scholarly journals Dietary Ingredients Requiring Further Research Before Evidence-Based Recommendations Can Be Made for Their Use as an Approach to Mitigating Pain

Pain Medicine ◽  
2019 ◽  
Vol 20 (8) ◽  
pp. 1619-1632 ◽  
Author(s):  
Cindy Crawford ◽  
Courtney Boyd ◽  
Kevin Berry ◽  
Patricia Deuster ◽  
Keyword(s):  
Decision Making ◽  
Meta Analysis ◽  
Self Care ◽  
Steering Committee ◽  
Sufficient Evidence ◽  
Evidence Based ◽  
Special Operations ◽  
Assessment Development ◽  
Trade Offs ◽  
Rose Hip

Abstract Objective Approximately 55–76% of Service members use dietary supplements for various reasons; although such use has become popular, decisions are often driven by information that is not evidence-based. This work evaluates whether current research on dietary ingredients for chronic musculoskeletal pain provides sufficient evidence to inform decisions for practice and self-care, specifically for Special Operations Forces personnel. Methods A steering committee convened to develop research questions and factors required for decision-making. Key databases were searched through August 2016. Eligible systematic reviews and randomized controlled trials were assessed for methodological quality. Meta-analysis was applied where feasible. Grading of Recommendations, Assessment, Development and Evaluation was used to determine confidence in the effect estimates. The committee used a decision table to make evidence-informed judgments across decision-making factors and recommendations for practice and self-care use. Results Nineteen dietary ingredients were assessed. No recommendations were given for boswellia, ginger, rose hip, or s-adenosyl-L-methionine (SAMe); specifically, although ginger can be obtained via food, no recommendation is provided for use as a supplement due to unclear research. Further, there were insufficient strong research on boswellia and SAMe and possible compliance issues (i.e., high number of capsules required daily) associated with rose hip. Conclusions No recommendations were made when the evidence was low quality or trade-offs were so closely balanced that any recommendation would be too speculative. Research recommendations are provided to enhance the quality and body of evidence for the most promising ingredients. Clinicians and those with chronic pain can rely on evidence-based recommendations to inform their decisions.

scholarly journals Conditional Recommendations for Specific Dietary Ingredients as an Approach to Chronic Musculoskeletal Pain: Evidence-Based Decision Aid for Health Care Providers, Participants, and Policy Makers

Pain Medicine ◽  
2019 ◽  
Vol 20 (7) ◽  
pp. 1430-1448 ◽  
Author(s):  
Courtney Boyd ◽  
Cindy Crawford ◽  
Kevin Berry ◽  
Patricia Deuster ◽  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Musculoskeletal Pain ◽  
Health Care Providers ◽  
Self Care ◽  
Chronic Musculoskeletal Pain ◽  
Sufficient Evidence ◽  
Evidence Based ◽  
Minimal Risk ◽  
Care Providers

Abstract Objective Approximately 55–76% of Service members use dietary supplements for various reasons; although such use has become popular for a wide range of pain conditions, decisions to use supplements are often driven by information that is not evidence-based. This work evaluates whether the current research on dietary ingredients for chronic musculoskeletal pain provides sufficient evidence to inform decisions for practice and self-care, specifically for Special Operations Forces personnel. Methods A steering committee convened to develop research questions and factors required for decision-making. Key databases were searched through August 2016. Eligible systematic reviews and randomized controlled trials were assessed for methodological quality. Meta-analysis was applied where feasible. GRADE was used to determine confidence in the effect estimates. A decision table was constructed to make evidence-informed judgments across factors required for decision-making, and recommendations were made for practice and self-care use. Results Nineteen dietary ingredients were included. Conditional evidence-based recommendations were made for the use of avocado soybean unsaponifiables, capsaicin, curcuma, ginger, glucosamine, melatonin, polyunsaturated fatty acids, and vitamin D. In these cases, desirable effects outweighed undesirable effects, but there was uncertainty about the trade-offs, either because the evidence was low quality or because benefits and downsides were closely balanced. Conclusions The evidence showed that certain dietary ingredients, when taken as part of a balanced diet and/or as a supplement (e.g., pill, tablet, capsule, cream), may alleviate musculoskeletal pain with no to minimal risk of harm. This finding emphasizes and reinforces the critical importance of shared decision-making between Operators and their health care providers.

Return to Play After Hip Arthroscopy: A Systematic Review and Meta-analysis

2018 ◽  
Vol 46 (11) ◽  
pp. 2780-2788 ◽  
Author(s):  
Michaela O’Connor ◽  
Anas A. Minkara ◽  
Robert W. Westermann ◽  
James Rosneck ◽  
T. Sean Lynch
Keyword(s):  
Systematic Review ◽  
Hip Arthroscopy ◽  
Meta Analysis ◽  
Return To Play ◽  
Sufficient Evidence ◽  
Harris Hip Score ◽  
Cochrane Library ◽  
Evidence Based ◽  
Rehabilitation Protocols ◽  
The Mean

