A Group-Based 8-Week Functional Interval-Type Outdoor Training Program Improves Physical Performance in Recreationally Active Adults

Even though physical activity is an important aspect of health, lack of time or motivation impede people from working out regularly. One type of training program that is both efficient and motivating is functional interval-type outdoor training. To evaluate this, our study had 81 participants complete a battery of physical performance tests (incremental treadmill test, core stability test and functional fitness test) before and after an 8-week outdoor interval-type training intervention. Training procedures included multimodal and high-intensity exercises performed in consistent, small groups. Results showed that the interval training program produced significant increases in the intervention group (n = 43) in functional and strength exercises (p < 0.001; squat (+27%), burpee (+24%), bridge (+39%), push-up (+34%), sit-up (+25%), high knees (+25%), row (+19%), effect sizes 0.4–0.11) for almost all parameters in comparison to a non-intervention control population (n = 38). Interestingly, trunk stability increased significantly (p < 0.001; flexion (+86%), extension (+43%), lateral left (+39%), lateral right (+32%), effect sizes 0.3–0.15) even though it was not explicitly trained; this was rather a secondary outcome of the functional exercises. Drop-out rates (Intervention group: 27%) suggest that this form of training seems to improve adherence to exercise and may help participants to stay committed to regular, intense activity. By simultaneously triggering adaptations in functional fitness, endurance and whole-body movements, this program can be used by people at different training levels.

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The effect of 6-week core stability training on core endurance and physical performance in professional rugby players: A randomized controlled pilot study

Asian Journal of Medical Sciences ◽

10.3126/ajms.v12i11.38816 ◽

2021 ◽

Vol 12 (11) ◽

pp. 60-65

Author(s):

Chamila S. Senavirathna ◽

Anuja P. Mallawaarachchi ◽

Aranjan L. Karunanayake ◽

Sampath Gunawardena

Keyword(s):

Physical Performance ◽

Physical Training ◽

Vertical Jump ◽

Intervention Group ◽

Core Stability ◽

Upper Body ◽

Control Group ◽

Physical Performances ◽

Stability Training ◽

Rugby Players

Background: Core stability training (CST) is used to enhance sports performance. The relationship between core endurance and physical performance in rugby players had not been evaluated before in Asia. Aims and Objectives: This study aims to determine the effects of a 6-week specific CST program on the core endurance and physical performances (speed, upper body power, lower body power, and agility) following a CST intervention in male rugby players. Materials and Methods: Professional rugby players (n=8, intervention and n=8, control) were randomly selected. Mean (SD) age, height and weight of intervention group were 25.25 (2.4) years, 1.64 (0.03) m, and 69.6 (14.9) kg, respectively. In the control group, corresponding values were 29.75 (4) years, 1.66 (0.04) m, and 72.3 (19.1) kg, respectively. Intervention group was trained CST sessions complementary to the usual physical training, 3 times/week for 6 weeks. The control group followed the usual physical training. Subjects were tested for four physical performances (using 40 m sprint, vertical jump, 3 kg medicine ball put, and agility T tests) and four core endurance tests (back extension, abdominal fatigue [AF], and left and right bridges). Results: AF, left bridge, right bridge, and total core endurance were significantly increased in the intervention group (P=0.028, P=0.006, P= 0.008, and P=0.001, respectively). Agility and AF were increased significantly in the control group (P=0.048, P=0.027). The right side bridge endurance (P=0.024) was significantly increased in the intervention group compared to the control group. Conclusion: The results suggest that the CST improves core endurance without improving physical performances in rugby players.

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Effectiveness of Non-Presential Individualized Exercise Training PrOgram(NIETO) in Lower Limb Physical Performance in Advanced COPD

Journal of Clinical Medicine ◽

10.3390/jcm10051010 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1010

Author(s):

Juan Miguel Sánchez-Nieto ◽

Irene Fernández-Muñoz ◽

Andrés Carrillo-Alcaraz ◽

Roberto Bernabeu-Mora

Keyword(s):

