An evaluation of a nurse-led rehabilitation programme (the ProBalance Programme) to improve balance and reduce fall risk of community-dwelling older people: A randomised controlled trial

ObjectiveThis study aims to assess the effect of a nurse-led rehabilitation programme (the ProBalance Programme) on balance and fall risk of community-dwelling older people from Madeira Island, Portugal.DesignSingle-blind, randomised controlled trial.SettingUniversity laboratory.Participants: Community-dwelling older people, aged 65–85, with balance impairments. Participants were randomly allocated to an intervention group (IG; n = 27) or a wait-list control group (CG; n = 25).InterventionA rehabilitation nursing programme included gait, balance, functional training, strengthening, flexibility, and 3D training. One trained rehabilitation nurse administered the group-based intervention over a period of 12 weeks (90 min sessions, 2 days per week). A wait-list control group was instructed to maintain their usual activities during the same time period.OutcomeBalance was assessed using the Fullerton Advanced Balance (FAB) scale. The time points for assessment were at zero (pre-test), 12 (post-test), and 24 weeks (follow up).ResultsChanges in the mean (SD) FAB scale scores immediately following the 12-week intervention were 5.15 (2.81) for the IG and −1.45 (2.80) for the CG. At follow-up, the mean (SD) change scores were −1.88 (1.84) and 0.75 (2.99) for the IG and CG, respectively. The results of a mixed between-within subjects analysis of variance, controlling for physical activity levels at baseline, revealed a significant interaction between group and time (F (2, 42) = 27.89, p < 0.001, Partial Eta Squared = 0.57) and a main effect for time (F (2, 43) = 3.76, p = 0.03, Partial Eta Squared = 0.15), with both groups showing changes in the mean FAB scale scores across the three time periods. A significant main effect comparing the two groups (F (1, 43) = 21.90, p < 0.001, Partial Eta Squared = 0.34) confirmed a clear positive effect of the intervention when compared to the control.ConclusionThis study demonstrated that the rehabilitation nursing programme was effective in improving balance and reducing fall risk in a group of older people with balance impairment, immediately after the intervention. A decline in balance was observed for the IG after a period of no intervention.Clinical Trial Registration NumberACTRN12612000301864.     

Effect of pulsed electromagnetic field on nonspecific low back pain patients: a randomized controlled trial

BackgroundFurther research on pulsed electromagnetic field (PEMF) effects on the different conditions of low back pain was warranted due to lack of studies in this area.ObjectivesTo investigate the effects of pulsed electromagnetic field therapy with 50 Hz frequency, with low intensity of 20 Gauss compared to conventional non-invasive treatment modalities in patients with chronic non-specific low back pain.MethodsDesign – A prospective, randomized, patient-blinded, controlled trial. Setting – The study was conducted at Outpatient Physiotherapy Clinic in Cairo, Egypt. The study was conducted between May 2015 and September 2016. Participants – Fifty participants with non-specific low back pain enrolled into experimental and control groups. Interventions – The experimental group received the Conventional physical therapy Protocol as well as magnetic field, while the control group received the same Conventional physical therapy and sham electromagnetic field. Both groups received 12 sessions over 4 weeks’ period. Outcome measures – Primary outcome measures was pain intensity while the secondary outcome measures were disability and lumbar range of motion – ROM. There were no adverse events occurred during the study.ResultsFifty participants with non-specific low back pain (control group n = 25; experimental group n = 25) were randomized. There were significant between-group differences in pain scores (mean difference – MD 1.52; 95%CI −0.34 to 3.35), function disability (MD 8.14; 95%CI 6.5 to 9.96), Range of Motion (ROM) of lumbar flexion (MD −1.27; 95%CI −1.09 to −1.45), ROM of lumbar extension (MD −1.1; 95%CI −0.97 to −1.23), ROM of lumbar right side bending (MD 8.2; 95%CI 6.56 to 9.84) and ROM of lumbar left side bending (MD 10.4; 95%CI 8.81 to 11.99) in favour of the experimental group.ConclusionAdding pulsed electromagnetic field to Conventional physical therapy Protocol yields superior clinical improvement in pain, functional disability, and lumbar ROM in patients with non-specific low back pain than Conventional physical therapy alone.     

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.     

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.     

