The importance of selecting the correct site to apply spinal manipulation when treating spinal pain: Myth or reality? A systematic review

AbstractThe concept that spinal manipulation therapy (SMT) outcomes are optimized when the treatment is aimed at a clinically relevant joint is commonly assumed and central to teaching and clinical use (candidate sites). This systematic review investigated whether clinical effects are superior when this is the case compared to SMT applied elsewhere (non-candidate sites). Eligible study designs were randomized controlled trials that investigated the effect of spinal manipulation applied to candidate versus non-candidate sites for spinal pain. We obtained data from four different databases. Risk of bias was assessed using an adjusted Cochrane risk of bias tool, adding four items for study quality. We extracted between-group differences for any reported outcome or, when not reported, calculated effect sizes from the within-group changes. We compared outcomes for SMT applied at a ‘relevant’ site to SMT applied elsewhere. We prioritized methodologically robust studies when interpreting results. Ten studies, all of acceptable quality, were included that reported 33 between-group differences—five compared treatments within the same spinal region and five at different spinal regions. None of the nine studies with low or moderate risk of bias reported statistically significant between-group differences for any outcome. The tenth study reported a small effect on pain (1.2/10, 95%CI − 1.9 to − 0.5) but had a high risk of bias. None of the nine articles of low or moderate risk of bias and acceptable quality reported that “clinically-relevant” SMT has a superior outcome on any outcome compared to “not clinically-relevant” SMT. This finding contrasts with ideas held in educational programs and clinical practice that emphasize the importance of joint-specific application of SMT.

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Technology-based counselling in dementia (TeCoDem): study protocol of a mixed-methods systematic review with qualitative comparative analysis and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2021-054157 ◽

2021 ◽

Vol 11 (12) ◽

pp. e054157

Author(s):

Julian Hirt ◽

Gero Langer ◽

Fabian Wilde ◽

Dorothee Bauernschmidt ◽

Gabriele Meyer ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Qualitative Comparative Analysis ◽

Primary Objective ◽

Risk Of Bias ◽

Second Primary ◽

Successful Implementation ◽

People With Dementia ◽

Informal Carers ◽

Study Designs

IntroductionInformation technology can enhance timely and individual support for people with dementia and informal carers. There is some evidence that people with dementia and informal carers would benefit from technology-based counselling. However, it remains unclear which features of those interventions relate to beneficial outcomes and which aspects are necessary for a successful implementation. Therefore, the primary objectives are: (1) to identify conditions of successful implementation of technology-based counselling interventions in dementia and (2) to investigate the effectiveness of those interventions.Methods and analysisWe will conduct a mixed-methods systematic review. The first primary objective requires evidence from various study designs addressing aspects on effective and non-effective implementation of technology-based counselling. This could be telephone-based, web-based or mobile-based interventions for people with dementia and informal carers. For the second primary objective, randomised controlled trials (RCTs) dealing with any outcomes will be included. Year of publication and language will not be restricted. We will search CINAHL, Cochrane Library, MEDLINE, PsycINFO and Web of Science up to April 2021. Additionally, we will perform web searching and citation tracking. To achieve the first primary objective, a Qualitative Comparative Analysis (QCA) will be conducted. The QCA enables us to identify necessary or sufficient components for a successful implementation. To reach the second primary objective, a meta-analysis will be performed with respect to potential clinical and statistical heterogeneity of RCTs. The revised Risk of Bias tool 2.0 will be used to check the risk of bias in RCTs. For all other study designs, the Mixed Method Appraisal Tool will be used.Ethics and disseminationEthics approval is not required for this review. We will disseminate our findings through scientific and non-scientific journal articles and conference presentations as well as formats directed to the public and decision-makers in healthcare.PROSPERO registration numberCRD42021245473.

