Effectiveness of Hydrodilatation in Adhesive Capsulitis of Shoulder: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 107 (4) ◽  
pp. 285-293 ◽  
Author(s):  
M. Saltychev ◽  
K. Laimi ◽  
P. Virolainen ◽  
M. Fredericson
Keyword(s):  
Confidence Interval ◽  
Effect Size ◽  
Meta Analysis ◽  
Adhesive Capsulitis ◽  
Treatment Method ◽  
Pain Severity ◽  
Current Evidence ◽  
Number Needed To Treat ◽  
Small Effect Size ◽  
Shoulder Motion

Background and Aims: Even though hydrodilatation has been used for 50 years, the evidence on its effectiveness is not clear. Only one earlier review has strictly focused on this treatment method. The aims of this study are to evaluate the evidence on the effectiveness of hydrodilatation in treatment of adhesive capsulitis and, if appropriate, to assess the correlation between the effects of this procedure and the amount of fluid injected. Materials and Methods: A literature search on MEDLINE, Embase, Scopus, Cochrane Central, Web of Science, and CINAHL databases was done; random-effects meta-analysis and meta-regression were employed; and cost-effectiveness and safeness analyses were left outside the scope of the review. Results: Of the 270 records identified through search, 12 studies were included in qualitative and quantitative analysis and seven were included in a meta-analysis. The lower 95% confidence interval for the effect of hydrodilatation on pain severity was 0.12 indicating small effect size and mean number needed to treat 12. The pooled effect of hydrodilatation on disability level was insignificant 0.2 (95% confidence interval: −0.04 to 0.44). The lower 95% confidence interval for the effect of hydrodilatation on the range of shoulder motion was close to zero (0.07) indicating small effect size with mean number needed to treat 12. The amount of injected solution did not have a substantial effect on pain severity or range of shoulder motion. The heterogeneity level I2 was acceptable from 0% to 60%. Conclusion: According to current evidence, hydrodilatation has only a small, clinically insignificant effect when treating adhesive capsulitis.

Effectiveness of a freely available computerised cognitive behavioural therapy programme (MoodGYM) for depression: Meta-analysis

2016 ◽  
Vol 51 (3) ◽  
pp. 260-269 ◽  
Author(s):  
Conal Twomey ◽  
Gary O’Reilly
Keyword(s):  
Psychological Distress ◽  
Confidence Interval ◽  
Effect Size ◽  
Meta Analysis ◽  
Behavioural Therapy ◽  
Medium Effect ◽  
Post Intervention ◽  
Small Effect Size ◽  
General Psychological Distress ◽  
Randomised Controlled

Objective: To investigate the effectiveness of a freely available computerised cognitive behavioural therapy programme (MoodGYM) for depression (primary outcome), anxiety and general psychological distress in adults. Method: We searched PsycINFO, CINAHL Plus, MEDLINE, EMBASE, Social Science Citation Index and references from identified papers. To assess MoodGYM’s effectiveness, we conducted random effects meta-analysis of identified randomised controlled trials. Results: Comparisons from 11 studies demonstrated MoodGYM’s effectiveness for depression symptoms at post-intervention, with a small effect size ( g = 0.36, 95% confidence interval: 0.17–0.56; I2 = 78%). Removing the lowest quality studies ( k = 3) had minimal impact; however, adjusting for publication bias reduced the effect size to a non-significant level ( g = 0.17, 95% confidence interval: −0.01 to 0.38). Comparisons from six studies demonstrated MoodGYM’s effectiveness for anxiety symptoms at post-intervention, with a medium effect size ( g = 0.57, 95% confidence interval: 0.20–0.94; I2 = 85%). Although comparisons from six studies did not yield significance for MoodGYM’s effectiveness for general psychological distress symptoms, the small effect size approached significance ( g = 0.34, 95% confidence interval: −0.04 to 0.68; I2 = 79%). Both the type of setting (clinical vs non-clinical) and MoodGYM-developer authorship in randomised controlled trials had no meaningful influence on results; however, the results were confounded by the type of control deployed, level of clinician guidance, international region of trial and adherence to MoodGYM. Conclusions: The confounding influence of several variables, and presence of publication bias, means that the results of this meta-analysis should be interpreted with caution. Tentative support is provided for MoodGYM’s effectiveness for symptoms of depression and general psychological distress. The programme’s medium effect on anxiety symptoms demonstrates its utility for people with this difficulty. MoodGYM benefits from its free accessibility over the Internet, but adherence rates can be problematic and at the extreme can fall below 10%. We conclude that MoodGYM is best placed as a population-level intervention that is likely to benefit a sizeable minority of its users.

