The Effectiveness of Acupuncture for Osteoarthritis of the Knee – a Systematic Review

2006 ◽  
Vol 24 (1_suppl) ◽  
pp. 40-48 ◽  
Author(s):  
Adrian White ◽  
Nadine Foster ◽  
Mike Cummings ◽  
Panos Barlas
Keyword(s):  
Systematic Review ◽  
Acupuncture Treatment ◽  
Meta Analysis ◽  
Internal Validity ◽  
Sham Acupuncture ◽  
Sensitivity Analyses ◽  
Osteoarthritis Of The Knee ◽  
Reduction Of Pain ◽  
Randomised Controlled ◽  
And Function

Objective To determine the effectiveness of acupuncture treatment for pain and function of patients with osteoarthritis of the knee. Methods A systematic review of randomised controlled trials was performed, including a meta-analysis which combined the results of trials that used adequate acupuncture treatment and used WOMAC scores to measure the effect. The internal validity (quality) and heterogeneity of studies were taken into account. Results Thirteen studies were available, of which eight, involving 2362 patients, could be combined. For both reduction of pain and improvement of function, acupuncture was significantly superior to sham acupuncture (P<0.05 for all comparisons) in both the short term and the long term. Compared with no additional intervention (usual care), acupuncture was again significantly superior for pain and function. The treatment effects were maintained after taking account of quality and heterogeneity in sensitivity analyses. Conclusion Acupuncture is an effective treatment for osteoarthritis of the knee. Its overall effect size is 0.8, and it can be considered instead of non-steroidal anti-inflammatory drugs for patients whose symptoms are not controlled by education, exercise, weight loss if appropriate and simple analgesics. Further research is necessary into the most efficient way of delivering acupuncture, and its longer term benefits.

scholarly journals Natriuretic peptide-guided treatment for heart failure: a systematic review and meta-analysis

2019 ◽  
Vol 25 (1) ◽  
pp. 33-37 ◽  
Author(s):  
Julie McLellan ◽  
Clare R Bankhead ◽  
Jason L Oke ◽  
F D Richard Hobbs ◽  
Clare J Taylor ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Natriuretic Peptide ◽  
Meta Analysis ◽  
Sensitivity Analyses ◽  
Individual Outcomes ◽  
All Cause Mortality ◽  
Registration Number ◽  
Randomised Controlled ◽  
Meta Analyses

BackgroundGUIDE-IT, the largest trial to date, published in August 2017, evaluating the effectiveness of natriuretic peptide (NP)-guided treatment of heart failure (HF), was stopped early for futility on a composite outcome. However, the reported effect sizes on individual outcomes of all-cause mortality and HF admissions are potentially clinically relevant.ObjectiveThis systematic review and meta-analysis aims to combine all available trial level evidence to determine if NP-guided treatment of HF reduces all-cause mortality and HF admissions in patients with HF.Study selectionEight databases, no language restrictions, up to November 2017 were searched for all randomised controlled trials comparing NP-guided treatment versus clinical assessment alone in adult patients with HF. No language restrictions were applied. Publications were independently double screened and extracted. Fixed-effect meta-analyses were conducted.Findings89 papers were included, reporting 19 trials (4554 participants), average ages 62–80 years. Pooled risk ratio estimates for all-cause mortality (16 trials, 4063 participants) were 0.87, 95% CI 0.77 to 0.99 and 0.80, 95% CI 0.72 to 0.89 for HF admissions (11 trials, 2822 participants). Sensitivity analyses, restricted to low risk of bias, produced similar estimates, but were no longer statistically significant.ConclusionsConsidering all the evidence to date, the pooled effects suggest that NP-guided treatment is beneficial in reducing HF admissions and all-cause mortality. However, there is still insufficient high-quality evidence to make definitive recommendations on the use of NP-guided treatment in clinical practice.Trial registration numberSystematic Review Cochrane Database Number: CD008966.

scholarly journals Parathyroid hormone analogues for fracture healing: protocol for a systematic review and meta-analysis of randomised controlled trials

BMJ Open ◽  
2018 ◽  
Vol 8 (1) ◽  
pp. e019291 ◽  
Author(s):  
Shenghan Lou ◽  
Houchen Lv ◽  
Zhirui Li ◽  
Peifu Tang ◽  
Yansong Wang
Keyword(s):  
Systematic Review ◽  
Parathyroid Hormone ◽  
Fracture Healing ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Sensitivity Analyses ◽  
Published Data ◽  
Controlled Trials ◽  
Anabolic Effect ◽  
Randomised Controlled

