The effectiveness of serious games in alleviating anxiety: A systematic review and meta-analysis (Preprint)

BACKGROUND Anxiety is one of the mental disorders characterized by apprehension, tension, uneasiness, and other related behavioral disturbances. One of the non-pharmacological treatments used for reducing anxiety is serious games, which are games that have a purpose other than entertainment. The effectiveness of serious games in alleviating anxiety was investigated by several systematic reviews, however, they are limited by design and methodological weaknesses. OBJECTIVE This study aims to assess the effectiveness of serious games in alleviating anxiety through summarizing the results of previous studies and providing an up-to-date review. METHODS We carried out a systematic review of randomized controlled trials (RCTs). We searched 7 databases: MEDLINE, CINAHL, PsycINFO, ACM Digital Library IEEE Xplore, Scopus, and Google Scholar. We also conducted backward and forward reference list checking of the included studies and relevant reviews. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. We used a narrative and statistical approach, as appropriate, to synthesize results of the included studies. RESULTS Out of 935 citations retrieved, 33 studies were included in this review. Of those, 22 RCTs were eventually included in meta-analyses. Very low quality evidence from 9 RCTs and 5 RCTs showed no statistically significant effect of exergames (games entailing physical exercises) on the anxiety level as compared to conventional exercises (P=0.70) and no intervention (P=0.27), respectively. While 6 RCTs demonstrated a statistically and clinically significant effect of computerized cognitive behavioral therapy (CBT) games on the anxiety level when compared with no intervention (P=0.01), the quality of the evidence reported was low. Likewise, low quality evidence from 3 RCTs showed a statistically and clinically significant effect of biofeedback games on the anxiety level when compared with conventional video games (P=0.03). CONCLUSIONS This review shows that serious games have the potential in alleviating anxiety levels. However, our findings remain inconclusive mainly due to the high risk of bias in the individual studies included, the low quality of meta-analyzed evidence, few studies included in some meta-analyses, patients without anxiety recruited in most studies, and using purpose-shifted serious games in most studies. Therefore, serious games should be deemed as complementary to existing interventions. To have adequate and robust evidence, researchers should use serious games that are designed specifically to alleviate depression and deliver other therapeutic modalities, recruit a diverse population of patients with anxiety, and minimize the risk of bias by following the recommended guidelines for conducting and reporting RCTs.

Download Full-text

The effectiveness of serious games in alleviating depression: A systematic review and meta-analysis (Preprint)

10.2196/preprints.32331 ◽

2021 ◽

Author(s):

Alaa Abd-Alrazaq ◽

Eiman Al-Jafar ◽

Mohannad Alajlani ◽

Carla Toro ◽

Dari Alhuwail ◽

...

Keyword(s):

Systematic Review ◽

Depressive Symptoms ◽

Systematic Reviews ◽

Serious Games ◽

Risk Of Bias ◽

Depression Symptoms ◽

Care Providers ◽

Meta Analyses ◽

Quality Evidence

BACKGROUND Depression is a common mental disorder characterized by disturbances in mood, thoughts, and/or behaviors. Serious games, which are games that have a purpose other than entertainment, have been used as a non-pharmacological therapeutic intervention for depression. Previous systematic reviews have summarized evidence of effectiveness of serious games in reducing depression symptoms, however, they are limited by design and methodological shortcomings. OBJECTIVE This study aims to assess the effectiveness of serious games in alleviating depression through summarizing and pooling the results of previous studies. METHODS A systematic review of randomized controlled trials (RCTs) was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The search sources included 6 bibliographic databases (e.g., MEDLINE, PsycINFO, IEEE Xplore), the search engine “Google Scholar,” and backward and forward reference list checking of the included studies and relevant reviews. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. Results of the included studies were synthesized narratively and statistically, as appropriate, according to the type of serious games (i.e., exergames or computerized cognitive behavioral therapy (CBT) games). RESULTS From an initial 966 citations retrieved, 27 studies met the eligibility criteria. Fifteen were eventually included in meta-analyses. Very low quality evidence from 7 RCTs and 5 RCTs showed no statistically significant effect of exergames on the severity of depressive symptoms as compared to conventional exercises (P=0.12) and no intervention level (P=0.30), respectively. Very low quality evidence from 9 RCTs showed a statistically and clinically significant effect of computerized CBT games on the severity of depressive symptoms in comparison with no intervention (P=0.003). CONCLUSIONS Serious games have the potential to alleviate depression as other active interventions do. However, we could not draw definitive conclusions regarding the effectiveness of serious games due to the high risk of bias in the individual studies examined and the low quality of meta-analyzed evidence. Therefore, we recommend that health care providers consider offering serious games as an adjunct to existing interventions until further, more robust, evidence is available. Future studies should assess the effectiveness of serious games that are designed specifically to alleviate depression and deliver other therapeutic modalities, recruit participants with depression, and avoid biases through following recommended guidelines for conducting and reporting RCTs.