scholarly journals A meta-analysis of effects of Internet CBT for anxiety disorders: open community versus clinical service recruitment (Preprint)

2018 ◽  
Author(s):  
Geke Romijn ◽  
Neeltje Batelaan ◽  
Robin Kok ◽  
Jeroen Koning ◽  
Anton van Balkom ◽  
...  
Keyword(s):  
Anxiety Disorders ◽  
Effect Size ◽  
Meta Analysis ◽  
Behavioural Therapy ◽  
Routine Care ◽  
Clinical Service ◽  
Effect Sizes ◽  
Current Evidence ◽  
Significant Difference ◽  
Small Effect Size

BACKGROUND Ample studies show the high potential of Internet-delivered cognitive behavioural therapy (iCBT) for anxiety disorders. However, evidence for its effectiveness in routine care is scarce. We conducted a meta-analysis to compare results obtained in trials with open recruitment to results obtained in trials with clinical service recruitment and updated previous findings. OBJECTIVE The present study thus aims 1) to update the current evidence on iCBT for anxiety disorders by assessing overall efficacy and 2) to assess whether open recruitment results are comparable to those with recruitment in a routine care context. METHODS Randomised controlled trials were included in which the effects of iCBT for anxiety disorders were compared to wait-list controls (WLC) or face-to-face (f2f) CBT controls. Pooled effect sizes based on anxiety measures (primary outcome), depression and quality of life measures (secondary outcomes) were computed. RESULTS We included 42 studies with 53 comparisons (43 open recruitment comparisons and 10 clinical recruitment comparisons). Overall effect size of (1) iCBT versus WLC was g=0.72 (p<.001) and (2) iCBT versus f2f CBT g=0.12 (p=0.11). Subgroup analyses revealed (3) iCBT clinical recruitment studies with WLC as comparator: g=0.29 (p<0.01), while iCBT open recruitment studies with WLC comparators showed a higher significant effect of g=0.76 (p<0.001). (4) Clinical recruitment studies comparing iCBT to f2f CBT revealed a non-significant and small effect size g=0.06 (p=0.51) while open recruitment studies comparing iCBT to f2f CBT showed an effect of g=0.19 (p=0.09). Comparing clinical recruitment trials with open recruitment trials showed a significant difference in effect size (p<.001) based on WLC comparators, and no significant difference (p=0.38) based on f2f CBT comparators. CONCLUSIONS iCBT is effective in samples recruited in routine clinical practice, but effect sizes are smaller than those found in open recruitment trials. More studies with routine care populations are needed to further validate these findings.

scholarly journals Protective Effects of Statins Administration in European and North American Patients Infected with COVID-19: A Meta-analysis

2021 ◽  
Author(s):  
Mairi Pucci ◽  
Diletta Onorato ◽  
Giovanni Carpene ◽  
Brandon Michael Henry ◽  
Fabian Sanchis-Gomar ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Statin Therapy ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Protective Role ◽  
Favorable Effect ◽  
Current Evidence ◽  
Severe Illness ◽  
Protective Effects ◽  
Time Data

