Trials Of Good Methodological Quality Research Articles

Effects of Dry Needling in Carpal Tunnel Syndrome: A Mini-review

Carpal Tunnel Syndrome (CTS) is a complicated ailment in which there is compression of the median nerve in the carpal tunnel and which can lead to pain, disrupt the range of motion, hand function, and finger grip force. Dry needling treatment is used for CTS by inserting the needle to reduce pain and lowering the tension over the nerve to improve symptoms. This review aimed to determine whether dry needling is useful in treating carpal tunnel syndrome symptoms. Studies published between 2000 and 2021 were identified by searching PubMed, Google Scholar, and Springer. Studies identified by the electronic search were screened against a set of predetermined inclusion criteria. Five studies were included in this review. The main variables measured were pain, range of motion, hand function, and grip strength. Results show that dry needling is effective in the short term for pain relief and increased range of motion and improved finger grip in patients with mild to moderate carpal tunnel syndrome. There is less literature on the treatment of carpal tunnel syndrome associated with dry needling. As there is some evidence of a positive effect in the short term and in mild to moderate CTS, further randomised clinical trials of good methodological quality using standardised and well-described procedures for the application of dry needling are needed.

Injections de corticoïdes, acide hyaluronique et plasma riche en plaquettes dans l’arthrose : où en sommes-nous ?

Because the intra-articular administration of a drug offers many advantages over the systemic route, corticosteroids or hyaluronic acid intra-articular injections are routinely used in the management of osteoarthritis, and recommended in the recent guidelines of the French Society of Rheumatology for the management of knee osteoarthritis. Nevertheless, international guidelines are not unanimous as to their use in the knee, hip or hand osteoarthritis. This discrepancy is explained by the results of meta-analyses of randomized controlled trials, showing a modest effect size and a disputable clinical relevance. Indeed, clinical trials do not take into account the contextual effect associated with the intra-articular procedure. This effect contributes to the greater placebo effect observed with intra-articular therapies than with oral or transdermal treatments, and the difficulty in demonstrating a clinically relevant effect of intra-articular drugs. Intra-articular injections have an advantageous safety profile compared to other therapies available for the management of osteoarthritis pain. The long-term tolerance of intra-articular corticosteroids remains uncertain, as they have been associated with accelerated structural progression, especially if they are repeated multiple times. Finally, the efficacy of platelet-rich plasma is debated. The literature on this topic is particularly heterogeneous, and randomized controlled trials of good methodological quality are warranted to determine their efficacy and tolerance in the short and long term.

Hip Muscle Strengthening for Knee Osteoarthritis: A Systematic Review of Literature.

Osteoarthritis (OA) of the knee joint results in chronic pain and functional decline among older adults. Hip muscle weakness has been observed in persons with knee OA and is claimed to increase the medial compartment loading on the knee joint. Although individual studies are available, no review has yet integrated the literature on the benefits of hip muscle strengthening for persons with knee OA. This review aims to systematically summarize the current evidence on the effectiveness of hip muscle strengthening on knee pain, lower extremity function, and biomechanical measures of the knee in persons with knee OA. An extensive electronic literature search was conducted in the databases PubMed, Scopus, Cumulative Index to Nursing and Allied Health (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), and Physiotherapy Evidence Database (PEDro) to identify the published trials in the English language from January 1990 to August 2017. Randomized controlled trials that studied the effectiveness of hip muscle strengthening in persons with knee OA on knee pain, physical function, and biomechanical measures of the knee were considered for inclusion. The key word combinations were knee osteoarthritis, degenerative arthritis, arthralgia, muscle strengthening, and resistance training using the Boolean operators AND, OR. Two reviewers independently performed the study selection, and a third reviewer intervened when the consensus was not attained. Quality assessment of the included studies was carried out using the PEDro scale. The search produced 774 results, from which 81 full-text articles were studied. Five randomized controlled trials of good methodological quality, including 331 participants, were included in the review. The effectiveness of hip muscle strengthening was assessed in isolation, combination, and comparison with other lower extremity exercise. Overall, the studies reported clear benefits of hip muscle strengthening on knee pain, physical function, and hip muscle strength. However, hip muscle strengthening was ineffective in improving the biomechanical measures such as dynamic alignment and knee adduction (also known as valgus) moment. The current review identified strong, high-quality evidence to recommend hip muscle strengthening in the conservative management of persons with knee OA. Further research is needed to establish the underlying mechanisms for the clinical benefits.

