Who Benefits from Electroconvulsive Therapy?

This paper describes the results obtained by combining data from the Northwick Park and Leicester randomised controlled trials of ECT. Patients who suffered from depression in which retardation and delusions were features and who received real ECT had a significantly improved outcome at the end of four weeks of treatment (as measured by improvement in the HRSD) in comparison with those who received simulated ECT. However, this treatment effect was not detectable at six-month follow-up. Patients who were neither retarded nor deluded did not benefit significantly from real as opposed to simulated ECT.

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Efficacy of electronic cigarettes for tobacco smoking cessation: An adapted systematic review

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1167 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

T O'Dowd

Keyword(s):

Smoking Cessation ◽

Cohort Studies ◽

Randomised Controlled Trials ◽

Electronic Cigarettes ◽

Controlled Trials ◽

Significant Heterogeneity ◽

Smoking Reduction ◽

Significant Difference ◽

Randomised Controlled

Abstract Background Worldwide smoking remains the leading cause of preventable morbidity and mortality. Electronic cigarettes (ECs) are increasingly used by tobacco smokers as an aid to smoking cessation; however, their efficacy remains uncertain. Methods Electronic databases, clinical trial registries and grey literature sources were searched. The aim was to examine randomised controlled trials or prospective cohort studies, published since the 2016 Cochrane review on this topic, that assessed the efficacy of ECs in achieving smoking cessation among current smokers. Results Two RCTs and five cohort studies, including a total of 16,460 participants, were eligible for inclusion. One RCT found sustained 1-year abstinence of 18.0% in the EC group versus 9.9% in the nicotine replacement therapy group (RR: 1.83; 95% CI 1.30 to 2.58; P < 0.001). The second RCT did not find a statistically significant difference in abstinence rates between EC users and non-users (RR 0.71). Of the five included cohort studies, four reported statistically significant RRs. Two found a positive association (RRs of 1.45 and 1.84) between EC use and smoking cessation but two studies showed EC use was associated with reduced smoking cessation (RRs of 0.25 and 0.35). Due to significant heterogeneity between the studies the data were deemed unsuitable for pooling into a meta-analysis. All trials assessing smoking reduction reported higher rates of reduction among EC users. No serious adverse events were reported with EC use. Follow-up periods of included trials ranged from one to four years, with an average of 1.6 years. Conclusions There is limited, low-quality evidence that ECs are an effective intervention for smoking cessation and smoking reduction. The overall quality of evidence is low as it is based on a small number of studies with inconsistent and imprecise results. Due to the short follow-up periods of the included trials, the long-term safety of ECs is unclear from this review. Key messages Limited evidence that electronic cigarettes are an effective smoking cessation intervention. Further well-designed randomised controlled trials are required to investigate the efficacy of ECs for smoking cessation.

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Potential impact on estimated treatment effects of information lost to follow-up in randomised controlled trials (LOST-IT): systematic review

BMJ ◽

10.1136/bmj.e2809 ◽

2012 ◽

Vol 344 (may18 1) ◽

pp. e2809-e2809 ◽

Cited By ~ 149

Author(s):

E. A. Akl ◽

M. Briel ◽

J. J. You ◽

X. Sun ◽

B. C. Johnston ◽

...

Keyword(s):

Systematic Review ◽

Randomised Controlled Trials ◽

Treatment Effects ◽

Controlled Trials ◽

Potential Impact ◽

Randomised Controlled ◽

Lost To Follow Up

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The impact of a run-in period on treatment effects in cardiovascular prevention randomised control trials: A protocol for a comprehensive review and meta-analysis

HRB Open Research ◽

10.12688/hrbopenres.13122.1 ◽

2020 ◽

Vol 3 ◽

pp. 82

Author(s):

Robert Murphy ◽

Emer McGrath ◽

Aoife Nolan ◽

Andrew Smyth ◽

Michelle Canavan ◽

...

