241,468 research outputs found
Interventions for treating pain and disability in adults with complex regional pain syndrome- an overview of systematic reviews
No full textVersion 3. Overview stabilised in line with the PaPaS Review Group's policy to assess overviews for updating every five years.Differences between protocol and review:
In this updated overview, we made a number of changes compared with the protocol (O'Connell 2011) and the original version of the overview (O'Connell 2013):
• Background: this section has been updated in the current version of the overview to include recent information on CRPS diagnosis, pathophysiology and incidence.
• Searches: in the current version of this overview, we searched Epistemonikos but did not search the Database of Abstracts of Reviews of Effects (DARE), as it is no longer updated.
• Outcomes: in the current version of this overview, we grouped outcomes into post‐intervention, short‐term, medium‐term and long‐term follow‐up periods, reporting only a single effect for each period.
• Assessment of methodological quality of included reviews: in the current version of this overview, we used the revised AMSTAR 2 instead of the original AMSTAR tool to assess the methodological quality of both Cochrane and non‐Cochrane reviews.
• Assessment of the certainty of the evidence in included reviews: where reviews did not use GRADE to assess the certainty in evidence, we conducted these assessments ourselves using updated criteria compared with the previous version of this overview and the protocol (for a full description see Assessment of methodological quality of included reviews). We applied these judgements to all outcomes rather than only the primary outcomes, as done in the previous version of this overview.
• Interpretation of effects: in the current version of this overview, we interpreted minimally important between‐group differences for pain intensity using OMERACT 12 recommendations.Background:
Complex regional pain syndrome (CRPS) is a chronic pain condition that usually occurs in a limb following trauma or surgery. It is characterised by persisting pain that is disproportionate in magnitude or duration to the typical course of pain after similar injury. There is currently no consensus regarding the optimal management of CRPS, although a broad range of interventions have been described and are commonly used. This is the first update of the original Cochrane review published in Issue 4, 2013.
Objectives:
To summarise the evidence from Cochrane and non‐Cochrane systematic reviews of the efficacy, effectiveness, and safety of any intervention used to reduce pain, disability, or both, in adults with CRPS.
Methods:
We identified Cochrane reviews and non‐Cochrane reviews through a systematic search of Ovid MEDLINE, Ovid Embase, Cochrane Database of Systematic Reviews, CINAHL, PEDro, LILACS and Epistemonikos from inception to October 2022, with no language restrictions. We included systematic reviews of randomised controlled trials that included adults (≥18 years) diagnosed with CRPS, using any diagnostic criteria.
Two overview authors independently assessed eligibility, extracted data, and assessed the quality of the reviews and certainty of the evidence using the AMSTAR 2 and GRADE tools respectively. We extracted data for the primary outcomes pain, disability and adverse events, and the secondary outcomes quality of life, emotional well‐being, and participants' ratings of satisfaction or improvement with treatment.
Main results:
We included six Cochrane and 13 non‐Cochrane systematic reviews in the previous version of this overview and five Cochrane and 12 non‐Cochrane reviews in the current version. Using the AMSTAR 2 tool, we judged Cochrane reviews to have higher methodological quality than non‐Cochrane reviews. The studies in the included reviews were typically small and mostly at high risk of bias or of low methodological quality. We found no high‐certainty evidence for any comparison.
There was low‐certainty evidence that bisphosphonates may reduce pain intensity post‐intervention (standardised mean difference (SMD) ‐2.6, 95% confidence interval (CI) −1.8 to −3.4, P = 0.001; I2 = 81%; 4 trials, n = 181) and moderate‐certainty evidence that they are probably associated with increased adverse events of any nature (risk ratio (RR) 2.10, 95% CI 1.27 to 3.47; number needed to treat for an additional harmful outcome (NNTH) 4.6, 95% CI 2.4 to 168.0; 4 trials, n = 181).
There was moderate‐certainty evidence that lidocaine local anaesthetic sympathetic blockade probably does not reduce pain intensity compared with placebo, and low‐certainty evidence that it may not reduce pain intensity compared with ultrasound of the stellate ganglion. No effect size was reported for either comparison.
There was low‐certainty evidence that topical dimethyl sulfoxide may not reduce pain intensity compared with oral N‐acetylcysteine, but no effect size was reported.
There was low‐certainty evidence that continuous bupivacaine brachial plexus block may reduce pain intensity compared with continuous bupivacaine stellate ganglion block, but no effect size was reported.
For a wide range of other commonly used interventions, the certainty in the evidence was very low and provides insufficient evidence to either support or refute their use. Comparisons with low‐ and very low‐certainty evidence should be treated with substantial caution. We did not identify any RCT evidence for routinely used pharmacological interventions for CRPS such as tricyclic antidepressants or opioids.