AbstractSevere acute respiratory syndrome coronavirus 2 has spread rapidly throughout the world, becoming an overwhelming global health emergency. The array of injuries caused by this virus is broad and not limited to the respiratory system, but encompassing also extensive endothelial and systemic tissue damage. Since statins effectively improve endothelial function, these drugs may have beneficial effects in patients with coronavirus disease 2019 (COVID-19). Therefore, this investigation aimed to provide an updated overview on the interplay between statins and COVID-19, with particular focus on their potentially protective role against progression toward severe or critical illness and death. A systematic electronic search was performed in Scopus and PubMed up to present time. Data on statins use and COVID-19 outcomes especially in studies performed in Europe and North America were extracted and pooled. A total of seven studies met our inclusion criteria, totaling 2,398 patients (1,075 taking statins, i.e., 44.8%). Overall, statin usage in Western patients hospitalized with COVID-19 was associated with nearly 40% lower odds of progressing toward severe illness or death (odds ratio: 0.59; 95% confidence interval: 0.35–0.99). After excluding studies in which statin therapy was started during hospital admission, the beneficial effect of these drugs was magnified (odds ratio: 0.51; 95% confidence interval: 0.41–0.64). In conclusion, although randomized trials would be necessary to confirm these preliminary findings, current evidence would support a favorable effect of statins as adjuvant therapy in patients with COVID-19. Irrespective of these considerations, suspension of statin therapy seems highly unadvisable in COVID-19 patients.

Exploring the Morning Morality Effect in the context of moral utilitarianism: a post-hoc analysis

2021 ◽  
Author(s):  
Bastien Trémolière ◽  
Corentin J Gosling
Keyword(s):  
Effect Size ◽  
Autonomous Vehicles ◽  
Meta Analysis ◽  
Individual Study ◽  
Post Hoc Analysis ◽  
Cognitive Reflection ◽  
Confounding Variables ◽  
Small Effect Size ◽  
Large Heterogeneity ◽  
Post Hoc

Recent research has shown mixed evidence for the morning morality effect (i.e., the observation that individuals are less immoral in the morning than in the afternoon). In the present research, we target the morning morality effect in the context of moral utilitarianism, by reanalyzing observational data previously collected by our lab. These data include different tasks capturing moral utilitarianism (i.e., standard sacrificial dilemmas, an ecological utilitarian scale, and/or dilemmas involving the morality of autonomous vehicles). We report a meta-analysis of 6 studies which showed that participants became less utilitarian as the day goes on, but with a small effect size (r = -0.14) and a large heterogeneity. Exploration of this heterogeneity showed that such a conclusion was statistically significant for classic sacrificial dilemmas only. Notably, even when restricting the analysis to the classic sacrificial dilemmas, a moderate inconsistency remained. Post-hoc analysis of an individual study showed that this small effect did not survive the inclusion of potentially confounding variables, such as psychopathy trait and cognitive reflection. Implications and limitations are discussed.

scholarly journals Changes of Ankle Dorsiflexion Using Compression Tissue Flossing: A Systematic Review and Meta-Analysis

2020 ◽  
pp. 1-9
Author(s):  
Devin S. Kielur ◽  
Cameron J. Powden
Keyword(s):  
Confidence Interval ◽  
Range Of Motion ◽  
Effect Size ◽  
Evidence Synthesis ◽  
Meta Analysis ◽  
Effect Sizes ◽  
Lower Extremity Injury ◽  
Level Of Evidence ◽  
Physically Active ◽  
Evidence Database

