Non-pharmacological Interventions For Management Research Articles

Study to Evaluate the Comparative Efficacy of Medhya Rasayana (Pharmacological) Versus Nonpharmacological Interventions in Management of Gadget Addiction in Children: Protocol for Parallel, Triple-Arm, Randomized Clinical Trial.

Gadget addiction is a common behavioral problem among children. It is known to hamper social and academic life as well as adversely affect the lives of children. Ayurveda offers many therapeutic modalities and Ayurvedic medicines that can be used in the management of gadget addiction in children. The purpose of this study is to evaluate and compare the effectiveness of nonpharmacological therapies and the pharmaceutical intervention Medhya Rasayana in treating childhood gadget addiction. This study aims to provide a detailed description of the study methodology that will be used to compare the efficacy of nonpharmacological versus pharmaceutical interventions in the treatment of children's gadget addiction. A randomized, parallel, triple-arm interventional study will be conducted on diagnosed participants of gadget addiction with an age group of 6- to 16-year-old children, which will be selected and equally distributed in 2 groups. Group P will be given Medhya Rasayana (pharmacological intervention), group N will be nonpharmacological Ayurveda intervention, and group C (cognitive behavioral therapy) will be an external group. The Study duration is 180 days with assessment at baseline, midpoint, and endpoint Appropriate statistical techniques, such as ANOVA and regression analysis, will be used to examine the data and evaluate the efficacy of the 3 groups' interventions. We will perform subgroup analysis according to initial addiction severity, gender, and age. Primary outcome measures include a reduction in gadget addiction and changes in the psychosocial well-being of participants. Standardized questionnaires and instruments will be used to collect data. In December 2023, the randomized controlled study got underway. Since participants may begin at any time, our goal is for everyone to be finished by December 2024. This research will provide crucial new information about the relative effectiveness of Ayurveda nonpharmacological therapies and Medhya Rasayana in treating children's gadget addiction. The results will guide evidence-based treatments aimed at reducing the negative impact of excessive gadget use on this susceptible population's psychosocial development. In the end, the findings are meant to help policy makers and medical professionals create sensible plans to deal with the rising issue of childhood gadget addiction. PRR1-10.2196/51833.

Effectiveness of Non-Pharmacological Interventions for Spasticity Management in Multiple Sclerosis: A Systematic Review.

This systematic review aims to determine the effectiveness of non-pharmacological interventions for the management of spasticity in people with multiple sclerosis (pwMS). A comprehensive literature search in health science databases (MEDLINE, Embase, CENTRAL, CINHAL) was performed to identify randomized controlled trials (RCTs) (up to April 2024). Manual searching in journals and screening of the reference lists of identified studies were conducted. Two authors independently selected the studies, assessed the methodological quality, and summarized the evidence. A meta-analysis was not feasible due to the methodological, clinical, and statistical diversity of the included studies. Overall, 32 RCTs (n=1,481 participants) investigated various types of non-pharmacological interventions including: physical activity, transcranial magnetic stimulation (intermittent theta burst stimulation [iTBS], repetitive transcranial magnetic stimulation [rTMS]), electromagnetic therapy, transcutaneous electrical nerve stimulation, vibration therapy, shock wave therapy, self-management educational programs, and acupuncture. All studies scored 'low' on the methodological quality assessment, implying a high risk of bias. The findings suggest 'moderate to low certainty' evidence for physical activity programs used in isolation or combination with other interventions (pharmacological or non-pharmacological), and for iTBS/rTMS with or without adjuvant exercise therapy in improving spasticity in adults with MS. There is 'very low certainty' evidence supporting the use of other modalities for treating spasticity in this population. Despite a wide range of non-pharmacological interventions used for the management of spasticity in pwMS, there is a lack of conclusive evidence for many. More robust trials with larger sample sizes and longer-term follow-ups are needed to build evidence for these interventions.