Authors' conclusions:
Despite a considerable increase in included evidence compared with the previous version of this overview, we identified no high‐certainty evidence for the effectiveness of any therapy for CRPS. Until larger, high‐quality trials are undertaken, formulating an evidence‐based approach to managing CRPS will remain difficult. Current non‐Cochrane systematic reviews of interventions for CRPS are of low methodological quality and should not be relied upon to provide an accurate and comprehensive summary of the evidence.This project was funded by the National Institute for Health Research (NIHR) via Cochrane Infrastructure funding to the Cochrane Pain, Palliative and Supportive Care Review Group (PaPaS). Brunel University, UK: Salary for NOC; University of Notre Dame, Australia: Salary for BW; University College London, UK: Salary for LM; Neuroscience Research Australia, Australia: Salary for JM; University of South Australia, Australia: Salary for GLM
Physical activity and education about physical activity for chronic musculoskeletal pain in children and adolescents
No full textThis is a protocol for a Cochrane Review (Intervention). The objectives are as follows:. To evaluate the effectiveness of physical activity or education about physical activity, or both, compared to active medical care, waiting list, or usual care in children and adolescents with chronic musculoskeletal pain.</p
Heterogeneity in search strategies among Cochrane acupuncture reviews: Is there room for improvement?
No full textObjective: Given the international focus and rigorous literature searches employed in Cochrane systematic reviews, this study was undertaken to evaluate strategies employed in Cochrane reviews and protocols assessing acupuncture as a primary or secondary intervention.
Methods: The Cochrane Collaboration of systematic reviews was searched in February 2009 for all reviews and protocols including information on acupuncture. Information was abstracted from all retrieved articles on review status, type and number of English and Chinese language databases searched, participation of at least one Chinese speaking author and language restriction. Frequencies were calculated and bivariate analyses were performed stratifying on interventions of interest to assess differences in search strategy techniques, language restrictions and results.
Results: The search retrieved 68 titles, including 48 completed reviews, 17 protocols and three previously withdrawn titles. Acupuncture was the primary intervention of interest in 44/65 (67.7%) of the retrieved reviews and protocols. While all articles searched at least one English language database, only 26/65 (40.0%) articles searched Chinese language databases. Significantly more articles where acupuncture was the primary intervention of interest searched Chinese language databases (53% vs 9%, p<0.01). Inconclusive findings as to the effectiveness of acupuncture were found in 28/48 (58.3%) of all completed reviews; this type of finding was more common in reviews which did not search any Chinese language databases.
Conclusions: It is important for reviews assessing the effectiveness of acupuncture to search Chinese language databases. The Cochrane Collaboration should develop specific criteria for Chinese language search strategies to ensure the continued publication of high-quality reviews
User involvement in a Cochrane systematic review: using structured methods to enhance the clinical relevance, usefulness and usability of a systematic review update
No full textBackground: This paper describes the structured methods used to involve patients, carers and health professionals in an update of a Cochrane systematic review relating to physiotherapy after stroke and explores the perceived impact of involvement.Methods: We sought funding and ethical approval for our user involvement. We recruited a stakeholder group comprising stroke survivors, carers, physiotherapists and educators and held three pre-planned meetings during the course of updating a Cochrane systematic review. Within these meetings, we used formal group consensus methods, based on nominal group techniques, to reach consensus decisions on key issues relating to the structure and methods of the review.Results: The stakeholder group comprised 13 people, including stroke survivors, carers and physiotherapists with a range of different experience, and either 12 or 13 participated in each meeting. At meeting 1, there was consensus that methods of categorising interventions that were used in the original Cochrane review were no longer appropriate or clinically relevant (11/13 participants disagreed or strongly disagreed with previous categories) and that international trials (which had not fitted into the original method of categorisation) ought to be included within the review (12/12 participants agreed or strongly agreed these should be included). At meeting 2, the group members reached consensus over 27 clearly defined treatment components, which were to be used to categorise interventions within the review (12/12 agreed or strongly agreed), and at meeting 3, they agreed on the key messages emerging from the completed review. All participants strongly agreed that the views of the group impacted on the review update, that the review benefited from the involvement of the stakeholder group, and that they believed other Cochrane reviews would benefit from the involvement of similar stakeholder groups.Conclusions: We involved a stakeholder group in the update of a Cochrane systematic review, using clearly described structured methods to reach consensus decisions. The involvement of stakeholders impacted substantially on the review, with the inclusion of international studies, and changes to classification of treatments, comparisons and subgroup comparisons explored within the meta-analysis. We argue that the structured approach which we adopted has implications for other systematic reviews.</p
Interventions in the alcohol server setting for preventing injuries.
