26,844 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overview, we searched Epistemonikos but did not search the Database of Abstracts of Reviews of Effects (DARE), as it is no longer updated.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
The use of language methodology for disseminating Cochrane Evidence through Cochrane Corners : Cochrane Rehabilitation experience.
No full textBackground. Health literacy has been recognized for a long time as an important factor both for understanding health information and prediction of health status. There are many efforts to translate health information in different languages, but particular challenge for achieving appropriate health literacy are systematic reviews of health interventions, because they summarize evidence from individual studies to help doctors and patients make informed choices about health treatments. One of these efforts are Cochrane Corners, a knowledge translation tool to disseminate Cochrane Evidence to make sure that all health professionals can make use of the best available evidence in their clinical work.
Objectives. The aim of this work is to highlight the use of qualitative statements, in Cochrane Corners, produced by Cochrane rehabilitation, to communicate the clinical implications of rehabilitation interventions to the clinicians, founded on the certainty of evidence.
Methods. Cochrane Corners have a specific structure: they are authored by one author who is rehabilitation professional to make comments from a rehabilitation perspective, the main section is founded on the summary of Cochrane Review contents and the last section is dedicated to “clinical implication for rehabilitation professionals”. It is founded on the use of qualitative statements, proposed by Cochrane Norway, to communicate the magnitude of rehabilitation intervention effects on specific outcome, based on the certainty of evidence.
Results. We published 8 Cochrane Corners on neurorehabilitation, rheumatology, musculoskeletal diseases and pain conditions. In each Cochrane Corner, it has been provided the clinical implications of each rehabilitation intervention in traumatic brain injury, stroke, fibromyalgia, migraine in adults and in older people living in community.
Conclusion. The use of qualitative statement is a good instrument to improve the applicability of evidence to clinical practice.
Patient or healthcare consumer involvement. Not applicable.
Relevance to diversity. The research addressed to rehabilitation clinicians to use short summary of Cochrane Systematic Reviews in rehabilitation field and to inform clinical and public health decisions on better evidence
Disseminating Cochrane evidence to the public health workforce via author-led webinars
No full text<b>Title</b>\ud
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- Disseminating Cochrane evidence to the public health workforce via author-led webinars\ud
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<b>Background</b> \ud
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- <u><a href="http://www.healthevidence.org/">Health Evidence™</a></u> is a free searchable repository, of 4,500+ quality-appraised public health relevant reviews, including nearly 700 Cochrane reviews. Author-led webinars is one knowledge translation strategy to disseminate the findings of Cochrane reviews.\ud
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<b>Objectives</b>\ud
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- (i) Disseminate the findings of Cochrane reviews via webinars\ud
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- (ii) Evaluate the impact of Cochrane author-led webinars \ud
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<b>Methods</b>\ud
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- Webinars are 60-90 minutes in length and include: an overview of the principles of evidence-informed decision making (15mins), a presentation of the findings by the review author (30mins), and a Q&A period (30mins). Webconferencing software monitors participant registration, attendance, engagement, poll responses, and questions. Standard polling questions are asked throughout each session to assess familiarity with and use of systematic reviews, as well as familiarity and agreement with session-specific review findings.\ud
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<b>Results</b>\ud
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- Since January 2015 Health Evidence™ has hosted six Cochrane author-led webinars. Webinar participants include: nurses, health promoters, physicians, dietitians, and knowledge brokers. On average, participants in each session were attentive and engaged 68.8% of the time. Google Analytics reflect an average 572% increase in users accessing the Cochrane review featured in each webinar on the day of the session compared to average daily access the month prior. On average, each session attracted 177 registrants, of which approximately half joined on the session date. Poll response data reveal 59.6% attendees use systematic reviews to inform their practice. Data collected pre/post on participant’s knowledge of the effectiveness of an intervention, suggest that webinars are an effective way to influence participant’s knowledge about intervention effectiveness (participant knowledge improved 10-31.8%, measured via pre/post poll questions). During the Q&A period, attendees submitted 5-12 questions per session.\ud
Conclusion: Webinars are an interactive and effective mechanism for promoting public health relevant Cochrane evidence to decision makers. Data from webinars highlight a high level of interest and engagement with Cochrane author-led sessions
Randomized Controlled Trials / Controlled Clinical Trials: A Cut and Paste Search Strategy adapted from the Cochrane ENT Group for Web of Science
No full textThis filter is designed to retrieve randomized controlled trials from the Web of Science database. It is a cut and paste filter was adapted from “RCT Filters used by Cochrane ENT. Oxford (UK): Cochrane ENT Group; 2018.
