Tai Chi and Parkinson’s disease (PD): A systematic overview of the scientific quality of the past systematic reviews

ObjectivesThe aim of the current study was to assess the scientific quality of the past systematic reviews regarding the application of Tai Chi in the management of Parkinson’s disease (PD) using a systematic overview.MethodsThe search of PubMed and PsycInfo in February 2018 identified k=10 relevant systematic reviews published in 2008–2017 with terms PD, Tai Chi, and review in titles or abstracts. The quality of reviews was assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR2) and the quality of meta-analytic procedures was assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.ResultsThe k=10 systematic reviews assessed various outcomes of Tai Chi in PD using a qualitative (k = 4) or a quantitative synthesis (meta-analysis; k = 6) of data from up to 14 primary studies published in English. The review strengths were the comprehensive search for literature, data coding, and data quality assessment. The review limitations were the high overlap in the primary data and the lack of either the review protocol, the list of excluded studies or the conflict of interest statement in the primary studies. The critical problems were that the qualitative data synthesis relied on the statistical significance of results in the primary studies with small sample sizes and that the computational details of meta-analysis were inadequately reported.ConclusionsThe past systematic reviews suggest that Tai Chi is a promising complementary treatment for PD. However, the quality of such past reviews is limited. Future systematic reviews can be improved by adequately reporting the methodological details and adhering to the guidelines for conducting such reviews. The clinical relevance of Tai Chi in terms of the magnitude and the longer-term durability of its outcomes should be tested in future RCTs with larger sample sizes.     

Does acupuncture provide pain relief in patients with osteoarthritis knee? An overview of systematic reviews

BackgroundKnee osteoarthritis (OA) is the most common condition that causes pain and disability in adults over 50 years old. The application of acupuncture, as a method of complementary intervention, could be beneficial for pain relief and knee function in patients with knee OA.ObjectiveAnalyze the effectiveness of acupuncture versus control interventions in patients with knee OA.MethodsAn electronic search was performed in the MEDLINE (via PubMed), EMBASE, PEDro, Cochrane CENTRAL, CINAHL, Web of Science and LILACS databases. The eligibility criteria for selecting systematic reviews included clinical trials that compared acupuncture versus control interventions for pain intensity in patients with knee OA.ResultsA total of 15 systematic reviews met the eligibility criteria for the quantitative synthesis. In the short term, the mean difference (MD) for pain intensity was −0.32 cm (95% CI = −0.57 to −0.08, p = 0.01). There was a very low quality of evidence according to the GRADE rating. In the short term, the mean difference (MD) for knee function was −8.74 points (95% CI = −13.36 to −4.12, p ≤ 0.001). There was low quality of evidence according to the GRADE rating. All differences were in favor of acupuncture.ConclusionAt short-term, there was low to very low evidence and there were statistically significant differences in pain intensity and knee function in favor of acupuncture versus control interventions in patients with knee OA. However, these differences were not clinically important. For the acupuncture versus sham, in the short-term, no differences clinical neither statistically significant to favor of acupuncture in pain intensity and knee function.     

The efficacy and feasibility of aquatic physiotherapy for people with Parkinson’s disease: a systematic review

Abstract

Purpose: To critically evaluate the literature regarding the efficacy and feasibility of aquatic physiotherapy in people with Parkinson’s disease.

Method: Relevant studies were identified through searches in nine health-related databases. Two independent reviewers assessed study quality using either the PEDro scale or a customised tool for safety and feasibility.

Results: Database searches yielded 88 articles, of which 10 met the inclusion criteria. Studies varied greatly in methodology, quality, interventions and outcome measures. Study quality was generally low in items reporting on safety precautions, adverse events, attrition, and adherence. Results suggest that aquatic physiotherapy may have a positive effect on motor symptoms, quality of life and balance.

Conclusions: Aquatic physiotherapy may improve aspects of motor performance, quality of life and balance in people with Parkinson’s disease, however, it remains unclear whether it is a safe and feasible treatment modality. The development of standardised outcome measures for people with Parkinson’s disease (unified Parkinson’s disease rating scale and Parkinson’s disease questionnaire-39) would aid study comparability and validate study outcomes. As safety criteria was grossly underreported, guidelines for mandatory reporting of safety criteria are essential to make conclusions regarding the feasibility of aquatic physiotherapy for people with Parkinson’s disease.

• Implications for Rehabilitation

• Aquatic physiotherapy may be a beneficial treatment modality for people with Parkinson’s disease.

• A minimum data set that includes the unified Parkinson’s disease rating scale and Parkinson’s disease questionnaire 39 is required to aid future meta-analysis and to allow more definitive conclusions to be made regarding aquatic physiotherapy for people with Parkinson’s disease.

• People with Parkinson’s disease are a vulnerable population, where safety within an aquatic physiotherapy program needs to be well documented and addressed.

