Limb volume reduction and infection outcomes following vascularized lymph node transfer for cancer treatment-related lymphoedema: A systematic review and meta-analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24040-e24040
Author(s):  
Joseph Alexander Ward ◽  
Ian CC King ◽  
Maria J Monroy-Iglesias ◽  
Beth Russell ◽  
Mieke Van Hemelrijck ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Lymph Node ◽  
Methodological Quality ◽  
Meta Analysis ◽  
Lower Limbs ◽  
Limb Volume ◽  
Lymph Node Transfer ◽  
Vascularized Lymph Node Transfer

e24040 Background: Cancer treatment-related lymphoedema (CTRL) is a chronic and disabling complication that carries a significant health burden during cancer survivorship. Vascularized lymph node transfer (VLNT) is employed increasingly to microsurgically reconstruct physiological lymphatic flow in affected limbs. We set out to synthesise and assess the efficacy of VLNT for reducing limb volume and infection outcomes in CTRL. Methods: A systematic review was conducted by searching PubMed, Medline and EMBASE databases during early 2020. All full-text English-language articles reporting VLNT as the sole therapeutic intervention for the management of CTRL that provided volumetric limb and/or patient-reported lymphatic quality of life and/or cellulitis-related outcomes were included. All studies were scored for methodological quality (STROBE and CONSORT checklists) and lymphoedema-specific data reporting quality. Using a random-effects model, we estimated the pooled limb volume reduction and 95% CI for upper and lower limbs stratifying according to site of measurement and VLNT donor. We also estimated the pooled reduction in cellulitis episodes and mean improvement in lymphoedema-related quality of life. PROSPERO ID: CRD42020204080. Results: The search strategy identified 277 articles. Thirty-one studies encompassing 581 patients were included with the overall methodological quality of studies assessed to be low. Meta-analysis demonstrated that performing VLNT for CTRL led to limb volume reductions in both upper limb (above elbow circumferential reduction rates (CRR) = 42.7 % (95% CI: 36.5-48.8, I2: 94.3 %, p = 0.000, 153 patients, 10 studies); below elbow CRR = 34.1 % (95% CI: 33.0-35.1, I2: 0.0 %, p = 0.919, 144 patients, 9 studies)) and lower limb (above knee CRR = 46.8 % (95% CI: 43.2-50.4, I2: 92.4 %, p = 0.000 26 patients, 3 studies); below knee CRR = 54.6 % (95% CI: 39.0-70.2, I2: 97.6%, p = 0.000, 26 patients, 3 studies)) CTRL. Similarly, extra-abdominal VLNT, abdominal VLNT and autologous breast reconstruction with VLNT reduced CTRL by CRRs of 49.5 % (95% CI: 46.5-52.5, I2: 8.3 %, p = 0.365, 7 studies, 108 patients), 39.6 % (95% CI: 37.2-42.0, I2: 89.5 %, p = 0.000, 3 studies, 15 patients) and 32.7 % (95% CI: 11.1-54.4, I2: 96.9 %, p = 0.000 3 studies, 29 patients). VLNT reduced mean annual cellulitis episodes by 2.1 (95% CI: -2.7- -1.4) episodes per annum and improved lymphoedema-specific quality of life was improved by 4.26 (LYMQOL “overall domain” scale). Conclusions: Performing VLNT for CTRL results in reductions of limb volume and cellulitis episodes for both upper and lower limbs. However, published studies were methodologically heterogeneous and of low quality highlighting the need for standardized outcome reporting and further well-designed randomized controlled trials comparing VLNT against existing therapies.

scholarly journals Quality of life and objective functional impairment in lumbar spinal stenosis: a protocol for a systematic review and meta-analysis of moderators

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e032314 ◽  
Author(s):  
Fabio Ferretti ◽  
Anna Coluccia ◽  
Roberto Gusinu ◽  
Giacomo Gualtieri ◽  
Vitaliano Francesco Muzii ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Functional Impairment ◽  
Methodological Quality ◽  
Meta Analysis ◽  
Healthy Controls ◽  
Lumbar Spinal ◽  
Objective Functional Impairment ◽  
Objective Functional