IntroductionFracture healing is a complex physiological process. Impaired healing will increase the need for care and cause serious complications. Thus, identifying strategies to accelerate the rate of healing, preventing delayed unions and non-unions, is essential. Parathyroid hormone (PTH) is a key systemic regulator of calcium and phosphate metabolism. It has been determined that intermittent administration of PTH and its analogue can exert anabolic effect on bone, increase bone mass and reduce bone loss, leading to an increase in bone formation. Owing to their anabolic effect, there is an increasing interest in its potential in promoting the process of fracture healing. However, in clinical studies, the results are in conflict. This objective of this study is to determine the role of PTH analogues for fracture healing in adults.Methods and analysisMEDLINE, EMBASE and Cochrane databases will be searched to identify all randomised controlled trials (RCTs) and quasi-RCTs that compare the different effects between PTH analogues and any other treatments in adults with any type of fracture. The primary outcome is the functional recovery. And the secondary outcomes are fracture union and adverse events. The meta-analysis will be performed using a random effects model. Heterogeneity will be assessed by the P values and I² statistic. And subgroup analyses and sensitivity analyses will be used to explore the heterogeneity. Risk of bias will be assessed using the Cochrane tool and the quality of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.Ethics and disseminationEthical approval is not required because this proposed systematic review and meta-analysis is based on published data, without including confidential personal data or data on interventions on patients. The findings of this study will be published in a peer-reviewed journaland presented at a relevant conference.PROSPERO registration numberCRD42017062093.

scholarly journals Title: The Effectiveness of Participant Blinding of Non-Penetrating Sham/Placebo Acupuncture in Clinical Trials: A Systematic Review with Meta-Analysis

2021 ◽  
Author(s):  
Yee Hung Gan ◽  
Nway Aye Saint ◽  
Yen Suan Sin
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Control Method ◽  
Data Extraction ◽  
Meta Analysis ◽  
Sham Acupuncture ◽  
Placebo Control ◽  
Skin Contact ◽  
Randomised Controlled ◽  
Healthy Participants

Abstract Background: Acupuncture clinical trial is important to evaluate the efficacy of acupuncture. However, it is challenging to achieve effective blinding due to the nature of acupuncture. A standardised placebo control method of acupuncture has yet to be established. The study focuses on the non-penetrating sham acupuncture because it eliminates the placebo effect and generates lesser physiological responses. The study aims to evaluate and compare the participant blinding effectiveness of non-penetrating sham acupuncture devices, and analyse the factors which may influence the participant blinding.Methods: The study followed the PRISMA guidelines. An electronic search was conducted on PubMed, Ovid and CNKI up until 1st of October 2020 to include English and Chinese randomised controlled trials which evaluated the awareness on the type of acupuncture (real or sham) in any population who received acupuncture. Data screening, data extraction and quality assessment were done independently by two researchers and discrepancies were sorted out via discussion with a co-researcher. Data analysis was performed using RevMan 5.4.1.Results: 34 full-text articles had been included in the systematic review and meta-analysis. The quality of the studies ranged from moderate to good. Generally, non-penetrating sham acupuncture devices were effective in blinding participants in clinical trials. The foam device demonstrated a better blinding effect, followed by Streitberger, Park and Takakura devices. Sham needles with no skin contact could not blind the participants successfully. Naive, experienced, healthy and diseased participants all could be blinded using non-penetrating sham acupuncture devices but naive and healthy participants could be blinded comparatively easily. Acupoints from different regions could achieve blinding, however, the acupoints on the back could blind the participants more easily compared to the other areas.Conclusion: Non-penetrating sham acupuncture devices are valid placebo control for acupuncture clinical trials. The foam device has a better blinding effect, followed by Streitberger, Park and Takakura devices. Recruiting naive healthy participants and choosing acupoints from the back can achieve better blinding effects in the participants.

scholarly journals Therapeutic interventions for osteoarthritis of the wrist: a systematic review and meta-analysis

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 1484
Author(s):  
Benjamin Dean ◽  
Shwan Henari ◽  
Neal Thurley ◽  
Chris Little ◽  
Ian McNab ◽  
...  
Keyword(s):  
Systematic Review ◽  
Prospective Studies ◽  
Meta Analysis ◽  
Therapeutic Interventions ◽  
Osteoarthritis Of The Wrist ◽  
Registration Number ◽  
Review Protocol ◽  
Post Traumatic ◽  
Randomised Controlled ◽  
And Function

