Cupping therapy and chronic back pain: systematic review and meta-analysis

ABSTRACT Objectives: to evaluate the evidence from the literature regarding the effects of cupping therapy on chronic back pain in adults, the most used outcomes to evaluate this condition, the protocol used to apply the intervention and to investigate the effectiveness of cupping therapy on the intensity of chronic back pain. Method: systematic review and meta-analysis carried out by two independent researchers in national and international databases. Reference lists of systematic reviews were also explored. The quality of evidence was assessed according to the Jadad scale. Results: 611 studies were identified, of which 16 were included in the qualitative analysis and 10 in the quantitative analysis. Cupping therapy has shown positive results on chronic back pain. There is no standardization in the treatment protocol. The main assessed outcomes were pain intensity, physical incapacity, quality of life and nociceptive threshold before the mechanical stimulus. There was a significant reduction in the pain intensity score through the use of cupping therapy (p = 0.001). Conclusion: cupping therapy is a promising method for the treatment of chronic back pain in adults. There is the need to establish standardized application protocols for this intervention.

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Radiofrequency denervation for chronic back pain: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2019-035540 ◽

2020 ◽

Vol 10 (7) ◽

pp. e035540

Author(s):

Mary Elizabeth Chappell ◽

Raj Lakshman ◽

Patrick Trotter ◽

Mark Abrahams ◽

Michael Lee

Keyword(s):

Systematic Review ◽

Back Pain ◽

Chronic Back Pain ◽

Meta Analysis ◽

Intervertebral Discs ◽

Cochrane Library ◽

Controlled Trials ◽

Short Term ◽

Radiofrequency Denervation

ObjectivesTo assess the effectiveness of radiofrequency denervation (RD) of lumbosacral anatomical targets for the management of chronic back pain.DesignSystematic review and meta-analysis of randomised controlled trials (RCTs).MethodsA database search (Medline, Medline in Process, Embase, CINHAL and the Cochrane library) was conducted from January 2014 to April 2019 for placebo or no-treatment controlled trials of RD for the management of chronic back pain. Included trials were quality assessed using the Cochrane Risk-of-Bias Tool and the quality of outcomes assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Meta-analysis was conducted to calculate mean difference (MD) in post-treatment Pain Score.ResultsNineteen RCTs were included in the review. There appears to be short-term pain relief (1–3 months) provided by RD of the sacroiliac joint (five trials, MD −1.53, CI −2.62 to 0.45) and intervertebral discs (four trials, MD −0.98, CI −1.84 to 0.12), but the placebo effect is large and additional intervention effect size is small (<1 on an 11 point (0–10) Pain Scale). Longer-term effectiveness (>6 months) is uncertain.ConclusionsRD of selected lumbosacral targets appears to have a small, short-term, positive effect for the management of patients with chronic back pain. However, the quality of evidence for the majority of outcomes is low or very low quality and there is still a degree of uncertainty, particularly around the duration of effect.

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An Update of the Systematic Appraisal of the Accuracy and Utility of Lumbar Discography in Chronic Low Back Pain

January 2018 - Pain Physician ◽

10.36076/ppj.2013/16/se55 ◽

2013 ◽

Vol 2s;16 (2s;4) ◽

pp. SE55-SE95

Author(s):

Laxmaiah Manchikanti

Keyword(s):

