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de Melo Santana B, Raffin Moura J, Martins de Toledo A, Burke TN, Fernandes Probst L, Pasinato F, Luiz Carregaro R. Efficacy of mHealth Interventions for Improving the Pain and Disability of Individuals With Chronic Low Back Pain: Systematic Review and Meta-Analysis. JMIR Mhealth Uhealth 2023; 11:e48204. [PMID: 37962085 PMCID: PMC10662677 DOI: 10.2196/48204] [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: 04/15/2023] [Revised: 07/14/2023] [Accepted: 07/21/2023] [Indexed: 11/15/2023] Open
Abstract
Background Low back pain is one of the main causes of disability worldwide. Individuals with chronic conditions have been widely affected by the COVID-19 pandemic. In this context, mobile health (mHealth) has become popular, mostly due to the widespread use of smartphones. Despite the considerable number of apps for low back pain available in app stores, the effectiveness of these technologies is not established, and there is a lack of evidence regarding the effectiveness of the isolated use of mobile apps in the self-management of low back pain. Objective We summarized the evidence on the effectiveness of mHealth interventions on pain and disability for individuals with chronic low back pain. Methods We conducted a systematic review and meta-analysis comparing mHealth to usual care or no intervention. The search terms used were related to low back pain and mHealth. Only randomized controlled trials were included. The primary outcomes were pain intensity and disability, and the secondary outcome was quality of life. Searches were carried out in the following databases, without date or language restriction: PubMed, Scopus, Embase, Physiotherapy Evidence Database (PEDro), the Cochrane Library, and OpenGrey, in addition to article references. The risk of bias was analyzed using the PEDro scale. Data were summarized descriptively and through meta-analysis (pain intensity and disability). In the meta-analysis, eligible studies were combined while considering clinical and methodological homogeneity. The certainty of evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) criteria. Results A total of 5 randomized controlled trials were included, totaling 894 participants (447 allocated to the mHealth group and 445 to the usual care group), and they had similar methodological structure and interventions. Follow-up ranged from 6 weeks to 12 months. The studies did not demonstrate significant differences for pain intensity (mean difference -0.86, 95% CI -2.29 to 0.58; P=.15) and disability (standardized mean difference -0.24, 95% CI -0.69 to 0.20; P=.14) when comparing mHealth and usual care. All studies showed biases, with emphasis on nonconcealed allocation and nonblinding of the outcome evaluator. The certainty of evidence was rated as low for the analyzed outcomes. Conclusions mHealth alone was no more effective than usual care or no treatment in improving pain intensity and disability in individuals with low back pain. Due to the biases found and the low certainty of evidence, the evidence remains inconclusive, and future quality clinical trials are needed.
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Affiliation(s)
- Bruna de Melo Santana
- Graduate Program in Rehabilitation Sciences, School of Physical Therapy, University of Brasilia, Campus UnB Ceilândia, Brasilia, Brazil
| | - Julia Raffin Moura
- Graduate Program in Rehabilitation Sciences, School of Physical Therapy, University of Brasilia, Campus UnB Ceilândia, Brasilia, Brazil
| | - Aline Martins de Toledo
- Graduate Program in Rehabilitation Sciences, School of Physical Therapy, University of Brasilia, Campus UnB Ceilândia, Brasilia, Brazil
| | - Thomaz Nogueira Burke
- School of Physical Therapy, Universidade Federal do Mato Grosso do Sul, Campo Grande, Brazil
| | - Livia Fernandes Probst
- Unidade de Avaliação de Tecnologias em Saúde, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Fernanda Pasinato
- Graduate Program in Rehabilitation Sciences, School of Physical Therapy, University of Brasilia, Campus UnB Ceilândia, Brasilia, Brazil
| | - Rodrigo Luiz Carregaro
- Graduate Program in Rehabilitation Sciences, School of Physical Therapy, University of Brasilia, Campus UnB Ceilândia, Brasilia, Brazil
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Xu S, Li X, Li Y, Li X, Lv E, Zhang X, Shi Y, Wang Y. Neuroprotective effect of Dl-3-n-butylphthalide against ischemia-reperfusion injury is mediated by ferroptosis regulation via the SLC7A11/GSH/GPX4 pathway and the attenuation of blood-brain barrier disruption. Front Aging Neurosci 2023; 15:1028178. [PMID: 36909944 PMCID: PMC9995665 DOI: 10.3389/fnagi.2023.1028178] [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: 08/25/2022] [Accepted: 02/07/2023] [Indexed: 02/25/2023] Open
Abstract
