Systematic Review of the Effects of Cognitive and Behavioral Interventions on Fall-Related Psychological Concerns in Older Adults

2020 ◽  
Vol 28 (1) ◽  
pp. 155-168 ◽  
Author(s):  
Angela Papadimitriou ◽  
Mark Perry
Keyword(s):  
Systematic Review ◽  
Random Effects ◽  
Behavioral Interventions ◽  
Fixed Effects ◽  
Best Practice ◽  
Fear Of Falling ◽  
Meta Analysis ◽  
Beneficial Effects ◽  
Behavioral Treatments

This systematic review aims to evaluate the efficacy of cognitive and behavioral interventions for improving fall-related psychological concerns. A systematic search yielded eight randomized controlled trials eligible for inclusion. All studies compared a cognitive and behavioral intervention with a control. The meta-analysis showed that cognitive and behavioral treatments had beneficial effects on fear of falling outcomes (lower score better) immediately after treatment (random-effects standardized mean difference [SMD]: −0.3, 95% confidence interval [CI] [−0.50, −0.10]) and at the longer term follow-up (random-effects SMD: −0.29, 95% CI [−0.49, −0.09]). Cognitive and behavioral treatments also showed a positive effect on falls efficacy outcomes (higher score better) immediately after treatment (fixed-effects SMD: 0.19, 95% CI [0.04, 0.34]) and over the longer term (fixed-effects SMD: 0.13, 95% CI [−0.00, 0.25]). However, the clinical significance of these effects on fear of falling and falls efficacy was unclear. Further work is required with best-practice comparators over a longer follow-up period.

scholarly journals Comparison of coated meshes for intraperitoneal placement in animal studies: a systematic review and meta-analysis

Hernia ◽  
2019 ◽  
Vol 24 (6) ◽  
pp. 1253-1261 ◽  
Author(s):  
H. Liu ◽  
S. van Steensel ◽  
M. Gielen ◽  
T. Vercoulen ◽  
J. Melenhorst ◽  
...  
Keyword(s):  
Systematic Review ◽  
Random Effects ◽  
Fixed Effects ◽  
Animal Studies ◽  
Meta Analysis ◽  
Adhesion Formation ◽  
Mean Difference ◽  
Random Effects Model ◽  
Fixed Effects Model

Abstract Purpose Laparoscopic intraperitoneal onlay mesh in hernia repair can result in adhesions leading to intestinal obstruction and fistulation. The aim of this systematic review is to compare the effects of mesh coatings reducing the tissue-to-mesh adhesion in animal studies. Methods Pubmed and Embase were systematically searched. Animal experiments comparing intraperitoneally placed meshes with coatings were eligible for inclusion. Only studies with comparable follow-up, measurements, and species were included for data pooling and subsequent meta-analysis. Results A total of 131 articles met inclusion criteria, with four studies integrated into one comparison and five studies integrated into another comparison. Compared to uncoated polypropylene (PP) mesh, PP mesh coated with hyaluronic acid/carboxymethyl cellulose (HA/CMC) showed significantly reduced adhesion formation at follow-up of 4 weeks measured with adhesion score of extent (random effects model, mean difference,−  0.96, 95% CI − 1.32 to − 0.61, P < 0.001, I2 = 23%; fixed effects model, mean difference,− 0.94, 95% CI − 1.25 to − 0.63, P < 0.001, I2 = 23%). Compared to PP mesh, polyester mesh coated with collagen (PC mesh) showed no significant difference at follow-up of 4 weeks regarding percentage of adhesion-area on a mesh, using random effects model (mean difference − 11.69, 95% CI − 44.14 to 20.76, P = 0.48, I2 = 92%). However, this result differed using fixed effects model (mean difference − 25.55, 95% CI − 33.70 to − 7.40, P < 0.001, I2 = 92%). Conclusion HA/CMC coating reduces adhesion formation to PP mesh effectively at a follow-up of 4 weeks, while the anti-adhesive properties of PC mesh are inclusive comparing all study data.

