RCTs Of Interventions Research Articles

Sex and gender reporting in RCTs of internet and mobile-based interventions for depression and anxiety in chronic conditions: A secondary analysis of a systematic review

Sex and gender reporting in RCTs of internet and mobile-based interventions for depression and anxiety in chronic conditions: A secondary analysis of a systematic review

Systematic review of motivational interventions to improve adherence to medication in patients with hypertension and meta-analysis

IntroductionAntihypertensive medication non-adherence is an important cause of poor control in hypertension. The role of motivational interventions to increase antihypertensive medication adherence remains unclear. ObjectiveTo systematically review RCTs of motivational interventions for improving medication adherence in hypertension. MethodsEMBASE and Pubmed were searched from inception to February 2019 for RCTs of motivational interventions for improving medication adherence in hypertension vs. usual care. Inclusion criteria: RCTs with motivational intervention to improve medication adherence in adults with hypertension. A blinded review was conducted by 2 reviewers. Disagreements were resolved by consensus/a third reviewer.Data extraction and quality appraisal was performed using the risk of bias tool from cochrane collaboration. The meta-analyses of blood pressure control used random-effects models to report mean difference and 95% CIs. Primary outcome was medication adherence and second outcome was blood pressure control. ResultsThe search methodology yielded 10 studies comprising 1171 participants. Medication adherence improved significantly in 5 studies. We could not perform pool analysis for this outcome due to different measurements of medication adherence. Seven trials reported significant results regarding blood pressure control.On pooled analysis, motivational interventions were not significantly associated with a systolic blood pressure (mean difference, −0.06; 95% CI, −0.05 to 0.18; p=0.63; I2=0.0%) or diastolic blood pressure (mean difference, −0.11; 95% CI, −0.10 to 0.31; p=0.28; I2=23.8%) decrease or blood pressure control. ConclusionsMotivational interventions seem to significantly improve medication adherence but not significantly blood pressure control in hypertension, although evidence is still being based on few studies, with unclear risk of bias.

The relationship between hyperglycaemia on admission and patient outcome is modified by hyperlactatemia and diabetic status: a retrospective analysis of the eICU collaborative research database

Both blood glucose and lactate are well-known predictors of organ dysfunction and mortality in critically ill patients. Previous research has shown that concurrent adjustment for glucose and lactate modifies the relationship between these variables and patient outcomes, including blunting of the association between blood glucose and patient outcome. We aim to investigate the relationship between ICU admission blood glucose and hospital mortality while accounting for lactate and diabetic status. Across 43,250 ICU admissions, weighted to account for missing data, we assessed the predictive ability of several logistic regression and generalised additive models that included blood glucose, blood lactate and diabetic status. We found that inclusion of blood glucose marginally improved predictive performance in all patients: AUC-ROC 0.665 versus 0.659 (p = 0.005), with a greater degree of improvement seen in non-diabetics: AUC-ROC 0.675 versus 0.663 (p < 0.001). Inspection of the estimated risk profiles revealed the standard U-shaped risk profile for blood glucose was only present in non-diabetic patients after controlling for blood lactate levels. Future research should aim to utilise observational data to estimate whether interventions such as insulin further modify this effect, with the goal of informing future RCTs of interventions targeting glycaemic control in the ICU.

Strategies to deliver smoking cessation interventions during targeted lung health screening - a systematic review and meta-analysis.

