Cervical Spinal Motion Restriction (FA): Scoping Review

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Conflict of Interest Declaration

The ILCOR Continuous Evidence Evaluation process is guided by a rigorous ILCOR Conflict of Interest policy. There were no declared conflicts of interest

Task Force Scoping Review Citation

Woodin JA, Orkin AM, Djarv T, Singletary EM, Zideman DA. On behalf of the International Liaison Committee on Resuscitation First Aid Task Force. Cervical Spinal Motion Restriction Scoping Review and Task Force Insights [Internet] Brussels, Belgium: International Liaison Committee on Resuscitation (ILCOR) First Aid Task Force, 2019 December 29. Available from: http://ilcor.org

Methodological Preamble and Link to Published Scoping Review

The continuous evidence evaluation process started with a scoping review of spinal motion restriction conducted by the ILCOR First Aid Task Force Scoping Review team. Evidence from published and grey literature was sought and considered by the First Aid Task Force. This topic was last reviewed in 2015 and a Consensus on Science with Treatment Recommendations was published (Singletary 2015 S269, Zideman 2015 278). Critical outcomes for the 2015 review included neurologic injury and complications. For the current scoping review, all clinical outcomes were considered.

Scoping Review

Webmaster to insert the Scoping Review citation and link to PubMed using this format when/if it is available.

Not available at this time.

PICOST

PICOST

Description

Population

Adults and children with possible traumatic cervical spinal injury

Intervention

spinal motion restriction

Comparison

no spinal motion restriction or another type of spinal motion restriction

Outcomes

All clinical outcomes were considered

Study Design

Randomized controlled trials (RCTs) and non-randomized studies (non-randomized controlled trials, interrupted time series, controlled before-and-after studies, cohort studies), case series or reports, unpublished studies (e.g., conference abstracts, trial protocols) are eligible for inclusion.

Timeframe

Scoping search strategy: 1999-2019 and all languages are included as long as there is an English abstract

Search Strategies

A search strategy was developed with assistance from an ILCOR Information Specialist for use with Medline and Embase (Appendix 1).

Final searches were run with a date limit of 1999-2019. Records from database searches were exported into EndNote (Clarivate Analytics X9.2) reference management software to facilitate removal of duplicates and screened by two reviewers (JW and AO). Final database searches were conducted November 6 and 10, 2019.

A detailed search of the gray literature was not performed for this review.

Appendix 1 Search Strategy

Items Identified by Database

Database Name

Number of items Identified*

Number of items (Duplicates Removed)

Medline

2298

2296

Embase

908

868

CDSR

3

0

CCRT

166

140

ACPJC

2

2

DARE

1

1

NHSEED

1

1

CINAHL

599

361

Total – All Sources

3978

3669

Inclusion and Exclusion criteria

Inclusion:

Human studies, including adults and children >1

All studies that address the question

All languages as long as an English abstract was available.

Exclusion:

Studies not reporting outcomes

Studies that reviewed intubation, airway devices, laryngoscopy, vertebroplasty, laminectomy, or other surgical interventions.

Appendix 2 PRISMA Chart

Data tables

Reference

Methods

Participants

Interventions

Comparisons

Outcomes

Notes

Cowley 2017 158

Review article

5 studies included;

Authors research question: in terms of the potential for

worsening a cervical spine injury, if the vehicle occupant

is alert and able, is it safe to allow them to self-extricate

with minimal or no cervical spine immobilization?

Hauswald article is an expert opinion stressing self-protection.

Shafer & Naunheim is a quasi-pilot study showing that self-extricating with a cervical collar had lower range of motion than other techniques.

Engsberg builds on Shafer & Naunheims study above but uses EMS personnel and lay persons, shows same result.

Dixon 2015 is a quasi-experimental study with same methods as studies above, it showed same results.

Dixon 2016 is a simulated study on 16 patients, showing that controlled self-extrication without a collar comes with least cervical motion.

The author concludes that evidence is building to support self-extrication in alert patients with minimal or no cervical spine.

Kim 2018 1,

Hong Kong

Experimental

30 healthy students 21-25 years of age were randomly assigned to three groups. Each group tested all three collars but in different order.

30 trials with cervical collar (Xcollar)

30 trials with Philadelphia Collar,

30 trials with Stifneck Select Collar

No cervical collar

Cervical range of motion was evaluated via a digital camera regarding flexion, extension, bilateral bending, bilateral axial rotation.

XCollar had least motion in all assessed directions.

