Intramuscular Stimulation Therapy for Healthcare: A Systematic Review of Randomised Controlled Trials

Objective A systematic review of randomised controlled trials was conducted to evaluate the efficacy and effectiveness of intramuscular stimulation (IMS). Methods Electronic databases including Medline, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, the Cochrane Library, China National Knowledge Infrastructure, KoreaMED, Korean Studies Information Service System, RISS and DBPIA were searched through June, 2012. The Cochrane criteria were used to assess the risk of bias for the individual studies. Results A total of 416 publications were initially collected and four studies were included in this review. One study evaluated the efficacy of IMS for chronic tension-type headaches; IMS showed a better effect than the sham (headache index: mean difference (MD) −4.90, 95% CI −9.53 to −0.27). Three studies tested the effectiveness of IMS for various conditions. In the first study no significant difference was observed in a comparison of IMS and meloxicam therapy for chronic shoulder pain (pain-visual analogue scale (VAS): MD −0.05, 95% CI −0.25 to 0.16). The second study in patients with myofascial pain syndrome of the upper trapezius muscle found that IMS had a greater effect than simple dry needling measured by the pain-VAS (MD −2.70, 95% CI −3.77 to −1.63). In the third study, patients with lower back pain who received IMS plus the standard treatment had a better status at discharge than those receiving the standard treatment alone (relative risk 1.63, 95% CI 1.18 to 2.24). Conclusions Despite the positive results of these individual studies, the level of evidence supporting the efficacy and effectiveness of IMS for several conditions remains insufficient because of concerns about a lack of precision and a high risk of bias of the included studies. Rigorous large-scale clinical trials of IMS are needed to evaluate the clinical utility of this technique.

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Should the duration of head bandaging be reduced after pinnaplasty? A systematic review

The Journal of Laryngology & Otology ◽

10.1017/s0022215114002114 ◽

2014 ◽

Vol 128 (11) ◽

pp. 948-951 ◽

Cited By ~ 1

Author(s):

A E L McMurran ◽

I Khan ◽

S Mohamad ◽

M Shakeel ◽

H Kubba

Keyword(s):

Systematic Review ◽

Randomised Controlled Trials ◽

Case Series ◽

Cochrane Library ◽

Controlled Trials ◽

Inclusion Criteria ◽

National Library ◽

Significant Difference ◽

Randomised Controlled ◽

The Cochrane Library

AbstractBackground:It is common practice to use head bandages for 7–10 days following pinnaplasty. However, head bandages are often troublesome for patients and can lead to serious complications.Method:A systematic review was performed to evaluate the use of head bandages after pinnaplasty. A search of Medline, Embase (Ovid) and CINAHL (EBSCO collections), the Cochrane Library, Pubmed (US National Library of Medicine) and Google Scholar identified 34 related articles. Of these, 14 were deemed relevant and 2 randomised controlled trials, 1 cohort study, 3 case series and 1 literature review met the inclusion criteria.Results:The two randomised controlled trials show no statistically significant difference in complications when a head bandage was used for the standard 7–10 days, for 24 hours or not at all. The three case series show that using a head bandage for 24 hours or not at all are safe alternatives. The review article recommended that when head bandages are applied after pinnaplasty it should be for the shortest duration possible.Conclusion:Based on the available evidence, not using a head bandage at all or using one for a maximum of 24 hours following pinnaplasty is recommended.

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Effectiveness of personal letters to healthcare professionals in changing professional behaviours: a systematic review protocol

Systematic Reviews ◽

10.1186/s13643-021-01650-4 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Aikaterini Grimani ◽

Louis Goffe ◽

Mei Yee Tang ◽

Fiona Beyer ◽

Falko F. Sniehotta ◽

...

