Effectiveness of Ultrasound-Guided Percutaneous Electrolysis for Musculoskeletal Pain: A Systematic Review and Meta-Analysis

Pain Medicine ◽  
2020 ◽  
Author(s):  
Guido F Gómez-Chiguano ◽  
Marcos J Navarro-Santana ◽  
Joshua A Cleland ◽  
Jose L Arias-Buría ◽  
César Fernández-de-las-Peñas ◽  
...  
Keyword(s):  
Size Effect ◽  
Pain Intensity ◽  
Musculoskeletal Pain ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Ultrasound Guided ◽  
Short Term ◽  
Large Size ◽  
Large Size Effect

Abstract Objective To evaluate the effects of ultrasound-guided percutaneous electrolysis alone or as an adjunct to other interventions on pain and pain-related disability for musculoskeletal pain conditions. Databases and Data Treatment Search of MEDLINE database, Allied and Complementary Medicine Database, EMBASE database, Cumulative Index to Nursing & Allied Health Literature database, EBSCO database, PubMed database, Physiotherapy Evidence Database, Cochrane Library database, Scopus database, and Web of Science database. Randomized controlled trials in which at least one group received ultrasound-guided percutaneous electrolysis for treatment of musculoskeletal pain. To be eligible, studies had to include humans and collect outcomes on pain intensity and pain-related disability for musculoskeletal pain syndromes. Data were extracted by two reviewers. The risk of bias was assessed by the Cochrane Guidelines and the quality of evidence was reported using the Grading of Recommendations Assessment, Development and Evaluation approach. Standardized mean differences (SMDs) and random effects were calculated. Results Ten studies were included. The meta-analysis found that ultrasound-guided percutaneous electrolysis reduced the mean pain intensity by –2.06 (95% confidence interval [CI], –2.69 to –1.42) and the pain intensity as assessed with a visual analog scale or a numeric pain rating scale with a large size effect (SMD = –1.15; 95% CI, –1.48 to –0.81) and also improved pain-related disability with a large size effect (SMD = 0.95; 95% CI, 0.73–1.18) as compared with comparison groups. No differences in effect sizes were found among the short-term, midterm, and long-term follow-ups. The risk of bias was generally low, but the heterogeneity of the overall result downgraded the evidence level. Trials included heterogeneous musculoskeletal pain conditions and short-term, midterm, and long-term follow-ups. Conclusion Moderate evidence suggests positive effects of ultrasound-guided percutaneous electrolysis for pain and pain-related disability in musculoskeletal pain conditions relative to a comparison group in the short term, midterm, and long term.

Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: a systematic review and meta-analysis of 2123 subjects in 30 trials

2020 ◽  
pp. bjsports-2020-102525
Author(s):  
Stefanos Karanasios ◽  
Vasileios Korakakis ◽  
Rod Whiteley ◽  
Ioannis Vasilogeorgis ◽  
Sarah Woodbridge ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Short Term ◽  
Lateral Elbow ◽  
Long Term Follow Up ◽  
Wait And See ◽  
Lateral Elbow Tendinopathy

ObjectiveTo evaluate the effectiveness of exercise compared with other conservative interventions in the management of lateral elbow tendinopathy (LET) on pain and function.DesignSystematic review and meta-analysis.MethodsWe used the Cochrane risk-of-bias tool 2 for randomised controlled trials (RCTs) to assess risk of bias and the Grading of Recommendations Assessment, Development and Evaluation methodology to grade the certainty of evidence. Self-perceived improvement, pain intensity, pain-free grip strength (PFGS) and elbow disability were used as primary outcome measures.Eligibility criteriaRCTs assessing the effectiveness of exercise alone or as an additive intervention compared with passive interventions, wait-and-see or injections in patients with LET.Results30 RCTs (2123 participants, 5 comparator interventions) were identified. Exercise outperformed (low certainty) corticosteroid injections in all outcomes at all time points except short-term pain reduction. Clinically significant differences were found in PFGS at short-term (mean difference (MD): 12.15, (95% CI) 1.69 to 22.6), mid-term (MD: 22.45, 95% CI 3.63 to 41.3) and long-term follow-up (MD: 18, 95% CI 11.17 to 24.84). Statistically significant differences (very low certainty) for exercise compared with wait-and-see were found only in self-perceived improvement at short-term, pain reduction and elbow disability at short-term and long-term follow-up. Substantial heterogeneity in descriptions of equipment, load, duration and frequency of exercise programmes were evident.ConclusionsLow and very low certainty evidence suggests exercise is effective compared with passive interventions with or without invasive treatment in LET, but the effect is small.PROSPERO registration numberCRD42018082703.

