Systematic Review Of Evidence Research Articles

Agomelatine bears promising potential in treating bipolar depression- a systematic review.

The controversy of antidepressant use in bipolar depression remains controversial. Agomelatine (AGO) is an effective antidepressant in major depressive disorder (MDD), but its application in bipolar depression was little discussed. We aimed to provide a comprehensive systematic review of clinical evidence from studies examining the efficacy and safety of AGO for bipolar depression. We conducted a systematic review about AGO trials for the treatment of bipolar patients. We searched PubMed, MEDLINE, Embase, and Cochrane for relevant studies published since each database's inception. We synthesised evidence regarding efficacy (mood and rhythm) and tolerability across studies. We identified 6 studies including 272 participants (44% female). All studies used 25-50 mg AGO per day for treatment combined or not combined with mood stabilisers (MS). Across all 6 studies, there were improvements in depression evaluated by depression rating scores and response rate over time. The response rates varied from 43% to 91% within 6-12 weeks. Although AGO was found of better efficacy in bipolar depression compared to recurrent depression, its efficacy remains controversial. Most studies have shown AGO to be effective after just about a week. AGO was reasonably well tolerated both in acute and extension period, without obvious risk in inducing mood switching. AGO is promising in treating bipolar depression with significant efficacy and well tolerability. However, more strictly designed and large-sample trials are needed in further research with homogeneity within intervention and treatment groups.

Parents’ and informal caregivers’ experiences of accessing childhood vaccination services within the United Kingdom: a systematic scoping review of empirical evidence

BackgroundDespite repeated calls to action and considerable attention, childhood vaccination uptake has declined for a thirteenth consecutive year in the United Kingdom (UK). Increasingly, stakeholders are advocating for research which goes beyond vaccine hesitancy and explores service accessibility in greater depth. This scoping review aims to identify and critically assess how accessibility is being conceptualised and investigated with a view to informing future research. Research, that in turn, will dictate the interventions pursued to improve vaccination coverage.MethodsA detailed search strategy was implemented across seven databases to identify research exploring parents’ experiences of accessing childhood vaccination services within the UK. The analysis explored the studies in relation to their conceptualisation of access, methodology, reported results, and recommendations for research or practice using a combination of descriptive qualitative content analysis, typologies, and frequency counts. Methods and reporting adhered to the ‘JBI Manual for Evidence Synthesis’ and the ‘Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews’.ResultsForty-five studies were included in the analysis. Studies claimed to consider only attitudinal constructs (4%) or did not discuss access at all (33%) despite findings, in part, including access related issues. Remaining studies used the term access in passing or ambiguously (24%), distinguished between attitudes and access in-text (27%), and a minority of studies utilised a theoretical framework which acknowledged accessibility (13%). The focus on access to information (92% of studies) was disproportionately large compared to other domains of accessibility such as availability (11%), affordability (13%), and proximity (16%). Of the seven identified intervention studies, five were centred on information provision.ConclusionAccessibility is poorly conceptualised within most of the research conducted on childhood immunisation uptake within the UK. This, in part, is because exploring accessibility was not an explicit objective of many of the studies included in the review. It is vital that the accessibility of childhood vaccination services is given greater priority and appropriately defined in empirical research. Otherwise, researchers run the risk of limiting the scope of their findings based on their own conceptual ideas regarding the drivers of poor uptake rather than the lived reality of parents.

