scholarly journals Periodontitis Impact in Interleukin-6 Serum Levels in Solid Organ Transplanted Patients: A Systematic Review and Meta-Analysis

Diagnostics ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. 184 ◽  
Author(s):  
Vanessa Machado ◽  
João Botelho ◽  
Joana Lopes ◽  
Mariana Patrão ◽  
Ricardo Alves ◽  
...  
Keyword(s):  
Systematic Review ◽  
Serum Levels ◽  
Case Control ◽  
Risk Of Bias ◽  
Solid Organ ◽  
Systemic Complications ◽  
Moderate Quality ◽  
Meta Analyses ◽  
The Impact ◽  
Quality Evidence

This systematic review aimed to investigate the influence of periodontitis on post-transplant IL-6 serum levels of solid organ transplanted patients as compared to healthy subjects. Four databases (PubMed, Scholar, EMBASE, and CENTRAL) were searched up to February 2020 (PROSPERO CRD42018107817). Case-control and cohort studies on the association of IL-6 serum levels with a periodontal status of patients after solid organ transplantation were included. The risk of bias of observational studies was assessed through the Newcastle-Ottawa Scale (NOS). Random effects meta-analyses were thoroughly conducted. GRADE assessment provided quality evidence. Four case-control studies fulfilled the inclusion criteria (274 transplant recipients and 146 healthy controls), all of low risk of bias. Meta-analyses revealed significantly higher IL-6 levels in transplanted patients than healthy individuals with low-quality evidence (Mean Difference (MD): 2.55 (95% confidence interval (CI): 2.07, 3.03)). Transplanted patients with periodontitis have higher serum IL-6 levels than transplanted patients without periodontitis with moderate quality evidence (MD: 2.20 (95% CI: 1.00, 3.39)). We found low-quality evidence of higher IL-6 levels than healthy patients in patients with heart and kidney transplant. In these transplanted patients, there was moderate quality evidence that periodontitis is associated with higher IL-6 serum levels. Future research should consider the impact of such a difference in organ failure and systemic complications.

scholarly journals Considering the methodological limitations in the evidence base of antidepressants for depression: a reanalysis of a network meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e024886 ◽  
Author(s):  
Klaus Munkholm ◽  
Asger Sand Paludan-Müller ◽  
Kim Boesen
Keyword(s):  
Systematic Review ◽  
Clinical Study ◽  
Effect Size ◽  
Meta Analysis ◽  
Evidence Base ◽  
Risk Of Bias ◽  
Depression Symptom ◽  
Meta Analyses ◽  
The Impact ◽  
Clinical Study Reports

ObjectivesTo investigate whether the conclusion of a recent systematic review and network meta-analysis (Ciprianiet al) that antidepressants are more efficacious than placebo for adult depression was supported by the evidence.DesignReanalysis of a systematic review, with meta-analyses.Data sources522 trials (116 477 participants) as reported in the systematic review by Ciprianiet aland clinical study reports for 19 of these trials.AnalysisWe used the Cochrane Handbook’s risk of bias tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to evaluate the risk of bias and the certainty of evidence, respectively. The impact of several study characteristics and publication status was estimated using pairwise subgroup meta-analyses.ResultsSeveral methodological limitations in the evidence base of antidepressants were either unrecognised or underestimated in the systematic review by Ciprianiet al. The effect size for antidepressants versus placebo on investigator-rated depression symptom scales was higher in trials with a ‘placebo run-in’ study design compared with trials without a placebo run-in design (p=0.05). The effect size of antidepressants was higher in published trials compared with unpublished trials (p<0.0001). The outcome data reported by Ciprianiet aldiffered from the clinical study reports in 12 (63%) of 19 trials. The certainty of the evidence for the placebo-controlled comparisons should be very low according to GRADE due to a high risk of bias, indirectness of the evidence and publication bias. The mean difference between antidepressants and placebo on the 17-item Hamilton depression rating scale (range 0–52 points) was 1.97 points (95% CI 1.74 to 2.21).ConclusionsThe evidence does not support definitive conclusions regarding the benefits of antidepressants for depression in adults. It is unclear whether antidepressants are more efficacious than placebo.

scholarly journals Prevalence of acute liver injury and hypertransaminemia in patients with COVID-19: a protocol for a systematic review

