Comparative Effectiveness Of Interventions Research Articles

Comparative effectiveness of conservative interventions for non-specific chronic spinal pain: Physical, behavioural/psychological or combined? A systematic review and meta-analysis

Comparative effectiveness of conservative interventions for non-specific chronic spinal pain: Physical, behavioural/psychological or combined? A systematic review and meta-analysis

Midterm outcomes of catheter-directed interventions for the treatment of acute pulmonary embolism.

Objective The hemodynamic benefits of catheter-directed thrombolysis for acute pulmonary embolism have not been clearly defined beyond the periprocedural period. The objective of this study is to report midterm outcomes of catheter-directed thrombolysis for treatment of acute pulmonary embolism. Methods Records of all patients undergoing catheter-directed thrombolysis for high- or intermediate-risk pulmonary embolism were retrospectively reviewed. Endpoints were clinical success, procedure-related complications, mortality, and longitudinal echocardiographic parameter improvement. Results A total of 69 patients underwent catheter-directed thrombolysis (mean age 59 ± 15 y, 56% male). Eleven had high-risk and 58 intermediate-risk pulmonary embolism. Baseline characteristics did not differ by pulmonary embolism subtype. Fifty-two percent of patients underwent ultrasound-assisted thrombolysis, 39% standard catheter-directed thrombolysis, and 9% other interventional therapy; 89.9% had bilateral treatment. Average treatment time was 17.7 ± 11.3 h with average t-Pa dose of 28.5 ± 19.6 mg. The rate of clinical success was 88%. There were two major (3%) and six minor (9%) periprocedural bleeding complications with no strokes. All echocardiographic parameters demonstrated significant improvement at one-year follow-up. Pulmonary embolism-related in-hospital mortality was 3.3%, and estimated survival was 81.2% at one year. Conclusions Catheter-directed thrombolysis is safe and effective for treatment of acute pulmonary embolism, with sustained hemodynamic improvement at one year. Further prospective large-scale studies are needed to determine comparative effectiveness of interventions for acute pulmonary embolism.

Comparative Effectiveness of Different Pharmacological Interventions for the Treatment of Minimal Hepatic Encephalopathy: A Systematic Review With Network Meta-Analysis

Comparative Effectiveness of Different Pharmacological Interventions for the Treatment of Minimal Hepatic Encephalopathy: A Systematic Review With Network Meta-Analysis

Comparative effectiveness of peripheral vascular intervention versus surgical bypass for critical limb ischemia in the Vascular Study Group of Greater New York

In this study, the effectiveness of peripheral vascular intervention (PVI) was compared with surgical bypass grafting (BPG) for critical limb ischemia (CLI) in the Vascular Study Group of Greater New York (VSGGNY). Patients undergoing BPG or PVI for CLI at VSGGNY centers (2011-2013) were included. The Society for Vascular Surgery objective performance goals for CLI were used to directly compare the safety and effectiveness of PVI and BPG. Propensity score matching was used for risk-adjusted comparisons of PVI with BPG. A total of 414 patients (268 PVI, 146 BPG) were treated for tissue loss (69%) or rest pain (31%). Patients undergoing PVI were more likely to have tissue loss (74.6% vs 57.5%; P< .001) and comorbidities such as diabetes (69.3% vs 57.5%; P= .02), heart failure (22% vs 13.7%; P= .04), and severe renal disease (13.1% vs 4.1%; P= .004). No significant differences were found between the groups across a panel of safety objective performance goals. In unadjusted analyses at 1year, BPG was associated with higher rates of freedom from reintervention, amputation, or restenosis (90.4% vs 81.7%; P= .02) and freedom from reintervention or amputation (92.5% vs 85.8%, P= .045). After propensity score matching, PVI was associated with improved freedom from major adverse limb events and postoperative death at 1year (95.6% vs 88.5%; P< .05). By unadjusted comparison, early reintervention and restenosis are more prevalent with PVI. However, risk-adjusted comparison underscores the safety and effectiveness of PVI in the treatment of CLI.

CO1 - Comparative Effectiveness of Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention Among Elderly Medicare Beneficiaries In Terms Of Cost And Resource Use

CO1 - Comparative Effectiveness of Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention Among Elderly Medicare Beneficiaries In Terms Of Cost And Resource Use

Current Challenges in Pain Management in Hip Fracture Patients.

