Effect of traditional Chinese medicine on intra-abdominal hypertension and abdominal compartment syndrome: A systematic review and Meta-analysis

ObjectiveTraditional Chinese medicine (TCM) recently become a widely used treatment option for treating intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). However, we still lack large-scale, high-quality, randomized controlled trials (RCTs). The purpose of this systematic review was to evaluate the existing clinical trials and to provide additional specific evidence.MethodsA systematic review of randomized controlled trials (RCTs) of TCM for IAH/ACS was conducted. The following databases were searched to identify relevant studies: PubMed, Medline (Ovid SP), The Cochrane Library, China Biology Medicine Database, Wanfang Database, Chinese Periodical Database, Chinese Clinical Trial Registry, and China Knowledge Resource Integrated Database. Meta-analysis was performed using Rev. Man 5.3.ResultsFifteen studies involving 735 participants were included in the analysis. Compared to conventional therapy, TCM has a significant effect on reducing intra-abdominal pressure (IAP) [15 studies, 700 patients, standard mean difference (SMD) = − 0.93, 95% credibility interval (CI): − 1.35- -0.52], improving the APACHE II (five studies, 199 patients, SMD = − 0.75, 95% CI: − 1.30- -0.21), and shortening the length of hospitalization (LOH) (six studies, 214 patients, SMD = − 1.21, 95% CI: − 1.50- -0.91). The influence of mortality (six studies, 241 patients) was not significant [The pooled risk ratio (RR) was − 0.07 (95% CI: − 0.17- 0.03)].ConclusionsTCMs seem to be effective for patients with IAH and ACS; however, most of the reviewed trials are of poor quality. Large-scale, high-quality clinical trials are warranted.     

Effects of mind–body exercises on the physiological and psychosocial well-being of individuals with Parkinson's disease: A systematic review and meta-analysis

ObjectivesThe effects of mind–body exercises on individuals with chronic illnesses have attracted increasing attention. However, little effort had been made to systematically review the effects of these mind–body exercises on individuals with Parkinson’s disease (PD). This review aimed to appraise the current evidence of the effects of mind–body exercises on the physiological and psychological outcomes for the PD population.DesignSystematic review and meta-analysis of randomized controlled trials.Data sourcesFour English databases, namely, the EMBASE, Ovid Medline, Psych Info, and Cochrane Library, were searched on January 2016.Review methodsStudies involving participants with idiopathic PD were included if mind–body exercises were applied and compared with a non-exercise control to improve physiological and psychosocial well-being. The Effective Public Health Practice Project quality assessment tool was used for quality appraisal. RevMan 5.3 was employed to perform this meta-analysis. A subgroup analysis regarding the types and the dose of intervention was conducted to explore the sources of heterogeneity.ResultsTen studies met the inclusion criteria for quality appraisal. The overall methodological rating of these studies indicated that one study was strong; five studies were moderate; and four studies were weak. Nine articles comprising five Tai Chi, two yoga, and two dance studies were included in the meta-analysis. The results of this review showed that mind–body exercises had a large, significant beneficial effect in motor symptoms in terms of UPDRS III for people with mild to moderate PD [SMD = −0.91, 95% CI (−1.37, −0.45), p < 0.05]. Significant subgroup differences were found among various types of mind–body exercises (p = 0.001). Yoga demonstrated the largest and most significant beneficial effect in reducing UPDRS III scores [SMD = −2.35, 95% CI (−3.21, −1.50), p < 0.01]. The pooled meta-analysis results showed that mind–body exercises had a large, significant effect in improving postural instability in terms of the Berg Balance Scale [SMD = 1.48, 95% CI (0.91, 2.06), p < 0.01] and Timed Up and Go test [SMD = −0.97, 95% CI (−1.46, −0.47), p < 0.01] and moderate, significant effect in improving functional mobility in terms of the Six-minute Walk test [SMD = 0.78, 95% CI (0.35, 1.21), p < 0.05].ConclusionsThis review found that mind–body exercises demonstrated immediate moderate to large beneficial effects on motor symptoms, postural instability, and functional mobility among individuals with mild to moderate PD. However, the effects of mind–body exercises on psychosocial well-being had not been amply investigated, especially for yoga intervention. Future research should address the psychosocial effects of mind–body exercises on the PD population.     