Lung cancer screening presents an important teachable moment to promote smoking cessation, but the most effective strategy to deliver support in this context remains to be established. We undertook a systematic review and meta-analysis of smoking cessation interventions delivered during lung health screening, published prior to 20/07/2022 MEDLINE, PsychINFO, CENTRAL, EMBASE, CINAHL and Scopus databases. Two reviewers screened titles, and abstracts, four reviewed each full text using prespecified criteria, extracted relevant data, assessed risk of bias and confidence in findings using the GRADE criteria. The review was registered prospectively on PROSPERO (CRD42021242431). 10 randomised controlled trials and three observational studies with a control group were identified. Meta-analysis of nine RCTs demonstrated that smoking cessation interventions delivered during lung screening programmes increased quit rates compared to usual care (odds ratios: 2.01, 95%: 1.49-2.72 p < 0.001). Six RCTs using intensive (≥3 behavioural counselling sessions) interventions demonstrated greater quit rates compared to usual care (OR: 2.11, 95% CI 1.53-2.90, p < 0.001). A meta-analysis of two RCTs found intensive interventions were more effective than non-intensive (OR: 2.07, 95%CI 1.26-3.40 p = 0.004), Meta-analysis of two RCTs of non-intensive interventions (≤2 behavioural counselling sessions or limited to online information audio take home materials such as pamphlets) did not show a higher quit rate than usual care (OR: 0.90, 95% CI 0.39-2.08 p = 0.80). Moderate quality evidence supports smoking cessation interventions delivered within a lung screening setting compared to usual care, with high-quality evidence that more intensive interventions are likely to be most effective.

Systematic Review Identifying Adverse Health Outcomes and Mortality Rates Associated with Telehealth

Background: The literature supporting telehealth management is growing accelerated by the COVID-pandemic. We hypothesize that there are risks of adverse events associated with telehealth interventions.&#x0D; Methods: A review of PubMed (including MEDLINE), Embase, ISI (Web of Science), VHL/GHL, Scopus, Science Direct, and PsycINFO was conducted for all adverse events associated with telehealth from January 1, 1960 to March 1, 2021. This systematic review and meta-analyses were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.&#x0D; Results: Of 5,144 citations 78 published studies met criteria for quality evaluation and underwent full text abstraction including the qualitative synthesis. Of the 78 included studies 8 were included in the quantitative synthesis resulting in 2 meta-analyses. The results of the meta-analysis suggest that monitoring patients using telehealth techniques is associated with 40% lower mortality risks among patients suffering from heart failure, compared to those who received traditional care. The results of the random-effects meta-analysis showed the pooled relative risk of mortality to be 0.60, indicating that patients that underwent telemonitoring had a lower mortality risk compared with the patients that underwent usual care. Among patients with heart implants, patients who received telemonitoring had a 35% lower mortality risk compared to patients receiving traditional care.&#x0D; Conclusions: While RCTs of telehealth interventions demonstrate enhanced patient outcomes in a number of studies and pave the way to evidence-based practice, the heterogeneity of the research questions suggest an important need for more complementary studies with consistent outcome assessments.

Assessment of Reporting of Patient-Reported Outcomes in Randomized Controlled Trials for Interventions of Post-Traumatic Stress Disorder.

Post-traumatic stress disorder (PTSD) has debilitating effects on quality of life. Patient-reported outcomes (PROs) assess changes in quality of life and serve as subjective measurements of patient experience. The aim of this study is to assess the completeness of PRO reporting within randomized controlled trials with interventions pertaining to PTSD. This cross-sectional, meta-epidemiological study assessed the completeness of PRO reporting in RCTs investigating PTSD interventions. We searched multiple databases for published RCTs of PTSD interventions that used PROs as a primary or secondary outcome. We assessed PRO completeness using the PRO adaptation of the Consolidated Standards of Reporting Trial (CONSORT). We used a bivariate regression model to determine the association between trial characteristics and the completeness of reporting. After an initial screening of 5906 articles, our final sample of RCTs for inclusion was 43. The mean completeness of reporting of PROs was 58.4% (SD = 14.50). We found no significant associations between trial characteristics and completeness of the CONSORT-PRO adaptation. Reporting of PROs was often incomplete among RCTs focused on PTSD. We believe that adherence to CONSORT-PRO will improve both PRO reporting and implementation into clinical practice to improve assessment of quality of life.