Download Full-text

The effectiveness of serious games in improving memory among elderly people with cognitive impairment: A systematic review and meta-analysis (Preprint)

10.2196/preprints.35202 ◽

2021 ◽

Author(s):

Alaa Abd-alrazaq ◽

Dari Alhuwail ◽

Eiman Al-Jafar ◽

Arfan Ahmed ◽

Shuja Mohd Reagu ◽

...

Keyword(s):

Systematic Review ◽

Working Memory ◽

Cognitive Impairment ◽

Verbal Memory ◽

Serious Games ◽

Meta Analysis ◽

The Elderly ◽

Quality Of Evidence ◽

Meta Analyses

BACKGROUND Memory, one of the main cognitive functions, is known to decline by age. Serious games have been used for improving memory among the elderly. The effectiveness of serious games in improving memory has been investigated by several systematic reviews; however, they are limited by design and methodological weaknesses. OBJECTIVE This study aims to assess the effectiveness of serious games in improving memory among the elderly with cognitive impairment. METHODS A systematic review of randomized controlled trials (RCTs) was carried out. The search sources included searching 8 databases, screening reference lists of the included studies and relevant reviews, and checking studies that cited the included studies. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. Extracted data were synthesized using a narrative approach and a statistical approach (i.e., meta-analysis), as appropriate. RESULTS Out of 466 citations retrieved, 18 studies met the eligibility criteria of this review. Of those, 15 RCTs were eventually included in 10 meta-analyses. We found that serious games are more effective than no or passive interventions in improving non-verbal memory (P=0.002) and working memory (P=0.02), but not verbal memory (P=0.13). The review also showed that serious games are more effective than conventional exercises in improving verbal memory (P=0.004), but not for non-verbal memory (P=0.12) and working memory (P=0.49). Serious games were as effective as conventional cognitive activities in improving verbal memory (P=0.07), non-verbal memory (P=0.94), and working memory (P=0.08) among the elderly with cognitive impairment. Lastly, the effect of adaptive serious games on working memory was comparable to non-adaptive serious games (P=0.08). CONCLUSIONS Serious games have the potential to improve verbal, non-verbal, and working memory among elderly people with cognitive impairment. However, our findings should be interpreted cautiously given that most meta-analyses were based on a few studies (≤3) and judged to have a low quality of evidence. Therefore, serious games should be offered as supplemental to existing proven and safe interventions, rather than a complete substitute until further, more robust evidence is available. Future studies should investigate the short and long-term effects of serious games on memory and other cognitive abilities among people from different age groups with or without cognitive impairment.

Download Full-text

Periodontitis Impact in Interleukin-6 Serum Levels in Solid Organ Transplanted Patients: A Systematic Review and Meta-Analysis

Diagnostics ◽

10.3390/diagnostics10040184 ◽

2020 ◽

Vol 10 (4) ◽

pp. 184 ◽

Cited By ~ 7

Author(s):

Vanessa Machado ◽

João Botelho ◽

Joana Lopes ◽

Mariana Patrão ◽

Ricardo Alves ◽

...

