scholarly journals Proprioceptive Training and Outcomes of Patients With Knee Osteoarthritis: A Meta-Analysis of Randomized Controlled Trials

2019 ◽  
Vol 54 (4) ◽  
pp. 418-428 ◽  
Author(s):  
Hee Seong Jeong ◽  
Sung-Cheol Lee ◽  
Hyunseok Jee ◽  
Jun Bom Song ◽  
Hyun Sik Chang ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Level Of Evidence ◽  
Knee Oa ◽  
Randomized Controlled ◽  
Proprioceptive Training ◽  
Evidence Database ◽  
Based Medicine ◽  
Test Outcomes

Objective To describe the effects of proprioceptive training on pain, stiffness, function, and functional test outcomes among patients with knee osteoarthritis (OA). Data Sources All studies completed from 1946 to 2017 were obtained from 4 databases (PubMed, MEDLINE, CINAHL, and SPORTDiscus). Study Selection Three reviewers independently identified appropriate studies and extracted data. Data Extraction Methodologic quality and level of evidence were assessed using the Physiotherapy Evidence Database scale and Oxford Centre for Evidence-Based Medicine guidelines. The standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated for pain, stiffness, function, and functional test outcomes. Data Synthesis Seven randomized controlled trials involving 558 patients with knee OA met the inclusion criteria. The selected studies had Physiotherapy Evidence Database scores of 6 to 8. All randomized controlled trials had an Oxford Centre for Evidence-Based Medicine level of evidence of 2. Meta-analysis of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale (SMD = −0.56; 95% CI = −1.06, −0.07; P = .026), function subscale (SMD = −0.40; 95% CI = −0.59, −0.21; P < .001), and non-WOMAC walking speed test (SMD = −1.07; 95% CI = −2.12, −0.01; P = .048) revealed that proprioceptive training had significant treatment effects. Proprioceptive training was not associated with reductions in WOMAC stiffness subscale scores and did not improve non-WOMAC get-up-and-go scores. Conclusions Proprioceptive training effectively promoted pain relief and completion of functional daily activity among patients with knee OA and should be included in rehabilitation programs. Stiffness and other mobility measures were unchanged after proprioceptive training. Modified proprioceptive training programs are needed to target stiffness and improve additional physical function domains.

scholarly journals Relative Efficacy of Weight Management, Exercise, and Combined Treatment for Muscle Mass and Physical Sarcopenia Indices in Adults with Overweight or Obesity and Osteoarthritis: A Network Meta-Analysis of Randomized Controlled Trials

Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1992
Author(s):  
Shu-Fen Chu ◽  
Tsan-Hon Liou ◽  
Hung-Chou Chen ◽  
Shih-Wei Huang ◽  
Chun-De Liao
Keyword(s):  
Randomized Controlled Trials ◽  
Weight Management ◽  
Muscle Mass ◽  
Lower Limb ◽  
Meta Analysis ◽  
Combined Treatment ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Standard Mean Difference ◽  
Evidence Database

Aging and osteoarthritis are associated with high risk of muscle mass loss, which leads to physical disability; this loss can be effectively alleviated by diet (DI) and exercise (ET) interventions. This study investigated the relative effects of different types of diet, exercise, and combined treatment (DI+ET) on muscle mass and functional outcomes in individuals with obesity and lower-limb osteoarthritis. A comprehensive search of online databases was performed to identify randomized controlled trials (RCTs) examining the efficacy of DI, ET, and DI+ET in patients with obesity and lower-extremity osteoarthritis. The included RCTs were analyzed through network meta-analysis and risk-of-bias assessment. We finally included 34 RCTs with a median (range/total) Physiotherapy Evidence Database score of 6.5 (4–8/10). DI plus resistance ET, resistance ET alone, and aerobic ET alone were ranked as the most effective treatments for increasing muscle mass (standard mean difference (SMD) = 1.40), muscle strength (SMD = 1.93), and walking speed (SMD = 0.46). Our findings suggest that DI+ET is beneficial overall for muscle mass in overweight or obese adults with lower-limb osteoarthritis, especially those who are undergoing weight management.

scholarly journals The Long-Lasting Effects of “Placebo Injections” in Knee Osteoarthritis: A Meta-Analysis