The Effect of Diet and Exercise Interventions on Body Composition in Liver Cirrhosis: A Systematic Review

Alterations in body composition, in particular sarcopenia and sarcopenic obesity, are complications of liver cirrhosis associated with adverse outcomes. This systematic review aimed to evaluate the effect of diet and/or exercise interventions on body composition (muscle or fat) in adults with cirrhosis. Five databases were searched from inception to November 2021. Controlled trials of diet and/or exercise reporting at least one body composition measure were included. Single-arm interventions were included if guideline-recommended measures were used (computed tomography/magnetic resonance imaging, dual-energy X-ray absorptiometry, bioelectrical impedance analysis, or ultrasound). A total of 22 controlled trials and 5 single-arm interventions were included. Study quality varied (moderate to high risk of bias), mainly due to lack of blinding. Generally, sample sizes were small (n = 6–120). Only one study targeted weight loss in an overweight population. When guideline-recommended measures of body composition were used, the largest improvements occurred with combined diet and exercise interventions. These mostly employed high protein diets with aerobic and or resistance exercises for at least 8 weeks. Benefits were also observed with supplementary branched-chain amino acids. While body composition in cirrhosis may improve with diet and exercise prescription, suitably powered RCTs of combined interventions, targeting overweight/obese populations, and using guideline-recommended body composition measures are needed to clarify if sarcopenia/sarcopenic obesity is modifiable in patients with cirrhosis.

An exploratory application of machine learning methods to optimize prediction of responsiveness to digital interventions for eating disorder symptoms.

ObjectiveDigital interventions show promise to address eating disorder (ED) symptoms. However, response rates are variable, and the ability to predict responsiveness to digital interventions has been poor. We tested whether machine learning (ML) techniques can enhance outcome predictions from digital interventions for ED symptoms.MethodData were aggregated from three RCTs (n = 826) of self‐guided digital interventions for EDs. Predictive models were developed for four key outcomes: uptake, adherence, drop‐out, and symptom‐level change. Seven ML techniques for classification were tested and compared against the generalized linear model (GLM).ResultsThe seven ML methods used to predict outcomes from 36 baseline variables were poor for the three engagement outcomes (AUCs = 0.48–0.52), but adequate for symptom‐level change (R 2 = .15–.40). ML did not offer an added benefit to the GLM. Incorporating intervention usage pattern data improved ML prediction accuracy for drop‐out (AUC = 0.75–0.93) and adherence (AUC = 0.92–0.99). Age, motivation, symptom severity, and anxiety emerged as influential outcome predictors.ConclusionA limited set of routinely measured baseline variables was not sufficient to detect a performance benefit of ML over traditional approaches. The benefits of ML may emerge when numerous usage pattern variables are modeled, although this validation in larger datasets before stronger conclusions can be made.

Process evaluations of mental health and psychosocial support interventions for populations affected by humanitarian crises

BackgroundRandomised controlled trials (RCTs) have been increasingly used to test the effectiveness of mental health and psychosocial support(MHPSS) interventions for populations affected by humanitarian crises. Process evaluations are often integrated within RCTs of psychological interventions to investigate the implementation of the intervention, the impact of context, and possible mechanisms of action. We aimed to explore limitations and strengths of how process evaluations are currently conceptualised and implemented within MHPSS RCTs specifically. MethodsIn April–June 2021 we conducted semi-structured interviews with 24 researchers involved in RCTs of MHPSS interventions in 23 different countries. Participants were selected based on systematic reviews of MHPSS interventions, funders’ databases, and personal networks. Data were analysed using codebook thematic analysis. ResultsThe conduct of process evaluations was characterized by high heterogeneity in perceived function, implementation outcomes assessed, and methods used. While process evaluations were overwhelmingly considered as an important component of an RCT, there were different opinions on their perceived quality. This could be explained by the varying prioritization of effectiveness data over implementation data, confusion around the nature of process evaluations, and challenges in the collection and analysis of process data in humanitarian settings. Various practical recommendations were made by participants to improve future process evaluations in relation to: (i) study design (e.g., embedding process evaluations in study protocol and overall study objectives); (ii) methods (e.g., use of mixed methods); and (iii) increased financial and human resources dedicated to process evaluations. ConclusionThe current state of process evaluations in MHPSS RCTs is heterogeneous. The quality of process evaluations should be improved to strengthen implementation science of the growing number of evidence-informed MHPSS interventions.