Keyword(s):

Systematic Review ◽

Serum Levels ◽

Case Control ◽

Risk Of Bias ◽

Solid Organ ◽

Systemic Complications ◽

Moderate Quality ◽

Meta Analyses ◽

The Impact ◽

Quality Evidence

This systematic review aimed to investigate the influence of periodontitis on post-transplant IL-6 serum levels of solid organ transplanted patients as compared to healthy subjects. Four databases (PubMed, Scholar, EMBASE, and CENTRAL) were searched up to February 2020 (PROSPERO CRD42018107817). Case-control and cohort studies on the association of IL-6 serum levels with a periodontal status of patients after solid organ transplantation were included. The risk of bias of observational studies was assessed through the Newcastle-Ottawa Scale (NOS). Random effects meta-analyses were thoroughly conducted. GRADE assessment provided quality evidence. Four case-control studies fulfilled the inclusion criteria (274 transplant recipients and 146 healthy controls), all of low risk of bias. Meta-analyses revealed significantly higher IL-6 levels in transplanted patients than healthy individuals with low-quality evidence (Mean Difference (MD): 2.55 (95% confidence interval (CI): 2.07, 3.03)). Transplanted patients with periodontitis have higher serum IL-6 levels than transplanted patients without periodontitis with moderate quality evidence (MD: 2.20 (95% CI: 1.00, 3.39)). We found low-quality evidence of higher IL-6 levels than healthy patients in patients with heart and kidney transplant. In these transplanted patients, there was moderate quality evidence that periodontitis is associated with higher IL-6 serum levels. Future research should consider the impact of such a difference in organ failure and systemic complications.

Download Full-text

P14.71 An assessment of the reporting and methodological quality of meningioma systematic reviews and meta-analyses

Neuro-Oncology ◽

10.1093/neuonc/noab180.178 ◽

2021 ◽

Vol 23 (Supplement_2) ◽

pp. ii51-ii52

Author(s):

A M George ◽

S Gupta ◽

S M Keshwara ◽

M A Mustafa ◽

C S Gillespie ◽

...

Keyword(s):

Systematic Review ◽

Systematic Reviews ◽

Methodological Quality ◽

Meta Analysis ◽

Neurofibromatosis Type ◽

Risk Of Bias ◽

Measurement Tool ◽

High Quality ◽

Meta Analyses

Abstract BACKGROUND Systematic reviews and meta-analyses constitute the highest level of research evidence and for a disease with limited clinical trial activity, are often relied upon to help inform clinical practice. This review of reviews evaluates both the reporting & methodological quality of meningioma evidence syntheses. MATERIAL AND METHODS Potentially eligible meningioma reviews published between 1st January 1990 and 31st December 2020 were identified from eight electronic databases. Inclusion required the study to meet the Cochrane guideline definition of a systematic review or meta-analysis. Reviews concerning neurofibromatosis type 2, spinal and pediatric meningiomas were excluded. The reporting and methodological quality of articles were assessed against the following modified guidelines: Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), A MeaSurement Tool to Assess Systematic Reviews (AMSTAR2) and the Risk of Bias in Systematic Reviews (ROBIS) guidelines. RESULTS 117 systematic reviews were identified, 57 of which included meta-analysis (48.7%). The number of meningioma systematic reviews published each year has increased with 63 studies (53.9%) published between 01/2018 and 12/2020. A median of 17 studies (IQR 9–29) were included per review. Impact factor of journals publishing a systematic review with or without a meta-analysis was similar (median 2.3 vs 1.8, P=0.397). The mean PRISMA scores for systematic reviews with a meta-analysis was 21.11 (SD 4.1, 78% adherence) and without was 13.89 (SD 3.4, 63% adherence). Twenty-nine systematic reviews with meta-analysis (51%) and 11 without meta-analysis (18%) achieved greater than 80% adherence to PRISMA recommendations. Methodological quality assessment using AMSTAR2 revealed one study (0.9%) as high quality whilst 111 (94.8%) studies were graded as critically low. One hundred and two articles (87.2%) did not utilize a comprehensive search strategy as defined by the AMSTAR2 tool. Ninety-nine studies (84.6%) obtained a high level of concern for potential bias as per the ROBIS assessment. One hundred and eight articles (92.3%) failed to present information that a protocol had been established prior to study commencement and 76 articles (65.0%) did not conduct a risk of bias assessment. Across the three tools, domains relating to the establishment of a protocol prior to review commencement and conducting appropriate risk of bias assessments were frequently low scoring. CONCLUSION Overall reporting and methodological quality of meningioma systematic reviews was sub-optimal. Established critical appraisal tools and reporting guidelines should be utilized a priori to assist in producing high-quality systematic reviews.