Cartilage ◽  
2020 ◽  
pp. 194760352090659 ◽  
Author(s):  
Davide Previtali ◽  
Giulia Merli ◽  
Giorgio Di Laura Frattura ◽  
Christian Candrian ◽  
Stefano Zaffagnini ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Randomized Controlled Trials ◽  
Placebo Effect ◽  
Meta Analysis ◽  
Grey Literature ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Level Of Evidence ◽  
Randomized Controlled ◽  
The Impact

Objectives To quantify the placebo effect of intraarticular injections for knee osteoarthritis in terms of pain, function, and objective outcomes. Factors influencing placebo effect were investigated. Design Meta-analysis of randomized controlled trials; Level of evidence, 2. PubMed, Web of Science, Cochrane Library, and grey literature databases were searched on January 8, 2020, using the string: (knee) AND (osteoarthritis OR OA) AND (injections OR intra-articular) AND (saline OR placebo). The following inclusion criteria were used: double-blind, randomized controlled trials on knee osteoarthritis, including a placebo arm on saline injections. The primary outcome was pain variation. Risk of bias was assessed using the RoB 2.0 tool, and quality of evidence was graded following the GRADE (Grading of Recommendations Assessment, Development and Evaluation) guidelines. Results Out of 2,363 records, 50 articles on 4,076 patients were included. The meta-analysis showed significant improvements up to the 6-month follow-up: Visual Analogue Scale (VAS)-pain −13.4 mean difference (MD) (95% confidence interval [CI]: −21.7/−5.1; P < 0.001), Western Ontario and McMaster Osteoarthritis Index (WOMAC)-pain −3.3 MD (95% CI: −3.9/−2.7; P < 0.001). Other significant improvements were WOMAC-stiffness −1.1 MD (95% CI: −1.6/−0.6; P < 0.001), WOMAC-function −10.1 MD (95% CI: −12.2/−8.0; P < 0.001), and Evaluator Global Assessment −21.4 MD (95% CI: −29.2/−13.6; P < 0.001). The responder rate was 52% (95% CI: 40% to 63%). Improvements were greater than the “minimal clinically important difference” for all outcomes (except 6-month VAS-pain). The level of evidence was moderate for almost all outcomes. Conclusions The placebo effect of knee injections is significant, with functional improvements lasting even longer than those reported for pain perception. The high, long-lasting, and heterogeneous effects on the scales commonly used in clinical trials further highlight that the impact of placebo should not be overlooked in the research on and management of knee osteoarthritis.

Suture Button Versus Syndesmotic Screw for Syndesmosis Injuries: A Meta-analysis of Randomized Controlled Trials

2018 ◽  
Vol 47 (11) ◽  
pp. 2764-2771 ◽  
Author(s):  
Yoshiharu Shimozono ◽  
Eoghan T. Hurley ◽  
C. Lucas Myerson ◽  
Christopher D. Murawski ◽  
John G. Kennedy
Keyword(s):  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
P Value ◽  
Controlled Trials ◽  
Level Of Evidence ◽  
Suture Button ◽  
Randomized Controlled ◽  
Syndesmotic Screw ◽  
Fixation Techniques ◽  
American Orthopaedic

Background: Operative treatment is indicated for unstable syndesmosis injuries, and approximately 20% of all ankle fractures require operative fixation for syndesmosis injuries. Purpose: To perform a meta-analysis of randomized controlled trials evaluating clinical outcomes between suture button (SB) and syndesmotic screw (SS) fixation techniques for syndesmosis injuries of the ankle. Study Design: Meta-analysis. Methods: A literature search was performed according to the PRISMA guidelines to identify randomized controlled trials comparing the SB and SS techniques for syndesmosis injuries. Level of evidence was assessed per the criteria of the Oxford Centre for Evidence-Based Medicine. Statistical analysis was performed with RevMan, and a P value ≤.05 was considered statistically significant. Results: Five clinical studies were identified, allowing comparison of 143 patients in the SB group with 142 patients in the SS group. Patients treated with the SB technique had a higher postoperative American Orthopaedic Foot & Ankle Society score at a mean 20.8 months (95.3 vs 86.7, P < .001). The SB group resulted in a lower rate of broken implants (0.0% vs 25.4%, P < .001), implant removal (6.0% vs 22.4%, P = .01), and joint malreduction (0.8% vs 11.5%, P = .05) as compared with the SS group. Conclusion: The SB technique results in improved functional outcomes as well as lower rates of broken implant and joint malreduction. Based on the findings of this meta-analysis, the SB technique warrants a grade A recommendation by comparison with the SS technique for the treatment of syndesmosis injuries.