The relationship between migraine and infant colic: A systematic review and meta-analysis

Cephalalgia ◽  
2014 ◽  
Vol 35 (1) ◽  
pp. 63-72 ◽  
Author(s):  
Amy A Gelfand ◽  
Peter J Goadsby ◽  
I Elaine Allen
Keyword(s):  
Systematic Review ◽  
Random Effects ◽  
Odds Ratio ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Random Effects Model ◽  
Fixed Effects Model ◽  
Primary Analysis ◽  
Infant Colic ◽  
The Relationship

Context Infant colic is a common and distressing disorder of early infancy. Its etiology is unknown, making treatment challenging. Several articles have suggested a link to migraine. Objective The objective of this article was to perform a systematic review and, if appropriate, a meta-analysis of the studies on the relationship between infant colic and migraine. Data sources Studies were identified by searching PubMed and ScienceDirect and by hand-searching references and conference proceedings. Study selection For the primary analysis, studies specifically designed to measure the association between colic and migraine were included. For the secondary analysis, studies that collected data on colic and migraine but were designed for another primary research question were also included. Data extraction Data were abstracted from the original studies, through communication with study authors, or both. Two authors independently abstracted data. Main outcomes and measures The main outcome measure was the association between infant colic and migraine using both a fixed-effects model and a more conservative random-effects model. Results Three studies were included in the primary analysis; the odds ratio for the association between migraine and infant colic was 6.5 (4.6–8.9, p < 0.001) for the fixed-effects model and 5.6 (3.3–9.5, p = 0.004) for the random-effects model. In a sensitivity analysis wherein the study with the largest effect size was removed, the odds ratio was 3.6 (95% CI 1.7–7.6, p = 0.001) for both the fixed-effects model and random-effects model. Conclusions In this meta-analysis, infant colic was associated with increased odds of migraine. If infant colic is a migrainous disorder, this would have important implications for treatment. The main limitation of this meta-analysis was the relatively small number of studies included.

Effect of Cashew Nut on Lipid Profile: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 27 (5) ◽  
pp. 348-356 ◽  
Author(s):  
Mojgan Morvaridzadeh ◽  
Mahdi Sepidarkish ◽  
Farnaz Farsi ◽  
Abolfazl Akbari ◽  
Roghayeh Mostafai ◽  
...  
Keyword(s):  
Systematic Review ◽  
Lipid Profile ◽  
Fixed Effects ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Density Lipoprotein ◽  
Cochrane Library ◽  
Analysis Model ◽  
Beneficial Effects ◽  
Cashew Nut

Introduction: Nuts are one of the dietary components which appear to have beneficial effects on cardiovascular disease biomarkers. Studies demonstrate beneficial effects of cash­ews on serum lipids concentration, but results in the literature remain inconclusive. We conducted a review to examine the effects of cashew nut supplementation on serum lipid profile. Methods: Two reviewers independently searched PubMed, Web of Science, Cochrane Library, Scopus, and EMBASE electronic databases from inception until June 2019 without language limitation. Random- and fixed-effects models were used to calculate 95% confidence intervals (CI) for studies. Results: Six randomized clinical trials comprising 531 participants were included in this systematic review. Three studies were included in the meta-analysis model. There were no significant changes for total cholesterol (TC) (standardized mean difference [SMD]: –0.02, 95% CI: –0.32, 0.28), triglycerides (TG) (SMD: –0.01, 95% CI: –0.22, 0.20), high-density lipoprotein (HDL) cholesterol (SMD: 0.09, 95% CI: –0.16, 0.34), or low-density lipoprotein (LDL) cholesterol (SMD: –0.18, 95% CI: –0.75, 0.39). Conclusion: The results of this analysis demonstrate that treatment with cashew nut supplementation alone did not significantly change serum levels of LDL, HDL, TC, or TG.