Download Full-text

Insomnia Interventions in the Workplace: A Systematic Review and Meta-Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17176401 ◽

2020 ◽

Vol 17 (17) ◽

pp. 6401

Author(s):

Juan Vega-Escaño ◽

Ana María Porcel-Gálvez ◽

Rocío de Diego-Cordero ◽

José Manuel Romero-Sánchez ◽

Manuel Romero-Saldaña ◽

...

Keyword(s):

Systematic Review ◽

Randomized Clinical Trials ◽

Behavioral Therapy ◽

Meta Analysis ◽

Sleep Onset ◽

Cochrane Collaboration ◽

Risk Of Bias ◽

Publication Date ◽

The Impact

The aim of this systematic review and meta-analysis was to identify and evaluate the impact of interventions to improve or reduce insomnia in the workforce through randomized clinical trials. Following the recommendations of the PRISMA and MARS statement, a systematic literature search was carried out on the PubMed, Web of Science, CINHAL, and PsycINFO databases, with no restrictions on the language or publication date. For the meta-analysis, a random-effects model and the Insomnia Severity Index were used as outcome measures. To assess the risk of bias and the quality of evidence, the Cochrane Collaboration tool and the GRADE method were used, respectively. Twenty-two studies were included in the systematic review and 12 studies in the meta-analysis, making a total of 14 intervention groups with a sample of 827 workers. Cognitive behavioral therapy was the most widely used intervention. According to the estimated difference between the means, a moderate effect for the reduction of insomnia symptoms after the intervention (MD −2.08, CI 95%: [−2.68, −1.47]) and a non-significant degree of heterogeneity were obtained (p = 0.64; I2 = 0%). The quality of the evidence and the risk of bias were moderate. The results suggest that interventions on insomnia in the workplace are effective for improving workers’ health, and that improvements in the quality of sleep and a decrease in the symptoms of insomnia are produced, thanks to an increase in weekly sleeping hours and a reduction in latency at sleep onset. As regards work, they also led to improvements in productivity, presenteeism, and job burnout.

Download Full-text

Exercise for Hand Osteoarthritis: A Cochrane Systematic Review

The Journal of Rheumatology ◽

10.3899/jrheum.170424 ◽

2017 ◽

Vol 44 (12) ◽

pp. 1850-1858 ◽

Cited By ~ 7

Author(s):

Nina Østerås ◽

Ingvild Kjeken ◽

Geir Smedslund ◽

Rikke H. Moe ◽

Barbara Slatkowsky-Christensen ◽

...

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Hand Function ◽

Joint Stiffness ◽

Risk Of Bias ◽

Finger Joint ◽

Hand Osteoarthritis ◽

Hand Pain ◽

Quality Evidence

Objective.To assess the benefits and harms of exercise compared with other interventions, including placebo or no intervention, in people with hand osteoarthritis (OA).Methods.Systematic review using Cochrane Collaboration methodology. Six electronic databases were searched up until September 2015. Inclusion criteria: randomized or controlled clinical trials comparing therapeutic exercise versus no exercise, or comparing different exercise programs. Main outcomes: hand pain, hand function, finger joint stiffness, quality of life, adverse events, and withdrawals because of adverse effects. Risk of bias and quality of the evidence were assessed.Results.Seven trials were included in the review, and up to 5 trials (n = 381) were included in the pooled analyses with data from postintervention. Compared to no exercise, low-quality evidence indicated that exercise may improve hand pain [5 trials, standardized mean difference (SMD) −0.27, 95% CI −0.47 to −0.07], hand function (4 trials, SMD −0.28, 95% CI −0.58 to 0.02), and finger joint stiffness (4 trials, SMD −0.36, 95% CI −0.58 to −0.15) in people with hand OA. Quality of life was evaluated by 1 study (113 participants) showing very low-quality evidence for no difference. Three studies reported on adverse events, which were very few and not severe.Conclusion.Pooled results from 5 studies with low risk of bias showed low-quality evidence for small to moderate beneficial effects of exercise on hand pain, function, and finger joint stiffness postintervention. Estimated effect sizes were small, and whether they represent a clinically important change may be debated.

Download Full-text

Association between components of the delirium syndrome and outcomes in hospitalised adults: a systematic review and meta-analysis

BMC Geriatrics ◽

10.1186/s12877-021-02095-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zoë Tieges ◽

Terence Quinn ◽

Lorn MacKenzie ◽

Daniel Davis ◽

Graciela Muniz-Terrera ◽

...