Interventions targeting postoperative pulmonary complications (PPCs) in patients undergoing esophageal cancer surgery: a systematic review of randomized clinical trials and narrative discussion.

Postoperative pulmonary complications (PPCs) represent the most common complications after esophageal cancer surgery. The lack of a uniform reporting nomenclature and a severity classification has hampered consistency of research in this area, including the study of interventions targeting prevention and treatment of PPCs. This systematic review focused on RCTs of clinical interventions used to minimize the impact of PPCs. Searches were conducted up to 08/02/2021 on MEDLINE (OVID), CINAHL, Embase, Web of Science, and the COCHRANE library for RCTs and reported in accordance with PRISMA guidelines. A total of 339 citations, with a pooled dataset of 1,369 patients and 14 RCTs, were included. Heterogeneity of study design and outcomes prevented meta-analysis. PPCs are multi-faceted and not fully understood with respect to etiology. The review highlights the paucity of high-quality evidence for best practice in the management of PPCs. Further research in the area of intraoperative interventions and early postoperative ERAS standards is required. A consistent uniform for definition of pneumonia after esophagectomy and the development of a severity scale appears warranted to inform further RCTs and guidelines.

Poor quality of dietary assessment in randomized controlled trials of nutritional interventions for type 2 diabetes may affect outcome conclusions: A systematic review and meta-analysis

ObjectivesThe aim of this study was to evaluate the quality of dietary assessment methods in randomized controlled trials focusing on individuals with type 2 diabetes (T2DM), and its impact on the favorability of conclusions. MethodsMEDLINE, EMBASE, CINAHL, and CENTRAL were searched, from inception until September 2019 for RCTs of dietary interventions in individuals with T2DM. Investigators assessed risk of bias and quality of the dietary measurements using the Cochrane Risk of Bias Assessment Tool 2.0 and the redeveloped EURICA tool, respectively. Random-effects meta-analysis assessed mean changes in hemoglobin (Hb)A1c. The study was conducted in accordance with the Preferred Reporting in Systematic Reviews and Meta-analyses. PROSPERO registration number: CRD42019146471. ResultsOf 2552 records retrieved, 23 studies met the inclusion criteria. Two studies were rated as good, 6 as medium, and 15 as poor in the quality assessment of the dietary measurement tool. All eight studies with higher quality of dietary assessment were associated with favorable conclusions. Among the 15 studies with poor quality, 5 failed to draw favorable conclusions. Among studies that sought to produce a reduction in HbA1c, 3 of 6 with better dietary assessment quality produced a significant difference of –0.38% (–0.67% to –0.08%), and 4 of 12 of poorer quality produced a significant difference of –0.26% (–0.37% to –0.14%). ConclusionsThe poor quality of dietary assessment in clinical trials casts uncertainty on the dietary outcomes and the validity of possible causal mechanisms. Attention to the accuracy and reliability of dietary assessment methods is indicated.

Development of expert recommendations for the treatment of PTSD with comorbid substance use disorder