The trends and hotspots of research on non-pharmacological interventions for labor pain management: a bibliometric analysis

Introduction This study aimed to examine important points of focus, trends, and depth of research on non-pharmacological interventions for the management of labor pain worldwide from a macro perspective and present an extensive definition of research fields regarding non-pharmacological interventions. Methods Bibliometric methods were used in this study. With comprehensive keyword lists, the Web of Science and PubMed databases were searched using different screening strategies for publications made until 25 February 2023. Results Studies on non-pharmacological interventions in the management of labor pain have continued to develop since 2003 with great momentum. In this study, the most productive country in research on non-pharmacological interventions was found to be Iran, while Australia, the USA, China, and the United Kingdom were the most notable ones in terms of collaboration. The most prevalently studied non-pharmacological interventions were hydrotherapy and acupuncture. The results of the co-word analysis revealed 5 main themes about this field of research. Conclusion The results of this study showed that interest in studies on non-pharmacological interventions in the management of labor pain has increased, the quality of research in the field is high, international collaboration is increasingly higher, and technological approaches have started to emerge in relevant studies.

Nonpharmacological Interventions for Management of the Pain-Fatigue-Sleep Disturbance Symptom Cluster in Breast Cancer Patients: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

The pain-fatigue-sleep disturbance symptom cluster is commonly experienced by breast cancer patients, and a variety of nonpharmacological interventions are used to treat this symptom cluster. To compare the efficacy of nonpharmacological interventions in improving the symptoms of the pain-fatigue-sleep disturbance symptom cluster in breast cancer patients. A comprehensive literature search was conducted in the PubMed, EMBASE, Cochrane Library, CINAHL, CNKI, and Wanfang databases to identify randomized controlled studies from database inception to May 2022. Two reviewers independently performed data retrieval and risk of bias assessments. The consistency model was used to conduct network meta-analyses (NMA) based on the frequentist framework to assess the interventions, which were ranked by the surface under the cumulative ranking curve (SUCRA). Finally, the CINeMA application was used to evaluate the results of the NMA and the evidence of quality. The results Twenty-three eligible studies assessing 14 interventions were included. According to SUCRA values, among the management effects of the three symptoms, the effect of progressive muscle relaxation (PMR) ranked first, followed by mindfulness-based stress reduction (MBSR). The overall evidence quality of our study ranges from very low to moderate. PMR and MBSR were effective interventions for the pain-fatigue-sleep disturbance symptom cluster in breast cancer patients. Clinical recommendations prioritize PMR for symptom management, followed by MBSR. However, this should be interpreted cautiously, as the confidence in the evidence was not high.

Pharmacological and non-pharmacological interventions in management of peripheral venipuncture-related pain: a randomized clinical trial

BackgroundVenipuncture is a routine nursing procedure in the pediatric ward for blood collection and transfusion. However, this procedure can cause severe pain and distress if not adequately managed.MethodsChildren aged 3–16 years old were randomized into three groups: EMLA group, distraction group, and combined group. The primary outcome was children’s self-reported pain scored using the Wong-Baker FACES® Pain Rating Scale. The parents-reported and observer-reported pain were scored using the Revised Face, Legs, Activity, Cry and Consolability Scale, and children’s salivary cortisol levels, heart rate, percutaneous oxygen saturation, venipuncture duration and retaining time of IV cannulas were the secondary outcomes.ResultsA total of 299 children (167 male, 55.8%, median age 8.5) were enrolled: EMLA group (n = 103), distraction group(n = 96) and combined group(n = 100). There was no statistical difference in self-reported pain (P = 0.051), parent-reported pain (P = 0.072), and observer-reported pain (P = 0.906) among the three groups. All three interventions can decrease children’s pain during IV cannulations. Additionally, the distraction group's salivary cortisol levels were lower than the combined group(P = 0.013). Furthermore, no significant difference was observed in the heart rate(P = 0.844), percutaneous oxygen saturation (P = 0.438), venipuncture duration (p = 0.440) and retaining time of IV cannulas (p = 0.843) among the three groups.ConclusionsAll three groups responded with slight pain during the peripheral venipuncture procedure. Therefore, medical workers in pediatric settings can use the interventions appropriate for their medical resources and availability while involving parents and children’s preferences whenever possible.Trial registrationThis trial was registered on https://register.clinicaltrials.gov/ (Gov.ID NCT04275336).

Mapping evidence of Iran diabetes research: protocol for a scoping review.