BackgroundLumbar spinal stenosis (LSS) is a common degenerative spine disease associated with a strong impairment in various quality of life areas, particularly the ability to perform work-related activity. Depression is a condition frequently associated. There is no comprehensive review on quality of life and objective functional impairment in LSS. This paper presents the protocol of the first systematic review and meta-analysis summarising evidence about quality of life and functional impairment in patients with LSS compared with healthy controls. Comorbid depressive disorders, age, gender, LSS duration, disability, pain severity and study methodological quality will be investigated as moderators.MethodsThe protocol is reported according to PRISMA-P guidelines. Studies will be included if they were conducted on patients aged 18 years old or older with primary LSS and if they reported data on differences in the levels of quality of life or objective functional impairment between patients with LSS and healthy controls. Independent reviewers will search published/unpublished studies through electronic databases and additional sources, will extract the data and assess the methodological quality. Random-effects meta-analysis will be carried out by calculating effect sizes as Cohen’sdindices. Heterogeneity will be examined by theI2and theQstatistics. Moderators will be investigated through meta-regression.ConclusionsA summary of the evidence on quality of life and functional impairment in LSS may suggest clinical and occupational health medicine strategies aimed to timely detect and prevent these outcomes. Higher percentages of patients with LSS with depression may be expected to be related to poorer quality of life. Depressive comorbidity might impact negatively on quality of life because it is associated with dysfunctional coping, disability and psychophysiological symptoms.Ethics and disseminationThe current review does not require ethics approval. The results will be disseminated through publications in peer-reviewed journals.Review registrationCRD42019132209.

scholarly journals The Impact of Tai Chi on Motor Function, Balance, and Quality of Life in Parkinson’s Disease: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Xing Yu ◽  
Xinze Wu ◽  
Guozhen Hou ◽  
Peipei Han ◽  
Liying Jiang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Motor Function ◽  
Methodological Quality ◽  
Tai Chi ◽  
Meta Analysis ◽  
Gait Velocity

Objective. Parkinson’s disease adversely affects function and quality of life, leading to increased mortality. The practice of Tai Chi has been associated with multifaceted improvements in health-related fitness. Considering the limited number of clinical studies included in previous reviews, inconsistent methodological quality, and inconclusive results, this meta-analysis aims to assess the effects of Tai Chi in patients with Parkinson’s disease. Method. Four English language databases and four Chinese databases were systematically searched for existing randomized controlled trials (RCTs) of Tai Chi in Parkinson’s disease from database inception through August 1, 2020. Methodological quality was appraised with the Cochrane Risk of Bias tool. A meta-analysis of comparative effects was performed using the Review Manager v.5.3 software. Results. Seventeen published RCTs totaling 951 subjects were included. Results showed that Tai Chi has a statistically significant effect on the outcomes of gait velocity, unified Parkinson’s disease rating scale (UPDRS) motor score, activities-specific balance confidence (ABC) score, and Berg Balance Scale (BBS). The effects on the Timed Up and Go Test (TUGT) and Parkinson’s Disease Questionnaire-39 (PDQ-39) were not statistically significant. Conclusions. This systematic review and meta-analysis of Parkinson’s disease and Tai Chi suggests Tai Chi is a relatively safe activity that can result in gains in general motor function and improve bradykinesia and balance. It has no statistically significant advantage for quality of life and functional mobility. Further randomized trials with larger sample sizes and of higher methodological quality are needed to confirm these results and to assess the feasibility of Tai Chi intervention for potential different clinical applications.

Home-Based Exercise for People With Chronic Kidney Disease: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1-12
Author(s):  
Renata Valle Pedroso ◽  
Miguel Adriano Sanchez-Lastra ◽  
Laura Iglesias Comesaña ◽  
Carlos Ayán
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Methodological Quality ◽  
Meta Analysis ◽  
Home Based ◽  
The Impact ◽  
At Home

Background: Exercise performed at home could be a useful therapy for people with chronic kidney disease. This systematic review and meta-analysis aimed at describing the characteristics, main findings, methodological quality, and adherence rate reported in the existent randomized controlled trials that have provided information regarding the impact of home-based exercise programs on people with chronic kidney disease. Methods: Electronic databases (MEDLINE/PubMed, SPORTDiscus, Scopus, and CENTRAL) were searched up to April 2021, using the keywords: “Exercise”; “Home”; “Kidney Disease.” Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was adopted. Jadad scale and Cochrane’s tool were used to assess the methodological quality and risk of bias. Results: Out of the 14 studies finally selected, 11 were included in the meta-analysis and most presented high methodological quality. The meta-analysis showed significant effects of home-based exercise on fitness and quality of life, but a little impact on renal function. Although exercise performed at home was mostly feasible and safe, adherence was not high and a considerable number of dropouts were observed. Conclusion: Home-based exercise has positive effects on the fitness’ level and on the quality of life on people with chronic kidney disease. Future studies are needed to identify whether exercise performed at home is a better physical therapy option than center-based exercise.

scholarly journals Efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission: systematic review and meta-analysis of published and unpublished randomized trial data

BMJ ◽  
2021 ◽  
pp. m4743
Author(s):  
Joshua Z Goldenberg ◽  
Andrew Day ◽  
Grant D Brinkworth ◽  
Junko Sato ◽  
Satoru Yamada ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Type 2 Diabetes ◽  
Weight Loss ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Low Carbohydrate ◽  
Remission Of Diabetes

