scholarly journals Mobile health technologies supporting colonoscopy preparation: A systematic review and meta-analysis of randomized controlled trials

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248679
Author(s):  
Maria El Bizri ◽  
Mariam El Sheikh ◽  
Ga Eun Lee ◽  
Maida J. Sewitch
Keyword(s):  
Bowel Preparation ◽  
User Satisfaction ◽  
Methodological Quality ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Funnel Plot ◽  
Randomized Controlled ◽  
Adherence To Diet ◽  
Colonoscopy Preparation ◽  
Colonoscopy Quality

Background Mobile health (mHealth) technologies are innovative solutions for delivering instructions to patients preparing for colonoscopy. Objective To systematically review the literature evaluating the effectiveness of mHealth technologies supporting colonoscopy preparation on patient and clinical outcomes. Methods MEDLINE, EMBASE, CINAHL and CENTRAL were searched for randomized controlled trials (RCTs) that evaluated the effectiveness of mHealth technologies for colonoscopy preparation on patient and clinical outcomes. Two reviewers independently assessed study eligibility, extracted data, and appraised methodological quality using the Cochrane Risk-of-Bias tool. Data were pooled using random effects models and when heterogeneity, assessed using I2, was statistically significant, a qualitative synthesis of the data was performed. Publication bias was assessed using a funnel plot. Results Ten RCTs (3,383 participants) met inclusion criteria. MHealth interventions included smartphone apps, SMS text messages, videos, camera apps, and a social media app. Outcomes were bowel cleanliness quality, user satisfaction, colonoscopy quality indicators (cecal intubation time, withdrawal time, adenoma detection rate), adherence to diet, and cancellation/no-show rates. MHealth interventions were associated with better bowel cleanliness scores on the Boston Bowel Preparation Scale [standardized mean difference (SMD) 0.57, 95%CI 0.37–0.77, I2 = 60%, p = 0.08] and the Ottawa Bowel Preparation Scale [SMD -0.39, 95%CI -0.59–0.19, I2 = 45%, p = 0.16], but they were not associated with rates of willingness to repeat the colonoscopy using the same regimen [odds ratio (OR) 1.88, 95%CI 0.85–4.15, I2 = 48%, p = 0.12] or cancellations/no-shows [OR 0.96, 95%CI 0.68–1.35, I2 = 0%]. Most studies showed that adequate bowel preparation, user satisfaction and adherence to diet were better in the intervention groups compared to the control groups, while inconsistent findings were observed for the colonoscopy quality indicators. All trials were at high risk of bias for lack of participant blinding. Visual inspection of a funnel plot revealed publication bias. Conclusions MHealth technologies show promise as a way to improve bowel cleanliness, but trials to date were of low methodological quality. High-quality research is required to understand the effectiveness of mHealth technologies on colonoscopy outcomes.

scholarly journals A159 ARE MOBILE HEALTH TECHNOLOGIES SUPPORTING COLONOSCOPY PREPARATION ASSOCIATED WITH BETTER PATIENT OUTCOMES: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 23-24
Author(s):  
M El Sheikh ◽  
G Lee ◽  
M El Bizri ◽  
M J Sewitch
Keyword(s):  
Systematic Review ◽  
Patient Outcomes ◽  
User Satisfaction ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Health Technologies ◽  
Randomized Controlled ◽  
Statistical Heterogeneity ◽  
Mcgill University ◽  
Colonoscopy Preparation

