1,721,069 research outputs found
Joint lavage for osteoarthritis of the knee
No full textBACKGROUND: Osteoarthritis is the most common form of joint disorder and a
leading cause of pain and physical disability. Observational studies suggested a
benefit for joint lavage, but recent, sham-controlled trials yielded conflicting
results, suggesting joint lavage not to be effective.
OBJECTIVES: To compare joint lavage with sham intervention, placebo or
non-intervention control in terms of effects on pain, function and safety
outcomes in patients with knee osteoarthritis.
SEARCH STRATEGY: We searched CENTRAL, MEDLINE, EMBASE, and CINAHL up to 3 August
2009, checked conference proceedings, reference lists, and contacted authors.
SELECTION CRITERIA: We included studies if they were randomised or
quasi-randomised trials that compared arthroscopic and non-arthroscopic joint
lavage with a control intervention in patients with osteoarthritis of the knee.
We did not apply any language restrictions.
DATA COLLECTION AND ANALYSIS: Two independent review authors extracted data using
standardised forms. We contacted investigators to obtain missing outcome
information. We calculated standardised mean differences (SMDs) for pain and
function, and risk ratios for safety outcomes. We combined trials using
inverse-variance random-effects meta-analysis.
MAIN RESULTS: We included seven trials with 567 patients. Three trials examined
arthroscopic joint lavage, two non-arthroscopic joint lavage and two tidal
irrigation. The methodological quality and the quality of reporting was poor and
we identified a moderate to large degree of heterogeneity among the trials (I(2)
= 65%). We found little evidence for a benefit of joint lavage in terms of pain
relief at three months (SMD -0.11, 95% CI -0.42 to 0.21), corresponding to a
difference in pain scores between joint lavage and control of 0.3 cm on a 10-cm
visual analogue scale (VAS). Results for improvement in function at three months
were similar (SMD -0.10, 95% CI -0.30 to 0.11), corresponding to a difference in
function scores between joint lavage and control of 0.2 cm on a WOMAC disability
sub-scale from 0 to 10. For pain, estimates of effect sizes varied to some degree
depending on the type of lavage, but this variation was likely to be explained by
differences in the credibility of control interventions: trials using sham
interventions to closely mimic the process of joint lavage showed a null-effect.
Reporting on adverse events and drop out rates was unsatisfactory, and we were
unable to draw conclusions for these secondary outcomes.
AUTHORS' CONCLUSIONS: Joint lavage does not result in a relevant benefit for
patients with knee osteoarthritis in terms of pain relief or improvement of
function
Doxycycline for osteoarthritis of the knee or hip
No full textBACKGROUND: Osteoarthritis is the most common form of joint disease and the
leading cause of pain and disability in the elderly. S-Adenosylmethionine may be
a viable treatment option but the evidence about its effectiveness and safety is
equivocal.
OBJECTIVES: We set out to compare S-Adenosylmethionine (SAMe) with placebo or no
specific intervention in terms of effects on pain and function and safety
outcomes in patients with knee or hip osteoarthritis.
SEARCH STRATEGY: We searched CENTRAL, MEDLINE, EMBASE, CINAHL and PEDro up to 5
August 2008, checked conference proceedings and reference lists, and contacted
authors.
SELECTION CRITERIA: Randomised or quasi-randomised controlled trials that
compared SAMe at any dosage and in any formulation with placebo or no
intervention in patients with osteoarthritis of the knee or hip.
DATA COLLECTION AND ANALYSIS: Two independent authors extracted data using
standardised forms. We contacted investigators to obtain missing outcome
information. We calculated standardised mean differences (SMDs) for pain and
function, and relative risks for safety outcomes. We combined trials using
inverse-variance random-effects meta-analysis.
MAIN RESULTS: Four trials including 656 patients were included in the systematic
review, all compared SAMe with placebo. The methodological quality and the
quality of reporting were poor. For pain, the analysis indicated a small SMD of
-0.17 (95% CI -0.34 to 0.01), corresponding to a difference in pain scores
between SAMe and placebo of 0.4 cm on a 10 cm VAS, with no between trial
heterogeneity (I(2) = 0). For function, the analysis suggested a SMD of 0.02 (95%
CI -0.68 to 0.71) with a moderate degree of between-trial heterogeneity (I2 =
54%). The meta-analyses of the number of patients experiencing any adverse event,
and withdrawals or drop-outs due to adverse events, resulted in relative risks of
1.27 (95% CI 0.94 to 1.71) and 0.94 (95% CI 0.48 to 1.86), respectively, but
confidence intervals were wide and tests for overall effect were not significant.