Exercises improve body composition,cardiovascular risk factors and bone mineral density for menopausal women: A systematic review and meta-analysis of randomized controlled trials

BackgroundMenopause has been considered as an aggravating factor for developing cardiovascular diseases and the metabolic syndromes for women. Exercise might be an effective intervention for reducing such threats.ObjectiveThe purpose of this study was to evaluate the exercise effects on body composition, cardiovascular risk factors, and bone mineral density of menopausal women.MethodsTwo reviewers did a complete search of five electronic database (Medline, PubMed, Cochrane Central Register of Controlled Trials, CINAHL, and the Chinese Electronic Periodical Service) records up to January 31, 2014. Randomized controlled trials (RCTs) that compared female menopausal participants with exercises, and those without exercise or with placebo were included. Risk of bias was classified based on the Cochrane Collaboration tool, the meta-analysis was conducted using Comprehensive Meta-Analysis Version 2.2. The study selection, data extraction, and validation were performed independently by the 2 reviewers.ResultsA total of 17 RCTs with 792 participants were included for meta-analysis. Among the eight RCTs (247 participants), a moderate effect size of exercise on body fat was found (SMD = − 0.34, 95% CI: − 0.60 to − 0.08). In five RCTs (195 participants), a moderate effect size of exercise on waist circumference (SMD = − 0.39, 95% CI: − 0.68 to − 0.09), in seven RCTs (162 participants), a moderate effect size on triglyceride level (SMD = − 0.37, 95% CI: − 0.62 to − 0.11), and in five RCTs (311 participants), a moderate effect size on bone mineral density (SMD = 0.38, 95% CI: 0.08–0.68). Subgroup analysis revealed a significant effect of aerobic exercise on body fat (SMD = − 0.29, 95% CI: − 0.53 to − 0.06), and a short-term exercise on body fat (SMD = − 0.50, 95% CI: − 0.89 to − 0.11) and on triglycerides (SMD = − 0.42, 95% CI: − 0.79 to − 0.04). The trials included in this meta-analysis were small and some had methodologic limitations.ConclusionsThis study provides evidences to clinical practice for menopause women that exercise, compared with nonexercise or placebo exerted significant benefits on body fat, waist circumference, triglyceride level, and lumbar spine bone mineral density. Particularly, aerobic exercise did help menopausal women improve their body fat. A short-term exercise intervention had a benefit on not only body fat but also triglyceride level. However, well-designed, well-executed RCTs, and a detailed long-term clinical research should be needed in the future.     

Nigella sativa improves glucose homeostasis and serum lipids in type 2 diabetes: A systematic review and meta-analysis

Background & objective(s)Global prevalence of type 2 diabetes (T2D) is very high and is currently growing alarmingly. With respect to recent researchers' attention to the potential role of herbal medicine in disease prevention and management, the present meta-analysis review investigates the effectiveness of Nigella sativa (N. sativa), a popular herb, in T2D.MethodsLiterature search was conducted covering PubMed/Medline, Scopus, and Cochrane Registry of Clinical Trials up to February 2017 to obtain the relevant published intervention studies. Study selection, quality rating and data extraction of studies were investigated by two independent reviewers. Heterogeneity was assessed using I-squared (I²) statistics test. Subgroup analysis was done to assess type of N. sativa supplement as source of heterogeneity. Effect sizes of eligible studies were pooled using STATA software version 12 (STATA corp, College Station, TX, USA).ResultsSeven trials were included in the meta-analysis of glycemic and serum lipid profile end points. Supplementation with N. sativa significantly improved fasting blood sugar (FBS) [−17.84 mg/dl, 95% CI: −21.19 to −14.49, p < 0.001], HbA1c [−0.71%, 95% CI: −1.04 to −0.39, p < 0.001], total-cholesterol (TC) [WMD: −22.99 mg/dl, 95% CI: −32.16 to −13.83, p < 0.001] and LDL-cholesterol (LDL-c) [−22.38 mg/dl, 95% CI: −33.60 to −11.15, p < 0.001]. The overall effects for triglyceride (TG) [−6.80 mg/dl, 95% CI: −33.59 to 19.99, p = 0.61] and HDL-cholesterol (HDL-c) [0.37 mg/dl, 95% CI: −1.59 to 2.33, p = 0.71] were insignificant. Subgroup analysis revealed significant reduction on TG with N. sativa seed oil [−14.8 mg/dl, 95% CI: −23.1 to −6.5, p < 0.001], while TG was increased with seed powder [29.4 mg/dl, 95% CI: 16.9–42.0, p < 0.001]. All measures, but HbA1c, showed no evidence of publication bias.ConclusionAlthough, the meta-analysis conducted included a few number of studies, but has shown promising results on the effectiveness of N. sativa on glucose homeostasis and serum lipids. Current findings suggest N. sativa supplementation a suitable choice in managing the complications of T2D, although future researches are necessary.     

