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Marques JM, Figueiredo CPM, Scanavino MDT. A review of published studies on virtual reality in sexuality research. Sex Med Rev 2024; 12:371-386. [PMID: 38705842 DOI: 10.1093/sxmrev/qeae024] [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: 11/20/2023] [Revised: 03/14/2024] [Accepted: 03/29/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Virtual reality (VR) technology contributes to greater approach of methodological safety to make ecological validity more feasible and a growing interest in sexuality behaviors. OBJECTIVES The aim of this study was to show VR in the sexuality area by a comprehensive review of outcomes, offer a synthesis of the studies, and make a methodological quality assessment of finding results. A secondary goal was to investigate the effect of immersion on diverse sexual responses outcomes. METHODS We designed a review based on a systematic review strategy describing types of studies, participants, data collection and outcomes; searched in 4 electronic databases (PubMed, EMBASE, PsycINFO, and SciELO), and made a full-text screening process. RESULTS The study found 18 articles that met research criteria synthesized within 3 outcome groups: erection measures, level of immersion, and biomarker studies. Synthesis shows a lack of methodological aspects that impair results, such as description of methods from bias protection, randomization, or concealment. The literature still needs to improve its methodology, even though it already shows relevant data for intervention in sexual dysfunction, forensic psychiatry, sexual attraction, orientation, and use of pornography. CONCLUSION Current methodological issues need better design to highlight relevant issues in sexuality with stronger quality of design, opening boundaries to new diagnostic or interventional technologies to sexual health.
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Affiliation(s)
- João Miguel Marques
- Excessive Sexual Drive and Prevention of Negative Outcome Associated to Sexual Behavior Outpatient Unit, Institute of Psyquiatry (IPq) Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Caio Petrus Monteiro Figueiredo
- Institute of Psyquiatry (IPq) Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Marco D T Scanavino
- Excessive Sexual Drive and Prevention of Negative Outcome Associated to Sexual Behavior Outpatient Unit, Institute of Psyquiatry (IPq) Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Experimental Pathophysiology Post Graduation Program, Institute of Psyquiatry (IPq) Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
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Kisely SR. Can new approaches to synthesising evidence help achieve a consensus in psychotherapy research? Australas Psychiatry 2024; 32:23-25. [PMID: 38079408 PMCID: PMC10809726 DOI: 10.1177/10398562231219851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE The recent debate around the College's Clinical Practice Guidelines on mood disorders have highlighted differences in opinion on interpreting evidence from randomised control trials (RCTs) for psychodynamic psychotherapy. This paper discusses new techniques of synthesising research evidence (e.g., umbrella reviews) that may help minimise disagreements in the interpretation of RCTs and foster greater consensus on treatment guidelines. CONCLUSIONS Findings from the latest umbrella review suggest that psychodynamic therapy is an evidence-based approach, among several, for common mental disorders.
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Affiliation(s)
- Stephen R Kisely
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia; Metro South Health Service, Woolloongabba, QLD, Australia; and Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
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Thakur B, Ayers GD, Atem F, DeClercq JJ, Jain NB. Statistical and Methodological Considerations for Randomized Controlled Trial Design in Physical Medicine and Rehabilitation. Am J Phys Med Rehabil 2023; 102:855-860. [PMID: 36882301 PMCID: PMC10471787 DOI: 10.1097/phm.0000000000002225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
ABSTRACT Well-designed randomized controlled clinical trials assessing treatments in the field of physical medicine and rehabilitation are essential for evidence-based patient care. However, there are challenges unique to clinical trials in physical medicine and rehabilitation due to complex health interventions in this field. We highlight routinely encountered empirical challenges and provide evidence-based recommendations on statistical and methodological approaches for the design and conduct of randomized controlled trials. Some of the issues addressed include challenges with blinding treatment groups in a rehabilitation setting, heterogeneity in treatment therapy, heterogeneity of treatment effects, uniformity in patient-reported outcome measures, and effect on power with varying scales of information. Furthermore, we discuss challenges with estimation of sample size and power, adaption to poor compliance with treatment and missing outcomes, and preferred statistical approaches for longitudinal data analysis. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES Upon completion of this article, the reader should be able to: (1) Appraise the complexities of interventions in physical medicine and rehabilitation and how these challenges impact the conduct of clinical trials; (2) Develop an analytical strategy for poor treatment compliance and missing outcomes that can compromise the causal effect sought in a randomized clinical trial; and (3) Recognize the role of a data and safety monitoring board in a clinical trial. LEVEL Advanced. ACCREDITATION The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Affiliation(s)
- Bhaskar Thakur
- From the Department of Physical Medicine and Rehabilitation, Family and Community Medicine, and Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas (BT); Center for Quantitative Sciences, Department of Biostatistics, Vanderbilt School of Medicine, Nashville, Tennessee (GDA); Department of Biostatistics and Data Science, University of Texas Health Science Center-Houston, Dallas, Texas (FA); Department of Biostatistics, Vanderbilt School of Medicine, Nashville, Tennessee (JD); Department of Physical Medicine and Rehabilitation, and Orthopedics, University of Texas Southwestern, Dallas, Texas (NBJ); and Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee (NBJ)
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Vorwerg-Gall S, Stamm O, Haink M. Virtual reality exergame in older patients with hypertension: a preliminary study to determine load intensity and blood pressure. BMC Geriatr 2023; 23:527. [PMID: 37644380 PMCID: PMC10466734 DOI: 10.1186/s12877-023-04245-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/19/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Lifestyle changes and physical activity can make an important contribution to reducing the risk factor for high blood pressure (BP). Whether virtual reality (VR) exergames are also appropriate and make a positive contribution to the reduction of BP has not yet been sufficiently investigated. Therefore, the aim of the study was to gain knowledge of the load intensities to be achieved during a VR exergame and to examine the short-term effects on BP. METHODS For the preliminary study, 22 participants with hypertension over the age of 65 years were analyzed. The study took place in a mobile laboratory truck. All participants visited on two occasions. During visit 1, VR strength endurance training (VR-SET) and during visit 2, VR endurance training (VR-ET) was performed. Each VR session lasted approximately 25 min and was of a moderate intensity. Heart rate (HR) was measured across the entire session, as well as BP before and after the VR exergame. The Rating of Perceived Exertion (RPE) and task load using NASA Task Load Index were determined after each VR session. Included in the statistical analysis were the Shapiro-Wilk test, the paired t-test, the Wilcoxon test and ANOVA for repeated measures. RESULTS During the "main part" (p < .001), at the "end" (p = .002) and for the "maximum HR" (p < .001), significant load differences between both VR sessions could be determined. In addition, significantly more participants in the VR-SET group achieved a moderate load intensity of at least 40% of heart rate reserve (p = .014). Regarding RPE, participants rated their subjectively perceived exertion significantly higher in the VR-SET than in the VR-ET (p = .028). Systolic BP decreased significantly in both VR sessions when compared before VR session and 5 min after VR session (p = .015; p = .003), as well as before VR session and 10 min after VR session (p = .018; p < .001). CONCLUSIONS An individual moderate load intensity of 40% can be reached during VR-SET. In addition, a positive short-term effect of the VR exergame on BP behavior (postexercise hypotension) was observed after both VR sessions. The preliminary results indicate that a VR exergaming could lead to blood pressure lowering effects for older people with hypertension. TRIAL REGISTRATION The study was registered in the German Clinical Trials Register (DRKS-ID: DRKS00022881, 07/09/2020, https://drks.de/search/de/trial/DRKS00022881 ).
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Affiliation(s)
- Susan Vorwerg-Gall
- Department of Geriatrics and Medical Gerontology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Reinickendorfer Straße 61, 13347 Berlin, Germany
| | - Oskar Stamm
- Department of Geriatrics and Medical Gerontology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Reinickendorfer Straße 61, 13347 Berlin, Germany
| | - Michele Haink
- Department of Geriatrics and Medical Gerontology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Reinickendorfer Straße 61, 13347 Berlin, Germany
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Annaswamy TM, Cunniff K, Rizzo JR, Naeimi T, Kumbhare D, Batavia M. Methodological Issues Relevant to Blinding in Physical Medicine and Rehabilitation Research. Am J Phys Med Rehabil 2023; 102:636-644. [PMID: 36897811 DOI: 10.1097/phm.0000000000002228] [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: 03/11/2023]
Abstract
ABSTRACT Blinding in research is important, and the field of physical medicine and rehabilitation poses special consideration owing to the patient populations and treatment methodologies used. Historically, blinding has been increasingly relevant to conducting good-quality research. The main reason to blind is to reduce bias. There are several strategies to blinding. At times, when blinding is not possible, alternatives to blinding include sham control and description of study and control groups. Illustrative examples of blinding used in physical medicine and rehabilitation research are described in this article, along with how to assess success and fidelity of blinding.
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Affiliation(s)
- Thiru M Annaswamy
- From the Department of Physical Medicine & Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Penn State Health Rehabilitation Hospital, Hummelstown, Pennsylvania (TMA); Spine Center, UT Southwestern Medical Center, Dallas, Texas (KC); Department of Rehabilitation Medicine & Neurology, Grossman School of Medicine, and Departments of Mechanical & Aerospace and Biomedical Engineering, NYU Tandon School of Engineering, New York University, New York City, New York (JRR); Department of Rehabilitation Medicine, New York University, New York City, New York (TN); Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada (DK); and Department of Physical Therapy, New York University Steinhardt, and Department of Rehabilitation Medicine, Grossman School of Medicine, New York University Langone, New York City, New York (MB)
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Hohenschurz-Schmidt D, Vase L, Scott W, Annoni M, Ajayi OK, Barth J, Bennell K, Berna C, Bialosky J, Braithwaite F, Finnerup NB, Williams ACDC, Carlino E, Cerritelli F, Chaibi A, Cherkin D, Colloca L, Côté P, Darnall BD, Evans R, Fabre L, Faria V, French S, Gerger H, Häuser W, Hinman RS, Ho D, Janssens T, Jensen K, Johnston C, Juhl Lunde S, Keefe F, Kerns RD, Koechlin H, Kongsted A, Michener LA, Moerman DE, Musial F, Newell D, Nicholas M, Palermo TM, Palermo S, Peerdeman KJ, Pogatzki-Zahn EM, Puhl AA, Roberts L, Rossettini G, Tomczak Matthiesen S, Underwood M, Vaucher P, Vollert J, Wartolowska K, Weimer K, Werner CP, Rice ASC, Draper-Rodi J. Recommendations for the development, implementation, and reporting of control interventions in efficacy and mechanistic trials of physical, psychological, and self-management therapies: the CoPPS Statement. BMJ 2023; 381:e072108. [PMID: 37230508 DOI: 10.1136/bmj-2022-072108] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- David Hohenschurz-Schmidt
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Research Department, University College of Osteopathy, London, UK
| | - Lene Vase
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Denmark
| | - Whitney Scott
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London; INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Marco Annoni
- Italian National Research Council, Interdepartmental Centre for Research Ethics and Integrity, Rome, Italy
| | - Oluwafemi K Ajayi
- Department of Arts and Music, College of Human Sciences, University of South Africa, Pretoria, South Africa
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Switzerland
| | - Kim Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, VIC, Australia
| | - Chantal Berna
- Centrer for Integrative and Complementary Medicine, Pain Center, Division of Anesthesiology, Sense Institute, Lausanne University Hospital, Lausanne University, Lausanne, Switzerland
| | - Joel Bialosky
- Department of Physical Therapy, University of Florida, Gainesville FL, USA; Brooks-PHHP Research Collaboration, Jacksonville, FL, USA
| | | | - Nanna B Finnerup
- Danish Pain Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Amanda C de C Williams
- Research Department of Clinical, Educational & Health Psychology, University College London, London, UK
| | - Elisa Carlino
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Turin, Italy
| | | | - Aleksander Chaibi
- Department for Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Dan Cherkin
- Osher Center for Integrative Health, Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Luana Colloca
- Department of Pain and Translational Symptom Science, School of Nursing; Department of Anesthesiology, School of Medicine; University of Maryland, Baltimore, MD, USA
| | - Pierre Côté
- Faculty of Health Sciences, Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, ON, Canada
| | - Beth D Darnall
- Stanford Pain Relief Innovations Lab; Stanford University School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford, CA, USA
| | - Roni Evans
- Integrative Health & Wellbeing Research Program; Center for Spirituality and Healing, University of Minnesota, Minneapolis, MN, USA
| | - Laurent Fabre
- Centre Européen d'Enseignement Supérieur de l'Ostéopathie, Paris, France
| | - Vanda Faria
- Department of Psychology, Uppsala University, Uppsala, Sweden; Smell & Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany; Brain and Eye Pain Imaging Lab, Pain and Affective Neuroscience Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Simon French
