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King MG, Scholes MJ, Fan I, Govil D, Semciw AI. Response to: You et al., 'Comment on: How effective are exercises delivered digitally (requiring internet), amongst patients with hip or knee osteoarthritis? A systematic review and meta-analysis'. Osteoarthritis Cartilage 2024; 32:964-965. [PMID: 38734366 DOI: 10.1016/j.joca.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024]
Affiliation(s)
- Matthew G King
- Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia; Australian IOC Research Centre, La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.
| | - Mark J Scholes
- Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia; Australian IOC Research Centre, La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Iryoung Fan
- Northern Health, Epping, Victoria, Australia
| | - Dhruv Govil
- Bass Coast Health, Wonthaggi, Victoria, Australia
| | - Adam I Semciw
- Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia; Northern Health, Epping, Victoria, Australia
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Preobrazenski N, McCaig A, Turner A, Kushner M, Pacitti L, Mendolia P, MacDonald B, Storoschuk K, Bouck T, Zaza Y, Lu S, Gurd BJ. Risk of bias in exercise science: A systematic review of 340 studies. iScience 2024; 27:109010. [PMID: 38405604 PMCID: PMC10884506 DOI: 10.1016/j.isci.2024.109010] [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: 10/04/2023] [Revised: 12/19/2023] [Accepted: 01/22/2024] [Indexed: 02/27/2024] Open
Abstract
Risk of bias can contribute to irreproducible science and mislead decision making. Analyses of smaller subsections of the exercise science literature suggest many exercise science studies have unclear or high risk of bias. The current review (osf.io/jznv8) assesses whether this unclear or high risk of bias is more widespread in the exercise science literature and whether this bias has decreased since the publication of the 1996 Consolidated Standards of Reporting Trials (CONSORT) guidelines. We report significant reductions in selection, performance, detection, and reporting biases in 2020 compared with 1995 in the 340 of 5,451 studies assessed using the Cochrane Risk of Bias tool. Despite these improvements, most 2020 studies still had unclear or high risks of bias. These results underscore the need for methodological vigilance, adherence to reporting standards, and education on experimental bias. Factors contributing to these improvements, such advancements in education and journal requirements, remain uncertain.
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Affiliation(s)
| | - Abby McCaig
- School of Kinesiology and Health Studies, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Anna Turner
- School of Kinesiology and Health Studies, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Maddy Kushner
- School of Kinesiology and Health Studies, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Lauren Pacitti
- School of Kinesiology and Health Studies, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Peter Mendolia
- School of Kinesiology and Health Studies, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Ben MacDonald
- School of Kinesiology and Health Studies, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Kristi Storoschuk
- School of Kinesiology and Health Studies, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Tori Bouck
- School of Kinesiology and Health Studies, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Youssef Zaza
- School of Kinesiology and Health Studies, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Stephanie Lu
- School of Kinesiology and Health Studies, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Brendon J. Gurd
- School of Kinesiology and Health Studies, Queen’s University, Kingston, ON K7L 3N6, Canada
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Long Y, Zhang N, Wang X, Tang R, Guo Q, Huang J, Du L. The impact of blinding on estimated treatment effects in randomized clinical trials on acupuncture: A meta-epidemiological study. J Evid Based Med 2024; 17:54-64. [PMID: 38465845 DOI: 10.1111/jebm.12589] [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: 12/20/2023] [Accepted: 02/25/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE To evaluate the sole impact of blinding patients and outcome assessors in acupuncture randomized controlled trials (RCTs) on treatment effects while considering the type of outcome measures. METHODS We searched databases for the meta-analyses on acupuncture with both blinded and non-blinded RCTs. Mixed-effects meta-regression models estimated the average ratio of odds ratios (ROR) and differences in standardized mean differences (dSMD) for non-blinded RCTs versus blinded mixed-effects meta-regression model. RESULTS The study included 96 meta-analyses (1012 trials). The average ROR for lack of patient blinding was 1.08 (95% confidence intervals 0.79-1.49) in 18 meta-analyses with binary patient-reported outcomes. The average ROR for lack of outcome assessor blinding was 0.98 (0.77-1.24) in 43 meta-analyses with binary subjective outcomes. The average dSMD was -0.38 (-0.96 to 0.20) in 10 meta-analyses with continuous patient-reported outcomes. The average dSMD was -0.13 (-0.45 to 0.18) in 25 meta-analyses with continuous subjective outcomes. The results of the subgroup analysis were consistent with the primary analysis findings. CONCLUSIONS Blinding of participants and outcome assessors does not significantly influence acupuncture treatment efficacy. It underscores the practical difficulties of blinding in acupuncture RCTs and the necessity to distinguish between trials with and without successful blinding to understand treatment expectations' effects. Enhancing blinding procedures' quality and assessment in future research is crucial for improving RCTs' internal validity and reliability.
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Affiliation(s)
- Youlin Long
- Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
- Medical Device Regulatory Research and Evaluation Centre, West China Hospital, Sichuan University, Chengdu, China
- Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Na Zhang
- Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
- Medical Device Regulatory Research and Evaluation Centre, West China Hospital, Sichuan University, Chengdu, China
- Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Xinyao Wang
- Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
- Medical Device Regulatory Research and Evaluation Centre, West China Hospital, Sichuan University, Chengdu, China
- Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Ruixian Tang
- Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
- Medical Device Regulatory Research and Evaluation Centre, West China Hospital, Sichuan University, Chengdu, China
- Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Qiong Guo
- Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
- Medical Device Regulatory Research and Evaluation Centre, West China Hospital, Sichuan University, Chengdu, China
- Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Jin Huang
- Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
- Medical Device Regulatory Research and Evaluation Centre, West China Hospital, Sichuan University, Chengdu, China
- Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China
- Med-X Centre for Manufacturing, West China Hospital, Sichuan University, Chengdu, China
| | - Liang Du
- Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
- Medical Device Regulatory Research and Evaluation Centre, West China Hospital, Sichuan University, Chengdu, China
- Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China
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Fan I, Govil D, King MG, Scholes MJ, Semciw AI. How effective are exercises delivered digitally (requiring internet), amongst patients with hip or knee osteoarthritis? A systematic review and meta-analysis. Osteoarthritis Cartilage 2024; 32:254-265. [PMID: 38030118 DOI: 10.1016/j.joca.2023.11.011] [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: 06/19/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis is to describe the effect of digitally delivered exercise on pain, physical function and quality of life (QoL) for people with knee or hip osteoarthritis (OA). METHODS Articles were eligible for inclusion if they were of a randomized control trial that evaluated the prescription of digitally delivered exercise (requiring the internet) in people with symptomatic primary hip and/or knee OA. Risk of bias was assessed using the Physiotherapy Evidence Database scale, and levels of evidence were assessed according to Grading of Recommendations Assessment, Development and Evaluation. RESULTS Digitally delivered exercise was delivered via synchronous and asynchronous methods (or a combination of both). Digitally delivered exercise was superior to education only for pain and physical function, with high-quality evidence for quality-of-life outcomes in the long-term (standardized mean difference -0.35, 95% confidence interval -0.59 to -0.12, P = 0.003) in people with knee OA. Furthermore, there was very low to low-quality evidence that digitally delivered exercise was comparable to face-to-face delivery in the short and long-term for people with hip or knee OA and comparable in the medium-term for people with knee OA only. DISCUSSION The review demonstrated very low to low-quality evidence that digitally delivered exercise was comparable to face-to-face delivery for pain, function and QoL. In the absence of higher-level evidence, we would provisionally recommend that healthcare providers offer the choice of face-to-face or digitally delivered exercise intervention for people with hip or knee OA. Further work is required to understand these programs' reach, access, uptake and implementation across diverse population groups.
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Affiliation(s)
- Iryoung Fan
- Allied Health, Northern Health, Epping, Victoria, Australia; Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.
| | - Dhruv Govil
- Bass Coast Health, Wonthaggi, Victoria, Australia.
| | - Matthew G King
- Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia; Australian IOC Research Centre, La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.
| | - Mark J Scholes
- Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia; Australian IOC Research Centre, La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.
| | - Adam I Semciw
- Allied Health, Northern Health, Epping, Victoria, Australia; Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.
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van Arnhem MML, van den Munckhof B, Arzimanoglou A, Perucca E, Metsähonkala L, Rubboli G, Søndergaard Khinchi M, de Saint-Martin A, Klotz KA, Jacobs J, Cross JH, Garcia Morales I, Otte WM, van Teeseling HC, Leijten FSS, Braun KPJ, Jansen FE. Corticosteroids versus clobazam for treatment of children with epileptic encephalopathy with spike-wave activation in sleep (RESCUE ESES): a multicentre randomised controlled trial. Lancet Neurol 2024; 23:147-156. [PMID: 38081201 DOI: 10.1016/s1474-4422(23)00409-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/30/2023] [Accepted: 10/16/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Epileptic encephalopathy with spike-wave activation in sleep (EE-SWAS) is a rare syndrome associated with cognitive and behavioural regression. On the basis of mostly small observational and retrospective studies, corticosteroids and clobazam are often considered the most effective treatments for this syndrome. We aimed to compare cognitive outcomes of children with EE-SWAS 6 months after starting treatment with either corticosteroids or clobazam. METHODS We did a multicentre, randomised controlled trial at eight tertiary referral centres for rare epilepsies in seven European countries. Children were eligible to participate if they were aged 2-12 years, were diagnosed with EE-SWAS within 6 months before inclusion, and had not been treated with corticosteroids or clobazam previously. Participants were randomly assigned (1:1) to treatment with corticosteroids (either continuous treatment with 1-2 mg/kg per day of prednisolone orally or pulse treatment with 20 mg/kg per day of methylprednisolone intravenously for 3 days every 4 weeks) or clobazam (0·5-1·2 mg/kg per day orally). The primary outcome was cognitive functioning after 6 months of treatment, which was assessed by either the intelligence quotient (IQ) responder rate (defined as improvement of ≥11·25 IQ points) or the cognitive sum score responder rate (defined as improvement of ≥0·75 points). Safety was assessed by number of adverse events and serious adverse events. Data were analysed in the intention-to-treat population, which included all children as randomised who had primary outcome data available at 6 months. The trial is registered with the Dutch Trial Register, Toetsingonline, NL43510.041.13, and the ISRCTN registry, ISRCTN42686094. The trial was terminated prematurely because enrolment of the predefined number of 130 participants was deemed not feasible. FINDINGS Between July 22, 2014, and Sept 3, 2022, 45 children were randomly assigned to either corticosteroids (n=22) or clobazam (n=23); two children assigned clobazam dropped out before 6 months and were excluded from the intention-to-treat analysis. At the 6-month assessment, an improvement of 11·25 IQ points or greater was reported for five (25%) of 20 children assigned corticosteroids versus zero (0%) of 18 assigned clobazam (risk ratio [RR] 10·0, 95% CI 1·2-1310·4; p=0·025). An improvement of 0·75 points or more in the cognitive sum score was recorded for one (5%) of 22 children assigned corticosteroids versus one (5%) of 21 children assigned clobazam (RR 1·0, 95% CI 0·1-11·7, p=0·97). Adverse events occurred in ten (45%) of 22 children who received corticosteroids, most frequently weight gain, and in 11 (52%) of 21 children who received clobazam, most often fatigue and behavioural disturbances. Occurrence of adverse events did not differ between groups (RR 0·8, 95% CI 0·4-1·4; p=0·65). Serious adverse events occurred in one child in the corticosteroid group (hospitalisation due to laryngitis) and in two children in the clobazam group (hospitalisation due to seizure aggravation, and respiratory tract infection). No deaths were reported. INTERPRETATION The trial was terminated prematurely, and the target sample size was not met, so our findings must be interpreted with caution. Our data indicated an improvement in IQ outcomes with corticosteroids compared with clobazam treatment, but no difference was seen in cognitive sum score. Our findings strengthen those from previous uncontrolled studies that support the early use of corticosteroids for children with EE-SWAS. FUNDING EpilepsieNL, WKZ fund, European Clinical Research Infrastructure Network, and Ming fund.
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Affiliation(s)
- Marleen M L van Arnhem
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Alexis Arzimanoglou
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, University Hospitals of Lyon, Lyon, France
| | - Emilio Perucca
- Department of Medicine, Austin Health, University of Melbourne, Heidelberg, VIC, Australia; Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Liisa Metsähonkala
- Department of Child Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Guido Rubboli
- Department of Epilepsy Genetics and Personalized Treatment, Danish Epilepsy Center, Dianalund, Denmark; Institute of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Anne de Saint-Martin
- Department of Pediatric Neurology, Strasbourg University Hospital, Strasbourg, France
| | - Kerstin A Klotz
- Department of Neuropediatrics and Muscle Disorders, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julia Jacobs
- Department of Neuropediatrics and Muscle Disorders, University Hospital Freiburg, Freiburg, Germany; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - J Helen Cross
- Developmental Neurosciences Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK; Paediatric Neurosciences, Great Ormond Street Hospital for Children, London, UK
| | | | - Wim M Otte
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Heleen C van Teeseling
- Department of Pediatric Psychology, Wilhelmina's Children Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Frans S S Leijten
- Department of Neurology, Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Kees P J Braun
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Floor E Jansen
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht, Netherlands.