Range of mean degree in all directions of cervical motion: No collar 27.6-65.1 degrees, Philadelphia 15.4-22.5 degrees, Stifneck 10.5-14.4, XCollar 6.2-9.5 degrees

Authors conclude that range of movement is decreased with the use of a cervical collar.

Lemzye 2011 532

France

Case report

32-year-old man, suicide attempt by hanging. Amongst other interventions the prehospital team applied a lightweight foam collar around his neck. After radiology, the neck collar was removed, significant neck swelling was observed bilaterally just below straps of the cervical collar.

The authors discuss that devices for neck stabilization might increase intracranial pressure by venous congestion. Authors suggest that cervical collars should be avoided in suicide attempts by hanging. Deaths due to hanging is mainly due to blockage of blood stream to the brain, not asphyxia due to spinal fracture.

March 2002 421,

USA

Single-blinded prospective cohort study

20 healthy volunteers were immobilized for one hour with cervical collar and strapped to a long wooden backboard. Midline palpation of vertebra was performed every 10 minutes. Participants self-rated pain (1 (lowest-10 highest) every 5 minutes

3/10 had pain within 40 minutes

5/10 developed point tenderness of vertebrae by 60 minutes, (mainly at vertebrae C7)

18/20 complained over increasing discomfort over time.

Median pain score increased from 1 (range 1-1) at 0 minutes to 4 (range 1-9) at 60 minutes

Authors conclude that immobilization causes false-positive exam for vertebral tenderness over time.

McGrath 2009 166,

USA

Brief report,

Prospective, experimental

13 healthy volunteers, both the intervention and comparison were applied on each volunteer

SAM splint molded to a cervical collar

Philadelphia cervical collar

No statistically significant difference in 5 different movements was found.

Mean degree of movement was 14.5-20.6 for SAM splint compared with 15.9-20.8 for Philadelphia collar (all p=>0.068)

Sample size and power calculation was done to detect an 11-degree difference. The largest detected mean difference was 2.54 more degrees for SAM on extension.

Schneider 2007 E1,

USA

Experimental

45 healthy adult volunteers wearing 7 cervical orthoses

Cervical collars;

Philadelphia cervical collar, Aspen cervical collar, PMT cervical collar, Miami J cervical collar

Cervicothoracic collars;

Minerva cervicothoracic orthosis, Lerman noninvasive halo, Sternal-Occipital-Manidbular-Immobilizer.

All devices reduced intervertebral motion. Cervico-throracic devices limited motions more than cervical devices.

Percentage of participants with intervertebral rotation >3 degrees on C1-C7, lowest rotation was mostly on C1-C2, greatest rotation was mostly on C3-C4-C5;

No collar:88.5-100%

Miami: 21.9-95.5%

Aspen: 32.4-88.6%

PMT: 17.2-86.7%

Philadelphia: 13.8-90.9

SOMI: 18.2.-70.5%

Pinless halo: 17.8-64.4%

Minerva: 10.8-40.0

Participants were asked to maximally flex/extend, laterally tilt bilateral and axial rotate bilat without deforming the device.

Task Force Insights

1. Why this topic was reviewed.

The 2015 ILCOR Consensus on Science for this topic identified very low certainty evidence from 8 observational studies evaluating the critical outcomes of neurologic injury and complications [Singletary 2015 S269, Zideman 2015 278]. That review was limited to mechanical cervical immobilization devices accessible to first aid providers, including cervical collars and sandbags with tape, but did not include spine boards. No evidence was identified to address the critical outcomes of neurologic injury and complications, the important outcomes of overall mortality, pain, and patient comfort, and the less important outcome of hospital length of stay. Since that review, the ILCOR continuous evidence evaluation process has included automated regular database searches for new studies, and no studies that would trigger a systematic review have been identified. Thus, the First Aid Task Force sought to conduct a scoping review to search for additional publications that would support past recommendations or lead to a systematic review.

2. Narrative summary of evidence identified

Six studies (Kim 2018 1, March 2002 421, Schneider 2007 E1, McGrath 2009 166, Cowley 2017 158, Lemzye 2011 532) were identified for inclusion for this scoping review; 1 single blinded prospective study, 2 comparative studies, 1 biomechanical evaluation of orthoses (experimental), 1 literature review, and 1 case report. Reported results and outcomes of these studies were insufficient to support a more specific systematic review for this PICOST.