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
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
Overview of Cochrane Systematic Reviews as a methodological tool to introduce Cochrane evidence in WHO guidelines: the Cochrane Rehabilitation experience
No full textBackground. The World Health Organization (WHO), following its “Rehabilitation 2030: a call for action”, launched a process to develop the Package of Rehabilitation Intervention (PRI), a minimum set to be proposed to all Health Ministries to achieve Universal Health Coverage, a WHO strategic priority. Cochrane Rehabilitation has been involved in developing the methodology of the PRI, and in providing the relevant Cochrane Evidence. Overviews of systematic reviews are a new methodology to synthesise the results of multiple systematic reviews. Since PRI is produced for different health intervention, overviews of Cochrane Systematic Reviews are a good tool to introduce Cochrane Evidence in the PRI.
Objectives. The aim is to present the methodology developed to answer to the requests of WHO in the development of PRI.
Methods. The main health condition studied has been stroke. The literature search used was the “tagging process” of Cochrane Rehabilitation as reported by Levack et al (Arch Phys Med Rehabil, 2019). The search was limited to the last 10 years. The reviewers collected for each CSR author, publication year, title, date of search, n° of included studies (n° of participants), population, setting, intervention, control, outcome, corresponding risk (95% CI), relative effect (95% CI), quality of evidence (GRADE), statistical method, heterogeneity, upgrade or downgrade motivation. Where not available in the original CSR, the Table of Findings with GRADE evaluation has been performed.
Results. We found 62 CSRs (to September 2018): 33 had GRADE evaluation and 29 did not. The study is still ongoing: final results will be provided to the WHO in April 2019 and will be reported at the Colloquium.
Conclusions. This study will provide recommendations on stroke rehabilitation, for different outcomes, based on Cochrane Evidence.
Patient or healthcare consumer involvement. Not applicable.
Relevance to diversity. The research addressed to rehabilitation stakeholders. The recommendations on stroke rehabilitation are important for all rehabilitation stakeholders to use better evidence that inform clinical and public health decisions
Debridement for venous leg ulcers
No full textBackground
Venous ulcers (also known as varicose or venous stasis ulcers) are a chronic, recurring and debilitating condition that affects up to 1% of the population. Best practice documents and expert opinion suggests that the removal of devitalised tissue from venous ulcers (debridement) by any one of six methods helps to promote healing. However, to date there has been no review of the evidence from randomised controlled trials (RCTs) to support this.
Objectives
To determine the effects of different debriding methods or debridement versus no debridement, on the rate of debridement and wound healing in venous leg ulcers.
Search methods
In February 2015 we searched: The Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid MEDLINE (In‐Process & Other Non‐Indexed Citations); Ovid EMBASE and EBSCO CINAHL. There were no restrictions with respect to language, date of publication or study setting. In addition we handsearched conference proceedings, journals not cited in MEDLINE, and the bibliographies of all retrieved publications to identify potential studies. We made contact with the pharmaceutical industry to enquire about any completed studies.
Selection criteria
We included RCTs, either published or unpublished, which compared two methods of debridement or compared debridement with no debridement. We presented study results in a narrative form, as meta‐analysis was not possible.
Data collection and analysis
Independently, two review authors completed all study selection, data extraction and assessment of trial quality; resolution of disagreements was completed by a third review author
Do Cochrane reviews drive clinical decision-making at the point of care?
