Exercise as a Treatment for Depression

Depression ◽  
2019 ◽  
pp. 345-356
Author(s):  
Chad D. Rethorst
Keyword(s):  
Clinical Practice ◽  
Personalized Medicine ◽  
Randomized Controlled Trials ◽  
Treatment Response ◽  
Exercise Prescription ◽  
Patient Adherence ◽  
Future Research ◽  
Controlled Trials ◽  
Practical Advice ◽  
Treatment Of Depression

Beginning with epidemiological evidence and moving to randomized controlled trials, researchers have established evidence supporting the effectiveness of exercise in the treatment of depression. This chapter will provide an overview of the benefits of exercise for patients with depression, discuss the challenges clinicians face in using exercise as a treatment in clinical practice, and provide practical advice on exercise prescription. The chapter concludes with a discussion of areas of need for future research, focusing on three areas: identifying strategies to ensure patient adherence with exercise prescriptions, identifying predictors of treatment response that will facilitate a personalized medicine approach to exercise prescription, and the use of exercise as a complementary agent with other depression treatments.

scholarly journals Leveraging Data Science for a Personalized Haemodialysis

2020 ◽  
Vol 6 (6) ◽  
pp. 385-394
Author(s):  
Miguel Hueso ◽  
Lluís de Haro ◽  
Jordi Calabia ◽  
Rafael Dal-Ré ◽  
Cristian Tebé ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Kidney Disease ◽  
Personalized Medicine ◽  
Data Collection ◽  
Randomized Controlled Trials ◽  
Data Science ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Use Of Data ◽  
The Right

<b><i>Background:</i></b> The 2019 Science for Dialysis Meeting at Bellvitge University Hospital was devoted to the challenges and opportunities posed by the use of data science to facilitate precision and personalized medicine in nephrology, and to describe new approaches and technologies. The meeting included separate sections for issues in data collection and data analysis. As part of data collection, we presented the institutional ARGOS e-health project, which provides a common model for the standardization of clinical practice. We also pay specific attention to the way in which randomized controlled trials offer data that may be critical to decision-making in the real world. The opportunities of open source software (OSS) for data science in clinical practice were also discussed. <b><i>Summary:</i></b> Precision medicine aims to provide the right treatment for the right patients at the right time and is deeply connected to data science. Dialysis patients are highly dependent on technology to live, and their treatment generates a huge volume of data that has to be analysed. Data science has emerged as a tool to provide an integrated approach to data collection, storage, cleaning, processing, analysis, and interpretation from potentially large volumes of information. This is meant to be a perspective article about data science based on the experience of the experts invited to the Science for Dialysis Meeting and provides an up-to-date perspective of the potential of data science in kidney disease and dialysis. <b><i>Key messages:</i></b> Healthcare is quickly becoming data-dependent, and data science is a discipline that holds the promise of contributing to the development of personalized medicine, although nephrology still lags behind in this process. The key idea is to ensure that data will guide medical decisions based on individual patient characteristics rather than on averages over a whole population usually based on randomized controlled trials that excluded kidney disease patients. Furthermore, there is increasing interest in obtaining data about the effectiveness of available treatments in current patient care based on pragmatic clinical trials. The use of data science in this context is becoming increasingly feasible in part thanks to the swift developments in OSS.

Trends in randomized controlled trials in ENT: a 30-year review

1997 ◽  
Vol 111 (7) ◽  
pp. 611-613 ◽  
Author(s):  
K. W. Ah-See ◽  
N. C. Molony ◽  
A. G. D. Maran
Keyword(s):  
Clinical Trials ◽  
Clinical Practice ◽  
Randomized Controlled Trials ◽  
Gold Standard ◽  
Controlled Trials ◽  
Evidence Based ◽  
Controlled Clinical Trials ◽  
Medline Search ◽  
Randomized Controlled Clinical Trials ◽  
Randomized Controlled

