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Journal of Foot and Ankle Research 2019Morton's neuroma (MN) is a compressive neuropathy of the common plantar digital nerve. It is a common compressive neuropathy often causing significant pain which limits... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Morton's neuroma (MN) is a compressive neuropathy of the common plantar digital nerve. It is a common compressive neuropathy often causing significant pain which limits footwear choices and weight bearing activities. This paper aims to review non-surgical interventions for MN, to evaluate the evidence base for the clinical management of MN.
METHODS
Electronic biomedical databases (CINAHL, EMBASE, MEDLINE and Cochrane) were searched to January 2018 for studies evaluating the effectiveness of non-surgical interventions for Morton's neuroma. Outcome measures of interest were treatment success rate (SR) (binary) and pain as measured using 100-point visual analogue scale (VAS) (continuous). Studies with and without control groups were included and were evaluated for methodological quality using the Downs and Black Quality Index. Results from randomised controlled trials (RCT) were compared between-groups, and case series were compared pre- versus post-treatment. Effect estimates are presented as odds ratios (OR) for binary data or mean differences (MD) for continuous data. Random effects models were used to pool effect estimates across studies where similar treatments were used. Heterogeneity was assessed using the statistic.
RESULTS
A total of 25 studies met the inclusion criteria, seven RCTs and 18 pre/post case series. Eight different interventions were identified, with corticosteroid or sclerosing injections being the most often reported (seven studies each). Results from a meta-analysis of two RCTs found corticosteroid injection decreased pain more than control on VAS (WMD: -5.3, 95%CI: -7.5 to - 3.2). Other RCTs reported efficacy of: manipulation/mobilisation versus control (MD: -15.3, 95%CI: -29.6 to - 1.0); extracorporeal shockwave therapy versus control (MD: -5.9, 95%CI: -21.9 to 10.1). Treatment success was assessed for extracorporeal shockwave therapy versus control (OR: 0.3, 95%CI: 0.0 to 7.1); and corticosteroid injection vs footwear/padding (OR: 6.0, 95%CI: 1.9 to 19.2). Sclerosing and Botox injections, radiofrequency ablation and cryoneurolysis have been investigated by case series studies, however these were of limited methodological quality.
CONCLUSIONS
Corticosteroid injections and manipulation/mobilisation are the two interventions with the strongest evidence for pain reduction, however high-quality evidence for a gold standard intervention was not found. Although the evidence base is expanding, further high quality RCTs are needed.
Topics: Foot Orthoses; Glucocorticoids; Humans; Morton Neuroma; Musculoskeletal Manipulations; Pain Management; Randomized Controlled Trials as Topic; Sclerotherapy
PubMed: 30809275
DOI: 10.1186/s13047-019-0320-7 -
BMJ (Clinical Research Ed.) Dec 2023We explored the comparative effectiveness of available therapies for chronic pain associated with temporomandibular disorders (TMD). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
We explored the comparative effectiveness of available therapies for chronic pain associated with temporomandibular disorders (TMD).
DESIGN
Systematic review and network meta-analysis of randomised clinical trials (RCTs).
DATA SOURCES
MEDLINE, EMBASE, CINAHL, CENTRAL, and SCOPUS were searched to May 2021, and again in January 2023.
STUDY SELECTION
Interventional RCTs that enrolled patients presenting with chronic pain associated with TMD.
DATA EXTRACTION AND SYNTHESIS
Pairs of reviewers independently identified eligible studies, extracted data, and assessed risk of bias. We captured all reported patient-important outcomes, including pain relief, physical functioning, emotional functioning, role functioning, social functioning, sleep quality, and adverse events. We conducted frequentist network meta-analyses to summarise the evidence and used the GRADE approach to rate the certainty of evidence and categorise interventions from most to least beneficial.