Keyword(s):

Systematic Review ◽

Randomised Controlled Trials ◽

Healthcare Professionals ◽

Grey Literature ◽

Behavioural Change ◽

Risk Of Bias ◽

Cochrane Library ◽

Controlled Trials ◽

Behaviour Change Techniques ◽

Randomised Controlled

Abstract Background Letters are regularly sent by healthcare organisations to healthcare professionals to encourage them to take action, change practice or implement guidance. However, whether letters are an effective tool in delivering a change in healthcare professional behaviour is currently uncertain. In addition, there are currently no evidence-based guidelines to support health providers and authorities with advice on how to formulate the communication, what information and behaviour change techniques to include in order to optimise the potential effect on the behaviour of the receivers. To address this research gap, we seek to inform such guidance through this systematic review, which aims to provide comprehensive evidence of the effectiveness of personal letters to healthcare professionals in changing their professional behaviours. Methods/design A comprehensive literature search of published and unpublished studies (the grey literature) in electronic databases will be conducted to identify randomised controlled trials (RCTs) that meet our inclusion criteria. We will include RCTs evaluating the effectiveness of personal letters to healthcare professionals in changing professional behaviours. The primary outcome will be behavioural change. The search will be conducted in five electronic databases (from their inception onwards): MEDLINE, Embase, PsycINFO, the Cochrane Library and CINAHL. We will also conduct supplementary searches in Google Scholar, hand search relevant journals, and conduct backward and forward citation searching for included studies and relevant reviews. A systematic approach to searching, screening, reviewing and data extraction will be applied in accordance with the process recommended by the Cochrane Collaboration. Two researchers will examine titles, abstracts, full-texts for eligibility independently. Risk of bias will be assessed using the Cochrane Risk of Bias 2 (RoB 2) tool for randomised controlled trials. Disagreements will be resolved by a consensus procedure. Discussion Health policy makers across government are expected to benefit from being able to increase compliance in clinical settings by applying theories of behaviour to design of policy communications. The synthesised findings will be disseminated through peer-reviewed publication. Systematic review registration PROSPERO CRD42020167674

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Impact of levothyroxine in women with positive thyroid antibodies on pregnancy outcomes: a systematic review and meta-analysis of randomised controlled trials

BMJ Open ◽

10.1136/bmjopen-2020-043751 ◽

2021 ◽

Vol 11 (2) ◽

pp. e043751

Author(s):

Lorraine Lau ◽

Jamie L Benham ◽

Patricia Lemieux ◽

Jennifer Yamamoto ◽

Lois E Donovan

Keyword(s):

Systematic Review ◽

Preterm Delivery ◽

Pregnancy Outcomes ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Risk Of Bias ◽

Controlled Trials ◽

Cochrane Central Register ◽

Significant Difference ◽

Randomised Controlled

ObjectiveTo evaluate the effect of levothyroxine therapy on pregnancy outcomes compared with placebo or no treatment in women without overt hypothyroidism with presence of thyroid peroxidase antibodies (TPOAb) and/or thyroglobulin antibodies (TgAb).DesignSystematic review and meta-analysis of randomised controlled trialsStudy eligibility criteriaPrespecified criteria for inclusion were: randomised trials of levothyroxine versus control (placebo or no treatment) among women with positive TPOAb or TgAb who were pregnant or considering conception.Data sourcesOvid MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials were searched from 1980 to 5 November 2020.Outcome measuresPrespecified data elements were extracted and where appropriate, meta-analyses were conducted. Main outcomes include pregnancy achieved, miscarriage, preterm delivery and live birth.Risk of bias assessmentCochrane Risk of Bias Tool for Quality Assessment of Randomised Controlled Trials.ResultsFrom 3023 citations, 79 citations were identified for full-text review. Of these, six trials (total of 2263 women) were included for qualitative and quantitative analyses. Risk of bias was deemed low for only one trial. There was no significant difference in the relative risk (RR) of pregnancy achieved (RR 1.03; 95% CI 0.93 to 1.13), miscarriage (RR 0.93; 95% CI 0.76 to 1.14), preterm delivery (RR 0.66; 95% CI 0.39 to 1.10) or live births (RR 1.01; 95% CI 0.89 to 1.16) in thyroid autoimmune women treated with levothyroxine compared with controls. Sensitivity analyses of preterm birth identified study quality and timing of levothyroxine initiation as sources of heterogeneity.ConclusionsAmong pregnant women or women planning conception, with thyroid autoimmunity, there is a lack of evidence of benefit for levothyroxine use (moderate to high Grading of Recommendations, Assessment, Development and Evaluations). Recommendations to use levothyroxine in this setting need to be reconsidered.PROSPERO registration numberCRD42019130459.