Anti-spastic effects of footbaths in post-stroke patients: A proof-of-principle study

ObjectivesTo investigate whether a footbath inhibits spasticity in the hemiplegic lower limbs of post-stroke patients.DesignRandomized, controlled study.SettingRehabilitation education and research hospital.InterventionsTwenty-two post-stroke patients were randomly allocated to control or experimental groups. After relaxing in a supine posture for 30 min, the experimental group subject's legs were immersed in 41 °C water below the knee joint for 15 min, while the control group remained in a resting posture.Main outcome measuresModified Ashworth Scale (MAS) scores of the affected triceps surae muscle and F-wave parameters (i.e., F-wave amplitude, F/M ratio, and F-wave persistence) were recorded before, immediately after, and 30 min after each intervention. Physiological parameters were simultaneously monitored to determine the thermo-therapeutic mechanisms and side effects of footbath usage.ResultsAt the time immediately after the intervention, F-wave amplitudes decreased significantly in the experimental group, compared to the control group (p < 0.01, difference: −106.8; 95% CI; −181.58 to −32.09). F-wave amplitudes decreased significantly after 30-min intervention in the experimental group, with a total reduction of 161.2 μV being recorded compared to 8.8 μV increase in the control group (p < 0.01, difference: −170.0; 95% CI; −252.73 to −87.33). There were also significant differences between the experimental and control group for both F/M ratio and F-wave persistence, immediately after and 30 min after the intervention. Further, there were significant differences between the experimental and control group for the MAS scores immediately after the intervention (p < 0.05, difference: −0.72; 95% CI; −1.262 to −0.193), and 30 min after the intervention (p < 0.05, difference: −0.73; 95% CI; −1.162 to −0.293).ConclusionThese findings demonstrate that the use of footbaths is an effective non-pharmacological anti-spastic treatment for use in stroke rehabilitation.     

Collaborative nurse-led self-management support for primary care patients with anxiety,depressive or somatic symptoms: Cluster-randomised controlled trial (findings of the SMADS study)

BackgroundCollaborative, nurse-led care is a well-established model of ambulatory care in many healthcare systems. Nurses play a key role in managing patients’ conditions as well as in enhancing symptom- and self-management skills.ObjectiveThe SMADS trial evaluated the effectiveness of a primary care-based, nurse-led, complex intervention to promote self-management in patients with anxiety, depressive or somatic symptoms. Change in self-efficacy 12 months post baseline was used as the primary outcome.DesignThe SMADS trial set up a two-arm, cluster randomised controlled trial in the city of Hamburg, a large metropolitan area in the North West of Germany.SettingWe randomly allocated participating primary care practices to either the intervention group (IG), implementing a nurse-led collaborative care model, or to the control group (CG), where patients with the above psychosomatic symptoms received routine treatment.ParticipantsPatients from 18 to 65 years of age, regularly consulting a participating primary care practice, scoring ≥ 5 on the anxiety, depressive or somatic symptom scales of the Patient Health Questionnaire (PHQ-D), German version.MethodsA mixed model regression approach was used to analyse the outcome data. Analyses were based on the intention-to-treat population: All enrolled patients were analysed at their follow-up. Additionally, we reported results as effect sizes. The robustness of the results was investigated by performing an observed cases analysis.Results325 participants (IG N = 134, CG N = 191) from ten practices in each study arm consented to take part and completed a baseline assessment. The mean group difference (ITT-LOCF, IG vs. CG) in self-efficacy at the post baseline follow-up (median 406 days) was 1.65 points (95% CI 0.50–2.8) in favour of IG (p = 0.004). This amounts to a small Cohen’s d effect size of 0.33. An observed cases analysis (168 participants, IG = 56, CG = 105) resulted in a mean difference of 3.13 (95% CI 1.07–5.18, p = 0.003) between the groups, amounting to a moderate effect size of d = 0.51.ConclusionA complex, nurse-led intervention, implemented as a collaborative care model, increased perceived self-efficacy in patients with symptoms of anxiety, depression or somatisation compare to control patients. For the first time in the German healthcare system, the SMADS trial validated the belief that a nurse can successfully complement the work of a general practitioner – particularly in supporting self-management of patients with psychosomatic symptoms and their psychosocial needs.     