Keyword(s):

Systematic Review ◽

Assessment Tool ◽

Meta Analysis ◽

Risk Of Bias ◽

Evaluation Framework ◽

Cochrane Central Register ◽

Symptom Domains ◽

Meta Analyses ◽

Psychotic Features ◽

Quality Evidence

Abstract Background Delirium is a heterogeneous syndrome with inattention as the core feature. There is considerable variation in the presence and degree of other symptom domains such as altered arousal, psychotic features and global cognitive dysfunction. Delirium is independently associated with increased mortality, but it is unclear whether individual symptom domains of delirium have prognostic importance. We conducted a systematic review and meta-analysis of studies in hospitalised adults in general settings to identify the relationship between symptom domains of delirium and outcomes. (PROSPERO: CRD42018093935). Methods We searched MEDLINE, EMBASE, PsycINFO, CINAHL, clinicaltrials.gov and the Cochrane Central Register of Controlled Trials from inception to November 2019. We included studies of hospitalised adults that reported associations between symptom domains of delirium and 30-day mortality (primary outcome), and other outcomes including mortality at other time points, length of stay, and dementia. Reviewer pairs independently screened articles, extracted data, and assessed risk of bias (Risk of Bias Assessment tool for Non-randomized Studies) and quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation framework. We performed random-effects meta-analyses stratified by delirium domain where possible. Results From 7092 citations we included 6 studies (6002 patients, 1112 with delirium). Higher mortality (ranging from in-hospital to follow-up beyond 12 months) was associated with altered arousal (pooled Odds Ratio (OR) 2.80, 95% Confidence Interval (CI) 2.33–3.37; moderate-quality evidence), inattention (pooled OR 2.57, 95% CI 1.74–3.80; low-quality evidence), and in single studies with disorientation, memory deficits and disorganised thoughts. Risk of bias varied across studies but was moderate-to-high overall, mainly due to selection bias, lack of blinding of assessments and unclear risk of selective outcome reporting. We found no studies on the association between psychotic features, visuospatial deficits or affective disturbances in delirium and outcomes, or studies reporting non-mortality outcomes. Conclusions Few studies have related symptom domains of delirium to outcomes, but the available evidence suggests that altered arousal and inattention in delirium are associated with higher mortality than normal arousal and attention in people with or without delirium. Measurable symptom domains of delirium may have value in predicting survival and stratifying patients for treatment. We recommend that future delirium studies report outcomes by symptom domain.

Download Full-text

Association Between Components of the Delirium Syndrome and Outcomes in Hospitalised Adults: A Systematic Review and Meta-Analysis.

10.21203/rs.3.rs-112696/v1 ◽

2020 ◽

Author(s):

Zoë Tieges ◽

Terence Quinn ◽

Lorn MacKenzie ◽

Daniel Davis ◽

Graciela Muniz-Terrera ◽

...

Keyword(s):

Systematic Review ◽

Assessment Tool ◽

Meta Analysis ◽

Risk Of Bias ◽

Evaluation Framework ◽

Cochrane Central Register ◽

Symptom Domains ◽

Meta Analyses ◽

Psychotic Features ◽

Quality Evidence

Abstract Background Delirium is a heterogeneous syndrome with inattention as the core feature. There is considerable variation in the presence and degree of other symptom domains such as altered arousal, psychotic features and global cognitive dysfunction. Delirium is independently associated with increased mortality, but it is unclear whether individual symptom domains of delirium have prognostic importance. We conducted a systematic review and meta-analysis of studies in hospitalised adults in general settings to identify the relationship between symptom domains of delirium and outcomes.(PROSPERO: CRD42018093935). Methods We searched MEDLINE, EMBASE, PsycINFO, CINAHL, clinicaltrials.gov and the Cochrane Central Register of Controlled Trials from inception to November 2019. We included studies of hospitalised adults that reported associations between symptom domains of delirium and 30-day mortality (primary outcome), and other outcomes including mortality at other time points, length of stay, and dementia. Reviewer pairs independently screened articles, extracted data, and assessed risk of bias (Risk of Bias Assessment tool for Non-randomized Studies) and quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation framework. We performed random-effects meta-analyses stratified by delirium domain where possible.Results From 7092 citations we included 6 studies (6002 patients, 1112 with delirium). Higher mortality was associated with altered arousal (pooled Odds Ratio (OR) 2.80, 95% Confidence Interval (CI) 2.33-3.37; moderate-quality evidence), inattention (pooled OR 2.57, 95% CI 1.74-3.80; low-quality evidence), and in single studies with disorientation, memory deficits and disorganised thoughts. Risk of bias varied across studies but was moderate-to-high overall, mainly due to selection bias, lack of blinding of assessments and unclear risk of selective outcome reporting. We found no studies on the association between psychotic features, visuospatial deficits or affective disturbances in delirium and outcomes, or studies reporting non-mortality outcomes.Conclusions Few studies have related symptom domains of delirium to outcomes, but the available evidence suggests that altered arousal and inattention in delirium are associated with higher mortality than normal arousal and attention in people with or without delirium. Measurable symptom domains of delirium may have value in predicting survival and stratifying patients for treatment. We recommend that future delirium studies report outcomes by symptom domain.