Context: Impaired dorsiflexion range of motion (DFROM) has been established as a predictor of lower-extremity injury. Compression tissue flossing (CTF) may address tissue restrictions associated with impaired DFROM; however, a consensus is yet to support these effects. Objectives: To summarize the available literature regarding CTF on DFROM in physically active individuals. Evidence Acquisition: PubMed and EBSCOhost (CINAHL, MEDLINE, and SPORTDiscus) were searched from 1965 to July 2019 for related articles using combination terms related to CTF and DRFOM. Articles were included if they measured the immediate effects of CTF on DFROM. Methodological quality was assessed using the Physiotherapy Evidence Database scale. The level of evidence was assessed using the Strength of Recommendation Taxonomy. The magnitude of CTF effects from pre-CTF to post-CTF and compared with a control of range of motion activities only were examined using Hedges g effect sizes and 95% confidence intervals. Randomeffects meta-analysis was performed to synthesize DFROM changes. Evidence Synthesis: A total of 6 studies were included in the analysis. The average Physiotherapy Evidence Database score was 60% (range = 30%–80%) with 4 out of 6 studies considered high quality and 2 as low quality. Meta-analysis indicated no DFROM improvements for CTF compared with range of motion activities only (effect size = 0.124; 95% confidence interval, −0.137 to 0.384; P = .352) and moderate improvements from pre-CTF to post-CTF (effect size = 0.455; 95% confidence interval, 0.022 to 0.889; P = .040). Conclusions: There is grade B evidence to suggest CTF may have no effect on DFROM when compared with a control of range of motion activities only and results in moderate improvements from pre-CTF to post-CTF. This suggests that DFROM improvements were most likely due to exercises completed rather than the band application.

Two decades of digital interventions for anxiety disorders: a systematic review and meta-analysis of treatment effectiveness

2021 ◽  
pp. 1-13
Author(s):  
Darin Pauley ◽  
Pim Cuijpers ◽  
Davide Papola ◽  
Clara Miguel ◽  
Eirini Karyotaki
Keyword(s):  
Systematic Review ◽  
Anxiety Disorder ◽  
Confidence Interval ◽  
Anxiety Disorders ◽  
Effect Size ◽  
Meta Analysis ◽  
Bibliographic Databases ◽  
Wait List ◽  
Digital Interventions ◽  
Significant Difference

Abstract Background Digital interventions for anxiety disorders are a promising solution to address barriers to evidence-based treatment access. Precise and powerful estimates of digital intervention effectiveness for anxiety disorders are necessary for further adoption in practice. The present systematic review and meta-analysis examined the effectiveness of digital interventions across all anxiety disorders and specific to each disorder v. wait-list and care-as-usual controls. Methods A systematic search of bibliographic databases identified 15 030 abstracts from inception to 1 January 2020. Forty-seven randomized controlled trials (53 comparisons; 4958 participants) contributed to the meta-analysis. Subgroup analyses were conducted by an anxiety disorder, risk of bias, treatment support, recruitment, location and treatment adherence. Results A large, pooled effect size of g = 0.80 [95% Confidence Interval: 0.68–0.93] was found in favor of digital interventions. Moderate to large pooled effect sizes favoring digital interventions were found for generalized anxiety disorder (g = 0.62), mixed anxiety samples (g = 0.68), panic disorder with or without agoraphobia (g = 1.08) and social anxiety disorder (g = 0.76) subgroups. No subgroups were significantly different or related to the pooled effect size. Notably, the effects of guided interventions (g = 0.84) and unguided interventions (g = 0.64) were not significantly different. Supplemental analysis comparing digital and face-to-face interventions (9 comparisons; 683 participants) found no significant difference in effect [g = 0.14 favoring digital interventions; Confidence Interval: −0.01 to 0.30]. Conclusion The precise and powerful estimates found further justify the application of digital interventions for anxiety disorders in place of wait-list or usual care.

scholarly journals Effectiveness of Rehabilitation Interventions to Improve Gait Speed in Children With Cerebral Palsy: Systematic Review and Meta-analysis

2016 ◽  
Vol 96 (12) ◽  
pp. 1938-1954 ◽  
Author(s):  
Noelle G. Moreau ◽  
Amy Winter Bodkin ◽  
Kristie Bjornson ◽  
Amy Hobbs ◽  
Mallary Soileau ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Resistance Training ◽  
Confidence Interval ◽  
Effect Size ◽  
Gait Speed ◽  
Outcome Measure ◽  
Meta Analysis ◽  
Gait Training ◽  
Biofeedback Training ◽  
Children With Cerebral Palsy