RESULTS
233 trials proved eligible for review, of which 153-enrolling 8713 participants and exploring 59 interventions or combinations of interventions-were included in network meta-analyses. All subsequent effects refer to comparisons with placebo or sham procedures. Effects on pain for eight interventions were supported by high to moderate certainty evidence. The three therapies probably most effective for pain relief were cognitive behavioural therapy (CBT) augmented with biofeedback or relaxation therapy (risk difference (RD) for achieving the minimally important difference (MID) in pain relief of 1 cm on a 10 cm visual analogue scale: 36% (95% CI 33 to 39)), therapist-assisted jaw mobilisation (RD 36% (95% CI 31 to 40)), and manual trigger point therapy (RD 32% (29 to 34)). Five interventions were less effective, yet more effective than placebo, showing RDs ranging between 23% and 30%: CBT, supervised postural exercise, supervised jaw exercise and stretching, supervised jaw exercise and stretching with manual trigger point therapy, and usual care (such as home exercises, self stretching, reassurance).Moderate certainty evidence showed four interventions probably improved physical functioning: supervised jaw exercise and stretching (RD for achieving the MID of 5 points on the short form-36 physical component summary score: 43% (95% CI 33 to 51)), manipulation (RD 43% (25 to 56)), acupuncture (RD 42% (33 to 50)), and supervised jaw exercise and mobilisation (RD 36% (19 to 51)). The evidence for pain relief or physical functioning among other interventions, and all evidence for adverse events, was low or very low certainty.
CONCLUSION
When restricted to moderate or high certainty evidence, interventions that promote coping and encourage movement and activity were found to be most effective for reducing chronic TMD pain.
REGISTRATION
PROSPERO (CRD42021258567).
Topics: Humans; Chronic Pain; Network Meta-Analysis; Exercise Therapy; Cognitive Behavioral Therapy; Physical Therapy Modalities; Randomized Controlled Trials as Topic
PubMed: 38101924
DOI: 10.1136/bmj-2023-076226 -
Journal of Manipulative and... Jul 2019The purpose of this study was to provide an updated systematic review and meta-analysis regarding the effectiveness of mobilization with movement (MWM) techniques on... (Meta-Analysis)
Meta-Analysis
Effectiveness of Mulligan's Mobilization With Movement Techniques on Range of Motion in Peripheral Joint Pathologies: A Systematic Review With Meta-analysis Between 2008 and 2018.
OBJECTIVES
The purpose of this study was to provide an updated systematic review and meta-analysis regarding the effectiveness of mobilization with movement (MWM) techniques on range of motion (ROM).
METHODS
An electronic search strategy of the Physiotherapy Evidence Database, PubMed, Cochrane Library, Embase, Google Scholar, and CINAHL was performed between August 2008 and January 2018. Two independent reviewers selected the studies. Only randomized controlled trials were included. The methodology was independently assessed by 2 reviewers using the Physiotherapy Evidence Database scale. The Z indicator was considered for the assessment of statistical significance of ROM change, whereas for each meta-analysis referring to a specific joint pathology, the total mean difference (95% confidence interval) was compared against minimum detectable change values from relevant studies conducted in similar populations to assess clinical significance.
RESULTS
Included were 18 studies with 753 participants in 10 separate meta-analyses for ROM. All studies were classified as high quality or medium quality. Peripheral joint MWM seems to produce better therapeutic results in comparison to sham, passive, other active, or no therapeutic approach, regarding improvement of joint ROM in specific peripheral joint pathologies, consistently in all movement directions for shoulder adhesive capsulitis (mean improvement 12.30-26.09, P < .02) and hip pain (mean improvement 4.50-14.80, P < .0001).
CONCLUSION
Mobilization with movement produced a statistically and clinically significant ROM increase consistently in all movement directions for shoulder adhesive capsulitis and hip pain. However, for shoulder impingement, shoulder pain/dysfunction, hamstring tightness, knee osteoarthritis, and chronic ankle instability pathologies, a therapeutic benefit regarding ROM could not be clearly established. Owing to the small number of individual studies included within the separate groups of pathologies examined in our systematic review, methodologically rigorous studies with longer follow-up periods are warranted to better inform the evidence base on the effects of MWM on ROM.