Keyword(s):

Randomised Controlled Trials ◽

Treatment Effects ◽

Meta Analysis ◽

Cardiovascular Prevention ◽

Controlled Trials ◽

Loss To Follow Up ◽

Relative Risks ◽

Prevention Trials ◽

Randomised Controlled

Background: A run-in period is often employed in randomised controlled trials to increase adherence to the intervention and reduce participant loss to follow-up in the trial population. However, it is uncertain whether use of a run-in period affects the magnitude of treatment effect. Methods: We will conduct a sensitive search for systematic reviews of cardiovascular preventative trials and a complete meta-analysis of treatment effects comparing cardiovascular prevention trials using a run-in period (“run-in trials”) with matched cardiovascular prevention trials that did not use a run-in period (“non-run-in trials”). We describe a comprehensive matching process which will match run-in trials with non-run-in trials by patient populations, interventions, and outcomes. For each pair of run-in trial and matched non-run-in trial(s), we will estimate the ratio of relative risks and 95% confidence interval. We will evaluate differences in treatment effect between run-in and non-run-in trials and our and our priamry outcome will be the ratio of relative risks for matched run-in and non-run-in trials for their reported cardiovascular composite outcome. Our secondary outcomes are comparisons of mortality, loss to follow up, frequency of adverse events and methodological quality of trials. Conclusions: This study will answer a key question about what influence a run-in period has on the magnitude of treatment effects in randomised controlled trials for cardiovascular prevention therapies.

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Effect of action observation therapy on motor function in children with cerebral palsy: a systematic review of randomized controlled trials with meta-analysis

Clinical Rehabilitation ◽

10.1177/0269215520954345 ◽

2020 ◽

pp. 026921552095434

Author(s):

Naglaa Abdelhaleem ◽

Samar Taher ◽

Menna Mahmoud ◽

Ahmad Hendawy ◽

Maged Hamed ◽

...

Keyword(s):

Cerebral Palsy ◽

Methodological Quality ◽

Randomised Controlled Trials ◽

Action Observation ◽

Meta Analysis ◽

Post Treatment ◽

Controlled Trials ◽

Children With Cerebral Palsy ◽

Randomised Controlled

Objective: To evaluate the evidence of using Action Observation Therapy in the rehabilitation of children with Cerebral Palsy. Study design: Systematic review with meta-analysis of Randomised Controlled Trials. Methods: For the purpose of identifying relevant studies, six databases were searched from inception until July 2020. The methodological quality was assessed by Physiotherapy Evidence Database scale. The outcomes were classified within the framework of the International Classification of Functioning. A pooled meta-analysis was performed on studies that demonstrated homogeneity. Results: Twelve randomised controlled trials with 307 participants were included with six of them were included in the meta-analysis. Non-significant difference between the groups was demonstrated by meta-analysis. Results of capacity assessed in post treatment and follow up evaluation were (0.06, –0.22 to 0.34, 95% (CI); P = 0.69 and (–0.35, –0.96 to 0.27, 95% (CI); P = 0.27); respectively. Actual performance in post-treatment and follow up were (0.10, –0.22 to 0.48, 95% (CI); P = 0.62) and (0.01, –0.40 to 0.41, 95% (CI); P = 0.97); respectively. Perceived performance evaluated using (ABILHAND-KIDS) were (0.30, –0.28 to 0.89, 95% (CI); P = 0.31) and (0.15, –0.43 to 0.73, 95% (CI); P = 0.61) for post treatment and follow up; respectively. Overall effect on activity domain was (0.08, –0.11 to 0.28, 95% (CI); P = 0.86) immediately and (0.04, –0.33 to 0.26, 95% (CI); P = 0.49) at follow-up; respectively. Conclusion: No evidence of benefit had been found to draw a firm conclusion regarding the effectiveness of action observation therapy in the rehabilitation of children with cerebral palsy due to limitations in methodological quality and variations between studies.

