1
|
Wilms P, Schröder J, Scheit L, Reer R. [The effect of electromagnetic fields on tendinopathies : Study on the effect analysis of a singular application of high-energy pulsed electromagnetic fields]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:668-676. [PMID: 39172175 PMCID: PMC11384642 DOI: 10.1007/s00132-024-04541-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/10/2024] [Indexed: 08/23/2024]
Abstract
OBJECTIVE Tendinopathies are diseases that often entail long-term treatment consisting of analgesics, physiotherapy, orthotics, and sparing. The aim of this study was to investigate the effect of a single application of a high-energy PEMF (pulsed electromagnetic field) on pain perception and blood born inflammation parameters. METHODS 34 patients were randomly assigned to a verum group (10 min PEMF, 0,78 T) or a placebo group (10 min sham condition). Prior to and up to one week after the patient blinded treatment (t1-t5), local pain state was assessed by means of algometry as pain pressure threshold (PPT). Accordingly, heat-shock protein 70 (HSP70) levels were analysed. Statistical analyses included 2‑way ANOVA (2 × 5). The clinical trial was registered (DRKS00031321). RESULTS After randomization and drop-out (verum n = 17, placebo n = 13) baseline-analyses did not reveal significant between-group differences for PPT (p = 0,096), for HSP70 (p = 0,524), or any other sample characteristics (p > 0,05). Pain reduction during one week of observation showed to be significantly higher (p = 0,045, η2 = 0,013) for the PEMF group (PPT: +83 bis +139%) compared to the placebo group (PPT: +10 bis +36%). There were no HSP70 associated effects. CONCLUSIONS A single bout of high energy PEMF led to an immediate pain relief in tendinopathy patients lasting at least for one week, but the hypothesized underlying HSP70 associated inflammatory pathway could not be confirmed.
Collapse
Affiliation(s)
- Patrick Wilms
- Institut für Bewegungswissenschaft, Sport- und Bewegungsmedizin, Universität Hamburg, Turmweg 2, 20148, Hamburg, Deutschland.
| | - Jan Schröder
- Institut für Bewegungswissenschaft, Sport- und Bewegungsmedizin, Universität Hamburg, Turmweg 2, 20148, Hamburg, Deutschland
| | - Lorenz Scheit
- Abteilung I - Innere Medizin, Bundeswehrkrankenhaus Hamburg, Lesserstr. 180, 22049, Hamburg, Deutschland
| | - Rüdiger Reer
- Institut für Bewegungswissenschaft, Sport- und Bewegungsmedizin, Universität Hamburg, Turmweg 2, 20148, Hamburg, Deutschland
| |
Collapse
|
2
|
Zhang Y, Zhang W, Yu E. Systematic Review and Meta-Analysis: Pharmacological and Nonpharmacological Interventions for Disruptive Mood Dysregulation Disorder. J Child Adolesc Psychopharmacol 2024; 34:217-225. [PMID: 38683583 DOI: 10.1089/cap.2024.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Objectives: Disruptive mood dysregulation disorder (DMDD) is a relatively new diagnosis that comprises severe, nonepisodic irritability and recurrent outbursts of emotional instability in adolescents. This meta-analysis examined the efficacy of the available pharmacological and nonpharmacological interventions for DMDD. Methods: Literature searches were conducted in July 2023. To determine relevant articles, 330 abstracts were reviewed, and 39 articles were identified for full review. A random-effects model was used for the meta-analysis, and a subgroup analysis was performed to assess the effects of study design and intervention type. Results: Eleven studies were reviewed, including six pharmacological and five nonpharmacological. Despite high heterogeneity in effects (I2 = 85%), we showed statistically significant improvements in irritability symptoms following intervention. We showed statistically significant enhancements in symptoms of irritability following the intervention. The subgroup analysis revealed that, compared with randomized controlled trials (RCTs), open trials showed significant improvements in irritability. In addition, drug intervention significantly improved irritability compared to nondrug interventions. Atomoxetine (ATX), optimized stimulants, and stimulants combined with other drugs and behavioral therapy effectively improved irritability. Conclusions: With research indicating potential benefits for irritability from a combination of pharmacological interventions and therapy, including ATX, stimulants in conjunction with antipsychotic or antidepressant medications, and cognitive-behavioral techniques such as Dialectical Behavior Therapy for Children. Future large-scale RCTs are essential to further explore and refine these treatment approaches, especially focusing on the efficacy of combining pharmacological with effective nonpharmacological to improve irritability and overall outcomes in this population.
Collapse
Affiliation(s)
- Yuhan Zhang
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China
| | - Wenxuan Zhang
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Enyan Yu
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China
| |
Collapse
|
3
|
Won J, Han JY, Ji YJ, Ha D, Han BJ, Lee H. Drug trials are more likely to disclose full placebo control information than non-drug trials: A cross-sectional study of participant information leaflets of placebo-controlled trials. Integr Med Res 2024; 13:101043. [PMID: 38779540 PMCID: PMC11109310 DOI: 10.1016/j.imr.2024.101043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/14/2024] [Accepted: 04/16/2024] [Indexed: 05/25/2024] Open
Abstract
Background This study aimed to investigate whether placebo control is differently disclosed in drug and non-drug randomised clinical trial (RCT) participant information leaflets (PILs) and how this might affect participant blinding and direction of study outcomes. Methods PILs were obtained from trials registered in the International Standard Randomised Controlled Trial Number database via email. Placebo descriptions in PILs were categorised as Full Disclosure (FD), Partial Disclosure (PD), or Missing Information (MI). Associations between intervention type (drug or non-drug)/placebo disclosure (FD or PD/MI) and participant blinding success/trial outcome direction (positive or non-positive) were examined using a two-sided Fisher's exact test. Results Of 116 collected PILs, 56 % were for drug trials and 44 % were for non-drug trials. Among them, 88 PILs had the corresponding publications available and 68 reports specified primary outcomes. Drug trials were more likely to fully disclose placebo information than non-drug trials (92.3 % vs. 74.5 %, p < 0.05). However, the success rate of blinding was only reported in 3 out of 88 trial publications (3.4 %), precluding further analysis. Furthermore, there was no significant association between the direction of trial results and the type of intervention or placebo disclosure. Conclusion Our study findings suggest that drug and non-drug RCTs might differ in the way they reveal placebo control information. Further research is warranted to understand what leads to more common PD of placebo information in non-drug trials than drug trials and to determine the optimal placebo control disclosure in specific trial context.
Collapse
Affiliation(s)
- Jiyoon Won
- Department of Meridian & Acupoint, College of Korean Medicine, Dong-eui University, Busan, South Korea
| | - Ji-Yeon Han
- Department of Medical Science of Meridian, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Yu-jin Ji
- Department of Medical Science of Meridian, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Dohyung Ha
- Department of Medical Science of Meridian, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Bong Jae Han
- Kyung Hee Tojung Korean Medicine Clinic, Seoul, South Korea
| | - Hyangsook Lee
- Department of Medical Science of Meridian, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| |
Collapse
|
4
|
Harinath G, Zalzala S, Nyquist A, Wouters M, Isman A, Moel M, Verdin E, Kaeberlein M, Kennedy B, Bischof E. The role of quality of life data as an endpoint for collecting real-world evidence within geroscience clinical trials. Ageing Res Rev 2024; 97:102293. [PMID: 38574864 DOI: 10.1016/j.arr.2024.102293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/21/2024] [Accepted: 04/01/2024] [Indexed: 04/06/2024]
Abstract
With geroscience research evolving at a fast pace, the need arises for human randomized controlled trials to assess the efficacy of geroprotective interventions to prevent age-related adverse outcomes, disease, and mortality in normative aging cohorts. However, to confirm efficacy requires a long-term and costly approach as time to the event of morbidity and mortality can be decades. While this could be circumvented using sensitive biomarkers of aging, current molecular, physiological, and digital endpoints require further validation. In this review, we discuss how collecting real-world evidence (RWE) by obtaining health data that is amenable for collection from large heterogeneous populations in a real-world setting can help speed up validation of geroprotective interventions. Further, we propose inclusion of quality of life (QoL) data as a biomarker of aging and candidate endpoint for geroscience clinical trials to aid in distinguishing healthy from unhealthy aging. We highlight how QoL assays can aid in accelerating data collection in studies gathering RWE on the geroprotective effects of repurposed drugs to support utilization within healthy longevity medicine. Finally, we summarize key metrics to consider when implementing QoL assays in studies, and present the short-form 36 (SF-36) as the most well-suited candidate endpoint.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Eric Verdin
- Buck Institute for Research on Aging, Novato, CA, USA
| | | | - Brian Kennedy
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Centre for Healthy Longevity, National University Health System, Singapore
| | - Evelyne Bischof
- Department of Medical Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai University of Medicine and Health Sciences, Shanghai, China; Sheba Longevity Center, Sheba Medical Center, Tel Aviv, Israel.
| |
Collapse
|
5
|
Xiong Z, Ma P, Zhang H, Liu C, Liu B, Liu Z, Yan S. Placebo response to sham electroacupuncture in patients with chronic functional constipation: A secondary analysis. Neurogastroenterol Motil 2024; 36:e14770. [PMID: 38361038 DOI: 10.1111/nmo.14770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 01/30/2024] [Accepted: 02/08/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Chronic severe functional constipation is a common disease that requires novel and effective treatment strategies. Acupuncture might constitute a promising therapeutic approach for chronic constipation, but it reportedly engenders an enhanced placebo response. Herein, we aimed to determine the magnitude of the placebo responses to electroacupuncture for constipation and identify its influencing factors. METHODS In this secondary analysis of a multicenter randomized trial, patients were randomized to a sham electroacupuncture group, which was administered for 8 weeks in 24 sessions of superficial needling at nonacupoints. The placebo response rates were assessed using three responder criteria: ≥3 complete spontaneous bowel movements per week (CSBMs/week), overall CSBM, and sustained CSBM. Logistic regression with backward selection method was employed to identify the potential factors that affected the placebo response. KEY RESULTS Overall, 539 patients were included in the study. The placebo response rate was 10.58%, 9.46%, and 9.09% according to the three aforementioned criteria, respectively. Those who exhibited more CSBMs/week at baseline were more likely to respond to sham electroacupuncture. Among patients with more than one CSBM per week at baseline, the response rates for achieving the criteria of ≥3 CSBMs per week, overall CSBM, and sustained CSBM were 25.40%, 30.16%, and 22.22%. CONCLUSIONS AND INFERENCE Electroacupuncture did not demonstrate a large placebo response in functional constipation treatment. The number of CSBMs at baseline may be a moderator of the placebo response to sham electroacupuncture. Thus, superficial needling sham acupuncture may be considered an ideal sham control for clinical trials of chronic constipation.
Collapse
Affiliation(s)
- Zhiyi Xiong
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Peihong Ma
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Haoran Zhang
- College of Preschool Education, Beijing Youth Politics College, Beijing, China
| | - Cunzhi Liu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Baoyan Liu
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhishun Liu
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shiyan Yan
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| |
Collapse
|
6
|
Saueressig T, Owen PJ, Pedder H, Tagliaferri S, Kaczorowski S, Altrichter A, Richard A, Miller CT, Donath L, Belavy DL. The importance of context (placebo effects) in conservative interventions for musculoskeletal pain: A systematic review and meta-analysis of randomized controlled trials. Eur J Pain 2024; 28:675-704. [PMID: 38116995 DOI: 10.1002/ejp.2222] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 10/04/2023] [Accepted: 11/25/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND AND OBJECTIVE Contextual effects (e.g. patient expectations) may play a role in treatment effectiveness. This study aimed to estimate the magnitude of contextual effects for conservative, non-pharmacological interventions for musculoskeletal pain conditions. A systematic review and meta-analysis of randomized controlled trials (RCTs) that compared placebo conservative non-pharmacological interventions to no treatment for musculoskeletal pain. The outcomes assessed included pain intensity, physical functioning, health-related quality of life, global rating of change, depression, anxiety and sleep at immediate, short-, medium- and/or long-term follow-up. DATABASES AND DATA TREATMENT MEDLINE, EMBASE, CINAHL, Web of Science Core Collection, CENTRAL and SPORTDiscus were searched from inception to September 2021. Trial registry searches, backward and forward citation tracking and searches for prior systematic reviews were completed. The Cochrane risk of bias 2 tool was implemented. RESULTS The study included 64 RCTs (N = 4314) out of 8898 records. For pain intensity, a mean difference of (MD: -5.32, 95% confidence interval (CI): -7.20, -3.44, N = 57 studies with 74 outcomes, GRADE: very low) was estimated for placebo interventions. A small effect in favour of the placebo interventions for physical function was estimated (SMD: -0.22, 95% CI: -0.35, -0.09; N = 37 with 48 outcomes, GRADE: very low). Similar results were found for a broad range of patient-reported outcomes. Meta-regression analyses did not explain heterogeneity among analyses. CONCLUSION The study found that the contextual effect of non-pharmacological conservative interventions for musculoskeletal conditions is likely to be small. However, given the known effect sizes of recommended evidence-based treatments for musculoskeletal conditions, it may still contribute an important component. SIGNIFICANCE Contextual effects of non-pharmacological conservative interventions for musculoskeletal conditions are likely to be small for a broad range of patient-reported outcomes (pain intensity, physical function, quality of life, global rating of change and depression). Contextual effects are unlikely, in isolation, to offer much clinical care. But these factors do have relevance in an overall treatment context as they provide almost 30% of the minimally clinically important difference.
Collapse
Affiliation(s)
| | - Patrick J Owen
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
| | - Hugo Pedder
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Scott Tagliaferri
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
| | - Svenja Kaczorowski
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany
| | - Adina Altrichter
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany
| | - Antonia Richard
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany
| | - Clint T Miller
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
| | - Lars Donath
- Department of Intervention Research in Exercise Training, German Sport University Cologne, Cologne, Germany
| | - Daniel L Belavy
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany
| |
Collapse
|
7
|
Laakso JT, Oehlandt H, Kivekäs I, Harju T, Jero J, Sinkkonen ST. Balloon Eustachian Tuboplasty-A Feasible Double-Blinded Sham Surgery Randomized Clinical Trial Protocol to Study Efficacy. Laryngoscope 2024; 134:1874-1881. [PMID: 37776248 DOI: 10.1002/lary.31092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 09/06/2023] [Accepted: 09/12/2023] [Indexed: 10/02/2023]
Abstract
INTRODUCTION Balloon Eustachian tuboplasty (BET) is used to treat obstructive Eustachian tube dysfunction (OETD) and recurrent otitis media with effusion (OME). However, there are no indisputable evidence of its efficacy. Here, we present a multicenter, double-blinded, randomized, placebo-controlled trial (MDRCT) design to evaluate the efficacy of BET, and the results of a pilot trial with 3- and 12-months' follow-up. MATERIAL AND METHODS This was a prospective MDRCT. For a pilot study, OETD (n = 10) and OME (n = 5) patients were recruited and followed. Detailed inclusion and exclusion criteria were used. Participants were randomized at beginning of the operation to active or sham surgery. All procedures were performed under local anesthesia. Controls were performed in double-blinded manner (both patient and physician), at 3 and 12 months after the procedure. RESULTS Altogether, 20 ears were treated and followed for 12 months, including 14 active BETs and 6 sham surgeries. Both the active and sham surgery were performed under local anesthesia without problems or deviations from the protocol. There were no differences in the preoperative symptoms (ETDQ-7) or objective measures (tympanometry, Valsalva and Toynbee maneuvers, tubomanometry, Eustachian tube score) between active and sham surgery arms. During follow-up, we noticed largely similar reduction in subjective symptoms and improvement in Eustachian tube score both in active and sham surgery arms. CONCLUSIONS The pilot study demonstrates that our MDRCT protocol is feasible, and that blinded RCTs are dearly needed to objectively measure the efficacy of BET. LEVEL OF EVIDENCE 2 Laryngoscope, 134:1874-1881, 2024.
Collapse
Affiliation(s)
- Juha T Laakso
- Department of Otorhinolaryngology-Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Heidi Oehlandt
- Department of Otorhinolaryngology-Head and Neck Surgery, Turku University Hospital and University of Turku, Turku, Finland
| | - Ilkka Kivekäs
- Department of Otorhinolaryngology-Head and Neck Surgery, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Teemu Harju
- Department of Otorhinolaryngology-Head and Neck Surgery, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Jussi Jero
- Department of Otorhinolaryngology-Head and Neck Surgery, Turku University Hospital and University of Turku, Turku, Finland
| | - Saku T Sinkkonen
- Department of Otorhinolaryngology-Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| |
Collapse
|
8
|
Hohenschurz-Schmidt D, Phalip J, Chan J, Gauhe G, Soliman N, Vollert J, Lunde SJ, Vase L. Placebo analgesia in physical and psychological interventions: Systematic review and meta-analysis of three-armed trials. Eur J Pain 2024; 28:513-531. [PMID: 37985188 DOI: 10.1002/ejp.2205] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/18/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND The magnitude of placebo effects from physical and psychological 'sham' is unknown but could impact efficacy trials and treatment understanding. To quantify placebo effects, this systematic review of three-armed randomised controlled trials (RCTs) of physical and psychological interventions for pain compared outcomes in 'sham' control intervention and non-exposure arms. METHODS RCTs with treatment, 'sham' control intervention, and non-exposure groups were included, enrolling adults with any pain. A protocol was pre-registered (PROSPERO: CRD42023413324), and twelve databases searched from 2008 to July 2023. Trial methods and blinding were analysed descriptively and risk of bias assessed. Meta-analysis of pain measures at short-, medium- and long-term was performed with random-effects models of standardised mean differences (SMD).Studies were sub-grouped according to control intervention type. RESULTS Seventeen RCTs were included. The average short-term placebo effect was small (0.21 SMD, 0.1-0.33 95% CI, p = 0.0002, 1440 participants). It showed no heterogeneity (Tau2 = 0.1, I2 = 11%, p = 0.3), preventing meta-regression analyses of effect modifiers. However, sub-group analyses revealed larger placebo effects in manual control interventions compared to disabled devices and miscellaneous control interventions. Overall, placebo analgesia accounted for 39% of treatments' short-term effectiveness. No placebo effects were found at medium-term (7 RCTs, 381 participants) or long-term follow-up (3 RCTs, 173 participants). CONCLUSIONS The observed placebo analgesia has mechanistic and methodological implications, though its clinical importance may be limited. Control intervention design affects placebo effects, highlighting the importance of considering methodology in RCT interpretation. Review limitations include a small number of long-term studies and sample heterogeneity. SIGNIFICANCE This systematic review directly quantifies placebo effects from physical and psychological 'sham' control interventions and compares them to treatments' overall effectiveness. By doing so, the review enhances our understanding of placebo effects, their relative contribution in clinical trials, and their susceptibly to trial design. It poses further questions regarding the influence of blinding, participant expectations, and features of the therapeutic context. Overall, the insights provided by this review carry methodological significance and are important for the interpretation and synthesis of efficacy trials in this field.