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CUPPING THERAPY: A PRUDENT APPROACH IN PAIN MANAGEMENT-A SYSTEMATIC REVIEW

Pakistan Journal of Rehabilitation ◽

10.36283/pjr.zu.10.1/003 ◽

2021 ◽

Vol 10 (1) ◽

pp. 5-13

Author(s):

Hafiza Javeria ◽

Yusra Obaid ◽

Ismail Naseem

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

English Language ◽

Experimental Studies ◽

Spinal Pain ◽

Cupping Therapy ◽

Cochrane Library ◽

Group Differences ◽

Eligibility Criteria

BACKGROUND AND AIMS Cupping Therapy is an ancient form of alternative medicine for treating variety of musculoskeletal disorders. Number of studies indicated the efficacy of various cupping methods in decreasing neck or back pain intensity within short duration and improves quality of life. DATABASES AND ELIGIBILITY CRITERIA The experimental studies were searched on the electronic databases including Google Scholar, PEDro, PubMed and Cochrane Library from June 2015 to December 2019. It was ensured that all articles were full-text in English language whereas screening was executed on relevant titles and abstracts, evaluated on the basis of cupping therapy and its effects on musculoskeletal pain. RESULTS A total of eight out of ten experimental studies showed significant decrease (p<0.05) in spinal pain in result of cupping therapy except for the two studies that demonstrated no significant pre-post group differences (p>0.05).

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Unravelling functional neurology: does spinal manipulation have an effect on the brain? - a systematic literature review

Chiropractic & Manual Therapies ◽

10.1186/s12998-019-0265-8 ◽

2019 ◽

Vol 27 (1) ◽

Author(s):

Anne-Laure Meyer ◽

Michel-Ange Amorim ◽

Martin Schubert ◽

Petra Schweinhardt ◽

Charlotte Leboeuf-Yde

Keyword(s):

Systematic Review ◽

Brain Function ◽

Methodological Quality ◽

Spinal Manipulation ◽

Final Analysis ◽

Spinal Pain ◽

Physical Stimulus ◽

Randomized Controlled Studies ◽

Clinical Benefits ◽

Functional Neurology

Abstract Background A recent hypothesis purports that spinal manipulation may cause changes at a brain level. Functional Neurology, a mainly chiropractic approach, promotes the use of spinal manipulation to improve ‘brain function’ as if it were a proven construct. No systematic review has been performed to investigate how well founded this hypothesis is. Objective To investigate whether spinal manipulation has an effect on ‘brain function’ that is associated with any clinical benefits. Method In this systematic review, the literature was searched in PubMed, Embase, and PEDro (final search February 2018). We included randomized or non-randomized controlled studies, in which spinal manipulation was performed to any region of the spine, applied on either symptomatic or asymptomatic humans, and compared to a sham or to another type of control. The outcome measures had to be stated as direct or proxy markers of ‘brain function’. Articles were reviewed blindly by at least two reviewers, using a quality checklist designed for the specific needs of the review. Studies were classified as of ‘acceptable’, ‘medium’, or ‘low’ methodological quality. Results were reported in relation to (i) control intervention (sham, ‘inactive control’, or ‘another physical stimulus’) and (ii) study subjects (healthy, symptomatic, or with spinal pain” subjects/spinal pain”), taking into account the quality. Only results obtained from between-group or between-intervention comparisons were considered in the final analysis. Results Eighteen of 1514 articles were included. Studies were generally of ‘low’ or ‘medium’ methodological quality, most comparing spinal manipulation to a control other than a sham. Thirteen out of the 18 studies could be included in the final analysis. Transitory effects of different types of ‘brain function’ were reported in the three studies comparing spinal manipulation to sham (but of uncertain credibility), in “subclinical neck/spinal pain” subjects or in symptomatic subjects. None of these three studies, of ‘medium’ or ‘acceptable’ quality, investigated whether the neurophysiological effects reported were associated with clinical benefits. The remaining 10 studies, generally of ‘low’ or ‘medium’ quality, compared spinal manipulation to ‘inactive control’ or ‘another physical stimulus’ and similarly reported significant between-group differences but inconsistently. Conclusion The available evidence suggests that changes occur in ‘brain function’ in response to spinal manipulation but are inconsistent across and - sometimes - within studies. The clinical relevance of these changes is unknown. It is therefore premature to promote the use of spinal manipulation as a treatment to improve ‘brain function’.