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW, Australia
| | - Heike Gerger
- Erasmus MC, University Medical Centre Rotterdam, Department of General Practice, Rotterdam, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Winfried Häuser
- Department Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany
| | - Rana S Hinman
- Centre for Health, Exercise & Sports Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Dien Ho
- Center for Health Humanities, School of Arts and Sciences, Massachusetts College of Pharmacy and Health Sciences, Boston MA, USA
| | - Thomas Janssens
- Health Psychology, KU Leuven; Ebpracticenet, Leuven, Belgium
| | - Karin Jensen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Chris Johnston
- BC Patient Safety & Quality Council's Patient Voices Network; Health Research BC's Partnership-Ready Network; Health Standards Organization's Emergency Management Technical Committee & Working Group
| | - Sigrid Juhl Lunde
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Denmark
| | - Francis Keefe
- Duke University, School of Medicine, Durham, NC, USA
| | - Robert D Kerns
- Departments of Psychiatry, Neurology, and Psychology, Yale University, New Haven, CT, USA
| | - Helen Koechlin
- Division of Psychosomatics and Psychiatry, University Children's Hospital Zurich; Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland; Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Chiropractic Knowledge Hub, Odense, Denmark
| | - Lori A Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles CA, USA
| | - Daniel E Moerman
- College of Arts, Sciences, and Letters, Behavioral Sciences, University of Michigan, Dearborn, MI, USA
| | - Frauke Musial
- National Research Centre in Complementary and Alternative Medicine, Department of Community Medicine, Faculty of Health Science UiT, Arctic University of Norway, Tromsø, Norway
| | | | - Michael Nicholas
- Pain Management Research Institute, University of Sydney Medical School (Northern) and Kolling Institute of Medical Research at Royal North Shore Hospital, Sydney, Australia
| | - Tonya M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Sara Palermo
- Diagnostic and Technology Department, Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Department of Psychology, University of Turin, Turin, Italy
| | - Kaya J Peerdeman
- Unit Health, Medical and Neuropsychology, Leiden University, Leiden, the Netherlands
| | - Esther M Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | | | - Lisa Roberts
- University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Campus of Savona, Savona, Italy; School of Physiotherapy, University of Verona, Verona, Italy
| | - Susan Tomczak Matthiesen
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Denmark
| | - Martin Underwood
- Warwick Clinical Trials Unit; University of Warwick, Coventry, UK; University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Paul Vaucher
- School of Health Sciences Fribourg, HES-SO University of Applied Sciences and Arts Western Switzerland, Switzerland
| | - Jan Vollert
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany; Neurophysiology, Mannheim Centre of Translational Neuroscience, Medical Faculty Mannheim, Heidelberg University, Germany; Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Germany
| | - Karolina Wartolowska
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Katja Weimer
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Centre, Ulm, Germany
| | - Christoph Patrick Werner
- School of Psychology, Faculty of Science, University of Sydney, Australia; Department of Clinical Research, University Hospital Basel, Switzerland
| | - Andrew S C Rice
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Jerry Draper-Rodi
- Research Department, University College of Osteopathy, London, UK
- National Council for Osteopathic Research, London, UK
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Zdziechowski A, Gluba-Sagr A, Rysz J, Woldańska-Okońska M. Why Does Rehabilitation Not (Always) Work in Osteoarthritis? Does Rehabilitation Need Molecular Biology? Int J Mol Sci 2023; 24:ijms24098109. [PMID: 37175818 PMCID: PMC10179350 DOI: 10.3390/ijms24098109] [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: 02/05/2023] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
Osteoarthritis (OA) is a common disease among the human population worldwide. OA causes functional impairment, leads to disability and poses serious socioeconomic burden. The rehabilitation offers a function-oriented method to reduce the disability using diverse interventions (kinesiotherapy, physical therapy, occupational therapy, education, and pharmacotherapy). OA as a widespread disease among elderly patients is often treated by rehabilitation specialists and physiotherapists, however the results of rehabilitation are sometimes unsatisfactory. The understanding of molecular mechanisms activated by rehabilitation may enable the development of more effective rehabilitation procedures. Molecular biology methods may prove crucial in rehabilitation as the majority of rehabilitation procedures cannot be estimated in double-blinded placebo-controlled trials commonly used in pharmacotherapy. This article attempts to present and estimate the role of molecular biology in the development of modern rehabilitation. The role of clinicians in adequate molecular biology experimental design is also described.
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Affiliation(s)
- Adam Zdziechowski
- Department of Internal Diseases, Rehabilitation and Physical Medicine, Medical University, 90-700 Łódź, Poland
| | - Anna Gluba-Sagr
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-549 Łódź, Poland
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-549 Łódź, Poland
| | - Marta Woldańska-Okońska
- Department of Internal Diseases, Rehabilitation and Physical Medicine, Medical University, 90-700 Łódź, Poland
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Hohenschurz-Schmidt D, Draper-Rodi J, Vase L, Scott W, McGregor A, Soliman N, MacMillan A, Olivier A, Cherian CA, Corcoran D, Abbey H, Freigang S, Chan J, Phalip J, Nørgaard Sørensen L, Delafin M, Baptista M, Medforth NR, Ruffini N, Skøtt Andresen S, Ytier S, Ali D, Hobday H, Santosa AANAA, Vollert J, Rice AS. Blinding and sham control methods in trials of physical, psychological, and self-management interventions for pain (article I): a systematic review and description of methods. Pain 2023; 164:469-484. [PMID: 36265391 PMCID: PMC9916059 DOI: 10.1097/j.pain.0000000000002723] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 05/17/2022] [Accepted: 06/12/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT Blinding is challenging in randomised controlled trials of physical, psychological, and self-management therapies for pain, mainly because of their complex and participatory nature. To develop standards for the design, implementation, and reporting of control interventions in efficacy and mechanistic trials, a systematic overview of currently used sham interventions and other blinding methods was required. Twelve databases were searched for placebo or sham-controlled randomised clinical trials of physical, psychological, and self-management treatments in a clinical pain population. Screening and data extraction were performed in duplicate, and trial features, description of control methods, and their similarity to the active intervention under investigation were extracted (protocol registration ID: CRD42020206590). The review included 198 unique control interventions, published between 2008 and December 2021. Most trials studied people with chronic pain, and more than half were manual therapy trials. The described control interventions ranged from clearly modelled based on the active treatment to largely dissimilar control interventions. Similarity between control and active interventions was more frequent for certain aspects (eg, duration and frequency of treatments) than others (eg, physical treatment procedures and patient sensory experiences). We also provide an overview of additional, potentially useful methods to enhance blinding, as well as the reporting of processes involved in developing control interventions. A comprehensive picture of prevalent blinding methods is provided, including a detailed assessment of the resemblance between active and control interventions. These findings can inform future developments of control interventions in efficacy and mechanistic trials and best-practice recommendations.
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Affiliation(s)
- David Hohenschurz-Schmidt
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea, London, United Kingdom
| | - Jerry Draper-Rodi
- Research Centre, University College of Osteopathy, London, United Kingdom
| | - Lene Vase
- Section for Psychology and Neuroscience, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus C, Denmark
| | - Whitney Scott
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Alison McGregor
- Human Performance Group, Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Nadia Soliman
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea, London, United Kingdom
| | - Andrew MacMillan
- Research Centre, University College of Osteopathy, London, United Kingdom
| | - Axel Olivier
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Cybill Ann Cherian
- Chemical Engineering Department, Khalifa University, Abu Dhabi, United Arab Emirates
| | | | - Hilary Abbey
- Research Centre, University College of Osteopathy, London, United Kingdom
| | - Sascha Freigang
- Department of Neurosurgery, Medical University Graz, Graz, Austria
| | - Jessica Chan
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | | | - Lea Nørgaard Sørensen
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Maite Delafin
- The Penn Clinic, Hertfordshire, Hatfield, United Kingdom
| | - Margarida Baptista
- Department of Psychology, Wolfson Centre for Age Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | - Nuria Ruffini
- National Centre Germany, Foundation C.O.M.E. Collaboration, Berlin, Germany
| | | | | | - Dorota Ali
- Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Harriet Hobday
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | - Jan Vollert
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea, London, United Kingdom
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Kiel, Germany
- Neurophysiology, Mannheim Center of Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Andrew S.C. Rice
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea, London, United Kingdom
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Jiang T, Jiang S, Cui Y, Yang JP, Du YH, Li J, Pang B, Li B. Assessment of reporting quality in randomized controlled trials of acupuncture for labor pain. FRONTIERS IN PAIN RESEARCH 2022; 3:999162. [DOI: 10.3389/fpain.2022.999162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/03/2022] [Indexed: 11/22/2022] Open
Abstract
ObjectiveTo evaluate the reporting quality of randomized controlled trials (RCTs) of acupuncture for labor pain, and to explore relevant factors for facilitating reporting transparency and integrity for future RCTs.MethodEight Chinese and English databases were systematically searched from their inception until August 31, 2021. General characteristics and methodological quality of the included reports were evaluated based on the CONSORT statement and the STRICTA guidelines. Descriptive statistical analysis was performed. Cohen's κ-statistics were calculated to assess the agreement of all items between two reviewers.ResultsA total of 84 RCTs were included. Based on the CONSORT statement, a positive reporting rate (greater than 80%) was evident for the items “trial design” “participants” “intervention” “outcomes” “numbers analyzed” and “generalizability”. The quality of reporting for the items “randomized in the title or abstract” “sample size” “allocation concealment” “implementation” “blinding” “recruitment” “ancillary analyses” “harms” “interpretation” “registration” and “protocol” was poor with positive rates less than 10%. Based on the STRICTA guidelines, the items “extent to which treatment varied” “number of needle insertions per subject per session” and “control or comparator interventions” had poor reporting quality with positive rates of less than 10%. Substantial agreement was observed for most items and excellent agreement for some items.ConclusionThe reporting quality of RCTs of acupuncture for labor pain is suboptimal generally. Rigorous adherence to the CONSORT statement and the STRICTA guidelines should be emphasized in future studies to improve the quality of acupuncture RCT reports.
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10
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Monroe JC, Pae BJ, Kargl C, Gavin TP, Parker J, Perkins SM, Han Y, Klein J, Motaganahalli RL, Roseguini BT. Effects of home-based leg heat therapy on walking performance in patients with symptomatic peripheral artery disease: a pilot randomized trial. J Appl Physiol (1985) 2022; 133:546-560. [PMID: 35771219 PMCID: PMC9448284 DOI: 10.1152/japplphysiol.00143.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 11/22/2022] Open
Abstract
Few noninvasive therapies currently exist to improve functional capacity in people with lower extremity peripheral artery disease (PAD). The goal of the present study was to test the hypothesis that unsupervised, home-based leg heat therapy (HT) using water-circulating trousers perfused with warm water would improve walking performance in patients with PAD. Patients with symptomatic PAD were randomized into either leg HT (n = 18) or a sham treatment (n = 16). Patients were provided with water-circulating trousers and a portable pump and were asked to apply the therapy daily (7 days/wk, 90 min/session) for 8 wk. The primary study outcome was the change from baseline in 6-min walk distance at 8-wk follow-up. Secondary outcomes included the claudication onset-time, peak walking time, peak pulmonary oxygen consumption and peak blood pressure during a graded treadmill test, resting blood pressure, the ankle-brachial index, postocclusive reactive hyperemia in the calf, cutaneous microvascular reactivity, and perceived quality of life. Of the 34 participants randomized, 29 completed the 8-wk follow-up. The change in 6-min walk distance at the 8-wk follow-up was significantly higher (P = 0.029) in the group exposed to HT than in the sham-treated group (Sham: median: -0.9; 25%, 75% percentiles: -5.8, 14.3; HT: median: 21.3; 25%, 75% percentiles: 10.1, 42.4, P = 0.029). There were no significant differences in secondary outcomes between the HT and sham group at 8-wk follow-up. The results of this pilot study indicate that unsupervised, home-based leg HT is safe, well-tolerated, and elicits a clinically meaningful improvement in walking tolerance in patients with symptomatic PAD.NEW & NOTEWORTHY This is the first sham-controlled trial to examine the effects of home-based leg heat therapy (HT) on walking performance in patients with peripheral artery disease (PAD). We demonstrate that unsupervised HT using water-circulating trousers is safe, well-tolerated, and elicits meaningful changes in walking ability in patients with symptomatic PAD. This home-based treatment option is practical, painless, and may be a feasible adjunctive therapy to counteract the decline in lower extremity physical function in patients with PAD.