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No differences in healing among different closure methods of arthroscopic portals: a systematic review

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2017-000132 ◽

2017 ◽

Vol 2 (6) ◽

pp. 297-307

Author(s):

Chetan Muralidhara Rao Dojode ◽

Murali Krishna ◽

Andrew James Shepherd ◽

Chandan Muralidhara Rao Dojode ◽

Raviprasad Kattimani ◽

...

Keyword(s):

Systematic Review ◽

Randomised Controlled Trials ◽

Tissue Adhesive ◽

Cochrane Library ◽

Controlled Trials ◽

Adhesive Tape ◽

Level Of Evidence ◽

Safe Alternative ◽

Significant Difference ◽

Randomised Controlled

BackgroundDuring arthroscopy the small skin incisions made over the joints are called arthroscopy portals. There are different methods described for arthroscopic portal closure. Very few randomised controlled trials and no systematic reviews have compared the methods of arthroscopic portal closure, and there are no clear guidelines recommending any one closure method. There is therefore a need for a systematic review that provides high-quality evidence to help surgeons choose the appropriate arthroscopic portal closure technique.ObjectiveTo undertake a systematic review to ascertain the outcome with three different closure methods for arthroscopic portals: (1) suturing; (2) application of sterile adhesive tapes; and (3) leaving wounds open covered with a dressing.MethodsRandomised controlled trials comparing the closure methods of arthroscopic portals were selected using strict search criteria from electronic databases (MEDLINE, EMBASE, CINAHL, BNI and Cochrane Library) and trial registers. Two independent authors conducted the study selection, data extraction and quality assessment of each study. Quality appraisal was done using the Cochrane Collaboration risk of bias tool. Three studies were eligible for inclusion and a narrative synthesis of the findings is provided.ResultsOne study did not show a statistically significant difference between suturing and leaving the wound open with a dressing. However, two studies found that leaving wounds open covered with a dressing had a significantly better outcome. In one of these studies, sterile adhesive tapes were used and the outcomes were better than with suturing but not so good as leaving the wounds open covered with a dressing.ConclusionSuturing of arthroscopic portal wounds confers no benefit over leaving them open covered with a simple dressing or applying sterile adhesive tapes. Meta-analysis was not performed, so a full estimate of effect size cannot be derived from this review. Managing arthroscopic portals by leaving them open covered with a dressing or by applying tissue adhesive tape can be safe alternative techniques to suturing. There is a need for randomised controlled trials with a larger sample size representing different populations in a number of centres with better methodological quality and outcome measures.Level of evidenceLevel 1 Systematic review of Randomised Control Trials (Level I studies).

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Effectiveness of non-pharmacological interventions for reducing postpartum fatigue: a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2021-051136 ◽

2021 ◽

Vol 11 (10) ◽

pp. e051136

Author(s):

Jialu Qian ◽

Shiwen Sun ◽

Lu Liu ◽

Xiaoyan Yu

Keyword(s):

Systematic Review ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Risk Of Bias ◽

Cochrane Library ◽

Published Data ◽

Controlled Trials ◽

Pharmacological Interventions ◽

Randomised Controlled ◽

Postpartum Fatigue

IntroductionPostpartum fatigue is a common symptom among new mothers after their pregnancy. It has a considerable negative impact on women’s functional and mental status as well as the development of babies. Identifying effective interventions to prevent or reduce postpartum fatigue is meaningful to improve the quality of life and avoid adverse outcomes of this vulnerable population. This systematic review aims to synthesise non-pharmacological evidence and evaluate the effectiveness of interventions for reducing postpartum fatigue among puerperas.Methods and analysisThis review will be conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. We will systematically search the Cochrane Library, PubMed, Embase, Web of Science, PsycINFO, CINAHL and ProQuest databases to identify clinical trials implementing non-pharmacological interventions conducted during 0–78 weeks postpartum for fatigue reduction. An additional search of OpenGrey will be conducted to identify grey literature. The search will be performed on 30 March 2021 without restrictions on time and language. Two independent reviewers will be responsible for study selection, data extraction and study quality assessment. The Cochrane risk-of-bias tool will be adopted to evaluate the risk biases of the included randomised controlled trials, and the Risk of Bias in Non-randomised Studies of Interventions will be applied to evaluate non-randomised controlled trials. Any disagreements will be referred to a third reviewer to reach a consensus. Findings will be qualitatively synthesised, and a meta-analysis will be conducted for the statistical combination if outcome data are sufficient and available.Ethics and disseminationThis systematic review will not involve the collection of primary data and will be based on published data. Therefore, ethics approval is not required. The final findings will be disseminated through peer-reviewed journals and academic conferences.PROSPERO registration numberCRD42021234869