Is intramedullary nailing better than the use of volar locking plates for fractures of the distal radius? A meta-analysis of randomized controlled trials

2016 ◽  
Vol 41 (5) ◽  
pp. 543-552 ◽  
Author(s):  
J. Wang ◽  
L. Zhang ◽  
J. Ma ◽  
Y. Yang ◽  
H. Jia ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Intramedullary Nailing ◽  
Meta Analysis ◽  
Cochrane Collaboration ◽  
Controlled Trials ◽  
Locking Plates ◽  
Distal Radial Fractures ◽  
Eligibility Criteria ◽  
Level Of Evidence ◽  
Randomized Controlled

We conducted a meta-analysis of randomized controlled trials that compared the use of intramedullary nails and volar locking plates in distal radial fractures. PubMed, EMBASE and the Cochrane Collaboration Central database were used to find randomized controlled trials that met the eligibility criteria. Two reviewers screened the studies, extracted the data, evaluated the methodological quality and analysed the data with RevMan 5.1 software. No statistically significant differences were detected in the disability of the arm, shoulder and hand and the Gartland and Werley scores, radiographic parameters, wrist range of motion, grip strength, total complication rate and incidence of tendon rupture between the two groups. However, carpal tunnel syndrome occurred less often after intramedullary nailing. The two fixation methods achieved equal clinical, functional and radiological outcomes for primary fixation of the indicated types of distal radial fractures. Level of evidence: Therapeutic/LevelI

Abstract WP349: Updated Meta-Analysis of Randomized Controlled Trials Investigating Blood-Pressure Lowering for Acute Intracerebral Hemorrhage

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Gregoire Boulouis ◽  
Andrea Morotti ◽  
Joshua N Goldstein ◽  
Andreas Charidimou
Keyword(s):  
Blood Pressure ◽  
Randomized Controlled Trials ◽  
Standard Treatment ◽  
Meta Analysis ◽  
Class I ◽  
Hematoma Expansion ◽  
Controlled Trials ◽  
Level Of Evidence ◽  
Treatment Protocols ◽  
Randomized Controlled

Objective: We performed a meta-analysis of randomized controlled trials (RCTs) to assess whether intensive blood pressure (BP) lowering in acute intracerebral haemorrhage (ICH) patients is safe and effective in improving clinical outcomes. Methods: We searched PubMed, EMBASE and the Cochrane databases for relevant RCTs and calculated pooled odds ratios (OR) for 3-month mortality (safety outcome) and 3-month death or dependency (efficacy outcome), in acute ICH patients randomized to either intensive BP-lowering vs. standard BP lowering treatment protocols. We also investigated the association between treatment arm and significant ICH expansion at 24h. Random effects models with DerSimonian-Laird weights were used. Results: Five eligible studies including 4360 acute ICH patients were pooled in meta-analysis. The risk of 3-month mortality was similar between patients randomized to intensive BP-lowering treatment vs. standard BP-lowering treatment (OR: 0.99; 95%CI: 0.82-1.20, p=0.909). Intensive BP-lowering treatment showed a (non-significant) trend for an association with lower 3-month death or dependency risk compared to standard treatment (OR: 0.91; 95%CI: 0.80-1.02), p=0.106). Intensive BP-reduction was associated with a trend for lower risk of significant ICH expansion compared to standard treatment (OR: 0.82; 95%CI: 0.68-1.00, p=0.056), especially in larger RCTs. Conclusion: For acute ICH patients similar to those included in RCTs and without contraindication to acute BP treatment, intensive acute BP-lowering is safe (Class I; Level of Evidence A), but does not seem to provide an incremental clinical benefit in terms of functional outcomes (Class I; Level of Evidence B). The effect of intensive BP-lowering on significant hematoma expansion at 24 hours warrants further investigation.

