scholarly journals Efficacy of Oral Ginger (Zingiber officinale) for Dysmenorrhea: A Systematic Review and Meta-Analysis

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Chen X. Chen ◽  
Bruce Barrett ◽  
Kristine L. Kwekkeboom
Keyword(s):  
Systematic Review ◽  
Methodological Quality ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Grey Literature ◽  
Zingiber Officinale ◽  
Mean Difference ◽  
Significant Difference ◽  
Meta Analyses

This systematic review examines the efficacy of oral ginger for dysmenorrhea. Key biomedical databases and grey literature were searched. We included randomized controlled trials comparing oral ginger against placebo or active treatment in women with dysmenorrhea. Six trials were identified. Two authors independently reviewed the articles, extracted data, and assessed risk of bias. Discrepancies were resolved by consensus with a third reviewer. We completed a narrative synthesis of all six studies and exploratory meta-analyses of three studies comparing ginger with placebo and two studies comparing ginger with a nonsteroidal anti-inflammatory drug (NSAID). Ginger appeared more effective for reducing pain severity than placebo. The weighted mean difference on a 10 cm visual analogue scale was 1.55 cm (favoring ginger) (95% CI 0.68 to 2.43). No significant difference was found between ginger and mefenamic acid (an NSAID). The standardized mean difference was 0 (95% CI −0.40 to 0.41). Available data suggest that oral ginger could be an effective treatment for menstrual pain in dysmenorrhea. Findings, however, need to be interpreted with caution because of the small number of studies, poor methodological quality of the studies, and high heterogeneity across trials. The review highlights the need for future trials with high methodological quality.

Medical visit time and predictors in health facilities: a mega systematic review and meta-analysis

2019 ◽  
Vol 12 (5) ◽  
pp. 373-402 ◽  
Author(s):  
Sakineh Hajebrahimi ◽  
Ali Janati ◽  
Morteza Arab-Zozani ◽  
Mobin Sokhanvar ◽  
Elaheh Haghgoshayie ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Visit Time ◽  
Medical Visit ◽  
High Quality ◽  
Content Type ◽  
Face To Face ◽  
Significant Difference ◽  
Meta Analyses

Purpose Visit time is a crucial aspect of patient–physician interaction; its inadequacy can negatively impact the efficiency of treatment and diagnosis. In addition, visit time is a fundamental demand of patients, and it is one of the rights of every patient. The purpose of this paper is to determine factors influencing the consultation length of physicians and to compare consultation length in different countries. Design/methodology/approach MEDLINE (PubMed), Web of Science, Cochrane, ProQuest, Scopus, and Google Scholar were searched. In addition, references of references were checked, and publication lists of individual scholars in the field were examined. We used data sources up to June 2018, without language restriction. We used a random-effects model for the meta-analyses. Meta-analyses were conducted using Comprehensive Meta-Analysis Version (CMA) 3.0. Findings Of 16,911 identified studies, 189 studies were assessed of which 125 cases (67 percent) have been conducted in the USA. A total of 189 studies, 164 (86.77 percent) involved face-to face-consultations. The effects of three variables, physician gender, patient gender, and type of consultation were analyzed. According to moderate and strong evidence studies, no significant difference was found in the consultation lengths of female and male doctors (Q=42.72, df=8, I2=81.27, p=0.891) and patients’ gender (Q=55.98, df=11, I2=80.35, p=0.314). In addition, no significant difference was found in the telemedicine or face-to-face visits (Q=41.25, df=5, I2=87.88, p=0.170). Originality/value In this systematic review and meta-analysis, all of physicians’ visits in 34 countries were surveyed. The evidence suggests that specified variables do not influence the length of consultations. Good relationship is essential to a safe and high-quality consultation and referral process. A high-quality consultation can improve decisions and quality of visits, treatment effectiveness, efficiency of service, quality of care, patient safety and physician and patient satisfaction.

scholarly journals Systematic Reviews and Meta-Analysis in Spine Surgery—How Good Are They in Methodological Quality? A Systematic Review