Collapse
Affiliation(s)
- David Hohenschurz-Schmidt
- Pain Research, Department of Surgery and Cancer, Imperial College London, London, UK
- Research Department, University College of Osteopathy, London, UK
| | - Jules Phalip
- Institut ANALGESIA, Faculté de Médecine, Université Clermont Auvergne, Clermont-Ferrand, France
- CHU Clermont-Ferrand, Inserm 1107 Neuro-Dol, Service de pharmacologie médicale, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Jessica Chan
- Faculty of Medicine, Imperial College London, London, UK
| | - Greta Gauhe
- Centre for Dance Research, Coventry University, Coventry, UK
| | - Nadia Soliman
- Pain Research, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jan Vollert
- Pain Research, Department of Surgery and Cancer, Imperial College London, London, UK
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Kiel, Germany
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Münster, Germany
- Neurophysiology, Mannheim Center of Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Sigrid Juhl Lunde
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Lene Vase
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| |
Collapse
|
9
|
Hemilä H, de Man AME. Vitamin C deficiency can lead to pulmonary hypertension: a systematic review of case reports. BMC Pulm Med 2024; 24:140. [PMID: 38504249 PMCID: PMC10949735 DOI: 10.1186/s12890-024-02941-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 03/01/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND In the early literature, unintentional vitamin C deficiency in humans was associated with heart failure. Experimental vitamin C deficiency in guinea pigs caused enlargement of the heart. The purpose of this study was to collect and analyze case reports on vitamin C and pulmonary hypertension. METHODS We searched Pubmed and Scopus for case studies in which vitamin C deficiency was considered to be the cause of pulmonary hypertension. We selected reports in which pulmonary hypertension was diagnosed by echocardiography or catheterization, for any age, sex, or dosage of vitamin C. We extracted quantitative data for our analysis. We used the mean pulmonary artery pressure (mPAP) as the outcome of primary interest. RESULTS We identified 32 case reports, 21 of which were published in the last 5 years. Dyspnea was reported in 69%, edema in 53% and fatigue in 28% of the patients. Vitamin C plasma levels, measured in 27 cases, were undetectable in 24 and very low in 3 cases. Diet was poor in 30 cases and 17 cases had neuropsychiatric disorders. Right ventricular enlargement was reported in 24 cases. During periods of vitamin C deficiency, the median mPAP was 48 mmHg (range 29-77 mmHg; N = 28). After the start of vitamin C administration, the median mPAP was 20 mmHg (range 12-33 mmHg; N = 18). For the latter 18 cases, mPAP was 2.4-fold (median) higher during vitamin C deficiency. Pulmonary vascular resistance (PVR) during vitamin C deficiency was reported for 9 cases, ranging from 4.1 to 41 Wood units. PVR was 9-fold (median; N = 5) higher during vitamin C deficiency than during vitamin C administration. In 8 cases, there was direct evidence that the cases were pulmonary artery hypertension (PAH). Probably the majority of the remaining cases were also PAH. CONCLUSIONS The cases analyzed in our study indicate that pulmonary hypertension can be one explanation for the reported heart failure of scurvy patients in the early literature. It would seem sensible to measure plasma vitamin C levels of patients with PH and examine the effects of vitamin C administration.
Collapse
Affiliation(s)
- Harri Hemilä
- Department of Public Health, University of Helsinki, POB 41, Helsinki, FI-00014, Finland.
| | - Angelique M E de Man
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands.
| |
Collapse
|
10
|
Pipaliya RM, Duckett KA, Monaghan NP, Miller EM, Young G, Brennan EA, Nguyen SA, Soler ZM, Schlosser RJ. The placebo effect in randomized-controlled trials of medical treatments for chronic rhinosinusitis: A systematic review and meta-analysis. Int Forum Allergy Rhinol 2024; 14:695-710. [PMID: 37985206 DOI: 10.1002/alr.23302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/12/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND The placebo effect observed in clinical trials evaluating medical treatments for chronic rhinosinusitis (CRS) is not well understood. This systematic review and meta-analysis sought to characterize the placebo effect present within CRS outcomes. METHODS A systematic review of PubMed, Scopus, and Cumulated Index in Nursing and Allied Health Nursing (CINAHL) was performed. Randomized controlled trials (RCTs) evaluating medical treatments for CRS versus placebo were included. We assessed patient-reported (sino-nasal outcome test 22 [SNOT-22], nasal obstruction, sense of smell, nasal obstruction visual analogue score [VAS], sense of smell VAS, anterior rhinorrhea, and postnasal drip) and objective (Lund-Mackay Computed tomography (CT) score, peak nasal inspiratory flow [PNIF], nasal polyp scores, 40-item Smell Identification Test, serum IgE, and blood eosinophil levels) outcomes. RESULTS Twenty-one RCTs were included, comprising 1437 patients (mean age 49.2 years). Biologics were the most common treatment investigated (n = 9). Eleven studies administered background steroids along with placebo. Following placebo administration, multiple patient-reported outcomes significantly decreased, including SNOT-22 (mean difference -9.49, 95% confidence interval [CI] [-11.26, -7.73]), nasal obstruction (-0.33 [-0.54, -0.13]), sense of smell (-0.22 [-0.33, -0.11]), nasal obstruction VAS (-2.47 [-2.87, -2.06]), and loss of smell VAS (-2.31 [-4.14, -0.47]) scores. For objective measures, significant changes occurred in Lund-Mackay CT score (-0.82, [-1.48, -0.16]) and PNIF (4.70, [4.76, 24.64]) with placebo. Placebo arms had the greatest impact when no background medications were used. CONCLUSIONS Placebo treatments have a statistically and potentially clinically significant effect on patient-reported and some objective CRS outcomes. Further investigation is required to fully understand placebo effect, which could improve assessment of RCTs and impact patient care.
Collapse
Affiliation(s)
- Royal M Pipaliya
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kelsey A Duckett
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Neil P Monaghan
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Emma Marin Miller
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Gabrielle Young
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Emily A Brennan
- MUSC Libraries, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Zachary M Soler
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rodney J Schlosser
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| |
Collapse
|
11
|
de Leeuw M, Laager M, Gaab J, Ruppen W, Schneider T. Boosting open-label placebo effects in acute induced pain in healthy adults (BOLPAP-study): study protocol of a randomized controlled trial. Front Med (Lausanne) 2024; 11:1238878. [PMID: 38420356 PMCID: PMC10900763 DOI: 10.3389/fmed.2024.1238878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Pain is a highly prevalent symptom in the hospital setting, but treatment options remain limited. Harnessing the placebo effect in an ethical manner could provide a new possibility to reduce pain in clinical practice. So called open-label placebos (OLP) have been shown to elicit significant effects in reducing acute pain. But, before implementation, more knowledge concerning the properties of OLPs is needed. This study aims to assess the duration of analgesic effects from OLP and to determine the possibility of boosting such effects. Methods and analysis This is the protocol of an ongoing (first patient enrolled in March 2023) single-site randomized trial investigating OLPs in two parts (i.e., substudies). In both parts, pain will be induced in healthy adults using an intradermal electrical stimulation model. Participants in Part 1 will have two study visits: An interventional visit with one OLP injection accompanied by an evidence-based treatment rationale and a control visit with no treatment. For Part 2, participants will be randomized into three groups: (1) A fixed-time "Booster" group including one single repetition of the OLP injection at a fixed time point, (2) an on-demand "Booster" group including one single repetition of the OLP injection on-demand, and (3) a control group who will receive just one OLP injection. Differences in pain ratings over time (using the Numeric Rating Scale) will be analyzed with several two-sample t-tests. The time point for a fixed-time "Booster" in Part 2 will be derived from Part 1 with additional statistical tools such as a broken-stick mixed-effect model. Discussion This study aims to further characterize the analgesic effects of OLPs. In doing so, it will provide valuable information needed for later implementation of OLPs in clinical practice, where they could play a role in multimodal analgesic concepts. Ethics and dissemination The "Ethikkommission Nordwest- und Zentralschweiz" (BASEC 2023-00296) approved the study protocol. Results of the analysis will be submitted for publication in a peer-reviewed journal. Clinical Trial Registration This study is registered at ClinicalTrials.gov (NCT05819476) and is listed in the Swiss National Registry at kofam.ch (SNCTP000005470).
Collapse
Affiliation(s)
- Matthijs de Leeuw
- Pain Unit, Clinic for Anesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Mirjam Laager
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Wilhelm Ruppen
- Pain Unit, Clinic for Anesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Tobias Schneider
- Pain Unit, Clinic for Anesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
12
|
Saueressig T, Pedder H, Owen PJ, Belavy DL. Contextual effects: how to, and how not to, quantify them. BMC Med Res Methodol 2024; 24:35. [PMID: 38350852 PMCID: PMC10863156 DOI: 10.1186/s12874-024-02152-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 01/16/2024] [Indexed: 02/15/2024] Open
Abstract
The importance of contextual effects and their roles in clinical care controversial. A Cochrane review published in 2010 concluded that placebo interventions lack important clinical effects overall, but that placebo interventions can influence patient-reported outcomes such as pain and nausea. However, systematic reviews published after 2010 estimated greater contextual effects than the Cochrane review, which stems from the inappropriate methods employed to quantify contextual effects. The effects of medical interventions (i.e., the total treatment effect) can be divided into three components: specific, contextual, and non-specific. We propose that the most effective method for quantifying the magnitude of contextual effects is to calculate the difference in outcome measures between a group treated with placebo and a non-treated control group. Here, we show that other methods, such as solely using the placebo control arm or calculation of a 'proportional contextual effect,' are limited and should not be applied. The aim of this study is to provide clear guidance on best practices for estimating contextual effects in clinical research.
Collapse
Affiliation(s)
- Tobias Saueressig
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany.
- Physio Meets Science GmbH, Johannes Reidel Str. 19, 69181, Leimen, Germany.
| | - Hugo Pedder
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall 39, Whatley Road, Bristol, BS8 2PN, UK
| | - Patrick J Owen
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Daniel L Belavy
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany
| |
Collapse
|
13
|
Seymour J, Mathers N. Placebo stimulates neuroplasticity in depression: implications for clinical practice and research. Front Psychiatry 2024; 14:1301143. [PMID: 38268561 PMCID: PMC10806142 DOI: 10.3389/fpsyt.2023.1301143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/26/2023] [Indexed: 01/26/2024] Open
Abstract
Neither psychological nor neuroscientific investigations have been able to fully explain the paradox that placebo is designed to be inert in randomized controlled trials (RCTs), yet appears to be effective in evaluations of clinical interventions in all fields of medicine and alternative medicine. This article develops the Neuroplasticity Placebo Theory, which posits that neuroplasticity in fronto-limbic areas is the unifying factor in placebo response (seen in RCTs) and placebo effect (seen in clinical interventions) where it is not intended to be inert. Depression is the disorder that has the highest placebo response of any medical condition and has the greatest potential for understanding how placebos work: recent developments in understanding of the pathophysiology of depression suggest that fronto-limbic areas are sensitized in depression which is associated with a particularly strong placebo phenomenon. An innovative linkage is made between diverse areas of the psychology and the translational psychiatry literature to provide supportive evidence for the Neuroplasticity Placebo Theory. This is underpinned by neuro-radiological evidence of fronto-limbic change in the placebo arm of antidepressant trials. If placebo stimulates neuroplasticity in fronto-limbic areas in conditions other than depression - and results in a partially active treatment in other areas of medicine - there are far reaching consequences for the day-to-day use of placebo in clinical practice, the future design of RCTs in all clinical conditions, and existing unwarranted assertions about the efficacy of antidepressant medications. If fronto-limbic neuroplasticity is the common denominator in designating placebo as a partially active treatment, the terms placebo effect and placebo response should be replaced by the single term "placebo treatment."
Collapse
Affiliation(s)
- Jeremy Seymour
- Retired Consultant Psychiatrist, Rotherham Doncaster and South Humber NHS Trust, Rotherham, United Kingdom
| | - Nigel Mathers
- Emeritus Professor, Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom
| |
Collapse
|
14
|
Liu T, Yu CP. How Do Expectations Modulate Pain? A Motivational Perspective. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2023; 18:1508-1519. [PMID: 37369088 DOI: 10.1177/17456916231178701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
Expectations can profoundly modulate pain experience, during which the periaqueductal gray (PAG) plays a pivotal role. In this article, we focus on motivationally evoked neural activations in cortical and brainstem regions both before and during stimulus administration, as has been demonstrated by experimental studies on pain-modulatory effects of expectations, in the hope of unraveling how the PAG is involved in descending and ascending nociceptive processes. This motivational perspective on expectancy effects on the perception of noxious stimuli sheds new light on psychological and neuronal substrates of pain and its modulation, thus having important research and clinical implications.
Collapse
Affiliation(s)
- Tao Liu
- The Second Teaching Hospital, University of Jilin
| | - Cui-Ping Yu
- Department of Basic Medicine, Changchun Medical College
| |
Collapse
|
15
|
Frisaldi E, Shaibani A, Benedetti F, Pagnini F. Placebo and nocebo effects and mechanisms associated with pharmacological interventions: an umbrella review. BMJ Open 2023; 13:e077243. [PMID: 37848293 PMCID: PMC10582987 DOI: 10.1136/bmjopen-2023-077243] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVES This review aimed to summarise the existing knowledge about placebo and nocebo effects associated with pharmacological interventions and their mechanisms. DESIGN Umbrella review, adopting the Assessment of Multiple Systematic Reviews 2 tool for critical appraisal. DATA SOURCES MEDLINE/PubMed, Scopus, Web of Science, PsycINFO, Cochrane Central Register of Controlled Trial were searched in September 2022, without any time restriction, for systematic reviews, narrative reviews, original articles. Results were summarised through narrative synthesis, tables, 95% CI. OUTCOME MEASURES Mechanisms underlying placebo/nocebo effects and/or their effect sizes. RESULTS The databases search identified 372 studies, for a total of 158 312 participants, comprising 41 systematic reviews, 312 narrative reviews and 19 original articles. Seventy-three per cent of the examined systematic reviews were of high quality.Our findings revealed that mechanisms underlying placebo and/or nocebo effects have been characterised, at least in part, for: pain, non-noxious somatic sensation, Parkinson's disease, migraine, sleep disorders, intellectual disability, depression, anxiety, dementia, addiction, gynaecological disorders, attention-deficit hyperactivity disorder, immune and endocrine systems, cardiovascular and respiratory systems, gastrointestinal disorders, skin diseases, influenza and related vaccines, oncology, obesity, physical and cognitive performance. Their magnitude ranged from 0.08 to 2.01 (95% CI 0.37 to 0.89) for placebo effects and from 0.32 to 0.90 (95% CI 0.24 to 1.00) for nocebo effects. CONCLUSIONS This study provides a valuable tool for clinicians and researchers, identifying both results ready for clinical practice and gaps to address in the near future. FUNDING Università Cattolica del Sacro Cuore, Milan, Italy with the 'Finanziamento Ponte 2022' grant. PROSPERO REGISTRATION NUMBER CRD42023392281.
Collapse
Affiliation(s)
- Elisa Frisaldi
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Aziz Shaibani
- Muscle and Nerve Center, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Fabrizio Benedetti
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Francesco Pagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| |
Collapse
|
16
|
Xiong ZY, Liu XY, Ma PH, Sun CY, Sun CY, Liu TL, Liu BY, Liu CZ, Yan SY. Placebo Response among Different Types of Sham Acupuncture for Low Back Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Chin J Integr Med 2023; 29:941-950. [PMID: 37580465 DOI: 10.1007/s11655-023-3608-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Low back pain (LBP) is a prevalent and debilitating condition that poses a significant burden on healthcare systems. Acupuncture has been proposed as a promising intervention for LBP, but the evidence supporting its specific effect is insufficient, and the use of sham acupuncture as a control in clinical trials presents challenges due to variations in sham acupuncture techniques and the magnitude of the placebo effect. OBJECTIVE To investigate the magnitude of the placebo response of sham acupuncture in trials of acupuncture for nonspecific LBP, and to assess whether different types of sham acupuncture are associated with different responses. METHODS Four databases including PubMed, EMBASE, MEDLINE, and the Cochrane Library were searched through April 15, 2023, and randomized controlled trials (RCTs) were included if they randomized patients with LBP to receive acupuncture or sham acupuncture intervention. The main outcomes included the placebo response in pain intensity, back-specific function and quality of life. Placebo response was defined as the change in these outcome measures from baseline to the end of treatment. Random-effects models were used to synthesize the results, standardized mean differences (SMDs, Hedges'g) were applied to estimate the effect size. RESULTS A total of 18 RCTs with 3,321 patients were included. Sham acupuncture showed a noteworthy pooled placebo response in pain intensity in patients with LBP [SMD -1.43, 95% confidence interval (CI) -1.95 to -0.91, I2=89%]. A significant placebo response was also shown in back-specific functional status (SMD -0.49, 95% CI -0.70 to -0.29, I2=73%), but not in quality of life (SMD 0.34, 95% CI -0.20 to 0.88, I2=84%). Trials in which the sham acupuncture penetrated the skin or performed with regular needles had a significantly higher placebo response in pain intensity reduction, but other factors such as the location of sham acupuncture did not have a significant impact on the placebo response. CONCLUSIONS Sham acupuncture is associated with a large placebo response in pain intensity among patients with LBP. Researchers should also be aware that the types of sham acupuncture applied may potentially impact the evaluation of the efficacy of acupuncture. Nonetheless, considering the nature of placebo response, the effect of other contextual factors cannot be ruled out in this study. (PROSPERO registration No. CRD42022304416).