Download Full-text

Anti-Diabetic and Antiresorptive Pharmacotherapies for Prevention and Treatment of Type 2 Diabetes-Induced Bone Disease: Protocol for a Two-Part Systematic Review and Network Meta-Analysis

10.1101/19007849 ◽

2019 ◽

Author(s):

Jiawen Deng ◽

Umaima Abbas ◽

Oswin Chang ◽

Sayan Dhivagaran ◽

Stephanie Sanger ◽

...

Keyword(s):

Systematic Review ◽

Type 2 Diabetes ◽

At Risk ◽

Bone Disease ◽

Bone Health ◽

Risk Of Bias ◽

Randomized Controlled ◽

Meta Analyses

ABSTRACTIntroductionPatients with type 2 diabetes mellitus (T2DM) are at risk for a variety of severe debilitating effects. One of the most serious complications experienced by T2DM patients are skeletal diseases caused by changes in the bone microenvironment. As a result, T2DM patients are at risk for higher prevalence of fragility fractures.There are a variety of treatments available for counteracting this effect. Some anti-diabetic medications, such as metformin, have been shown to have a positive effect on bone health without the addition of additional drugs into patients’ treatment plans. Chinese randomized controlled trial (RCT) studies have also proposed antiresorptive pharmacotherapies as a viable alternative treatment strategy. Previous network meta-analyses (NMAs) and meta-analyses regarding this topic did not include all available RCT trials, or only performed pairwise comparisons. We present a protocol for a two-part NMA that incorporates all available RCT data to provide the most comprehensive ranking of anti-diabetics (Part I) and antiresorptive (Part II) pharmacotherapies in terms of their ability to decrease fracture incidences, increase bone mineral density (BMD), improve indications of bone turnover markers (BTMs), and decrease pain in adult T2DM patients.Methods and AnalysisWe will search MEDLINE, EMBASE, PubMed, Web of Science, CINAHL, CENTRAL and Chinese literature sources (CNKI, CQVIP, Wanfang Data, Wanfang Med Online) for randomized controlled trials (RCTs) which fit our criteria. We will include adult T2DM patients who have taken anti-diabetics (Part I) or antiresorptive (Part II) therapies with relevant outcome measures in our study.We will perform title/abstract and full-text screening as well as data extraction in duplicate. Risk of bias (RoB) will be evaluated in duplicate for each study, and the quality of evidence will be examined using CINeMA in accordance to the GRADE framework. We will use R and gemtc to perform the NMA. We will report changes in BMD, BTM and pain scores in either weighted or standardized mean difference, and we will report fracture incidences as odds ratios. We will use the surface under the cumulative ranking curve (SUCRA) scores to provide numerical estimates of the rankings of interventions.Ethics and DisseminationThe study will not require ethics approval. The findings of the two-part NMA will be disseminated in peer-reviewed journals and presented at conferences. We aim to produce the most comprehensive quantitative analysis regarding the management of T2DM bone disease. Our analysis should be able to provide physicians and patients with up-to-date recommendations for anti-diabetic medications and antiresorptive pharmacotherapies for maintaining bone health in T2DM patients.Systematic Review RegistrationInternational Prospective Register for Systematic Reviews (PROSPERO) — CRD42019139320ARTICLE SUMMARYStrengths and limitations of this studyLiterature search in Chinese databases will yield new RCT evidence regarding the efficacy of anti-diabetics in treating T2DM bone diseaseUsing network meta-analytical techniques to analyze the relative efficacy of antiresorptive therapies will allow us to include new treatment arms, such as zoledronic acid and risedronate.Only RCTs will be included and the quality of trials and networks will be evaluated using Risk of Bias, GRADE and comparison-adjusted funnel plots.Chinese clinicians may not use the same procedures and practices as Western clinicians, therefore the outcomes from Chinese RCTs may not apply to the Western healthcare systems.The study design does not allow the comparison of anti-diabetics with antiresorptive therapies or combinations of the two.