2020 ◽  
pp. 219256822090681 ◽  
Author(s):  
Muthu Sathish ◽  
Ramakrishnan Eswar
Keyword(s):  
Systematic Review ◽  
Spine Surgery ◽  
Systematic Reviews ◽  
Methodological Quality ◽  
Meta Analysis ◽  
Eligibility Criteria ◽  
Cochrane Database ◽  
Critical Flaw ◽  
Meta Analyses

Study Design: Systematic review. Objectives: To assess the methodological quality of systematic reviews and meta-analyses in spine surgery over the past 2 decades. Materials and Methods: We conducted independent and in duplicate systematic review of the published systematic reviews and meta-analyses between 2000 and 2019 from PubMed Central and Cochrane Database pertaining to spine surgery involving surgical intervention. We searched bibliographies to identify additional relevant studies. Methodological quality was evaluated with AMSTAR score and graded with AMSTAR 2 criteria. Results: A total of 96 reviews met the eligibility criteria, with mean AMSTAR score of 7.51 (SD = 1.98). Based on AMSTAR 2 criteria, 13.5% (n = 13) and 18.7% (n = 18) of the studies had high and moderate level of confidence of results, respectively, without any critical flaws. A total of 29.1% (n = 28) of the studies had at least 1 critical flaw and 38.5% (n = 37) of the studies had more than 1 critical flaw, so that their results have low and critically low confidence, respectively. Failure to analyze the conflict of interest of authors of primary studies included in review and lack of list of excluded studies with justification were the most common critical flaw. Regression analysis demonstrated that studies with funding and studies published in recent years were significantly associated with higher methodological quality. Conclusion: Despite improvement in methodological quality of systematic reviews and meta-analyses in spine surgery in current decade, a substantial proportion continue to show critical flaws. With increasing number of review articles in spine surgery, stringent measures must be taken to adhere to methodological quality by following PRISMA and AMSTAR guidelines to attain higher standards of evidence in published literature.

P14.71 An assessment of the reporting and methodological quality of meningioma systematic reviews and meta-analyses

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii51-ii52
Author(s):  
A M George ◽  
S Gupta ◽  
S M Keshwara ◽  
M A Mustafa ◽  
C S Gillespie ◽  
...  
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Methodological Quality ◽  
Meta Analysis ◽  
Neurofibromatosis Type ◽  
Risk Of Bias ◽  
Measurement Tool ◽  
High Quality ◽  
Meta Analyses

Abstract BACKGROUND Systematic reviews and meta-analyses constitute the highest level of research evidence and for a disease with limited clinical trial activity, are often relied upon to help inform clinical practice. This review of reviews evaluates both the reporting & methodological quality of meningioma evidence syntheses. MATERIAL AND METHODS Potentially eligible meningioma reviews published between 1st January 1990 and 31st December 2020 were identified from eight electronic databases. Inclusion required the study to meet the Cochrane guideline definition of a systematic review or meta-analysis. Reviews concerning neurofibromatosis type 2, spinal and pediatric meningiomas were excluded. The reporting and methodological quality of articles were assessed against the following modified guidelines: Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), A MeaSurement Tool to Assess Systematic Reviews (AMSTAR2) and the Risk of Bias in Systematic Reviews (ROBIS) guidelines. RESULTS 117 systematic reviews were identified, 57 of which included meta-analysis (48.7%). The number of meningioma systematic reviews published each year has increased with 63 studies (53.9%) published between 01/2018 and 12/2020. A median of 17 studies (IQR 9–29) were included per review. Impact factor of journals publishing a systematic review with or without a meta-analysis was similar (median 2.3 vs 1.8, P=0.397). The mean PRISMA scores for systematic reviews with a meta-analysis was 21.11 (SD 4.1, 78% adherence) and without was 13.89 (SD 3.4, 63% adherence). Twenty-nine systematic reviews with meta-analysis (51%) and 11 without meta-analysis (18%) achieved greater than 80% adherence to PRISMA recommendations. Methodological quality assessment using AMSTAR2 revealed one study (0.9%) as high quality whilst 111 (94.8%) studies were graded as critically low. One hundred and two articles (87.2%) did not utilize a comprehensive search strategy as defined by the AMSTAR2 tool. Ninety-nine studies (84.6%) obtained a high level of concern for potential bias as per the ROBIS assessment. One hundred and eight articles (92.3%) failed to present information that a protocol had been established prior to study commencement and 76 articles (65.0%) did not conduct a risk of bias assessment. Across the three tools, domains relating to the establishment of a protocol prior to review commencement and conducting appropriate risk of bias assessments were frequently low scoring. CONCLUSION Overall reporting and methodological quality of meningioma systematic reviews was sub-optimal. Established critical appraisal tools and reporting guidelines should be utilized a priori to assist in producing high-quality systematic reviews.