The high incidence of hip fracture, together with considerable associated morbidity, mortality, and cost of care, makes this injury a major clinical challenge. Of particular importance is the pain associated with hip fracture, which can have potentially severe consequences and may lead to delayed recovery. The prevailing opioid-dependent model of analgesia, however, presents multiple drawbacks and risks that can compromise outcomes in the hip fracture population. The pain management process has essential preoperative, intraoperative, and postoperative components, yet data on the comparative effectiveness of different pain management interventions in patients undergoing surgery for hip fracture are not clear cut. A Cochrane database review that included 83 different pain management studies indicated that there are not enough well-designed studies to show unequivocally which pain management approaches work well after hip fracture surgery. Yet a growing body of data on certain interventions, such as nerve blocks and multimodal analgesia, supports consideration of these options.

Clinical effectiveness and cost-effectiveness of interventions for the treatment of anogenital warts: systematic review and economic evaluation.

Typically occurring on the external genitalia, anogenital warts (AGWs) are benign epithelial skin lesions caused by human papillomavirus infection. AGWs are usually painless but can be unsightly and physically uncomfortable, and affected people might experience psychological distress. The evidence base on the clinical effectiveness and cost-effectiveness of treatments for AGWs is limited. To systematically review the evidence on the clinical effectiveness of medical and surgical treatments for AGWs and to develop an economic model to estimate the cost-effectiveness of the treatments. Electronic databases (MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, The Cochrane Library databases and Web of Science) were searched from inception (or January 2000 for Web of Science) to September 2014. Bibliographies of relevant systematic reviews were hand-searched to identify potentially relevant studies. The World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov were searched for ongoing and planned studies. A systematic review of the clinical effectiveness literature was carried out according to standard methods and a mixed-treatment comparison (MTC) undertaken. The model implemented for each outcome was that with the lowest deviance information criterion. A de novo economic model was developed to assess cost-effectiveness from the perspective of the UK NHS. The model structure was informed through a systematic review of the economic literature and in consultation with clinical experts. Effectiveness data were obtained from the MTC. Costs were obtained from the literature and standard UK sources. Of 4232 titles and abstracts screened for inclusion in the review of clinical effectiveness, 60 randomised controlled trials (RCTs) evaluating 19 interventions were included. Analysis by MTC indicated that ablative techniques were typically more effective than topical interventions at completely clearing AGWs at the end of treatment. Podophyllotoxin 0.5% solution (Condyline(®), Takeda Pharmaceutical Company Ltd; Warticon(®) solution, Stiefel Laboratories Ltd) was found to be the most effective topical treatment evaluated. Networks for other outcomes included fewer treatments, which restrict conclusions on the comparative effectiveness of interventions. In total, 84 treatment strategies were assessed using the economic model. Podophyllotoxin 0.5% solution first line followed by carbon dioxide (CO2) laser therapy second line if AGWs did not clear was most likely to be considered a cost-effective use of resources at a willingness to pay of £20,000-30,000 per additional quality-adjusted life-year gained. The result was robust to most sensitivity analyses conducted. Limited reporting in identified studies of baseline characteristics for the enrolled population generates uncertainty around the comparability of the study populations and therefore the generalisability of the results to clinical practice. Subgroup analyses were planned based on type, number and size of AGWs, all of which are factors thought to influence treatment effect. Lack of data on clinical effectiveness based on these characteristics precluded analysis of the differential effects of treatments in the subgroups of interest. Despite identification of 60 studies, most comparisons in the MTC are informed by only one RCT. Additionally, lack of head-to-head RCTs comparing key treatments, together with minimal reporting of results in some studies, precluded comprehensive analysis of all treatments for AGWs. The results generated by the MTC are in agreement with consensus opinion that ablative techniques are clinically more effective at completely clearing AGWs after treatment. However, the evidence base informing the MTC is limited. A head-to-head RCT that evaluates the comparative effectiveness of interventions used in clinical practice would help to discern the potential advantages and disadvantages of the individual treatments. The results of the economic analysis suggest that podophyllotoxin 0.5% solution is likely to represent a cost-effective first-line treatment option. More expensive effective treatments, such as CO2 laser therapy or surgery, may represent cost-effective second-line treatment options. No treatment and podophyllin are unlikely to be considered cost-effective treatment options. There is uncertainty around the cost-effectiveness of treatment with imiquimod, trichloroacetic acid and cryotherapy. This study is registered as PROSPERO CRD42013005457. The National Institute for Health Research Health Technology Assessment programme.