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Drug-induced orthostatic hypotension: A systematic review and meta-analysis of randomised controlled trials

PLoS Medicine ◽

10.1371/journal.pmed.1003821 ◽

2021 ◽

Vol 18 (11) ◽

pp. e1003821

Author(s):

Cini Bhanu ◽

Danielle Nimmons ◽

Irene Petersen ◽

Mine Orlu ◽

Daniel Davis ◽

...

Keyword(s):

Systematic Review ◽

Orthostatic Hypotension ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Risk Of Bias ◽

Controlled Trials ◽

Drug Induced ◽

Evidence Summary ◽

Significant Difference ◽

Randomised Controlled

Background Drug-induced orthostatic hypotension (OH) is common, and its resulting cerebral hypoperfusion is linked to adverse outcomes including falls, strokes, cognitive impairment, and increased mortality. The extent to which specific medications are associated with OH remains unclear. Methods and findings We conducted a systematic review and meta-analysis to evaluate the extent to which specific drug groups are associated with OH. EMBASE, MEDLINE, and Web of Science databases were searched from inception through 23 November 2020. Placebo-controlled randomised controlled trials (RCTs) on any drug reporting on OH as an adverse effect in adults (≥18 years) were eligible. Three authors extracted data on the drug, OH, dose, participant characteristics, and study setting. The revised Cochrane risk-of-bias tool for randomised trials (RoB 2) was used to appraise evidence. Summary odds ratios (ORs) were estimated for OH using fixed effects Mantel–Haenszel statistics. We conducted subgroup analysis on validity of OH measurement, drug dose, risk of bias, age, and comorbidity. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool was used to summarise the certainty of evidence. Of 36,940 citations, 69 eligible RCTs were included in the meta-analysis comprising 27,079 participants. Compared with placebo, beta-blockers and tricyclic antidepressants were associated with increased odds of OH (OR 7.76 [95% CI 2.51, 24.03]; OR 6.30 [95% CI 2.86, 13.91]). Alpha-blockers, antipsychotics, and SGLT-2 inhibitors were associated with up to 2-fold increased odds of OH, compared to placebo. There was no statistically significant difference in odds of OH with vasodilators (CCBs, ACE inhibitors/ARBs, SSRIs), compared to placebo. Limitations of this study are as follows: data limited to placebo-controlled studies, (excluding head-to-head trials), many RCTs excluded older participants; therefore results may be amplified in older patients in the clinical setting. The study protocol is publicly available on PROSPERO (CRD42020168697). Conclusions Medications prescribed for common conditions (including depression, diabetes, and lower urinary tract symptoms) were associated with significantly increased odds of OH. Drugs causing sympathetic inhibition were associated with significantly increased odds of OH, while most vasodilators were associated with small nonsignificant differences in odds of OH, compared to placebo. Drugs targeting multiple parts of the orthostatic blood pressure (BP) reflex pathway (e.g. sympathetic inhibition, vasodilation, cardio-inhibitory effects) may carry cumulative risk, suggesting that individuals with polypharmacy could benefit from postural BP monitoring.

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Systematic review protocol examining the effectiveness of hospital clowns for symptom cluster management in paediatrics

BMJ Open ◽

10.1136/bmjopen-2018-026524 ◽

2019 ◽

Vol 9 (1) ◽

pp. e026524 ◽

Cited By ~ 4

Author(s):

Luís Carlos Lopes-Júnior ◽

Regina Aparecida Garcia Lima ◽

Karin Olson ◽

Emiliana Bomfim ◽

Eliane Tatsch Neves ◽

...