Systematic review of evidence for the impact and effectiveness of the 1-3-7 strategy for malaria elimination

BackgroundThe 1-3-7 approach to eliminate malaria was first implemented in China in 2012. It has since been expanded to multiple countries, but no systematic review has examined the evidence for its use. A systematic review was conducted aiming to evaluate the impact and effectiveness of the strategy and identify key challenges and variations in its implementation across different countries.MethodsPUBMED, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CABS s, LILACS, Global Health, Medrxiv, Biorxiv were searched for all studies containing 1-3-7 and articles included if they contained information on 1-3-7 impact, effectiveness, challenges and/or adaptations for implementation in different countries.Results31 studies were included from China (19), Thailand (6), Myanmar (2), Tanzania (1), Cambodia (1), India (1) and Vietnam (1). During 1-3-7 implementation, malaria cases in China decreased by 99.1–99.9%, in Thailand by 66.9% during 2013–19, 65,1% in Cambodia during 2015–17 and 30.3% in India during 2015–16, with some differences in implementation. It was not possible to separate the impact of 1-3-7 from that due to other contemporaneous interventions. Implementing the 1-3-7 policy was largely effective, with reporting within 1 day in 99.8–100% of individuals in China and 36–100% in other countries, investigation within 3 days in 81.5–99.4% in China and 79.4–100% in other countries, and foci investigation within 7 days in 90.1–100% in China and 83.2–100% in other countries. Adaptations to 1-3-7 were described in 5 studies, mostly adjustment of the timing and/or definitions of each component. Key challenges identified included those related to staffing, equipment, process, and patient-provided information.ConclusionOverall, the 1-3-7 approach was effectively implemented with a concomitant decrease in cases in malaria elimination settings, however, it was not possible to quantify impact as it was not implemented in isolation. Implementing adequate measures for testing, reporting, treatment, and containment is crucial for its success, which is dependent on the availability of resources, infrastructure, staffing, and consistent compliance across regions and throughout the year. However, achieving this nationally and maintaining compliance, especially at borders with malaria-affected countries, poses significant challenges.

Fostering Media Literacy: A Systematic Evidence Review of Intervention Effectiveness for Diverse Target Groups

Investigating the effectiveness of media literacy interventions is essential to identify the most promising programs. This 2022 systematic evidence review, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline, aimed to collect and synthesize scientific evidence on effective media literacy intervention programs across different target groups and the used frameworks. A comprehensive search across major scientific databases (Web of Science, Scopus, ProQuest, Communication & Mass Media Complete, and Education Resources Information Centre) and rigorous screening and coding processes identified 119 studies on media literacy intervention effectiveness and outcomes. This review offers valuable insights into the current state of media literacy intervention research, emphasizing the importance of considering diverse target groups and exploring a wide range of outcomes to enhance our understanding of these interventions’ impact.

Understanding access to sexual and reproductive health in general practice using an adapted Candidacy Framework; a systematic review and qualitative evidence synthesis.

Background General practice has a key role in reducing inequity in access to sexual and reproductive health (SRH). Unplanned pregnancy, abortion and STIs are increasing and disproportionately affects deprived communities and ethnic minority groups. The candidacy framework offers a practical, theoretical framework for understanding the complex interactional processes of access to SRH in general practice. Aim To use the candidacy framework to explore access of SRH in general practice. The seven interaction stages include, identification of need, navigation of services, permeability of services, appearing and asserting need, adjudication by healthcare professional, offers or resistance of offer and the local operating conditions or local production of candidacy. Design and setting This study involved a systematic review with qualitative evidence synthesis using a framework approach. Methods A systematic search of MEDLINE, EMBASE, PUBMED, and the Web of Science was conducted to identify primary qualitative research studies exploring access to SRH in general practice from practitioner, public, and patient perspectives in countries with universal healthcare. The candidacy framework was used to synthesise the findings. Results Analysis of 42 studies revealed the impact of stigma, shame, and embarrassment among individuals, communities, and healthcare practitioners. Findings showed limited inclusion of demographics such as ethnicity and socio-economic status. Barriers to access were more evident for those from lower socio-economic communities, ethnic minorities and LGBTQ+. There are multiple barriers, which include the behaviours of healthcare professionals who have a crucial role in recognising an individual's SRH need. Conclusions General practice offers a cradle-to-grave healthcare service, which should have SRH as a priority area of provision. Further understanding is needed of the impact of historic harms by medicine and healthcare on racialised individuals and gender minorities.