Endovascular Treatment of Infrapopliteal Peripheral Artery Disease.

Endovascular treatment of infrapopliteal disease is focused on the treatment of patients with rest pain or critical limb ischemia (CLI) due to severe atherosclerotic disease. While the evidence base surrounding the comparative effectiveness of endovascular intervention vs. surgery is lacking, many operators have adopted an "endovascular first" approach to the treatment of infrapopliteal atherosclerotic disease due to the lower morbidity of these procedures. This manuscript reviews current data on the endovascular treatment of CLI, including a comparison of endovascular and surgical approaches, current indications for and outcomes with balloon angioplasty of infrapopliteal PAD, angiosome-guided revascularization, and emerging technologies to improve long-term vessel patency after endovascular intervention.

Effectiveness of Prevention Strategies for Contrast-Induced Nephropathy: A Systematic Review and Meta-analysis.

N-acetylcysteine, sodium bicarbonate, statins, and ascorbic acid have been studied for reducing contrast-induced nephropathy (CIN). To evaluate the comparative effectiveness of interventions to reduce CIN in adults receiving contrast media. MEDLINE, EMBASE, Cochrane Library, ClinicalTrials.gov, and Scopus databases through June 2015. Risk of bias and overall strength of evidence (SOE) of studies were assessed. Randomized, controlled trials of N-acetylcysteine, sodium bicarbonate, statins, or ascorbic acid that used intravenous (IV) or intra-arterial contrast media and defined CIN with enough data for meta-analysis. Two reviewers independently extracted data and assessed study quality. Low-dose N-acetylcysteine plus IV saline compared with IV saline (risk ratio [RR], 0.75 [95% CI, 0.63 to 0.89]; low SOE), N-acetylcysteine plus IV saline compared with IV saline in patients receiving low-osmolar contrast media (RR, 0.69 [CI, 0.58 to 0.84]; moderate SOE), and statins plus N-acetylcysteine plus IV saline versus N-acetylcysteine plus IV saline (RR, 0.52 [CI, 0.29 to 0.93]; low SOE) had clinically important and statistically significant benefits. The following 3 comparisons suggested a clinically important difference that was not statistically significant: sodium bicarbonate versus IV saline in patients receiving low-osmolar contrast media (RR, 0.65 [CI, 0.33 to 1.25]; low SOE), statins plus IV saline versus IV saline (RR, 0.68 [CI, 0.39 to 1.20]; low SOE), and ascorbic acid versus IV saline (RR, 0.72 [CI, 0.48 to 1.01]; low SOE). Strength of evidence was generally insufficient for comparisons of the need for renal replacement, cardiac events, and mortality. Too few studies were done in patients receiving IV contrast media. The greatest reduction in CIN was seen with N-acetylcysteine plus IV saline in patients receiving LOCM and with statins plus N-acetylcysteine plus IV saline. Agency for Healthcare Research and Quality.

Comparative Effectiveness of Conservative Interventions for Nonspecific Chronic Spinal Pain: Physical, Behavioral/Psychologically Informed, or Combined? A Systematic Review andMeta-Analysis.

Nonspecific chronic spinal pain (NSCSP) is highly disabling. Current conservative rehabilitation commonly includes physical and behavioral interventions, or a combination of these approaches. Physical interventions aim to enhance physical capacity by using methods such as exercise, manual therapy, and ergonomics. Behavioral/psychologically informed interventions aim to enhance behaviors, cognitions, or mood by using methods such as relaxation and cognitive behavioral therapy. Combined interventions aim to target physical and also behavioral/psychological factors contributing to patients' pain by using methods such as multidisciplinary pain management programs. Because it remains unclear whether any of these approaches are superior, this review aimed to assess the comparative effectiveness of physical, behavioral/psychologically informed, and combined interventions on pain and disability in patients with NSCSP. Ten electronic databases were searched for randomized controlled trials (RCTs) including participants reporting NSCSP. Studies were required to have an "active" conservative treatment control group for comparison. Studies were not eligible if the interventions were from the same domain (eg, if the study compared 2 physical interventions). Study quality was assessed used the Cochrane Back Review Group risk of bias criteria. The treatment effects of physical, behavioral/psychologically informed, and combined interventions were assessed using meta-analyses. Twenty-four studies were included. No clinically significant differences were found for pain and disability between physical, behavioral/psychologically informed, and combined interventions. The simple categorization of interventions into physical, behavioral/psychologically informed, and combined could be considered a limitation of this review, because these interventions may not be easily differentiated to allow accurate comparisons to be made. Further work should consider investigating whether tailoring rehabilitation to individual patients and their perceived risk of chronicity, as seen in recent RCTs for low back pain, can enhance outcomes in NSCSP. In this systematic review of RCTs in NSCSP, only small differences in pain or disability were observed between physical, behavioral/psychologically informed, and combined interventions.

