scholarly journals Systematic Review of Rehabilitation Versus Operative Stabilization for the Treatment of First-Time Anterior Shoulder Dislocations

2010 ◽  
Vol 2 (2) ◽  
pp. 156-165 ◽  
Author(s):  
Jonathan Godin ◽  
Jon K. Sekiya
Keyword(s):  
Randomized Controlled Trials ◽  
Shoulder Dislocation ◽  
English Language ◽  
Surgical Intervention ◽  
Controlled Trials ◽  
Anterior Shoulder Dislocation ◽  
Randomized Controlled ◽  
Operative Stabilization ◽  
Level 1 ◽  
First Time

Context: Primary anterior shoulder dislocation is a frequent injury in young active patients. Traditionally, conservative nonoperative primary treatment has been advocated for a majority of first-time dislocators, whereas operative stabilization has been reserved for recurrent dislocators or those involved in strenuous physical activity. Currently, no consensus exists on whether to treat a first-time anterior shoulder dislocation surgically. Objective: (1) To provide clinical recommendations regarding the therapeutic intervention for first-time anterior shoulder dislocators and (2) to determine if there is sufficient Level 1 or 2 evidence available for the establishment of a uniform, optimal treatment protocol. Data Sources: A systematic review of prospective randomized controlled trials with human participants was performed. PubMed, the Cochrane Database of Systematic Reviews, and secondary references were appraised for studies published between 1994 and 2009. Study Selection: Inclusion criteria were English-language Level 1 or 2 studies involving the treatment of primary anterior shoulder dislocation. Exclusion criteria included non-English-language articles; Level 3, 4, or 5 studies; and studies examining treatment of recurrent/posterior shoulder dislocation or diagnoses other than primary anterior shoulder dislocations. Data Extraction: Each author conducted an independent quality appraisal of the included studies, identifying strengths, weaknesses, and biases, then reached consensus regarding their values. Results: Five randomized controlled trials were included, and they supported the use of operative management in a focused population. No long-term follow-up data were available describing the effects of surgical intervention or the development of osteoarthritis. Each study design had weaknesses that decreased the validity of the findings. Conclusions: While limited, the available evidence from randomized controlled trials supports operative stabilization as a reasonable alternative to nonoperative treatment for primary acute shoulder dislocation in young, active adults participating in highly demanding physical activities. Recommendations on the optimal surgical intervention cannot be provided. There is no conclusive evidence available to determine whether operative stabilization or conservative rehabilitation is superior for other patient or injury types.

scholarly journals Randomized controlled trials and neurosurgery: the ideal fit or should alternative methodologies be considered?

2016 ◽  
Vol 124 (2) ◽  
pp. 558-568 ◽  
Author(s):  
Alireza Mansouri ◽  
Benjamin Cooper ◽  
Samuel M. Shin ◽  
Douglas Kondziolka
Keyword(s):  
Randomized Controlled Trials ◽  
Sample Size ◽  
English Language ◽  
Sample Size Calculation ◽  
Median Number ◽  
Controlled Trials ◽  
Quality Of Reporting ◽  
Randomized Controlled ◽  
Mesh Terms

OBJECT Randomized-controlled trials (RCTs) are advocated to provide high-level medical evidence. However, in neurosurgery, there are barriers to conducting RCTs. The authors of this study sought to analyze the quality of neurosurgical RCTs since 2000 to determine the adequacy of their design and reporting. METHODS A search of the MEDLINE and EMBASE databases (2000–2014) was conducted. The medical subject heading (MeSH) terms used in the search included: “neurosurgery” OR “neurosurgical procedure,” “brain neoplasms,” “infarction” and “decompression,” “carotid stenosis,” “cerebral hemorrhage,” and “spinal fusion.” These studies were limited to RCTs, in humans, and in the English language. The Consolidated Standards for Reporting of Trials (CONSORT) and Jadad scales were used to assess the quality of RCT design and reporting. The standardized median times cited (median citations divided by years since publication) were used to assess impact. A pragmatic-explanatory continuum indicator summary-based scale was used to assess the design of the studies as primarily pragmatic or explanatory. RESULTS Sixty-one articles were identified, and the following subspecialties were the most common: vascular (23, 37%), followed by functional neurosurgery and neurooncology (both 13, 21%). The following nations were the primary leaders in RCTs: US (25 studies, 41%), Germany (8 studies, 13%), and the United Kingdom (7 studies, 11%). Median sample size was 100 (interquartile range [IQR] 41.5–279). The majority of the studies (40, 66%) had pragmatic objectives. The median number of times cited overall was 69 (IQR 20.5–193). The combined median CONSORT score was 36 (IQR 27.5–39). Blinding was most deficiently reported. Other areas with a relatively low quality of reporting were sample size calculation (34.2% of surgical, 38.5% of drug, and 20% of device studies), allocation concealment (28.9% of surgical, 23.1% of drug, and 50% of device studies), and protocol implementation (18.4% of surgical, 23% of drug, and 20% of device studies). The quality of reporting did not correlate with the study impact. All studies had a median Jadad score ≤ 3. Thirty-three pragmatic studies (83%) and 5 explanatory studies (25%) met the design objectives. All pragmatic studies based on drug and device trials met their objectives, while 74% of pragmatic surgical trials met their objectives. CONCLUSIONS The prevalence of neurosurgical RCTs is low. The quality of RCT design and reporting in neurosurgery is also low. Many study designs are not compatible with stated objectives. Pragmatic studies were more likely to meet design objectives. Given the role of RCTs as one of the highest levels of evidence, it is critical to improve on their methodology and reporting.

