How Well Do Randomized Controlled Trials Reflect Standard Care: A Comparison between Scientific Research Data and Standard Care Data in Patients with Intermittent Claudication undergoing Supervised Exercise Therapy

Abstract Background: The primary purpose of this study is to develop a decision support approach to support physicians or other healthcare professionals in comparing diﬀerent exercise therapies and identifying the most preferred one by balancing among cost, ability of improving physical function and reducing pain in patients with knee osteoarthritis.Methods: Thirty-one exercise therapies were selected from twenty-one randomized controlled trials from a previous meta-analysis. A multiobjective optimization model was designed to characterize the goodness of an exercise therapy based on ﬁve conﬂicting criteria: minimizing cost, maximizing pain reduction and disability improvement, minimizing the number of supervised exercise sessions and the length of the treatment period. Costs were estimated based on personal expenses regarding the information given in the collected randomized controlled trials. A novel interactive multiobjective optimization method was introduced to solve the model, where the physician’s preferences were taken into account in ﬁnding the most preferred exercise therapy. Results: An experienced physiotherapist was involved as a decision maker in the interactive solution process testing the proposed decision support approach. He iteratively provided preference information until he was satisﬁed with the set of therapies shown. After a more in-depth detailed analysis of selected therapies, the decision maker was able to ﬁnd the most preferred exercise therapy based on the patient's needs and health status. Conclusions: The proposed interactive multiobjective optimization method is promising in supporting the decision maker in balancing among conﬂicting criteria to ﬁnd the most preferred exercise therapy for patients with knee osteoarthritis. Moreover, the proposed method is generic enough to be applied in any field of medical and healthcare settings, where several alternative treatment options exist.

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Abstract 19720: Jay D. Coffman Early Career Investigator Award: Comparative Efficacy of Initial Endovascular Revascularization vs. Supervised Exercise Training in Patients With Intermittent Claudication: A Meta-analysis of Randomized Controlled Trials

Circulation ◽

10.1161/circ.132.suppl_3.19720 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Ambarish Pandey ◽

Subhash Banerjee ◽

Christian Ngo ◽

Purav Mody ◽

Steven Marso ◽

...

Keyword(s):

Exercise Training ◽

Randomized Controlled Trials ◽

Intermittent Claudication ◽

Meta Analysis ◽

Walking Distance ◽

Controlled Trials ◽

Randomized Controlled ◽

Supervised Exercise ◽

Endovascular Revascularization

Introduction: Current guidelines recommend supervised exercise training (SET) as the initial treatment modality for patients with intermittent claudication (IC), in addition to optimal medical therapy. The role of endovascular revascularization (ER) as a primary treatment option has been controversial. We performed a meta-analysis to compare the efficacy of initial ER vs. initial SET in patients with IC using data from randomized controlled trials. Methods: The primary outcome was treadmill-measured maximum walking distance (MWD) at the end of follow-up. Secondary outcomes included resting ankle brachial index (ABI) and treadmill-measured ischemic claudication distance (ICD) on follow-up. Risk of adverse limb events (revascularization, amputations) was also compared between the two groups. Random effects models were used for all analyses. Results: We included 1,145 patients from nine trials with a mean follow up duration of 13.7 months (42% aortoiliac lesions; 35% stent use; mean baseline ABI 0.64 vs. 0.67 for ER vs. SET). Follow-up MWD was not significantly different between patients undergoing ER vs. SET [Weighted mean difference (WMD) (95% CI): 19.1 m (-79.6 to 117.8 m); publication bias p=0.86]. Metaregression did not identify significant differences based on stent use or presence of aortoiliac disease. ICD was also similar between the two groups [WMD (95% CI): 36.1 m (-99.4 to 171.5 m)]. In contrast, patients undergoing ER had higher resting ABI on follow-up [WMD (95% CI): 0.14 (0.11 to 0.17), p<0.0001]. Adverse limb event rates were similar [5.4% vs. 8.2%, p=0.21]. Conclusion: Compared with initial SET, initial ER significantly improves resting ABI values. Although longer walking distance and lower rates of adverse limb events also appeared favorable for ER, these differences were not statistically significant in these intermediate term studies. Longer-term studies and those incorporating contemporary revascularization techniques are necessary.

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Cost-effectiveness Analysis of a Randomized Controlled Trial (SUPER): Endovascular Revascularization or Supervised Exercise Therapy for Intermittent Claudication Due to Iliac Artery Obstruction

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2019.06.926 ◽

2019 ◽

Vol 58 (6) ◽

pp. e315-e316

Author(s):

Nick S. Van Reijen ◽

Susan van Dieren ◽

Mark J. Koelemay

Keyword(s):

Randomized Controlled Trial ◽

Cost Effectiveness ◽

Intermittent Claudication ◽

Exercise Therapy ◽

Iliac Artery ◽

Controlled Trial ◽

Randomized Controlled ◽

Supervised Exercise ◽

Effectiveness Analysis ◽

Artery Obstruction

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Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis

Physical Therapy ◽

10.2522/ptj.20140548 ◽

2016 ◽

Vol 96 (1) ◽

pp. 9-25 ◽

Cited By ~ 78

Author(s):

Susan Armijo-Olivo ◽

Laurent Pitance ◽

Vandana Singh ◽

Francisco Neto ◽

Norman Thie ◽

...

Keyword(s):

Systematic Review ◽

Randomized Controlled Trials ◽

Manual Therapy ◽

Temporomandibular Disorders ◽

Standard Care ◽

Risk Of Bias ◽

Controlled Trials ◽

Therapeutic Exercise ◽

Randomized Controlled

Background Manual therapy (MT) and exercise have been extensively used to treat people with musculoskeletal conditions such as temporomandibular disorders (TMD). The evidence regarding their effectiveness provided by early systematic reviews is outdated. Purpose The aim of this study was to summarize evidence from and evaluate the methodological quality of randomized controlled trials that examined the effectiveness of MT and therapeutic exercise interventions compared with other active interventions or standard care for treatment of TMD. Data Sources Electronic data searches of 6 databases were performed, in addition to a manual search. Study Selection Randomized controlled trials involving adults with TMD that compared any type of MT intervention (eg, mobilization, manipulation) or exercise therapy with a placebo intervention, controlled comparison intervention, or standard care were included. The main outcomes of this systematic review were pain, range of motion, and oral function. Forty-eight studies met the inclusion criteria and were analyzed. Data Extraction Data were extracted in duplicate on specific study characteristics. Data Synthesis The overall evidence for this systematic review was considered low. The trials included in this review had unclear or high risk of bias. Thus, the evidence was generally downgraded based on assessments of risk of bias. Most of the effect sizes were low to moderate, with no clear indication of superiority of exercises versus other conservative treatments for TMD. However, MT alone or in combination with exercises at the jaw or cervical level showed promising effects. Limitations Quality of the evidence and heterogeneity of the studies were limitations of the study. Conclusions No high-quality evidence was found, indicating that there is great uncertainty about the effectiveness of exercise and MT for treatment of TMD.

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