Patients' Experiences of Healthcare Professionals' Competence in Digital Counselling in Healthcare Settings-A Qualitative Systematic Review.

To critically appraise and synthesise qualitative evidence about patients' experiences of healthcare professionals' competence in digital counselling in healthcare settings. A qualitative systematic review. The review followed the Joanna Briggs Institute methodology for systematic reviews of qualitative evidence. The review included studies that focused on patient experiences of healthcare professionals' competence in digital counselling and were published in English, Finnish or Swedish, with no time limits. Study selection, quality appraisal and data extraction were performed by two independent reviewers. Findings from the studies included were pooled using the meta-aggregation method. Eight databases (Web of Science, CINAHL, Scopus, PsycArticles, Medic, Medline (Ovid), EBSCO Open Dissertations and MedNar) were systematically searched on 25 September 2023. Sixteen studies (published between 2009 and 2023) were included in the review, from which 42 findings were extracted and organised into eight categories based on their meaning. Three synthesised findings were identified: (1) Competence to provide efficient digital counselling, (2) competence to support patient self-management during digital counselling and (3) competence in establishing a reciprocal relationship in digital counselling. The evidence from the review can be used to support healthcare professionals' competence in digital counselling. It was found that competence in digital counselling includes the competence to provide digital counselling that is efficient and enables counselling to be implemented in health care, supports patients to self-manage and establishes a reciprocal counselling relationship in a digital environment. Recognising healthcare professionals' competence in digital counselling can enhance their motivation and professional growth, potentially improving the quality of services and patient outcomes. These findings can inform the development of healthcare education, fostering the training of more competent healthcare professionals and digital counsellors. The review was undertaken and reported using the PRISMA guidelines. PROSPERO CRD42024499509. No Patient or Public Contribution.

Identifying effective obesity prevention intervention components: An umbrella review mapping systematic review evidence.

This overview of reviews synthesizes the effectiveness of obesity prevention interventions in children and adults on BMI/zBMI, following JBI and Cochrane Handbook guidelines. The protocol was prospectively registered in OSF in September 2020. Searches for eligible reviews were run in five databases and gray literature in May 2022. Systematic reviews published in 2010 and assessed BMI/zBMI outcomes of obesity prevention interventions were eligible. Screening, data extraction, and quality assessment were performed independently and in duplicate using standardized tools. For similar interventions, the more recent, higher-quality review was included. Thirty reviews reporting on 60 discrete interventions (i.e., a specific intervention component), mapped to 14 of 21 IOM sub-domains, were included. Nine interventions were classified as effective in improving BMI outcomes, including digital health or counseling interventions for adults in 'healthcare environments', behavioral interventions for children (broadly nutrition education), physical education curriculum modifications, and policies targeting food and beverages in 'School environments'. This review extends on previous reviews by consolidating evidence from high-quality, recent reviews to identify effective intervention components. Thus, this review provides direction for implementation efforts and highlights research gaps, where future research is warranted. However, as primary studies were not directly analyzed, gaps may reflect a lack of systematic reviews rather than primary research.

The Neurobiology of Pain, Emotion, and Stress Regulation in Suicide: Role of Cannabinoid, Opioid, Vanilloid, and Galaninergic Systems – A Systematic Review of Postmortem Evidence

The Neurobiology of Pain, Emotion, and Stress Regulation in Suicide: Role of Cannabinoid, Opioid, Vanilloid, and Galaninergic Systems – A Systematic Review of Postmortem Evidence

Barriers and facilitators for the use of telehealth by healthcare providers in India-A systematic review.

