Multilevel Network Meta-Analysis of Non-Pharmacological Interventions for Migraine: Focusing on the Dose-Effect of Physical Exercise and Its Moderators.

BackgroundTo elucidate the relative efficacy of diverse exercise modalities for migraine and quantify the optimal therapeutic dosage.MethodA systematic search was conducted across four electronic databases from their inception to May 2025. Two reviewers independently performed data extraction and risk of bias assessment. A multilevel network meta-analysis (ML-NMA) integrated with a dose-response analysis was employed to comprehensively compare these interventions.ResultsTwenty-seven randomized controlled trials (RCTs) (n = 1,611) were included. The most effective interventions were combined aerobic+resistance exercise (g = − 1.85, 95% credible interval (CrI): [−2.53 to −1.18]; surface under the cumulative ranking curve (SUCRA) = 0.91), followed by resistance exercise (g = − 1.45, 95% CrI [−1.79 to −1.10]; SUCRA = 0.81), yoga (g = − 0.35, 95% CrI [−0.63 to −0.06]; SUCRA = 0.49), and tai chi (g = − 0.48, 95% CrI [−0.91 to −0.05]; SUCRA = 0.46). The dose-response analysis identified an optimal therapeutic window of 300-600 metabolic equivalent of task (MET)-min/week, an intensity of 4.5–5.5 METs, and a duration of 8–10 weeks. The overall certainty of evidence was rated from very low to low.ConclusionCombined aerobic+resistance exercise, resistance exercise, tai chi, and yoga represent promising therapeutic options for migraine. The optimal dose was identified as approximately 70–135 minutes of moderate-intensity or 45–90 minutes of vigorous-intensity activity weekly, for 8–10 weeks. These findings, however, must be interpreted with caution due to the low quality of the underlying evidence.

To synthesise existing evidence assessing the impact of exercise-based therapies on pain in patients with fibromyalgia syndrome (FM), determine the efficacy of various exercise modalities, and establish the optimal exercise dosage for pain management. Systematic review and network meta-analysis. MEDLINE, Embase, Web of Science, Cochrane Library, Scopus and SPORT Discus were searched from inception to July 2024. Randomised controlled trials (RCTs) that included adult patients with FM compared any exercise intervention with a non-exercise control group and reported pain-related outcomes. A total of 50 RCTs involving 3761 participants were included in this meta-analysis. Aerobic + flexibility training demonstrated the most significant intervention effect compared to controls (g = -0.82, 95% credible interval [CrI]: -1.07 to -0.58; five comparisons; surface under the cumulative ranking curve [SUCRA] = 0.91), followed by water-based exercise (g = -0.72, 95% CrI: -0.92 to -0.52; 11 comparisons; SUCRA = 0.87) and Pilates (g = -0.87, 95% CrI: -1.14 to -0.59; 11 comparisons; SUCRA = 0.60). A weekly exercise volume of 875 metabolic equivalent of task (MET) minutes was required to achieve minimal clinically important difference (MCID). The overall quality of evidence ranged from low to very low. Aerobic + flexibility training and water-based exercises may be effective strategies for pain management in patients with FM. However, given the substantial heterogeneity, high risk of bias, and overall low quality of evidence, these findings should be interpreted with caution. The temporary nature of these benefits underscores the importance of maintaining a consistent, professionally guided and tailored exercise regimen. While acknowledging the overall low to very low quality of the available evidence, this study suggests that combining aerobic and flexibility training or engaging in water-based exercises may be effective for pain reduction in fibromyalgia. Our analysis indicates that a weekly exercise volume of approximately 875 METs-min, potentially achieved through 2-3 sessions per week, is associated with a minimal clinically important difference. These parameters should serve as a guide for clinicians rather than a strict prescription. Crucially, exercise programmes should start at a low intensity and be progressively tailored by professionals to the patient's individual tolerance and preference, as long-term adherence is key to sustaining benefits. PROSPERO number: CRD42024585864.

Comparative efficacy of exercise versus passive physical therapy in improving nonspecific neck pain: a multilevel network meta-analysis and dose-response analysis.

Imaging modalities for the detection of posterior pelvic floor disorders in women with obstructed defaecation syndrome.

Little is known of the effectiveness of nonpharmacological interventions for fibromyalgia syndrome (FMS). The authors therefore carried out a systematic review from 1980 to May 2000 of randomized controlled trials (RCTs) of nonpharmacological interventions for FMS. A search of computerized databases was supplemented by hand searching of bibliographies of key publications. The methodological quality of studies included in the review was evaluated independently by two researchers according to a set of formal criteria. Discrepancies in scoring were resolved through discussion. The review yielded 25 RCTs, and the main categories of interventions tested in the studies were exercise therapy, educational intervention, relaxation therapy, cognitive-behavioral therapy, acupuncture, and forms of hydrotherapy. Methodological quality of studies was fairly low (mean score = 49.5/100). Most studies had small samples (median for individual treatment groups after randomization = 20), and the mean power of the studies to detect a medium effect ( > or = 0.5) was 0.36. Sixteen studies had blinded outcome assessment, but patients were blinded in only 6 studies. The median longest follow-up was 16 weeks. Statistically significant between-group differences on at least one outcome variable were reported in 17 of the 24 studies. The varying combinations of interventions studied in the RCTs and the wide range of outcome measures used make it hard to form conclusions across studies. Strong evidence did not emerge in respect to any single intervention, though preliminary support of moderate strength existed for aerobic exercise. There is a need for larger, more methodologically rigorous RCTs in this area.