Systematic Review ◽

Back Pain ◽

Intervertebral Disc ◽

Diagnostic Accuracy ◽

Chronic Back Pain ◽

Task Force ◽

International Association ◽

Extensive Literature ◽

Discogenic Pain

Background: The intervertebral disc has been implicated as a major cause of chronic lumbar spinal pain based on clinical, basic science, and epidemiological research. There is, however, a lack of consensus regarding the diagnosis and treatment of intervertebral disc disorders. Based on controlled evaluations, lumbar intervertebral discs have been shown to be the source of chronic back pain without disc herniation in 26% to 39% of patients. Lumbar provocation discography, which includes disc stimulation and morphological evaluation, is often used to distinguish a painful disc from other potential sources of pain. Despite the extensive literature, intense debate continues about lumbar discography as a diagnostic tool. Study Design: A systematic review of the diagnostic accuracy of lumbar provocation and analgesic discography literature. Objective: To systematically assess and re-evaluate the diagnostic accuracy of lumbar discography. Methods: The available literature on lumbar discography was reviewed. A methodological quality assessment of included studies was performed using the Quality Appraisal of Reliability Studies (QAREL) checklist. Only diagnostic accuracy studies meeting at least 50% of the designated inclusion criteria were included in the analysis. However, studies scoring less than 50% are presented descriptively and critically analyzed. The level of evidence was classified as good, fair, and limited or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to September 2012, and manual searches of the bibliographies of known primary and review articles. Results: Over 160 studies were considered for inclusion. Of these, 33 studies compared discography with other diagnostic tests, 30 studies assessed the diagnostic accuracy of discography, 22 studies assessed surgical outcomes for discogenic pain, and 3 studies assessed the prevalence of lumbar discogenic pain. The quality of the overall evidence supporting provocation discography based on the above studies appears to be fair. The prevalence of internal disc disruption is estimated to be 39% to 42%, whereas the prevalence of discogenic pain without assessing internal disc disruption is 26%. Conclusion: This systematic review illustrates that lumbar provocation discography performed according to the International Association for the Study of Pain (IASP) criteria may be a useful tool for evaluating chronic lumbar discogenic pain. Key words: Lumbar intervertebral disc, lumbar discography, provocation discography, analgesic discography, diagnostic accuracy

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Is cupping therapy effective in patients with neck pain? A systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2017-021070 ◽

2018 ◽

Vol 8 (11) ◽

pp. e021070 ◽

Cited By ~ 7

Author(s):

Seoyoun Kim ◽

Sook-Hyun Lee ◽

Me-Riong Kim ◽

Eun-Jung Kim ◽

Deok-Sang Hwang ◽

...

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Neck Pain ◽

Active Control ◽

Meta Analysis ◽

Cupping Therapy ◽

Treatment Modalities ◽

Secondary Outcome ◽

Control Group

ObjectivesNeck pain is a significant condition that is second only to depression as a cause of years lived with disability worldwide. Thus, identifying and understanding effective treatment modalities for neck pain is of heightened importance. This systematic review aimed to investigate the effects of cupping on neck pain from the current literature.DesignSystematic review and meta-analysis of randomised controlled trials (RCTs).SettingNine databases, including Chinese, Korean and Japanese databases, were searched for data up to January 2018 with no restrictions on publication language.ParticipantsPatients with neck pain.InterventionsCupping therapy as the sole or add-on intervention compared with no treatment or active controls.Primary and secondary outcome measuresPain severity, functional disability and quality of life.ResultsEighteen RCTs were selected. Compared with the no intervention group, the cupping group exhibited significant reduction in pain (mean difference (MD) −2.42(95% CI −3.98 to −0.86)) and improvement in function (MD −4.34(95% CI −6.77 to −1.19)). Compared with the active control, the cupping group reported significant reduction in pain (p=0.0009) and significantly improved quality of life (p=0.001). The group that received control treatment with cupping therapy (add-on group) displayed significant pain reduction compared with the active control group (p=0.001). Of the 18 studies, only 8 reported occurrence of adverse events, which were mostly mild and temporary.ConclusionsCupping was found to reduce neck pain in patients compared with no intervention or active control groups, or as an add-on treatment. Depending on the type of control group, cupping was also associated with significant improvement in terms of function and quality of life; however, due to the low quality of evidence of the included studies, definitive conclusions could not be drawn from this review. Future well-designed studies are needed to substantiate the effectiveness of cupping on neck pain.PROSPERO registration numberCRD42016047218.

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The Effect of Cognitive Functional Therapy for Chronic Nonspecific Low Back Pain: Systematic Review and Meta-analysis

10.21203/rs.3.rs-357578/v2 ◽

2021 ◽

Author(s):

Takahiro Miki ◽

Yu Kondo ◽

Hiroshi kurakata ◽

Eva Buzasi ◽

Tsuneo Takebayashi ◽

...

