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Duarte GS, Rodrigues FB, Prescott D, Ferreira J, Costa J. Deep brain stimulation for dystonia. Hippokratia 2016. [DOI: 10.1002/14651858.cd012405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Gonçalo S Duarte
- Faculdade de Medicina de Lisboa; Laboratório de Farmacologia Clínica e Terapêutica; Avenida Professor Egas Moniz Lisboa Lisboa Portugal 1649-028
| | - Filipe B Rodrigues
- Faculdade de Medicina de Lisboa; Laboratório de Farmacologia Clínica e Terapêutica; Avenida Professor Egas Moniz Lisboa Lisboa Portugal 1649-028
| | - David Prescott
- Faculdade de Medicina de Lisboa; Laboratório de Farmacologia Clínica e Terapêutica; Avenida Professor Egas Moniz Lisboa Lisboa Portugal 1649-028
| | - Joaquim Ferreira
- Faculdade de Medicina de Lisboa; Laboratório de Farmacologia Clínica e Terapêutica; Avenida Professor Egas Moniz Lisboa Lisboa Portugal 1649-028
| | - João Costa
- Faculdade de Medicina de Lisboa; Laboratório de Farmacologia Clínica e Terapêutica; Avenida Professor Egas Moniz Lisboa Lisboa Portugal 1649-028
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Abstract
Study Design Systematic review. Background Soft tissue injuries to the lower limb bring a substantial health and economic burden to society. Physical agents are commonly used to treat these injuries. However, the effectiveness of many such physical agents is not clearly established in the literature. Objective To evaluate the effectiveness and safety of physical agents for soft tissue injuries of the lower limb. Methods We searched 5 databases from 1990 to 2015 for randomized controlled trials (RCTs), cohort studies, and case-control studies. Paired reviewers independently screened the retrieved literature and appraised relevant studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with a high risk of bias were excluded. We synthesized low-risk-of-bias studies according to principles of best-evidence synthesis. Results We screened 10261 articles. Of 43 RCTs identified, 20 had a high risk of bias and were excluded from the analysis, and 23 RCTs had a low risk of bias and were included in the analysis. The available higher-quality evidence suggests that patients with persistent plantar fasciitis may benefit from ultrasound or foot orthoses, while those with persistent midportion Achilles tendinopathy may benefit from shockwave therapy. However, the current evidence does not support the use of shockwave therapy for recent plantar fasciitis, low-Dye taping for persistent plantar fasciitis, low-level laser therapy for recent ankle sprains, or splints for persistent midportion Achilles tendinopathy. Finally, evidence on the effectiveness of the following interventions is not established in the current literature: (1) shockwave therapy for persistent plantar fasciitis, (2) cryotherapy or assistive devices for recent ankle sprains, (3) braces for persistent midportion Achilles tendinopathy, and (4) taping or electric muscle stimulation for patellofemoral pain syndrome. Conclusion Almost half the identified RCTs that evaluated the effectiveness of physical agents for the management of lower-limb soft tissue injuries had a high risk of bias. High-quality RCTs are still needed to assess the effectiveness of physical agents for managing the broad range of lower-limb soft tissue injuries. The effectiveness of most interventions remains unclear. Level of Evidence Therapy, 1a. Protocol registered July 10, 2014 with PROSPERO (CRD42014010621). J Orthop Sports Phys Ther 2016;46(7):523-554. Epub 6 Jun 2016. doi:10.2519/jospt.2016.6521.
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Tek C, Kucukgoncu S, Guloksuz S, Woods SW, Srihari VH, Annamalai A. Antipsychotic-induced weight gain in first-episode psychosis patients: a meta-analysis of differential effects of antipsychotic medications. Early Interv Psychiatry 2016; 10:193-202. [PMID: 25962699 PMCID: PMC5589463 DOI: 10.1111/eip.12251] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 04/12/2015] [Indexed: 12/19/2022]
Abstract
AIM The first-episode psychosis (FEP) represents a critical period to prevent cardiovascular and metabolic morbidity decades later. Antipsychotic (AP)-induced weight gain is one modifiable factor in this period. The purpose of this study is to conduct a meta-analysis of AP-induced weight and body mass index (BMI) change in FEP. METHODS A comprehensive literature search identified 28 articles that reported data on AP-specific weight or BMI change in FEP. We conducted a meta-analysis of short- and long-term mean weight and BMI differences between placebo and AP medications. We also performed subgroup and meta-regression analysis to examine weight, BMI outcomes and their relationship with location (Asian vs. Western), sponsorship and baseline weight and BMIs. RESULTS Compared to placebo, AP-caused mean weight gain was 3.22 kg and 1.4 points BMI in the short-term, and 5.30 kg and 1.86 points BMI in the long term. Clinically significant weight gain risk increased about twofold with AP use. Weight gain was associated with duration of AP use. AP medications were associated with more weight gain in Western samples as opposed to Asian samples. Most AP medications were associated with significant body weight gain and BMI increase in FEP patients, except for ziprasidone. Olanzapine and clozapine caused the highest weight gain compared to placebo. CONCLUSION Except for ziprasidone, most AP medications were associated with body weight gain and BMI increase in FEP patients. Early and continuing effects of various AP medications on weight gain and BMI increase should be taken into consideration by clinicians.
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Affiliation(s)
- Cenk Tek
- Yale University Department of Psychiatry, Connecticut Mental Health Hospital, New Haven, Connecticut, USA
| | - Suat Kucukgoncu
- Yale University Department of Psychiatry, Connecticut Mental Health Hospital, New Haven, Connecticut, USA
| | - Sinan Guloksuz
- Yale University Department of Psychiatry, Connecticut Mental Health Hospital, New Haven, Connecticut, USA
| | - Scott W Woods
- Yale University Department of Psychiatry, Connecticut Mental Health Hospital, New Haven, Connecticut, USA
| | - Vinod H Srihari
- Yale University Department of Psychiatry, Connecticut Mental Health Hospital, New Haven, Connecticut, USA
| | - Aniyizhai Annamalai
- Yale University Department of Psychiatry, Connecticut Mental Health Hospital, New Haven, Connecticut, USA
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Effectiveness of Acupuncture Therapies to Manage Musculoskeletal Disorders of the Extremities: A Systematic Review. J Orthop Sports Phys Ther 2016; 46:409-29. [PMID: 27117725 DOI: 10.2519/jospt.2016.6270] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Systematic review. Background Little is known about the effectiveness of acupuncture therapies for musculoskeletal disorders. Objective To assess the effectiveness and safety of acupuncture therapies for musculoskeletal disorders of the extremities. Methods We searched MEDLINE, Embase, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials from 1990 to 2015 for randomized controlled trials, cohort studies, and case-control studies. Eligible studies were appraised with Scottish Intercollegiate Guidelines Network criteria. A best-evidence synthesis was performed to synthesize results from included studies with a low risk of bias. A sensitivity analysis was conducted to determine the impact of excluding studies with a high risk of bias. Results The search revealed 5180 articles; 15 were included (10 with a low risk of bias, 5 with a high risk of bias). The studies with a low risk of bias suggested that (1) traditional needle acupuncture was superior to oral steroids (1 RCT, n = 77) and may be superior to vitamin B1/B6 supplements (1 RCT, n = 64) for carpal tunnel syndrome (CTS), and was superior to exercise for Achilles tendinopathy (1 RCT, n = 64). Traditional needle acupuncture did not provide important benefit over placebo for upper extremity pain (1 RCT, n = 128), or no intervention for patellofemoral pain (1 RCT, n = 75), and was inconclusive for shoulder pain (2 RCTs, n = 849), suggesting no important benefit; (2) electroacupuncture may be superior to placebo for shoulder injuries (1 RCT, n = 130) and may not be superior to night splinting for persistent CTS (1 RCT, n = 78); and (3) dry needling may be superior to placebo for plantar fasciitis (1 RCT, n = 84). Sensitivity analysis suggests that including studies with a high risk of bias might have impacted the evidence synthesis in support of managing shoulder pain with traditional needle acupuncture, and that would suggest traditional needle acupuncture may be effective for lateral epicondylitis and piriformis syndrome. Conclusion Evidence for the effectiveness of acupuncture for musculoskeletal disorders of the extremities was inconsistent. Traditional needle acupuncture may be beneficial for CTS and Achilles tendinopathy, but not for nonspecific upper extremity pain and patellofemoral syndrome. Electroacupuncture may be effective for shoulder injuries and may show similar effectiveness to that of night wrist splinting for CTS. The effectiveness of dry needling for plantar fasciitis is equivocal. Level of Evidence Therapy, 1a-. J Orthop Sports Phys Ther 2016;46(6):409-429. Epub 26 Apr 2016. doi:10.2519/jospt.2016.6270.
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Marques RE, Duarte GS, Rodrigues FB, Castelão M, Ferreira J, Sampaio C, Moore AP, Costa J. Botulinum toxin type B for cervical dystonia. Cochrane Database Syst Rev 2016; 2016:CD004315. [PMID: 27176573 PMCID: PMC8552447 DOI: 10.1002/14651858.cd004315.pub3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND This is an update of a Cochrane review first published in 2004, and previously updated in 2009 (no change in conclusions). Cervical dystonia is a frequent and disabling disorder characterised by painful involuntary head posturing. Botulinum toxin type A (BtA) is usually considered the first line therapy for this condition, although botulinum toxin type B (BtB) is an alternative option. OBJECTIVES To compare the efficacy, safety and tolerability of botulinum toxin type B (BtB) versus placebo in people with cervical dystonia. SEARCH METHODS We identified studies for inclusion in the review using the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, reference lists of articles and conference proceedings, last run in October 2015. We ran the search from 1977 to 2015. The search was unrestricted by language. SELECTION CRITERIA Double-blind, parallel, randomised, placebo-controlled trials (RCTs) of BtB versus placebo in adults with cervical dystonia. DATA COLLECTION AND ANALYSIS Two independent authors assessed records, selected included studies, extracted data using a paper pro forma and evaluated the risk of bias. We resolved disagreements by consensus or by consulting a third author. We performed one meta-analysis for the comparison BtB versus placebo. We used random-effects models when there was heterogeneity and fixed-effect models when there was no heterogeneity. In addition, we performed pre-specified subgroup analyses according to BtB doses and BtA previous clinical responsiveness. The primary efficacy outcome was overall improvement on any validated symptomatic rating scale. The primary safety outcome was the number of participants with any adverse event. MAIN RESULTS We included four RCTs of moderate overall methodological quality, including 441 participants with cervical dystonia. Three studies excluded participants known to have poorer response to Bt treatment, therefore including an enriched population with a higher probability of benefiting from Bt treatment. None of the trials were independently funded. All RCTs evaluated the effect of a single Bt treatment session using doses between 2500 U and 10,000 U. BtB was associated with an improvement of 14.7% (95% CI 9.8% to 19.5) in the patients' baseline clinical status as assessed by investigators, with reduction of 6.8 points in the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS-total score) at week 4 after injection (95% CI 4.54 to 9.01). Mean difference (MD) in TWSTRS-pain score at week 4 was 2.20 (95% CI 1.25 to 3.15). Overall, both participants and clinicians reported an improvement of subjective clinical status. There were no differences between groups in the withdrawals rate due to adverse events or in the proportion of participants with adverse events. However, BtB-treated patients had a 7.65 (95% CI 2.75 to 21.32) and a 6.78 (95% CI 2.42 to 19.05) increased risk of treatment-related dry mouth and dysphagia, respectively. Statistical heterogeneity between studies was low to moderate for most outcomes. All tested dosages were efficacious against placebo without clear-cut evidence of a dose-response gradient. However, duration of effect (time until return to baseline TWSTRS-total score) and risk of dry mouth and dysphagia were greater in the subgroup of participants treated with higher BtB doses. Subgroup analysis showed a higher improvement with BtB among BtA-non-responsive participants, although there were no differences in the effect size between the BtA-responsive and non-responsive subgroups. AUTHORS' CONCLUSIONS A single BtB-treatment session is associated with a significant and clinically relevant reduction of cervical dystonia impairment including severity, disability and pain, and is well tolerated, when compared with placebo. However, BtB-treated patients are at an increased risk of dry mouth and dysphagia. There are no data from RCTs evaluating the effectiveness and safety of repeated BtB injection cycles. There are no RCT data to allow us to draw definitive conclusions on the optimal treatment intervals and doses, usefulness of guidance techniques for injection, and impact on quality of life.