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Wang Y, Parpia S, Couban R, Wang Q, Armijo-Olivo S, Bassler D, Briel M, Brignardello-Petersen R, Gluud LL, Keitz SA, Letelier LM, Ravaud P, Schulz KF, Siemieniuk RAC, Zeraatkar D, Guyatt GH. Compelling evidence from meta-epidemiological studies demonstrates overestimation of effects in randomized trials that fail to optimize randomization and blind patients and outcome assessors. J Clin Epidemiol 2024; 165:111211. [PMID: 37939743 DOI: 10.1016/j.jclinepi.2023.11.001] [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: 07/08/2023] [Revised: 10/29/2023] [Accepted: 11/01/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES To investigate the impact of potential risk of bias elements on effect estimates in randomized trials. STUDY DESIGN AND SETTING We conducted a systematic survey of meta-epidemiological studies examining the influence of potential risk of bias elements on effect estimates in randomized trials. We included only meta-epidemiological studies that either preserved the clustering of trials within meta-analyses (compared effect estimates between trials with and without the potential risk of bias element within each meta-analysis, then combined across meta-analyses; between-trial comparisons), or preserved the clustering of substudies within trials (compared effect estimates between substudies with and without the element, then combined across trials; within-trial comparisons). Separately for studies based on between- and within-trial comparisons, we extracted ratios of odds ratios (RORs) from each study and combined them using a random-effects model. We made overall inferences and assessed certainty of evidence based on Grading of Recommendations, Assessment, development, and Evaluation and Instrument to assess the Credibility of Effect Modification Analyses. RESULTS Forty-one meta-epidemiological studies (34 of between-, 7 of within-trial comparisons) proved eligible. Inadequate random sequence generation (ROR 0.94, 95% confidence interval [CI] 0.90-0.97) and allocation concealment (ROR 0.92, 95% CI 0.88-0.97) probably lead to effect overestimation (moderate certainty). Lack of patients blinding probably overestimates effects for patient-reported outcomes (ROR 0.36, 95% CI 0.28-0.48; moderate certainty). Lack of blinding of outcome assessors results in effect overestimation for subjective outcomes (ROR 0.69, 95% CI 0.51-0.93; high certainty). The impact of patients or outcome assessors blinding on other outcomes, and the impact of blinding of health-care providers, data collectors, or data analysts, remain uncertain. Trials stopped early for benefit probably overestimate effects (moderate certainty). Trials with imbalanced cointerventions may overestimate effects, while trials with missing outcome data may underestimate effects (low certainty). Influence of baseline imbalance, compliance, selective reporting, and intention-to-treat analysis remain uncertain. CONCLUSION Failure to ensure random sequence generation or adequate allocation concealment probably results in modest overestimates of effects. Lack of patients blinding probably leads to substantial overestimates of effects for patient-reported outcomes. Lack of blinding of outcome assessors results in substantial effect overestimation for subjective outcomes. For other elements, though evidence for consistent systematic overestimate of effect remains limited, failure to implement these safeguards may still introduce important bias.
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Affiliation(s)
- Ying Wang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
| | - Sameer Parpia
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Rachel Couban
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Qi Wang
- School of Public Health, Capital Medical University, Beijing, China
| | - Susan Armijo-Olivo
- University of Applied Sciences, Faculty of Business and Social Sciences, Osnabrück, Germany; Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton Canada
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias Briel
- Department of Clinical Research, Meta-Research Centre Basel, University Hospital Basel, Basel, Switzerland
| | | | - Lise Lotte Gluud
- Gastro Unit, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Sheri A Keitz
- Department of Medicine, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Luz M Letelier
- Department of Internal Medicine, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Philippe Ravaud
- Epidemiology and Statistics Sorbonne Paris Cité Research Center (CRESS), INSERM, Université Paris Descartes, Paris, France
| | - Kenneth F Schulz
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Reed A C Siemieniuk
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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Ter Meulen BC, van Dongen JM, Maas E, van de Vegt MH, Haumann J, Weinstein HC, Ostelo R. Effect of Transforaminal Epidural Corticosteroid Injections in Acute Sciatica: A Randomized Controlled Trial. Clin J Pain 2023; 39:654-662. [PMID: 37712323 DOI: 10.1097/ajp.0000000000001155] [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] [Received: 11/29/2022] [Accepted: 08/01/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE Transforaminal epidural steroid injections (TESIs) are widely administered for sciatica. The aim of this trial was to evaluate the effectiveness of TESIs in patients with acute sciatica (<8 wk). METHODS This study was conducted in 2 Dutch hospitals. Participants (n=141) were randomly assigned to (1) usual care and TESI of 1 ml of 40 mg/ml Methylprednisolone plus 1 ml of 0.5% Levobupivacaine (intervention 1); (2) usual care and transforaminal epidural injection with 1 ml of 0.5% Levobupivacaine and 1 ml NaCl 0.9% (intervention 2); (3) usual care consisting of oral pain medication with or without physiotherapy (control). Co-primary outcomes were back pain and leg pain intensity, physical functioning, and recovery measured during 6-month follow-up. RESULTS There were no statistically significant mean differences in co-primary outcomes between groups during follow-up, except for leg pain when comparing intervention group 1 with control (-0.96 95%CI:-1.83 to -0.09). For secondary outcomes, some statistical significant between-group differences were found for treatment satisfaction and surgery, but only when comparing intervention group 2 to control. Post hoc analyses showed a statistically significant difference in response [50% improvement of leg pain (yes/no)] between intervention 1 and the control group at 3 months and that both intervention groups used less opioids. DISCUSSION Except for a statistically significant effect of TESI on leg pain for patients with acute sciatica compared with usual care, there were no differences in co-primary outcomes. Nonetheless, transforaminal epidural injections seem to be associated with less opioid use, which warrants further exploration.
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Affiliation(s)
- Bastiaan C Ter Meulen
- Department of Neurology at OLVG Teaching Hospital
- Department of Epidemiology and Data Sciences, Amsterdam UMC
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and the Amsterdam Movement Sciences Research Institute, Amsterdam
| | - Johanna M van Dongen
- Department of Epidemiology and Data Sciences, Amsterdam UMC
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and the Amsterdam Movement Sciences Research Institute, Amsterdam
| | - Esther Maas
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and the Amsterdam Movement Sciences Research Institute, Amsterdam
| | | | - Johan Haumann
- Department of Anesthesiology and Pain Medicine, OLVG, Amsterdam, The Netherlands
| | | | - Raymond Ostelo
- Department of Epidemiology and Data Sciences, Amsterdam UMC
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and the Amsterdam Movement Sciences Research Institute, Amsterdam
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8
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Innocenti T, Hayden JA, Salvioli S, Giagio S, Piano L, Cosentino C, Brindisino F, Feller D, Ogilvie R, Gianola S, Castellini G, Bargeri S, Twisk JWR, Ostelo RW, Chiarotto A. Bias in the measurement of the outcome is associated with effect sizes in randomized clinical trials on exercise therapy for chronic low back pain: a meta-epidemiological study. J Clin Epidemiol 2023; 162:145-155. [PMID: 37704114 DOI: 10.1016/j.jclinepi.2023.09.001] [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: 05/10/2023] [Revised: 08/23/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVES To explore the relationships between the risk of bias and treatment effect estimates for exercise therapy interventions on pain intensity and physical functioning outcomes in randomized controlled trials (RCTs) involving patients with chronic low back pain. STUDY DESIGN AND SETTING A cross-sectional meta-epidemiological study of the 230 RCTs (31,674 participants) in the 2021 'Exercise therapy for chronic low back pain' Cochrane Review were included. Study design characteristics, sample size, prospective trial registration, flowchart information, interventions, and comparisons were extracted. Independent pairs of reviewers assessed the risk of bias using the Cochrane Risk of Bias 2 tool. RESULTS The metaregression included 220 (pain intensity) and 203 (physical functioning) effect sizes. Unadjusted and adjusted metaregression models showed no significant associations between the bias domains and pain intensity effect sizes. Only domain 'bias in the measurement of the outcome' was significantly associated with physical functioning (standardized mean difference: -0.40, 95% confidence interval: -0.77 to -0.02) when adjusted for flowchart reported (yes/no), prospective trial registration, sample size, and comparator type. CONCLUSION The risk of bias in the measurement of the outcome could lead to slight overestimates of the effect size for physical functioning. Clinicians should consider this when they read and assess RCT results in this field. We encourage metaresearchers to replicate our findings using a consistent approach for evaluating the risk of bias (i.e., the RoB 2 tool) in other musculoskeletal conditions and interventions to investigate their generalizability.
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Affiliation(s)
- Tiziano Innocenti
- Faculty of Science, Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; GIMBE Foundation, Bologna, Italy.
| | - Jill A Hayden
- Department of Community Health & Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Stefano Salvioli
- GIMBE Foundation, Bologna, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Silvia Giagio
- Division of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Leonardo Piano
- Unit of Rehabilitation and Functional Recovery, Fondazione dei Santi Lorenzo e Teobaldo, Rodello, Italy
| | - Carola Cosentino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Daniel Feller
- Provincial Agency for Health of the Autonomous Province of Trento, Trento, Italy
| | - Rachel Ogilvie
- Department of Community Health & Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Silvia Gianola
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
| | - Greta Castellini
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
| | - Silvia Bargeri
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam, The Netherlands
| | - Raymond W Ostelo
- Faculty of Science, Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Department of Epidemiology and Data Science, Amsterdam UMC, Location VUmc, Amsterdam Movement Sciences research institute, The Netherlands
| | - Alessandro Chiarotto
- Faculty of Science, Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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9
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Park S, Park R, Westwood D, Moayedi M, Khan JS. Effect of Peripheral Magnetic Stimulation on Acute and Chronic Pain After Surgery: A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2023; 24:1151-1162. [PMID: 36878385 DOI: 10.1016/j.jpain.2023.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 02/16/2023] [Accepted: 02/28/2023] [Indexed: 03/07/2023]
Abstract
Peripheral magnetic stimulation (PMS) is a potentially promising modality to help manage postoperative pain. We systematically reviewed the effect of PMS on acute and chronic postoperative pain. MEDLINE, Cochrane CENTRAL, EMBASE, ProQuest Dissertations, and clinical trials.gov were searched from inception until May 2021. We included studies of any study design that included patients ≥18 years of age undergoing any type of surgery that administered PMS within the perioperative period and evaluated postoperative pain. Seventeen randomized controlled trials and 1 nonrandomized clinical trial were included into the review. Thirteen out of the 18 studies found a positive effect with PMS on postoperative pain scores. In our meta-analysis, peripheral magnetic stimulation was more efficacious than sham or no intervention within the first 7 postoperative days (mean difference [MD] -1.64 on a 0 to 10 numerical rating score, 95% confidence interval [CI] -2.08 to -1.20, I2 = 77%, 6 studies, 231 patients). This was also true at 1 and 2 months after surgery (MD -1.82, 95% CI -2.48 to -1.17, I2 = 0%, 3 studies, 104 patients; and MD -1.96, 95% CI -3.67 to -.26, I2 = 84%, 3 studies, 104 patients, respectively). A difference was not seen with persistent pain at 6 and 12-months after surgery, acute postoperative opioid consumption, or adverse events between groups. Results are limited by heterogeneity and generally low-quality studies, as well as low or very low quality of evidence. High-quality and adequately blinded trials are needed to definitively confirm the benefits of peripheral magnetic stimulation administered in the perioperative period. PERSPECTIVE: This review evaluates the efficacy and safety of PMS on postoperative pain. The results help elucidate PMS' role in postoperative pain management and identify gaps where more research is required.
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Affiliation(s)
- Stephanie Park
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rex Park
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Duncan Westwood
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada; Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Massieh Moayedi
- Centre for Multimodal Sensorimotor and Pain Research, University of Toronto, Ontario, Canada; University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, Ontario, Canada; Department of Dentistry, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - James S Khan
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada; Mount Sinai Hospital, Toronto, Ontario, Canada.