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A systematic review of the effects of implementing clinical pathways supported by health information technologies

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocy176 ◽

2019 ◽

Vol 26 (4) ◽

pp. 356-363 ◽

Cited By ~ 6

Author(s):

Matthew T Neame ◽

Jerry Chacko ◽

Anna E Surace ◽

Ian P Sinha ◽

Daniel B Hawcutt

Keyword(s):

Systematic Review ◽

Health Information ◽

Information Technologies ◽

Clinical Pathways ◽

Interrupted Time Series ◽

Clinical Decision ◽

Healthcare Resource Utilization ◽

Risk Of Bias ◽

Electronic Patient Records ◽

Study Designs

AbstractObjectiveHealth information technology (HIT) interventions include electronic patient records, prescribing, and ordering systems. Clinical pathways are multidisciplinary plans of care that enable the delivery of evidence-based healthcare. Our objective was to systematically review the effects of implementing HIT-supported clinical pathways.Materials and MethodsA systematic review protocol was developed including Medline, Embase, and CENTRAL database searches. We recorded data relating to study design, participants, intervention, and outcome characteristics and formally assessed risk of bias.ResultsForty-four studies involving more than 270 000 patients were included. Investigation methodologies included before-after (n = 16, 36.4%), noncomparative (n = 14, 31.8%), interrupted time series (n = 5, 11.4%), retrospective cohort (n = 4, 9.1%), cluster randomized (n = 2, 4.5%), controlled before-after (n = 1, 2.3%), prospective case-control (n = 1, 2.3%), and prospective cohort (n = 1, 2.3%) study designs. Clinical decision support (n = 25, 56.8%), modified electronic documentation (n = 23, 52.3%), and computerized provider order entry (n = 23, 52.3%) were the most frequently utilized HIT interventions. The majority of studies (n = 38, 86.4%) reported benefits associated with HIT-supported pathways. These included reported improvements in objectively measured patient outcomes (n = 15, 34.1%), quality of care (n = 29, 65.9%), and healthcare resource utilization (n = 10, n = 22.7%).DiscussionAlthough most studies reported improvements in outcomes, the strength of evidence was limited by the study designs that were utilized.ConclusionsOngoing evaluations of HIT-supported clinical pathways are justified but would benefit from study designs that report key outcomes (including adverse events) and minimize the risk of bias.

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Tocilizumab and mortality in hospitalised patients with covid-19. A systematic review comparing randomised trials with observational studies

10.1101/2021.04.23.21255815 ◽

2021 ◽

Author(s):

Bélène Podmore ◽

Nawab Qizilbash ◽

Alessandra Lacetera ◽

Itziar Ubillos ◽

Kirsty Andresen ◽

...

Keyword(s):

Systematic Review ◽

Hospital Mortality ◽

Observational Studies ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Risk Of Bias ◽