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OP66 Effect of pedometer-based walking interventions on long-term health outcomes: prospective 4-year follow-up of 2 randomised controlled trials using routine primary care data

10.1136/jech-2019-ssmabstracts.67 ◽

2019 ◽

Author(s):

DG Cook ◽

T Harris ◽

E Limb ◽

F Hosking ◽

IM Carey ◽

...

Keyword(s):

Primary Care ◽

Health Outcomes ◽

Randomised Controlled Trials ◽

Controlled Trials ◽

Primary Care Data ◽

Randomised Controlled

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Treating depression with physical activity in adolescents and young adults: a systematic review and meta-analysis of randomised controlled trials

Psychological Medicine ◽

10.1017/s0033291717002653 ◽

2017 ◽

Vol 48 (7) ◽

pp. 1068-1083 ◽

Cited By ~ 70

Author(s):

A. P. Bailey ◽

S. E. Hetrick ◽

S. Rosenbaum ◽

R. Purcell ◽

A. G. Parker

Keyword(s):

Physical Activity ◽

Young Adults ◽

Treatment Effect ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Risk Of Bias ◽

Adolescents And Young Adults ◽

Controlled Trials ◽

Randomised Controlled

AbstractWe aimed to establish the treatment effect of physical activity for depression in young people through meta-analysis. Four databases were searched to September 2016 for randomised controlled trials of physical activity interventions for adolescents and young adults, 12–25 years, experiencing a diagnosis or threshold symptoms of depression. Random-effects meta-analysis was used to estimate the standardised mean difference (SMD) between physical activity and control conditions. Subgroup analysis and meta-regression investigated potential treatment effect modifiers. Acceptability was estimated using dropout. Trials were assessed against risk of bias domains and overall quality of evidence was assessed using GRADE criteria. Seventeen trials were eligible and 16 provided data from 771 participants showing a large effect of physical activity on depression symptoms compared to controls (SMD = −0.82, 95% CI = −1.02 to −0.61, p < 0.05, I2 = 38%). The effect remained robust in trials with clinical samples (k = 5, SMD = −0.72, 95% CI = −1.15 to −0.30), and in trials using attention/activity placebo controls (k = 7, SMD = −0.82, 95% CI = −1.05 to −0.59). Dropout was 11% across physical activity arms and equivalent in controls (k = 12, RD = −0.01, 95% CI = −0.04 to 0.03, p = 0.70). However, the quality of RCT-level evidence contributing to the primary analysis was downgraded two levels to LOW (trial-level risk of bias, suspected publication bias), suggesting uncertainty in the size of effect and caution in its interpretation. While physical activity appears to be a promising and acceptable intervention for adolescents and young adults experiencing depression, robust clinical effectiveness trials that minimise risk of bias are required to increase confidence in the current finding. The specific intervention characteristics required to improve depression remain unclear, however best candidates given current evidence may include, but are not limited to, supervised, aerobic-based activity of moderate-to-vigorous intensity, engaged in multiple times per week over eight or more weeks. Further research is needed. (Registration: PROSPERO-CRD 42015024388).

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Treatment effect bias in randomised controlled trials using surrogate outcomes: a preliminary cohort study analysis

Trials ◽

10.1186/1745-6215-12-s1-a73 ◽

2011 ◽

Vol 12 (S1) ◽

Author(s):

Oriana Ciani ◽

Rod S Taylor

Keyword(s):

Cohort Study ◽

Treatment Effect ◽

Randomised Controlled Trials ◽

Controlled Trials ◽

Study Analysis ◽

Surrogate Outcomes ◽

Randomised Controlled

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Incidence and prognostic factors of knee extension deficits following anterior cruciate ligament reconstruction: A systematic review and meta-analysis of randomised controlled trials

10.1101/2020.11.26.20239046 ◽

2020 ◽

Author(s):

Nalan Ektas ◽

Corey Scholes ◽

Meredith Harrison-Brown ◽

Maha Jegatheesan ◽

Ashwin Rajesh ◽

...

