Positive Treatment Effect Research Articles

Several components of postural control are affected by benign paroxysmal positional vertigo but improve after particle-repositioning maneuvers: A systematic review and meta-analysis.

Benign Paroxysmal Positional Vertigo is a vestibular disorder causing vertigo and imbalance. This systematic review and meta-analysis aims to explore the impact of benign paroxysmal positioning vertigo and repositioning maneuvers on postural control. In September 2024, PubMed, Web of Science, Scopus and reference lists of included studies were systematically searched. Articles comparing measures of postural control between patients and controls, and/or pre- and posttreatment were considered relevant. Study selection, data extraction and identification of risk of bias were done by two researchers. If possible, meta-analysis was performed with Review Manager version 5.4.1 and standardized mean differences were calculated with a random-effects model. Twenty-one of the 37 included studies were useful for meta-analyses. Meta-analyses revealed that benign paroxysmal positional vertigo negatively affects perception of verticality (p < .001; SMD = 0.73; 95% CI = [0.39;1.08]) and sensory orientation (p < .001; SMD = -1.66; 95% CI = [-2.08, -1.23]). The perception of verticality (p < .001; SMD = 0.99; 95% CI = [0.76;1.21]) and sensory orientation (p < .001; SMD = -0.77; 95% CI = [-1.11, -0.44]) improved after treatment with repositioning maneuvers. Results of systematic review indicate stability in gait was impaired, vertigo but improve after repositioning maneuvers. Limits of stability were impaired in older patients, but did not improved after repositioning maneuvers. Benign paroxysmal positioning vertigo affects several underlying components of postural control. Repositioning maneuvers can significantly improve the related postural control impairments. This may partly explain the increased odds of falling in these patients, and the positive treatment effect of repositioning maneuvers on falls and fear of falling.

Responses of Legumes to Rhizobia and Arbuscular Mycorrhizal Fungi Under Abiotic Stresses: A Global Meta-Analysis

Arbuscular mycorrhizal fungi (AMF) and rhizobia play a pivotal role in enhancing crop productivity, shaping microbial community structure, and improving soil quality, making them key components for sustainable ecosystem development. The symbiotic relationship between AMF and rhizobia is crucial for facilitating efficient biological nitrogen fixation and nutrient absorption, thereby reducing the dependence on chemical fertilizers and promoting sustainable agricultural practices. The findings of various studies, however, indicate that soil environment can impede the symbiotic relationship between AMF and rhizobia. We conducted a comprehensive meta-analysis of 158 articles from 1980 to 2022 to explore the synergistic interactions in legume–AMF–rhizobium systems and the potential mechanisms underlying this synergism. Our findings revealed that the inoculation with AMF and/or rhizobia significantly (p &lt; 0.001) increased legume plant nitrogen content, phosphorus content, shoot biomass, yield, AMF colonization rate, and the number and weight of nodules compared to uninoculated controls (effect size d &gt; 0). Moreover, there was a substantial synergistic effect between AMF and rhizobia (p &lt; 0.001). Nevertheless, soil salinity stress, drought stress, and pH stress could hinder the positive effects of inoculation treatments, possibly due to the plant trade-off strategies under abiotic stress conditions. This research may potentially lead to new solutions for sustainable agricultural systems amidst the challenges posed by global climate change.

Optimizing the treatment of patients with intrinsic temporomandibular joint disorders

Temporomandibular joint (TMJ) dysfunctions are conditions in which there is a disruption in the anatomical and functional relationship between the various structures of the joint, including the articular disc, intra-articular ligaments, mandibular head and capsule. These disorders have a negative impact on the patient’s quality of life, resulting in limitations in masticatory function and articulation. The multifactorial nature of this pathology emphasizes the need for an individualized and comprehensive approach to the treatment of each patient. In most cases, treatment includes both surgical and orthopedic methods. Currently, combined treatment approaches aimed at synergistic effects are being actively developed to maximize therapeutic Results.The purpose of this study. To evaluate the efficacy of the combination of treatment with a repositioning mouthguard and the use of the hydraulic articular disk repositioning method in patients with internal TMJ disorders combined with dental row end defects.Materials and methods. The study included 6 patients with TMJ dysfunction and end defects of the dentition. The study was conducted between September 2023 and May 2024. As part of the study, each patient underwent cone beam computed tomography (CBCT) to evaluate the bony structures of the TMJ and ultrasound (US) to evaluate the soft tissue structures of this joint.Results. The CBCT data showed that the mean posterior temporomandibular joint displacement before treatment was 1.67, while this value increased to 3.02 after treatment. The US results showed a significant decrease in the mean value of mandibular head displacement after treatment ranging from 0.21 to 0.03, indicating a positive effect of treatment. In addition, there was a decrease in the difference in the size of the anterior and posterior parts of the articular disc, confirming the elimination of its displacement.Conclusion. The treatment combination of using a repositioning mouth guard with the hydraulic repositioning method brought about a synergistic effect on the restoration of TMJ function.

