Effectiveness of Multimodal Training on Functional Capacity in Frail Older People: A Meta-Analysis of Randomized Controlled Trials

2018 ◽  
Vol 26 (3) ◽  
pp. 407-418 ◽  
Author(s):  
Pedro Lopez ◽  
Mikel Izquierdo ◽  
Regis Radaelli ◽  
Graciele Sbruzzi ◽  
Rafael Grazioli ◽  
...  
Keyword(s):  
Older People ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Maximum Strength ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Frail Older People ◽  
Timed Up And Go ◽  
Positive Effects ◽  
Multimodal Training

In this meta-analysis, we investigated the effect of resistance training (RT) alone or included in a multimodal training on physical frailty outcomes, and whether different variables of RT prescription affect these outcomes. We identified 15 relevant studies searching through MEDLINE, Cochrane Central Register of Controlled Trials, SPORTDiscus, and PEDro database. Postintervention standardized mean difference scores were computed and combined using fixed effects meta-analysis. Analyses have shown positive effects of interventions on maximum strength, gait speed, and Timed Up and Go test. Further analyses have shown significant greater effect of shorter periods on maximum strength. Regarding RT prescription, percentage of one-repetition maximum showed significant effect on physical variables, whereas RT based on rate of perceived effort presented lower effect in the Timed Up and Go test. Although multimodal training is an effective intervention to increase physical capacity, caution should be taken regarding the period and the method to control RT intensity to optimize enhancements in frail older people.

scholarly journals Randomized Controlled Trials of Early Ambulatory Hydroxychloroquine in the Prevention of COVID-19 Infection, Hospitalization, and Death: Meta-Analysis

2020 ◽  
Author(s):  
Joseph A. Ladapo ◽  
John E. McKinnon ◽  
Peter A. McCullough ◽  
Harvey Risch
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Side Effects ◽  
Fixed Effects ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Randomized Controlled ◽  
Exposure Prophylaxis

Objective--To determine if hydroxychloroquine (HCQ) reduces the incidence of new illness, hospitalization or death among outpatients at risk for or infected with SARS-CoV-2 (COVID-19). Design--Systematic review and meta-analysis of randomized clinical trials. Data sources--Search of MEDLINE, EMBASE, PubMed, medRxiv, PROSPERO, and the Cochrane Central Register of Controlled Trials. Also review of reference lists from recent meta-analyses. Study selection--Randomized clinical trials in which participants were treated with HCQ or placebo/standard-of-care for pre-exposure prophylaxis, post-exposure prophylaxis, or outpatient therapy for COVID-19. Methods--Two investigators independently extracted data on trial design and outcomes. Medication side effects and adverse reactions were also assessed. The primary outcome was COVID-19 hospitalization or death. When unavailable, new COVID-19 infection was used. We calculated random effects meta-analysis according to the method of DerSimonian and Laird. Heterogeneity between the studies was evaluated by calculation of Cochran Q and I2 parameters. An Egger funnel plot was drawn to investigate publication bias. We also calculated the fixed effects meta-analysis summary of the five studies. All calculations were done in Excel, and results were considered to be statistically significant at a two-sided threshold of P=.05. Results--Five randomized controlled clinical trials enrolling 5,577 patients were included. HCQ was associated with a 24% reduction in COVID-19 infection, hospitalization or death, P=.025 (RR, 0.76 [95% CI, 0.59 to 0.97]). No serious adverse cardiac events were reported. The most common side effects were gastrointestinal. Conclusion--Hydroxychloroquine use in outpatients reduces the incidence of the composite outcome of COVID-19 infection, hospitalization, and death. Serious adverse events were not reported and cardiac arrhythmia was rare. Systematic review registration--This review was not registered.

scholarly journals Cinacalcet Treatment Significantly Improves All-Cause and Cardiovascular Survival in Dialysis Patients: Results from a Meta-Analysis

2019 ◽  
Vol 44 (6) ◽  
pp. 1327-1338 ◽  
Author(s):  
Yuan Zu ◽  
Xiangxue Lu ◽  
Jinghong Song ◽  
Ling Yu ◽  
Han Li ◽  
...  
Keyword(s):  
Cardiovascular Mortality ◽  
Observational Studies ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Fixed Effects Model ◽  
Long Term Effects ◽  
Dialysis Patients ◽  
All Cause Mortality