Topics: Arthralgia; Bursitis; Hip Joint; Humans; Musculoskeletal Manipulations; Range of Motion, Articular
PubMed: 31324377
DOI: 10.1016/j.jmpt.2019.04.001 -
Cureus Nov 2022Bennett's fracture is a relatively common fracture of the base of the thumb with no consensus on optimum management. Determining the optimal treatment method for... (Review)
Review
Bennett's fracture is a relatively common fracture of the base of the thumb with no consensus on optimum management. Determining the optimal treatment method for Bennett's fractures remain a challenge and has been the subject of much debate. This systematic review aims to investigate present and past literature and determine the optimum treatment intervention for Bennett's fracture-dislocation. The primary outcome measure is post-traumatic arthritis, and the secondary outcome measures are reoperation, pain, infection, and nonunion. As per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review of the literature was performed to evaluate patient demographics, clinical profile, management, and treatment outcomes. Two authors independently performed electronic searches of the Embase, Medical Literature Analysis and Retrieval System Online (MEDLINE), and Cochrane databases. Studies conducted between 1963 and 2021 with articles reporting Bennett's fracture management were included. The study was registered with PROSPERO (CRD42021295464). In the initial screening, 58 articles were identified, of which 13 articles met the criteria and were included in the final review, evaluating 558 patients. Out of these, 439 were managed by various surgical procedures, and 119 were treated by manipulation and plaster of Paris (POP) immobilization. Of the 13 studies considered, eight have a clear mention of post-traumatic osteoarthritis, with a total of 50 (9%) patients. Secondary outcomes included pain in 76 (13%) patients, infection in four patients, reoperation in 11 (2%) patients, and no nonunion. This review was conducted with the help of retrospective studies as there is no randomized controlled trial on the management of Bennett's fracture. Our primary outcome measure of post-traumatic arthritis in patients being treated by operative and conservative methods was mentioned in these studies. However, due to the sample size being small and the heterogenicity of these studies, the strength of these findings is low. Due to these shortfalls, this review study cannot recommend any single (or) particular treatment for all patients with Bennett's fracture.
PubMed: 36514567
DOI: 10.7759/cureus.31340 -
Microbial Pathogenesis May 2017Manipulation of the intestinal microbiota has been linked to weight changes and obesity. To explore the influence of specific agents that alter the intestinal flora on... (Review)
Review
Manipulation of the intestinal microbiota has been linked to weight changes and obesity. To explore the influence of specific agents that alter the intestinal flora on weight in different patient groups we conducted a meta-analysis of randomized controlled trials (RCTs) reporting on the effects of probiotics, prebiotics, synbiotics, and antibiotics on weight. We searched the Pubmed and Cochrane Library databases for trials on adults, children, and infants evaluating the effects of these substances on weight. Our primary outcome was weight change from baseline. Standardized mean differences (SMDs) with 95% confidence intervals were calculated. We identified and included 13 adult, 17 children, and 23 infant RCTs. Effects were opposite among adults and children, showing weight loss among adults (SMD -0.54 [-0.83, -0.25)) and minor weight gains among children (SMD 0.20 [0.04, 0.36]) and infants (SMD 0.30 [-0.01, 0.62]) taking mainly Lactobacillus probiotic supplements. Heterogeneity was substantial in the adult and infant analyses and could not be explained by intervention or patient characteristics. Azithromycin administration in children with pulmonary disease was associated with weight gain (SMD 0.39 [0.24, 0.54]), without heterogeneity. A high risk of selective reporting and attrition bias was detected across the studies, making it difficult to draw firm conclusions. Overall, our meta-analysis suggests that there may be a role for probiotics in promoting weight loss in adults and weight gain in children, however additional studies are needed. Though we cannot recommend antibiotic administration for weight manipulation, its use provides advantageous weight gain in children with cystic fibrosis and bronchiectasis.
Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Bronchiectasis; Child; Child, Preschool; Gastrointestinal Microbiome; Humans; Infant; Lactobacillus; Lung Diseases; Meta-Analysis as Topic; Obesity; Placebo Effect; Prebiotics; Probiotics; Randomized Controlled Trials as Topic; Synbiotics; Weight Gain; Weight Loss
PubMed: 26792677
DOI: 10.1016/j.micpath.2016.01.002 -
Neuroscience and Biobehavioral Reviews Aug 2022Subitizing is the fast and accurate enumeration of small sets. Whether attention is necessary for subitizing remains controversial considering (1) subitizing is claimed... (Meta-Analysis)
Meta-Analysis Review
Subitizing is the fast and accurate enumeration of small sets. Whether attention is necessary for subitizing remains controversial considering (1) subitizing is claimed to be "pre-attentive", and (2) existing experimental methods and results are inconsistent. To determine whether manipulations to attention demonstratively affect subitizing, the current study comprises a systematic review and meta-analysis. Results from fourteen studies (22 experiments, 35 comparisons) suggest that changes to attentional demands interferes with enumeration of small sets; leading to slower response times, lower accuracy, and poorer Weber acuity (p < .010; p < .001; p < .001; respectively)-notwithstanding a potential publication bias. A unifying framework is proposed to explain the role of attention in visual enumeration, with progressively greater attentional involvement from estimation to subitizing to counting. Our findings suggest attention is integral for subitizing and highlights the need to emphasise attentional mechanisms into neurocognitive models of numerosity processing. We also discuss the possible role of attention in numerical processing difficulties (e.g., dyscalculia).
