Controlled Trials Of Non-pharmacological Interventions Research Articles

Randomised controlled trials of non-pharmacological interventions to improve patient-reported outcomes of colonoscopy: a scoping review

Background and aimsNon-pharmacological interventions to improve patient-reported outcomes of colonoscopy may be effective at mitigating negative experiences and perceptions of the procedure, but research to characterise the extent and features...

Non-Pharmacological Interventions to Improve Physical Function in Patients with End-Stage Renal Disease: A Network Meta-Analysis

Introduction: Chronic kidney disease is estimated to become the fifth leading cause of death globally by 2040. Due to the high incidence of fatigue in patients with end-stage renal disease without reliable pharmacological treatments, more and more studies on non-pharmacological interventions to improve physical function appear; which might be the best approach remains unknown. This study aimed to compare and rank the efficacy of all known non-pharmacological interventions on improving physical function from multiple outcomes for adults with end-stage renal disease. Methods: This systematic review and network meta-analysis included searches of PubMed, Embase, CINAHL, and Cochrane Library from inception to September 1, 2022, for randomized controlled trials of non-pharmacological interventions to improve physical function in adults with end-stage renal disease. Literature screening, data extraction, and quality appraisal were performed systematically by two independent reviewers. The frequentist random-effect network meta-analysis was adopted to pool the evidence from five outcomes, namely, 6-min walk test, handgrip strength, knee extension strength, physical component summary, and mental component summary, respectively. Results: A total of 1,921 citations were identified by this search, of which 44 eligible trials enrolled 2,250 participants, and 16 interventions were identified. All subsequent figures refer to comparisons with usual care. For increasing walking distance, the combined resistance and aerobic exercise with virtual reality or music were the most effective interventions, with a mean difference plus 95% confidence interval of 90.69 (8.92–172.46) and 92.59 (23.13–162.06), respectively. Resistance exercise with blood flow restriction (8.13, 0.09–16.17) was the best treatment to improve handgrip strength. Combined resistance and aerobic exercise (11.93, 3.63–20.29) and whole-body vibration (6.46, 1.71–11.20) were associated with improving knee extension strength. For life quality, all treatment effects did not show statistically significant differences. Conclusions: It was found via network meta-analysis that combined resistance and aerobic exercise is the most effective intervention. Besides, if virtual reality or music is added to the training, there will be better results. Resistance exercise with blood flow restriction and whole-body vibration might be good alternative treatments for improving muscle strength. None of the interventions improved quality of life, suggesting a need for alternative interventions in this regard. The results of this study contribute evidence-based data to decision-making.

Leisure-Related Social Work Interventions for Patients with Cognitive Impairment: A Systematic Review and Meta-Analysis.

The social work profession has been exploring nonpharmacological interventions for patients with cognitive impairment, but there are few evidence-based research outputs. Systematically evaluating the effectiveness of social work interventions for people with cognitive impairment can shed light on the matter to further improve similar interventions. Randomized controlled trials of nonpharmacological interventions for patients with cognitive impairment were selected from key literature databases in both English and Chinese from 2010 to 2021. A systematic review and meta-analysis with Revman 5.4 were performed. Seven trials were included, involving 851 patients with cognitive impairment. The meta-analysis showed that, in terms of overall cognitive function, the Montreal Cognitive Assessment score (MD = 1.64, 95% CI [0.97, 2.30], p < 0.001) of the intervention group was superior to the control group, but there was no significant difference in the Mini-Mental State Examination score between the two groups (MD = 0.33, 95% CI [-0.16, 0.82], p = 0.18). Compared with the control group, nonpharmacological intervention can effectively improve the neuropsychiatric condition of patients (SMD = -0.42, 95% CI [-0.64, -0.20], p = 0.0002). In summary, the current evidence shows that nonpharmacological social work interventions had a positive effect on the cognitive function and neuropsychiatric status of patients with cognitive impairment. Suggestions for future nonpharmacological intervention practice are discussed.