25 years of Eye Movement Desensitization and Reprocessing (EMDR): The EMDR therapy protocol, hypotheses of its mechanism of action and a systematic review of its efficacy in the treatment of post-traumatic stress disorder

Eye movement desensitization and reprocessing (EMDR) is a relatively new psychotherapy that has gradually gained popularity for the treatment of post-traumatic stress disorder. In the present work, the standardised EMDR protocol is introduced, along with current hypotheses of its mechanism of action, as well as a critical review of the available literature on its clinical effectiveness in adult post-traumatic stress disorder. A systematic review of the published literature was performed using PubMed and PsycINFO databases with the keywords “eye movement desensitization and reprocessing” and “post-traumatic stress disorder” and its abbreviations “EMDR” and “PTSD”. Fifteen randomised controlled trials of good methodological quality were selected. These studies compared EMDR with unspecific interventions, waiting lists, or specific therapies. Overall, the results of these studies suggest that EMDR is a useful, evidence-based tool for the treatment of post-traumatic stress disorder, in line with recent recommendations from different international health organisations.

25 years of Eye Movement Desensitization and Reprocessing (EMDR): The EMDR therapy protocol, hypotheses of its mechanism of action and a systematic review of its efficacy in the treatment of post-traumatic stress disorder.

Eye movement desensitization and reprocessing (EMDR) is a relatively new psychotherapy that has gradually gained popularity for the treatment of post-traumatic stress disorder. In the present work, the standardised EMDR protocol is introduced, along with current hypotheses of its mechanism of action, as well as a critical review of the available literature on its clinical effectiveness in adult post-traumatic stress disorder. A systematic review of the published literature was performed using PubMed and PsycINFO databases with the keywords «eye movement desensitization and reprocessing» and «post-traumatic stress disorder» and its abbreviations «EMDR» and «PTSD». Fifteen randomised controlled trials of good methodological quality were selected. These studies compared EMDR with unspecific interventions, waiting lists, or specific therapies. Overall, the results of these studies suggest that EMDR is a useful, evidence-based tool for the treatment of post-traumatic stress disorder, in line with recent recommendations from different international health organisations.

Interventions for treating painful nipples among breastfeeding women.

Interventions for treating painful nipples among breastfeeding women.

Transcutaneous electrical nerve stimulation for relieving acute pain in the prehospital setting

Although medics in many services are equipped with pharmacological analgesia, legislative or logistical restrictions in some systems result in the need to rely on nonpharmacological avenues for the management of acute pain. Transcutaneous electrical nerve stimulation (TENS) has been proposed as an alternative to analgesic medication that could be feasible and effective in the prehospital setting. The aim of this systematic review was to determine the effectiveness and safety of TENS when administered by medics to patients with acute pain in the prehospital setting. A systematic literature review was carried out to identify randomized-controlled trials investigating the safety and efficacy of TENS compared with 'sham' (placebo) TENS in the prehospital setting. Quality assessment of included studies was carried out to identify potential for bias. Qualitative and quantitative synthesis of results was performed to determine effectiveness and safety. The studies included were meta-analysed using a random-effects model to produce pooled results for comparison of the mean post-treatment pain scores using a visual analogue scale (VAS). Four studies were included in the analysis, all of which were prospective clinical trials of good methodological quality. Meta-analysis indicated that TENS produced a clinically significant reduction in severity of pain [mean VAS reduction 38 mm (95% confidence interval 28-44); P<0.0001] for patients with moderate-to-severe acute pain. TENS produced post-treatment mean pain scores that were significantly lower than 'sham' TENS [33 mm VAS (95% confidence interval 21-44); P<0.0001]. TENS was also effective in reducing acute anxiety secondary to pain. No safety risks were identified. When administered by medics in the prehospital setting to patients with acute pain, TENS appears to be an effective and safe nonpharmacological analgesic modality that should be considered by emergency medical services organizations in which pharmacological pain management is restricted or unavailable.

