scholarly journals HIP ARTHROSCOPY VS. PHYSICAL THERAPY IN PATIENTS WITH FEMOROACETABULAR IMPINGEMENT: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0021
Author(s):  
Maria Schwabe ◽  
Abby L Cheng ◽  
Cecilia Pascual-Garrido ◽  
Marcie Harris-Hayes ◽  
Michael Harris ◽  
...  
Keyword(s):  
Systematic Review ◽  
Physical Therapy ◽  
Randomized Controlled Trials ◽  
Femoroacetabular Impingement ◽  
Meta Analysis ◽  
Patient Characteristics ◽  
Mean Difference ◽  
Controlled Trials ◽  
Intention To Treat ◽  
Randomized Controlled

Introduction: Both physical therapy (PT) and surgery appear to have some efficacy in treating femoroacetabular impingement (FAI). Only recently have high-level evidence studies compared these two options, though results of these randomized controlled trials (RCTs) are contradictory. The purpose of this study was to perform a systematic review and meta-analysis of RCTs comparing PT and surgery in patients with FAI. Methods: A systematic review was performed to identify randomized trials comparing FAI and PT. Data was extracted for demographics, study design, patient reported outcomes (PROs), and study quality/bias. In total, 819 abstracts were reviewed, with three RCTs identified (Griffin 2018, Mansell 2018, and Palmer 2019). All three RCTs reported iHOT-33, while two studies reported HOS ADL and Sport (Mansell 2019 and Palmer 2019). In a random effects meta-analysis, between-group differences in post-intervention scores were assessed using intention-to-treat analysis in each study. Results: All 3 RCTs reported PROs improvement from baseline to follow-up for both PT and surgery. The meta-analysis demonstrated greater improved iHOT-33 outcomes with surgery compared to PT with a mean relative difference of 11.3 (95% CI 1.86-20.73, p=0.014). The meta-analysis for HOS ADL and Sports (two RCTs) similarly demonstrated higher scores with surgery with a mean difference of 3.9 (95% CI -9.6-17.3, p=0.571) and 6.2 (95% CI -6.8-19.2, p=0.347), respectively, though without statistical significance. The quality of two RCTs was assessed as good with minimal bias (Griffin and Palmer). In the third RCT, an extremely high crossover rate may affect its validity (Mansell 2018, 70% crossover from PT to surgery). For instance, HOS ADL outcome based on treatment received, adjusting for Mansell’s crossover rate, favored surgery with a larger mean difference of 12.0 (95% CI 7.5-16.5, p<0.001) (compared to intention-to-treat difference of 3.9). Discussion: In patients with FAI, combined results of three RCTs demonstrate superior outcomes of surgery compared to PT. However, PT can result in improvements in some patients and does not appear to compromise surgical outcomes. Provided that the studies adjusted for certain patient characteristics, further research needs to identify patient characteristics that predict success of non-operative and operative treatment of FAI in specific patient subgroups. [Figure: see text]

scholarly journals Short-term Clinical Outcomes of Hip Arthroscopy Versus Physical Therapy in Patients With Femoroacetabular Impingement: A Systematic Review and Meta-analysis of Randomized Controlled Trials

2020 ◽  
Vol 8 (11) ◽  
pp. 232596712096849
Author(s):  
Maria T. Schwabe ◽  
John C. Clohisy ◽  
Abby L. Cheng ◽  
Cecilia Pascual-Garrido ◽  
Marcie Harris-Hayes ◽  
...  
Keyword(s):  
Systematic Review ◽  
Physical Therapy ◽  
Randomized Controlled Trials ◽  
Hip Arthroscopy ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Short Term ◽  
Intention To Treat ◽  
Randomized Controlled

Background: Both physical therapy (PT) and surgery are effective in treating femoroacetabular impingement (FAI), but their relative efficacy has not been well established until recently. Several randomized controlled trials (RCTs) comparing the early clinical outcomes of these treatments have been published, with contradictory results. Purpose/Hypothesis: The purpose of this study was to perform a meta-analysis of RCTs that compared early patient-reported outcomes (PROs) of hip arthroscopy versus PT in patients with symptomatic FAI. The hypothesis was that surgical treatment of FAI leads to better short-term outcomes than PT. Study Design: Systematic review; Level of evidence, 1. Methods: In March 2019, a systematic review was performed to identify RCTs comparing hip arthroscopy and PT in patients with symptomatic FAI. A total of 819 studies were found among 6 databases; of these, 3 RCTs met eligibility (Griffin et al, 2018; Mansell et al, 2018; and Palmer et al, 2019). All 3 RCTs reported international Hip Outcome Tool--33 (iHOT-33) scores, and 2 reported Hip Outcome Score (HOS)–Activities of Daily Living (ADL) and HOS-Sport results. In a random-effects meta-analysis, between-group differences in postintervention scores were assessed according to intention-to-treat and as-treated approaches. Quality was assessed with CONSORT, CERT, TiDieR, and the Cochrane Collaboration tool. Results: The 3 RCTs included 650 patients with FAI; the mean follow-up ranged from 8 to 24 months. All studies reported PRO improvement from baseline to follow-up for both PT and surgery. The quality of the Griffin and Palmer studies was good, with minimal bias. In the Mansell study, a 70% crossover rate from PT to surgery increased the risk of bias. The meta-analysis demonstrated improved iHOT-33 outcomes with surgery compared with PT for intention-to-treat (mean difference [MD], 11.3; P = .046) and as-treated (MD, 12.6; P = .007) analyses. The as-treated meta-analysis of HOS-ADL scores favored surgery (MD, 12.0; P < .001), whereas the intention-to-treat analysis demonstrated no significant difference between groups for HOS-ADL (MD, 3.9; P = .571). Conclusion: In patients with FAI, the combined results of 3 RCTs demonstrated superior short-term outcomes for surgery versus PT. However, PT did result in improved outcomes and did not appear to compromise the surgical outcomes of patients for whom therapy failed and who progressed to surgery.

