title: Positioning and spinal bracing for pain relief in metastatic spinal cord compression in adults.
abstract: BACKGROUND
  This is an updated version of the original Cochrane review published in Issue 3 (Lee 2012) on patient positioning (mobilisation) and bracing for pain relief and spinal stability in adults with metastatic spinal cord compression.Many patients with metastatic spinal cord compression (MSCC) have spinal instability, but their clinician has determined that due to their advanced disease they are unsuitable for surgical internal fixation. Mobilising may be hazardous in the presence of spinal instability as further vertebral collapse can occur. Current guidance on positioning (whether a patient should be managed with bed rest or allowed to mobilise) and whether spinal bracing is helpful, is contradictory.
  
  
  OBJECTIVE
  To investigate the correct positioning and examine the effects of spinal bracing to relieve pain or to prevent further vertebral collapse in patients with MSCC.
  
  
  METHODS
  For this update, we searched for relevant studies from February 2012 to 31 March 2015. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and MEDLINE In Process, EMBASE, AMED, CINAHL, TRIP, SIGN, NICE, UK Clinical Research Network, National Guideline Clearinghouse and PEDro database. We also searched the metaRegister of Controlled Trials (mRCT), ClinicalTrials.gov, UK Clinical Trials Gateway (UKCTG), WHO International Clinical Trials Registry Platform (ICTRP) and Australia New Zealand Clinical Trials Registry (ANZCTR).For the original version, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, CANCERLIT, NICE, SIGN, AMED, TRIP, National Guideline Clearinghouse, and PEDro database, in February 2012.
  
  
  METHODS
  We selected randomised controlled trials (RCTs) of adults with MSCC of interventions on positioning (mobilisation) and bracing.
  
  
  METHODS
  Two review authors independently assessed each possible study for inclusion and quality.
  
  
  RESULTS
  For the original version of the review, we screened 1611 potentially relevant studies. No studies met the inclusion criteria. Many papers identified the importance of mobilisation, but no RCTs of bed rest versus mobilisation have been undertaken. We identified no RCTs of bracing in MSCC.For this update, we identified 347 potential titles. We screened 300 titles and abstracts after removal of duplicates. We did not identify any additional studies for inclusion.
  
  
  CONCLUSIONS
  Since publication of the original version of this review, no new studies were found and our conclusions remain unchanged.There is a 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: Department of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Health Sciences Building, Room HS3-029, Limerick, Ireland.
authors.forename: Siew Hwa
authors.initials: SH
authors.lastname: Lee
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