Background: PTSD and substance use disorder (SUD) frequently co-occur. Estimates of life time PTSD amongst SUD patients range from 26% to 52%, with estimates of current PTSD between 15% and 42%. Amongst individual diagnosed with PTSD estimates of comorbid substance abuse range from 19% to 35% and comorbid alcohol abuse from 36% to 52% (Roberts, Roberts, Jones, & Bisson, 2016). PTSD-SUD comorbidity presents many clinical challenges for treating clinicians. Individuals with PTSD-SUD present with a more severe clinical profile, tend to have poorer functioning and wellbeing, and inferior treatment outcomes. Clinicians view this comorbidity to be substantially more difficult to treat than either disorder alone (Schäfer & Lotzin, 2018). There are now a number of well-established psychological therapies for PTSD. These include prolonged exposure, cognitive therapy, cognitive processing therapy and EMDR (Bisson et al., 2019). However, patients with PTSD-SUD comorbidity are often excluded from clinical trials of psychological intervention. Clinicians are therefore often uncertain about how best to implement effective treatment, and traditionally, patients with this comorbidity have been offered treatment sequentially. This normally involves referral for to PTSD treatment only after completion of treatment for addiction (Roberts, Back, Mueser, & Murray, 2020). However, there are concerns about whether this approach causes some patients to ‘fall through the cracks’ between services and there is debate about whether integrated or simultaneous approaches might be more effective. A number of integrated treatment approaches have been developed. These are often grouped into past focused treatments, which include components of exposure-based trauma processing; and present focused treatments, which focus more on improving current coping skills (see Roberts et al., 2020). Recent reviews have tended to report more support for exposure-based approaches, particularly in relation to PTSD outcomes (Roberts et al., 2020), although findings have been based on a small number of studies and high drop-out from treatment has been noted as a problem across different approaches. Most recent guidelines (e.g. ISTSS 2018 – see NICE 2018; Bisson et al., 2019) have not included scoping questions to address issues of comorbidity, and there are no widely accepted guidelines about how to deliver optimal care and treatment for such individuals. Objectives and methodology: To describe the work of a task force which has been established to develop expert recommendations for the psychological treatment of this comorbidity for ESTSS, following principles used in guideline development through two stages. Stage 1. Update of a systematic review and meta-analysis (Roberts et al., 2016) of RCTs of psychological interventions aimed at treating comorbid PTSD and SUD, with the aim of establishing the current evidence base for a number of approaches including: Trauma focused CBT trauma focused treatments plus treatment as usual for SUD, such as COPE Present focused treatments such as Seeking Safety plus treatment as usual for SUD Integrated cognitive restructuring-based interventions plus treatment as usual for SUD EMDR plus treatment as usual for SUD. The working group also seeks to investigate whether there is evidence for different models of treatment delivery: i.e. sequential treatments, vs. integrated treatments delivered by the same therapist vs simultaneous treatments delivered by different therapists. Treatment recommendations will be based on the strength and quality of the findings addressing which will be evaluated through the GRADE approach. Stage 2. It is anticipated that many of the challenges faced in clinical practice are unlikely to be addressed through the Stage 1 process, where there is limited high-quality evidence to make evidence-based recommendations. Stage 2 will involve the collation good practice/consensus point recommendations made in trusted methodologically rigorous treatment guidelines and expert guidance publications. Findings and Recommendations: This project is currently ongoing. The presentation will provide an update of the progress of the working group, share preliminary findings where these are available and make recommendations for future research.

E-mental health interventions for the treatment and prevention of eating disorders: An updated systematic review and meta-analysis.

E-mental health (digital) interventions can help overcome existing barriers that stand in the way of people receiving help for an eating disorder (ED). Although e-mental health interventions for treating and preventing EDs have been met with enthusiasm, earlier reviews brought attention to poor quality of evidence, and offered solutions to enhance their evidence base. To assess developments in the field, we conducted an updated meta-analysis on the efficacy of e-mental health interventions for treating and preventing EDs, paying attention to whether trial quality and outcomes have improved in recent trials. We also assessed whether user-centered design principles have been implemented in existing digital interventions. Four databases were searched for RCTs of digital interventions for treating and preventing EDs. Thirty-six RCTs (28 prevention- and 8 treatment-focused) were included. Some evidence that study quality improved in recent prevention-focused trials was found. Few trials involved the end-user in the design or development stage of the intervention. Issues with intervention engagement were noted, and 1 in 4 participants dropped out from prevention- and treatment-focused trials. Digital interventions were more effective than control conditions in reducing established risk factors and symptoms in prevention- (g's = 0.19 to 0.43) and treatment-focused trials (g's = 0.29 to 0.69), respectively. Effect sizes have not increased in recent trials. Few trials compared a digital intervention with a face-to-face intervention. Whether digital interventions can prevent ED onset is unclear. Digital interventions are a promising approach to ED treatment and prevention, but improvements are still needed. Three key recommendations are provided. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Efficacy of interventions to improve psychological adjustment for parents of infants with or at risk of neurodevelopmental disability: A systematic review.

