Overall Strength Of Evidence Research Articles

Pharmacotherapy for patients with calcium oxalate stones and abnormal urine chemistry: A systematic review and meta-analysis for the Japanese Clinical Practice Guidelines for the Management of Urinary Stones, Third Edition.

We performed a systematic review and meta-analysis to evaluate the benefits and harms of pharmacotherapies for patients with calcium oxalate stones and abnormal urine chemistry. This article is a modified and detailed version of the commentary on Clinical Question 10 described in the Japanese Clinical Practice Guidelines for the Management of Urinary Stones, Third Edition. PubMed and Ichushi Web were searched through August 2020 for articles on pharmacotherapies for calcium oxalate stones (thiazides, citrate preparations, uric acid production inhibitors, and magnesium preparations). Two reviewers independently selected randomized controlled trials reporting reduction of stone recurrence and adverse drug reactions as outcomes and performed data extraction and quality assessment. Meta-analyses with random effects models and rating of the strength of evidence were performed. Pharmacotherapies were shown to significantly reduce stone recurrence (risk ratio 0.47, 95% confidence interval 0.35-0.63). Meanwhile, the pharmacotherapies increased adverse drug reactions leading to study dropout (risk ratio 2.51, 95% confidence interval 1.09-5.75) and adverse drug reactions/adverse events (risk ratio 1.95, 95% confidence interval 1.07-3.56). The reported adverse drug reactions were, however, mainly minor and did not frequently require discontinuation of medication (2%-16%). The strengths of evidence for both outcomes were rated as moderate, because the risk of bias, indirectness, inconsistency, imprecision, and publication bias were all serious except for one item. The overall strength of evidence across outcomes was therefore determined to be moderate. These results support the conditional recommendation to initiate pharmacotherapies for patients with calcium oxalate stones and abnormal urine chemistry.

Treatment of Stages I-III Squamous Cell Anal Cancer: A Comparative Effectiveness Systematic Review.

To assess the effectiveness and harms of initial treatment strategies for stages I-III anal squamous cell cancer (SCC). We searched Medline®, Embase®, and CENTRAL®, between January 1, 2000- March 2024, for randomized controlled trials and nonrandomized studies of interventions comparing initial treatment strategies. Individual study risk of bias (RoB) and overall strength of evidence (SOE) were evaluated for a prespecified outcome list using standardized methods. We identified 33 eligible studies and extracted data. Six were deemed low/moderate RoB. Compared with radiotherapy (RT) alone, chemoradiotherapy (CRT) with 5-fluorouracil (FU) and mitomycin C (MMC) probably shows a benefit in locoregional failure (LRF), disease-specific (DSS), and colostomy-free survival (CFS) (moderate SOE) yet may result in greater overall and acute hematologic toxicity, with no difference in late harms (low SOE). CRT with 5FU+MMC may show a benefit in LRF, DSS, and CFS rates compared with 5FU alone (low SOE). CRT with 5FU+cisplatin vs 5FU+MMC probably results in no differences in several effectiveness outcomes or overall acute or late harms, and probably increases hematologic toxicity with MMC (moderate SOE). Compared with CRT using capecitabine+MMC, CRT with capecitabine+MMC+paclitaxel may improve OS, DSS, and CFS, yet cause more acute harms (low SOE). Evidence was insufficient for remaining comparisons. CRT with 5FU+MMC or 5FU+cisplatin is likely more effective yet incurs greater acute hematologic toxicity than RT alone or single-agent CRT. Adding paclitaxel to capecitabine+MMC may increase treatment efficacy and toxicity. Evidence is insufficient comparing post-treatment surveillance strategies and patient-reported outcomes, highlighting research opportunities.

Self-acknowledged limitations in exercise therapy trials for low back pain.

Despite the widespread recommendation to engage in therapeutic exercise for the treatment of low back pain (LBP), there is conflicting evidence regarding clinical outcomes and effectiveness. Poor methodological quality may be to blame for reducing the overall strength of evidence for this intervention, yet little is known about the difficulties researchers encounter when designing and implementing their study methods. The aim of this study was to characterize the extent and type of self-acknowledged limitations (SALs) in exercise therapy trials for LBP to gain a better understanding of challenges encountered when conducting this research. This is a methodological review of clinical trials in which SALs were extracted, categorized by theme and subcategorized within each theme. Counts and prevalence rates were tabulated for the number of SALs in each category and subcategory. There were 914 SALs among the 312 included trials, with a mean of 2.93 (95% confidence interval [CI], 2.77-3.09) per trial. Analysis of the data resulted in the development of 13 distinct categories of limitations, among which were 37 subcategories. The top three categories pertained to statistical power (14.3% of total SALs), study length and/or follow-up (14.3%) and inclusion criteria (14.2%). The top three subcategories were lack of long-term follow-up (13.8% of total SALs), inadequate sample size (13.3%) and inclusion of specific populations (12.3%). Statistical power, study length and/or follow-up, and inclusion criteria were the three most commonly reported categories of SALs in exercise trials for LBP. Lack of long-term follow-up, inadequate sample size and inclusion of specific populations were the most common subcategories. Research protocols recognizing and avoiding these limitations will enhance the overall quality of evidence of exercise therapy trials for LBP.