Comparison of the effect of SMS-based education and face-to-face teaching on self-care behavior of type 2 diabetic patients in Khorramabad city

IntroductionConsidering that the adoption of self-care behaviors in patients with type 2 diabetes can reduce the complications caused by this disease, aim of the present study was compared the effect of SMS-based teaching and face-to-face teaching on self-care behavior of type 2 diabetic patients in Khorramabad city.MethodsThis was a pre- and post-test semi-experimental study. The research sample size was composed of 135 diabetic patients referred to the Khorramabad diabetes clinic who were selected using random sampling method and were randomly divided into face-to-face teaching group (n = 45), SMS-based teaching group (n = 45), and control (n = 45). Data collection tools were demographic information questionnaire, Tubert self-care behaviours questionnaire, and self-efficacy questionnaire. The educational intervention in the face-to-face training group included four face-to-face training sessions and in the SMS-based training group included three to four daily training SMS and without training intervention in the control group. For all analysis, SPSS software version 24 was done and at a significance level of 0.05.ResultsAt the baseline, average score of self-efficacy and self-care, and blood sugar were not significant between the face-to-face teaching, SMS-based and control groups. However, at the end of intervention, the mean score of these variables were significantly more in the face-to-face teaching and SMS-based groups compared to the control group (p-value < 0.001).DiscussionConsidering the positive effect of educational intervention in promoting self-care in patients with type 2 diabetic, it is suggested to use empowerment programs with self-care approach to improve the health of diabetic patients.

Exploring the Impact of Social Support on Tuberculosis Treatment: A Thematic Review

Aims: Tuberculosis (TB) remains a critical global health issue, characterized by significant morbidity and mortality rates. Recent research highlights the potential of social support interventions to enhance TB treatment outcomes and improve patient quality of life. This study examines the positive effects of social support interventions on TB patients throughout their treatment process. Method: Utilizing a traditional review approach, this study applies thematic analysis to synthesize findings from the literature. The review encompasses 17 articles selected from reputable databases, including PubMed, Wiley Online Library, ProQuest, and Google Scholar, based on predefined inclusion criteria. These articles underwent quality assessment using the Critical Appraisal Skills Programme (CASP) tool. The PRISMA flowchart provided transparency in the selection process. Results: Key themes identified through the analysis include treatment adherence, psychological well-being, motivation to recover, health-related quality of life, prevention of TB transmission, successful TB treatment, and self-efficacy to recover. Conclusion: The findings suggest that social support interventions can play a crucial role in addressing the persistent challenges of TB management globally.

Thermal Conductivity of AlSi10MnMg Alloy in Relation to Casting Technology and Heat Treatment Method

Nowadays, with the development of electromobility, the requirements not only for the mechanical properties but also for the thermal conductivity of castings are increasing. This paper investigates the influence of casting and heat treatment technology on the thermal diffusivity and thermal conductivity of an AlSi10MnMg alloy. The thermal diffusivity was monitored as a function of temperature in the range of 50–300 °C for the material cast by high-pressure die casting (HPDC) and also by gravity sand casting (GSC) and gravity die casting (GDC). This study also investigated the effect of the T5 heat treatment temperature (artificial ageing without prior solution treatment—HT200, HT300, and HT400) on the thermal conductivity of the material cast by different technologies. Experiments confirmed that the thermal diffusivity or thermal conductivity of the alloy depends on the casting technology. The slower the cooling rate of the casting, the higher the thermal conductivity value. For the alloy in the as-cast condition, the thermal conductivity at 50 °C is in the range of about 125 to 138 [W·m−1·K−1]. Regardless of the casting method, the thermal conductivity tends to increase with temperature (50–300 °C). Furthermore, a positive effect of heat treatment without prior solution treatment (HT200, HT300, and HT400) on the thermal conductivity was demonstrated. Regardless of the casting method of the samples, the thermal conductivity also increases with increasing heat treatment temperature. The results further showed that when artificial ageing is performed in industrial practice on castings to increase mechanical properties in the temperature range of 160–230 °C, this heat treatment has a positive effect on thermal conductivity.