Collapse
Affiliation(s)
- Zhi-Yi Xiong
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Xiao-Yu Liu
- School of Acupuncture-Moxibustion and Tuina, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Pei-Hong Ma
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Chong-Yang Sun
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Cheng-Yi Sun
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Ting-Lan Liu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Bao-Yan Liu
- China Academy of Chinese Medical Sciences, Beijing, 100007, China
| | - Cun-Zhi Liu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Shi-Yan Yan
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China.
| |
Collapse
|
17
|
Møller-Hansen M. Mesenchymal stem cell therapy in aqueous deficient dry eye disease. Acta Ophthalmol 2023; 101 Suppl 277:3-27. [PMID: 37840443 DOI: 10.1111/aos.15739] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
ENGLISH SUMMARY Dry eye disease (DED) is characterized by ocular dryness, irritation and blurred vision and has a significant impact on the patient's quality of life. This condition can be particularly severe in patients with aqueous deficient dry eye disease (ADDE) due to Sjögren's syndrome (SS), an autoimmune disease that affects the lacrimal and salivary glands. Current treatments for ADDE are often limited to symptomatic relief. A literature review was conducted to explore the current surgical interventions used or tested in humans with ADDE (I). These interventions include procedures involving the eyelids and tear ducts, transplantation of amniotic membrane or salivary glands, injections around the tear ducts and cell-based injections into the lacrimal gland (LG). Each treatment has its advantages and disadvantages; however, treating dry eyes in patients with SS presents a particular challenge due to the systemic nature of the disease. Moreover, there is a need for new therapeutic options. Mesenchymal stem cells (MSCs) are a type of stem cell that have shown promise in regenerating damaged tissue and reducing inflammation in various diseases. Previous studies in animal models have suggested that MSCs could be effective in treating ADDE. Thus, this thesis aims to investigate the safety and efficacy of injecting MSCs into the LG as a treatment option for patients with ADDE secondary to SS. The study also aims to see this treatment in light of existing and novel investigational treatment options. The clinical studies conducted for this thesis are the first of their kind in humans. MSCs derived from healthy donors' adipose tissue (ASCs) were cultured in a laboratory, frozen and thawed ready for use. In the safety study, we performed the first human trial involving the administration of a single injection of ASCs into the LG of one eye in seven patients suffering from severe ADDE (II). The primary objective was to test the safety of this treatment, while the secondary objective was to assess improvements in subjective and objective signs of dry eye. The results of the trial showed no serious side effects within 4 months of follow-up after treatment. On average, there was a 40% reduction in dry eye symptoms assessed with the Ocular Surface Disease Index (OSDI) questionnaire. Additionally, in the treated eye, there was a significant decrease in tear osmolarity, an increase in tear film stability and an increase in tear production. To further investigate the efficacy of this treatment, our research group performed a clinical, randomized study aiming to compare the ASC injection into the LG with the injection of a vehicle (the excipient in which the ASCs are dissolved) and observation (no intervention) (III). The study involved 20 subjects receiving ASC injection, 20 subjects receiving vehicle injection and 14 patients being observed without intervention. The subjects were examined to assess the outcomes with a 12-month follow-up after treatment. Both intervention groups showed a significant reduction in subjective dry eye symptoms of approximately 40%. This improvement was evident at the 1-week follow-up and persisted until the 12-month follow-up. The observation group did not experience any change in OSDI score. The ASCs group exhibited a significant mean increase in non-invasive tear break-up time (NIKBUT) of 6.48 s (149%) at the four-week follow-up, which was significantly higher than that in the vehicle group (p = 0.04). Moreover, the ASCs group showed a significant increase in NIKBUT compared to that in the observation group at the 12-month follow-up (p = 0.004). In both the ASCs and vehicle group, a significant increase in Schirmer test scores at the 4-month follow-up and the 12-month follow-up was observed. In conclusion, this thesis contributes valuable findings with a new treatment option for patients with dry eye disease. Injection of ASCs into the LG was shown to be safe and to improve subjective dry eye symptoms and specifically the tear film stability in patients with ADDE due to SS. Compared to other treatment modalities of ADDE, this treatment has greater potential, as ASCs could potentially be used as an anti-inflammatory therapeutic option for managing DED of other causes as well. RESUMÉ (DANISH SUMMARY): Tørre øjne, karakteriseret ved tørhedsfornemmelse og irritation af øjnene samt sløret syn, har en betydelig indvirkning på patientens livskvalitet. Denne tilstand kan vaere saerligt alvorlig hos patienter med nedsat tåreproduktion (ADDE) som følge af Sjögrens syndrom (SS), en autoimmun sygdom, der påvirker tårekirtlerne og spytkirtlerne. Nuvaerende behandlinger for ADDE er ofte begraenset til symptomlindring. Vi gennemførte en litteraturgennemgang for at undersøge, hvilke nuvaerende kirurgiske behandlingsmetoder, der anvendes eller testes hos patienter med ADDE (I). Disse interventioner inkluderer procedurer, der involverer øjenlåg og tårekanaler, transplantation af amnionhinde eller spytkirtler, injektioner omkring tårekanalerne samt cellebaserede injektioner i tårekirtlen. Hver behandling har sine fordele og ulemper, men behandling af tørre øjne hos patienter med SS udgør en saerlig udfordring på grund af sygdommens systemiske udbredning, og der er behov for nye behandlingsmuligheder. Mesenkymale stamceller (MSCs) er en type stamcelle, der har vist lovende resultater med hensyn til at regenerere beskadiget vaev og reducere inflammation i forskellige sygdomme. Tidligere undersøgelser i dyremodeller har indikeret, at MSCs kan vaere en effektiv behandling af ADDE. Denne afhandling har til formål at undersøge sikkerheden og effekten af injektion af MSCs i tårekirtlen som en mulig behandling til patienter med ADDE som følge af SS. Afhandlingen sigter også mod at sammenligne denne behandling med andre eksisterende, kirurgiske behandlingsmuligheder af ADDE. Som led i dette projekt udførte vi de første kliniske forsøg af sin art i mennesker. MSCs fra raske donorers fedtvaev (ASCs) blev dyrket i et laboratorium, frosset ned og er optøet klar til brug. Det første mål var at teste sikkerheden ved denne behandling og sekundaert at undersøge behandlingens effekt. For at undersøge dette modtog syv forsøgspersoner med svaer ADDE én injektion med ASCs i tårekirtlen på det ene øje (II). Resultaterne af forsøget viste ingen alvorlige bivirkninger inden for fire måneders opfølgning efter behandlingen. I gennemsnit fandt vi yderligere en 40% reduktion i symptomer på tørre øjne vurderet med et spørgeskema, og en markant stigning i tåreproduktionen og af tårefilmens stabilitet i det behandlede øje. For yderligere at undersøge effekten af denne behandling udførte vi et klinisk, randomiseret forsøg med det formål at sammenligne injektion af ASCs i tårekirtlen med injektion af en kontrolopløsning (vaesken, hvor stamcellerne var opløst) og observation (ingen intervention) (III). Studiet omfattede 20 forsøgspersoner, der modtog ASC-injektion, 20 forsøgspersoner, der modtog injektion af kontrolopløsningen, og 14 forsøgspersoner i observationsgruppen. Forsøgspersonerne blev undersøgt med en opfølgningstid på 12 måneder efter behandling. Begge interventionsgrupper viste en betydelig reduktion på ca. 40% i subjektive symptomer på tørre øjne. Denne forbedring var betydelig allerede ved opfølgning efter en uge og varede ved 12 måneder efter behandling. Observationsgruppen oplevede ingen betydelig aendring i symptomer. ASCs gruppen viste desuden en signifikant stigning i tårefilmsstabiliteten (NIKBUT) på 6,48 sekunder (149%) ved opfølgning efter fire uger, hvilket var markant højere end efter injektion af kontrolopløsning (p = 0,04). Desuden viste ASCs gruppen en betydelig stigning i NIKBUT sammenlignet med observationsgruppen ved opfølgning efter 12 måneder (p = 0,004). Både injektion af ASCs og kontrolopløsning medførte en betydelig stigning i tåreproduktionen ved opfølgning fire måneder og 12 måneder efter behandling. Denne afhandling bidrager med vigtige resultater inden for en ny behandlingsmulighed af tørre øjne. Injektion af ASCs i tårekirtlen viste sig at vaere sikker, forbedrede subjektive symptomer på tørre øjne og øgede saerligt tårfilmens stabilitet hos patienter med ADDE på grund af SS. Sammenlignet med andre behandlingsmuligheder for ADDE har denne behandling vist et stort potentiale. ASCs kan muligvis også bruges som en anti-inflammatorisk behandling af tørre øjne af andre årsager i fremtiden.
Collapse
Affiliation(s)
- Michael Møller-Hansen
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
18
|
Gossenheimer AN, de Freitas MB, Pádua Borges RD, Pohlmann L, Dalzochio M, Todendi P, Ziegelmann PK, Telo GH, Schaan EBD. The power of the placebo effect in diabetes: A systematic review and meta-analysis. Prim Care Diabetes 2023; 17:221-228. [PMID: 37003927 DOI: 10.1016/j.pcd.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/16/2023] [Accepted: 03/22/2023] [Indexed: 04/03/2023]
Abstract
This review aims to identify the magnitude of the placebo effect in people with type 2 diabetes mellitus. Literature research was conducted Medline, Embase and Virtual Health Library for studies published between the date of inception and June 2021. The eligibility criteria included randomized controlled trials, showing comparison to placebo, having participants with type 2 diabetes mellitus, and having glycated hemoglobin (HbA1c) as the primary outcome. Meta-analysis was conducted with the effect of changing HbA1c in relation to the baseline. Exploration of heterogeneity was performed.The meta-analysis showed an increase in the average of HbA1c compared to the baseline of 0.14% (95% CI: 0.07-0.21). There was a significant difference between follow-up times (p = 0.03) and between administration routes (p = 0.01), with an increase in HbA1c in the oral route [0.15% (95% CI: 0.07-0.23)]. The meta-regression of the year of publication showed a significant downward trend (p = 0.01) of the increase in HbA1c compared to the baseline.In this study, the expected placebo effect of Hba1c reduction was not found; instead, higher Hba1c levels were observed in the control groups, although this effect was reduced over the years. Registration: PROSPERO ID CRD42020172797.
Collapse
Affiliation(s)
- Agnes Nogueira Gossenheimer
- Department of Internal Medicine, Faculty of Medicine, Graduate Program in Medical Sciences: Endocrinology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
| | | | | | | | | | - Pâmela Todendi
- Department of Internal Medicine, Faculty of Medicine, Graduate Program in Medical Sciences: Endocrinology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Patrícia Klarmann Ziegelmann
- Department of Statistics and the Postgraduate Program in Cardiology and Cardiovascular Sciences at Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Gabriela H Telo
- School of Medicine, Graduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - E Beatriz D Schaan
- Department of Internal Medicine, Faculty of Medicine, Graduate Program in Medical Sciences: Endocrinology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| |
Collapse
|
19
|
Xie Y, Liu X, Liu T, Sun C, Xin Z, Hu Y, Wang Y, Zhang C, Yan S. Descriptions of sham acupuncture in randomised controlled trials: a critical review of the literature. BMC Complement Med Ther 2023; 23:173. [PMID: 37254178 PMCID: PMC10227975 DOI: 10.1186/s12906-023-04007-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 05/22/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Sham acupuncture is usually used to assess the specific effects of acupuncture. However, the reporting quality of sham acupuncture remains unclear despite its critical importance in understanding and analyzing the effects of acupuncture. This paper presents a literature review aimed at assessing the quality of reporting of sham acupuncture in randomized controlled trials (RCTs) based on STRICTA 2010 and TIDieR-Placebo. METHODS Three electronic English-language databases (PubMed, MEDLINE and Embase) were searched from inception to March 7, 2022, and RCTs of sham acupuncture were identified. The reporting quality of sham acupuncture was assessed in accordance with the items recommended in STRICTA 2010 and TIDieR-Placebo. The reporting quality of other items related to sham acupuncture apart from items from these two checklists was also captured to further assess the reporting quality of sham acupuncture. RESULTS A total of 609 eligible studies were included. For all of the items recommended in STRICTA 2010 and TIDieR-Placebo, 100% of the studies reported a brief name that described the sham acupuncture, 93.9% studies reported the needle type, and 90.0% reported the names of the points used. Other items for which the reporting rates were above 50% included the number, frequency and duration of treatment sessions; needle retention time; and number of needle insertions per subject per session. Overall, 49.4% of the studies revealed the rationale why sham acupuncture was chosen, 39.7% of the studies involving insertion processes reported the depth of insertion, and 37.9% of the studies reported the needle manufacturer. Other items for which the reporting rates were below 30% included practitioner-related information, response sought, evaluation of blinding, intervention mode and environment, assisting tools, and the extent to which the treatment was varied. The items "Modifications", "How well (planned)" and "How well (actual)" were not reported in any of the analyzed studies. CONCLUSIONS The overall reporting quality of sham acupuncture in RCTs was suboptimal. Although STRICTA 2010 and TIDieR-Placebo could be beneficial for describing sham acupuncture, neither can offer recommendations specifically for sham acupuncture. There is thus an urgent need to develop specialized guidelines for reporting sham acupuncture in clinical trials.
Collapse
Affiliation(s)
- Yixuan Xie
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoyu Liu
- School of Acupuncture-Moxibustion and Tuina, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Tinglan Liu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Chiyun Sun
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Zeyin Xin
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Yuzhi Hu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Yue Wang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Cheng Zhang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Shiyan Yan
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China.
| |
Collapse
|
20
|
Kerschbaumer A, Stimakovits NM, Smolen JS, Stefanova T, Chwala E, Aletaha D. Influence of active versus placebo control on treatment responses in randomised controlled trials in rheumatoid arthritis. Ann Rheum Dis 2023; 82:476-482. [PMID: 36627167 DOI: 10.1136/ard-2022-223349] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/12/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To investigate whether treatment effects of pharmaceutical compounds compared with placebo controls are systematically different to the effects of the same compounds compared with active treatment controls in rheumatoid arthritis (RA) clinical trials. METHODS We systematically identified randomised controlled trials (RCTs) in RA, and matched active treatment arms with comparable regimens, populations, background therapy, and outcome reporting, by the nature of their control group (active comparator or placebo). Medline, EMBASE and CENTRAL were used to identify RCTs investigating disease modifying anti-rheumatic drug therapies until December 2021. Using mixed-model logistic regression we estimated OddsRatios (OR) for achieving an American College of Rheumatology (ACR) 20/50/70% response at weeks 12 and 24. Risk of bias was assessed using the Cochrane Tool. RESULTS We screened 8328 studies and included 40 for analysis after detailed review of 590 manuscripts; unique compounds had significantly higher responses in active comparator trials compared with their effects observed in placebo controlled trials, with ORs of 1.67 (95% CI 1.46 to 1.91; p<0.001) for ACR20, 1.50 (95% CI 1.29 to 1.75; p<0.001) for ACR50 and 1.65 (95% CI 1.30 to 2.10; p<0.001) for ACR70 (week 12); corresponding ORs for ACR 20, 50, and 70 (week 24) were 1.93 (95% CI 1.50 to 2.48; p<0.001), 1.75 (95% CI 1.32 to 2.33; p<0.001) and 1.68 (95% CI 1.21 to 2.34; p<0.001), respectively. Sensitivity analyses showed consistent results. CONCLUSION Placebo controlled trials lead to smaller effect sizes of active compounds in RCTs compared with the same compound in head-to-head trials. This difference may be explained by potential nocebo effects in placebo-controlled settings and needs to be considered when interpreting head-to-head and placebo-controlled trials, by patients, investigators, sponsors and regulatory agencies.
Collapse
Affiliation(s)
- Andreas Kerschbaumer
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Wien, Austria
| | - Nina Maria Stimakovits
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Wien, Austria
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Wien, Austria
| | - Tijen Stefanova
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Wien, Austria
| | - Eva Chwala
- University Library, Medical University of Vienna, Wien, Austria
| | - Daniel Aletaha
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Wien, Austria
| |
Collapse
|
21
|
Els C, Jackson TD, Hagtvedt R, Kunyk D, Sonnenberg B, Lappi VG, Straube S. High-dose opioids for chronic non-cancer pain: an overview of Cochrane Reviews. Cochrane Database Syst Rev 2023; 3:CD012299. [PMID: 36961252 PMCID: PMC10037930 DOI: 10.1002/14651858.cd012299.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
BACKGROUND This overview was originally published in 2017, and is being updated in 2022. Chronic pain is typically described as pain on most days for at least three months. Chronic non-cancer pain (CNCP) is any chronic pain that is not due to a malignancy. Chronic non-cancer pain in adults is a common and complex clinical issue, for which opioids are prescribed by some physicians for pain management. There are concerns that the use of high doses of opioids for CNCP lacks evidence of effectiveness, and may increase the risk of adverse events. OBJECTIVES To describe the evidence from Cochrane Reviews and overviews regarding the efficacy and safety of high-dose opioids (defined as 200 mg morphine equivalent or more per day) for CNCP. METHODS We identified Cochrane Reviews and overviews by searching the Cochrane Database of Systematic Reviews in The Cochrane Library. The date of the last search was 21 July 2022. Two overview authors independently assessed the search results. We planned to analyse data on any opioid agent used at a high dose for two weeks or more for the treatment of CNCP in adults. MAIN RESULTS We did not identify any reviews or overviews that met the inclusion criteria. The excluded reviews largely reflected low doses or titrated doses, where all doses were analysed as a single group; we were unable to extract any data for high-dose use only. AUTHORS' CONCLUSIONS There is a critical lack of high-quality evidence, in the form of Cochrane Reviews, about how well high-dose opioids work for the management of CNCP in adults, and regarding the presence and severity of adverse events. No evidence-based argument can be made on the use of high-dose opioids, i.e. 200 mg morphine equivalent or more daily, in clinical practice. Considering that high-dose opioids have been, and are still being used in clinical practice to treat CNCP, knowing about the efficacy and safety of these higher doses is imperative.