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Affiliation(s)
- Raquel E Marques
- Faculdade de Medicina de LisboaLaboratório de Farmacologia Clínica e TerapêuticaAv. Professor Egas MonizLisboaPortugal1649‐028
- Instituto de Medicina MolecularClinical Pharmacology UnitAvenida Professor Egas MonizLisboaPortugal1649‐028
| | - Gonçalo S Duarte
- Faculdade de Medicina de LisboaLaboratório de Farmacologia Clínica e TerapêuticaAv. Professor Egas MonizLisboaPortugal1649‐028
- Instituto de Medicina MolecularClinical Pharmacology UnitAvenida Professor Egas MonizLisboaPortugal1649‐028
| | - Filipe B Rodrigues
- Faculdade de Medicina de LisboaLaboratório de Farmacologia Clínica e TerapêuticaAv. Professor Egas MonizLisboaPortugal1649‐028
- Instituto de Medicina MolecularClinical Pharmacology UnitAvenida Professor Egas MonizLisboaPortugal1649‐028
| | - Mafalda Castelão
- Faculdade de Medicina de LisboaLaboratório de Farmacologia Clínica e TerapêuticaAv. Professor Egas MonizLisboaPortugal1649‐028
- Instituto de Medicina MolecularClinical Pharmacology UnitAvenida Professor Egas MonizLisboaPortugal1649‐028
| | - Joaquim Ferreira
- Faculdade de Medicina de LisboaLaboratório de Farmacologia Clínica e TerapêuticaAv. Professor Egas MonizLisboaPortugal1649‐028
- Instituto de Medicina MolecularClinical Pharmacology UnitAvenida Professor Egas MonizLisboaPortugal1649‐028
| | - Cristina Sampaio
- CHDI Foundation155 Village BoulevardSuite 200PrincetonNJUSA08540
| | - A Peter Moore
- The Walton Centre NHS Foundation TrustLower LaneLiverpoolUKL9 7LJ
| | - João Costa
- Faculdade de Medicina de LisboaLaboratório de Farmacologia Clínica e TerapêuticaAv. Professor Egas MonizLisboaPortugal1649‐028
- Instituto de Medicina MolecularClinical Pharmacology UnitAvenida Professor Egas MonizLisboaPortugal1649‐028
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Sutton D, Gross DP, Côté P, Randhawa K, Yu H, Wong JJ, Stern P, Varatharajan S, Southerst D, Shearer HM, Stupar M, Goldgrub R, van der Velde G, Nordin M, Carroll LJ, Taylor-Vaisey A. Multimodal care for the management of musculoskeletal disorders of the elbow, forearm, wrist and hand: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Chiropr Man Therap 2016; 24:8. [PMID: 26955466 PMCID: PMC4780149 DOI: 10.1186/s12998-016-0089-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 02/11/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Musculoskeletal disorders of the elbow, forearm, wrist and hand are associated with pain, functional impairment and decreased productivity in the general population. Combining several interventions in a multimodal program of care is reflective of current clinical practice; however there is limited evidence to support its effectiveness. The purpose of our review was to investigate the effectiveness of multimodal care for the management of musculoskeletal disorders of the elbow, forearm, wrist and hand on self-rated recovery, functional recovery, or clinical outcomes in adults or children. METHODS We conducted a systematic review of the literature and best evidence synthesis. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials from January 1990 to March 2015. Randomized controlled trials, cohort studies, and case-control studies were eligible. Random pairs of independent reviewers screened studies for relevance and critically appraised relevant studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with a low risk of bias were synthesized following best evidence synthesis principles. RESULTS We screened 5989 articles, and critically appraised eleven articles. Of those, seven had a low risk of bias; one addressed carpal tunnel syndrome and six addressed lateral epicondylitis. Our search did not identify any low risk of bias studies examining the effectiveness of multimodal care for the management of other musculoskeletal disorders of the elbow, forearm, wrist or hand. The evidence suggests that multimodal care for the management of lateral epicondylitis may include education, exercise (strengthening, stretching, occupational exercise), manual therapy (manipulation) and soft tissue therapy (massage). The evidence does not support the use of multimodal care for the management of carpal tunnel syndrome. CONCLUSIONS The current evidence on the effectiveness of multimodal care for musculoskeletal disorders of the elbow, forearm, wrist and hand is limited. The available evidence suggests that there may be a role for multimodal care in the management of patients with persistent lateral epicondylitis. Future research is needed to examine the effectiveness of multimodal care and guide clinical practice. SYSTEMATIC REVIEW REGISTRATION NUMBER CRD42014009093.
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Affiliation(s)
- Deborah Sutton
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario Canada M2H 3J1 ; Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario Canada M2H 3J1
| | - Douglas P Gross
- Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, 8205 114 St, 3-28 Corbett Hall, Edmonton, AB Canada T6G 2G4 ; Rehabilitation Research Centre, University of Alberta, 8205 114 St, 3-48 Corbett Hall, Edmonton, AB Canada T6G 2G4
| | - Pierre Côté
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario Canada M2H 3J1 ; Canada Research Chair in Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Oshawa, Ontario Canada L1H 7L7 ; Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Oshawa, Ontario Canada L1H 7L7
| | - Kristi Randhawa
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario Canada M2H 3J1 ; Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario Canada M2H 3J1 ; Division of Undergraduate Education, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario Canada M2H 3J1
| | - Hainan Yu
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario Canada M2H 3J1 ; Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario Canada M2H 3J1
| | - Jessica J Wong
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario Canada M2H 3J1 ; Division of Undergraduate Education, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario Canada M2H 3J1
| | - Paula Stern
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario Canada M2H 3J1 ; Graduate Education Program, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario Canada M2H 3J1
| | - Sharanya Varatharajan
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario Canada M2H 3J1 ; Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario Canada M2H 3J1 ; Division of Undergraduate Education, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario Canada M2H 3J1
| | - Danielle Southerst
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario Canada M2H 3J1 ; Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex, 60 Murray Street, 2nd Floor (Main), Toronto, Ontario Canada M5T 3L9
| | - Heather M Shearer
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario Canada M2H 3J1 ; Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario Canada M2H 3J1
| | - Maja Stupar
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario Canada M2H 3J1
| | - Rachel Goldgrub
- Graduate Student, Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Oshawa, L1H 7L7 Ontario Canada
| | - Gabrielle van der Velde
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, 6th Floor, Room 658, 144 College Street, Toronto, Ontario Canada M5S 3M2 ; Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, Ontario Canada M5S 3M2 ; Institute for Work and Health, 481 University Avenue, Toronto, Ontario Canada M5G 2E9
| | - Margareta Nordin
- Departments of Orthopedic Surgery and Environmental Medicine, Occupational and Industrial Orthopedic Center, NYU School of Medicine, New York University, 550 1st Avenue, New York, NY 10016 USA
| | - Linda J Carroll
- School of Public Health and Injury Prevention Centre, University of Alberta, 3-300 Edmonton Clinic Health Academy 11405 - 87 Ave, Edmonton, Alberta Canada T6G 1C9
| | - Anne Taylor-Vaisey
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario Canada M2H 3J1
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Varatharajan S, Ferguson B, Chrobak K, Shergill Y, Côté P, Wong JJ, Yu H, Shearer HM, Southerst D, Sutton D, Randhawa K, Jacobs C, Abdulla S, Woitzik E, Marchand AA, van der Velde G, Carroll LJ, Nordin M, Ammendolia C, Mior S, Ameis A, Stupar M, Taylor-Vaisey A. Are non-invasive interventions effective for the management of headaches associated with neck pain? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:1971-99. [PMID: 26851953 DOI: 10.1007/s00586-016-4376-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 01/06/2016] [Accepted: 01/07/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE To update findings of the 2000-2010 Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders and evaluate the effectiveness of non-invasive and non-pharmacological interventions for the management of patients with headaches associated with neck pain (i.e., tension-type, cervicogenic, or whiplash-related headaches). METHODS We searched five databases from 1990 to 2015 for randomized controlled trials (RCTs), cohort studies, and case-control studies comparing non-invasive interventions with other interventions, placebo/sham, or no interventions. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria to determine scientific admissibility. Studies with a low risk of bias were synthesized following best evidence synthesis principles. RESULTS We screened 17,236 citations, 15 studies were relevant, and 10 had a low risk of bias. The evidence suggests that episodic tension-type headaches should be managed with low load endurance craniocervical and cervicoscapular exercises. Patients with chronic tension-type headaches may also benefit from low load endurance craniocervical and cervicoscapular exercises; relaxation training with stress coping therapy; or multimodal care that includes spinal mobilization, craniocervical exercises, and postural correction. For cervicogenic headaches, low load endurance craniocervical and cervicoscapular exercises; or manual therapy (manipulation with or without mobilization) to the cervical and thoracic spine may also be helpful. CONCLUSIONS The management of headaches associated with neck pain should include exercise. Patients who suffer from chronic tension-type headaches may also benefit from relaxation training with stress coping therapy or multimodal care. Patients with cervicogenic headache may also benefit from a course of manual therapy.
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Affiliation(s)
- Sharanya Varatharajan
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada.,Division of Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada.,Division of Undergraduate Education, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
| | - Brad Ferguson
- Department of Graduate Studies, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
| | - Karen Chrobak
- Department of Graduate Studies, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
| | - Yaadwinder Shergill
- University of Ottawa Centre for Interdisciplinary Pain Research, Ottawa Hospital Research Institute, The Ottawa Hospital General Campus, 501 Smyth Rd, Box 249-B, Ottawa, ON, K1H 8L6, Canada
| | - Pierre Côté
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada. .,Canada Research Chair in Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Oshawa, ON, L1H 7L7, Canada. .,Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Oshawa, ON, L1H 7L7, Canada.
| | - Jessica J Wong
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada.,Division of Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
| | - Hainan Yu
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada.,Division of Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
| | - Heather M Shearer
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada.,Division of Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
| | - Danielle Southerst
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada.,Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex, 60 Murray Street, 2nd Floor (Main), Toronto, ON, M5T 3L9, Canada
| | - Deborah Sutton
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada.,Division of Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
| | - Kristi Randhawa
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada.,Division of Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada.,Division of Undergraduate Education, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
| | - Craig Jacobs
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada.,Division of Clinical Education, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
| | - Sean Abdulla
- Department of Graduate Studies, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
| | - Erin Woitzik
- Department of Graduate Studies, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
| | - Andrée-Anne Marchand
- Département d'anatomie, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, C.P. 500, Trois-Rivières, QUÉBEC, G9A 5H7, Canada
| | - Gabrielle van der Velde
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, 6th Floor, Room 658, 144 College Street, Toronto, ON, M5S 3M2, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada.,Institute for Work and Health, 481 University Avenue, Toronto, ON, M5G 2E9, Canada
| | - Linda J Carroll
- Injury Prevention Centre and School of Public Health, University of Alberta, 3-300 ECHA, 11405-87 Ave, Edmonton, AB, T6G 1C9, Canada
| | - Margareta Nordin
- Departments of Orthopedic Surgery and Environmental Medicine, Occupational and Industrial Orthopedic Center, NYU School of Medicine, New York University, 550 1st Avenue, New York, NY, 10016, USA
| | - Carlo Ammendolia
- Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Oshawa, ON, L1H 7L7, Canada.,Institute for Work and Health, 481 University Avenue, Toronto, ON, M5G 2E9, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, 4th Flodior, 155 College St, Toronto, ON, M5T 3M6, Canada
| | - Silvano Mior
- Division of Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada.,Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Oshawa, ON, L1H 7L7, Canada
| | - Arthur Ameis
- Certification Program in Insurance Medicine and Medico-legal Expertise, Faculty of Medicine, University of Montreal, N-414, Roger-Gaudry Building, 2900, Boulevard Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada
| | - Maja Stupar
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
| | - Anne Taylor-Vaisey
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
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The Effectiveness of Exercise on Recovery and Clinical Outcomes in Patients With Soft Tissue Injuries of the Hip, Thigh, or Knee: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. J Manipulative Physiol Ther 2016; 39:110-120.e1. [DOI: 10.1016/j.jmpt.2016.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/07/2015] [Accepted: 10/13/2015] [Indexed: 01/05/2023]
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110
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Sutton DA, Nordin M, Côté P, Randhawa K, Yu H, Wong JJ, Stern P, Varatharajan S, Southerst D, Shearer HM, Stupar M, Chung C, Goldgrub R, Carroll LJ, Taylor-Vaisey A. The Effectiveness of Multimodal Care for Soft Tissue Injuries of the Lower Extremity: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. J Manipulative Physiol Ther 2016; 39:95-109.e2. [DOI: 10.1016/j.jmpt.2016.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/30/2015] [Accepted: 10/13/2015] [Indexed: 12/26/2022]
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111
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Lee SWH, Lee JY, Tan CSS, Wong CP. Strategies to Make Ramadan Fasting Safer in Type 2 Diabetics: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials and Observational Studies. Medicine (Baltimore) 2016; 95:e2457. [PMID: 26765440 PMCID: PMC4718266 DOI: 10.1097/md.0000000000002457] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Ramadan is the holy month for Muslims whereby they fast from predawn to after sunset and is observed by all healthy Muslim adults as well as a large population of type 2 diabetic Muslims.To determine the comparative effectiveness of various strategies that have been used for type 2 diabetic Muslim who fast during Ramadan.A systematic review and network meta-analysis of randomized controlled studies (RCT) as well as observational studies for patients with type 2 diabetes who fasted during Ramadan was conducted. Eight databases were searched from January 1980 through October 2015 for relevant studies. Two reviewers independently screened and assessed study for eligibility, assessed the risk of bias, and extracted relevant data. A network meta-analysis for each outcome was fitted separately, combining direct and indirect evidence for each comparison.Twenty-nine studies, 16 RCTs and 13 observational studies each met the inclusion criteria. The most common strategy used was drug changes during the Ramadan period, which found that the use of DPP-4 (Dipeptidyl peptidase inhibitor -4) inhibitors were associated with a reduction in incidence of experiencing hypoglycemia during Ramadan in both RCTs (pooled relative risk: 0.56; 95% confidence interval: 0.44-0.72) as well as in observational studies (pooled relative risk: 0.27; 0.09-0.75). Ramadan-focused education was shown to be beneficial in reducing hypoglycemia in observational studies but not RCTs (0.25 versus 1.00). Network meta-analyses suggest that incretin mimetics can reduce the risk of hypoglycemia by nearly 1.5 times.The newer antidiabetic agents appear to lower the risk of hypoglycemia and improved glycemic control when compared with sulfonylureas. Ramadan-focused education shows to be a promising strategy but more rigorous examination from RCTs are required.
