The effectiveness of pelvic floor exercises,digital vaginal palpation and interpersonal support on stress urinary incontinence: An experimental study

Background/aimsThe objective of this study is to examine if interpersonal support and digital vaginal palpation (DVP) as part of the pelvic floor muscle exercise (PFME) training is more effective for stress urinary incontinence (SUI) than PFME with a printed handout instruction.Methods108 women who presented to the family medicine outpatient clinic without having urine leakage as a chief complaint were selected. They were randomized to either the group who received interpersonal support and DVP as part of the PFME training (experimental group), or the group who received PFME with a printed handout instruction (control group). The effects were assessed with 1-h pad tests.ResultsA total of 99 patients (50 experimental, 49 control) completed the study. The patients’ mean age was 55.35 ± 9.60 years, ranging from 20 to 80 years. All patients without urinary leakage listed as a chief complaint exhibited more or less urine leakage during the 1-h pad test. A significant decrease in the weight of 1-h pad test from baseline was observed in the experimental group (p < 0.001) compared to the control group (p = 0.514).ConclusionInterpersonal support and DVP as part of the PFME training is more effective than PFME with a printed handout instruction. PFME, performed correctly and consistently, is effective even in patients who have very few symptoms of SUI.     

Is pelvic floor muscle strength and thickness associated with pelvic organ prolapse in Nepali women? – A cross-sectional study

BackgroundPelvic floor muscle function has been shown to be inversely associated with pelvic organ prolapse in Western women, however differences have been documented between ethnic groups.ObjectiveTo determine if pelvic floor muscle strength and thickness and hiatal area are associated with pelvic organ prolapse in Nepali women.MethodsThis cross-sectional study included non-pregnant Nepali women ≥18 years attending an outpatient gynecology clinic in Kathmandu, Nepal. A clinical examination included the pelvic organ prolapse quantification (POP-Q)- system examination and Modified Oxford Scale. Puborectalis muscle thickness and hiatal area were assessed using 3D/4D translabial ultrasound. Statistical analysis included Pearson's correlation and multiple regression (p < 0.05).ResultsOf the 123 women; 14 (11%) had POP-Q stage 0 prolapse, 29 (24%) stage I, 69 (56%) stage II, 8 (7%) stage III, and 3 (2%) stage IV. Mean ± SD Modified Oxford Scale was 3.37 ± 0.48 and muscle thickness was 1.14 ± 0.21 cm, hiatal area at rest was 14.67 ± 3.11 cm² and on contraction was 11.29 ± 2.51 cm². No associations were found between pelvic floor muscle strength or thickness and POP-Q stages 0–IV. There was a positive correlation found between hiatal area at rest and pelvic organ prolapse stage (r = 0.34, p < 0.001)and hiatal area on contraction and prolapse stage (r = 0.30, p < 0.001) and a negative correlation between pelvic floor muscle strength and hiatal area on contraction (r = ?0.36, p < 0.001).ConclusionIn contrast to previous findings, pelvic floor muscle strength and thickness are not associated with pelvic organ prolapse in this sample of Nepali women. It is important to consider these findings when developing pelvic organ prolapse treatment and management strategies in this population.     

Impact of pelvic floor muscle training on sexual function of women with urinary incontinence and a comparison of electrical stimulation versus standard treatment (IPSU trial): a randomised controlled trial

Aims

To evaluate the clinical and cost-effectiveness of electric stimulation plus standard pelvic floor muscle training compared to standard pelvic floor muscle training alone in women with urinary incontinence and sexual dysfunction.