Safety of Intra-Articular Hyaluronic Acid for Knee Osteoarthritis: Systematic Review and Meta-Analysis of Randomized Trials Involving More than 8,000 Patients

Cartilage ◽  
2019 ◽  
pp. 194760351988878
Author(s):  
Larry E. Miller ◽  
Samir Bhattacharyya ◽  
William R. Parrish ◽  
Michael Fredericson ◽  
Brad Bisson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hyaluronic Acid ◽  
Adverse Events ◽  
Knee Osteoarthritis ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Knee Oa ◽  
Randomized Controlled ◽  
Symptomatic Knee

Objective The objective of this systematic review and meta-analysis was to report the safety of intra-articular hyaluronic acid (IAHA) in patients with symptomatic knee osteoarthritis (OA). Methods We identified randomized controlled trials reporting the safety of IAHA versus IA saline in adults with symptomatic knee OA. Main safety outcomes were adverse events (AEs), local AEs, serious adverse events (SAEs), study withdrawals, and AE-related study withdrawals. Results A total of 35 randomized controlled trials with 38 group comparisons comprising 8,078 unique patients (IAHA: 4,295, IA saline: 3,783) were included in the meta-analysis. Comparing IAHA with IA saline over a median of 6 months follow-up, there were no differences in the risk of AEs (42.4% vs. 39.7%, risk ratio [RR] = 1.01, 95% CI = 0.96-1.07, P = 0.61), SAEs (1.8% vs. 1.2%, RR = 1.44, 95% CI = 0.91-2.26, P=0.12), study withdrawals (12.3% vs. 12.7%, RR = 0.99, 95% CI = 0.87-1.12, P = 0.83), or AE-related study withdrawals (2.7% vs. 2.1%, RR = 1.37, 95% CI = 0.97-1.93, P = 0.08). Local AEs, all of which were nonserious, were more common with IAHA vs. IA saline (14.5% vs. 11.7%, RR = 1.21, 95% CI = 1.07-1.36, P = 0.003) and typically resolved within days. Conclusion IAHA was shown to be safe for use in patients with symptomatic knee OA. Compared with IA saline, IAHA is associated with an increased risk of nonserious, transient local reactions. There was no evidence to suggest any additional safety risks of IAHA.

Robot-assisted therapy for upper extremity motor impairment after stroke: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Jingyi Wu ◽  
Hao Cheng ◽  
Jiaqi Zhang ◽  
Shanli Yang ◽  
Sufang Cai
Keyword(s):  
Randomized Controlled Trials ◽  
Upper Extremity ◽  
Meta Analysis ◽  
Motor Impairment ◽  
Controlled Trials ◽  
Robot Assisted ◽  
Randomized Controlled ◽  
Small Effect Size ◽  
Evidence Database ◽  
Upper Extremity Motor Impairment

Abstract Objective The purpose of this study was to review the effects of robot-assisted therapy (RT) for improving poststroke upper extremity motor impairment. Methods The PubMed, EMBASE, Medline, and Web of Science databases were searched from inception to April 8, 2020. Randomized controlled trials that were conducted to evaluate the effects of RT on upper extremity motor impairment poststroke and that used Fugl-Meyer Assessment Upper Extremity (FMA-UE) scores as an outcome were included. Two authors independently screened articles, extracted data, and assessed the methodological quality of the included studies using the Physiotherapy Evidence Database (PEDro) scale. A random-effects meta-analysis was performed to pool the effect sizes across the studies. Results Forty-one randomized controlled trials with 1916 stroke patients were included. Compared with dose-matched conventional rehabilitation, RT significantly improved the FMA-UE scores of the patients with stroke, with a small effect size (Hedges g = 0.25; 95% CI = 0.11 to 0.38; I2 = 45.9%). The subgroup analysis revealed that the effects of unilateral RT, but not that of bilateral RT, was superior to conventional rehabilitation (Hedges g = 0.32; 95% CI = 0.15 to 0.50; I2 = 55.9%). Regarding the type of robot devices, the effects of the end effector device (Hedges g = 0.22; 95% CI = 0.09 to −0.36; I2 = 35.4%), but not the exoskeleton device, were superior to conventional rehabilitation. Regarding the stroke stage, the between-group difference (ie, RT vs convention rehabilitation) was significant only for people with late subacute or chronic stroke (Hedges g = 0.33; 95% CI = 0.16 to 0.50; I2 = 34.2%). Conclusion RT might be superior to conventional rehabilitation in improving upper extremity motor impairment in people after stroke with notable upper extremity hemiplegia and limited potential for spontaneous recovery.