Controlled Trials ◽

Significant Heterogeneity ◽

Moderate Risk ◽

Randomised Controlled

Objective: To summarise and compare evidence from randomised controlled trials and observational studies of the effect of tocilizumab on in-hospital mortality in patients with covid-19. Design: Systematic review and meta-analysis. Data sources: Searches conducted in Embase and PubMed from July 2020 until 1 March 2021. Study Selection: Observational studies and randomised controlled trials (RCTs) assessing in-hospital mortality in patients receiving tocilizumab compared with standard care or placebo. Data extraction: The primary outcome was in-hospital mortality at 30 days. The risk of bias in observational studies was assessed using the ROBINS-I tool. A fixed effect meta-analysis was used to combine relative risks, with random effects and risk of bias as a sensitivity analysis. Results: Of 5,792 publications screened for inclusion, eight RCTs and 35 observational studies were identified. The RCTs showed an overall relative risk reduction in in-hospital mortality at 30 days of 0.86 (95% CI 0.78 to 0.96) with no statistically significant heterogeneity. 23 of the observational studies had a severe risk of bias, 10 of which did not adjust for potential confounders. The 10 observational studies with moderate risk of bias reported a larger reduction in mortality at 30-days (relative risk 0.72, 95% CI 0.64 to 0.81) but with significant heterogeneity (P<0.01). Conclusion: This meta-analysis provides strong evidence from RCTs that tocilizumab reduces the risk of mortality in hospitalised covid-19 patients. Observational studies with moderate risk of bias exaggerated the benefits on mortality two-fold and showed heterogeneity. Collectively observational studies provide a less reliable evidence base for evaluating treatments for covid-19.

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Effect of COVID-19 on Liver Abnormalities: A Systematic review and Meta‐analysis

10.21203/rs.3.rs-46207/v1 ◽

2020 ◽

Author(s):

Khalid Bzeizi ◽

Maheeba Abdulla ◽

Nafeesa Mohammed ◽

Jehad Alqamish ◽

Negar Jamshidi ◽

...

Keyword(s):

Systematic Review ◽

Liver Function ◽

Liver Enzymes ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Clinical Effects ◽

Coagulation Profile ◽

Study Designs ◽

Event Rates

Abstract Emerging evidence suggest association of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with development of many liver abnormalities. The overarching aim of this study was therefore to assess the available evidence on the clinical effects of SARS-CoV-2 on liver function laboratory tests and coagulation profile in affected individuals. We considered all study designs including epidemiological and observational that reported liver function test abnormalities in patients diagnosed with SARS-CoV-2 infection. Medline, Embase databases and Google Scholar as well as relevant reviews were searched to identify appropriate studies from inception to April 30th, 2020. We calculated pooled mean with 95% confidence intervals (95%CI) through a random-effect model meta-analysis. A total of 29 studies with 9991 participants were considered for the review from which 20 studies with sufficient quantitative data were included for the meta-analysis. The pooled mean for liver enzymes and coagulation parameters did not significantly change in patients affected by COVID-19 and remained within normal range. Our systematic review and meta-analysis findings of the available evidence suggest that COVID-19 did not have a significant impact on the liver enzymes or coagulation profile of patients with SARS-CoV-2 infection. Future studies need to adequately report all the liver function parameters with event rates.

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Clinical Effects of Mercury in Conservative Dentistry: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Controlled Trials

International Journal of Dentistry ◽

10.1155/2020/8857238 ◽

2020 ◽

Vol 2020 ◽

pp. 1-12

Author(s):

Romeo Patini ◽

Gianrico Spagnuolo ◽

Federica Guglielmi ◽

Edoardo Staderini ◽

Michele Simeone ◽

...

Keyword(s):