Effect of Supervised Exercise, Home-based Exercise and Endovascular Revascularization on Physical Activity in Patients with Intermittent Claudication: A Network Meta-analysis

How completely are randomized controlled trials of non-pharmacological interventions following concussion reported? A systematic review

The Effect of Supervised Exercise, Home Based Exercise and Endovascular Revascularisation on Physical Activity in Patients With Intermittent Claudication: A Network Meta-analysis

Background: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing joint estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large number of individual experts. Evidence from human, animal and mechanistic data suggests that occupational exposure to dusts and/or fibres (silica, asbestos and coal dust) causes pneumoconiosis. In this paper, we present a systematic review and meta-analysis of the prevalences and levels of occupational exposure to silica, asbestos and coal dust. These estimates of prevalences and levels will serve as input data for

Physical activity, diet and other behavioural interventions for improving cognition and school achievement in children and adolescents with obesity or overweight.

IntroductionAlthough several non-pharmacological interventions have been tested in the management of Fibromyalgia (FM), there is little consensus regarding the best options for the treatment of this health condition. The purpose of this network meta-analysis (NMA) is to investigate the comparative efficacy and acceptability of non-pharmacological interventions for FM, in order to assist clinical decision making through a ranking of interventions in relation to the most important clinical outcomes in these patients.Methods and analysisWe will perform a systematic search to identify randomised controlled trials of non-pharmacological interventions endorsed in guidelines and systematic reviews. Information sources searched will include major bibliographic databases without language or date restrictions (MEDLINE, Cochrane Library, EMBASE, AMED, PsycINFO and PEDro). Our primary outcomes will be pain intensity, patient-reported quality of life (QoL), and acceptability of treatment will be our secondary outcome. Risk of bias of the included trials will be assessed using the Cochrane risk of bias tool (RoB2). For each pairwise comparison between the different interventions, we will present mean differences (MDs) for pain intensity and QoL outcomes and Relative Risks (RRs) for acceptability, both with respective 95% confidence intervals (CIs). Initially, standard pairwise meta-analyses will be performed using a DerSimonian-Laird random effects model for all comparisons with at least two trials and then we will perform a frequentist NMA using the methodology of multivariate meta-analysis assuming a common heterogeneity parameter, using the mvmeta command and network suite in STATA. In the NMA, two different types of control group, such as placebo/sham and no intervention/waiting list will be combined as one node called “Control”. The competing interventions will be ranked using the P-score, which is the frequentist analogue of surface under the cumulative ranking curve (SUCRA) for the outcomes of interest at immediate- (intervention duration of up to 2 weeks), short- (over 2 weeks up to 12 weeks) and long-terms (over 12 weeks). The confidence in the results from NMA will be assessed using the Confidence in Network Meta‐analysis (CINeMA) framework.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.RegistrationOSF (DOI: 10.17605/OSF.IO/7MS25) and registered in the PROSPERO database (CRD42020216374).

ObjectiveTo identify the optimal dose and type of physical activity to improve functional capacity and reduce adverse events in acutely hospitalised older adults.DesignSystematic review and Bayesian model-based network meta-analysis.Data sourcesFour...

Methods to decrease blood loss during liver resection: a network meta-analysis.

Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used in diabetes management, but their association with venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), remains unclear. Research Questions: We sought to determine whether glucagon-like peptide-1 receptor agonists (GLP-1RAs) significantly increase venous thromboembolism (VTE) risk compared to placebo or other anti-diabetic drugs. Methods: A systematic search of PubMed, SCOPUS, and EMBASE was conducted for RCTs comparing GLP-1RAs (dulaglutide, lixisenatide, exenatide, semaglutide, albiglutide, liraglutide) with placebo or other anti-diabetic drugs, reporting DVT and PE outcomes. A Bayesian network meta-analysis was performed to estimate odds ratios (OR) with 95% credible intervals (CrI) using Markov Chain Monte Carlo (MCMC) methods, and convergence was evaluated through the Gelman-Rubin diagnostic. Surface under the cumulative ranking curve (SUCRA) ranked treatments by efficacy. Results: From 39 RCTs with 70,499 participants, GLP-1RAs showed varied risks. For VTE versus control: dulaglutide (OR: 1.63, 95% CrI: 0.05 to 8.45; SUCRA: 65.23%), lixisenatide (OR: 3.66, 95% CrI: 0.03 to 20.47; SUCRA: 61.02%), exenatide (OR: 5.75, 95% CrI: 0.03 to 30.48; SUCRA: 53.77%), semaglutide (OR: 1.59, 95% CrI: 0.28 to 5.82; SUCRA: 50.51%), albiglutide (OR: 3.48, 95% CrI: 0.19 to 16.31; SUCRA: 33.95%), liraglutide (OR: 6.15, 95% CrI: 0.31 to 34.48; SUCRA: 29.15%), control (SUCRA: 56.38%). For DVT versus control: dulaglutide (OR: 1.24, 95% CrI: 0.02 to 6.82; SUCRA: 79.04%), lixisenatide (OR: 8.08, 95% CrI: 0.05 to 45.38; SUCRA: 49.66%), albiglutide (OR: 5.49, 95% CrI: 0.19 to 29.58; SUCRA: 38.77%), liraglutide (OR: 12.28, 95% CrI: 0.21 to 69.73; SUCRA: 33.24%), semaglutide (OR: 5.11, 95% CrI: 0.41 to 24.78; SUCRA: 33.07%), control (SUCRA: 66.23%). For PE versus control: lixisenatide (OR: 0.94, 95% CrI: 0.03 to 3.15; SUCRA: 82.64%), exenatide (OR: 1.28, 95% CrI: 0.05 to 5.91; SUCRA: 62.62%), semaglutide (OR: 0.88, 95% CrI: 0.28 to 2.15; SUCRA: 60.08%), liraglutide (OR: 1.45, 95% CrI: 0.33 to 5.06; SUCRA: 43.99%), dulaglutide (OR: 1.48, 95% CrI: 0.24 to 5.03; SUCRA: 43.58%), control (SUCRA: 44.71%), albiglutide (OR: 4.10, 95% CrI: 0.57 to 16.20; SUCRA: 12.38%). Conclusions: GLP-1RAs exhibit varied VTE risks, with liraglutide showing the highest risk for VTE, and albiglutide for PE. Dulaglutide and lixisenatide appear safer for DVT and PE, respectively.

Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) are cardioprotective glucose-lowering therapies, but their impact on dementia risk in type 2 diabetes remains underexplored. Methods: We searched PubMed, Scopus, and Embase from inception to May 1, 2025, for randomized controlled trials (RCTs) comparing GLP-1RAs or SGLT2is with controls, reporting dementia or cognitive score changes. Included trials featured guideline-recommended drugs for cardiovascular risk reduction. A Bayesian network meta-analysis estimated risk ratios (RR) with 95% credible intervals (CrI) using Markov Chain Monte Carlo methods, with Gelman-Rubin diagnostics for convergence. Surface under the cumulative ranking curve (SUCRA) ranked treatments. Results: From 22 RCTs with 156,697 patients, therapies showed varied dementia risk reductions. For all-cause dementia versus control according to the SUCRA: albiglutide (RR: 0.03, 95% CrI: 0.00 to 0.08; SUCRA: 94.4%), lixisenatide (RR: 0.08, 95% CrI: 0.00 to 0.20; SUCRA: 93.62%), efpeglenatide (RR: 0.24, 95% CrI: 0.00 to 1.38; SUCRA: 70.09%), canagliflozin (RR: 0.31, 95% CrI: 0.01 to 1.47; SUCRA: 61.81%), semaglutide (RR: 0.50, 95% CrI: 0.03 to 1.98; SUCRA: 50.06%), liraglutide (RR: 2.12, 95% CrI: 0.02 to 9.89; SUCRA: 41.91%), empagliflozin (RR: 0.68, 95% CrI: 0.05 to 2.35; SUCRA: 39.63%), exenatide (RR: 4.13, 95% CrI: 0.02 to 20.28; SUCRA: 35.41%), dulaglutide (RR: 3.38, 95% CrI: 0.03 to 15.72; SUCRA: 32.89%), dapagliflozin (RR: 1.19, 95% CrI: 0.09 to 4.96; SUCRA: 30.37%), ertugliflozin (RR: 6.79, 95% CrI: 0.02 to 29.23; SUCRA: 30.1%), control (SUCRA: 19.67%). For vascular dementia versus control: dapagliflozin (RR: 0.01, 95% CrI: 0.00 to 0.08; SUCRA: 86.65%), ertugliflozin (RR: 0.03, 95% CrI: 0.00 to 0.16; SUCRA: 85.98%), dulaglutide (RR: 0.05, 95% CrI: 0.00 to 0.32; SUCRA: 84.35%), while semaglutide (RR: 3.83, 95% CrI: 0.05 to 21.72; SUCRA: 17.4%), and control (SUCRA: 13.2%). For Alzheimer’s dementia versus control: dulaglutide showed the lowest (RR: 0.87, 95% CrI: 0.01 to 4.68; SUCRA: 77.64%), while exenatide the highest (RR: 60.62, 95% CrI: 0.21 to 185.09; SUCRA: 23.36%), and control (SUCRA: 50.29%). Conclusions: GLP-1RAs and SGLT2is reduce dementia risk, with albiglutide and lixisenatide excelling for all-cause dementia, dapagliflozin and ertugliflozin for vascular dementia, and dulaglutide for Alzheimer’s. Higher risks with some drugs highlight tailored therapy needs.