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Affiliation(s)
- Jacob C Monroe
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana
| | - Byung Joon Pae
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana
| | - Christopher Kargl
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana
| | - Timothy P Gavin
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana
| | - Jason Parker
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
| | - Susan M Perkins
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana
| | - Yan Han
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana
| | - Janet Klein
- Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Raghu L Motaganahalli
- Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Bruno T Roseguini
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana
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11
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Armijo-Olivo S, Mohamad N, Sobral de Oliveira-Souza AI, de Castro-Carletti EM, Ballenberger N, Fuentes J. Performance, Detection, Contamination, Compliance, and Cointervention Biases in Rehabilitation Research: What Are They and How Can They Affect the Results of Randomized Controlled Trials? Basic Information for Junior Researchers and Clinicians. Am J Phys Med Rehabil 2022; 101:864-878. [PMID: 35978455 DOI: 10.1097/phm.0000000000001893] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Bias is a systematic error that can cause distorted results leading to incorrect conclusions. Intervention bias (i.e., contamination bias, cointervention bias, compliance bias, and performance bias) and detection bias are the most common biases in rehabilitation research. A better understanding of these biases is essential at all stages of research to enhance the quality of evidence in rehabilitation trials. Therefore, this narrative review aims to provide insights to the readers, clinicians, and researchers about contamination, cointervention, compliance, performance, and detection biases and ways of recognizing and mitigating them. 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.This review provides several strategies to guard against the impact of bias on study results. Clinicians, researchers, and other stakeholders are encouraged to apply these recommendations when designing and conducting rehabilitation trials.
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Affiliation(s)
- Susan Armijo-Olivo
- From the Faculty of Economics and Social Sciences, Osnabrück University of Applied Sciences, Osnabrück, Germany (SA-O, AISdO-S, NB); Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, Edmonton, Canada (SA-O, NM); Faculty of Health Sciences, Center of Physiotherapy, Universiti Teknologi MARA, Puncak Alam, Malaysia (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 (EMdC-C); and Clinical Research Lab, Department of Physical Therapy, Catholic University of Maule, Talca, Chile (JF)
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D’Souza RS, Her YF, Jin MY, Morsi M, Abd-Elsayed A. Neuromodulation Therapy for Chemotherapy-Induced Peripheral Neuropathy: A Systematic Review. Biomedicines 2022; 10:1909. [PMID: 36009456 PMCID: PMC9405804 DOI: 10.3390/biomedicines10081909] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/31/2022] [Accepted: 08/04/2022] [Indexed: 11/26/2022] Open
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating and painful condition in patients who have received chemotherapy. The role of neuromodulation therapy in treating pain and improving neurological function in CIPN remains unclear and warrants evidence appraisal. In compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a systematic review to assess change in pain intensity and neurological function after implementation of any neuromodulation intervention for CIPN. Neuromodulation interventions consisted of dorsal column spinal cord stimulation (SCS), dorsal root ganglion stimulation (DRG-S), or peripheral nerve stimulation (PNS). In total, 15 studies utilized SCS (16 participants), 7 studies utilized DRG-S (7 participants), and 1 study utilized PNS (50 participants). Per the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria, there was very low-quality GRADE evidence supporting that dorsal column SCS, DRG-S, and PNS are associated with a reduction in pain severity from CIPN. Results on changes in neurological function remained equivocal due to mixed study findings on thermal sensory thresholds and touch sensation or discrimination. Future prospective, well-powered, and comparative studies assessing neuromodulation for CIPN are warranted.
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Affiliation(s)
- Ryan S. D’Souza
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Yeng F. Her
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Max Y. Jin
- Department of Anesthesiology, University of Wisconsin, Madison, WI 53706, USA
| | - Mahmoud Morsi
- Department of Anesthesiology, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL 60621, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin, Madison, WI 53706, USA
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Weerasekara I, Osmotherly PG, Snodgrass SJ, Walmsley S, Tessier J, Rivett DA. Feasibility of Using Detuned Laser as a Placebo In Manual Therapy Research: An Analysis of Participant Perceptions. J Manipulative Physiol Ther 2022; 45:163-169. [PMID: 35753872 DOI: 10.1016/j.jmpt.2022.04.001] [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: 09/11/2020] [Revised: 03/23/2022] [Accepted: 04/02/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the feasibility of using detuned laser as a placebo intervention in manual therapy research. METHODS We performed a secondary data analysis of a randomized controlled trial. In our analysis, 30 participants with chronic ankle instability (manual therapy group: n = 13, age = 33.1 ± 8.1 years, female participants = 50%; detuned laser group: n = 17, age = 31.9 ± 11.8 years, female participants = 72%) were asked to indicate which intervention (manual therapy [active] or detuned laser [placebo]), they thought they had received and to give a confidence rating on their response regarding the received intervention at the conclusion of the course of intervention. Independent t tests were used to compare the groups. Participants in both groups were asked the following open-ended question: "What did you think of the intervention?". RESULTS There were 52.9% participants in the detuned laser group and 53.8% participants in the manual therapy group who perceived that they had received the active intervention. The confidence ratings about their perceptions (6.7 ± 2.0, detuned laser group; 6.3 ± 2.4, manual therapy group) (P = .66) and the self-reported recovery ratings (1.9 ± 1.5 and 1.8 ± 1.2, respectively) (P = .77) were similar. CONCLUSIONS Participants in this study confidently perceived that detuned laser was an active intervention. They positively rated their recovery following the course of the placebo intervention and perceived that detuned laser was effective in treating their condition. Therefore, it is feasible for detuned laser to be used as a placebo for manual therapy trials.
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Affiliation(s)
- Ishanka Weerasekara
- Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Sri Lanka; School of Health Sciences, The University of Newcastle, Callaghan, New South Wales, Australia.
| | - Peter G Osmotherly
- School of Health Sciences, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Suzanne J Snodgrass
- School of Health Sciences, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Sarah Walmsley
- School of Health Sciences, The University of Newcastle, Callaghan, New South Wales, Australia
| | - John Tessier
- School of Health Sciences, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Darren A Rivett
- School of Health Sciences, The University of Newcastle, Callaghan, New South Wales, Australia
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Thibaut A, Beaudart C, Martens G, Bornheim S, Kaux JF. Common Bias and Challenges in Physical and Rehabilitation Medicine Research: How to Tackle Them. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:873241. [PMID: 36189055 PMCID: PMC9397780 DOI: 10.3389/fresc.2022.873241] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022]
Abstract
The importance of evidence-based medicine is crucial, especially in physical and rehabilitation medicine (PRM), where there is a need to conduct rigorous experimental protocols, as in any medical field. Currently, in clinical practice, therapeutic approaches are often based on empirical data rather than evidence-based medicine. However, the field of PRM faces several challenges that may complicate scientific research. In addition, there is often a lack of appropriate research training in educational programs. In this context, we aim to review the methodological challenges in PRM and provide clear examples for each of them as well as potential solutions when possible. This article will cover the following themes: (1) Choosing the right study design and conducting randomized and benchmarking controlled trials; (2). Selecting the appropriate controlled, placebo or sham condition and the issue of blinding in non-pharmacological trials; (3) The impact of populations' heterogeneity and multi-comorbidities; (4). The challenge of recruitment and adherence; (5). The importance of homogeneity and proper quantification of rehabilitative strategies; and (6). Ethical issues. We are convinced that teaching the basics of scientific research in PRM could help physicians and therapists to choose a treatment based on (novel) scientific evidence. It may also promote scientific research in PRM to develop novel and personalized rehabilitation strategies using rigorous methodologies and randomized or benchmarking controlled trials in order to improve patients' management.
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Affiliation(s)
- Aurore Thibaut
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Center du Cerveau 2, University Hospital of Liège, Liège, Belgium
| | - Charlotte Beaudart
- Department of Rehabilitation and Sports Sciences, University of Liège, Liège, Belgium
- World Health Organization Collaborating Center for Public Health Aspects of Musculoskeletal Health and Aging, Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Géraldine Martens
- Department of Rehabilitation and Sports Sciences, University of Liège, Liège, Belgium
- Réseau Francophone Olympique de la Recherche en Médecine du Sport (ReFORM) International Olympic Committee (IOC) Research Center for Prevention of Injury and Protection of Athlete Health, Liège, Belgium
| | - Stephen Bornheim
- Department of Rehabilitation and Sports Sciences, University of Liège, Liège, Belgium
- Department of Physical Medicine and Sports Traumatology, Sports, FIFA Medical Center of Excellence, FIMS Collaborative Center of Sports Medicine, University and University Hospital of Liège, Liège, Belgium
| | - Jean-François Kaux
- Department of Rehabilitation and Sports Sciences, University of Liège, Liège, Belgium
- Réseau Francophone Olympique de la Recherche en Médecine du Sport (ReFORM) International Olympic Committee (IOC) Research Center for Prevention of Injury and Protection of Athlete Health, Liège, Belgium
- Department of Physical Medicine and Sports Traumatology, Sports, FIFA Medical Center of Excellence, FIMS Collaborative Center of Sports Medicine, University and University Hospital of Liège, Liège, Belgium
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15
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Donzelli S, Loss KL, Zaina F, Negrini S. Observational Studies: Specific Considerations for the Physical and Rehabilitation Medicine Physician. Am J Phys Med Rehabil 2022; 101:575-580. [PMID: 35594408 DOI: 10.1097/phm.0000000000001824] [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: 11/25/2022]
Abstract
ABSTRACT The development of high-quality research is desired in all healthcare fields. Experimental and nonexperimental designs are used to investigate the effect or association of an intervention and clinical or surrogate outcome. The aims of these methods are to improve knowledge and to develop new strategies to manage a disease or condition. Randomized clinical trials are considered one of the standard methods to test the efficacy of a new drug or intervention; however, they are costly, have reduced generalizability, and cannot be feasible in all scenarios. Well-designed observational studies can provide valuable information regarding exposure factor and the event under investigation. In physical and rehabilitation medicine, where complex procedures and multiple risk factors can be involved in the same disease, the use of observational study must be planned in detail and a priori to avoid overestimations. In this article, we will give an overview of the methods used for observational design studies in physical and rehabilitation medicine using clinical examples to illustrate each method. We will describe when it is appropriate and how to use the observational studies in different scenarios explaining how to deal with potential bias and confounders using the adequate design and statistical plan for the situation.
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Affiliation(s)
- Sabrina Donzelli
- From the ISICO (Italian Scientific Spine Institute), Milan, Italy (SD, FZ); Heart Institute at Children's Hospital Los Angeles, Los Angeles, California (KLL); Department of Biomedical, Surgical and Dental Sciences, University "La Statale," Milan, Italy (SN); and IRCCS Istituto Ortopedico Galeazzi, Milan, Italy (SN)
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Wang CC, Lo J, Saunders R, Adama E, Bulsara C, Etherton-Beer C, Yang AWH. Light acupuncture and five-element music therapy for nurses' mental health and well-being during and post-COVID-19: protocol for a randomised cross-over feasibility study. BMJ Open 2022; 12:e057106. [PMID: 35487736 PMCID: PMC9058290 DOI: 10.1136/bmjopen-2021-057106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 04/14/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Australian nurses have experienced higher levels of anxiety during the COVID-19 pandemic compared with the prepandemic. This may have affected their long-term mental health and intention to stay in the profession resulting in a workforce shortage, which further impacts the health of the public. Management is urgently required to improve nurses' well-being. However, there is limited evidence available. The proposed clinical trial aims to evaluate the feasibility and therapeutic effects of using a combination of light acupuncture and five-element music therapy to improve nurses' mental health and well-being during and post-COVID-19. METHODS AND ANALYSIS This randomised, single blinding, two-arm cross-over feasibility study involves a 1-week run-in period, 2-week intervention and 1-week run-in period in between interventions. Thirty-six eligible nurses will be recruited from the community and randomised into either a combination of light acupuncture treatment and five-element music therapy group or no treatment group for 2 weeks. After a 1-week run in period, they will be swapped to the different group. The primary outcome of this study is to evaluate the feasibility of a combination of light acupuncture treatment and five-element music therapy to improve nurses' mental health and well-being. The secondary outcomes will include anxiety and depression, work productivity and activity, and quality of life assessments. Participants will be asked to complete a set of online questionnaires throughout the trial period. All analyses will be performed in R Studio V.1.1.463. ETHICS AND DISSEMINATION Ethical approval was attained from Edith Cowan University's Human Research Ethics Committee (No. 2021-02728-WANG). Research findings will be shared with hospitals and in various forms to engage broader audiences, including national and international conferences, presentations, open-access peer-reviewed journal publications, and local community workshop dissemination with healthcare professionals. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry: ACTRN12621000957897p https://www.anzctr.org.au/ACTRN12621000957897p.aspx.