Exercise Training ◽

Training Program ◽

Physical Performance ◽

Intervention Group ◽

Quadriceps Strength ◽

Lower Limbs ◽

Control Group ◽

Chronic Obstructive ◽

Muscle Training ◽

Exercise Training Program

Muscle training, a component of pulmonary rehabilitation (PR), improves the physical performance of patients with chronic obstructive pulmonary disease (COPD). Despite the existing evidence, the traditional center-based PR model is applied to a small percentage of patients and presents numerous problems of accessibility, adherence, and costs. This study presents a home model of simple muscle training, non-presential, monitored by telephone and individualized, according to the severity of the COPD. In addition, to evaluate the results, simple tests associated with the physical performance of the lower limbs, previously validated in COPD, have been used, such as the four-meter walk, speed test (4MGS) and the five-repetition test sitting and standing (5STS). The objective was to evaluate whether the Individualized Non-Presential Exercise Training PrOgram (NIETO) induces improvements in the 4MGS, 5STS and quadriceps muscle strength (QMS) tests in outpatients with advanced COPD (FEV1 ≤ 50%). After one year, the QMS was significantly higher in the intervention group (IG) than in the control group (CG) (2.44 ± 4.07 vs. 0.05 ± 4.26 kg; p = 0.009). The 4MGS and 5STS tests were significantly shorter in IG than in CG (−0.39 ± 0.86 vs. 0.37 ± 0.96 s; p = 0.001) and (−1.55 ± 2.83 vs. 0.60 ± 2.06 s; p = 0.001), respectively. A home model of simple muscle training monitored by telephone such as NIETO, can improve 4MGS, 5STS, and quadriceps strength tests in outpatients with advanced COPD.

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Does adding an integrated physical therapy and neuromuscular electrical stimulation therapy to standard rehabilitation improve functional outcome in elderly patients with pneumonia? A randomised controlled trial

Clinical Rehabilitation ◽

10.1177/0269215519859930 ◽

2019 ◽

Vol 33 (11) ◽

pp. 1757-1766 ◽

Cited By ~ 3

Author(s):

Laura López-López ◽

Irene Torres-Sánchez ◽

Janet Rodríguez-Torres ◽

Irene Cabrera-Martos ◽

Araceli Ortiz-Rubio ◽

...

Keyword(s):

Elderly Patients ◽

Physical Performance ◽

Functional Performance ◽

Controlled Trial ◽

Intervention Group ◽

Short Physical Performance Battery ◽

University Hospital ◽

Secondary Outcome ◽

Control Group ◽

Electrical Therapy

Objective: To compare the effects of an integrated programme of physical and electrical therapy to standard rehabilitation to improve physical and functional performance in elderly patients with pneumonia. Design: Randomized clinical trial. The study was registered in the ClinicalTrial.gov website (identifier: NCT02515565). Setting: University Hospital. Subjects: In total, 185 elderly patients with pneumonia were eligible for the study, of which 95 were finally randomized. Interventions: Patients were randomized to a control group which received the standard treatment or to an intervention group which received additionally an integrated programme of physical and electrical therapy. Main measures: Demographic and clinical information was acquired. Pulmonary function, length of hospital stay, handgrip strength, independence levels and comorbidities were assessed as descriptive outcomes. The main outcome measure was functional and physical performance, evaluated with the short physical performance battery. Secondary outcome measures were respiratory symptoms including dyspnoea, fatigue and cough. Results: Mean age of patients was 74.92 (11.03) years in the intervention group and 72.53 (9.24) years in the control group. Significant between groups differences ( P < 0.05) were found in short physical performance battery chair stand test (2.17 (0.97) vs. 0.58 (0.61)) and total score (5.91 (3.61) vs. 4.15 (3.15)). The intervention group showed better performance than the control group in both cases. Fatigue (32.04 (18.58) vs. 46.22 (8.90)) and cough (18.84 (2.47) vs. 17.40 (3.67)) showed higher improvement in the intervention group, and significant differences were observed between the groups. Conclusion: An integrated programme of physical and electrical therapy during hospitalization improves physical and functional performance in patients with pneumonia.