scholarly journals Anticholinergic drugs and incident dementia, mild cognitive impairment and cognitive decline: a meta-analysis

2020 ◽  
Vol 49 (6) ◽  
pp. 939-947 ◽  
Author(s):  
Nina T Pieper ◽  
Carlota M Grossi ◽  
Wei-Yee Chan ◽  
Yoon K Loke ◽  
George M Savva ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Decline ◽  
Meta Analysis ◽  
Anticholinergic Drug ◽  
Risk Of Bias ◽  
Anticholinergic Drugs ◽  
Short Term ◽  
Incident Dementia

Abstract Background the long-term effect of the use of drugs with anticholinergic activity on cognitive function remains unclear. Methods we conducted a systematic review and meta-analysis of the relationship between anticholinergic drugs and risk of dementia, mild cognitive impairment (MCI) and cognitive decline in the older population. We identified studies published between January 2002 and April 2018 with ≥12 weeks follow-up between strongly anticholinergic drug exposure and the study outcome measurement. We pooled adjusted odds ratios (OR) for studies reporting any, and at least short-term (90+ days) or long-term (365+ days) anticholinergic use for dementia and MCI outcomes, and standardised mean differences (SMD) in global cognition test scores for cognitive decline outcomes. Statistical heterogeneity was measured using the I2 statistic and risk of bias using ROBINS-I. Results twenty-six studies (including 621,548 participants) met our inclusion criteria. ‘Any’ anticholinergic use was associated with incident dementia (OR 1.20, 95% confidence interval [CI] 1.09–1.32, I2 = 86%). Short-term and long-term use were also associated with incident dementia (OR 1.23, 95% CI 1.17–1.29, I2 = 2%; and OR 1.50, 95% CI 1.22–1.85, I2 = 90%). ‘Any’ anticholinergic use was associated with cognitive decline (SMD 0.15; 95% CI 0.09–0.21, I2 = 3%) but showed no statistically significant difference for MCI (OR 1.24, 95% CI 0.97–1.59, I2 = 0%). Conclusions anticholinergic drug use is associated with increased dementia incidence and cognitive decline in observational studies. However, a causal link cannot yet be inferred, as studies were observational with considerable risk of bias. Stronger evidence from high-quality studies is needed to guide the management of long-term use.

Is Dry Needling Effective for the Management of Plantar Heel Pain or Plantar Fasciitis? An Updated Systematic Review and Meta-analysis

Pain Medicine ◽  
2021 ◽  
Author(s):  
Luis Llurda-Almuzara ◽  
Noé Labata-Lezaun ◽  
Toni Meca-Rivera ◽  
Marcos J Navarro-Santana ◽  
Joshua A Cleland ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Plantar Fasciitis ◽  
Meta Analysis ◽  
Heel Pain ◽  
Risk Of Bias ◽  
Dry Needling ◽  
Level Of Evidence ◽  
Plantar Heel Pain ◽  
Quality Evidence

Abstract Objective Dry needling is commonly used for the management of plantar fasciitis. This meta-analysis evaluated the effects of dry needling over trigger points (TrPs) associated with plantar heel pain on pain intensity and related disability or function. Methods Electronic databases were searched for randomized controlled trials where at least one group received dry needling, not acupuncture, for TrPs associated with plantar heel pain and collected outcomes on pain intensity and related-disability. The risk of bias (RoB) was assessed using the Cochrane risk of bias tool, methodological quality was assessed with PEDro score, and the level of evidence is reported using the GRADE approach. Between-groups mean differences (MD) and standardized mean difference (SMD) were calculated. Results The search identified 297 publications with 6 trials eligible for inclusion. The meta-analysis found low quality evidence that TrP dry needling reduces pain intensity at short term (MD -1.70 points, 95%CI -2.80 to -0.60; SMD -1.28, 95%CI -2.11 to -0.44) and moderate quality evidence for improving pain intensity (MD -1.77 points, 95%CI -2.44 to -1.11; SMD -1.45, 95%CI -2.19 to -0.70) and related-disability (SMD -1.75, 95% CI -2.22 to -1.28) at long-term compared to a comparison group. The RoB of the trials was generally low, but the heterogeneity of the results downgraded the level of evidence. Discussion Moderate to low evidence suggests a positive effect of TrP dry needling for improving pain intensity and pain-related disability in patients with plantar heel pain of musculoskeletal origin at short- and long-term, respectively. Current results should be considered with caution due to the small number of trials.