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Affiliation(s)
- Shaun Wen Huey Lee
- From the School of Pharmacy, Monash University Malaysia, Bandar Sunway (SWHL, JYL), School of Allied Health Sciences, SEGi University, Kota Damansara (CSST); and Jeffery Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia (CPW)
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Southerst D, Yu H, Randhawa K, Côté P, D'Angelo K, Shearer HM, Wong JJ, Sutton D, Varatharajan S, Goldgrub R, Dion S, Cox J, Menta R, Brown CK, Stern PJ, Stupar M, Carroll LJ, Taylor-Vaisey A. The effectiveness of manual therapy for the management of musculoskeletal disorders of the upper and lower extremities: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Chiropr Man Therap 2015; 23:30. [PMID: 26512315 PMCID: PMC4623271 DOI: 10.1186/s12998-015-0075-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 10/14/2015] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Musculoskeletal disorders (MSDs) of the upper and lower extremities are common in the general population and place a significant burden on the health care system. Manual therapy is recommended by clinical practice guidelines for the management of these injuries; however, there is limited evidence to support its effectiveness. The purpose of our review was to investigate the effectiveness of manual therapy in adults or children with MSDs of the upper or lower extremity. METHODS Randomized controlled trials (RCTs), cohort studies, and case-control studies evaluating the effectiveness of manual therapy were eligible. We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials from 1990 to 2015. Paired reviewers screened studies for relevance and critically appraised relevant studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with low risk of bias were synthesized following best-evidence synthesis principles. Where available, we computed mean changes between groups, relative risks and 95 % CI. RESULTS We screened 6047 articles. Seven RCTs were critically appraised and three had low risk of bias. For adults with nonspecific shoulder pain of variable duration, cervicothoracic spinal manipulation and mobilization in addition to usual care may improve self-perceived recovery compared to usual care alone. For adults with subacromial impingement syndrome of variable duration, neck mobilization in addition to a multimodal shoulder program of care provides no added benefit. Finally, for adults with grade I-II ankle sprains of variable duration, lower extremity mobilization in addition to home exercise and advice provides greater short-term improvements in activities and function over home exercise and advice alone. No studies were included that evaluated the effectiveness of manual therapy in children or for the management of other extremity injuries in adults. CONCLUSIONS The current evidence on the effectiveness of manual therapy for MSDs of the upper and lower extremities is limited. The available evidence supports the use of manual therapy for non-specific shoulder pain and ankle sprains, but not for subacromial impingement syndrome in adults. Future research is needed to determine the effectiveness of manual therapy and guide clinical practice. SYSTEMATIC REVIEW REGISTRATION NUMBER CRD42014009899.
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Affiliation(s)
- Danielle Southerst
- Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario Canada M5G 1X5
| | - Hainan Yu
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario Canada M2H 3J1 ; Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario Canada M2H 3J1
| | - Kristi Randhawa
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario Canada M2H 3J1 ; Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario Canada M2H 3J1 ; Division of Undergraduate Education, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario Canada M2H 3J1
| | - Pierre Côté
- Canada Research Chair in Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St N, Science building, Room 3000, Oshawa, Ontario Canada L1H 7K4 ; Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St N, Science building, Room 3000, Oshawa, Ontario Canada L1H 7K4 ; UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, 6100 Leslie St, Toronto, Ontario Canada M2H 3J1
| | - Kevin D'Angelo
- Department of Graduate Studies, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario Canada M2H 3J1
| | - Heather M Shearer
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario Canada M2H 3J1 ; Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario Canada M2H 3J1
| | - Jessica J Wong
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario Canada M2H 3J1 ; Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario Canada M2H 3J1 ; Department of Graduate Studies, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario Canada M2H 3J1
| | - Deborah Sutton
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario Canada M2H 3J1 ; Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario Canada M2H 3J1
| | - Sharanya Varatharajan
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario Canada M2H 3J1 ; Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario Canada M2H 3J1 ; Division of Undergraduate Education, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario Canada M2H 3J1
| | - Rachel Goldgrub
- Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St N, Science building, Room 3000, Oshawa, Ontario Canada L1H 7K4
| | - Sarah Dion
- Department of Graduate Studies, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario Canada M2H 3J1
| | - Jocelyn Cox
- Department of Graduate Studies, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario Canada M2H 3J1
| | - Roger Menta
- Department of Graduate Studies, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario Canada M2H 3J1
| | - Courtney K Brown
- Department of Graduate Studies, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario Canada M2H 3J1
| | - Paula J Stern
- Graduate Education Program, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario Canada M2H 3J1 ; Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario Canada M2H 3J1
| | - Maja Stupar
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario Canada M2H 3J1 ; Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario Canada M2H 3J1
| | - Linda J Carroll
- Injury Prevention Centre and School of Public Health, University of Alberta, 4075 Research Transition Facility, 8308-114 St, Edmonton, Alberta Canada T6G 2E1
| | - Anne Taylor-Vaisey
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario Canada M2H 3J1
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Is exercise effective for the management of subacromial impingement syndrome and other soft tissue injuries of the shoulder? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. ACTA ACUST UNITED AC 2015; 20:646-56. [DOI: 10.1016/j.math.2015.03.013] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 03/05/2015] [Accepted: 03/18/2015] [Indexed: 11/21/2022]
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Woitzik E, Jacobs C, Wong JJ, Côté P, Shearer HM, Randhawa K, Sutton D, Southerst D, Varatharajan S, Brison RJ, Yu H, van der Velde G, Stern PJ, Taylor-Vaisey A, Stupar M, Mior S, Carroll LJ. The effectiveness of exercise on recovery and clinical outcomes of soft tissue injuries of the leg, ankle, and foot: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. ACTA ACUST UNITED AC 2015; 20:633-45. [DOI: 10.1016/j.math.2015.03.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 03/09/2015] [Accepted: 03/18/2015] [Indexed: 12/26/2022]
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Results of Vertebral Augmentation Treatment for Patients of Painful Osteoporotic Vertebral Compression Fractures: A Meta-Analysis of Eight Randomized Controlled Trials. PLoS One 2015; 10:e0138126. [PMID: 26378444 PMCID: PMC4574925 DOI: 10.1371/journal.pone.0138126] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 08/25/2015] [Indexed: 11/19/2022] Open
Abstract
Background In 2009 two RCTs were publicated to question the efficacy of vertebroplasty comparing with sham treatment (ST) in the New England Journal of Medicine (NEJM), which provoked an academic debate on the efficacy of PVA. The purposes of our study were to compare clinical differences in pain relief, spinal functional outcomes, and overall quality of life between PVA and CT for painful osteoporotic VCFs. Methods We searched PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials and Web of Knowledge from January 1980 to June 2013 with Medical Subject Headings terms and keywords. Risk of bias in the included studies was assessed in accordance with the Cochrane risk of bias tool. In this Meta-analysis dichotomous and continuous variables were calculated using the risk ratio (RR) and standardized mean difference (SMD), respectively. Results Eight studies involving 987 patients met the criteria for inclusion. The VAS SMD was favoring the experimental group significantly (p < 0.001). Subgroup analysis suggested that the patients performed PVA with mean fracture age less than 3 months would got pain relief earlier and more durable than the control group (P <0.05). The SMD of spinal function assessed with RDQ and Oswestry LBP data was in favor of the experimental groups. QOL outcome improvement was demonstrated statistically significant at early, middle and late-term follow-up for PVA than the control group (P <0.05). Conclusions In conclusion, this meta-analysis, which evaluated PVA for osteoporotic VCFs, demonstrated significant improvement regarding VAS, spinal function and QOL outcomes. The optimal fracture age was less than 12 weeks.
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Thomas RL, Parker GC. Comments on Meta-Analyses in General and in Stem Cell Research: An Overview and Cautionary Advice. Stem Cells Dev 2015; 24:2079-81. [DOI: 10.1089/scd.2015.29000.par] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Ronald L. Thomas
- Carman and Ann Adam Department of Pediatrics, Children's Research Center of Michigan, Wayne State University School of Medicine, Detroit, Michigan
| | - Graham C. Parker
- Carman and Ann Adam Department of Pediatrics, Children's Research Center of Michigan, Wayne State University School of Medicine, Detroit, Michigan
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D’Angelo K, Sutton D, Côté P, Dion S, Wong JJ, Yu H, Randhawa K, Southerst D, Varatharajan S, Cox (Dresser) J, Brown C, Menta R, Nordin M, Shearer HM, Ameis A, Stupar M, Carroll LJ, Taylor-Vaisey A. The Effectiveness of Passive Physical Modalities for the Management of Soft Tissue Injuries and Neuropathies of the Wrist and Hand: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. J Manipulative Physiol Ther 2015; 38:493-506. [DOI: 10.1016/j.jmpt.2015.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 06/05/2015] [Accepted: 06/05/2015] [Indexed: 01/18/2023]
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Piper S, Shearer HM, Côté P, Wong JJ, Yu H, Varatharajan S, Southerst D, Randhawa KA, Sutton DA, Stupar M, Nordin MC, Mior SA, van der Velde GM, Taylor-Vaisey AL. The effectiveness of soft-tissue therapy for the management of musculoskeletal disorders and injuries of the upper and lower extremities: A systematic review by the Ontario Protocol for Traffic Injury management (OPTIMa) collaboration. ACTA ACUST UNITED AC 2015; 21:18-34. [PMID: 26386912 DOI: 10.1016/j.math.2015.08.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 04/29/2015] [Accepted: 08/21/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND Soft-tissue therapy is commonly used to manage musculoskeletal injuries. OBJECTIVE To determine the effectiveness of soft-tissue therapy for the management of musculoskeletal disorders and injuries of the upper and lower extremities. DESIGN Systematic Review. METHODS We searched six databases from 1990 to 2015 and critically appraised eligible articles using Scottish Intercollegiate Guidelines Network (SIGN) criteria. Evidence from studies with low risk of bias was synthesized using best-evidence synthesis methodology. RESULTS We screened 9869 articles and critically appraised seven; six had low risk of bias. Localized relaxation massage provides added benefits to multimodal care immediately post-intervention for carpal tunnel syndrome. Movement re-education (contraction/passive stretching) provides better long-term benefit than one corticosteroid injection for lateral epicondylitis. Myofascial release improves outcomes compared to sham ultrasound for lateral epicondylitis. Diacutaneous fibrolysis (DF) or sham DF leads to similar outcomes in pain intensity for subacromial impingement syndrome. Trigger point therapy may provide limited or no additional benefit when combined with self-stretching for plantar fasciitis; however, myofascial release to the gastrocnemius, soleus and plantar fascia is effective. CONCLUSION Our review clarifies the role of soft-tissue therapy for the management of upper and lower extremity musculoskeletal disorders and injuries. Myofascial release therapy was effective for treating lateral epicondylitis and plantar fasciitis. Movement re-education was also effective for managing lateral epicondylitis. Localized relaxation massage combined with multimodal care may provide short-term benefit for treating carpal tunnel syndrome. More high quality research is needed to study the appropriateness and comparative effectiveness of this widely utilized form of treatment.
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Affiliation(s)
- Steven Piper
- Department of Graduate Studies, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario, Canada M2H 3J1
| | - Heather M Shearer
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario, Canada M2H 3J1; Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario, Canada M2H 3J1.
| | - Pierre Côté
- Canada Research Chair in Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Oshawa, Ontario, Canada L1H 7K4; Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Oshawa, Ontario, Canada L1H 7K4; UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, 6100 Leslie St., Toronto, Ontario, Canada M2H 3J1
| | - Jessica J Wong
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario, Canada M2H 3J1; Division of Undergraduate Education, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario, Canada M2H 3J1
| | - Hainan Yu
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario, Canada M2H 3J1; Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario, Canada M2H 3J1
| | - Sharanya Varatharajan
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario, Canada M2H 3J1; Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario, Canada M2H 3J1; Division of Undergraduate Education, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario, Canada M2H 3J1
| | - Danielle Southerst
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario, Canada M2H 3J1; Division of Undergraduate Education, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario, Canada M2H 3J1
| | - Kristi A Randhawa
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario, Canada M2H 3J1; Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario, Canada M2H 3J1; Division of Undergraduate Education, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario, Canada M2H 3J1
| | - Deborah A Sutton
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario, Canada M2H 3J1; Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario, Canada M2H 3J1
| | - Maja Stupar
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario, Canada M2H 3J1; UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, 6100 Leslie St., Toronto, Ontario, Canada M2H 3J1
| | - Margareta C Nordin
- Department of Orthopedic Surgery, Occupational and Industrial Orthopedic Center, NYU School of Medicine, New York University, 63 Downing Street, New York, NY 10014, USA; Department of Environmental Medicine, Occupational and Industrial Orthopedic Center, NYU School of Medicine, New York University, 63 Downing Street, New York, NY 10014, USA
| | - Silvano A Mior
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario, Canada M2H 3J1; Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Oshawa, Ontario, Canada L1H 7K4
| | - Gabrielle M van der Velde
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Leslie Dan Pharmacy Building, University of Toronto, 6th Floor, Room 658, 144 College Street, Toronto, Ontario, Canada M5S 3M2; Faculty of Pharmacy, University of Toronto, Leslie Dan Pharmacy Building, University of Toronto, 144 College Street, Toronto, Ontario, Canada M5S 3M2; Institute for Work and Health, 481 University Ave., Toronto, Ontario, Canada M5G 2E9
| | - Anne L Taylor-Vaisey
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario, Canada M2H 3J1
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Young I, Waddell L, Harding S, Greig J, Mascarenhas M, Sivaramalingam B, Pham MT, Papadopoulos A. A systematic review and meta-analysis of the effectiveness of food safety education interventions for consumers in developed countries. BMC Public Health 2015; 15:822. [PMID: 26307055 PMCID: PMC4548310 DOI: 10.1186/s12889-015-2171-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 08/19/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Foodborne illness has a large public health and economic burden worldwide, and many cases are associated with food handled and prepared at home. Educational interventions are necessary to improve consumer food safety practices and reduce the associated burden of foodborne illness. METHODS We conducted a systematic review and targeted meta-analyses to investigate the effectiveness of food safety education interventions for consumers. Relevant articles were identified through a preliminary scoping review that included: a comprehensive search in 10 bibliographic databases with verification; relevance screening of abstracts; and extraction of article characteristics. Experimental studies conducted in developed countries were prioritized for risk-of-bias assessment and data extraction. Meta-analysis was conducted on data subgroups stratified by key study design-intervention-population-outcome categories and subgroups were assessed for their quality of evidence. Meta-regression was conducted where appropriate to identify possible sources of between-trial heterogeneity. RESULTS We identified 79 relevant studies: 17 randomized controlled trials (RCTs); 12 non-randomized controlled trials (NRTs); and 50 uncontrolled before-and-after studies. Several studies did not provide sufficient details on key design features (e.g. blinding), with some high risk-of-bias ratings due to incomplete outcome data and selective reporting. We identified a moderate to high confidence in results from two large RCTs investigating community- and school-based educational training interventions on behaviour outcomes in children and youth (median standardized mean difference [SMD] = 0.20, range: 0.05, 0.35); in two small RCTs evaluating video and written instructional messaging on behavioural intentions in adults (SMD = 0.36, 95% confidence interval [CI]: 0.02, 0.69); and in two NRT studies for university-based education on attitudes of students and staff (SMD = 0.26, 95% CI: 0.10, 0.43). Uncontrolled before-and-after study outcomes were very heterogeneous and we have little confidence that the meta-analysis results reflect the true effect. Some variation in outcomes was explained in meta-regression models, including a dose effect for behaviour outcomes in RCTs. CONCLUSIONS In controlled trials, food safety education interventions showed significant effects in some contexts; however, many outcomes were very heterogeneous and do not provide a strong quality of evidence to support decision-making. Future research in this area is needed using more robust experimental designs to build on interventions shown to be effective in uncontrolled before-and-after studies.