Effects of acupressure on chemotherapy-induced nausea and vomiting-a systematic review with meta-analyses and trial sequential analysis of randomized controlled trials

BackgroundAcupressure has been used as an effective way in treating with stomach upset. However the efficacy of acupressure in preventing chemotherapy-induced nausea and vomiting is uncertain.ObjectiveTo assess the effectiveness of acupressure on three categories of chemotherapy-induced nausea and vomiting.Data sourcesDatabases had been retrieved from inception through February 2016 for the randomized controlled trials in accordance with the inclusion criteria, including PubMed, Cochrane Central Register of Controlled Trials, Web of Science, EMBASE, Science Direct, CINAHL, China Biology Medicine, Chinese National Knowledge infrastructure, Wan Fang and Database for Chinese Technical Periodicals. Additional studies were identified through hand searches of bibliographies and Internet searches.DesignSystematic review with meta-analyses and trial sequential analysis of randomized controlled trials.Review methodsTwo reviewers selected relevant eligible articles, critical appraisal of the methodological quality was conducted on the basis of using Cochrane Handbook. A standardized Excel form was used to extract information. Meta-analysis and trial sequential analysis was performed using software RevMan 5.3 and TSA 0.9.ResultsTwelve studies with 1419 patients were included. Only three studies were assessed as high quality, one study was evaluated as moderate, and eight studies were evaluated as poor. The meta-analysis showed that acupressure reduced the severity of acute (SMD = −0.18, 95% CI −0.31 to −0.05, p < 0.01) and delayed (SMD = −0.33, 95% CI −0.64 to −0.01, p = 0.04) nausea. However, there was no benefit effect on the incidence or frequency of vomiting. No definitive conclusions were drawn from the trial sequential analysis.ConclusionThis systematic review suggested a protective effect of acupressure on chemotherapy-induced nausea and vomiting, while more well-designed clinical trials with larger sample size were needed to draw a definitive conclusion.     

Acupoint stimulation,massage therapy and expressive writing for breast cancer: A systematic review and meta-analysis of randomized controlled trials

Researches have accumulated using non-pharmacologic interventions including acupoint stimulation, massage therapy and expressive writing to manage breast cancer-related symptoms. Results from randomized controlled trials (RCTs) can get contradictory.ObjectiveA systematic review and meta-analysis were conducted to determine the effects on the quality of life, negative emotions and disease-related symptoms among women with breast cancer.MethodsTwo independent researchers performed a structured search using data sources including MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, EMBASE, PubMed and PsychINFO from the beginning of time until the first week of January 2015. A total of 23 acupoint stimulation, massage therapy and expressive writing RCTs were included in the review.ResultsThe study showed that no single intervention could be put under the spotlight exhibiting an overall effective result on all measured outcomes; however, looking into each one in detail shows different results in specific outcomes. Among the three interventions, acupoint stimulation has a treatment effect for general pain (MD = −1.46, 95% CI = −2.38 to −0.53) and fatigue (MD = −2.22, 95% CI = −3.68 to −0.77), massage therapy has a treatment effect for anxiety (MD = −0.50, 95% CI = −0.77 to −0.24), and expressive writing has a treatment effect for quality of life (MD = 7.18, 95% CI = 0.38 to 13.98). The measurement other outcomes showed either ineffective or equivocal results.ConclusionNon-pharmacologic interventions including acupoint stimulation, massage therapy and expressive writing have an effect on a middle-age woman with breast cancer. However, because of limitations, the seemingly promising results should be interpreted with caution.     

Effectiveness of static stretching positioning on post-stroke upper-limb spasticity and mobility: Systematic review with meta-analysis

ObjectiveTo systematically review the effects of static stretching with positioning orthoses or simple positioning combined or not with other therapies on upper-limb spasticity and mobility in adults after stroke.MethodsThis meta-analysis was conducted according to PRISMA guidelines and registered at PROSPERO. MEDLINE (Pubmed), Embase, Cochrane CENTRAL, Scopus and PEDro databases were searched from inception to January 2018 for articles. Two independent researchers extracted data, assessed the methodological quality and rated the quality of evidence of studies.ResultsThree studies (57 participants) were included in the spasticity meta-analysis and 7 (210 participants) in the mobility meta-analysis. Static stretching with positioning orthoses reduced wrist-flexor spasticity as compared with no therapy (mean difference [MD] = −1.89, 95% confidence interval [CI] −2.44 to −1.34; I² 79%, P < 0.001). No data were available concerning the spasticity of other muscles. Static stretching with simple positioning, combined or not with other therapies, was not better than conventional physiotherapy in preventing loss of mobility of shoulder external rotation (MD = 3.50, 95% CI −3.45 to 10.45; I² 54.7%, P = 0.32), shoulder flexion (MD = −1.20, 95% CI −8.95 to 6.55; I² 0%, P = 0.76) or wrist extension (MD = −0.32, 95% CI −6.98 to 5.75; I² 38.5%, P = 0.92). No data were available concerning the mobility of other joints.ConclusionThis meta-analysis revealed very low-quality evidence that static stretching with positioning orthoses reduces wrist flexion spasticity after stroke as compared with no therapy. Furthermore, we found low-quality evidence that static stretching by simple positioning is not better than conventional physiotherapy for preventing loss of mobility in the shoulder and wrist. Considering the limited number of studies devoted to this issue in post-stroke survivors, further randomized clinical trials are still needed.Clinical Trial RegistrationPROSPERO (CRD42017078784).     

