe than large vessel occlusion (LVO). While endovascular treatment (EVT) has proven superior to best medical treatment (BMT) in LVO, its efficacy and safety in MeVO are not yet fully established. The recently published DUSK trial, which did not demonstrate significant benefits of EVT for MeVO, has not been included in prior reviews, making it essential to integrate and critically evaluate the implications of this new evidence.Aim:This meta-analysis aims to evaluate the efficacy and safety of EVT compared to BMT in patients with MeVO.Methods:We conducted a systematic search of PubMed, Embase, and the Cochrane Library up to August 2024, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our analysis focused exclusively on peer-reviewed randomized controlled trials (RCTs) that compared the efficacy of EVT with BMT in patients with MeVOs. The primary outcomes were excellent functional outcome (defined as modified Rankin Scale [mRS] 0-1) and functional independence (defined as mRS 0-2) at 3 months. Effect sizes were computed as odd ratio (OR) with random-effect models.Results:Three RCTs with 862 patients (448 randomized into EVT vs. 414 randomized into BMT) were included. The pooled analysis demonstrated that EVT did not significantly increase the likelihood of achieving an excellent functional outcome (mRS 0-1: OR 0.89, 95% CI 0.67–1.18, p = 0.42) or functional independence (mRS 0-2: OR 0.93, 95% CI 0.62–1.40, p = 0.73) at 3 months compared to BMT. Additionally, EVT did not significantly elevate the risk of symptomatic intracranial hemorrhage (sICH: OR 1.13, 95% CI 0.55–2.33, p = 0.75) or mortality (mRS 6: OR 1.19, 95% CI 0.53–2.65, p = 0.67).Conclusions:Our systematic review and meta-analysis suggest that EVT for MeVO is not associated with a significant improvement in functional outcomes or an increased risk of adverse events such as sICH and mortality at 3 months, when compared to BMT. These findings underscore the need for further investigation, particularly with forthcoming RCTs to clarify the role of EVT in this patient population.

Stroke, Volume 56, Issue Suppl_1, Page ATP12-ATP12, February 1, 2025. Introduction:Preventing ischemic strokes in patients with atrial cardiopathy is particularly challenging due to the elevated risks associated with the condition. While numerous studies have established the efficacy of anticoagulants in preventing stroke, their benefits for patients with atrial cardiopathy are not clearly understood. Herein, this systematic review and meta-analysis aims to assess the efficacy of Apixaban in preventing ischemic stroke recurrence in patients with atrial cardiopathy.Methods:A database search of published studies at PubMed, Web of Science, Cochrane, and Scopus was performed. Randomized clinical trials and observational studies comparing the administration of Apixaban with a placebo in adult patients were included. Risk ratio (RR) was used for binary endpoints with 95% confidence intervals (CIs). Heterogeneity was evaluated with I2statistics and p value < 0,05 were considered statistically significant. Statistical analysis was performed using R statistical software 4.4.1 version.Results:5 studies and 2593 patients were included. Among them, 1401 (54%) were allocated to receive Apixaban and 1192 (46%) were allocated to receive a placebo. The number of female and male patients was similar, with 1331 (51,3%) women and 1262 (48,7%) men. The recurrence of ischemic stroke (RR 0.89; 95% CI 0.64 to 1.23; P=0.479406; I2=0%) did not present a statistically significant difference between groups. Similarly, mortality (RR 1.36; 95% CI 0.92 to 2.02; P=0.121981; I2=0%) and recurrent fatal stroke (RR 0.31; 95% CI 0.07 to 1.38; P=0.123799; I2=0%) also showed no statistical significant difference between Apixaban and control group.Conclusion:In this systematic review and meta-analysis, we analyzed patients with ischemic stroke and evidence of atrial cardiopathy. Apixaban did not present significant reduction in recurrent stroke risk, recurrent fatal stroke incidence or mortality when compared with a placebo. Despite this, potential efficacy of early initiation of Apixaban should be clarified from new larger randomized clinical trials.