Robotic-Assisted versus Manual Unicompartmental Knee Arthroplasty: Contemporary Systematic Review and Meta-analysis of Early Functional Outcomes

2020 ◽  
Author(s):  
Michael A. Gaudiani ◽  
Linsen T. Samuel ◽  
Atul F. Kamath ◽  
P. Maxwell Courtney ◽  
Gwo-Chin Lee
Keyword(s):  
Systematic Review ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Forest Plot ◽  
Robotic Assisted ◽  
Unicompartmental Knee ◽  
Surgeon Experience

AbstractRobotic-assisted unicompartmental knee arthroplasty (RA-UKA) aims to improve accuracy of component placement. Studies have shown improvement in radiographic positioning/alignment with RA-UKA but have not addressed clinical outcome measures (COMs). The purpose of this study was to determine if RA-UKA is associated with improved early revision rates and functional outcome scores (FOS) compared with manual UKA. A systematic review of all English language articles from 1999 to 2019 on RA-UKA using Medline, EMBASE, Scopus, and Web of Science databases identified 277 studies. Seven (three randomized controlled trials) met inclusion criteria. Revision rates/FOS were aggregated for RA-UKA and manual UKA; a forest plot was constructed utilizing inverse variance/Mantel–Haenszel fixed-effects meta-analysis. The seven articles included a total of 363 RA-UKA patients and 425 manual UKA patients. Mean age was 66 ± 3.5 and 65 ± 4.0 years, and mean body mass index (BMI) was 26.8 ± 2.1 and 27.1 ± 1.5 kg/m2, respectively. Mean follow-up was 25.5 months (4.5–48) and 29.1 months (4.5–48) for RA-UKA and manual UKA, respectively. At latest follow-up, RA-UKA patients showed a 26% ± 12 improvement in COMs versus 24% ± 12 improvement for manual UKA patients (p = 0.6). The revision rate was 3% for both groups (p = 0.8); however, a meta-analysis of RCTs showed no difference. Robotic and manual UKAs offer comparable improvements in pain, FOS, and revision rates. The effects of follow-up duration, ceiling effects of COMs, and surgeon experience remain unknown. Future studies comparing robotic versus manual UKAs with longer term follow-up may inform further benefits of each, with respect to component durability, alignment, and functional improvement.

scholarly journals Behavioral interventions for sleep disturbances in children with neurological and neurodevelopmental disorders: a systematic review and meta-analysis of randomized controlled trials

SLEEP ◽  
2020 ◽  
Vol 43 (9) ◽  
Author(s):  
Natalie L Phillips ◽  
Teleri Moore ◽  
Arthur Teng ◽  
Naomi Brookes ◽  
Tonya M Palermo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Neurodevelopmental Disorders ◽  
Functional Outcomes ◽  
Behavioral Interventions ◽  
Sleep Disturbances ◽  
Meta Analysis ◽  
Sleep Onset ◽  
Controlled Trials ◽  
Randomized Controlled

Abstract Study Objectives Sleep disturbances are common and associated with negative functional and health consequences in children with neurological and neurodevelopmental disorders (NNDDs) and represent an important potential target for behavioral interventions. This systematic review examined the efficacy of behavioral sleep interventions (BSIs) for children with NNDDs and comorbid sleep disturbances. Methods A systematic search of MEDLINE, EMBASE, PsychINFO, and CENTRAL was conducted in April 2019. Randomized controlled trials (RCTs) of BSI for children with NNDDS were included. Meta-analysis and GRADE quality ratings were performed on sleep and secondary functional outcomes (cognition, academics, and behavior). Results Nine RCTs were identified (n = 690; Mage = 8.39 ± 2.64years; 71.11% male). The quality of the evidence was predominantly rated as moderate. Posttreatment improvements in sleep were found on self-reported sleep disturbances (total sleep disturbance [standardized mean difference, i.e. SMD = 0.89], night wakings [SMD = 0.52], bedtime resistance [SMD = 0.53], parasomnias [SMD = 0.34], sleep anxiety [SMD = 0.50]) and self-reported sleep patterns (sleep duration [SMD = 0.30], sleep onset duration [SMD = 0.75]) and (2) objectively measured actigraphic sleep patterns (total sleep time [MD = 18.09 min; SMD = 0.32], sleep onset latency [MD = 11.96 min; SMD = 0.41]). Improvements in sleep (self-reported, not actigraphy) were maintained at follow-up, but few studies conducted follow-up assessments resulting in low-quality evidence. Reduction in total behavioral problems (SMD = 0.48) posttreatment and attention/hyperactivity (SMD = 0.28) at follow-up was found. Changes in cognition and academic skills were not examined in any studies. Conclusions BSIs improve sleep, at least in the short term, in children with NNDDs. Benefits may extend to functional improvements in behavior. More rigorous RCTs involving placebo controls, blinded outcome assessment, longer follow-up durations, and assessment of functional outcomes are required.

