Effect of Normal Saline Injections on Lateral Epicondylitis Symptoms: A Systematic Review and Meta-analysis of Randomized Clinical Trials

Background: Lateral epicondylitis, or tennis elbow, is a painful degenerative disorder that commonly occurs in adults between 40 and 60 years of age. Normal saline (NS) injections have been used as placebo through a large number of randomized controlled trials (RCTs) focused on the treatment of lateral epicondylitis. Purpose: This meta-analysis of RCTs aimed to assess the therapeutic effect of NS injections on lateral epicondylitis symptoms and compare results with established minimal clinically important difference criteria. Study Design: Systematic review and meta-analysis. Methods: MEDLINE, Embase, Web of Science, and Scopus databases were searched for clinical trials reporting pain and joint function with the visual analog scale, Patient-Rated Tennis Elbow Evaluation, and Disabilities of the Arm, Shoulder and Hand in patients with lateral epicondylitis. The meta-analysis was conducted with a random effects model and generic inverse variance method. Heterogeneity was tested with the I2 statistic index. Results: A total of 15 RCTs included in this meta-analysis revealed a significant improvement in pain (mean difference, 3.61 cm [95% CI, 2.29-4.92 cm]; P < .00001; I2 = 88%; visual analog scale) and function (mean difference, 25.65 [95% CI, 13.30-37.99]; P < .0001; I2 = 82%; Patient-Rated Tennis Elbow Evaluation / Disabilities of the Arm, Shoulder and Hand) after NS injection (≥6 months). Conclusion: NS injections yielded a statistically significant and clinically meaningful improvement in pain and functional outcomes in patients with lateral epicondylitis. New research should focus on better methods to diminish the potential confounders that could lead to this effect because NS injections could mask the real effect of an active therapeutic intervention in RCT. Registration: CRD42019127547 (PROSPERO).

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Surveillance in inflammatory bowel disease: is chromoendoscopy the only way to go? A systematic review and meta-analysis of randomized clinical trials

Endoscopy International Open ◽

10.1055/a-1120-8376 ◽

2020 ◽

Vol 08 (05) ◽

pp. E578-E590

Author(s):

Ricardo Hannum Resende ◽

Igor Braga Ribeiro ◽

Diogo Turiani Hourneaux de Moura ◽

Facundo Galetti ◽

Rodrigo Silva de Paula Rocha ◽

...

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Randomized Clinical Trials ◽

Narrow Band ◽

Narrow Band Imaging ◽

Meta Analysis ◽

Mean Difference ◽

Procedure Time ◽

High Definition ◽

Number Of Patients

Abstract Background and study aims Ulcerative colitis (UC) and Crohn’s disease (CD) have higher risk of colorectal cancer (CRC). Guidelines recommend dysplasia surveillance with dye-spraying chromoendoscopy (DCE). The aim of this systematic review and meta-analysis was to review all randomized clinical trials (RCTs) available and compare the efficacy of different endoscopic methods of surveillance for dysplasia in patients with UC and CD. Methods Databases searched were Medline, EMBASE, Cochrane and SCIELO/LILACS. It was estimated the risk difference (RD) for dichotomous outcomes (number of patients diagnosed with one or more dysplastic lesions, total number of dysplastic lesions diagnosed and number of dysplastic lesions detected by targeted biopsies) and mean difference for continuous outcomes (procedure time). Results This study included 17 RCTs totaling 2,457 patients. There was superiority of DCE when compared to standard-definiton white light endoscopy (SD-WLE). When compared with high-definition (HD) WLE, no difference was observed in all outcomes (number of patients with dysplasia (RD 0.06; 95 % CI [–0.01, 0.13])). Comparing other techniques, no difference was observed between DCE and virtual chromoendoscopy (VCE – including narrow-band imaging [NBI], i-SCAN and flexible spectral imaging color enhancement), in all outcomes except procedure time (mean difference, 6.33 min; 95 % CI, 1.29, 11.33). DCE required a significantly longer procedure time compared with WLE (mean difference, 7.81 min; 95 % CI, 2.76, 12.86). Conclusions We found that dye-spraying chromoendoscopy detected more patients and dysplastic lesions than SD-WLE. Although no difference was observed between DCE and HD-WLE or narrow-band imaging, the main outcomes favored numerically dye-spraying chromoendoscopy, except procedure time. Regarding i-SCAN, FICE and auto-fluorescence imaging, there is still not enough evidence to support or not their recommendation.