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Functional Status ◽

Meta Analysis ◽

Tertiary Care ◽

Low Back ◽

Functional Therapy

Abstract BackgroundTo apply the Bio-Psych-Social (BPS) model into clinical practice, it is important not to focus on psychosocial domains only since biomedical factors can also contribute to chronic pain conditions. The cognitive functional therapy (CFT) is the management system based on the BPS model for chronic nonspecific low back pain (CNSLBP). ObjectivesTo compare CFT with the other interventions for CNSLBP regarding pain, disability/functional status, QoL and psychological factors. DesignSystematic review and meta-analysis. MethodLiterature Search was conducted in electronic search engines. Enrolled participants included 1) CNSLBP and 2) primary, secondary, or tertiary care patients. CFT was the interventions included. Comparisons were any types of treatment. ResultsThree studies met the eligibility criteria. The total number of participants was 336. For pain intensity, MD [95% CIs] was -2.78 [-2.78−0.02] and -1.01 [-1.92−-0.10] at intermediate and long term for two studies, respectively. About disability/functional status, SMD [95% CIs] was -0.76 [-1.46−-0.07]　at the intermediate for three studies and MD [95% CIs] was -0.84 [-11.47−-5.49] at long term for two studies. About fear of physical activity, MD [95% CIs] was -3.01 [-5.14−-0.88] and -3.56 [-6.43−-0.68] at intermediate and long term for two studies, respectively. No studies reported scores associated with QOL. All the quality of the evidence was very low. ConclusionsThree studies were included and the quality of all the evidence was very low. Although the study found statistically significant differences in some measures, the effectiveness of the CFT will need to be re-evaluated in the future.PROSPERO registration number CRD42020158182

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Virtual Reality in the Treatment of Adults with Chronic Low Back Pain: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182211806 ◽

2021 ◽

Vol 18 (22) ◽

pp. 11806

Author(s):

Beatriz Brea-Gómez ◽

Irene Torres-Sánchez ◽

Araceli Ortiz-Rubio ◽

Andrés Calvache-Mateo ◽

Irene Cabrera-Martos ◽

...

Keyword(s):

Systematic Review ◽

Virtual Reality ◽

Low Back Pain ◽

Back Pain ◽

Pain Intensity ◽

Chronic Low Back Pain ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Risk Of Bias ◽

Low Back

Virtual reality (VR) can present advantages in the treatment of chronic low back pain. The objective of this systematic review and meta-analysis was to analyze the effectiveness of VR in chronic low back pain. This review was designed according to PRISMA and registered in PROSPERO (CRD42020222129). Four databases (PubMed, Cinahl, Scopus, Web of Science) were searched up to August 2021. Inclusion criteria were defined following PICOS recommendations. Methodological quality was assessed with the Downs and Black scale and the risk of bias with the Cochrane Risk of Bias Assessment Tool. Fourteen studies were included in the systematic review and eleven in the meta-analysis. Significant differences were found in favor of VR compared to no VR in pain intensity postintervention (11 trials; n = 569; SMD = −1.92; 95% CI = −2.73, −1.11; p < 0.00001) and followup (4 trials; n = 240; SDM = −6.34; 95% CI = −9.12, −3.56; p < 0.00001); and kinesiophobia postintervention (3 trials; n = 192; MD = −8.96; 95% CI = −17.52, −0.40; p = 0.04) and followup (2 trials; n = 149; MD = −12.04; 95% CI = −20.58, −3.49; p = 0.006). No significant differences were found in disability. In conclusion, VR can significantly reduce pain intensity and kinesiophobia in patients with chronic low back pain after the intervention and at followup. However, high heterogeneity exists and can influence the consistency of the results.

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Efficacy, acceptability, and safety of antidepressants for low back pain: a systematic review and meta-analysis

Systematic Reviews ◽

10.1186/s13643-021-01599-4 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Michael C. Ferraro ◽

Matthew K. Bagg ◽

Michael A. Wewege ◽

Aidan G. Cashin ◽

Hayley B. Leake ◽

...