scholarly journals Effects of Trigger Point Dry Needling for the Management of Knee Pain Syndromes: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 9 (7) ◽  
pp. 2044 ◽  
Author(s):  
Youssef Rahou-El-Bachiri ◽  
Marcos J. Navarro-Santana ◽  
Guido F Gómez‐Chiguano ◽  
Joshua Cleland ◽  
Ibai López‐de‐Uralde‐ Villanueva ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Knee Pain ◽  
Trigger Point ◽  
Meta Analysis ◽  
Patellofemoral Pain ◽  
Risk Of Bias ◽  
Dry Needling ◽  
Short Term ◽  
Post Surgery

Background: To evaluate the effect of trigger point dry needling alone or as an adjunct with other interventions on pain and related disability in people with knee pain. Methods: Several electronic databases were searched for randomized controlled trials where at least one group received dry needling for knee pain. Studies had to include human subjects and collect outcomes on pain and pain-related disability in musculoskeletal knee pain. Data were extracted by two reviewers. The risk of bias was assessed by the Cochrane Guidelines, methodological quality was assessed with the Physiotherapy Evidence Database (PEDro) score, and the quality of evidence by using the GRADE approach. Standardized mean differences (SMD) were calculated. Results: Ten studies (six patellofemoral pain, two knee osteoarthritis, two post-surgery knee pain) were included. The meta-analysis found moderate effect sizes of dry needling for reducing pain (SMD −0.53, 95% CI −0.87 to −0.19) and improving related disability (SMD −0.58, 95% CI −1.08 to −0.09) as compared to a comparison group at short-term. The main effect was observed for patellofemoral pain (SMD −0.64, 95% CI −1.17 to −0.11). No significant effects were observed at mid- or long-term follow-ups. The risk of bias was generally low, but the heterogenicity and the imprecision of the results downgraded the level of evidence. Conclusion: Low to moderate evidence suggests a positive effect of trigger point dry needling on pain and related disability in patellofemoral pain, but not knee osteoarthritis or post-surgery knee pain, at short-term. More high-quality trials investigating long-term effects are clearly needed.

scholarly journals Individualised exercise in chronic non-specific low back pain: a systematic review with meta-analysis on the effects of exercise alone or in combination with psychological interventions on pain and disability

2021 ◽  
Author(s):  
Johannes Fleckenstein ◽  
Philipp Floessel ◽  
Tilman Engel ◽  
Laura Klewinghaus ◽  
Josefine Stoll ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Intensity ◽  
Meta Analysis ◽  
Group Analysis ◽  
Low Back ◽  
Short Term ◽  
Long Term Follow Up

Objective To investigate the effects of individualised exercise interventions consisting with or without combined psychological intervention on pain intensity and disability in patients with chronic non-specific low back pain. Design Systematic review with meta-analysis and meta-regression. Data sources Five databases (PubMed, Cochrane Central, EMBASE, Clarivate Web of Science, and Google Scholar) were searched up to 31 March 2021. Selection criteria Randomised controlled trials were eligible if they included participants with chronic non-specific low back pain, compared at least one individualised/personalised/stratified exercise intervention with or without psychological treatment to any control / comparator group, and if they assessed at least pain intensity or disability as outcome measure. Results Fifty-eight studies (n = 9099 patients, 44.3 years, 56% female) compared individualised to other types of exercise (n = 44; 62%), usual care (n = 16; 23%), advice to stay active, or true controls. The remaining studies had passive controls. At short-term follow-up, low-certainty evidence for pain intensity (SMD -0.33 [95%CI -0.47 to -0.18]) and very low-certainty evidence for disability (-0.16 [-0.30 to -0.02]) indicates effects of individualised exercise compared to other exercises. Very low-certainty evidence for pain intensity (-0.35; [-0.53 to -0.17])) and low-certainty evidence for disability (-0.12; [-0.22 to -0.02]) indicates effects compared to passive controls. At long-term follow-up, moderate-certainty evidence for pain intensity (-0.14 [-0.23 to -0.06]) and disability (-0.23 [-0.33 to -0.12]) indicates effects compared to passive controls exercises. All findings stayed below the threshold for minimal clinically important difference (MCID). Certainty of evidence was downgraded mainly due to evidence of risk of bias, publication bias and inconsistency that could not be explained. Sensitivity analyses indicated that the effects on pain, but not on disability (always short-term and versus active treatments) were robust. Sub-group analysis of pain outcomes suggested that individualised exercise treatment is probably more effective in combination with psychological interventions (-0.32 [-0.51 to -0.14]), a clinically important difference Conclusion We found very low to moderate-certainty evidence that individualised exercise is effective for treatment of chronic non-specific low back pain. Individualised exercise seems superior to other active treatments and sub-group analysis suggests that some forms of individualised exercise (especially motor-control based treatments) combined with behavioural therapy interventions enhances the treatment effect. Certainty of evidence was higher for long-term follow-up. In summary, individualised exercise can be recommended from a clinical point of view.