Uso profiláctico de apósitos de silicona para minimizar las lesiones por presión: revisión sistemática y metaanálisis

ObjectivePreventing hospital-acquired pressure injuries (PI) in critically ill patients remains a significant clinical challenge because of its associated high risk for comorbid conditions. We assessed the preventive effectiveness of silicone dressings among patients admitted in intensive care units and non-intensive care units settings.MethodsA literature search was conducted across 3 electronic databases (MEDLINE, EMBASE, Cochrane Central) from inception through December 2021. Studies assessing the effectiveness of silicone dressing on the incidence of PI on the sacral area were included. evaluations were reported as risk ratios (RRs) with 95% confidence interval, and analysis was performed using a random-effects model.ResultsOf the 1,056 articles retrieved from the initial search, 11 studies were included in the final analysis. Silicone dressings significantly reduced the incidence of PI compared to usual care (RR: 0.30, 95%CI: 0.19-0.45, P < 0.01). We found no significant difference between results of studies conducted in intensive care settings (RR = 0.25, 95%CI: 0.15-0.43, P < 0.01) and non-intensive care settings (RR = 0.38, 95%CI: 0.17-0.83, P = 0.01) (P-interaction: 0.39). Silicone dressings reduced the risk of developing PI among patients using five-layer foam Border dressing (Mepilex® Sacrum) (RR: 0.31, 95%CI: 0.20-0.48, P < 0.01), and dressing Allevyn Gentle Border® (RR: 0.10, 95%CI: 0.01-0.73, P = 0.02) with no significant difference upon subgroup analysis (P-interaction: 0.27).ConclusionThe present meta-analysis suggests that silicone dressings consistently reduce the incidence of PI in intensive as well as in non-intensive care settings, regardless of the type of dressing used.     

Role of yoga for patients with type II diabetes mellitus: A systematic review and meta-analysis

To understand the role and efficacy of yoga in the management of type 2 diabetes mellitus, this meta-analysis was conducted. Electronic data bases searched were PubMed/Medline, ProQuest, PsycINFO, IndMED, CENTRAL, Cochrane library, CamQuest and CamBase till December 17, 2014. Eligible outcomes were fasting blood sugar (FBS), post prandial blood sugar (PPBS) and glycosylated haemoglobin (HBA1C). Randomized controlled trials and controlled trials were eligible. Studies focussing only on relaxation or meditation or multimodal intervention were not included. A total of 17 RCTs were included for review. Data from research articles on patients, methods, interventions- control and results were extracted. Mean and standard deviations were utilized for calculating standardized mean difference with 95% confidence interval. Heterogeneity was assessed with the help of I² statistics. χ² was used to rule out the effects of heterogeneity due to chance alone. Beneficial effects of yoga as an add-on intervention to standard treatment in comparison to standard treatment were observed for FBS [Standardized Mean Difference (SMD) −1.40, 95%CI −1.90 to −0.90, p ˂ 0.00001]; PPBS [SMD −0.91, 95%CI −1.34 to −0.48, p ˂ 0.0001] as well as HBA1C [SMD −0.64, 95%CI −0.97 to −0.30, p ˂ 0.0002]. But risk of bias was overall high for included studies. With this available evidence, yoga can be considered as add-on intervention for management of diabetes.     