     

Effectiveness and safety of acupuncture in the treatment of Parkinson’s disease: A systematic review and meta-analysis of randomized controlled trials

ObjectiveThis study aimed to examine the effectiveness and safety of acupuncture in the treatment of Parkinson’s disease (PD).MethodsEnglish, Chinese, and Korean electronic databases were searched up to June 2016. Randomized controlled trials (RCTs) were eligible. The methodological quality was assessed using Cochrane’s risk of bias tool. Meta-analysis was performed using RevMan 5.3.ResultsIn total, 42 studies involving 2625 participants were systematically reviewed. Participants treated using combined acupuncture and conventional medication (CM) showed significant improvements in total Unified PD Rating Scale (UPDRS), UPDRS I, UPDRS II, UPDRS III, and the Webster scale compared to those treated using CM alone. The combination of electroacupuncture and CM was significantly superior to CM alone in total UPDRS, UPDRS I, UPDRS II, and UPDRS IV. Similarly, the combination of scalp electroacupuncture, acupuncture, and CM was significantly more effective than CM alone in total UPDRS. However, our meta-analysis showed that the combination of electroacupuncture and CM was not significantly more effective than CM alone in UPDRS III, the Webster, and the Tension Assessment Scale. The results also failed to show that acupuncture was significantly more effective than placebo acupuncture in total UPDRS. Overall, the methodological quality of the RCTs was low. No serious adverse events were reported.ConclusionsWe found that acupuncture might be a safe and useful adjunctive treatment for patients with PD. However, because of methodological flaws in the included studies, conclusive evidence is still lacking. More rigorous and well-designed placebo-controlled trials should be conducted.     

Gene therapy for Parkinson’s disease

Significant progress has been made in the field of gene therapy for Parkinson’s disease (PD). Successful vehicles for gene transfer into the central nervous system have been developed and clinical efficacy and safety have both been shown in various animal models of PD. Further optimisation of dosing, timing and location of gene therapy delivery as well as the ability to regulate and prolong gene expression will be important for the commencement of human trials. Current gene therapy models for PD have focused on two treatment strategies. One is the replacement of biosynthetic enzymes for dopamine synthesis and the second strategy is the addition of neurotrophic factors for protection and restoration of dopaminergic neurones. Concepts of neuroprotection and restoration of the nigrostriatal pathway will become important themes for future genetic treatment strategies for PD and may include, in addition to neurotrophic factors, genes to prevent apoptosis or detoxify free radical species. This review will highlight the recent literature on gene therapy for PD and summarise general approaches to gene therapy.     

Efficacy of rasagiline for the treatment of Parkinson’s disease: an updated meta-analysis

Objective: Rasagiline is a second-generation potent selective inhibitor of monoamine oxidase-B. The aim of the study was to analyze the effectiveness of rasagiline in treatment of Parkinson’s disease (PD), both as monotherapy and combination therapy.

Methods: Medline, Cochrane, EMBASE, and Google Scholar databases were searched until 9 March 2016 using the keywords: Rasagiline, Azilect, Parkinson’s disease. Randomized controlled trials of patients with PD who were randomized to treatment with rasagiline or placebo were included. Outcomes were unified Parkinson’s disease rating scale (UPDRS) and the three subscales.

Results: Ten studies fulfilled the inclusion criteria and 2709 patients were evaluated. The overall analysis revealed a significant improvement in change of total UPDRS scores in 1?mg/day and 2?mg/day rasagiline groups compared to placebo. Significant improvement in Part I (Mentation) of UPDRS scores was observed in 1?mg/day, but not in 2?mg/day rasagiline treatment group. Part II (ADL) and Part III (Motor) subscales significantly improved with both doses of rasagiline. Both monotherapy and combination therapy significantly improved total UPDRS scores.

Conclusions: Our results confirm the efficacy of rasagiline in PD. Further studies are required to establish the optimal dose of rasagiline, as well as to determine its effectiveness in different combination therapy protocols.

• KEY MESSAGES

• Rasagiline treatment was associated with significant improvement of UPDRS scores and the scores of the subscales.

• Both monotherapy and combination therapy significantly improved total UPDRS scores.

• Effect of rasagiline on total UPDRS scores was not dose-dependent.

     

An overview of systematic reviews of adaptive seating interventions for children with cerebral palsy: where do we go from here?

Purpose: This article provides an overview and assessment of systematic reviews of adaptive seating outcomes in children with cerebral palsy (CP) and proposes strategies to advance and improve the clinical utility of future research evidence. Methods: A comprehensive search for systematic reviews was performed to locate and evaluate the functional effects of adaptive seating in children with CP. Relevant electronic databases were searched to identify reviews published between January 1990 and December 2010. Results: The search yielded five reviews of adaptive seating interventions that found generally positive, but inconclusive evidence of effectiveness for postural control and management, seated posture, upper extremity function, and overall clinical outcomes. Review authors consistently reported that they were unable to combine data from original research studies to make sound clinical recommendations due to the low quality of studies, the lack of appropriate outcome indicators, and the heterogeneity and lack of clarity in population characteristics and adaptive seating interventions. Conclusions: Strategies to improve the quality and clinical relevance of new research evidence for adaptive seating interventions include the adoption of an expanded view of child functioning, a child motor function classification and development approach, and contemporary frameworks for the measurement and evaluation of assistive technology outcomes.