Autism Spectrum Disorder in Children: Early Signs and Therapeutic Interventions

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition characterized by challenges in communication, social interaction difficulties, and repetitive behaviors that can hinder a child’s development. The growing prevalence of autism necessitates early detection and effective intervention strategies. This review summarizes the current knowledge of early indicators of ASD, including brain development markers and behavioral signs visible in infants. It investigates diagnostic processes, emphasizing the importance of timely detection at 18 to 24 months using established screening tools. We discuss a variety of therapeutic approaches, including behavioral interventions, educational strategies such as music therapy, and technological advancements such as speech-generating devices. Furthermore, we investigate pharmacological options for treating associated symptoms, emphasizing the lack of targeted medications for core ASD symptoms. Finally, we present evidence highlighting the positive effects of early intervention on developmental outcomes, advocating for individualized treatment plans to enhance the well-being of children with ASD. This comprehensive overview aims to inform ongoing ASD research and clinical practices.

Positive Airway Pressure Treatment Effects on the Serum Nod-like Receptor Protein 3 and Nitric Oxide Levels in Obstructive Sleep Apnea Syndrome

Positive Airway Pressure Treatment Effects on the Serum Nod-like Receptor Protein 3 and Nitric Oxide Levels in Obstructive Sleep Apnea Syndrome

A systematic review on the effect of identity-related interventions on physical activity and smoking

Abstract Background Identity (self-perceptions of ‘who I am’) is important for health behavior change. Hence, identity-related interventions, aiming to influence how people view themselves, show promise for health promotion. This systematic review describes the effect of identity-related interventions on physical activity (PA), a health-promoting behavior, and smoking, a health-compromising behavior, and PA- and smoking-related identities in adults. Methods A comprehensive search, updated in May 2023, identified 5801 publications across eleven databases. After screening, 19 quantitative and mixed-methods publications were selected, describing 20 different studies. Relevant data were systematically extracted and a quality assessment was conducted using the Mixed Methods Appraisal Tool. Results Identity-related interventions were more common for enhancing PA (n = 13) than for smoking cessation (n = 6). Only one study targeted PA- and smoking-related identities to change both behaviors simultaneously. Various identity-related interventions were used, e.g. possible (future) selves manipulations and avatar games. The target population was rarely involved in intervention development. The results are mixed; some studies showed (significant) positive effects of identity-related interventions on identities or behavior, and no significant negative effects were shown. Similar results were found for PA and smoking. The one study targeting both behaviors showed positive results. Conclusions Identity-related interventions hold promise in promoting PA and smoking cessation. Future research could investigate identity-related interventions targeting multiple health behaviors, e.g., PA-promotion and smoking cessation, leveraging the synergy between those identities and behaviors. Collaboratively developing these interventions with the target population (i.e., patient and public involvement) could optimize them for different populations, improving public health and reducing health disparities. Key messages • Identity-related interventions could improve public health. • Collaboratively developing identity-related interventions with the target population could optimize them for different populations.

Implementing acceptance and commitment therapy for adherence to antiretroviral therapy: a randomized study

The objective of the research was to evaluate the effectiveness of ACT in optimizing adherence to ART. A quantitative study was conducted with a Solomon experimental design and follow-up. The sample comprised 84 seropositive patients randomly selected and distributed into four groups, two experimental and two controls. Symptoms of anxiety and depression (Hospital Anxiety and Depression Scale), level of treatment adherence (Questionnaire for Adherence to Treatment for HIV / AIDS) and experiential avoidance (Acceptance and Action Questionnaire) were measured. An ACT-based group intervention protocol was applied to the experimental groups, consisting of eight sessions. The results showed negative correlation between adherence and experiential avoidance, anxiety and depression. They also showed positive effects of ACT-based intervention on adherence to ART, with increase in adherence in the experimental groups and statistical difference in adherence in comparison with the control groups, according to the ANOVA test. It is concluded conclude that ACT is effective in optimising adherence to ART, allowing for behavioural changes that promote adaptation to diagnosis and treatment and reducing the presence of avoidance behaviours and emotional involvement.