Oxygen therapy for acute myocardial infarction: A systematic review and meta-analysis

BackgroundPotential benefits or risks of oxygen inhalation for patients with acute myocardial infarction are not fully understood.ObjectiveWe performed this study to systematically assess the effectiveness and safety of oxygen therapy for patients with acute myocardial infarction.DesignA systematic review and meta-analysis.Data sourcesWe searched randomized controlled trials systematically in PubMed, EMBASE, Web of Science and Cochrane Library up to June 2016.Review methodsRandomized controlled trials that estimated the effectiveness and safety of oxygen therapy for patients with acute myocardial infarction were identified by two independent reviewers. The primary outcomes were short-term mortality and recurrent rate of myocardial infarction, and the secondary outcomes were arrhythmia incidence and pain incidence. Relative risks (RRs) and 95% confidence intervals (CIs) were used to measure the pooled data.ResultsA total of five randomized controlled trials were in accordance with inclusion criteria and were included in this meta-analysis. Compared with no oxygen group, the oxygen group did not significantly reduce short-term death (RR: 1.08, 95%CI: 0.31–3.74), and there was moderate heterogeneity (I² = 50.8%, P < 0.107) among studies. We found a significant increase in the rate of recurrent myocardial infarction (RR: 6.73, 95%CI: 1.80–25.17, I² = 0.0%, P = 0.598) in the oxygen group. The oxygen group did not have a significant reduction in arrhythmia (RR: 1.12, 95%CI: 0.91–1.36; I² = 46.2%, P < 0.156) or pain (RR: 0.97, 95%CI: 0.91–1.04; I² = 7.2%, P = 0.340).ConclusionsOxygen inhalation did not benefit patients with acute myocardial infarction with normal oxygen saturation. It may increase the rate of recurrent myocardial infarction. High quality trials with larger sample sizes are required.     

The cost-effectiveness of a patient centred pressure ulcer prevention care bundle: Findings from the INTACT cluster randomised trial

BackgroundPressure ulcers are serious, avoidable, costly and common adverse outcomes of healthcare.ObjectivesTo evaluate the cost-effectiveness of a patient-centred pressure ulcer prevention care bundle compared to standard care.DesignCost-effectiveness and cost-benefit analyses of pressure ulcer prevention performed from the health system perspective using data collected alongside a cluster-randomised trial.SettingsEight tertiary hospitals in Australia.ParticipantsAdult patients receiving either a patient-centred pressure ulcer prevention care bundle (n = 799) or standard care (n = 799).MethodsDirect costs related to the intervention and preventative strategies were collected from trial data and supplemented by micro-costing data on patient turning and skin care from a 4-week substudy (n = 317). The time horizon for the economic evaluation matched the trial duration, with the endpoint being diagnosis of a new pressure ulcer, hospital discharge/transfer or 28 days; whichever occurred first. For the cost-effectiveness analysis, the primary outcome was the incremental costs of prevention per additional hospital acquired pressure ulcer case avoided, estimated using a two-stage cluster-adjusted non-parametric bootstrap method. The cost-benefit analysis estimated net monetary benefit, which considered both the costs of prevention and any difference in length of stay. All costs are reported in AU$(2015).ResultsThe care bundle cost AU$144.91 (95%CI: $74.96 to $246.08) more per patient than standard care. The largest contributors to cost were clinical nurse time for repositioning and skin inspection. In the cost-effectiveness analysis, the care bundle was estimated to cost an additional $3296 (95%CI: dominant to $144,525) per pressure ulcer avoided. This estimate is highly uncertain. Length of stay was unexpectedly higher in the care bundle group. In a cost-benefit analysis which considered length of stay, the net monetary benefit for the care bundle was estimated to be −$2320 (95%CI −$3900, −$1175) per patient, suggesting the care bundle was not a cost-effective use of resources.ConclusionsA pressure ulcer prevention care bundle consisting of multicomponent nurse training and patient education may promote best practice nursing care but may not be cost-effective in preventing hospital acquired pressure ulcer.     

The minimal important difference for Glittre-ADL test in patients with chronic obstructive pulmonary disease