Stroke, Volume 56, Issue Suppl_1, Page ATP45-ATP45, February 1, 2025. Introduction:Standardized cognitive assessments such as the Montreal Cognitive Assessment (MOCA) and Mini-Mental State Examination (MMSE) are generally administered using paper-and-pencil methods. Technological advancements have digitized these exams and expanded cognitive testing capabilities in the post-stroke population.Methods:Studies from 2010-2022 were identified from PubMed, Embase, Web of Science, Cumulated Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Google Scholar to include digital cognitive assessments utilized for acute and chronic ischemic and hemorrhagic stroke patients. The research questions aim to evaluate technical aspects of digital tests, digital tool effectiveness, cognitive domains assessed, study population characteristics, patient usability, and exam feasibility. The methodological framework for this review included research question identification, relevant study collection, final study selection, data extraction, analysis, and summary. Covidence was used to compile relevant studies.Results:72 articles were included for final analysis. 8 different digital methods (e.g., tablet, computer, virtual reality) were used to assess cognition, with 26 studies creating a new cognitive test and 24 creating a cognitive test based on a standardized exam. Participants were tested in both acute and chronic phases (5 strictly in acute, 55 strictly in subacute/chronic, and 11 in both). 58% of articles assessed ischemic and hemorrhagic stroke participants, and 9 studies only tested aphasia patients. Exams consisted of a variety of cognitive domains, with the majority of studies testing multiple domains (e.g., executive functioning, attention, and visuospatial processing), and some studies testing only one cognitive domain. The average rate of digital test completion was 95%. Validation of the digital tool was compared with a standardized, paper-and-pencil test (e.g., MOCA, MMSE) in 48 articles (67%). An overall positive satisfaction with the digital test was seen in 8 articles that incorporated patient questionnaires.Conclusion:This review suggests that post-stroke digital cognitive assessments are feasible in the acute and post-acute settings across multiple domains similar to the MOCA and MMSE. Enhancements in these tools will expand access to testing and allow for increased identification of post-stroke cognitive impairment.

Stroke, Volume 56, Issue Suppl_1, Page AWP270-AWP270, February 1, 2025. Introduction:Patients experiencing a transient ischemic attack (TIA) or minor stroke have a high long-term risk of subsequent stroke that persists for over one year following presentation. While risk stratification tools like the ABCD2score have been used to identify patients at high risk of stroke in the short-term (within the first 90 days), less is known about factors that determine long-term risk. Some studies suggest that traditional predictors of early stroke risk may not be associated with long-term risk, while others have reported conflicting results. We aimed to summarize the association between clinical, demographic, imaging factors and the long-term risk of stroke in patients experiencing TIA or minor stroke.Methods:We searched MEDLINE, Embase, and the Web of Science from inception to June 2024, for observational studies that examined factors associated with subsequent stroke in patients experiencing TIA or minor stroke during a minimum follow-up of one year. Two reviewers independently performed study screening and data extraction. For the primary analysis, we included prognostic factors if they were derived from a multivariable Cox proportional hazards model and reported in at least 2 studies. We contacted the corresponding authors of the studies to obtain adjusted effect estimates when these values could not be extracted from the reported data. We conducted random effects meta-analyses of adjusted hazard ratios and report pooled effect estimates with 95% confidence intervals.Results:Of 13051 citations identified, we included 28 studies examining 85,328 patients including unpublished data from 8 studies that we directly obtained from study authors. Factors associated with an increased risk of stroke at one year or beyond included male sex, older age, hypertension, diabetes mellitus, atrial fibrillation, history of stroke or TIA before the qualifying event, history of coronary artery disease, presence of hemiparesis, aphasia, baseline ABCD2score of 4 or greater, acute infarct on brain imaging, large-artery atherosclerosis, and cardioembolism (Figure 1).Conclusion:We have identified important prognostic factors associated with long-term risk of stroke after a TIA or minor stroke. These findings provide a framework for evidence-based risk stratification of patients who may require extended treatment and vigorous monitoring.

Introduction
The results of open defecation-free (ODF) programmes vary greatly, especially in low- and middle-income countries (LMICs). This study will systematically investigate available qualitative research to identify the elements contributing to open defecation programmes’ effectiveness in various situations across LMICs. Furthermore, this review seeks to identify gaps in the available literature and areas that require additional investigation and action.

Methods and analysis
Inclusion criteria were developed considering issues related to open defecation in LMICs, sanitation interventions and behavioural change. Research examining sanitation interventions in schools, shelters, disability communities and virtual communities was excluded, as the review focused exclusively on community-based interventions. Studies published in English and Indonesian were included without limitation of the initial year until 31 January 2025. Systematic research will be carried out using ScienceDirect, PubMed, ProQuest and Scopus databases. Information from grey literature, including conference proceedings and reports from relevant organisations, will be systematically searched using Google Scholar and the websites of leading institutions, such as the WHO, UNICEF and WaterAid. This systematic review did not impose any restrictions on the place and date of publication. Two reviewers followed Joanna Briggs Institute guidelines in selecting studies, conducting critical appraisal using confidential tools and extracting data using a structured approach. Data synthesis will be performed using meta-aggregate methods to identify the themes. A ConQual Summary will be used to assess confidence in the findings.

