scholarly journals Cognitive Behavioral Therapy combined with physical exercise for depression, anxiety, fatigue and pain in adults with chronic diseases: systematic review and meta-analysis

2018 ◽  
Author(s):  
Paquito Bernard ◽  
Romain Ahmed Jérôme ◽  
Johan Caudroit ◽  
Guillaume Chevance ◽  
Carayol Marion ◽  
...  
Keyword(s):  
Physical Exercise ◽  
Methodological Quality ◽  
Randomized Clinical Trials ◽  
Behavioral Therapy ◽  
Meta Analysis ◽  
Effect Sizes ◽  
Cognitive Behavior ◽  
Cochrane Central Register ◽  
Depression And Anxiety ◽  
Central Register

Objective. The present meta-analysis aimed to determine the overall effect of cognitive behavior therapy combined with physical exercise (CBTEx) interventions on depression, anxiety, fatigue, and pain in adults with chronic illness; to identify the potential moderators of efficacy; and to compare the efficacy of CBTEx versus each condition alone (CBT and physical exercise). Methods. Relevant randomized clinical trials, published before July 2017, were identified through database searches in Pubmed, PsycArticles, CINAHL, SportDiscus and the Cochrane Central Register for Controlled Trials.Results. A total of 30 studies were identified. CBTEx interventions yielded small-to-large effect sizes for depression (SMC = -0.34, 95% CI [-0.53; -0.14]), anxiety (SMC = -0.18, 95% CI [-0.34; -0.03]) and fatigue (SMC = -0.96, 95% CI [-1.43; -0.49]). Moderation analyses revealed that longer intervention was associated with greater effect sizes for depression and anxiety outcomes. Low methodological quality was also associated with increased CBTEx efficacy for depression. When compared directly, CBTEx interventions did not show greater efficacy than CBT alone or physical exercise alone for any of the outcomes. Conclusion. The current literature suggests that CBTEx interventions are effective for decreasing depression, anxiety, and fatigue symptoms, but not pain. However, the findings do not support an additive effect of CBT and exercise on any of the four outcomes compared to each condition alone.

scholarly journals The comparative effectiveness of physical exercise interventions in individuals with chronic non-specific neck pain: protocol for a network meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e034846 ◽  
Author(s):  
Rutger MJ de Zoete ◽  
James H McAuley ◽  
Nigel R Armfield ◽  
Michele Sterling
Keyword(s):  
Physical Exercise ◽  
Neck Pain ◽  
Meta Analysis ◽  
Network Effect ◽  
Effect Sizes ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Exercise Interventions ◽  
Meta Analyses

IntroductionNeck pain is a global burdensome problem, with a large proportion of neck pain cases becoming chronic. Although physical exercise is a commonly prescribed treatment, the evidence on the effectiveness of isolated exercise interventions remains limited. Traditional pairwise randomised controlled trials (RCTs) and meta-analyses are limited in only comparing two interventions. This protocol describes the design of a network meta-analysis, which enables a comparative investigation of all physical exercise interventions for which RCTs are available. We aim to systematically compare the effectiveness of different types of physical exercise in people with chronic non-specific neck pain.Methods and analysisNine electronic databases (AMED, CINAHL, Cochrane Central Register of Controlled Trials, Embase, MEDLINE, Physiotherapy Evidence Database, PsycINFO, Scopus and SPORTDiscus) were searched for RCTs from inception to 12 March 2019. Titles and abstract firstly, and full-text papers secondly, will be screened by two reviewers. Data will be extracted by two reviewers. The primary outcome measure is effectiveness of the intervention. Methodological quality of included studies will be assessed by two reviewers using the PEDro scale. The overall quality of evidence will be assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework, which has been adapted for network meta-analyses. The available evidence will be summarised using a network diagram. A contribution matrix will be presented to allow assessment of direct and indirect evidence. Forest plots will be constructed to visualise effects of all included exercise interventions. Pairwise effect sizes will be calculated by including all evidence available in the network. Effect measures for treatments that have not been compared in a pairwise RCT can be compared indirectly by contrasting effect sizes of comparisons with a common comparator.Ethics and disseminationThis work synthesises evidence from previously published studies and does not require ethics review or approval. A manuscript describing the findings will be submitted for publication in a peer-reviewed scientific journal.PROSPERO registration numberCRD42019126523.