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Effectiveness of Ginger on Pain and Function in Knee Osteoarthritis: A PRISMA Systematic Review and Meta-Analysis

January 2018 - Pain Physician ◽

10.36076/ppj.2020/23/e151 ◽

2020 ◽

Vol 2;23 (4;2) ◽

pp. E151-E163

Author(s):

Felipe Araya-Quintanilla

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Pain Relief ◽

Knee Osteoarthritis ◽

Meta Analysis ◽

Knee Function ◽

Mean Difference ◽

Eligibility Criteria ◽

Standard Mean Difference ◽

And Function

Background: Ginger has been proposed as a complementary treatment for musculoskeletal pain. However, efficacy, type, and safety remains unclear. Objectives: To determine the effectiveness of consumption or topical application of ginger for pain relief and knee function improvement in patients with knee osteoarthritis. Study Design: Systematic review with meta-analysis of randomized clinical trials. Methods: An electronic search was performed on Medline, Central, CINAHL, PEDro, SPORTDiscus, and LILACS databases. The eligibility criteria for selecting studies included clinical trials that compared consumption and/or topical ginger with placebo or other interventions for the pain relief and knee function in patients with medical diagnosis of knee osteoarthritis. Results: Seven clinical trials met the eligibility criteria, and for the quantitative synthesis, 4 studies were included. For the comparison capsules versus placebo, mean difference for pain was −7.88 mm; 95% confidence interval (CI), 11.92 to 3.85 (P = 0.00), and standard mean difference for knee function was −1.61 points; 95% CI, −4.30 to −1.09 (P = 0.24). For the comparison of topical ginger versus standard treatment, standard mean difference for pain was 0.79 mm; 95% CI, −1.97 to 0.39 (P = 0.19), and standard mean difference for knee function was −0.51 points; 95% CI, −1.15 to 0.13 (P = 0.12). Limitations: The current evidence is heterogeneous and has a poor methodologic quality. Conclusions: There is insufficient evidence to support the use of oral ginger compared with placebo in the pain relief and function improvement in patients with knee osteoarthritis. For other comparisons, no statistically significant differences were found. Key words: Osteoarthritis, knee osteoarthritis, ginger, pain, randomized clinical trial, systematic review

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Clinical Outcomes of Treating Cervical Adjacent Segment Disease by Anterior Cervical Discectomy and Fusion Versus Total Disc Replacement: A Systematic Review and Meta-Analysis

Global Spine Journal ◽

10.1177/2192568218789115 ◽

2018 ◽

Vol 9 (5) ◽

pp. 559-567 ◽

Cited By ~ 3

Author(s):

Victor M. Lu ◽

Ralph J. Mobbs ◽

Kevin Phan

Keyword(s):

Systematic Review ◽

Clinical Outcomes ◽

Visual Analog Scale ◽

Systematic Reviews ◽

Meta Analysis ◽

Total Disc Replacement ◽

Anterior Cervical Discectomy ◽

Adjacent Segment ◽

Analog Scale ◽

Cervical Discectomy

Study Design: Systematic review and meta-analysis. Objective: To compare clinical outcomes of all available adjacent segment disease (ASD) cohorts being treated by either anterior cervical discectomy and fusion (ACDF) or total disc replacement (TDR). Methods: We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews. Searches of electronic databases from inception to August 2017 identified 349 articles for screening. Data was extracted and analyzed using meta-analysis of proportions. Results: The search identified 1 double-armed study and 8 single-armed studies from which data of 5 TDR and 5 ACDF cohorts treating ASD were extracted. Between the 2 pooled TDR (n = 103) and ACDF (n = 258) groups, baseline characteristics were predominantly similar. Compared with ACDF, TDR demonstrated superior operation duration (107 vs 188 minutes, P = .011) and range of motion of C2-C7 at final follow-up at least 1 year after surgery (40.2° vs 35.1°, P = .001). Other surgical and performance parameters including estimated blood loss, complications, and Japanese Orthopedic Association score, Neck Disability Index, Visual Analog Scale neck, and Visual Analog Scale upper limb measures were comparable between cohorts. Conclusion: TDR confers similar surgical and postoperative outcomes to the treatment of ASD as ACDF. Both procedures lead to improvement in all performance outcomes. Larger, prospective, randomized studies will validate the findings of this meta-analysis. Longer term studies are required to ascertain the recurrence rates of ASD following either surgical treatment of primary ASD.