Kim, J. G. et al. (Kim 2018 1) measured cervical range of motion (CROM) in three planes involving flexion/ extension, bilateral bending, and bilateral axial rotation in three cervical collars: Philadelphia® Collar (Philadelphia Collar Company, Philadelphia, PA), Stifneck® Select™ Collars (Laerdal, Wappingers Falls, NY) and XCollarÒ (Emegear). A total of 30 healthy university students including 15 men and 15 women aged 21-25 years, were allocated into three randomized groups. Cervical range of flexion and extension were measured in the seated position, and cervical range of bilateral axial rotation was measured in the supine position. The results showed that CROM was reduced with all collars, but that one collar was superior in its performance.

March et al. (March 2002 421) performed a single-blinded, prospective study enrolling twenty healthy volunteers (13 male and 7 females) without previous back pain or injuries, to determine whether spinal immobilization causes changes in physical exam findings over time. This study was undertaken to determine whether immobilization with a cervical collar and long board causes midline vertebral pain that is reproducible on palpation. Participants were fully immobilized for one hour with a cervical collar and strapped to a long wooden backboard. Midline palpation of vertebrae to illicit pain was performed at 10-minute intervals. In addition, the participants were asked to rate neck and back pain on a scale from 1 to 10 (1 for no pain, and 10 for unbearable pain), to see whether subjective pain from immobilization correlated with tenderness to palpation. Three participants had point tenderness of cervical vertebrae within 40 minutes. Five developed point tenderness of vertebrae by 60 minutes. Eighteen of 20 participants complained of increasing discomfort over time. The median initial pain scale was 1 (range 1–1), in contrast to 4 (range 1–9) at 60 minutes, p < 0.05.

Schneider et al. (Schneider 2007 E1) evaluated the biomechanical effectiveness of 7 different contemporary cervical orthoses for restricting head motion in 45 healthy adult volunteers as well as intervertebral motion in the cervical spine. Reported comfort of each brace was also recorded. Overall range of motion of the head in 3 planes as well as intervertebral motion in the sagittal plane were measured while wearing 7 cervical orthoses. This study showed all cervical braces significantly reduced overall sagittal plane flexion/extension motion of the head, as well as axial rotation and coronal plane side-to-side bending (p<0.0001) and all braces significantly (p <0.001) reduced intervertebral rotation at all levels. Comfort varied between braces.

McGrath et al. (McGrath 2009 166) performed a prospective study using 13 healthy volunteers evaluating the effectiveness in limitation of cervical spine motion in 5 different movements with use of a single piece SAMÒ splint molded into a cervical collar compared with use of a 2-piece PhiladelphiaÒ cervical collar. The results of this small study showed no statistically significant difference between the PhiladelphiaÒ collar and the SAMÒ splint at limiting movement of the cervical spine in any of the measured movements or in total allowed degrees of movement and suggest that the SAMÒ splint, when molded into a cervical collar, is as effective as the PhiladelphiaÒ collar at limiting movement of the cervical spine.

Cowley et al. (Cowley 2017 158) performed a review of the literature evaluating cervical spine motion during vehicle extrication. Five motion capture studies suggest that a patient who is allowed to self-extricate from a vehicle may move their neck up to four times less than a patient who is extricated by traditional methods, and an alert patient with a neck injury will demonstrate a self-protection mechanism, ensuring injuries are not worsened.

Lemzye et al. (Lemzye, 2011, 532) reported the case of a young man who attempted suicide by hanging and whose neurological status deteriorated until the cervical collar, which had been correctly placed by the prehospital team, was removed.

3. Narrative Reporting of the task force discussions

Similar to the 2015 CoSTR on cervical spinal motion restriction (Singletary 2015 S269, Zideman 2015 e225), this scoping review identified biomechanical and cohort studies (Schneider 2007 E1, Kim 2018 1, McGrath 2009 166) that report the ability to restrict cervical motion in varying amounts with the use of cervical collars. We also identified one case report (Lemzye 2011 532) and one small cohort study (March 2002 421) that identified a complication of worsening neurologic status, and a small prospective cohort study in healthy volunteers demonstrating a false positive tenderness with midline vertebral palpation following use of a cervical collar in combination with spinal motion restriction using a long backboard.

No studies were identified that directly addressed other outcomes such as neurological injury, survival, hospital length of stay, or additional outcomes such as the ability to correctly apply a cervical collar.