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10
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Preobrazenski N, Seigel J, Halliday S, Janssen I, McGlory C. Single-leg disuse decreases skeletal muscle strength, size, and power in uninjured adults: A systematic review and meta-analysis. J Cachexia Sarcopenia Muscle 2023; 14:684-696. [PMID: 36883219 PMCID: PMC10067508 DOI: 10.1002/jcsm.13201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/01/2022] [Accepted: 02/02/2023] [Indexed: 03/09/2023] Open
Abstract
We aimed to quantify declines from baseline in lower limb skeletal muscle size and strength of uninjured adults following single-leg disuse. We searched EMBASE, Medline, CINAHL, and CCRCT up to 30 January 2022. Studies were included in the systematic review if they (1) recruited uninjured participants; (2) were an original experimental study; (3) employed a single-leg disuse model; and (4) reported muscle strength, size, or power data following a period of single-leg disuse for at least one group without a countermeasure. Studies were excluded if they (1) did not meet all inclusion criteria; (2) were not in English; (3) reported previously published muscle strength, size, or power data; or (4) could not be sourced from two different libraries, repeated online searches, and the authors. We used the Cochrane Risk of Bias Assessment Tool to assess risk of bias. We then performed random-effects meta-analyses on studies reporting measures of leg extension strength and extensor size. Our search revealed 6548 studies, and 86 were included in our systematic review. Data from 35 and 20 studies were then included in the meta-analyses for measures of leg extensor strength and size, respectively (40 different studies). No meta-analysis for muscle power was performed due to insufficient homogenous data. Effect sizes (Hedges' gav ) with 95% confidence intervals for leg extensor strength were all durations = -0.80 [-0.92, -0.68] (n = 429 participants; n = 68 aged 40 years or older; n ≥ 78 females); ≤7 days of disuse = -0.57 [-0.75, -0.40] (n = 151); >7 days and ≤14 days = -0.93 [-1.12, -0.74] (n = 206); and >14 days = -0.95 [-1.20, -0.70] (n = 72). Effect sizes for measures of leg extensor size were all durations = -0.41 [-0.51, -0.31] (n = 233; n = 32 aged 40 years or older; n ≥ 42 females); ≤7 days = -0.26 [-0.36, -0.16] (n = 84); >7 days and ≤14 days = -0.49 [-0.67, -0.30] (n = 102); and >14 days = -0.52 [-0.74, -0.30] (n = 47). Decreases in leg extensor strength (cast: -0.94 [-1.30, -0.59] (n = 73); brace: -0.90 [-1.18, -0.63] (n = 106)) and size (cast: -0.61[-0.87, -0.35] (n = 41); brace: (-0.48 [-1.04, 0.07] (n = 41)) following 14 days of disuse did not differ for cast and brace disuse models. Single-leg disuse in adults resulted in a decline in leg extensor strength and size that reached a nadir beyond 14 days. Bracing and casting led to similar declines in leg extensor strength and size following 14 days of disuse. Studies including females and males and adults over 40 years of age are lacking.
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Affiliation(s)
| | - Joel Seigel
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Sandra Halliday
- Queen's University Library, Queen's University, Kingston, Ontario, Canada
| | - Ian Janssen
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Chris McGlory
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada.,Department of Medicine, Queen's University, Kingston, Ontario, Canada
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11
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Armijo-Olivo S, de Oliveira-Souza AIS, Mohamad N, de Castro Carletti EM, Fuentes J, Ballenberger N. Selection, Confounding, and Attrition Biases in Randomized Controlled Trials of Rehabilitation Interventions: What Are They and How Can They Affect Randomized Controlled Trials Results? Basic Information for Junior Researchers and Clinicians. Am J Phys Med Rehabil 2022; 101:1042-1055. [PMID: 35067560 DOI: 10.1097/phm.0000000000001947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
ABSTRACT A thorough knowledge of biases in intervention studies and how they influence study results is essential for the practice of evidence-based medicine. The objective of this review was to provide a basic knowledge and understanding of the concept of biases and associated influence of these biases on treatment effects, focusing on the area of rehabilitation research. This article provides a description of selection biases, confounding, and attrition biases. In addition, useful recommendations are provided to identify, avoid, or control these biases when designing and conducting rehabilitation trials. The literature selected for this review was obtained mainly by compiling the information from several reviews looking at biases in rehabilitation. In addition, separate searches by biases and looking at reference lists of selected studies as well as using Scopus forward citation for relevant references were used. If not addressed appropriately, biases related to intervention research are a threat to internal validity and consequently to external validity. By addressing these biases, ensuring appropriate randomization, allocation concealment, appropriate retention techniques to avoid dropouts, appropriate study design and statistical analysis, among others, will generate more accurate treatment effects. Based on their impact on clinical results, a proper understanding of these concepts is central for researchers, rehabilitation clinicians, and other stakeholders working on this field.
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Affiliation(s)
- Susan Armijo-Olivo
- From the University of Applied Sciences Osnabrück, Faculty of Economics and Social Sciences, Osnabrück, Germany (SA-O, AISdO-S, NB); Faculties of Rehabilitation Medicine and Dentistry, University of Alberta, Edmonton, Canada (SA-O); Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, Edmonton, Canada (SA-O, NM); Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Pernambuco, Brazil (AISdO-S); Post Graduate Program in Human Movement Sciences, Methodist University of Piracicaba-UNIMEP, Piracicaba, Brazil (EMdCC); and Clinical Research Lab, Department of Physical Therapy, Catholic University of Maule, Talca, Chile (JF)
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12
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Conde-Agudelo A, Romero R. Does vaginal progesterone prevent recurrent preterm birth in women with a singleton gestation and a history of spontaneous preterm birth? Evidence from a systematic review and meta-analysis. Am J Obstet Gynecol 2022; 227:440-461.e2. [PMID: 35460628 PMCID: PMC9420758 DOI: 10.1016/j.ajog.2022.04.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of vaginal progesterone to prevent recurrent preterm birth and adverse perinatal outcomes in singleton gestations with a history of spontaneous preterm birth. DATA SOURCES MEDLINE, Embase, LILACS, and CINAHL (from their inception to February 28, 2022), Cochrane databases, Google Scholar, bibliographies, and conference proceedings. STUDY ELIGIBILITY CRITERIA Randomized controlled trials that compared vaginal progesterone to placebo or no treatment in asymptomatic women with a singleton gestation and a history of spontaneous preterm birth. METHODS The primary outcomes were preterm birth <37 and <34 weeks of gestation. The secondary outcomes included adverse maternal and perinatal outcomes. Pooled relative risks with 95% confidence intervals were calculated. We assessed the risk of bias in the included studies, heterogeneity (I2 test), small-study effects, publication bias, and quality of evidence; performed subgroup and sensitivity analyses; and calculated 95% prediction intervals and adjusted relative risks. RESULTS Ten studies (2958 women) met the inclusion criteria: 7 with a sample size <150 (small studies) and 3 with a sample size >600 (large studies). Among the 7 small studies, 4 were at high risk of bias, 2 were at some concerns of bias, and only 1 was at low risk of bias. All the large studies were at low risk of bias. Vaginal progesterone significantly decreased the risk of preterm birth <37 weeks (relative risk, 0.64; 95% confidence interval, 0.50-0.81; I2=75%; 95% prediction interval, 0.31-1.32; very low-quality evidence) and <34 weeks (relative risk, 0.62; 95% confidence interval, 0.42-0.92; I2=66%; 95% prediction interval, 0.23-1.68; very low-quality evidence), and the risk of admission to the neonatal intensive care unit (relative risk, 0.53; 95% confidence interval, 0.33-0.85; I2=67%; 95% prediction interval, 0.16-1.79; low-quality evidence). There were no significant differences between the vaginal progesterone and the placebo or no treatment groups in other adverse perinatal and maternal outcomes. Subgroup analyses revealed that vaginal progesterone decreased the risk of preterm birth <37 weeks (relative risk, 0.43; 95% confidence interval, 0.33-0.55; I2=0%) and <34 weeks (relative risk, 0.27; 95% confidence interval, 0.15-0.49; I2=0%) in the small but not in the large studies (relative risk, 0.98; 95% confidence interval, 0.88-1.09; I2=0% for preterm birth <37 weeks; and relative risk, 0.94; 95% confidence interval, 0.78-1.13; I2=0% for preterm birth <34 weeks). Sensitivity analyses restricted to studies at low risk of bias indicated that vaginal progesterone did not reduce the risk of preterm birth <37 weeks (relative risk, 0.96; 95% confidence interval, 0.84-1.09) and <34 weeks (relative risk, 0.90; 95% confidence interval, 0.71-1.15). There was clear evidence of substantial small-study effects in the meta-analyses of preterm birth <37 and <34 weeks of gestation because of funnel plot asymmetry and the marked differences in the pooled relative risks obtained from fixed-effect and random-effects models. The adjustment for small-study effects resulted in a markedly reduced and nonsignificant effect of vaginal progesterone on preterm birth <37 weeks (relative risk, 0.86; 95% confidence interval, 0.68-1.10) and <34 weeks (relative risk, 0.92; 95% confidence interval, 0.60-1.42). CONCLUSION There is no convincing evidence supporting the use of vaginal progesterone to prevent recurrent preterm birth or to improve perinatal outcomes in singleton gestations with a history of spontaneous preterm birth.
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Affiliation(s)
- Agustin Conde-Agudelo
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD and Detroit, MI; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI; Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI; Detroit Medical Center, Detroit, MI.
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13
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Bonafiglia JT, Islam H, Preobrazenski N, Gurd BJ. Risk of bias and reporting practices in studies comparing VO 2max responses to sprint interval vs. continuous training: A systematic review and meta-analysis. JOURNAL OF SPORT AND HEALTH SCIENCE 2022; 11:552-566. [PMID: 33722760 PMCID: PMC9532877 DOI: 10.1016/j.jshs.2021.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/22/2020] [Accepted: 01/28/2021] [Indexed: 05/13/2023]
Abstract
BACKGROUND It remains unclear whether studies comparing maximal oxygen uptake (VO2max) response to sprint interval training (SIT) vs. moderate-intensity continuous training (MICT) are associated with a high risk of bias and poor reporting quality. The purpose of this study was to evaluate the risk of bias and quality of reporting in studies comparing changes in VO2max between SIT and MICT. METHODS We conducted a comprehensive literature search of 4 major databases: AMED, CINAHL, EMBASE, and MEDLINE. Studies were excluded if participants were not healthy adult humans or if training protocols were unsupervised, lasted less than 2 weeks, or utilized mixed exercise modalities. We used the Cochrane Collaboration tool and the CONSORT checklist for non-pharmacological trials to evaluate the risk of bias and reporting quality, respectively. RESULTS Twenty-eight studies with 30 comparisons (3 studies included 2 SIT groups) were included in our meta-analysis (n = 360 SIT participants: body mass index (BMI) = 25.9 ± 3.7 kg/m2, baseline VO2max = 37.9 ± 8.0 mL/kg/min; n = 359 MICT participants: BMI = 25.5 ± 3.8 kg/m2, baseline VO2max = 38.3 ± 8.0 mL/kg/min; all mean ± SD). All studies had an unclear risk of bias and poor reporting quality. CONCLUSION Although we observed a lack of superiority between SIT and MICT for improving VO2max (weighted Hedge's g = -0.004, 95% confidence interval (95%CI): -0.08 to 0.07), the overall unclear risk of bias calls the validity of this conclusion into question. Future studies using robust study designs are needed to interrogate the possibility that SIT and MICT result in similar changes in VO2max.
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Affiliation(s)
- Jacob T Bonafiglia
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, K7L 3N6, Canada
| | - Hashim Islam
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, K7L 3N6, Canada
| | - Nicholas Preobrazenski
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, K7L 3N6, Canada
| | - Brendon J Gurd
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, K7L 3N6, Canada.
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14
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Choong SYX, Tan XYJ, Cheng LJ, Lau Y. Effectiveness of Exercise in Improving Sleep Outcomes among Perinatal Women: A Systematic Review and Meta-analysis of randomised Controlled Trials. Behav Sleep Med 2022; 20:410-428. [PMID: 34081551 DOI: 10.1080/15402002.2021.1931221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Sleep problems are prevalent among perinatal women, contributing to the poor overall well-being of mother and child. Exercise is an inexpensive and sustainable intervention to improve sleep outcomes and can be personalized accordingly to individuals. This systematic review and meta-analysis aim to consolidate available evidence to evaluate the effectiveness of exercise on improving sleep outcomes among perinatal women. METHODS Eight databases (CINAHL, Cochrane, EMBASE, PsycINFO, PubMed, Scopus, Web of Science and ProQuest) were used to perform a systematic search for studies in the English language from the inception of each database to 7 December 2019. The quality of studies was assessed using the risk of bias and GRADE. Review Manager was used for meta-analyses. Heterogeneity was determined by Cochran's Q (chi-square) and I2 values. The overall effect was evaluated using effect size and Z-statistics. RESULTS A total of 2,139 records were identified. Ten randomized controlled trials were included, with seven in the meta-analysis, involving 998 pregnant and postpartum women across eight countries. With medium to very large effect sizes, the results favored exercise interventions on sleep quality, sleep efficiency, sleep duration, sleep latency, insomnia, diurnal tiredness and daytime dysfunction. CONCLUSION Exercise interventions produced significant effects on improving sleep among perinatal women. This can increase advocacy for exercise among perinatal women to improve sleep and general health. Future randomized controlled trial designs should adhere to the Consolidated Standards of Reporting Trials and Template to ensure reliability when conducting and reporting such studies.