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Affiliation(s)
- Carol Chunfeng Wang
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Johnny Lo
- School of Science, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Rosemary Saunders
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Esther Adama
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Caroline Bulsara
- School of Nursing and Midwifery, University of Notre Dame, Fremantle, Western Australia, Australia
| | | | - Angela Wei Hong Yang
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
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Kim TH, Lee MS, Birch S, Alraek T. Plausible Mechanism of Sham Acupuncture Based on Biomarkers: A Systematic Review of Randomized Controlled Trials. Front Neurosci 2022; 16:834112. [PMID: 35185461 PMCID: PMC8850388 DOI: 10.3389/fnins.2022.834112] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/03/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Sham acupuncture was developed to be used as an inert control intervention in clinical trials of acupuncture. However, controversies exist regarding the validity of sham acupuncture. In this systematic review (SR) of acupuncture trials, we assessed whether serum biomarkers showed significant differences after sham and verum acupuncture treatments. Methods Any acupuncture clinical trials that evaluated serum biomarker changes between sham acupuncture and verum acupuncture were included in this review. Relevant literature was searched in the PubMed database, EMBASE, and The Cochrane Central Register of Controlled Trials (CENTRAL) database from inception until June 2021. The Cochrane risk of bias was assessed. Summary effect estimates for each biomarker between groups were calculated with a random effect model. Results From 51 sham acupuncture trials, we found that there were no significant differences in most of the 36 serum biomarkers after sham acupuncture and verum acupuncture needling. Only VEGF, IG-E, TNF-a, NGF, GABA, NPY, and VIP serum levels were identified as being different between the groups. The overall risk of bias of the included studies and the limited numbers of studies for meta-analysis do not strongly support the results of this SR. Conclusion Sham acupuncture techniques might have similar effects on biomarkers as the so-called “real acupuncture” techniques, which indicates that sham acupuncture, as an inert intervention similar to a placebo drug, needs to be reconsidered. Systematic Review PROSPERO Registration identifier [CRD42021260889].
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Affiliation(s)
- Tae-Hun Kim
- Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Kyung Hee University, Seoul, South Korea
| | - Myeong Soo Lee
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
- *Correspondence: Myeong Soo Lee
| | - Stephen Birch
- School of Health Sciences, Kristiania University College, Oslo, Norway
| | - Terje Alraek
- School of Health Sciences, Kristiania University College, Oslo, Norway
- Department of Community Medicine, Faculty of Medicine, National Research Center in Complementary and Alternative Medicine, UiT the Arctic University of Norway, Tromso, Norway
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The effects of foam rolling on ankle dorsiflexion range of motion in healthy adults: A systematic literature review. J Bodyw Mov Ther 2022; 30:53-59. [DOI: 10.1016/j.jbmt.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 01/30/2022] [Indexed: 11/20/2022]
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Fazeli MS, McIntyre L, Huang Y, Chevalier X. Intra-articular placebo effect in the treatment of knee osteoarthritis: a survey of the current clinical evidence. Ther Adv Musculoskelet Dis 2022; 14:1759720X211066689. [PMID: 35126683 PMCID: PMC8808023 DOI: 10.1177/1759720x211066689] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/23/2021] [Indexed: 01/06/2023] Open
Abstract
Knee osteoarthritis (KOA) is a debilitating disease characterized by chronic pain, stiffness, and decreased mobility. Intra-articular injectable therapies show good clinical efficacy in improving symptoms; however, these therapies and their comparators (intra-articular saline) have been associated with a large underlying placebo effect. We aimed to describe the existing evidence on the challenges, hypotheses, and potential solutions to mitigate the intra-articular placebo effect in clinical trials in KOA. A targeted literature review was conducted by searching Embase, MEDLINE®, and CENTRAL using predefined study selection criteria. All eligible studies identified were extracted for relevant data, and results were narratively summarized. Forty-three studies were included following screening. Challenges associated with the intra-articular placebo effect included its ability to mask the comparative efficacy of active treatments in trials (n = 7 studies), long-lasting effects (up to 6 months; n = 3), and substantial variation of placebo effect sizes across populations (n = 3). Hypotheses for the mechanism of the placebo effect included aspiration of synovial fluid during administration (n = 6) and dilution of inflammatory mediators (n = 2). Factors affecting the placebo effect size were more invasive routes of administration (e.g., injection versus oral; n = 4) and patient expectations (n = 2). Proposed solutions included the suggestion for readers to weigh the relevance of clinical trial evidence against the presence of large underlying placebo effects (n = 9), discontinuation of intra-articular saline as an appropriate placebo (n = 5), and inclusion of 'no treatment' or sham injection as a control (n = 4). The intra-articular placebo effect is a well-documented occurrence in KOA clinical trials, and it is suggested that it be accounted for when designing randomized controlled trials. Awareness and understanding of the intra-articular placebo effect in KOA are required for fair interpretation of clinical trial evidence.
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Affiliation(s)
- Mir Sohail Fazeli
- Evidinno Outcomes Research Inc., 1750 Davie Street, Suites 601 & 602, Vancouver, BC V6G 1W3, Canada
| | | | - Yili Huang
- Northwell Health, New Hyde Park, NY, USA
| | - Xavier Chevalier
- Hôpital Henri Mondor, Université Paris XII, UPEC, Créteil, France
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Meireles CV, Ferreira SF, Avelino PR, Menezes KKPD. Effects of virtual reality training in the upper limb motor coordination of individuals post- stroke: a systematic review with meta-analysis. FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/19039029012022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT After a stroke, 75% of people are affected in their upper limbs, remaining with sequelae at these limbs. Results from recent clinical trials have been contradictory regarding the effectiveness of Virtual Reality (VR) therapy in rehabilitating upper limb motor coordination in this population. This study aimed to perform a systematic literature review with meta-analysis to investigate the effects of VR training on upper limb motor coordination in patients post-stroke. Searches were performed in the electronic databases PubMed, LILACS, SciELO, PEDro, in addition to manual searches. The whole process was performed by two independent raters. The methodological quality of the studies was assessed by the PEDro scale. In total, we selected 18 studies, out of which only 13 were included in the meta-analysis. In general, VR training was effective in improving upper limb motor coordination (SMD 0.32; 95% CI 0.08-0.56; I2=42%; p<0.01). When subgroup analysis assessed control group type, VR training was superior than no intervention (SMD 0.36; 95% CI: 0.06-0.66; p<0.05). However, when compared to other interventions, we found no significant difference (SMD 0.26; 95% CI: −0.12-0.64; p=0.18). Overall, VR training is effective in improving upper limb motor coordination in post-stroke individuals compared to no intervention. However, it shows no superiority when compared to other types of intervention used in the rehabilitation of upper limb motor coordination in these patients.
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Diarbakerli E, Thoreson O, Björklund M, Dahlberg LE, Englund M, Gerdhem P, Kvist J, Mohaddes M, Peolsson A, Rolfson O, Öberg B, Abbott A. Learning from the past to plan for the future: A scoping review of musculoskeletal clinical research in Sweden 2010-2020. Ups J Med Sci 2022; 127:8709. [PMID: 36337277 PMCID: PMC9602198 DOI: 10.48101/ujms.v127.8709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The aims of this study are to 1) determine the scope of musculoskeletal (MSK)-related clinical research in Sweden; 2) collate the amount of first-tier funding received; 3) discuss strategies and infrastructure supporting future MSK clinical trials in Sweden. METHODS A systematic scoping review protocol was applied in PubMed, Scopus, and SweCRIS databases. The articles were examined, and data were extracted in multiple stages by three blinded authors. RESULTS The search strategy resulted in 3,025 publications from 479 Swedish-affiliated authors. Primary health care was the basis for 14% of the publications, 84% from secondary health care, and 2% from occupational health care with a similar proportional distribution of first-tier research grant financing. Approximately one in six publications were randomized controlled trials (RCTs), while the majority were of observational cohort design. The majority of publications in primary and occupational health care were related to pain disorders (51 and 67%, respectively), especially diagnosis, prognosis, and healthcare organizational-related interventions (34%) and rehabilitation (15%) with similar proportional distribution of first-tier research grant financing. In secondary health care, rheumatic inflammatory disorder-related publications were most prevalent (30%), most frequently concerning diagnosis, prognosis, and healthcare organizational-related interventions (20%), attracting approximately half of all first-tier funding. Publications related to degenerative joint disorders (25%), fractures (16%), and joint, tendon, and muscle injuries (13%) frequently concerned surgical and other orthopedic-related interventions (16, 6, and 8%, respectively). Pain disorder-related publications (10%) as well as bone health and osteoporosis-related publications (4%) most frequently concerned diagnosis, prognosis, and healthcare organizational-related interventions (5 and 3%, respectively). CONCLUSIONS Swedish-affiliated MSK disorder research 2010-2020 was predominantly observational cohort rather than RCT based. There was skewed first-tier funding allocation considering prevalence/incidence and burden of disease. Use of infrastructure supporting register-based RCTs, placebo-controlled RCTs, and hybrid effectiveness-implementation studies on prevention and clinical intervention is important strategies for the future in all healthcare sectors.
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Affiliation(s)
- Elias Diarbakerli
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
| | - Olof Thoreson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Björklund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
- Centre for Musculoskeletal Research, Department of Occupational Health Sciences and Psychology, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
| | - Leif E Dahlberg
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
| | - Martin Englund
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Paul Gerdhem
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
| | - Joanna Kvist
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine & Surgery, Karolinska Institute, Solna, Sweden
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University
| | - Maziar Mohaddes
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anneli Peolsson
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University
- Occupational and Environmental Medicine Center, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Linköping University, Linköping, Sweden
| | - Ola Rolfson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Birgitta Öberg
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University
| | - Allan Abbott
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University
- Department of Orthopaedics, Linköping University Hospital, SE 581 83 Linköping, Sweden
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Meireles CV, Ferreira SF, Avelino PR, Menezes KKPD. Efeitos do treino de realidade virtual na coordenação motora dos membros superiores de indivíduos após acidente vascular encefálico: uma revisão sistemática com meta-análise. FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/19039029012022pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Após um acidente vascular encefálico (AVE), 75% das pessoas tem o membro superior acometido, permanecendo com sequelas nessa extremidade. Resultados de ensaios clínicos recentes são contraditórios quanto à eficácia da terapia de realidade virtual (RV) na reabilitação da coordenação motora dos membros superiores dessa população. Assim, o objetivo deste trabalho foi realizar uma revisão sistemática da literatura, com meta-análise, a fim de investigar os efeitos do treinamento com RV na coordenação motora dos membros superiores em pacientes pós-AVE. Para isso, foram feitas buscas nas bases de dados PubMed, LILACS, SciELO, PEDro e buscas manuais. Esse processo foi realizado por dois avaliadores independentes, e a qualidade metodológica dos estudos foi avaliada pela escala PEDro. Foram selecionados 18 estudos, sendo que apenas 13 foram incluídos na meta-análise. De forma geral, o treino de RV se mostrou eficaz na melhora da coordenação motora dos membros superiores da população (SMD 0,32; IC95% 0,08 a 0,56; I2=42%; p<0,01). Após uma análise de subgrupos, o treino de RV demonstrou ser superior quando comparado a nenhuma intervenção (SMD 0,36; IC95% 0,06 a 0,66; p<0,05). No entanto, quando comparado a outras intervenções, não houve diferença significativa (SMD 0,26; IC95% −0,12 a 0,64; p=0,18). De forma geral, o treino de RV é eficaz na melhora da coordenação motora dos membros superiores de indivíduos pós-AVE em comparação a nenhuma intervenção. No entanto, não é superior quando comparado a outros tipos de intervenção utilizados na reabilitação da coordenação motora dos membros superiores dos pacientes.