scholarly journals Does pain influence force steadiness? A protocol for a systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e042525
Author(s):  
Michail Arvanitidis ◽  
Deborah Falla ◽  
Andy Sanderson ◽  
Eduardo Martinez-Valdes
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Grey Literature ◽  
Force Steadiness ◽  
Assessment Development ◽  
Ethical Approval ◽  
Registration Number ◽  
Meta Analyses

IntroductionPerforming contractions with minimum force fluctuations is essential for everyday life as reduced force steadiness impacts on the precision of voluntary movements and functional ability. Several studies have investigated the effect of experimental or clinical musculoskeletal pain on force steadiness but with conflicting findings. The aim of this systematic review is to summarise the current literature to determine whether pain, whether it be clinical or experimental, influences force steadiness.Methods and analysisThis protocol for a systematic review was informed and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols and the Cochrane Handbook for Systematic Reviews of Interventions. Key databases will be searched from inception to 31 August 2020, including MEDLINE, EMBASE, PubMed, CINAHL Plus, ZETOC and Web of Science. Grey literature and key journals will be also reviewed. Risk of bias will be assessed with the Newcastle-Ottawa tool, and the quality of the cumulative evidence assessed with the Grading of Recommendations, Assessment, Development and Evaluation guidelines. If homogeneity exists between groups of studies, meta-analysis will be conducted. Otherwise, a narrative synthesis approach and a vote-counting method will be used, while the results will be presented as net increases or decreases of force steadiness.Ethics and disseminationThe findings will be presented at conferences and the review will be also submitted for publication in a refereed journal. No ethical approval was required.PROSPERO registration numberCRD42020196479

scholarly journals Evaluating the Quality of the Iranian Systematic Reviews, Meta-Analyses, and Economic Evaluations in Healthcare from 2005 to 2015

2021 ◽  
Author(s):  
Morteza Arab-Zozani ◽  
Zahra Heidarifard ◽  
Efat Jabarpour
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Methodological Quality ◽  
Time Horizon ◽  
Meta Analysis ◽  
Economic Evaluations ◽  
Evidence Based ◽  
Economic Perspective ◽  
Meta Analyses

Context: The number of studies on health is increasing rapidly worldwide and in Iran. Systematic review studies, meta-analyses, and economic evaluation are of great importance in evidence-based decision making because of their standing in the evidence-based pyramid. The purpose of this study was to evaluate the reporting and methodological quality of Iranian systematic reviews, meta-analysis studies and economic evaluations on healthcare. Evidence Acquisition: PubMed and Scopus databases were searched to find considered studies, including systematic reviews, meta analyses and economic evaluations published from 2005 to 2015. Because of the high volume of review studies, 10% of all systematic reviews and meta-analyses were selected as a random sample. Also, all economic evaluations were included. Articles were evaluated using checklists, including PRISMA, AMSTAR and QHES with a maximum score of 27, 11 and 100, respectively. The quality score for each criterion as well as the epidemiological and descriptive characteristics of all articles was determined. Data were analyzed using SPSS V. 16 software. Results: After searching the databases, 1084 systematic reviews and meta-analyses were obtained, 10% of which were included in the study. A total of 41 economic evaluations were also included. The mean scores of systematic reviews and meta-analyses based on PRISMA and AMSTAR checklists were 17.04 (5.35) and 5.42 (1.97), respectively, and 68.21 (12.44) for economic evaluations based on QHES. Only three systematic reviews and meta-analysis articles had recorded protocols and 85% of the studies included the terms “systematic review” and “meta-analysis” in their titles. Only one study had been updated. In addition, 81% of the systematic reviews and meta-analyses were published in specialized journals and 47% in Iranian journals. Financial resources and conflict of interests had been mentioned in 33% and 66% of the studies, respectively. Of the selected studies, 60% had evaluated the quality of the articles and 35% of the studies had assessed publication bias. In economic evaluations, 56% had used CEA analysis, 22% CUA analysis, 12% CBA analysis, and one study had used CMA analysis. Of these studies, 54% were model-based health economic studies and 12% were trial-based. The economic perspective was the health care system in most studies. Forty-four percent of the studies had a short time horizon of one year or less, whereas 33% had a lifetime horizon. Moreover, 68% of the studies showed sensitivity analysis and only 5 included the magnitude and direction of the bias. Conclusions: Overall, the reporting and methodological quality of the selected studies were estimated at a moderate level. Based on these results, it is recommended to adopt strategies to reduce preventable errors in studies. Having a primary plan and protocol and registering it as a systematic review can be an important factor in improving the quality of studies. Economic evaluations should also focus on issues, such as economic perspective, time horizon, available bias, and sensitivity analysis.