In Task Force discussions it was noted that the ability to properly apply a cervical collar is not a skill typically taught in first aid courses, although some large groups of first aid providers or first responders may receive specialized training and regular practice to allow them to use cervical collars, such as for sports-associated injuries. Task Force members representing multiple different countries and continents noted that cervical collars are no longer used routinely for trauma, other than for accidents where there is concern for high risk of cervical spinal injury. Additional concerns were expressed over the ability of a first aid provider to discriminate between high- or low-risk for spine injury. It was noted that criteria for determining high risk for cervical spine injury were reviewed in 2010 for ILCOR, but that other criteria have been developed by various organizations since then, and this topic of first aid recognition of high risk for c-spine injury may be in need of a future scoping or systematic review.

Given these discussion points, combined with the limited additional evidence on spinal motion restriction identified in this review, the task force did not feel there was sufficient information to prompt new systematic reviews or the reconsideration of current resuscitation guidelines/treatment recommendations.

Knowledge Gaps

Although this scoping review has not identified sufficient new evidence to prompt a systematic review it highlights significant gaps in the research evidence related to spinal motion restriction.

  • There were no randomized controlled trials identified that evaluated spinal motion restriction compared with no spinal motion restriction adults and children considered to be at high-risk for cervical spine injury
  • No comparative studies in children with potential spine injuries were identified that evaluate outcomes with cervical spinal motion restriction
  • Research is needed to evaluate training requirements for the proper application of a cervical collar

PRISMA: Cervical Spine Motion Restriction

References

Cowley A, Hague A, Durge N; Cervical spine immobilization during extrication of the awake patient: a narrative review. Eur J Emergency Med. 2017 Jun;24(3):158-161.

Kim, JG, Bang SH , Kang GH, Jang YS, Kim W, Choi HY, Kim GM; Comparison of the Efficacy of Three Cervical Collars in Restricting Cervical Range of Motion: A randomized study. Hong Kong Journal of Emergency Medicine 2018 11/12 1–6

Lemzye M, Palud A, Favory R, Mathieu D; Unintentional Strangulation by a Cervical Collar After Attempted Suicide by Hanging Emergency Medicine Journal 2011:28:532.

March JA, Ausband SC, Brown LH; Changes in Physical Examination Caused by Use of Spinal Immobilization Prehospital Emergency Care 2002;6:421–424

McGrath T, Murphy C; Comparison of a SAM Splint-Molded Cervical Collar with a Philadelphia Cervical Collar. Wilderness and Environmental Medicine, 20, 166 168 (2009)

Schneider AM, Hipp JA, Nguyen L, Reitman CA; Reduction in Head and Intervertebral Motion Provided by 7 Contemporary Cervical Orthoses in 45 individuals 2007 SPINE Volume 32, Number 1, pp E1–E6

Singletary EM, Zideman DA, De Buck ED, Chang WT, Jensen JL, Swain JM, Woodin JA, Blanchard IE, Herrington RA, Pellegrino JL, Hood NA, Lojero-Wheatley LF, Markenson DS, Yang HJ; Part 9: First Aid: 2015 International Consensus on First Aid Science with Treatment Recommendations. Circulation. Oct 20 2015;132 (16 Suppl 1):S269-311.

Zideman DA, Singletary EM, , De Buck EDJ, Chang WT, Jensen JL, Swain JM, Woodin JA, Blanchard IE, Herrington RA, Pellegrino JL, Hood NA, Lojero-Wheatley LF, Markenson DS, Yang HJ; on behalf of the First Aid Chapter Collaborators. Part 9: First aid: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.

Resuscitation. 2015; 95: e225 - e261

Appendix

Appendix 1

Search strategy

Ovid Multi-Database Search – run November 6, 2019

Cochrane Database of Systematic Reviews 2005 to October 30, 2019, EBM Reviews - ACP Journal Club 1991 to October 2019, EBM Reviews - Database of Abstracts of Reviews of Effects 1st Quarter 2016, EBM Reviews - Cochrane Clinical Answers September 2019, EBM Reviews - Cochrane Central Register of Controlled Trials September 2019, EBM Reviews - Cochrane Methodology Register 3rd Quarter 2012, EBM Reviews - Health Technology Assessment 4th Quarter 2016, EBM Reviews - NHS Economic Evaluation Database 1st Quarter 2016, Embase 1974 to 2019 November 05, Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily 1946 to November 05, 2019

1

exp "Neck Injuries"/ or exp "Cervical Vertebrae"/in

15189

2

(exp "Neck"/ or exp "Cervical Vertebrae"/) and (injury or injuries or trauma* or compression).ti,ab,kf,kw.

22459

3

(((neck or cervical) adj2 (injury or injuries or trauma* or compression or cadaver* or volunteer*)) or whiplash*).ti,ab,kf,kw.