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Individualized Homeopathic Medicines in Chronic Rhinosinusitis: Randomized, Double-Blind, Placebo-Controlled Trial

Homeopathy ◽

10.1055/s-0040-1715842 ◽

2020 ◽

Author(s):

Pankhuri Misra ◽

Chintamani Nayak ◽

Abhijit Chattopadhyay ◽

Tarun Kumar Palit ◽

Bharti Gupta ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Rating Scales ◽

Controlled Trial ◽

Intervention Group ◽

Attrition Rate ◽

Effect Sizes ◽

Medium Effect ◽

Secondary Outcome ◽

Group Differences ◽

Double Blind

Abstract Background Chronic rhinosinusitis (CRS) is a common disorder, with up to an estimated 134 million Indian sufferers, and having significant impact on quality of life (QOL) and health costs. Despite the evidence favoring homeopathy in CRS being inadequate, it is highly popular. This trial attempts to study the efficacy of individualized homeopathy (IH) medicines in comparison with placebo in patients with CRS. Methods A double-blind, randomized (1:1), placebo-controlled, preliminary trial (n = 62) was conducted at the National Institute of Homoeopathy, West Bengal, India. Primary outcome measure was the sino-nasal outcome test-20 (SNOT-20) questionnaire; secondary outcomes were the EQ-5D-5L questionnaire and EQ-5D-5L visual analog scale scores, and five numeric rating scales (0–10) assessing intensity of sneezing, rhinorrhea, post-nasal drip, facial pain/pressure, and disturbance in sense of smell, all measured at baseline and after the 2nd and 4th months of intervention. Group differences and effect sizes (Cohen's d) were calculated on the intention-to-treat sample. Results Groups were comparable at baseline. Attrition rate was 6.5% (IH: 1, Placebo: 3). Although improvements in both primary and secondary outcome measures were higher in the IH group than placebo, with small to medium effect sizes, the group differences were statistically non-significant (all p > 0.05, unpaired t-tests). Calcarea carbonica, Lycopodium clavatum, Sulphur, Natrum muriaticum and Pulsatilla nigricans were the most frequently prescribed medicines. No harmful or unintended effects, homeopathic aggravations or any serious adverse events were reported from either group. Conclusion There was a small but non-significant direction of effect favoring homeopathy, which ultimately renders the trial as inconclusive. Rigorous trials and independent replications are recommended to arrive at a confirmatory conclusion. [Trial registration: CTRI/2018/03/012557; UTN: U1111–1210–7201].

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Vitamin D Supplementation and Change in Objectively Measured Physical Performance

Innovation in Aging ◽

10.1093/geroni/igaa057.2739 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 759-760

Author(s):

Jack Guralnik ◽

Jennifer Schrack ◽

Amal Wanigatunga ◽

Alice Sternberg ◽

Christine Mitchell ◽

...

Keyword(s):

Vitamin D ◽

Physical Performance ◽

Gait Speed ◽

Intervention Group ◽

Vitamin D Supplementation ◽

Secondary Outcome ◽

Timed Up And Go ◽

Objectively Measured ◽

6 Minute Walk Test

Abstract Change in usual gait speed (GS) was a prespecified secondary outcome in STURDY and additional physical performance measures were also assessed. Over 12 months, gait speed declined slightly in both the 200IU/d (control) and the intervention groups receiving 1000 or more IU/d, with identical declines in both groups. However, at month 24 GS declined 0.09 m/s from baseline in controls and 0.03 m/s in the intervention group (p=0.03). Subgroup analyses of persons receiving just 1000IU/d throughout the trial compared to controls did not reach significance (p=0.07). Neither SPPB, balance, chair stand tests, or 6-minute walk test showed differences between controls and intervention at any follow-up point. The timed up and go (TUG) test showed a significantly greater improvement in the intervention group at 2 months (p=0.004) but not 12 or 24 months (p=0.17 and 0.79, respectively). Effects of long-term vitamin D supplementation on physical functioning remain unclear.

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Office work and stretch training (OST) study: effects on the prevalence of musculoskeletal diseases and gender differences: a non-randomised control study

BMJ Open ◽

10.1136/bmjopen-2020-044453 ◽

2021 ◽

Vol 11 (5) ◽

pp. e044453

Author(s):

Fabian Holzgreve ◽

Laura Fraeulin ◽

Jasmin Haenel ◽

Helmut Schmidt ◽

Andreas Bader ◽

...