No full textBACKGROUND: Injuries are a significant public health burden and alcohol intoxication is recognised as a risk factor for injuries. There is increasing attention on supply-side interventions, which aim to modify the environment and context within which alcohol is supplied and consumed. OBJECTIVES: To quantify the effectiveness of interventions implemented in the server setting for reducing injuries. SEARCH STRATEGY: We searched the Cochrane Injuries Group Specialised Register (September 2004), Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2004), MEDLINE (January 1966 to September 2004), EMBASE (1980 to 2004, wk 36), other specialised databases and reference lists of articles. We also contacted experts in the field. SELECTION CRITERIA: Randomised controlled trials (RCTs) and non-randomised controlled studies (NRS) of the effectiveness of interventions administered in the server setting which attempted to modify the conditions under which alcohol is served and consumed, to facilitate sensible alcohol consumption and reduce the occurrence of alcohol-related harm. DATA COLLECTION AND ANALYSIS: Two authors independently screened search results and assessed the full texts of potentially relevant studies for inclusion. Data were extracted and methodological quality was examined. Due to variability in the intervention types investigated, a pooled analysis was not appropriate. MAIN RESULTS: Twenty studies met the inclusion criteria. Overall methodological quality was poor. Five studies used an injury outcome measure; only one of these studies was randomised. The studies were grouped into broad categories according to intervention type. One NRS investigated server training and estimated a reduction of 23% in single vehicle night-time crashes in the experimental area (controlled for crashes in the control area). Another NRS examined the impact of a drink driving service, and reported a reduction in injury road crashes of 15% in the experimental area, with no change in the control; no difference was found for fatal crashes. One NRS investigating the impact of a policy intervention, reported that pre-intervention the serious assault rate in the experimental area was 52% higher than the rate in the control area. After intervention, the serious assault rate in the experimental area was 37% lower than in the control. The only RCT targeting the server setting environment with an injury outcome compared toughened glassware (experimental) to annealed glassware (control) on number of bar staff injuries; a greater number of injuries were detected in the experimental group (relative risk 1.72, 95% CI 1.15 to 2.59). A NRS investigating the impact of a intervention aiming to reduce crime experienced by drinking premises; found a lower rate of all crime in the experimental premises (rate ratio 4.6, 95% CI 1.7 to 12, P = 0.01), no difference was found for injury (rate ratio 1.1. 95% CI 0.1 to 10, P = 0.093). The effectiveness of the interventions on patron alcohol consumption is inconclusive. One randomised trial found a statistically significant reduction in observed severe aggression exhibited by patrons. There is some indication of improved server behaviour but it is difficult to predict what effect this might have on injury risk. AUTHORS' CONCLUSIONS: There is no reliable evidence that interventions in the alcohol server setting are effective in reducing injury. Compliance with interventions appears to be a problem; hence mandated interventions may be more likely to show an effect. Randomised controlled trials, with adequate allocation concealment and blinding are required to improve the evidence base. Further well conducted non-randomised trials are also needed, when random allocation is not feasible
Interventions for the management of obesity in people with bipolar disorder
No full textThis is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effectiveness of interventions for the management of obesity in people with bipolar disorder. © 2018 The Cochrane Collaboration
The Cochrane Library: more systematic reviews on nutrition needed.
No full textThe knowledge and relevance of nutrition as well as the demand for well-funded advices increase. The Cochrane Collaboration plays a leading role within the evidence-based medicine and practice. We advocate therefore more specialized nutritional interest within the Cochrane Collaboration. In case 'Nutrition' needs more attention within the Cochrane Library, one of the first priorities is deciding about whether to include non-randomized studies into the Specialized Register and generating lists of journals to handsearch for such a Specialized Register. Preparatory to these activities an inventory of Nutritional content within the Cochrane Library is needed. We estimate that reviews directly related to nutrition and those of borderline interest to nutrition represent less than 4% of all published reviews in The Cochrane Library
Combination formoterol and budesonide as maintenance and reliever therapy versus combination inhaler maintenance for chronic asthma in adults and children.