It is widely assumed that telehealth tools like mHealth (mobile health), telemedicine, and tele-education can supplement the efficiency of Healthcare Providers (HCPs). We conducted a systematic review of evidence on the barriers and facilitators associated with the use of telehealth by HCPs in India. A systematic literature search following a pre-registered protocol (https://doi.org/10.17605/OSF.IO/KQ3U9 [PROTOCOL DOI]) was conducted on PubMed. The search strategy, inclusion, and exclusion criteria were based on the World Health Organization's action framework on Human Resources for Health (HRH) and Universal Health Coverage (UHC) in India with a specific focus on telehealth tools. Eligible articles published in English from 1st January 2001 to 17th February 2022 were included. One hundred and six studies were included in the review. Of these, 53 studies (50%) involved mHealth interventions, 25 (23.6%) involved telemedicine interventions whereas the remaining 28 (26.4%) involved the use of tele-education interventions by HCPs in India. In each category, most of the studies followed a quantitative study design and were mostly published in the last 5 years. The study sites were more commonly present in states in south India. The facilitators and barriers related to each type of intervention were analyzed under the following sub-headings- 1) Human resource related, 2) Application related 3) Technical, and 4) Others. The interventions were most commonly used for improving the management of mental health, non-communicable diseases, and maternal and child health. The use of telehealth has not been uniformly studied in India. The facilitators and barriers to telehealth use need to be kept in mind while designing the intervention. Future studies should focus on looking at region-specific, intervention-specific, and health cadre-specific barriers and facilitators for the use of telehealth.

Clinical Practice Guidelines for Adult Vascular Access: The Protocol for the Association for Vascular Access Clinical Practice Guidelines Systematic Review

Abstract The Institute of Medicine (IOM) defines clinical practice guidelines (CPGs) as “statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options. Creating clinical practice guidelines involves a systematic process that ensures the development of evidence-based and reliable recommendations for health care professionals. The Association for Vascular Access’ CPGs are being developed by a diverse multidisciplinary team to provide evidence-based recommendations and guidance for health care professionals involved directly and indirectly in vascular access administration, leadership, device insertion, and care. This protocol outlines the process implemented to develop CPGs to ensure the reader trusts in the accuracy. The AVA CPG protocol presents a comprehensive and evidence-based approach to vascular access care. By providing standardized recommendations, it aims to improve patient outcomes, reduce complications, and enhance the delivery of high-quality care. The protocol serves as a valuable resource for health care professionals involved in vascular access management, facilitating best practices and promoting standardized approaches to enhance patient safety and quality of care.

Spanish-Language Measures of Intimate Partner Violence: A Systematic Review of Psychometric Evidence and Translation Methodology.

Intimate partner violence (IPV) is prevalent worldwide, including in Latinx populations. Reported rates of IPV in Latinx populations vary widely, indicating that measurement errors may be impeding researchers' and clinicians' understanding of IPV in these populations. We conducted a systematic review across a range of social science databases to evaluate psychometric properties and translation methodologies of Spanish-language IPV measures. Records were included if they included Spanish measures assessing IPV victimization. We identified 91 records with a total of 70 measures and evaluated the measures' extant psychometric evidence using the COnsensus-based Standards for the selection of health Measurement Instruments. For the measures translated from English to Spanish, we evaluated the translation methodology based on best-practice recommendations for achieving translations that are psychometrically equivalent to their original versions. We found that validation information about measures was sparse and that few translations adhered to best-practice recommendations. Based on our a priori criteria we recommend the Plazaola-Castaño translation of the Index of Spouse Abuse. In closing, we discuss the validity evidence of translated measures independent of the original language version and best-practice recommendations in translating psychological measures.

Assessing the Impact of Climate Change on Vector-Borne Diseases: A Systematic Review of Current Evidence

Assessing the Impact of Climate Change on Vector-Borne Diseases: A Systematic Review of Current Evidence

Use of Esketamine in the Treatment of Depression: A Systematic Review of Clinical Evidence

Use of Esketamine in the Treatment of Depression: A Systematic Review of Clinical Evidence

Pesticide safe use practice and acute health symptoms, and associated factors among farmers in developing countries: a systematic review and meta-analysis of an epidemiological evidence