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Affiliation(s)
- Ian Young
- Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, 160 Research Lane, Suite 206, Guelph, ON, N1G 5B2, Canada.
| | - Lisa Waddell
- Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, 160 Research Lane, Suite 206, Guelph, ON, N1G 5B2, Canada.
- Department of Population Medicine, University of Guelph, 50 Stone Road, Guelph, ON, N1G 2W1, Canada.
| | - Shannon Harding
- Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, 160 Research Lane, Suite 206, Guelph, ON, N1G 5B2, Canada.
| | - Judy Greig
- Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, 160 Research Lane, Suite 206, Guelph, ON, N1G 5B2, Canada.
| | - Mariola Mascarenhas
- Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, 160 Research Lane, Suite 206, Guelph, ON, N1G 5B2, Canada.
| | - Bhairavi Sivaramalingam
- Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, 160 Research Lane, Suite 206, Guelph, ON, N1G 5B2, Canada.
- Department of Population Medicine, University of Guelph, 50 Stone Road, Guelph, ON, N1G 2W1, Canada.
| | - Mai T Pham
- Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, 160 Research Lane, Suite 206, Guelph, ON, N1G 5B2, Canada.
- Department of Population Medicine, University of Guelph, 50 Stone Road, Guelph, ON, N1G 2W1, Canada.
| | - Andrew Papadopoulos
- Department of Population Medicine, University of Guelph, 50 Stone Road, Guelph, ON, N1G 2W1, Canada.
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Southerst D, Marchand AA, Côté P, Shearer HM, Wong JJ, Varatharajan S, Randhawa K, Sutton D, Yu H, Gross DP, Jacobs C, Goldgrub R, Stupar M, Mior S, Carroll LJ, Taylor-Vaisey A. The effectiveness of noninvasive interventions for musculoskeletal thoracic spine and chest wall pain: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) collaboration. J Manipulative Physiol Ther 2015; 38:521-31. [PMID: 26141077 DOI: 10.1016/j.jmpt.2015.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 03/31/2015] [Accepted: 05/26/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The purpose of this study was to critically appraise and synthesize evidence on the effectiveness of noninvasive interventions, excluding pharmacological treatments, for musculoskeletal thoracic pain. METHODS Randomized controlled trials (RCTs), cohort studies, and case-control studies evaluating the effectiveness of noninvasive interventions were eligible. We searched MEDLINE, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled Trials accessed through Ovid Technologies, Inc, and CINAHL Plus with Full Text accessed through EBSCOhost from 1990 to 2015. Our search strategies combined controlled vocabulary relevant to each database (eg, MeSH for MEDLINE) and text words relevant to our research question and the inclusion criteria. Random pairs of independent reviewers screened studies for relevance and critically appraised relevant studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with a low risk of bias were synthesized following best evidence synthesis principles. RESULTS We screened 6988 articles and critically appraised 2 studies. Both studies had a low risk of bias and were included in our synthesis. One RCT compared thoracic spinal manipulation, needle acupuncture, and placebo electrotherapy for recent thoracic spine pain. There were statistically significant but clinically nonimportant short-term reductions in pain favoring manipulation. There were no differences between acupuncture and placebo electrotherapy. Another RCT compared a multimodal program of care and a session of education for recent musculoskeletal chest wall pain. The multimodal care resulted in statistically significant but clinically nonimportant short-term reductions in pain over education. However, participants receiving multimodal care were more likely to report important improvements in chest pain. CONCLUSIONS Quality evidence on the management of musculoskeletal thoracic pain is sparse. The current evidence suggests that compared to placebo, spinal manipulation is associated with a small and clinically nonimportant reduction in pain intensity and that acupuncture leads to similar outcomes as placebo. Furthermore, a multimodal program of care (ie, manual therapy, soft tissue therapy, exercises, heat/ice, and advice) and a single education session lead to similar pain reduction for recent-onset musculoskeletal chest wall pain. However, patients who receive multimodal care are more likely to report pain improvements.
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Affiliation(s)
- Danielle Southerst
- Research Coordinator, Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, Toronto, ON, Canada
| | - Andrée-Anne Marchand
- Graduate Student, Department of Graduate Studies, Canadian Memorial Chiropractic College (CMCC), North York, ON, Canada
| | - Pierre Côté
- Canada Research Chair in Disability Prevention Rehabilitation, University of Ontario Institute of Technology (UOIT), Oshawa, ON, Canada; Associate Professor, Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada; Director, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Oshawa, ON, Canada
| | - Heather M Shearer
- Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College, North York, ON, Canada; Clinical Research Manager, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Oshawa, ON, Canada
| | - Jessica J Wong
- Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Oshawa, ON, Canada; Instructor, Division of Undergraduate Education, Canadian Memorial Chiropractic College, North York, ON, Canada; Instructor, Department of Graduate Studies, Canadian Memorial Chiropractic College, North York, ON, Canada
| | - Sharanya Varatharajan
- Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College, North York, ON, Canada; Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Oshawa, ON, Canada; Instructor, Division of Undergraduate Education, Canadian Memorial Chiropractic College, North York, ON, Canada
| | - Kristi Randhawa
- Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College, North York, ON, Canada; Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Oshawa, ON, Canada; Instructor, Division of Undergraduate Education, Canadian Memorial Chiropractic College, North York, ON, Canada
| | - Deborah Sutton
- Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Oshawa, ON, Canada; Adjunct Professor, Division of Undergraduate Education, Canadian Memorial Chiropractic College, North York, ON, Canada
| | - Hainan Yu
- Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College, North York, ON, Canada; Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Oshawa, ON, Canada.
| | - Douglas P Gross
- Professor, Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada; Director, Rehabilitation Research Centre, University of Alberta, Edmonton, AB, Canada
| | - Craig Jacobs
- Assistant Clinical Professor, Graduate Education and Research, Canadian Memorial Chiropractic College, North York, ON, Canada; Director, Division of Clinical Education and Patient Care, Canadian Memorial Chiropractic College, North York, ON, Canada
| | - Rachel Goldgrub
- Graduate Student, Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada
| | - Maja Stupar
- Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College, North York, ON, Canada; Postdoctoral Fellow, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Oshawa, ON, Canada
| | - Silvano Mior
- Professor, Graduate Education and Research, Canadian Memorial Chiropractic College, North York, ON, Canada; Adjunct Professor, Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada
| | - Linda J Carroll
- Professor, Injury Prevention Centre and School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Anne Taylor-Vaisey
- Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Oshawa, ON, Canada
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Menta R, Randhawa K, Côté P, Wong JJ, Yu H, Sutton D, Varatharajan S, Southerst D, D'Angelo K, Cox J, Brown C, Dion S, Mior S, Stupar M, Shearer HM, Lindsay GM, Jacobs C, Taylor-Vaisey A. The effectiveness of exercise for the management of musculoskeletal disorders and injuries of the elbow, forearm, wrist, and hand: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) collaboration. J Manipulative Physiol Ther 2015; 38:507-20. [PMID: 26130104 DOI: 10.1016/j.jmpt.2015.06.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 05/02/2015] [Accepted: 05/26/2015] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The purpose of this systematic review was to evaluate the effectiveness of exercise compared to other interventions, placebo/sham intervention, or no intervention in improving self-rated recovery, functional recovery, clinical, and/or administrative outcomes in individuals with musculoskeletal disorders and injuries of the elbow, forearm, wrist, and hand. METHODS We searched MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials from 1990 to 2015. Paired reviewers independently screened studies for relevance and assessed the risk of bias using the Scottish Intercollegiate Guidelines Network criteria. We synthesized the evidence using the best evidence synthesis methodology. RESULTS We identified 5 studies with a low risk of bias. Our review suggests that, for patients with persistent lateral epicondylitis, (1) adding concentric or eccentric strengthening exercises to home stretching exercises provides no additional benefits; (2) a home program of either eccentric or concentric strengthening exercises leads to similar outcomes; (3) home wrist extensor strengthening exercises lead to greater short-term improvements in pain reduction compared to "wait and see"; and (4) clinic-based, supervised exercise may be more beneficial than home exercises with minimal improvements in pain and function. For hand pain of variable duration, supervised progressive strength training added to advice to continue normal physical activity provides no additional benefits. CONCLUSION The relative effectiveness of stretching vs strengthening for the wrist extensors remains unknown for the management of persistent lateral epicondylitis. The current evidence shows that the addition of supervised progressive strength training does not provide further benefits over advice to continue normal physical activity for hand pain of variable duration.
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Affiliation(s)
- Roger Menta
- Graduate Student, Department of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Kristi Randhawa
- Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario, Canada; Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada; Instructor, Division of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
| | - Pierre Côté
- Canada Research Chair in Disability Prevention and Rehabilitation, University of Ontario Institute of Technology, Oshawa, Ontario, Canada; Associate Professor, Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada; Director, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Toronto, Ontario, Canada
| | - Jessica J Wong
- Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario, Canada; Instructor, Division of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada; Instructor, Department of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Hainan Yu
- Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario, Canada; Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Deborah Sutton
- Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario, Canada; Adjunct Professor, Division of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Sharanya Varatharajan
- Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario, Canada; Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada; Instructor, Division of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Danielle Southerst
- Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario, Canada; Research Coordinator, Department of Medicine, Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Kevin D'Angelo
- Graduate Student, Department of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Jocelyn Cox
- Graduate Student, Department of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Courtney Brown
- Graduate Student, Department of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Sarah Dion
- Graduate Student, Department of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Silvano Mior
- Professor, Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada; Adjunct Professor, Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | - Maja Stupar
- Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada; Postdoctoral Fellow, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Toronto, Ontario, Canada
| | - Heather M Shearer
- Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada; Clinical Research Manager, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Toronto, Ontario, Canada
| | - Gail M Lindsay
- Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario, Canada; Associate Professor, Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | - Craig Jacobs
- Assistant Clinical Professor, Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada; Director, Division of Clinical Education and Patient Care, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Anne Taylor-Vaisey
- Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario, Canada
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Burry L, Mehta S, Williamson DR, Hutton B, Ely EW, Adhikari NKJ, Egerod I, Fergusson DA, Rose L. Pharmacological interventions for the treatment of delirium in critically ill patients. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Lisa Burry
- Mount Sinai Hospital, Leslie Dan Faculty of Pharmacy, University of Toronto; Department of Pharmacy; 600 University Avenue, Room 18-377 Toronto ON Canada M5G 1X5
| | - Sangeeta Mehta
- Mount Sinai Hospital, University of Toronto; Interdepartmental Division of Critical Care Medicine; 600 University Ave, Rm 1504 Toronto ON Canada M5G 1X5
| | - David R Williamson
- Université de Montréal / Höpital du Sacré-Coeur de Montréal; Faculty of Pharmacy / Department of Pharmacy; 5400 Gouin W Montreal QC Canada H4J 1C5
| | - Brian Hutton
- Ottawa Hospital Research Institute; Knowledge Synthesis Group; 501 Smyth Road Ottawa ON Canada K1H 8L6
| | - E. Wes Ely
- Vanderbilt University School of Medicine; Center for Health Services Research; 1215 21st Avenue South, MCE Suite 6100 Nashville TN USA 37232-8300
| | - Neill KJ Adhikari
- University of Toronto; Interdepartmental Division of Critical Care; 2057 Bayview Avenue Toronto ON Canada M4N 3M5
| | - Ingrid Egerod
- Rigshospitalet, University of Copenhagen; Intensive Care Unit 4131; Blegdamsvej 9 Copenhagen Ø Denmark 2100
| | - Dean A Fergusson
- Ottawa Hospital Research Institute; Clinical Epidemiology Program; 501 Smyth Road Ottawa ON Canada K1H 8L6
| | - Louise Rose
- Sunnybrook Health Sciences Centre and Sunnybrook Research Institute; Department of Critical Care Medicine; Toronto Canada
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Effectiveness of passive physical modalities for shoulder pain: systematic review by the Ontario protocol for traffic injury management collaboration. Phys Ther 2015; 95:306-18. [PMID: 25394425 DOI: 10.2522/ptj.20140361] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Shoulder pain is a common musculoskeletal condition in the general population. Passive physical modalities are commonly used to treat shoulder pain. However, previous systematic reviews reported conflicting results. PURPOSE The aim of this study was to evaluate the effectiveness of passive physical modalities for the management of soft tissue injuries of the shoulder. DATA SOURCES MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials were searched from January 1, 1990, to April 18, 2013. STUDY SELECTION Randomized controlled trials (RCTs) and cohort and case-control studies were eligible. Random pairs of independent reviewers screened 1,470 of 1,760 retrieved articles after removing 290 duplicates. Twenty-two articles were eligible for critical appraisal. Eligible studies were critically appraised using the Scottish Intercollegiate Guidelines Network criteria. Of those, 11 studies had a low risk of bias. DATA EXTRACTION The lead author extracted data from low risk of bias studies and built evidence tables. A second reviewer independently checked the extracted data. DATA SYNTHESIS The findings of studies with a low risk of bias were synthesized according to principles of best evidence synthesis. Pretensioned tape, ultrasound, and interferential current were found to be noneffective for managing shoulder pain. However, diathermy and corticosteroid injections led to similar outcomes. Low-level laser therapy provided short-term pain reduction for subacromial impingement syndrome. Extracorporeal shock-wave therapy was not effective for subacromial impingement syndrome but provided benefits for persistent shoulder calcific tendinitis. LIMITATIONS Non-English studies were excluded. CONCLUSIONS Most passive physical modalities do not benefit patients with subacromial impingement syndrome. However, low-level laser therapy is more effective than placebo or ultrasound for subacromial impingement syndrome. Similarly, shock-wave therapy is more effective than sham therapy for persistent shoulder calcific tendinitis.