Wenxin Keli for Ventricular premature complexes with Heart failure: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

ObjectiveTo evaluate the efficacy and safety of Wenxin Keli (WXKL) alone or combined with Western medicine in treating ventricular premature complexes (VPCs) with heart failure (HF).MethodsWe searched five databases to identify relevant randomized controlled trials (RCTs) published before May 2016. Two review authors independently searched and screened the literature, extracted the data as well as assessed the methodological quality of the included studies by using criteria from the Cochrane Handbook, and analyzed via using Review Manager 5.3 software.ResultsEight studies of WXKL were included. The results of the Meta-analysis showed that WXKL was more significant on the frequency of VPCs (MD = −427.08, 95% CI: −526.73 ∼ −327.43, P < 0.01), left ventricular ejection fraction (LVEF) (MD = −4.12, 95% CI: 2.97 ∼ 5.27, P < 0.01), the total effect of VPCs (RR = 0.48, 95% CI: 0.34 ∼ 0.69, P < 0.01) and 6-min walking test (MD = 28.05, 95% CI: 19.56 ∼ 36.54, P < 0.01). The treatment group presented a significant reduction at left ventricular end-diastolic diameter (LVED) (MD = −3.94, 95% CI: −6.57 ∼ −1.31, P < 0.01) when treatment time was 12 weeks, however, there was no statistical difference at 8 weeks. In addition, the included trials generally showed low methodological quality.ConclusionsWenxin Keli may be effective and safe for treating VPCs and HF. However, further RCTs of larger scale, multi-center/country, longer follow-up periods, and higher quality are still required to verify the efficacy of Wenxin Keli in ventricular premature beat with heart failure.     

The addition of blood flow restriction to resistance exercise in individuals with knee pain: a systematic review and meta-analysis

BackgroundBlood flow restriction (BFR) is an effective clinical intervention used to increase strength in healthy individuals. However, its effects on pain and function in individuals with knee pain are unknown.ObjectiveTo determine the effectiveness of adding BFR to resistance exercise for pain relief and improvement of function in patients with knee pain.MethodsSystematic review with meta-analysis of randomized clinical trials. Medline, Central, Embase, PEDro, Lilacs, CINAHL, SPORTDiscus, and Web of Science databases were searched from inception to May 2019. Randomized clinical trials that compared resistance exercise with or without BFR to treat knee pain and function in individuals older than 18 years of age with knee pain were included.ResultsEight randomized clinical trials met the eligibility criteria and for the quantitative synthesis, five studies were included. The pooled standardized mean difference (SMD) estimate showed that resistance exercises with BFR was not more effective than resistance exercises for reducing pain (SMD: −0.37 cm, 95% CI = −0.93, 0.19) and improving knee function (SMD = −0.23 points, 95% CI = −0.71, 0.26) in patients with knee pain.ConclusionIn the short term, there is low quality of evidence that resistance exercise with BFR does not provide significant differences in pain relief and knee function compared to resistance exercises in patients with knee pain.PROSPERO registration number: CRD42018102839.     

A systematic review and meta-analysis of the herbal formula Buzhong Yiqi Tang for stable chronic obstructive pulmonary disease

ObjectiveTo systematically evaluate the efficacy and safety of Buzhong Yiqi Tang (BZYQT) for stable chronic obstructive pulmonary disease (COPD).MethodsThree electronic English databases (PubMed, EMBASE and CENTRAL) and four Chinese databases (CBM, CNKI, CQVIP and WFMO) were searched from their inceptions until 30th June 2016. Participants were diagnosed with COPD according to the Chinese Medical Association’s COPD diagnosis and treatment guidelines or Global Initiative for Chronic Obstructive Lung Disease (GOLD), and were in stable stage. Randomized controlled trials (RCTs) of oral BZYQT, alone or combined with conventional treatment, compared with conventional treatment alone or plus placebo were included in the review. Clinical improvement and the six-minute walking test (6MWT) were the primary outcome measures. The secondary outcome measures were defined as forced expiratory volume in one second (FEV1), forced vital capacity (FVC), respiratory muscle strength index with maximum inspiratory pressure (MIP), COPD Assessment Test (CAT), and frequency of acute exacerbations. To assess risk of bias the Cochrane, Risk of Bias tool was used, and statistical analysis was performed using RevMan 5.3.0 software.ResultsSixteen studies (1400 participants) were included. The results of meta-analysis indicated patients receiving BZYQT alone or BZYQT in combination with conventional treatment showed a significant increase in clinical improvement (RR 1.25, 95% CI 1.18 to 1.33, I² = 0%), enhanced exercise capacity 6MWT (MD 51.22 m, 95% CI 45.56 to 56.89, I² = 44%), improved lung function FVC (L) (MD 0.26 liters, 95% CI 0.18 to 0.33, I² = 37%), reduced respiratory muscle fatigue MIP (MD 0.46 liters, 95% CI 0.11 to 0.80, I² = 0%), and improved quality of life CAT (MD −2.56 points, 95% CI −3.40 to −1.72, I² = 0%) when compared with conventional treatment alone, or plus placebo. BZYQT also showed small but significant improvements in FEV1% and decreased acute exacerbations of COPD. Four studies reported that no adverse events occurred, other studies did not mention adverse events. The finding should be considered with caution because the included studies had methodological shortfalls.ConclusionsBZYQT improves clinically important outcomes for patients with stable COPD, such as improved clinical symptoms, exercise capacity, lung function and quality of life. Moreover, it has an excellent safety profile. However further evaluation is needed to validate these preliminary findings in high quality RCTs.     