BackgroundThe increasing use of pesticides has become a global public health concern. The problem is more devastating in developing countries, which deters the implementation of effective intervention strategies. Moreover, the existing evidences are inconsistent and not comprehensive. Therefore, this study aimed to determine the pooled pesticide safe use practices and acute health symptoms, and identify factors among farmers in developing countries.MethodsA comprehensive search using databases such as PubMed, HINARI, Google Scholar, and Epistemonikos, as well as grey literature, was searched up to June 30, 2023. The updated preferred reporting items for systematic reviews and meta-analysis guidelines were used. Data were extracted using Microsoft Excel, and it was exported to STATA 14/SE software for analysis. The Joanna Briggs Institute’s quality appraisal tool was used to assure the quality of the included articles. A random-effects model was used during analysis. The funnel plot and Egger’s regression test were used to assess the publication bias, and sensitivity analysis was conducted to assess the effect of a single study.ResultsThe pooled pesticide safe use practice was 43.1% (95% CI: 31.01–55.2), and the prevalence of acute health symptoms was 30.36% (95% CI: 19.61–41.1). Farmers with good knowledge (OR = 3.83, 95% CI: 2.36–5.29), good attitudes (OR = 2.16, 95% CI: 1.46–2.86), being educated (OR = 5.11, 95% CI: 2.96–7.26), and having more than five years of experience (OR = 6.13, 95% CI: 2.56–9.71) were found to be the identified factors associated with pesticide safe use practice.ConclusionsThis study highlighted a significant gap in pesticide safe use practices and a high prevalence of acute health symptoms among farmers. Therefore, comprehensive intervention measures such as providing educational and safety training programs are required for pesticide users among farmers.

What is the relationship between hospital management practices and quality of care? A systematic review of the global evidence.

There is a widely held view that good management improves organisational performance. However, hospitals are complex organisations and the relationship between management practices and health service delivery is not straightforward. We conducted a global, systematic literature review of the quantitative evidence on the link between the adoption of management practices and quality of care in hospitals. We searched in PubMed, EMBASE, EconLit, Global Health and Web of Science on 16th October 2024, without language or country restrictions. We included empirical studies from January 1, 2000, onward, examining the quantitative association between hospital management practices and quality of care. Outcomes included structural quality (availability of resources such as drugs and equipment), clinical quality (adherence to guidelines), health outcomes and patient satisfaction or experience with care. In every study, each tested association was categorised as significantly positive (at the 5 percent level), null or significantly negative. The study was registered with PROSPERO (CRD42022301462). Of 11,731 articles, 25 studies met the inclusion criteria and had acceptable risk of bias. Studies were equally distributed between high-income and low- and middle-income countries, with 22 cross-sectional and three intervention studies. Of 111 associations, 55 (49.5%) were significantly positive, 1 (1%) was significantly negative, and 55 (49.5%) were null. Among associations tested, the majority were significantly positive for structural quality (79%), clinical quality (60%) and health outcomes (57%), while most associations between hospital management and patient satisfaction (80%) were null. The findings are mixed, with a similar proportion of positive and null associations between management practices and quality of care across studies. The evidence is limited by risk of bias introduced by non-randomised study designs. Evidence of positive associations in some settings warrants further investigation of the association through intervention studies or natural experiments. This could leverage methodological developments in quantitatively measuring management, highlighted by this review.

Seroprevalence of Hepatitis C in Ethiopia: First National Study Based on the 2016 Ethiopian Demographic and Health Survey.

