scholarly journals Community-deliverable exercise and anxiety in adults with arthritis and other rheumatic diseases: a systematic review with meta-analysis of randomised controlled trials

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e019138 ◽  
Author(s):  
George A Kelley ◽  
Kristi S Kelley ◽  
Leigh F Callahan
Keyword(s):  
Rheumatic Diseases ◽  
Randomised Controlled Trials ◽  
Exercise Intervention ◽  
Meta Analysis ◽  
Small Study ◽  
Controlled Trials ◽  
Number Needed To Treat ◽  
Significant Heterogeneity ◽  
Inclusion Length ◽  
Randomised Controlled

Background/purposeGiven conflicting findings, the purpose of this study was to use the meta-analytic approach to examine the effects of exercise (aerobic, strength training or both) on anxiety in adults with arthritis and other rheumatic diseases (AORD).MethodsRandomised controlled exercise intervention trials ≥4weeks in adults ≥18 years of age with osteoarthritis, rheumatoid arthritis or fibromyalgia were included. Studies were located by searching eight electronic databases, cross-referencing and expert review. Dual selection and data abstraction of studies were performed. Hedge’s standardised effect size (ES) was calculated for each result and pooled using the recently developed inverse heterogeneity model. Two-tailedz-alpha values ≤0.05 and non-overlapping 95% CI were considered statistically significant. Heterogeneity was estimated using Q andI2with alpha values ≤0.10 for Q considered statistically significant. Small-study effects were examined using funnel plots and Egger’s regression test. In addition, the number needed to treat (NNT), percentile improvement and meta-regression were conducted.ResultsOf the 639 citations screened, 14 studies representing 926 initially enrolled participants (539 exercise, 387 control) met the criteria for inclusion. Length of training (mean±SD) averaged 15.8±6.7 weeks, frequency 3.3±1.3 times per week and duration 28.8±14.3 min per session. Overall, statistically significant reductions in anxiety were found (exercise minus control changes ES=−0.40, 95% CI −0.65 to −0.15, tau2=0.14; Q=40.3, P=0.0004;I2=62.8%). The NNT was 6 with a percentile improvement of 15.5% and an estimated 5.3 million inactive US adults with AORD improving their anxiety if they started exercising regularly. Statistically significant small-study effects were observed (P<0.0001).ConclusionsExercise is associated with reductions in anxiety among adults with selected types of AORD. However, a need exists for additional, well-designed, randomised controlled trials on this topic.PROSPERO registration numberCRD42016048728.

Effect of probiotic supplementation in pregnant women: a meta-analysis of randomised controlled trials

2019 ◽  
Vol 123 (8) ◽  
pp. 870-880 ◽  
Author(s):  
Linghan Kuang ◽  
Yongmei Jiang
Keyword(s):  
Pregnant Women ◽  
Atopic Eczema ◽  
Gestational Age ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Significant Heterogeneity ◽  
Probiotic Supplementation ◽  
Randomised Controlled

AbstractProbiotics are being used increasingly in pregnant women, whereas the efficiency on pregnancy outcomes is yet lacking. PubMed, Embase and the Cochrane Library were searched. Relative risks (RR) or weighted mean differences (WMD) with 95 % CI were employed to calculate the summary outcomes. A total of eighteen randomised controlled trials (RCT) including 4356 pregnant women were eligible. The summary RR indicated that probiotic supplementation was associated with a significant decrease in the risk of atopic eczema (RR 0·68; 95 % CI 0·58, 0·81; P < 0·001) and eczema (RR 0·79; 95 % CI 0·68, 0·91; P = 0·002) without significant heterogeneity. Probiotic supplementation was associated with a prolonged gestational age (WMD 0·09; 95 % CI 0·04, 0·15; P = 0·001) with insignificant heterogeneity, whereas no significant effect was exerted on birth weight (P = 0·851). The risks of death (RR 0·34; 95 % CI 0·13, 0·91; P = 0·031) and necrotising enterocolitis (NEC) (RR 0·38; 95 % CI 0·18, 0·81; P = 0·012) were significantly reduced in pregnant women receiving probiotics without evidence of heterogeneity. These findings suggested that probiotics in pregnant women were beneficial for atopic eczema, eczema, gestational age, death and NEC.

scholarly journals Acupuncture in sham device controlled trials may not be as effective as acupuncture in the real world: a preliminary network meta-analysis of studies of acupuncture for hot flashes in menopausal women

