Effectiveness of perioperative pain science education on pain, psychological factors and physical functioning: A systematic review

Objective: To synthesize the evidence on the effectiveness of pain science education on pain, psychological factors and physical functioning in adults who underwent surgery. Data sources: A systematic literature search of English articles using PubMed/Medline, Embase, Web of Science Core Collection, and Cochrane Library. Review methods: The search strategy was constructed as follows: (((pain) AND (education)) OR (pain education)) AND (surgery). Only controlled quantitative studies in adults reporting outcome(s) on pain, psychological factors and/or physical functioning were included. Risk of bias was assessed using the Cochrane risk of bias tools. P-values and corresponding effect sizes for interaction-effect (time × group) portrayed the difference in change over time between groups were of interest. The last search was conducted on February 28, 2021. Results: Nine papers ( n = 1078) were deemed eligible for this review. Two randomized controlled trials showed significant interaction effects. Breast cancer patients who had received one preoperative pain science education session showed a significant increase in postoperative pain compared to controls ( P-value = 0.0394). Furthermore, p sychological factors (pain catastrophizing and kinesiophobia) decreased in participants who had received pain science education before total knee arthroplasty, while this was not the case in the control group ( P-value < 0.001, ƞ2p:0.11). Conclusions: Overall, pain science education did not result in any significant postoperative effects on pain, psychological factors and/or physical functioning compared to controls. There is currently no strong evidence for the implementation of pain science education in the perioperative period. Registration number: PROSPERO: ID 161267, registration number CRD42020161267

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YOGA IN CHRONIC NECK PAIN: AN EFFECTIVE COMPLEMENTARY THERAPEUTIC OPTION - A META - ANALYSIS

Pakistan Journal of Rehabilitation ◽

10.36283/pjr.zu.7.2/003 ◽

2018 ◽

Vol 7 (2) ◽

pp. 3-12

Author(s):

Jaza Rizvi ◽

Batool Hassan ◽

Sadia Shafaq

Keyword(s):

Neck Pain ◽

Therapeutic Option ◽

Meta Analysis ◽

Chronic Neck Pain ◽

Well Being ◽

Risk Of Bias ◽

Adverse Outcomes ◽

Cochrane Library ◽

P Value ◽

Complementary Method

BACKGROUND Neck pain is recognized as the fourth leading cause of disability worldwide. The severity of neck pain may lead to adverse outcomes related to individual’s health and well-being that augment the risk of disability and may severely interfere in activities of daily living (ADL’s) and participation in the society. AIM The aim of the quantitative analysis is to determine the effectiveness of yoga in relieving chronic neck pain and disability. METHODS Databases such as Google scholar, MEDLINE, PEDro, the Cochrane Library and Pub Med were explored from October-November for randomized controlled trials which assessed neck pain and related disability among chronic neck pain individuals. RESULTS Total six studies consisted of 298 participants with chronic neck pain. In risk of bias assessment, all six studies reported low risk of allocation and reporting bias, while one or two study disclosed high or unknown risk of bias in several domains. Moderate to large effect of -0.857 SMD at 95% CI suggest evidence in favor of the effectiveness of yoga; (Q 30.32, df 5, I2 83.51%) on a significant P-value of <0.0001. CONCLUSION The analysis of studies provided robust evidence with pool effect of -0.857 SMD at 95% CI (p<0.0001) concluded that yoga is an effectual and complementary method for the management of chronic or non-specific neck pain. KEYWORDS Yoga, Neck Pain, Cervical, Therapeutic, Prevention, Meditation

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Randomized Controlled Trials of Headache Treatments in Pregnancy: A Systematic Review

American Journal of Perinatology ◽

10.1055/s-0040-1705180 ◽

2020 ◽

Author(s):

Elisa T. Bushman ◽

Gabriella Cozzi ◽

Rachel G. Sinkey ◽

Catherine H. Smith ◽

Michael W. Varner ◽

...