On-clamp versus off-clamp robotic partial nephrectomy: A systematic review and meta-analysis

2019 ◽  
Vol 86 (2) ◽  
pp. 52-62 ◽  
Author(s):  
Alessandro Antonelli ◽  
Alessandro Veccia ◽  
Simone Francavilla ◽  
Riccardo Bertolo ◽  
Pierluigi Bove ◽  
...  
Keyword(s):  
Systematic Review ◽  
Confidence Interval ◽  
Partial Nephrectomy ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Mean Difference ◽  
Robotic Partial Nephrectomy ◽  
Weighted Mean ◽  
Robot Assisted ◽  
Significant Difference

Background: The debate on the pros and cons of robot-assisted partial nephrectomy performed with (on-clamp) or without (off-clamp) renal artery clamping is ongoing. The aim of this meta-analysis is to summarize the available evidence on the comparative studies assessing the outcomes of these two approaches. Material and methods: A systematic review of the literature on PubMed, ScienceDirect®, and Embase® was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement (PRISMA). Only comparative and case-control studies were submitted to full-text assessment and meta-analysis. RevMan 5.3 software was used. Results: From the initial retrieval of 1937 studies, 15 fulfilling inclusion criteria were selected and provided 2075 patients for analysis (702 off-clamp, 1373 on-clamp). Baseline tumor’s features showed a significant difference in size (weighted mean difference: –0.58 cm; 95% confidence interval: [–1.06, –0.10]; p = 0.02) and R.E.N.A.L. score (weighted mean difference: –0.53; 95% confidence interval: [–0.81, –0.25]; p = 0.0002), but not in the exophytic property, the location, and the PADUA score. Pooled analysis revealed shorter operative time (p = 0.02) and higher estimated blood loss (p = 0.0002) for the off-clamp group. Overall complication and transfusion rates were similar, while higher major complication rate was observed in the on-clamp approach (5.6% vs 1.9%, p = 0.03). No differences in oncological outcomes were found. Finally, functional outcomes (assessed by estimated glomerular filtration rate at early postoperative, 3 month, 6 month, and last available follow-up) were not statistically different. Conclusion: This meta-analysis shows that off-clamp robot-assisted partial nephrectomy is reserved to smaller renal masses. Under such conditions, no differences with the on-clamp approach emerged.

scholarly journals Association of variants within the GST and other genes with anti-tubercular agents related toxicity: a systematic review and meta-analysis

2019 ◽  
Author(s):  
Marty Richardson ◽  
Jamie Kirkham ◽  
Kerry Dwan ◽  
Derek J Sloan ◽  
Geraint Davies ◽  
...  
Keyword(s):  
Systematic Review ◽  
Genetic Variants ◽  
Methodological Quality ◽  
Meta Analysis ◽  
Evidence Base ◽  
Wild Type ◽  
Mutant Type ◽  
Significant Difference ◽  
Homozygous Mutant