scholarly journals Between Inhale and Exhale

2014 ◽  
Vol 19 (2) ◽  
pp. 144-149 ◽  
Author(s):  
Chia-Liang Dai ◽  
Manoj Sharma
Keyword(s):  
Smoking Cessation ◽  
Randomized Controlled Trials ◽  
English Language ◽  
Controlled Trials ◽  
Evidence Based ◽  
Inclusion Criteria ◽  
Randomized Controlled ◽  
Quitting Smoking ◽  
Quantitative Design

The current study provided a review of evidence-based yoga interventions’ impact on smoking cessation. The researchers reviewed articles obtained from MEDLINE (PubMed), EBSCOHOST, PROQUEST, MEDINDIA, CINAHL, Alt HealthWatch, and AMED databases. Inclusion criteria were as follows: ( a) study published between 2004 and 2013, ( b) study published in English language, ( c) study used yoga-based interventions, ( d) study involved smokers with varying level of smoking, ( e) study used any quantitative design, and ( f) study had physiological and/or psychological outcomes. A total of 10 studies met the inclusion criteria. Designs were 2 pre–post tests and 8 randomized controlled trials. Majority of the interventions were able to enhance quitting smoking rates in the participants under study. Yoga-based interventions hold promise for smoking cessation. Some of the limitations include short follow-up measurements and short duration of intervention.

Efficacy of First-Time Intragastric Balloon in Weight Loss: a Systematic Review and Meta-analysis of Randomized Controlled Trials

2016 ◽  
Vol 27 (2) ◽  
pp. 277-287 ◽  
Author(s):  
Alan A. Saber ◽  
Saeed Shoar ◽  
Mahmoud W. Almadani ◽  
Natan Zundel ◽  
Mohammed J. Alkuwari ◽  
...  
Keyword(s):  
Systematic Review ◽  
Weight Loss ◽  
Randomized Controlled Trials ◽  
Intragastric Balloon ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
First Time

Evidence Based Acupuncture Practice Recommendations for Peripheral Facial Paralysis

2009 ◽  
Vol 37 (01) ◽  
pp. 35-43 ◽  
Author(s):  
Hui Zheng ◽  
Ying Li ◽  
Min Chen
Keyword(s):  
Randomized Controlled Trials ◽  
Facial Paralysis ◽  
English Language ◽  
Controlled Trials ◽  
Peripheral Facial Paralysis ◽  
Duration Of Treatment ◽  
China National Knowledge Infrastructure ◽  
Randomized Controlled ◽  
Knowledge Infrastructure ◽  
Chinese And English

The objective is to analyze the treatment used in relatively high quality randomized controlled trials to identify any similarities of therapeutic approaches and subsequently present recommendations for a standard acupuncture procedure for the treatment of peripheral facial paralysis (PFP). We searched Chinese and English language literatures through MEDLINE (January 1966 to October 2007), EMbase (January 1980 to October 2007), Chinese Biomedical Database (January 1978 to October 2007) and China National Knowledge Infrastructure (January 1979 to October 2007) for randomized controlled trials. With independent assessment by 2 observers, 33 of 386 originally identified articles were finally included. The extracted information from these articles was focused on the selection of meridians and acupoints, types of stimulation and duration of treatment. On the whole, when treating PFP, the best acupoints options are Dicang (ST4), Xiaguan (ST7), Jiache (ST6), Chengjiang (CV24), Yingxiang (LI20), Quanliao (SI18), Yifeng (TE17), Yangbai (GB14), Sibai (ST2), Fengchi (GB20), Shuigou (GV26), Yuyao (EX-HN4) and Hegu (LI4). Manual stimulation or electro-acupuncture combined with moxibustion is recommended. Moreover, the suggested duration of acupuncture treatment refers to once a day, 10 times for each course, 2 to 5 days as courses interval, and 20 to 40 treatments in total.

scholarly journals Effect of Comorbidities on Outcomes of Neurorehabilitation Interventions in Multiple Sclerosis