Supportive and targeted interventions for families are required to optimize parental adjustment and the parent-infant relationship in line with earlier diagnosis of neurodevelopmental risk for infants. The purpose of this systematic review was to determine the efficacy of interventions in improving psychological adjustment and well-being for parents who have an infant diagnosed with or at risk of neurodevelopmental disability. The Cochrane Review Group search strategy was followed with search of The Cochrane Central Register of Controlled Trials, PubMed, CINAHL, PsycINFO, and Embase between July and December 2017. Methodological quality of included articles was assessed using the Physiotherapy Evidence Database (PEDro) Scale by two independent reviewers. Twelve studies met the inclusion criteria. A small number of high-quality trials demonstrated moderate to large effectiveness of reducing adverse parent psychological symptoms of trauma and stress. Significant improvements in depression and anxiety symptoms emerged at longer-term (6 months to 8 years) follow-up postinterventions. There is promising support for the effectiveness of some interventions to reduce maladaptive psychological symptoms in parents with infants diagnosed at risk of neurodevelopmental disability. Further quality RCTs of psychological interventions addressing broader neurodevelopmental risk conditions for infants are required.

Early Life Interventions During the First 1,000 Days of Life: Data Synthesis for Birth Outcomes and Child Linear Growth

Background: The first 1,000 days of life encompasses three important life-stages: pregnancy, exclusive breastfeeding (EBF:0-6mo), and complementary feeding period (CFP:6-24mo). We evaluated the effectiveness of interventions under the domains of micronutrient and balanced energy protein and food supplements, deworming, maternal education, and water sanitation and hygiene (WASH), across the three life-stages. Methods: We applied a Bayesian network analysis. We conducted comprehensive searches and network meta-analyses using RCTs of interventions provided to pregnant women, infants (0-6mo), and children (6-24mo) in LMICs. We compared effects on preterm birth and birthweight for pregnancy, LAZ for EBF, and HAZ for CFP, and probabilities of interventions being superior to standard-of-care (SOC) by at least a minimal clinically importance difference (MCID) for each life-stage. Findings: We found several nutritional interventions that demonstrated effectiveness against SOC. For instance, compared to SOC, maternal supplements of multiple micronutrients (MMN) reduced the odds for preterm birth (OR=0·54; 95%CrI: 0·27, 0·97) and improved mean birthweight (Mean difference=0·36kg; 95%CrI: 0·12, 0·59kg), but not LAZ during EBF (Mean difference=−0·02; 95%CrI: −0·18, 0·14). Supplementing infants and children with MMN improved LAZ (Mean difference=0·20; 95% CrI: 0·03, 0·35) and HAZ (Mean difference=0·14; 95%CrI: 0·02, 0·25). We also found that pregnancy interventions generally had higher MCID probabilities than the interventions for the EBF/CFP. Interpretation: Our analyses highlight the importance of intervening early, during pregnancy if possible. There is a need to combine compelling and evidence-based interventions from multiple domains and test for their effectiveness as a package. Funding Statement: The Bill and Melinda Gates Foundation Declaration of Interests: No authors have any competing interests.

Reporting randomised trials of social and psychological interventions: the CONSORT-SPI 2018 Extension