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Affiliation(s)
- Shanise Yi Xin Choong
- Department of Nursing, Khoo Teck Puat Hospital, Yishun Health Campus, National Healthcare Group, Singapore, Singapore
| | - Xing Yee Jolyn Tan
- Department of Nursing, Khoo Teck Puat Hospital, Yishun Health Campus, National Healthcare Group, Singapore, Singapore
| | - Ling Jie Cheng
- Health Systems and Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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15
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Armijo-Olivo S, R da Costa B, Ha C, Saltaji H, Cummings GG, Fuentes J. Are Biases Related to Attrition, Missing Data, and the Use of Intention to Treat Related to the Magnitude of Treatment Effects in Physical Therapy Trials?: A Meta-Epidemiological Study. Am J Phys Med Rehabil 2022; 101:520-529. [PMID: 34225281 DOI: 10.1097/phm.0000000000001837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The objective of this study was to determine the association between biases related to attrition, missing data, and the use of intention to treat and changes in effect size estimates in physical therapy randomized trials. A meta-epidemiological study was conducted. A random sample of randomized controlled trials included in meta-analyses in the physical therapy discipline were identified. Data extraction including assessments of the use of intention to treat principle, attrition-related bias, and missing data was conducted independently by two reviewers. To determine the association between these methodological issues and effect sizes, a two-level analysis was conducted using a meta-meta-analytic approach. Three hundred ninety-three trials included in 43 meta-analyses, analyzing 44,622 patients contributed to this study. Trials that did not use the intention-to-treat principle (effect size = -0.13, 95% confidence interval = -0.26 to 0.01) or that were assessed as having inappropriate control of incomplete outcome data tended to underestimate the treatment effect when compared with trials with adequate use of intention to treat and control of incomplete outcome data (effect size = -0.18, 95% confidence interval = -0.29 to -0.08).Researchers and clinicians should pay attention to these methodological issues because they could provide inaccurate effect estimates. Authors and editors should make sure that intention-to-treat and missing data are properly reported in trial reports.
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Affiliation(s)
- Susan Armijo-Olivo
- From the Faculty of Business and Social Sciences, University of Applied Sciences, Osnabrück, Germany (SA-O); Faculty of Rehabilitation Medicine, Department of Physical Therapy, Rehabilitation Research Center and Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada (SA-O); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada (BRdC); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (CH, JF); Orthodontic Graduate Program, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada (HS); Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada (GGC); and Clinical Research Lab, Department of Physical Therapy, Catholic University of Maule, Maule, Chile (JF)
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16
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Gallego-Sendarrubias GM, Voogt L, Arias-Buría JL, Braithwaite FA, Fernández-de-Las-Peñas C. Effects of previous experience with dry needling therapy on blinding effectiveness and pain outcomes in people with neck pain: A preliminary sham-controlled study. Musculoskelet Sci Pract 2022; 58:102515. [PMID: 35085999 DOI: 10.1016/j.msksp.2022.102515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/11/2022] [Accepted: 01/18/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Participants' previous experience with an intervention may be an important variable when conducting sham-controlled trials. OBJECTIVE This study explored if previous experience with dry needling (DN) influenced blinding effectiveness and pain outcomes, after the application of DN in patients with neck pain. DESIGN A preliminary randomized, sham-controlled study. METHODS Participants were randomized to receive a single session of real or sham DN. Previous experience with DN (yes/no) was recorded. Blinding effectiveness was assessed by asking participants to guess their group allocation (real/sham/not sure) 5 min post-intervention. Outcomes including pain intensity, pressure pain thresholds, and self-perceived improvement, were assessed by a blinded assessor at baseline, one- and seven-days post-intervention. RESULTS Of 50 patients recruited, 30 had previous experience and 20 did not. Fifty-seven percent (n = 17/30) with previous experience and 35% (n = 7/20) without experience correctly identified their group allocation, but this difference was not significant (χ2 = 2.333; P = 0.127). No interaction between previous experience and clinical outcomes were found, except that participants with previous experience receiving real DN showed greater improvements in pain during cervical rotation than those without previous experience at one (Δ -11.5 mm 95%CI -22.0 to -1.0 mm) and seven days (Δ -8.5 mm, -16.00 to -1.0 mm) post-intervention. CONCLUSIONS Participants with previous experience were 22% more accurate at identifying their group allocation than those without experience, but the difference was not significant. Previous experience did not influence most clinical outcomes, except for pain intensity after real DN. Future studies evaluating effects of previous experience of DN should include more detailed information of previous experience.
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Affiliation(s)
| | - Lennard Voogt
- Rotterdam University of Applied Sciences, Department of Physiotherapy, Rotterdam, the Netherlands
| | - José Luis Arias-Buría
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain; Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
| | | | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain; Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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17
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Comparative effectiveness of multiple acupuncture therapies for primary insomnia: A systematic review and network meta-analysis of randomized trial. Sleep Med 2022; 93:39-48. [DOI: 10.1016/j.sleep.2022.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/13/2022] [Accepted: 03/15/2022] [Indexed: 12/25/2022]
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18
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Sydes MR, Wong WK, Bakhai A, Joffe N, Love SB. Protecting blinded trials in electronic hospital systems. Clin Trials 2022; 19:231-233. [PMID: 35012379 PMCID: PMC9036147 DOI: 10.1177/17407745211069985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Matthew R Sydes
- Institute of Clinical Trials and Methodology, MRC Clinical Trials Unit at UCL, London, UK.,British Heart Foundation Data Science Centre, London, UK.,Health Data Research UK, London, UK
| | | | - Ameet Bakhai
- Royal Free London NHS Foundation Trust, London, UK.,Amore Health Ltd, London, UK
| | - Nicola Joffe
- Institute of Clinical Trials and Methodology, MRC Clinical Trials Unit at UCL, London, UK
| | - Sharon B Love
- Institute of Clinical Trials and Methodology, MRC Clinical Trials Unit at UCL, London, UK
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Tack M. Problems with the MetaBLIND study: An examination of data on blinding patients in trials with patient-reported outcomes. J Health Psychol 2021:13591053211059391. [PMID: 34875934 DOI: 10.1177/13591053211059391] [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] [Indexed: 01/06/2023] Open
Abstract
MetaBLIND is the largest meta-epidemiological study on the impact of blinding in randomized trials to date. We examined MetaBLIND data on the impact of blinding patients on patient-reported outcomes. 68 out of 132 included trials tested knowledge recall and had questionable relevance to clinical trials. In 17 out of 18 comparisons, the number of trials in the blinded or nonblinded group was 2 or lower. In several key trials, the blinding status was uncertain. Effect sizes compared in MetaBLIND appear to reflect random differences in study design and setting rather than the impact of blinding trial participants.
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Sousa Filho LF, Barbosa Santos MM, Dos Santos GHF, da Silva Júnior WM. Corticosteroid injection or dry needling for musculoskeletal pain and disability? A systematic review and GRADE evidence synthesis. Chiropr Man Therap 2021; 29:49. [PMID: 34857021 PMCID: PMC8638538 DOI: 10.1186/s12998-021-00408-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/22/2021] [Indexed: 12/24/2022] Open
Abstract
Background Corticosteroid injection and dry needling have been used in the treatment of musculoskeletal conditions, but it is unclear which intervention is the most effective. The purpose of this study was to compare the effects of corticosteroid injection and dry needling for musculoskeletal conditions at short-, medium-, and long-term follow-up. Methods Electronic databases were searched up to 31 October 2021. Two researchers independently screened titles, abstracts and full-text articles. Randomized clinical trials (RCTs) that investigated the effectiveness of dry needling compared to corticosteroid injection in patients over 18 years with a musculoskeletal condition were included in the review. The studies had to report pain and/or disability as outcome. Risk of bias was assessed by using the revised Cochrane Collaboration tool (RoB 2.0). Quality of evidence was evaluated by using the GRADE approach. Results Six studies were included (n = 384 participants). Four musculoskeletal conditions were investigated. There is very low-quality evidence that CSI is superior to DN for reducing heel pain (plantar fasciitis) and lateral elbow pain at short- and medium-term follow-up, but not for myofascial pain and greater trochanteric pain. There is very low-quality evidence that DN is more effective than CSI at long-term follow-up for reducing pain in people with plantar fasciitis and lateral epicondylitis. Very low-certainty evidence shows that there is no difference between DN and CSI for disability at short-term follow-up. One study showed that CSI is superior to DN at medium-term follow-up and another observed that DN is superior to CSI for reducing disability at long-term. Conclusions There are no differences between DN and CSI in pain or disability for myofascial pain and greater trochanteric pain syndrome. Very-low certainty evidence suggests that CSI is superior to DN at shorter follow-up periods, whereas DN seems to be more effective than CSI at longer follow-up durations for improving pain in plantar fasciitis and lateral epicondylitis. Large RCTs with higher methodological quality are needed in order to draw more incisive conclusions. PROSPERO registration number CRD42020148650. Supplementary Information The online version contains supplementary material available at 10.1186/s12998-021-00408-y.
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Affiliation(s)
- Luis Fernando Sousa Filho
- Graduate Program in Physical Education, Federal University of Sergipe, Av Marechal Rondon, s/n, Rosa Elze, São Cristovão, Sergipe, 49100-000, Brazil. .,Department of Physical Therapy, Federal University of Sergipe, Av Marechal Rondon, s/n, Rosa Elze, São Cristovão, Sergipe, 49100-000, Brazil.
| | - Marta Maria Barbosa Santos
- Department of Physical Therapy, Federal University of Sergipe, Av Marechal Rondon, s/n, Rosa Elze, São Cristovão, Sergipe, 49100-000, Brazil
| | - Gabriel Henrique Freire Dos Santos
- Department of Physical Therapy, Federal University of Sergipe, Av Marechal Rondon, s/n, Rosa Elze, São Cristovão, Sergipe, 49100-000, Brazil
| | - Walderi Monteiro da Silva Júnior
- Graduate Program in Physical Education, Federal University of Sergipe, Av Marechal Rondon, s/n, Rosa Elze, São Cristovão, Sergipe, 49100-000, Brazil.,Department of Physical Therapy, Federal University of Sergipe, Av Marechal Rondon, s/n, Rosa Elze, São Cristovão, Sergipe, 49100-000, Brazil
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Respiratory muscle training improves exercise tolerance and respiratory muscle function/structure post-stroke at short term: A systematic review and meta-analysis. Ann Phys Rehabil Med 2021; 65:101596. [PMID: 34687960 DOI: 10.1016/j.rehab.2021.101596] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 07/21/2021] [Accepted: 07/31/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Previous reviews relating to the effects of respiratory muscle training (RMT) after stroke tend to focus on only one type of training (inspiratory or expiratory muscles) and most based the results on poor-quality studies (PEDro score ≤4). OBJECTIVES With this systematic review and meta-analysis, we aimed to determine the effects of RMT (inspiratory or expiratory muscle training, or mixed) on exercise tolerance, respiratory muscle function and pulmonary function and also the effects depending on the type of training performed at short- and medium-term in post-stroke. METHODS Databases searched were MEDLINE, PEDro, CINAHL, EMBASE and Web of Science up to the end of April 2020. The quality and risk of bias for each included study was examined by the PEDro scale (including only high-quality studies) and Cochrane Risk of Bias tool. RESULTS Nine studies (463 patients) were included. The meta-analysis showed a significant increase in exercise tolerance [4 studies; n = 111; standardized mean difference [SMD] = 0.65 (95% confidence interval 0.27-1.04)]; inspiratory muscle strength [9 studies; n = 344; SMD = 0.65 (0.17-1.13)]; inspiratory muscle endurance [3 studies; n = 81; SMD = 1.19 (0.71-1.66)]; diaphragm thickness [3 studies; n = 79; SMD = 0.9 (0.43-1.37)]; and peak expiratory flow [3 studies; n = 84; SMD = 0.55 (0.03-1.08)] in the short-term. There were no benefits on expiratory muscle strength and pulmonary function variables (forced expiratory volume in 1 s) in the short-term. CONCLUSIONS The meta-analysis provided moderate-quality evidence that RMT improves exercise tolerance, diaphragm thickness and pulmonary function (i.e., peak expiratory flow) and low-quality evidence for the effects on inspiratory muscle strength and endurance in stroke survivors in the short-term. None of these effects are retained in the medium-term. Combined inspiratory and expiratory muscle training seems to promote greater respiratory changes than inspiratory muscle training alone.
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22
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Nejstgaard CH, Lundh A, Abdi S, Clayton G, Gelle MHA, Laursen DRT, Olorisade BK, Savović J, Hróbjartsson A. Combining meta-epidemiological study datasets on commercial funding of randomised clinical trials: Database, methods, and descriptive results of the COMFIT study. Res Synth Methods 2021; 13:214-228. [PMID: 34558198 DOI: 10.1002/jrsm.1527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/09/2021] [Accepted: 09/20/2021] [Indexed: 11/08/2022]
Abstract
Randomised trials are often funded by commercial companies and methodological studies support a widely held suspicion that commercial funding may influence trial results and conclusions. However, these studies often have a risk of confounding and reporting bias. The risk of confounding is markedly reduced in meta-epidemiological studies that compare fairly similar trials within meta-analyses, and risk of reporting bias is reduced with access to unpublished data. Therefore, we initiated the COMmercial Funding In Trials (COMFIT) study aimed at investigating the impact of commercial funding on estimated intervention effects in randomised clinical trials based on a consortium of researchers who agreed to share meta-epidemiological study datasets with information on meta-analyses and trials included in meta-epidemiological studies. Here, we describe the COMFIT study, its database, and descriptive results. We included meta-epidemiological studies with published or unpublished data on trial funding source and results or conclusions. We searched five bibliographic databases and other sources. We invited authors of eligible meta-epidemiological studies to join the COMFIT consortium and to share data. The final construction of the COMFIT database involves checking data quality, identifying trial references, harmonising variable categories, and removing non-informative meta-analyses as well as correlated meta-analyses and trial results. We included data from 17 meta-epidemiological studies, covering 728 meta-analyses and 6841 trials. Seven studies (405 meta-analyses, 3272 trials) had not published analyses on the impact of commercial funding, but shared unpublished data on funding source. On this basis, we initiated the construction of a combined database. Once completed, the database will enable comprehensive analyses of the impact of commercial funding on trial results and conclusions with increased statistical power and a markedly reduced risk of confounding and reporting bias.