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Reilly S, Miranda‐Castillo C, Malouf R, Hoe J, Toot S, Challis D, Orrell M. Case management approaches to home support for people with dementia. Cochrane Database Syst Rev 2015; 1:CD008345. [PMID: 25560977 PMCID: PMC6823260 DOI: 10.1002/14651858.cd008345.pub2] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Over 35 million people are estimated to be living with dementia in the world and the societal costs are very high. Case management is a widely used and strongly promoted complex intervention for organising and co-ordinating care at the level of the individual, with the aim of providing long-term care for people with dementia in the community as an alternative to early admission to a care home or hospital. OBJECTIVES To evaluate the effectiveness of case management approaches to home support for people with dementia, from the perspective of the different people involved (patients, carers, and staff) compared with other forms of treatment, including 'treatment as usual', standard community treatment and other non-case management interventions. SEARCH METHODS We searched the following databases up to 31 December 2013: ALOIS, the Specialised Register of the Cochrane Dementia and Cognitive Improvement Group,The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS, Web of Science (including Science Citation Index Expanded (SCI-EXPANDED) and Social Science Citation Index), Campbell Collaboration/SORO database and the Specialised Register of the Cochrane Effective Practice and Organisation of Care Group. We updated this search in March 2014 but results have not yet been incorporated. SELECTION CRITERIA We include randomised controlled trials (RCTs) of case management interventions for people with dementia living in the community and their carers. We screened interventions to ensure that they focused on planning and co-ordination of care. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as required by The Cochrane Collaboration. Two review authors independently extracted data and made 'Risk of bias' assessments using Cochrane criteria. For continuous outcomes, we used the mean difference (MD) or standardised mean difference (SMD) between groups along with its confidence interval (95% CI). We applied a fixed- or random-effects model as appropriate. For binary or dichotomous data, we generated the corresponding odds ratio (OR) with 95% CI. We assessed heterogeneity by the I² statistic. MAIN RESULTS We include 13 RCTs involving 9615 participants with dementia in the review. Case management interventions in studies varied. We found low to moderate overall risk of bias; 69% of studies were at high risk for performance bias.The case management group were significantly less likely to be institutionalised (admissions to residential or nursing homes) at six months (OR 0.82, 95% CI 0.69 to 0.98, n = 5741, 6 RCTs, I² = 0%, P = 0.02) and at 18 months (OR 0.25, 95% CI 0.10 to 0.61, n = 363, 4 RCTs, I² = 0%, P = 0.003). However, the effects at 10 - 12 months (OR 0.95, 95% CI 0.83 to 1.08, n = 5990, 9 RCTs, I² = 48%, P = 0.39) and 24 months (OR 1.03, 95% CI 0.52 to 2.03, n = 201, 2 RCTs, I² = 0%, P = 0.94) were uncertain. There was evidence from one trial of a reduction in the number of days per month in a residential home or hospital unit in the case management group at six months (MD -5.80, 95% CI -7.93 to -3.67, n = 88, 1 RCT, P < 0.0001) and at 12 months (MD -7.70, 95% CI -9.38 to -6.02, n = 88, 1 RCT, P < 0.0001). One trial reported the length of time until participants were institutionalised at 12 months and the effects were uncertain (hazard ratio (HR): 0.66, 95% CI 0.38 to 1.14, P = 0.14). There was no difference in the number of people admitted to hospital at six (4 RCTs, 439 participants), 12 (5 RCTs, 585 participants) and 18 months (5 RCTs, 613 participants). For mortality at 4 - 6, 12, 18 - 24 and 36 months, and for participants' or carers' quality of life at 4, 6, 12 and 18 months, there were no significant effects. There was some evidence of benefits in carer burden at six months (SMD -0.07, 95% CI -0.12 to -0.01, n = 4601, 4 RCTs, I² = 26%, P = 0.03) but the effects at 12 or 18 months were uncertain. Additionally, some evidence indicated case management was more effective at reducing behaviour disturbance at 18 months (SMD -0.35, 95% CI -0.63 to -0.07, n = 206, 2 RCTs I² = 0%, P = 0.01) but effects were uncertain at four (2 RCTs), six (4 RCTs) or 12 months (5 RCTs).The case management group showed a small significant improvement in carer depression at 18 months (SMD -0.08, 95% CI -0.16 to -0.01, n = 2888, 3 RCTs, I² = 0%, P = 0.03). Conversely, the case management group showed greater improvement in carer well-being in a single study at six months (MD -2.20 CI CI -4.14 to -0.26, n = 65, 1 RCT, P = 0.03) but the effects were uncertain at 12 or 18 months. There was some evidence that case management reduced the total cost of services at 12 months (SMD -0.07, 95% CI -0.12 to -0.02, n = 5276, 2 RCTs, P = 0.01) and incurred lower dollar expenditure for the total three years (MD= -705.00, 95% CI -1170.31 to -239.69, n = 5170, 1 RCT, P = 0.003). Data on a number of outcomes consistently indicated that the intervention group received significantly more community services. AUTHORS' CONCLUSIONS There is some evidence that case management is beneficial at improving some outcomes at certain time points, both in the person with dementia and in their carer. However, there was considerable heterogeneity between the interventions, outcomes measured and time points across the 13 included RCTs. There was some evidence from good-quality studies to suggest that admissions to care homes and overall healthcare costs are reduced in the medium term; however, the results at longer points of follow-up were uncertain. There was not enough evidence to clearly assess whether case management could delay institutionalisation in care homes. There were uncertain results in patient depression, functional abilities and cognition. Further work should be undertaken to investigate what components of case management are associated with improvement in outcomes. Increased consistency in measures of outcome would support future meta-analysis.
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Affiliation(s)
- Siobhan Reilly
- Faculty of Health and Medicine, Lancaster UniversityDivision of Health ResearchC07 Furness BuildingLancasterUKLA1 4YG
| | - Claudia Miranda‐Castillo
- Universidad de ValparaísoEscuela de Psicología, Facultad de MedicinaAv Brasil 2140ValparaísoChile
| | - Reem Malouf
- University of OxfordNational Perinatal Epidemiology Unit (NPEU)Old Road CampusOxfordUKOX3 7LF
| | - Juanita Hoe
- University College LondonMental Health Sciences UnitCharles Bell House67‐73 Riding House StreetLondonUKW1W 7EJ
| | - Sandeep Toot
- North East London NHS Foundation Trust, Goodmayes HospitalResearch and Development DepartmentBarley Lane, GoodmayesEssexLondonUKIG3 8XJ
| | - David Challis
- University of ManchesterPersonal Social Services Research UnitDover Street BuildingOxford RoadManchesterUKM13 9PL
| | - Martin Orrell
- University College LondonMental Health Sciences UnitCharles Bell House67‐73 Riding House StreetLondonUKW1W 7EJ
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How safe is acetaminophen use in patients treated with vitamin K antagonists? A systematic review and meta-analysis. Thromb Res 2015; 135:58-61. [DOI: 10.1016/j.thromres.2014.10.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 09/18/2014] [Accepted: 10/14/2014] [Indexed: 11/22/2022]
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Varatharajan S, Côté P, Shearer HM, Loisel P, Wong JJ, Southerst D, Yu H, Randhawa K, Sutton D, van der Velde G, Mior S, Carroll LJ, Jacobs C, Taylor-Vaisey A. Are work disability prevention interventions effective for the management of neck pain or upper extremity disorders? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) collaboration. JOURNAL OF OCCUPATIONAL REHABILITATION 2014; 24:692-708. [PMID: 24522460 DOI: 10.1007/s10926-014-9501-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE We conducted a systematic review to critically appraise and synthesize literature on the effectiveness of work disability prevention (WDP) interventions in workers with neck pain, whiplash-associated disorders (WAD), or upper extremity disorders. METHODS We searched electronic databases from 1990 to 2012. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. Scientifically admissible studies were summarized and synthesized following best-evidence synthesis methodology. RESULTS Of the 6,359 articles retrieved, 16 randomized controlled trials were eligible for critical appraisal and five were admissible. We found that a return-to-work coordination program (including workplace-based work hardening) was superior to clinic-based work hardening for persistent rotator cuff tendinitis. Workplace high-intensity strength training and workplace advice had similar outcomes for neck and shoulder pain. Mensendieck/Cesar postural exercises and strength and fitness exercises had similar outcomes for non-specific work-related upper limb complaints. Adding a brief job stress education program to a workplace ergonomic intervention was not beneficial for persistent upper extremity symptoms. Adding computer-prompted work breaks to ergonomic adjustments and workplace education benefited workers' recovery from recent work-related neck and upper extremity complaints. CONCLUSIONS At present, no firm conclusions can be drawn regarding the effectiveness of WDP interventions for managing neck pain, WAD, and upper extremity disorders. Our review suggests a return-to-work coordination program is more effective than clinic-based work hardening. Also, adding computer-prompted breaks to ergonomic and workplace interventions benefits workers' recovery. The current quality of evidence does not allow for a definitive evaluation of the effectiveness of ergonomic interventions.
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Affiliation(s)
- Sharanya Varatharajan
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada,
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Li SM, Chen R, Li Y, Yang ZR, Deng QJ, Zhong Z, Ong ML, Zhan SY. Meta-analysis of randomized controlled trials comparing latanoprost with timolol in the treatment of Asian populations with chronic angle-closure glaucoma. PLoS One 2014; 9:e96852. [PMID: 24816233 PMCID: PMC4016135 DOI: 10.1371/journal.pone.0096852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 04/11/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To evaluate the efficacy and safety of latanoprost compared with timolol in the treatment of Asian patients with chronic angle-closure glaucoma (CACG). METHODS Relevant trials were identified through systematic searches of Medline, EMBASE, PubMed, Cochrane Library, Google Scholar and several Chinese databases. The main outcome measures included absolute and relative reduction of intraocular pressure (IOP) at mean, peak and trough from baseline, ocular adverse effects and systemic adverse events. RESULTS Seven randomized controlled trials with 685 patients were included. In comparison with timolol, latanoprost reduced absolute IOP in CACG patients by more than 2.3 mmHg (95%CI, 1.8∼2.9, P<0.01), 2.4 mmHg (95%CI, 1.9∼2.9, P<0.01) and 2.5 mmHg (95%CI, 1.6∼3.3, P<0.01) at mean, peak and trough, respectively. As for relative IOP, there is 9.0% (95%CI, 6.6∼11.4, P<0.01), 9.7% (95%CI, 7.6∼11.8, P<0.01), and 10.8% (95%CI, 7.4∼14.3, P<0.01) greater reduction among latanoprost users than among timolol users. The differences were statistically significant at all time points (1, 2, 4, 8, 12, and 24 weeks). More ocular adverse effects (OR = 1.49, 95% CI, 1.05∼2.10, P = 0.02) and less systemic adverse events (OR = 0.46, 95% CI, 0.25∼0.84, P = 0.01) were observed in latanoprost group in comparison with timolol group. CONCLUSION Compared with timolol, latanoprost was significantly more effective in lowering IOP of Asian patients with CACG, with higher risk of ocular adverse effects but lower risk of systemic adverse events, and might be a good substitute for CACG patients.
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Affiliation(s)
- Shi-Ming Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ru Chen
- Department of Epidemiology and Health Statistics, Peking University School of Public Health, Beijing, China
| | - Yuan Li
- Pfizer China, Beijing, China
| | - Zhi-Rong Yang
- Department of Epidemiology and Health Statistics, Peking University School of Public Health, Beijing, China
| | - Qiu-Ju Deng
- Department of Genetics, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Hai Dian District, Beijing, China
| | | | - Moh-Lim Ong
- Pfizer Global Pharmaceuticals, New York, New York, United States of America
| | - Si-Yan Zhan
- Department of Epidemiology and Health Statistics, Peking University School of Public Health, Beijing, China
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Zang M, Zhang T, Mao J, Zhou S, He B. Beneficial effects of catheter ablation of frequent premature ventricular complexes on left ventricular function. Heart 2014; 100:787-93. [DOI: 10.1136/heartjnl-2013-305175] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Yin MC, Ye J, Yao M, Cui XJ, Xia Y, Shen QX, Tong ZY, Wu XQ, Ma JM, Mo W. Is extracorporeal shock wave therapy clinical efficacy for relief of chronic, recalcitrant plantar fasciitis? A systematic review and meta-analysis of randomized placebo or active-treatment controlled trials. Arch Phys Med Rehabil 2014; 95:1585-93. [PMID: 24662810 DOI: 10.1016/j.apmr.2014.01.033] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 01/02/2014] [Accepted: 01/22/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the efficacy of extracorporeal shockwave therapy (ESWT) and provide clinicians with an evidence base for their clinical decision making. DATA SOURCES PubMed, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Evidence-Based Medicine Reviews. STUDY SELECTION All randomized or quasi-randomized controlled trials of ESWT for chronic recalcitrant plantar fasciitis were searched. Searching identified 108 potentially relevant articles; of these, 7 studies with 550 participants met inclusion criteria. DATA EXTRACTION Number of patients, population, body mass index, duration of symptoms, adverse effects, blinding method, and details of shockwave therapy were extracted. DATA SYNTHESIS For intervention success rate, ESWT of low intensity was more effective than control treatment of low intensity. For pain relief, the pooled data showed a significant difference between the ESWT and control groups. For function, only low-intensity ESWT was significantly superior over the control treatment. CONCLUSIONS The efficacy of low-intensity ESWT is worthy of recognition. The short-term pain relief and functional outcomes of this treatment are satisfactory. However, owing to the lack of a long-term follow-up, its long-term efficacy remains unknown.