Cognition in Schizophrenia: Exploring the Dynamics of Improvement and the Influencing Determinants

Background: Cognitive impairments are fundamental characteristics of schizophrenia, significantly impacting the overall functioning of individuals with the disorder. However, the trajectory of cognitive deficits and the factors influencing their changes over the course of treatment remain poorly understood. Objectives: The present study aimed to investigate the changes in cognitive status of patients with schizophrenia and the factors that influence these changes following hospitalization and treatment. Methods: The study utilized a longitudinal design, enrolling thirty hospitalized patients (15 males and 15 females) from the psychiatric inpatient unit of a general educational hospital. Cognitive assessments were conducted upon admission and discharge. A Generalized Estimating Equation (GEE) model was used to analyze the data, accounting for demographic and clinical variables such as age, gender, Body Mass Index (BMI), family history, and smoking status. Results: The findings revealed a reduction in cognitive deficits following hospitalization and treatment. Significant improvements were observed in verbal memory, working memory, and executive function. However, older patients showed poorer performance in motor speed, verbal fluency, and symbol coding compared to younger patients. Male patients and smokers demonstrated lower cognitive functioning, particularly in verbal fluency, symbol coding, and executive function. Conclusions: This study highlighted the positive effect of comprehensive inpatient treatment on reducing cognitive impairments in individuals with schizophrenia. While improvements were noted in several cognitive domains, the persistence of certain deficits, particularly in relation to demographic factors (age, gender, and smoking status), underscores the need for further research and tailored cognitive rehabilitation interventions. A personalized, multidimensional approach to managing cognitive deficits in schizophrenia could lead to better functional outcomes and enhance the quality of life for affected individuals.

Complex therapy of musculoskeletal pain: the role of centrally acting muscle relaxants

Chronic pain is the main manifestation of musculoskeletal diseases (MSDs), leading to deterioration of quality of life and loss of ability to work. The importance of this problem is determined by the widespread prevalence of MSDs, osteoarthritis (OA), acute and chronic non-specific back pain (NBP), periarticular soft tissues lesions. Introduction of effective methods of treatment of musculoskeletal pain (MSP) into medical practice is one of the fundamental tasks of modern medicine.The pathogenesis of MSP includes mechanisms such as injury, inflammation, peripheral sensitization, biomechanical disorders, dysfunction of the nociceptive system and psychoemotional disorders. Painful muscle tension plays an important role in the development of MSP, especially in NBP. Given the complex pathogenesis of MSP, its treatment is based on the combined use of drugs with different mechanisms of action and nonpharmacological methods. Non-steroidal anti-inflammatory drugs (NSAIDs) have a central place in this context. However, they can cause serious adverse reactions (ARs), so when choosing NSAIDs, it is necessary to consider comorbid pathology and risk factors. One of the most acceptable NSAIDs with a pronounced analgesic effect and low incidence of ARs is aceclofenac, which is available in various dosage forms (tablets, sachets, topical cream for external use). This medication is characterized by proven efficacy and good tolerability.Centrally acting muscle relaxants (CM) play an important role in the treatment of MSP. They eliminate muscle spasm, enhance the effect of analgesics and reduce the need for NSAIDs. The effect of CM has been demonstrated in spasticity and NBP. However, the use of many drugs of this group can be associated with serious ARs, which limits their use.Tolperisone has the best combination of efficacy and favorable safety profile among CM. Its positive effect in the complex treatment of NBP has been confirmed in several well-organized, placebo-controlled trials. There are also studies demonstrating the efficacy of tolperisone in OA. An important advantage of this drug is virtually no sedative effect, and no negative impact on hemodynamics and on the ability to perform concentration-intensive work. Emergence of a new form of tolperisone – extended-release tablets (Mydocalm® Long 450 mg) – increases patient compliance with CM therapy and facilitates the physician's work.

HED-Start: A Brief Positive Psychology Cluster-Randomized Controlled Trial to Improve Psychological Adjustment in Patients New on Hemodialysis.