Ethics and dissemination
The findings of the systematic review will be disseminated through a publication in a peer-reviewed journal and presented at a relevant conference. Since the data used will not contain individual patient information, ethical approval is unnecessary.

PROSPERO registration number
CRD42023408851.

Introduction
Inhalers are critical in asthma treatment, and inappropriate inhaler use leads to poor asthma outcomes. In adults and adolescents, dry powder inhalers (DPIs) are safe and effective alternatives to mainstay pressurised metered dose inhalers and could bridge the asthma care gap while also reducing the environmental burden of asthma care. Despite being licensed for use in ages 5 years old and older, the evidence for clinical effectiveness is less clear for patients between ages 5 and 12 years. This protocol describes a scoping review. The primary aim of the review is to identify and synthesise evidence on the clinical effectiveness of DPI use in children aged 5–12 years old with asthma and other wheezing conditions. The secondary aim of the review is to outline the implementation strategies and outcomes supporting the prescribing or switching to DPIs in children.

Methods and analysis
We will conduct a systematic and comprehensive literature search across four electronic databases (Medline, Embase, Cochrane Library and CINAHL) and grey literature. Screening and data extraction will be done independently by two review authors with discrepancies resolved through consensus. Data will be extracted and charted by two independent reviewers, then presented diagrammatically or tabulated with an accompanying narrative summary.

Ethics and dissemination
Ethical approval was not required for this study as it is a scoping review. The results of this scoping review will be submitted to a peer-reviewed scientific journal for publication.

Introduction
The majority of patients with coronary heart disease (CHD) are at high sedentary levels, which severely affects patient prognosis and outcome. Despite the proven benefits of reducing sedentary behaviour (SB), intervention studies’ effectiveness has been limited. Thus, the factors influencing SB change in patients with CHD need to be explored. This scoping review aimed to identify barriers and facilitators to improved SB in CHD patients and map these factors to the Capability–Opportunity–Motivation-Behaviour model.

Methods
We conducted a scoping review in accordance with the Arksey and O’Malley framework. Eligibility criteria included qualitative and quantitative studies on SB in patients with CHD. Nine databases were searched (PubMed, Medline, Embase, CINAHL, Web of Science Core Collection, Scopus, CNKI, WanFang and VIP) from inception through 31 December 2023, following the scoping review methodology.

Results
A total of 24 studies, including two qualitative and 22 quantitative studies, were included, with 15 847 patients. Barriers to improved SB in CHD patients included capability (eg, physical characteristics, lack of knowledge to improve SB), opportunity (eg, lack of partnership support, lack of resources to carry out activities) and motivation (eg, maintaining the habit of SB, impaired belief in activities). Facilitators included capability (eg, exercise session, improving understanding of SB), opportunity (eg, utilisation of support, tele-rehabilitation guidance, diversification of living environments) and motivation (perceived benefit).

Conclusions
Patients with CHD have unique barriers and facilitators to improving SB. Future research should adequately reduce barriers and promote facilitators to increase the effectiveness of interventions.

Introduction
To improve surgical quality and safety, health systems must prioritise equitable care for surgical patients. Racialised patients experience worse postoperative outcomes when compared with non-racialised surgical patients in settler colonial nation-states. Identifying preventable adverse outcomes for equity-deserving patient populations is an important starting point to begin to address these gaps in care. To derive literature-based estimates of the outcome gap for racialised surgical patients, we will systematically review and meta-analyse rates of adverse postoperative events associated with common and/or high-risk operations performed in Canada and the USA.

Methods and analysis
An electronic search of Medline, Embase, Web of Science, Cochrane Central, CINAHL and Scopus will be conducted to identify studies reviewing complication rates of racialised compared with non-racialised patients from inception to December 2023. We will include publications from the USA and Canada comparing surgical outcomes of racialised and non-racialised patients. The procedures of interest will be the four most common (hip arthroplasty, knee arthroplasty, appendectomy and cholecystectomy), and the five highest risk (oesophagectomy, abdominal aortic aneurysm, aortic valve replacement, coronary artery bypass graft and pancreatectomy) surgical procedures performed in these countries. The outcomes will be mortality, length of stay in hospital, readmission, reoperation, wound dehiscence, surgical site infection, pulmonary embolism, sepsis or septic shock, pneumonia, blood transfusion, stroke, myocardial infarction and bile duct injury. Summary estimates of cumulative incidence, prevalence, incidence rate and occurrence rate of complications using DerSimonian and Laird random effects models will be calculated for the systematic review and meta-analysis. Heterogeneity in these estimates will be examined using subgroup analyses and meta-regression.