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Pain Intensity ◽

Meta Analysis ◽

Low Back ◽

Trial Registry ◽

Clinical Trial Registry ◽

Link Type ◽

Stopping Treatment

Abstract Background Antidepressant medicines are used to manage symptoms of low back pain. The efficacy, acceptability, and safety of antidepressant medicines for low back pain (LBP) are not clear. We aimed to evaluate the efficacy, acceptability, and safety of antidepressant medicines for LBP. Methods We searched CENTRAL, MEDLINE, Embase, CINAHL, ClinicalTrials.gov, the EU Clinical Trials Register, and the WHO International Clinical Trial Registry Platform from inception to May 2020. We included published and trial registry reports of RCTs that allocated adult participants with LBP to receive an antidepressant medicine or a placebo medicine. Pairs of authors independently extracted data in duplicate. We extracted participant characteristics, study sample size, outcome values, and measures of variance for each outcome. We data using random-effects meta-analysis models and calculated estimates of effects and heterogeneity for each outcome. We formed judgments of confidence in the evidence in accordance with GRADE. We report our findings in accordance with the PRISMA statement. We prespecified all outcomes in a prospectively registered protocol. The primary outcomes were pain intensity and acceptability. We measured pain intensity at end-of-treatment on a 0–100 point scale and considered 10 points the minimal clinically important difference. We defined acceptability as the odds of stopping treatment for any reason. Results We included 23 RCTs in this review. Data were available for pain in 17 trials and acceptability in 14 trials. Treatment with antidepressants decreased pain intensity by 4.33 points (95% CI − 6.15 to − 2.50) on a 0–100 scale, compared to placebo. Treatment with antidepressants increased the odds of stopping treatment for any reason (OR 1.27 [95% CI 1.03 to 1.56]), compared to placebo. Conclusions Treatment of LBP with antidepressants is associated with small reductions in pain intensity and increased odds of stopping treatment for any reason, compared to placebo. The effect on pain is not clinically important. The effect on acceptability warrants consideration. These findings provide Level I evidence to guide clinicians in their use of antidepressants to treat LBP. Trial registration We prospectively registered the protocol for this systematic review on PROSPERO (CRD42020149275).

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Is Vitamin D Supplementation Effective for Low Back Pain? A Systematic Review and Meta-Analysis

January 2018 - Pain Physician ◽

10.36076/ppj.2018.2.121 ◽

2018 ◽

Vol 1 (21;1) ◽

pp. 121-145 ◽

Cited By ~ 13

Author(s):

Joshua Robert Zadro

Keyword(s):