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Pérez-Llanes R, Ruiz-Cárdenas JD, Meroño-Gallut AJ, Fernández-Calero MI, Ríos-Díaz J. Effectiveness of suboccipital muscle inhibition combined with interferential current in patients with chronic tension-type headache: a randomised controlled clinical trial. NEUROLOGÍA (ENGLISH EDITION) 2021; 37:717-725. [PMID: 34583886 DOI: 10.1016/j.nrleng.2019.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 12/12/2019] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Manual therapy has been shown to reduce self-reported symptoms in patients with chronic tension-type headache (CTTH). However, simultaneous application of suboccipital muscle inhibition and interferential current has not previously been investigated. This study evaluates the effectiveness of combined treatment with suboccipital muscle inhibition and interferential current compared to standard treatment for pain, disability, and headache impact in patients with CTTH. METHODS Patients were randomly allocated to receive either standard treatment (n = 13) or the experimental treatment (n = 12), consisting of 20 minutes of suboccipital muscle inhibition plus interferential current twice weekly for 4 weeks. The primary outcome was improvement in pain, and secondary outcomes included improvement in headache-related disability and reduction in headache impact, which were assessed at baseline and at 4 weeks by a blinded rater. RESULTS Statistical analysis showed improvements in the experimental treatment group at 4 weeks for headache-related disability (Neck Disability Index: Hedges' g = 1.01, P = .001; and Headache Disability Inventory: Hedges' g = 0.48, P = .022) and headache impact (6-item Headache Impact Test: Hedges' g = 0.15, P = .037) but not for self-reported pain (numerical rating scale: Hedges' g = 1.13, P = .18). CONCLUSIONS Combined treatment with suboccipital muscle inhibition and interferential current in patients with CTTH did not significantly improve self-reported pain but did reduce disability and the impact of headache on daily life at 4 weeks. These improvements exceed the minimum clinically important difference, demonstrating the clinical relevance of our findings.
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Affiliation(s)
- R Pérez-Llanes
- Physical Therapy Department, Faculty of Health Sciences, Catholic University of Murcia, Murcia, Spain
| | - J D Ruiz-Cárdenas
- ECOFISTEM Research Group Physical Therapy Department, Faculty of Health Sciences, Catholic University of Murcia, Murcia, Spain.
| | | | - M I Fernández-Calero
- INGRIS Research Group, Physical Therapy Department, Faculty of Health Sciences, Catholic University of Murcia, Murcia, Spain
| | - J Ríos-Díaz
- Physical Therapy Research Group (INFIS), Fundación San Juan de Dios, Centro de Ciencias de la Salud San Rafael, Universidad Antonio de Nebrija, Madrid, Spain
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Birch S, Lee MS, Kim TH, Alraek T. Historical perspectives on using sham acupuncture in acupuncture clinical trials. Integr Med Res 2021; 11:100725. [PMID: 34458094 PMCID: PMC8379290 DOI: 10.1016/j.imr.2021.100725] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/05/2021] [Accepted: 03/23/2021] [Indexed: 11/17/2022] Open
Abstract
Background Trials of acupuncture in the West began before textbooks about acupuncture were generally available. This placed trials at risk of possible faulty assumptions about the practice of acupuncture and adoption of problematic research assumptions and methods. Further, this lack of information has had an influence on the theories of developing a valid and reliable sham control treatment in clinical trials of acupuncture. This commentary explores these issues. Methods Literature review focussing on the time line of developments in the field, developments of sham interventions and use thereof and knowledge of physiological effects of needling. Results Early trials demonstrated a lack of knowledge about acupuncture. As the methodology of trials improved, new sham treatment methods were developed and adopted; however, the sham treatment methods were implemented without physiological studies exploring their potential physiological effects and without examining the broader practice of acupuncture internationally. Conclusions Mistaken assumptions about the practice of acupuncture reinforced by paucity of physiological investigations are factors that led to use of inappropriate sham interventions for acupuncture trials. These not only lead to confusing or misleading trial results, they, as far as we can see underestimate the effects of acupuncture leading to bias against acupuncture. There are significant problems with sham interventions and how they are applied in trials of acupuncture. Further research is needed to explore the effects of this both for future trials and for interpreting existing evidence.
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Affiliation(s)
- Stephen Birch
- School of Health Sciences, Kristiania University College, Oslo, Norway
| | - Myeong Soo Lee
- Division of Clinical Medicine, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Tae-Hun Kim
- Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Kyung Hee University, Seoul, Republic of Korea
| | - Terje Alraek
- School of Health Sciences, Kristiania University College, Oslo, Norway.,Department of Community Medicine, Faculty of Medicine, National Research Center in Complementary and Alternative Medicine, UiT The Arctic University of Norway, Tromso, Norway
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Exercise Therapy is Effective for Improvement in Range of Motion, Function, and Pain in Patients With Frozen Shoulder: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2021; 103:998-1012.e14. [PMID: 34425089 DOI: 10.1016/j.apmr.2021.07.806] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE(S) To determine (1) the effect of exercise therapy alone or in combination with other interventions compared with solely exercises and programs with or without exercises and (2) what kind of exercise therapy or combination with other interventions is most effective. DATA SOURCES PubMed, Web of Science and Cochrane Central Register of Controlled Trials. STUDY SELECTION Studies were screened in a 2-phase approach by 2 independent reviewers (M.M. and L.M.). Reference lists of included studies and interesting systematic reviews were hand searched. DATA EXTRACTION Two independent reviewers (M.M. and L.M.) extracted information about origin, characteristics of study participants, eligibility criteria, characteristics of interventions, outcome measures and main results in a pre-defined template. DATA SYNTHESIS Thirty-three studies were included in the qualitative and 19 in the meta-analysis. Preliminary evidence was found for supervised exercises to be more beneficial than home exercises for ROM and function. Multimodal programs comprising exercises may result in little to no difference in ROM compared to solely exercises. Programs comprising muscle energy techniques show little to no difference in ROM when compared with programs with other exercises. Adding stretches to a multimodal program with exercises may increase ROM. There is uncertain evidence that there is a difference between those programs regarding function and pain. Preliminary evidence was found for several treatment programs including exercises to be beneficial for improvement in both passive and active ROM, function, pain, and muscle strength. No studies used patient satisfaction as an outcome measure. CONCLUSIONS ROM, function, and pain improve with both solely exercises and programs with exercises, but for ROM and pain there was little to no difference between programs and for function the evidence was uncertain. Adding exercises improve active ROM compared with a program without exercises, whereas adding physical modalities has no beneficial effect. Muscle energy techniques are a beneficial type of exercise therapy for improving function compared with other types of exercise. Unfortunately, no conclusion can be drawn about the results in the long-term and most effective dose of exercise therapy.
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26
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Franzoni L, Zubaran GPDR, da Motta SB. Walking Training Improve Ambulatorial Blood Pressure Variability in Claudicants. Arq Bras Cardiol 2021; 116:906-907. [PMID: 34008812 PMCID: PMC8121462 DOI: 10.36660/abc.20210140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Leandro Franzoni
- Universidade Federal do Rio Grande do SulPorto AlegreRSBrasilUniversidade Federal do Rio Grande do Sul - Programa de Pós-Graduação em Ciências da Saúde: Cardiologia e Ciências Cardiovasculares, Porto Alegre, RS - Brasil
| | - Gabriel Pereira de Reis Zubaran
- Hospital de Clínicas de Porto AlegrePorto AlegreRSBrasilHospital de Clínicas de Porto Alegre - Grupo de Pesquisa em Cardiologia do Exercício, Porto Alegre, RS - Brasil
| | - Stephanie Bastos da Motta
- Hospital de Clínicas de Porto AlegrePorto AlegreRSBrasilHospital de Clínicas de Porto Alegre - Grupo de Vascular e Exercício - VascuEx, Porto Alegre, RS - Brasil
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27
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Liu X, Lu J, Wang G, Chen X, Xv H, Huang J, Xue M, Tang J. Acupuncture for Arthralgia Induced by Aromatase Inhibitors in Patients with Breast Cancer: A Systematic Review and Meta-analysis. Integr Cancer Ther 2021; 20:1534735420980811. [PMID: 33586504 PMCID: PMC7883140 DOI: 10.1177/1534735420980811] [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] [Indexed: 01/21/2023] Open
Abstract
Background: Aromatase inhibitor-induced arthralgia (AIA) is the most common side effect of aromatase inhibitors (AIs) used in breast cancer patients and is related to the rate of adherence to AIs. The clinical effects of acupuncture on AIA have been assessed by some randomized controlled trials (RCTs). However, some studies reported that acupuncture was effective, while others claimed that it was ineffective. To clarify the clinical and placebo effects of acupuncture in treating AIA, we conducted this meta-analysis. Methods: Two reviewers (XL and GW) independently searched for RCTs in 5 English databases (PubMed, Web of Science, Embase, Springer, Cochrane Library) and 4 Chinese databases (China National Knowledge Infrastructure Database (CNKI), SinoMed, VIP and Wanfang Database) from their inception to 30 November 2019. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this meta-analysis was performed by fixed or random-effects models, and data were pooled with mean differences (MDs). Results: Seven trials involving 603 patients were reviewed. The primary outcome, the Brief Pain Inventory (BPI) score, significantly differed between the acupuncture and control groups [pain-related interference: MD = −1.89, 95% confidence interval (CI) [−2.99, −0.79], Z = 3.36 (P = .008 < .05), pain severity: MD = −1.57, 95% CI [−2.46, −0.68], Z = 3.45 (P = .0006 < .05), worst pain: MD = −2.31, 95% CI [−3.15, −1.48], Z = 5.47 (P < .0001 < .05)]. No severe adverse events were reported in any study. Conclusion: This meta-analysis showed that acupuncture is a safe and effective treatment for breast cancer patients with AIA. Additional research with improved blinding methods is warranted to further explore the nature of non-specific and placebo effects in true and sham acupuncture.
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Affiliation(s)
- Xiaomeng Liu
- Nanjing University of Chinese Medicine, Nanjing, People's Republic of China.,The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Jing Lu
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Guoxin Wang
- Nanjing University of Chinese Medicine, Nanjing, People's Republic of China
| | - Xiu Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Haiping Xv
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Jing Huang
- Third Affiliated Hospital of Kunming Medical University, Kunming, People's Republic of China
| | - Mingxin Xue
- Nanjing University of Chinese Medicine, Nanjing, People's Republic of China.,The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Jinhai Tang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
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28
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Ranker A, Weigl M. Microcurrent therapy - more transparency is needed in used parameters. Clin Rehabil 2021; 35:1073-1074. [PMID: 33508950 DOI: 10.1177/0269215521991753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Alexander Ranker
- Department of Rehabilitation Medicine, Hannover Medical School, Hannnover, Germany
| | - Martin Weigl
- Department of Orthopedics, Physical Medicine and Rehabilitation, Ludwig Maximilians University of Munich, Munich, Germany
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29
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Alighieri C, Bettens K, Bruneel L, D'haeseleer E, Van Gaever E, Van Lierde K. Effectiveness of Speech Intervention in Patients With a Cleft Palate: Comparison of Motor-Phonetic Versus Linguistic-Phonological Speech Approaches. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:3909-3933. [PMID: 33253622 DOI: 10.1044/2020_jslhr-20-00129] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The purpose of this study was to compare the effect of two different speech therapy approaches, a traditional motor-phonetic approach and a linguistic-phonological approach, on the speech and health-related quality of life in Dutch-speaking children with a cleft palate with or without a cleft lip (CP ± L) between 4 and 12 years old. Method A block-randomized, sham-controlled design was used. Fourteen children with a CP ± L (M age = 7.71 years) were divided into two groups using block randomization stratified by age and gender: one receiving motor-phonetic intervention (n = 7) and one receiving linguistic-phonological intervention (n = 7). Each group received 10 hr of speech therapy divided over 2 weeks. Perceptual speech assessments were performed on several baseline and posttreatment data points. The psychosocial effects of the intervention were assessed using the patient-reported Velopharyngeal Insufficiency Effects on Life Outcomes questionnaire. Both groups were compared over time using (generalized) linear mixed models. Within-group effects of time were determined using pairwise comparisons with post hoc Bonferroni correction. Results Significant Time × Group interactions with large effect sizes were revealed in terms of consonant proficiency, indicating significant differences in evolution over time among the two groups. Only in the group receiving linguistic-phonological intervention, percentage of correctly produced consonants and places significantly improved after the treatment. Total Velopharyngeal Insufficiency Effects on Life Outcomes scores of the parents significantly improved in both groups after the intervention. Conclusions Both motor-phonetic and linguistic-phonological speech interventions can have a positive impact on the occurrence of cleft speech characteristics and consonant proficiency in children with a CP ± L. A linguistic-phonological approach, however, was observed to be more effective in terms of improving these speech outcomes compared with a motor-phonetic approach. Speech intervention, irrespective of the used approach, significantly improved the participant's health-related quality of life.