Initiation onto hemodialysis marks a critical transition with intense psychosocial demands. Interventions using cognitive-behavioral therapy to improve distress have been variably effective but require trained staff and are typically delivered only to those who screen positive for clinically significant distress. Interventions guided by positive psychology are lacking. To investigate the effectiveness of a brief positive-skills RCT in improving psychological adjustment in new hemodialysis patients. Using a parallel (2:1) design, blinded cluster-randomized controlled trial (cRCT) design, incident patients (<6 months at NKF dialysis centers) undergoing hemodialysis were randomized to intervention or usual care (UC). HED-Start intervention comprised four group sessions delivered by healthcare staff on positive emotions, acceptance, and life-orientated goal setting. Measures were taken at baseline (pre-randomization) and at 12 weeks: distress/mood (HADS; SPANE); quality of life (KDQOL-SF, WHOQOL-BREF); benefit-finding (BFS, BIPQ); life-oriented skills (HEIQ, CD-RISC-2); self-efficacy (CD-SES). A total of 147 participants enrolled in the trial (response rate, 51.0%; retention [assessment], 90.5%). Study arms were comparable on all baseline and outcome variables except for age, diabetic nephropathy, and hypertensive nephrosclerosis which were subsequently controlled for. Repeated measures ANCOVAs (intention to treat) were used. HED-Start yielded significant reductions over time in depression, and increased quality of life, self-efficacy, benefit finding, and skills relative to UC (moderate effect sizes). Rates of clinically significant depression significantly decreased in HED-Start (p < .001) and increased in UC (p = .002). The significant positive effects of HED-Start, a low-intensity and cost intervention, on several adjustment indices, suggest that programs focusing on positive life skills can value add to existing renal care services.

Does Employing Skilled Immigrants Enhance Competitive Performance? Evidence from European Football Clubs

We investigate the effect of employing skilled immigrants on the competitive performance of organizations by studying European football (soccer) clubs in Germany, Italy, France, England, and Spain from 1990 to 2020. Microdata from this setting offers unusual transparency about players’ birthplaces and their contributions to organizational performance. Further, country-level rules govern how many immigrant players clubs can deploy. Using changes to these rules as the basis for instrumental variables, we find that the number of immigrant players in the club’s starting lineup has a positive local average treatment effect on the club’s performance. We show that this occurs for two related reasons. First, immigrants exhibit higher individual talent. Second, immigrants play a coordinating role that enables the organization to broaden the variety of on-field strategies and actions it uses to outperform rivals. The latter mechanism is novel to the literature. This paper was accepted by Olav Sorenson, organizations. Funding: F. Morales acknowledges research funding from Agencia Nacional de Investigación y Desarrollo, Chile (Fondecyt de Iniciación) [Grant 11200342]. Supplemental Material: The online appendix and data files are available at https://doi.org/10.1287/mnsc.2021.03356 .

Impact of an mHealth intervention on parents' emotional health and on the neurodevelopment of high-risk infants.

We assess the prenatal and postnatal effect of the High-Risk Pregnancy and Baby Parenting programme, which is complemented with two mHealth (app-based) resources. The GLM Repeated Measures Model technique was used to explore differences in the emotional health of the participants and in their infants' neurodevelopment, comparing programme versus usual care groups, composed of 150 and 195 participants, respectively. The mothers presented lower levels of depression (mean difference 1.74, p = 0.04, 95% CI 0.07, 3.40) and higher levels of resilience (mean difference 4.09, p = 0.004, 95% CI 1.40, 6.78). For the fathers, positive effects on resilience were recorded (p < 0.001). A positive treatment effect was perceived in the infants' cognitive (p = 0.014), language (p < 0.001) and motor (p = 0.006) development. These findings suggest application of the programme can benefit maternal emotional health and infant neurodevelopment. M-Health technology could make this programme more accessible.

Systematic review and meta-analysis of standalone digital interventions for cognitive symptoms in people without dementia

Cognitive symptoms are prevalent across neuropsychiatric disorders, increase distress and impair quality of life. Self-guided digital interventions offer accessibility, scalability, and may overcome the research-to-practice treatment gap. Seventy-six trials with 5214 participants were identified. A random-effects meta-analysis investigated the effects of all digital self-guided interventions, compared to controls, at post-treatment. We found a small-to-moderate positive pooled effect on cognition (k = 71; g = −0.51, 95%CI −0.64 to −0.37; p < 0.00001) and mental health (k = 30; g = −0.41, 95%CI −0.60 to −0.22; p < 0.0001). Positive treatment effects on fatigue (k = 8; g = −0.27, 95%CI −0.53 to −0.02; p = 0.03) and quality of life (k = 22; g = −0.17, 95%CI −0.34 to −0.00; p = 0.04) were only marginally significant. No significant benefit was found for performance on activities of daily living. Results were independent of control groups, treatment duration, risk of bias and delivery format. Self-guided digital transdiagnostic interventions may benefit at least a subset of patients in the short run, yet their impact on non-cognitive outcomes remains uncertain.