ObjectiveTo determine Glittre-ADL test minimal important difference in patients with chronic obstructive pulmonary disease.MethodsThis is quasi-experimental study. Sixty patients with moderate to very severe chronic obstructive pulmonary disease (age 64.1, SD = 9.09 years; forced expiratory volume in the first second 37.9, SD = 13.0% predicted participated in a pulmonary rehabilitation program based on physical training, conducted over 24 sessions supervised, three times a week, including aerobic training in treadmill and resistance training for upper limbs and lower limbs. The main outcomes were the Glittre-ADL test and six-minute walk test, before and after 24 sessions of pulmonary rehabilitation. The minimal important difference was established using the distribution and anchor-based methods.ResultsPatients improved their functional capacity after the pulmonary rehabilitation. The effect sizes of Glittre-ADL test and six-minute walk test improvement were similar (0.45 vs 0.44, respectively). The established minimal important differences ranged from −0.38 to −1.05. The reduction of 0.38 min (23 s) corresponded to a sensitivity of 64% and a specificity of 69% with an area under the curve of 0.66 (95%CI 0.51–0.81; p = 0.04). Subjects who achieved the minimal important difference of −0.38 min for the Glittre-ADL test had a superior improvement of approximately 42 m in the six-minute walk test when compared to patients who did not.ConclusionsThe present findings suggest −0.38 min as the minimal important difference in the time spent in the Glittre-ADL test after 24 sessions of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease.Trial registration: NCT03251781 (https://clinicaltrials.gov/ct2/show/NCT03251781)     

Impaired performance of women with patellofemoral pain during functional tests

ObjectiveTo compare the performance, reliability, and validity of functional tests between women with and without patellofemoral pain.MethodsTwenty women with a diagnosis of patellofemoral pain between 18 and 40 years of age and 20 age-matched pain-free controls participated in the study. All participants performed a set of five function tests: sitting-rising test, sit-to-stand in 30 seconds, stair-climb test, stair descent test, and six-minute step test. To investigate reliability, participants were assessed on two different days, seven days apart, by two independent investigators blinded to the results of the other investigator. Validity was evaluated through associations with the results on the Anterior Knee Pain Scale.ResultsPerformance in the tests was worse in women with patellofemoral pain than in the control group for the sit-to-stand in 30 seconds (mean difference [MD] 3.4reps; 95%CI: 0.4, 6.4), stair-climb test (MD: 0.36 s; 95%CI: 0.1, 0.63), and six-minute step test (MD: 45reps; 95%CI: 20, 70). No differences were observed for the sitting-rising and stair descent tests. All tests in both groups showed moderate to excellent intra- and inter-rater reliability (intraclass correlation coefficients: 0.61 to 0.91 and 0.72 to 0.96, respectively). Finally, only the results on the sit-to-stand in 30 seconds test correlated with the Anterior Knee Pain Scale (r = 0.44, p = 0.047) in the patellofemoral pain group.ConclusionWomen with patellofemoral pain present lower performance on some functional tests. Functional tests are reliable in patients with patellofemoral pain, although they are not associated with the results on the Anterior Knee Pain Scale self-questionnaire.     

Effects of self-management on chronic kidney disease: A meta-analysis

BackgroundSelf-management programs may facilitate the improvement of outcomes in medical, role, and emotional management and health-related quality of life in patients with chronic kidney disease. Studies on the effect of three self-management tasks have reported conflicting findings. In addition, systematic reviews are unavailable.ObjectiveThis study evaluated the effects of self-management programs on medical, role, and emotional management and health-related quality of life in chronic kidney disease.DesignMeta-analysis of randomized controlled studies.Data sourcesThe meta-analysis involved an online search of the English literature from PubMed, Cochrane, Web of Science, and CINAHL and the Chinese literature from the Airiti Library that were published from the inception of the websites until January 1, 2017.Review methodsThe meta-analysis was conducted to evaluate the effects of self-management on chronic kidney disease outcomes. Electronic databases were searched by using keywords: chronic kidney disease, end-stage renal disease, renal failure, dialysis, self-management, self-efficacy, empowerment, cognitive behavioral, and educational. The methodological quality of randomized controlled trials was assessed using the Cochrane Handbook. Data were analyzed using Comprehensive Meta-Analysis software 2.0.ResultsEighteen randomized controlled trials met our inclusion criteria. The results revealed that the self-management program significantly enhanced the effects of self-management on outcomes of medical, role, and emotional management and health-related quality of life in patients with chronic kidney disease. The following Hedges’ g (effect size) values were obtained: (1) interdialytic weight gain, −0.36 (95% confidence interval, −0.60 to −0.12, p < 0.01); (2) self-efficacy, 0.57 (95% confidence interval, 0.18–0.96, p < 0.01); (3) anxiety, −0.95 (95% confidence interval, −1.65 to −0.25, p = 0.01); (4) depression, −0.63 (95% confidence interval, −0.85 to −0.41, p < 0.01) (5) health-related quality of life for the mental component of the SF-36, 0.71 (95% confidence interval, 0.45–0.97, p < 0.01); (6) the physical component of the SF-36, 0.61 (95% confidence interval, 0.35–0.86, p < 0.01); and (7) the Kidney Disease Quality of Life, 0.41 (95% confidence interval, 0.17–0.65, p < 0.01).DiscussionThis study revealed a small effect of self-management on interdialytic weight gain; medium effects on self-efficacy, depression, and health-related quality of life; and a large effect on anxiety. However, high-quality randomized controlled trial designs are required to confirm these results, although the existing evidence can guide clinical practitioners and health policy makers.     