Keyword(s):

Musculoskeletal Diseases ◽

Workplace Health Promotion ◽

Intervention Group ◽

Subjective Health ◽

Office Workers ◽

Secondary Outcome ◽

Full Time ◽

Office Work ◽

Musculoskeletal Complaints ◽

Control Study

ObjectivesFor the prevention of musculoskeletal diseases (MSDs), stretch training can be a measure of the workplace health promotion (WHP) for office workers. This can lead to an increase in mobility and, ultimately, reduce or prevent MSD. The aim of the study was to examine a standardised and individualised stretch training on a device, specifically ‘five Business’, for the prevalence of MSD.DesignThis study is a non-randomised control study.SettingWHP programme with clerical employees of a German car manufacturer.Participants252 (110 women; 142 men) subjects (median age of 44 (X∼ 21 years) finished the study successfully. Inclusion criteria included a full-time employment in the office workplace and subjective health.InterventionThe intervention group completed 22–24 training units of 10 min each on the ‘five-Business’ device two times a week for 12 weeks.Primary and secondary outcome measuresData were collected in the form of a pre–post study Nordic Questionnaire.ResultsAfter the intervention, significantly fewer subjects reported pain in the area of the neck (−17.79), shoulder (−11.28%), upper back (−14.7%), lower back (−12.78%) and feet (−8.51%). The gender analysis revealed that women are, in general, more often affected by musculoskeletal complaints than men, especially in the neck (+29.5%) and feet (+15.03%). Both sexes had significant reductions of MSD in the most commonly affected regions. Thus, 27.12% less women reported having neck pain, while 13.14% less men reported having low back pain.ConclusionsThe results suggest that a stretching programme performed for 3 months can reduce musculoskeletal complaints in the most commonly affected areas in office workers. Both men and women benefited from the stretch training to a similar extent, suggesting that this would be a promising measure for therapy and prevention as part of WHP.

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Cardiovascular risk prediction using physical performance measures in COPD: results from a multicentre observational study

BMJ Open ◽

10.1136/bmjopen-2020-038360 ◽

2020 ◽

Vol 10 (12) ◽

pp. e038360

Author(s):

Jilles M Fermont ◽

Marie Fisk ◽

Charlotte E Bolton ◽

William MacNee ◽

John R Cockcroft ◽

...

Keyword(s):

Risk Factors ◽

Physical Performance ◽

Risk Prediction ◽

Survival Data ◽

Airflow Obstruction ◽

Secondary Outcome ◽

Chronic Obstructive ◽

Bode Index ◽

Gold Stage ◽

Improved Model

ObjectivesAlthough cardiovascular disease (CVD) is a common comorbidity associated with chronic obstructive pulmonary disease (COPD), it is unknown how to improve prediction of cardiovascular (CV) risk in individuals with COPD. Traditional CV risk scores have been tested in different populations but not uniquely in COPD. The potential of alternative markers to improve CV risk prediction in individuals with COPD is unknown. We aimed to determine the predictive value of conventional CVD risk factors in COPD and to determine if additional markers improve prediction beyond conventional factors.DesignData from the Evaluation of the Role of Inflammation in Chronic Airways disease cohort, which enrolled 729 individuals with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage II–IV COPD were used. Linked hospital episode statistics and survival data were prospectively collected for a median 4.6 years of follow-up.SettingFive UK centres interested in COPD.ParticipantsPopulation-based sample including 714 individuals with spirometry-defined COPD, smoked at least 10 pack years and who were clinically stable for >4 weeks.InterventionsBaseline measurements included aortic pulse wave velocity (aPWV), carotid intima–media thickness (CIMT), C reactive protein (CRP), fibrinogen, spirometry and Body mass index, airflow Obstruction, Dyspnoea and Exercise capacity (BODE) Index, 6 min walk test (6MWT) and 4 m gait speed (4MGS) test.Primary and secondary outcome measuresNew occurrence (first event) of fatal or non-fatal hospitalised CVD, and all-cause and cause-specific mortality.ResultsOut of 714 participants, 192 (27%) had CV hospitalisation and 6 died due to CVD. The overall CV risk model C-statistic was 0.689 (95% CI 0.688 to 0.691). aPWV and CIMT neither had an association with study outcome nor improved model prediction. CRP, fibrinogen, GOLD stage, BODE Index, 4MGS and 6MWT were associated with the outcome, independently of conventional risk factors (p<0.05 for all). However, only 6MWT improved model discrimination (C=0.727, 95% CI 0.726 to 0.728).ConclusionPoor physical performance defined by the 6MWT improves prediction of CV hospitalisation in individuals with COPD.Trial registration numberID 11101.