Background Stroke is one of the most severe diseases worldwide, resulting in physical and mental problems. Dl-3-n-butylphthalide, a compound derived from celery seed, has been approved for treating ischemic stroke in China. No study has evaluated how Dl-3-n-butylphthalide affects the ferroptosis SLC7A11/GSH/GPX4 signal pathway and blood-brain barrier (BBB) PDGFRβ/PI3K/Akt signal pathways in the rat middle cerebral artery occlusion/reperfusion (MCAO/R) model of ischemic stroke. Methods Sprague-Dawley rats were used to develop the MCAO/R model. Our study used three incremental doses (10, 20, and 30) of Dl-3-n-butylphthalide injected intraperitoneally 24 h after MCAO/R surgery. The neuroprotective effect and success of the model were evaluated using the neurofunction score, brain water content determination, and triphenyl-tetrazolium chloride-determined infarction area changes. Pathological changes in the brain tissue and the degree of apoptosis were examined by hematoxylin and eosin, Nissl, and terminal deoxynucleotidyl transferase dUTP nick end labeling staining. In addition, pathway proteins and RNA expression levels were studied to verify the effects of Dl-3-n-butyphthalide on both pathways. At the same time, commercial kits were used to detect glutathione, reactive oxygen species, and malondialdehyde, to detect oxidative stress in brain tissues. Results The middle dose of Dl-3-n-butylphthalide not only improved MCAO-induced brain dysfunction and alleviated pathological damage, brain inflammatory response, oxidative stress, and apoptosis but also protected against ferroptosis and reduced BBB damage. These changes resulted in improved neurological function in the cerebral cortex. Conclusion We speculate that Dl-3-n-butylphthalide has a neuroprotective effect on focal cerebral ischemia/reperfusion, which may be mediated through ferroptosis-dependent SLC7A11/GSH/GPX4 signal pathway and PDGFRβ/PI3/Akt signal pathway.
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Affiliation(s)
- Shuangli Xu
- Emergency Department, The Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Xuewei Li
- Department of Rheumatology, The Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Yutian Li
- School of Pharmacy, Weifang Medical University, Weifang, Shandong, China
| | - Xiangling Li
- Department of Internal Medicine, The Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - E Lv
- Department of Histology and Embryology, Weifang Medical University, Weifang, Shandong, China
| | - Xiaojun Zhang
- Department II of Neurology, The Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Youkui Shi
- Emergency Department, The Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Yanqiang Wang
- Department of Rheumatology, The Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
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Pacheco RL, Martimbianco ALC, Riera R. Blinding of interventions in clinical trials helps to prevent selection bias by making the allocation sequence difficult to decipher. J Eval Clin Pract 2022; 28:1050-1052. [PMID: 35384156 DOI: 10.1111/jep.13682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/09/2022] [Accepted: 03/23/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Rafael Leite Pacheco
- Centre of Health Technology Assessment, Hospital Sírio-Libanês, Bela Vista, Brazil.,Núcleo de Ensino e Pesquisa em Saúde Baseada em Evidências e Medicina Baseada em Evidências (Nep-Sbeats), Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.,Centro de Pesquisa Médica, Centro Universitário São Camilo, São Paulo, Brazil
| | - Ana Luiza Cabrera Martimbianco
- Centre of Health Technology Assessment, Hospital Sírio-Libanês, Bela Vista, Brazil.,Programa de Pós-graduação em Saúde e Meio Ambiente, Universidade Metropolitana de Santos (UNIMES), Santos, Brazil
| | - Rachel Riera
- Centre of Health Technology Assessment, Hospital Sírio-Libanês, Bela Vista, Brazil.,Discipline of Evidence-Based Health, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil
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Koterov AN. Causal Criteria in Medical and Biological Disciplines: History, Essence, and Radiation Aspect. Report 3, Part 2: Hill’s Last Four Criteria: Use and Limitations. BIOL BULL+ 2022. [DOI: 10.1134/s1062359022110115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Ayala NK, Rouse DJ. Assessment and Interpretation of Small or Underpowered Randomized Clinical Trials. Clin Obstet Gynecol 2022; 65:252-259. [PMID: 35476618 DOI: 10.1097/grf.0000000000000696] [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: 11/26/2022]
Abstract
The randomized controlled trial has long been recognized as the gold standard of research designs. As small or underpowered trials have become increasingly common in obstetrics and gynecology, it is essential to appraise the trial design and results with a critical eye and understand the limitations of these trials including the potential for selection bias, inability to discriminate uncommon outcomes and the imprecision of point estimates. When small or underpowered trials are designed to be assessed in combination with other trials in high-quality meta-analysis, some of these limitations are minimized.