Chinese herbal medicine Kuntai capsule for treatment of menopausal syndrome: a systematic review of randomized clinical trials

ObjectivesKuntai capsule has been widely used for the treatment of menopausal syndrome in China for long time. We conducted this review to assess efficacy and safety of Kuntai capsule for the treatment of menopausal syndrome.MethodsWe searched studies in PubMed, ClinicalTrials, the Cochrane Library, China National Knowledge Infrastructure Database(CNKI), China Science and Technology Journal Database (VIP), Wan fang Database and Chinese Biomedical Literature Database(CBM) until November 20, 2014. Randomized trials on Kuntai capsule for menopausal syndrome, compared with placebo or hormone replacement therapy (HRT) were included. Two reviewers independently retrieved the randomized controlled trials (RCTs) and extracted the information. The Cochrane risk of bias method was used to assess the quality of the included studies, and a Meta-analysis was conducted with Review Manager 5.2 software.ResultsA total of 17 RCTs (1455 participants) were included. The studies were of low methodological quality. Meta-analysis indicated that there was no statistical difference in the Kupperman index (KI) [WMD = 0.51, 95% CI (−0.04, 1.06)], the effective rate of KI [OR = 1.21, 95% CI (0.72, 2.04)], E2 level [WMD = −15.18, 95% CI (−33.93, 3.56)], and FSH level [WMD = −3.46, 95% CI (−7.2, 0.28)] after treatment between Kuntai versus HRT group (P > 0.05). However, Compared with HRT, Kuntai capsule could significantly reduce the total incidence of adverse events [OR = 0.28, 95% CI (0.17, 0.45)].ConclusionsKuntai capsule may be effective for treating menopausal syndrome and lower risk of side effects. The studies we analyzed were of low methodological quality. Therefore, more strictly designed large-scale randomized clinical trials are needed to evaluate the efficacy of Kuntai capsule in menopausal syndrome.     

Effectiveness of mechanical diagnosis and therapy in patients with non-specific chronic low back pain: a literature review with meta-analysis

ObjectiveTo determine the effectiveness of mechanical diagnosis and therapy (MDT) in patients with chronic low back pain (CLBP) compared to other traditional physical therapy interventions.MethodsRandomized controlled trials investigating the effect of MDT compared to other traditional physical therapy interventions in individuals with CLBP were considered eligible. For the purpose of this review, MDT was compared to active and passive physical therapy interventions. Independent reviewers assessed the eligibility of studies, extracted data, and assessed the risk of bias. The primary outcomes investigated were pain and disability.ResultsFourteen studies were included in the review. Of these, 11 provided data to be included in the meta-analyses. Our findings showed that MDT was no more effective in decreasing pain (standardized mean difference [SMD] = 0.01, 95% confidence interval [CI]: ?0.44, 0.46) and disability (SMD = 0.08, 95% CI: ?0.53, 0.68) than other active treatments. Similar results were found when comparing MDT to other passive treatments for pain (SMD = ?0.39, 95% CI: ?0.90, 0.11) and disability (SMD = ?0.13, 95% CI: ?0.29, 0.03).ConclusionThere is low to moderate quality evidence that MDT is not superior than other traditional physical therapy interventions in improving pain and disability in people with CLBP.     

Baduanjin exercise for patients with breast cancer: A systematic review and meta-analysis

ObjectiveBaduanjin exercise is a traditional Chinese mind-body exercise routine characterized by slow, coordinated, and sequential movements. We have performed the first meta-analysis on the main effect of Baduanjin exercise in patients with breast cancer.MethodsThis study followed the 2020 PRISMA guideline. We searched for randomized controlled trials in PubMed, Embase, Cochrane Library, Web of Science, Clinical Trials.gov, Chinese National Knowledge Infrastructure, Wanfang Data Information Site, Chinese Biomedical Database, and Chinese Science and Technique Journals Database through 31 August 2022. Data were analyzed for the outcomes of quality of life, anxiety, and depression. Review Manager 5.4 software was used for data analysis.ResultsSeven randomized controlled trials with a total of 537 patients with breast cancer were examined. Compared with the control therapies, Baduanjin exercise significantly improved the total quality of life score (SMD = 0.83; 95 % CI, 0.58–1.08; P < 0.00001) and in two associated domains: emotional well-being (SMD = 0.67; 95 % CI, 0.26–1.07; P = 0.001), functional well-being (SMD = 0.55; 95 % CI, 0.30–0.79; P < 0.00001) and breast cancer subscale (SMD = 0.39; 95 % CI, 0.02–0.77; P = 0.04). Meanwhile, it significantly reduced anxiety score (SMD = − 0.60; 95 % CI, − 1.15 to − 0.05; P = 0.03) and in depression score (SMD = − 0.70 95 % CI, − 0.97 to − 0.42; P < 0.00001). None adverse event was reported.ConclusionThe meta-analysis suggests that Baduanjin exercise is an effective and safe exercise for improving quality of life and alleviating depression and anxiety in patients with breast cancer. Significant methodological concerns of the included studies limit the interpretation of the results. For future trials of Baduanjin exercise on BC, we highlight the importance of adopting more rigorous study design in terms of assessor blinding, hypothesis/purpose blinding, allocation concealment, objective outcome selection and consistent reporting of adverse events.     