Keyword(s):

Systematic Review ◽

At Risk ◽

English Language ◽

Statistical Significance ◽

Cochrane Library ◽

Control Group ◽

Inclusion Criteria ◽

Headache Diagnosis ◽

Registration Number ◽

In Pregnancy

Abstract Objective Headaches affect 88% of reproductive-aged women. Yet data are limited addressing treatment of headache in pregnancy. While many women experience improvement in pregnancy, primary and secondary headaches can develop. Consequently, pregnancy is a time when headache diagnosis can influence maternal and fetal interventions. This study was aimed to summarize existing randomized control trials (RCTs) addressing headache treatment in pregnancy. Study Design We searched PubMed, CINAHL, EMBASE, ClinicalTrials.gov, Cochrane Library, CINAHL, and SCOPUS from January 1, 1970 through June 31, 2019. Studies were eligible if they were English-language RCTs addressing treatment of headache in pregnancy. Conference abstracts and studies investigating postpartum headache were excluded. Three authors reviewed English-language RCTs addressing treatment of antepartum headache. To be included, all authors agreed each article to meet the following criteria: predefined control group, participants underwent randomization, and treatment of headache occurred in the antepartum period. If inclusion criteria were met no exclusions were made. Our systematic review registration number was CRD42019135874. Results A total of 193 studies were reviewed. Of the three that met inclusion criteria all were small, with follow-up designed to measure pain reduction and showed statistical significance. Conclusion Our systematic review of RCTs evaluating treatment of headache in pregnancy revealed only three studies. This paucity of data limits treatment, puts women at risk for worsening headache disorders, and delays diagnosis placing both the mother and fetus at risk for complications.

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Changes in apical base sagittal relationship in Class II malocclusion treatment with and without premolar extractions: A systematic review and meta-analysis

The Angle Orthodontist ◽

10.2319/030716-198.1 ◽

2016 ◽

Vol 87 (2) ◽

pp. 338-355 ◽

Cited By ~ 1

Author(s):

Guilherme Janson ◽

Aron Aliaga-Del Castillo ◽

Ana Niederberger

Keyword(s):

Meta Analysis ◽

Cochrane Collaboration ◽

Class Ii ◽

Risk Of Bias ◽

Sensitivity Analyses ◽

Cochrane Library ◽

Control Group ◽

Qualitative Synthesis ◽

Class Ii Treatment ◽

Apical Base

ABSTRACT Objective: To evaluate the changes in apical base sagittal relationship in Class II treatment with and without premolar extractions. Materials and Methods: Controlled studies evaluating ANB angle changes after Class II Division 1 malocclusion treatment with or without premolar extractions were considered. Electronic databases (PubMed, Embase, Web of Science, Scopus, The Cochrane Library, Lilacs, and Google Scholar) without limitations regarding publication year or language were searched. Risk of bias was assessed with Risk Of Bias in Non-randomized Studies—of Interventions tool of the Cochrane Collaboration. Mean difference (MD) and 95% confidence interval (CI) were calculated from the random-effects meta-analysis. Subgroup and sensitivity analyses were also performed. Results: Twenty-five studies satisfied the inclusion criteria and were included in the qualitative synthesis. Eleven nonextraction and only one extraction Class II treatment studies presented untreated Class II control group. Therefore, meta-analysis was performed only for the nonextraction protocol. In treated Class II nonextraction patients, the average of the various effects was a reduction in the ANB angle of 1.56° (95% CI: 1.03, 2.09, P < .001) compared with untreated Class II subjects. Class II malocclusions treated with two maxillary-premolar extractions and four-premolar extractions produced estimated mean reductions in ANB of −1.88° and −2.55°, respectively. However, there is a lack of low-risk-of-bias studies. Conclusions: According to the existing low quality evidence, the apical base sagittal relationship in nonextraction, two-maxillary and four-premolar extractions Class II treatments decreases −1.56°, 1.88° and 2.55°, respectively. Further studies are necessary to obtain more robust information.

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Effect of yoga on sleep quality and insomnia in women with sleep problems: a systematic review and meta-analysis

10.21203/rs.2.12592/v3 ◽

2019 ◽

Author(s):

Weili Wang ◽

Kuang-Huei Chen ◽

Ying-Chieh Pan ◽

Szu-Nian Yang ◽

Yuan-Yu Chan

Keyword(s):