A considerable amount of research funding goes to diabetes management strategies to improve therapeutic goals and reduce the burden of diabetes. A vast amount of the budget is wasted due to unnecessary studies. A scoping review is a pivotal study to overview the available evidence and avoid research waste. In this review, we will try to find out the scope of available studies on diabetes management interventions, identify associated research gaps, and prioritize future studies. We will carry out a study using Arksey and O'Malley's scoping review framework. We will search the Scopus and PubMed databases from 01/01/2015 till 01/01/2020. Only original articles related to pharmacological and non-pharmacological management interventions will be included. These interventional studies should be conducted on the Iranian population. After data extraction, a descriptive data analysis will be used to present information in different charts or tables. We will evaluate related published articles based on their document type, level of evidence, type of diabetes, subject area, interventions types, main findings and outcomes. This study represents the first attempt to sum up available studies related to diabetes management interventions performed in Iran. The results of this study will be useful for all the stakeholders and policy-makers involved in diabetes research. It can help clinicians to be informed about studies on management interventions and can guide scientists eager to diabetes research to choose their future research plans based on diabetes research requirements and gaps.

Nonpharmacological Interventions for Management of Behavioral and Psychological Symptoms of Dementia in Long-Term Care Facilities by Direct Caregivers: A Systematic Review.

Behavioral and psychological symptoms of dementia (BPSD) are a worldwide problem. Estimates indicate approximately 96% of persons with dementia (PWD) exhibit BPSD that are directly associated with long-term care (LTC) placement and approximately one half of these persons experience symptoms classified as severe. BPSD are associated with lost days of work, high turnover, and poor job satisfaction for direct caregivers. Nonpharmacological interventions (NPIs) are effective for management of BPSD when used properly. NPIs are more likely to be used by direct caregivers who are knowledgeable about and have confidence in BPSD effectiveness. Various training techniques promote development of this self-efficacy. The current systematic review synthesizes evidence concerning the use of NPIs for management of BPSD by direct caregivers in LTC settings. Gaps in the literature include evaluation of positive impact of NPIs on PWD and behavior precedent factors. This review emphasizes the need for development and provision of quality NPI education for direct caregivers in LTC settings. [Journal of Gerontological Nursing, 48(7), 18-23.].

Non-pharmacological management interventions for chronic obstructive pulmonary disease: an overview of Cochrane Reviews

The protocol is out of date and does not meet the current methodological standards of Cochrane.

42. The Effect of Non-pharmacologic Interventions on Pain and Anxiety During IUD and Contraceptive Implant Insertions in Young Women

<h3>Background</h3> Intrauterine devices (IUDs) and the contraceptive implant are long acting reversible contraception (LARC) methods commonly used by adolescents. Gynecology visits and insertion of LARC devices can provoke anxiety and pain for adolescents. Research on non-pharmacological interventions for management of adolescent anxiety and pain and is lacking; we aimed to determine the impact of non-pharmacologic interventions on patient reported pain and anxiety during office LARC insertions. <h3>Methods</h3> Patients undergoing an office LARC insertion were eligible. After IRB approval, a systematic controlled trial was conducted; allocating patients to an intervention group (aromatherapy, Buzzy Bee device, aromatherapy + Buzzy Bee device, nursing bedside support) using an alternating sequence. Three outcome variables were analyzed: self-reported pain scores and responses to 2 survey questions (regarding perceived effectiveness of the intervention on pain and anxiety). Numeric data was summarized using medians/IQRs and categorical data as frequency/percent. Chi-squared tests were used to detect differences by group in categorical variables and Kruskal-Wallis tests in continuous variables. A linear mixed effects model determined pain score association with age, time, procedure, and intervention. Proportional odds ordinal regression models were used for survey questions (age, procedure, intervention as possible predictor variables). <h3>Results</h3> 58%) underwent IUD insertion. Intervention groups were roughly equal in size. After adjusting for age, procedure, and time, we found no evidence for an effect of intervention on pain scores [(χ]_3^2=1.7,p=0.64). Variability in pain scores was driven by time point and procedure. Nexplanon insertions had lower pain scores throughout compared to IUD insertions. There was little evidence of an effect of intervention on the pain effectiveness survey question (χ_3^2=4.1,p=0.25) or anxiety effectiveness survey question after controlling for age and procedure (χ_3^2=2.5,p=0.47). However, the effect of procedure was significant in both models (pain: p=0.01, anxiety: p=0.05). <h3>Conclusions</h3> IUD insertion was more painful than Nexplanon insertion regardless of age; this may impact preprocedural counseling. When controlling for age and procedure, pain scores did not differ among intervention groups. The value of bedside nursing support cannot be underestimated. Ongoing research regarding non-pharmacologic interventions is needed to help minimize patient anxiety/discomfort and increase acceptability of office gynecologic procedures.