Tanreqing injection for acute bronchitis disease: A systematic review and meta-analysis of randomized controlled trials

BackgroundAcute bronchitis (AB) is one of the common diseases. Tanreqing injection (TRQ) was widely used to treat patients with acute bronchitis, and many randomized controlled trials have been conducted to investigate its efficacy.ObjectiveThe purpose of this systematic review is to evaluate the efficacy and safety of TRQ for AB.MethodsEight English and Chinese electronic databases, up to October 2014, were searched to identify randomized controlled trials on TRQ for AB. Two reviewers independently extracted data and assessed the quality of each trial by using Cochrane handbook. Meta-analysis was carried out by using Review Manager software.ResultA total of 49 trials with 5131 participants were collected. Data of three main outcomes were pooled and analyzed as following: (1) effective rates: TRQ versus antibiotics (RR 1.12; 95% CI 1.05, 1.18; P = 0.0002); TRQ plus antiviral drugs versus antiviral drugs (RR: 5.12; 95% CI 3.03, 8.66; P < 0.00001); TRQ plus antibiotics versus antibiotics (RR 3.46; 95% CI 2.59, 4.62; P < 0.00001); TRQ versus antibiotics plus antiviral drugs (RR 2.03; 95% CI 1.10, 3.74; P = 0.02); TRQ plus conventional therapy versus conventional therapy alone (RR 1.21; 95% CI 1.15, 1.27; P < 0.00001). (2) Time for fever resolution: TRQ plus antiviral drugs versus antiviral drugs (MD: −1.08; 95% CI −1.59, −0.57; P < 0.00001); TRQ plus antibiotics versus antibiotics (MD −1.33; 95% CI −1.81, −0.86; P < 0.00001); TRQ versus antibiotics plus antiviral drugs (MD −0.88; 95% CI −1.25, −0.51; P < 0.00001); TRQ plus conventional therapy versus conventional therapy alone (MD −1.06; 95% CI −1.13, −0.98; P < 0.00001). (3) Resolution of cough: TRQ plus antiviral drugs versus antiviral drugs (MD: −2.09; 95% CI −3.11, −1.43; P < 0.00001); TRQ plus antibiotics versus antibiotics (MD: −2.65; 95% CI −2.88, −2.42; P < 0.00001); TRQ plus conventional therapy versus conventional therapy alone (MD −1.84; 95% CI −2.85, −0.83; P = 0.0003). Four trials described the adverse drug reactions of TRQ, while no severe adverse drug reactions reported.ConclusionsAs a therapy for AB, TRQ has potentially beneficial effect in improving effective rates, reducing the time to resolution of fever, cough, crackles and absorption of shadows on X-ray. However, due to the limitations of methodological quality of the included trials, it is difficult to make a conclusive recommendation about TRQ treating patients with AB. Further rigorous clinical trials are warranted to evaluate the efficacy and safety of TRQ.     

The effect of Chinese herbal medicine on hemorrhagic shock: A systematic review and meta-analysis

BackgroundChinese herbal medicine (CHM) has been widely used in the treatment of hemorrhagic shock (HS) in China. Many controlled trials have been undertaken to investigate its efficacy.ObjectiveTo evaluate the effectiveness and safety of CHM for Hemorrhagic Shock patients.MethodsWe screening the Web of ScienceDirect database, PubMed, the Cochrane Library, EMBASE, China Biomedical Database web (CBM), China National Knowledge Infrastructure (CNKI) and WanFang database (WF), from inception to January 2015. All the randomized controlled trials (RCTs) that compared CHM plus conventional therapy with conventional therapy alone for HS patients were included. Meta-analysis on included studies was performed using fixed-effects model with RevMan 5.2. Risk ratio (RR) or mean difference (MD) with a 95% confidence interval (CI) was used as effect measure. STATA 12.0 was used for publication bias.ResultsFifteen RCTs involving 1076 participants were included in the meta-analysis. CHM combined with conventional therapy was tested to be more effective in reduce mortality (RR = 0.24, 95%CI:0.13–0.46, P < 0.0001), reduce the incidence of MODS (RR = 0.47, 95%CI: 0.34–0.66,P < 0.00001), symptomatic improvement: increase blood pressure (BP) (MD = 8.83, 95%CI:6.82–10.84,P < 0.00001), regulate heart rate (MD = −7.6,95%CI:−9.17 to −6.02,P < 0.00001), increase urine volume (MD = 7.26, 95%CI:5.00–9.53, P < 0.00001), compared with conventional therapy alone. No serious adverse events were reported.ConclusionsCHM combined with conventional therapy seems to be more effective on HS patients. However, the analysis results should be interpreted with caution due to the low methodological quality of the included trials. Future, the rigorously designed, high methodological quality, multicenter and large-scale trials are needed to confirm these conclusions.     