BackgroundRandomised controlled trials (RCTs) are used to evaluate social and psychological interventions and inform policy decisions about them. Accurate, complete, and transparent reports of social and psychological intervention RCTs are essential for understanding their design, conduct, results, and the implications of the findings. However, the reporting of RCTs of social and psychological interventions remains suboptimal. The CONSORT Statement has improved the reporting of RCTs in biomedicine. A similar high-quality guideline is needed for the behavioural and social sciences. Our objective was to develop an official extension of the Consolidated Standards of Reporting Trials 2010 Statement (CONSORT 2010) for reporting RCTs of social and psychological interventions: CONSORT-SPI 2018.MethodsWe followed best practices in developing the reporting guideline extension. First, we conducted a systematic review of existing reporting guidelines. We then conducted an online Delphi process including 384 international participants. In March 2014, we held a 3-day consensus meeting of 31 experts to determine the content of a checklist specifically targeting social and psychological intervention RCTs. Experts discussed previous research and methodological issues of particular relevance to social and psychological intervention RCTs. They then voted on proposed modifications or extensions of items from CONSORT 2010.ResultsThe CONSORT-SPI 2018 checklist extends 9 of the 25 items from CONSORT 2010: background and objectives, trial design, participants, interventions, statistical methods, participant flow, baseline data, outcomes and estimation, and funding. In addition, participants added a new item related to stakeholder involvement, and they modified aspects of the flow diagram related to participant recruitment and retention.ConclusionsAuthors should use CONSORT-SPI 2018 to improve reporting of their social and psychological intervention RCTs. Journals should revise editorial policies and procedures to require use of reporting guidelines by authors and peer reviewers to produce manuscripts that allow readers to appraise study quality, evaluate the applicability of findings to their contexts, and replicate effective interventions.

Workplace-Based Interventions for Neck Pain in Office Workers: Systematic Review and Meta-Analysis.

AbstractBackgroundAt present, there is no consolidated evidence for workplace-based interventions for the prevention and reduction of neck pain in office workers.PurposeThe purpose of this review was to investigate the effectiveness of workplace-based interventions for neck pain in office workers.Data SourcesMEDLINE, PEDro, CINAHL, and CENTRAL were searched for trials published since inception and before May 31, 2016.Study SelectionRandomized controlled trials (RCTs) were considered when they met the following criteria: population consisted of office workers, intervention(s) was performed at the workplace, outcome measures included neck and/or neck/shoulder pain intensity and incidence/prevalence, and comparator groups included no/other intervention.Data ExtractionData were extracted by 1 reviewer using predefined data fields and checked by a second reviewer. Risk of bias was assessed by 2 independent reviewers using the 2015 Cochrane Back and Neck Group guidelines. Evidence quality was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation system.Data SynthesisTwenty-seven RCTs were included. There was moderate-quality evidence that neck/shoulder strengthening exercises and general fitness training were effective in reducing neck pain in office workers who were symptomatic, although the effect size was larger for strengthening exercises. Greater effects were observed with greater participation in exercise. Ergonomic interventions were supported by low-quality evidence.LimitationsData could not be obtained from some studies for meta-analysis and assessment of risk of bias. Reporting bias might have been present because only studies in the English language were included.ConclusionsWorkplace-based strengthening exercises were effective in reducing neck pain in office workers who were symptomatic, and the effect size was larger when the exercises were targeted to the neck/shoulder. Future RCTs of ergonomic interventions targeted at office workers who are symptomatic are required. More research on neck pain prevention is warranted.

Systematic review of management of chronic pain after surgery.

BackgroundPain present for at least 3 months after a surgical procedure is considered chronic postsurgical pain (CPSP) and affects 10–50 per cent of patients. Interventions for CPSP may focus on the underlying condition that indicated surgery, the aetiology of new‐onset pain or be multifactorial in recognition of the diverse causes of this pain. The aim of this systematic review was to identify RCTs of interventions for the management of CPSP, and synthesize data across treatment type to estimate their effectiveness and safety.Methods MEDLINE, Embase, PsycINFO, CINAHL and the Cochrane Library were searched from inception to March 2016. Trials of pain interventions received by patients at 3 months or more after surgery were included. Risk of bias was assessed using the Cochrane risk‐of‐bias tool.ResultsSome 66 trials with data from 3149 participants were included. Most trials included patients with chronic pain after spinal surgery (25 trials) or phantom limb pain (21 trials). Interventions were predominantly pharmacological, including antiepileptics, capsaicin, epidural steroid injections, local anaesthetic, neurotoxins, N‐methyl‐d‐aspartate receptor antagonists and opioids. Other interventions included acupuncture, exercise, postamputation limb liner, spinal cord stimulation, further surgery, laser therapy, magnetic stimulation, mindfulness‐based stress reduction, mirror therapy and sensory discrimination training. Opportunities for meta‐analysis were limited by heterogeneity. For all interventions, there was insufficient evidence to draw conclusions on effectiveness.ConclusionThere is a need for more evidence about interventions for CPSP. High‐quality trials of multimodal interventions matched to pain characteristics are needed to provide robust evidence to guide management of CPSP.