Keyword(s):

Systematic Review ◽

Randomised Controlled Trials ◽

Risk Of Bias ◽

Library Science ◽

Symptom Cluster ◽

Cochrane Library ◽

Controlled Trials ◽

Human Beings ◽

Cluster Management ◽

Randomised Controlled

IntroductionClown intervention may playing an important complementary role in paediatric care and recovery. However, data on its utility for symptom cluster management of hospitalised children and adolescents in acute and chronic disorders are yet to be critically evaluated. As clinicians strive to minimise the psychological burden during hospitalisation, it is important that they are aware of the scientific evidences available regarding clown intervention for symptom management. We aim to provide quality evidence for the effectiveness of clown intervention on symptom cluster management in paediatric inpatients, both in acute and chronic conditions.Methods and analysisA systematic review of randomised controlled trials (RCTs) and non-randomised controlled trials (NRCTs) will be conducted. MEDLINE, Web of Science, Cochrane Library, Science Direct, PsycINFO, CINAHL, LILACS and SciELO databases will be searched from January 2000 to December 2018. Primary outcomes will include measures related with the effect of clown intervention on symptom cluster of paediatric inpatients (anxiety, depression, pain, fatigue, stress and psychological, emotional responses and perceived well-being). Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the methodological appraisal of the studies will be assessed by the Jadad Scale as well as Cochrane Risk-of-Bias Tool for RCTs, and Risk-of-Bias In Non-Randomized Studies Tool for NRCTs. A narrative synthesis will be conducted for all included studies. Also, if sufficient data are available, a meta-analysis will be conducted. The effect sizes will be generated using Hedges’ g score for both fixed and random effect models. I2statistics will be used to assess heterogeneity and identify their potential sources.Ethics and disseminationAs it will be a systematic review, without human beings involvement, there will be no requirement for ethical approval. Findings will be disseminated widely through peer-reviewed publication and in various media, for example, conferences, congresses or symposia.Trial registration numberCRD42018107099.

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Microbial colonisation associated with conventional and self-ligating brackets: a systematic review

Journal of Orthodontics ◽

10.1177/14653125211056023 ◽

2021 ◽

pp. 146531252110560

Author(s):

Nidhi P Parmar ◽

Gabrielle L Thompson ◽

Nikki E Atack ◽

Anthony J Ireland ◽

Martyn Sherriff ◽

...

Keyword(s):

Systematic Review ◽

Randomised Controlled Trials ◽

Data Extraction ◽

Meta Analysis ◽

Risk Of Bias ◽

Controlled Trials ◽

Significant Difference ◽

Critical Appraisal Skills ◽

Randomised Controlled ◽

Bracket Design

Background: Decalcification and gingivitis caused by plaque accumulation around brackets are common iatrogenic effects of fixed appliances. The influence of conventional versus self-ligating bracket design on microbial colonisation is unknown. Objective: To assess the levels of microbial colonisation associated with conventional and self-ligating brackets. Search sources: Three databases were searched for publications from 2009 to 2021. Data selection: Randomised controlled trials comparing levels of microbial colonisation before and during treatment with conventional and self-ligating brackets were assessed independently and in duplicate. Data extraction: Data were extracted independently by two authors from the studies that fulfilled the inclusion criteria. Risk of bias assessments were made using the revised Cochrane risk of bias tool for randomized trials. The quality of the included studies was assessed using the Critical Appraisal Skills Programme Checklist. Results: A total of 11 randomised controlled trials were included in this systematic review. Six of the studies were found to be at low risk of bias and five presented with some concerns. The studies were considered moderate to high quality. Five trials reported no statistically significant difference in microbial colonisation between bracket types. The remaining studies showed mixed results, with some reporting increased colonisation of conventional brackets and others increased colonisation of self-ligating brackets. The heterogeneity of study methods and outcomes precluded meta-analysis. Conclusion: Of the 11 studies included in this systematic review, five found no differences in colonisation between conventional and self-ligating brackets. The remaining studies showed mixed results. The evidence is inconclusive regarding the association between bracket design and levels of microbial colonisation.