Topics: Attention; Humans; Mathematics; Pattern Recognition, Visual; Reaction Time
PubMed: 35772633
DOI: 10.1016/j.neubiorev.2022.104753 -
BMC Surgery Nov 2017Laparoscopic distal pancreatectomy (LDP) reduces postoperative morbidity, hospital stay and recovery as compared with open distal pancreatectomy. Many authors believe... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Laparoscopic distal pancreatectomy (LDP) reduces postoperative morbidity, hospital stay and recovery as compared with open distal pancreatectomy. Many authors believe that robotic surgery can overcome the difficulties and technical limits of LDP thanks to improved surgical manipulation and better visualization. Few studies in the literature have compared the two methods in terms of surgical and oncological outcome. The aim of this study was to compare the results of robotic (RDP) and laparoscopic distal pancreatectomy.
METHODS
A systematic review and meta-analysis was conducted of control studies published up to December 2016 comparing LDP and RDP. Two Reviewers independently assessed the eligibility and quality of the studies. The meta-analysis was conducted using either the fixed-effect or the random-effect model.
RESULTS
Ten studies describing 813 patients met the inclusion criteria. This meta-analysis shows that the RDP group had a significantly higher rate of spleen preservation [OR 2.89 (95% confidence interval 1.78-4.71, p < 0.0001], a lower rate of conversion to open OR 0.33 (95% CI 0.12-0.92), p = 0.003] and a shorter hospital stay [MD -0.74; (95% CI -1.34 -0.15), p = 0.01] but a higher cost than the LDP group, while other surgical outcomes did not differ between the two groups.
CONCLUSION
This meta-analysis suggests that the RDP procedure is safe and comparable in terms of surgical results to LDP. However, even if the RDP has a higher cost compared to LDP, it increases the rate of spleen preservation, reduces the risk of conversion to open surgery and is associated to shorter length of hospital stay.
Topics: Conversion to Open Surgery; Humans; Laparoscopy; Length of Stay; Pancreatectomy; Postoperative Period; Robotic Surgical Procedures; Spleen; Treatment Outcome
PubMed: 29121885
DOI: 10.1186/s12893-017-0301-3 -
Complementary Therapies in Clinical... Nov 2022The aim of this systematic review and meta-analysis is to evaluate whether osteopathic manipulative interventions can reduce pain levels and enhance the functional... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The aim of this systematic review and meta-analysis is to evaluate whether osteopathic manipulative interventions can reduce pain levels and enhance the functional status in patients with non-specific neck pain (NS-NP).
METHODS
A systematic review and meta-analysis was conducted following the 2020 PRISMA statement. Randomized controlled trials (RCTs) were searched in five databases, assessed through a standardized form, and evaluated using the "13 items Cochrane risk of bias (RoB) tool". Effect sizes (ES) were calculated post-treatment, and the quality of evidence was assessed through GRADE criteria.
RESULTS
Five articles were included in the review, and none of these was completely judged at low RoB. Four of these were included in the meta-analysis. Osteopathic interventions compared to no intervention/sham treatment showed statistically significant results for pain levels (ES = -1.57 [-2.50, -0.65]; P = 0.0008) and functional status (ES = -1.71 [-3.12, -0.31]; P = 0.02). The quality of evidence was "very low" for all the assessed outcomes. Other results were presented in a qualitative synthesis.
CONCLUSIONS
Osteopathic interventions could be effective for pain levels and functional status improvements in adults with NS-NP. However, these findings are affected by a very low quality of evidence. Therefore, further high-quality RCTs are necessary to improve the quality of evidence and generalize the results.