scholarly journals Melatonin and Cardioprotection in Humans: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 8 ◽  
Author(s):  
Alberto Domínguez-Rodríguez ◽  
Pedro Abreu-González ◽  
Néstor Báez-Ferrer ◽  
Russel J. Reiter ◽  
Pablo Avanzas ◽  
...  
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Mean Difference ◽  
Left Ventricular Ejection ◽  
Favorable Effect ◽  
Controlled Trials ◽  
Weighted Mean ◽  
Randomized Controlled ◽  
Mean Differences

Myocardial ischemia/reperfusion (IR) injury represents a critical problem associated with interventional approaches for coronary reperfusion. Pharmacological cardioprotective interventions are advocated to ameliorate IR injury. Melatonin is an anti-inflammatory and antioxidant agent with a wide range of therapeutic properties that may contribute to its cardioprotective effects. No systematic review or meta-analysis has compared melatonin vs. placebo as a cardioprotective agent in humans. The present study, based on a systematic review and meta-analysis, was carried out to assess melatonin's efficacy as a cardioprotective treatment. We performed a systematic review of the available literature. Randomized controlled trials (RCTs) were identified and information was extracted using predefined data extraction forms. The primary outcomes were (a) left ventricular ejection fraction (LVEF) and (b) blood troponin levels in patients who underwent myocardial revascularization and were randomized to melatonin or placebo. The inverse-variance random-effects method was used to pool the estimates. Heterogeneity and publication bias were assessed. Weighted mean differences or standardized mean differences were calculated. A total of 283 records were screened and seven RCTs met all the inclusion criteria. After the pooled analysis, the results on LVEF were consistent across all studies, and a significant heterogeneity was found in the results on troponin levels. The melatonin-treated patients had on average higher LVEF than the placebo-treated individuals with a weighted mean difference = 3.1% (95% CI 0.6–5.5, p = 0.01). Five works compared the levels of troponin after melatonin or placebo treatment. The melatonin-treated patients had lower levels of troponin with a standardized mean difference = −1.76 (95% CI −2.85 to −0.67, p = 0.002). The findings of this meta-analysis revealed that melatonin administration in humans as a cardioprotective agent attenuated heart dysfunction with a favorable effect on the LVEF.

scholarly journals Additional Physical Interventions to Conventional Physical Therapy in Parkinson’s Disease: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

2020 ◽  
Vol 9 (4) ◽  
pp. 1038 ◽  
Author(s):  
Ruben D. Hidalgo-Agudo ◽  
David Lucena-Anton ◽  
Carlos Luque-Moreno ◽  
Alberto Marcos Heredia-Rizo ◽  
Jose A. Moral-Munoz
Keyword(s):  
Systematic Review ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Physical Therapy ◽  
Randomized Controlled Trials ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Balance Confidence ◽  
Randomized Controlled

Parkinson’s disease (PD) represents the second most common neurodegenerative disease. Currently, conventional physical therapy is complemented by additional physical interventions with recreational components, improving different motor conditions in people with PD. This review aims to evaluate the effectiveness of additional physical interventions to conventional physical therapy in Parkinson’s disease. A systematic review and meta-analysis of randomized controlled trials were performed. The literature search was conducted in PubMed, Physiotherapy Evidence Database (PEDro), Scopus, SciELO and Web of Science. The PEDro scale was used to evaluate the methodological quality of the studies. A total of 11 randomized controlled trials were included in this review. Five of them contributed information to the meta-analysis. The statistical analysis showed favorable results for dance-based therapy in motor balance: (Timed Up and Go: standardized mean difference (SMD) = −1.16; 95% Confidence Interval (CI):(−2.30 to −0.03); Berg Balance Scale: SMD = 4.05; 95%CI:(1.34 to 6.75)). Aquatic interventions showed favorable results in balance confidence (Activities-Specific Balance Confidence: SMD=10.10; 95%CI:(2.27 to 17.93)). The results obtained in this review highlight the potential benefit of dance-based therapy in functional balance for people with Parkinson’s disease, recommending its incorporation in clinical practice. Nonetheless, many aspects require clarification through further research and high-quality studies on this subject.