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Dietary interventions with or without omega-3 supplementation for the management of rheumatoid arthritis: a systematic review protocol

HRB Open Research ◽

10.12688/hrbopenres.13136.1 ◽

2020 ◽

Vol 3 ◽

pp. 72 ◽

Cited By ~ 1

Author(s):

Tala Raad ◽

Elena George ◽

Anne Griffin ◽

Louise Larkin ◽

Alexander Fraser ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Systematic Review ◽

Systematic Reviews ◽

Randomised Controlled Trials ◽

Risk Of Bias ◽

Cochrane Library ◽

Controlled Trials ◽

Omega 3 ◽

Dietary Interventions ◽

Randomised Controlled

Background: Rheumatoid arthritis (RA) is an autoimmune disease characterised by swollen and painful joints. It is hypothesised that changes in lifestyle factors such as consuming a healthier diet may reduce the severity of RA symptoms. People living with RA commonly make alterations to their dietary intake with the hope of improving their symptoms. This systematic review aims to discuss the effects of dietary interventions with and without omega-3 supplementation for the management of rheumatoid arthritis. Methods: A systematic review of randomised controlled trials (RCTs) and non-randomised controlled trials (NRCTs) will be conducted. MEDLINE, EMBASE, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register) and CINAHL will be searched from inception without using date restrictions. Primary outcomes will include measures of disease activity, inflammation and quality of life among adults living with RA. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the methodological appraisal of the studies will be assessed independently by two different reviewers (TR and AG) using the Cochrane Risk-of-Bias Tool for RCTs, and Risk-of-Bias In Non-Randomised Studies Tool for NRCTs. Ethics and dissemination: Ethical approval is not required for this systematic review. Only publically available data from previously published studies will be used. The findings of this systematic review will be submitted for publication in a peer-reviewed journal and presented at relevant conferences. PROSPERO registration: CRD42020147415 (11/02/2020).

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Comparative efficacy and safety of interventions for treating head lice: a protocol for systematic review and network meta-analysis

BMJ Paediatrics Open ◽

10.1136/bmjpo-2021-001129 ◽

2021 ◽

Vol 5 (1) ◽

pp. e001129

Author(s):

Bill Stevenson ◽

Wubshet Tesfaye ◽

Julia Christenson ◽

Cynthia Mathew ◽

Solomon Abrha ◽

...

Keyword(s):

Systematic Review ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Grey Literature ◽

Risk Of Bias ◽

Controlled Trials ◽

Head Lice ◽

Efficacy And Safety ◽

Randomised Controlled ◽

Meta Analyses

BackgroundHead lice infestation is a major public health problem around the globe. Its treatment is challenging due to product failures resulting from rapidly emerging resistance to existing treatments, incorrect treatment applications and misdiagnosis. Various head lice treatments with different mechanism of action have been developed and explored over the years, with limited report on systematic assessments of their efficacy and safety. This work aims to present a robust evidence summarising the interventions used in head lice.MethodThis is a systematic review and network meta-analysis which will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement for network meta-analyses. Selected databases, including PubMed, Embase, MEDLINE, Web of Science, CINAHL and Cochrane Central Register of Controlled Trials will be systematically searched for randomised controlled trials exploring head lice treatments. Searches will be limited to trials published in English from database inception till 2021. Grey literature will be identified through Open Grey, AHRQ, Grey Literature Report, Grey Matters, ClinicalTrials.gov, WHO International Clinical Trials Registry and International Standard Randomised Controlled Trials Number registry. Additional studies will be sought from reference lists of included studies. Study screening, selection, data extraction and assessment of methodological quality will be undertaken by two independent reviewers, with disagreements resolved via a third reviewer. The primary outcome measure is the relative risk of cure at 7 and 14 days postinitial treatment. Secondary outcome measures may include adverse drug events, ovicidal activity, treatment compliance and acceptability, and reinfestation. Information from direct and indirect evidence will be used to generate the effect sizes (relative risk) to compare the efficacy and safety of individual head lice treatments against a common comparator (placebo and/or permethrin). Risk of bias assessment will be undertaken by two independent reviewers using the Cochrane Risk of Bias tool and the certainty of evidence assessed using the Grading of Recommendations, Assessment, Development and Evaluations guideline for network meta-analysis. All quantitative analyses will be conducted using STATA V.16.DiscussionThe evidence generated from this systematic review and meta-analysis is intended for use in evidence-driven treatment of head lice infestations and will be instrumental in informing health professionals, public health practitioners and policy-makers.PROSPERO registration numberCRD42017073375.

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