High spatial resolution pressure distribution of the vaginal canal in Pompoir practitioners: A biomechanical approach for assessing the pelvic floor

BackgroundPompoir is a technique poorly studied in the literature that claims to improve pelvic floor strength and coordination. This study aims to investigate the pelvic floor muscles' coordination throughout the vaginal canal among Pompoir practitioners and non-practitioners by describing a high resolution map of pressure distribution.MethodsThis cross-sectional, study included 40 healthy women in two groups: control and Pompoir. While these women performed both sustained and “waveform” pelvic floor muscle contractions, the spatiotemporal pressure distribution in their vaginal canals was evaluated by a non-deformable probe fully instrumented with a 10 × 10 matrix of capacitive transducers.FindingsPompoir group was able to sustain the pressure levels achieved for a longer period (40% longer, moderate effect, P = 0.04). During the “waveform” contraction task, Pompoir group achieved lower, earlier peak pressures (moderate effect, P = 0.05) and decreased rates of contraction (small effect, P = 0.04) and relaxation (large effect, P = 0.01). During both tasks, Pompoir group had smaller relative contributions by the mid-region and the anteroposterior planes and greater contributions by the caudal and cranial regions and the latero-lateral planes.InterpretationResults suggest that specific coordination training of the pelvic floor muscles alters the pressure distribution profile, promoting a more-symmetric distribution of pressure throughout the vaginal canal. Therefore, this study suggests that pelvic floor muscles can be trained to a degree beyond strengthening by focusing on coordination, which results in changes in symmetry of the spatiotemporal pressure distribution in the vaginal canal.     

Nursing students' knowledge and attitudes toward urinary incontinence: A cross-sectional survey

BackgroundNurses must have adequate knowledge to manage the complexities of urinary incontinence. Nursing students are the nurses of the future, yet little is known about urinary incontinence education in undergraduate nursing programs.ObjectivesThe aim of this study was (a) to assess the knowledge and attitudes of urinary incontinence held by undergraduate nursing students in China and (b) to explore the relationship between knowledge, attitudes and socio-demographic characteristics.DesignA cross-sectional survey using cluster random sampling.SettingsUndergraduate departments of Nursing within the Faculty of Health Sciences at six Universities, located in different areas of China.ParticipantsA random selection of 6 faculties with a total of 1313 full time undergraduate nursing students completed the survey.MethodsSelf-reported data were collected using two validated questionnaires, the Urinary Incontinence Knowledge Scale and the Urinary Incontinence Attitude Scale, to access students' knowledge and attitudes toward urinary incontinence.ResultsOverall urinary incontinence knowledge was poor (49.9%, 15.0/30) and attitudes about urinary incontinence were generally positive (71.7%, 43.0/60). A high level of interest in learning more about urinary incontinence was found. There was a weak correlation between urinary incontinence knowledge and attitudes (r = 0.135, p < 0.01). There was also a significant positive correlation between urinary incontinence knowledge and attitudes and nursing students' year of study, urinary incontinence education and training, and formal clinical practicum experience in urology (p < 0.05).ConclusionsChinese nursing students showed poor urinary incontinence knowledge but generally positive attitudes toward urinary incontinence. This study suggests there is a need to examine urinary incontinence content throughout undergraduate nursing curricula in China.     

Validity and reliability of an instrumented speculum designed to minimize the effect of intra-abdominal pressure on the measurement of pelvic floor muscle strength

BackgroundMeasurements of pelvic floor muscle strength are contaminated by crosstalk from intra-abdominal pressure. We tested an improved instrumented speculum designed to minimize this crosstalk. The hypotheses were that the speculum yields: 1) maximum vaginal closure forces unrelated to intra-abdominal pressure, 2) discriminatory validity between women with strong vs. weak pelvic floor muscles, and 3) acceptable test-retest reliability.MethodsMaximum voluntary vaginal closure force was measured in 40 incontinent women (20–77 years) on two visits spaced one month apart. At the baseline visit, intra-abdominal pressure was also estimated via intra-vesical catheterization during the vaginal closure force measurement. Subjective estimate of pelvic floor muscle strength was also assessed using digital palpation by a skilled examiner to determine group placement as “strong” (n = 31) or “weak” (n = 9).FindingsVaginal closure force was not significantly correlated with intra-abdominal pressure (r = − .26, P = .109). The groups with subjectively scored strong and weak pelvic floor muscles differed significantly by mean [SD] maximum vaginal closure force (3.8 [1.7] vs. 1.9 [0.8] N respectively, P < .01.) Across both time points the mean vaginal closure force was 3.42 [1.67] N with a range of .68 to 9.05 N. Mean Visit 1 and Visit 2 vaginal closure force scores did not differ (3.41 [1.8] and 3.42 [1.6] N, respectively). The vaginal closure force repeatability coefficient was 3.1 N.InterpretationThe improved speculum measured maximum vaginal closure force without evidence of crosstalk from intra-abdominal pressure, while retaining acceptable discriminant validity and repeatability.     