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Endoscopic Gluteus Medius Repair With an ITB-Sparing Versus ITB-Splitting Approach: A Systematic Review and Meta-analysis

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120922196 ◽

2020 ◽

Vol 8 (5) ◽

pp. 232596712092219

Author(s):

Emily A. Parker ◽

Alex M. Meyer ◽

Jovan R. Laskovski ◽

Robert W. Westermann

Keyword(s):

Systematic Review ◽

Visual Analog Scale ◽

Comparative Studies ◽

Meta Analysis ◽

Gluteus Medius ◽

Harris Hip Score ◽

Failure Rates ◽

Analog Scale ◽

Surgical Failure ◽

Coleman Methodology Score

Background: During hip endoscopy, the iliotibial band (ITB) can be split or preserved to access the peritrochanteric workspace. To our knowledge, no comparative studies have been performed to analyze patient-reported outcomes (PROs) and surgical failure rates (gluteus medius retear and/or revision surgery rates) for ITB-sparing versus ITB-splitting approaches in endoscopic gluteus medius repairs. Purpose: To perform a systematic review and meta-analysis of the literature to evaluate PROs and failure rates of patients undergoing ITB-sparing versus ITB-splitting repairs of the gluteus medius. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed by following PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines and using the PubMed, Cochrane CENTRAL, and Embase databases. The quality of evidence was evaluated using the modified Coleman Methodology Score. Level 1-4 studies were evaluated for endoscopic abductor repair techniques on all types of gluteus medius tears. Given the small number of studies and varying population sizes, all quantitative data were adjusted for study population size. Results: A total of 13 studies met our inclusion criteria, while more granular data, including ITB approach, were available for 8 studies. Because of the paucity of literature on the subject, all included studies were of lower quality per the modified Coleman Methodology Score. The visual analog scale for pain, the modified Harris Hip Score (mHHS), and the surgical failure rates were compared between approaches. Patients who underwent ITB splitting had a significantly greater change in mHHS (45.5 ± 4.6 vs 27.3 ± 6.5; P < .001) and lower surgical failure rates (3.67 ± 2.33 vs 4.75 ± 2.54; P = .04). There was no significant difference in change in visual analog scale for splitting versus sparing (4.26 ± 0.41 vs 4.39 ± 0.14; P = .96). The results may have been biased by between-group differences, such as patients who undergo ITB sparing being significantly younger. Conclusion: Endoscopic gluteus medius repair is a reliable procedure to improve pain and function in appropriately selected patients. This study highlighted the lack of high-quality literature available regarding ITB approach. However, the evidence to date has suggested that ITB approach may influence hip-specific PROs. Splitting the ITB during abductor repair may be associated with a greater improvement in mHHS and lower surgical failure rates. Further prospective comparative studies are warranted to evaluate the effect of ITB approach.

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Effects of Flavonoid Supplementation on Common Eye Disorders: A Systematic Review and Meta-Analysis of Clinical Trials

Frontiers in Nutrition ◽

10.3389/fnut.2021.651441 ◽

2021 ◽

Vol 8 ◽

Author(s):

Sergio Davinelli ◽

Sawan Ali ◽

Giovanni Scapagnini ◽

Ciro Costagliola

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Meta Analysis ◽

Clinical Manifestations ◽

Mean Difference ◽

Cochrane Library ◽

Standard Mean Difference ◽

Eye Disorders ◽

Ocular Disorders ◽

Intervention Trials

Background: Emerging studies show that certain plant compounds may reduce the severity of most prevalent ocular abnormalities. The aim of this systematic review and meta-analysis was to assess the effect of dietary flavonoids on major eye disorders.Methods: Eligible studies were identified by searching PubMed, Web of Science, Scopus, and Cochrane Library databases for all articles published up to April 2021. The literature search yielded 1,134 articles, and a total of 16 studies were included in the systematic review. A meta-analysis of 11 intervention trials involving a total of 724 participants was performed.Results: Using a random-effects model, the pooled results revealed an overall significant effect of flavonoids on common ophthalmic disorders (standard mean difference = −0.39; 95% CI: −0.56, −0.21, p < 0.01). Of the subclasses of flavonoids, flavan-3-ols (standard mean difference = −0.62; 95% CI: −1.03, −0.22, p < 0.01), and anthocyanins (standard mean difference = −0.42; 95% CI: −0.63, −0.21, p < 0.01) were the only effective intervention for improving the outcomes of ocular conditions. For several of the other flavonoid subclasses, evidence on efficacy was insufficient.Conclusion: Our findings indicate that flavonoids may improve the clinical manifestations associated with ocular disorders. However, further well-constructed clinical trials are required to confirm these results and examine the effect of flavonoids on eye disorders other than those identified in this review.Systematic Review Registration: PROSPERO, identifier CRD42021247332.

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