Efficacy Of Non-pharmacological Interventions Research Articles

Reader response: The efficacy of nonpharmacologic intervention for orthostatic hypotension associated with aging.

I read with interest the nonpharmacologic manipulations for management of orthostatic hypotension (OH) detailed by Drs. Newton and Frith.1 Regardless of guidelines,2 OH is clinically meaningless in the absence of regular or inevitable syncope, as systolic blood pressure (SBP), syncope, and cerebral arteriosclerosis do not necessarily run pari passu. While fall in SBP is a part of the guidelines, it is the diastolic blood pressure (DBP) that determines steady cerebral blood flow. A total of 480 mL tap water consumed within 5 minutes will neither be fully absorbed by the gastrointestinal system nor will be retained fully by the renal tubular system. No wonder only 56% of participants of a tiny cohort responded with a modest rise in SBP while DBP remained unaffected.1 While standing cross-legged is truly enigmatic, will abdominal compression and elastic stockings improve or worsen venous return in uncomplicated hypotensive nonobese elderly?

Author response: The efficacy of nonpharmacologic intervention for orthostatic hypotension associated with aging.

We thank Dr. Gupta for the interest in our recent study.1 It is incorrect to state that orthostatic hypotension (OH) is meaningless in the absence of syncope. OH results in a broad range of symptoms and can impair even simple activities of daily living.2

Reader response: The efficacy of nonpharmacologic intervention for orthostatic hypotension associated with aging

I read, with interest, the article by Drs. Newton and Frith,1 which demonstrated bolus water drinking as a potential first-line nonpharmacologic management for aging-related orthostatic hypotension (OH). It is also clear that one of the unbridged gaps in knowledge lies in the effective management of patients with varying etiologies of OH.

Nonpharmacological interventions for persistent, noncancer pain in elders residing in long-term care facilities: An integrative review of the literature.

Elders residing in long-term care facilities experience ongoing moderate to severe pain, relief from and increased comfort remain relevant healthcare concerns. However, persistent, noncancer pain may not have been properly addressed due to insufficient attention to research that exists to support the utilization and efficacy of nonpharmacological intervention(s) for elders in long-term care facilities. Our aim of this integrated review was to evaluate the current state of the science on nonpharmacological intervention(s) for pain that are currently utilized in elders who reside in long-term care facilities. Exercise, massage, heat therapy, and relaxation/rest were identified as significant nonpharmacological interventions for persistent pain in elder residents living in long-term care facilities.

Non-pharmacological management of phantom limb pain in lower limb amputation: a systematic review

Background: The incidence and severity of phantom limb pain (PLP) does not differ much between the extremities of amputation. However, its impact on functional ability and quality of life in lower limb amputation may be different, as prosthetic weight bearing is a key component in the movement and functional rehabilitation of individuals with a lower limb amputation.Objective: To evaluate the evidence for effectiveness or efficacy of non-pharmacological interventions in the management of PLP in adults with lower limb amputation.Methods: A comprehensive literature search conducted on 11 electronic databases, from their inception to 25 March 2016 identified 626 potentially relevant articles. Full-text randomised controlled trials in English which examined any form of non-pharmacologic intervention for managing PLP in lower limb amputees were included. The data with regard to characteristics of the studies, participants, intervention and outcome measures and overall statistical result were extracted. The Cochrane ‘Risk of bias assessment tool’ was used to assess the bias of all included articles.Results: Four studies met the final criteria to be included in the review. Four treatment techniques had been used in the treatment of 204 patients with lower limb amputation. Two trials showed a positive impact of intervention on PLP compared to control group. Risk of bias varied across studies, and only one included study was assessed as having a low risk of bias.Conclusion: The review identified lack of evidence to support non-pharmacological interventions in the management of PLP. Adequately powered high-quality trials are needed in this area to inform rehabilitation.

The Efficacy of Non-Pharmacological Interventions on Brain-Derived Neurotrophic Factor in Schizophrenia: A Systematic Review and Meta-Analysis.

Several studies have investigated the relationship between non-pharmacological interventions (NPIs) and peripheral brain-derived neurotrophic factor (BDNF) in schizophrenia patients. We conducted a systematic review and meta-analysis to review the efficacy of NPIs on peripheral serum and plasma BDNF in subjects with schizophrenia (including schizoaffective disorder). Meta-analyses were conducted to examine the effects of NPIs on blood BDNF levels by using the standardized mean differences (SMDs) between the intervention groups and controls. In total, six randomized controlled trials with 289 participants were included. Of them, five studies used exercise, physical training or diet products. One study used cognitive training. Overall, the BDNF levels in the NPI group increased significantly compared with the control groups (SMD = 0.95, 95% confidence interval (CI) = 0.07 to 1.83, p = 0.03). Subgroup analyses indicated beneficial effects of a non-exercise intervention on peripheral BDNF levels (SMD = 0.41, 95% CI = 0.08 to 0.74, p = 0.01). Meta-regression analyses showed that the completion rate influenced the variation in SMD (p = 0.01). Despite insufficient evidence to draw a conclusion, our results suggest that use of NPIs as adjunctive treatments, specifically non-exercise interventions, may affect positively serum or plasma BDNF in patients with schizophrenia.