scholarly journals Network meta-analysis for clinicians

2021 ◽  
Vol 23 (3) ◽  
pp. 418-424
Author(s):  
Alexey A. Bogdanov ◽  
Andrey A. Bogdanov
Keyword(s):  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Evidence Base ◽  
Controlled Trials ◽  
Evidence Based ◽  
Efficacy And Safety ◽  
Analysis Method ◽  
Medical Interventions ◽  
Randomized Controlled ◽  
Based Medicine

Decision making in clinical practice requires consideration of the relative efficacy and safety of medical interventions. A systematic review and meta-analysis, the results of which have the highest level of confidence in evidence-based medicine, only compare the effectiveness of two interventions, provided that there is a direct comparison between them in a set of randomized controlled trials. The development of statistical methods has led to the development of the network meta-analysis method, the application of which allows comparison for more than two interventions and even if the interventions were not directly compared in randomized controlled trials, but have a common comparison intervention. As a result, network meta-analysis is increasingly being used as an evidence base for the effectiveness of medical interventions. However, there are important assumptions and conditions underlying the performance of network meta-analysis. In this work, we tried to outline the main aspects of network meta-analysis that are important for clinicians in terms of its implementation and interpretation of its results.

Levels of evidence of articles in podiatric medical journals

2000 ◽  
Vol 90 (6) ◽  
pp. 300-302 ◽  
Author(s):  
MA Turlik ◽  
D Kushner
Keyword(s):  
Randomized Controlled Trials ◽  
Evidence Based Medicine ◽  
Medical Profession ◽  
Controlled Trials ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Medical Journals ◽  
Levels Of Evidence ◽  
Randomized Controlled ◽  
Based Medicine

The authors reviewed 322 articles in podiatric medical journals to determine their level of evidence. Only 1% of the articles reviewed were randomized controlled trials. The authors concluded that if the podiatric medical profession wishes to become a participant in evidence-based medicine, greater emphasis must be placed on studies that assess hypotheses.

scholarly journals Efficacy of mesenchymal stromal cells for the treatment of knee osteoarthritis: a meta-analysis of randomized controlled trials

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Huazheng Qu ◽  
Shui Sun
Keyword(s):  
Knee Osteoarthritis ◽  
Randomized Controlled Trials ◽  
Mesenchymal Stromal Cells ◽  
Stromal Cells ◽  
Meta Analysis ◽  
Biomedical Literature ◽  
Womac Pain ◽  
Controlled Trials ◽  
Knee Oa ◽  
Randomized Controlled

Abstract Background Mesenchymal stromal cells (MSCs) are used as an emerging new option for the treatment of knee osteoarthritis (OA). However, their efficacy remains controversial across studies with different doses of MSCs and cell processing methods. We conducted this meta-analysis to assess the efficacy of MSCs in the treatment of knee OA. Methods Randomized controlled trials (RCTs) published in PubMed, Embase, Web of Science, SinoMed (Chinese BioMedical Literature Service System, China), and CNKI (National Knowledge Infrastructure, China) databases were systematically reviewed. The pain level and function improvements were evaluated using visual analog scale (VAS), McMaster Universities Osteoarthritis Index (WOMAC), and International Knee Documentation Committee (IKDC). The pooled estimate was calculated with weighted mean difference (WMD) with 95% confidence intervals (95%CIs). Results Nine RCTs involving 476 patients were included in this meta-analysis. The pooled estimate showed that the treatment of MSCs significantly reduced VAS, WOMAC pain, WOMAC stiffness, and WOMAC function scores at a long-term follow-up (12 or 24 months). However, for the IKDC and WOMAC total scores, MSCs also showed significant improvement in these outcomes, although this was not statistically significant when compared to the control. Conclusion Based on the current studies, our results suggested that MSCs were a promising option for the treatment of patients with knee OA. However, considering the potential limitations, more well-performed, large-scale RCTs are needed to verify our findings.

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