Radiographic and Clinical Outcomes After Tibial Tubercle Osteotomy for the Treatment of Patella Alta: A Systematic Review and Meta-analysis

2021 ◽  
pp. 036354652110123
Author(s):  
Derrick M. Knapik ◽  
Kyle N. Kunze ◽  
Eric Azua ◽  
Amar Vadhera ◽  
Adam B. Yanke ◽  
...  
Keyword(s):  
Systematic Review ◽  
Random Effects ◽  
Patellar Instability ◽  
Meta Analysis ◽  
Patellar Height ◽  
Patella Alta ◽  
Tibial Tubercle ◽  
Tibial Tubercle Osteotomy ◽  
The Mean

Background: Patella alta is a known risk factor for patellar instability and, in the setting of recurrent patellar instability with significant patella alta, correction of patellar height with a tibial tubercle osteotomy (TTO) may help decrease the failure of soft tissue–based stabilization. Purpose: To perform a systematic review and meta-analysis of radiographic and clinical outcomes after TTO for patella alta. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: PubMed, OVID/Medline, and Cochrane databases were queried in June 2020 for studies reporting outcomes of TTO for patella alta. Data pertaining to study characteristics and design, radiographic and clinical outcome values, and incidence of complications and reoperations were extracted. DerSimonian-Laird continuous and binary random-effects models were constructed to (1) perform subgroup-based analysis of mean changes in radiographic indices after TTO and (2) quantify the pooled incidence of complications and reoperations. Results: Eight studies including 340 patients (420 knees) with a mean age of 24.7 ± 8.4 years were included. The mean follow-up was 53.1 months (range, 3-120 months), with 1 study reporting a mean follow-up of less than 2 years. The pooled mean anterior transfer was 5.6 mm; the mean medial transfer was 8.7 ± 1.3 mm; and the pooled mean distalization of the tibial tubercle was 12.2 ± 4.5 mm. Continuous random-effects meta-analysis determined that significant reductions in the mean Insall-Salvati ratio (1.40 vs 0.98, P < .001), Caton-Deschamps index (1.26 vs 0.97, P < .001), and tibial tubercle to trochlear groove ratio (18.27 vs 10.69, P < .001) were observed after TTO. The overall incidence of complications was 7.6% (95% CI, 4.8%-10.5%), while the overall incidence of reoperations was 14.3% (95% CI 6.2%-22.4%). Conclusion: TTO for patellar instability in the setting of patella alta results in a significant decrease in patellar height with varying degrees of medialization depending on the utilized technique. A mean postoperative complication rate of 7.6% was reported with a reoperation incidence of 14.3%, related primarily to hardware removal.

scholarly journals Impact of Environmental Airborne Manganese Exposure on Cognitive and Motor Functions in Adults: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 18 (8) ◽  
pp. 4075
Author(s):  
Laura Ruiz-Azcona ◽  
Ignacio Fernández-Olmo ◽  
Andrea Expósito ◽  
Bohdana Markiv ◽  
María Paz-Zulueta ◽  
...  
Keyword(s):  
Systematic Review ◽  
Motor Function ◽  
Random Effects ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Random Effect ◽  
Random Effect Model ◽  
Motor Functions ◽  
Effect Model