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Affiliation(s)
- Meng-Chen Yin
- Department of Orthopedics, Shanghai Longhua Hospital, Shanghai, China
| | - Jie Ye
- Department of Orthopedics, Shanghai Longhua Hospital, Shanghai, China
| | - Min Yao
- Department of Orthopedics, Shanghai Longhua Hospital, Shanghai, China
| | - Xue-Jun Cui
- Department of Orthopedics, Shanghai Longhua Hospital, Shanghai, China
| | - Ye Xia
- Department of Orthopedics, Shanghai Longhua Hospital, Shanghai, China
| | - Qi-Xing Shen
- Department of Orthopedics, Shanghai Longhua Hospital, Shanghai, China
| | - Zheng-Yi Tong
- Department of Orthopedics, Shanghai Longhua Hospital, Shanghai, China
| | - Xue-Qun Wu
- Department of Orthopedics, Shanghai Longhua Hospital, Shanghai, China
| | - Jun-Ming Ma
- Department of Orthopedics, Shanghai Longhua Hospital, Shanghai, China
| | - Wen Mo
- Department of Orthopedics, Shanghai Longhua Hospital, Shanghai, China.
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Effect of fenugreek (Trigonella foenum-graecum L.) intake on glycemia: a meta-analysis of clinical trials. Nutr J 2014; 13:7. [PMID: 24438170 PMCID: PMC3901758 DOI: 10.1186/1475-2891-13-7] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 01/16/2014] [Indexed: 11/10/2022] Open
Abstract
Background and aim Fenugreek is a herb that is widely used in cooking and as a traditional medicine for diabetes in Asia. It has been shown to acutely lower postprandial glucose levels, but the long-term effect on glycemia remains uncertain. We systematically reviewed clinical trials of the effect of fenugreek intake on markers of glucose homeostasis. Methods PubMed, SCOPUS, the Cochrane Trials Registry, Web of Science, and BIOSIS were searched up to 29 Nov 2013 for trials of at least 1 week duration comparing intake of fenugreek seeds with a control intervention. Data on change in fasting blood glucose, 2 hour postload glucose, and HbA1c were pooled using random-effects models. Results A total of 10 trials were identified. Fenugreek significantly changed fasting blood glucose by -0.96 mmol/l (95% CI: -1.52, -0.40; I2 = 80%; 10 trials), 2 hour postload glucose by -2.19 mmol/l (95% CI: -3.19, -1.19; I2 = 71%; 7 trials) and HbA1c by -0.85% (95% CI: -1.49%, -0.22%; I2 = 0%; 3 trials) as compared with control interventions. The considerable heterogeneity in study results was partly explained by diabetes status and dose: significant effects on fasting and 2 hr glucose were only found for studies that administered medium or high doses of fenugreek in persons with diabetes. Most of the trials were of low methodological quality. Conclusions Results from clinical trials support beneficial effects of fenugreek seeds on glycemic control in persons with diabetes. However, trials with higher methodology quality using a well characterized fenugreek preparation of sufficient dose are needed to provide more conclusive evidence.
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McKenzie JE, Salanti G, Lewis SC, Altman DG. Meta-analysis and The Cochrane Collaboration: 20 years of the Cochrane Statistical Methods Group. Syst Rev 2013; 2:80. [PMID: 24280020 PMCID: PMC4219183 DOI: 10.1186/2046-4053-2-80] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 11/07/2013] [Indexed: 11/10/2022] Open
Abstract
The Statistical Methods Group has played a pivotal role in The Cochrane Collaboration over the past 20 years. The Statistical Methods Group has determined the direction of statistical methods used within Cochrane reviews, developed guidance for these methods, provided training, and continued to discuss and consider new and controversial issues in meta-analysis. The contribution of Statistical Methods Group members to the meta-analysis literature has been extensive and has helped to shape the wider meta-analysis landscape.In this paper, marking the 20th anniversary of The Cochrane Collaboration, we reflect on the history of the Statistical Methods Group, beginning in 1993 with the identification of aspects of statistical synthesis for which consensus was lacking about the best approach. We highlight some landmark methodological developments that Statistical Methods Group members have contributed to in the field of meta-analysis. We discuss how the Group implements and disseminates statistical methods within The Cochrane Collaboration. Finally, we consider the importance of robust statistical methodology for Cochrane systematic reviews, note research gaps, and reflect on the challenges that the Statistical Methods Group faces in its future direction.
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Affiliation(s)
- Joanne E McKenzie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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Sreeramareddy CT, Sathyanarayana TN. Decentralised versus centralised governance of health services. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010830] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - TN Sathyanarayana
- Public Health Foundation of India; Health Policy and Management; A N V Arcade, Plot No.1, Amar co-oprerative society, Lane opposite to Madhapur P.S Kavuri Hills, Madhapur Hyderabad Andhra Pradesh India 500081
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Dietary management of childhood diarrhea in low- and middle-income countries: a systematic review. BMC Public Health 2013; 13 Suppl 3:S17. [PMID: 24564685 PMCID: PMC3847348 DOI: 10.1186/1471-2458-13-s3-s17] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Current WHO guidelines on the management and treatment of diarrhea in children strongly recommend continued feeding alongside the administration of oral rehydration solution and zinc therapy, but there remains some debate regarding the optimal diet or dietary ingredients for feeding children with diarrhea. Methods We conducted a systematic search for all published randomized controlled trials evaluating food-based interventions among children under five years old with diarrhea in low- and middle-income countries. We classified 29 eligible studies into one or more comparisons: reduced versus regular lactose liquid feeds, lactose-free versus lactose-containing liquid feeds, lactose-free liquid feeds versus lactose-containing mixed diets, and commercial/specialized ingredients versus home-available ingredients. We used all available outcome data to conduct random-effects meta-analyses to estimate the average effect of each intervention on diarrhea duration, stool output, weight gain and treatment failure risk for studies on acute and persistent diarrhea separately. Results Evidence of low-to-moderate quality suggests that among children with acute diarrhea, diluting or fermenting lactose-containing liquid feeds does not affect any outcome when compared with an ordinary lactose-containing liquid feeds. In contrast, moderate quality evidence suggests that lactose-free liquid feeds reduce duration and the risk of treatment failure compared to lactose-containing liquid feeds in acute diarrhea. Only limited evidence of low quality was available to assess either of these two approaches in persistent diarrhea, or to assess lactose-free liquid feeds compared to lactose-containing mixed diets in either acute or persistent diarrhea. For commercially prepared or specialized ingredients compared to home-available ingredients, we found low-to-moderate quality evidence of no effect on any outcome in either acute or persistent diarrhea, though when we restricted these analyses to studies where both intervention and control diets were lactose-free, weight gain in children with acute diarrhea was shown to be greater among those fed with a home-available diet. Conclusions Among children in low- and middle-income countries, where the dual burden of diarrhea and malnutrition is greatest and where access to proprietary formulas and specialized ingredients is limited, the use of locally available age-appropriate foods should be promoted for the majority of acute diarrhea cases. Lactose intolerance is an important complication in some cases, but even among those children for whom lactose avoidance may be necessary, nutritionally complete diets comprised of locally available ingredients can be used at least as effectively as commercial preparations or specialized ingredients. These same conclusions may also apply to the dietary management of children with persistent diarrhea, but the evidence remains limited.
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Zhou Y, Long H, Ye N, Xue J, Yang X, Liao L, Lai W. The effectiveness of non-surgical maxillary expansion: a meta-analysis. Eur J Orthod 2013; 36:233-42. [DOI: 10.1093/ejo/cjt044] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Dias S, Sutton AJ, Ades AE, Welton NJ. Evidence synthesis for decision making 2: a generalized linear modeling framework for pairwise and network meta-analysis of randomized controlled trials. Med Decis Making 2013; 33:607-17. [PMID: 23104435 PMCID: PMC3704203 DOI: 10.1177/0272989x12458724] [Citation(s) in RCA: 879] [Impact Index Per Article: 79.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 06/22/2012] [Indexed: 11/27/2022]
Abstract
We set out a generalized linear model framework for the synthesis of data from randomized controlled trials. A common model is described, taking the form of a linear regression for both fixed and random effects synthesis, which can be implemented with normal, binomial, Poisson, and multinomial data. The familiar logistic model for meta-analysis with binomial data is a generalized linear model with a logit link function, which is appropriate for probability outcomes. The same linear regression framework can be applied to continuous outcomes, rate models, competing risks, or ordered category outcomes by using other link functions, such as identity, log, complementary log-log, and probit link functions. The common core model for the linear predictor can be applied to pairwise meta-analysis, indirect comparisons, synthesis of multiarm trials, and mixed treatment comparisons, also known as network meta-analysis, without distinction. We take a Bayesian approach to estimation and provide WinBUGS program code for a Bayesian analysis using Markov chain Monte Carlo simulation. An advantage of this approach is that it is straightforward to extend to shared parameter models where different randomized controlled trials report outcomes in different formats but from a common underlying model. Use of the generalized linear model framework allows us to present a unified account of how models can be compared using the deviance information criterion and how goodness of fit can be assessed using the residual deviance. The approach is illustrated through a range of worked examples for commonly encountered evidence formats.
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Affiliation(s)
- Sofia Dias
- School of Social and Community Medicine, University of Bristol, Bristol, UK (SD, AEA, NJW)
| | - Alex J Sutton
- Department of Health Sciences, University of Leicester, Leicester, UK (AJS)
| | - A E Ades
- School of Social and Community Medicine, University of Bristol, Bristol, UK (SD, AEA, NJW)
| | - Nicky J Welton
- School of Social and Community Medicine, University of Bristol, Bristol, UK (SD, AEA, NJW)
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Nezu U, Kamiyama H, Kondo Y, Sakuma M, Morimoto T, Ueda S. Effect of low-protein diet on kidney function in diabetic nephropathy: meta-analysis of randomised controlled trials. BMJ Open 2013; 3:e002934. [PMID: 23793703 PMCID: PMC3664345 DOI: 10.1136/bmjopen-2013-002934] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 04/25/2013] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To evaluate the effect of low-protein diet on kidney function in patients with diabetic nephropathy. DESIGN A systematic review and a meta-analysis of randomised controlled trials. DATA SOURCES MEDLINE, EMBASE, Cochrane Library, ClinicalTrials.gov, International Standard Randomised Controlled Trial Number (ISRCTN) Register and University Hospital Medical Information Network-Clinical Trials Registry (UMIN-CTR) from inception to 10 December 2012. Internet searches were also carried out with general search engines (Google and Google Scholar). STUDY SELECTION Randomised controlled trials that compared low-protein diet versus control diet and assessed the effects on kidney function, proteinuria, glycaemic control or nutritional status. PRIMARY AND SECONDARY OUTCOME MEASURES AND DATA SYNTHESIS The primary outcome was a change in the glomerular filtration rate (GFR). The secondary outcomes were changes in proteinuria, post-treatment value of glycated haemoglobin A1C (HbA1c) and post-treatment value of serum albumin. The results were summarised as the mean difference for continuous outcomes and pooled by the random effects model. Subgroup analyses and sensitivity analyses were conducted regarding patient characteristics, intervention period, methodological quality and assessment of diet compliance. The assessment of diet compliance was performed based on the actual protein intake ratio (APIR) of the low-protein diet group to the control group. RESULTS We identified 13 randomised controlled trials enrolling 779 patients. A low-protein diet was associated with a significant improvement in GFR (5.82 ml/min/1.73 m(2), 95% CI 2.30 to 9.33, I(2)=92%; n=624). This effect was consistent across the subgroups of type of diabetes, stages of nephropathy and intervention period. However, GFR was improved only when diet compliance was fair (8.92, 95% CI 2.75 to 15.09, I(2)=92% for APIR <0.9 and 0.03, 95% CI -1.49 to 1.56, I(2)=90% for APIR ≥0.9). Proteinuria and serum albumin were not differed between the groups. HbA1c was slightly but significantly decreased in the low-protein diet group (-0.26%, 95% CI -0.35 to -0.18, I(2)=0%; n=536). CONCLUSIONS Low-protein diet was significantly associated with improvement of diabetic nephropathy. The adverse effects of low-protein diet were not apparent such as worsening of glycaemic control and malnutrition.