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Affiliation(s)
| | - Kim Bettens
- Department of Rehabilitation Sciences, Ghent University, Belgium
| | - Laura Bruneel
- Department of Rehabilitation Sciences, Ghent University, Belgium
| | | | - Ellen Van Gaever
- Department of Rehabilitation Sciences, Ghent University, Belgium
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30
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Husted RS, Juhl C, Troelsen A, Thorborg K, Kallemose T, Rathleff MS, Bandholm T. The relationship between prescribed pre-operative knee-extensor exercise dosage and effect on knee-extensor strength prior to and following total knee arthroplasty: a systematic review and meta-regression analysis of randomized controlled trials. Osteoarthritis Cartilage 2020; 28:1412-1426. [PMID: 32890744 DOI: 10.1016/j.joca.2020.08.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 08/17/2020] [Accepted: 08/26/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this systematic review was to evaluate the relationship between prescribed knee-extensor strength exercise dosage in pre-operative exercise intervention and the effect on knee-extensor muscle strength prior to and following TKA. Additional meta-analyses report the effect of pre-habilitation on outcomes prior to and following TKA. DESIGN A systematic literature search was performed including RCT's evaluating the effect of pre-operative exercise prior to and following TKA. Meta-regression analysis was performed to evaluate the dose-response relationship between prescribed exercise dose and the pooled effect, measured as standardized mean difference (SMD). The prescribed exercise dose was quantified using a formula accounting for as many exercise descriptors as possible. Risk of bias in the included trials was assessed using the Cochrane Risk of Bias Tool. RESULTS Twelve trials with 616 patients were included. Meta-regression analysis showed no relationship between prescribed pre-operative knee-extensor exercise dosage and change in knee-extensor strength neither prior to (slope 0.0005 [95%CI -0.007 to 0.008]) or 3 months following TKA (slope 0.0014 [95%CI -0.006 to 0.009]). Prior to TKA, a moderate effect favoring pre-operative exercise for increase in knee-extensor strength was found (SMD 0.50 [95%CI 0.12 to 0.88]), but not at 3 months following TKA (SMD -0.01 [95%CI -0.45 to 0.43]). Risk of bias was generally assessed as unclear. CONCLUSION Meta-regression analysis of existing trials suggests no relationship between the prescribed pre-operative knee-extensor exercise dosage and the change in knee-extensor strength observed prior to and following TKA. Pre-operative exercise including knee-extensor muscle strength exercise increased knee-extensor strength moderately prior to but not 3 months following TKA. PROTOCOL REGISTRATION PROSPERO ID (CRD42018076308) (http://www.crd.york.ac.uk/PROSPERO/).
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Affiliation(s)
- R S Husted
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C) Department of Physical and Occupational Therapy Clinical Research Centre Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Clinical Orthopedic Research Hvidovre (CORH), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
| | - C Juhl
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - A Troelsen
- Clinical Orthopedic Research Hvidovre (CORH), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
| | - K Thorborg
- Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C) Department of Physical and Occupational Therapy Clinical Research Centre Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Sports Orthopaedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
| | - T Kallemose
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
| | - M S Rathleff
- Center for General Practice at Aalborg University, Aalborg, Denmark; Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark; Department of Health Science and Technology, Aalborg University, Denmark.
| | - T Bandholm
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C) Department of Physical and Occupational Therapy Clinical Research Centre Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
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31
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Monroe JC, Lin C, Perkins SM, Han Y, Wong BJ, Motaganahalli RL, Roseguini BT. Leg heat therapy improves perceived physical function but does not enhance walking capacity or vascular function in patients with peripheral artery disease. J Appl Physiol (1985) 2020; 129:1279-1289. [PMID: 33002377 DOI: 10.1152/japplphysiol.00277.2020] [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: 12/17/2022] Open
Abstract
A single session of leg heat therapy (HT) has been shown to elicit increases in leg blood flow and reduce blood pressure (BP) and the circulating levels of endothelin-1 (ET-1) in patients with symptomatic peripheral artery disease (PAD). We assessed whether 6 wk of supervised leg HT (3 times/wk) with water-circulating trousers perfused with water at 48°C improved 6-min walk distance in individuals with PAD compared with a sham treatment. Secondary outcomes included the assessment of leg vascular function, BP, quality of life, and serum ET-1 and nitrite plus nitrate (NOx) levels. Of 32 PAD patients randomized, 30 [age: 68 ± 8 yr; ankle-brachial index (ABI): 0.6 ± 0.1] completed the 3- and 6-wk follow-ups. Participants completed 98.7% of the treatment sessions. Compared with the sham treatment, exposure to HT did not improve 6-min walk distance, BP, popliteal artery reactive hyperemia, cutaneous microvascular reactivity, resting ABI, or serum NOx levels. The change from baseline to 6 wk in scores of the physical functioning subscale of the 36-item Short Form Health Survey was significantly higher in the HT group (control -6.9 ± 10 vs. HT 6.8 ± 15; 95% confidence interval: 2.5-24.3, P = 0.017). Similarly, the change in ET-1 levels after 6 wk was different between groups, with the HT group experiencing a 0.4 pg/mL decrease (95% confidence interval: -0.8-0.0, P = 0.03). These preliminary results indicate that leg HT may improve perceived physical function in symptomatic PAD patients. Additional, larger studies are needed to confirm these findings and determine the optimal treatment regimen for symptomatic PAD patients.NEW & NOTEWORTHY This is the first sham-controlled study to investigate the effects of leg heat therapy (HT) on walking performance, vascular function, and quality of life in patients with peripheral artery disease (PAD). Adherence to HT was high, and the treatment was well tolerated. Our findings revealed that HT applied with water-circulating trousers evokes a clinically meaningful increase in perceived physical function and reduces the serum concentration of the potent vasoconstrictor endothelin-1 in patients with PAD.
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Affiliation(s)
- Jacob C Monroe
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana
| | - Chen Lin
- Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Susan M Perkins
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Yan Han
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Brett J Wong
- Department of Kinesiology and Health, Georgia State University, Atlanta, Georgia
| | - Raghu L Motaganahalli
- Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Bruno T Roseguini
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana
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A systematic review highlights the need to improve the quality and applicability of trials of physical therapy interventions for low back pain. J Clin Epidemiol 2020; 126:106-115. [DOI: 10.1016/j.jclinepi.2020.06.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/10/2020] [Accepted: 06/23/2020] [Indexed: 11/22/2022]
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Exploratory analysis of randomized clinical trials in physiotherapy aimed at improving walking speed after stroke. Int J Rehabil Res 2020; 43:361-368. [DOI: 10.1097/mrr.0000000000000426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Alvarez G, Solà I, Sitjà-Rabert M, Fort-Vanmeerhaeghe A, Gich I, Fernández C, Bonfill X, Urrútia G. A methodological review revealed that reporting of trials in manual therapy has not improved over time. J Clin Epidemiol 2020; 121:32-44. [DOI: 10.1016/j.jclinepi.2020.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 01/08/2020] [Accepted: 01/15/2020] [Indexed: 12/12/2022]
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Pérez-Llanes R, Ruiz-Cárdenas JD, Meroño-Gallut AJ, Fernández-Calero MI, Ríos-Díaz J. Effectiveness of suboccipital muscle inhibition combined with interferential current in patients with chronic tension-type headache: a randomised controlled clinical trial. Neurologia 2020; 37:S0213-4853(20)30042-6. [PMID: 32345452 DOI: 10.1016/j.nrl.2019.12.004] [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: 06/26/2019] [Revised: 10/24/2019] [Accepted: 12/12/2019] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Manual therapy has been shown to reduce self-reported symptoms in patients with chronic tension-type headache (CTTH). However, simultaneous application of suboccipital muscle inhibition and interferential current has not previously been investigated. This study evaluates the effectiveness of combined treatment with suboccipital muscle inhibition and interferential current compared to standard treatment for pain, disability, and headache impact in patients with CTTH. METHODS Patients were randomly allocated to receive either standard treatment (n = 13) or the experimental treatment (n = 12), consisting of 20 minutes of suboccipital muscle inhibition plus interferential current twice weekly for 4 weeks. The primary outcome was improvement in pain, and secondary outcomes included improvement in headache-related disability and reduction in headache impact, which were assessed at baseline and at 4 weeks by a blinded rater. RESULTS Statistical analysis showed improvements in the experimental treatment group at 4 weeks for headache-related disability (Neck Disability Index: Hedges' g = 1.01, P = .001; and Headache Disability Inventory: Hedges' g = 0.48, P = .022) and headache impact (6-item Headache Impact Test: Hedges' g = 0.15, P = .037) but not for self-reported pain (numerical rating scale: Hedges' g = 1.13, P = .18). CONCLUSIONS Combined treatment with suboccipital muscle inhibition and interferential current in patients with CTTH did not significantly improve self-reported pain but did reduce disability and the impact of headache on daily life at 4 weeks. These improvements exceed the minimum clinically important difference, demonstrating the clinical relevance of our findings.
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Affiliation(s)
- R Pérez-Llanes
- Physical Therapy Department, Faculty of Health Sciences, Catholic University of Murcia, Murcia, Spain
| | - J D Ruiz-Cárdenas
- ECOFISTEM Research group Physical Therapy Department, Faculty of Health Sciences, Catholic University of Murcia, Murcia, Spain.
| | | | - M I Fernández-Calero
- INGRIS Research group, Physical Therapy Department, Faculty of Health Sciences, Catholic University of Murcia, Murcia, Spain
| | - J Ríos-Díaz
- Physical Therapy Research Group (INFIS), Fundación San Juan de Dios, Centro de Ciencias de la Salud San Rafael, Universidad Antonio de Nebrija, Madrid, España
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Ranker A, Husemeyer O, Cabeza-Boeddinghaus N, Mayer-Wagner S, Crispin A, Weigl MB. Microcurrent therapy in the treatment of knee osteoarthritis: could it be more than a placebo effect? A randomized controlled trial. Eur J Phys Rehabil Med 2020; 56:459-468. [PMID: 32293810 DOI: 10.23736/s1973-9087.20.05921-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Microcurrent therapy (MCT) is a novel electrotherapy modality with very low current-levels that may reduce pain especially in joints and muscles. AIM The aim of this study is to explore potential effects of MCT on pain in patients with knee osteoarthritis, to explore effects of different treatment parameters and to distinguish them from placebo-effects. DESIGN Randomized four arms controlled clinical trial. SETTING Outpatient tertiary medical care center. POPULATION Fifty-six patients with knee OA (Kellgren-Lawrence Score II or III, 14 male and 38 female, mean age: 71.7±7.3 years, pain intensity higher than Numeric Rating Scale [NRS] score 3 from 10). METHODS Patients were randomized into four groups: MCT with 100 µA (group A), MCT with 25 µA (group B), sham-treatment (group C) and a control-group without intervention. Treatment groups received 10 sessions of MCT for 30 minutes each over a period of 22 days. The primary outcome was daily pain intensity throughout the treatment period measured by a NRS from 0-10. Second outcome measurements were the Knee Osteoarthritis Outcome Score (KOOS), the SF-36 Questionnaire, the Six-Minute Walking Test and the Get-Up-and-Go Test. RESULTS Evening pain was reduced significantly in the verum-groups compared to sham group (Group A vs. Group C: P<0.001, Group B vs. Group C: P=0.006) and to no intervention (Group A vs. Group D: P<0.001, Group B vs. Group D: P=0.002). The difference between sham-therapy and no therapy was not significant. In the pre-post analysis of the KOOS group A improved significantly in the subscale Symptoms. Group A and B and D improved in the Activities of Daily Living subscale. CONCLUSIONS The results of this RCT suggest that MCT has beneficial effects on pain in patients with knee osteoarthritis that are not explained by a placebo effect. Due to the explorative, pilot character of the study, further confirmation is needed before clear recommendations can be given. CLINICAL REHABILITATION IMPACT More high-quality RCTs with transparent parameters should be investigated to elucidate potential effects of MCT in the field of physical medicine and rehabilitation. At the present time MCT is a treatment option that could be helpful, in particular for patients who are afraid of unpleasant sensations from electrotherapy with stronger currents.