AbstractBackgroundChildren with cerebral palsy (CP) have decreased gait speeds, which can negatively affect their community participation and quality of life. However, evidence for effective rehabilitation interventions to improve gait speed remains unclear.PurposeThe purpose of this study was to determine the effectiveness of interventions for improving gait speed in ambulatory children with CP.Data SourcesMEDLINE/PubMed, CINAHL, ERIC, and PEDro were searched from inception through April 2014.Study SelectionThe selected studies were randomized controlled trials or had experimental designs with a comparison group, included a physical therapy or rehabilitation intervention for children with CP, and reported gait speed as an outcome measure.Data ExtractionMethodological quality was assessed by PEDro scores. Means, standard deviations, and change scores for gait speed were extracted. General study information and dosing parameters (frequency, duration, intensity, and volume) of the intervention were recorded.Data SynthesisTwenty-four studies were included. Three categories of interventions were identified: gait training (n=8), resistance training (n=9), and miscellaneous (n=7). Meta-analysis showed that gait training was effective in increasing gait speed, with a standardized effect size of 0.92 (95% confidence interval=0.19, 1.66; P=.01), whereas resistance training was shown to have a negligible effect (effect size=0.06; 95% confidence interval=−0.12, 0.25; P=.51). Effect sizes from negative to large were reported for studies in the miscellaneous category.LimitationsGait speed was the only outcome measure analyzed.ConclusionsGait training was the most effective intervention in improving gait speed for ambulatory children with CP. Strength training, even if properly dosed, was not shown to be effective in improving gait speed. Velocity training, electromyographic biofeedback training, and whole-body vibration were effective in improving gait speed in individual studies and warrant further investigation.

Urgent Carotid Endarterectomy for Patients with Unstable Symptoms: Systematic Review and Meta-Analysis of Outcomes

Vascular ◽  
2009 ◽  
Vol 17 (5) ◽  
pp. 243-252 ◽  
Author(s):  
Benjamin O. Patterson ◽  
Peter J. Holt ◽  
Robert J. Hinchliffe ◽  
Matt M. Thompson ◽  
Ian M. Loftus
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Confidence Interval ◽  
Carotid Endarterectomy ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Long Term Results ◽  
Current Evidence ◽  
Ischemic Attack

Current evidence suggests that carotid endarterectomy (CEA) performed within 2 weeks of symptoms produces better long-term results than if it is delayed. Urgent endarterectomy following unstable presentations such as crescendo transient ischemic attack (cTIA) or progressive stroke has been associated with variable results. The evidence for this treatment strategy required reviewing. A systematic review of articles related to urgent CEA between 1980 and 2008 was performed. For cTIA, there was an odds ratio of 5.6 (95% confidence interval 3.3–9.7, p ≤ .0001) for combined stroke or death compared with surgery for “standard” indications. For unstable stroke, the odds ratio was 5.5 (95% confidence interval 3.1–9.3, p ≤ .0001). Patients with unstable neurologic presentations are at higher risk of complications if operated on urgently. Clearer definitions would help more precise patient selection to avoid inadvertently operating on patients with an unacceptably high risk of poor outcome.

scholarly journals Clinical determinants associated with quality of life for people who live with HIV/AIDS: a Meta-analysis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Hesam Ghiasvand ◽  
Katherine M. Waye ◽  
Mehdi Noroozi ◽  
Gholamreza Ghaedamini Harouni ◽  
Bahram Armoon ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Confidence Interval ◽  
Effect Size ◽  
Meta Analysis ◽  
Random Effect Model ◽  
Cd4 Count ◽  
Co Morbidity ◽  
The Impact ◽  
Hiv Aids