28811

4

("Spinal Cord Injuries"/ or "spinal cord injury"/ or (((spinal or spine) adj2 (injury or injuries or trauma* or compression)) or cadaver* or volunteer*).ti,ab,kf,kw.) and ("Neck"/ or (neck or cervical).ti,ab,kf,kw.)

42497

5

or/1-4 [NECK INJURY]

78407

6

exp "Spinal Cord Injuries"/ or exp "Spine"/in

60933

7

((spine or spinal or vertebra* or coccyx or intervertebral or lumbar or sacrum or sacral) adj2 (injury or injuries or trauma* or compression or cadaver* or volunteer*)).ti,ab,kf,kw.

139548

8

6 or 7 [SPINE INJURY]

165185

9

5 or 8 [NECK/SPINE INJURY]

210688

10

(immobiliz* or immobilis* or immobile or stabiliz* or stabilis* or restrain* or "trap squeeze" or "trapezius squeeze" or "head squeeze" or "trap grip" or "trapezius grip" or "head grip").ti,ab,kf,kw.

922769

11

((reduction or reducing or reduce* or restrain* or decreas* or limit or limiting or restrict*) adj2 (movement or movements or motion or mobility or mobile)).ti,ab,kf,kw.

46661

12

(neutral adj2 position*).ti,ab,kf,kw.

7587

13

"Movement"/ph or "Head Movements"/ or "head movement"/ or (movement or motion or application).ti,ab,kf,kw.

1220630

14

"Emergency Medical Services"/mt or "First Aid"/mt

6922

15

(out-of-hospital or "out of hospital" or prehospital or pre-hospital or pre-hospitalization or prehospitalization or pre-hospitalisation or prehospitalisation or (before adj2 hospital) or (before adj2 hospitalization) or (before adj2 hospitalisation)).ti,ab,kf,kw.

208318

16

(EMS or "emergency medical service" or paramedic* or EMT or "emergency medical technician*" or "first responder*" or ambulance*).ti,ab,kf,kw.

124775

17

(bystander* or by-stander* or stranger or strangers or layperson* or lay or public or "first aid" or "in position found").ti,ab,kf,kw.

1072733

18

"Orthotic Devices"/ or "orthoses"/ or "Braces"/ or "brace"/ or "Restraint, Physical"/mt or (orthotic* or orthosis or orthoses or orthesis or "orthopedic support device*" or "orthopaedic support device*" or collar* or brace* or bracing or restraint*).ti,ab,kf,kw.

62391

19

(or/13-17) and 18

10134

20

or/10-12,19 [IMMOBILIZATION/STABILIZATION]

977323

21

9 and 20 [(NECK/SPINE INJURY) + (IMMOBILIZATION/STABILIZATION]

14370

22

(Animals/ or "Animal Experimentation"/ or "Models, Animal"/ or "Disease Models, Animal"/) not (Humans/ or "Human Experimentation"/)

8011146

23

(exp "animal model"/ or exp "animal experiment"/ or "nonhuman"/ or exp "vertebrate"/) not (exp "human"/ or exp "human experiment"/)

9923897

24

21 not (22 or 23) [(NECK/SPINE INJURY) + (IMMOBILIZATION/STABILIZATION), HUMAN]

13509

25

(comment or letter or "newspaper article" or news or note).pt.

3491608

26

24 not 25 [(NECK/SPINE INJURY) + (IMMOBILIZATION/STABILIZATION), HUMAN, SUBSTANTIVE]

13451

27

(Randomized Controlled Trial or Controlled Clinical Trial or Pragmatic Clinical Trial or Equivalence Trial or Clinical Trial, Phase III).pt.

1209797

28

Randomized Controlled Trial/

1071893

29

exp Randomized Controlled Trials as Topic/

309675

30

Controlled Clinical Trial/

556044

31

exp Controlled Clinical Trials as Topic/

321814

32

Randomization/

185770

33

Random Allocation/

206534

34

Double-Blind Method/

446267

35

Double-Blind Studies/

279094

36

Single-Blind Method/

84068

37

Single-Blind Studies/

85973

38

Placebos/

347423

39

Control Groups/

112184

40

Control Group/

112082

41

(random* or sham or placebo*).ti,ab,kf,kw.

3984945

42

((singl* or doubl*) adj (blind* or dumm* or mask*)).ti,ab,kf,kw.

697273

43

((tripl* or trebl*) adj (blind* or dumm* or mask*)).ti,ab,kf,kw.

3766

44

(control* adj3 (study or studies or trial* or group*)).ti,ab,kf,kw.