scholarly journals Long-Term and Short-Term Prognostic Value of Circulating Soluble Suppression of Tumorigenicity-2 Concentration in Chronic Heart Failure: A Systematic Review and Meta-Analysis

Cardiology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Guoqi Dong ◽  
Hao Chen ◽  
Hongru Zhang ◽  
Yihuang Gu
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Prognostic Value ◽  
Web Of Science ◽  
Meta Analysis ◽  
Short Term ◽  
Prisma Statement ◽  
All Cause Mortality ◽  
Increasing Risk

<b><i>Introduction:</i></b> Soluble suppression of tumorigenicity-2 (sST2) has been considered as a prognostic factor of cardiovascular disease. However, the prognostic value of sST2 concentration in chronic heart failure remains to be summarized. <b><i>Methods:</i></b> We searched PubMed, Embase, and Web of Science for eligible studies up to January 1, 2020. Data extracted from articles and provided by authors were used in agreement with the PRISMA statement. The endpoints were all-cause mortality (ACM), cardiovascular mortality (CVM)/heart failure-related hospitalization (HFH), and all-cause mortality (ACM)/heart failure-related readmission (HFR). <b><i>Results:</i></b> A total of 11 studies with 5,121 participants were included in this analysis. Higher concentration of sST2 predicted the incidence of long-term ACM (hazard ratio [HR]: 1.03, 95% confidence interval [CI]: 1.02–1.04), long-term ACM/HFR (HR: 1.42, CI: 1.27–1.59), and long-term CVM/HFH (HR: 2.25, CI: 1.82–2.79), regardless of short-term ACM/HFR (HR: 2.31, CI: 0.71–7.49). <b><i>Conclusion:</i></b> Higher sST2 concentration at baseline is associated with increasing risk of long-term ACM, ACM/HFR, and CVM/HFH and can be a tool for the prognosis of chronic heart failure.

scholarly journals Comparison of the efficacy of hematopoietic stem cell mobilization regimens: a systematic review and network meta-analysis of preclinical studies

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Chengxin Luo ◽  
Li Wang ◽  
Guixian Wu ◽  
Xiangtao Huang ◽  
Yali Zhang ◽  
...  
Keyword(s):  
Standard Dose ◽  
Meta Analysis ◽  
Secondary Outcome ◽  
Preclinical Studies ◽  
Mice Model ◽  
Short Term ◽  
Hematopoietic Stem ◽  
Support Unit ◽  
Meta Analyses