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OP0010 EFFECTIVENESS OF THE MAKING IT WORK™ PROGRAM AT IMPROVING PRESENTEEISM AND WORK CESSATION IN WORKERS WITH INFLAMMATORY ARTHRITIS – RESULTS OF A RANDOMIZED CONTROLLED TRIAL

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.2383 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 7.1-8

Author(s):

A. Luquini ◽

Y. Zheng ◽

H. Xie ◽

C. Backman ◽

P. Rogers ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Work Disability ◽

Inflammatory Arthritis ◽

Missing Values ◽

Controlled Trial ◽

Intervention Group ◽

Secondary Outcome ◽

Mixed Effect ◽

Randomized Controlled ◽

Baseline Characteristics

Background:Arthritis often leads to presenteeism (decreased at-work productivity), missed days from work and permanent work disability, leading to reduced quality of life and high costs to individuals and society. Yet, health services addressing the employment needs of people with arthritis are lacking.Objectives:We evaluated the effectiveness of the Making-it-WorkTM(MiW) program, an online self-management program developed to help people with inflammatory arthritis (IA) deal with employment issues.Methods:A multi-center RCT evaluated the effectiveness of MiW at improving presenteeism and preventing work cessation (WC) over two years. Participants were recruited from rheumatologist practices, consumer organizations and arthritis programs, in three Canadian provinces. Eligibility criteria: diagnosis of IA, employed, age 18-59, and concerned about ability to work. Participants were randomized 1:1 to MiW or usual care plus printed material on workplace tips. MiW consists of five online self-learning modules and group meetings, and individual vocational counselling and ergonomic consultations. Questionnaires were administered every 6 months. Outcomes were presenteeism [Rheumatoid Arthritis Work Instability Scale (RA-WIS)], time to WC ≥ 6 months, and time to WC ≥ 2 months (secondary outcome). Baseline characteristics (age, gender, ethnicity, occupation, education, disease duration and self-employment) were collected. Intention-to-treat (ITT) longitudinal analysis of RA-WIS using linear mixed effect regression models with 2-year comparison as primary endpoint and survival analysis for time to WC using Kaplan-Meier and Cox Proportional Hazard models were performed. Robustness analyses were conducted by using various missing values imputation methods like last observation carried forward, imputation using worse possible outcomes and model-based multiple imputations; using square root transformation of RA-WIS outcome; and adjusting for baseline covariates. SAS version 9.4 was used.Results:A total of 564 participants were recruited, with 478 (84.75%) completing 2-year follow-up. Baseline characteristics were similar between groups. Mean RA-WIS scores were significantly lower in the intervention group from 6 months onwards, with the greatest difference observed at 2 years (-1.78, 95%CI: -2.7, -0.9, p < .0001), yielding a standardized effect size of 32%. Satisfactory robustness was observed. Work cessation occurred less often in intervention than control groups, but only reached statistical significance for WC ≥ 2 months (WC ≥ 6 months: 31 versus 44 events, aHR 0.70, 95%CI: 0.44, 1.11, p = 0.13; WC ≥ 2 months: 39 versus 61 events, aHR: 0.65, 95%CI: 0.43, 0.98, p = 0.04).Conclusion:Results of the RCT reveal the program was effective at improving presenteeism and preventing short-term WC. Effectiveness at preventing long-term work disability will be assessed at 5 years. This program fills one of the most important and costly unmet needs for people with inflammatory arthritis.References:[1]Carruthers EC, Rogers P, Backman CL, et al. “Employment and arthritis: making it work” a randomized controlled trial evaluating an online program to help people with inflammatory arthritis maintain employment (study protocol).BMC Med Inform Decis Mak. 2014;14:59. Published 2014 Jul 21. doi:10.1186/1472-6947-14-59Disclosure of Interests:Andre Luquini: None declared, Yufei Zheng: None declared, Hui Xie: None declared, Catherine Backman: None declared, Pamela Rogers: None declared, Alex Kwok: None declared, Astrid Knight: None declared, Monique Gignac: None declared, Dianne Mosher: None declared, Linda Li: None declared, John Esdaile: None declared, Carter Thorne Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer, Speakers bureau: Medexus/Medac, Diane Lacaille: None declared