Systematic Review ◽

Vitamin D ◽

Low Back Pain ◽

Back Pain ◽

Meta Analysis ◽

Vitamin D Supplementation ◽

Low Back ◽

Pharmacological Interventions ◽

Meta Analyses

Background: Low back pain (LBP) is the leading cause of years lived with disability worldwide. Current intervention strategies are failing to reduce the enormous global burden of LBP and are prompting researchers to investigate alternative management strategies, such as vitamin D supplementation. Vitamin D supplementation appears to down regulate pro-inflammatory cytokines which lead to pain and up regulate anti-inflammatory cytokines that reduce inflammation. These mechanisms might explain the increasing interest in the use of vitamin D supplementation for LBP. Objectives: To determine whether vitamin D supplementation improves pain more than a control intervention for individuals with LBP. Study Design: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Methods: We performed searches in numerous electronic databases combining key words relating to “vitamin D” and “LBP” until March 2017. Studies were included if they investigated vitamin D supplementation in participants with LBP, provided there was a comparison intervention. There was no restriction on the type of LBP, the intervention parameters investigated, or the type of clinical trial (e.g., randomized, non-randomized). Two reviewers independently performed the selection of studies, extracted data, rated the methodological quality of the included studies, and evaluated the overall quality of the evidence using the Grading of Recommendations Assessment, Delevopment, and Evaulation (GRADE) approach. Results: After screening 3,534 articles, 8 clinical trials were included in this systematic review. There is very low quality evidence (based on the GRADE approach) that vitamin D supplementation is not more effective than any intervention (including placebo, no intervention, and other conservative/ pharmacological interventions) (continuous pain measures [0–100]: mean difference [MD] = -2.65, 95% confidence interval [CI]: -10.42 to 5.12, P = 0.504, n = 5; self-reported reduction in pain: pooled odds ratio [OR] = 1.07, 95% CI: 0.35 to 3.26, P = 0.906, n = 5) or placebo/no intervention for individuals with LBP (continuous pain measures: MD = 1.29, 95% CI: -3.81 to 6.39, P = 0.620, n = 4; self-reported reduction in pain: pooled OR = 1.53, 95% CI: 0.38 to 6.20, P = 0.550, n = 4), where ‘n’ is the number of studies included in the meta-analysis. These results did not change when we stratified the meta-analyses by the type of vitamin supplementation (vitamin D3 vs. alfacalcidol) or the type of LBP (non-specific vs. LBP resulting from osteoporosis or vertebral fractures). Limitations: The overall quality of evidence was “very low” due to the poor methodological quality and small sample sizes of the included studies. Conclusions: Vitamin D supplementation is not more effective than placebo, no intervention, or other conservative/pharmacological interventions for LBP (based on very low quality evidence). These results are consistent, regardless of the type of LBP or vitamin D supplementation. Until well-designed and adequately powered clinical trials suggest otherwise, the prescription of vitamin D for LBP cannot be recommended. PROSPERO Registration No: CRD42016046874. www.crd.york.ac.uk/PROSPERO/display_record. asp?ID = CRD42016046874 Key words: Vitamin D, low back pain, chronic low back pain, alfacalcidol, osteoporosis, vertebral fractures, serum 25-hydroxyvitamin D, systematic review

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The Effect of Cognitive Functional Therapy for Chronic Nonspecific Low Back Pain: A Systematic Review and Meta-analysis

10.21203/rs.3.rs-287213/v1 ◽

2021 ◽

Author(s):

Takahiro Miki ◽

Yu Kondo ◽

Hiroshi Kurakata ◽

Eva Buzasi ◽

Tsuneo Takebayashi ◽

...

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Functional Status ◽

Meta Analysis ◽

Tertiary Care ◽

Low Back ◽

Functional Therapy

Abstract Background: To apply the Bio-Psych-Social (BPS) model into clinical practice, it is important not to focus on psychosocial domains only since biomedical factors can also contribute to chronic pain conditions. The cognitive functional therapy (CFT) is the management system based on the BPS model for chronic nonspecific low back pain (CNSLBP). Objectives: To compare CFT with the other interventions for CNSLBP regarding pain, disability/functional status, QoL and psychological factors.Design: Systematic review and meta-analysis. Method: Literature Search was conducted in electronic search engines. Enrolled participants included 1) CNSLBP and 2) primary, secondary, or tertiary care patients. CFT was the interventions included. Comparisons were any types of treatment.Results: Three studies met the eligibility criteria. The total number of participants was 336. For pain intensity, MD [95% CIs] was -2.78 [-2.78−0.02] and -1.01 [-1.92−-0.10] at intermediate and long term for two studies, respectively. About disability/functional status, SMD [95% CIs] was -0.76 [-1.46−-0.07]　at the intermediate for three studies and MD [95% CIs] was -0.84 [-11.47−-5.49] at long term for two studies. About fear of physical activity, MD [95% CIs] was -3.01 [-5.14−-0.88] and -3.56 [-6.43−-0.68] at intermediate and long term for two studies, respectively. No studies reported scores associated with QOL. All the quality of the evidence was very low. Conclusions: Three studies were included and the quality of all the evidence was very low. Although the study found statistically significant differences in some measures, the effectiveness of the CFT will need to be re-evaluated in the future.PROSPERO registration number CRD42020158182

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Pre-emptive epidural analgesia for acute and chronic post-thoracotomy pain in adults: a systematic review and meta-analysis

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2020-101708 ◽

2020 ◽

Vol 45 (12) ◽

pp. 1006-1016

Author(s):

Sun-Kyung Park ◽

Susie Yoon ◽

Bo Rim Kim ◽

Suk Hyung Choe ◽

Jae-Hyon Bahk ◽

...