Background: In order to evaluate the effectiveness of interventions for osteoarthritis of the wrist in adults we performed a systematic review and meta-analysis. Methods: The MEDLINE and EMBASE via OVID, CINAHL and SPORTDiscus via EBSCO databases were searched from inception to 25th April  2018.All randomised controlled clinical trials (RCTs) and any prospective studies of adults with wrist osteoarthritis investigating any intervention with a comparator were included.  Data were extracted and checked for accuracy and completeness by pairs of reviewers. Primary outcomes were pain and function. Comparative treatment effects were analysed by random effects at all time points. Results: Three RCTs were identified for inclusion after screening and all had a high risk of bias. Two compared proximal row carpectomy (PRC) with four corner fusion (4CF) for post-traumatic osteoarthritis, while the other compared leather with commercial wrist splints in patients with chronic wrist pain, of which a small group had wrist osteoarthritis.  Conclusion: There is no prospective study comparing operative to non-operative treatment for wrist osteoarthritis, while there is a paucity of prospective studies assessing the effectiveness of both non-operative and operative interventions.  Further research is necessary in order to better define which patients benefit from which specific interventions. Registration: The review protocol was registered with PROSPERO under the registration number CRD42018094799.

scholarly journals Does adding hip exercises to quadriceps exercises result in superior outcomes in pain, function and quality of life for people with knee osteoarthritis? A systematic review and meta-analysis

2019 ◽  
Vol 54 (5) ◽  
pp. 263-271 ◽  
Author(s):  
Andrew Craig Hislop ◽  
Natalie J Collins ◽  
Kylie Tucker ◽  
Margaret Deasy ◽  
Adam Ivan Semciw
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Knee Osteoarthritis ◽  
Meta Analysis ◽  
Eligibility Criteria ◽  
Patient Reported ◽  
Randomised Controlled ◽  
And Function ◽  
Hip Strengthening

ObjectivesTo determine, in people with knee osteoarthritis (KOA): i) the effectiveness of adding hip strengthening exercises to quadriceps exercises and ii) the type of hip strengthening exercise with the greatest evidence for improving pain, function and quality of life.DesignSystematic review with meta-analysis.Data sourcesMedline, Embase, Cochrane, CINAHL and SportDiscus databases were searched from inception to January 2018.Eligibility criteria for selecting studiesRandomised controlled trials investigating the effect of adding hip exercises to quadriceps exercises in people with KOA on pain, function and/or quality of life were included. Three subgroups of hip exercises were included: resistance, functional neuromuscular or multimodal exercise.ResultsEight studies were included. Pooled data provide evidence that combined hip and quadriceps exercise is significantly more effective than quadriceps exercise alone for improving walking function (standardised mean difference −1.06, 95% CI −2.01 to −0.12), but not for outcomes of pain (−0.09, 95% CI –0.96 to 0.79), patient-reported function (−0.74, 95% CI –1.56 to 0.08) or stair function (−0.7, 95% CI –1.67 to 0.26). Subgroup analyses reveal that hip resistance exercises are more effective than functional neuromuscular exercises for improving pain (p<0.0001) and patient-reported function (p<0.0001). Multimodal exercise is no more effective than quadriceps strengthening alone for pain (0.13, 95% CI –0.31 to 0.56), patient-reported function (−0.15, 95% CI –0.58 to 0.29) or stair function (0.13, 95% CI –0.3 to 0.57).ConclusionWalking improved after the addition of hip strengthening to quadriceps strengthening in people with KOA. The addition of resistance hip exercises to quadriceps resulted in greater improvements in patient-reported pain and function.

scholarly journals Helicobacter pylorieradication treatment for gastric carcinoma prevention in asymptomatic or dyspeptic adults: systematic review and Bayesian meta-analysis of randomised controlled trials

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e026002 ◽  
Author(s):  
Teruhiko Terasawa ◽  
Chisato Hamashima ◽  
Katsuaki Kato ◽  
Isao Miyashiro ◽  
Takaki Yoshikawa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Gastric Carcinoma ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Eradication Therapy ◽  
Sensitivity Analyses ◽  
Controlled Trials ◽  
H Pylori ◽  
Randomised Controlled ◽  
Carcinoma Risk