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Affiliation(s)
- Nina K Ayala
- Division of Maternal Fetal Medicine Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Providence, Rhode Island
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Fisher SA, Miller ES. Critical Evaluation of Clinical Research in Obstetrics and Gynecology. Clin Obstet Gynecol 2022; 65:290-301. [PMID: 35467576 DOI: 10.1097/grf.0000000000000695] [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: 11/26/2022]
Abstract
Within the evolving field of obstetrics and gynecology, providers should possess the ability to effectively and critically evaluate medical literature in order to best adapt and incorporate evidence-based practice. For both clinicians and researchers alike, we provide a systematic approach for reviewing a journal article published in the medical literature. We summarize the various types of study designs, with dedicated attention to observational and experimental studies, and examine sources of bias inherent to these study designs. Finally, we review important considerations when interpreting the validity and significance of the results and conclusions of a research study.
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Affiliation(s)
- Stephanie A Fisher
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Lang TA, Stroup DF. Who knew? The misleading specificity of "double-blind" and what to do about it. Trials 2020; 21:697. [PMID: 32758278 PMCID: PMC7409478 DOI: 10.1186/s13063-020-04607-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 07/13/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND In randomized trials, the term "double-blind" (and its derivatives, single- and triple-blind, fully blind, and partially blind or masked) has no standard or widely accepted definition. Agreement about which groups are blinded is poor, and authors using these terms often do not identify which groups were blinded, despite specific reporting guidelines to the contrary. Nevertheless, many readers assume-incorrectly-that they know which groups are blinded. Thus, the term is ambiguous at best, misleading at worst, and, in either case, interferes with the accurate reporting, interpretation, and evaluation of randomized trials. The problems with the terms have been thoroughly documented in the literature, and many authors have recommended that they be abandoned. PROPOSAL We and our co-signers suggest eliminating the use of adjectives that modify "blinding" in randomized trials; a trial would be described as either blinded or unblinded. We also propose that authors report in a standard table which groups or individuals were blinded, what they were blinded to, how blinding was implemented, and whether blinding was maintained. Individuals with dual responsibilities, such as caregiving and data collecting, would also be identified. If blinding was compromised, authors should describe the potential implications of the loss of blinding on interpreting the results. CONCLUSION "Double blind" and its derivatives are terms with little to recommend their continued use. Eliminating the use of adjectives that impart a false specificity to the term would reduce misinterpretations, and recommending that authors report who was blinded to what and how in a standard table would require them to be specific about which groups and individuals were blinded.
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Affiliation(s)
- Thomas A Lang
- West China Hospital/Sichuan Medical School Publishing Group, Kirkland, WA, USA.