Oxcarbazepine for acute affective episodes in bipolar disorder

Oxcarbazepine, a keto derivative of the 'mood stabiliser' carbamazepine, may have efficacy in the treatment of acute episodes of bipolar disorder. Potentially, it may offer pharmacokinetic advantages over carbamazepine. To review the efficacy and acceptability of oxcarbazepine compared to placebo and other agents in the treatment of acute bipolar episodes including mania, mixed episodes and depression. Electronic databases were searched up to 2 September 2011. Specialist journals and conference proceedings were handsearched. Authors, experts in the field and pharmaceutical companies were contacted requesting information on published and unpublished trials. Randomised controlled trials (RCTs) which compared oxcarbazepine with placebo or alternative agents, where the stated intent of intervention was the acute treatment of bipolar affective disorder were sought. Participants with bipolar disorder of either sex and of all ages were included. Data were extracted from the original reports individually by two review authors. For dichotomous data, odds ratios (ORs) were calculated with 95% confidence intervals (CI). Continuous data were analysed using standardised mean differences (with 95% CI). Seven studies were included in the analysis (368 participants in total). All were on mania, hypomania, mixed episodes or rapid-cycling disorder. Overall, their methodological quality was relatively low.There was no difference in the primary outcome analysis - a fall of 50% or more on the Young Mania Rating Scale (YMRS) - between oxcarbazepine and placebo (N=1, n=110, OR =2.10, 95% CI 0.94 to 4.73) in one study, conducted in children; no studies were available in adult participants.In comparison with other mood stabilisers, there was no difference between oxcarbazepine and valproate as an antimanic agent using the primary outcome (50% or more fall in YMRS, OR=0.44, 95% CI 0.10 to 1.97, 1 study, n=60, P=0.273) or the secondary outcome measure (differences in YMRS between the two groups, SMD=0.18, 95% CI -0.24 to 0.59, 2 studies, n=90, P=0.40). No primary or secondary efficacy outcome measures were found comparing oxcarbazepine with lithium monotherapy.As an adjunctive treatment to lithium, oxcarbazepine reduced depression rating scale scores more than carbamazepine in a group of manic participants on the Montgomery-Åsberg Depression Rating Scale (MADRS) (SMD=- 1.12, 95% CI -1.71 to -0.53, 1 study, n=52, P=0.0002) and on the Hamilton Depression Rating Scale (HDRS) (SMD=- 0.77, 95% CI -1.35 to -0.20, 1 study, n=52, P=0.008).There was a higher incidence of adverse effects, particularly neuropsychiatric, in participants randomised to oxcarbazepine compared to those on placebo (1 study, n=115, 17% to 39% of participants on oxcarbazepine had at least one such event compared to 7% to 10% on placebo).There was no difference in adverse events rates between oxcarbazepine and other mood stabilisers or haloperidol. Currently, there are insufficient trials of adequate methodological quality on oxcarbazepine in the acute treatment of bipolar disorder to inform us on its efficacy and acceptability. Studies predominantly examine the treatment of mania: there are data from subgroup analysis on mixed affective, hypomania and rapid-cycling states.From the few studies included in this review, oxcarbazepine did not differ in efficacy compared to placebo in children and adolescents. It did not differ from other active agents in adults. It may have a poorer tolerability profile compared to placebo. No data were found on outcomes relevant to patients and clinicians, such as length of hospital admission. There is a need for adequately powered randomised controlled trials of good methodological quality to inform us of the therapeutic potential of oxcarbazepine across the spectrum of acute episodes in bipolar disorder.

Aerosolized antibiotic therapy for chronic cystic fibrosis airway infections: continuous or intermittent?

The use of inhaled therapies for chronic respiratory infections in cystic fibrosis represents a substantive treatment burden to patients. In this paper, we review the evidence supporting two commonly used inhaled antibiotic regimens for chronic respiratory infections - continuous vs. intermittent (28 days on followed by 28 days off) therapy. We included trials of good methodological quality and excluded those in which the primary intent was eradication. In total, we included 13 trials (5 of intermittent therapy and 8 of continuous therapy) and summarized their main findings, placing particular emphasis on change in FEV(1), emergence of resistance and patient adherence. What is evident from our review is that both continuous and intermittent inhaled therapies work. Although an intermittent regimen would be intuitively "better" in terms of cost savings and patient tolerability, there is currently a lack of head-to-head trials that compare the same drugs (and dosages) using the two different regimens to make such a recommendation based on robust clinical evidence.