Systematic Review ◽

Sleep Quality ◽

Sleep Problems ◽

Meta Analysis ◽

Risk Of Bias ◽

Cochrane Library ◽

Control Group ◽

Serious Adverse Events ◽

Positive Effects ◽

Meta Analyses

Abstract Objectives To examine the effectiveness and safety of yoga for women with sleep problems by performing a systematic review and meta-analysis.Methods Medline/PubMed, Clincalkey, ScienceDirect, Embase, PsycINFO, and the Cochrane Library were searched throughout the month of June 2019. Randomized controlled trials comparing yoga groups with control groups in women with sleep problems were included. Two reviewers independently evaluated risk of bias by using the risk of bias tool suggested by the Cochrane Collaboration for programming and conducting systematic reviews and meta-analyses. The main outcome measure was sleep quality or the severity of insomnia, which was measured using subjective instruments, such as the Pittsburgh Sleep Quality Index (PSQI), Insomnia severity index (ISI), or objective instruments, such as polysomnography, actigraphy, and safety of the intervention. For each outcome, standardized mean difference (SMD) and 95% confidence intervals (CIs) were determined. Results Nineteen studies including 1832 participants were included in this systematic review. Meta-analyses revealed positive effects of yoga using PSQI or ISI scores in 16 randomized control trials (RCTs) compared with the control group in improving sleep quality in women, PSQI (SMD = −0.54; 95% CI = −0.89 to −0.19 ; P = 0.003). However, three RCTs revealed no effects of yoga compared with the control group in reducing the severity of insomnia in women using ISI (SMD = −0.13; 95% CI = −0.74 to 0.48; P = 0.69). Seven RCTs revealed no evidence for effects of yoga compared with the control group in improving sleep quality for women with breast cancer using PSQI (SMD = −0.15 ; 95% CI = −0.31 to 0.01; P = 0.5). Four RCTs revealed no evidence for the effects of yoga compared with the control group in improving the sleep quality for peri-or postmenopausal women using PSQI (SMD = −0.31; 95% CI = −0.95 to 0.33; P = 0.34).Yoga was not associated with serious adverse events. Discussion This systematic review and meta-analysis found that yoga intervention in some groups of women was beneficial in managing sleep problems. Despite certain disadvantages in methodology in the included studies, yoga may be recommended as a complementary therapy to women.

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TNF-α inhibitors can increase the risk of respiratory infection when used in rheumatism: a meta-analysis and systematic review

10.21203/rs.3.rs-17199/v1 ◽

2020 ◽

Author(s):

Wenwen Luo ◽

Luo Wenwen ◽

Zhu Jialian ◽

Cheng Xuan ◽

Li Yun ◽

...

Keyword(s):

Respiratory Infection ◽

Meta Analysis ◽

Cochrane Library ◽

Control Group ◽

P Value ◽

Upper Respiratory Infection ◽

Serious Infection ◽

Tnf Α ◽

Serious Infections ◽

Upper Respiratory

Abstract Background The risk of tumor necrosis factor-α(TNF-α) inhibitors (infliximab, etanercept, adalimumab) for the treatment of rheumatic diseases leading to infection events has not yet been established. This meta-analysis aims to assess the risk of developing serious infections of three TNF-α inhibitors for rheumatic diseases.Methods A systematic literature search of Pubmed, Embase and Cochrane Library was conducted through December 2018. Selecting the RCTs which subjects were diagnosed as rheumatoid diseases according to ACR criteria or other authoritative diagnostic criteria and over 18-year-old. Finally, RCTs with Jadad score greater than or equal to 4 were included in this meta-analysis. The Odds Ratio (OR), Confidence Interval (CI) and p value were calculated to assess the risk of serious infections. Results 34 RCTs involving 14166 subjects were included, including 11 RCTs for infliximab, 7 RCTs for etanercept, and 16 for adalimumab. Meta-analysis demonstrated that, with the pooled OR of 1.29 (95%CI 1.04 to 1.60), the TNF-α inhibitors group had a higher risk of serious infection than control group. In the subgroup analysis, infliximab and adalimumab had a higher risk of serious infection than control group, and the pooled ORs were 1.48 (p=0.03) and 1.47 (p=0.03), respectively. For other infections including pneumonia, upper respiratory infection, and nasopharyngitis, the risks of these adverse events were higher in experimental group than control group, while the risk of tuberculosis were not, with the pooled OR of 2.31 (p=0.08）.Conclusions TNF-α inhibitors, especially infliximab and adalimumab, can increase the risk of infections. Among the infections, pneumonia, upper respiratory infection and nasopharyngitis have higher risks in TNF-α inhibitors group than control group. As a result, we summarized that TNF-α inhibitors can increase the risks of respiratory infection when used in rheumatic disease. It is suggested that clinicians should pay attention to the prevention of respiratory infections when using TNF-α inhibitors, so as to achieve a better prognosis for patients with rheumatism.