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Improving nurses’ readiness for evidence-based practice in critical care units: results of an information literacy training program

BMC Nursing ◽

10.1186/s12912-021-00599-y ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Jamileh Farokhzadian ◽

Somayeh Jouparinejad ◽

Farhad Fatehi ◽

Fatemeh Falahati-Marvast

Keyword(s):

Critical Care ◽

Training Program ◽

Information Literacy ◽

Intervention Group ◽

Literacy Skills ◽

Evidence Based ◽

Control Groups ◽

Critical Care Units ◽

Literacy Training ◽

Information Literacy Skills

Abstract Background One of the most important prerequisites for nurses’ readiness to implement Evidence-Based Practice (EBP) is to improve their information literacy skills. This study aimed to evaluate the impact of a training program on nurses’ information literacy skills for EBP in critical care units. Methods In this interventional study, 60 nurses working in critical care units of hospitals affiliated to Kerman University of Medical Sciences were randomly assigned into the intervention or control groups. The intervention group was provided with information literacy training in three eight-hour sessions over 3 weeks. Data were collected using demographic and information literacy skills for EBP questionnaires before and 1 month after the intervention. Results At baseline, the intervention and control groups were similar in terms of demographic characteristics and information literacy skills for EBP. The training program significantly improved all dimensions of information literacy skills of the nurses in the intervention group, including the use of different information resources (3.43 ± 0.48, p < 0.001), information searching skills and the use of different search features (3.85 ± 0.67, p < 0.001), knowledge about search operators (3.74 ± 0.14, p < 0.001), and selection of more appropriate search statement (x2 = 50.63, p = 0.001) compared with the control group. Conclusions Nurses can learn EBP skills and apply research findings in their nursing practice in order to provide high-quality, safe nursing care in clinical settings. Practical workshops and regular training courses are effective interventional strategies to equip nurses with information literacy skills so that they can apply these skills to their future nursing practice.

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Proton therapy for craniopharyngioma in adults: a protocol for systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-046043 ◽

2021 ◽

Vol 11 (6) ◽

pp. e046043

Author(s):

Pengtao Li ◽

Jialing Wang ◽

Aximujiang Axier ◽

Kai Zhou ◽

Jingwei Yun ◽

...

Keyword(s):

Proton Therapy ◽

Ion Beam ◽

Grey Literature ◽

Intervention Group ◽

Heavy Ion ◽

Cochrane Library ◽

Secondary Outcome ◽

Significant Heterogeneity ◽

Recurrence Rates ◽

X Ray

IntroductionCraniopharyngioma is the most challenging to treat brain tumour with high recurrence rates, which can be effectively reduced by adjuvant radiotherapy. In recent years, proton therapy (PT), with its physical properties of heavy ion beam, that is, Prague peak phenomenon, has been more frequently used in patients with craniopharyngioma. Compared with conventional X-ray beam radiotherapy, PT can reduce the damage to normal tissues and enlarge the damage to tumours. Some studies have shown that PT has advantages in the treatment of craniopharyngioma in adults. However, the optimal management of craniopharyngioma remains controversial. The purpose of this study was to evaluate the efficacy and safety of PT for craniopharyngioma in adults.Methods and analysisWe will search six databases (MEDLINE, EMBASE, Web of Science, the Cochrane Library, Amed, Scopus), clinical research registration websites and grey literature, aiming to identify randomised controlled trials (RCTs) on PT for craniopharyngioma in adults between 1 January 1954 and 28 September 2021. In the RCTs, PT will be used as the intervention group, and conventional X-ray beam radiotherapy will be used as the comparator group. Tumour recurrence and survival will be the primary outcome, and treatment-related toxicity will be the secondary outcome. The study selection, data extraction, bias risk and quality evaluation will be operated by two to four researchers independently. We will use Review Manager V.5.2 (RevMan V.5.2) for data analysis. If there is significant heterogeneity, we will identify the source of heterogeneity by subgroup analysis.Ethics and disseminationOur study is based on existing RCTs and does not require ethical approval. The results of the study will be published in a peer-reviewed journal or at a related conference.PROSPERO registration numberCRD42020200909.

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