¿Pinzamiento precoz o tardío del cordón umbilical? Una revisión sistemática de la literatura médica

There is wide variability in clinical practice in the moment of clamping the umbilical cord. Opinions in the medical community differ on the harm and/or benefits, both for the mother and for the newborn, of early versus late cord clamping. Currently, the debate among those who defend and/or criticize one or other of these practices continues. The aim of this study was to evaluate the effects of early versus late clamping of the umbilical cord in full-term newborns on maternal and neonatal outcomes. A literature search of randomized clinical trials was carried out in the Cochrane Library, MEDLINE and Lilacs. It was completed with a hand search of references in relevant articles. All randomized controlled clinical trials of good methodological quality that compared early versus late cord clamping in term newborns were selected. Of seven identified studies, four had the required characteristics for inclusion in this systematic review. Comparison of early versus late clamping in these studies revealed that late clamping could diminish the prevalence of children with low iron reserves at 3 months of age by 50%, but this result comes from a study that lost more than 40% of the patients during follow-up. The results concerning anemia at 3 months of age showed statistical heterogeneity since the two studies that analyzed this outcome had opposite results. For other outcomes such as birth weight, Apgar < 5, and tachypnea the studies were too small for significant differences to be detected. This review shows that there is no clear evidence for defending any of the modalities of cord clamping in full-term newborns. Further research is needed to identify the best moment for cord clamping.

The Use of Aprotinin to Reduce Transfusion Requirements in Children Undergoing Cardiac Surgery: A Meta-Analysis.

Background. Aprotinin, an antifibrinolytic medication, reduces the requirement for allogeneic red blood cell (RBC) transfusion following elective cardiac surgery in adults. The effect of aprotinin for this indication in children is unclear.Objective. To determine if intravenous aprotinin, administered perioperatively to patients <18 years of age undergoing cardiac surgery with cardiopulmonary bypass (CPB), reduces post-operative allogeneic blood transfusion requirements (RBCs or whole blood transfusions), compared to children who do not receive aprotinin.Methods. Systematic review of all relevant randomized controlled trials. We searched MEDLINE, EMBASE, the Cochrane Library and published abstracts. In duplicate, 2 investigators independently selected studies based on explicit inclusion and exclusion criteria; disagreement was resolved by consensus. Using a validated scale, and blinded to outcomes, authors and journal, 2 investigators independently rated the methodological quality of each selected study. Study results were combined using the random effects model to obtain a pooled relative risk.Results. Of 547 studies identified, 11 studies published from 1993 to 2003 were included. Four of the 11 studies were judged to be of good methodological quality. Overall, aprotinin was associated with a lower proportion of children requiring transfusion, but this was not significant (relative risk 0.73, 95% CI: 0.51–1.04). We found significant heterogeneity among studies (I2= 73.0%, p= 0.001), attributed largely to methodological quality. When we pooled the 4 studies of good methodological quality, aprotinin significantly reduced the proportion of children requiring transfusion (relative risk 0.60, 95% CI 0.38–0.95). Aprotinin had no effect on the total amount of blood transfused or on the volume of chest tube drainage.Conclusions. Aprotinin reduced the proportion of children exposed to allogeneic blood transfusion following cardiac surgery by 40% in randomized trials of good methodological quality. Additional high quality studies are needed to confirm the potential benefit of aprotinin in this population.

Complementary and alternative medicine for bronchial asthma: is there new evidence?

Complementary and alternative medicine is widely used in bronchial asthma. Data on efficacy of these treatment modalities are lacking. Studies published since June 2002 on complementary and alternative medicine in bronchial asthma were systematically reviewed. Studies do not support the use of homeopathy, air ionizers, manual therapy, or acupuncture for asthma. These methods bear some risks to patients related to undertreatment and side effects. There might be a possible, but so far not clearly established, role for antioxidant dietary supplementation, and some natural antiinflammatory and immunomodulatory remedies. However, their effect size compared with the classical treatment and side-effect profile is not clearly established. Strategies influencing breathing technique or perception, such as breathing or retraining exercises, need to be studied over the next few years to establish their additive role in the treatment of asthma. Breathing exercises could improve lung function and quality of life in different studies. Psychotherapy-related methods such as relaxation, hypnosis, autogenic training, speleotherapy, and biofeedback might have a small effect in selected cases, but have not proven to be superior to placebo. Nevertheless, more randomized controlled trials of good methodological quality are required to allow firm conclusions.

Effectiveness of treatments for infantile colic: systematic review

Objective: To evaluate the effectiveness of diets, drug treatment, and behavioural interventions on infantile colic in trials with crying or the presence of colic as the primary outcome measure.Data sources:...