Implications for Rehabilitation

• Assistive technology practitioners recommend adaptive seating devices to improve child functioning.

• Past systematic reviews of adaptive seating outcomes in children with cerebral palsy provide limited empirical support.

• Current thinking about child health and assistive technology outcomes provides direction to inform research and clinical practice.

     

Stroke patients’ and informal carers’ experiences with life after stroke: an overview of qualitative systematic reviews

Purpose To provide a systematic overview of current qualitative systematic reviews and metasyntheses of patients’ and informal carers’ experiences with rehabilitation and life after stroke following discharge. Method A systematic literature search was performed based on PRISMA guidelines. Nine databases were systematically searched by a university librarian. The search yielded 1093 unique entries and screening by title/abstract identified 60 reviews for potential inclusion. After full-text assessment by two independent observers, 11 reviews satisfied the inclusion criteria. Following quality appraisal, four studies were excluded. Results Seven qualitative reviews (containing 108 primary studies) were included: five reviews of patients’ experiences and two reviews of carers’ experiences. Stroke causes profound disruption of life as known, and both patients and carers must engage in a process of adapting and rebuilding a post-stroke life and identity. This process of rehabilitation is described as temperamental and unstable rather than progressive. From the reviews, five key experiences in this process are identified: autonomy, uncertainty, engagement, hope and social relations. Conclusions The need for broad, qualitative syntheses of stroke patients’ experiences is currently fulfilled. Future qualitative reviews could focus more on implications for practice, e.g., by grading the quality of the metafindings.

• Implications for Rehabilitation

• Stroke is a profound disruption of life as known, and patients and carers value information that helps them prepare for and adjust to this new situation.

• Optimal rehabilitation is a main concern and goal for patients and carers, and thus carers may be a valuable asset to professionals in the rehabilitation process.

• Practical and emotional support is important for patients and carers, and rehabilitation professionals should be aware of the increased risk of social isolation post-stroke.

• Hope is a strong motivational factor and coping strategy for patients and carers. However, as hope may wane in the case of continued residual impairment, rehabilitation professionals should prepare patients and carers for this situation.

     

Comparison of remicade to curcumin for the treatment of Crohn’s disease: A systematic review

ObjectiveThe aim of this study was to review the literature to assess if there is evidence to support the use of Curcumin as a safe complementary therapy in treating Crohn’s Disease (CD) in conjunction with Remicade.DesignSystematic searches were performed by three researchers using electronic databases (ProQuest Medical Library, CINAHL Complete, and PUBMED) to locate and identify articles to meet a predetermined set of inclusion criteria. Specifically full text, peer-reviewed articles published after 2007 were included if they studied human participants 18 years or older.ResultsTumor necrosis factor-alpha (TNF-a) and Interleukin-1 (IL-1) levels increase in CD patients. Remicade reduces TNF-a in adults with CD. The issues are eventual loss of response (LOR) once IL-1 increases, and severe risks such as malignancy. CD patients using Curcumin saw a 55 point mean reduction in the Crohn’s Disease Activity Index, reducing IL-1 and Crp. Plus it reduced TNF-a and PPMTase which improved colorectal cancer outcomes.ConclusionsLOR of Remicade occurs when IL-1 increases, and it can cause malignancy. Research shows Curcumin reduces IL-1 and improves cancer outcomes. Future research, using both Remicade and Curcumin, would have to be done, but preliminary data would suggest using both would reduce LOR. Curcumin, even by itself, was found to be a cheap and safe way to reduce CD symptoms and inflammatory markers.     

The role of social support in anxiety and depression among Parkinson’s disease patients

Abstract

Purpose: To explore how social support is associated with anxiety and depression in Parkinson’s disease (PD) patients controlling for gender, disease duration and disease severity. Methods: The sample consisted of 124 patients (52.4% male; mean age 68.1?±?8.4 years; mean disease duration 6.3?±?5.5 years). Anxiety and depression were measured with the Hospital Anxiety and Depression Scale, social support with the Multidimensional Scale of Perceived Social Support and disease severity with the Unified Parkinson Disease Rating Scale. Data were analyzed using linear regression. Results: Gender, disease duration, disease severity and social support explained 31% of the total variance in anxiety in younger PD patients but did not significantly contribute to the explanation of depression. In the older group, this model explained 41% of the variance in depression but did not significantly contribute to the explanation of anxiety. Conclusion: PD patients experience the positive influence of social support differently according to age. In the younger group, disease duration plays the primary role regarding anxiety. In the older group, poor social support especially from friends is associated with more depression after controlling for the relevant variables.

• Implications of Rehabilitation

• PD is a disease of older age with a neurodegenerative character and treatment should focus on increasing quality of life.

• Anxiety and depression are common co-morbidities in PD patients.

• The support network should also be screened regularly and involved in enhancing the quality of life.