2019 ◽  
Vol 38 (1) ◽  
pp. 37-44 ◽  
Author(s):  
Tae-Hun Kim ◽  
Myeong Soo Lee ◽  
Terje Alraek ◽  
Stephen Birch
Keyword(s):  
Randomised Controlled Trials ◽  
Data Extraction ◽  
Meta Analysis ◽  
Hot Flashes ◽  
Sham Acupuncture ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Significant Heterogeneity ◽  
Randomised Controlled

Background: Randomised controlled trials of acupuncture performed using sham interventions to control for the placebo effect have mostly used two types of sham techniques: techniques with minimal insertion of acupuncture needles with no additional stimulation (shallow needling control) and techniques with sham acupuncture devices that do not penetrate the skin (sham device control). To achieve successful blinding, sham device controlled acupuncture trials also use the acupuncture base unit in the verum acupuncture group, but in the shallow needling control trials this is not necessary for the verum acupuncture treatment. Objective: In this study, we analysed the estimated comparative effectiveness of these two verum acupuncture modalities in studies of acupuncture for menopausal hot flashes that used two types of sham control treatments. Methods: We conducted a network meta-analysis that included randomised controlled trials of acupuncture for hot flashes. Electronic databases, including Medline, Embase, Cochrane Library and AMED, were searched through March 2017. Data were extracted using a predefined data extraction tool by two independent reviewers. The risk of bias was assessed using the Cochrane risk of bias tool for randomised controlled trials. A five-node network meta-analysis was conducted based on the frequentist framework. Results: Eight studies were included in this review. From the network meta-analysis, we found that verum acupuncture in the shallow needling controlled trials was more effective than verum acupuncture in the sham device controlled trials (SMD −7.27, 95% CI−9.11 to −5.43). Significant heterogeneity and inconsistency were not observed among the included studies or the comparisons. Conclusions: From this preliminary analysis, we found that different types of verum acupuncture may have different effect sizes with respect to the severity of menopausal hot flashes.

scholarly journals Soya products and serum lipids: a meta-analysis of randomised controlled trials

2015 ◽  
Vol 114 (6) ◽  
pp. 831-843 ◽  
Author(s):  
Oluwabunmi A. Tokede ◽  
Temilola A. Onabanjo ◽  
Alfa Yansane ◽  
J. Michael Gaziano ◽  
Luc Djoussé
Keyword(s):  
Lipid Profile ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Hdl Cholesterol ◽  
Cholesterol Concentration ◽  
Controlled Trials ◽  
Significant Heterogeneity ◽  
Beneficial Effects ◽  
Soya Proteins ◽  
Randomised Controlled

AbstractSoya proteins and isoflavones have been reported to exert beneficial effects on the serum lipid profile. More recently, this claim is being challenged. The objective of this study was to comprehensively examine the effects of soya consumption on the lipid profile using published trials. A detailed literature search was conducted via MEDLINE (from 2004 through February 2014), CENTRAL (The Cochrane Controlled Clinical Trials Register) andClinicalTrials.govfor randomised controlled trials assessing the effects of soya on the lipid profile. The primary effect measure was the difference in means of the final measurements between the intervention and control groups. In all, thirty-five studies (fifty comparisons) were included in our analyses. Treatment duration ranged from 4 weeks to 1 year. Intake of soya products resulted in a significant reduction in serum LDL-cholesterol concentration, –4·83 (95 % CI –7·34, –2·31) mg/dl, TAG, –4·92 (95 % CI –7·79, –2·04) mg/dl, and total cholesterol (TC) concentrations, –5·33 (95 % CI –8·35, –2·30) mg/dl. There was also a significant increase in serum HDL-cholesterol concentration, 1·40 (95 % CI 0·58, 2·23) mg/dl. TheI2statistic ranged from 92 to 99 %, indicating significant heterogeneity. LDL reductions were more marked in hypercholesterolaemic patients, –7·47 (95 % CI –11·79, –3·16) mg/dl, than in healthy subjects, –2·96 (95 % CI –5·28, –0·65) mg/dl. LDL reduction was stronger when whole soya products (soya milk, soyabeans and nuts) were used as the test regimen, –11·06 (95 % CI –15·74, –6·37) mg/dl, as opposed to when ‘processed’ soya extracts, –3·17 (95 % CI –5·75, –0·58) mg/dl, were used. These data are consistent with the beneficial effects of soya proteins on serum LDL, HDL, TAG and TC concentrations. The effect was stronger in hypercholesterolaemic subjects. Whole soya foods appeared to be more beneficial than soya supplementation, whereas isoflavone supplementation had no effects on the lipid profile.