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Affiliation(s)
- Uru Nezu
- Department of Clinical Pharmacology & Therapeutics, University of the Ryukyus, Okinawa, Japan
| | - Hiroshi Kamiyama
- Department of Endocrinology & Metabolism, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Yoshinobu Kondo
- Department of Endocrinology & Metabolism, Chigasaki Municipal Hospital, Kanagawa, Japan
| | - Mio Sakuma
- Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Takeshi Morimoto
- Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Shinichiro Ueda
- Department of Clinical Pharmacology & Therapeutics, University of the Ryukyus, Okinawa, Japan
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Beggs S, Foong YC, Le HCT, Noor D, Wood-Baker R, Walters JAE. Swimming training for asthma in children and adolescents aged 18 years and under. Cochrane Database Syst Rev 2013:CD009607. [PMID: 23633375 DOI: 10.1002/14651858.cd009607.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Asthma is the most common chronic medical condition in children and a common reason for hospitalisation. Observational studies have suggested that swimming, in particular, is an ideal form of physical activity to improve fitness and decrease the burden of disease in asthma. OBJECTIVES To determine the effectiveness and safety of swimming training as an intervention for asthma in children and adolescents aged 18 years and under. SEARCH METHODS We searched the Cochrane Airways Group's Specialised Register of trials (CENTRAL), MEDLINE , EMBASE, CINAHL, in November 2011, and repeated the search of CENTRAL in July 2012. We also handsearched ongoing Clinical Trials Registers. SELECTION CRITERIA We included all randomised controlled trials (RCTs) and quasi-RCTs of children and adolescents comparing swimming training with usual care, a non-physical activity, or physical activity other than swimming. DATA COLLECTION AND ANALYSIS We used standard methods specified in the Cochrane Handbook for Systematic reviews of Interventions. Two review authors used a standard template to independently assess trials for inclusion and extract data on study characteristics, risk of bias elements and outcomes. We contacted trial authors to request data if not published fully. When required, we calculated correlation coefficients from studies with full outcome data to impute standard deviation of changes from baseline. MAIN RESULTS Eight studies involving 262 participants were included in the review. Participants had stable asthma, with severity ranging from mild to severe. All studies were randomised trials, three studies had high withdrawal rates. Participants were between five to 18 years of age, and in seven studies swimming training varied from 30 to 90 minutes, two to three times a week, over six to 12 weeks. The programme in one study gave 30 minutes training six times per week. The comparison was usual care in seven studies and golf in one study. Chlorination status of swimming pool was unknown for four studies. Two studies used non-chlorinated pools, one study used an indoor chlorinated pool and one study used a chlorinated but well-ventilated pool.No statistically significant effects were seen in studies comparing swimming training with usual care or another physical activity for the primary outcomes; quality of life, asthma control, asthma exacerbations or use of corticosteroids for asthma. Swimming training had a clinically meaningful effect on exercise capacity compared with usual care, measured as maximal oxygen consumption during a maximum effort exercise test (VO2 max) (two studies, n = 32), with a mean increase of 9.67 mL/kg/min; 95% confidence interval (CI) 5.84 to 13.51. A difference of equivalent magnitude was found when other measures of exercise capacity were also pooled (four studies, n = 74), giving a standardised mean difference (SMD) 1.34; 95% CI 0.82 to 1.86. Swimming training was associated with small increases in resting lung function parameters of varying statistical significance; mean difference (MD) for FEV1 % predicted 8.07; 95% CI 3.59 to 12.54. In sensitivity analyses, by risk of attrition bias or use of imputed standard deviations, there were no important changes on effect sizes. Unknown chlorination status of pools limited subgroup analyses.Based on limited data, there were no adverse effects on asthma control or occurrence of exacerbations. AUTHORS' CONCLUSIONS This review indicates that swimming training is well-tolerated in children and adolescents with stable asthma, and increases lung function (moderate strength evidence) and cardio-pulmonary fitness (high strength evidence). There was no evidence that swimming training caused adverse effects on asthma control in young people 18 years and under with stable asthma of any severity. However whether swimming is better than other forms of physical activity cannot be determined from this review. Further adequately powered trials with longer follow-up periods are needed to better assess the long-term benefits of swimming.
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Affiliation(s)
- Sean Beggs
- Department of Paediatrics, Royal Hobart Hospital, 48 Liverpool Street, Hobart, Tasmania, Australia, 7000
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138
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Riley RD, Kauser I, Bland M, Thijs L, Staessen JA, Wang J, Gueyffier F, Deeks JJ. Meta-analysis of randomised trials with a continuous outcome according to baseline imbalance and availability of individual participant data. Stat Med 2013; 32:2747-66. [PMID: 23303608 DOI: 10.1002/sim.5726] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 12/12/2012] [Indexed: 11/09/2022]
Abstract
We describe methods for meta-analysis of randomised trials where a continuous outcome is of interest, such as blood pressure, recorded at both baseline (pre treatment) and follow-up (post treatment). We used four examples for illustration, covering situations with and without individual participant data (IPD) and with and without baseline imbalance between treatment groups in each trial. Given IPD, meta-analysts can choose to synthesise treatment effect estimates derived using analysis of covariance (ANCOVA), a regression of just final scores, or a regression of the change scores. When there is baseline balance in each trial, treatment effect estimates derived using ANCOVA are more precise and thus preferred. However, we show that meta-analysis results for the summary treatment effect are similar regardless of the approach taken. Thus, without IPD, if trials are balanced, reviewers can happily utilise treatment effect estimates derived from any of the approaches. However, when some trials have baseline imbalance, meta-analysts should use treatment effect estimates derived from ANCOVA, as this adjusts for imbalance and accounts for the correlation between baseline and follow-up; we show that the other approaches can give substantially different meta-analysis results. Without IPD and with unavailable ANCOVA estimates, reviewers should limit meta-analyses to those trials with baseline balance. Trowman's method to adjust for baseline imbalance without IPD performs poorly in our examples and so is not recommended. Finally, we extend the ANCOVA model to estimate the interaction between treatment effect and baseline values and compare options for estimating this interaction given only aggregate data.
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Affiliation(s)
- Richard D Riley
- School of Health and Population Sciences, University of Birmingham, Public Health Building, Edgbaston, Birmingham, B15 2TT, UK.
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Vasudev A, Macritchie K, Rao SK, Geddes J, Young AH. Tiagabine for acute affective episodes in bipolar disorder. Cochrane Database Syst Rev 2012; 12:CD004694. [PMID: 23235614 PMCID: PMC7388918 DOI: 10.1002/14651858.cd004694.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Bipolar disorder is a common recurrent illness with high levels of chronicity. Treatment resistance persists despite the use of established medications, such as lithium and valproate. New medications are required for the treatment of refractory cases. Some open-label reports have suggested that the anticonvulsant tiagabine may be efficacious in bipolar disorder. There is a need to clarify the evidence available, in the form of randomised controlled trials, for its use in the treatment of acute affective episodes in bipolar disorder. OBJECTIVES To review the evidence for the efficacy and acceptability of tiagabine in the treatment of acute mood episodes in bipolar disorder. SEARCH METHODS In this update, we searched the Cochrane Depression, Anxiety and Neurosis Group's Specialised Register (CCDANCTR-Studies and CCDANCTR-References) to October 2012. This register contains relevant randomised controlled trials from: The Cochrane Library (all years), EMBASE (1974 to date), MEDLINE (1950 to date) and PsycINFO (1967 to date). We examined reference lists of relevant papers and major textbooks of affective disorder. We contacted authors, other experts in the field and pharmaceutical companies for knowledge of suitable published or unpublished trials. We handsearched specialist journals and conference proceedings. SELECTION CRITERIA Randomised controlled trials, which compared tiagabine with placebo or with active agents in the treatment of any acute mood episodes in bipolar disorder in adults, male and female, aged 18 to 74 years. DATA COLLECTION AND ANALYSIS Two review authors performed data extraction and methodological quality assessment independently. For analysis, we planned to use risk ratio for binary efficacy outcomes and mean difference or standardised mean difference for continuously distributed outcomes. MAIN RESULTS In this updated review we found no studies which fulfilled the Cochrane criteria for randomised controlled trials. AUTHORS' CONCLUSIONS We found no randomised controlled trials of tiagabine in the treatment of acute episodes of bipolar disorder. However, there are reports that a number of patients suffered episodes of syncope or seizure. Further investigation of the efficacy and acceptability of tiagabine in the treatment of acute affective episodes of bipolar disorder should await the clarification of the nature of the reported episodes of syncope and seizure-like activity and an examination of the level of risk involved.
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Affiliation(s)
- Akshya Vasudev
- University ofWesternOntario, London Health Sciences Centre, Victoria Hospital, London, Canada.
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Saramago P, Manca A, Sutton AJ. Deriving input parameters for cost-effectiveness modeling: taxonomy of data types and approaches to their statistical synthesis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2012; 15:639-649. [PMID: 22867772 DOI: 10.1016/j.jval.2012.02.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 01/24/2012] [Accepted: 02/19/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND The evidence base informing economic evaluation models is rarely derived from a single source. Researchers are typically expected to identify and combine available data to inform the estimation of model parameters for a particular decision problem. The absence of clear guidelines on what data can be used and how to effectively synthesize this evidence base under different scenarios inevitably leads to different approaches being used by different modelers. OBJECTIVES The aim of this article is to produce a taxonomy that can help modelers identify the most appropriate methods to use when synthesizing the available data for a given model parameter. METHODS This article developed a taxonomy based on possible scenarios faced by the analyst when dealing with the available evidence. While mainly focusing on clinical effectiveness parameters, this article also discusses strategies relevant to other key input parameters in any economic model (i.e., disease natural history, resource use/costs, and preferences). RESULTS The taxonomy categorizes the evidence base for health economic modeling according to whether 1) single or multiple data sources are available, 2) individual or aggregate data are available (or both), or 3) individual or multiple decision model parameters are to be estimated from the data. References to examples of the key methodological developments for each entry in the taxonomy together with citations to where such methods have been used in practice are provided throughout. CONCLUSIONS The use of the taxonomy developed in this article hopes to improve the quality of the synthesis of evidence informing decision models by bringing to the attention of health economics modelers recent methodological developments in this field.
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Affiliation(s)
- Pedro Saramago
- Centre for Health Economics, University of York, York, UK.
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Effect of domperidone on insufficient lactation in puerperal women: a systematic review and meta-analysis of randomized controlled trials. Obstet Gynecol Int 2012; 2012:642893. [PMID: 22461793 PMCID: PMC3306907 DOI: 10.1155/2012/642893] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 10/06/2011] [Indexed: 11/18/2022] Open
Abstract
Background. There is a controversy within the medical community regarding the role of domperidone as a galactagogue and the drug has been removed from the US market owing to safety concerns. Objective. To perform a systematic review and meta-analysis of the available data assessing the effect of domperidone on breast milk production in women experiencing insufficient lactation. Study Selection. Randomized controlled trials (RCTs) examining the effect of domperidone on breast milk production of puerperal women were eligible for inclusion. Data Analysis. Absolute and relative changes from baseline were calculated for individual studies and pooled using a random effects model. Results. Three RCTs including 78 participants met the inclusion criteria. All showed a statistically significant increase in breast milk production following treatment with domperidone. The analysis of pooled data demonstrated a statistically significant relative increase of 74.72% (95% CI = 54.57; 94.86, P < 0.00001) in daily milk production with domperidone treatment compared to placebo. No maternal or neonatal adverse events were observed in any of the trials. Conclusions. Evidence from a few small RCTs of moderate to high quality suggests that domperidone produces a greater increase in breast milk supply than placebo.
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Vasudev A, Macritchie K, Vasudev K, Watson S, Geddes J, Young AH. Oxcarbazepine for acute affective episodes in bipolar disorder. Cochrane Database Syst Rev 2011:CD004857. [PMID: 22161387 DOI: 10.1002/14651858.cd004857.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Oxcarbazepine, a keto derivative of the 'mood stabiliser' carbamazepine, may have efficacy in the treatment of acute episodes of bipolar disorder. Potentially, it may offer pharmacokinetic advantages over carbamazepine. OBJECTIVES To review the efficacy and acceptability of oxcarbazepine compared to placebo and other agents in the treatment of acute bipolar episodes including mania, mixed episodes and depression. SEARCH METHODS Electronic databases were searched up to 2 September 2011. Specialist journals and conference proceedings were handsearched. Authors, experts in the field and pharmaceutical companies were contacted requesting information on published and unpublished trials. SELECTION CRITERIA Randomised controlled trials (RCTs) which compared oxcarbazepine with placebo or alternative agents, where the stated intent of intervention was the acute treatment of bipolar affective disorder were sought. Participants with bipolar disorder of either sex and of all ages were included. DATA COLLECTION AND ANALYSIS Data were extracted from the original reports individually by two review authors. For dichotomous data, odds ratios (ORs) were calculated with 95% confidence intervals (CI). Continuous data were analysed using standardised mean differences (with 95% CI). MAIN RESULTS Seven studies were included in the analysis (368 participants in total). All were on mania, hypomania, mixed episodes or rapid-cycling disorder. Overall, their methodological quality was relatively low.There was no difference in the primary outcome analysis - a fall of 50% or more on the Young Mania Rating Scale (YMRS) - between oxcarbazepine and placebo (N=1, n=110, OR =2.10, 95% CI 0.94 to 4.73) in one study, conducted in children; no studies were available in adult participants.In comparison with other mood stabilisers, there was no difference between oxcarbazepine and valproate as an antimanic agent using the primary outcome (50% or more fall in YMRS, OR=0.44, 95% CI 0.10 to 1.97, 1 study, n=60, P=0.273) or the secondary outcome measure (differences in YMRS between the two groups, SMD=0.18, 95% CI -0.24 to 0.59, 2 studies, n=90, P=0.40). No primary or secondary efficacy outcome measures were found comparing oxcarbazepine with lithium monotherapy.As an adjunctive treatment to lithium, oxcarbazepine reduced depression rating scale scores more than carbamazepine in a group of manic participants on the Montgomery-Åsberg Depression Rating Scale (MADRS) (SMD=- 1.12, 95% CI -1.71 to -0.53, 1 study, n=52, P=0.0002) and on the Hamilton Depression Rating Scale (HDRS) (SMD=- 0.77, 95% CI -1.35 to -0.20, 1 study, n=52, P=0.008).There was a higher incidence of adverse effects, particularly neuropsychiatric, in participants randomised to oxcarbazepine compared to those on placebo (1 study, n=115, 17% to 39% of participants on oxcarbazepine had at least one such event compared to 7% to 10% on placebo).There was no difference in adverse events rates between oxcarbazepine and other mood stabilisers or haloperidol. AUTHORS' CONCLUSIONS Currently, there are insufficient trials of adequate methodological quality on oxcarbazepine in the acute treatment of bipolar disorder to inform us on its efficacy and acceptability. Studies predominantly examine the treatment of mania: there are data from subgroup analysis on mixed affective, hypomania and rapid-cycling states.From the few studies included in this review, oxcarbazepine did not differ in efficacy compared to placebo in children and adolescents. It did not differ from other active agents in adults. It may have a poorer tolerability profile compared to placebo. No data were found on outcomes relevant to patients and clinicians, such as length of hospital admission. There is a need for adequately powered randomised controlled trials of good methodological quality to inform us of the therapeutic potential of oxcarbazepine across the spectrum of acute episodes in bipolar disorder.