Abstract Background Mobile health technologies are innovative solutions for delivering instructions to patients preparing for their colonoscopy appointments. Aims To systematically review the literature of the effect of smartphone-based technologies supporting colonoscopy appointment preparation on patient outcomes. Methods With the assistance of a librarian, one author searched MEDLINE, EMBASE, CINAHL and CENTRAL for randomized controlled trials (RCTs) that evaluated the effect of smartphone-based technologies for colonoscopy preparation on bowel cleanliness and user satisfaction. Two independent reviewers extracted data on patient and intervention characteristics and study outcomes, and appraised study quality using the Cochrane Risk-of-Bias tool. Summary statistics were generated using random effects models for the trials that used either the Boston Bowel Preparation Scale (BPPS) or the Ottawa Bowel Preparation Scale (OBPS). Statistical heterogeneity was assessed using I2. Results Ten RCTs met our inclusion criteria. Smartphone-based interventions included apps, SMS text messages, video clips, camera apps, and social media apps. Most studies showed smartphone-based interventions were associated with better quality bowel cleanliness scores and higher user satisfaction compared to usual care. Standardized mean differences for the BBPS and OBPS differed between the intervention and control groups [SMD 0.57, 95%CI 0.18, 0.95] and [SMD -0.39, 95%CI -0.59, -0.19], respectively. Statistically significant statistical heterogeneity was found for the meta-analyses for the trials employing the BBPS (I2=80%, p=0.03) but not for the trials using the OBPS (I2=45%, p=0.16). All RCTs were at high risk of bias from non-blinded participants, and most studies were at high or unclear risk of bias due to lack of allocation concealment. Funnel plots to evaluate publication bias were not generated as there were too few studies with sufficient data to analyze. Conclusions This systematic review found that smartphone-based technology users had better bowel cleanliness quality scores and higher satisfaction with the method of delivering instructions compared to patients given usual care. Given that all RCTs were at high risk of bias, high-quality RCTs that blind participants and conceal study group allocation are needed. Funding Agencies CIHRDepartment of Medicine, McGill University and the Research Institute of the McGill University Health Centre

RANDOMISED CONTROLLED TRIALS OF CHRONIC PAIN IN CHILDREN AND ADOLESCENTS: A SYSTEMATIC REVIEW

2015 ◽  
Vol 101 (1) ◽  
pp. e1.66-e1
Author(s):  
Rym Boulkedid ◽  
Armiya Yousouf Abdou ◽  
Emilie Desselas ◽  
Marlène Monegat ◽  
Corinne Alberti ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Randomized Controlled Trials ◽  
Children And Adolescents ◽  
Methodological Quality ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Recurrent Pain ◽  
Pharmacological Agents ◽  
Randomized Controlled

BackgroundApproximately 15 to 30% of children and adolescents suffer from daily pain persistent over more than 3 months and there is evidence supporting that the prevalence of chronic pain is steadily increasing in this population. Chronic pain is known to have a negative impact on children's development and social behaviour, leading often to severe psychological distress and physical disability. We reviewed medical literature to assess the characteristics and quality of randomized controlled trials (RCTs) on pharmacological and non-pharmacological therapies in chronic and recurrent pain in the paediatric population.MethodsWe performed a systematic search of PubMed, Embase and the Cochrane Library up to March 2014. Bibliographies of relevant articles were also hand-searched. We included all RCTs that involved children and adolescents (age 0 to 18 years) and evaluated the use of a pharmacological agent or a non-pharmacological approach in the context of chronic or recurrent pain. The latter was defined as pain persisting for more than 3 months. Methodological quality was evaluated using the Cochrane Risk of Bias Tool. Two reviewers independently assessed studies for inclusion and evaluated methodological quality.ResultsA total of 52 randomized controlled trials were selected and included in the analysis. The majority were conducted in single hospital institutions, with no information on study funding. Median sample size was 45 (34–57) participants. Almost 50% of the RCTs included both adults and children with a median age at inclusion of 13 years. Non-pharmacological approaches were more commonly tested whereas evaluation of pharmacological agents concerned less than 30% of RCTs. Abdominal pain and headache were the most common types of chronic pain experienced among trial participants. Overall, the methodological quality was poor and did not parallel the number of RCTs that increased over the years. The risk of bias was high or unclear in 70% of the trials.ConclusionsThis is the first systematic review of RCTs conducted to evaluate pharmacological and non-pharmacological therapies in chronic and recurrent pain in children and adolescents. Although, management of pain in adults has significantly improved over the years due to the evaluation of numerous analgesic therapies, our results highlight the existing knowledge gap with regards to children and adolescents. Therapeutic strategies, in particular pharmacological agents, applied to relieve chronic or recurrent pain in children and adolescents are not evaluated through high quality RCTs. The need to improve analgesic therapy in children and adolescents with chronic pain is still unmet. We discuss possible research constraints and challenges related to this fact as well as adequate methodologies to circumvent them.