Background: The use of arthroscopic treatment for intra-articular hip pathology has demonstrated improved patient-reported outcomes (PROs) with a lower rate of complications, reoperation, and patient morbidity as compared with traditional methods. Although the use of this minimally invasive approach has increased in prevalence, no evidence-based return-to-play (RTP) criteria have been developed to ensure an athlete’s preparedness for sporting activities. Purpose: To determine if there exists sufficient evidence in the literature to support an RTP protocol and functional assessment after hip arthroscopy, as well as to assess the mean rate and duration of RTP. Study Design: Systematic review and meta-analysis. Methods: The search terms “hip arthroscopy,” “return to play,” and 10 related terms were searched in PubMed, Cochrane Library, Scopus, and Web of Science, yielding 263 articles. After screening, 22 articles were included. RTP timeline, rehabilitation protocols, and conditional criteria measures were assessed with previously established criteria. Pooled estimates were calculated for RTP rate and duration, and weighted mean scores were determined for PROs. Results: A total of 1296 patients with 1442 total hips were identified. Although 54.5% (12 of 22) of studies did not provide a guideline for RTP duration after hip arthroscopy, 36.4% (8 of 22) recommended a duration of 4 months, while 9.1% (2 of 22) recommended 3 months. The most frequently described postoperative rehabilitation protocols were weightbearing guidelines (15 studies) and passive motion exercises (9 studies). Only 2 studies satisfied the criteria for a sufficient RTP protocol, and 3 provided a specific replicable test for RTP. The mean RTP duration was 7.4 months (95% CI, 6.1-8.8 months), and the return rate was 84.6% (95% CI, 80.4%-88.8%; P = .008) at a mean ± SD follow-up of 25.8 ± 2.4 months. Mean modified Harris Hip Score (mHHS) improved from 63.1 to 84.1 postoperatively (+33.3%), while Non-arthritic Hip Score improved from 61.7 to 86.8 (+40.7%). A lower preoperative mHHS was significantly associated with a higher postoperative improvement ( r = −0.95, P = .0003). Conclusion: Significant variability exists in RTP protocols among institutions owing to a lack of standardization. Despite a high overall rate of RTP and improvement in PROs after hip arthroscopy, the majority of rehabilitation protocols are not evidence based and rely on expert opinion. No validated functional test currently exists to assess RTP.

No Choice Is the “Right” Choice: Black Parents’ Educational Decision-Making in Their Search for a “Good” School

2021 ◽  
Vol 91 (1) ◽  
pp. 38-61
Author(s):  
LINN POSEY-MADDOX ◽  
MAXINE MCKINNEY de ROYSTON ◽  
ALEA R. HOLMAN ◽  
RAQUEL M. RALL ◽  
RACHEL A. JOHNSON
Keyword(s):  
Decision Making ◽  
School Choice ◽  
Meta Analysis ◽  
School Type ◽  
Black Parents ◽  
Public And Private ◽  
Educational Decision ◽  
Trade Offs ◽  
The Right ◽  
Educational Decision Making

In this article, Linn Posey-Maddox, Maxine McKinney de Royston, Alea R. Holman, Raquel M. Rall, and Rachel A. Johnson examine Black parents’ educational decision-making in the racial and educational contexts of predominantly white suburban districts, majority-Black urban schools with an Afrocentric focus, and racially diverse urban public and private schools. Undertaking a qualitative meta-analysis, they ask, How and why is anti-Black racism salient in Black parents’ educational decision-making around schooling? Their findings reveal that race and anti-Black racism are central to Black parents’ school choice decisions. Specifically, they shape the trade-offs parents made in choosing a school for their child(ren), their ongoing risk assessments regarding the potential for racialized harm in their child(ren)’s schooling, and their continuous decision-making about whether to keep their child enrolled or move them to a different school. Regardless of geography, school type, grade level, and/or social class, race and anti-Black racism shape Black parents’ educational decision-making as they work to ensure that their child(ren) receive a high-quality education within highly racialized schooling contexts.

Evidence-Based Decision-Making 2: Systematic Reviews and Meta-Analysis

2021 ◽  
pp. 405-428
Author(s):  
Aminu Bello ◽  
Ben Vandermeer ◽  
Natasha Wiebe ◽  
Amit X. Garg ◽  
Marcello Tonelli
Keyword(s):  
Decision Making ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Evidence Based ◽  
Evidence Based Decision Making

scholarly journals Understanding the value of adhering to or adapting evidence-based interventions: a study protocol of a discrete choice experiment

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Ulrica von Thiele Schwarz ◽  
Aaron R. Lyon ◽  
Kristoffer Pettersson ◽  
Fabrizia Giannotta ◽  
Pernilla Liedgren ◽  
...  
Keyword(s):  
Decision Making ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Local Context ◽  
Optimal Decision ◽  
Evidence Based ◽  
Trade Offs ◽  
Using Data ◽  
The Way