Abstract Background Mobilization failure may occur when the conventional hematopoietic stem cells (HSCs) mobilization agent granulocyte colony-stimulating factor (G-CSF) is used alone, new regimens were developed to improve mobilization efficacy. Multiple studies have been performed to investigate the efficacy of these regimens via animal models, but the results are inconsistent. We aim to compare the efficacy of different HSC mobilization regimens and identify new promising regimens with a network meta-analysis of preclinical studies. Methods We searched Medline and Embase databases for the eligible animal studies that compared the efficacy of different HSC mobilization regimens. Primary outcome is the number of total colony-forming cells (CFCs) in per milliliter of peripheral blood (/ml PB), and the secondary outcome is the number of Lin− Sca1+ Kit+ (LSK) cells/ml PB. Bayesian network meta-analyses were performed following the guidelines of the National Institute for Health and Care Excellence Decision Support Unit (NICE DSU) with WinBUGS version 1.4.3. G-CSF-based regimens were classified into the SD (standard dose, 200–250 μg/kg/day) group and the LD (low dose, 100–150 μg/kg/day) group based on doses, and were classified into the short-term (2–3 days) group and the long-term (4–5 days) group based on administration duration. Long-term SD G-CSF was chosen as the reference treatment. Results are presented as the mean differences (MD) with the associated 95% credibility interval (95% CrI) for each regimen. Results We included 95 eligible studies and reviewed the efficacy of 94 mobilization agents. Then 21 studies using the poor mobilizer mice model (C57BL/6 mice) to investigate the efficacy of different mobilization regimens were included for network meta-analysis. Network meta-analyses indicated that compared with long-term SD G-CSF alone, 14 regimens including long-term SD G-CSF + Me6, long-term SD G-CSF + AMD3100 + EP80031, long-term SD G-CSF + AMD3100 + FG-4497, long-term SD G-CSF + ML141, long-term SD G-CSF + desipramine, AMD3100 + meloxicam, long-term SD G-CSF + reboxetine, AMD3100 + VPC01091, long-term SD G-CSF + FG-4497, Me6, long-term SD G-CSF + EP80031, POL5551, long-term SD G-CSF + AMD3100, AMD1300 + EP80031 and long-term LD G-CSF + meloxicam significantly increased the collections of total CFCs. G-CSF + Me6 ranked first among these regimens in consideration of the number of harvested CFCs/ml PB (MD 2168.0, 95% CrI 2062.0−2272.0). In addition, 7 regimens including long-term SD G-CSF + AMD3100, AMD3100 + EP80031, long-term SD G-CSF + EP80031, short-term SD G-CSF + AMD3100 + IL-33, long-term SD G-CSF + ML141, short-term LD G-CSF + ARL67156, and long-term LD G-CSF + meloxicam significantly increased the collections of LSK cells compared with G-CSF alone. Long-term SD G-CSF + AMD3100 ranked first among these regimens in consideration of the number of harvested LSK cells/ml PB (MD 2577.0, 95% CrI 2422.0–2733.0). Conclusions Considering the number of CFC and LSK cells in PB as outcomes, G-CSF plus AMD3100, Me6, EP80031, ML141, FG-4497, IL-33, ARL67156, meloxicam, desipramine, and reboxetine are all promising mobilizing regimens for future investigation.

scholarly journals Robot-assisted thoracic surgery versus video-assisted thoracic surgery for lung lobectomy or segmentectomy in patients with non-small cell lung cancer: a meta-analysis

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jianglei Ma ◽  
Xiaoyao Li ◽  
Shifu Zhao ◽  
Jiawei Wang ◽  
Wujia Zhang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Sensitivity Analysis ◽  
Thoracic Surgery ◽  
Conversion Rate ◽  
Meta Analysis ◽  
Small Cell ◽  
Small Cell Lung ◽  
Robot Assisted ◽  
Short Term

Abstract Background It remains no clear conclusion about which is better between robot-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) for the treatment of patients with non-small cell lung cancer (NSCLC). Therefore, this meta-analysis aimed to compare the short-term and long-term efficacy between RATS and VATS for NSCLC. Methods Pubmed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Medline, and Web of Science databases were comprehensively searched for studies published before December 2020. The quality of the articles was evaluated using the Newcastle-Ottawa Scale (NOS) and the data analyzed using the Review Manager 5.3 software. Fixed or random effect models were applied according to heterogeneity. Subgroup analysis and sensitivity analysis were conducted. Results A total of 18 studies including 11,247 patients were included in the meta-analyses, of which 5114 patients were in the RATS group and 6133 in the VATS group. Compared with VATS, RATS was associated with less blood loss (WMD = − 50.40, 95% CI -90.32 ~ − 10.48, P = 0.010), lower conversion rate (OR = 0.50, 95% CI 0.43 ~ 0.60, P < 0.001), more harvested lymph nodes (WMD = 1.72, 95% CI 0.63 ~ 2.81, P = 0.002) and stations (WMD = 0.51, 95% CI 0.15 ~ 0.86, P = 0.005), shorter duration of postoperative chest tube drainage (WMD = − 0.61, 95% CI -0.78 ~ − 0.44, P < 0.001) and hospital stay (WMD = − 1.12, 95% CI -1.58 ~ − 0.66, P < 0.001), lower overall complication rate (OR = 0.90, 95% CI 0.83 ~ 0.99, P = 0.020), lower recurrence rate (OR = 0.51, 95% CI 0.36 ~ 0.72, P < 0.001), and higher cost (WMD = 3909.87 USD, 95% CI 3706.90 ~ 4112.84, P < 0.001). There was no significant difference between RATS and VATS in operative time, mortality, overall survival (OS), and disease-free survival (DFS). Sensitivity analysis showed that no significant differences were found between the two techniques in conversion rate, number of harvested lymph nodes and stations, and overall complication. Conclusions The results revealed that RATS is a feasible and safe technique compared with VATS in terms of short-term and long-term outcomes. Moreover, more randomized controlled trials comparing the two techniques with rigorous study designs are still essential to evaluate the value of robotic surgery for NSCLC.

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