ObjectivesRecent meta-analyses of eradication therapy inHelicobacter pylori-infected adults reported significant reductions in gastric carcinoma risk. However, concerns about supporting unfocused screening and eradication programme in healthy, asymptomatic populations have arisen. We performed a systematic review and Bayesian meta-analysis to provide an accurate interpretation of randomised evidence on the preventive effectiveness of eradication therapy on gastric carcinoma risk.MethodsWe searched databases including PubMed, Cochrane Central and Embase for reference and citation tracking without language restrictions, from inception through 31 July 2018. Paired investigators independently selected randomised controlled trials (RCTs) comparing eradication therapy with placebo or no treatment for asymptomatic or dyspepticH. pylori-infected adults with no previous gastric carcinoma. The main outcome was gastric carcinoma incidence; secondary outcomes included gastric carcinoma-specific, non-gastric carcinoma and all-cause mortality.ResultsA total of 5 population-based and 2 outpatient care-based RCTs involving 7303 adults were eligible. Eradication algorithms were heterogeneous, and unsuccessful eradication and reinfection were frequently observed. A Bayesian meta-analysis with competing risk outcomes found low-certainty evidence that eradication therapy might be more likely than control to reduce gastric carcinoma risk (HR=0.65; 95% credible interval (CrI) 0.41 to 1.0;I2=11%). The CrIs included the null effects across the subgroup and sensitivity analyses, apart from those based on particular models that excluded two RCTs that enrolled subjects with specific histological findings only (HR=0.55; CrI 0.30 to 0.89;I2=14%). The uncertainty of the average 41% risk reduction in gastric carcinoma-specific mortality included a clinically important mortality risk increase (HR=0.59 favouring eradication therapy; CrI 0.25 to 1.20;I2=13%; low certainty).ConclusionsThere is insufficient evidence to support or refute the effectiveness of eradication therapy in preventing gastric carcinoma inH. pylori-infected, high-risk populations. Rigorously conducted large RCTs of healthy infected adults only would provide evidence of the true efficacy of successful eradication.PROSPERO registration number:CRD42014009245.

scholarly journals Safety of tranexamic acid in thrombotic adverse events and seizure in patients with haemorrhage: a protocol for a systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e036020
Author(s):  
Shuhei Murao ◽  
Hidekazu Nakata ◽  
Kazuma Yamakawa
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Tranexamic Acid ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Underlying Disease ◽  
Sensitivity Analyses ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Randomised Controlled

IntroductionTranexamic acid (TXA) is a synthetic derivative of the amino acid lysine that inhibits fibrinolysis by blocking lysine-binding sites on plasminogen, which contribute to reduced bleeding, the need for transfusion and mortality. Although there is reliable evidence of the efficacy of TXA, its effects on other important outcomes, adverse events, including thrombotic events and seizure, remain uncertain.Methods and analysisWe will conduct a systematic review and meta-analysis of randomised controlled trials with the objective of evaluating the incidence of thrombotic adverse events and seizure and how the effect of TXA varies by dose and underlying disease. We will include patients with bleeding in any underlying disease. We will search MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials for randomised controlled trials. The planned date of our systematic search is 1 June 2020. We will follow the recommendations of the Cochrane Collaboration and the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Subgroup and sensitivity analyses will be performed to explore residual heterogeneity and inconsistency. Meta-regression analysis will be carried out to investigate the association between the incidence of adverse events and the TXA dose. The risk of systematic errors (bias) and random errors will be assessed and the overall quality of evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach.Ethics and disseminationThis study will not involve primary data collection, and formal ethics approval will therefore not be required. We aim to publish this systematic review in a peer-review journal.Trial registration numberUMIN000039611.

Effects of neurofeedback versus methylphenidate for the treatment of ADHD: systematic review and meta-analysis of head-to-head trials

2019 ◽  
Vol 22 (3) ◽  
pp. 111-117 ◽  
Author(s):  
Lixia Yan ◽  
Siyuan Wang ◽  
Yang Yuan ◽  
Junhua Zhang
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Sensitivity Analyses ◽  
Comparative Efficacy ◽  
Chinese Studies ◽  
Registration Number ◽  
Mean Differences ◽  
Randomised Controlled ◽  
Core Symptoms

BackgroundThe comparative efficacy and tolerability of methylphenidate (MPH) and neurofeedback (NF) in individuals with attention-deficit/hyperactivity disorder (ADHD) remains uncertain. This study aimed to fill this gap by means of a systematic review/meta-analysis.MethodsPubMed, OVID, ERIC, Web of Science, ClinialTrials.gov and a set of Chinese databases were searched until 22 August 2018. Standardised mean differences (SMD) were pooled using comprehensive meta-analysis software.Results18 randomised controlled trials (RCTs) were included (778 individuals with ADHD in the NF arm and 757 in the MPH group, respectively; 13 studies in Chinese, five in English). At the study first endpoint, MPH was significantly more efficacious than NF on ADHD core symptoms (ADHD symptoms combined: SMD=−0.578, 95% CI (−1.063 to –0.092)) and on two neuropsychological parameters (inattention:−0.959 (-1.711 to –0.208); inhibition:−0.469 (-0.872 to –0.066)). Dropouts were significantly lower in NF versus MPH (OR=0.412, 0.186 to 0.913). Results were robust to sensitivity analyses, with two important exceptions: removing Chinese studies and non-funded studies, no differences emerged between MPH and NF, although the number of studies was small. At the study follow-up, MPH was superior to NF in some outcomes, but results were inconsistent across raters.ConclusionsDue to the risk of bias of included studies, the results of the sensitivity analysis excluding Chinese and non-funded studies, and the mixed findings on at the follow-up endpoint, further high quality studies are needed to assess the comparative efficacy and acceptability of NF and MPH in individuals with ADHD.Trial registration numberCRD42018090256.