Objective: To assess the long-term effects including all-cause mortality, cardiovascular mortality, and fracture incidence, of cinacalcet on secondary hyperparathyroidism (SHPT) in patients on dialysis. Methods: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from their inception to October 2018. Randomized controlled trials (RCTs) and cohort design prospective observational studies assessing cinacalcet for the treatment of SHPT in dialysis patients were included. Data extraction was independently completed by 2 authors who determined the methodological quality of the studies and extracted data in duplicate. Study-specific risk estimates were tested by using a fixed effects model. Results: A total of 14 articles with 38,219 participants were included, of which 10 RCTs with 7,471 participants and 4 prospective observational studies with 30,748 participants fulfilled the eligibility criteria. Compared with no cinacalcet, cinacalcet administration reduced all-cause mortality (relative risk [RR] 0.91, 95% CI 0.89–0.94, p < 0.001) and cardiovascular mortality (RR 0.92, 95% CI 0.89–0.95, p < 0.001), but it did not significantly reduce the incidence of fractures (RR 0.93, 95% CI 0.87–1.00, p = 0.05). Conclusions: The results of this meta-analysis indicated that the treatment of SHPT with cinacalcet may in fact reduce all-cause mortality and cardiovascular mortality among patients receiving maintenance dialysis.

scholarly journals Efficacy and safety of daptomycin: systematic review and meta-analysis

2019 ◽  
Vol 6 ◽  
pp. 204993611988646
Author(s):  
María Teresa Rosanova ◽  
David Bes ◽  
Pedro Serrano-Aguilar ◽  
Norma Sberna ◽  
Estefania Herrera-Ramos ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Failure Rates ◽  
Efficacy And Safety ◽  
Fixed Effects Model ◽  
Intention To Treat ◽  
Central Register

Background: The aim of this study was to assess whether daptomycin is safer and more efficacious than comparators for the treatment of serious infection caused by gram-positive microorganisms. Methods: Electronic databases (Medline, EMBASE, the Cochrane Central Register of Controlled Trials and clinical registered trials) were searched to identify randomized controlled trials (RCTs) that assessed the efficacy and safety of daptomycin versus therapy with any other antibiotic comparator. Two reviewers independently applied selection criteria, performed a quality assessment and extracted the data. Heterogeneity was assessed, and a random-effects or fixed-effects model, when appropriate, was used for estimates of risk ratio (RR). The primary outcome assessed was the risk of clinical treatment failure among the intention-to-treat population and the presence of any treatment related adverse event (AEs). Results: A total of seven trials fulfilled the inclusion criteria. Daptomycin treatment failure rates were no different to comparator regimens (RR = 0.96; CI 95% 0.86–1.06). No significantly different treatment related AEs were identified when comparing groups (RR = 0.91; CI 95% 0.83–1.01). Conclusions: No significant differences in treatment failure rates and safety were found using daptomycin or any of the comparators treatment.

scholarly journals Dietary Modification for Reproductive Health in Women With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Yujie Shang ◽  
Huifang Zhou ◽  
Ruohan He ◽  
Wentian Lu
Keyword(s):  
Systematic Review ◽  
Reproductive Health ◽  
Polycystic Ovary Syndrome ◽  
Polycystic Ovary ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Ovary Syndrome ◽  
Positive Effects ◽  
Statistical Heterogeneity

ObjectiveDiet has been reported as the first-line management of polycystic ovary syndrome (PCOS). However, the relationship between diet and fertility in PCOS is still controversial. This meta-analysis aimed to evaluate whether diet could promote reproductive health in women with PCOS while providing evidence-based nutrition advice for clinical practice.MethodsSeven databases, including Cochrane Central Register of Controlled Trials, PubMed, Embase, Web of Science, and some Chinese database, were searched up to January 31, 2021. Randomized controlled trials evaluating the effects of diet in women with PCOS were included. Based on a preregistered protocol (PROSPERO CRD42019140454), the systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Two reviewers made study selection, data extraction and bias assessment independently. Risk ratios and mean difference with 95% confidence intervals were assessed by a random-effects model. Statistical heterogeneity within comparisons was evaluated by Cochran’s Q test and quantified by the I-squared (I2) statistic.ResultsTwenty RCTs with 1113 participants were included. Results showed diet significantly related to improved fertility outcomes (increasing clinical pregnancy, ovulation and menstrual regularity rate; reducing miscarriage rate), reproductive endocrine [increasing sex hormone-binding globulin (SHBG); decreasing Anti-Müllerian Hormone (AMH), free androgen index (FAI), total testosterone (T)] and clinical hyperandrogenism (hirsutism assessed by Ferriman-Gallwey score) in PCOS. Specifically, subgroup analyses indicated low-carbohydrate diets were superior in optimizing reproductive outcomes and calorie restriction was critical in ameliorating hyperandrogenism. Additionally, the positive effects were associated with the treatment duration. The longer the duration, the greater the improvement was.ConclusionOverall, diet is an effective intervention for improving fertility health, thus professional and dynamic dietary advice should be offered to all PCOS patients, based on the changeable circumstances, personal needs and expectations of the individuals.