scholarly journals The efficacy of psychotherapy, pharmacotherapy and their combination on functioning and quality of life in depression: a meta-analysis

2016 ◽  
Vol 47 (3) ◽  
pp. 414-425 ◽  
Author(s):  
K. Kamenov ◽  
C. Twomey ◽  
M. Cabello ◽  
A. M. Prina ◽  
J. L. Ayuso-Mateos
Keyword(s):  
Quality Of Life ◽  
Depressive Disorders ◽  
Meta Analysis ◽  
Combined Treatment ◽  
Effect Sizes ◽  
Controlled Trials ◽  
Depression Symptom ◽  
Cochrane Central Register ◽  
Central Register

BackgroundThere is growing recognition of the importance of both functioning and quality of life (QoL) outcomes in the treatment of depressive disorders, but the meta-analytic evidence is scarce. The objective of this meta-analysis of randomized controlled trials (RCTs) was to determine the absolute and relative effects of psychotherapy, pharmacotherapy and their combination on functioning and QoL in patients with depression.MethodOne hundred and fifty-three outcome trials involving 29 879 participants with depressive disorders were identified through database searches in Pubmed, PsycINFO and the Cochrane Central Register of Controlled Trials.ResultsCompared to control conditions, psychotherapy and pharmacotherapy yielded small to moderate effect sizes for functioning and QoL, ranging from g = 0.31 to g = 0.43. When compared directly, initial analysis yielded no evidence that one of them was superior. After adjusting for publication bias, psychotherapy was more efficacious than pharmacotherapy (g = 0.21) for QoL. The combination of psychotherapy and medication performed significantly better for both outcomes compared to each treatment alone yielding small effect sizes (g = 0.32 to g = 0.39). Both interventions improved depression symptom severity more than functioning and QoL.ConclusionDespite the small number of comparative trials for some of the analyses, this study reveals that combined treatment is superior, but psychotherapy and pharmacotherapy alone are also efficacious for improving functioning and QoL. The overall relatively modest effects suggest that future tailoring of therapies could be warranted to better meet the needs of individuals with functioning and QoL problems.

scholarly journals Acupuncture in oncological pain relief: A systematic review of randomized clinical trials

2021 ◽  
Vol 34 ◽  
Author(s):  
Michel Marcos Dalmedico ◽  
Caroline Machado de Toledo ◽  
Paula Karina Hembecker ◽  
Juliana Londero Silva Ávila ◽  
Chayane Karla Lucena de Carvalho ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Cancer Pain ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Cochrane Central Register ◽  
Opioid Use ◽  
Central Register ◽  
Considerable Impact ◽  
Analgesic Use

Abstract Introduction: Cancer pain has a considerable impact on patients’ health and quality of life, and its treatment is essentially based on opioid use. Objective: To report the effectiveness of acupuncture in relieving cancer pain (secondary to the disease or to the corresponding therapy) or in decreasing opioid use compared to other interventions. Methods: A systematic review of randomized clinical trials was conducted following the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. The trials were selected from the PubMed, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Results: The search strategy resulted in the inclusion of eight trials, of which five compared acupuncture and drug therapy and three compared acupuncture and placebo. Seven trials reported decreased pain and analgesic use. The trials showed clinical heterogeneity, making a meta-analysis unfeasible. Conclusion: The findings herein provided no robust evidence to support the routine use of acupuncture as an adjuvant therapy in the treatment of cancer pain. However, its use is promising since the results showed a trend toward decreased pain and analgesic use, thus justifying further studies in the future.

scholarly journals Non-invasive diagnostic techniques for skin tumors and their potential for use in skin melanoma screening: a systematic literature review

2020 ◽  
pp. 102-120
Author(s):  
O. E. Garanina ◽  
I. V. Samoylenko ◽  
I. L. Shlivko ◽  
I. A. Klemenova ◽  
M. S. Neznakhina ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Data Extraction ◽  
Meta Analysis ◽  
Cost Effective ◽  
Skin Neoplasms ◽  
Diagnostic Techniques ◽  
Cochrane Central Register ◽  
Skin Melanoma ◽  
Noninvasive Methods ◽  
Central Register