NICE: type 2 diabetes in adults, 2015

NICE: type 2 diabetes in adults, 2015

Overview of Network Meta-analysis for a Rheumatologist

The need to combine direct and indirect evidence is increasing in clinical fields, and this is especially true when direct evidence is inconclusive. Thus, in recent years, network meta-analysis has been utilized increasingly in medicine. Network meta-analysis is a statistical method that enables comparison of multiple treatments simultaneously—by combining direct and indirect evidence of the relative treatment effects—to assess the comparative effectiveness of multiple interventions even if there are no head-to-head comparisons. Network meta-analysis has some advantages in addressing all treatments for a specific condition, comparing interventions and ranking the efficacy and safety of multiple treatments, and increasing the certainty of evidence by pooling direct and indirect evidence to generate overall estimates. The major assumption in network meta-analysis is exchangeability of the studies, and other key assumptions include similarity, consistency, and transitivity. The Bayesian approach is used most commonly in network meta-analysis because it provides greater flexibility that allows for the use of more complex models and can produce estimates of rank probabilities. Bayesian network meta-analysis produces treatment rankings according to the probability of being the best treatment, the second best, third best, and so forth. Network meta-analysis is an interesting method that provides useful information for use in by rheumatologists in decision-making. (J Rheum Dis 2016;23:4-10)

Deterring Future Incidents of Intimate Partner Violence: Does Type of Formal Intervention Matter?

Few studies examine the comparative effectiveness of different formal interventions for domestic violence. Using arrest and civil protection order data, we compare three intervention scenarios (arrest, civil protection order, and both). Results suggest that intervention type has no substantive influence on the odds of reoffending. However, subsequent domestic violence is significantly associated with offender age, sex, and prior offense history as well as victim age and sex. We discuss our findings and their policy implications, noting that responding agencies should be sensitive to the characteristics that increase the odds of reoffending among those they come into contact with.

Comparative study on effects of tobacco control curriculum in different major students

Objective To compare the impact of tobacco control curriculum on self-efficacy of tobacco control in different major of public health students, and offer theoretical foundation for improving tobacco control curriculum. Methods We offered tobacco control curriculum for 150 public health students (including students of preventive medicine and public service administration research direction) in medical university of Harbin, and investigated twice general self-efficacy, smoking self-efficacy and tobacco control self-efficacy before and after tobacco control curriculum, then compared intervention effects between two major students by t test. Results There were no differences of tobacco control self-efficacy, smoking self-efficacy and general self-efficacy between two major students, tvalues were -0.832 (P=0.407), 0.190 (P=0.849) and -0.492 (P=0.624). The tobacco control self-efficacy (t=-3.566,P=0.001) and general self-efficacy (t=-2.237,P=0.028) increased remarkably but smoking self-efficacy (t=-1.102,P=0.273) in preventive medicine students after intervention. And all of three kinds of self-efficacy were not gotten better by intervention in public service administration students. There was no obvious difference of intervention effects between tobacco control self-efficacy and general self-efficacy among preventive medicine students (t=1.541,P=0.125). Conclusions The improvement of preventive medicine students by tobacco control curriculum is better than that of public service administration students. We should further perfect the tobacco control course, and on the one hand, improve the intervention effect of students majoring in course of public health management; on the other hand, strengthen the target effects of the tobacco control curriculum to students' tobacco control self-efficacy and smoking self-efficacy. Key words: Tobacco control curriculum; Preventive medicine specialty; Public service administration specialty; Tobacco control self-efficacy

The rationale, design, and baseline characteristics of PREVENT-DM: A community-based comparative effectiveness trial of lifestyle intervention and metformin among Latinas with prediabetes