Hepatitis C virus (HCV) is hypothesised to be a public health problem in Ethiopia, and systematic review evidence suggested 1%-3% seroprevalence. We aimed to estimate the seroprevalence of HCV overall and across regions of Ethiopia. We estimated HCV seroprevalence using the 2016 Ethiopian Demographic and Health Survey (EDHS-2016). EDHS-2016 is a nationwide household survey conducted using two-stage cluster sampling methods. We tested all 26,753 samples from participating adult women (15-49 years) and men (15-59 years) using HCV Enzyme Immunoassay. Descriptive analyses were performed based on the Guide to Demographic Health Survey statistics. We applied sample weighting to derive representative estimates. Of the total tested, more than half (54.40%) were aged 15-29 years and 51.59% were women. Overall HCV seroprevalence was 0.18% (95% Confidence Interval: 0.10-0.32). Higher seroprevalences were found in Afar (0.92%) and South Nations Nationality Peoples Region (0.43%); people living with HIV (PLWH) (0.62%); the poorest wealth index (0.35%); people having multiple lifetime sexual partners (0.31%); and widowed/divorced individuals (0.30%). In stratified analyses by sex and residency, we found higher seroprevalences in non-Christian and non-Muslim males (1.98%) and rural population (1.00%), male PLWH (1.67%), rural PLWH (1.45%), widowed/divorced males (0.97%), and in all groups from the Afar region: males (1.30%), females (0.61%), urban (1.07%), and rural (0.86%). HCV seroprevalence among the general population in Ethiopia is much lower than from previous estimates. General population screening is unlikely to be cost-effective, and so screening programs targeted to people at greater risk of HCV will be required.

A systematic review of evidence relating to the use of telesupervision for speech-language pathology students on clinical placements.

The use of telepractice in delivering speech-language pathology services is increasing and speech-language pathologists are providing supervision to students on clinical placements through telesupervision. The review examined literature on telesupervision for speech-language pathology students on a clinical placement. To systematically review the literature on how, when, and why telesupervision is used by speech-language pathologists supervising students; and the views and experiences of students, practice educators, and clients on telesupervision. A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines through searches in six databases (CINAHL, EMBASE, MEDLINE, PsycINFO, Web of Science and Educational Resources Information Center). Quality of the studies was examined using the Quality Assessment Tool for Studies with Diverse Designs. In total, the eight studies included in the review described the use of telesupervision with speech-language pathology students. The studies revealed that telesupervision is considered an effective supervision model for speech-language pathology students, as an adjunct to in-person supervision. Multiple aspects of telesupervision in the studies related to workplace settings, access to and training of technology, type of caseload, practice educator attributes, and the student-educator supervisory relationship. Speech-language pathology educators and students consider telesupervision to be a useful and effective model of supervision, when used as an adjunct to in-person supervision. Although there is limited research to date examining the use of telesupervision in speech-language pathology, the findings of this review can be used to guide support of educators and students as well as inform future research in this area. What is already known on this subject Telesupervision in speech-language pathology allows for an extension of clinical placement opportunities into a wider variety of locations including rural and remote settings and where a practice educator might not be available in person. Telesupervision can reduce costs and travel time and increase the time in the day available for supervision. What this study adds to existing knowledge Considering the potential for telesupervision to expand placement opportunities, this review provides important insights into educator and student views on its implementation and outcomes. All studies in this review occurred prior to COVID-19 restrictions on placements and so provide a context for any developments since and inform future research on telesupervision. What are the clinical implications of this work? While there is some evidence that practice educators and students alike consider that telesupervision can be effective, no studies were found to report on telesupervision as a standalone supervision method. Review findings could be used by speech-language pathology student placement co-ordinators and practice educators in (a) deciding if telesupervision holds potential for the specific work setting and clinical caseload, (b) determining if they have suitable technology and support in the use of the technology, and (c) identifying ways to support the educator-student relationship when using telesupervision.

Uncovering the impact of digital technologies on strategising: Evidence from a systematic literature review

AbstractAdopting digital technologies in different organizations has become a trend over the last decade, yet our understanding regarding impact of digital technologies on strategising needs to be more cohersive. This paper reviews existing research on how digital transformation intersects with strategic management to adress this gap. Specifically, the aim is to explore how the digital context changes strategising. Based on a systematic review of empirical evidence from 163 journal papers, we showcased the manifestation of strategising in the digital age in terms of strategic practitioners, practices and praxis. By consolidating these findings, a typology of strategic actions in the digital age is developed and discussed, highlighting the interplay among changes in strategy‐as‐practice parameters. This framework clarifies in strategic scenarios of digital transformation and identifies various strategic directions and actions. Overall, we argue that although digital transformation has created additional strategic options, it has yet to change the underlying assumptions of strategising in firms.