3039502

45

(nonrandom* or non random* or non-random* or quasi-random* or quasirandom*).ti,ab,kf,kw.

106973

46

allocated.ti,ab,kf,kw.

202888

47

((open label or open-label) adj5 (study or studies or trial*)).ti,ab,kf,kw.

132985

48

((equivalence or superiority or non-inferiority or noninferiority) adj3 (study or studies or trial*)).ti,ab,kf,kw.

30493

49

(pragmatic study or pragmatic studies).ti,ab,kf,kw.

1160

50

((pragmatic or practical) adj3 trial*).ti,ab,kf,kw.

12796

51

((quasiexperimental or quasi-experimental) adj3 (study or studies or trial*)).ti,ab,kf,kw.

18250

52

(phase adj3 (III or "3") adj3 (study or studies or trial*)).ti,ab,kf,kw.

164965

53

or/27-52 [RCT/CT]

6359525

54

"Observational Studies as Topic"/ or observational study.pt.

257141

55

Cohort Studies/ or Follow-Up Studies/ or Longitudinal Studies/ or Prospective Studies/ or Retrospective Studies/

4144413

56

Cross-Sectional Studies/

509674

57

"Evaluation Studies as Topic"/ or evaluation studies.pt.

400112

58

Case-Control Studies/

388727

59

Comparative Study.pt.

2030551

60

(((evaluation or cohort or cohorts or longitudinal or followup or follow-up or prospective or observational or retrospective or population-based or multidimensional or multi-dimensional or case-control or comparative or cross-sectional or evaluation) adj1 (study or studies)) or "cohort analys*").ti,ab,kf,kw.

2762511

61

or/54-60 [OBSERVATIONAL]

7987702

62

"Epidemiologic Studies"/ or "Cross-Over Studies"/ or "crossover procedure"/

360834

63

(((epidemiologic* or intervention or experimental) adj1 (study or studies)) or cross-over or crossover or questionnaire* or survey*).ti,ab,kf,kw.

3131261

64

("before and after" or "interrupted time series").ti,ab,kf,kw.

628823

65

"case series".ti,ab,kf,kw.

169497

66

or/62-65 [ADDITIONAL STUDIES]

4040248

67

26 and (53 or 61 or 66) [(NECK/SPINE INJURY) + (IMMOBILIZATION/STABILIZATION), HUMAN, SUBSTANTIVE, WITH STUDY FILTERS]

5646

68

limit 67 to yr="1999 -Current" [Limit not valid in DARE; records were retained]

EBM Reviews - Cochrane Database of Systematic Reviews <2005 to November 6, 2019>

EBM Reviews - ACP Journal Club <1991 to October 2019>

EBM Reviews - Database of Abstracts of Reviews of Effects <1st Quarter 2016>

EBM Reviews - Cochrane Clinical Answers <October 2019>

EBM Reviews - Cochrane Central Register of Controlled Trials <October 2019>

EBM Reviews - Cochrane Methodology Register <3rd Quarter 2012>

EBM Reviews - Health Technology Assessment <4th Quarter 2016>

EBM Reviews - NHS Economic Evaluation Database <1st Quarter 2016>

Embase <1974 to 2019 November 05>

Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily <1946 to November 05, 2019>

4706

3

2

1

0

411

0

0

1

1989

2299

69

remove duplicates from 68

EBM Reviews - Cochrane Database of Systematic Reviews <2005 to November 6, 2019>

EBM Reviews - ACP Journal Club <1991 to October 2019>

EBM Reviews - Database of Abstracts of Reviews of Effects <1st Quarter 2016>

EBM Reviews - Cochrane Clinical Answers <October 2019>

EBM Reviews - Cochrane Central Register of Controlled Trials <October 2019>

EBM Reviews - Cochrane Methodology Register <3rd Quarter 2012>

EBM Reviews - Health Technology Assessment <4th Quarter 2016>

EBM Reviews - NHS Economic Evaluation Database <1st Quarter 2016>

Embase <1974 to 2019 November 05>

Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily <1946 to November 05, 2019>

3379

3

2

1

0

166

0

0

1

908

2298

CINAHL Plus with Full Text (EBSCOhost) – run November 10, 2019

S1

(MH "Neck Injuries+") OR (MH "Cervical Vertebrae+/IN")

5,080

S2

((MH "Neck") OR (MH "Cervical Vertebrae+")) AND (TI (injury OR injuries OR trauma* OR compression) OR AB (injury OR injuries OR trauma* OR compression))