Introduction. Currently, numerous studies are published by authors of different countries to demonstrate the effectiveness of noninvasive methods in the diagnosis of melanoma. Methods. A systematic search was conducted independently in the databases PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) until April 2020 according to certain inclusion criteria. Data extraction was carried out independently, followed by generalization using descriptive tables. Due to the heterogeneity of the included studies and the impossibility of carrying out a meta-analysis in view of this, we performed a narrative description. Results. A total of 765 potential publications for inclusion were found and checked, of which 53 were included. By design, the studies were assigned to studies of simultaneous design – 40, to randomized clinical trials – 7, to meta-analysis – 6. Data in the included publications on 76802 skin neoplasms were reported, of which 9070 were melanomas. The extracted data were summarized in descriptive tables. Conclusion. With continuing technological progress, the development of noninvasive imaging technologies in the diagnosis of skin melanoma should follow the path of cost-effective, simple and accurate diagnosis.

scholarly journals Digital Interventions for Problematic Cannabis Users in Non-Clinical Settings: Findings from a Systematic Review and Meta-Analysis

2016 ◽  
Vol 22 (5) ◽  
pp. 233-242 ◽  
Author(s):  
Eva Hoch ◽  
Ulrich W. Preuss ◽  
Marica Ferri ◽  
Roland Simon
Keyword(s):  
Systematic Review ◽  
Behavioral Therapy ◽  
Meta Analysis ◽  
Cannabis Use ◽  
Treatment Programs ◽  
Controlled Trials ◽  
Clinical Settings ◽  
Cochrane Central Register ◽  
Digital Interventions ◽  
Central Register

Background: Existing cannabis treatment programs reach only a very limited proportion of people with cannabis-related problems. The aim of this systematic review and meta-analysis was to assess the effectiveness of digital interventions applied outside the health care system in reducing problematic cannabis use. Methods: We systematically searched the Cochrane Central Register of Controlled Trials (2015), PubMed (2009-2015), Medline (2009-2015), Google Scholar (2015) and article reference lists for potentially eligible studies. Randomized controlled trials examining the effects of internet- or computer-based interventions were assessed. Study effects were estimated by calculating effect sizes (ESs) using Cohen's d and Hedges' g bias-corrected ES. The primary outcome assessed was self-reported cannabis use, measured by a questionnaire. Results: Fifty-two studies were identified. Four studies (including 1,928 participants) met inclusion criteria. They combined brief motivational interventions and cognitive behavioral therapy delivered online. All studies were of good quality. The pooled mean difference (Δ = 4.07) and overall ES (0.11) give evidence of small effects at 3-month follow-up in favor of digital interventions. Conclusions: Digital interventions can help to successfully reduce problematic cannabis use outside clinical settings. They have some potential to overcome treatment barriers and increase accessibility for at-risk cannabis users.

scholarly journals The Combined Effect of Exercise and Behavioral Therapy for Depression and Anxiety: Systematic Review and Meta-Analysis

2020 ◽  
Vol 10 (7) ◽  
pp. 116
Author(s):  
Kelsey Bourbeau ◽  
Terence Moriarty ◽  
Akeisha Ayanniyi ◽  
Micah Zuhl
Keyword(s):  
Depressive Symptoms ◽  
Exercise Intensity ◽  
Behavioral Therapy ◽  
Meta Analysis ◽  
Anxiety Symptoms ◽  
Combined Effect ◽  
Moderate Intensity ◽  
Cochrane Central Register ◽  
Depression And Anxiety ◽  
Baseline Levels

Behavioral therapy (BT) and exercise are efficacious treatments for depression and anxiety when employed separately. The combination of BT and exercise (BT+Ex) may augment improvements but the combined effect of these therapies is not fully elucidated. The purpose of this meta-analysis was to determine if BT+Ex yielded a significant reduction in depression and anxiety symptoms compared to BT alone (BT). Randomized controlled studies published prior to September 2019 were searched among several databases (PUBMED, MEDLINE, PsychArticle, and Cochrane Central Register of Clinical Trials). Studies that measured depression and anxiety symptoms following BT+Ex vs. BT were extracted and analyzed. The effect of these therapies on depression and anxiety were analyzed. Subgroup analyses were performed to evaluate the effect of exercise intensity (moderate and high), exercise type (aerobic and combined exercise), and baseline levels of depression. The moderating effects of gender, age, and treatment duration were performed. Data were extracted from 18 studies (1686 participants, mean age = 47 years, 65% female). There was a significant effect of BT+Ex on symptoms of depression. The effect of BT+Ex was significant for moderate intensity exercise and elevated baseline levels of depression. Age moderated the effect for depression. There was a significant effect of BT+Ex on depressive symptoms in humans. Exercise intensity and elevated depressive symptoms may play a role in the effect of exercise.