EVIDENCE FOR THE EFFECT OF EXERCISE ON PHYSICAL CAPACITY, FUNCTIONAL PERFORMANCE, AND FATIGUE IN BRAIN CANCER SURVIVORS: A SYSTEMATIC REVIEW

INTRODUCTION & AIMS Physical capacity, functional performance, and fatigue status have prognostic value and protective benefits against all-cause mortality and future adverse health events in prostate, breast, and colon cancer survivors. However, the effects of exercise on these parameters in cancers with disproportionately high rates of mortality and morbidity remain unclear. Therefore, this systematic review aims to evaluate the effects of exercise on aerobic fitness, muscle strength, balance, gait, and fatigue symptoms among adult brain cancer survivors. METHODS Following PRIMSA guidelines, databases were searched using subject MESH headings for papers published before June 2023. Studies involving adults with a primary brain cancer diagnosis where exercise interventions were applied with the intent to treat and where pre- and post-intervention outcome measures were available. The risk of bias tool for non-randomised trials was used and the overall strength of evidence was assessed using the GRADE approach. RESULTS Ten studies from 367 retrieved papers were eligible for inclusion. A total of 293 participants aged 18-82 years, all diagnosed with gliomas, who were on-treatment or <62 months post-treatment were involved. Interventions varied substantially across studies regarding duration (4-26 weeks), assessments, prescriptions (frequencies, intensities, modalities, and durations), and delivery. Findings were consistent, reporting significant positive effects of exercise on submaximal aerobic capacity, upper and lower limb strength, balance, fatigue scores, 30s sit-to-stand, and gait speed. However, all studies had a serious risk of bias with numerous methodological problems. Overall certainty of the evidence was rated as very low for each outcome. CONCLUSION Results from these preliminary studies are encouraging and suggest that exercise may improve health and functional outcomes and potentially reduce the risk of all-cause mortality in adult brain cancer survivors. However, these findings should be interpreted with caution due to the small body of literature, high risk of bias, and weak evidence available.

Timing of Decompressive Surgery in Patients With Acute Spinal Cord Injury: Systematic Review Update.

Systematic review and meta-analysis. Surgical decompression is a cornerstone in the management of patients with traumatic spinal cord injury (SCI); however, the influence of the timing of surgery on neurological recovery after acute SCI remains controversial. This systematic review aims to summarize current evidence on the effectiveness, safety, and cost-effectiveness of early (≤24hours) or late (>24hours) surgery in patients with acute traumatic SCI for all levels of the spine. Furthermore, this systematic review aims to evaluate the evidence with respect to the impact of ultra-early surgery (earlier than 24hours from injury) on these outcomes. A systematic search of the literature was performed using the MEDLINE database (PubMed), Cochrane database, and EMBASE. Two reviewers independently screened the citations from the search to determine whether an article satisfied predefined inclusion and exclusion criteria. For all key questions, we focused on primary studies with the least potential for bias and those that controlled for baseline neurological status and specified time from injury to surgery. Risk of bias of each article was assessed using standardized tools based on study design. Finally, the overall strength of evidence for the primary outcomes was assessed using the GRADE approach. Data were synthesized both qualitatively and quantitively using meta-analyses. Twenty-one studies met inclusion and exclusion criteria and formed the evidence base for this review update. Seventeen studies compared outcomes between patients treated with early (≤24hours from injury) compared to late (>24hours) surgical decompression. An additional 4 studies evaluated even earlier time frames: <4, <5, <8 or <12hours. Based on moderate evidence, patients were 2times more likely to recover by ≥ 2 grades on the ASIA Impairment Score (AIS) at 6months (RR: 2.76, 95% CI 1.60 to 4.98) and 12months (RR: 1.95, 95% CI 1.26 to 3.18) if they were decompressed within 24hours compared to after 24 hours. Furthermore, moderate evidence suggested that patients receiving early decompression had an additional 4.50 (95% CI 1.70 to 7.29) point improvement on the ASIA motor score. With respect to administrative outcomes, there was low evidence that early decompression may decrease acute hospital length of stay. In terms of safety, there was moderate evidence that suggested the rate of major complications does not differ between patients undergoing early compared to late surgery. Furthermore, there was no difference in rates of mortality, surgical device-related complications, sepsis/systemic infection or neurological deterioration based on timing of surgery. Firm conclusions were not possible with respect to the impact of ultra-early surgery on neurological, functional or safety outcomes given the poor-quality studies, imprecision and the overlap in the time frames examined. This review provides an evidence base to support the update on clinical practice guidelines related to the timing of surgical decompression in acute SCI. Overall, the strength of evidence was moderate that early surgery (≤24hours from injury) compared to late (>24hours) results in clinically meaningful improvements in neurological recovery. Further studies are required to delineate the role of ultra-early surgery in patients with acute SCI.