3,663

S3

(TI (((neck OR cervical) N2 (injury OR injuries OR trauma* OR compression OR cadaver* OR volunteer*)) OR whiplash*) OR AB (((neck OR cervical) N2 (injury OR injuries OR trauma* OR compression OR cadaver* OR volunteer*)) OR whiplash*))

5,577

S4

((MH "Spinal Cord Injuries+") OR (TI (((spinal OR spine) N2 (injury OR injuries OR trauma* OR compression)) OR cadaver* OR volunteer*) OR AB (((spinal OR spine) N2 (injury OR injuries OR trauma* OR compression)) OR cadaver* OR volunteer*)) AND ((MH "Neck") OR (TI (neck OR cervical) OR AB (neck OR cervical))

99,477

S5

S1 OR S2 OR S3 OR S4

101,704

S6

(MH "Spinal Cord Injuries+") OR (MH "Spine/IN")

19,242

S7

TI ((spine OR spinal OR vertebra* OR coccyx OR intervertebral OR lumbar OR sacrum OR sacral) N2 (injury OR injuries OR trauma* OR compression OR cadaver* OR volunteer*)) OR AB ((spine OR spinal OR vertebra* OR coccyx OR intervertebral OR lumbar OR sacrum OR sacral) N2 (injury OR injuries OR trauma* OR compression OR cadaver* OR volunteer*))

21,356

S8

S6 OR S7

27,421

S9

S5 OR S8

107,644

S10

TI (immobiliz* OR immobilis* OR immobile OR stabiliz* OR stabilis* OR restrain* OR "trap squeeze" OR "trapezius squeeze" OR "head squeeze" OR "trap grip" OR "trapezius grip" OR "head grip") OR AB (immobiliz* OR immobilis* OR immobile OR stabiliz* OR stabilis* OR restrain* OR "trap squeeze" OR "trapezius squeeze" OR "head squeeze" OR "trap grip" OR "trapezius grip" OR "head grip")

34,300

S11

TI ((reduction OR reducing OR reduce* OR restrain* OR decreas* OR limit OR limiting OR restrict*) N2 (movement OR movements OR motion OR mobility OR mobile)) OR AB ((reduction OR reducing OR reduce* OR restrain* OR decreas* OR limit OR limiting OR restrict*) N2 (movement OR movements OR motion OR mobility OR mobile))

5,675

S12

TI (neutral N2 position*) OR AB (neutral N2 position*)

1,083

S13

(MH "Movement/PH") OR TI (movement OR motion OR application) OR AB (movement OR motion OR application)

189,744

S14

(MH "Emergency Medical Services/MT") OR (MH "First Aid/MT")

1,949

S15

TI (out-of-hospital OR "out of hospital" OR prehospital OR pre-hospital OR pre-hospitalization OR prehospitalization OR pre-hospitalisation OR prehospitalisation OR (before N2 hospital) OR (before N2 hospitalization) OR (before Nj2 hospitalisation)) OR AB (out-of-hospital OR "out of hospital" OR prehospital OR pre-hospital OR pre-hospitalization OR prehospitalization OR pre-hospitalisation OR prehospitalisation OR (before N2 hospital) OR (before N2 hospitalization) OR (before Nj2 hospitalisation))

15,844

S16

TI (EMS OR "emergency medical service" OR paramedic* OR EMT OR "emergency medical technician*" OR "first responder*" OR ambulance*) OR TI (EMS OR "emergency medical service" OR paramedic* OR EMT OR "emergency medical technician*" OR "first responder*" OR ambulance*)

11,394

S17

TI (bystander* OR by-stander* OR stranger OR strangers OR layperson* OR lay OR public OR "first aid" OR "in position found") OR AB (bystander* OR by-stander* OR stranger OR strangers OR layperson* OR lay OR public OR "first aid" OR "in position found")

162,230

S18

(MH "Orthoses") OR (MH "Restraint, Physical/MT") OR TI (orthotic* OR orthosis OR orthoses OR orthesis OR "orthopedic support device*" OR "orthopaedic support device*" OR collar* OR brace* OR bracing OR restraint*) OR AB (orthotic* OR orthosis OR orthoses OR orthesis OR "orthopedic support device*" OR "orthopaedic support device*" OR collar* OR brace* OR bracing OR restraint*)

18,872

S19

(S13 OR S14 OR S15 OR S16 OR S16 OR S17) AND S18

2,946

S20

S10 OR S11 OR S12 OR S19

42,128

S21

S9 AND S20

3,671

S22

(MH "Vertebrates+") NOT (MH "Human")