Quality and Risk of Bias in Panax ginseng Randomized Controlled Trials: A Review

2013 ◽  
Vol 41 (02) ◽  
pp. 231-252 ◽  
Author(s):  
Johannah L. Shergis ◽  
Anthony L. Zhang ◽  
Wenyu Zhou ◽  
Charlie C. Xue
Keyword(s):  
Randomized Controlled Trials ◽  
Panax Ginseng ◽  
Methodological Quality ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Publication Date ◽  
Inclusion Criteria ◽  
Randomized Controlled ◽  
Clinical Benefits

Panax ginseng is one of the most frequently used herbs in the world. Numerous trials have evaluated its clinical benefits. However, the quality of these studies has not been comprehensively and systematically assessed. We reviewed randomized controlled trials (RCTs) of Panax ginseng to evaluate their quality and risk of bias. We searched four English databases, without publication date restriction. Two reviewers extracted details about the studies' methodological quality, guided by the Consolidated Standards of Reporting Trials (CONSORT) checklist and its extension for herbal interventions. Risk of bias was determined using the Cochrane Risk of Bias tool. Of 475 potentially relevant studies, 58 met our inclusion criteria. In these 58 studies, 48.3% of the suggested CONSORT checklist items and 35.9% of the extended herbal items were reported. The quality of RCTs published after the CONSORT checklist improved. Until 1995 (before CONSORT) (n = 4), 32.8% of the items were reported in studies. From 1996–2006 (CONSORT published and revised) (n = 30), 46.1% were reported, and from 2007 (n = 24), 53.5% were reported (p = 0.005). After the CONSORT extension for herbal interventions was published in 2006, RCT quality also improved, although not significantly. Until 2005 (n = 34), 35.2% of the extended herbal items were reported in studies; and from 2006 onwards (n = 24), 37.3% were reported (p = 0.64). Most studies classified risk of bias as "unclear". Overall, the quality of Panax ginseng RCT methodology has improved since the CONSORT checklist was introduced. However, more can be done to improve the methodological quality of, and reporting in, RCTs.

scholarly journals Pharmacological Prevention of Postoperative Delirium: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Yong Liu ◽  
Xiao-Jin Li ◽  
Yi Liang ◽  
Yan Kang
Keyword(s):  
Beneficial Effect ◽  
Randomized Controlled Trials ◽  
Methodological Quality ◽  
Postoperative Delirium ◽  
Risk Of Bias ◽  
Low Risk ◽  
Sufficient Evidence ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Pharmacological Prevention

Background. The high prevalence of delirium among postoperative patients has increased morbidity and mortality. The kind of drug that can effectively reduce the incidence of delirium has become the focus of discussion in recent years. However, a consensus in this respect has yet to be reached. Methods. Randomized controlled trials (RCTs) were retrieved from the PubMed, Cochrane Library, ClinicalTrials.gov, and Embase databases from their inception through October 12, 2018. We included RCTs of pharmacological prevention for postoperative delirium in adults (at least 18 years), and the Cochrane risk of bias tool was used to evaluate the methodological quality of trials. The primary outcomes were the risk ratios (RRs) of incidence of postoperative delirium, and the secondary outcomes were the RRs of mortality and adverse events in the intervention and control groups. Results. Thirty-eight trials, which comprised 20302 patients and 18 different drugs, were included in the analysis. Of the 38 studies, 17 were rated as low risk with respect to methodological quality. Dexmedetomidine administration (RR 0.58, 95%CI 0.44-0.76, P<0.01) was associated with a significantly lower incidence of postoperative delirium than the control conditions. However, the findings from the studies with a low risk of bias did not show a significant difference in this beneficial effect (RR 0.64, 95%CI 0.39-1.04, P=0.07). The antipsychotic drugs olanzapine (RR 0.44, 95%CI 0.30- 0.65, P<0.01) and risperidone (RR 0.42, 95%CI 0.19-0.92, P=0.03) had promising effects, but there was a lack of sufficient evidence to obtain a definitive conclusion. The beneficial effect of other drugs, including haloperidol, methylprednisolone, dexamethasone, gabapentin, ketamine, cyproheptadine, donepezil, hypertonic saline, melatonin, nimodipine, ondansetron, pregabalin, rivastigmine, TJ-54, and tryptophan, was not proven on the basis of present evidence. Conclusion. Among the pharmacological prophylactic measures for postoperative delirium, dexmedetomidine, olanzapine, and risperidone showed higher efficacy than other drugs. However, more high-quality evidence is needed to confirm these results.