Feasibility and efficacy of adding high-intensity interval training to a multidisciplinary lifestyle intervention in children with obesity-a randomized controlled trial.

Multidisciplinary lifestyle interventions for children with obesity in Denmark often include recommendations regarding physical activity, but no structured exercise program. We hypothesized that adding high-intensity interval training (HIIT) to a multidisciplinary lifestyle intervention would improve BMI z-score (primary outcome), waist circumference, blood pressure, and health-related quality of life (HRQOL). This randomized controlled trial included 173 children and adolescents with obesity. Participants were allocated to 12-months lifestyle intervention (N = 83), or 12-month lifestyle intervention accompanied by a 12-week HIIT program (N = 90). HIIT consisted of three weekly sessions and included activities eliciting intensities >85% of maximal heart rate. Attendance rate for the 3-months HIIT intervention was 68.0 ± 23.2%. Dropout was lower in HIIT compared to control at three months (7.8% vs. 20.5%) and 12 months (26.5% vs 48.2%). Changes in BMI z-score did not differ between HIIT and control at 3 months (Mean Difference (MD): 0.01, 95% confidence interval (CI): -0.09; 0.12, P = 0.82) or 12 months (MD: 0.06, CI: -0.07;0.19, P = 0.34). Across randomization, BMI z-score was reduced by 0.11 (CI: 0.17; 0.06, P < 0.01) at 3 months and 0.20 (CI: 0.26;0.14, P < 0.01) at 12 months. At 3 months, HIIT experienced a greater increase in HRQOL of 2.73 (CI: 0.01;5.44, P = 0.05) in PedsQL Child total-score and 3.85 (CI: 0.96; 6.74, P < 0.01) in psychosocial health-score compared to control. At 12 months, PedsQL Child physical-score was reduced by 6.89 (CI: 10.97; 2.83, P < 0.01) in HIIT compared to control. No group differences or changes over time were found for waist circumference or blood pressure. Adding a 12-week HIIT program did not further augment the positive effects of a 12-month lifestyle intervention on BMI z-score. Adding HIIT improved HRQOL after 3 months, but reduced HRQOL at 12 months. Implementation of HIIT in community-based settings was feasible and showed positive effects on adherence to the lifestyle intervention.

Direct and Legacy Effects of Varying Cool-Season Precipitation Totals on Ecosystem Carbon Flux in a Semi-Arid Mixed Grassland.

In the semi-arid grasslands of the southwest United States, annual precipitation is divided between warm-season (July-September) convective precipitation and cool-season (December-March) frontal storms. While evidence suggests shifts in precipitation seasonal distribution, there is a poor understanding of the ecosystem carbon flux responses to cool-season precipitation and the potential legacy effects on subsequent warm-season carbon fluxes. Results from a two-year experiment with three cool-season precipitation treatments (dry, received 5th percentile cool-season total precipitation; normal, 50th; wet, 95th) and constant warm-season precipitation illustrate the direct and legacy effects on carbon fluxes, but in opposing ways. In wet cool-season plots, gross primary productivity (GPP) and ecosystem respiration (ER) were 103% and 127% higher than in normal cool-season plots. In dry cool-season plots, GPP and ER were 47% and 85% lower compared to normal cool-season plots. Unexpectedly, we found a positive legacy effect of the dry cool-season treatment on warm-season carbon flux, resulting in a significant increase in both GPP and ER in the subsequent warm season, compared to normal cool-season plots. Our results reveal positive legacy effects of cool-season drought on warm-season carbon fluxes and highlight the importance of the relatively under-studied cool-growing season and its direct/indirect impact on the ecosystem carbon budget.

Randomized Controlled Trials Studying Nonoperative Treatments of Osteoarthritis Often Use Misleading and Uninformative Control Groups: A Systematic Review.