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Affiliation(s)
- Akshya Vasudev
- University of Western Ontario, London Health Sciences Centre, Victoria Hospital, 800 Commissioners Road East, PO BOX 5010, London, Ontario, Canada
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Vasudev A, Macritchie K, Rao SN, Geddes J, Young AH. Tiagabine in the maintenance treatment of bipolar disorder. Cochrane Database Syst Rev 2011:CD005173. [PMID: 22161389 DOI: 10.1002/14651858.cd005173.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Tiagabine, an anticonvulsant, has been reported to have efficacy in prophylactic treatment of bipolar disorder in case reports and in case series. OBJECTIVES To assess the efficacy and acceptability of tiagabine, relative to placebo, and other agents in the prevention or attenuation, or both, of episodes of bipolar disorder in adults. The efficacy and acceptability of tiagabine were considered in terms of mood symptoms, mortality, general health, social functioning, adverse effects and overall acceptability to participants. SEARCH METHODS The Cochrane Collaboration Depression, Anxiety and Neurosis review group's specialised registers (CCDANCTR-Studies and CCDANCTR-References) were searched to 1 October 2011. These registers contains relevant randomised controlled trials from: The Cochrane Library (all years to date), EMBASE, (1974 to date) MEDLINE (1950 to date) and PsycINFO (1967 to date). Reference lists of relevant papers and major textbooks of affective disorder were examined. Authors, other experts in the field and pharmaceutical companies were contacted for knowledge of suitable published or unpublished trials. Specialist journals and conference proceedings were handsearched. SELECTION CRITERIA Randomised controlled trials of tiagabine versus placebo, alternative mood stabilisers or antipsychotics, for the maintenance treatment of bipolar disorder in adults, male and female, aged 18 to 74 years. DATA COLLECTION AND ANALYSIS Data were to be extracted from the original reports of included studies independently by two authors. The main outcomes to be assessed were:(1) the efficacy of tiagabine treatment in preventing or attenuating further episodes of bipolar disorder, including its efficacy in rapid cycling disorder; (2) the acceptability of tiagabine treatment to participants; (3) the prevalence of side effects; and (4) mortality, if any, on tiagabine treatment.Outcomes concerning relapse or recurrence were to be analysed excluding data from studies using discontinuation protocols, which were to be analysed separately. Subgroup analyses were to be performed to examine the effects of tiagabine treatment in rapid cycling bipolar disorder and previous mood stabiliser non-responders. Data were to be analysed using Review Manager 5. MAIN RESULTS No randomised controlled trials of tiagabine in the maintenance treatment of bipolar disorder were found. AUTHORS' CONCLUSIONS There is an insufficient methodologically rigorous evidence base to draw any conclusions regarding the use of tiagabine in the maintenance treatment of bipolar disorder. There is a need for randomised controlled trials examining the therapeutic potential of this agent in bipolar disorder. There have been some reports of syncope or seizures, or both, when tiagabine has been used for the acute treatment of mania. It needs to be established if such adverse effects occur in the maintenance phase as well.
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Affiliation(s)
- Akshya Vasudev
- University of Western Ontario, London Health Sciences Centre, Victoria Hospital, 800 Commissioners Road East, PO BOX 5010, London, Ontario, Canada
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Epstein D, Sutton A. Modelling correlated clinical outcomes in health technology appraisal. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2011; 14:793-799. [PMID: 21914498 DOI: 10.1016/j.jval.2011.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 04/18/2011] [Accepted: 04/25/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Many clinical treatments have multiple effects that can only be effectively captured on multiple outcome scales. It might be important to understand how these outcomes are correlated to evaluate the effectiveness and cost-effectiveness of treatments in decision models. METHODS The probabilities are estimated that both, one, or neither outcome occurs, given estimates of the marginal probability for each outcome and information about the correlation between them. Methods are shown for different measures of association. Lower and upper bounds for the correlation coefficient are calculated for given values of the marginal probabilities. The approach is illustrated using a simplified decision model based on a recent evaluation of adalimumab, a biologic drug for psoriatic arthritis. RESULTS Assuming the outcomes are positively correlated, the probability of both a skin and arthritis response after adalimumab was estimated to be 0.387 (95% confidence interval 0.210-0.570). The incremental cost-effectiveness ratio (ICER) of adalimumab versus no biologic is £18,500 per quality-adjusted life-year (QALY). The ICER increases to £19,500 per QALY if the responses are independent. CONCLUSION Estimates of ICERs can be sensitive to assumptions about how multiple outcomes are correlated. These assumptions should be explored in univariate and probabilistic sensitivity analyses.
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Affiliation(s)
- David Epstein
- Centre for Health Economics, University of York, York, UK.
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Hirji KF, Fagerland MW. Calculating unreported confidence intervals for paired data. BMC Med Res Methodol 2011; 11:66. [PMID: 21569392 PMCID: PMC3115921 DOI: 10.1186/1471-2288-11-66] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 05/12/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Confidence intervals (or associated standard errors) facilitate assessment of the practical importance of the findings of a health study, and their incorporation into a meta-analysis. For paired design studies, these items are often not reported. Since the descriptive statistics for such studies are usually presented in the same way as for unpaired designs, direct computation of the standard error is not possible without additional information. METHODS Elementary, well-known relationships between standard errors and p-values were used to develop computation schemes for paired mean difference, risk difference, risk ratio and odds ratio. RESULTS Unreported confidence intervals for large sample paired binary and numeric data can be computed fairly accurately using simple methods provided the p-value is given. In the case of paired binary data, the design based 2 × 2 table can be reconstructed as well. CONCLUSIONS Our results will facilitate appropriate interpretation of paired design studies, and their incorporation into meta-analyses.
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Affiliation(s)
- Karim F Hirji
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Kumbhani DJ, Bavry AA, Harvey JE, de Souza R, Scarpioni R, Bhatt DL, Kapadia SR. Clinical outcomes after percutaneous revascularization versus medical management in patients with significant renal artery stenosis: a meta-analysis of randomized controlled trials. Am Heart J 2011; 161:622-630.e1. [PMID: 21392620 DOI: 10.1016/j.ahj.2010.12.006] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 12/06/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND We sought to systematically evaluate whether percutaneous revascularization is associated with additional clinical benefit in patients with renal artery stenosis (RAS) as compared with medical management alone. METHODS We included randomized controlled trials that compared percutaneous revascularization in addition to medical therapy versus medical management alone in patients with RAS. Six trials with 1,208 patients were included. RESULTS At a mean follow-up of 29 months, there was no change in systolic blood pressure (weighted mean difference [WMD] = 1.20 mm Hg, 95% CI -1.18 to 3.58 mm Hg) or diastolic blood pressure (WMD = -1.60 mm Hg, 95% CI -4.22 to 1.02 mm Hg) from baseline in the percutaneous revascularization arm compared with the medical management arm. There was a reduction in the mean number of antihypertensive medications (WMD = -0.26, 95% CI -0.39 to -0.13, P < .001), but not serum creatinine (WMD = -0.14 mg/dL, 95% CI -0.29 to 0.007 mg/dL), in the percutaneous revascularization arm at the end of follow-up. Percutaneous revascularization was not associated with a significant difference in all-cause mortality (relative risk [RR] = 0.96, 95% CI 0.74-1.25), congestive heart failure (RR = 0.79, 95% CI 0.56-1.13), stroke (RR = 0.86, 95% CI 0.50-1.47), or worsening renal function (RR = 0.91, 95% CI 0.67-1.23) as compared with medical management. CONCLUSIONS In patients with RAS, percutaneous renal revascularization in addition to medical therapy may result in a lower requirement for antihypertensive medications, but not with improvements in serum creatinine or clinical outcomes, as compared with medical management over an intermediate period of follow-up. Further studies are needed to identify the appropriate patient population most likely to benefit from its use.
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Mila AL, Ngugi HK. A Bayesian approach to meta-analysis of plant pathology studies. PHYTOPATHOLOGY 2011; 101:42-51. [PMID: 20822433 DOI: 10.1094/phyto-03-10-0070] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Bayesian statistical methods are used for meta-analysis in many disciplines, including medicine, molecular biology, and engineering, but have not yet been applied for quantitative synthesis of plant pathology studies. In this paper, we illustrate the key concepts of Bayesian statistics and outline the differences between Bayesian and classical (frequentist) methods in the way parameters describing population attributes are considered. We then describe a Bayesian approach to meta-analysis and present a plant pathological example based on studies evaluating the efficacy of plant protection products that induce systemic acquired resistance for the management of fire blight of apple. In a simple random-effects model assuming a normal distribution of effect sizes and no prior information (i.e., a noninformative prior), the results of the Bayesian meta-analysis are similar to those obtained with classical methods. Implementing the same model with a Student's t distribution and a noninformative prior for the effect sizes, instead of a normal distribution, yields similar results for all but acibenzolar-S-methyl (Actigard) which was evaluated only in seven studies in this example. Whereas both the classical (P = 0.28) and the Bayesian analysis with a noninformative prior (95% credibility interval [CRI] for the log response ratio: -0.63 to 0.08) indicate a nonsignificant effect for Actigard, specifying a t distribution resulted in a significant, albeit variable, effect for this product (CRI: -0.73 to -0.10). These results confirm the sensitivity of the analytical outcome (i.e., the posterior distribution) to the choice of prior in Bayesian meta-analyses involving a limited number of studies. We review some pertinent literature on more advanced topics, including modeling of among-study heterogeneity, publication bias, analyses involving a limited number of studies, and methods for dealing with missing data, and show how these issues can be approached in a Bayesian framework. Bayesian meta-analysis can readily include information not easily incorporated in classical methods, and allow for a full evaluation of competing models. Given the power and flexibility of Bayesian methods, we expect them to become widely adopted for meta-analysis of plant pathology studies.
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Affiliation(s)
- A L Mila
- Department of Plant Pathology, North Carolina State University, Campus Box 7405, Raleigh 27606, USA
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Lloyd S, Bujkiewicz S, Wailoo AJ, Sutton AJ, Scott D. The effectiveness of anti-TNF-alpha therapies when used sequentially in rheumatoid arthritis patients: a systematic review and meta-analysis. Rheumatology (Oxford) 2010; 49:2313-21. [PMID: 20566736 PMCID: PMC2982750 DOI: 10.1093/rheumatology/keq169] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives. To systematically review and meta-analyse evidence on the effectiveness of the TNF-α inhibitors when used sequentially. Methods. Systematic review of comparative and single-arm observational studies. Data were synthesized using random-effects meta-analysis. Treatment effects were estimated using four outcome measures from the included studies: European League Against Rheumatism (EULAR) and ACR20 response rates and mean improvement in disease activity score-28 (DAS-20) and HAQ. The effect of other factors was explored via meta-regression and sub-group analyses. Results. Twenty studies comprising 2705 patients were included in the analysis. All studies were observational and most had no control group. Therefore, our primary analysis considered patient changes from baseline. The mean percentage of ACR20 responders was 60.8% (95% CI 53.8, 67.4), EULAR responders 70.5% (95% CI 63.7, 76.6), mean overall improvement in DAS-28 scores was 1.53 (95% CI 1.25, 1.80) and in HAQ scores was 0.25 (95% CI 0.11, 0.40). Four studies made comparisons with patients who received TNF-α inhibitors for the first time. Response rates associated with sequential TNF-α inhibitor treatment were lower than for first-time use. Conclusions. Sequential TNF-α inhibitor use is likely to lead to treatment benefit in terms of the signs and symptoms of disease and physical function. There is also some evidence to suggest that the probability of achieving a response is lower, and the average magnitude of response is lower than the first use. Further evidence from randomized controlled trials is required to confirm and further quantify the role specific anti-TNF-α agents have when used sequentially.
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Affiliation(s)
- Suzanne Lloyd
- Department of Health Sciences, University of Leicester, Leicester, UK
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Welton NJ, Caldwell DM, Adamopoulos E, Vedhara K. Mixed treatment comparison meta-analysis of complex interventions: psychological interventions in coronary heart disease. Am J Epidemiol 2009; 169:1158-65. [PMID: 19258485 DOI: 10.1093/aje/kwp014] [Citation(s) in RCA: 215] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Meta-analyses of psychological interventions typically find a pooled effect of "psychological intervention" compared with usual care. This answers the research question, "Are psychological interventions in general effective?" In fact, psychological interventions are usually complex with several different components. The authors propose that mixed treatment comparison meta-analysis methods may be a valuable tool when exploring the efficacy of interventions with different components and combinations of components, as this allows one to answer the research question, "Are interventions with a particular component (or combination of components) effective?" The authors illustrate the methods using a meta-analysis of psychological interventions for patients with coronary heart disease for a variety of outcomes. The authors carried out systematic literature searches to update an earlier Cochrane review and classified components of interventions into 6 types: usual care, educational, behavioral, cognitive, relaxation, and support. Most interventions were a combination of these components. There was some evidence that psychological interventions were effective in reducing total cholesterol and standardized mean anxiety scores, that interventions with behavioral components were effective in reducing the odds of all-cause mortality and nonfatal myocardial infarction, and that interventions with behavioral and/or cognitive components were associated with reduced standardized mean depression scores.
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Affiliation(s)
- Nicky J Welton
- Department of Community Based Medicine, University of Bristol, Bristol, United Kingdom.
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Idris NRN, Robertson C. The Effects of Imputing the Missing Standard Deviations on the Standard Error of Meta Analysis Estimates. COMMUN STAT-SIMUL C 2009. [DOI: 10.1080/03610910802556106] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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