Abstract Background Whereas the value of an evidence-based intervention (EBI) is often determined by its effect on clinical outcomes, the value of implementing and using EBIs in practice is broader, reflecting qualities such as appropriateness, equity, costs, and impact. Reconciling these value conflicts involves a complicated decision process that has received very limited scholarly attention. Inspired by studies on decision-making, the objective of this project is to explore how practitioners appraise the values of different outcomes and to test how this appraisal influences their decisions surrounding the so-called fidelity–adaptation dilemma. This dilemma is related to the balance between using an EBI as it was designed (to ensure its effectiveness) and making appropriate adaptations (to ensure alignment with constraints and possibilities in the local context). Methods This project consists of three sub-studies. The participants will be professionals leading evidence-based parental programs in Sweden and, in Sub-study 1, parents and decision-makers. Sub-study 1 will use sequential focus groups and individual interviews to explore parameters that influence fidelity and adaptation decisions—the dilemmas encountered, available options, how outcomes are valued by practitioners as well as other stakeholders, and value trade-offs. Sub-study 2 is a discrete choice experiment that will test how value appraisals influence decision-making using data from Sub-study 1 as input. Sub-study 3 uses a mixed-method design, with findings from the two preceding sub-studies as input in focus group interviews to investigate how practitioners make sense of findings from optimal decision situations (experiment) and constrained, real-world decision situations. Discussion The project will offer unique insights into decision-making processes that influence how EBIs are used in practice. Such knowledge is needed for a more granular understanding of how practitioners manage the fidelity–adaptation dilemma and thus, ultimately, how the value of EBI implementation can be optimized. This study contributes to our knowledge of what happens once EBIs are adopted—that is, the gap between the way in which EBIs are intended to be used and the way in which they are used in practice.

Komplementäre Therapien: Verlässliche Informationen richtig vermitteln

2020 ◽  
Vol 7 (4) ◽  
pp. 208-209
Author(s):  
Claudia M. Witt
Keyword(s):  
Standard Care ◽  
Decision Aid ◽  
Meta Analysis ◽  
Supplementary Information ◽  
Evidence Based ◽  
Healing Touch ◽  
Children With Cancer ◽  
Assessment Development ◽  
Group A ◽  
Randomized Control

<b>Purpose:</b> To develop an evidence-based decision aid for parents of children with cancer and to help guide them in the use of complementary and alternative medicine (CAM) for cancer care. <b>Methods:</b> This study had a mixed research design. The needs of parents were investigated by survey and focus group. A systematic review and meta-analysis were performed on the effectiveness of CAM using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Clinical experts were interviewed and a decision aid on CAM treatment for pain was developed. <b>Results:</b> Parents emphasized the importance of reliable information on CAM, focusing primarily on communication and a broad spectrum of complaints related to cancer treatment. The decision aid on CAM for pain included five modalities based on 11 randomized control trials (RCTs): hypnotherapy, mind-body techniques, massage, healing touch, and music therapy. Meta-analysis could be performed on hypnotherapy, which significantly reduced cancer-related procedural pain compared with standard care (MD, – 1.37; 95% CI, – 1.60, – 1.15; P &#x3c; 0.00001) and attention control (MD, – 1.13; 95% CI, – 1.34, – 0.94; P &#x3c; 0.00001), and massage, demonstrating no effect on pain compared with standard care (MD, – 0.77; 95% CI, – 1.82, 0.28; P = 0.15). Research evidence and supplementary information from clinical practice and patient were incorporated in a website-based decision aid. <b>Conclusions:</b> An evidence-based decision aid was developed to support parents of children with cancer in making decisions about CAM for pain management. Next steps will be to expand the website to include additional childhood cancer-related complaints and to evaluate its use in practice.

scholarly journals A Methodological Quality Assessment of Meta-Analysis Studies in Dance Therapy Using AMSTAR and AMSTAR 2

Healthcare ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 446
Author(s):  
Hye-Ryeon Kim ◽  
Chang-Hwan Choi ◽  
Eunhye Jo
Keyword(s):  
Decision Making ◽  
Dance Therapy ◽  
Methodological Quality ◽  
Meta Analysis ◽  
Assessment Tools ◽  
Quality Level ◽  
Evidence Based ◽  
Evaluation Scores ◽  
Significant Difference

Although earlier meta-analysis studies have provided evidence-based information useful for decision-making, debate regarding their quality continues. This study aimed to evaluate the quality of meta-analysis studies in the field of dance therapy (DT) using the Assessment of Multiple Systematic Reviews (AMSTAR) and AMSTAR 2 assessment tools. Meta-analysis studies on DT were collected from various databases. Seven meta-analysis studies were selected for this study. Our findings showed that the quality level of the meta-analysis studies related to DT was “High” on the AMSTAR evaluation, but their quality decreased to “Low” on the AMSTAR 2 evaluation. Moreover, using AMSTAR 2, 71.43% of the studies fell within the category of “Moderate” or below. There was no statistically significant difference in the quality scores of the characteristics of these studies. Our results suggest that (1) education on meta-analysis guidelines is required to improve the quality of DT-related meta-analysis studies, and (2) methodological caution is warranted, since different outcomes in evaluation scores for each tool may be obtained when using AMSTAR and AMSTAR 2. Based on this study, it is expected that common and specific guidelines for meta-analysis in DT can be established.

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