Because there are no known treatments that alter the natural course of the pathophysiology of osteoarthritis, nonoperative treatment needs to be compared with known effective treatments that seek to mitigate symptoms or with similarly invasive inert (placebo) treatments to determine effectiveness. Comparing a treatment to an uninformative control group may inappropriately legitimize and support the use of potentially ineffective treatments. We therefore investigated the prevalence of inappropriate control groups in musculoskeletal research and asked whether these are associated with reporting a positive treatment effect. We systematically reviewed randomized trials of nonoperative treatments of osteoarthritis and asked: (1) What proportion of randomized trials use uninformative control groups (defined as a treatment less invasive than the tested treatment, or a treatment that might possibly not outperform placebo but is not acknowledged as such)? (2) Is the use of uninformative control groups independently associated with reporting a positive treatment effect (defined as p < 0.05 in favor of the intervention, or as making a recommendation favoring the intervention over the control treatment)? In a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched PubMed, Cochrane, and Embase up to September 2023 for randomized controlled trials published between 2020 to 2022 that compared one or more nonoperative treatments for the symptoms of osteoarthritis. We excluded studies that contained a surgical treatment group. We identified 103 trials that met eligibility criteria, with a total of 15,491 patients. The risk of bias was high in 60% (n = 62) of trials using the Cochrane Risk of Bias Tool, version 2. Although the high risk of bias in the included studies is concerning, it does not invalidate our design; instead, it highlights that some studies may use flawed methods to recommend treatments with unproven effectiveness beyond nonspecific effects because the kinds of bias observed would tend to increase the apparent benefit of the treatment(s) being evaluated. We used logistic regression to test the association of uninformative control groups with a positive treatment effect, accounting for potential confounders such as conflict of interest and study bias using the Cochrane Risk of Bias score. The use of uninformative control groups (treatments less invasive than the tested treatment, or treatments that might not outperform placebo but are not acknowledged as such) was found in 46% (47 of 103) of included studies. After accounting for potential confounding, there was no association between reporting positive treatment effects and the use of an uninformative control group. Studies with a low risk of bias had a lower likelihood of reporting a positive treatment effect (OR 0.2 [95% confidence interval 0.05 to 0.9]; p = 0.04, model pseudo R2 = 0.21). The finding that recent studies that mimic high-level evidence often use uninformative control groups that do not adequately account for nonspecific effects (perceived treatment benefits unrelated to a treatment's direct physiological effects) points to a high risk of legitimizing ineffective treatments. This raises the ethical imperative for patients, clinicians, journal peer reviewers, and journal editors to hold researchers to the standard of an adequate, informative control group. Awareness and risk of bias checklists might help patients and clinicians forgo new treatments based on seemingly high-level evidence that may carry only iatrogenic, financial, and psychological harm (false hope, in particular). Level I, therapeutic study.

Analysis of the Effectiveness of a Fall Prevention Program Incorporating an Interprofessional Team Collaboration Model on Reducing Fall Risk in Elderly Living in Long-term Care Facilities

Concurrent with population ageing, falls have become a significantly more challenging public health issue among older adults. Three years of data collected recently from a nursing home in northern Taiwan reveals an increasing trend in fall density that is primarily associated with aging, physiological decline, chronic diseases, polypharmacy, osteoporosis, and lack of exercise. The percentage of nursing home residents at high risk of falls is currently at 12.6%, and the fall rate has been reported as reaching as high as 30% annually. A fall prevention program was implemented to reduce the fall incidence rate to 18%, with secondary goals of improving fall prevention awareness, behavior, self-efficacy, lower limb muscle strength, balance, and gait by 10% on average, respectively, between pre-test and post-test. From September 30, 2023 to February 29, 2024, a health promotion activity and fall prevention exercise course were implemented using an interdisciplinary team collaboration model over a six-week period, providing individualized exercise for the participants. The study included 20 older adults with an average age of 88 years. Most (90%; n = 18) had chronic diseases, 25% (n = 5) were on more than nine medications, 70% (n = 14) had reduced bone mass, and 40% (n = 8) were at high risk of falls, with a fall incidence rate of 30% during the immediately preceding year. Post-intervention, the fall incidence rate dropped to 5%, fall prevention awareness, behavior, and self-efficacy increased by 18.3%, and lower limb muscle strength, balance, and gait improved by 11.7%. The post-test results in fall prevention awareness, behavioral changes, self-efficacy, and lower limb strength, balance, and gait were all significantly better than pre-test results, with all results achieving statistical significance. The project results support the positive effects of the developed intervention effectively on elderly physical fitness and fall risk, providing valuable insights for the implementation of fall prevention strategies in nursing homes.