Dizzy from March #GeriMedJC? Check-out the related April 2015 #GeriMedJC article.

What does a short article mean?  In the live version of the Geriatric Medicine Journal Club held at the University of Toronto, the last 15 minutes of the hour is devoted to the presentation and discussion of the article.

For those who couldn't get enough of orthostatic hypotension from last month's #GeriMedJC (link to Droxidopa discussion here), the April #GeriMedJC short article will explore the non-pharmacologic management of this entity.

Mills PB, Fung CK, Travlos A, Krassioukov A. Nonpharmacologic management of orthostatic hypotension: a systematic review. Arch Phys Med Rehabil. 2015 Feb;96(2):366-375. 

Engage in the discussion on Twitter on April 24, 2015 at 08:00 EDT / 12:00 GMT and don't forget to use the hashtag #GeriMedJC.

The full article can be found here and the abstract is posted below:

OBJECTIVE:

To systematically review the literature on nonpharmacologic treatment of orthostatic hypotension.

DATA SOURCES:

MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, Cochrane Central Register of Controlled Trials, and SPORTDiscus were searched for human studies written in the English language between January 1980 and April 2013. Reference lists of relevant articles were reviewed for citations to expand the data set.

STUDY SELECTION:

Prospective experimental studies assessing nonpharmacologic interventions for management of orthostatic drop in blood pressure in various patient populations were included. All studies identified through the literature search were reviewed independently in duplicate. Of the 642 studies, 23 met the selection criteria.

DATA EXTRACTION:

Two reviewers independently extracted data for analysis, including systolic and diastolic blood pressure and orthostatic symptoms in response to postural challenge before and after the intervention. All 23 studies were assessed in duplicate for risk of bias using the Physiotherapy Evidence Database scale for randomized controlled trials and the Downs and Black tool for nonrandomized trials.

DATA SYNTHESIS:

There were 8 identified nonpharmacologic interventions for management of orthostatic hypotension under 2 general categories: physical modalities (exercise, functional electrical stimulation, compression, physical countermaneuvers, compression with physical countermaneuvers, sleeping with head up) and dietary measures (water intake, meals). Owing to the clinically diverse nature of the studies, statistical comparison (meta-analysis) was deemed inappropriate. Instead, descriptive comparisons were drawn. Levels of evidence were assigned.

CONCLUSIONS:

Strong levels of evidence were found for 4 of the 8 interventions: functional electrical stimulation in spinal cord injury, compression of the legs and/or abdomen, physical countermaneuvers in various patient populations, and eating smaller and more frequent meals in chronic autonomic failure. However, this conclusion is based on a limited number of studies with small sample sizes. Further research into all interventions is warranted.

Did you miss last month's discussion on orthostatic hypotension? We reviewed a double-blind, placebo-controlled trial of droxidopa for neurogenic orthostatic hypotension.  See the transcript of the tweet chat here.

Note that for this month, we will not have a long article preceding the short article discussion.  The first part of the live journal club will be a special presentation from Dr. Paula Rochon on Exploring Sex Differences in Adverse Drug Events.  Dr. Rochon is a geriatrician and the Vice-President of Research at Women’s College Hospital. She is also a senior scientist at Women's College Research Institute, a University of Toronto professor (Department of Medicine, and the Institute of Health Policy, Management & Evaluation) and a senior scientist at the Institute for Clinical Evaluative Sciences.