Systematic Review ◽

Sequential Analysis ◽

Biological Fluids ◽

Meta Analysis ◽

Dental Amalgam ◽

Risk Of Bias ◽

Composite Resins ◽

Trial Sequential Analysis ◽

Controlled Trials ◽

Clinical Effects

Background and Purpose. Following the new directives of the European Union, which foresee the amalgam ban, the debate on its hypothetical toxicity has started again. So, the aim of this systematic review is to definitively evaluate the eventual effects of the exposure to Hg in adults and children with and without dental amalgam fillings measuring the Hg concentration in various biological fluids. Methods. A systematic literature search was conducted in four electronic databases (Ovid via PubMed, Web of Science, Scopus, and CENTRAL) including all available randomised controlled trials published in the last 15 years comparing the use of dental amalgam with composite resins in humans with a follow-up period of at least one year. The primary outcome was the Hg concentration in biological fluids (urine, hair, blood, and saliva) with the aim of assessing their reliability as biomarkers of Hg exposure. The risk of bias was assessed through the Cochrane Collaboration tool and the overall quality of evidence through the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system. The results of the meta-analysis were expressed using a random-effects model, and their power was assessed through the trial sequential analysis (TSA). Results. From the initial 2555 results, only 6 publications were included in the review: five were considered as having high risk of bias, whereas one as having moderate risk. Only two articles were eligible for quantitative analysis. The meta-analysis gathered data from 859 patients but was nevertheless not significant (p = 0.12). The TSA confirmed this evidence revealing that it was due to a lack of statistical power since the required information size (RIS) threshold is not reached. Conclusions. The existing evidence revealed that there are not enough data to support the hypothesis that restorations with dental amalgam can cause nephrotoxicity when compared with composite resins restorations.

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The importance of the local twitch response during needling interventions in spinal pain associated with myofascial trigger points: a systematic review and meta-analysis

Acupuncture in Medicine ◽

10.1177/09645284211056346 ◽

2021 ◽

pp. 096452842110563

Author(s):

César Fernández-de-las-Peñas ◽

Gustavo Plaza-Manzano ◽

Jorge Sanchez-Infante ◽

Guido F Gómez-Chiguano ◽

Joshua A Cleland ◽

...

Keyword(s):

Pain Intensity ◽

Randomized Clinical Trials ◽

Trigger Points ◽

Spinal Pain ◽

Risk Of Bias ◽

Clinical Effects ◽

Myofascial Trigger Points ◽

Pain Thresholds ◽

Pressure Pain ◽

Pressure Pain Thresholds

Objective: To compare the clinical effects of needling interventions eliciting local twitch responses (LTRs) versus needling without eliciting LTRs when applied to muscle trigger points (TrPs) associated with spinal pain of musculoskeletal origin. Databases and data treatment: Electronic databases were searched for randomized or non-randomized clinical trials where one group received needling intervention where LTRs were elicited and was compared with another group receiving the same intervention without elicitation of LTRs in spinal pain disorders associated with TrPs. Outcomes included pain intensity, pain-related disability, and pressure pain thresholds. The risk of bias (RoB) was assessed using the Cochrane risk of bias tool or ROBINS-I tool, methodological quality was assessed with the PEDro score, and quality of evidence was evaluated using the GRADE approach. Results: Six trials were included. The application of a needling intervention eliciting LTRs was associated with a significant reduction in pain intensity immediately after treatment (mean difference (MD): −2.03 points, 95% confidence interval (CI): −3.77 to −0.29; standardized MD (SMD): −1.35, 95% CI: −2.32 to −0.38, p = 0.02) when compared to the same needling intervention without elicitation of LTRs. No effect at short-term follow-up (MD: −0.20 points, 95% CI: −1.46 to 1.06, p = 0.75) was observed. No significant differences based on elicitation or non-elicitation of LTRs were found in related disability (SMD: −0.05, 95% CI: −0.41 to 0.30, p = 0.77) or pressure pain thresholds (MD: 23.39 kPa, 95% CI: −13.68 to 60.47, p = 0.22). Discussion: Low-level evidence suggests an immediate effect of obtaining LTRs during needling interventions on pain intensity, with no significant effects on related disability or pressure pain sensitivity in spinal pain disorders associated with muscle TrPs. Registration number: OSF Registry— https://doi.org/10.17605/OSF.IO/5ZX9N

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Auricular Vagus Neuromodulation – A Systematic Review on Quality of Evidence and Clinical Effects

10.1101/2020.11.26.20239509 ◽

2020 ◽

Author(s):

Nishant Verma ◽

Jonah D Mudge ◽

Maïsha S E Kasole ◽

Rex C Chen ◽

Stephan L Blanz ◽

...