No trial provided information concerning the occurrence of serious adverse
events.
AUTHORS' CONCLUSIONS: The current systematic review is inconclusive, hampered by
the inclusion of mainly small trials of questionable quality. The effects of SAMe
on both pain and function may be potentially clinically relevant and, although
effects are expected to be small, deserve further clinical evaluation in
adequately sized randomised, parallel-group trials in patients with knee or hip
osteoarthritis. Meanwhile, routine use of SAMe should not be advised
The importance of allocation concealment and patient blinding in osteoarthritis trials: a meta-epidemiologic study
No full textOBJECTIVE: To evaluate the association of adequate allocation concealment and
patient blinding with estimates of treatment benefits in osteoarthritis trials.
METHODS: We performed a meta-epidemiologic study of 16 meta-analyses with 175
trials that compared therapeutic interventions with placebo or nonintervention
control in patients with hip or knee osteoarthritis. We calculated effect sizes
from the differences in means of pain intensity between groups at the end of
followup divided by the pooled SD and compared effect sizes between trials with
and trials without adequate methodology.
RESULTS: Effect sizes tended to be less beneficial in 46 trials with adequate
allocation concealment compared with 112 trials with inadequate or unclear
concealment of allocation (difference -0.15; 95% confidence interval [95% CI]
-0.31, 0.02). Selection bias associated with inadequate or unclear concealment of
allocation was most pronounced in meta-analyses with large estimated treatment
benefits (P for interaction < 0.001), meta-analyses with high between-trial
heterogeneity (P = 0.009), and meta-analyses of complementary medicine (P =
0.019). Effect sizes tended to be less beneficial in 64 trials with adequate
blinding of patients compared with 58 trials without (difference -0.15; 95% CI
-0.39, 0.09), but differences were less consistent and disappeared after
accounting for allocation concealment. Detection bias associated with a lack of
adequate patient blinding was most pronounced for nonpharmacologic interventions
(P for interaction < 0.001).
CONCLUSION: Results of osteoarthritis trials may be affected by selection and
detection bias. Adequate concealment of allocation and attempts to blind patients
will minimize these biases
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Overestimation of treatment effects associated with small sample size in osteoarthritis research [Abstract P08-79]
No full textSmall study effects in meta-analyses of osteoarthritis trials: meta-epidemiological study
Full text linkOBJECTIVE: To examine the presence and extent of small study effects in clinical
osteoarthritis research.
DESIGN: Meta-epidemiological study.
DATA SOURCES: 13 meta-analyses including 153 randomised trials (41 605 patients)
that compared therapeutic interventions with placebo or non-intervention control
in patients with osteoarthritis of the hip or knee and used patients' reported
pain as an outcome.
METHODS: We compared estimated benefits of treatment between large trials (at
least 100 patients per arm) and small trials, explored funnel plots supplemented
with lines of predicted effects and contours of significance, and used three
approaches to estimate treatment effects: meta-analyses including all trials
irrespective of sample size, meta-analyses restricted to large trials, and
treatment effects predicted for large trials.
RESULTS: On average, treatment effects were more beneficial in small than in
large trials (difference in effect sizes -0.21, 95% confidence interval -0.34 to
-0.08, P=0.001). Depending on criteria used, six to eight funnel plots indicated
small study effects. In six of 13 meta-analyses, the overall pooled estimate
suggested a clinically relevant, significant benefit of treatment, whereas
analyses restricted to large trials and predicted effects in large trials yielded
smaller non-significant estimates.
CONCLUSIONS: Small study effects can often distort results of meta-analyses. The
influence of small trials on estimated treatment effects should be routinely
assessed
Hylan versus hyaluronic acid for osteoarthritis of the knee: a systematic review and meta-analysis
No full text- …