AbstractThere is a growth in the demand for clinical practice to be evidence based. Recent years have seen a rise in the number of randomized controlled clinical trials (RCTS). Such trials while acknowledged as the gold standard for evidence can be difficult to perform in surgical specialities. We have recently identified a low proportion of RCTS in the otolaryngology literature. Our aim was to identify any trend in the number of published RCTS within the ENT literature over a 30-year period and to identify which areas of our speciality lend themselves to this form of study design. A Medline search of 10 prominent journals published between 1966 and 1995 was performed. Two hundred and ninety-six RCTS were identified. Only five were published before 1980. Two hundred (71 per cent) of RCTS were in the areas of otology and rhinology. An encouraging trend is seen in RCTS within ENT literature.

Registry-based randomized controlled trials- what are the advantages, challenges, and areas for future research?

2016 ◽  
Vol 80 ◽  
pp. 16-24 ◽  
Author(s):  
Guowei Li ◽  
Tolulope T. Sajobi ◽  
Bijoy K. Menon ◽  
Lawrence Korngut ◽  
Mark Lowerison ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Future Research ◽  
Controlled Trials ◽  
Randomized Controlled

scholarly journals Moving stroke rehabilitation evidence into practice: a systematic review of randomized controlled trials

2019 ◽  
Vol 33 (10) ◽  
pp. 1586-1595 ◽  
Author(s):  
Marie-Louise Bird ◽  
Tiev Miller ◽  
Louise A Connell ◽  
Janice J Eng
Keyword(s):  
Clinical Practice ◽  
Randomized Controlled Trials ◽  
Stroke Rehabilitation ◽  
Educational Interventions ◽  
Risk Of Bias ◽  
Practice Change ◽  
Audit And Feedback ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Multicomponent Interventions

Objective: The aim of this study was to investigate the effectiveness of interventions aimed at moving research evidence into stroke rehabilitation practice through changing the practice of clinicians. Data sources: EMBASE, CINAHL, Cochrane and MEDLINE databases were searched from 1980 to April 2019. International trial registries and reference lists of included studies completed our search. Review methods: Randomized controlled trials that involved interventions aiming to change the practice of clinicians working in stroke rehabilitation were included. Bias was evaluated using RevMan to generate a risk of bias table. Evidence quality was evaluated using GRADE criteria. Results: A total of 16 trials were included (250 sites, 14,689 patients), evaluating a range of interventions including facilitation, audit and feedback, education and reminders. Of which, 11 studies included multicomponent interventions (using a combination of interventions). Four used educational interventions alone, and one used electronic reminders. Risk of bias was generally low. Overall, the GRADE criteria indicated that this body of literature was of low quality. This review found higher efficacy of trials which targeted fewer outcomes. Subgroup analysis indicated moderate-level GRADE evidence (103 sites, 10,877 patients) that trials which included both site facilitation and tailoring for local factors were effective in changing clinical practice. The effect size of these varied (odds ratio: 1.63–4.9). Education interventions alone were not effective. Conclusion: A large range of interventions are used to facilitate clinical practice change. Education is commonly used, but in isolation is not effective. Multicomponent interventions including facilitation and tailoring to local settings can change clinical practice and are more effective when targeting fewer changes.

scholarly journals Placebo interventions, placebo effects and clinical practice

2011 ◽  
Vol 366 (1572) ◽  
pp. 1905-1912 ◽  
Author(s):  
Klaus Linde ◽  
Margrit Fässler ◽  
Karin Meissner
Keyword(s):  
Clinical Practice ◽  
Randomized Controlled Trials ◽  
Context Effects ◽  
Clinical Investigation ◽  
Controlled Trials ◽  
Placebo Effects ◽  
Randomized Controlled ◽  
Placebo Intervention ◽  
Therapeutic Context

This article reviews the role of placebo interventions and placebo effects in clinical practice. We first describe the relevance of different perspectives among scientists, physicians and patients on what is considered a placebo intervention in clinical practice. We then summarize how placebo effects have been investigated in randomized controlled trials under the questionable premise that such effects are produced by placebo interventions. We further discuss why a shift of focus from the placebo intervention to the overall therapeutic context is necessary and what research methods can be used for the clinical investigation of the relevance of context effects. In the last part of the manuscript, we discuss why placebo or context effects are seen as positive in clinical practice when they are associated with active treatments, while placebo interventions pose major ethical and professional problems and have to be avoided.