Topics: Adult; Humans; Low Back Pain; Neck Pain; Manipulation, Osteopathic; Osteopathic Medicine; Neck
PubMed: 35986986
DOI: 10.1016/j.ctcp.2022.101655 -
Chiropractic & Manual Therapies 2017Although many conservative management options are available for patients with non-surgical shoulder conditions, there is little evidence of their effectiveness. This... (Review)
Review
PURPOSE
Although many conservative management options are available for patients with non-surgical shoulder conditions, there is little evidence of their effectiveness. This review investigated one manual therapy approach, thrust manipulation, as a treatment option.
METHODS
A systematic search was conducted of the electronic databases from inception to March 2016: PubMed, PEDro, ICL, CINAHL, and AMED. Two independent reviewers conducted the screening process to determine article eligibility. Inclusion criteria were manuscripts published in peer-reviewed journals with human participants of any age. The intervention included was thrust, or high-velocity low-amplitude, manipulative therapy directed to the shoulder and/or the regions of the cervical or thoracic spine. Studies investigating secondary shoulder pain or lacking diagnostic confirmation procedures were excluded. Methodological quality was assessed using the PEDro scale and the Cochrane risk-of-bias tool.
RESULTS
The initial search rendered 5041 articles. After screening titles and abstracts, 36 articles remained for full-text review. Six articles studying subacromial impingement syndrome met inclusion criteria. Four studies were randomized controlled trials (RCTs) and 2 were uncontrolled clinical studies. Five studies included 1 application of a thoracic spine thrust manipulation and 1 applied 8 treatments incorporating a shoulder joint thrust manipulation. Statistically significant improvements in pain scores were reported in all studies. Three of 4 RCTs compared a thrust manipulation to a sham, and statistical significance in pain reduction was found within the groups but not between them. Clinically meaningful changes in pain were inconsistent; 3 studies reported that scores met minimum clinically important difference, 1 reported scores did not, and 2 were unclear. Four studies found statistically significant improvements in disability; however, 2 were RCTs and did not find statistical significance between the active and sham groups.
CONCLUSIONS
No clinical trials of thrust manipulation for non-surgical shoulder conditions other than subacromial impingement syndrome were found. There is limited evidence to support or refute thrust manipulation as a solitary treatment for this condition. Studies consistently reported pain reduction, but active treatments were comparable to shams. High-quality studies of thrust manipulation with safety data, longer treatment periods and follow-up outcomes are needed.
PubMed: 28070268
DOI: 10.1186/s12998-016-0133-8 -
Surgical Technology International Jun 2018Unicompartmental knee arthroplasty (UKA) effectively improves pain and function associated with isolated compartmental knee arthritis. The developments of... (Review)
Review
INTRODUCTION
Unicompartmental knee arthroplasty (UKA) effectively improves pain and function associated with isolated compartmental knee arthritis. The developments of computer-navigated and robotic-assisted UKA are among the most significant changes that have improved patient outcomes. This study aimed to systematically review the literature to identify differences between computer-navigated and robotic-assisted UKAs.
MATERIALS AND METHODS
Twenty total articles were identified. Data pertaining to demographics, outcomes, and complications/failures were extracted from each study. Reoperation/revision rates, indications for reoperation/revision, type of procedure, and number of patients who underwent conversion to TKA (when available) were recorded.
RESULTS
Nine studies reported 451 computer-navigated medial UKAs, with 19 (3.9%) reportedly requiring reoperation: primary revision (n=8; 42.1%), conversion to TKA (n=6), and manipulation under anesthesia (n=5). Eleven studies reported 2,311 robotic-assisted UKAs (74 lateral UKAs), with 106 (5.0%) requiring reoperation: conversion to TKA (n=46; 43.4%), primary revision (n=43), reoperations without component-removal (n=15), subchondroplasty, and partial meniscectomy/synovectomy (both n=1). Reoperation rate discrepancy between computer-navigated and robotic-assisted UKA was not statistically significant (p=0.495); age and BMI differed between both groups (p<0.0001).
DISCUSSION
This study represents the first known comparison of revision rates of computer-navigated and robotic-assisted UKA, suggesting that these methods can benefit orthopaedic surgeons, especially those new to UKA or in a low-volume practice.
Topics: Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Knee; Female; Humans; Knee Joint; Male; Middle Aged; Postoperative Complications; Reoperation; Robotic Surgical Procedures; Treatment Outcome
PubMed: 29611157
DOI: No ID Found