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Affiliation(s)
- Camilla Hansen Nejstgaard
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Open Patient Data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Andreas Lundh
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Open Patient Data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark.,Department of Infectious Diseases, Hvidovre Hospital, Hvidovre, Denmark
| | - Suhayb Abdi
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Open Patient Data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Gemma Clayton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Mustafe Hassan Adan Gelle
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Open Patient Data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - David Ruben Teindl Laursen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Open Patient Data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Babatunde Kazeem Olorisade
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Jelena Savović
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,NIHR Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Asbjørn Hróbjartsson
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Open Patient Data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
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Muthukumaraswamy SD, Forsyth A, Lumley T. Blinding and expectancy confounds in psychedelic randomized controlled trials. Expert Rev Clin Pharmacol 2021; 14:1133-1152. [PMID: 34038314 DOI: 10.1080/17512433.2021.1933434] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: There is increasing interest in the potential for psychedelic drugs such as psilocybin, LSD and ketamine to treat several mental health disorders, with a growing number of randomized controlled trials (RCTs) being conducted to investigate the therapeutic effectiveness of psychedelics.Areas covered: We review previous literature on expectancy effects and blinding in the context of psychedelic RCTs - literature which strongly suggest that psychedelic RCTs might be confounded by de-blinding and expectancy. We conduct systematic reviews of psychedelic RCTs using Medline, PsychInfo and EMBASE (Jan 1990 - Nov 2020) and show that currently reported psychedelic RCTs have generally not reported pre-trial expectancy, nor the success of blinding procedures.Expert opinion: While psychedelic RCTs have generally shown promising results, with large effect sizes reported, we argue that treatment effect sizes in psychedelic RCTs are likely over-estimated due to de-blinding of participants and high levels of response expectancy. We suggest that psychedelic RCTs should routinely measure de-blinding and expectancy. Careful attention should be paid to clinical trial design and the instructions given to participants to allow these confounds to be reduced, estimated and removed from effect size estimates. We urge caution in interpreting effect size estimates from extant psychedelic RCTs.
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Affiliation(s)
| | - Anna Forsyth
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
| | - Thomas Lumley
- Department of Statistics, The University of Auckland, Auckland, New Zealand
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24
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Guo Y, Fan L. Bayesian network meta-analysis of the efficacy of 22 ventilation strategies in premature infants with respiratory distress syndrome. Expert Rev Respir Med 2021; 15:1197-1216. [PMID: 33955307 DOI: 10.1080/17476348.2021.1925544] [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: 10/21/2022]
Abstract
Introduction: Respiratory Distress Syndrome (RDS) is a common lung disease in the neonatal period. The infants are mostly premature, with a high mortality rate and many complications. Currently, respiratory support therapy is still one of the primary treatment measures for RDS in preterm infants. There are 22 modes of ventilation currently in use.Areas covered: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, EMBASE, MEDLINE, CINAHL, and Web of Science by using a combination of Medical Subject Headings (MeSH) and text words. The search time limit is set from the establishment of the above-mentioned databases to August 2020.Expert opinion: In total, 37 randomized controlled trials were included for the network meta-analysis, which consisted of 5,101 patients who received one of 22 ventilation modes. The results of the network meta-analysis showed that the Volume-Control (by adjusting tidal volume) ventilation mode is the most successful in reducing the mortality of preterm infants with RDS, followed by Synchronized Intermittent Mechanical Ventilation and Volume Guaranteed Ventilation. This network meta-analysis highlights the variability in techniques within treatment of acute respiratory distress syndrome in premature infants and compares different ventilation strategies. This study is registered with PROSPERO, number CRD42020213050.Conclusion: This network meta-analysis highlights the variability in techniques within treatment of acute respiratory distress syndrome in premature infants and compares different ventilation strategies. Future studies need to be rigorous in design and delivery and include comprehensive descriptions of all aspects of methodology to further enable appraisal and interpretation of results. This study is registered with PROSPERO, number CRD42020213050.
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Affiliation(s)
- Yunyun Guo
- Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Ling Fan
- Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
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25
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Roydhouse JK, Mishra-Kalyani PS, Bhatnagar V, Gutman R, King-Kallimanis BL, Sridhara R, Kluetz PG. Does Knowledge of Treatment Assignment Affect Patient Report of Symptoms, Function, and Health Status? An Evaluation Using Multiple Myeloma Trials. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:822-829. [PMID: 34119080 DOI: 10.1016/j.jval.2020.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 11/22/2020] [Accepted: 12/19/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Unblinded trials are common in oncology, but patient knowledge of treatment assignment may bias response to questionnaires. We sought to ascertain the extent of possible bias arising from patient knowledge of treatment assignment. METHODS This is a retrospective analysis of data from 2 randomized trials in multiple myeloma, 1 double-blind and 1 open label. We compared changes in patient reports of symptoms, function, and health status from prerandomization (screening) to baseline (pretreatment but postrandomization) across control and investigational arms in the 2 trials. Changes from prerandomization scores at ~2 and 6 months on treatment were evaluated only across control arms to avoid comparisons between 2 different experimental drugs. All scores were on 0- to 100-point scales. Inverse probability weighting, entropy balancing, and multiple imputation using propensity score splines were used to compare score changes across similar groups of patients. RESULTS Minimal changes from screening were seen at baseline in all arms. In the control arm, mean changes of <7 points were seen for all domains at 2 and 6 months. The effect of unblinding at 6 months in social function was a decline of less than 6 points (weighting: -3.09; 95% confidence interval -8.41 to 2.23; balancing: -4.55; 95% confidence interval -9.86 to 0.76; imputation: -5.34; 95% confidence interval -10.64 to -0.04). CONCLUSION In this analysis, we did not find evidence to suggest that there was a meaningful differential effect on how patients reported their symptoms, function or health status after knowing their treatment assignment.
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Affiliation(s)
- Jessica K Roydhouse
- ORISE Fellow, Office of Hematology and Oncology Products, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA; Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
| | | | - Vishal Bhatnagar
- Oncology Center of Excellence, Food and Drug Administration, Silver Spring, MD, USA
| | - Roee Gutman
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | | | - Rajeshwari Sridhara
- Office of Biostatistics, Center for Drug Evaluation and Research, Silver Spring, MD, USA
| | - Paul G Kluetz
- Oncology Center of Excellence, Food and Drug Administration, Silver Spring, MD, USA
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Ultrasound-guided transversus abdominis plane block vs trigger point injections for chronic abdominal wall pain: a randomized clinical trial. Pain 2021; 162:1800-1805. [PMID: 33433147 DOI: 10.1097/j.pain.0000000000002181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/28/2020] [Indexed: 11/26/2022]
Abstract
ABSTRACT The primary aim of this randomized clinical trial is to investigate the effects of ultrasound-guided transversus abdominis plane (TAP) vs ultrasound-guided trigger point injections (TPIs) on numerical rating scale pain scores at month 3 follow-up in patients with a chronic abdominal wall pain. The primary outcome measure was the difference in mean numeric rating scale pain scores between the TAP and TPI groups at month 3 in an intent-to-treat (ITT) analysis. A total of 60 patients were randomized 1:1 to receive an ultrasound-guided TAP block (n = 30) or an ultrasound-guided TPI (n = 30). No significant group differences in baseline demographic or clinical characteristics were observed. The mean baseline pain score for the TAP and TPI groups was 5.5 and 4.7, respectively. In the ITT analysis at month 3, the between-group difference in pain scores was 1.7 (95% confidence interval, 0.3-3.0) favoring the TPI group. In a secondary per-protocol analysis, the between-group difference in pain scores was 1.8 (95% confidence interval, 0.4-3.2) favoring the TPI group. For the ITT and per-protocol analyses, the group differences in pain scores were consistent with a medium effect size. The main finding of this randomized clinical trial is that adults with chronic abdominal wall pain who received a TPI reported significantly lower pain scores at month 3 follow-up compared with patients who received a TAP block.
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Armijo-Olivo S, Patrini M, Oliveira-Souza AISD, Dennett L, Arienti C, Dahchi M, Negrini S. Tools to Assess the Risk of Bias and Reporting Quality of Randomized Controlled Trials in Rehabilitation. Arch Phys Med Rehabil 2021; 102:1606-1613. [PMID: 33989599 DOI: 10.1016/j.apmr.2021.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES (1) To determine whether new tools and items have been developed to evaluate the risk of bias (RoB) and reporting of randomized controlled trials (RCTs) in rehabilitation; (2) to determine which items are included in the existing reporting guidelines, and to create a matrix of items to report and conduct trials in rehabilitation as the first step for a starting a rigorous validation process. DATA SOURCES Searches were conducted in MEDLINE, EMBASE, and Cumulative Index to Nursing and Allied Health databases. STUDY SELECTION Studies should describe a newly developed tool to evaluate the RoB or quality of reporting for RCTs in the area of rehabilitation. DATA EXTRACTION (1) First, we extracted items from new tools identified by the electronic search strategies and then (2) we looked at the items provided by the Consolidated Standards of Reporting Trials statement and its relevant extensions. We determined whether these items were already included in our matrix of items. Items were classified based on methodological domains they accomplish, biases they were able to target, and whether they guide reporting or conduct. DATA SYNTHESIS Among the 1596 citations found, 23 articles were potentially relevant. From these, only 3 new scales (National Institute for Complementary Medicine Acupuncture Network, Quality of reports on spa and balneotherapy [SPAC], Assessment of Study Quality and Reporting in Exercise) were found. In addition, the newly updated Cochrane RoB tool (RoB 2.0) was included. Our matrix contained 122 unique items for any rehabilitation area, 46 items (37.7%) were related to conduct, and 58 (47.5%) were related to the reporting; 18 (14.8%) were related to both. Overall, 76 new items were added among all domains. CONCLUSIONS Many individual and diverse items have been used to guide the reporting and conduct of rehabilitation trials. This indicates a great variability in number of items and an apparent lack of consensus on a core set of items to be used in rehabilitation. Future research should look into developing a core set of items for the rehabilitation field.
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Affiliation(s)
- Susan Armijo-Olivo
- University of Applied Sciences, Faculty of Business and Social Sciences, Osnabrück, Germany; Faculties of Rehabilitation Medicine and Medicine and Dentistry Edmonton, Alberta, Canada; Don Carlo Gnocchi Foundation (IRCCS), Milan, Italy.
| | | | - Ana Izabela S de Oliveira-Souza
- University of Applied Sciences, Faculty of Business and Social Sciences, Osnabrück, Germany; Federal University of Pernambuco, Graduate Program in Neupsychiatry and Behavioral Sciences, Recife, Brazil
| | - Liz Dennett
- Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
| | | | - Mustafa Dahchi
- Faculties of Rehabilitation Medicine and Medicine and Dentistry Edmonton, Alberta, Canada
| | - Stefano Negrini
- Don Carlo Gnocchi Foundation (IRCCS), Milan, Italy; Physical and Rehabilitation Medicine, University "La Statale", Milan, Italy
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Preobrazenski N, Islam H, Gurd BJ. Molecular regulation of skeletal muscle mitochondrial biogenesis following blood flow-restricted aerobic exercise: a call to action. Eur J Appl Physiol 2021; 121:1835-1847. [PMID: 33830325 DOI: 10.1007/s00421-021-04669-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/16/2021] [Indexed: 12/13/2022]
Abstract
Blood flow-restricted (BFR) exercise can induce training adaptations comparable to those observed following training in free flow conditions. However, little is known about the acute responses within skeletal muscle following BFR aerobic exercise (AE). Moreover, although preliminary evidence suggests chronic BFR AE may augment certain training adaptations in skeletal muscle mitochondria more than non-BFR AE, the underlying mechanisms are poorly understood. In this review, we summarise the acute BFR AE literature examining mitochondrial biogenic signalling pathways and provide insight into mechanisms linked to skeletal muscle remodelling following BFR AE. Specifically, we focus on signalling pathways potentially contributing to augmented peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α) mRNA following work-rate-matched BFR AE compared with non-BFR AE. We present evidence suggesting reductions in muscle oxygenation during acute BFR AE lead to increased intracellular energetic stress, AMP-activated protein kinase (AMPK) activation and PGC-1α mRNA. In addition, we briefly discuss mitochondrial adaptations to BFR aerobic training, and we assess the risk of bias using the Cochrane Collaboration risk of bias assessment tool. We ultimately call for several straightforward modifications to help minimise bias in future BFR AE studies.
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Affiliation(s)
| | - Hashim Islam
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, V1V 1V7, Canada
| | - Brendon J Gurd
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, K7L 3N6, Canada.