Collapse
Affiliation(s)
- Charl Els
- Department of Psychiatry, University of Alberta, Edmonton, Canada
- College of Physicians and Surgeons of Alberta, Edmonton, Canada
| | - Tanya D Jackson
- Department of Medicine, Division of Preventive Medicine, University of Alberta, Edmonton, Canada
| | - Reidar Hagtvedt
- Accounting and Business Analytics, Alberta School of Business, University of Alberta, Edmonton, Canada
| | - Diane Kunyk
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Barend Sonnenberg
- Medical Services, Workers' Compensation Board - Alberta, Edmonton, Canada
| | - Vernon G Lappi
- Department of Medicine, Division of Preventive Medicine, University of Alberta, Edmonton, Canada
| | - Sebastian Straube
- Department of Medicine, Division of Preventive Medicine, University of Alberta, Edmonton, Canada
| |
Collapse
|
22
|
Tsutsumi Y, Tsujimoto Y, Tajika A, Omae K, Fujii T, Onishi A, Kataoka Y, Katsura M, Noma H, Sahker E, Ostinelli EG, Furukawa TA. Proportion attributable to contextual effects in general medicine: a meta-epidemiological study based on Cochrane reviews. BMJ Evid Based Med 2023; 28:40-47. [PMID: 35853683 PMCID: PMC9887379 DOI: 10.1136/bmjebm-2021-111861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Our objectives were to examine the magnitude of the proportion attributable to contextual effects (PCE), which shows what proportion of the treatment arm response can be achieved by the placebo arm across various interventions, and to examine PCE variability by outcome type and condition. DESIGN We conducted a meta-epidemiological study. SETTING We searched the Cochrane Database of Systematic Reviews with the keyword 'placebo' in titles, abstracts and keywords on 1 January 2020. PARTICIPANTS We included reviews that showed statistically significant beneficial effects of the intervention over placebo for the first primary outcome. MAIN OUTCOME MEASURES We performed a random-effects meta-analysis to calculate PCEs based on the pooled result of each included review, grouped by outcome type and condition. The PCE quantifies how much of the observed treatment response can be achieved by the contextual effects. PUBLIC AND PATIENT INVOLVEMENT STATEMENT No patient or member of the public was involved in conducting this research. RESULTS We included 328 out of 3175 Cochrane systematic reviews. The results of meta-analyses showed that PCEs varied greatly depending on outcome type (I2=98%) or condition (I2=98%), but mostly lie between 0.40 and 0.95. Overall, the PCEs were 0.65 (95% CI 0.59 to 0.72) on average. Subjective outcomes were 0.50 (95% CI 0.41 to 0.59), which was significantly smaller than those of semiobjective (PCE 0.78; 95% CI 0.72 to 0.85) or objective outcomes (PCE 0.94; 95% CI 0.91 to 0.97). CONCLUSIONS The results suggest that much of the observed benefit is not just due to the specific effect of the interventions. The specific effects of interventions may be larger for subjective outcomes than for objective or semiobjective outcomes. However, PCEs were exceptionally variable. When we evaluate the magnitude of PCEs, we should consider each PCE individually, for each condition, intervention and outcome in its context, to assess the importance of an intervention for each specific clinical setting.
Collapse
Affiliation(s)
- Yusuke Tsutsumi
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Emergency Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - Yasushi Tsujimoto
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/ School of Public Health, Kyoto, Japan
- Department of Nephrology and Dialysis, Kyoritsu Hospital, Kawanishi, Japan
| | - Aran Tajika
- Department of Psychiatry, Kyoto University Hospital, Kyoto, Japan
| | - Kenji Omae
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/ School of Public Health, Kyoto, Japan
- Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima, Japan
| | - Tomoko Fujii
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
- Intensive Care Unit, Jikei University Hospital, Tokyo, Japan
| | - Akira Onishi
- Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Yuki Kataoka
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/ School of Public Health, Kyoto, Japan
- Hospital Care Research Unit/ Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | | | - Hisashi Noma
- Department of Data Science, The Institute of Statistical Mathematics, Tokyo, Japan
| | - Ethan Sahker
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
- Population Health and Policy Research Unit, Medical Education Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Edoardo Giuseppe Ostinelli
- Oxford Health NHS Foundation Trust, Warneford Hospital /Department of Psychiatry, University of Oxford, Oxford, UK
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| |
Collapse
|
23
|
Estimation of placebo effect in randomized placebo-controlled trials for moderate or severe vasomotor symptoms: a meta-analysis. Menopause 2023; 30:5-10. [PMID: 36576440 DOI: 10.1097/gme.0000000000002094] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The Food and Drug Administration guidance recommended that for the indication of vasomotor symptoms (VMS), studies should enroll participants with minimum of seven to eight moderate to severe VMS per day at baseline, and coprimary endpoints should be the mean change in frequency/severity at weeks 4 and 12. This study aimed to estimate placebo effects in randomized controlled trials (RCTs) fulfilling this guidance. METHODS PubMed was searched using the following terms: "vasomotor symptom or hot flash or hot flashes or hot flash or hot flashes [title/abstract]," "menopause or climacteric," "RCT or randomized controlled or randomized controlled," "placebo [title/abstract]," and "frequency or severity." Inclusion criteria were as follows: (1) placebo controlled RCTs, (2) enrolling women with moderate or severe VMS with a minimal frequency more than seven to eight times per day or 50 times per week, and (3) efficacy measurements including mean change in VMS frequency from baseline at week 12. A random-effects model was used in the meta-analysis. RESULTS Seventeen studies were included for the estimation of VMS frequency reduction and 13 studies for severity. Estimated change of VMS frequency in placebo arms was -5.44 times per day (95% CI, -5.81 to -5.07 times per day) at week 12. For VMS severity, the estimated change at week 12 was -0.36 (95% CI, -0.46 to -0.27). CONCLUSION Substantial and consistent placebo effects were observed in RCTs for VMS treatment. These data suggest a reduction of 5.44 times per day in frequency and 0.36 in severity might be observed as a placebo effect.
Collapse
|
24
|
Zunhammer M, Goltz G, Schweifel M, Stuck BA, Bingel U. Savor the flavor: A randomized double-blind study assessing taste-enhanced placebo analgesia in healthy volunteers. Clin Transl Sci 2022; 15:2709-2719. [PMID: 36088659 PMCID: PMC9652436 DOI: 10.1111/cts.13397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/01/2022] [Accepted: 08/06/2022] [Indexed: 01/26/2023] Open
Abstract
Placebo effects substantially contribute to analgesic treatment outcomes and might be leveraged to enhance gold-standard treatments. The taste of oral medications has been proposed to boost placebo effects. Here, we aimed at estimating how far the taste of an oral medication enhances placebo analgesia. We conducted a randomized, double-blind, between-group, single-visit study, with pre-treatment baseline. Over the course of three substudies, 318 healthy volunteers (297 included) were tested in a clinical trial setting. Participants were subjected to experimental tonic cold water pain (cold pressor test) before and after receiving taste-neutral (water), or bitter (quinine), or sweet (saccharin), or no placebo drops. Pre- versus post-treatment changes in area under the pain rating curve, the main outcome, indicated that placebo treatment showed a small analgesic effect versus no treatment. Added taste induced placebo enhancement in the very small effect size range, but accounted for a substantial portion of the overall placebo effect. No noteworthy advantage of sweet over bitter placebo was observed. An exploration of heart rate (HR) recordings indicated that placebo treatments were associated with an increase in peak HR-response to cold water, but these were not associated with placebo analgesia at an individual level. Placebo treatments were associated with minimal side effects. These results indicate that added taste may be an easy-to-implement, cost-effective, and safe way to optimize treatment outcomes and that taste-neutral preparations may reduce placebo-related outcome variance in clinical trials. Further studies are needed to test if these findings can be translated into clinical scenarios.
Collapse
Affiliation(s)
- Matthias Zunhammer
- Department of Neurology, Center for Translational Neuro‐ and Behavioral Sciences (C‐TNBS)University Hospital EssenEssenGermany
| | - Gerrit Goltz
- Department of Neurology, Center for Translational Neuro‐ and Behavioral Sciences (C‐TNBS)University Hospital EssenEssenGermany
| | - Maximilian Schweifel
- Department of Neurology, Center for Translational Neuro‐ and Behavioral Sciences (C‐TNBS)University Hospital EssenEssenGermany
| | - Boris A. Stuck
- Department of Otolaryngology, Head and Neck Surgery, University Hospital MarburgPhilipps‐Universität MarburgMarburgGermany
| | - Ulrike Bingel
- Department of Neurology, Center for Translational Neuro‐ and Behavioral Sciences (C‐TNBS)University Hospital EssenEssenGermany
| |
Collapse
|
25
|
Effectiveness of 38% Silver Diamine Fluoride in Reducing Dentine Hypersensitivity on Exposed Root Surface in Older Chinese Adults: Study Protocol for a Randomised Double-Blind Study. Dent J (Basel) 2022; 10:dj10100194. [PMID: 36286004 PMCID: PMC9600009 DOI: 10.3390/dj10100194] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/30/2022] [Accepted: 10/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Dentine hypersensitivity on an exposed root surface induces pain, affects daily oral hygiene practice, limits dietary choices and negatively affects quality of life. Silver diamine fluoride is marketed in the United States as a desensitising agent, but well-designed clinical trials are limited. This study evaluates the anti-hypersensitivity effect of silver diamine fluoride on hypersensitive teeth due to an exposed root surface in older Chinese adults. Methods/design: We will conduct a randomised double-blind clinical trial with a sample size of at least 148 Chinese older adults aged 65 or above who have dentine hypersensitivity due to an exposed root surface. We will collect written consent before the study. A trained examiner will examine the participants’ teeth with a blast of compressed air from a 3-in-1 syringe. Those adults who report a self-perceived sensitivity score (SS) (0 to 10) of 8 or more on at least one tooth with an exposed root surface will be recruited. The recruited older adults will be randomly allocated into two groups using a block randomisation of six. Group 1 participants will receive the application of 38% silver diamine fluoride solution every 4 weeks. Group 2 participants will receive the application of 5% potassium nitrate solution every 4 weeks. Dietary advice, oral hygiene instruction and fluoride toothpaste at 1450 ppm will be provided to participants in both groups. The same trained examiner will perform follow-up examinations for the participants and determine the dentine hypersensitivity in SS of the most hypersensitive tooth (with the highest pre-treatment SS) immediately after the intervention and at 4-week and 8-week intervals. Discussion: There is no consensus on the standard of care for a professionally applied desensitising agent in older adults. This trial will provide evidence for clinicians to devise an effective dental care plan for older adults with dentine hypersensitivity. Trial registration: NCT05392868 Registered on 22 May 2022.
Collapse
|
26
|
Feldman HA, Feldman JA, Miller CC, Walsh G, Tyson JE. Informed Consent for Placebo-Controlled Trials: Do Ethics and Science Conflict? Ethics Hum Res 2022; 44:42-48. [PMID: 36047276 PMCID: PMC9841466 DOI: 10.1002/eahr.500142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The use of a placebo has been considered the best method for controlling bias in a prospective randomized clinical trial and provides the most rigorous test of treatment efficacy for evaluating a medical therapy. Placebos commonly produce clinically important effects particularly in studies where the primary outcomes are subjective. Yet the potential beneficial or harmful effects of placebos are often not addressed in designing a clinical trial, calculating the sample size, seeking consent, or interpreting clinical trial results. In this manuscript, we use an actual study to indicate three approaches that might be considered in seeking informed consent for placebo-controlled trials, and we explore the fundamental ethical and scientific complexities involved with each.
Collapse
Affiliation(s)
- Hope A. Feldman
- Department of Thoracic and Cardiovascular Surgery at the University of Texas MD Anderson Cancer Center
| | - James A. Feldman
- Department of Emergency Medicine at the Boston Medical Center at the Boston University School of Medicine
| | - Charles C. Miller
- University of Texas Health Science Center at Houston in the McGovern Medical School
| | - Garrett Walsh
- Department of Thoracic and Cardiovascular Surgery at the University of Texas MD Anderson Cancer Center
| | - Jon E. Tyson
- University of Texas Health Science Center at Houston in the McGovern Medical School
| |
Collapse
|
27
|
Pardo-Cabello AJ, Manzano-Gamero V, Puche-Cañas E. Placebo: a brief updated review. Naunyn Schmiedebergs Arch Pharmacol 2022; 395:1343-1356. [PMID: 35943515 PMCID: PMC9361274 DOI: 10.1007/s00210-022-02280-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/03/2022] [Indexed: 11/04/2022]
Abstract
Our aims were to provide updated information on placebo/nocebo effect and the potential use of placebo in clinical practice. This article can only provide a rough overview on the placebo and nocebo effect and is intended to serve as a starting point for the reader to go deeper into the corresponding literature. The placebo effect has been observed in multiple medical conditions, after oral administration, with manual therapies as well as with surgery and invasive procedures. The use of placebo in clinical trials is fundamental, although the ethics of its use is under discussion. The placebo may behave like a drug from the pharmacokinetic and pharmacodynamic point of view and can also be associated with adverse events (nocebo effect). Placebo can modify treatment by increasing or decreasing the effects of drugs. The factors associated with the occurrence of placebo effect are multiple, but in addition to those that depend on the placebo itself, the doctor-patient relationship would be the most important. As a result of findings that were published in the last two decades, the psycho-neurobiological basis of placebo is becoming better understood, although further studies are needed. In conclusion, the placebo effect in the clinic exhibits weak to moderate intensity. Placebo, in addition to its use in the clinical trial, should be considered another therapeutic remedy either as stand alone or in association with treatment, and could be useful in certain circumstances. The use of placebo should be regulated by the European health authorities through a guide in clinical practice that will improve patient care.
Collapse
Affiliation(s)
- Alfredo Jose Pardo-Cabello
- Department of Internal Medicine, Hospital Universitario San Cecilio, Avda. de La Innovación, s/n, 18016, Granada, Spain.
| | - Victoria Manzano-Gamero
- Department of Internal Medicine, Hospital Universitario Virgen de Las Nieves, Granada, Spain
| | - Emilio Puche-Cañas
- Department of Pharmacology, School of Medicine, University of Granada, Granada, Spain
| |
Collapse
|
28
|
Giandomenico D, Nuria R, Alessandro A, Matteo G, Mattia I, Marco T, Francesco C. Differences between experimental and placebo arms in manual therapy trials: a methodological review. BMC Med Res Methodol 2022; 22:219. [PMID: 35941533 PMCID: PMC9358888 DOI: 10.1186/s12874-022-01704-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/04/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND To measure the specific effectiveness of a given treatment in a randomised controlled trial, the intervention and control groups have to be similar in all factors not distinctive to the experimental treatment. The similarity of these non-specific factors can be defined as an equality assumption. The purpose of this review was to evaluate the equality assumptions in manual therapy trials. METHODS Relevant studies were identified through the following databases: EMBASE, MEDLINE, SCOPUS, WEB OF SCIENCE, Scholar Google, clinicaltrial.gov, the Cochrane Library, chiloras/MANTIS, PubMed Europe, Allied and Complementary Medicine (AMED), Physiotherapy Evidence Database (PEDro) and Sciencedirect. Studies investigating the effect of any manual intervention compared to at least one type of manual control were included. Data extraction and qualitative assessment were carried out independently by four reviewers, and the summary of results was reported following the PRISMA statement. RESULT Out of 108,903 retrieved studies, 311, enrolling a total of 17,308 patients, were included and divided into eight manual therapy trials categories. Equality assumption elements were grouped in three macro areas: patient-related, context-related and practitioner-related items. Results showed good quality in the reporting of context-related equality assumption items, potentially because largely included in pre-existent guidelines. There was a general lack of attention to the patient- and practitioner-related equality assumption items. CONCLUSION Our results showed that the similarity between experimental and sham interventions is limited, affecting, therefore, the strength of the evidence. Based on the results, methodological aspects for planning future trials were discussed and recommendations to control for equality assumption were provided.
