title: 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.
  
  
  OBJECTIVE
  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.
  
  
  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.
  
  
  METHODS
  We selected randomised controlled trials (RCTs) of adults with MSCC of interventions on positioning or mobilisation and bracing.
  
  
  METHODS
  Two review authors independently assessed each possible study for inclusion and quality.
  
  
  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.
  
  
  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.
authors.affiliation: School of Nursing, Midwifery and Social Care, Faculty of Health, Life & Social Sciences, Edinburgh Napier University, Edinburgh,UK.
authors.forename: Siew Hwa
authors.initials: SH
authors.lastname: Lee
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Cox
authors.forename: Robin
authors.initials: R
authors.lastname: Grant
authors.forename: Catriona
authors.initials: C
authors.lastname: Kennedy
authors.forename: Lynn
authors.initials: L
authors.lastname: Kilbride
mesh_terms: D001915:Braces; D006801:Humans; D007593:Joint Instability / Q000628:therapy*; D059408:Pain Management / Q000379:methods*; D056888:Patient Positioning / Q000379:methods*; D013117:Spinal Cord Compression / Q000150:complications*; D013125:Spinal Neoplasms / Q000556:secondary; D013131:Spine