Keyword(s):

Systematic Review ◽

Epidural Analgesia ◽

Pain Intensity ◽

Meta Analysis ◽

Control Group ◽

Quality Of Evidence ◽

Grade Method ◽

Meta Analyses ◽

Thoracotomy Incision

Background and objectivesEpidural analgesia is the gold standard for post-thoracotomy pain management and can be started before or after surgical incision. This systematic review and meta-analysis investigated whether pre-emptive epidural analgesia before thoracotomy incision reduces acute and chronic post-thoracotomy pain in adults compared with epidural analgesia after incision.MethodsWe searched databases including MEDLINE, Embase, and CENTRAL for randomized controlled trials comparing epidural analgesia initiated before (pre-emptive group) and after (control group) thoracotomy incision in adults. The primary outcomes were the pain intensity during rest and coughing within 72 hours after surgery and the incidence of pain 1 to 6 months after surgery. Data were combined with random-effects meta-analyses. We rated the quality of evidence as high, moderate, low, and very low using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method.ResultsWe included 19 trials with 1062 participants involving 529 in the pre-emptive group and 533 in the control group. The pain intensity was significantly lower at rest within 72 hours after surgery (19 studies, n=1062) and during coughing within 48 hours after surgery (11 studies, n=638), and the incidence of pain was significantly lower 1 to 6 months after surgery (6 studies, n=276) in the pre-emptive group than in the control group. The quality of evidence was moderate or low in the primary outcomes.ConclusionsOur review provides low-quality evidence that pre-emptive epidural analgesia reduces the intensity of acute pain and the incidence of chronic pain after thoracotomy in adults.Protocol registration numberCRD42019131620.

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Sham treatment effects in manual therapy trials on back pain patients: a systematic review and pairwise meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-045106 ◽

2021 ◽

Vol 11 (5) ◽

pp. e045106

Author(s):

Carolina Lavazza ◽

Margherita Galli ◽

Alessandra Abenavoli ◽

Alberto Maggiani

Keyword(s):

Systematic Review ◽

Back Pain ◽

Manual Therapy ◽

Treatment Effects ◽

Meta Analysis ◽

Drop Out ◽

Sham Treatment ◽

Quality Of Evidence ◽

Drop Outs

ObjectiveTo assess the effects and reliability of sham procedures in manual therapy (MT) trials in the treatment of back pain (BP) in order to provide methodological guidance for clinical trial development.DesignSystematic review and meta-analysis.Methods and analysisDifferent databases were screened up to 20 August 2020. Randomised controlled trials involving adults affected by BP (cervical and lumbar), acute or chronic, were included.Hand contact sham treatment (ST) was compared with different MT (physiotherapy, chiropractic, osteopathy, massage, kinesiology and reflexology) and to no treatment. Primary outcomes were BP improvement, success of blinding and adverse effect (AE). Secondary outcomes were number of drop-outs. Dichotomous outcomes were analysed using risk ratio (RR), continuous using mean difference (MD), 95% CIs. The minimal clinically important difference was 30 mm changes in pain score.Results24 trials were included involving 2019 participants. Very low evidence quality suggests clinically insignificant pain improvement in favour of MT compared with ST (MD 3.86, 95% CI 3.29 to 4.43) and no differences between ST and no treatment (MD -5.84, 95% CI −20.46 to 8.78).ST reliability shows a high percentage of correct detection by participants (ranged from 46.7% to 83.5%), spinal manipulation being the most recognised technique.Low quality of evidence suggests that AE and drop-out rates were similar between ST and MT (RR AE=0.84, 95% CI 0.55 to 1.28, RR drop-outs=0.98, 95% CI 0.77 to 1.25). A similar drop-out rate was reported for no treatment (RR=0.82, 95% 0.43 to 1.55).ConclusionsMT does not seem to have clinically relevant effect compared with ST. Similar effects were found with no treatment. The heterogeneousness of sham MT studies and the very low quality of evidence render uncertain these review findings.Future trials should develop reliable kinds of ST, similar to active treatment, to ensure participant blinding and to guarantee a proper sample size for the reliable detection of clinically meaningful treatment effects.PROSPERO registration numberCRD42020198301.

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