An Update of a Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Role and Timing of Decompressive Surgery.

Clinical practice guideline development. Acute spinal cord injury (SCI) can result in devastating motor, sensory, and autonomic impairment; loss of independence; and reduced quality of life. Preclinical evidence suggests that early decompression of the spinal cord may help to limit secondary injury, reduce damage to the neural tissue, and improve functional outcomes. Emerging evidence indicates that "early" surgical decompression completed within 24hours of injury also improves neurological recovery in patients with acute SCI. The objective of this clinical practice guideline (CPG) is to update the 2017 recommendations on the timing of surgical decompression and to evaluate the evidence with respect to ultra-early surgery (in particular, but not limited to, <12hours after acute SCI). A multidisciplinary, international, guideline development group (GDG) was formed that consisted of spine surgeons, neurologists, critical care specialists, emergency medicine doctors, physical medicine and rehabilitation professionals, as well as individuals living with SCI. A systematic review was conducted based on accepted methodological standards to evaluate the impact of early (within 24hours of acute SCI) or ultra-early (in particular, but not limited to, within 12hours of acute SCI) surgery on neurological recovery, functional outcomes, administrative outcomes, safety, and cost-effectiveness. The GRADE approach was used to rate the overall strength of evidence across studies for each primary outcome. Using the "evidence-to-recommendation" framework, recommendations were then developed that considered the balance of benefits and harms, financial impact, patient values, acceptability, and feasibility. The guideline was internally appraised using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. The GDG recommended that early surgery (≤24hours after injury) be offered as the preferred option for adult patients with acute SCI regardless of level. This recommendation was based on moderate evidence suggesting that patients were 2times more likely to recover by ≥ 2 ASIA Impairment Score (AIS) grades at 6 months (RR: 2.76, 95% CI 1.60 to 4.98) and 12months (RR: 1.95, 95% CI 1.26 to 3.18) if they were decompressed within 24hours compared to after 24hours. Furthermore, patients undergoing early surgery improved by an additional 4.50 (95% 1.70 to 7.29) points on the ASIA Motor Score compared to patients undergoing surgery after 24hours post-injury. The GDG also agreed that a recommendation for ultra-early surgery could not be made on the basis of the current evidence because of the small sample sizes, variable definitions of what constituted ultra-early in the literature, and the inconsistency of the evidence. It is recommended that patients with an acute SCI, regardless of level, undergo surgery within 24hours after injury when medically feasible. Future research is required to determine the differential effectiveness of early surgery in different subpopulations and the impact of ultra-early surgery on neurological recovery. Moreover, further work is required to define what constitutes effective spinal cord decompression and to individualize care. It is also recognized that a concerted international effort will be required to translate these recommendations into policy.

Do non-traumatic stressful life events and ageing negatively impact working memory performance and do they interact to further impair working memory performance?

Stress and normal ageing produce allostatic load, which may lead to difficulties with cognition thereby degrading quality of life. The current study's objective was to assess whether ageing and cumulative stress interact to accelerate cognitive decline. With 60 participants, Marshall et al. found that ageing and cumulative stress interact significantly to impair working memory performance in older adults, suggesting vulnerability to the cumulative effects of life events beyond 60 years old. To replicate and extend this finding, we increased the sample size by conducting 3 independent studies with 156 participants and improved the statistical methods by conducting an iterative Bayesian meta-analysis with Bayes factors. Bayes factors deliver a more comprehensive result because they provide evidence for either the null hypothesis (H0), the alternative hypothesis (H1) or for neither hypothesis due to evidence not being sufficiently sensitive. Young (18-35 yrs) and older (60-85 yrs) healthy adults were categorised as high or low stress based on their life events score derived from the Life Events Scale for Students or Social Readjustment Rating Scale, respectively. We measured accuracy and reaction time on a 2-back working memory task to provide: a) Bayes factors and b) Bayesian meta-analysis, which iteratively added each study's effect sizes to evaluate the overall strength of evidence that ageing, cumulative stress and/or the combination of the two detrimentally affect working memory performance. Using a larger sample (N = 156 vs. N = 60) and a more powerful statistical approach, we did not replicate the robust age by cumulative stress interaction effect found by Marshall et al.. The effects of ageing and cumulative stress also fell within the anecdotal range (⅓<BF<3). We therefore conclude that there was inconclusive statistical evidence, as measured with a life events scale, that ageing and cumulative life stress interact to accelerate cognitive decline.