Collapse
Affiliation(s)
- D.’Alessandro Giandomenico
- Clinical-Based Human Research Department, Foundation C.O.ME. Collaboration, 65121 Pescara, Italy ,Centre Pour L’Etude, La Recherche Et La Diffusion Ostéopathiques “C.E.R.D.O”, 00199 Rome, Italy
| | - Ruffini Nuria
- Clinical-Based Human Research Department, Foundation C.O.ME. Collaboration, 65121 Pescara, Italy ,Foundation C.O.ME. Collaboration, National Centre Germany, 10825 Berlin, Germany
| | - Aquino Alessandro
- Clinical-Based Human Research Department, Foundation C.O.ME. Collaboration, 65121 Pescara, Italy ,grid.4708.b0000 0004 1757 2822Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Galli Matteo
- Clinical-Based Human Research Department, Foundation C.O.ME. Collaboration, 65121 Pescara, Italy ,Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Innocenti Mattia
- Centre Pour L’Etude, La Recherche Et La Diffusion Ostéopathiques “C.E.R.D.O”, 00199 Rome, Italy
| | - Tramontano Marco
- grid.417778.a0000 0001 0692 3437Fondazione Santa Lucia IRCCS, 00179 Rome, Italy
| | - Cerritelli Francesco
- Clinical-Based Human Research Department, Foundation C.O.ME. Collaboration, 65121 Pescara, Italy
| |
Collapse
|
29
|
Chen J, Zhou S, Sun M, Wang Y, Chen X, Guo T, Liu L, Luo J, Ni X, Yang X, Li D, Gao S, He Z, Cai D, Zhao L. Manual acupuncture as prophylaxis for migraine without aura: study protocol for a multi-center, randomized, single-blinded trial. Trials 2022; 23:574. [PMID: 35854329 PMCID: PMC9295267 DOI: 10.1186/s13063-022-06510-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 07/05/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Migraine is a highly prevalent neurological disorder. It is the third most prevalent disorder and the seventh highest cause of disability worldwide. Acupuncture may be a viable prophylactic treatment option for frequent or uncontrolled migraine. Clinical studies comparing acupuncture and placebo acupuncture have not reached a consistent conclusion in confirming whether acupuncture is effective in migraine prophylaxis. The effect of acupuncture mainly depends on acupoints and needles operation. We found that the design of the placebo acupuncture in previous studies included shallow needling at sham acupoints, non-penetrating needling at sham acupoints, and needling at inactive acupuncture points to achieve the inert effect of control group, but the non-penetrating needling at true acupoints was ignored. This randomized controlled trial aims to use true acupoints for non-penetrating acupuncture as control to evaluate the efficacy of manual acupuncture for the prophylaxis of migraine without aura (MWoA). METHODS/DESIGN This is a single-blinded, randomized, controlled, prospective, multi-center trial with two parallel treatment groups. A total of 198 eligible patients with MWoA will be randomly divided into two groups (1:1 allocation ratio). The intervention group will receive manual acupuncture and the control group will receive placebo acupuncture (non-penetrating). Patients will receive three acupuncture treatment sessions per week for 4 consecutive weeks. All patients will then receive a 12-week follow-up. DISCUSSION In this study, we are evaluating the efficacy and safety of manual acupuncture in the prophylaxis of MWoA. The placebo control is using non-penetrating needling verum acupoints. It is essential to determine an appropriate control method to ensure the methodological quality of a randomized controlled trial. TRIAL REGISTRATION The trial has been registered in the Chinese Clinical Trial Registry (approval no. ChiCTR2000032308 ) in April 2020.
Collapse
Affiliation(s)
- Jiao Chen
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No.37 Shier Qiao Road, Chengdu, 610075 Sichuan China
- Clinical Research Center for Acupuncture and Moxibustion in Sichuan Province, No.37 Shier Qiao Road, Chengdu, 610075 Sichuan China
| | - Siyuan Zhou
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No.37 Shier Qiao Road, Chengdu, 610075 Sichuan China
- Clinical Research Center for Acupuncture and Moxibustion in Sichuan Province, No.37 Shier Qiao Road, Chengdu, 610075 Sichuan China
| | - Mingsheng Sun
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No.37 Shier Qiao Road, Chengdu, 610075 Sichuan China
| | - Yanan Wang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No.37 Shier Qiao Road, Chengdu, 610075 Sichuan China
| | - Xiaoqin Chen
- Chengdu Pidu District Hospital of Traditional Chinese Medicine, No. 342, South Street, Pidu District, Chengdu, 610075 Sichuan China
| | - Taipin Guo
- Acupuncture and Massage-Rehabilitation School, Yunnan University of Chinese Medicine, No.1076 Yuhua Road, Kunming, 650500 Yunnan China
| | - Lu Liu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No.37 Shier Qiao Road, Chengdu, 610075 Sichuan China
| | - Jing Luo
- Hospital (T. C. M) Affiliated to Southwest Medical University, No.182 Chunhui Road, Longmatan District, Luzhou City, 610075 Sichuan China
| | - Xixiu Ni
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No.37 Shier Qiao Road, Chengdu, 610075 Sichuan China
| | - Xuguang Yang
- Third Affiliated Hospital of Henan University of Traditional Chinese Medicine, No.63, Dongming Road, Zhengzhou, 450000 Henan China
| | - Dehua Li
- Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, No.39 Shier Qiao Road, Chengdu, 610075 Sichuan China
| | - Shan Gao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No.37 Shier Qiao Road, Chengdu, 610075 Sichuan China
| | - Zhenxi He
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No.37 Shier Qiao Road, Chengdu, 610075 Sichuan China
| | - Dingjun Cai
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No.37 Shier Qiao Road, Chengdu, 610075 Sichuan China
- Clinical Research Center for Acupuncture and Moxibustion in Sichuan Province, No.37 Shier Qiao Road, Chengdu, 610075 Sichuan China
| | - Ling Zhao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No.37 Shier Qiao Road, Chengdu, 610075 Sichuan China
- Clinical Research Center for Acupuncture and Moxibustion in Sichuan Province, No.37 Shier Qiao Road, Chengdu, 610075 Sichuan China
| |
Collapse
|
30
|
Wunram HL, Hamacher S, Oberste M, Neufang S, Belke L, Jänicke F, Graf C, Schönau E, Bender S, Fricke O. Influence of motivational placebo-related factors on the effects of exercise treatment in depressive adolescents. Eur Child Adolesc Psychiatry 2022; 31:1-14. [PMID: 33709258 PMCID: PMC9343287 DOI: 10.1007/s00787-021-01742-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/08/2021] [Indexed: 11/26/2022]
Abstract
Recent meta-analyses reveal a moderate effect of physical activity (PA) in the treatment of adolescent depression. However, not only the underlying neurobiological mechanisms, also the influences of placebo-related motivational factors (beliefs and expectancies in sporting, enjoyment and prior sports experiences), are still unclear. Based on the data of our prior study "Mood Vibes", we hypothesized that placebo-inherent factors like positive prior sports experiences and motivational factors, (positive beliefs, expectancies, and enjoyment related to PA), would increase the effects of an add-on exercise-therapy in juvenile depression. From 64 included depressed adolescents, 41 underwent an intensive add-on PA-therapy. Motivational factors were assessed using sport-specific scales. The changes in depression scores under treatment were rated by self-rating scale (German "Childhood Depression Inventory", (DIKJ)). A mixed model for repeated measures (MMRM) was used to analyze the effects of the different motivational variates on DIKJ. While prior sports experiences had no impact, motivational factors showed a significant effect on PA-induced changes in DIKJ scores (p = 0.002). The demotivated participants improved less, whereas it was sufficient to be neutral towards sporting to benefit significantly more. Motivational placebo-related factors (beliefs, expectancies and enjoyment regarding PA) affected the outcomes of an exercise treatment in depressed adolescents. Yet, a neutral mindset was sufficient to profit more from PA. Prior sporting in the sense of positive conditioning and as a protective factor did not play a role. Knowledge about these influences could in a second step help to develop tailored therapies.
Collapse
Affiliation(s)
- Heidrun Lioba Wunram
- Department of Child and Adolescent Psychiatry Psychosomatic and Psychotherapy, University Hospital of Cologne, Cologne, Germany
| | - Stefanie Hamacher
- Department of Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Cologne, Germany
| | - Max Oberste
- Department of Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Cologne, Germany
- Department for Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Susanne Neufang
- Department of Psychiatry and Psychotherapy, Medical Faculty Heinrich-Heine University, Düsseldorf, Germany
| | - Luisa Belke
- Children’s Hospital Amsterdam Street, Cologne, Germany
| | | | - Christine Graf
- Institute of Movement and Neuroscience, German Sport University Cologne, Cologne, Germany
| | - Eckhard Schönau
- Children’s Hospital, University Hospital of Cologne and UniReha®, University Hospital of Cologne, Cologne, Germany
| | - Stephan Bender
- Department of Child and Adolescent Psychiatry Psychosomatic and Psychotherapy, University Hospital of Cologne, Cologne, Germany
| | - Oliver Fricke
- Department of Child and Adolescent Psychiatry, Psychotherapy and Child Neurology, Gemeinschaftskrankenhaus Herdecke and Chairs of Child and Adolescent Psychiatry, Witten/Herdecke University, Witten, Germany
| |
Collapse
|
31
|
Aday JS, Heifets BD, Pratscher SD, Bradley E, Rosen R, Woolley JD. Great Expectations: recommendations for improving the methodological rigor of psychedelic clinical trials. Psychopharmacology (Berl) 2022; 239:1989-2010. [PMID: 35359159 PMCID: PMC10184717 DOI: 10.1007/s00213-022-06123-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/14/2022] [Indexed: 11/29/2022]
Abstract
RATIONALE Psychedelic research continues to garner significant public and scientific interest with a growing number of clinical studies examining a wide range of conditions and disorders. However, expectancy effects and effective condition masking have been raised as critical limitations to the interpretability of the research. OBJECTIVE In this article, we review the many methodological challenges of conducting psychedelic clinical trials and provide recommendations for improving the rigor of future research. RESULTS Although some challenges are shared with psychotherapy and pharmacology trials more broadly, psychedelic clinical trials have to contend with several unique sources of potential bias. The subjective effects of a high-dose psychedelic are often so pronounced that it is difficult to mask participants to their treatment condition; the significant hype from positive media coverage on the clinical potential of psychedelics influences participants' expectations for treatment benefit; and participant unmasking and treatment expectations can interact in such a way that makes psychedelic therapy highly susceptible to large placebo and nocebo effects. Specific recommendations to increase the success of masking procedures and reduce the influence of participant expectancies are discussed in the context of study development, participant recruitment and selection, incomplete disclosure of the study design, choice of active placebo condition, as well as the measurement of participant expectations and masking efficacy. CONCLUSION Incorporating the recommended design elements is intended to reduce the risk of bias in psychedelic clinical trials and thereby increases the ability to discern treatment-specific effects of psychedelic therapy.
Collapse
Affiliation(s)
- Jacob S Aday
- Department of Psychiatry and Behavioral Sciences, San Francisco VA Medical Center, University of California, 401 Parnassus Ave., San Francisco, CA, 94143, USA.
| | - Boris D Heifets
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, USA
| | - Steven D Pratscher
- Department of Community Dentistry and Behavioral Science, Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Ellen Bradley
- Department of Psychiatry and Behavioral Sciences, San Francisco VA Medical Center, University of California, 401 Parnassus Ave., San Francisco, CA, 94143, USA
| | - Raymond Rosen
- Department of Psychiatry and Behavioral Sciences, San Francisco VA Medical Center, University of California, 401 Parnassus Ave., San Francisco, CA, 94143, USA
| | - Joshua D Woolley
- Department of Psychiatry and Behavioral Sciences, San Francisco VA Medical Center, University of California, 401 Parnassus Ave., San Francisco, CA, 94143, USA
| |
Collapse
|
32
|
Boussageon R, Howick J, Baron R, Naudet F, Falissard B, Harika-Germaneau G, Wassouf I, Gueyffier F, Jaafari N, Blanchard C. HOW DO THEY ADD UP? THE INTERACTION BETWEEN THE PLACEBO AND TREATMENT EFFECT: A SYSTEMATIC REVIEW. Br J Clin Pharmacol 2022; 88:3638-3656. [PMID: 35384004 PMCID: PMC9545282 DOI: 10.1111/bcp.15345] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 03/25/2022] [Accepted: 03/27/2022] [Indexed: 11/30/2022] Open
Abstract
Aim The placebo effect and the specific effect are often thought to add up (additive model). Whether additivity holds can dramatically influence the external validity of a trial. This assumption of additivity was tested by Kleijnen et al in 1994 but the data produced since then have not been synthetized. In this review, we aimed to systematically review the literature to determine whether additivity held. Methods We searched Medline and PsychInfo up to 10 January 2019. Studies using the balanced placebo design (BPD), testing two different strengths of placebos, were included. The presence of interaction was evaluated by comparing each group in the BPD with analysis of variance or covariance. Results Thirty studies were included and the overall risk of bias was high: four found evidence of additivity and 16 studies found evidence of interaction (seven had evidence of positive additivity). Conclusion Evidence of additivity between placebo and specific features of treatments was rare in included studies. We suggest interventions for placebo‐sensitive ailments should be tested in trials designed to take interactions seriously once an exploratory RCTs has proven their efficacy with sufficient internal validity.
Collapse
Affiliation(s)
- Rémy Boussageon
- Laboratoire de Biométrie et Biologie Evolutive, Equipe Evaluation et modélisation des effets thérapeutiques, UMR CNRS 5558, Lyon, France
| | - Jeremy Howick
- Faculty of Philosophy, University of Oxford, Radcliffe Infirmary Quarter, Oxford, United Kingdom
| | - Raphael Baron
- Collège Universitaire de Médecine Générale, University of Lyon, Lyon Cedex, France
| | - Florian Naudet
- University of Rennes 1, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France
| | - Bruno Falissard
- CESP/INSERM U1018 (Centre de Recherche en Epidemiologie et Santé des Populations), Paris cedex, France
| | - Ghina Harika-Germaneau
- Unité de recherche clinique intersectorielle en psychiatrie à vocation régionale Pierre Deniker du Centre Hospitalier Henri, Laborit, France
| | - Issa Wassouf
- Unité de recherche clinique intersectorielle en psychiatrie à vocation régionale Pierre Deniker du Centre Hospitalier Henri, Laborit, France
| | - François Gueyffier
- Laboratoire de Biométrie et Biologie Evolutive, Equipe Evaluation et modélisation des effets thérapeutiques, UMR CNRS 5558, Lyon, France
| | - Nemat Jaafari
- Unité de recherche clinique intersectorielle en psychiatrie à vocation régionale Pierre Deniker du Centre Hospitalier Henri, Laborit, France
| | - Clara Blanchard
- Department of General Practice, University of Poitiers, Poitiers, France
| |
Collapse
|
33
|
Faltinsen E, Todorovac A, Staxen Bruun L, Hróbjartsson A, Gluud C, Kongerslev MT, Simonsen E, Storebø OJ. Control interventions in randomised trials among people with mental health disorders. Cochrane Database Syst Rev 2022; 4:MR000050. [PMID: 35377466 PMCID: PMC8979177 DOI: 10.1002/14651858.mr000050.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Control interventions in randomised trials provide a frame of reference for the experimental interventions and enable estimations of causality. In the case of randomised trials assessing patients with mental health disorders, many different control interventions are used, and the choice of control intervention may have considerable impact on the estimated effects of the treatments being evaluated. OBJECTIVES To assess the benefits and harms of typical control interventions in randomised trials with patients with mental health disorders. The difference in effects between control interventions translates directly to the impact a control group has on the estimated effect of an experimental intervention. We aimed primarily to assess the difference in effects between (i) wait-list versus no-treatment, (ii) usual care versus wait-list or no-treatment, and (iii) placebo interventions (all placebo interventions combined or psychological, pharmacological, and physical placebos individually) versus wait-list or no-treatment. Wait-list patients are offered the experimental intervention by the researchers after the trial has been finalised if it offers more benefits than harms, while no-treatment participants are not offered the experimental intervention by the researchers. SEARCH METHODS In March 2018, we searched MEDLINE, PsycInfo, Embase, CENTRAL, and seven other databases and six trials registers. SELECTION CRITERIA We included randomised trials assessing patients with a mental health disorder that compared wait-list, usual care, or placebo interventions with wait-list or no-treatment . DATA COLLECTION AND ANALYSIS Titles, abstracts, and full texts were reviewed for eligibility. Review authors independently extracted data and assessed risk of bias using Cochrane's risk of bias tool. GRADE was used to assess the quality of the evidence. We contacted researchers working in the field to ask for data from additional published and unpublished trials. A pre-planned decision hierarchy was used to select one benefit and one harm outcome from each trial. For the assessment of benefits, we summarised continuous data as standardised mean differences (SMDs) and dichotomous data as risk ratios (RRs). We used risk differences (RDs) for the assessment of adverse events. We used random-effects models for all statistical analyses. We used subgroup analysis to explore potential causes for heterogeneity (e.g. type of placebo) and sensitivity analyses to explore the robustness of the primary analyses (e.g. fixed-effect model). MAIN RESULTS We included 96 randomised trials (4200 participants), ranging from 8 to 393 participants in each trial. 83 trials (3614 participants) provided usable data. The trials included 15 different mental health disorders, the most common being anxiety (25 trials), depression (16 trials), and sleep-wake disorders (11 trials). All 96 trials were assessed as high risk of bias partly because of the inability to blind participants and personnel in trials with two control interventions. The quality of evidence was rated low to very low, mostly due to risk of bias, imprecision in estimates, and heterogeneity. Only one trial compared wait-list versus no-treatment directly but the authors were not able to provide us with any usable data on the comparison. Five trials compared usual care versus wait-list or no-treatment and found a SMD -0.33 (95% CI -0.83 to 0.16, I² = 86%, 523 participants) on benefits. The difference between all placebo interventions combined versus wait-list or no-treatment was SMD -0.37 (95% CI -0.49 to -0.25, I² = 41%, 65 trials, 2446 participants) on benefits. There was evidence of some asymmetry in the funnel plot (Egger's test P value of 0.087). Almost all the trials were small. Subgroup analysis found a moderate effect in favour of psychological placebos SMD -0.49 (95% CI -0.64 to -0.30; I² = 53%, 39 trials, 1656 participants). The effect of pharmacological placebos versus wait-list or no-treatment on benefits was SMD -0.14 (95% CI -0.39 to 0.11, 9 trials, 279 participants) and the effect of physical placebos was SMD -0.21 (95% CI -0.35 to -0.08, I² = 0%, 17 trials, 896 participants). We found large variations in effect sizes in the psychological and pharmacological placebo comparisons. For specific mental health disorders, we found significant differences in favour of all placebos for sleep-wake disorders, major depressive disorder, and anxiety disorders, but the analyses were imprecise due to sparse data. We found no significant differences in harms for any of the comparisons but the analyses suffered from sparse data. When using a fixed-effect model in a sensitivity analysis on the comparison for usual care versus wait-list and no-treatment, the results were significant with an SMD of -0.46 (95 % CI -0.64 to -0.28). We reported an alternative risk of bias model where we excluded the blinding domains seeing how issues with blinding may be seen as part of the review investigation itself. However, this did not markedly change the overall risk of bias profile as most of the trials still included one or more unclear bias domains. AUTHORS' CONCLUSIONS We found marked variations in effects between placebo versus no-treatment and wait-list and between subtypes of placebo with the same comparisons. Almost all the trials were small with considerable methodological and clinical variability in factors such as mental health population, contents of the included control interventions, and outcome domains. All trials were assessed as high risk of bias and the evidence quality was low to very low. When researchers decide to use placebos or usual care control interventions in trials with people with mental health disorders it will often lead to lower estimated effects of the experimental intervention than when using wait-list or no-treatment controls. The choice of a control intervention therefore has considerable impact on how effective a mental health treatment appears to be. Methodological guideline development is needed to reach a consensus on future standards for the design and reporting of control interventions in mental health intervention research.