scholarly journals Effects of Phytoestrogen Supplement on Quality of Life of Postmenopausal Women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2019 ◽  
Vol 2019 ◽  
pp. 1-11 ◽  
Author(s):  
Ching-Ching Peng ◽  
Chia-Yu Liu ◽  
Nai-Rong Kuo ◽  
Tao-Hsin Tung
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Postmenopausal Women ◽  
Meta Analysis ◽  
Mean Difference ◽  
Current Evidence ◽  
Controlled Trials ◽  
Randomized Controlled

Background. The effect of phytoestrogen on postmenopausal quality of life is unclear. This study evaluated the effects of phytoestrogen supplement on quality of life for postmenopausal women. Methods. We conducted a systematic review and meta-analysis of randomized controlled trials on the effects of phytoestrogen supplements on the quality of life of postmenopausal women. We searched PubMed, MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials on March 31, 2018, for relevant randomized controlled trials. Two authors independently selected studies, assessed risk of bias, and extracted data. Disagreement was resolved through discussion with a third author. Results. We involved 10 articles in the systematic review. 8 studies and a total of 1,129 subjects were included in the meta-analysis. The questionnaires used in the evaluation of quality of life were as follows: SF-36, 4 studies; MENQOL, 4 studies; For Short Form 36 surveys, phytoestrogen groups scored significantly higher for body pain (mean difference = 3.85, 95% confidence interval [CI] = [1.14, 6.57], P < 0.01), mental health (mean difference = 4.01, 95% CI = [1.49, 6.57], P < 0.01), and role limitations caused by emotional problems domains (mean difference = 3.83, 95% CI = [1.81, 5.85], P < 0.01). No statistically significant difference was obtained from Menopause-Specific Quality of Life surveys (vasomotor domain mean difference 0.14, 95% CI = [−0.08, 0.36], P = 0.20; physical domain mean difference 0.20, 95% CI [−0.08, 0.48], P = 0.15; psychological domain mean difference −0.10, 95% CI [−0.26, 0.07], P = 0.27; sexual domain mean difference −0.17, 95% CI [−0.42, 0.09], P = 0.19). Conclusion. Current evidence does not support phytoestrogen supplementation improving postmenopausal quality of life. Further comprehensive trials or long-term follow-up studies are warranted.

scholarly journals Electroacupuncture for post-thoracotomy pain: A systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254093
Author(s):  
Sohyeon Park ◽  
Yee Ran Lyu ◽  
So Jung Park ◽  
Min Seok Oh ◽  
In Chul Jung ◽  
...  
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Total Dose ◽  
Meta Analysis ◽  
Opioid Analgesics ◽  
Sham Acupuncture ◽  
Mean Difference ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Standard Mean Difference

Background Thoracotomy is an invasive surgical procedure that produces intense postoperative pain. Electroacupuncture has been used to induce analgesia in various situations, including after surgery. The aim of the following systematic review and meta-analysis was to evaluate the effect of electroacupuncture on post-thoracotomy pain. Methods The studies for the systematic review were searched using the following 9 databases: PubMed, Cochrane Library, EMBASE, MEDLINE Complete, Google Scholar, China National Knowledge Infrastructure (CNKI), Korean Medical Database (KMBASE), Koreanstudies Information Service System (KISS), and OASIS, without language restriction. Randomized controlled trials (RCTs) that met the inclusion criteria were selected. The quality assessment was performed using the Cochrane risk-of-bias tool, and RevMan 5.3 was used for meta-analysis. The review protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO) as CRD42019142157. Results Eleven randomized controlled trials were included in the systematic review. The meta-analysis was performed for two outcome measures: pain score 24 hours after surgery and total dose of opioid analgesics. A subgroup analysis was performed according to the control group: sham acupuncture and conventional analgesia group. Pain score 24 hours after surgery of electroacupuncture group showed a standard mean difference of -0.98 (95% CI: -1.62 to -0.35) compared to sham acupuncture. The standard mean difference was -0.94 (95% CI: -1.33 to -0.55) compared to conventional analgesia. The total dose of opioid analgesics of electroacupuncture group showed a standard mean difference values of -0.95 (95% CI: -1.42 to -0.47) compared to sham acupuncture. The standard mean difference was -1.96 (95% CI: -2.82 to -1.10) compared to conventional analgesia. Conclusion Current evidence suggests that electroacupuncture might provide useful pain relieving effect on post-thoracotomy patients. However, due to low quality and high heterogeneity of existing data, further rigorously designed studies should be performed to confirm the safety and efficacy.

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