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e040517
Author(s):  
Gang Li ◽  
Yongxing Xu ◽  
Yi Tian Yang ◽  
Peng Fei Liu
Keyword(s):  
Systematic Review ◽  
Liver Injury ◽  
Acute Liver Injury ◽  
Epidemiological Data ◽  
Risk Of Bias ◽  
Published Data ◽  
Language Restriction ◽  
Ethical Approval ◽  
Meta Analyses ◽  
The Impact

IntroductionCOVID-19 has spread rapidly in China and around the world. Published studies have revealed that some patients with COVID-19 had abnormal liver function in laboratory tests. However, the results were inconsistent and the analysis of epidemiological data stratified by the severity of COVID-19 was not available in previous meta-analyses. Furthermore, these meta-analyses were suspected of overestimating the incidence of liver injury in patients with COVID-19 because some studies considered transaminase elevation as liver injury, which might partially result from cardiac and muscle injury. This systematic review aims to enrol published literatures related to COVID-19 without language restriction, analyse the data based on the severity of the COVID-19 and explore the impact of varied definitions of liver injury on the incidence of liver injury.Methods and analysisWe have conducted a preliminary search on PubMed and Excerpta Medica Database on 13 April 2020, for the studies published after December 2019 on the prevalence of acute liver injury and hypertransaminemia in patients with COVID-19. Two reviewers will independently screen studies, extract data and assess the risk of bias. We will estimate the pooled incidence of hypertransaminemia and acute liver injury in patients with COVID-19 by using the random-effects model. The I² test will be used to identify the extent of heterogeneity. Publication bias will be assessed by funnel plot and performing the Begg’s and Egger’s test if adequate studies are available. We will perform a risk of bias assessment using the Joanna Briggs Institute’s critical appraisal checklist.Ethics and disseminationSince this study will be based on the published data, it does not require ethical approval. The final results of this study will be published in a peer-reviewed journal.PROSPERO registration numberCRD42020179462.

scholarly journals Association Between Components of the Delirium Syndrome and Outcomes in Hospitalised Adults: A Systematic Review and Meta-Analysis.

2020 ◽  
Author(s):  
Zoë Tieges ◽  
Terence Quinn ◽  
Lorn MacKenzie ◽  
Daniel Davis ◽  
Graciela Muniz-Terrera ◽  
...  
Keyword(s):  
Systematic Review ◽  
Assessment Tool ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Evaluation Framework ◽  
Cochrane Central Register ◽  
Symptom Domains ◽  
Meta Analyses ◽  
Psychotic Features ◽  
Quality Evidence

Abstract Background Delirium is a heterogeneous syndrome with inattention as the core feature. There is considerable variation in the presence and degree of other symptom domains such as altered arousal, psychotic features and global cognitive dysfunction. Delirium is independently associated with increased mortality, but it is unclear whether individual symptom domains of delirium have prognostic importance. We conducted a systematic review and meta-analysis of studies in hospitalised adults in general settings to identify the relationship between symptom domains of delirium and outcomes.(PROSPERO: CRD42018093935). Methods We searched MEDLINE, EMBASE, PsycINFO, CINAHL, clinicaltrials.gov and the Cochrane Central Register of Controlled Trials from inception to November 2019. We included studies of hospitalised adults that reported associations between symptom domains of delirium and 30-day mortality (primary outcome), and other outcomes including mortality at other time points, length of stay, and dementia. Reviewer pairs independently screened articles, extracted data, and assessed risk of bias (Risk of Bias Assessment tool for Non-randomized Studies) and quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation framework. We performed random-effects meta-analyses stratified by delirium domain where possible.Results From 7092 citations we included 6 studies (6002 patients, 1112 with delirium). Higher mortality was associated with altered arousal (pooled Odds Ratio (OR) 2.80, 95% Confidence Interval (CI) 2.33-3.37; moderate-quality evidence), inattention (pooled OR 2.57, 95% CI 1.74-3.80; low-quality evidence), and in single studies with disorientation, memory deficits and disorganised thoughts. Risk of bias varied across studies but was moderate-to-high overall, mainly due to selection bias, lack of blinding of assessments and unclear risk of selective outcome reporting. We found no studies on the association between psychotic features, visuospatial deficits or affective disturbances in delirium and outcomes, or studies reporting non-mortality outcomes.Conclusions Few studies have related symptom domains of delirium to outcomes, but the available evidence suggests that altered arousal and inattention in delirium are associated with higher mortality than normal arousal and attention in people with or without delirium. Measurable symptom domains of delirium may have value in predicting survival and stratifying patients for treatment. We recommend that future delirium studies report outcomes by symptom domain.