Collapse
Affiliation(s)
- Erlend Faltinsen
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Adnan Todorovac
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
| | | | - Asbjørn Hróbjartsson
- Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Mickey T Kongerslev
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ole Jakob Storebø
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
34
|
Benatto MT, Florencio LL, Bragatto MM, Dach F, Fernández-de-Las-Peñas C, Bevilaqua-Grossi D. Neck-specific strengthening exercise compared with placebo sham ultrasound in patients with migraine: a randomized controlled trial. BMC Neurol 2022; 22:126. [PMID: 35366822 PMCID: PMC8976325 DOI: 10.1186/s12883-022-02650-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/21/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Migraine patients have musculoskeletal disorders and pain in the cervical. And, despite the pathophysiology demonstrating the relationship between migraine and the cervical spine, the effectiveness of craniocervical exercises in these patients has not been verified. So, the aimed of this study was verify the effectiveness of craniocervical muscle-strengthening exercise (CMSE) in reducing the frequency and intensity of headache in migraine patients. METHODS: A two-armed, parallel-group randomized controlled trial with a 3-month follow-up was performed. For eight weeks, the volunteers in the intervention group (n = 21) performed a protocol of CMSE, while those in the sham ultrasound group (n = 21) received the application of disconnected therapeutic ultrasound in the upper trapezius and guideline for home-stretching. The primary outcomes were the frequency and intensity of the headache. The secondary outcomes were questionnaires about migraine and neck disability, and satisfaction with the treatment, cervical range of motion, the pressure pain threshold, craniocervical flexion test (CCFT), cervical muscle strength and endurance test, and the cervical muscle activity during the physical tests. RESULTS No differences were observed for the changes observed in primary outcomes after eight weeks and at the 3-months follow up (p > 0.05). For the secondary outcomes, craniocervical exercises improved the sensitivity of the frontal muscle (p = 0.040) and promoted a reduced amplitude of muscle activity of the anterior scalene and upper trapezius in the last stages of CCFT (p ≤ 0.010). There was also reduced muscle activity of the anterior scalene and splenius capitis in the endurance test (p ≤ 0.045), as evaluated by surface electromyography. CONCLUSION CMSE were insufficient in reducing the frequency and intensity of headache, improving the performance of the cervical muscles, or reducing migraine and neck pain-related disabilities. This was found despite a decreased electromyographic activity of the cervical muscles during the last stages of CCFT and increased median frequency during the endurance test. TRIAL REGISTRATION Accession code RBR-8gfv5j , registered 28/11/2016 in the Registro Brasileiro de Ensaios Clínicos (ReBEC).
Collapse
Affiliation(s)
- Mariana Tedeschi Benatto
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Lidiane Lima Florencio
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Marcela Mendes Bragatto
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Fabíola Dach
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Débora Bevilaqua-Grossi
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| |
Collapse
|
35
|
Effective Oriental Magic for Analgesia: Acupuncture. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1451342. [PMID: 35313481 PMCID: PMC8934214 DOI: 10.1155/2022/1451342] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 01/21/2022] [Accepted: 02/08/2022] [Indexed: 12/22/2022]
Abstract
Pain is a kind of complex physiological and psychological symptom, which makes the person debilitated and uncomfortable. Some persistent pain is unbearable for the patients, reducing the quality of life and bringing considerable pressure to the individuals and society. Pain killers seem to be effective in analgesia for patients, but their safety and addiction are crucial issues. From the theory of traditional Chinese medicine (TCM), the blocked meridian is the main cause of pain, and effective acupuncture can play a positive analgesic effect. Acupuncture that can date back thousands of years is one of the ancient medical practices in China. Its safety and effectiveness are respected. Based on its superior safety and inferior side effects, it has been gradually recognized as a therapeutic intervention method for complementary medicine, which is also generally used to treat multiple pain diseases. It is shown by modern medical studies that neurotransmitters are the material basis for the acupuncture effect, and the effect of acupuncture analgesia is related to changes in neurotransmitters. However, the specific mechanism has not been elucidated. This review aims to comprehensively discuss the historical evolution of acupuncture analgesia, clinical research of acupuncture analgesia, comparison of acupuncture and drug therapy, the neurotransmitter mechanism of acupuncture analgesia, the effect of acupuncture manipulation on analgesia, and bibliometric analysis of acupuncture treatment for pain, to explore the superiority and related mechanism of acupuncture analgesia from different aspects, and to provide a more effective treatment for alleviating patients' pain.
Collapse
|
36
|
Martins J, Neto IS, Gonçalves AF, Pereira A, Santiago M, Ferro I, Lopes T, Carvalho JL. Platelet-Rich Plasma Injection Associated With Microtenotomy in Lateral Epicondylitis – is a Tendon Tear Associated with the Therapeutic Response? Cureus 2022; 14:e22425. [PMID: 35371831 PMCID: PMC8941632 DOI: 10.7759/cureus.22425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Ultrasound-guided platelet-rich plasma (PRP) injections, as well as needle tenotomy, are becoming increasingly popular in the treatment of epicondylitis. Whether ultrasound (US) findings predict the clinical benefit of these techniques is unclear at the moment. This study aimed to investigate the relationship between the presence of tendon tear assessed by US and the therapeutic response of the PRP injection following needle microtenotomy in patients with epicondylitis. Methodology This is a retrospective observational study. Twenty-six patients with chronic (>three months) lateral epicondylitis recalcitrant to conservative treatment or corticosteroid injection. Patients underwent US-guided microtenotomy followed by PRP injection. Data regarding gender, age, US findings at baseline, and numeric pain rating scale (NPRS) scores before and after intervention were collected. Pain improvement rates were calculated at several follow-up time points, namely one, three, six, and 12 months post-intervention. Results are stated as mean ± standard deviation. Results At the time of intervention, the mean age was 47.6±6.5 years, and 57.7% of patients were men. Overall, the mean initial NPRS score was 7.5±1.2, and there were no statistically significant differences in mean initial NPRS scores between the groups with or without tendon tear on the US imaging. The mean improvement rate at one, three, and six months was similar between patients with and without tendon tear. However, a statistically significant difference was observed at 12 months (73.1±37.6% vs. 16.0±21.9, p=0.029). Conclusions Patients with tendon tear demonstrated a higher pain improvement rate at 12 months follow-up. This finding could predict the clinical response to this technique, thus allowing a better selection of the candidates.
Collapse
|
37
|
Van Hollebeke M, Poddighe D, Clerckx B, Muller J, Hermans G, Gosselink R, Langer D, Louvaris Z. High-Intensity Inspiratory Muscle Training Improves Scalene and Sternocleidomastoid Muscle Oxygenation Parameters in Patients With Weaning Difficulties: A Randomized Controlled Trial. Front Physiol 2022; 13:786575. [PMID: 35222072 PMCID: PMC8864155 DOI: 10.3389/fphys.2022.786575] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/04/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCritically ill patients who have difficulties weaning from the mechanical ventilator are prone to develop respiratory muscle weakness. Inspiratory muscle training (IMT) can improve respiratory muscle strength. Whether IMT can improve scalene and sternocleidomastoid muscle oxygenation parameters is unknown.AimTo compare changes in muscle oxygenation parameters of scalene and sternocleidomastoid inspiratory muscles during a standardized task between patients with weaning difficulties who received either high-intensity IMT (intervention) or sham low-intensity IMT (control).MethodForty-one patients performed daily IMT sessions (4 sets, 6–10 breaths) until weaning success or for 28 consecutive days. The training load was progressively adjusted in the intervention group (n = 22) to the highest tolerable load, whilst the control group (n = 19) kept training at 10% of their baseline maximal inspiratory pressure (PImax). Breathing characteristics (i.e., work and power of breathing, PoB), respiratory muscle function [i.e., PImax and forced vital capacity (FVC)] were measured during a standardized loaded breathing task against a load of 30% of baseline PImax before and after the IMT period. In addition, during the same loaded breathing task, absolute mean and nadir changes from baseline in local scalene and sternocleidomastoid muscle oxygen saturation index (Δ%StiO2) (an index of oxygen extraction) and nadir Δ%StiO2 normalized for the PoB were measured by near-infrared spectroscopy.ResultsAt post measures, only the intervention group improved mean PoB compared to pre measures (Pre: 0.42 ± 0.33 watts, Post: 0.63 ± 0.51watts, p-value < 0.01). At post measures, both groups significantly improved nadir scalene muscles StiO2% normalized for the mean PoB (ΔStiOnadir%/watt) compared to pre measurements and the improvement was not significant different between groups (p-value = 0.40). However, at post measures, nadir sternocleidomastoid muscle StiO2% normalized for the mean PoB (ΔStiOnadir%/watt) was significantly greater improved in the intervention group (mean difference: +18.4, 95%CI: −1.4; 38.1) compared to the control group (mean difference: +3.7, 95%CI: −18.7; 26.0, between group p-value < 0.01). Both groups significantly improved PImax (Intervention: +15 ± 13 cmH2O p-value < 0.01, Control: +13 ± 15 cmH2O p-value < 0.01). FVC only significantly improved in the intervention group (+0.33 ± 0.31 L p < 0.01) report also change in control group.ConclusionThis exploratory study suggests that high-intensity IMT induces greater improvements in scalene and sternocleidomastoid muscle oxygenation parameters attributed for oxygen delivery, utilization and oxygen saturation index compared to low-intensity IMT in patients with weaning difficulties.
Collapse
Affiliation(s)
- Marine Van Hollebeke
- Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, Leuven, Belgium
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
- *Correspondence: Marine Van Hollebeke,
| | - Diego Poddighe
- Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, Leuven, Belgium
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Beatrix Clerckx
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Jan Muller
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Greet Hermans
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Rik Gosselink
- Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, Leuven, Belgium
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Daniel Langer
- Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, Leuven, Belgium
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Zafeiris Louvaris
- Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, Leuven, Belgium
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
38
|
The Effects and Safety of Chinese Herbal Medicine on Blood Lipid Profiles in Placebo-Controlled Weight-Loss Trials: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1368576. [PMID: 35082903 PMCID: PMC8786479 DOI: 10.1155/2022/1368576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 12/13/2021] [Accepted: 12/22/2021] [Indexed: 02/03/2023]
Abstract
This study was conducted to assess the effects and safety of Chinese herbal medicine (CHM) on blood lipids among adults with overweight or obesity. Fourteen bibliographic databases were comprehensively searched, from their respective inceptions up to April 2021, for randomised placebo-controlled weight-loss trials using CHM formulation on total cholesterol, triglycerides, LDL cholesterol, and HDL cholesterol over ≥4 weeks. Data collection, risk of bias assessment, and statistical analyses were guided by the Cochrane Handbook (v6.1). Continuous outcomes were expressed as the mean difference with 95% confidence intervals, and categorical outcomes were expressed as a risk ratio with 95% confidence intervals. All analyses were two-tailed with a statistical significance of p < 0.05. Fifteen eligible studies with 1,533 participants were included in this meta-analysis. Findings from meta-analyses indicated that CHM interventions, compared to placebo, reduced triglyceride (MD −0.21 mmol/L, 95% CI −0.41 to −0.02, I2 = 81%) and increased HDL cholesterol (MD 0.16 mmol/L, 95% CI 0.04 to 0.27, I2 = 94%) over a median of 12 weeks. The reduction in total cholesterol and LDL cholesterol were not statistically significant. Furthermore, the tendency of reduced triglycerides was identified among overweight participants with high baseline triglycerides. Attrition rates and frequency of adverse events were indifferent between the two groups. CHM may provide lipid-modulating benefits on triglycerides and HDL cholesterol among participants with overweight/obesity, with the tendency for significant triglyceride reduction observed among overweight participants with high baseline triglycerides. However, rigorously conducted randomised controlled trials with larger sample sizes are required to validate these findings.
Collapse
|
39
|
Smith EA, Horan WP, Demolle D, Schueler P, Fu DJ, Anderson AE, Geraci J, Butlen-Ducuing F, Link J, Khin NA, Morlock R, Alphs LD. Using Artificial Intelligence-based Methods to Address the Placebo Response in Clinical Trials. INNOVATIONS IN CLINICAL NEUROSCIENCE 2022; 19:60-70. [PMID: 35382067 PMCID: PMC8970233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The placebo response is a highly complex psychosocial-biological phenomenon that has challenged drug development for decades, particularly in neurological and psychiatric disease. While decades of research have aimed to understand clinical trial factors that contribute to the placebo response, a comprehensive solution to manage the placebo response in drug development has yet to emerge. Advanced data analytic techniques, such as artificial intelligence (AI), might be needed to take the next leap forward in mitigating the negative consequences of high placebo-response rates. The objective of this review was to explore the use of techniques such as AI and the sub-discipline of machine learning (ML) to address placebo response in practical ways that can positively impact drug development. This examination focused on the critical factors that should be considered in applying AI and ML to the placebo response issue, examples of how these techniques can be used, and the regulatory considerations for integrating these approaches into clinical trials.