Abstract Background During recent years, Quality of Life (QoL) is a significant assessment factor in clinical trials and epidemiological researches due to the advent of Antiretroviral Therapy (ART), Human Immunodeficiency Virus (HIV) has become a manageable,chronic disease. With regards, more attention must be paid to the QoL of infected patients. Limited evidence exists on the impact of ART on QoL among HIV infected patients. Due to lacking of a systematic approach to summarizing the available evidence on the clinical determinants of People Who Live with HIV/AIDS (PWLHs’) QoL, this study aimed to analyze the impact of clinical determinants (ART experience, CD4 count < 200, co-morbidities, time diagnosis and accessibility to cares) on QoL among PWLHs’. Methods This study was designed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed, Science Direct, Web of Science, and Cochrane electronic databases were searched in February 2017 to identify all past studies that discussed social and behavioral characteristics of QoL in PLWHA. To recognize effective factors on social and behavioral QoL, a meta-analysis was conducted. Polled Odds Ratios (ORs) were utilized at a 95% confidence level. Since sampling methods differed between articles in the systematic review, we evaluated pooled estimates using a random effect model. Metan, metareg, metacum, and metabias commands in STATA version 13.0 were applied to analyze the data. Results Our findings indicated that ART has a positive impact on QoL, with a pooled effect size at approximately 1.04 with a confidence interval between 0.42 to 1.66 which indicates this impact is not very considerable and may be relatively neutral. The pooled effect size for CD4 count on QoL was .29 (95%CI = .22–.35), indicating that there is a negative associate between CD4 count and QoL. The co-morbidity as a negative determinant for QoL among HIV/AIDS infected people. The pooled effect size implies on a relative neutral association, although the confidence interval is wide and ranges between 0.32 to 1.58. The pooled effect size is about 1.82 with confidence interval 1.27 to 2.37 which indicates a considerable positive association with lowest level of heterogeneity. Conclusions The results illustrated that time diagnosing and availability to hospital services had significant relationship with a higher QoL and CD4 < 200 was associated with a lower QoL. In conclusion, policy makers should set an agenda setting to provide a suitable diagnostic and therapeutic facilities to early detecting and continues monitoring the health status of People Who Live with HIV/AIDS (PWLHs’).

Association Between Chiropractic Use and Opioid Receipt Among Patients with Spinal Pain: A Systematic Review and Meta-analysis

Pain Medicine ◽  
2019 ◽  
Author(s):  
Kelsey L Corcoran ◽  
Lori A Bastian ◽  
Craig G Gunderson ◽  
Catherine Steffens ◽  
Alexandria Brackett ◽  
...  
Keyword(s):  
Systematic Review ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Spinal Pain ◽  
Chiropractic Care ◽  
Current Evidence ◽  
Inverse Association ◽  
Case Control Studies ◽  
Opioid Prescription

Abstract Objective To investigate the current evidence to determine if there is an association between chiropractic use and opioid receipt. Design Systematic review and meta-analysis. Methods The protocol for this review was registered on PROSPERO (CRD42018095128). The MEDLINE, PubMed, EMBASE, AMED, CINAHL, and Web of Science databases were searched for relevant articles from database inception through April 18, 2018. Controlled studies, cohort studies, and case–control studies including adults with noncancer pain were eligible for inclusion. Studies reporting opioid receipt for both subjects who used chiropractic care and nonusers were included. Data extraction and risk of bias assessment were completed independently by pairs of reviewers. Meta-analysis was performed and presented as an odds ratio with 95% confidence interval. Results In all, 874 articles were identified. After detailed selection, 26 articles were reviewed in full, and six met the inclusion criteria. Five studies focused on back pain and one on neck pain. The prevalence of chiropractic care among patients with spinal pain varied between 11.3% and 51.3%. The proportion of patients receiving an opioid prescription was lower for chiropractic users (range = 12.3–57.6%) than nonusers (range = 31.2–65.9%). In a random-effects analysis, chiropractic users had a 64% lower odds of receiving an opioid prescription than nonusers (odds ratio = 0.36, 95% confidence interval = 0.30–0.43, P < 0.001, I2 = 92.8%). Conclusions This review demonstrated an inverse association between chiropractic use and opioid receipt among patients with spinal pain. Further research is warranted to assess this association and the implications it may have for case management strategies to decrease opioid use.

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