scholarly journals Association between components of the delirium syndrome and outcomes in hospitalised adults: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zoë Tieges ◽  
Terence Quinn ◽  
Lorn MacKenzie ◽  
Daniel Davis ◽  
Graciela Muniz-Terrera ◽  
...  
Keyword(s):  
Systematic Review ◽  
Assessment Tool ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Evaluation Framework ◽  
Cochrane Central Register ◽  
Symptom Domains ◽  
Meta Analyses ◽  
Psychotic Features ◽  
Quality Evidence

Abstract Background Delirium is a heterogeneous syndrome with inattention as the core feature. There is considerable variation in the presence and degree of other symptom domains such as altered arousal, psychotic features and global cognitive dysfunction. Delirium is independently associated with increased mortality, but it is unclear whether individual symptom domains of delirium have prognostic importance. We conducted a systematic review and meta-analysis of studies in hospitalised adults in general settings to identify the relationship between symptom domains of delirium and outcomes. (PROSPERO: CRD42018093935). Methods We searched MEDLINE, EMBASE, PsycINFO, CINAHL, clinicaltrials.gov and the Cochrane Central Register of Controlled Trials from inception to November 2019. We included studies of hospitalised adults that reported associations between symptom domains of delirium and 30-day mortality (primary outcome), and other outcomes including mortality at other time points, length of stay, and dementia. Reviewer pairs independently screened articles, extracted data, and assessed risk of bias (Risk of Bias Assessment tool for Non-randomized Studies) and quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation framework. We performed random-effects meta-analyses stratified by delirium domain where possible. Results From 7092 citations we included 6 studies (6002 patients, 1112 with delirium). Higher mortality (ranging from in-hospital to follow-up beyond 12 months) was associated with altered arousal (pooled Odds Ratio (OR) 2.80, 95% Confidence Interval (CI) 2.33–3.37; moderate-quality evidence), inattention (pooled OR 2.57, 95% CI 1.74–3.80; low-quality evidence), and in single studies with disorientation, memory deficits and disorganised thoughts. Risk of bias varied across studies but was moderate-to-high overall, mainly due to selection bias, lack of blinding of assessments and unclear risk of selective outcome reporting. We found no studies on the association between psychotic features, visuospatial deficits or affective disturbances in delirium and outcomes, or studies reporting non-mortality outcomes. Conclusions Few studies have related symptom domains of delirium to outcomes, but the available evidence suggests that altered arousal and inattention in delirium are associated with higher mortality than normal arousal and attention in people with or without delirium. Measurable symptom domains of delirium may have value in predicting survival and stratifying patients for treatment. We recommend that future delirium studies report outcomes by symptom domain.

The effectiveness of serious games in alleviating anxiety: A systematic review and meta-analysis (Preprint)

2021 ◽  
Author(s):  
Alaa Abd-alrazaq ◽  
Mohannad Alajlani ◽  
Dari Alhuwail ◽  
Jens Schneider ◽  
Laila Akhu-Zaheya ◽  
...  
Keyword(s):  
Systematic Review ◽  
Serious Games ◽  
Behavioral Therapy ◽  
Risk Of Bias ◽  
Anxiety Level ◽  
Reference List ◽  
Clinically Significant ◽  
Meta Analyses ◽  
Quality Evidence