No full textBackground:“Without Cochrane Reviews, people making decisions are unlikely to be able to access and make full use of existing healthcare research”, the Cochrane Collaboration website reports. Although systematic reviews (SR) are increasingly popular as a form of convenient synthesis of evidence to support clinical decision-making, it is difficult to measure to what extent may back practitioners up in their daily practice. A proxy of this achievement is whether Cochrane Reviews are utilized at the point of care. Point-of-care summaries provide physicians with comprehensive, condensed evidence in easily digestible formats.
Objectives: We compared Cochrane and non-Cochrane SR citations in point-of-care summaries. Our null hypothesis was that the citation hazard of a relevant sample of Cochrane and non-Cochrane reviews did not differ.
Methods: We selected the top five point-of-care summaries for coverage of medical conditions, editorial quality and evidence-based methodology.
As samples of relevant non-Cochrane SRs, we selected all the SRs signalled by two literature surveillance journals (ACP Journal Club and Evidence-Based Medicine Primary Care and Internal Medicine). For Cochrane SRs we selected those labelled as “Conclusion changed” in the Cochrane Library. Parallel sampling ran from April to December 2009. We measured the occurrence and timing of Cochrane and non-Cochrane SR citation in point-of-care summaries from June 2009 to May 2010. We assessed the updating cumulative rate using Kaplan-Meier survival analyses. Cox model was used to calculate hazard ratios (HR) between the non- and Cochrane review citation.
Results: The analysis included 128 SRs, 68 non-Cochrane (53%) and 60 Cochrane (47%). The difference between the non- and Cochrane review citation speeds was not significant (HR 1.13, IC 95% 0.87 to 1.46, p=0.36). Both were cited with similar patterns by point-of-care summaries.
Conclusions: This finding belies down the criticism that Cochrane reviews are undervalued as a source of evidence for bedside clinical decision making
Planned early birth versus expectant management for women with preterm prelabour rupture of membranes prior to 37 weeks' gestation for improving pregnancy outcome
No full textDelivery after preterm prelabour rupture of the membranes (PPROM) may be initiated soon after PPROM or, alternatively, be delayed. It is unclear which strategy is most beneficial for mothers and their babies.To assess the effect of planned early birth compared with expectant management for pregnancies complicated with PPROM prior to 37 weeks' gestation.We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (May 2009), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, Issue 1), MEDLINE (1996 to May 2009), EMBASE (1974 to May 2009), and reference lists of trials and other review articles.Randomised controlled trials comparing expectant management with early delivery for women with PPROM prior to 37 weeks' gestation. We excluded quasi randomised trials.Two review authors independently evaluated trials for inclusion into the review and for methodological quality.We included seven trials (690 women) in the review. We identified no difference in the primary outcomes of neonatal sepsis (risk ratio (RR) 1.33, 95% confidence interval (CI) 0.72 to 2.47) or respiratory distress (RR 0.98, 95% CI 0.74 to 1.29). Early delivery increased the incidence of caesarean section (RR 1.51, 95% CI 1.08 to 2.10). There was no difference in the overall perinatal mortality (RR 0.98, 95% CI 0.41 to 2.36), intrauterine deaths (RR 0.26, 95% CI 0.04 to 1.52) or neonatal deaths (RR 1.59, 95% CI 0.61 to 4.16) when comparing early delivery with expectant management. There was no significant difference in measures of neonatal morbidity, including cerebroventricular haemorrhage (RR 1.90 95% CI 0.52 to 6.92), necrotising enterocolitis (RR 0.58, 95% CI 0.08 to 4.08), or duration of neonatal hospitalisation (mean difference (MD) -0.33 days, 95% CI -1.06 to 0.40 days). In assessing maternal outcomes, we found that early delivery increased endometritis (RR 2.32, 95% CI 1.33 to 4.07), but that early delivery had no effect on chorioamnionitis (RR 0.44, 95% CI 0.17 to 1.14). There was a significant reduction of early delivery on the duration of maternal hospital stay (MD -1.13 days, 95% CI -1.75 to -0.51 days).There is insufficient evidence to guide clinical practice on the benefits and harms of immediate delivery compared with expectant management for women with PPROM. To date all of the clinical trials have had methodological weaknesses and have been underpowered to detect meaningful measures of infant and maternal morbidity
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