scholarly journals Protocol for a systematic review and meta-analysis assessing the effectiveness of deprescribing in falls prevention in older people

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e047190
Author(s):  
Lotta J Seppala ◽  
Nellie Kamkar ◽  
Jesper Ryg ◽  
Tahir Masud ◽  
Joost Daams ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older People ◽  
Current Knowledge ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Falls Prevention ◽  
Sensitivity Analyses ◽  
Forest Plot ◽  
Controlled Trials ◽  
Cochrane Central Register

IntroductionOne of the known risk factors for fall incidents is the use of specific medications, fall-risk-increasing drugs (FRIDs). However, to date, there is uncertainty related to the effectiveness of deprescribing as a single intervention in falls prevention. Thus, a comprehensive update of the literature focusing on all settings in which older people receive healthcare and all deprescribing interventions is warranted to enhance the current knowledge.Methods and analysisThis systematic review protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search was performed in Cochrane Central Register of Controlled Trials, MEDLINE, Embase and PsycINFO (2 November 2020). We will also search in trial registers. We will include randomised controlled trials, in which any deprescribing intervention is compared with usual care and reports falls as an outcome. Both title and abstract screening and full-text screening will be done by two reviewers. The Cochrane Collaboration revised tool of Risk of Bias will be applied to perform risk of bias assessment. We will categorise the results separately for every setting. If a group of sufficiently comparable studies will be identified, we will perform a meta-analysis applying random effects model. We will investigate heterogeneity using a combination of visual inspection of the forest plot along with consideration of the χ2 test and the I2 statistic results. We have prespecified several subgroup and sensitivity analyses.Ethics and disseminationEthics approval is not applicable for this study since no original data will be collected. The results will be disseminated through peer-reviewed publication and conference presentations. Furthermore, this systematic review will inform the recommendations of working group of polypharmacy and FRIDs of the anticipated World’s Falls Guidelines.PROSPERO registration numberCRD42020218231.

scholarly journals Assessment of Hydroxychloroquine and Chloroquine Safety Profiles – A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Lu Ren ◽  
Wilson Xu ◽  
James L Overton ◽  
Shandong Yu ◽  
Nipavan Chiamvimonvat ◽  
...  
Keyword(s):  
Fixed Effects ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Regression Analyses ◽  
Inclusion Criteria ◽  
Randomized Controlled ◽  
Central Register ◽  
Precautionary Measures ◽  
Meta Analyses

AbstractBackgroundRecently, chloroquine (CQ) and its derivative hydroxychloroquine (HCQ) have emerged as potential antiviral and immunomodulatory options for the treatment of 2019 coronavirus disease (COVID-19). To examine the safety profiles of these medications, we systematically evaluated the adverse events (AEs) of these medications from published randomized controlled trials (RCTs).MethodsWe systematically searched PubMed, MEDLINE, Cochrane, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, and the ClinicalTrials.gov for all the RCTs comparing CQ or HCQ with placebo or other active agents, published before March 31, 2020. The random-effects or fixed-effects models were used to pool the risk estimates relative ratio (RR) with 95% confidence interval (CI) for the outcomes.ResultsThe literature search yielded 23 and 17 studies for CQ and HCQ, respectively, that satisfied our inclusion criteria. Of these studies, we performed meta-analysis on the ones that were placebo-controlled, which included 6 studies for CQ and 14 studies for HCQ. We did not limit our analysis to published reports involving viral treatment alone; data also included the usage of either CQ or HCQ for the treatment of other diseases. The trials for the CQ consisted of a total of 2,137 participants (n=1,077 CQ, n=1,060 placebo), while the trials for HCQ involved 1,096 participants (n=558 HCQ and n=538 placebo). The overall mild or total AEs were statistically higher comparing CQ or HCQ to placebo. The AEs were further categorized into four groups and analyses revealed that neurologic, gastrointestinal, dermatologic, and ophthalmic AEs were higher in participants taking CQ compared to placebo. Although this was not evident in HCQ treated groups, further analyses suggested that there were more AEs attributed to other organ system that were not included in the categorized meta-analyses. Additionally, meta-regression analyses revealed that total AEs was affected by dosage for the CQ group.ConclusionsTaken together, we found that participants taking either CQ or HCQ have more AEs than participants taking placebo. Precautionary measures should be taken when using these drugs to treat COVID-19.