BACKGROUND Anxiety is one of the mental disorders characterized by apprehension, tension, uneasiness, and other related behavioral disturbances. One of the non-pharmacological treatments used for reducing anxiety is serious games, which are games that have a purpose other than entertainment. The effectiveness of serious games in alleviating anxiety was investigated by several systematic reviews, however, they are limited by design and methodological weaknesses. OBJECTIVE This study aims to assess the effectiveness of serious games in alleviating anxiety through summarizing the results of previous studies and providing an up-to-date review. METHODS We carried out a systematic review of randomized controlled trials (RCTs). We searched 7 databases: MEDLINE, CINAHL, PsycINFO, ACM Digital Library IEEE Xplore, Scopus, and Google Scholar. We also conducted backward and forward reference list checking of the included studies and relevant reviews. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. We used a narrative and statistical approach, as appropriate, to synthesize results of the included studies. RESULTS Out of 935 citations retrieved, 33 studies were included in this review. Of those, 22 RCTs were eventually included in meta-analyses. Very low quality evidence from 9 RCTs and 5 RCTs showed no statistically significant effect of exergames (games entailing physical exercises) on the anxiety level as compared to conventional exercises (P=0.70) and no intervention (P=0.27), respectively. While 6 RCTs demonstrated a statistically and clinically significant effect of computerized cognitive behavioral therapy (CBT) games on the anxiety level when compared with no intervention (P=0.01), the quality of the evidence reported was low. Likewise, low quality evidence from 3 RCTs showed a statistically and clinically significant effect of biofeedback games on the anxiety level when compared with conventional video games (P=0.03). CONCLUSIONS This review shows that serious games have the potential in alleviating anxiety levels. However, our findings remain inconclusive mainly due to the high risk of bias in the individual studies included, the low quality of meta-analyzed evidence, few studies included in some meta-analyses, patients without anxiety recruited in most studies, and using purpose-shifted serious games in most studies. Therefore, serious games should be deemed as complementary to existing interventions. To have adequate and robust evidence, researchers should use serious games that are designed specifically to alleviate depression and deliver other therapeutic modalities, recruit a diverse population of patients with anxiety, and minimize the risk of bias by following the recommended guidelines for conducting and reporting RCTs.

scholarly journals Effects of presurgical interventions on chronic pain after total knee replacement: a systematic review and meta-analysis of randomised controlled trials

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e033248 ◽  
Author(s):  
Jane Dennis ◽  
Vikki Wylde ◽  
Rachael Gooberman-Hill ◽  
AW Blom ◽  
Andrew David Beswick
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Moderate Quality ◽  
Total Knee ◽  
Randomised Controlled ◽  
Quality Evidence

ObjectiveNearly 100 000 primary total knee replacements (TKR) are performed in the UK annually. The primary aim of TKR is pain relief, but 10%–34% of patients report chronic pain. The aim of this systematic review was to evaluate the effectiveness of presurgical interventions in preventing chronic pain after TKR.DesignMEDLINE, Embase, CINAHL,The Cochrane Libraryand PsycINFO were searched from inception to December 2018. Screening and data extraction were performed by two authors. Meta-analysis was conducted using a random effects model. Risk of bias was assessed using the Cochrane tool and quality of evidence was assessed by Grading of Recommendations Assessment, Development and Evaluation.Primary and secondary outcomesPain at 6 months or longer; adverse events.InterventionsPresurgical interventions aimed at improving TKR outcomes.ResultsEight randomised controlled trials (RCTs) with data from 960 participants were included. The studies involved nine eligible comparisons. We found moderate-quality evidence of no effect of exercise programmes on chronic pain after TKR, based on a meta-analysis of 6 interventions with 229 participants (standardised mean difference 0.20, 95% CI −0.06 to 0.47, I2=0%). Sensitivity analysis restricted to studies at overall low risk of bias confirmed findings. Another RCT of exercise with no data available for meta-analysis showed no benefit. Studies evaluating combined exercise and education intervention (n=1) and education alone (n=1) suggested similar findings. Adverse event data were reported by most studies, but events were too few to draw conclusions.ConclusionsWe found low to moderate-quality evidence to suggest that neither preoperative exercise, education nor a combination of both is effective in preventing chronic pain after TKR. This review also identified a lack of evaluations of other preoperative interventions, such as multimodal pain management, which may improve long-term pain outcomes after TKR.PROSPERO registration numberCRD42017041382.

scholarly journals Comparative efficacy and acceptability of different antihypertensive drug classes for cardiovascular disease prevention: protocol for a systematic review and network meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044302
Author(s):  
Heidi Jussil ◽  
Anna Chaimani ◽  
Bo Carlberg ◽  
Mattias Brunström
Keyword(s):  
Systematic Review ◽  
Antihypertensive Drug ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Major Adverse Cardiovascular Events ◽  
Bias Assessment ◽  
Drug Classes ◽  
Randomised Controlled ◽  
Meta Analyses ◽  
The Impact