HOW DO CARE HOME STAFF EXPERIENCE, UNDERSTAND AND MANAGE AGITATION IN RESIDENTS WITH DEMENTIA? A QUALITATIVE STUDY

Agitation in dementia is common, persistent, distressing and related to care home admission and increased costs. There is limited evidence for sustained effects of any intervention targeting agitation in care home residents and little is known about how front-line care home staff understand and manage agitated residents. To inform the development of sustainable and practical psychosocial interventions for agitation we conducted the first qualitative study of care home staff experiences of caring for agitated residents. We conducted 25 in-depth interviews with staff from six care homes. We used purposive sampling to include staff of either sex, differing ages, ethnicities, nationalities and with different roles. We transcribed interviews and entered them into NVivo 11 software and conducted thematic analysis. Care staff experienced agitation as diverse, unpredictable and of varying severity. They reported feeling frightened, powerless and overwhelmed when residents were agitated, especially when attempted solutions did not work, or if they felt unsupported by colleagues and managers or unable to meet the competing demands of their role. Staff understood agitation as expression of unmet social, emotional, physical or environmental need, which the person with dementia can no longer resolve. Despite experiencing a range of barriers to managing agitation at individual, interpersonal, organizational and socio-political levels, staff responses to agitation were flexible and adaptive, applying a process of ‘trial and error’ based upon prior experience. Strategies ranged from ‘hands on’ de-escalation techniques, to team based approaches, however it was acknowledged that sometimes ‘nothing worked’. Medication was described as a last resort, with side-effects and limited effectiveness. Using skilled communication, getting to know residents and maximising pleasant interaction was seen as integral to preventing agitation from happening. Future RCTs of psychosocial interventions to reduce agitation in care homes should support staff to respond to resident unmet needs and incorporate how staff can minimise the impact of agitation upon themselves. To ensure sustainability, interventions should build upon approaches and strategies already being used by care home staff whilst addressing barriers to staff putting potentially beneficial strategies into practice.

Are community-based nurse-led self-management support interventions effective in chronic patients? Results of a systematic review and meta-analysis.

The expansion of primary care and community-based service delivery systems is intended to meet emerging needs, reduce the costs of hospital-based ambulatory care and prevent avoidable hospital use by the provision of more appropriate care. Great emphasis has been placed on the role of self-management in the complex process of care of patient with long-term conditions. Several studies have determined that nurses, among the health professionals, are more recommended to promote health and deliver preventive programs within the primary care context. The aim of this systematic review and meta-analysis is to assess the efficacy of the nurse-led self-management support versus usual care evaluating patient outcomes in chronic care community programs. Systematic review was carried out in MEDLINE, CINAHL, Scopus and Web of Science including RCTs of nurse-led self-management support interventions performed to improve observer reported outcomes (OROs) and patients reported outcomes (PROs), with any method of communication exchange or education in a community setting on patients >18 years of age with a diagnosis of chronic diseases or multi-morbidity. Of the 7,279 papers initially retrieved, 29 met the inclusion criteria. Meta-analyses on systolic (SBP) and diastolic (DBP) blood pressure reduction (10 studies—3,881 patients) and HbA1c reduction (7 studies—2,669 patients) were carried-out. The pooled MD were: SBP -3.04 (95% CI -5.01—-1.06), DBP -1.42 (95% CI -1.42—-0.49) and HbA1c -0.15 (95% CI -0.32–0.01) in favor of the experimental groups. Meta-analyses of subgroups showed, among others, a statistically significant effect if the interventions were delivered to patients with diabetes (SBP) or CVD (DBP), if the nurses were specifically trained, if the studies had a sample size higher than 200 patients and if the allocation concealment was not clearly defined. Effects on other OROs and PROs as well as quality of life remain inconclusive.