Keyword(s):

Systematic Review ◽

Early Stage ◽

Risk Of Bias ◽

Vagal Activity ◽

Clinical Effects ◽

Target Engagement ◽

Double Blind ◽

Diverse Range ◽

Direct Measures

ABSTRACTBackgroundThe auricular branch of the vagus runs superficial to the surface of the skin, making it a favorable target for non-invasive techniques to modulate vagal activity. For this reason, there have been many early-stage clinical trials on a diverse range of conditions. Unfortunately, often with conflicting results.MethodsTo investigate the conflicting results, we conducted a systematic review of auricular vagus nerve stimulation (aVNS) randomized controlled trials (RCTs) using the established Cochrane Risk of Bias tool as a framework. The Risk of Bias tool is intended to identify deviations from an ideal RCT that may cause the effect of an intervention to be overestimated or underestimated. As is common for early-stage studies, the majority of aVNS studies were assessed as having ‘some’ or ‘high’ risk of bias, which makes interpreting their results in a broader context problematic.ResultsThe reported trial outcomes were qualitatively synthesized across studies. There is evidence of a modest decrease in HR during higher stimulation current amplitudes. Findings on heart rate variability (HRV) conflicted between studies and were hindered by trial design including inappropriate washout periods and multiple methods used to quantify HRV. There is early-stage evidence to suggest aVNS may reduce circulating levels or endotoxin induced levels of inflammatory markers. Studies on epilepsy reached primary endpoints similar to previous RCTs on implantable VNS, albeit with concerns over quality of blinding. aVNS showed preliminary evidence of ameliorating pathological pain but not induced pain.DiscussionDrawing on the fundamentals of neuromodulation, we establish the need for direct measures of neural target engagement in aVNS. Firstly, for the optimization of electrode design, placement, and stimulation waveform parameters to improve on-target engagement and minimize off-target engagement. Secondly, direct measures of target engagement, along with consistent evaluation of the double blind, must be used to improve the design of controls in the long term - a major source of concern identified in the Cochrane analysis. Lastly, we list common improvements for the reporting of results that can be addressed in the short term.ConclusionThe need for direct measures of neural target engagement and consistent evaluation of the double blind is applicable to other paresthesia-inducing neuromodulation therapies and their control designs. We intend for this review to contribute to the successful translation of neuromodulation therapies such as aVNS.

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A systematic review of tailored mHealth interventions for physical activity promotion among adults

Translational Behavioral Medicine ◽

10.1093/tbm/ibz190 ◽

2020 ◽

Vol 10 (5) ◽

pp. 1221-1232

Author(s):

Ashlee Davis ◽

Ryan Sweigart ◽

Rebecca Ellis

Keyword(s):

Physical Activity ◽

Systematic Review ◽

Physical Activity Promotion ◽

Risk Of Bias ◽

Cochrane Library ◽

Group Differences ◽

Tailored Intervention ◽

Central Register ◽

Activity Promotion ◽

Measurement Tools

Abstract The purpose of this systematic review was to critically examine the effectiveness of tailored mHealth interventions for promoting physical activity (PA) in adult populations. Cochrane Library Central Register of Controlled Trials, Medline, SportDiscus, PubMed, PsycINFO, and ProQuest databases were searched systematically in June 2019. Studies were eligible if they were experimentally designed studies, included adult populations (18+ years), and consisted of a tailored intervention that was delivered via a mobile device (i.e., cell phone, tablet). The primary outcome was change in PA. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Sixteen articles were reviewed. Ten studies reported significant positive outcomes for the intervention groups compared to the controls. Three studies reported significant improvements in PA for the tailored intervention arms compared to the non-tailored treatment arms. Four of six studies that reported no between group differences used SMS to deliver tailored materials. Differences on tailoring dimension, PA outcomes, and measurement tools were not identified between studies. Tailored mHealth interventions appear to be promising for promoting PA among adults. Most interventions used multiple intervention components. Additional research is needed to identify best practices and to make programs scalable.

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