IntroductionClinical practice guidelines differ in their recommendations on first-line antihypertensive drug classes. No adequately powered randomised controlled trial have assessed all major drug classes against each other, and previous meta-analyses have mainly relied on pairwise meta-analyses for treatment comparisons.Methods and analysisA systematic review and network meta-analysis will be carried out to assess the efficacy and acceptability of all major antihypertensive drug classes. PubMed and CENTRAL were searched on 21 February 2020 to identify randomised controlled trials with at least 1000 person-years of follow-up, assessing any antihypertensive agent against other agents or placebo. All trials fulfilling the inclusion criteria will be assessed for risk of bias using the second version of Cochrane’s risk of bias assessment tool. The study selection process, risk of bias assessment and data extraction are done by two authors in duplicate. Relative risks from individual trials will be combined in pairwise meta-analyses; in the absence of important intransitivity, random-effects network meta-analysis will be performed. The primary outcome for efficacy will be major adverse cardiovascular events, whereas the primary acceptability outcome will be treatment discontinuation for any reason. Additional outcomes include all-cause mortality, cardiovascular mortality, stroke, myocardial infarction, heart failure and acute renal failure. The impact of differences within drug classes will be explored through alternative networks, including analysing thiazide-like and thiazide-type diuretics separately.Ethics and disseminationThis review will only process aggregated study level data and does not require ethical approval. The findings will be published in a peer-reviewed medical journal.PROSPERO registration numberCRD42020205482.

scholarly journals Physically active lessons in schools and their impact on physical activity, educational, health and cognition outcomes: a systematic review and meta-analysis

2019 ◽  
Vol 54 (14) ◽  
pp. 826-838 ◽  
Author(s):  
Emma Norris ◽  
Tommy van Steen ◽  
Artur Direito ◽  
Emmanuel Stamatakis
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Health Outcomes ◽  
Educational Outcomes ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Control Group ◽  
Physically Active ◽  
Meta Analyses ◽  
The Impact

ObjectiveThis review provides the first meta-analysis of the impact of physically active lessons on lesson-time and overall physical activity (PA), as well as health, cognition and educational outcomes.DesignSystematic review and meta-analysis of controlled studies. Six meta-analyses pooled effects on lesson-time PA, overall PA, in-class educational and overall educational outcomes, cognition and health outcomes. Meta-analyses were conducted using the metafor package in R. Risk of bias was assessed using the Cochrane tool for risk of bias.Data sourcesPubMed, Embase, PsycINFO, ERIC and Web of Science, grey literature and reference lists were searched in December 2017 and April 2019.Studies eligibility criteriaPhysically active lessons compared with a control group in a randomised or non-randomised design, within single component interventions in general school populations.Results42 studies (39 in preschool or elementary school settings, 27 randomised controlled trials) were eligible to be included in the systematic review and 37 of them were included across the six meta-analyses (n=12 663). Physically active lessons were found to produce large, significant increases in lesson-time PA (d=2.33; 95% CI 1.42 to 3.25: k=16) and small, increases on overall PA (d=0.32; 95% CI 0.18 to 0.46: k=8), large, improvement in lesson-time educational outcomes (d=0.81; 95% CI 0.47 to 1.14: k=7) and a small improvement in overall educational outcomes (d=0.36; 95% CI 0.09 to 0.63: k=25). No effects were seen on cognitive (k=3) or health outcomes (k=3). 25/42 studies had high risk of bias in at least two domains.ConclusionIn elementary and preschool settings, when physically active lessons were added into the curriculum they had positive impact on both physical activity and educational outcomes. These findings support policy initiatives encouraging the incorporation of physically active lessons into teaching in elementary and preschool setting.Trial registration numberCRD42017076933.

scholarly journals Serum C-Reactive Protein and Periodontitis: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Vanessa Machado ◽  
João Botelho ◽  
Cláudia Escalda ◽  
Syed Basit Hussain ◽  
Shailly Luthra ◽  
...  
Keyword(s):  
Systematic Review ◽  
Serum Levels ◽  
Aggressive Periodontitis ◽  
Low Grade ◽  
Cochrane Central Register ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Hs Crp ◽  
Meta Analyses ◽  
The Impact