Recognition and management of autonomic dysreflexia in patients with a spinal cord injury.

Autonomic dysreflexia is a potentially life-threatening condition that affects patients with a spinal cord injury at the level of T6 or above. It is characterised by uncontrolled elevation of systolic blood pressure of more than 20mmHg, which may occur alongside bradycardia. This article explains the pathophysiology of autonomic dysreflexia, alongside its causes, signs and symptoms. It also details the pharmacological and non-pharmacological management interventions that should be promptly initiated in patients who present to the emergency department with autonomic dysreflexia, to alleviate their symptoms and prevent further complications.

Feasability and Clinical Impact Study of Non Pharmacological Interventions in Management of Chronic Pain

Feasability and Clinical Impact Study of Non Pharmacological Interventions in Management of Chronic Pain

A new atrial fibrillation protocol and rationale for acute care

The prevalence of atrial fibrillation (AF) continues to rise in the UK and this article provides clinicians with an evidence-based protocol for use in an acute ward setting for patients who are diagnosed with acute AF. The protocol has been based on the National Institute for Health Care Excellence (NICE) guidelines to ensure that it can be used in trusts across the UK. There is guidance for most members of the multidisciplinary team to follow to ensure they are providing evidence-based care within their own settings. Although this protocol is more focused on acute care settings, it can also be used by clinicians in primary care settings, as they can implement certain guidelines to suit their care settings. As well as pharmacological management, there are also some non-pharmacological management interventions that can be used by nurses and other clinicians to help their patients manage their condition more effectively.

285 Non-pharmacological interventions for people with fibromyalgia: a systematic review

Background: Fibromyalgia (FM) affects approximately 2% of the population and characterised by chronic widespread pain, fatigue, sleep and cognitive problems. The revised European League Against Rheumatism (EULAR) recommendations for the management of FM advise that initial management should focus on patient education and non-pharmacological interventions. This systematic review aimed to evaluate the evidence-base for non-pharmacological interventions to improve the health related quality of life of people with FM. Methods: Database search included Medline (OVID), Allied and Complementary Medicine Database (AMED), CINAHL, Health Management Information Consortium (HMIC) and PsychINFO up to July 2017. The 27-item PRISMA statement checklist and a four-phase flow diagram were used to guide the review process. Randomised controlled trials (RCT) were assessed for methodological quality using the 11-item Critical Appraisal Skills Programme (CASP) checklist for RCTs by two researchers. Results: Fourteen studies published between 2003 and 2017 were included in the full review following the systematic elimination process. Interventional approaches included multi-disciplinary (MDT) rehabilitation, patient education, cognitive behavioural therapy (CBT), aquatic or aerobic-based exercise, an internet based pain course, mindfulness meditation, movement therapy and acceptance & commitment therapy (ACT). Most common outcome measure used was Fibromyalgia Impact Questionnaire (FIQ) (11 out of 14 studies) which has three domains to measure function, overall impact and symptoms of FM. Evidence to support non-pharmacological interventions for management of FM ranged from low to moderate quality rated by CASP. Majority of studies (n = 13) reported statistically significant changes in participant’s psychological status, pain, anxiety and depression, functional capacity, motivation and sleep scores post-intervention. The evidence to support the positive impact of patient education and combined exercise on quality of life of people with FM was consistent across the studies. However, there was no evidence to support the effectiveness of mindfulness meditation and Qigong movement therapy over and above patient education. MDT rehabilitation improved functional status and physical activity level, as well as significant changes in health outcomes up to 15 months post-intervention. In terms of ACT, less pain and better overall functionality was reported nine months post-intervention, when compared to control. CBT resulted in some improvements in FM symptoms, but only in the short-term. Limitations included small sample sizes, high attrition rates, short follow-ups and lack of patient partner involvement in design and development of studies. Although statistically significant findings were reported, clinical importance of these scores was only touched upon by nine studies. Also, mixed-methods trial design was only adopted by one study. Conclusion: The RCT evidence to support non-pharmacological interventions for FM range from low to moderate quality and main recommendations encompasses patient education and combined exercise therapy. There is a need for large-scale, mixed-methods, longer term RCTs designed with patient research partner involvement to investigate wide range of treatment modalities.