P.3.d.006 - The efficacy of non-pharmacological interventions on brain-derived neurotrophic factor in schizophrenia: a systematic review and meta-analysis

P.3.d.006 - The efficacy of non-pharmacological interventions on brain-derived neurotrophic factor in schizophrenia: a systematic review and meta-analysis

Should the use of pharmacological treatments still be recommended for the management of osteoarthritis?

Pharmacological treatments including acetaminophen and non-steroidal anti-inflammatory drugs are widely recommended in national and international guidelines for the management of osteoarthritis (OA) in primary care settings. Other pharmacological modalities such as intra-articular corticosteroid or hyaluronic acid injections and symptomatic slow-acting drugs remain controversial across organisations, as there are important differences in interpretation of the evidence base. Recommendations are usually based on the results of systematic reviews and meta-analysis of randomized clinical trials. These reviews are often inconclusive for the benefits of these treatments and are limited by the heterogeneity and the quality of the included studies. Furthermore, concerns have been raised about the benefit-risk profile of these drugs, including acetaminophen. Therefore, in the light of most recent evidence, one can question if the use of pharmacological treatments should still be recommended for the management of OA, especially when the level of evidence for efficacy of non-pharmacological treatments is comparable, with less concerns about side effects. Recently, network meta-analyses have been proposed as a powerful methodological approach to compare available pharmacological treatments in OA according to their relative efficacy, safety profiles and relative costs. Their results could be helpful in formulating new evidence-based rational treatment algorithms and individualized patient care decisions, in updating current guidelines, and in deciding which place pharmacological treatments should take in physician's armamentarium.

Evidence of and recommendations for non-pharmacological interventions for common geriatric conditions: the SENATOR-ONTOP systematic review protocol

IntroductionNon-pharmacological therapies for common chronic medical conditions in older patients are underused in clinical practice. We propose a protocol for the assessment of the evidence of non-pharmacological interventions to prevent...

Additional benefit of yoga to standard lifestyle modification on blood pressure in prehypertensive subjects: a randomized controlled study.

High blood pressure (BP) is a known risk factor for cardiovascular disease morbidity. Considering the growing evidence of nonpharmacological interventions in the management of high BP, we designed a randomized, parallel active-controlled study on the effect of yoga and standard lifestyle modification (LSM) on BP and heart rate in individuals with prehypertension (systolic BP 120-139 mm Hg and/or diastolic BP 80-89 mm Hg). Volunteers (20-60 years) of both genders without any known cardiovascular disease were randomized into either LSM group (n = 92) or LSM+yoga group (n = 92). Before the intervention, age, waist circumference, physical activity, BP and fasting plasma glucose and lipids were comparable between the groups. After 12 weeks of intervention, we observed a significant reduction in the BP and heart rate in both the groups. Further, the reduction in systolic BP was significantly more in LSM+yoga group (6 mm Hg) as compared with LSM group (4 mm Hg). In addition, 13 prehypertensives became normotensives in LSM+yoga group and four in LSM group. The results indicate efficacy of nonpharmacological intervention and the additional benefit of yoga to standard LSM. Further research in this field may add to the level of evidence on the benefit of yoga, in the reduction of BP in high BP subjects, in the scientific literature.

Predictors of the impact of nonpharmacologic interventions for agitation in nursing home residents with advanced dementia.

Research is needed to determine specific factors that contribute to the success of nonpharmacologic interventions. In this study, we examined the influence of personal characteristics (demographic, medical, and functional variables) and possible barriers (eg, staff or family barriers) on the efficacy of nonpharmacological interventions in reducing agitation. Agitation was systematically observed at baseline and intervention stages using the Agitation Behavior Mapping Instrument (ABMI) in a sample of 89 residents from 6 Maryland nursing homes (mean age = 85.9 years). Each participant received interventions based on an individualized algorithm (TREA-Treatment Routes for Exploring Agitation), which identifies unmet needs and matches interventions to needs and to the participant's sensory, cognitive, and functional abilities, as well as to self-identity and preferences. The study was conducted between June 2006 and December 2011. Analyses revealed that decreased levels of agitation during intervention correlated significantly with higher levels of cognitive function (r = 0.36, P < .001), with fewer difficulties in the performance of activities of daily living (r = 0.29, P < .01), speech (r = 0.47, P < .001), communication (r = 0.23, P < .05), and responsiveness (r = 0.28, P < .01). In addition, less reduction of agitation during intervention was significantly related to the presence of staff barriers (eg, refusals, interruptions) (r = -0.38, P < .001) and the occurrence of pain (r = -0.21, P ≤ .05). The findings elucidate the characteristics of those who are most likely to respond to TREA intervention, and point to the need of systemic changes to reduce staff-related barriers and to improve methodologies for increasing the impact of intervention on those at the lowest levels of functioning.