scholarly journals Effect of exercise on depression severity in older people: systematic review and meta-analysis of randomised controlled trials

2012 ◽  
Vol 201 (3) ◽  
pp. 180-185 ◽  
Author(s):  
Christopher Bridle ◽  
Kathleen Spanjers ◽  
Shilpa Patel ◽  
Nicola M. Atherton ◽  
Sarah E. Lamb
Keyword(s):  
Systematic Review ◽  
Older People ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Sensitivity Analyses ◽  
Controlled Trials ◽  
Depression Severity ◽  
Symptoms Of Depression ◽  
Individual Ability ◽  
Randomised Controlled

BackgroundThe prevelance of depression in older people is high, treatment is inadequate, it creates a substantial burden and is a public health priority for which exercise has been proposed as a therapeutic strategy.AimsTo estimate the effect of exercise on depressive symptoms among older people, and assess whether treatment effect varies depending on the depression criteria used to determine participant eligibility.MethodSystematic review and meta-analysis of randomised controlled trials of exercise for depression in older people.ResultsNine trials met the inclusion criteria and seven were meta-analysed. Exercise was associated with significantly lower depression severity (standardised mean difference (SMD) =–0.34, 95% CI –0.52 to –0.17), irrespective of whether participant eligibility was determined by clinical diagnosis (SMD =–0.38, 95% CI –0.67 to –0.10) or symptom checklist (SMD =–0.34, 95% CI –0.62 to –0.06). Results remained significant in sensitivity analyses.ConclusionsOur findings suggest that, for older people who present with clinically meaningful symptoms of depression, prescribing structured exercise tailored to individual ability will reduce depression severity.

scholarly journals The effect of nut consumption on markers of inflammation and endothelial function: a systematic review and meta-analysis of randomised controlled trials

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e016863 ◽  
Author(s):  
Elizabeth P Neale ◽  
Linda C Tapsell ◽  
Vivienne Guan ◽  
Marijka J Batterham
Keyword(s):  
Systematic Review ◽  
Endothelial Function ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Sensitivity Analyses ◽  
Intercellular Adhesion Molecule ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Markers Of Inflammation ◽  
Randomised Controlled

ObjectivesTo examine the effect of nut consumption on inflammatory biomarkers and endothelial function.DesignA systematic review and meta-analysis.Data sourcesMEDLINE, PubMed, Cumulative Index to Nursing and Allied Health Literature and Cochrane Central Register of Controlled Trials (all years to 13 January 2017).Eligibility criteriaRandomised controlled trials (with a duration of 3 weeks or more) or prospective cohort designs conducted in adults; studies assessing the effect of consumption of tree nuts or peanuts on C-reactive protein (CRP), adiponectin, tumour necrosis factor alpha, interleukin-6, intercellular adhesion molecule 1, vascular cell adhesion protein 1 and flow-mediated dilation (FMD).Data extraction and analysisRelevant data were extracted for summary tables and analyses by two independent researchers. Random effects meta-analyses were conducted to explore weighted mean differences (WMD) in change or final mean values for each outcome.ResultsA total of 32 studies (all randomised controlled trials) were included in the review. The effect of nut consumption on FMD was explored in nine strata from eight studies (involving 652 participants), with consumption of nuts resulting in significant improvements in FMD (WMD: 0.79%(95% CI 0.35 to 1.23)). Nut consumption resulted in small, non-significant differences in CRP (WMD: −0.01 mg/L (95% CI −0.06 to 0.03)) (26 strata from 25 studies), although sensitivity analyses suggest results for CRP may have been influenced by two individual studies. Small, non-significant differences were also found for other biomarkers of inflammation.ConclusionsThis systematic review and meta-analysis of the effects of nut consumption on inflammation and endothelial function found evidence for favourable effects on FMD, a measure of endothelial function. Non-significant changes in other biomarkers indicate a lack of consistent evidence for effects of nut consumption on inflammation. The findings of this analysis suggest a need for more research in this area, with a particular focus on randomised controlled trials.PROSPERO registration numberCRD42016045424.

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