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The effect of yoga on sleep quality and insomnia in women with sleep problems: a systematic review and meta-analysis

10.21203/rs.2.12592/v5 ◽

2020 ◽

Author(s):

Weili Wang ◽

Kuang-Huei Chen ◽

Ying-Chieh Pan ◽

Szu-Nian Yang ◽

Yuan-Yu Chan

Keyword(s):

Systematic Review ◽

Sleep Quality ◽

Sleep Problems ◽

Meta Analysis ◽

Risk Of Bias ◽

Cochrane Library ◽

Control Group ◽

Serious Adverse Events ◽

Positive Effects ◽

Meta Analyses

Abstract Background: To examine the effectiveness and safety of yoga of women with sleep problems by performing a systematic review and meta-analysis. Methods: Medline/PubMed, ClinicalKey, ScienceDirect, Embase, PsycINFO, and the Cochrane Library were searched throughout the month of June, 2019. Randomized controlled trials comparing yoga groups with control groups in women with sleep problems were included. Two reviewers independently evaluated risk of bias by using the risk of bias tool suggested by the Cochrane Collaboration for programming and conducting systematic reviews and meta-analyses. The main outcome measure was sleep quality or the severity of insomnia, which was measured using subjective instruments, such as the Pittsburgh Sleep QualityIndex (PSQI),Insomnia Severity Index (ISI), or objective instruments such as polysomnography, actigraphy, and safety of the intervention. For each outcome, a standardized mean difference (SMD) and confidence intervals (CIs) of 95% were determined. Results: Nineteen studies in this systematic review included 1832 participants. The meta-analysis of the combined data conducted according to Comprehensive Meta-Analysis showed a significant improvement in sleep (SMD =−0.327, 95% CI=−0.506 to −0.148,P<0.001).Meta-analyses revealed positive effects of yoga using PSQI scores in 16 randomized control trials (RCTs), compared with the control group in improving sleep quality among women usingPSQI (SMD = −0.54; 95% CI = −0.89 to −0.19; P = 0.003). However, three RCTs revealed no effects of yoga compared to the control groupin reducing insomnia among women using ISI (SMD = −0.13; 95% CI = −0.74 to 0.48; P = 0.69).Yoga was not associated with any serious adverse events. Discussion: This systematic review and meta-analysis demonstrated that yoga intervention in women can be beneficial whencompared to non-active control conditions in term of managing sleep problems.The moderator analyses suggest that participants in the non-breast cancer subgroup and participants in the non-peri/postmenopausal subgroup were associated with greater benefits, with a direct correlation of total class time with quality of sleep among other related benefits.

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Effectiveness of eHealth Interventions in Improving Treatment Adherence for Patients With COPD or Asthma: Systematic Review (Preprint)

10.2196/preprints.29475 ◽

2021 ◽

Author(s):

Mieke Hendrika Johanna Schulte ◽

Jiska Joëlle Aardoom ◽

Lisa Loheide-Niesmann ◽

Leonie L.L. Verstraete ◽

Hans C. Ossebaard ◽

...

Keyword(s):