Detecting Delirium in Hospitalized Elderly Patients: A Review of Practice Compliance.

Background: The Ontario Senior Friendly Hospital Strategy recognizes delirium prevention and management as a top priority and recommends implementation of delirium screening as well as management protocols. This strategy proposes that hospitals monitor 2 specific indicators: (1) rate of baseline delirium screening and (2) rate of hospital-acquired delirium. Objective: To (1) determine compliance with the Ontario Senior Friendly Hospital Strategy indicators; (2) describe the use of pharmacological and nonpharmacological interventions for management of delirious patients; and (3) identify predictors of screening compliance. Methods: We conducted a retrospective review of patients aged ≥65 years admitted to 4 different inpatient units for ≥48 hours. Data were extracted for 7 two-month time blocks chosen between September 2010 and October 2013, following the implementation of various geriatric and delirium related initiatives at the hospital. Results: A total of 786 patients met study inclusion criteria. Overall, 68.2% had baseline delirium screening (indicator 1), with screening rates increasing over time (P < .001). Inpatient unit and year of study were both statistically significant predictors of delirium screening. Among those screened, the overall rate of hospital-acquired delirium was 17.2% (indicator 2). Early mobilization and device removal were the most common nonpharmacological interventions, while initiation of an antipsychotic and discontinuation of benzodiazepines were the most common pharmacological interventions. Conclusions: Although the rates of baseline delirium screening have significantly increased over the sampled time period, rates are still below the averages referenced in other literature. Our study suggests we need additional efforts to improve compliance with delirium screening in our institution.

Poststroke Fatigue: Emerging Evidence and Approaches to Management: A Scientific Statement for Healthcare Professionals From the American Heart Association.

At least half of all stroke survivors experience fatigue; thus, it is a common cause of concern for patients, caregivers, and clinicians after stroke. This scientific statement provides an international perspective on the emerging evidence surrounding the incidence, prevalence, quality of life, and complex pathogenesis of poststroke fatigue. Evidence for pharmacological and nonpharmacological interventions for management are reviewed, as well as the effects of poststroke fatigue on both stroke survivors and caregivers.

Association Between Social and Physical Activities and Insomnia Symptoms Among Community-Dwelling Older Adults.

To examine the association between organized social activity, walking exercise, and insomnia symptoms. Data for analysis are derived from the National Health Aging Trends Study (NHATS). At baseline, demographic characteristics, socioeconomic status, health-related behaviors, sleep-related problems, and health status were assessed using questionnaires. Data for 7,162 community-dwelling older adults were available for analysis. Difficulty falling asleep, trouble staying asleep, and both insomnia symptoms were reported by 12%, 5%, and 11% of the participants, respectively. The proportion of participants who reported engaging in organized social activity, walking exercise, and both activities were 11%, 35%, and 26%, respectively. Participants who reported engaging in organized social activity and/or walking exercise were significantly less likely to report insomnia symptoms. These results have important implications for future studies that plan to implement nonpharmacological interventions for management of insomnia among older adults.

Acupuncture in Primary Headache Disorders; Review of the Evidence

Primary headache disorders affect large number of people worldwide. Migraine and tension type headaches constitute 95% of all headaches. Both tension type headaches and migraine impose huge socioeconomic impact on society. The role of non-pharmacological interventions in management of primary headaches is not entirely clear. Acupuncture is one of the most historical non pharmacological ways of treating migraine and tension type headaches. The evidence in support of its effectiveness however is conflicting. This review evaluates the available evidence regarding effectiveness of acupuncture for migraine and tension type headaches.

Non-pharmacological management for patients with frontotemporal dementia: a systematic review.