Download Full-text

Optimal Pharmacological Management and Prevention of Glucocorticoid-Induced Osteoporosis (GIOP): Protocol for a Systematic Review and Network Meta-Analysis

10.1101/19010520 ◽

2019 ◽

Author(s):

Jiawen Deng ◽

Emma Huang ◽

Zachary Silver ◽

Elena Zheng ◽

Kyra Kavanaugh ◽

...

Keyword(s):

Systematic Review ◽

Vertebral Fracture ◽

Bone Loss ◽

Risk Of Bias ◽

Adult Patients ◽

List Type ◽

Mineral Density ◽

Mean Differences ◽

Meta Analyses

ABSTRACTIntroductionGlucocorticoid (GC) administration is an effective therapy commonly used in the treatment of autoimmune and inflammatory diseases. However, the use of GC can give rise to serious complications. The main detrimental side effect of GC therapy is significant bone loss, resulting in glucocorticoid-induced osteoporosis (GIOP).There are a variety of treatments available for preventing and managing GIOP; however, without clearly defined guidelines, it can be very difficult for physicians to choose the optimal therapy for their patients. Previous network meta-analyses (NMAs) and meta-analyses did not include all available RCT trials, or only performed pairwise comparisons. We present a protocol for a NMA that incorporates all available RCT patient data to provide the most comprehensive ranking of all available GIOP treatments in terms of their ability to increase bone mineral density (BMD) and decrease fracture incidences among adult patients undergoing GC treatments.Methods and AnalysisWe will search MEDLINE, EMBASE, PubMed, Web of Science, CINAHL, CENTRAL and Chinese literature sources (CNKI, CQVIP, Wanfang Data, Wanfang Med Online) for randomized controlled trials (RCTs) which fit our criteria. RCTs that evaluate different antiresorptive regimens taken by adult patients undergoing GC therapy during the study or had taken GC for at least 3 months in the year prior to study commencement with lumbar spine BMD, femoral neck BMD, total hip BMD, vertebral fracture incidences and/or non-vertebral fracture incidences as outcomes will be selected.We will perform title/abstract and full-text screening as well as data extraction in duplicate. Risk of bias (ROB) will be evaluated in duplicate for each study, and the quality of evidence will be examined using CINeMA in accordance to the GRADE framework. We will use R and gemtc to perform the NMA. We will report BMD results as weighted mean differences (WMDs) and standardized mean differences (SMDs), and we will report fracture incidences as odds ratios. We will use the surface under the cumulative ranking curve (SUCRA) scores to provide numerical estimations of the rankings of interventions.Ethics and DisseminationThe study will not require ethical approval. The findings of the NMA will be disseminated in a peer-reviewed journal and presented at conferences. We aim to produce the most comprehensive quantitative analysis regarding the management of GIOP. Our analysis should be able to provide physicians and patients with an up-to-date recommendation for pharmacotherapies in reducing incidences of bone loss and fractures associated with GIOP.Systematic Review RegistrationInternational Prospective Register for Systematic Reviews (PROSPERO) — CRD42019127073ARTICLE SUMMARYStrengths and limitations of this studyLiterature search in Chinese databases will likely yield huge amounts of new RCT evidence regarding GIOPReporting change in BMD outcomes as standardized mean differences allow the pooling of absolute and percentage change data, increasing the number of RCT trials includedOnly RCTs will be included, quality of trials and networks will be evaluated using Risk of Bias and GRADEOlder trials may report inaccurate results due to outdated procedures and hardwareChinese clinicians may not use the same procedures and practices as Western clinicians

Download Full-text