scholarly journals Improved survival rate and functional recovery of TKA in cementless fixation compared with cemented component: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Yuan Liu ◽  
Yi Zeng ◽  
Yuangang Wu ◽  
Mingyang Li ◽  
Huiqi Xie ◽  
...  
Keyword(s):  
Functional Recovery ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Standard Form ◽  
Mean Difference ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Cementless Fixation ◽  
Significant Difference

Abstract Background: Whether the cement could be given up in total knee arthroplasty (TKA) was still in controversy. We perform this meta-analysis to compare the rate of revision and functional recovery between two kinds of fixation in TKA. Methods: Randomized controlled trials (RCTs), prospective/retrospective observational studies from PubMed (on 2019 Sep), EMBASE (on 2019 Sep), and the Cochrane Central Register of Controlled Trials (CENTRAL) and Web of Science (on 2019 Sep) were searched. Continuous outcomes were presented as mean difference or standard mean difference with 95% CI and discontinuous outcomes were reported as relative risk (RR) with 95% CI. Random-effects or fixed-effects model was conducted to analyze the extracted data. The PRISMA guidelines and Cochrane Handbook were adopted to assess the quality of the results reported in included studies to ensure that the results of our meta-analysis were reliable and veritable. The continuous and dichotomous outcome were collected in a standard form, and the data were analysed by using Review Manager 5.3 software. Finally, the results were presented in the Forest plots. The rate of revision and reasons caused revision was the primary outcome of our study.Results: Twenty-six studies involving 2369 patients in cementless TKA and 2654 patients in cemented TKA were finally included in our meta-analysis. 26 studies were divided into three subgroups according to the length of follow-up. The studies in the first subgroup followed less than 5.5 years, the second followed less than 10.5 years, and the third followed more than 10.5 years. Cementless fixation significantly decreased the rate of aseptic loosing (p=0.0002) and revision (p=0.0002) in the first subgroup. Other reasons such as periprosthetic joint infection (PJI), instability and polyethylene wear were not significantly different between two groups. Significantly better functional recovery was got in cementless TKA in terms of Knee Society Function Score (p=0.01) when followed longer than 8.5 years. Significantly less patients in cementless group require manipulation under anesthesia (p=0.02) when duration was longer than 5.5 years. However, there was no significant difference regarding the rate of complication between two kinds of fixation in TKA.Conclusion: Not only the rate of aseptic loosing was decreased, rate of revision was also significantly decreased in cementless TKA within 5.5 years. In addition, the cementless TKA seemed performed better in postoperative functional recovery when had a long-term follow-up. However, the rate of complication was not significantly different in two kinds of fixation in TKA.

scholarly journals Effectiveness of exergames for improving mobility and balance in older adults: A systematic review and meta-analysis.

2020 ◽  
Author(s):  
Thaiana Barbosa Ferreira Pacheco ◽  
Candice Simões Pimenta de Medeiros ◽  
Victor Hugo Brito de Oliveira ◽  
Edgar Ramos Vieira ◽  
Fabrícia Azevêdo da Costa Cavalcanti
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Center Of Pressure ◽  
Meta Analysis ◽  
Functional Mobility ◽  
Control Group ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Timed Up And Go ◽  
Perfect Agreement

Abstract Background: Exergaming is a fun, engaging, and interactive form of exercising and it may help overcome some of the traditional exercise barriers and help improve adherence by older adults providing therapeutic applications for balance recovery and functional mobility. The purpose of this systematic review is to summarize the effects of exergames in older adults’ mobility and balance. Methods: The PRISMA guidelines for systematic reviews were followed. The following databases were searched from inception to August 2019: Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PEDro, CINAHL and INSPEC. We selected randomized controlled trials that assessed the effects of exergames on balance or mobility of older adults without neurological conditions, in comparison to no intervention or health education. Two review authors independently screened the trials titles and abstracts and identified trials for inclusion according to the eligibility criteria. Trial selection presented an almost perfect agreement between the authors regarding the interrater reliability (kappa = 0.84; p<0,001). Then, a descriptive analysis of the quantitative data was performed to summarize the evidence. Meta-analysis was carried using Revman. Random effects model was used to compute the pooled prevalence at 95% confidence interval. Results: After screening 822 trials, twelve trials comparing exergames with no intervention were included. A total of 1520 older adults participated in the studies, with mean age of 76±6 years for the experimental group and 76±5 years for the control group. Three studies found significant improvements in balance based on center of pressure sway and Berg Balance Scale scores. Three studies found improved mobility based on the timed up and go, 30-second chair stand, and 8-foot up and go test. Conclusions: Exergames improved balance and mobility in older adults without neurological disorders. High quality studies with standardized assessment protocols are necessary to improve evidence.