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Affiliation(s)
- Alexander Ranker
- Department of Orthopedics, Physical Medicine, and Rehabilitation, University Hospital, Ludwig Maximilian University of Munich (LMU), Munich, Germany -
| | - Ole Husemeyer
- Department of Orthopedics, Physical Medicine, and Rehabilitation, University Hospital, Ludwig Maximilian University of Munich (LMU), Munich, Germany
| | - Natalia Cabeza-Boeddinghaus
- Department of Orthopedics, Physical Medicine, and Rehabilitation, University Hospital, Ludwig Maximilian University of Munich (LMU), Munich, Germany
| | - Susanne Mayer-Wagner
- Department of Orthopedics, Physical Medicine, and Rehabilitation, University Hospital, Ludwig Maximilian University of Munich (LMU), Munich, Germany
| | - Alexander Crispin
- Institute for Medical Information Processing, Biometry, and Epidemiology, University Hospital, Ludwig Maximilian University of Munich (LMU), Munich, Germany
| | - Martin B Weigl
- Department of Orthopedics, Physical Medicine, and Rehabilitation, University Hospital, Ludwig Maximilian University of Munich (LMU), Munich, Germany
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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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Treatment of Symptomatic Convergence Insufficiency in Children Enrolled in the Convergence Insufficiency Treatment Trial-Attention & Reading Trial: A Randomized Clinical Trial. Optom Vis Sci 2020; 96:825-835. [PMID: 31651593 PMCID: PMC6855327 DOI: 10.1097/opx.0000000000001443] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
SIGNIFICANCE These data confirm the effectiveness of office-based vergence/accommodative therapy for improving convergence in children with symptomatic convergence insufficiency. They also highlight the importance of using a primary outcome measure that is as objective as possible rather than relying solely on self-reported symptoms for studies of binocular vision in children. PURPOSE The purpose of this study was to report changes in clinical signs and symptoms of convergence insufficiency (secondary outcome measures) from a multicenter clinical trial (Convergence Insufficiency Treatment Trial–Attention & Reading Trial [CITT-ART]) evaluating the effectiveness of vergence/accommodative therapy for improving reading and attention in children with symptomatic convergence insufficiency. METHODS Three hundred eleven children aged 9 to 14 years with symptomatic convergence insufficiency were randomly assigned to 16 weeks of office-based vergence/accommodative therapy or to placebo therapy. Improvements in (1) near point of convergence (NPC), (2) positive fusional vergence (PFV), and (3) self-reported symptoms (Convergence Insufficiency Symptom Survey [CISS] score) were compared after 16 weeks of treatment. RESULTS Mean NPC improved 10.4 cm in the vergence/accommodative and 6.2 cm in the placebo therapy group (mean difference of −4.2 cm [95% confidence interval {CI}, −5.2 to −3.2 cm; P < .001]); mean PFV increased 23.2 and 8.8Δ in the vergence/accommodative and placebo therapy groups, respectively (mean difference of 14.4Δ [95% CI, 12.1 to 16.8Δ; P < .001]). The mean CISS score improved 11.8 and 10.4 points in the vergence/accommodative and placebo therapy groups, respectively (mean difference of 1.5 points [95% CI, −3.8 to +0.8 points; P = .21]). CONCLUSIONS Our results demonstrate that office-based vergence/accommodative therapy is effective for improving the NPC and PFV in children with symptomatic convergence insufficiency. However, given that both treatment groups had a similar reduction in self-reported symptoms, it may not be prudent to use the CISS alone as a measure of successful treatment.
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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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Neuwersch-Sommeregger S, Köstenberger M, Pipam W, Breschan C, Stettner H, Demschar S, Trummer B, Likar R. [Electrical muscle stimulation in combination with heat for patients with chronic, nonspecific low back pain : A randomized, double-blind, stratified, placebo-controlled clinical trial]. Schmerz 2019; 34:65-73. [PMID: 31784906 DOI: 10.1007/s00482-019-00431-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chronic non-specific low back pain (LBP) causes more disability than any other medical condition worldwide. Electrical muscle stimulation in combination with heat (EMS/H) for management of LBP has yet not been properly studied. Our hypothesis was that EMS/H provides better pain relief and improves subjective and objective data compared to standard treatment. METHODS Between 2015 and 2017, we conducted a 6 week randomized, double-blind, stratified, placebo controlled clinical trial, comparing two different forms of EMS/H with placebo treatment with a follow-up 12 weeks after randomization. Patients >18 years with LBP for >6 months and a pain intensity of numerical rating scale (NRS) ≥4/10 were enrolled. RESULTS A total of 100 patients were recruited. Patients were representative of a LBP population with moderate to severe pain (NRS 5.7/10). After 18 treatments, we found a statistically significant pain reduction, which was also observed at the 12 week follow-up. CONCLUSION EMS/H is an effective and safe method for managing LBP. A clinically relevant and persisting pain reduction, a stable decrease in self-perceived disability, an improvement in both mood and affective characterization as well as sensory characterization of pain, muscle strength and endurance may have a significant impact on the management of LBP.
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Affiliation(s)
- Stefan Neuwersch-Sommeregger
- Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Österreich.
- Medizinische Universität Graz, Graz, Österreich.
| | - Markus Köstenberger
- Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Österreich
- Medizinische Universität Graz, Graz, Österreich
| | - Wolfgang Pipam
- Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Österreich
| | - Christian Breschan
- Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Österreich
| | - Haro Stettner
- Institut für Statistik, Alpen-Adria-Universität Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Österreich
| | - Susanne Demschar
- Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Österreich
| | - Brigitte Trummer
- Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Österreich
| | - Rudolf Likar
- Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Österreich
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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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Cai L, He L. Placebo effects and the molecular biological components involved. Gen Psychiatr 2019; 32:e100089. [PMID: 31552390 PMCID: PMC6738668 DOI: 10.1136/gpsych-2019-100089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/18/2019] [Accepted: 07/30/2019] [Indexed: 12/20/2022] Open
Abstract
Pharmacologically inactive substances have been used in medicine for more than 700 years and can trigger beneficial responses in the human body, which is referred to as the placebo effects or placebo responses. This effect is robust enough to influence psychosocial and physiological responses to the placebo and to active treatments in many settings, which has led to increased interest from researchers. In this article, we summarise the history of placebo, the characteristics of placebo effects and recent advancements reported from the studies on placebo effects and highlight placebome studies to identify various molecular biological components associated with placebo effects. Although placebos have a long history, the placebome concept is still in its infancy. Although behavioural, neurobiological and genetic studies have identified that molecules in the dopamine, opioid, serotonin and endocannabinoid systems might be targets of the placebo effect, placebome studies with a no-treatment control (NTC) are necessary to identify whole-genome genetic targets. Although bioinformatics analysis has identified the molecular placebome module, placebome studies with NTCs are also required to validate the related findings.
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Affiliation(s)
- Lei Cai
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Collaborative Innovation Center of Genetics and Development, Shanghai Jiaotong University, Shanghai 200240, China
| | - Lin He
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Collaborative Innovation Center of Genetics and Development, Shanghai Jiaotong University, Shanghai 200240, China
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Ekhtiari H, Tavakoli H, Addolorato G, Baeken C, Bonci A, Campanella S, Castelo-Branco L, Challet-Bouju G, Clark VP, Claus E, Dannon PN, Del Felice A, den Uyl T, Diana M, di Giannantonio M, Fedota JR, Fitzgerald P, Gallimberti L, Grall-Bronnec M, Herremans SC, Herrmann MJ, Jamil A, Khedr E, Kouimtsidis C, Kozak K, Krupitsky E, Lamm C, Lechner WV, Madeo G, Malmir N, Martinotti G, McDonald WM, Montemitro C, Nakamura-Palacios EM, Nasehi M, Noël X, Nosratabadi M, Paulus M, Pettorruso M, Pradhan B, Praharaj SK, Rafferty H, Sahlem G, Salmeron BJ, Sauvaget A, Schluter RS, Sergiou C, Shahbabaie A, Sheffer C, Spagnolo PA, Steele VR, Yuan TF, van Dongen JDM, Van Waes V, Venkatasubramanian G, Verdejo-García A, Verveer I, Welsh JW, Wesley MJ, Witkiewitz K, Yavari F, Zarrindast MR, Zawertailo L, Zhang X, Cha YH, George TP, Frohlich F, Goudriaan AE, Fecteau S, Daughters SB, Stein EA, Fregni F, Nitsche MA, Zangen A, Bikson M, Hanlon CA. Transcranial electrical and magnetic stimulation (tES and TMS) for addiction medicine: A consensus paper on the present state of the science and the road ahead. Neurosci Biobehav Rev 2019; 104:118-140. [PMID: 31271802 PMCID: PMC7293143 DOI: 10.1016/j.neubiorev.2019.06.007] [Citation(s) in RCA: 171] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/30/2019] [Accepted: 06/08/2019] [Indexed: 12/21/2022]
Abstract
There is growing interest in non-invasive brain stimulation (NIBS) as a novel treatment option for substance-use disorders (SUDs). Recent momentum stems from a foundation of preclinical neuroscience demonstrating links between neural circuits and drug consuming behavior, as well as recent FDA-approval of NIBS treatments for mental health disorders that share overlapping pathology with SUDs. As with any emerging field, enthusiasm must be tempered by reason; lessons learned from the past should be prudently applied to future therapies. Here, an international ensemble of experts provides an overview of the state of transcranial-electrical (tES) and transcranial-magnetic (TMS) stimulation applied in SUDs. This consensus paper provides a systematic literature review on published data - emphasizing the heterogeneity of methods and outcome measures while suggesting strategies to help bridge knowledge gaps. The goal of this effort is to provide the community with guidelines for best practices in tES/TMS SUD research. We hope this will accelerate the speed at which the community translates basic neuroscience into advanced neuromodulation tools for clinical practice in addiction medicine.
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Affiliation(s)
| | - Hosna Tavakoli
- Institute for Cognitive Science Studies (ICSS), Iran; Iranian National Center for Addiction Studies (INCAS), Iran
| | - Giovanni Addolorato
- Alcohol Use Disorder Unit, Division of Internal Medicine, Gastroenterology and Hepatology Unit, Catholic University of Rome, A. Gemelli Hospital, Rome, Italy; Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Chris Baeken
- Department of Psychiatry and Medical Psychology, University Hospital Ghent, Ghent, Belgium
| | - Antonello Bonci
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA; Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | - Vincent P Clark
- University of New Mexico, USA; The Mind Research Network, USA
| | | | | | - Alessandra Del Felice
- University of Padova, Department of Neuroscience, Padova, Italy; Padova Neuroscience Center (PNC), University of Padova, Padova, Italy
| | | | - Marco Diana
- 'G. Minardi' Laboratory of Cognitive Neuroscience, Department of Chemistry and Pharmacy, University of Sassari, Italy
| | | | - John R Fedota
- Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
| | | | - Luigi Gallimberti
- Novella Fronda Foundation, Human Science and Brain Research, Padua, Italy
| | | | - Sarah C Herremans
- Department of Psychiatry and Medical Psychology, University Hospital Ghent, Ghent, Belgium
| | - Martin J Herrmann
- Center of Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - Asif Jamil
- Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | | | | | - Karolina Kozak
- University of Toronto, Canada; Centre for Addiction and Mental Health (CAMH), Canada
| | - Evgeny Krupitsky
- V. M. Bekhterev National Medical Research Center for Psychiatry and Neurology, St.-Petersburg, Russia; St.-Petersburg First Pavlov State Medical University, Russia
| | - Claus Lamm
- Department of Basic Psychological Research and Research Methods, Faculty of Psychology, University of Vienna, Austria
| | | | - Graziella Madeo
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
| | | | | | - William M McDonald
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Chiara Montemitro
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA; University G.d'Annunzio of Chieti-Pescara, Italy
| | | | - Mohammad Nasehi
- Cognitive and Neuroscience Research Center (CNRC), Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Xavier Noël
- Université Libre de Bruxelles (ULB), Belgium
| | | | | | | | | | - Samir K Praharaj
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Haley Rafferty
- Spaulding Rehabilitation Hospital, Harvard Medical School, USA
| | | | - Betty Jo Salmeron
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
| | - Anne Sauvaget
- Laboratory «Movement, Interactions, Performance» (E.A. 4334), University of Nantes, 25 Bis Boulevard Guy Mollet, BP 72206, 44322, Nantes Cedex 3, France; CHU de Nantes Addictology and Liaison Psychiatry Department, University Hospital Nantes, Nantes Cedex 3, France
| | - Renée S Schluter
- Laureate Institute for Brain Research, USA; Institute for Cognitive Science Studies (ICSS), Iran
| | | | - Alireza Shahbabaie
- Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | | | | | - Vaughn R Steele
- Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
| | - Ti-Fei Yuan
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, China
| | | | - Vincent Van Waes
- Laboratoire de Neurosciences Intégratives et Cliniques EA481, Université Bourgogne Franche-Comté, Besançon, France
| | | | | | | | - Justine W Welsh
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Fatemeh Yavari
- Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Mohammad-Reza Zarrindast
- Department of Pharmacology School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Laurie Zawertailo
- University of Toronto, Canada; Centre for Addiction and Mental Health (CAMH), Canada
| | - Xiaochu Zhang
- University of Science and Technology of China, China
| | | | - Tony P George
- University of Toronto, Canada; Centre for Addiction and Mental Health (CAMH), Canada
| | | | - Anna E Goudriaan
- Department of Psychiatry, Amsterdam Institute for Addiction Research, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Arkin, Department of Research and Quality of Care, Amsterdam, The Netherlands
| | | | | | - Elliot A Stein
- Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
| | - Felipe Fregni
- Spaulding Rehabilitation Hospital, Harvard Medical School, USA
| | - Michael A Nitsche
- Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany; University Medical Hospital Bergmannsheil, Dept. Neurology, Bochum, Germany
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Gianola S, Castellini G, Corbetta D, Moja L. Rehabilitation interventions in randomized controlled trials for low back pain: proof of statistical significance often is not relevant. Health Qual Life Outcomes 2019; 17:127. [PMID: 31331343 PMCID: PMC6647152 DOI: 10.1186/s12955-019-1196-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 07/11/2019] [Indexed: 11/21/2022] Open
Abstract
Background An observed statistically significant difference between two interventions does not necessarily imply that this difference is clinically important for patients and clinicians. We aimed to assess if treatment effects of randomized controlled trials (RCTs) for low back pain (LBP) are statistically significant and clinically relevant, and if RCTs were powered to achieve clinically relevant differences on continuous outcomes. Methods We searched for all RCTs included in Cochrane Systematic Reviews focusing on the efficacy of rehabilitation interventions for LBP and published until April 2017. RCTs having sample size calculation and a planned minimal important difference were considered. In the primary analysis, we calculated the proportion of RCTs classified as “statistically significant and clinically relevant”, “statistically significant but not clinically relevant”, “not statistically significant but clinically relevant”, and “not statistically significant and not clinically relevant”. Then, we investigated how many times the mismatch between statistical significance and clinical relevance was due to inadequate power. Results From 20 eligible SRs including 101 RCTs, we identified 42 RCTs encompassing 81 intervention comparisons. Overall, 60% (25 RCTs) were statistically significant while only 36% (15 RCTs) were both statistically and clinically significant. Most trials (38%) did not discuss the clinical relevance of treatment effects when results did not reached statistical significance. Among trials with non-statistically significant findings, 60% did not reach the planned sample size, therefore being at risk to not detect an effect that is actually there (type II error). Conclusion Only a minority of positive RCT findings was both statistically significant and clinically relevant. Scarce diligence or frank omissions of important tactic elements of RCTs, such as clinical relevance, and power, decrease the reliability of study findings to current practice. Electronic supplementary material The online version of this article (10.1186/s12955-019-1196-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Silvia Gianola
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy.