SAT0592-HPR Non-Pharmacological Interventions for Primary SjÖGren's Syndrome: A Systematic Review of the Evidence

BackgroundSymptoms of primary Sjögren's syndrome are varied and impact on quality of life. Non pharmacological interventions such as complimentary therapies, psychotherapy and medical devices aim to relieve symptoms and improve...

Prevention of type 2 diabetes among youth: a systematic review, implications for the school nurse.

Childhood obesity and the early development of type 2 diabetes (T2 DM) place students at risk for chronic health problems. The school nurse is uniquely situated to promote school health initiatives that influence health behavior. The purpose of this review was to determine effective nonpharmacological interventions for prevention of T2 DM in youth. Researchers from 35 reports modified T2 DM risk factors. These nonpharmacological interventions often include increasing daily activity, decreasing caloric intake, and increasing muscle mass. Some researchers also included psychological and social support interventions intended to strengthen initiating and/or maintaining health behavior. Characteristics of effective nonpharmacological T2 DM prevention interventions are discussed. Findings from this review are a useful guide for the implementation of T2 DM prevention strategies in the school setting. Few school-based studies included high school students; therefore, further research is needed among older adolescents on the efficacy of nonpharmacological interventions in the high school.

OP0075-HPR A multidisciplinary and multidimensional program for hand osteoarthritis is not effective: Results of a randomized controlled study

BackgroundAlthough research on the efficacy of non-pharmacological interventions is very limited and mainly based on low quality studies, international guidelines for management of hand osteoarthritis (OA) strongly recommend to treat...

Psychotherapeutic intervention in somatisation disorder: results of a controlled study from India

Somatisation disorder is a chronic condition often associated with poor response to treatment, troublesome symptoms, distress, disability and burden. Psychosocial interventions have an important role to play in treatment. However, there is a lack of controlled studies especially from the non-western world. The present study assessed the efficacy of non-pharmacological interventions in somatisation disorder using a case control design. Fifteen patients each diagnosed as somatisation disorder as per ICD DCR criteria received six sessions of a specific psychological intervention (designed specifically for the study) or a non-specific psychological intervention along with fluoxetine. The subjects were followed up for 8 weeks. Assessments were carried out at 0, 4 and 8 weeks using structured measures. Mean age of the sample was 33 ± 7.11 years. Both the groups suffered moderate level of depression, anxiety and disability, and high neuroticism and subjective distress as measured on different instruments. A significant improvement was observed in both the groups in all the measures following the intervention. The group receiving the specific interventions showed more improvement. The study concludes that both specific as well as non specific psychotherapeutic interventions can bring substantial improvement in patients with somatisation disorder, with more improvement seen with specific psychotherapeutic interventions.

Efficacy of non-pharmacological interventions in controlling type 2 diabetes in patients of African descent: A systematic review

Purpose: The purpose of this review is to systematically assess the potential effectiveness of targeted educational and other non-pharmacological interventions on diabetes control in populations of African descent in developed countries. Such information can inform intervention strategies and highlight evidence-based approaches to deal with this significant problem in this population. Methods: A systematic review and a meta-analysis of random controlled trials and cohort studies evaluating the influence of education and other non-pharmacological interventions on HbA1Cconcentrations in patients of African descent with diabetes. A comprehensive search of PubMed, EMBASE, CINAHL, ZETOC, SIGLE databases was carried out. Results: Although nine studies (8 randomised controlled trials and 1 cohort study) met the inclusion criteria, relevant HbA1Cdata were available for 6 of the studies for the subsequent meta-analysis. Heterogeneity of meta-analysis was high (I2 = 92%), the random effects pooled standard mean difference favoured the intervention -0.66 (-1.15, -0.17), p = 0.009. After sensitivity analysis, I2 remained moderate to high at 69%. The random effects pooled standard mean difference continued to favour the intervention -0.48 (-0.81, -0.16), p = 0.009. Conclusion: There is evidence supporting the efficacy of educational and other non-pharmacological interventions in diabetes control in populations of African descent in English speaking developed countries. This conclusion is tempered by the significant heterogeneity of selected interventions and paucity of high quality research in the target population.