2016 ◽  
Vol 18 (6) ◽  
pp. 282-290 ◽  
Author(s):  
Afolasade Fakolade ◽  
Etienne J. Bisson ◽  
Julie Pétrin ◽  
Julie Lamarre ◽  
Marcia Finlayson
Keyword(s):  
Multiple Sclerosis ◽  
Randomized Controlled Trials ◽  
English Language ◽  
Controlled Trials ◽  
Pubmed Central ◽  
Randomized Controlled ◽  
Magnetic Field Therapy ◽  
Wide Range ◽  
Field Therapy ◽  
Task Oriented

Background: Interest in comorbidities has increased in the past few years, but the effect of comorbidities on outcomes of multiple sclerosis (MS) neurorehabilitation interventions is unclear. The aim of this review was to identify and summarize the existing evidence regarding the effect of comorbidities on outcomes of neurorehabilitation interventions targeting people with MS. Methods: Five databases (Embase, MEDLINE through Ovid, PubMed Central, Cumulative Index to Nursing and Allied Health Literature, and Web of Science) were searched using index terms and keywords relating to MS and a wide range of rehabilitation interventions. Studies screened were limited to English-language randomized controlled trials. Information related to included and excluded comorbidities and how they were reported and described was extracted from the included studies. Results: Fifty-four neurorehabilitation randomized controlled trials were included and were grouped into categories: robotics/technology-enhanced (n = 7), task-oriented training/neurorehabilitation principles (n = 7), electrical stimulation (n = 12), temperature regulation (n = 6), magnetic field therapy (n = 5), vibration (n = 9), and miscellaneous (n = 8). Although the issue of comorbidity was considered in 40 studies, it was limited to excluding individuals from participating in the trials. Only two studies reported on comorbidity, but neither examined the possible mediating or moderating effect of comorbidities on intervention outcomes. Conclusions: This review documents important knowledge gaps about the effect of comorbidity on neurorehabilitation outcomes and identifies a critical need for future studies to address this issue. Without this information, we limit our understanding of the mechanisms of comorbidity and its effects on relevant clinical and research outcomes specific to neurorehabilitation.

P188 QUALITY ASSURANCE OF SURGICAL INTERVENTION WITHIN RANDOMIZED CONTROLLED TRIALS FOR GASTRO-ESOPHAGEAL REFLUX DISEASE

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
R Markar Sheraz ◽  
Jamel* Sara ◽  
Wiggins Tom ◽  
B Hanna George
Keyword(s):  
Quality Assurance ◽  
Randomized Controlled Trials ◽  
Surgical Intervention ◽  
Controlled Trials ◽  
Case Volume ◽  
Surgical Quality ◽  
Surgical Interventions ◽  
Video Assessment ◽  
Randomized Controlled ◽  
Surgeon Experience

Abstract Aim Randomized controlled trials provide level 1 evidence for surgical intervention in the treatment of gastro-esophageal reflux disease (GERD). This systematic review aimed to investigate the practice of surgical quality assurance in RCTs concerning surgical interventions in GERD. Background & Methods A systematic literature search for articles was performed in Medline, Embase, Web of Science and Cochrane library for randomized controlled trials (RCT) evaluating surgical intervention in the management of GERD. Each RCT was assesses for surgical quality assurance (SQA) using an eight-point checklist in three main areas and given a SQA score out of 8. Clinical outcomes from each trial including reoperation rates were then compared against the SQA score. Results Thirty-one publications were included compromising 5803 patients. The assurance of surgical quality was poor with the randomized controlled trials included, ranging from 3% to 68% for the factors examined: Credentialing surgeon experience before entry into the trial by; 1. Case volume – 26% (8/31) 2. Operative reports – 6% (2/31) 3. Video assessment – 6% (2/31) 4. Live operating room evaluation – 3% (1/31) Pre-trial standardization by; 5. Education of surgeons – 13% (13%) 6. Consensus for standardization – 68% (21/31) Monitoring surgical performance during the trial by; 7. Video assessment – 10% (3/31) 8. Monitoring of data – 3% (1/31) RCTs with a high SQA score had a reduced average rate of reoperation (SQA score 4 to 8 vs. 0 to 3; 0% vs. 3.19%; P<0.05). Credentialing surgeons by case volume before entry into the trial was also associated with a reduced rate of reoperation (0.04% vs. 3%; P<0.05). Conclusion Surgical quality assurance has been largely lacking in randomized controlled trials for GERD previously. High surgical quality assurance was associated with reduced reoperation rates within RCTs, highlighting the need for good SQA within these types of trials. Future RCTs in benign UGI conditions with surgical interventions should ensure SQA in three main areas: (i) Credentialing surgeon experience before trial; to ensure they are past learning curve. (ii) Standardizing the surgical technique; to ensure less heterogeneity in operative performance. (iii) Monitoring performance during trial; to ensure standard of surgical quality is maintained within the trial.

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