170,306

S23

S21 NOT S22

3,608

S24

(PT "commentary" OR "editorial" OR "letter" OR "pamphlet" OR "pamphlet chapter")

325,656

S25

S23 NOT S24

3,537

S26

(MH "Randomized Controlled Trials+") OR (MH "Clinical Trials") OR (MH "Random Assignment") OR (MH "Single-Blind Studies") OR (MH "Double-Blind Studies") OR (MH "Triple-Blind Studies") OR (MH "Placebos") OR (MH "Control Group")

296,021

S27

TI (random* OR sham OR placebo*) OR AB (random* OR sham OR placebo*)

323,775

S28

TI ((singl* OR doubl* OR tripl* OR trebl*) W (blind* OR dumm* OR mask*)) OR AB ((singl* OR doubl* OR tripl* OR trebl*) W (blind* OR dumm* OR mask*))

309

S29

TI (control* N3 (study OR studies OR trial* OR group*)) OR AB (control* N3 (study OR studies OR trial* OR group*))

251,366

S30

TI (nonrandom* OR non random* OR non-random* OR quasi-random* OR quasirandom* OR ALLOCATED) OR AB (nonrandom* OR non random* OR non-random* OR quasi-random* OR quasirandom* OR ALLOCATED)

56,142

S31

TI (nonrandom* OR non random* OR non-random* OR quasi-random* OR quasirandom* OR allocated) OR AB (nonrandom* OR non random* OR non-random* OR quasi-random* OR quasirandom* OR allocated)

56,142

S32

TI (("open label" OR open-label) N5 (study OR studies OR trial*)) OR AB (("open label" OR open-label) N5 (study OR studies OR trial*))

11,032

S33

TI ((equivalence OR superiority OR non-inferiority OR noninferiority) N3 (study OR studies OR trial*)) OR AB ((equivalence OR superiority OR non-inferiority OR noninferiority) N3 (study OR studies OR trial*))

3,407

S34

TI ("pragmatic study" OR "pragmatic studies") OR AB ("pragmatic study" OR "pragmatic studies")

169

S35

TI ((pragmatic OR practical) N3 trial*) OR AB ((pragmatic OR practical) N3 trial*)

2,269

S36

TI ((quasiexperimental OR quasi-experimental) N3 (study OR studies OR trial*)) OR AB (quasiexperimental OR quasi-experimental) N3 (study OR studies OR trial*))

5,147

S37

TI (phase Nj3 (III OR "3") N3 (study OR studies OR trial*)) OR AB (phase N3 (III OR "3") N3 (study OR studies OR trial*))

9,685

S38

S26 OR S27 OR S28 OR S29 OR S30 OR S31 OR S32 OR S33 OR S34 OR S35 OR S36 OR S37

569,502

S39

(MH "Nonexperimental Studies") OR (MH "Prospective Studies+") OR (MH "Retrospective Design") OR (MH "Cross-Sectional Studies") OR (MH "Evaluation Research+") OR (MH "Case-Control Studies+") OR "MH "Comparitive Studies")

690,222

S40

TI (((evaluation OR cohort OR cohorts OR longitudinal OR followup OR follow-up OR prospective OR observational OR retrospective OR population-based OR multidimensional OR multi-dimensional OR case-control OR comparative OR cross-sectional OR evaluation) N1 (study OR studies)) OR "cohort analys*") OR AB (((evaluation OR cohort OR cohorts OR longitudinal OR followup OR follow-up OR prospective OR observational OR retrospective OR population-based OR multidimensional OR multi-dimensional OR case-control OR comparative OR cross-sectional OR evaluation) N1 (study OR studies)) OR "cohort analys*")

347,908

S41

S39 OR S40

854,338

S42

(MH "Epidemiologic Research") OR (MH "Crossover Design")

17,625

S43

TI (((epidemiologic* OR intervention OR experimental) N1 (study OR studies)) OR cross-over OR crossover OR questionnaire* OR survey*) OR AB (((epidemiologic* OR intervention OR experimental) N1 (study OR studies)) OR cross-over OR crossover OR questionnaire* OR survey*)

431,515

S44

TI ("before AND after" OR "interrupted time series") OR AB ("before AND after" OR "interrupted time series")

51,966

S45

TI ("case series") OR AB ("case series")

19,482

S46

S42 OR S43 OR S44 OR S45

497,744

S47

S25 AND (S38 OR S41 0R S46)

599

S48

S47 AND (DT 1999-2019

568


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