Periodontitis has been associated with low-grade inflammation as assessed by C-reactive protein (CRP) levels and its treatment can decrease CRP serum levels. The aim of this systematic review was to critically appraise the evidence comparing CRP serum levels (standard and high-sensitivity [hs]) of otherwise healthy patients suffering from periodontitis when compared to controls. The impact of intensive and non-intensive nonsurgical periodontal treatment (NSPT) on hs-CRP was also investigated. Four electronic databases (Pubmed, The Cochrane Central Register of Controlled Trials [CENTRAL], EMBASE and Web of Science) were searched up to February 2021 and the review was completed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO No. CRD42020167454). Observational and intervention studies that: 1) evaluated CRP and hs-CRP serum levels in patients with and without periodontitis, and; 2) hs- CRP levels after NSPT were included. Following risk of bias appraisal, both qualitative and quantitative analyses were performed. Pooled estimates were rendered through ratio of means (RoM) random-effects meta-analyses. After screening 485 studies, 77 case-control studies and 67 intervention trials were included. Chronic and aggressive periodontitis diagnoses were consistently associated with higher levels of CRP and hs-CRP (p&lt;0.001). Patients with aggressive periodontitis exhibited on average more than 50% higher levels of CRP (RoM [95% confidence interval [CI]]: 1.56 [1.15; 2.12], p=0.0039) than patients with chronic periodontitis. Intensive NSPT induced an immediate increase of hs-CRP followed by a progressive decrease whilst non-intensive NSPT consistently decreased hs-CRP after treatment up to 180 days (p&lt;0.001). These findings provide robust evidence that periodontitis is associated with systemic inflammation as measured by serum CRP levels. Periodontitis treatment induces a short-term acute inflammatory increase when performed in an intensive session, whilst a progressive reduction up to 6 months was demonstrated when performed in multiple visits.

The effectiveness of serious games in alleviating depression: A systematic review and meta-analysis (Preprint)

2021 ◽  
Author(s):  
Alaa Abd-Alrazaq ◽  
Eiman Al-Jafar ◽  
Mohannad Alajlani ◽  
Carla Toro ◽  
Dari Alhuwail ◽  
...  
Keyword(s):  
Systematic Review ◽  
Depressive Symptoms ◽  
Systematic Reviews ◽  
Serious Games ◽  
Risk Of Bias ◽  
Depression Symptoms ◽  
Care Providers ◽  
Meta Analyses ◽  
Quality Evidence

BACKGROUND Depression is a common mental disorder characterized by disturbances in mood, thoughts, and/or behaviors. Serious games, which are games that have a purpose other than entertainment, have been used as a non-pharmacological therapeutic intervention for depression. Previous systematic reviews have summarized evidence of effectiveness of serious games in reducing depression symptoms, however, they are limited by design and methodological shortcomings. OBJECTIVE This study aims to assess the effectiveness of serious games in alleviating depression through summarizing and pooling the results of previous studies. METHODS A systematic review of randomized controlled trials (RCTs) was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The search sources included 6 bibliographic databases (e.g., MEDLINE, PsycINFO, IEEE Xplore), the search engine “Google Scholar,” and backward and forward reference list checking of the included studies and relevant reviews. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. Results of the included studies were synthesized narratively and statistically, as appropriate, according to the type of serious games (i.e., exergames or computerized cognitive behavioral therapy (CBT) games). RESULTS From an initial 966 citations retrieved, 27 studies met the eligibility criteria. Fifteen were eventually included in meta-analyses. Very low quality evidence from 7 RCTs and 5 RCTs showed no statistically significant effect of exergames on the severity of depressive symptoms as compared to conventional exercises (P=0.12) and no intervention level (P=0.30), respectively. Very low quality evidence from 9 RCTs showed a statistically and clinically significant effect of computerized CBT games on the severity of depressive symptoms in comparison with no intervention (P=0.003). CONCLUSIONS Serious games have the potential to alleviate depression as other active interventions do. However, we could not draw definitive conclusions regarding the effectiveness of serious games due to the high risk of bias in the individual studies examined and the low quality of meta-analyzed evidence. Therefore, we recommend that health care providers consider offering serious games as an adjunct to existing interventions until further, more robust, evidence is available. Future studies should assess the effectiveness of serious games that are designed specifically to alleviate depression and deliver other therapeutic modalities, recruit participants with depression, and avoid biases through following recommended guidelines for conducting and reporting RCTs.

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