scholarly journals Safety and Efficacy of Acceptance and Commitment Therapy (ACT) in Schizophrenia Spectrum and Other Psychotic Disorders: Protocol for a Systematic Review and Meta-Analysis

2018 ◽  
Vol 1 (4) ◽  
pp. 38 ◽  
Author(s):  
Richard Gray ◽  
Stav Hillel ◽  
Ellie Brown ◽  
Amal Al Ghareeb

Acceptance and commitment therapy (ACT) has been reported to be effective in the treatment of some psychiatric disorders. It remains uncertain, however, whether ACT is safe and effective in treating schizophrenia spectrum and other psychotic disorders (e.g., psychosis). This protocol describes the methodology for a systematic review and meta-analysis of the safety and efficacy of ACT in the treatment of psychosis. The review will be guided by the standards set by the Cochrane Collaboration. We will search the Allied and Complementary Medicine Database (AMED), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), Excerpta Medica database (EMBASE), EMCARE, Education Resources Information Center (ERIC), MEDLINE, and PsycINFO databases for randomized controlled trials, whose arms are ACT and any comparator, as well as ClinicalTrials.gov, Australian New Zealand Clinical Trials Registry (ANZCTR), and Current Controlled Trials (ISRCTN), for unpublished and ongoing trials. The primary outcome will be any standard (or surrogate) measure of psychotic pathology. The meta-analysis will summarize short-term and long-term effects and different control conditions with or without treatment as usual or comparative to other interventions. In cases where heterogeneity is detected (via χ2 and I2), we will adopt the random effects model for computation.

Neurosurgery ◽  
2017 ◽  
Vol 80 (5) ◽  
pp. 701-715 ◽  
Author(s):  
Daniel Yavin ◽  
Steven Casha ◽  
Samuel Wiebe ◽  
Thomas E Feasby ◽  
Callie Clark ◽  
...  

Abstract BACKGROUND: Due to uncertain evidence, lumbar fusion for degenerative indications is associated with the greatest measured practice variation of any surgical procedure. OBJECTIVE: To summarize the current evidence on the comparative safety and efficacy of lumbar fusion, decompression-alone, or nonoperative care for degenerative indications. METHODS: A systematic review was conducted using PubMed, MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (up to June 30, 2016). Comparative studies reporting validated measures of safety or efficacy were included. Treatment effects were calculated through DerSimonian and Laird random effects models. RESULTS: The literature search yielded 65 studies (19 randomized controlled trials, 16 prospective cohort studies, 15 retrospective cohort studies, and 15 registries) enrolling a total of 302 620 patients. Disability, pain, and patient satisfaction following fusion, decompression-alone, or nonoperative care were dependent on surgical indications and study methodology. Relative to decompression-alone, the risk of reoperation following fusion was increased for spinal stenosis (relative risk [RR] 1.17, 95% confidence interval [CI] 1.06-1.28) and decreased for spondylolisthesis (RR 0.75, 95% CI 0.68-0.83). Among patients with spinal stenosis, complications were more frequent following fusion (RR 1.87, 95% CI 1.18-2.96). Mortality was not significantly associated with any treatment modality. CONCLUSION: Positive clinical change was greatest in patients undergoing fusion for spondylolisthesis while complications and the risk of reoperation limited the benefit of fusion for spinal stenosis. The relative safety and efficacy of fusion for chronic low back pain suggests careful patient selection is required (PROSPERO International Prospective Register of Systematic Reviews number, CRD42015020153).


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