scholarly journals Identifying Items to Assess Methodological Quality in Physical Therapy Trials: A Factor Analysis

2014 ◽  
Vol 94 (9) ◽  
pp. 1272-1284 ◽  
Author(s):  
Susan Armijo-Olivo ◽  
Greta G. Cummings ◽  
Jorge Fuentes ◽  
Humam Saltaji ◽  
Christine Ha ◽  
...  
Keyword(s):  
Factor Analysis ◽  
Physical Therapy ◽  
Methodological Quality ◽  
Principal Axis ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Confirmatory Factor ◽  
Principal Axis Factoring

Background Numerous tools and individual items have been proposed to assess the methodological quality of randomized controlled trials (RCTs). The frequency of use of these items varies according to health area, which suggests a lack of agreement regarding their relevance to trial quality or risk of bias. Objective The objectives of this study were: (1) to identify the underlying component structure of items and (2) to determine relevant items to evaluate the quality and risk of bias of trials in physical therapy by using an exploratory factor analysis (EFA). Design A methodological research design was used, and an EFA was performed. Methods Randomized controlled trials used for this study were randomly selected from searches of the Cochrane Database of Systematic Reviews. Two reviewers used 45 items gathered from 7 different quality tools to assess the methodological quality of the RCTs. An exploratory factor analysis was conducted using the principal axis factoring (PAF) method followed by varimax rotation. Results Principal axis factoring identified 34 items loaded on 9 common factors: (1) selection bias; (2) performance and detection bias; (3) eligibility, intervention details, and description of outcome measures; (4) psychometric properties of the main outcome; (5) contamination and adherence to treatment; (6) attrition bias; (7) data analysis; (8) sample size; and (9) control and placebo adequacy. Limitation Because of the exploratory nature of the results, a confirmatory factor analysis is needed to validate this model. Conclusions To the authors' knowledge, this is the first factor analysis to explore the underlying component items used to evaluate the methodological quality or risk of bias of RCTs in physical therapy. The items and factors represent a starting point for evaluating the methodological quality and risk of bias in physical therapy trials. Empirical evidence of the association among these items with treatment effects and a confirmatory factor analysis of these results are needed to validate these items.

scholarly journals The Effects of Respiratory Training in Parkinson’s Disease: A Systematic Review

2020 ◽  
Vol 10 (4) ◽  
pp. 1315-1333
Author(s):  
Veerle A. van de Wetering-van Dongen ◽  
Johanna G. Kalf ◽  
Philip J. van der Wees ◽  
Bastiaan R. Bloem ◽  
Maarten J. Nijkrake
Keyword(s):  
Systematic Review ◽  
Muscle Strength ◽  
Methodological Quality ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Respiratory Dysfunction ◽  
Positive Effects ◽  
Randomized Controlled ◽  
Respiratory Training ◽  
Incentive Spirometry