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Effectiveness of placebo interventions for patients with nonspecific low back pain: a systematic review and meta-analysis. Pain 2021; 162:2792-2804. [PMID: 33769366 DOI: 10.1097/j.pain.0000000000002272] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 03/05/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Little is known about the effectiveness of placebo interventions in patients with nonspecific low back pain (LBP). This systematic review assessed the magnitude of the effects of placebo interventions as compared to no intervention in randomized controlled trials (RCTs) including patients with LBP. Embase, MEDLINE (Ovid), and Cochrane CENTRAL databases were searched from inception to December 5, 2019. Randomized controlled trials comparing placebo intervention vs no intervention in adult patients with nonspecific LBP were included. Pain intensity, physical functioning, and health-related quality of life measured at short-term, medium-term, and long-term follow-up were the outcomes of this review. Twenty-one randomized controlled trials were included; one concerning acute LBP and one subacute LBP, whereas 19 studies reported on chronic LBP. In chronic LBP, placebo interventions were more effective than no intervention at short-term follow-up for pain intensity (standardized mean difference = -0.37, 95% confidence interval [CI] = -0.55 to -0.18, moderate-quality evidence), physical functioning (standardized mean difference -0.19, 95% CI = -0.39-0.01, moderate-quality evidence), and physical quality of life (mean difference = -2.71, 95% CI = -4.71-0.71, high-quality evidence), respectively. These effects were not significant at medium-term follow-up, and no data were available at long-term follow-up. These results show placebo interventions are more effective than no intervention at short-term follow-up in patients with chronic LBP. However, the magnitude of the effects is probably not clinically relevant (approximately 8 points on a 0-100 pain scale). Future research should identify effect modifiers and causal mechanisms explaining the short-term effects of placebo interventions in patients with chronic LBP.
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da Costa BR, Saadat P, Basciani R, Agarwal A, Johnston BC, Jüni P. Visual Analogue Scale has higher assay sensitivity than WOMAC pain in detecting between-group differences in treatment effects: a meta-epidemiological study. Osteoarthritis Cartilage 2021; 29:304-312. [PMID: 33271331 DOI: 10.1016/j.joca.2020.10.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/24/2020] [Accepted: 10/14/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare assay sensitivity of the Visual Analogue Scale (VAS) for global osteoarthritis pain and the Western Ontario and McMaster University (WOMAC) pain subscale, and the associated between-trial heterogeneity in effect sizes (ES). DESIGN We included trials with placebo, sham or non-intervention control that included at least 100 patients with hip or knee osteoarthritis per arm, reporting both VAS and WOMAC pain scores. ES were calculated as between-group difference in means divided by the pooled standard deviation and compared using a paired t-test. ES and τ2 as a measure of between-trial heterogeneity were combined using random-effects meta-regression with robust variance estimation to account for the correlation of data within trials and meta-analyses. RESULTS Twenty-eight trials with 44 randomized comparisons were included. In 28 comparisons (64%), ES from VAS favoured the intervention more than those from WOMAC pain (P = 0.003). Twenty-six p-values (59%) were smaller according to VAS (P = 0.008). The 44 comparisons contributed to 12 meta-analyses. Eleven meta-analyses (92%) showed larger benefits of interventions according to VAS, with a combined overall difference in ES of -0.08 (95% CI -0.14 to -0.02). τ2 was similar for VAS and WOMAC pain (difference in τ2, -0.003, 95% CI -0.009 to 0.004). CONCLUSION The VAS for global pain had slightly higher assay sensitivity at trial and meta-analysis levels than the WOMAC pain subscale without relevant increase in between-trial heterogeneity.
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Affiliation(s)
- Bruno R da Costa
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
| | - Pakeezah Saadat
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
| | - Reto Basciani
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland; Department of Anesthesiology, Cantonal Hospital Aarau, Aarau, Switzerland.
| | - Arnav Agarwal
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Bradley C Johnston
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Department of Nutrition, Texas A&M University, College Station, TX, 77845, USA.
| | - Peter Jüni
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada.
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Doleman B, Mathiesen O, Jakobsen JC, Sutton AJ, Freeman S, Lund JN, Williams JP. Methodologies for systematic reviews with meta-analysis of randomised clinical trials in pain, anaesthesia, and perioperative medicine. Br J Anaesth 2021; 126:903-911. [PMID: 33558052 DOI: 10.1016/j.bja.2021.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/16/2020] [Accepted: 01/07/2021] [Indexed: 02/07/2023] Open
Abstract
Systematic reviews and meta-analyses (SRMAs) are increasing in popularity, but should they be used to inform clinical decision-making in anaesthesia? We present evidence that the certainty of evidence from SRMAs in anaesthesia (and in general) may be unacceptably low because of risks of bias exaggerating treatment effects, unexplained heterogeneity reducing certainty in estimates, random errors, and widespread prevalence of publication bias. We also present the latest methodological advances to help improve the certainty of evidence from SRMAs. The target audience includes both review authors and practising clinicians to help with SRMA appraisal. Issues discussed include minimising risks of bias from included trials, trial sequential analysis to reduce random error, updated methods for presenting effect estimates, and novel publication bias tests for commonly used outcome measures. These methods can help to reduce spurious conclusions on clinical significance, explain statistical heterogeneity, and reduce false positives when evaluating small-study effects. By reducing concerns in these domains of Grading of Recommendations, Assessment, Development and Evaluation, it should help improve the certainty of evidence from SRMAs used for decision-making in anaesthesia, pain, and perioperative medicine.
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Affiliation(s)
- Brett Doleman
- Department of Anaesthesia and Surgery, Graduate Entry Medicine, University of Nottingham, Nottingham, UK.
| | - Ole Mathiesen
- Department of Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Anaesthesia, Zealand University Hospital, Køge, Denmark
| | - Janus C Jakobsen
- Copenhagen Trial Unit, Copenhagen, Denmark; Department of Regional Health Research, Faculty of Heath Sciences, University of Southern Denmark, Odense, Denmark
| | - Alex J Sutton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Suzanne Freeman
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Jonathan N Lund
- Department of Anaesthesia and Surgery, Graduate Entry Medicine, University of Nottingham, Nottingham, UK
| | - John P Williams
- Department of Anaesthesia and Surgery, Graduate Entry Medicine, University of Nottingham, Nottingham, UK
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Doshi H, Hsia B, Shahani J, Mowrey W, Jariwala SP. Impact of Technology-Based Interventions on Patient-Reported Outcomes in Asthma: A Systematic Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2336-2341. [PMID: 33548519 DOI: 10.1016/j.jaip.2021.01.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Technology-based interventions (TBIs) can improve asthma management by facilitating patient education, symptom monitoring, environmental trigger control, comorbid condition management, and medication adherence. Collecting patient-reported outcomes (PROs) can identify effective interventions and ensure patient-centered care, but it is unclear which TBIs have been formally evaluated using PROs. OBJECTIVES We aim to: (1) identify the TBIs that have been evaluated in clinical trials using PROs; (2) identify the most commonly used PROs in these trials; and (3) determine the impact of TBIs on PROs in the management of chronic asthma. METHODS We searched the PubMed and Clinicaltrials.gov databases for studies published in English between January 2000 and February 2020 using the following search criteria: "asthma," "IT-based interventions," "information technology," "technology," "dyspnea," "patient reported outcomes," "PROs," "telehealth," "telemedicine," and "mobile devices." Two independent reviewers screened the studies and determined study inclusion. Studies were examined for the types of interventions used, the types of PROs collected, and outcomes. RESULTS The final analysis included 14 clinical trials with either 1, 2, or 3 arms. Five different types of TBIs were identified, most commonly involving multimedia education. Four different categories of PROs were identified, most commonly involving treatment self-efficacy. Positive outcomes in at least 1 PRO domain were reported in 12 of 14 studies. Pooled meta-analysis was not possible due to the heterogeneity of PRO instruments across studies. CONCLUSION TBIs improve PROs overall in patients with asthma. Future trials investigating TBIs should include standardized PROs as endpoints to better clarify this relationship.
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Affiliation(s)
- Hiten Doshi
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Brian Hsia
- Mount Sinai School of Medicine, Mount Sinai Hospital, New York, NY
| | | | - Wenzhu Mowrey
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Sunit P Jariwala
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY.
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Essential statistical principles of clinical trials of pain treatments. Pain Rep 2020; 6:e863. [PMID: 33521483 PMCID: PMC7837867 DOI: 10.1097/pr9.0000000000000863] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 01/13/2023] Open
Abstract
This article presents an overview of fundamental statistical principles of clinical trials of pain treatments. Statistical considerations relevant to phase 2 proof of concept and phase 3 confirmatory randomized trials investigating efficacy and safety are discussed, including (1) research design; (2) endpoints and analyses; (3) sample size determination and statistical power; (4) missing data and trial estimands; (5) data monitoring and interim analyses; and (6) interpretation of results. Although clinical trials of pharmacologic treatments are emphasized, the key issues raised by these trials are also directly applicable to clinical trials of other types of treatments, including biologics, devices, nonpharmacologic therapies (eg, physical therapy and cognitive-behavior therapy), and complementary and integrative health interventions.
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Does Type of Sponsorship of Randomized Controlled Trials Influence Treatment Effect Size Estimates in Rehabilitation: A Meta-Epidemiological Study. Am J Phys Med Rehabil 2020; 99:909-916. [PMID: 32960528 DOI: 10.1097/phm.0000000000001444] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Sponsorship bias could affect research results to inform decision makers when using the results of these trials. The extent to which sponsorship bias affect results in the field of physical therapy has been unexplored in the literature. Therefore, the main aim of this study was to evaluate the influence of sponsorship bias on the treatment effects of randomized controlled trials in physical therapy area. METHODS This was a meta-epidemiological study. A random sample of randomized controlled trials included in meta-analyses of physical therapy area were identified. Data extraction including assessments of appropriate influence of funders was conducted independently by two reviewers. To determine the association between biases related to sponsorship biases and effect sizes, a two-level analysis was conducted using a meta-meta-analytic approach. RESULTS We analyzed 393 trials included in 43 meta-analyses. The most common sources of sponsorship for this sample of physical therapy trials were government (n = 205, 52%), followed by academic (n = 44, 11%) and industry (n = 39, 10%). The funding was not declared in a high percentage of the trials (n = 85, 22%). The influence of the trial sponsor was assessed as being appropriate in 246 trials (63%) and considered inappropriate/unclear in 147 (37%) of them. We have moderate evidence to say that trials with inappropriate/unclear influence of funders tended to have on average a larger effect size than those with appropriate influence of funding (effect size = 0.15; 95% confidence interval = -0.03 to 0.33). CONCLUSIONS Based on our sample of physical therapy trials, it seems that most of the trials are funded by either government and academia and a small percentage are funded by the industry. Treatment effect size estimates were on average 0.15 larger in trials with lack of appropriate influence of funders as compared with trials with appropriate influence of funding. Contrarily to other fields, industry funding was relatively small and their influence perhaps less marked. All these results could be explained by the relative youth of the field and/or the absence of clear industry interests. In front of the call for action by the World Health Organization to strengthen rehabilitation in health systems, these results raise the issue of the need of public funding in the field.
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Byra J, Czernicki K. The Effectiveness of Virtual Reality Rehabilitation in Patients with Knee and Hip Osteoarthritis. J Clin Med 2020; 9:E2639. [PMID: 32823832 PMCID: PMC7465023 DOI: 10.3390/jcm9082639] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 12/16/2022] Open
Abstract
Osteoarthritis (OA) is a common health problem leading to pain, limitation in physical function, a decrease in the quality of life and disability. OA affects 60-70% of the population above 65 years of age all over the world, and is associated with a high cost of healthcare. The main method of treatment of OA, apart from pharmacotherapy and surgery, is comprehensive rehabilitation. Advances in medical technology have resulted in the possibility of using computer-assisted interventions in rehabilitation. The present narrative review is aimed at investigating the effectiveness of virtual reality (VR) in the rehabilitation of elderly patients with knee or hip osteoarthritis, including patients after arthroplasty. This literature review based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was carried out in five databases: PubMed, Medline, Web of Science, Scopus and PEDro. It includes ten randomized controlled trials focused on the application of games and biofeedback in the rehabilitation of patients with knee and hip osteoarthritis. There are no conclusive reports that interventions based on VR are more effective than standard physical therapy. Moreover, evidence regarding patients after total hip arthroplasty (THA) is very scarce. The effectiveness of VR-based rehabilitation is unclear, although interventions based on VR are promising in view of pain management, postural and proprioception training. However, this evidence is not sufficient to create clinical guidelines and further high-quality studies are needed.