Comparative efficacy and acceptability of non-pharmacological interventions in fibromyalgia: Protocol for a network meta-analysis.

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).

Effects of the non-pharmacological interventions of traditional Chinese medicine on postpartum depression: A protocol for systematic review and network meta-analysis.

Background:Postpartum depression (PPD) has become one of the common disorders during the postpartum period. The non-pharmacological interventions of traditional Chinese medicine (TCM) have achieved good results in the treatment of PPD. However, the efficacy of different non-pharmacological interventions of TCM for PPD has not been fully elucidated. Due to the large number of non-pharmacological intervention of TCM modalities, the selection of appropriate non-pharmacological interventions of TCM has become an urgent clinical problem. The aim of this network meta-analysis was to explore the best choice for different non-pharmacological interventions of TCM for PPD.Methods:PubMed, Web of Science, Scopus, Cochrane Library, Embase, China Scientific Journal Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Wanfang Data were searched to identify the randomized controlled trials of non-pharmacological interventions of TCM for PPD from the inception to February 2022. Two researchers will be independently responsible for literature screening, data extraction, and assessment of their quality. Standard pair-wise and Bayesian network meta-analysis will be performed to compare the efficacy of different non-pharmacological interventions of TCM for PPD via Stata 14.0 and WinBUGS1.4 software.Results:The results of this meta-analysis will be submitted to a peer-reviewed journal for publication.Conclusions:The conclusion of this systematic review will provide evidence for the selection of an optimal non-pharmacological interventions of TCM for PPD.Ethics and dissemination:Ethical approval is not required for this study. The systematic review will be published in a peer-reviewed journal, presented at conferences, and shared on social media platforms.OSF REGISTRATION NUMBER:DOI 10.17605/OSF.IO/TM96G.

Nonpharmaceutical therapy for autism spectrum disorder: A protocol for systematic review and network meta-analysis.

Background:Autism spectrum disorder (ASD) is a widespread developmental disorder of the nervous system with an unclear etiology and pathogenesis. Its global incidence is currently increasing, and no effective drugs are available to improve its core symptoms. Nonpharmaceutical therapy can effectively relieve the core symptoms of autism, has fewer side effects than drugs, and is easily accepted by patients. This systematic and network meta-analysis aimed to evaluate the impact of non-pharmaceutical therapy on autism to explore preferable therapeutic options for autism.Methods:Online databases, including the China National Knowledge Infrastructure [CNKI], SinoMed, Wanfang Database [WF], China Science and Technology Journal Database [VIP], MEDLINE, Web of Science, EMBASE, and the Cochrane Library will be searched for randomized controlled trials of nonpharmacological interventions for autism published before October 2021. Two researchers will be independently responsible for the literature screening, data extraction, and quality assessment. Standard paired and Bayesian network meta-analyses will be performed using RevMan 5.3 Software and GEMTC 0.14.3, to compare the efficacy and safety of different nonpharmacological regimens.Results:The results of this systematic and network meta-analysis will be submitted to a peer-reviewed journal for publication.Conclusion:This study provides a comprehensive and reliable evidence-based reference for the efficacy and safety of different non-pharmacological interventions for autism.PROSPERO registration number:CRD 42021275571

Effect of non-pharmacological interventions on sleep in preterm infants in the neonatal intensive care unit: A protocol for systematic review and network meta-analysis.