Influence of reducing anterior pelvic tilt on shoulder posture and the electromyographic activity of scapular upward rotators

BackgroundModifications of posture in a segment may influence the posture of adjacent and nonadjacent segments and muscular activity. The spine–shoulder and spine–pelvis relationships suggest that the pelvis may influence shoulder posture.ObjectiveTo investigate the effect of the active reduction of the anterior pelvic tilt on shoulder and trunk posture during static standing posture and on the electromyographic activity of the scapular upward rotators during elevation and lowering of the arm.MethodsThirty-one young adults were assessed in a relaxed standing position and a standing position with 30% active reduction of the anterior pelvic tilt. The pelvic tilt, trunk posture, and forward shoulder posture during the static standing posture and the electromyographic activity during elevation and lowering of the arm were assessed.ResultsPaired t-tests indicated that the active reduction of the anterior pelvic tilt reduced the trunk extension (MD = 1.09; 95%CI = −2.79 to −1.03). There were no effects on the forward shoulder posture (MD = 0.09; 95%CI = −0.92 to 1.09). Repeated measures of analyses of variance indicated an increase in lower trapezius electromyographic activity (MD = 3.6; 95%CI = 1.28 to 5.92). There was a greater reduction in upper trapezius activity after pelvic tilt reduction during arm elevation (MD = 1.52%; 95%CI = −2.79 to −0.25) compared to that during the lowering phase. There were no effects of pelvic tilt reduction on the electromyographic activity of the serratus anterior (MD = 3.26; 95%CI = −3.36 to 9.87).ConclusionThe influence of pelvic posture on the trunk posture and lower trapezius activation should be considered when assessing or planning exercise for individuals with shoulder or trunk conditions.     

A nurse facilitated mind-body interactive exercise (Chan-Chuang qigong) improves the health status of non-Hodgkin lymphoma patients receiving chemotherapy: Randomised controlled trial

BackgroundNon-Hodgkin’s lymphoma is a heterogeneous group of lymphoproliferative malignancies. Chemotherapy can improve patient survival rates, yet it is also associated with many adverse physical and psychosocial effects. It is suggested that qigong practices may be used to reduce patient distress and side effects.ObjectivesTo evaluate the effects of Chan-Chuang qigong on fatigue, complete blood cells, sleep quality, and quality of life for patients with non-Hodgkin lymphoma who had undergone the first course of chemotherapy.DesignA randomized controlled study.SettingsAn oncology ward of medical centre in northern Taiwan.ParticipantsFifty participants in each of the two groups.MethodsParticipants were randomly assigned to either the qigong group (n = 50) that received a 21-day Chan-Chuang qigong programme, or the control group (n = 50). The primary outcome was fatigue measured by Brief Fatigue Inventory. The secondary outcomes were complete blood cell counts, sleep quality measured by Verran and Snyder-Halpern Sleep Scale, and quality of life measured by European Organization for Research and Treatment of Cancer Quality of Life Questionnaire.ResultsAfter 21 days of intervention, the results obtained from ninety six participants were analysed. Participants in the qigong group exhibited decreased fatigue intensity and fatigue interference from 5.49 (SD = 1.02) and 5.53 (SD = 1.27) to 0.37 (SD = 1.39) and 0.20 (SD = 1.93), respectively. Generalized estimating equations analyses revealed that the qigong group, when compared to the control group, had significant improvement in fatigue intensity and fatigue interference over time (β = −1.04, 95% confidence interval [CI] from −1.59 to −0.48, p < 0.001; and β = −1.22, 95% CI from −1.86 to −0.59, p < 0.001, respectively). There was a significant between-group difference in the improvement in white blood cell counts (t = 5.14, p < 0.001), hemoglobin levels (t = 3.17, p = 0.002), and sleep quality (t = 17.73, p < 0.001), but not in platelet counts (p = 0.05). With regard to quality of life, the scores of the qigong group improved in all subscales and all symptom items when compared to that of the control group. No adverse effects were observed in the qigong group.ConclusionsThe findings of this study indicate that the 21-day Chan- Chuang qigong can reduce fatigue intensity and fatigue interference, and improved white blood cell counts, haemoglobin levels, sleep quality, and quality of life for patients with non-Hodgkin lymphoma who had undergone the first course of chemotherapy. Further studies involving a prolonged extended intervention period and follow-up are necessary for determining the long-term effect of qigong exercise.     