Background/Objective: Whether environmental exposure to Manganese (Mn) in adults is associated with poorer results in cognitive and motor function is unclear. We aimed to determine these associations through a meta-analysis of published studies. Methods: A systematic review was conducted to identify epidemiological studies on a population ≥18 years old exposed to environmental airborne Mn, and in which results on specific tests to evaluate cognitive or motor functions were reported. We consulted Medline through PubMed, Web of Science and SCOPUS databases. We also performed a manual search within the list of bibliographic references of the retrieved studies and systematic reviews. To weight Mn effects, a random effects versus fixed effect model was chosen after studying the heterogeneity of each outcome. Results. Eighteen studies met the inclusion criteria. Among them, eleven studies reported data susceptible for meta-analysis through a pooled correlation or a standardized means difference (SMD) approach between exposed and non-exposed groups. Regarding cognitive function, the results of the studies showed heterogeneity among them (I2 = 76.49%, p < 0.001). The overall effect was a statistically significant negative correlation in the random effects model (pooled r = −0.165; 95%CI: −0.214 to −0.116; p < 0.001). For SMD, the results showed a lower heterogeneity with a negative SMD that did not reach statistical significance under the fixed effects model (SMD = −0.052; 95%CI −0.108 to 0.004; p = 0.068). Regarding motor function, heterogeneity (I2 = 75%) was also observed in the correlation approach with a pooled r (random effect model) = −0.150; 95%CI: −0.219 to −0.079; p < 0.001. Moderate heterogeneity was observed according to the SMD approach (I2 = 52.28%), with a pooled SMD = −0.136; 95%CI: −0.188 to−0.084; p < 0.001, indicating worse motor function in those exposed. Conclusions: Correlation approach results support a negative effect on cognitive and motor functions (the higher the Mn levels, the poorer the scores). Regarding the SMD approach, results also support a worse cognitive and motor functions in those exposed, although only for motor function statistical significance was obtained.

The effects of proprioceptive neuromuscular facilitation in treating chronic low back pain: A systematic review and meta-analysis

2021 ◽  
pp. 1-13
Author(s):  
Pincao Gao ◽  
Fang Tang ◽  
Weiguo Liu ◽  
Yu Mo
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Pulmonary Function ◽  
Dynamic Balance ◽  
Meta Analysis ◽  
Control Group ◽  
Low Back ◽  
Beneficial Effects ◽  
Proprioceptive Neuromuscular Facilitation

BACKGROUND: Proprioceptive neuromuscular facilitation (PNF) has been widely used in the clinical treatment of chronic low back pain (LBP) in recent years. However, its role remains controversial and it is unclear whether PNF offers more advantages for patients with chronic LBP. OBJECTIVE: The purpose of this systematic review is to evaluate the evidence on the effect of PNF on pain, waist function, pulmonary function and dynamic balance in patients with chronic LBP. METHODS: Seven English and Chinese electronic databases were searched to identify articles published from 1970 to February 2020. Relevant randomized controlled trials (RCTs) were selected by two independent reviewers to investigate PNF in treatment of chronic LBP. Data extraction was performed by the same reviewers. RESULTS: Twelve eligible trials involving 410 participants were included in this meta-analysis. Compared with the control group, the aggregated results suggested that PNF showed beneficial effects in relieving pain (SMD =-1.17; 95% CI: -1.50 to -0.84; p< 0.00001) and improving waist functional disability (MD =-1.63; 95% CI: -1.89 to -1.37; p< 0.00001). In addition, PNF was shown to have a significant effect on pulmonary function (MD = 0.65; 95% CI: 0.26 to 1.03; p= 0.001). However, the results of the study show that PNF could not significantly improve dynamic balance in patients with chronic LBP compared with the control group (MD =-0.04; 95% CI: -2.16 to 2.08; p= 0.97). A high risk of bias occurred in the areas of blinding (i.e., participants/personnel and outcome assessment). CONCLUSIONS: PNF showed more beneficial effects in pain relief and waist function improvement in patients with chronic LBP in the short term (4 to 8 weeks of intervention) or at 12-week follow-up and also played a positive role in pulmonary function. However, no significant effect of PNF on dynamic balance was found compared with the control group. However, these results have certain limitations, and these conclusions were supported by low-quality data. Therefore, articles that are methodologically reasonable and more authoritative are required to verify the effects. In addition, articles with long-term follow-up and other outcomes are needed to confirm additional findings.

scholarly journals Cognitive behavioural therapy for anxiety in children and young people on the autism spectrum: a systematic review and meta-analysis