Medication Adherence ◽

Treatment Adherence ◽

Exercise Adherence ◽

Mixed Effects ◽

Risk Of Bias ◽

Health Concern ◽

Cochrane Library ◽

Secondary Outcome ◽

Control Group ◽

Adherence To Medication

BACKGROUND Poor treatment adherence in patients with chronic obstructive pulmonary disease (COPD) or asthma is a global public health concern with severe consequences in terms of patient health and societal costs. eHealth is a promising tool for addressing poor compliance. OBJECTIVE This review investigates the effects of eHealth interventions on adherence to medication treatment in patients with COPD or asthma and adherence to exercise regimens by patients with COPD. METHODS A systematic literature search was conducted in the databases of Cochrane Library, PsycINFO, PubMed, and Embase. We selected randomized controlled trials, conducted on adult patients with COPD or asthma, which evaluated the effectiveness of an eHealth intervention in terms of medication adherence or exercise behavior (for COPD), or medication adherence only (for asthma). Risk of bias in the included studies was examined using the Cochrane Collaboration’s risk-of-bias tool. RESULTS Thirteen studies focusing on COPD, and seven focusing on asthma, were analyzed. Of the COPD studies, five targeted medication adherence, seven targeted exercise adherence, and one examined both. Adherence was a primary outcome in four studies and a secondary outcome in nine. As to medication adherence, two studies reported non-significant effects of the eHealth interventions, one study found a significant improvement, and three reported mixed effects. Regarding exercise adherence, four studies reported no significant effects of the eHealth interventions, three found significant improvements, and one found mixed results. Of the seven studies focusing on medication adherence in asthma, three found significant effects, two reported non-significant effects, and two reported mixed effects. Across all studies, 12 were standalone interventions, whereas eight were added to care as usual. Most studies used care as usual as a control group, whereas a small number of studies used a face-to-face intervention provided by a healthcare professional or waitlist control condition. CONCLUSIONS The mixed results on the effectiveness of eHealth interventions in improving treatment adherence for asthma and COPD are presumably related to the type, context, and intensity of the interventions, as well as to differences in the operationalization and measurement of adherence outcomes. Much remains to be learned about the potentials of eHealth to optimize treatment adherence in COPD and asthma.

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Role of Interferon Therapy in Severe COVID-19: The COVIFERON Randomized Controlled Trial

10.21203/rs.3.rs-136499/v1 ◽

2021 ◽

Author(s):

Ilad Alavi Darazam ◽

Mohamad Amin Pourhoseingholi ◽

Shervin Shokouhi ◽

Seyed Sina Naghibi Irvani ◽

Majid Mokhtari ◽

...

Keyword(s):

Viral Infections ◽

Controlled Trial ◽

Ordinal Scale ◽

Control Group ◽

P Value ◽

Open Label ◽

Subcutaneous Injections ◽

Positive Effects ◽

Significant Difference ◽

Registration Number

Abstract Type 1 Interferons (IFNs) have been associated with positive effects on Coronaviruses. Previous studies point towards the superior potency of IFNβ compared to IFNα against viral infections. We conducted a three-armed, individually-randomized, open-label, controlled trial of IFNβ1a and IFNβ1b, comparing them against each other and a control group. Patients were randomly assigned in a 1:1:1 ratio to IFNβ1a (subcutaneous injections of 12,000 IU on days 1, 3, 6), IFNβ1b (subcutaneous injections of 8,000,000 IU on days 1, 3, 6), or the control group. All three arms orally received Lopinavir/Ritonavir (400mg/100 mg twice a day for ten days) and a single dose of Hydroxychloroquine 400 mg on the first day. Our utilized primary outcome measure was Time To Clinical Improvement (TTCI) defined as the time from enrollment to discharge or a decline of two steps on the clinical seven-step ordinal scale, whichsoever came first. A total of 60 severely ill patients with positive RT-PCR and Chest CT scans underwent randomization (20 patients to each arm). In the Intention-To-Treat population, IFNβ1a was associated with a significant difference against the control group, in the TTCI; (HR; 2.36, 95% CI=1.10-5.17, P-value=0.031) while the IFNβ1b indicated no significant difference compared with the control; HR; 1.42, (95% CI=0•63-3•16, P-value=0•395). The median TTCI for both of the intervention groups was five days vs. seven days for the control group. The mortality was numerically lower in both of the intervention groups (20% in the IFNβ1a group and 30% in the IFNβ1b group vs. 45% in the control group). There were no significant differences between the three arms regarding the adverse events. In patients with laboratory-confirmed SARS-CoV-2 infection, as compared with the base therapeutic regiment, the benefit of a significant reduction in TTCI was observed in the IFNβ1a arm. This finding needs further confirmation in larger studies. Trial Registration Number: ClinicalTrials.gov, NCT04343768. (Submitted: 08/04/2020; First Online: 13/04/2020) (Registration Number: NCT04343768)

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Effect of yoga on sleep quality and insomnia in women with sleep problems: a systematic review and meta-analysis

10.21203/rs.2.12592/v2 ◽

2019 ◽

Author(s):

Weili Wang ◽

Kuang-Huei Chen ◽

Ying-Chieh Pan ◽

Szu-Nian Yang ◽

Yuan-Yu Chan

Keyword(s):