Abstract Objective To determine the efficacy and safety of low carbohydrate diets (LCDs) and very low carbohydrate diets (VLCDs) for people with type 2 diabetes. Design Systematic review and meta-analysis. Data sources Searches of CENTRAL, Medline, Embase, CINAHL, CAB, and grey literature sources from inception to 25 August 2020. Study selection Randomized clinical trials evaluating LCDs (<130 g/day or <26% of a 2000 kcal/day diet) and VLCDs (<10% calories from carbohydrates) for at least 12 weeks in adults with type 2 diabetes were eligible. Data extraction Primary outcomes were remission of diabetes (HbA 1c <6.5% or fasting glucose <7.0 mmol/L, with or without the use of diabetes medication), weight loss, HbA 1c , fasting glucose, and adverse events. Secondary outcomes included health related quality of life and biochemical laboratory data. All articles and outcomes were independently screened, extracted, and assessed for risk of bias and GRADE certainty of evidence at six and 12 month follow-up. Risk estimates and 95% confidence intervals were calculated using random effects meta-analysis. Outcomes were assessed according to a priori determined minimal important differences to determine clinical importance, and heterogeneity was investigated on the basis of risk of bias and seven a priori subgroups. Any subgroup effects with a statistically significant test of interaction were subjected to a five point credibility checklist. Results Searches identified 14 759 citations yielding 23 trials (1357 participants), and 40.6% of outcomes were judged to be at low risk of bias. At six months, compared with control diets, LCDs achieved higher rates of diabetes remission (defined as HbA 1c <6.5%) (76/133 (57%) v 41/131 (31%); risk difference 0.32, 95% confidence interval 0.17 to 0.47; 8 studies, n=264, I 2 =58%). Conversely, smaller, non-significant effect sizes occurred when a remission definition of HbA 1c <6.5% without medication was used. Subgroup assessments determined as meeting credibility criteria indicated that remission with LCDs markedly decreased in studies that included patients using insulin. At 12 months, data on remission were sparse, ranging from a small effect to a trivial increased risk of diabetes. Large clinically important improvements were seen in weight loss, triglycerides, and insulin sensitivity at six months, which diminished at 12 months. On the basis of subgroup assessments deemed credible, VLCDs were less effective than less restrictive LCDs for weight loss at six months. However, this effect was explained by diet adherence. That is, among highly adherent patients on VLCDs, a clinically important reduction in weight was seen compared with studies with less adherent patients on VLCDs. Participants experienced no significant difference in quality of life at six months but did experience clinically important, but not statistically significant, worsening of quality of life and low density lipoprotein cholesterol at 12 months. Otherwise, no significant or clinically important between group differences were found in terms of adverse events or blood lipids at six and 12 months. Conclusions On the basis of moderate to low certainty evidence, patients adhering to an LCD for six months may experience remission of diabetes without adverse consequences. Limitations include continued debate around what constitutes remission of diabetes, as well as the efficacy, safety, and dietary satisfaction of longer term LCDs. Systematic review registration PROSPERO CRD42020161795.

scholarly journals The Prevalence of Sarcopenia and Its Impact on Clinical Outcomes in Lumbar Degenerative Spine Disease—A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (4) ◽  
pp. 773
Author(s):  
Wei-Ting Wu ◽  
Tsung-Min Lee ◽  
Der-Sheng Han ◽  
Ke-Vin Chang
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Clinical Manifestations ◽  
Current Evidence ◽  
Degenerative Spine ◽  
Degenerative Spine Disease ◽  
Spine Disease

The association of sarcopenia with poor clinical outcomes has been identified in various medical conditions, although there is a lack of quantitative analysis to validate the influence of sarcopenia on patients with lumbar degenerative spine disease (LDSD) from the available literature. Therefore, this systematic review and meta-analysis aimed to summarize the prevalence of sarcopenia in patients with LDSD and examine its impact on clinical outcomes. The electronic databases (PubMed and Embase) were systematically searched from inception through December 2020 for clinical studies investigating the association of sarcopenia with clinical outcomes in patients with LDSD. A random-effects model meta-analysis was carried out for data synthesis. This meta-analysis included 14 studies, comprising 1953 participants. The overall prevalence of sarcopenia among patients with LDSD was 24.8% (95% confidence interval [CI], 17.3%–34.3%). The relative risk of sarcopenia was not significantly increased in patients with LDSD compared with controls (risk ratio, 1.605; 95% CI, 0.321–8.022). The patients with sarcopenia did not experience an increase in low back and leg pain. However, lower quality of life (SMD, −0.627; 95% CI, −0.844–−0.410) were identified postoperatively. Sarcopenia did not lead to an elevated rate of complications after lumbar surgeries. Sarcopenia accounts for approximately one-quarter of the population with LDSD. The clinical manifestations are less influenced by sarcopenia, whereas sarcopenia is associated with poorer quality of life after lumbar surgeries. The current evidence is still insufficient to support sarcopenia as a predictor of postoperative complications.

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