Search

Purpose: Anorectal and urogenital dysfunctions are common after rectal surgery and have a significant impact on quality of life. Intraoperative pelvic autonomic nerve monitoring (pIONM) has been proposed as a tool to identify patients at risk of these functional sequelae. This systematic review aims to evaluate the diagnostic accuracy of pIONM in detecting anorectal and urogenital dysfunction following rectal surgery. Methods: A systematic review of articles published since 1990 was conducted using MEDLINE, Embase, CINAHL, Google Scholar, Scopus, and Web of Science. Studies describing pIONM for rectal surgery and reporting anorectal or urogenital functional outcomes were included. The risk of bias was assessed using the QUADS-2 tool. The diagnostic accuracy of pIONM was established with pooled sensitivity and specificity alongside summary receiver-operating characteristic curves. Results: Twenty studies including 686 patients undergoing pIONM were identified, with seven of these studies including a control group. There was heterogeneity in the pIONM technique and reported outcome measures used. Results from five studies indicate pIONM may be able to predict postoperative anorectal (sensitivity 1.00 [95% CI 0.03–1.00], specificity 0.98 [0.91–0.99]) and urinary (sensitivity 1.00 [95% CI 0.03–1.00], specificity 0.99 [0.92–0.99]) dysfunction. Conclusions: This review identifies the diagnostic accuracy of pIONM in detecting postoperative anorectal and urogenital dysfunction following rectal surgery. Further research is necessary before pIONM can be routinely used in clinical practice. PROSPERO Registration Details: CRD42022313934. [ABSTRACT FROM AUTHOR]

In recent decades, the senior adults population worldwide has increased, as well as the medical conditions related to aging, such as cognitive decline. Virtual reality (VR) games are a valuable addition to conventional cognitive rehabilitation as they increase engagement to the therapy through customization, socialization, immersion, and feedback. This review, performed according to PRISMA protocol, addresses the following questions: How VR games have been used for cognitive rehabilitation?, What cognitive domains have been addressed by VR games and in which populations have these games been used?, Which features have been considered to improve engagement in VR games for cognitive rehabilitation?, How is the difficulty adjustment of exercises carried out in VR games for cognitive rehabilitation?. We found 25 scientific works related to these questions, 92% of them treating one cognitive domain at a time, despite the fact that the related literature recognizes the value of training multiple domains simultaneously. Our review indicates that, despite the existence of serious VR games for working memory training, such as those described in Flak et al. (Front Psychol 10:807, 2019. ), to our knowledge, there are no applications that simultaneously address multiple cognitive domains and incorporate dynamic difficulty adjustment, which are important to ensure ecological validity of therapy and therapy adherence, respectively. In addition, we found that games themselves could be used to monitor the user’s progression. It is also important to determine the impact of multiplayer interactions in the game, test difficulty adjustment approaches that use physiological variables, and define difficulty-skill relationships aligned with the user’s preferences. This paper concludes that the main barriers to implement dynamic difficulty adjustment in VR games for cognitive rehabilitation are: (i) the absence of metrics to estimate when the game offers to the players a challenge adapted their skills, and (ii) the lack of a conceptual framework that integrates relevant theories such as state of flow, cognitive load, cognitive rehabilitation, and feedback systems. [ABSTRACT FROM AUTHOR]