Cerebral oximetry and return of spontaneous circulation after cardiac arrest: A systematic review and meta-analysis

AimThe prediction of return of spontaneous circulation (ROSC) during resuscitation of patients suffering of cardiac arrest (CA) is particularly challenging. Regional cerebral oxygen saturation (rSO₂) monitoring through near-infrared spectrometry is feasible during CA and could provide guidance during resuscitation.MethodsWe conducted a systematic review and meta-analysis on the value of rSO₂ in predicting ROSC both after in-hospital (IH) or out-of-hospital (OH) CA. Our search included MEDLINE (PubMed) and EMBASE, from inception until April 4th, 2015. We included studies reporting values of rSO₂ at the beginning of and/or during resuscitation, according to the achievement of ROSC.ResultsA total of nine studies with 315 patients (119 achieving ROSC, 37.7%) were included in the meta-analysis. The majority of those patients had an OHCA (n = 225, 71.5%; IHCA: n = 90, 28.5%). There was a significant association between higher values of rSO₂ and ROSC, both in the overall calculation (standardized mean difference, SMD –1.03; 95%CI –1.39,–0.67; p < 0.001), and in the subgroups analyses (rSO₂ at the beginning of resuscitation: SMD –0.79; 95%CI –1.29,–0.30; p = 0.002; averaged rSO₂ value during resuscitation: SMD –1.28; 95%CI –1.74,–0.83; p < 0.001).ConclusionsHigher initial and average regional cerebral oxygen saturation values are both associated with greater chances of achieving ROSC in patients suffering of CA. A note of caution should be made in interpreting these results due to the small number of patients and the heterogeneity in study design: larger studies are needed to clinically validate cut-offs for guiding cardiopulmonary resuscitation.     

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).     

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.     

Assessing the necessity of including a crossover period with dual reporting when changing total prostate-specific antigen methods

ObjectivesOptions are limited for the laboratory when changing analytical methods for tumor markers. Standardization between methods should alleviate this burden. Our objective was to assess the necessity of dual reporting for total prostate-specific antigen (tPSA) when changing methods that have been calibrated against the World Health Organization PSA reference material.Design and methodsFollowing an initial validation where 40 patient samples were divided and analyzed on the Roche E-modular (current method) and Abbott ARCHITECT (new method) for tPSA, a crossover period ensued with dual reporting of tPSA over 54 days (n = 1110 samples with both tPSA results reported). Passing & Bablok regression was performed, with agreement during the crossover period also determined by two methods. Method#1: if the percent difference between the result pair was ≤ 0.33 × the intraindividual biological variation (0.33 × CVi = 6.0%) for tPSA; and Method#2: if the Roche tPSA result was within an acceptable analytical range based on Abbott's maximum allowable imprecision for the tPSA assay (CV ≤ 8%) to determine if there was a range of optimal agreement that might not require dual reporting.ResultsDuring the crossover period, Passing & Bablok regression yielded the following relationship: Abbott tPSA = 1.04(95% CI: 1.03 to 1.04) × (Roche tPSA) − 0.02(95% CI: − 0.03 to − 0.02). Only 52% (95%CI: 49 to55) of the results were in agreement by Method#1 whereas 95% (95% CI: 92 to 97) of the results between 3.3 and 19 μg/L were found to have acceptable agreement based on Method#2.ConclusionsThese findings suggest that dual reporting of tPSA is required when changing methods. However, the extent of dual reporting may be limited to specific concentration ranges with future studies required to validate selective dual reporting when changing tPSA assays.