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Shivani Sharma ◽  
Abigail Hucker ◽  
Terry Matthews ◽  
Dominique Grohmann ◽  
Keith R. Laws
Keyword(s):  
Systematic Review ◽  
Cognitive Behavioural Therapy ◽  
Random Effects ◽  
Meta Analysis ◽  
Behavioural Therapy ◽  
Autism Spectrum ◽  
Reporting Bias ◽  
Cognitive Behavioural ◽  
Meta Analyses

Abstract Background Anxiety is common in youth on the autism spectrum and cognitive behavioural therapy (CBT) has been adapted to address associated symptoms. The aim of the current systematic review and meta-analysis was to examine the efficacy of CBT for reducing anxiety in autistic youth. Method Searches of PubMed and Scopus databases were undertaken from January 1990 until December 2020. Studies were included if they consisted of randomised controlled trials (RCTs) using CBT to reduce anxiety in autistic youth. Separate random effects meta-analyses assessed anxiety ratings according to informant (clinician; parent; child), both at end-of-trial and at follow-up. Results A total of 19 RCTs met our inclusion criteria (833 participants: CBT N = 487; controls N = 346). Random effects meta-analyses revealed a large effect size for clinician rated symptoms (g = 0.88, 95% CI 0.55, 1.12, k = 11), while those for both parent (g = 0.40, 95% CI 0.24, 0.56; k = 18) and child-reported anxiety (g = 0.25, 95% CI 0.06, 0.43; k = 13) were smaller, but significant. These benefits were not however maintained at follow-up. Moderator analyses showed that CBT was more efficacious for younger children (for clinician and parent ratings) and when delivered as individual therapy (for clinician ratings). Using the Cochrane Risk of Bias 2 tool, we found concerns about reporting bias across most trials. Conclusions The efficacy of CBT for anxiety in autistic youth was supported in the immediate intervention period. However, substantial inconsistency emerged in the magnitude of benefit depending upon who was rating symptoms (clinician, parent or child). Follow-up analyses failed to reveal sustained benefits, though few studies have included this data. It will be important for future trials to address robustness of treatment gains overtime and to further explore inconsistency in efficacy by informant. We also recommend pre-registration of methods by trialists to address concerns with reporting bias.

scholarly journals Therapeutic efficacy of alternative primaquine regimens to standard treatment in preventing relapses by Plasmodium vivax: A systematic review and meta-analysis

2015 ◽  
pp. 183-191 ◽  
Author(s):  
Lina Marcela Zuluaga Idarraga ◽  
Maria Eulalia Tamayo Perez ◽  
Daniel Camilo Aguirre Acevedo
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Relative Risk ◽  
Fixed Effects ◽  
Standard Treatment ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Efficacy And Safety ◽  
Standard Regimen

Objective: To compare efficacy and safety of primaquine regimens currently used to prevent relapses by P. vivax. Methods: A systematic review was carried out to identify clinical trials evaluating efficacy and safety to prevent malaria recurrences by P. vivax of primaquine regimen 0.5 mg / kg / day for 7 or 14 days compared to standard regimen of 0.25 mg/kg/day for 14 days. Efficacy of primaquine according to cumulative incidence of recurrences after 28 days was determined. The overall relative risk with fixed-effects meta-analysis was estimated. Results: For the regimen 0.5 mg/kg/day/7 days were identified 7 studies, which showed an incidence of recurrence between 0% and 20% with follow-up 60-210 days; only 4 studies comparing with the standard regimen 0.25 mg/kg/day/14 days and no difference in recurrences between both regimens (RR= 0.977, 95% CI= 0.670 to 1.423) were found. 3 clinical trials using regimen 0.5 mg/kg/day/14 days with an incidence of recurrences between 1.8% and 18.0% during 330-365 days were identified; only one study comparing with the standard regimen (RR= 0.846, 95% CI= 0.484 to 1.477). High risk of bias and differences in handling of included studies were found. Conclusion: Available evidence is insufficient to determine whether currently PQ regimens used as alternative rather than standard treatment have better efficacy and safety in preventing relapse of P. vivax. Clinical trials are required to guide changes in treatment regimen of malaria vivax.

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