No full textBACKGROUND: Asthma is characterised by chronic inflammation of the airways and recurrent exacerbations with wheezing, chest tightness and cough. Treatment with inhaled steroids and bronchodilators often results in good control of symptoms, prevention of further morbidity and mortality and improved quality of life. Several steroids and beta2-agonists (long- and short-acting) as well as combinations of these treatments are available in a single inhaler to be used once or twice a day, with a separate inhaler for relief of symptoms when needed (for patients in Step three or higher, according to Global Initiative for Asthma (GINA) guidelines). Budesonide/formoterol is also licenced for use as maintenance and reliever therapy from a single inhaler (SiT; sometimes referred to as SMART therapy). SiT can be prescribed at a lower dose than other combination therapy because of the additional steroid doses being received as reliever therapy. It has been suggested that using SiT improves compliance and hence reduces symptoms and exacerbations, but it is unclear whether it increases side effects associated with the use of inhaled steroids. OBJECTIVES: To assess the efficacy and safety of budesonide/formoterol in a single inhaler (SiT) to be used for both maintenance and reliever therapy in asthma in comparison with maintenance treatment provided through combination inhalers with a higher maintenance steroid dose (either fluticasone/salmeterol or budesonide/formoterol), along with additional fast-acting beta2-agonists for relief of symptoms. SEARCH METHODS: We searched the Cochrane Airways Group Specialised Register of trials, online trial registries and drug company websites. The most recent search was conducted in November 2013. SELECTION CRITERIA: We included parallel-group, randomised controlled trials of at least 12 weeks' duration. Studies were included if they compared single-inhaler therapy with budesonide/formoterol (SiT) versus combination inhalers at a higher maintenance dose of steroids than was given in the SiT arm (either salmeterol/fluticasone or budesonide/formoterol). DATA COLLECTION AND ANALYSIS: We used standard methods expected by The Cochrane Collaboration. Primary outcomes were exacerbations requiring hospitalisation, exacerbations requiring oral corticosteroids and serious adverse events (including mortality). MAIN RESULTS: Four studies randomly assigning 9130 people with asthma were included; two were six-month double-blind studies, and two were 12-month open-label studies. No trials included children younger than age 12. Trials included more women than men, with mean age ranging from 38 to 45, and mean baseline steroid dose (inhaled beclomethasone (BDP) equivalent) from 636 to 888 μg. Mean baseline forced expiratory volume in one second (FEV1) percentage predicted was between 70% and 73% in three of the trials, and 96% in another. All studies were funded by AstraZeneca and were generally free from methodological biases, although the two open-label studies were rated as having high risk for blinding, and some evidence of selective outcome reporting was found. These possible sources of bias did not lead us to downgrade the quality of the evidence. The quantity of inhaled steroids, including puffs taken for relief from symptoms, was consistently lower for SiT than for the comparison groups.Separate data for exacerbations leading to hospitalisations, to emergency room (ER) visits or to a course of oral steroids could not be obtained. Compared with higher fixed-dose combination inhalers, fewer people using SiT had exacerbations requiring hospitalisation or a visit to the ER (odds ratio (OR) 0.72, 95% confidence interval (CI) 0.57 to 0.90; I(2) = 0%, P = 0.66), and fewer had exacerbations requiring a course of oral corticosteroids (OR 0.75, 95% CI 0.65 to 0.87; I(2) = 0%, P = 0.82). This translates to one less person admitted to hospital or visiting the ER (95% CI 0 to 2 fewer) and two fewer people needing oral steroids (95% CI 1 to 3 fewer) compared with fixed-dose combination treatment with a short-acting beta-agonist (SABA) reliever (per 100 treated over eight months). No statistical heterogeneity was observed in either outcome, and the evidence was rated of high quality. Although issues with blinding were evident in two of the studies, and one study recruited a less severe population, sensitivity analyses did not change the main results, so quality was not downgraded.We could not rule out the possibility that SiT increased rates of serious adverse events (OR 0.92, 95% CI 0.74 to 1.13; I(2) = 0%, P = 0.98; moderate-quality evidence, downgraded owing to imprecision).We were unable to say whether SiT improved results for several secondary outcomes (morning and evening peak expiratory flow (PEF), rescue medication use, symptoms scales), and in cases where results were significant, the effect sizes were not considered clinically meaningful (predose FEV1, nocturnal awakenings and quality of life). AUTHORS' CONCLUSIONS: SiT reduces the number of people having asthma exacerbations requiring oral steroids and the number requiring hospitalisation or an ER visit compared with fixed-dose combination inhalers. Evidence for serious adverse events was unclear. The mean daily dose of inhaled corticosteroids (ICS) in SiT, including the total dose administered with reliever use, was always lower than that of the other combination groups. This suggests that the flexibility in steroid administration that is possible with SiT might be more effective than a standard fixed-dose combination by increasing the dose only when needed and keeping it low during stable stages of the disease. Data for hospitalisations alone could not be obtained, and no studies have yet addressed this question in children younger than age 12
Interventions for uterine fibroids : an overview of cochrane reviews
No full textThis is a protocol for a Cochrane Review (Overview). The objectives are as follows: The objective is to summarize evidence from Cochrane Reviews on the effectiveness and safety of treatment options available to premenopausal women with uterine fibroid‐associated symptomsThe authors wish to acknowledge the support of the Cochrane Gynaecology and Fertility Group for their suggestions in the pre‐registration phase and peer‐reviewing process before publication of this protocol. They also thank Jane Marjoribanks, Ying Cheong and Roger Hart for supplying referee comments on the dra
Ben Cochrane interview
No full text6 p. transcript of an interview with Ben Cochrane conducted by Margaret Stobie. Tape number IH-MS.023A,.027A, transcript disc 44A.Discussion of his life, especially his fishing activities. No date given, probably in the 1970's.Othern
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