| | - Greta Castellini
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Davide Corbetta
- IRCCS San Raffaele Hospital, Rehabilitation and Functional Recovery Department, Milan, Italy.,Vita-Salute San Raffaele University, Physiotherapy Degree Course, Milan, Italy
| | - Lorenzo Moja
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Acupuncture for type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials. Complement Ther Clin Pract 2019; 36:100-112. [PMID: 31383426 DOI: 10.1016/j.ctcp.2019.04.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 04/12/2019] [Accepted: 04/24/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Acupuncture has been used to treat type 2 diabetes (T2DM) for 2000 years and there are emerging clinical evidence and animal studies for its efficacy. However, we are unable to conclude the effectiveness and safety on this issue yet. OBJECTIVES To assess the effects and safety of acupuncture for T2DM. METHODS We systematically searched 5 databases and 2 clinical registry platforms from inception to 2018-6-4. RCTs for acupuncture or its variants compared with sham acupuncture or no acupuncture controls for T2DM were included. The primary outcomes were glycemic control and adverse events. RESULTS A total of 21 studies, which comprised a total of 1943 participants, were included in the final meta-analysis. Compared with sham acupuncture or no acupuncture plus baseline treatments, acupuncture plus baseline treatments yield reduction in FBG(MD 1.21 mmol/l, 95%CI 1.56 to 0.87), 2 h BG(MD 2.13 mmol/l, 95%CI 2.79 to 1.46), HA1c (MD 1.12%, 95%CI 1.62 to 0.62). Our results also show acupuncture can improve blood lipids and blood pressure control, and reduce weight. CONCLUSIONS As one type of multifactorial intervention, acupuncture could be recommended as a supplementary treatment in the management of T2DM, especially in those with obesity or metabolic disorders. However, due to the small sample size, poor methodological quality of trials reviewed, the amount of evidence is not fully convincing. There is a need for well-planned, long-term studies. REGISTRATION International Prospective Register of Systematic Reviews (Number CRD42018094573).
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Conclusiveness of Cochrane Reviews in physiotherapy: a systematic search and analytical review. Int J Rehabil Res 2019; 42:97-105. [DOI: 10.1097/mrr.0000000000000338] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Effectiveness of splinting for pain and function in people with thumb carpometacarpal osteoarthritis: a systematic review with meta-analysis. Osteoarthritis Cartilage 2019; 27:547-559. [PMID: 30317000 DOI: 10.1016/j.joca.2018.09.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/21/2018] [Accepted: 09/26/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the effectiveness of splinting for reducing pain and improving function and health-related quality of life (HR-QoL) in people with thumb carpometacarpal osteoarthritis (CMC OA). DESIGN The Cochrane Library, MEDLINE, Embase, CINAHL, ISI Web of Science, Scopus and Google Scholar, 3 trial registries and 4 conference proceedings were systematically searched for randomised and non-randomised controlled trials up to March 17th, 2018. Two reviewers independently applied the inclusion criteria to select potential studies and assess risk of methodologic bias using the Cochrane Collaboration's Risk of Bias Tool. Studies were pooled using the inverse variance method to calculate standardised mean difference (SMD). Sensitivity analyses were conducted and the quality of evidence for each outcome was judged following the Grades of Recommendation Assessment, Development and Evaluation (GRADE) approach. RESULTS Twelve studies were retrieved (n = 1353), 4 comparing a splint to control and 8 to another splint. In the medium-term (3-12 months), low quality evidence showed that splints cause a moderate to large reduction in pain (SMD 0.7 [95% confidence interval (CI) 1.04, 0.35], P < 0.0001) and small to moderate improvement in function (SMD 0.42 [95% CI 0.77, 0.08], P = 0.02). No significant effect was found at short-term or for different types of splints. No studies reported HR-QoL. CONCLUSIONS Splinting demonstrated a moderate to large effect for pain and small to moderate effect for function in the medium-term but not in the short term. Quality of the evidence is low. Major challenges are the lack of diagnostic criteria and of a gold-standard outcome measure for thumb CMC OA.
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Rotolo N, Cattoni M, D'Andria M, Cavanna L, Patrizio G, Imperatori A, Nicolini A. Comparison of an expiratory flow accelerator device versus positive expiratory pressure for tracheobronchial airway clearance after lung cancer lobectomy: a preliminary study. Physiotherapy 2019; 110:34-41. [PMID: 33563372 DOI: 10.1016/j.physio.2019.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 01/06/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE A new type of device has recently been introduced in chest physiotherapy as an aid to tracheo-bronchial airway clearance: expiratory flow accelerator (EFA). It promotes mucus clearance without generating any pressure gradient, allowing patients to breathe at tidal volume against no resistance. DESIGN Pilot randomized controlled study. SETTING Tertiary hospital. PARTICIPANTS Fifty adult patients who underwent lung cancer lobectomy were randomized to undergo chest physiotherapy with EFA (n=26) or PEP (n=24). INTERVENTIONS EFA; PEP bottle. MAIN OUTCOMES Incidence of postoperative pulmonary complications (PPC) and length of stay. SECONDARY OUTCOMES trends in inspiratory capacity, respiratory rate, oxygen saturation, and dyspnoea. Patients rated user-friendliness of the two devices on a 5-point Likert scale. RESULTS A slightly different incidence of PPCs was observed between the EFA and PEP group. Nevertheless, the length of stay was similar in the two groups. No substantial differences were seen in trends of inspiratory capacity, respiratory rate, oxygen saturation, dyspnoea between the two groups. Patient-reported user-friendliness of the two devices did not differ significantly, although the use of the EFA device appeared less strenuous. CONCLUSIONS Results of this pilot study point to the use of EFA as an alternative treatment option rather than as a replacement for the PEP bottle in chest physiotherapy following lung cancer lobectomy. EFA may be preferable for weaker patients and/or with airway leakages in whom PEP has limited indications. Further investigation in a larger sample is required to statistically confirm the findings. Clinical Trial Registration Number ChiCTR-ONC-17013255.
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Affiliation(s)
- Nicola Rotolo
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Maria Cattoni
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Michele D'Andria
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Laura Cavanna
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Giorgia Patrizio
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
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Pérez Chaparro CGA, Zech P, Schuch F, Wolfarth B, Rapp M, Heiβel A. Effects of aerobic and resistance exercise alone or combined on strength and hormone outcomes for people living with HIV. A meta-analysis. PLoS One 2018; 13:e0203384. [PMID: 30180202 PMCID: PMC6122835 DOI: 10.1371/journal.pone.0203384] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 08/20/2018] [Indexed: 01/20/2023] Open
Abstract
Background Infection with human immunodeficiency virus (HIV) affects muscle mass, altering independent activities of people living with HIV (PLWH). Resistance training alone (RT) or combined with aerobic exercise (AE) is linked to improved muscle mass and strength maintenance in PLWH. These exercise benefits have been the focus of different meta-analyses, although only a limited number of studies have been identified up to the year 2013/4. An up-to-date systematic review and meta-analysis concerning the effect of RT alone or combined with AE on strength parameters and hormones is of high value, since more and recent studies dealing with these types of exercise in PLWH have been published. Methods Randomized controlled trials evaluating the effects of RT alone, AE alone or the combination of both (AERT) on PLWH was performed through five web-databases up to December 2017. Risk of bias and study quality was attained using the PEDro scale. Weighted mean difference (WMD) from baseline to post-intervention changes was calculated. The I2 statistics for heterogeneity was calculated. Results Thirteen studies reported strength outcomes. Eight studies presented a low risk of bias. The overall change in upper body strength was 19.3 Kg (95% CI: 9.8–28.8, p< 0.001) after AERT and 17.5 Kg (95% CI: 16–19.1, p< 0.001) for RT. Lower body change was 29.4 Kg (95% CI: 18.1–40.8, p< 0.001) after RT and 10.2 Kg (95% CI: 6.7–13.8, p< 0.001) for AERT. Changes were higher after controlling for the risk of bias in upper and lower body strength and for supervised exercise in lower body strength. A significant change towards lower levels of IL-6 was found (-2.4 ng/dl (95% CI: -2.6, -2.1, p< 0.001). Conclusion Both resistance training alone and combined with aerobic exercise showed a positive change when studies with low risk of bias and professional supervision were analyzed, improving upper and, more critically, lower body muscle strength. Also, this study found that exercise had a lowering effect on IL-6 levels in PLWH.
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Affiliation(s)
- Camilo Germán Alberto Pérez Chaparro
- University Outpatient Clinic–Center for Sports Medicine, Department Sports & Health Sciences, University of Potsdam, Potsdam, Brandenburg, Germany
- * E-mail:
| | - Philipp Zech
- Social and Preventive Medicine, Department Exercise and Health Sciences, University of Potsdam, Potsdam, Brandenburg, Germany
| | - Felipe Schuch
- Post-graduate Program in Health and Human Development, La Salle University, Canoas, RS, Brazil
| | - Bernd Wolfarth
- Department of Sports Sciences, Division of Sports Medicine, Humboldt Universität zu Berlin, Berlin, Germany
| | - Michael Rapp
- Social and Preventive Medicine, Department Exercise and Health Sciences, University of Potsdam, Potsdam, Brandenburg, Germany
| | - Andreas Heiβel
- Social and Preventive Medicine, Department Exercise and Health Sciences, University of Potsdam, Potsdam, Brandenburg, Germany
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The Compound Effect of Cupping Therapy: Searching Beyond the Meridians. JOURNAL OF ACUPUNCTURE RESEARCH 2018. [DOI: 10.13045/jar.2018.00136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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