Background: Signs of respiratory dysfunction can be present already early in the course of Parkinson’s disease (PD). Respiratory training could alleviate this, but its effectiveness is not well understood. Objective: The purpose of this systematic review is to review the efficacy of different respiratory training interventions in PD. Methods: A search strategy was performed in four databases: PubMed, Physiotherapy Evidence Database (PEDro), Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Methodological quality of original full-text articles was assessed using the Cochrane Risk of Bias tool for randomized controlled trials (RCTs) and the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool for the controlled trials (CTs). Levels of evidence were rated by the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. Results: Six papers reporting on four randomized controlled trials and another four controlled trials were included. Positive effects were reported for inspiratory muscle strength training (IMST), expiratory muscle strength training (EMST), air stacking, breath-stacking, incentive spirometry and postural training on respiratory muscle strength, swallowing safety, phonatory aspects and chest wall volumes. Best methodological quality was found for breath-stacking and incentive spirometry. Best levels of evidence were found for EMST, IMST and EMST plus air stacking. Conclusion: Respiratory training shows positive effects and should be considered when people with PD experience respiratory dysfunction. Future studies should focus on standardizing both training devices, instruments to measure outcomes and intervention protocols to further increase the level of evidence.

scholarly journals Complementary and Alternative Medicine for the Treatment of Abnormal Endometrial Conditions in Women with PCOS: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 2021 ◽  
pp. 1-17
Author(s):  
Jiayu Hu ◽  
Wenhua Shi ◽  
Jiayue Xu ◽  
Shaoxuan Liu ◽  
Siya Hu ◽  
...  
Keyword(s):  
Chinese Medicine ◽  
Traditional Chinese Medicine ◽  
Randomized Controlled Trials ◽  
Western Medicine ◽  
Methodological Quality ◽  
Endometrial Thickness ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Randomized Controlled

Background. Endometrial lesions in patients with polycystic ovary syndrome (PCOS) exhibit complex pathological features, and these patients are at risk of both short-term and long-term complications. Complementary and alternative medicine (CAM), which is gradually becoming more accepted and is believed to be clinically effective, claims to be promising for treating PCOS, and thus its effect on the abnormal endometrium of PCOS patients should be assessed. The present meta-analysis sought to evaluate the efficacy and safety of CAM in treating endometrial lesions in patients with PCOS. Methods. Randomized trials on CAM were identified in four Chinese and seven English-language databases from their establishment to January 2020. The present study included patients diagnosed with PCOS and abnormal endometrial conditions who underwent CAM therapy independently or in combination with traditional western medicine. Data were extracted, and the Cochrane “risk of bias” tool was used to assess methodological quality. Effects were expressed as the relative risk (RR) or mean difference (MD/SMD) with 95% confidence interval (CI) as calculated with Rev Man 5.3. Results. A total of 13 randomized controlled trials were included, involving 1,297 PCOS patients treated for endometrial abnormalities. Methodological quality was generally unclear or had a low risk of bias. The trials tested four different types of CAM therapies (i.e., traditional Chinese medicine treatment, acupuncture treatment, traditional Chinese medicine in combination with western medicine treatment, and acupuncture in combination with western medicine treatment). CAM treatment could significantly reduce the endometrial thickness in PCOS patients compared to western medicine alone (SMD −0.88, 95% CI [−0.12, −0.57]; I2 = 64%). Compared with clomiphene treatment for the induction of ovulation, CAM treatment showed a clear improvement in endometrial thickness during ovulation (SMD 2.03, 95% CI [1.64, 2.02]; I2 = 48%). Moreover, CAM was more effective than western medicine alone in reducing the endometrial spiral artery pulsatility index. No significant difference was seen between CAM and traditional treatment when these were used to improve traditional Chinese medicine syndrome scores. Acupuncture alone or traditional Chinese medicines (taken orally) in combination with western medicine significantly increased the pregnancy rate of PCOS patients (RR 1.59, 95% CI [1.30, 1.93]; I2 = 51%, P < 0.00001 ), and CAM was more effective than western medicine alone for improving hormone levels. No serious adverse events were reported in 11 of the 13 trials. Conclusions. CAM may effectively ameliorate the endometrial condition of PCOS patients, and it can regulate the level of hormone secretion to increase the ovulation rate and the pregnancy rate.