Ethics and dissemination
This study uses secondary data and, therefore, does not require ethics approval. This study will be communicated through presentations at international conferences and published in peer-reviewed literature. The results from this study will inform the development of future surgical equity tools and quality improvement programmes and provide benchmarks on the impact of racism on surgical outcomes.

PROSPERO registration number
CRD42024491439.

Introduction
Understanding causal risk factors that contribute to the development of multimorbidity is essential for designing and targeting effective preventive strategies. Despite a large body of research in this field, there has been little critical discussion about the appropriateness of the various analytical approaches used. This proposed scoping review aims to summarise and appraise the analytical approaches used in the published literature that evaluated risk factors of multimorbidity and to provide guidance for researchers conducting analyses in this field.

Methods and analysis
We will systematically search three electronic databases—Embase, Global Health and MEDLINE, as well as the reference lists of identified relevant review articles, from inception to September 2024. We will screen titles and abstracts using the artificial intelligence-aided software ASReview, followed by screening for eligible articles in full text and extracting data. We will then categorise the analytical approaches used across studies, provide a comprehensive overview of the methodology and discuss the potential strengths and limitations of each analytical approach.

Ethics and dissemination
We will undertake a secondary analysis of published literature; therefore, ethical approval is not required. The results will be disseminated through an open-access, peer-reviewed publication. This systematic scoping review will serve as a guide for researchers in selecting analytical approaches for aetiological multimorbidity research, thereby improving the quality and comparability of research in this field.

Background
Garment workers are at high risk of musculoskeletal disorders (MSDs) due to repetitive physical tasks, long working hours and varying workstations. As there is no existing epidemiological overview of MSDs among garment workers, this systematic review aimed to evaluate the global evidence on prevalence of MSDs in this population.

Methods
A systematic review of the literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Medline, Cumulative Index to Nursing and Allied Health Literature, PubMed, Scopus and Web of Science electronic databases were searched to identify studies published in English up to November 2022. Random-effects meta-analysis was used to estimate pooled prevalence.

Results
The search yielded 258 published studies, of which 14 were deemed relevant and were included in this review. The included studies reported prevalence from India (n=3), Bangladesh (n=2), Ethiopia (n=2), Thailand (n=2), Botswana (n=1), Iran (n=1), Sri Lanka (n=1), Cambodia (n=1) and Denmark (n=1) and involved 15 029 garment workers. Most of the included studies (79%) were assessed to be methodologically sound (low risk of bias). The mean age of participants ranged from 24.2 to 40 years. The prevalence of MSDs ranged from 15.5% to 92%. The pooled prevalence of MSDs from nine studies was 65.6% (95% CI 44.5% to 51.9%). Low back pain and neck pain were reported as the common MSDs in the included studies.

Conclusions
The findings highlight the considerable risk of MSDs, especially low back and neck pain, linked to repetitive tasks, extended hours and inconsistent workstations. Given the heavy toll of MSDs on this workforce, targeted interventions and ergonomic improvements are crucial to mitigate the risks and improve garment workers’ well-being.

Objectives
Neonatal pain prevention is not only a humanistic but also an ethical imperative. Fitting with the principles of family-centred care, parental involvement in neonatal pain management plays an active role in infant development and parental well-being. However, the process of parental involvement faces constant challenges. To help structure and implement a family engagement programme in neonatal pain management in the neonatal intensive care unit (NICU), we conducted a scoping review to identify facilitators and barriers to parental involvement in neonatal pain management.

Methods
We conducted the scoping review using the Arksey and O’Malley framework. PubMed, Cochrane Library, Web of Science, CINAHL, Scopus, Wanfang database (Chinese), CNKI (Chinese), VIP database(Chinese) and SinoMed (Chinese) were searched systematically for relevant studies published in English and Chinese from inception up to October 2023. We categorised the facilitators and barriers based on the socioecological model and analysed the results thematically in each category.

Results
Ten English qualitative studies were included in the final analysis. The 34 facilitators and 41 barriers extracted were grouped into 4 domains of the socioecological model framework. Of the 10 facilitator themes, the most critical theme was informational and emotional support. Of the 10 barrier themes, the most frequently reported theme was restricted policies and resources.

Conclusions
Our review highlights the essential roles of intrapersonal and interpersonal factors in parental involvement in pain management while suggesting the interconnectedness of factors in various domains within the context of the socioecological model. It implies that most interventions require development and administration at both intrapersonal and interpersonal levels. Regarding the macrolevel, a broad programme with clear regulatory approaches and targeted guidelines could be developed in the future to drive innovations in NICU pain management mode.