Association between immediate oxygenation response and survival in preterm infants receiving rescue inhaled nitric oxide therapy for hypoxemia from pulmonary hypertension: A systematic review and meta-analysis

PurposeTo investigate whether immediate response to inhaled nitric oxide (iNO) therapy is associated with reduced mortality in preterm infants with hypoxemic respiratory failure (HRF) and pulmonary hypertension (PH). MethodsA systematic review and meta-analysis of observational studies was conducted to examine the association between immediate response (improved oxygenation ≤6 h) compared to non-response, and all-cause mortality among preterm infants <34 weeks gestational age without congenital anomalies or genetic disorders who received iNO treatment. Adjusted and unadjusted odds ratio, were pooled using a random effects meta-analysis Hartung-Knapp-Sidik-Jonkman approach. Subgroup analyses were planned for infants with preterm premature rupture of membranes (PPROM) and those treated within 72 h after birth. ResultsThe primary analysis included 5 eligible studies, a total of 400 infants (196 responders; 204 non-responders). The studies were rated as low to moderate risk of bias based on the Quality in Prognostic Studies tool. Immediate iNO responsiveness was associated with reduced odds of mortality [odds ratio (OR) 0.22, 95 % confidence interval (95 % CI) (0.10–0.49)]. Although there was insufficient data for a subgroup analysis of infants with PPROM, infants treated with iNO within 72 h demonstrated consistent findings of reduced mortality [OR 0.21 95 % CI (0.13–0.36)]. Based on the GRADE approach, considering the risk of bias of included studies, the overall strength of evidence was rated as moderate. ConclusionThere is evidence to suggest that immediate improvement in oxygenation following iNO therapy is associated with reduced odds of mortality before discharge in preterm infants with HRF and clinically suspected or confirmed PH.

Effects of aerobic, resistance, and combined exercise training on health-related quality of life in multiple sclerosis: Systematic review and meta-analysis.

Multiple sclerosis (MS) is an immune-mediated, neurodegenerative disease of the central nervous system that manifests in symptoms that compromise health-related quality of life (HRQOL). HRQOL focuses on a person's overall, subjective evaluation of health status primarily in the physical and mental domains. Exercise training is a form of rehabilitation for managing MS-related outcomes that might influence HRQOL. Reviews on exercise training are available, but we are unaware of a recent comprehensive review and meta-analysis of exercise effects for improving physical and mental domains of HRQOL. This analysis provides an updated review and meta-analysis of randomized controlled trials (RCTs) examining interventions consisting of aerobic, resistance and combined exercise training for improving HRQOL in persons with MS. This systematic review 1) assessed the overall strength of evidence for exercise interventions on HRQOL, 2) evaluated the relative effect of exercise interventions on physical and mental domains of HRQOL, and 3) determined moderators of exercise intervention effects on HRQOL. Seven databases were searched for RCTs evaluating physical and/or mental domains of HRQOL with adults diagnosed with MS and undergoing an intervention of aerobic, resistance or combined exercise training compared with a non-exercise comparator. Data extraction included participant and intervention characteristics, and pre- and post-intervention HRQOL outcome data. Effect sizes (ESs) were calculated as standardized mean differences (SMDs) and a multilevel random-effects model was used to generate an aggregated SMD that compared exercise with non-exercise control conditions. Twelve RCTs met the inclusion criteria and yielded 23 ESs to be analyzed. Participants (N=593; 308 intervention vs. 285 control conditions) had a mean (±standard deviation) age of 42.4 (6.5) years and 80% (18.3%) were female. Results generated a medium effect of exercise for improving overall HRQOL (ES=0.64, p=0.0001) with high heterogeneity (Q11=58.8, I2=86.7%). Exercise training yielded a large effect on the physical domain (k=12, ES=0.82, p<0.0009) and a medium effect on the mental domain (k=11, ES=0.41, p<0.0001). Moderator analyses identified exercise modality, supervision level, intervention delivery and length, HRQOL tool, and number of participants with relapsing-remitting MS as significant influences of ES for HRQOL. Exercise training is clinically effective for improving overall HRQOL in MS and produces greater improvements in the physical domain of HRQOL than the mental domain. The moderator analysis suggests that supervised, aerobic, and group-delivered exercise training of ≥3 months yields the most influence on HRQOL. Such results may have major implications for MS treatment and care.