Promotora Effectiveness Versus Metformin Trial (PREVENT-DM) is a randomized comparative effectiveness trial of a lifestyle intervention based on the Diabetes Prevention Program delivered by community health workers (or promotoras), metformin, and standard care. Eligibility criteria are Hispanic ethnicity, female sex, age≥20years, fluent Spanish-speaking status, BMI ≥23kg/m2, and prediabetes. We enrolled 92 participants and randomized them to one of the following three groups: standard care, DPP-based lifestyle intervention, or metformin. The primary outcome of the trial is the 12-month difference in weight between groups. Secondary outcomes include the following cardiometabolic markers: BMI, waist circumference, blood pressure, and fasting plasma glucose, hemoglobin A1C (HbA1c), total cholesterol, triglycerides, LDL cholesterol, HDL cholesterol, and insulin. PREVENT-DM participants are socioeconomically disadvantaged Latinas with a mean annual household income of $15,527±9922 and educational attainment of 9.7±3.6years. Eighty-six percent of participants are foreign born, 20% have a prior history of gestational diabetes, and 71% have a first-degree relative with diagnosed diabetes. At baseline, PREVENT-DM participants had a mean age of 45.1±12.5years, weight of 178.8±39.3lbs, BMI of 33.3±6.5kg/m2, HbA1c of 5.9±0.2%, and waist circumference of 97.4±11.1cm. Mean baseline levels of other cardiometabolic markers were normal. The PREVENT-DM study successfully recruited and randomized an understudied population of Latinas with prediabetes. This trial will be the first U.S. study to test the comparative effectiveness of metformin and lifestyle intervention versus standard care among prediabetic adults in a “real-world” setting.

Treatment preference and patient centered prostate cancer care: Design and rationale

Prostate cancer is a slow progressing cancer that affects millions of men in the US. Due to uncertainties in outcomes and treatment complications, it is important that patients engage in informed decision making to choose the "optimal treatment". Patient centered care that encompasses informed decision-making can improve treatment choice and quality of care. Thus, assessing patient treatment preferences is critical for developing an effective decision support system. The objective of this patient-centered randomized clinical trial was to study the comparative effectiveness of a conjoint analysis intervention compared to usual care in improving subjective and objective outcomes in prostate cancer patients. We identified preferred attributes of alternative prostate cancer treatments that will aid in evaluating attributes of treatment options. In this two-phase study, in Phase 1 we used mixed methods to develop an adaptive conjoint task instrument. The conjoint task required the patients to trade-off attributes associated with treatments by assessing their relative importance. Phase 2 consisted of a randomized controlled trial of men with localized prostate cancer. We analyzed the effect of conjoint task intervention on the association between preferences, treatment and objective and subjective outcomes. Our conjoint task instrument can lead to a values-based patient-centered decision aid tool and help tailor treatment decision making to the values of prostate cancer patients. This will ultimately improve clinical decision making, clinical policy process, enhance patient centered care and improve prostate cancer outcomes.

An Analysis of Learning Rate and Curricular Scope: Caution When Choosing Academic Interventions Based on Aggregated Outcomes

.We aggregated and analyzed single-case research targeting math-fact fluency to investigate whether learning (behavior change) data were sufficient to summarize and compare intervention outcomes or if learning rate (learning/cumulative instructional time) data would provide divergent effect size (ES) results. We also extracted the curricular scope or set size data (how many items were targeted) and evaluated the relationship with obtained ESs. The results suggest that ESs calculated without accounting for cumulative instructional time and curricular scope result in different estimates of effect than ESs that do account for cumulative instructional time and curricular scope. Discussion focuses on the importance of using learning rate and curricular scope when comparing intervention effects and limitations associated with drawing relative-effectiveness conclusions by aggregating outcomes across studies.