scholarly journals Determinants of parathyroid hormone response to vitamin D supplementation: a systematic review and meta-analysis of randomised controlled trials

2015 ◽  
Vol 114 (9) ◽  
pp. 1360-1374 ◽  
Author(s):  
Nazanin Moslehi ◽  
Sakineh Shab-Bidar ◽  
Parvin Mirmiran ◽  
Farhad Hosseinpanah ◽  
Fereidoun Azizi
Keyword(s):  
Systematic Review ◽  
Vitamin D ◽  
Parathyroid Hormone ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Vitamin D Supplementation ◽  
Controlled Trials ◽  
Significant Heterogeneity ◽  
Randomised Controlled ◽  
Pth Level

AbstractThis systematic review aimed to assess the determinants of the parathyroid hormone (PTH) level response to vitamin D supplementation. We searched Medline, Google Scholar and the reference lists of previous reviews. All randomised controlled trials (RCT) on vitamin D supplementation that involved apparently healthy human subjects with a report of PTH were selected. Potential studies were screened independently and in duplicate. Results are summarised as mean differences with 95 % confidence intervals. Quality assessment, subgroup analysis, meta-analysis and meta-regression analysis were carried out. Thirty-three vitamin D supplementation RCT were included. Vitamin D supplementation significantly raised circulating 25-hydroxyvitamin D (25(OH)D) with significant heterogeneity among studies with a pooled mean difference (PMD) of 15.5 ng/ml (test for heterogeneity: P<0·001 and I2=97·3 %). Vitamin D supplementation significantly reduced PTH level with PMD of −8·0 pg/ml, with significant heterogeneity ((test for heterogeneity: P<0·001) and the I2 value was 97·3 %). In the subgroup analyses, the optimum treatment effect for PTH was observed with Ca doses of 600–1200 mg/d (−22·48 pg/ml), after the duration of a >12-month trial (−18·36 pg/ml), with low baseline 25(OH)D concentration of <20 ng/ml (−16·70 pg/ml) and in those who were overweight and obese (−18·11 pg/ml). Despite the present meta-analysis being hindered by some limitations, it provided some interesting evidence, suggesting that suppression of PTH level needs higher vitamin D intake (75 μg/d) than the current recommendations and longer durations (12 months), which should be taken into account for nutritional recommendations.

scholarly journals Effect of exercise training on liver function in adults who are overweight or exhibit fatty liver disease: a systematic review and meta-analysis

2016 ◽  
Vol 52 (13) ◽  
pp. 834-843 ◽  
Author(s):  
N A Smart ◽  
N King ◽  
J R McFarlane ◽  
P L Graham ◽  
G Dieberg
Keyword(s):  
Liver Disease ◽  
Exercise Training ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Randomised Controlled Trials ◽  
Exercise Intervention ◽  
Meta Analysis ◽  
Exercise Programme ◽  
Controlled Trials ◽  
Randomised Controlled

ObjectiveExercise training has been shown to have beneficial effects on liver function in adults overweight or with fatty liver disease. To establish which exercise programme characteristics were likely to elicit optimal improvements.DesignSystematic review and meta-analysis of randomised, controlled trials.Data sourcesPubMed, CINAHL and Cochrane controlled trials registry searched (1966 to 2 October 2015).Eligibility criteria for selecting studiesExercise intervention, with or without dietary intervention, versus usual care in adults undertaking, exercise training, who were overweight, obese or exhibited fatty liver disease (non-alcoholic fatty liver disease or non-alcoholic steatohepatitis).ResultsWe included 21 randomised controlled trials, totalling 1530 participants. Exercise intervention studies with total exercise programme workload >10 000 kcal produced significant improvements in intrahepatic fat, −3.46% (95% CI −5.20% to −1.73%), p<0.0001, I2=73%; effect size (standardised mean difference, SMD) −1.77 (−3.11 to −0.42), p=0.01, I2=77%. When data from only exercise studies were pooled, there was a reduction in fasting free fatty acids (FFAs) −74.15 µmol/L (95% CI −118.47 to −29.84), p=0.001, I2=67% with a large effect size (SMD) −0.94 (−1.36 to −0.52), p<0.0001, I2=0%. When data from only exercise studies were pooled, there was a significant reduction in insulin MD −1.88 UL (95% CI −3.43 to −0.34), p=0.02, I2=31%. The liver enzymes, alanine aminotransferase, aspartate aminotransferase and γ-glutamyl transpeptidase, were not significantly altered with exercise.ConclusionsExercise training reduces intrahepatic fat and FFAs while increasing cardiorespiratory fitness. An aggregate exercise programme energy expenditure (>10 000 kcal) may be required to promote reductions in intrahepatic fat.