Systematic Review ◽

Sleep Quality ◽

Sleep Problems ◽

Meta Analysis ◽

Complementary Therapy ◽

Risk Of Bias ◽

Cochrane Library ◽

Control Group ◽

Positive Effects ◽

Meta Analyses

Abstract Objectives To examine the effectiveness and safety of yoga for women with sleep problems by performing a systematic review and meta-analysis.Methods Medline/PubMed, Clincalkey, ScienceDirect, Embase, PsycINFO, and the Cochrane Library were searched throughout the month of June 2019. Randomized controlled trials comparing yoga groups with control groups in women with sleep problems were included. Two reviewers independently evaluated risk of bias by using the risk of bias tool suggested by the Cochrane Collaboration for programming and conducting systematic reviews and meta-analyses. The main outcome measure was sleep qualityor the severity of insomnia, which was measured using subjective instruments, such as the Pittsburgh Sleep Quality Index (PSQI), Insomnia severity index (ISI), or objective instruments, such as polysomnography, actigraphy, and safety of the intervention. For each outcome, standardized mean difference (SMD) and 95% confidence intervals (CIs) were determined.Results Nineteen studies including 1832 participants were included in this systematic review. Meta-analyses revealed positive effects of yoga using PSQI or ISI scores in 16 randomized control trials (RCTs) compared with the control group in improving sleep quality in women, PSQI (SMD = −0.54; 95% CI = −0.89 to −0.19 ; P = 0.003). However, three RCTs revealed no effects of yoga compared with the control group in reducing the severity of insomnia in women using ISI (SMD = −0.13; 95% CI = −0.74 to 0.48; P = 0.69). Seven RCTs revealed no evidence for effects of yoga compared with the control group in improving sleep quality for women with breast cancer using PSQI (SMD = −0.15 ; 95% CI = −0.31 to 0.01; P = 0.5). Four RCTs revealed no evidence for the effects of yoga compared with the control group in improving the sleep quality for peri-or postmenopausal women using PSQI (SMD = −0.31; 95% CI = −0.95 to 0.33; P = 0.34).Yoga was not associated with serious adverse events.Discussion This systematic review and meta-analysis found that yoga intervention in some groups of women was beneficial in managing sleep problems. Despite certain disadvantages in methodology in the included studies, yoga may be recommended as a complementary therapy to women.

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Perioperative intravenous lignocaine infusion for postoperative pain control in patients undergoing surgery of the spine: protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-036908 ◽

2020 ◽

Vol 10 (10) ◽

pp. e036908

Author(s):

Ana Licina ◽

Andrew Silvers

Keyword(s):

Systematic Review ◽

Postoperative Pain ◽

Evaluation System ◽

Elective Surgery ◽

Risk Of Bias ◽

Hospital Length Of Stay ◽

Primary Data ◽

Cochrane Library ◽

Control Group ◽

Late Time

IntroductionIntravenous lignocaine is an amide local anaesthetic known for its analgesic, antihyperalgesic and anti-inflammatory properties. Administration of intravenous lignocaine has been shown to enhance perioperative recovery parameters. This is the protocol for a systematic review which intends to summarise the evidence base for perioperative intravenous lignocaine administration in patients undergoing spinal surgery.Methods and analysisOur primary outcomes include: postoperative pain scores at rest and movement at predefined early, intermediate and late time points and adverse events. Other outcomes of interest include perioperative opioid consumption, composite morbidity, surgical complications and hospital length of stay. We will include randomised controlled trials, which compared intravenous lignocaine infusion vs standard treatment for perioperative analgesia. We will search electronic databases from inception to present; MEDLINE, EMBASE and Cochrane Library (Cochrane Database of Systematic Reviews and CENTRAL). Two team members will independently screen all citations, full-text articles and abstract data. The individual study risk of bias will be appraised using the Cochrane risk of bias tool. We will obtain a risk ratio or mean difference (MD) from the intervention and control group event rates based on the nature of data. We will correct for the variable measurement tools by using the standardised MD (SMD). We will use a random-effects model to synthesise data. We will conduct five subgroup analysis: major versus minor surgery, emergency versus elective surgery, patients with chronic pain conditions versus patients without, duration of lignocaine infusion and adult versus paediatric. Confidence in cumulative evidence for will be classified according to the Grading of Recommendations, Assessment, Development and Evaluation system. We will construct summary of findings tables supported detailed evidence profile tables for predefined outcomes.Ethics and disseminationFormal ethical approval is not required as primary data will not be collected. The results will be disseminated through a peer-reviewed publication.PROSPERO registration numberCRD420201963314

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