OP73 The effect of complex workplace dietary interventions on dietary behaviours, nutrition knowledge and health status: a cluster controlled trial

Background Although the workplace is a potentially important setting to influence dietary behaviours, evidence on effective interventions is limited. The study aim was to assess the comparative effectiveness of a workplace environmental dietary modification intervention and an educational intervention both alone and in combination versus a control workplace on employees’ dietary behaviours, nutrition knowledge and health status. Methods In the Food Choice at Work cluster controlled trial, four large, purposively selected manufacturing workplaces were allocated to A, (Control), B, nutrition education alone (Education), C, environmental dietary modification alone (Environment) and D, nutrition education and environmental dietary modification (Combined intervention). Nutrition education included: group presentations, individual consultations and detailed nutrition information (traffic light menu-labelling, posters and emails). Environmental dietary modification included: menu modification (restriction of fat, saturated fat, sugar and salt), increase in fruit and vegetables, price discounts for fruit, strategic positioning of healthier alternatives and portion size control. Data on dietary intakes (24-hour dietary recalls and food frequency questionnaires), nutrition knowledge (validated questionnaire tool), BMI, waist circumference and blood pressure were obtained at baseline and follow-up at 7–9 months. The Dietary Approaches to Stopping Hypertension (DASH) score was used as a composite measure of diet quality. Analysis of covariance was used to compare changes between baseline and follow-up across the four groups with adjustment for age, gender, educational status and other baseline characteristics. Results At baseline, 850 employees aged 18–64 years were recruited with N (response rate%) in each workplace as follows: A-control: 111(72%), B-Education: 226(71%), C-Environment: 113(91%), D-Combined intervention: 400(61%). Complete follow-up data was obtained for 517 employees (61%). There were significant positive changes in intakes of saturated fat (p = 0.013), salt (p = 0.010) and nutrition knowledge (p = 0.009) between baseline and follow-up in the combined intervention versus the control workplace in the fully adjusted multivariate analysis. Small but significant changes in BMI (–1.4kg/m 2 (95% CI –2.447, –0.346, p = 0.047) were observed in the combined intervention. Changes in the DASH score (p = 0.028) were only significant when adjusted for age and gender. No significant changes in waist circumference and blood pressure were observed. Effects in the education alone and environment alone workplaces were smaller and generally non-significant. Conclusion The ‘Food Choice at Work’ combined intervention represents a potentially viable model that is effective and feasible in a large workplace setting. However, it needs to be fully tested using an optimal randomised controlled trial design and full-scale evaluation to provide robust evidence for policy makers. Current Controlled Trials: ISRCTN35108237.

Exam 2: Comparative Effectiveness of Pharmacological Interventions for Severe Alcoholic Hepatitis: A Systematic Review and Network Meta-analysis

Exam 2: Comparative Effectiveness of Pharmacological Interventions for Severe Alcoholic Hepatitis: A Systematic Review and Network Meta-analysis

Comparative effectiveness of Pilates and yoga group exercise interventions for chronic mechanical neck pain: quasi-randomised parallel controlled study

ObjectivesTo determine the effectiveness of Pilates and yoga group exercise interventions for individuals with chronic neck pain (CNP). DesignQuasi-randomised parallel controlled study. SettingCommunity, university and private practice settings in four locations. ParticipantsFifty-six individuals with CNP scoring ≥3/10 on the numeric pain rating scale for >3 months (controls n=17, Pilates n=20, yoga n=19). InterventionsExercise participants completed 12 small-group sessions with modifications and progressions supervised by a physiotherapist. Main outcome measuresThe primary outcome measure was the Neck Disability Index (NDI). Secondary outcomes were pain ratings, range of movement and postural measurements collected at baseline, 6 weeks and 12 weeks. Follow-up was performed 6 weeks after completion of the exercise classes (Week 18). ResultsNDI decreased significantly in the Pilates {baseline: 11.1 [standard deviation (SD) 4.3] vs Week 12: 6.8 (SD 4.3); mean difference −4.3 (95% confidence interval −1.64 to −6.7); P<0.001} and yoga groups [baseline: 12.8 (SD 7.4) vs Week 12: 8.1 (SD 5.6); mean difference −4.7 (95% confidence interval −2.1 to −7.4); P<0.00], with no change in the control group. Pain ratings also improved significantly. Moderate-to-large effect sizes (0.7 to 1.8) and low numbers needed to treat were found. There were no differences in outcomes between the exercise groups or associated adverse effects. No improvements in range of movement or posture were found. ConclusionsPilates and yoga group exercise interventions with appropriate modifications and supervision were safe and equally effective for decreasing disability and pain compared with the control group for individuals with mild-to-moderate CNP. Physiotherapists may consider including these approaches in a plan of care. Clinical Trial Registration NumberClinicalTrials.gov NCT01999283.