Skeletal and dental effects of surgically assisted rapid palatal expansion: a systematic review of randomized controlled trials

2019 ◽  
Vol 42 (4) ◽  
pp. 434-440 ◽  
Author(s):  
Francesco Bortolotti ◽  
Livia Solidoro ◽  
Maria Lavinia Bartolucci ◽  
Serena Incerti Parenti ◽  
Corrado Paganelli ◽  
...  
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Methodological Quality ◽  
Meta Analysis ◽  
Transverse Dimension ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Quality Of Evidence ◽  
Randomized Controlled

Summary Background Surgically assisted rapid maxillary expansion (SARME) is a surgical technique developed to correct transverse discrepancies in skeletally mature patients. However, there is limited evidence concerning the immediate skeletal and dental changes obtained only due to SARME. Objective The aim of the present systematic review is to investigate the immediate skeletal and dental effects of SARME in adult patients with transverse maxillary hypoplasia. Search Methods An electronic search of the literature in MEDLINE, The Cochrane Library, Lilacs and Scopus databases was performed. Selection Criteria Only randomized controlled trials (RCTs) studies investigating the skeletal and dental effects of SARME procedures in adult patients were included. Data Collection and Analysis The included studies received a methodological quality scoring according to the revised Cochrane risk-of-bias tool for randomized trials. The quality of evidence was assessed by means of the Grading Recommendation Assessment, Development and Evaluation (GRADE) system. For each included study and for each analysed parameter, the difference in means and 95 per cent confidence interval was calculated between baseline and immediate post-expansion. A meta-analysis of original outcome data, if possible, was conducted. Results Nine articles were selected. The methodological quality ratings indicated that one study was at low risk of bias, seven presented some concerns and only one was at high risk of bias. In all the included studies, the SARME procedure resulted in a significant expansion of the maxillary transverse dimension. The meta-analysis compared skeletal and dental inter-molar width before and after treatment: the mean difference was of 3.3 mm (2.8–3.9) and 7.0 mm (6.1–7.8), respectively (P-value less than 0.001). The quality of evidence was low-moderate. Conclusions SARME is effective in obtaining a significant expansion of the maxillary transverse dimension. However, the immediate SARME effect is mainly a molar expansion rather than a pure bone transverse widening of the maxilla. Registration The review protocol was registered at PROSPERO database with the registration number CRD42018117967.

scholarly journals Efficacy of Mind-Body Therapies for the Treatment of Urinary Incontinence in Women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 8 (2) ◽  
Author(s):  
Kannan P ◽  
◽  
Sy SL ◽  
Boghra S ◽  
◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Pelvic Floor ◽  
Randomized Controlled Trials ◽  
Methodological Quality ◽  
Pooled Analysis ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Low Grade ◽  
Randomized Controlled ◽  
Evidence Database

Introduction: The efficacy of mind-body therapies to manage urinary incontinence in women is outdated and inconclusive. This review aims to determine the efficacy of mind - body therapies for Stress Urinary Incontinence (SUI) in women. Methods: The databases AMED, CINAHL, EMBASE, Medline, Physiotherapy Evidence Database (PEDro), PubMed, Scopus, and Web of Science, were searched from database inception until May 2020. Randomized controlled trials comparing mind-body therapies to control were included. The methodological quality and the quality of the evidence were evaluated using the Physiotherapy Evidence Database (PEDro) scale and the Grading of Recommendations, Assessment, Development, and Evaluation tool, respectively. The risk of bias was assessed using the Cochrane risk of bias tool. Results: Six studies were included in the review. Pooled analysis of data from two studies of low to high methodological quality, low-grade evidence revealed a statistically significant decrease in the number of SUI episodes in the yoga group than in the control group (MD 0.83 [95% CI-1.64 to 0.02]; p=0.04). Pooled analysis of three methodologically low-quality, very low-grade studies revealed no significant difference between groups receiving Paula exercise and pelvic floor muscle training on grams of urine lost in the 1h pad test (MD 0.15 [95% CI-1.15 to 1.46] p=0.82). Conclusions: This review found hatha yoga poses intended to address the pelvic floor as beneficial for managing SUI in women. Yoga is a low-risk intervention and therefore it may be considered for clinical use. The effect of Paula exercise on SUI remains inconclusive.

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