Nonpharmacological Approaches to the Management of Chronic Pain in Community‐Dwelling Older Adults: A Review of Empirical Evidence

The objective of this literature review is to gain insight into the efficacy of nonpharmacological interventions in chronic pain management in community-dwelling older adults. An extensive search of pertinent databases was performed to identify reports of studies of nonpharmacological (physical and psychosocial) pain interventions. The review identifies intervention studies that used randomized controlled trials (RCTs) and summarizes existing evidence of effectiveness of nonpharmacological interventions. A literature search yielded 28 RCT intervention studies (18 for physical interventions and 10 for psychosocial interventions) that met inclusion criteria and are included in this review. Twenty-one studies (75%) identified in this review demonstrated statistically significant differences (P < .05) in pain scores between nonpharmacological interventions and no intervention or sham interventions; the intervention groups showed lower pain intensity. More research is needed to determine the best format, intensity, duration, and content of such treatments, as well as their efficacy in the older adult population. Methodological limitations are identified in many of the studies, such as low statistical power due to sample size and imprecise measurement, lack of reliable sham controls, and inadequate blinding. Future intervention studies of nonpharmacological pain therapies may require larger sample sizes, control for comorbidities, and long-term follow-up.

The effectiveness of music on pain among preterm infants in the neonatal intensive care unit: a systematic review.

Review question/objective The objective of this review is to synthesize the best available evidence related to the effectiveness of music as pain relieving method among preterm infants during painful procedures in the neonatal intensive care unit. Review questions are: Among preterm infants in the neonatal intensive care unit, is music effective in reducing - pain scores? - physiological pain indicators? - behavioural pain indicators? - hormonal pain indicators? Inclusion criteria Types of participants This review will consider studies that include preterm infants (i.e. born at or before 37 gestational weeks) in neonatal intensive care unit (NICU) Types of intervention(s) This review will consider studies that evaluate any type of music (recorded or lived music), which is implemented for premature infants by a music therapist or any health care providers during painful procedures. Comparator No music intervention (the infant will receive the usual care based on the routine practices in the unit) Types of outcomes This review will consider studies that include the following outcome measures: level of pain measured by pain scores and/ or physiological (e.g. hearth rate, blood pressure, respiration, oxygen saturation), behavioural (e.g. cry, facial expression, movements, sleep-wake state) and hormonal (e.g. blood glucose, cortisol level, catecholamine acids) pain indicators.

Cortisol and anxiety response to a relaxing intervention on pregnant women awaiting amniocentesis

Stress and anxiety during pregnancy have been associated with premature and low birth weight babies, presumably through fetus over exposion to glucocorticoids. Antenatal stress also seems to have long-term effects upon infant development and adult health. However, medication for stress may carry risks to the expectant mother, therefore the efficacy of non-pharmacological interventions should be investigated. Pregnant women (n=154) awaiting amniocentesis, were randomly assigned in the morning and the afternoon to three groups for 30 min: (1) listening to relaxing music, (2) sitting and reading magazines, and (3) sitting in the waiting-room. Before and after that period, they completed the Spielberger's State and Trait anxiety inventory and provided blood samples for cortisol. The groups were then compared regarding change in cortisol levels and anxiety. Maternal cortisol and state anxiety were correlated (r=0.25, p=0.04) in the afternoon, but not in the morning. The larger decreases in cortisol occurred in the music group (-61.8 nmol/L, ANOVA: p=0.01), followed by magazine, being differences among groups more pronounced in the morning. Women in the music group also exhibited the greater decreases in state anxiety (p<0.001). Younger mothers with less gestational age were on average the most anxious, and also the ones with greater decreases in cortisol and anxiety levels after relaxation. A relaxing intervention as short as 30 min, especially listening to music, decreases plasma cortisol and self-reported state anxiety score. Pregnant women might benefit from the routine practice of relaxation in the imminence of clinical stressful events.

Snoezelen, structured reminiscence therapy and 10-minutes activation in long term care residents with dementia (WISDE): study protocol of a cluster randomized controlled trial

BackgroundPeople with dementia are often inapproachable due to symptoms of their illness. Therefore nurses should establish relationships with dementia patients via their remaining resources and facilitate communication. In order to achieve this, different targeted non-pharmacological interventions are recommended and practiced. However there is no sufficient evidence about the efficacy of most of these interventions. A number of publications highlight the urgent need for methodological sound studies so that more robust conclusions may be drawn.Methods/DesignThe trial is designed as a cluster randomized controlled trial with 20 nursing homes in Saxony and Saxony-Anhalt (Germany) as the units of randomization. Nursing homes will be randomly allocated into 4 study groups consisting of 5 clusters and 90 residents: snoezelen, structured reminiscence therapy, 10-minutes activation or unstructured verbal communication (control group). The purpose is to determine whether the interventions are effective to reduce apathy in long-term care residents with dementia (N = 360) as the main outcome measure. Assessments will be done at baseline, 3, 6 and 12 months after beginning of the interventions.DiscussionThis trial will particularly contribute to the evidence on efficacy of non-pharmacological interventions in dementia care.Trial RegistrationClinicalTrials.gov NCT00653731