AbstractBackgroundIndividuals receiving treatment with anti-tuberculosis (TB) drugs may experience serious side-effects, such as anti-TB drug-induced hepatotoxicity (ATDH). Genetic variants, such as polymorphisms of the GST gene and other genes, may increase the risk of experiencing such toxicity events. This systematic review and meta-analysis provides a comprehensive evaluation of the evidence base for associations between variants of the GST gene and other genes and toxicity outcomes related to anti-TB drugs.MethodsWe searched for relevant studies in MEDLINE, PubMed, EMBASE, BIOSIS and Web of Science. We pooled effect estimates for each genotype on each outcome, and stratified all analyses by country. We qualitatively assessed the methodological quality of the included studies.ResultsWe included data from 28 distinct cohorts of patients in the review. The methodological quality of included studies was variable, with several important areas of concern. For GSTM1, patients with the homozygous null genotype were significantly more likely to experience hepatotoxicity than patients with heterozygous or homozygous present genotype (odds ratio [OR]=1.44, 95% confidence interval [CI] 1.15, 1.82). Moderate heterogeneity was observed in this analysis (I2=51.2%). No significant difference was observed for the GSTT1 null polymorphism. For the rs3814057 polymorphism of the PXR gene, both heterozygous genotype and homozygous mutant-type significantly increased hepatotoxicity risk compared with homozygous wild-type (heterozygous versus homozygous wild-type: OR=1.98, 95% CI 1.06, 3.69; I2=0%; homozygous mutant-type versus homozygous wild-type: OR=2.18, 95% CI 1.07, 4.44; I2=0%).ConclusionsWe found that it is challenging to perform robust synthesis of the evidence base for associations between GST and other genetic variants and toxicity related to anti-TB drugs. We identified significant associations between the GSTM1 null and PXR rs3814057 polymorphisms and ATDH. To the best of our knowledge, no meta-analyses on genetic variants other than variants of the NAT2, CYP2E1, GSTM1 and GSTT1 genes have been published. Our results therefore add to the existing understanding of the association between genetic variants and hepatotoxicity.

scholarly journals Periodontitis is associated with hypertension: a systematic review and meta-analysis

2019 ◽  
Vol 116 (1) ◽  
pp. 28-39 ◽  
Author(s):  
Eva Muñoz Aguilera ◽  
Jean Suvan ◽  
Jacopo Buti ◽  
Marta Czesnikiewicz-Guzik ◽  
Aline Barbosa Ribeiro ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Primary Outcome ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Health Assessment ◽  
Periodontal Therapy ◽  
Mean Difference ◽  
Weighted Mean ◽  
Meta Analyses

Abstract Recent evidence suggests a link between periodontitis (PD) and hypertension, but the nature of this association remains unclear. The overall aim of this review was to critically appraise the evidence linking these two common disorders. Systematic search was conducted for studies published up to December 2018. Prevalence of hypertension in patients with PD (moderate/severe groups) vs. those without PD (non-PD) was the primary outcome. Additional outcomes included adjusted mean difference in systolic (SBP) and diastolic (DBP) blood pressure (BP) levels in PD vs. non-PD, assessment of biomarkers in PD and hypertension, and BP changes after periodontal therapy. From 81 studies selected, 40 were included in quantitative meta-analyses. Diagnoses of moderate-severe PD [odds ratio (OR) = 1.22; 95% confidence interval (CI): 1.10–1.35] and severe PD (OR = 1.49; 95% CI: 1.09–2.05) were associated with hypertension. Prospective studies confirmed PD diagnosis increased likelihood of hypertension occurrence (OR = 1.68; 95% CI: 0.85–3.35). Patients with PD exhibited higher mean SBP [weighted mean difference (WMD) of 4.49 mmHg; 95% CI: 2.88–6.11] and DBP (2.03 mmHg; 95% CI: 1.25–2.81) when compared with non-PD. Lastly, only 5 out of 12 interventional studies confirmed a reduction in BP following periodontal therapy, ranging from 3 to 12.5 mmHg of SBP and from 0 to 10 mmHg of DBP. PD is associated with increased odds of hypertension (SORT C) and higher SBP/DBP levels. The evidence suggesting that PD therapy could reduce BP is inconclusive. Although additional research is warranted on this association, these results suggest that oral health assessment and management of PD could not only improve oral/overall health and quality of life but also be of relevance in the management of patients with hypertension.