Collapse
Affiliation(s)
- Erica A Smith
- Drs. Smith and Demolle are with Cognivia in Mont St. Guibert, Belgium
- Dr. Horan is with VeraSci in Durham, North Carolina
- Drs. Horan and Anderson are with the University of California at Los Angeles in Los Angeles, California
- Dr. Schueler is with ICON Clinical Research in Langen, Germany
- Dr. Fu is with Janssen Reasearch and Development, LLC, in Titusville, New Jersey
- Dr. Geraci is with Nurosene Health, Inc. in Toronto, Ontario; Queen's University in Kingston, Ontario; and the Center for Biotechnology and Genomics Medicine, Medical College of Georgia, in Augusta, Georgia
- Dr. Butlen-Ducuing is with European Medicines Agency in Amsterdam, Netherlands
- Ms. Link is with Boehringer Ingelheim Pharma GmbH and Company KG in Baden Württenberg, Germany
- Dr. Khin is with Neurocrine Biosciences, Inc. in San Diego, California
- Dr. Morlock is with YourCareChoice in Ann Arbor, Michigan
- Dr. Alphs is with Denovo Biopharma, LLC in San Diego, California (at the time of writing, he was with Newron Pharmaceuticals in Morriston, New Jersey)
| | - William P Horan
- Drs. Smith and Demolle are with Cognivia in Mont St. Guibert, Belgium
- Dr. Horan is with VeraSci in Durham, North Carolina
- Drs. Horan and Anderson are with the University of California at Los Angeles in Los Angeles, California
- Dr. Schueler is with ICON Clinical Research in Langen, Germany
- Dr. Fu is with Janssen Reasearch and Development, LLC, in Titusville, New Jersey
- Dr. Geraci is with Nurosene Health, Inc. in Toronto, Ontario; Queen's University in Kingston, Ontario; and the Center for Biotechnology and Genomics Medicine, Medical College of Georgia, in Augusta, Georgia
- Dr. Butlen-Ducuing is with European Medicines Agency in Amsterdam, Netherlands
- Ms. Link is with Boehringer Ingelheim Pharma GmbH and Company KG in Baden Württenberg, Germany
- Dr. Khin is with Neurocrine Biosciences, Inc. in San Diego, California
- Dr. Morlock is with YourCareChoice in Ann Arbor, Michigan
- Dr. Alphs is with Denovo Biopharma, LLC in San Diego, California (at the time of writing, he was with Newron Pharmaceuticals in Morriston, New Jersey)
| | - Dominique Demolle
- Drs. Smith and Demolle are with Cognivia in Mont St. Guibert, Belgium
- Dr. Horan is with VeraSci in Durham, North Carolina
- Drs. Horan and Anderson are with the University of California at Los Angeles in Los Angeles, California
- Dr. Schueler is with ICON Clinical Research in Langen, Germany
- Dr. Fu is with Janssen Reasearch and Development, LLC, in Titusville, New Jersey
- Dr. Geraci is with Nurosene Health, Inc. in Toronto, Ontario; Queen's University in Kingston, Ontario; and the Center for Biotechnology and Genomics Medicine, Medical College of Georgia, in Augusta, Georgia
- Dr. Butlen-Ducuing is with European Medicines Agency in Amsterdam, Netherlands
- Ms. Link is with Boehringer Ingelheim Pharma GmbH and Company KG in Baden Württenberg, Germany
- Dr. Khin is with Neurocrine Biosciences, Inc. in San Diego, California
- Dr. Morlock is with YourCareChoice in Ann Arbor, Michigan
- Dr. Alphs is with Denovo Biopharma, LLC in San Diego, California (at the time of writing, he was with Newron Pharmaceuticals in Morriston, New Jersey)
| | - Peter Schueler
- Drs. Smith and Demolle are with Cognivia in Mont St. Guibert, Belgium
- Dr. Horan is with VeraSci in Durham, North Carolina
- Drs. Horan and Anderson are with the University of California at Los Angeles in Los Angeles, California
- Dr. Schueler is with ICON Clinical Research in Langen, Germany
- Dr. Fu is with Janssen Reasearch and Development, LLC, in Titusville, New Jersey
- Dr. Geraci is with Nurosene Health, Inc. in Toronto, Ontario; Queen's University in Kingston, Ontario; and the Center for Biotechnology and Genomics Medicine, Medical College of Georgia, in Augusta, Georgia
- Dr. Butlen-Ducuing is with European Medicines Agency in Amsterdam, Netherlands
- Ms. Link is with Boehringer Ingelheim Pharma GmbH and Company KG in Baden Württenberg, Germany
- Dr. Khin is with Neurocrine Biosciences, Inc. in San Diego, California
- Dr. Morlock is with YourCareChoice in Ann Arbor, Michigan
- Dr. Alphs is with Denovo Biopharma, LLC in San Diego, California (at the time of writing, he was with Newron Pharmaceuticals in Morriston, New Jersey)
| | - Dong-Jing Fu
- Drs. Smith and Demolle are with Cognivia in Mont St. Guibert, Belgium
- Dr. Horan is with VeraSci in Durham, North Carolina
- Drs. Horan and Anderson are with the University of California at Los Angeles in Los Angeles, California
- Dr. Schueler is with ICON Clinical Research in Langen, Germany
- Dr. Fu is with Janssen Reasearch and Development, LLC, in Titusville, New Jersey
- Dr. Geraci is with Nurosene Health, Inc. in Toronto, Ontario; Queen's University in Kingston, Ontario; and the Center for Biotechnology and Genomics Medicine, Medical College of Georgia, in Augusta, Georgia
- Dr. Butlen-Ducuing is with European Medicines Agency in Amsterdam, Netherlands
- Ms. Link is with Boehringer Ingelheim Pharma GmbH and Company KG in Baden Württenberg, Germany
- Dr. Khin is with Neurocrine Biosciences, Inc. in San Diego, California
- Dr. Morlock is with YourCareChoice in Ann Arbor, Michigan
- Dr. Alphs is with Denovo Biopharma, LLC in San Diego, California (at the time of writing, he was with Newron Pharmaceuticals in Morriston, New Jersey)
| | - Ariana E Anderson
- Drs. Smith and Demolle are with Cognivia in Mont St. Guibert, Belgium
- Dr. Horan is with VeraSci in Durham, North Carolina
- Drs. Horan and Anderson are with the University of California at Los Angeles in Los Angeles, California
- Dr. Schueler is with ICON Clinical Research in Langen, Germany
- Dr. Fu is with Janssen Reasearch and Development, LLC, in Titusville, New Jersey
- Dr. Geraci is with Nurosene Health, Inc. in Toronto, Ontario; Queen's University in Kingston, Ontario; and the Center for Biotechnology and Genomics Medicine, Medical College of Georgia, in Augusta, Georgia
- Dr. Butlen-Ducuing is with European Medicines Agency in Amsterdam, Netherlands
- Ms. Link is with Boehringer Ingelheim Pharma GmbH and Company KG in Baden Württenberg, Germany
- Dr. Khin is with Neurocrine Biosciences, Inc. in San Diego, California
- Dr. Morlock is with YourCareChoice in Ann Arbor, Michigan
- Dr. Alphs is with Denovo Biopharma, LLC in San Diego, California (at the time of writing, he was with Newron Pharmaceuticals in Morriston, New Jersey)
| | - Joseph Geraci
- Drs. Smith and Demolle are with Cognivia in Mont St. Guibert, Belgium
- Dr. Horan is with VeraSci in Durham, North Carolina
- Drs. Horan and Anderson are with the University of California at Los Angeles in Los Angeles, California
- Dr. Schueler is with ICON Clinical Research in Langen, Germany
- Dr. Fu is with Janssen Reasearch and Development, LLC, in Titusville, New Jersey
- Dr. Geraci is with Nurosene Health, Inc. in Toronto, Ontario; Queen's University in Kingston, Ontario; and the Center for Biotechnology and Genomics Medicine, Medical College of Georgia, in Augusta, Georgia
- Dr. Butlen-Ducuing is with European Medicines Agency in Amsterdam, Netherlands
- Ms. Link is with Boehringer Ingelheim Pharma GmbH and Company KG in Baden Württenberg, Germany
- Dr. Khin is with Neurocrine Biosciences, Inc. in San Diego, California
- Dr. Morlock is with YourCareChoice in Ann Arbor, Michigan
- Dr. Alphs is with Denovo Biopharma, LLC in San Diego, California (at the time of writing, he was with Newron Pharmaceuticals in Morriston, New Jersey)
| | - Florence Butlen-Ducuing
- Drs. Smith and Demolle are with Cognivia in Mont St. Guibert, Belgium
- Dr. Horan is with VeraSci in Durham, North Carolina
- Drs. Horan and Anderson are with the University of California at Los Angeles in Los Angeles, California
- Dr. Schueler is with ICON Clinical Research in Langen, Germany
- Dr. Fu is with Janssen Reasearch and Development, LLC, in Titusville, New Jersey
- Dr. Geraci is with Nurosene Health, Inc. in Toronto, Ontario; Queen's University in Kingston, Ontario; and the Center for Biotechnology and Genomics Medicine, Medical College of Georgia, in Augusta, Georgia
- Dr. Butlen-Ducuing is with European Medicines Agency in Amsterdam, Netherlands
- Ms. Link is with Boehringer Ingelheim Pharma GmbH and Company KG in Baden Württenberg, Germany
- Dr. Khin is with Neurocrine Biosciences, Inc. in San Diego, California
- Dr. Morlock is with YourCareChoice in Ann Arbor, Michigan
- Dr. Alphs is with Denovo Biopharma, LLC in San Diego, California (at the time of writing, he was with Newron Pharmaceuticals in Morriston, New Jersey)
| | - Jasmine Link
- Drs. Smith and Demolle are with Cognivia in Mont St. Guibert, Belgium
- Dr. Horan is with VeraSci in Durham, North Carolina
- Drs. Horan and Anderson are with the University of California at Los Angeles in Los Angeles, California
- Dr. Schueler is with ICON Clinical Research in Langen, Germany
- Dr. Fu is with Janssen Reasearch and Development, LLC, in Titusville, New Jersey
- Dr. Geraci is with Nurosene Health, Inc. in Toronto, Ontario; Queen's University in Kingston, Ontario; and the Center for Biotechnology and Genomics Medicine, Medical College of Georgia, in Augusta, Georgia
- Dr. Butlen-Ducuing is with European Medicines Agency in Amsterdam, Netherlands
- Ms. Link is with Boehringer Ingelheim Pharma GmbH and Company KG in Baden Württenberg, Germany
- Dr. Khin is with Neurocrine Biosciences, Inc. in San Diego, California
- Dr. Morlock is with YourCareChoice in Ann Arbor, Michigan
- Dr. Alphs is with Denovo Biopharma, LLC in San Diego, California (at the time of writing, he was with Newron Pharmaceuticals in Morriston, New Jersey)
| | - Ni A Khin
- Drs. Smith and Demolle are with Cognivia in Mont St. Guibert, Belgium
- Dr. Horan is with VeraSci in Durham, North Carolina
- Drs. Horan and Anderson are with the University of California at Los Angeles in Los Angeles, California
- Dr. Schueler is with ICON Clinical Research in Langen, Germany
- Dr. Fu is with Janssen Reasearch and Development, LLC, in Titusville, New Jersey
- Dr. Geraci is with Nurosene Health, Inc. in Toronto, Ontario; Queen's University in Kingston, Ontario; and the Center for Biotechnology and Genomics Medicine, Medical College of Georgia, in Augusta, Georgia
- Dr. Butlen-Ducuing is with European Medicines Agency in Amsterdam, Netherlands
- Ms. Link is with Boehringer Ingelheim Pharma GmbH and Company KG in Baden Württenberg, Germany
- Dr. Khin is with Neurocrine Biosciences, Inc. in San Diego, California
- Dr. Morlock is with YourCareChoice in Ann Arbor, Michigan
- Dr. Alphs is with Denovo Biopharma, LLC in San Diego, California (at the time of writing, he was with Newron Pharmaceuticals in Morriston, New Jersey)
| | - Robert Morlock
- Drs. Smith and Demolle are with Cognivia in Mont St. Guibert, Belgium
- Dr. Horan is with VeraSci in Durham, North Carolina
- Drs. Horan and Anderson are with the University of California at Los Angeles in Los Angeles, California
- Dr. Schueler is with ICON Clinical Research in Langen, Germany
- Dr. Fu is with Janssen Reasearch and Development, LLC, in Titusville, New Jersey
- Dr. Geraci is with Nurosene Health, Inc. in Toronto, Ontario; Queen's University in Kingston, Ontario; and the Center for Biotechnology and Genomics Medicine, Medical College of Georgia, in Augusta, Georgia
- Dr. Butlen-Ducuing is with European Medicines Agency in Amsterdam, Netherlands
- Ms. Link is with Boehringer Ingelheim Pharma GmbH and Company KG in Baden Württenberg, Germany
- Dr. Khin is with Neurocrine Biosciences, Inc. in San Diego, California
- Dr. Morlock is with YourCareChoice in Ann Arbor, Michigan
- Dr. Alphs is with Denovo Biopharma, LLC in San Diego, California (at the time of writing, he was with Newron Pharmaceuticals in Morriston, New Jersey)
| | - Larry D Alphs
- Drs. Smith and Demolle are with Cognivia in Mont St. Guibert, Belgium
- Dr. Horan is with VeraSci in Durham, North Carolina
- Drs. Horan and Anderson are with the University of California at Los Angeles in Los Angeles, California
- Dr. Schueler is with ICON Clinical Research in Langen, Germany
- Dr. Fu is with Janssen Reasearch and Development, LLC, in Titusville, New Jersey
- Dr. Geraci is with Nurosene Health, Inc. in Toronto, Ontario; Queen's University in Kingston, Ontario; and the Center for Biotechnology and Genomics Medicine, Medical College of Georgia, in Augusta, Georgia
- Dr. Butlen-Ducuing is with European Medicines Agency in Amsterdam, Netherlands
- Ms. Link is with Boehringer Ingelheim Pharma GmbH and Company KG in Baden Württenberg, Germany
- Dr. Khin is with Neurocrine Biosciences, Inc. in San Diego, California
- Dr. Morlock is with YourCareChoice in Ann Arbor, Michigan
- Dr. Alphs is with Denovo Biopharma, LLC in San Diego, California (at the time of writing, he was with Newron Pharmaceuticals in Morriston, New Jersey)
| |
Collapse
|
40
|
Jones CMP, Maher CG. "To the Editor of the Journal of Pain Research" [Letter]. J Pain Res 2021; 14:3649-3650. [PMID: 34876849 PMCID: PMC8643216 DOI: 10.2147/jpr.s344005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/18/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Caitlin M P Jones
- The Institute for Musculoskeletal Health, The University of Sydney, Sydney, NSW, Austalia
| | - Christopher G Maher
- The Institute for Musculoskeletal Health, The University of Sydney, Sydney, NSW, Austalia
| |
Collapse
|
41
|
Del Mar Seguí-Crespo M, Ronda-Pérez E, Yammouni R, Arroyo Sanz R, Evans BJW. Randomised controlled trial of an accommodative support lens designed for computer users. Ophthalmic Physiol Opt 2021; 42:82-93. [PMID: 34747042 DOI: 10.1111/opo.12913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Accommodative support (AS) lenses are a low add progressive addition spectacle lens designed to ease symptoms in computer vision syndrome (CVS). The study aims to investigate if (1) AS lenses improve CVS symptoms; (2) binocular/accommodative functions predict a benefit from AS lenses and (3) wearing AS lenses for six months impacts on binocular/accommodative functions. METHODS Pre-presbyopic adults with symptoms of CVS (Computer Vision Syndrome Questionnaire, CVS-Q© , score ≥ 6) were randomly allocated to wear AS lenses or control single vision (SV) lenses. The CVS-Q© and a battery of optometric tests were applied at baseline and after three and six months. Participants and researchers were masked to participant group. After six months, the SV group were unmasked and changed to AS lenses and one week later asked to choose which they preferred. RESULTS The change in CVS-Q© scores from baseline to six months did not differ significantly in the two groups. At the end of the one week period, when the control group wore the AS lenses, control group participants were significantly more likely to prefer AS lenses to SV lenses. No optometric functions correlated with the benefit from AS lenses. AS lenses did not have any adverse effects on binocular or accommodative function. CONCLUSIONS In pre-presbyopic adults, there was no greater improvement in CVS-Q© scores in the group wearing AS lenses than in the control group. No adverse effects on optometric function (including accommodation) are associated with wearing AS lenses.
Collapse
Affiliation(s)
| | | | | | | | - Bruce J W Evans
- Institute of Optometry, London, UK.,City, University of London, London, UK
| |
Collapse
|
42
|
Bernard Healey SA, Scholtes I, Abrahams M, McNaughton PA, Menon DK, Lee MC. Role of hyperpolarization-activated cyclic nucleotide-gated ion channels in neuropathic pain: a proof-of-concept study of ivabradine in patients with chronic peripheral neuropathic pain. Pain Rep 2021; 6:e967. [PMID: 34712888 PMCID: PMC8547924 DOI: 10.1097/pr9.0000000000000967] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/23/2021] [Accepted: 09/11/2021] [Indexed: 11/25/2022] Open
Abstract
Hyperpolarization-activated cyclic nucleotide-gated (HCN) channel receptors mediate neuropathic pain in preclinical models. Here, exploratory analysis reveals a dose-dependent reduction in pain with HCN blockade in patients with neuropathic pain. Introduction: Hyperpolarization-activated cyclic nucleotide-gated (HCN) ion channels mediate repetitive action potential firing in the heart and nervous system. The HCN2 isoform is expressed in nociceptors, and preclinical studies suggest a critical role in neuropathic pain. Ivabradine is a nonselective HCN blocker currently available for prescription for cardiac indications. Mouse data suggest that ivabradine in high concentrations is equianalgesic with gabapentin. We sought to translate these findings to patients with chronic peripheral neuropathic pain. Objectives: We sought to translate these findings to patients with chronic peripheral neuropathic pain. Methods: We adopted an open-label design, administering increasing doses of ivabradine to target a heart rate of 50 to 60 BPM, up to a maximum of 7.5 mg twice daily. All participants scored their pain on an 11-point numerical rating scale (NRS). Results: Seven (7) participants received the drug and completed the study. There was no significant treatment effect on the primary endpoint, the difference between the mean score at baseline and at maximum dosing (mean reduction = 0.878, 95% CI = −2.07 to 0.31, P = 0.1). Exploratory analysis using linear mixed models, however, revealed a highly significant correlation between ivabradine dose and pain scores (χ2(1) = 74.6, P < 0.001), with a reduction of 0.12 ± 0.01 (SEM) NRS points per milligram. The 2 participants with painful diabetic neuropathy responded particularly well. Conclusion: This suggests that ivabradine may be efficacious at higher doses, particularly in patients with diabetic neuropathic pain. Importantly, participants reported no adverse effects. These data suggest that ivabradine, a peripherally restricted drug (devoid of central nervous system side effects), is well tolerated in patients with chronic neuropathic pain. Ivabradine is now off-patent, and its analgesic potential merits further investigation in clinical trials.
Collapse
Affiliation(s)
| | - Ingrid Scholtes
- Division of Anaesthesia, University of Cambridge, Cambridge, United Kingdom
| | - Mark Abrahams
- Pain Service, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - Peter A McNaughton
- Wolfson Centre for Age-Related Diseases, King's College London, London, United Kingdom
| | - David K Menon
- Division of Anaesthesia, University of Cambridge, Cambridge, United Kingdom
| | - Michael C Lee
- Division of Anaesthesia, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
43
|
Uhe T, Beimel S, Langhammer R, Stegmann T, Hindricks G, Laufs U, Dagres N, Wachter R. Patients' attitude towards a sham-controlled trial on pulmonary vein isolation in atrial fibrillation. Clin Res Cardiol 2021; 111:114-123. [PMID: 34709451 PMCID: PMC8766391 DOI: 10.1007/s00392-021-01959-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/19/2021] [Indexed: 01/09/2023]
Abstract
Background The interpretation of recent trials on pulmonary vein ablation (PVI) for the treatment of atrial fibrillation (AF) is hampered by the lack of blinding and sham controls. The feasibility of a sham-controlled trial has been questioned. We aimed to assess the attitude of potential participants regarding a sham-controlled trial in a common AF-patient population planned for PVI. Methods Patients in two tertiary care centres planned for PVI were asked for their current AF symptoms using the Atrial Fibrillation Effect on QualiTy of Life (AFEQT) questionnaire 1 day before catheter ablation. Subsequently, the study design of a hypothetical sham-controlled PVI-study was introduced, and patients were asked for their agreement in participation. Telephone follow-up of the AFEQT questionnaire was conducted 3 months after PVI. Results One hundred and ninety-six patients (mean age 64 ± 11 years, 63% male) were included. Seventy-nine (40%) patients expressed their agreement to participate in the hypothetical sham-controlled trial. An additional 7% agreed to participate if a cross-over option after three months was offered. Agreement rate was similar in patients with first and Redo-PVI and minimal, moderate or severe symptoms. Mean overall AFEQT at baseline was 55 ± 19 and improved by 25 ± 20 points after 3 months (p < 0.001 versus baseline). Conclusion With a participation rate of 40% in potential study participants, a sham-controlled trial for pulmonary vein isolation seems feasible. Patient-reported symptom relief after pulmonary vein isolation is in accordance with previous randomized open studies. The benefit of PVI should be rigorously evaluated in a sham-controlled trial. Graphic abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-021-01959-z.
Collapse
Affiliation(s)
- Tobias Uhe
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04317, Leipzig, Germany.
| | - Samira Beimel
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04317, Leipzig, Germany.,Abteilung für Rhythmologie, Herzzentrum Leipzig, Leipzig, Germany
| | - Romy Langhammer
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04317, Leipzig, Germany
| | - Tina Stegmann
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04317, Leipzig, Germany
| | | | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04317, Leipzig, Germany
| | - Nikolaos Dagres
- Abteilung für Rhythmologie, Herzzentrum Leipzig, Leipzig, Germany
| | - Rolf Wachter
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04317, Leipzig, Germany
| |
Collapse
|
44
|
Cutoff criteria for the placebo response: a cluster and machine learning analysis of placebo analgesia. Sci Rep 2021; 11:19205. [PMID: 34584181 PMCID: PMC8479132 DOI: 10.1038/s41598-021-98874-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/16/2021] [Indexed: 11/08/2022] Open
Abstract
Computations of placebo effects are essential in randomized controlled trials (RCTs) for separating the specific effects of treatments from unspecific effects associated with the therapeutic intervention. Thus, the identification of placebo responders is important for testing the efficacy of treatments and drugs. The present study uses data from an experimental study on placebo analgesia to suggest a statistical procedure to separate placebo responders from nonresponders and suggests cutoff values for when responses to placebo treatment are large enough to be separated from reported symptom changes in a no-treatment condition. Unsupervised cluster analysis was used to classify responders and nonresponders, and logistic regression implemented in machine learning was used to obtain cutoff values for placebo analgesic responses. The results showed that placebo responders can be statistically separated from nonresponders by cluster analysis and machine learning classification, and this procedure is potentially useful in other fields for the identification of responders to a treatment.