Antipsychotics Efficacy in Treatment of Schizophrenia Negative Symptoms: Meta-analysis of Randomized Clinical Trials

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
J. Darbá ◽  
A. Minoves ◽  
E. Rojo ◽  
F. Jiménez ◽  
J. Rejas
Keyword(s):  
Negative Symptoms ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Effect Sizes ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Double Blind ◽  
Cohen’S D ◽  
Meta Analyses ◽  
Cohen's D

Purpose:To examine the efficacy of second-generation-antipsychotics (SGAs) in the treatment of negative symptoms in Schizophrenia.Methods:Two meta-analyses were carried out using placebo or haloperidol as comparators. Studies were identified by searching for randomized, double-blind, placebo and/or haloperidol -controlled trials reporting data on efficacy of SGAs. Search was extended to the following databases: Pubmed, The Cochrane Central Register of Controlled Trials, Proquest Health and Medical Complete, Science Citation Index Expanded, and Current Contents Connect. The outcome measure used was the change in negative symptoms, choosing a standardized statistic (Cohen's d) to synthesize data.Results:A total of 46 homogeneous trials (Q=45.18, df=50, p=0.667, I2=0%) were included. In the placebo-controlled meta-analysis, the effect sizes (Cohen's d) obtained for amisulpride, haloperidol, olanzapine, quetiapine, risperidone and ziprasidone were 0.52, 0.34, 0.43, 0.36, 0.40 and 0.46, respectively, favoring active treatment against placebo (p< 0.001 in all cases). Comparing SGAs against haloperidol, showed just a statistically significant trend favoring SGA's in treatment of negative symptoms (Cohen's d = 0.15, p=0.008). Comparisons by drug showed a significant low and low-to-moderate standardized mean favoring SGA: Cohen's d = 0.34, p< 0.001; Cohen's d = 0.27, p< 0.001 and Cohen's d = 0.19, p=0.030, respectively for ziprasidone, risperidone and olanzapine.Conclusion:Most antipsychotics (aminosulpride, haloperidol, olanzapine. quetiapine, risperidone, ziprasidone) are effective in treatment of negative symptoms, showing moderate effect sizes. Amisulpride and ziprasidone were slightly better than the rest of drugs when compared with placebo. Compared with haloperidol, SGA showed controversial results.

Antipsychotics Efficacy in Treatment of Schizophrenia Negative Symptoms: Meta-analysis of Randomized Clinical Trials

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
J. Darbá ◽  
A. Minoves ◽  
E. Rojo ◽  
F. Jiménez ◽  
J. Rejas
Keyword(s):  
Negative Symptoms ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Effect Sizes ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Double Blind ◽  
Cohen’S D ◽  
Meta Analyses ◽  
Cohen's D

Purpose:To examine the efficacy of second-generation-antipsychotics (SGAs) in the treatment of negative symptoms in Schizophrenia.Methods:Two meta-analyses were carried out using placebo or haloperidol as comparators. Studies were identified by searching for randomized, double-blind, placebo and/or haloperidol -controlled trials reporting data on efficacy of SGAs. Search was extended to the following databases: Pubmed, the Cochrane Central Register of Controlled Trials, Proquest Health and Medical Complete, Science Citation Index Expanded, and Current Contents Connect. the outcome measure used was the change in negative symptoms, choosing a standardized statistic (Cohen's d) to synthesize data.Results:A total of 46 homogeneous trials (Q=45.18, df=50, p=0.667, I2=0%) were included. in the placebo-controlled meta-analysis, the effect sizes (Cohen's d) obtained for amisulpride, haloperidol, olanzapine, quetiapine, risperidone and ziprasidone were 0.52, 0.34, 0.43, 0.36, 0.40 and 0.46, respectively, favoring active treatment against placebo (p< 0.001 in all cases). Comparing SGAs against haloperidol, showed just a statistically significant trend favoring SGA's in treatment of negative symptoms (Cohen's d = 0.15, p=0.008). Comparisons by drug showed a significant low and low-to-moderate standardized mean favoring SGA: Cohen's d = 0.34, p< 0.001; Cohen's d = 0.27, p< 0.001 and Cohen's d = 0.19, p=0.030, respectively for ziprasidone, risperidone and olanzapine.Conclusion:Most antipsychotics (aminosulpride, haloperidol, olanzapine. quetiapine, risperidone, ziprasidone) are effective in treatment of negative symptoms, showing moderate effect sizes. Amisulpride and ziprasidone were slightly better than the rest of drugs when compared with placebo. Compared with haloperidol, SGA showed controversial results.