Psychotherapy for Psychopathology During Pregnancy and the Postpartum Period

2015 ◽  
Author(s):  
Amy Wenzel ◽  
Scott Stuart ◽  
Hristina Koleva
Keyword(s):  
Randomized Controlled Trials ◽  
Large Scale ◽  
Behavioral Therapy ◽  
Treatment Retention ◽  
Future Research ◽  
Controlled Trials ◽  
Depression And Anxiety ◽  
Randomized Controlled ◽  
Medication Exposure ◽  
Perinatal Women

Psychotherapy is often the treatment of choice for perinatal women who wish to limit their fetus’s or infant’s medication exposure. The vast majority of empirical research that has examined psychotherapy for perinatal women has focused on depression. Interpersonal psychotherapy (IPT) and cognitive behavioral therapy (CBT) have been examined in several studies to determine their efficacy in perinatal depression and anxiety. Recent research has begun to examine the manner in which psychotherapies can be delivered in alternative formats (e.g., teletherapy) in order to overcome problems with treatment retention and compliance. Suggestions for future research include large-scale randomized controlled trials that compare two active approaches to psychotherapy, mediation studies to uncover the mechanisms of change associated with the successful treatment of perinatal women, and randomized controlled trials evaluating the efficacy of psychotherapy for mental health disorders other than depression.

scholarly journals Non-Immersive Virtual Reality for Rehabilitation of the Older People: A Systematic Review into Efficacy and Effectiveness

2019 ◽  
Vol 8 (11) ◽  
pp. 1882 ◽  
Author(s):  
Bevilacqua ◽  
Maranesi ◽  
Riccardi ◽  
Donna ◽  
Pelliccioni ◽  
...  
Keyword(s):  
Systematic Review ◽  
Virtual Reality ◽  
Older People ◽  
Randomized Controlled Trials ◽  
Cognitive Abilities ◽  
Positive Impact ◽  
Data Extraction ◽  
Future Research ◽  
Controlled Trials ◽  
Randomized Controlled

: Objective: the objective of this review is to analyze the advances in the field of rehabilitation through virtual reality, while taking into account non-immersive systems, as evidence have them shown to be highly accepted by older people, due to the lowest “cibersikness” symptomatology. Data sources: a systematic review of the literature was conducted in June 2019. The data were collected from Cochrane, Embase, Scopus, and PubMed databases, analyzing manuscripts and articles of the last 10 years. Study selection: we only included randomized controlled trials written in English aimed to study the use of the virtual reality in rehabilitation. We selected 10 studies, which were characterized by clinical heterogeneity. Data extraction: quality evaluation was performed based on the Physioterapy Evidence Database (PEDro) scale, suggested for evidence based review of stroke rehabilitation. Of 10 studies considered, eight were randomized controlled trials and the PEDro score ranged from four to a maximum of nine. Data synthesis: VR (Virtual Reality) creates artificial environments with the possibility of a patient interaction. This kind of experience leads to the development of cognitive and motor abilities, which usually positively affect the emotional state of the patient, increasing collaboration and compliance. Some recent studies have suggested that rehabilitation treatment interventions might be useful and effective in treating motor and cognitive symptoms in different neurological disorders, including traumatic brain injury, multiple sclerosis, and progressive supranuclear palsy. Conclusions: as it is shown by the numerous studies in the field, the application of VR has a positive impact on the rehabilitation of the most predominant geriatric syndromes. The level of realism of the virtual stimuli seems to have a crucial role in the training of cognitive abilities. Future research needs to improve study design by including larger samples, longitudinal designs, long term follow-ups, and different outcome measures, including functional and quality of life indexes, to better evaluate the clinical impact of this promising technology in healthy old subjects and in neurological patients.

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