Collapse
|
45
|
Howick J. Unethical informed consent caused by overlooking poorly measured nocebo effects. JOURNAL OF MEDICAL ETHICS 2021; 47:590-594. [PMID: 32063581 DOI: 10.1136/medethics-2019-105903] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/04/2020] [Accepted: 01/13/2020] [Indexed: 06/10/2023]
Abstract
Unlike its friendly cousin the placebo effect, the nocebo effect (the effect of expecting a negative outcome) has been almost ignored. Epistemic and ethical confusions related to its existence have gone all but unnoticed. Contrary to what is often asserted, adverse events following from taking placebo interventions are not necessarily nocebo effects; they could have arisen due to natural history. Meanwhile, ethical informed consent (in clinical trials and clinical practice) has centred almost exclusively on the need to inform patients about intervention risks with patients to preserve their autonomy. Researchers have failed to consider the harm caused by the way in which the information is conveyed. In this paper, I argue that the magnitude of nocebo effects must be measured using control groups consisting of untreated patients. And, because the nocebo effect can produce harm, the principle of non-maleficence must be taken into account alongside autonomy when obtaining (ethical) informed consent and communicating intervention risks with patients.
Collapse
Affiliation(s)
- Jeremy Howick
- Faculty of Philosophy, University of Oxford, Oxford OX2 6GG, UK
| |
Collapse
|
46
|
Miettinen M, Rämö L, Lähdeoja T, Sirola T, Sandelin H, Ponkilainen V, Repo JP. Treatment of hallux rigidus (HARD trial): study protocol of a prospective, randomised, controlled trial of arthrodesis versus watchful waiting in the treatment of a painful osteoarthritic first metatarsophalangeal joint. BMJ Open 2021; 11:e049298. [PMID: 34452964 PMCID: PMC8404449 DOI: 10.1136/bmjopen-2021-049298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Hallux rigidus is a common problem of pain and stiffness of the first metatarsophalangeal joint (MTPJ) caused mainly by degenerative osteoarthritis. Several operative techniques have been introduced for the treatment of this condition without high-quality evidence comparing surgical to non-surgical care. In this trial, the most common surgical procedure, arthrodesis, will be compared with watchful waiting in the management of hallux rigidus. METHODS AND ANALYSIS Ninety patients (40 years or older) with symptomatic first MTPJ osteoarthritis will be randomised to arthrodesis or watchful waiting in a ratio of 1:1. The primary outcome will be pain during walking, assessed using the 0-10 Numerical Rating Scale (NRS) at 1 year after randomisation. The secondary outcomes will be pain at rest (NRS), physical function (Manchester-Oxford Foot Questionnaire), patient satisfaction in terms of the patient-acceptable symptom state, health-related quality of life (EQ-5D-5L), activity level (The Foot and Ankle Ability Measure Sports subscale), use of analgesics or orthoses and the rate of complications. Our null hypothesis is that there will be no difference equal to or greater than the minimal important difference of the primary outcome measure between arthrodesis and watchful waiting. Our primary analysis follows an intention-to-treat principle. ETHICS AND DISSEMINATION The study protocol has been approved by the Ethics Committee of Helsinki and Uusimaa Hospital District, Finland. Written informed consent will be obtained from all the participants. We will disseminate the findings of this study through peer-reviewed publications and conference presentations. PROTOCOL VERSION 21 June 2021 V.2.0. TRIAL REGISTRATION NUMBER NCT04590313.
Collapse
Affiliation(s)
- Mikko Miettinen
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Uusimaa, Finland
| | - Lasse Rämö
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Uusimaa, Finland
- Finnish Centre for Evidence-Based Orthopaedics, FICEBO, Helsinki, Finland
| | - Tuomas Lähdeoja
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Uusimaa, Finland
- Finnish Centre for Evidence-Based Orthopaedics, FICEBO, Helsinki, Finland
| | - Timo Sirola
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Uusimaa, Finland
| | - Henrik Sandelin
- Department of Orthopaedics and Traumatology, Vaasa Central Hospital and University of Helsinki, Helsinki, Uusimaa, Finland
- Sports Hospital, Mehiläinen, Helsinki, Uusimaa, Finland
| | - Ville Ponkilainen
- Department of Orthopaedics and Traumatology, Central Finland Hospital Nova, Jyväskylä, Central Finland, Finland
| | - Jussi P Repo
- Department of Orthopaedics and Traumatology, University of Tampere and Tampere University Hospital, Tampere, Finland
| |
Collapse
|
47
|
Gianni E, Bertoli M, Simonelli I, Paulon L, Tecchio F, Pasqualetti P. tDCS randomized controlled trials in no-structural diseases: a quantitative review. Sci Rep 2021; 11:16311. [PMID: 34381076 PMCID: PMC8357949 DOI: 10.1038/s41598-021-95084-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/21/2021] [Indexed: 11/26/2022] Open
Abstract
The increasing number and quality of randomized controlled trials (RCTs) employing transcranial direct current stimulation (tDCS) denote the rising awareness of neuroscientific community about its electroceutical potential and opening to include these treatments in the framework of medical therapies under the indications of the international authorities. The purpose of this quantitative review is to estimate the recommendation strength applying the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria and PICO (population, intervention, comparison, outcome) model values for effective tDCS treatments on no-structural diseases, and to provide an estimate of Sham effect for future RCTs. Applying GRADE evaluation pathway, we searched in literature the tDCS-based RCTs in psychophysical diseases displaying a major involvement of brain electrical activity imbalances. Three independent authors agreed on Class 1 RCTs (18 studies) and meta-analyses were carried out using a random-effects model for pathologies sub-selected based on PICO and systemic involvement criteria. The meta-analysis integrated with extensive evidence of negligible side effects and low-cost, easy-to-use procedures, indicated that tDCS treatments for depression and fatigue in Multiple Sclerosis ranked between moderately and highly recommendable. For these interventions we reported the PICO variables, with left vs. right dorsolateral prefrontal target for 30 min/10 days against depression and bilateral somatosensory vs occipital target for 15 min/5 days against MS fatigue. An across-diseases meta-analysis devoted to the Sham effect provided references for power analysis in future tDCS RCTs on these clinical conditions. High-quality indications support tDCS as a promising tool to build electroceutical treatments against diseases involving neurodynamics alterations.
Collapse
Affiliation(s)
- Eugenia Gianni
- LET'S - ISTC - CNR, via Palestro 32, 00185, Rome, Italy
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Massimo Bertoli
- LET'S - ISTC - CNR, via Palestro 32, 00185, Rome, Italy
- Department of Imaging and Neuroscience and Clinical Sciences, University 'G. D'Annunzio' of Chieti-Pescara, Chieti, Italy
| | - Ilaria Simonelli
- Service of Medical Statistics and Information Technology, Fatebenefratelli Foundation for Health Research and Education, Rome, Italy
| | - Luca Paulon
- LET'S - ISTC - CNR, via Palestro 32, 00185, Rome, Italy
| | - Franca Tecchio
- LET'S - ISTC - CNR, via Palestro 32, 00185, Rome, Italy.
| | - Patrizio Pasqualetti
- Department of Public Health and Infectious Diseases, Section of Medical Statistics, University of Rome "Sapienza", Rome, Italy
| |
Collapse
|
48
|
McKetin R, Dean OM, Turner A, Kelly PJ, Quinn B, Lubman DI, Dietze P, Carter G, Higgs P, Sinclair B, Reid D, Baker AL, Manning V, Pas NT, Thomas T, Bathish R, Raftery DK, Wrobel A, Saunders L, Arunogiri S, Cordaro F, Hill H, Hall S, Clare PJ, Mohebbi M, Berk M. N-acetylcysteine (NAC) for methamphetamine dependence: A randomised controlled trial. EClinicalMedicine 2021; 38:101005. [PMID: 34308314 PMCID: PMC8283342 DOI: 10.1016/j.eclinm.2021.101005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Methamphetamine dependence is a significant global health concern for which there are no approved medications. The cysteine prodrug, N-acetylcysteine (NAC), has been found to ameliorate glutamate dysregulation in addiction, and to reduce craving for methamphetamine and other drugs. We evaluated the efficacy and safety of NAC as a pharmacotherapy for methamphetamine dependence. METHODS A parallel double-blind randomised placebo-controlled trial of people dependent on methamphetamine recruited from Geelong, Melbourne and Wollongong, Australia, between July 2018 and December 2019. Participants were randomised to receive either 12 weeks of oral NAC (2400 mg/day) or matched placebo, delivered as a take-home medication. The primary outcome was methamphetamine use, measured in two ways: (a) change in days of use in the past 4 weeks from baseline to weeks 4, 8 and 12, assessed using the Timeline Followback; and (b) methamphetamine-positive oral fluid samples taken weekly. Analyses were intention-to-treat and based on imputed data. Secondary outcomes were craving, severity of dependence, withdrawal severity and psychiatric symptoms (depression, suicidality, hostility and psychotic symptoms). Significance levels were p < 0.025 for primary outcomes and p < 0.01 for secondary outcomes. Adverse events were compared between groups by system organ class. The study was prospectively registered, ACTRN12618000366257. RESULTS Participants (N = 153; 59% male, mean [SD] age 38 [8]) were randomised to placebo (n = 77) or NAC (n = 76). Both groups had a median (IQR) of 24 (15-28) days of methamphetamine use in the 4 weeks prior to baseline. Both groups significantly reduced methamphetamine use (mean [SE] reduction of 7.3 [1.2]) days for placebo, 6.8 [1.2] for NAC) but NAC did not reduce days of methamphetamine use more than placebo (group difference of 0.5 days, 97.5% CI -3.4-4.3). There was no significant effect of NAC on methamphetamine-positive oral fluid samples (placebo 79%, NAC 76%; mean difference -2.6, 97.5% CI -12.6-7.4). NAC did not significantly reduce craving, severity of dependence, withdrawal, suicidality, depression, hostility or psychotic symptoms relative to placebo. Adverse events did not differ significantly between placebo and NAC groups. INTERPRETATION These findings suggest that take-home oral NAC has no significant effect on methamphetamine use or most clinically related outcomes amongst people who are dependent on the drug.
Collapse
Affiliation(s)
- Rebecca McKetin
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia
| | - Olivia M. Dean
- Deakin University, School of Medicine, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, Geelong, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Alyna Turner
- Deakin University, School of Medicine, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, Geelong, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Peter J. Kelly
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - Brendan Quinn
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Australia
| | - Dan I. Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
- Turning Point, Eastern Health, Richmond, Australia
| | - Paul Dietze
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Australia
- National Drug Research Institute, Curtin University, Australia
| | - Gregory Carter
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Peter Higgs
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Barbara Sinclair
- Drug and Alcohol Services, Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - David Reid
- Drug and Alcohol Services, Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Amanda L. Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Victoria Manning
- Monash Addiction Research Centre, Eastern Health Clinical School, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
- Turning Point, Eastern Health, Richmond, Australia
| | - Nina te Pas
- National Drug Research Institute, Curtin University, Australia
| | - Tamsin Thomas
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - Ramez Bathish
- Monash Addiction Research Centre, Eastern Health Clinical School, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
- Turning Point, Eastern Health, Richmond, Australia
| | - Dayle K. Raftery
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - Anna Wrobel
- Deakin University, School of Medicine, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, Geelong, Australia
| | - Lucy Saunders
- Deakin University, School of Medicine, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, Geelong, Australia
| | - Shalini Arunogiri
- Monash Addiction Research Centre, Eastern Health Clinical School, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
- Monash Alfred Psychiatry Research Centre, Monash University, Melbourne, Australia
| | - Frank Cordaro
- Drug and Alcohol Services, Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Harry Hill
- Monash Alfred Psychiatry Research Centre, Monash University, Melbourne, Australia
| | - Scott Hall
- Monash Alfred Psychiatry Research Centre, Monash University, Melbourne, Australia
| | - Philip J. Clare
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia
- Prevention Research Collaboration, School of Public Health, University of Sydney, Australia
| | - Mohammadreza Mohebbi
- Deakin University, School of Medicine, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, Geelong, Australia
- Faculty of Health, Biostatistics Unit, Deakin University, Geelong, Australia
| | - Michael Berk
- Deakin University, School of Medicine, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, Geelong, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
- Department of Psychiatry, University of Melbourne, Parkville, Australia
- Health Drug and Alcohol Services, Geelong, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, Australia
| |
Collapse
|
49
|
Hafliðadóttir SH, Juhl CB, Nielsen SM, Henriksen M, Harris IA, Bliddal H, Christensen R. Placebo response and effect in randomized clinical trials: meta-research with focus on contextual effects. Trials 2021; 22:493. [PMID: 34311793 PMCID: PMC8314506 DOI: 10.1186/s13063-021-05454-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 07/13/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Contextual effects (i.e., placebo response) refer to all health changes resulting from administering an apparently inactive treatment. In a randomized clinical trial (RCT), the overall treatment effect (i.e., the post-treatment effect in the intervention group) can be regarded as the true effect of the intervention plus the impact of contextual effects. This meta-research was conducted to examine the average proportion of the overall treatment effect attributable to contextual effects in RCTs across clinical conditions and treatments and explore whether it varies with trial contextual factors. METHODS Data was extracted from trials included in the main meta-analysis from the latest update of the Cochrane review on "Placebo interventions for all clinical conditions" (searched from 1966 to March 2008). Only RCTs reported in English having an experimental intervention group, a placebo comparator group, and a no-treatment control group were eligible. RESULTS In total, 186 trials (16,655 patients) were included. On average, 54% (0.54, 95%CI 0.46 to 0.64) of the overall treatment effect was attributable to contextual effects. The contextual effects were higher for trials with blinded outcome assessor and concealed allocation. The contextual effects appeared to increase proportional to the placebo effect, lower mean age, and proportion of females. CONCLUSION Approximately half of the overall treatment effect in RCTs seems attributable to contextual effects rather than to the specific effect of treatments. As the study did not include all important contextual factors (e.g., patient-provider interaction), the true proportion of contextual effects could differ from the study's results. However, contextual effects should be considered when assessing treatment effects in clinical practice. TRIAL REGISTRATION PROSPERO CRD42019130257 . Registered on April 19, 2019.
Collapse
Affiliation(s)
- Sigurlaug H Hafliðadóttir
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, DK-2000, Copenhagen F, Denmark.,SEARCH Research Group, Research Unit of Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Carsten B Juhl
- SEARCH Research Group, Research Unit of Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, University Hospital of Copenhagen, Herlev, Gentofte, Denmark
| | - Sabrina M Nielsen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, DK-2000, Copenhagen F, Denmark.,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Marius Henriksen
- The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Ian A Harris
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,Faculty of Medicine, South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.,Institute of Musculoskeletal Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Henning Bliddal
- The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, DK-2000, Copenhagen F, Denmark. .,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark.
| |
Collapse
|
50
|
Yammouni R, Evans BJW. Is reading rate in digital eyestrain influenced by binocular and accommodative anomalies? JOURNAL OF OPTOMETRY 2021; 14:229-239. [PMID: 33115619 PMCID: PMC8258174 DOI: 10.1016/j.optom.2020.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Symptoms experienced when using digital devices are known as digital eyestrain (DES) or computer vision syndrome. They can be categorised as either external (associated with dry eye) or internal (related to refractive, accommodative or binocular vision anomalies). In a large cohort of adults with DES, we investigate the prevalence of binocular and accommodative anomalies, contrasting different diagnostic approaches, to evaluate potential mechanisms for the benefit from +0.75D addition lens that has been previously reported. METHODS Participants (20-40y) were selected using the Computer Vision Syndrome Questionnaire (CVS-Q) tool as suffering with DES. A comprehensive eye examination was given to each participant, and this paper concentrates on "internal factors", detected with a refraction and comprehensive testing of binocular and accommodative functions. The effects of low-powered addition lenses (+0.50D, +0.75D, +1.25D; and plano controls) were assessed by double-masked testing with the Wilkins Rate of Reading Test (WRRT) and by subjective preference. RESULTS As previously reported, most participants showed a subjective preference for one of the three convex lenses we used, with +0.75D chosen most frequently. Performance at the WRRT was significantly improved with +0.50D and +0.75D, but not +1.25D. Using a variety of diagnostic criteria, there were no strong associations between WRRT results or CVS-Q scores and any binocular or accommodation functions. The one finding of significance is that a disproportionate number of participants who benefited from adds had an eso-fixation disparity on the near Mallett unit, although this only affected 5% of the population. CONCLUSIONS DES is a collection of diverse symptoms that have a multifactorial aetiology. In the sample described here, binocular and accommodative anomalies do not seem to be a major cause of DES. Nevertheless, in view of the multifactorial aetiology it is recommended that patients with the symptoms of DES are assessed with a comprehensive eye examination. Patients with an esophoric fixation disparity on the near Mallett unit are particularly likely to benefit from near additions.
Collapse
Affiliation(s)
- Robert Yammouni
- Neville Chappell Research Clinic, Institute of Optometry, 56-62 Newington Causeway, London, SE1 6DS, UK.
| | - Bruce J W Evans
- Neville Chappell Research Clinic, Institute of Optometry, 56-62 Newington Causeway, London, SE1 6DS, UK; Division of Optometry & Visual Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK
| |
Collapse
|