Use of opioids in patients with cancer with hepatic impairment—a systematic review

2021 ◽  
pp. bmjspcare-2021-003065
Author(s):  
Lewis Thomas Hughes ◽  
David Raftery ◽  
Paul Coulter ◽  
Barry Laird ◽  
Marie Fallon
Keyword(s):  
Systematic Review ◽  
Cancer Pain ◽  
Hepatic Impairment ◽  
Evaluation System ◽  
Meta Analysis ◽  
Hepatic Function ◽  
Cochrane Central Register ◽  
Assessment Development ◽  
Patients With Cancer ◽  
Central Register

PurposeOpioids are recommended for moderate-to-severe cancer pain; however, in patients with cancer, impaired hepatic function can affect opioid metabolism. The aim of this systematic review was to evaluate the evidence for the use of opioids in patients with cancer with hepatic impairment.MethodsA systematic review was conducted and the following databases searched: AMED (−2021), MEDLINE (−2021), EMBASECLASSIC + EMBASE (−2021) and Cochrane Central Register of Controlled Trials (−2021). Eligible studies met the following criteria: patients with cancer-related pain, taking an opioid (as defined by the WHO Guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents); >18 years of age; patients with hepatic impairment defined using recognised or study-defined definitions; clinical outcome hepatic impairment related; and primary studies. All eligible studies were appraised using the Grading of Recommendations Assessment, Development and Evaluation system.ResultsThree studies (n=95) were eligible but heterogeneity meant meta-analysis was not possible. Each individual study focused on only one each of oxycodone±hydrocotarnine, oxycodone/naloxone and morphine. No recommendations could be formulated on the preferred opioid in patients with hepatic impairment.ConclusionsMorphine is the preferred opioid in hepatic impairment owing to clinical experience and pharmacokinetics. This review, however, found little clinical evidence to support this. Dose adjustments of morphine and the oxycodone formulations reviewed remain necessary in the absence of quality evidence. Overall, the quality of existing evidence on opioid treatments in cancer pain and hepatic impairment is low and there remains a need for high-quality clinical studies examining this.

scholarly journals Systematic Review and Meta-Analysis of 16 Randomized Clinical Trials of Radix Astragali and Its Prescriptions for Diabetic Retinopathy

2013 ◽  
Vol 2013 ◽  
pp. 1-13 ◽  
Author(s):  
Lin Cheng ◽  
Gai Zhang ◽  
Yi Zhou ◽  
Xuejing Lu ◽  
Fuwen Zhang ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Methodological Quality ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Plasma Viscosity ◽  
Control Group ◽  
Radix Astragali ◽  
Manual Search ◽  
Computer Based

Objective. To evaluate the efficacy and safety of radix astragali and its prescriptions for diabetic retinopathy.Methods. A computer-based online and manual search was conducted for randomized controlled trials addressing radix astragali and its prescriptions for diabetic retinopathy.Results. 16 RCTs involving 977 subjects and 1586 eyes were identified. Meta-analysis indicated that the effect of radix astragali and its prescriptions in improving visual acuity and fundus manifestations, lowering FBG, TG, plasma viscosity, and RAI, was superior to that of control group (WMD or OR 0.20, 0.27, −0.26, −0.36, −0.93, −1.27; 95% CI [0.09, 0.30], [0.17, 0.40], [−0.51, 0.00], [−0.60, −0.12], [−1.67, −0.20], [−2.35, −0.19];P<0.05, resp.). In contrary, the efficacy of radix astragali and its prescriptions was not superior to those of control group in descending HbA1C and TC with WMD 0.45, −0.96 and 95% CI [−1.00, 1.90], [−2.19, 0.27],P>0.05, respectively. GRADE software suggested that the studies were of low methodological quality.Conclusion. Radix astragali and its prescriptions were superior to other treatments for diabetic retinopathy in terms of improving visual acuity and fundus manifestations, reducing FBG, TG, RAI, and plasma viscosity. The evaluated studies were of low methodological quality, indicating that the previous findings should be read with care.

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