Predictors of change in social networks,support and satisfaction following a first episode psychosis: A cohort study

BackgroundDiminished social networks are common in psychosis but few studies have measured these comprehensively and prospectively to determine how networks and support evolve during the early phase. There is little information regarding perceived support in the early phase of illness. The aim of this study was to describe social support, networks and perceived satisfaction, explore the clinical correlates of these outcomes and examine whether phases of untreated psychosis are linked with social network variables to determine potential opportunities for intervention.MethodsDuring the study period, we assessed 222 people with first-episode psychosis at entry into treatment using valid and reliable measures of diagnosis, positive and negative symptoms, periods of untreated psychosis and prodrome and premorbid adjustment. For follow-up we contacted participants to conduct a second assessment (n = 158). There were 97 people who participated which represented 61% of those eligible. Social network and support information obtained at both time points included the number of friends, self-reported satisfaction with support and social network size and clinician’s evaluation of the degree of support received through networks. Mixed effects modelling determined the contribution of potential explanatory variables to social support measured.ResultsA number of clinical variables were linked with social networks, support and perceived support and satisfaction. The size of networks did not change over time but those with no friends and duration of untreated psychosis was significantly longer for those with no friends at entry into treatment (n = 129, Median = 24.5 mths, IQR = 7.25–69.25; Mann-Whitney U = 11.78, p = 0.008). Social support at baseline and at one year was predicted by homelessness (t = −2.98, p = 0.001, CI −4.74 to −1.21), duration of untreated psychosis (t = −0.86, p = 0.031, CI −1.65 to −0.08) and premorbid adjustment (t = −2.26, p = 0.017, CI −4.11 to −0.42). Social support improved over time but the duration of untreated psychosis was not linked with the rate of improvement in this outcome.ConclusionsImproved social support could indicate greater reliance on social support or becoming more adept at mobilising resources to meet social needs. Particularly vulnerable groups with very long duration of untreated psychosis confirm the need for earlier intervention or targeted social network interventions to preserve social connectedness.     

An evidence map of yoga for low back pain

ObjectiveYoga is being increasingly studied as a treatment strategy for a variety of different clinical conditions, including low back pain (LBP). We set out to conduct an evidence map of yoga for the treatment, prevention and recurrence of acute or chronic low back pain (cLBP).MethodsWe searched Medline, Cochrane Database of Systematic Reviews, EMBASE, Allied and Complementary Medicine Database and ClinicalTrials.gov for randomized controlled trials (RCT), systematic reviews or planned studies on the treatment or prevention of acute back pain or cLBP. Two independent reviewers screened papers for inclusion, extracted data and assessed the quality of included studies.ResultsThree eligible systematic reviews were identified that included 10 RCTs (n = 956) that evaluated yoga for non-specific cLBP. We did not identify additional RCTs beyond those included in the systematic reviews. Our search of ClinicalTrials.gov identified one small (n = 10) unpublished trial and one large (n = 320) planned clinical trial. The most recent good quality systematic review indicated significant effects for short- and long-term pain reduction (n = 6 trials; standardized mean difference [SMD] −0.48; 95% CI, −0.65 to −0.31; I² = 0% and n = 5; SMD −0.33; 95% CI, −0.59 to −0.07; I² = 48%, respectively). Long-term effects for back specific disability were also identified (n = 5; SMD −0.35; 95% CI, −0.55 to −0.15; I² = 20%). No studies were identified evaluating yoga for prevention or treatment of acute LBP.ConclusionEvidence suggests benefit of yoga in midlife adults with non-specific cLBP for short- and long-term pain and back-specific disability, but the effects of yoga for health-related quality of life, well- being and acute LBP are uncertain. Without additional studies, further systematic reviews are unlikely to be informative.     

Depth of anaesthesia monitoring during procedural sedation and analgesia: A systematic review and meta-analysis