scholarly journals Correction of Breech Presentation with Moxibustion and Acupuncture: A Systematic Review and Meta-Analysis

Healthcare ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 619
Author(s):  
Jian-An Liao ◽  
Shih-Chieh Shao ◽  
Chian-Ting Chang ◽  
Pony Yee-Chee Chai ◽  
Kok-Loon Owang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Sensitivity Analysis ◽  
Meta Analysis ◽  
Asian Population ◽  
Breech Presentation ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Positive Effects ◽  
Randomized Controlled ◽  
Central Register

Acupuncture-type interventions (such as moxibustion and acupuncture) at Bladder 67 (BL67, Zhiyin point) have been proposed to have positive effects on breech presentation. The aim of this systematic review and meta-analysis was to evaluate the effectiveness and safety of moxibustion and acupuncture in correcting breech presentation. We searched PubMed, MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the Chinese Electronic Periodical Services (CEPS), and databases at ClinicalTrials.gov to identify relevant randomized controlled trials (RCTs). In this study, sixteen RCTs involving 2555 participants were included. Compared to control, moxibustion significantly increased cephalic presentation at birth (RR = 1.39; 95% CI = 1.21–1.58). Moxibustion also seemed to elicit better clinical outcomes in the Asian population (RR = 1.42; 95% CI = 1.21–1.67) than in the non-Asian population (RR = 1.20; 95% CI = 1.01–1.43). The effects of acupuncture on correcting breech presentation after sensitivity analysis were inconsistent relative to control. The effect of moxibustion plus acupuncture was synergistic for correcting breech presentation (RR = 1.53; 95% CI = 1.26–1.86) in one RCT. Our findings suggest that moxibustion therapy has positive effects on correcting breech presentation, especially in the Asian population.

scholarly journals Statin-associated muscle symptoms (SAMS) in primary prevention for cardiovascular disease in older adults: a protocol for a systematic review and meta-analysis of randomised controlled trials

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e017587 ◽  
Author(s):  
Zhen Zhou ◽  
Loai Albarqouni ◽  
Monique Breslin ◽  
Andrea J Curtis ◽  
Mark Nelson
Keyword(s):  
Systematic Review ◽  
Cardiovascular Disease ◽  
Older Adults ◽  
Primary Prevention ◽  
Older People ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Randomised Controlled

IntroductionAlthough statins are commonly used for prevention of cardiovascular disease, there is limited evidence about statin-related adverse effects in older people. Statin-related adverse events (AEs), especially the statin-associated muscle symptoms (SAMS), are the most common reasons for their discontinuation. Therefore, it is important to determine the risk of SAMS in the older population. We will undertake a systematic review and meta-analysis primarily focusing on the risk of SAMS and secondarily targeting myopathy, rhabdomyolysis, AEs and serious AEs, dropouts due to SAMS in run-in period, related permanent discontinuation rate of statins and creatine kinase level, among older people who received statins for primary prevention.Methods and analysisThis study has been developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols statement. We will include randomised controlled trials in which statin was compared with placebo with at least 1 year follow-up among older adults aged ≥65. This review is an update of a Cochrane systematic review that included the articles published before 2012. Cochrane Central Register of Controlled Trials, Medline OvidSP and Embase electronic database searches will be performed to identify relevant articles, limiting the publication date from 1 January 2012 to 13 February 2017. There will be no language limitation. Two independent reviewers will screen titles and abstracts and full text in duplicate. Risk of bias and evidence quality will be assessed using the Cochrane Collaboration’s tool and the Grading of Recommendations Assessment, Development and Evaluation approach, respectively. A meta-analysis using pooled data will be undertaken, if appropriate. We will also perform metaregression and subgroup analyses to identify sources of heterogeneity.Ethics and disseminationThis study is exempt from ethics approval due to the anonymous and aggregated data used. The outcomes will be disseminated by conference presentations and published in a peer-reviewed journal.Trial registration numberCRD42017058436.

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