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Climent‐Sanz C, Gea‐Sánchez M, Moreno‐Casbas MT, Blanco‐Blanco J, García‐Martínez E, Valenzuela‐Pascual F. A web‐based therapeutic patient education intervention for pain and sleep for women with fibromyalgia: A sequential exploratory mixed‐methods research protocol. J Adv Nurs 2020; 76:1425-1435. [DOI: 10.1111/jan.14333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/29/2020] [Accepted: 02/05/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Carolina Climent‐Sanz
- Faculty of Nursing and Physiotherapy University of Lleida Lleida Spain
- Grup d'Estudis Societat, Salut, Educació i Cultura GESEC Department of Nursing and Physiotherapy University of Lleida Lleida Spain
- Grup de Recerca de Cures en Salut GRECS Institut de Recerca Biomèdica Lleida Spain
| | - Montserrat Gea‐Sánchez
- Faculty of Nursing and Physiotherapy University of Lleida Lleida Spain
- Grup d'Estudis Societat, Salut, Educació i Cultura GESEC Department of Nursing and Physiotherapy University of Lleida Lleida Spain
- Grup de Recerca de Cures en Salut GRECS Institut de Recerca Biomèdica Lleida Spain
| | - María T. Moreno‐Casbas
- Instituto de Salud Carlos III Nursing and Healthcare Research Unit (Investen‐isciii) Madrid Spain
- Ciber Fragilidad y Envejecimiento Saludable (CIBERFES) Madrid Spain
| | - Joan Blanco‐Blanco
- Faculty of Nursing and Physiotherapy University of Lleida Lleida Spain
- Grup d'Estudis Societat, Salut, Educació i Cultura GESEC Department of Nursing and Physiotherapy University of Lleida Lleida Spain
- Grup de Recerca de Cures en Salut GRECS Institut de Recerca Biomèdica Lleida Spain
| | - Ester García‐Martínez
- Faculty of Nursing and Physiotherapy University of Lleida Lleida Spain
- Grup de Recerca de Cures en Salut GRECS Institut de Recerca Biomèdica Lleida Spain
| | - Fran Valenzuela‐Pascual
- Faculty of Nursing and Physiotherapy University of Lleida Lleida Spain
- Grup d'Estudis Societat, Salut, Educació i Cultura GESEC Department of Nursing and Physiotherapy University of Lleida Lleida Spain
- Grup de Recerca de Cures en Salut GRECS Institut de Recerca Biomèdica Lleida Spain
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Bovbjerg ML. Current Resources for Evidence-Based Practice, May 2019. J Obstet Gynecol Neonatal Nurs 2019; 48:361-371. [DOI: 10.1016/j.jogn.2019.04.281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Propadalo I, Tranfic M, Vuka I, Barcot O, Pericic TP, Puljak L. In Cochrane reviews, risk of bias assessments for allocation concealment were frequently not in line with Cochrane's Handbook guidance. J Clin Epidemiol 2019; 106:10-17. [DOI: 10.1016/j.jclinepi.2018.10.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/18/2018] [Accepted: 10/02/2018] [Indexed: 01/08/2023]
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Deeks JJ, Hopewell S, Moher D, Higgins JPT, Moons KGM, Chandler J, Antes G. Doug Altman's legacy to Cochrane and evidence synthesis. Cochrane Database Syst Rev 2018; 8:ED000127. [PMID: 30221350 PMCID: PMC10284314 DOI: 10.1002/14651858.ed000127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Jonathan J Deeks
- Institute of Applied Health Research, University of BirminghamUK
| | - Sally Hopewell
- University of OxfordOxford Clinical Trials Research UnitUK
| | - David Moher
- University of OttawaOttawa Hospital Research InstituteCanada
| | - Julian PT Higgins
- University of BristolPopulation Health Sciences, Bristol Medical SchoolUK
| | - Karel GM Moons
- Utrecht UniversityJulius Center for Health Sciences and Primary Care and Cochrane Netherlands, UMC UtrechtThe Netherlands
| | | | - Gerd Antes
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Albert‐Ludwigs‐UniversityFreiburg i.B.Germany
- Cochrane Germany FoundationFreiburg i.B.Germany
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Abbasi K. How to fund the NHS. Med Chir Trans 2018; 111:187. [DOI: 10.1177/0141076818782032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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