Background:Premature infants are prone to suffer multisystem complications after birth due to the incomplete development of organ tissues and low immunity, and they require a longer period of supervised treatment in the neonatal intensive care unit (NICU). However, due to the specificity of medical care in the NICU, the sleep of preterm infants is highly susceptible that has an impact on the prognosis of preterm infants. Recently, various non-pharmacological interventions have been applied to the sleep of preterm infants in the NICU, which have shown positive outcomes. However, the efficacy and safety of them are unclear. This study aims to evaluate the effects of non-pharmacological interventions on sleep in preterm infants in the NICU through a network meta-analysis.Methods:Randomized controlled trials of non-pharmacological interventions on sleep in preterm infants in the NICU published before September 2021 will be searched in online databases, including the Chinese Scientific Journal Database, China National Knowledge Infrastructure Database, Wanfang, China Biomedical Literature Database, PubMed, Cochrane Library, Embase, and Web of Science. Two researchers will be independently responsible for screening and selecting eligible literatures, extracting data and evaluating the risk of bias in the included studies. Stata 14.0 software will be used for data analysis.Results:The results of this meta-analysis will be submitted to a peer-reviewed journal for publication.Conclusion:This study will provide comprehensive and reliable evidence-based references for the efficacy and safety in different non-pharmacological interventions on sleep in preterm infants in the NICU.

Rehabilitation of cognitive deficits poststroke: protocol for a systematic review and meta-analysis of randomised controlled trials of non-pharmacological interventions

IntroductionStroke is among the leading causes of death and disability worldwide. Poststroke cognitive impairment is a common sequela of stroke. The burden of cognitive impairment poststroke has significant impacts on...

Nonpharmacological Interventions to Improve Depression, Anxiety, and Quality of Life (QoL) in People With Dementia: An Overview of Systematic Reviews.

This overview aimed to systematically synthesize evidence from existing systematic reviews to signpost practitioners to the current evidence base on nonpharmacological interventions to improve depression, anxiety, and quality of life (QoL) in people with dementia and to discuss priorities for future research. The databases MEDLINE, PsycINFO, Scopus, and Cochrane Central Register of Controlled Trials were searched in August 2017 with an updated search in January 2019. Fourteen systematic reviews of randomized controlled trials of nonpharmacological interventions were identified. Dementia stage was rated moderate or severe in the majority of the reviews and type of dementia varied. Interventions reported to be effective were cognitive stimulation (QoL: standardized mean difference [SMD] = 0.38), music-based therapeutic interventions (depression: SMD = -0.27, anxiety: SMD = -0.43, QoL: SMD = 0.32), and psychological treatments (mainly cognitive behavior therapy; depression: SMD = -0.22, anxiety: MD = -4.57). Although health-care professionals are recommended to continue using these approaches, future research needs to focus on the type and form of interventions that are most effective for different stages and types of dementia.

Ageing well with chronic musculoskeletal pain: protocol for a systematic review of non-pharmacological interventions aimed at reducing pain in an ageing population

Background: Chronic musculoskeletal pain in the elderly is highly prevalent, with osteoarthritis, low back pain, neck pain and other musculoskeletal disorders as the leading contributors to pain chronicity and disability. Previous reviews identifying effective components of non-pharmacological interventions for treating chronic pain have either few studies or the included studies examine outcome over a limited time span. This systematic review will investigate the effectiveness and components of interventions associated with management of chronic musculoskeletal pain in older adults (≥65 years).Methods/Design: This systematic review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. Randomised controlled trials of non-pharmacological interventions aimed at reducing pain in older adults with chronic musculoskeletal pain will be included. Articles will be identified through a comprehensive search of the following databases: Ovid MEDLINE, Embase, CINAHL, AMED, Scopus, Web of Science and PEDro. Two review authors will independently screen articles retrieved from the search for eligibility, and extract relevant data on methodological issues. A narrative synthesis will be completed if there are insufficient data for a meta-analysis. The narrative synthesis will summarise the current state of knowledge, interventions, study designs and robustness of evidence.Discussion: Findings of the study will inform support programs and interventions to assist people aging with pain, carers and other supporters and practitioners.Systematic review registration: PROSPERO 2017:CRD42017074173.

Nonpharmacological Interventions for Sleep Promotion in the Intensive Care Unit.

Nonpharmacological Interventions for Sleep Promotion in the Intensive Care Unit.

Non-pharmacological interventions for people with epilepsy and intellectual disabilities.