The Effect of Exercise on Pain in People with Cancer: A Systematic Review with Meta-analysis.

Cancer-related pain is common and undertreated. Exercise is known to have a pain-relieving effect in non-cancer pain. This systematic review aimed to evaluate (1) the effect of exercise on cancer-related pain in all cancers, and (2) whether the effect of exercise differed according to exercise mode, degree of supervision, intervention duration and timing (during or after cancer treatment), pain types, measurement tool and cancer type. Electronic searches were undertaken in six databases to identify exercise studies evaluating pain in people with cancer, published prior to 11 January 2023. All stages of screening and data extraction were conducted independently by two authors. The Cochrane risk of bias tool for randomised trials (RoB 2) was used and overall strength of evidence was assessed using the GRADE approach. Meta-analyses were performed overall and by study design, exercise intervention and pain characteristics. In total, 71 studies reported in 74 papers were eligible for inclusion. The overall meta-analysis included 5877 participants and showed reductions in pain favouring exercise (standardised mean difference - 0.45; 95% confidence interval - 0.62, - 0.28). For most (> 82%) of the subgroup analyses, the direction of effect favoured exercise compared with usual care, with effect sizes ranging from small to large (median effect size - 0.35; range - 0.03 to - 1.17). The overall strength of evidence for the effect of exercise on cancer-related pain was very low. The findings provide support that exercise participation does not worsen cancer-related pain and that it may be beneficial. Better pain categorisation and inclusion of more diverse cancer populations in future research would improve understanding of the extent of benefit and to whom. CRD42021266826.

Effects of high temperatures and heatwaves on dengue fever: a systematic review and meta-analysis

Studies have shown that dengue virus transmission increases in association with ambient temperature. We performed a systematic review and meta-analysis to assess the effect of both high temperatures and heatwave events on dengue transmission in different climate zones globally. A systematic literature search was conducted in PubMed, Scopus, Embase, and Web of Science from January 1990 to September 20, 2022. We included peer reviewed original observational studies using ecological time series, case crossover, or case series study designs reporting the association of high temperatures and heatwave with dengue and comparing risks over different exposures or time periods. Studies classified as case reports, clinical trials, non-human studies, conference abstracts, editorials, reviews, books, posters, commentaries; and studies that examined only seasonal effects were excluded. Effect estimates were extracted from published literature. A random effects meta-analysis was performed to pool the relative risks (RRs) of dengue infection per 1°C increase in temperature, and further subgroup analyses were also conducted. The quality and strength of evidence were evaluated following the Navigation Guide systematic review methodology framework. The review protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO). The study selection process yielded 6367 studies. A total of 106 studies covering more than four million dengue cases fulfilled the inclusion criteria; of these, 54 studies were eligible for meta-analysis. The overall pooled estimate showed a 13% increase in risk of dengue infection (RR=1.13; 95% confidence interval (CI): 1.11-1.16, I2=98.0%) for each 1°C increase in high temperatures. Subgroup analyses by climate zones suggested greater effects of temperature in tropical monsoon climate zone (RR=1.29, 95% CI: 1.11-1.51) and humid subtropical climate zone (RR=1.20, 95% CI: 1.15-1.25). Heatwave events showed association with an increased risk of dengue infection (RR=1.08; 95% CI: 0.95-1.23, I2=88.9%), despite a wide confidence interval. The overall strength of evidence was found to be "sufficient" for high temperatures but "limited" for heatwaves. Our results showed that high temperatures increased the risk of dengue infection, albeit with varying risks across climate zones and different levels of national income. High temperatures increased the relative risk of dengue infection. Future studies on the association between temperature and dengue infection should consider local and regional climate, socio-demographic and environmental characteristics to explore vulnerability at local and regional levels for tailored prevention. Australian Research Council Discovery Program.