Operations and pelvic muscle training in the management of apical support loss (OPTIMAL) trial: Design and methods

The primary aims of this trial are: 1) to compare surgical outcomes following sacrospinous ligament fixation to uterosacral vaginal vault suspension in women undergoing vaginal surgery for apical or uterine pelvic organ prolapse and stress urinary incontinence and 2) to examine the effects of a structured perioperative program consisting of behavioral techniques and pelvic floor muscle training compared to usual care. This trial is performed through the Pelvic Floor Disorders Network (PFDN), which is funded by National Institute of Child Health and Human Development. Subjects will be enrolled from hospitals associated with seven PFDN clinical centers across the United States. A centralized biostatistical coordinating center will oversee data collection and analysis. Two approaches will be investigated simultaneously using a 2 × 2 randomized factorial design: a surgical intervention (sacrospinous ligament fixation versus uterosacral vaginal vault suspension) and a perioperative behavioral intervention (behavioral and pelvic floor muscle training versus usual care). Surgeons have standardized essential components of each surgical procedure and have met specific standards of expertise. Providers of the behavioral intervention have undergone standardized training. Anatomic, functional, and health-related quality of life outcomes will be assessed using validated measures by researchers blinded to all randomization assignments. Cost-effectiveness analysis will be performed using prospectively collected data on health care costs and resource utilization. The primary surgical endpoint is a composite outcome defined by anatomic recurrence, recurrence of bothersome vaginal prolapse symptoms and/or retreatment and will be assessed 2 years after the index surgery. Endpoints for the behavioral intervention include both short-term (6-month) improvement in urinary symptoms and long-term (2-year) improvement in anatomic outcomes and prolapse symptoms. This article describes the rationale and design of this randomized trial, focusing on several key design features of potential interest to researchers in the field of female pelvic floor disorders and others conducting randomized surgical trials.     

Exercise regimens other than pelvic floor muscle training cannot increase pelvic muscle strength-a systematic review

BackgroundAlthough pelvic floor muscle training is widely recommendedin the literature as the gold standard for the treatment of pelvic floor dysfunctions, such as urinary incontinence, interest in other exercise regimens is increasing. However, it is unknown whether other exercise regimens increase pelvic floor muscle strength.MethodsThis was a systematic review of randomized clinical trials found in PEDro, tridatabase, Cochrane and PubMed on the efficacy of nonspecific exercises, such as Pilates, the Paula method, and hypopressive exercises, in strengthening pelvic floor muscles in adults without underlying neurological disorders and with or without pelvic floor dysfunction.ResultsSeven studies were analyzed, and the results demonstrated that Pilates, the Paula method, and hypopressive exercises are ineffective in increasing pelvic muscle strength unless they are performed in conjunction with pelvic floor muscle training. The protocol was registered in the PROSPERO database (www.crd.york.ac.uk/prospero/) under the number CRD42019123396.ConclusionConsidering the available studies, we have concluded that Pilates, the Paula method and hypopressive exercises performed alone do not increase pelvic floor muscle strength. Pelvic floor muscle training continues to be the gold standard for increasing pelvic muscle strength.     