ObjectivesProcessed electroencephalogram-based depth of anaesthesia monitoring devices provide an additional method to monitor level of consciousness during procedural sedation and analgesia. The objective of this systematic review was to determine whether using a depth of anaesthesia monitoring device improves the safety and efficacy of sedation.DesignSystematic review and meta-analysis.Data sourcesElectronic databases (CENTRAL; Medline; CINAHL) were searched up to May 2015.Review methodsRandomised controlled trials that compared use of a depth of anaesthesia monitoring device to a control group who received standard monitoring during procedural sedation and analgesia were included. Study selection, data extraction and risk of bias assessment (Cochrane risk of bias tool) were performed by two reviewers. Safety outcomes were hypoxaemia, hypotension and adverse events. Efficacy outcomes were amount of sedation used, duration of sedation recovery and rate of incomplete procedures.ResultsA total of 16 trials (2138 participants) were included. Evidence ratings were downgraded to either low or moderate quality due to study limitations and imprecision. Meta-analysis of 8 trials (766 participants) found no difference in hypoxaemia (RR 0.87; 95% CI = 0.67–1.12). No statistically significant difference in hypotension was observed in meta-analysis of 8 trials (RR 0.96; 95% CI = 0.54–1.7; 942 participants). Mean dose of propofol was 51 mg lower for participants randomised to depth of anaesthesia monitoring (95% CI = −88.7 to −13.3 mg) in meta-analysis of results from four trials conducted with 434 participants who underwent interventional endoscopy procedures with propofol infusions to maintain sedation. The difference in recovery time between depth of anaesthesia and standard monitoring groups was not clinically significant (standardised mean difference −0.41; 95% CI = −0.8 to −0.02; I² = 86%; 8 trials; 809 participants).ConclusionsDepth of anaesthesia monitoring did impact sedation titration during interventional procedures with propofol infusions. For this reason, it seems reasonable for anaesthetists to utilise a depth of anaesthesia monitoring device for select populations of patients if it is decided that limiting the amount of sedation would be beneficial for the individual patient. However, there is no need to invest in purchasing extra equipment or training staff who are not familiar with this technology (e.g. nurses who do not routinely use a depth of anaesthesia monitoring device during general anaesthesia) because there is no high quality evidence suggestive of clear clinical benefits for patient safety or sedation efficacy.     

Clinical effectiveness of individual patient education in heart surgery patients: A systematic review and meta-analysis

The objective of this systematic review was to compare the effectiveness of individualized patient education interventions to standardized patient education interventions on the rate of readmission, performance of specific health behaviours, depression, anxiety, and cognition during the post-hospital discharge recovery period following cardiovascular surgery.Design and data sourcesRandomized controlled trials that included study participants who underwent their first bypass and/or valve replacement surgery; were eighteen years of age or older; and were recovering in the community.Review methodsFor all data analyzed, data was entered based on the principle of intention to treat. To be included in a given comparison, outcome data had to have been available for at least 80% of those who were randomized. Assessment of statistical heterogeneity was tested. Generic inverse variance methods based on random effects models were used to pool effect estimates across included studies.ResultsSeventeen trials involving 2624 study participants where individualized patient education was the primary interventional intent was included in this review. Four studies that included 930 participants reported on hospital readmissions. The sources of bias that remain unclear or were judged as containing high risk of bias most frequently across included trials were blinding of outcome assessment, incomplete outcome data, and selective reporting. An effect of the individualized patient education in reducing hospital readmission rates (Mean Difference: −1.28, 95% CI −1.87 to −0.68, p < 0.00), depression (Mean Difference: −23.32, 95% CI −23.70 to −22.95, p < 0.00), and anxiety (Mean Difference: −19.34, 95% CI −20.46 to −18.23, p < 0.00) was noted. While an increase in the performance of specific health behaviours (Mean Difference: 3.45, 95% CI 3.27–3.63, p < 0.00) and cognition (Mean Difference: 11.17, 95% CI 10.66–11.68, p < 0.00) was found. Most effect estimates were prone to statistical heterogeneity among the trials.ConclusionThe findings from this systematic review suggest favorable effects on the readmission rates. However, a major limitation notes in the current body of evidence relates to the small number of or even lacking number of trials for clinically important outcomes. As well, the individualized patient education intervention is effective in promoting statistically significant changes in quality of life, performance of health behaviours, depression, and anxiety.     

Effects of exercise programs on depressive symptoms,quality of life,and self-esteem in older people: A systematic review of randomized controlled trials

ObjectiveThis study attempted to show evidence of exercise programs as intervention to decrease depressive symptoms and to improve quality of life and self-esteem in older people.DesignSystematic review of randomized controlled trials.Data sourcesElectronic databases of KoreaMed, Korea Scientific and Technological Intelligence Center, Korean Society of Nursing Science, Korean Academy of Psychiatric Mental Health Nursing, Ovid-Medline and Embase were searched up to May 25th, 2012 for relevant articles.ReviewWe searched studies of randomized controlled trials involving exercise programs administered to participants aged 65 years or over. Of 461 publications identified, 18 met the inclusion criteria for the meta-analysis. Quality assessment of the studies utilized Cochrane's Risk of Bias.ResultsExercise therapy in older people was effective, as evidenced by a decrease in depressive symptoms [standardized mean difference (SMD) − 0.36; 95% confidence interval (CI) − 0.64, − 0.08], and improvements in quality of life (SMD 0.86; 95% CI 0.11, 1.62) and self-esteem (SMD 0.49; 95% CI 0.09, 0.88). The changes were significant statistically, with no heterogeneity.ConclusionsExercise programs in older people are effective in improving depressive symptoms, quality of life and self-esteem. Development and efficient use of tailored exercise programs for elderly people is a prudent strategy.