GENETIC AND MATERNAL FACTORS IN HYPEREMESIS GRAVIDARUM: A SYSTEMATIC REVIEW

Hyperemesis gravidarum (HG) is the severe form of nausea and vomiting during pregnancy, which can extremely lead to dehydration, significant weight loss, electrolyte and metabolic imbalances. Importantly, early identification of HG symptoms can help to reduce the severity and prevent complications. Although HG is associated with many adverse maternal and fetal outcomes, there is limited understanding about the risk factors. This review provides current data of genetic and maternal factors that are linked to HG. All observational studies published in English that investigated the genetic or maternal factors associated with HG from 2011 until 2021 were systematically searched using PubMed, Scopus, and ProQuest electronic databases. A total of 1462 citation titles was identified, of which 47 potentially relevant abstracts were screened. Of those, 15 studies met the inclusion and exclusion criteria. The genetic variants in ryanodine receptor 2 gene (RYR2), growth differentiation factor-15 gene (GDF15), and protein coding insulin-like growth factor-binding protein 7 (IGFBP7) were found to be associated with HG. On the other hand, several potential maternal factors contributing to the onset of HG were age, Helicobacter pylori infection, body mass index status, a history of HG in a previous pregnancy, high serotonin levels, and reproductive factors. In view of the lack of strength of overall evidence for risk factors related to HG, it is first imperative to establish a precise definition for HG in a diverse study population. Nevertheless, to conclude, this review was able to provide current data of genetic and maternal factors that are associated with HG.

Measurement properties of pain scoring instruments in farm animals: A systematic review using the COSMIN checklist.

This systematic review aimed to investigate the measurement properties of pain scoring instruments in farm animals. According to the PRISMA guidelines, a registered report protocol was previously published in this journal. Studies reporting the development and validation of acute and chronic pain scoring instruments based on behavioral and/or facial expressions of farm animals were searched. Data extraction and assessment were performed individually by two investigators using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines. Nine categories were assessed: two for scale development (general design requirements and development, and content validity and comprehensibility) and seven for measurement properties (internal consistency, reliability, measurement error, criterion and construct validity, responsiveness and cross-cultural validity). The overall strength of evidence (high, moderate, low, or very low) of each instrument was scored based on methodological quality, number of studies and studies' findings. Twenty instruments for three species (bovine, ovine and swine) were included. There was considerable variability concerning their development and measurement properties. Three behavior-based instruments scored high for strength of evidence: UCAPS (Unesp-Botucatu Unidimensional Composite Pain Scale for assessing postoperative pain in cattle), USAPS (Unesp-Botucatu Sheep Acute Composite Pain Scale) and UPAPS (Unesp-Botucatu Pig Composite Acute Pain Scale). Four instruments scored moderate for strength of evidence: MPSS (Multidimensional Pain Scoring System for bovine), SPFES (Sheep Pain Facial Expression Scale), LGS (Lamb Grimace Scale) and PGS-B (Piglet Grimace Scale-B). Most instruments (n = 13) scored low or very low for final overall evidence. Construct validity was the most reported measurement property followed by criterion validity and reliability. Instruments with reported validation are urgently required for pain assessment of buffalos, goats, camelids and avian species.

Measures of neck muscle strength and their measurement properties in adults with chronic neck pain—a systematic review

BackgroundMeasurement of neck muscle strength is common during the assessment of people with chronic neck pain (CNP). This systematic review evaluates the measurement properties (reliability, validity, and responsiveness) of neck muscle strength measures in people with CNP.Databases and data treatmentThis systematic review followed a PROSPERO registered protocol (CRD42021233290). Electronic databases MEDLINE (OVID interface), CINAHL, SPORTDiscuss via (EBSCO interface), EMBASE (OVID interface), and Web of Science were searched from inception to 21 June 2021. Screening, data extraction, and quality assessment (Consensus-based Standards for the selection of Health Measurement Instruments (COSMIN) checklist) were conducted independently by two reviewers. The overall strength of evidence was evaluated using the modified Grading of Recommendations Assessment, Development and Evaluation.ResultsFrom 794 records, nine articles were included in this review which concerned six different neck strength outcome measures. All studies evaluated reliability and one evaluated construct validity. The reliability of neck strength measures ranged from good to excellent. However, the risk of bias was rated as doubtful/inadequate for all except one study and the overall certainty of evidence was rated low/very low for all measures except for the measurement error of a handheld dynamometer.ConclusionA multitude of measures are used to evaluate neck muscle strength in people with CNP, but their measurement properties have not been fully established. Further methodologically rigorous research is required to increase the overall quality of evidence.

Theoretical Schemas to Guide BACPAC Chronic Low Back Pain Clinical Research.