scholarly journals Tocilizumab and mortality in hospitalised patients with covid-19. A systematic review comparing randomised trials with observational studies

2021 ◽  
Author(s):  
Bélène Podmore ◽  
Nawab Qizilbash ◽  
Alessandra Lacetera ◽  
Itziar Ubillos ◽  
Kirsty Andresen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hospital Mortality ◽  
Observational Studies ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Significant Heterogeneity ◽  
Moderate Risk ◽  
Randomised Controlled

Objective: To summarise and compare evidence from randomised controlled trials and observational studies of the effect of tocilizumab on in-hospital mortality in patients with covid-19. Design: Systematic review and meta-analysis. Data sources: Searches conducted in Embase and PubMed from July 2020 until 1 March 2021. Study Selection: Observational studies and randomised controlled trials (RCTs) assessing in-hospital mortality in patients receiving tocilizumab compared with standard care or placebo. Data extraction: The primary outcome was in-hospital mortality at 30 days. The risk of bias in observational studies was assessed using the ROBINS-I tool. A fixed effect meta-analysis was used to combine relative risks, with random effects and risk of bias as a sensitivity analysis. Results: Of 5,792 publications screened for inclusion, eight RCTs and 35 observational studies were identified. The RCTs showed an overall relative risk reduction in in-hospital mortality at 30 days of 0.86 (95% CI 0.78 to 0.96) with no statistically significant heterogeneity. 23 of the observational studies had a severe risk of bias, 10 of which did not adjust for potential confounders. The 10 observational studies with moderate risk of bias reported a larger reduction in mortality at 30-days (relative risk 0.72, 95% CI 0.64 to 0.81) but with significant heterogeneity (P<0.01). Conclusion: This meta-analysis provides strong evidence from RCTs that tocilizumab reduces the risk of mortality in hospitalised covid-19 patients. Observational studies with moderate risk of bias exaggerated the benefits on mortality two-fold and showed heterogeneity. Collectively observational studies provide a less reliable evidence base for evaluating treatments for covid-19.

scholarly journals Efficacy of ultrasound guidance for lumbar punctures: a systematic review and meta-analysis of randomised controlled trials

2020 ◽  
Vol 97 (1143) ◽  
pp. 40-47
Author(s):  
LiPei Shu ◽  
Jiao Huang ◽  
Jing Chen Liu
Keyword(s):  
Systematic Review ◽  
Random Effects ◽  
Randomised Controlled Trials ◽  
Ultrasound Guidance ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Significant Heterogeneity ◽  
Ultrasound Guided ◽  
Randomised Controlled

Ultrasound guidance has been reported to facilitate the performance of lumbar punctures (LPs). However, the use of ultrasound guidance has not yet received consistent conclusions. We performed a systematic review and meta-analysis to determine the efficacy of ultrasound-guided LPs. PubMed, Embase and the Cochrane Library were searched for randomised controlled trials comparing ultrasound guidance with traditional palpation for LPs in adults. The primary outcome was risk of failed procedures. A random-effects Mantel-Haenzsel model or random-effects inverse variance model was used to calculate relative risks (RRs) or standardised mean differences (SMDs) with 95% CIs. Twenty-eight trials (N=2813) met the inclusion criteria. Ultrasound-guided LPs were associated with a reduced risk of failed procedures (RR=0.58, 95% CI 0.39 to 0.85, p=0.005). No significant heterogeneity was detected (I2=27%) among these trials. It further decreased first attempt to failure (RR=0.43, 95% CI 0.30 to 0.62, p<0.00001), mean attempts to success (SMD=−0.61, 95% CI −0.80 to −0.43, p=0.00001) and incidences of complications of headache and backache (RR=0.63, 95% CI 0.46 to 0.85, p=0.003). Ultrasound guidance is an effective technique for LPs in adults.

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