Response of the muscles in the pelvic floor and the lower lateral abdominal wall during the Active Straight Leg Raise in women with and without pelvic girdle pain: An experimental study

BackgroundThe relationship between activation of the stabilizing muscles of the lumbopelvic region during the Active Straight Leg Raise test and pelvic girdle pain remains unknown. Therefore, the aim was to examine automatic contractions in relation to pre-activation in the muscles of the pelvic floor and the lower lateral abdominal wall during leg lifts, performed as the Active Straight Leg Raise test, in women with and without persistent postpartum pelvic girdle pain.MethodsSixteen women with pelvic girdle pain and eleven pain-free women performed contralateral and ipsilateral leg lifts, while surface electromyographic activity was recorded from the pelvic floor and unilaterally from the lower lateral abdominal wall. As participants performed leg lifts onset time was calculated as the time from increased muscle activity to leg lift initiation.FindingsNo significant differences were observed between the groups during the contralateral leg lift. During the subsequent ipsilateral leg lift, pre-activation in the pelvic floor muscles was observed in 36% of women with pelvic girdle pain and in 91% of pain-free women (P = 0.01). Compared to pain-free women, women with pelvic girdle pain also showed significantly later onset time in both the pelvic floor muscles (P = 0.01) and the muscles of the lower lateral abdominal wall (P < 0.01).InterpretationWe suggest that disturbed motor activation patterns influence women's ability to stabilize the pelvis during leg lifts. This could be linked to provocation of pain during repeated movements.     

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.     

Are falls in people with multiple sclerosis related to the severity of urinary disorders?

BackgroundLower urinary tract symptoms (LUTSs), especially overactive bladder, are frequent in people with multiple sclerosis (PwMS). Urinary urgency and urge urinary incontinence could lead to precipitation and thus could increase the risk of falling in these individuals.ObjectiveWe aimed to assess the association between severity of LUTSs and risk of falling in PwMS.MethodsPwMS with LUTSs were recruited in a neuro-urology department. Participants were asked about the number of falls in the past 3 months and their circumstances. Severity of LUTSs was assessed by the Urinary Symptoms Profile (USP) score, and individuals were classified as with or without urinary incontinence.ResultsThis cross-sectional study included 154 patients (69% women); the mean (SD) age was 50.1 (11.5) years and median EDSS was 5 (interquartile range 3–6). Overall, 20 (13%) patients reported one fall during the past 3 months, and 43 (28%) reported at least 2 falls. Only 9 (6%) patients reported a fall on the way to the toilet, 6 during a urinary urgency. No link was found between falls and urinary incontinence (P = 0.71), type or severity of urinary symptoms (overactivity, voiding dysfunction or stress incontinence, P > 0.05). Falls on the way to the bathroom was associated with high USP score related to overactive bladder (P = 0.03) and severe nocturia (> 2 nocturnal micturitions) (P < 0.01). Falling at night was also associated with severe nocturia (P < 0.001).ConclusionsThe severity of LUTSs and presence of urinary incontinence do not appear related to the risk of falling in PwMS and urinary disorders but rather to the specific risk of falling on the way to the bathroom. Severe nocturia increases the risk of falling at night. Further studies are needed to assess the impact of LUTS treatment on the risk of falling. ClinicalTrials.gov (NCT04338646).     

Sacral reflexes and urinary incontinence in women: New concepts

ObjectiveThe physiology of urinary continence is complex and the respective role of active and passive mechanisms is still subject to debate. Many different sacral reflexes are involved in these processes. The present literature review focuses on the neuromuscular mechanisms, which are involved in the pathophysiology of female stress urinary incontinence (SUI).Material and methodsWe performed a systematic review of the literature in the Medline, Pascal and Embase databases by using the following keywords: reflex, perineal, sacral, urethral pressure, urethra, pelvic floor, fatigue, continence, incontinence and muscle.ResultsIn recent years, new pathophysiological hypotheses concerning abnormal pelvic floor muscle reflex responses to stress have been discussed and included an abnormal time course of pelvic floor muscle activation during coughing. It has also been suggested that unusually rapid fatigue of the pelvic floor muscle reflex may be involved in some women.ConclusionOverall, there are arguments in favour of the involvement of neuromuscular dysfunction in the pathophysiology of female SUI – particularly dysfunctional and delayed pelvic floor muscle reflex responses during coughing. It would be useful to establish whether these neuromuscular dysfunctions may be remedied by physiotherapeutic pelvic floor muscle training.     

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.     

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.     

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.     

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.     

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.     

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)     

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.