Chronic low back pain (cLBP) is a complex with a heterogenous clinical presentation. A better understanding of the factors that contribute to cLBP is needed for accurate diagnosis, optimal treatment, and identification of mechanistic targets for new therapies. The Back Pain Consortium (BACPAC) Research Program provides a unique opportunity in this regard as it will generate large clinical datasets including a diverse set of harmonized measurements. The Theoretical Model Working Group (TMWG) was established to guide BACPAC research, and to organize new knowledge within a mechanistic framework. This article summarizes the initial works of the TMWG. It includes a three-stage integration of expert opinion and an umbrella literature review of factors that affect cLBP severity and chronicity. During Stage 1, experts from across BACPAC established a taxonomy for risk and prognostic factors (RPFs) and preliminary graphical depictions. During Stage 2, a separate team conducted a literature review according to PRISMA guidelines to establish working definitions, associated data elements (ADEs), and overall strength-of-evidence (SOE) for identified RPFs. These were subsequently integrated with expert opinion during Stage 3. The majority (∼80%) of RPFs had little SOE confidence, while 7 factors had substantial confidence for either a positive association (pain-related anxiety, serum c-reactive protein, diabetes, and anticipatory/compensatory postural adjustments) or no association (serum interleukin 1-beta/interleukin 6, transversus muscle morphology/activity, and quantitative sensory testing) with cLBP. This theoretical perspective will evolve over time as BACPAC investigators link empirical results to theory, challenge current ideas of the biopsychosocial model, and utilize a systems approach to develop tools and algorithms that disentangle the dynamic interactions between cLBP factors.

An umbrella review of the evidence linking oral health and systemic noncommunicable diseases.

Oral diseases are highly prevalent worldwide. Recent studies have been supporting a potential bidirectional association of oral diseases with systemic noncommunicable diseases (NCDs). Available evidence supports that people with NCDs have a greater prevalence of oral diseases particularly those with limited ability of oral self-care. Regarding the reverse relationship, the lines of evidence pointing out NCDs as putative risk factors for oral diseases have increased significantly but not with a consistent agreement. This umbrella review of meta-analyses appraises the strength and validity of the evidence for the association between oral health and systemic health (registered at PROSPERO, ID: CRD42022300740). An extensive search included systematic reviews that have provided meta-analytic estimates on the association of oral diseases with NCDs. The overall strength of evidence was found to be unfavorable and with methodological inconsistencies. Twenty-eight NCDs were strongly associated with oral diseases. Among those NCDs are five types of cancer, diabetes mellitus, cardiovascular diseases, depression, neurodegenerative conditions, rheumatic diseases, inflammatory bowel disease, gastric helicobacter pylori, obesity, and asthma. According to fail-safe number statistics, the evidence levels are unlikely to change in the future, indicating a fairly robust consistency.

Inclusion of nonrandomized studies of interventions in systematic reviews of interventions: updated guidance from the Agency for Health Care Research and Quality Effective Health Care program

ObjectivesWe developed guidance to inform decisions regarding the inclusion of nonrandomized studies of interventions (NRSIs) in systematic reviews (SRs) of the effects of interventions. Study Design and SettingThe guidance workgroup comprised SR experts and used an informal consensus generation method. ResultsInstead of recommending NRSI inclusion only if randomized controlled trials (RCTs) are insufficient to address the SR key question, different topics may require different decisions regarding NRSI inclusion. We identified important considerations to inform such decisions from topic refinement through protocol development. During topic scoping and refinement, considerations were related to the clinical decisional dilemma, adequacy of RCTs to address the key questions, risk of bias in NRSIs, and the extent to which NRSIs are likely to complement RCTs. When NRSIs are included, during SR team formation, familiarity with topic-specific data sources and advanced analytic methods for NRSIs should be considered. During protocol development, the decision regarding NRSI inclusion or exclusion should be justified, and potential implications explained. When NRSIs are included, the protocol should describe the processes for synthesizing evidence from RCTs and NRSIs and determining the overall strength of evidence. ConclusionWe identified specific considerations for decisions regarding NRSI inclusion in SRs and highlight the importance of flexibility and transparency.

Exploring pain interference with motor skill learning in humans: A systematic review.