Approximately 30% of patients with epilepsy remain refractory to drug treatment and continue to experience seizures whilst taking one or more antiepileptic drugs (AEDs). Several non-pharmacological interventions that may be used in conjunction with or as an alternative to AEDs are available for refractory patients. In view of the fact that seizures in people with intellectual disabilities are often complex and refractory to pharmacological interventions, it is evident that good quality randomised controlled trials (RCTs) are needed to assess the efficacy of alternatives or adjuncts to pharmacological interventions.This is an updated version of the original Cochrane review (Beavis 2007) published in The Cochrane Library (2007, Issue 4). To assess data derived from randomised controlled trials of non-pharmacological interventions for people with epilepsy and intellectual disabilities.Non-pharmacological interventions include, but are not limited to, the following.• Surgical procedures.• Specialised diets, for example, the ketogenic diet, or vitamin and folic acid supplementation.• Psychological interventions for patients or for patients and carers/parents, for example, cognitive-behavioural therapy (CBT), electroencephalographic (EEG) biofeedback and educational intervention.• Yoga.• Acupuncture.• Relaxation therapy (e.g. music therapy). For the latest update of this review, we searched the Cochrane Epilepsy Group Specialised Register (19 August 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) via CRSO (19 August 2014), MEDLINE (Ovid, 1946 to 19 August 2014) and PsycINFO (EBSCOhost, 1887 to 19 August 2014). Randomised controlled trials of non-pharmacological interventions for people with epilepsy and intellectual disabilities. Two review authors independently applied the inclusion criteria and extracted study data. One study is included in this review. When two surgical procedures were compared, results indicated that corpus callosotomy with anterior temporal lobectomy was more effective than anterior temporal lobectomy alone in improving quality of life and performance on IQ tests among people with epilepsy and intellectual disabilities. No evidence was found to support superior benefit in seizure control for either intervention. This is the only study of its kind and was rated as having an overall unclear risk of bias. The previous update (December 2010) identified one RCT in progress. The study authors have confirmed that they are aiming to publish by the end of 2015; therefore this study (Bjurulf 2008) has not been included in the current review. This review highlights the need for well-designed randomised controlled trials conducted to assess the effects of non-pharmacological interventions on seizure and behavioural outcomes in people with intellectual disabilities and epilepsy.

Non-pharmacological interventions for wandering of people with dementia in the domestic setting.

A number of studies exist of interventions for wandering in the institutional setting, but much less work has been done on wandering in the domestic setting. The prevalence of wandering by people with dementia is difficult to assess; wandering is not a simple or static behaviour and the reasons why people wander remain unclear. In the absence of a theory of wandering and an agreed definition of wandering, it is difficult to discover effective strategies for managing wandering and difficult to design appropriate intervention strategies. Also, the same behaviour or type of wandering might occur for different reasons in different individuals; any theoretical formulation is going to have to allow for different triggers for the behaviour and so to get a 'one size fits all' kind of explanation is unlikely. Thus what we mostly encounter in this field is a 'trial and error' approach which does not always do justice to the complex interactions of personal and environmental factors that lead people with dementia to wander. While there seems to be a consensus in the literature that in the majority of cases non-pharmacological approaches may work as well as drug treatment and with fewer side effects, in practice clinicians often resort to drugs as the first line of treatment. This review reports the lack of evidence from RCTs and discusses the range of non-pharmacological interventions that have been carried out using other study designs. To evaluate the effectiveness and safety of non-pharmacological interventions in reducing wandering in the domestic setting by people with dementia. The secondary objective is to highlight the quality and quantity of research evidence available and to set an agenda for future research. The trials were identified from a search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 11 May 2006 using the terms exit* or wander* or elopement or ambulat* or walk*. This Register contains records from all major healthcare databases and many ongoing trial databases and is updated regularly. Randomised clinical trials comparing intervention with no intervention or usual treatment ('standard care') or another intervention. No suitable trials of non-pharmacological interventions for the prevention and management of wandering in the domestic setting were found. As no randomised controlled trials were found, no results can be reported. There is an urgent need for randomised controlled trials of non-pharmacological interventions for wandering in the domestic setting.