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Affiliation(s)
- Joanna Byra
- Faculty of Health Sciences, Jagiellonian University Medical College, Michalowskiego 12, 31-126 Cracow, Poland
- Department of Rehabilitation, Lesser Poland Orthopaedic and Rehabilitation Hospital, Modrzewiowa 22, 30-224 Cracow, Poland;
| | - Krzysztof Czernicki
- Department of Rehabilitation, Lesser Poland Orthopaedic and Rehabilitation Hospital, Modrzewiowa 22, 30-224 Cracow, Poland;
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Nielsen SM, Storgaard H, Ellingsen T, Shea BJ, Wells GA, Welch VA, Furst DE, de Wit M, Voshaar M, Juhl CB, Boers M, Escorpizo R, Woodworth TG, Boonen A, Bliddal H, March LM, Tugwell P, Christensen R. Population characteristics as important contextual factors in rheumatological trials: an exploratory meta-epidemiological study from an OMERACT Working Group. Ann Rheum Dis 2020; 79:1269-1276. [PMID: 32606042 DOI: 10.1136/annrheumdis-2020-217237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/24/2020] [Accepted: 06/02/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To explore whether trial population characteristics modify treatment responses across various interventions, comparators and rheumatic conditions. METHODS In this meta-epidemiological study, we included trials from systematic reviews available from the Cochrane Musculoskeletal Group published up to 23 April 2019 in Cochrane Library with meta-analyses of five or more randomised controlled trials (RCTs) published from year 2000. From trial reports, we extracted data on 20 population characteristics. For characteristics with sufficient data (ie, available for ≥2/3 of the trials), we performed multilevel meta-epidemiological analyses. RESULTS We identified 19 eligible systematic reviews contributing 187 RCTs (212 comparisons). Only age and sex were explicitly reported in ≥2/3 of the trials. Using information about the country of the trials led to sufficient data for five further characteristics, that is, 7 out of 20 (35%) protocolised characteristics were analysed. The meta-regressions showed effect modification by economic status, place of residence, and, nearly, from healthcare system (explaining 4.8%, 0.9% and 1.5% of the between-trial variation, respectively). No effect modification was demonstrated from age, sex, patient education/health literacy or predominant religion. CONCLUSIONS This study demonstrates the scarce reporting of most population characteristics, hampering investigation of their impact with meta-research. Our sparse results suggest that place of residence (ie, continent of the trial), economic status (based on World Bank classifications) and healthcare system (based on WHO index for health system performance) may be important in explaining the variation in treatment response across trials. There is an urgent need for consistent reporting of important population characteristics in trials. PROSPERO REGISTRATION NUMBER CRD42019127642.
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Affiliation(s)
- Sabrina Mai Nielsen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark .,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Helene Storgaard
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Torkell Ellingsen
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Beverley J Shea
- Ottawa Hospital Research Institute, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - George A Wells
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Vivian Andrea Welch
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Daniel E Furst
- David Geffen School of Medicine, Division of Rheumatology, UCLA, Los Angeles, California, USA.,University of Washington, Seattle, Washington, USA.,University of Florence, Florence, Italy
| | - Maarten de Wit
- OMERACT Patient Research Partner, Zaltbommel, The Netherlands
| | - Marieke Voshaar
- Department Psychology, Health and Technology, University of Twente, Twente, The Netherlands
| | - Carsten Bogh Juhl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev & Gentofte, Denmark
| | - Maarten Boers
- Department of Epidemiology & Biostatistics, Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA.,Swiss Paraplegic Research, Nottwil, Switzerland
| | - Thasia G Woodworth
- David Geffen School of Medicine, Division of Rheumatology, UCLA, Los Angeles, California, USA
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Care and Public Health Research Institute (CAPHRI), 6229 ER Maastricht University, Maastricht, The Netherlands
| | - Henning Bliddal
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lyn M March
- Florance and Cope Professorial Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Peter Tugwell
- Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
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Boutron I, Créquit P, Williams H, Meerpohl J, Craig JC, Ravaud P. Future of evidence ecosystem series: 1. Introduction Evidence synthesis ecosystem needs dramatic change. J Clin Epidemiol 2020; 123:135-142. [DOI: 10.1016/j.jclinepi.2020.01.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 12/23/2019] [Accepted: 01/07/2020] [Indexed: 12/13/2022]
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Braithwaite FA, Walters JL, Moseley GL, Williams MT, McEvoy MP. Towards more credible shams for physical interventions: A Delphi survey. Clin Trials 2020; 17:295-305. [PMID: 32153205 DOI: 10.1177/1740774520910365] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND/AIMS In clinical trials of physical interventions, participant blinding is often poorly addressed and therapist blinding routinely omitted. This situation presents a substantial barrier to moving the field forward. Improving the success of blinding will be a vital step towards determining the true mechanisms of physical interventions. We used a Delphi approach to identify important elements of shams for physical interventions to maximise the likelihood of participant and therapist blinding in clinical trials. METHODS Two expert groups were recruited: (1) experts in research methodology and (2) experts in deceptive and/or hypnotic techniques including magic. Magicians were included because they were considered a potentially rich source of innovation for developing credible shams due to their unique skills in altering perceptions and beliefs. Three rounds of survey were conducted, commencing with an open-ended question. Responses were converted to single 'items', which participants rated in the following two rounds using a 9-point Likert scale, categorised as 'Not important' (0-3), 'Depends' (4-6) and 'Essential' (7-9). Consensus was pre-defined as ≥80% agreement within a 3-point category. RESULTS Thirty-eight experts agreed to participate (research methodology: n = 22; deceptive and/or hypnotic techniques: n = 16), and 30 experts responded to at least one round (research methodology: n = 19; deceptive and/or hypnotic techniques: n = 11). Of 79 items, five reached consensus in the 'Essential' category in both groups, which related to beliefs of participants (n = 3 items), interactions with researchers (n = 1 item) and standardisation of clinical assessments (n = 1 item). Thirteen additional items reached consensus in the 'Essential' category in one group. Experts in research methodology had one additional item reach consensus, related to authentic delivery of study information. The remaining 12 additional items that reached consensus in the deceptive and/or hypnotic techniques group related mainly to therapist attitude and behaviour and the clinical interaction. CONCLUSION Experts agreed that, for shams to be believable, consideration of cognitive influences is essential. Contrary to the focus of previous shams for physical interventions, replicating the tactile sensation of the active treatment was not considered an essential part of sham development. Therefore, when designing sham-controlled clinical trials, researchers should carefully consider the cognitive credibility of the entire intervention experience, and not just the indistinguishability of the sham intervention itself. The findings provide new guidance to researchers on important contributors to blinding in physical intervention trials.
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Affiliation(s)
| | - Julie L Walters
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - G Lorimer Moseley
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Marie T Williams
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Maureen P McEvoy
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia
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Malmivaara A, Armijo-Olivo S, Dennett L, Heinemann AW, Negrini S, Arokoski J. Blinded or Nonblinded Randomized Controlled Trials in Rehabilitation Research. Am J Phys Med Rehabil 2020; 99:183-190. [DOI: 10.1097/phm.0000000000001369] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Towards more homogenous and rigorous methods in sham-controlled dry needling trials: two Delphi surveys. Physiotherapy 2020; 106:12-23. [DOI: 10.1016/j.physio.2019.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Indexed: 12/23/2022]
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Moustgaard H, Clayton GL, Jones HE, Boutron I, Jørgensen L, Laursen DRT, Olsen MF, Paludan-Müller A, Ravaud P, Savović J, Sterne JAC, Higgins JPT, Hróbjartsson A. Impact of blinding on estimated treatment effects in randomised clinical trials: meta-epidemiological study. BMJ 2020; 368:l6802. [PMID: 31964641 PMCID: PMC7190062 DOI: 10.1136/bmj.l6802] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To study the impact of blinding on estimated treatment effects, and their variation between trials; differentiating between blinding of patients, healthcare providers, and observers; detection bias and performance bias; and types of outcome (the MetaBLIND study). DESIGN Meta-epidemiological study. DATA SOURCE Cochrane Database of Systematic Reviews (2013-14). ELIGIBILITY CRITERIA FOR SELECTING STUDIES Meta-analyses with both blinded and non-blinded trials on any topic. REVIEW METHODS Blinding status was retrieved from trial publications and authors, and results retrieved automatically from the Cochrane Database of Systematic Reviews. Bayesian hierarchical models estimated the average ratio of odds ratios (ROR), and estimated the increases in heterogeneity between trials, for non-blinded trials (or of unclear status) versus blinded trials. Secondary analyses adjusted for adequacy of concealment of allocation, attrition, and trial size, and explored the association between outcome subjectivity (high, moderate, low) and average bias. An ROR lower than 1 indicated exaggerated effect estimates in trials without blinding. RESULTS The study included 142 meta-analyses (1153 trials). The ROR for lack of blinding of patients was 0.91 (95% credible interval 0.61 to 1.34) in 18 meta-analyses with patient reported outcomes, and 0.98 (0.69 to 1.39) in 14 meta-analyses with outcomes reported by blinded observers. The ROR for lack of blinding of healthcare providers was 1.01 (0.84 to 1.19) in 29 meta-analyses with healthcare provider decision outcomes (eg, readmissions), and 0.97 (0.64 to 1.45) in 13 meta-analyses with outcomes reported by blinded patients or observers. The ROR for lack of blinding of observers was 1.01 (0.86 to 1.18) in 46 meta-analyses with subjective observer reported outcomes, with no clear impact of degree of subjectivity. Information was insufficient to determine whether lack of blinding was associated with increased heterogeneity between trials. The ROR for trials not reported as double blind versus those that were double blind was 1.02 (0.90 to 1.13) in 74 meta-analyses. CONCLUSION No evidence was found for an average difference in estimated treatment effect between trials with and without blinded patients, healthcare providers, or outcome assessors. These results could reflect that blinding is less important than often believed or meta-epidemiological study limitations, such as residual confounding or imprecision. At this stage, replication of this study is suggested and blinding should remain a methodological safeguard in trials.
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Affiliation(s)
- Helene Moustgaard
- Centre for Evidence-Based Medicine Odense (CEBMO), Odense University Hospital, Kløvervænget 10, DK-5000 Odense C, Denmark
- Nordic Cochrane Centre, Copenhagen, Denmark
| | - Gemma L Clayton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hayley E Jones
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | - David R T Laursen
- Centre for Evidence-Based Medicine Odense (CEBMO), Odense University Hospital, Kløvervænget 10, DK-5000 Odense C, Denmark
- Nordic Cochrane Centre, Copenhagen, Denmark
| | | | | | | | - Jelena Savović
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Jonathan A C Sterne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Julian P T Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Asbjørn Hróbjartsson
- Centre for Evidence-Based Medicine Odense (CEBMO), Odense University Hospital, Kløvervænget 10, DK-5000 Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Moustgaard H, Jones HE, Savović J, Clayton GL, Sterne JAC, Higgins JPT, Hróbjartsson A. Ten questions to consider when interpreting results of a meta‐epidemiological study—the MetaBLIND study as a case. Res Synth Methods 2020; 11:260-274. [PMID: 31851427 DOI: 10.1002/jrsm.1392] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 09/22/2019] [Accepted: 12/13/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Helene Moustgaard
- Centre for Evidence‐Based Medicine Odense (CEBMO)Odense University Hospital Odense C Denmark
- Department of Clinical ResearchUniversity of Southern Denmark Odense M Denmark
- Open patient Data Explorative Network (OPEN)Odense University Hospital Odense C Denmark
| | - Hayley E Jones
- Population Health Sciences, Bristol Medical SchoolUniversity of Bristol Bristol UK
| | - Jelena Savović
- Population Health Sciences, Bristol Medical SchoolUniversity of Bristol Bristol UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West)University Hospitals Bristol NHS Foundation Trust Bristol UK
| | - Gemma L Clayton
- Population Health Sciences, Bristol Medical SchoolUniversity of Bristol Bristol UK
| | - Jonathan AC Sterne
- Population Health Sciences, Bristol Medical SchoolUniversity of Bristol Bristol UK
| | - Julian PT Higgins
- Population Health Sciences, Bristol Medical SchoolUniversity of Bristol Bristol UK
| | - Asbjørn Hróbjartsson
- Centre for Evidence‐Based Medicine Odense (CEBMO)Odense University Hospital Odense C Denmark
- Department of Clinical ResearchUniversity of Southern Denmark Odense M Denmark
- Open patient Data Explorative Network (OPEN)Odense University Hospital Odense C Denmark
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Braithwaite FA, Walters JL, Li LSK, Moseley GL, Williams MT, McEvoy MP. Blinding Strategies in Dry Needling Trials: Systematic Review and Meta-Analysis. Phys Ther 2019; 99:1461-1480. [PMID: 31373369 DOI: 10.1093/ptj/pzz111] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 01/21/2019] [Accepted: 03/23/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Blinding of participants and therapists in trials of physical interventions is a significant and ongoing challenge. There is no widely accepted sham protocol for dry needling. PURPOSE The purpose of this review was to summarize the effectiveness and limitations of blinding strategies and types of shams that have been used in dry needling trials. DATA SOURCES Twelve databases were searched from inception to February 2016. STUDY SELECTION Trials that compared active dry needling with a sham that simulated dry needling were included. DATA EXTRACTION The main domains of data extraction were participant/therapist details, intervention details, blinding strategies, blinding assessment outcomes, and key conclusions of authors. Reported blinding strategies and sham types were synthesized descriptively, with available blinding effectiveness data synthesized using a chance-corrected measurement of blinding (blinding index). DATA SYNTHESIS The search identified 4894 individual publications with 27 trials eligible for inclusion. In 22 trials, risk of methodological bias was high or unclear. Across trials, blinding strategies and sham types were heterogeneous. Notably, no trials attempted therapist blinding. Sham protocols have focused on participant blinding using strategies related to group standardization and simulation of tactile sensations. There has been little attention given to the other senses or cognitive strategies to enhance intervention credibility. Nonpenetrating sham types may provide effective participant blinding. LIMITATIONS Trials were clinically and methodologically diverse, which limited the comparability of blinding effectiveness across trials. Reported blinding evaluations had a high risk of chance findings with power clearly achieved in only 1 trial. CONCLUSIONS Evidence-based consensus on a sham protocol for dry needling is required. Recommendations provided in this review may be used to develop sham protocols so that future protocols are more consistent and potentially more effective.