Keyword(s):

Prognostic Factors ◽

Randomised Controlled Trials ◽

Acl Injury ◽

Knee Extension ◽

Cochrane Library ◽

Controlled Trials ◽

Extension Deficit ◽

Eligibility Criteria ◽

Randomised Controlled

ABSTRACTBackground and aimsKnee extension deficits complicate recovery from ACL injury and reconstruction, however the incidence of knee extension loss is not well defined. The aim of this review was to identify the incidence of loss of extension (LOE) following ACL rupture and reconstruction, explore the definitions of knee extension deficits reported and identify prognostic factors affecting LOE incidence.Methods and analysisA systematic search was conducted in Medline, Cochrane Library and PEDro for studies in publication up to September 2019, with no restrictions on publication year. References were screened and assessed for inclusion using predetermined eligibility criteria. Randomised controlled trials (RCTs) that quantified knee angle, loss of extension or incidence of extension deficit were included for quality assessment and data extraction. Statistical summaries were generated and meta-analyses performed in two parts to examine: (i) the probability of a datapoint being zero incidence compared to a non-zero incidence, and (ii) the relationship between the predictors and non-zero LOE incidence.ResultsA sample of 8594 papers were retrieved using the search criteria, with 48 studies meeting eligibility criteria. Pooled results from 4065 participants were included for analysis, with 3965 participants who had undergone ACLR. The proportion of included studies judged at an overall low risk of bias was small (6%). The analysis revealed median LOE incidence of 15.9% (IQR 1.4 - 46.5) at a median follow up from treatment of 4.9 months (IQR 1.9 - 24). Median LOE incidence was 23 % (IQR 8.4 - 50.0) for the subset of studies reporting up to 12 months of follow up. The observed group and study were the most important predictors for whether a datapoint reported an incidence of extension deficit. Time to follow up (P < 0.001) and graft type (P = 0.02) were found to have a significant influence on non-zero LOE incidence (%).ConclusionsThis review examined the definitions for the measurement and interpretation of postoperative knee extension, and established the trajectory of knee extension deficit after ACL injury and reconstruction. While factors associated with loss of extension were identified, the trajectory of knee extension deficits were difficult to infer due to discrepancies in measurement techniques and patient variation. Clinicians should expect up to 1 in 3 patients to present postoperatively with loss of extension of at least 3 degrees, which may partially resolve over time. Future work should focus on the development of a standardised framework for postoperative measurement and reporting of LOE.

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Electroconvulsive therapy (ECT) versus sham ECT for depression: do study limitations invalidate the evidence (and mean we should stop using ECT)?

BJPsych Advances ◽

10.1192/bja.2021.23 ◽

2021 ◽

Vol 27 (5) ◽

pp. 285-291

Author(s):

Ian M. Anderson

Keyword(s):

Electroconvulsive Therapy ◽

Randomised Controlled Trials ◽

Memory Loss ◽

Placebo Treatment ◽

Controlled Trials ◽

Therapeutic Benefits ◽

Permanent Memory ◽

Randomised Controlled ◽

Meta Analyses

SUMMARYElectroconvulsive therapy (ECT) for depression is a controversial treatment with highly polarised views about the balance between therapeutic benefits and adverse effects. Studies investigating whether ECT is more effective than a placebo treatment started in the 1950s, with the most important randomised controlled trials carried out about four decades ago in which ECT was compared with sham ECT (SECT) involving anaesthesia but no electrically induced seizure. Subsequently the data have been pooled in a number of meta-analyses which have found that ECT is an effective treatment. However, a recent review of the quality of the SECT-controlled studies, and the meta-analyses based on them, concludes that their quality is too poor to allow assessment of the efficacy of ECT and that, given its risks (permanent memory loss and death), the use of ECT should be suspended. This commentary critically discusses the methodology of this review and its conclusions.

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