Health technology assessment to support health benefits package design: a systematic review of economic evaluation evidence in Zambia.

Health technology assessment uses explicit economic evaluation evidence to support health benefits package design. However, the limited availability of technical expertise, data, and methods has restricted the production of economic evaluation evidence in low- and middle-income countries. Zambia has initiated a roadmap to support its policy of reviewing and implementing its national benefits package. This study characterises economic evaluation evidence to support this process's evidence mapping, synthesis, and appraisal stages. This systematic review applies deductive analysis and the preferred reporting items for systematic review and meta-analyses. Four databases were searched to identify studies from 1993 that coincided with Zambia's health benefits package reform. A total of 61 studies met the inclusion criteria. Most of the studies were first authored by nonlocal authors, and the number of local-based authors in each study was low. Almost all funding for economic evaluation research was not local, and only a few studies sought local ethical clearance to conduct research. Infectious diseases were the highest disease control priority for the studies, with HIV research having the highest output. Most of the studies were cost-effectiveness studies that utilised trial-based data and a combination of program, published, and unpublished data for analysis. The studies generally utilised direct cost and applied the ingredient-based costing approach. Natural units were predominantly used for outcomes alongside DALYs. Most studies reported using a 3% discount rate for both costs and outcomes, with only a few reporting methods for sensitivity analysis. Economic evaluation evidence in Zambia has increased, revealing limited local research leadership, methodological inconsistencies, and a focus on infectious diseases. These findings are crucial for revising Zambia's benefits package and may guide researchers and decision-makers in improving the transparency and quality of future research.

Does acupuncture combined with MOTOmed movement therapy have a better rehabilitation effect on post-stroke hemiplegia patients? A systematic review and meta-analysis

ABSTRACT Background Combinations of rehabilitation therapies are widely used in patients with post-stroke hemiplegia. A combination of acupuncture and MOTOmed had been shown to promote the recovery of post-stroke hemiplegia patients. We conducted a systematic review of evidence from studies that investigated the use of acupuncture combined with MOTOmed for rehabilitation of patients with post-stroke hemiplegia. Objective To estimate the rehabilitation effect of acupuncture combined with MOTOmed movement therapy in patients with post-stroke hemiplegia. Methods Randomized controlled trials (RCTs) of acupuncture combined with MOTOmed movement therapy in patients with post-stroke hemiplegia were retrieved from nine databases. Risk-of-bias assessments were conducted using the Cochrane Risk-of-bias Tool. Meta-analysis of outcome measures was performed using RevMan 5.4 software. And we followed the PRISMA 2020 guidelines. Results Eighteen studies involving 1637 participants were included. Compared with conventional rehabilitation, acupuncture, or MOTOmed movement therapy alone, acupuncture combined with MOTOmed movement therapy increased the scores of Fugl-Meyer Assessment Scale-lower extremity (FMA-LE), Berg Balance Scale (BBS), Functional Ambulation Categories scale (FAC), Maximal Walking Speed test (MWS), gait parameters of 3D gait analysis, Barthel Index (BI), Modified Barthel Index (MBI), total effective rate, and the levels of neurotrophic factors (NGF, BDNF and NT-3) in serum, while reduced the scores of Clinic Spasticity Index (CSI) and National Institutes of Health Stroke Scale-Lower Extremity (NIHSS-LE) (p < 0.05 for all). Conclusion Acupuncture combined with MOTOmed movement therapy has better efficacy than conventional rehabilitation, acupuncture, or MOTOmed alone in patients with post-stroke hemiplegia. This combination therapy can promote the rehabilitation of these patients.