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Affiliation(s)
- Felicity A Braithwaite
- Division of Health Sciences, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Julie L Walters
- Division of Health Sciences, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Lok Sze Katrina Li
- Division of Health Sciences, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - G Lorimer Moseley
- Division of Health Sciences, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Marie T Williams
- Division of Health Sciences, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Maureen P McEvoy
- Division of Health Sciences, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Young HML, March DS, Graham-Brown MPM, Jones AW, Curtis F, Grantham CS, Churchward DR, Highton P, Smith AC, Singh SJ, Bridle C, Burton JO. Effects of intradialytic cycling exercise on exercise capacity, quality of life, physical function and cardiovascular measures in adult haemodialysis patients: a systematic review and meta-analysis. Nephrol Dial Transplant 2019; 33:1436-1445. [PMID: 29608708 DOI: 10.1093/ndt/gfy045] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 02/05/2018] [Indexed: 11/13/2022] Open
Abstract
Background Intradialytic cycling (IDC), delivered during haemodialysis (HD), has the potential to improve many health issues. This systematic review and meta-analysis examine the evidence on the effects of IDC on exercise capacity, quality of life (QoL), physical function and cardiovascular health. Methods Twenty-four databases were searched alongside Internet and hand searching, and consultation with experts. Eligibility criteria were cluster randomized, randomized and quasi-randomized controlled trials (RCTs) of IDC versus usual care in prevalent adult HD patients. Primary outcome measures were exercise capacity (VO2 peak and field tests) and QoL. Secondary measures were cardiac and physical function. Results Thirteen RCTs were eligible. Eight provided data for use in meta-analyses, which indicated no significant change in VO2 peak (mean difference, MD 1.19 mL/kg/min, 95% confidence interval -1.15 to 3.52, P = 0.3), physical (mean change, MC 1.97, -8.27 to 12.22, P = 0.7) or mental component (MC 3.37, -7.94 to 14.68, P = 0.6) summary scores of the Medical Outcomes Short Form 36, pulse wave velocity (MD -0.57 m/s, -1.55 to 0.41, P = 0.4), systolic (MD -2.28 mmHg, -14.46 to 9.90, P = 0.7) or diastolic blood pressure (MD 2.25 mmHg, -3.01 to 7.50, P = 0.4) following IDC. IDC, however, leads to an improvement in performance on the 6-min walk test (MD 87.84 m, 39.60-136.09, P = 0.0004). All included studies were considered to have high risk of bias. Conclusions There is insufficient evidence demonstrating whether cycling exercise during HD improves patient outcomes. High-quality, adequately powered RCTs of IDC are required.
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Affiliation(s)
- Hannah M L Young
- Department of Infection, Immunity & Inflammation; and John Walls Renal Unit, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Daniel S March
- Department of Infection, Immunity & Inflammation; and John Walls Renal Unit, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Matthew P M Graham-Brown
- Department of Infection, Immunity & Inflammation; and John Walls Renal Unit, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK.,National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Arwel W Jones
- Lincoln Institute for Health, University of Lincoln, Lincoln, UK
| | - Ffion Curtis
- Lincoln Institute for Health, University of Lincoln, Lincoln, UK
| | - Charlotte S Grantham
- Department of Infection, Immunity & Inflammation; and John Walls Renal Unit, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Darren R Churchward
- Department of Infection, Immunity & Inflammation; and John Walls Renal Unit, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Patrick Highton
- Department of Infection, Immunity & Inflammation; and John Walls Renal Unit, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK.,National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Alice C Smith
- Department of Infection, Immunity & Inflammation; and John Walls Renal Unit, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sally J Singh
- Centre for Exercise & Rehabilitation Science, Leicester Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Chris Bridle
- Lincoln Institute for Health, University of Lincoln, Lincoln, UK
| | - James O Burton
- Department of Infection, Immunity & Inflammation; and John Walls Renal Unit, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK.,National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
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Systematic review on the quality of randomized controlled trials from Saudi Arabia. Contemp Clin Trials Commun 2019; 16:100441. [PMID: 31517135 PMCID: PMC6737301 DOI: 10.1016/j.conctc.2019.100441] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/28/2019] [Accepted: 08/21/2019] [Indexed: 12/21/2022] Open
Abstract
Background The quality of randomized controlled trials from Saudi Arabia is unknown since most are observational studies. Objective To determine (1) the quantity and quality of randomized controlled trials published from Saudi Arabia, and (2) whether significance of intervention effect varied by study quality. Methods PubMed, SCOPUS, and Cochrane were searched with keywords for trials published from Saudi Arabia until February 2018. A total of 422 records were identified and screened, resulting in 61 eligible trials for analysis. Two researchers abstracted trial characteristics and assessed quality in seven domains (randomization, allocation concealment, blinding of assessors or participants, incomplete outcome data, selective reporting, and other sources of bias) using the Cochrane Collaboration Risk of Bias Tool. Results A majority of the trials (57%) were published during 2010–2018. High risk of bias was present for blinding (outcome: 13%; participants and personnel: 28%). Biases could not be assessed due to lack of information (unclear risk) in the domains of randomization (54%), allocation concealment (44%), and blinding of outcome assessment (57%). When all seven domains were considered together (summary risk of bias), 0% of the trials had low risk, 39% had high risk, and 61% had unclear risk of biases. A greater proportion of high-risk trials had significant intervention effect than unclear-risk trials (79% vs. 67%). Conclusion The volume and quality of trials in Saudi Arabia was low. More high-quality randomized controlled trials are warranted to address chronic diseases.
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de Almeida MO, Saragiotto BT, Maher C, Costa LOP. Allocation Concealment and Intention-To-Treat Analysis Do Not Influence the Treatment Effects of Physical Therapy Interventions in Low Back Pain Trials: a Meta-epidemiologic Study. Arch Phys Med Rehabil 2019; 100:1359-1366. [DOI: 10.1016/j.apmr.2018.12.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 11/06/2018] [Accepted: 12/06/2018] [Indexed: 01/26/2023]
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Interventional studies performed in emergency medical communication centres: systematic review. Eur J Emerg Med 2019; 27:21-26. [PMID: 31094711 DOI: 10.1097/mej.0000000000000608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We aimed to both quantitatively and qualitatively describe interventional research performed in emergency medical communication centres. We conducted a systematic review of articles published in MEDLINE, Cochrane Central Register of Controlled Trials and Web of Science. Studies evaluating therapeutic or organizational interventions directed by call centres in the context of emergencies were included. Studies of call centre management for general practice or nonhealthcare agencies were excluded. We assessed general characteristics and methodological information for each study. Quality was evaluated by the Cochrane Risk of Bias tool or the Newcastle-Ottawa Scale. Among 3896 articles screened, we retained 59; 41 studies were randomized controlled trials (69%) and 18 (31%) were before-after studies; 41 (69%) took place in a single centre. For 33 (56%), 22 (37%) and 4 (7%) studies, the models used were simulation training, patient-based or experimental, respectively. The main topic was cardiac arrests (n = 45, 76%), with outcome measures of cardiopulmonary resuscitation quality and dispatch assistance. Among randomized controlled trials, risk of bias was unclear or high for selective reporting for 37 (90%) studies, low for blinding of outcomes for 34 (83%) and low for incomplete outcomes for 31 (76%). Regarding before-after studies, quality was high in 9 (50%) studies. Few interventional studies have been performed in call centres. Studies mainly involved simulation and focussed on cardiac arrest. The quality of studies needs improvement to allow for a better recognition and understanding of emergency medical call control.
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Ibargoyen-Roteta N, Mateos Del Pino M, Gutiérrez-Ibarluzea I, Benguria-Arrate G, Rada-Fernández de Jauregui D, Domingo-Rico C, Regidor Fuentes I, González Santisteban R, Armendáriz Cuñado M, Jaio Atela N. Variability in the prescription of drugs with uncertain effectiveness. The case of SYSADOA in the Basque Country. GMS HEALTH TECHNOLOGY ASSESSMENT 2019; 14:Doc01. [PMID: 31015866 PMCID: PMC6460939 DOI: 10.3205/hta000130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: The majority of clinical practice guidelines do not recommend the use of SYSADOA (Symptomatic Slow Action Drugs for Osteoarthritis) for the treatment of osteoarthritis because of the lack of evidence or uncertainty around their efficacy. Nevertheless, the Spanish Public Health Service continues funding these drugs. Aim: The aim of this study is to describe the prescription status of SYSADOA in the primary care units of the Basque Country during 2011; to determine if variability exists among them; and to examine if the variability could be explained by the health care region each PC unit belongs to. Methods: Prescription data for SYSADOA during 2011 was obtained from the Basque Ministry for Health. In the Basque Country, primary care is divided into seven regions, each region consisting of several primary care units, which were used as the unit of analysis. Defined daily doses (DDD) per 1,000 inhabitant-days (DHD) were calculated. Data were standardized by sex and age using the total population of the Basque Country as the reference population. Small area statistics were calculated (extremal quotient, coefficient of variation and systematic component of variation). The influence of the region to which primary care units belonged was also analysed. R software (version R-2.15.0) was used for the analysis. Results: SYSADOA prescription during 2011 accounted for an expense of 4.5 million euros for the Basque Health Service. The crude rate of consumption of SYSADOA was 7.81 DDD per 1,000 inhabitant-days. The obtained external quotient was 13.67. The prescription of SYSADOA of the primary care units located in the 95th percentile was six times higher than the ones located in the 5th percentile. The region to which units belonged accounted for 57% of the observed variability. Discussion: The uncertainty around these drugs could be reflected in the existing variability of their prescription level. The analysis of the variability in the prescription of drugs with no demonstrated efficacy could help in allocating resources into other services or health technologies supported by evidence, thereby contributing to the improvement of health outcomes.
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Affiliation(s)
- Nora Ibargoyen-Roteta
- Osteba (Basque Office for Health Technology Assessment), Ministry for Health, Basque Government, Vitoria-Gasteiz, Spain
| | - Maider Mateos Del Pino
- Health Research and Studies Unit, Ministry for Health, Basque Government, Vitoria-Gasteiz, Spain
| | - Iñaki Gutiérrez-Ibarluzea
- Osteba (Basque Office for Health Technology Assessment), Ministry for Health, Basque Government, Vitoria-Gasteiz, Spain
| | - Gaizka Benguria-Arrate
- Osteba (Basque Office for Health Technology Assessment), Ministry for Health, Basque Government, Vitoria-Gasteiz, Spain
| | - Diego Rada-Fernández de Jauregui
- Department of Preventive Medicine and Public Health, University of the Basque Country/Euskal Herriko Unibertsitatea (UPV/EHU), Vitoria-Gasteiz, Spain
| | - Cristina Domingo-Rico
- Medical Directorate of the Interior Care Setting, Osakidetza, Basque Health Service, Amorebieta, Spain
| | - Iratxe Regidor Fuentes
- Quality and Research Unit, Interior Care Setting, Osakidetza, Basque Health Service, Amorebieta, Spain
| | | | - María Armendáriz Cuñado
- Pharmaceutical Unit, Barrualde-Galdakao Integrated Health Services Setting, Osakidetza, Basque Health Service, Amorebieta, Spain
| | - Nekane Jaio Atela
- Pharmaceutical Unit, Barrualde-Galdakao Integrated Health Services Setting, Osakidetza, Basque Health Service, Amorebieta, Spain
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Sonbol MB, Firwana BM, Hilal T, Murad MH. How to read a published clinical trial: A practical guide for clinicians. Avicenna J Med 2019; 10:68-75. [PMID: 32500045 PMCID: PMC7252615 DOI: 10.4103/ajm.ajm_186_19] [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] [Indexed: 11/04/2022] Open
Abstract
Over the last 5 years, there have been more than 140 new drug approvals in the field of Oncology alone, all based on newly published clinical trials. These approvals have led to an ongoing change in clinical practice, offering new therapeutic options for patients. Therefore, it is important for healthcare providers to be able to appraise a clinical trial and determine its validity, understand its results, and be able to apply such results to their patients. In this guide, we provide a simplified approach tailored to practicing clinicians and trainees. The same concepts and principles apply to other medical specialties.
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Affiliation(s)
| | - Belal M Firwana
- Heartland Cancer Research, National Cancer Institute Community Oncology Research Program (NCORP), Missouri Baptist Medical Center, St. Louis, Missouri, USA
| | - Talal Hilal
- University of Mississippi Medical Center, Jackson, Mississippi, USA
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