scholarly journals Systematic review and stratified meta-analysis of the efficacy of carnosine in animal models of ischemic stroke

2016 ◽  
Vol 36 (10) ◽  
pp. 1686-1694 ◽  
Author(s):  
Charles K Davis ◽  
Peter J Laud ◽  
Zsanett Bahor ◽  
GK Rajanikant ◽  
Arshad Majid
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Methodological Quality ◽  
Infarct Volume ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Young Male ◽  
In Vivo Models

Carnosine is a naturally occurring pleotropic dipeptide which influences multiple deleterious mechanisms that are activated during stroke. Numerous published studies have reported that carnosine has robust efficacy in ischemic stroke models. To further evaluate these data, we have conducted a systematic review and meta-analysis of published studies. We included publications describing in vivo models of ischemic stroke where the neuroprotective efficacy of carnosine was being evaluated through the reporting of infarct volume and/or neurological score as outcomes. Overall efficacy was evaluated using weighted mean difference random effects meta-analysis. We also evaluated for study quality and publication bias. We identified eight publications that met our inclusion criteria describing a total of 29 comparisons and 454 animals. Overall methodological quality of studies was moderate (median = 4/9). Carnosine reduced infarct volume by 29.4% (95% confidence interval (CI), 24.0% to 34.9%; 29 comparisons). A clear dose-response effect was observed, and efficacy was reduced when carnosine was administered more than 6 h after ischemia. Our findings suggest that carnosine administered before or after the onset of ischemia exhibits robust efficacy in experimental ischemic stroke. However, the methodological quality of some of the studies was low and testing occurred only in healthy young male animals.

scholarly journals The Impact of Calcitriol on Orthodontic Tooth Movement: A Cumulative Systematic Review and Meta-Analysis

2021 ◽  
Vol 11 (19) ◽  
pp. 8882
Author(s):  
Ali Al-Attar ◽  
Mushriq Abid ◽  
Arkadiusz Dziedzic ◽  
Mustafa M. Al-Khatieeb ◽  
Maisa Seppala ◽  
...  
Keyword(s):  
Systematic Review ◽  
Sample Size ◽  
Tooth Movement ◽  
Meta Analysis ◽  
Mean Difference ◽  
Level Of Evidence ◽  
Inadequate Sample Size ◽  
Significant Difference ◽  
The Impact

A cumulative review with a systematic approach aimed to provide a comparison of studies’ investigating the possible impact of the active form of vitamin D3, calcitriol (CTL), on the tooth movement caused by orthodontic forces (OTM) by evaluating the quality of evidence, based on collating current data from animal model studies, in vivo cell culture studies, and human clinical trials. Methods: A strict systematic review protocol was applied following the application of the International Prospective Register of Systematic Reviews (PROSPERO). A structured search strategy, including main keywords, was defined during detailed search with the application of electronic database systems: Medline/Pubmed, EMBASE, Scopus, Web of Science, and PsycINFO. In addition, a search was carried out with the use of ClinicalTrials.gov search in order to include ongoing or recently completed trials. The Oxford Level of Evidence and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was utilized to critically evaluate the risk of bias and relative quality of studies included. Meta-analysis with the use of RevMan5 software, random effect, and inverted variable method allowed the quantification of cumulative results. Results: Twenty-seven studies were identified which fulfilled inclusion criteria, including two clinical studies. The assessed level of evidence was variable and inconsistent, predominantly being moderate or low due to a significant difference in study design, sample size, and study protocols. Data synthesis rendered from meta-analysis involving various CTL doses demonstrated slight discrepancies in tooth movement between control and experimental groups (mean difference = 0.27; 95% CI: 0.01–0.53, std mean difference = 0.49; 95% CI: 0.09–0.89), as well as relatively moderate heterogenicity. Conclusions: Although it has been suggested that CTL could accelerate OTM in animal studies and clinical context, these scarce data were supported by a low level of evidence and the studies were carried out using inadequate sample size. Well-powered RCT studies would help to overcome the lack of robustness of the research.

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