Motor learning underpins successful motor skill acquisition. Although it is well known that pain changes the way we move, it's impact on motor learning is less clear. The aim of this systematic review was to synthesize evidence on the impact of experimental and clinical pain on task performance and activity-dependent plasticity measures across learning and explore these findings in relation to different pain and motor learning paradigms. Five databases were searched: Web of Science, Scopus, MEDLINE, Embase and CINAHL. Two reviewers independently screened the studies, extracted data, and assessed risk of bias using the Cochrane ROB2 and ROBIN-I. The overall strength of evidence was rated using the GRADE guidelines. Due to the heterogeneity of study methodologies a narrative synthesis was employed. Twenty studies were included in the review: fifteen experimental pain and five clinical pain studies, covering multiple motor paradigms. GRADE scores for all outcome measures suggested limited confidence in the reported effect for experimental pain and clinical pain, on motor learning. There was no impact of pain on any of the task performance measures following acquisition except for 'accuracy' during a tongue protrusion visuomotor task and 'timing of errors' during a motor adaptation locomotion task. Task performance measures at retention, and activity dependent measures at both acquisition and retention showed conflicting results. This review delivers a detailed synthesis of research studies exploring the impact of pain on motor learning. This is despite the challenges provided by the heterogeneity of motor learning paradigms, outcome measures and pain paradigms employed in these studies. The results highlight important questions for further research with the goal of strengthening the confidence of findings in this area.

Interventions for malnutrition in hospitalized adults: A systematic review and meta-analysis.

Malnutrition is associated with poor outcomes in hospitalized adults. We aimed to assess the effectiveness of hospital-initiated interventions for patients with malnutrition. Data sources included MEDLINE, Embase, Cochrane Library from January 1, 2000 to June 3, 2021. We included randomized controlled trials (RCTs) assessing interventions for hospitalized adults diagnosed or identified as at-risk for malnutrition using malnutrition screening and diagnostic assessment tools. Individual reviewers extracted study data and performed quality checks for accuracy. Meta-analysis was conducted using a random-effects model with variance correction. We assessed the overall strength of evidence at the outcome level. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. We found 11 RCTs that assessed two types of interventions: specialized nutrition care (8RCTs) and increased protein provision (3RCTs). The pooled findings of 11 RCTs found moderate strength of evidence that specialized nutrition care and increased protein provision reduced mortality by 21% (relative risk [RR]: 0.79, 95% confidence interval [CI]: 0.63-0.98; absolute risk reduction [ARR]: -0.02, 95% CI: -0.03 to -0.00). Pooled estimates indicated a nonsignificant decrease of 0.18 days in the length of stay (9 RCTs) and a 10% reduction in readmissions (7 RCTs). No eligible RCTs assessed parenteral or enteral nutrition. Certain malnutrition-focused hospital-initiated interventions (e.g., specialized nutrition care and increased protein provision) reduce mortality and may improve the quality of life among patients at risk for or diagnosed with malnutrition. Future trials are needed to assess the effectiveness of parenteral and enteral nutrition.

Methodology and reporting quality of 544 studies related to ageing: a continued discussion in setting priorities for ageing research in Africa

Background The quality assessment provides information on the overall strength of evidence and methodological quality of a research design, highlighting the level of confidence the reader should place on the findings for decision making. This paper aimed to assess the quality (methodology and quality of reporting) of ageing studies in Sub-Saharan Africa (SSA). Method This paper is the second of a Four-Part Series paper of a previous systematic mapping review of peer-reviewed literature on ageing studies conducted in SSA. We updated the literature search to include additional 32 articles, a total of 544 articles included in this paper. Downs &amp; Black checklist, Case Report guidelines checklist, the 45-items Lundgren et al. checklist, and the Mixed Method Appraisal Tool were used to assess the methodological quality of quantitative, case reports, qualitative, and mixed-method studies. Quality assessment was piloted and conducted in pairs for each study type. Depending on the checklist, each study was classified as excellent, good, fair, or poor. Result Of the 544 articles, we performed the quality assessment of a total of 451 quantitative studies [Randomized control trials (RCTs) and pre-post (n=15), longitudinal (n=122), case-control (n=15) and cross-sectional (n=300); 4 case reports, 74 qualitative and 15 mixed-method studies. Only 20.4% (n=111) articles were of high quality [one RCT, 27 longitudinal, 4 case-control, 48 cross-sectional studies, 19 qualitative, and 12 mixed-method studies]. The remaining 433 were rated as moderate quality (n=292, 53.7%), fair quality (n = 96, 17.7%) and poor quality (n = 45, 8.2%). Most (80%) quantitative articles’ sample size is small, resulting in insufficient power to detect a clinically or significant important effect. Three-quarter (75%) of the qualitative studies did not report their research team characteristics and a reflexivity component of the 45-items Lundgren et al. checklist. Mixed-method studies with low quality did not report the qualitative studies properly. Conclusion We conclude that the methodological and quality reporting of published studies on ageing in SSA show variable quality, albeit primarily moderate quality, against high quality. Studies with a large sample size are recommended, and qualitative researchers should provide a section on research team members’ characteristics and reflexivity in their paper or as an appendix.