Frontotemporal dementia (FTD) is a neurodegenerative disorder characterized by changes in behavior and language caused by focal degeneration of the frontal and anterior temporal lobes. The behavioral symptoms are distressing to patients and their caregivers. Non-pharmacological management is important as no disease-specific pharmacological treatment for FTD is currently available. The primary objective is to review the literature on non-pharmacological management for FTD and to propose directions for future research, with reference to findings. A search was performed using PubMed, MEDLINE, and EMBASE. Search terms included "frontotemporal dementia", and words related to non-pharmacological management, and it identified a total of 858 articles. Results revealed that very few randomized controlled trials exist on non-pharmacological management interventions for FTD. These interventions have been proposed by literature based on clinical experience. A small number of studies have supported behavioral management techniques that exploit disease-specific behaviors and preserved functions in patients with FTD, along with the management of caregivers' distress. These limitations warrant well-designed large-scale research to examine effects of non-pharmacological interventions on behavioral symptoms of FTD.

A systematic critical appraisal of non-pharmacological management of rheumatoid arthritis with Appraisal of Guidelines for Research and Evaluation II.

Clinical practice guidelines (CPGs) have been developed to summarize evidence about the management of rheumatoid arthritis (RA) and facilitate the uptake of evidence-based knowledge by consumers, health professionals, health administrators and policy makers. The objectives of this review was to assess the quality of CPGS on non-pharmacological management of RA with a standardized and validated instrument - the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool and summarize the key recommendations from these CPGs. Scientific literature databases from 2001 to 2013 were systematically searched and a total of 13 CPGs for RA was identified. Only a minority of AGREE II domains were effectively addressed by the CPGS. Scope and purpose was effectively addressed in 10 out of 13 CPGs, stakeholder involvement in 11 CPGs, rigor of development in 6 CPGs, clarity/presentation in 9 CPGs, editorial independence in 1 CPGs, and applicability in none of the CPGs. The overall quality of the included CPGs according to the 7-point AGREE II scoring system was 4.8±1.04. Patient education/self-management, aerobic, dynamic and stretching exercises were the commonly recommended for the non-pharmacological management of RA by the high-quality CPGs. The general clinical management recommendations tended to be similar among high-quality CPGs. Non-pharmacological management interventions were superficially addressed in more than half of the selected CPGs. CPGs creators should use the AGREE II criteria when developing guidelines. Innovative and effective methods of CPGs implementation to users are needed to ultimately enhance the quality of life of arthritic individuals. In addition, it was difficult to establish between strongly recommended, recommended and weakly recommended, as there is no consensus between the strength of the recommendations between the appraised CPGs.

A Systematic Critical Appraisal for Non-Pharmacological Management of Osteoarthritis Using the Appraisal of Guidelines Research and Evaluation II Instrument

Clinical practice CPGs (CPGs) have been developed to summarize evidence related to the management of osteoarthritis (OA). CPGs facilitate uptake of evidence-based knowledge by consumers, health professionals, health administrators and policy makers. The objectives of the present review were: 1) to assess the quality of the CPGs on non-pharmacological management of OA; using a standardized and validated instrument - the Appraisal of Guidelines Research and Evaluation (AGREE II) tool - by three pairs of trained appraisers; and 2) to summarize the recommendations based on only high-quality existing CPGs. Scientific literature databases from 2001 to 2013 were systematically searched for the state of evidence, with 17 CPGs for OA being identified. Most CPGs effectively addressed only a minority of AGREE II domains. Scope and purpose was effectively addressed in 10 CPGs on the management of OA, stakeholder involvement in 12 CPGs, rigour of development in 10 CPGs, clarity/presentation in 17 CPGs, editorial independence in 2 CPGs, and applicability in none of the OA CPGs. The overall quality of the included CPGs, according to the 7-point AGREE II scoring system, is 4.8±0.41 for OA. Therapeutic exercises, patient education, transcutaneous electrical nerve stimulation, acupuncture, orthoses and insoles, heat and cryotherapy, patellar tapping, and weight control are commonly recommended for the non-pharmacological management of OA by the high-quality CPGs. The general clinical management recommendations tended to be similar among high-quality CPGs, although interventions addressed varied. Non-pharmacological management interventions were superficially addressed in more than half of the selected CPGs. For CPGs to be standardized uniform creators should use the AGREE II criteria when developing CPGs. Innovative and effective methods of CPG implementation to users are needed to ultimately enhance the quality of life of arthritic individuals.