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BMJ Open Oct 2023Low back pain (LBP) is a major global public health problem and the majority (nearly 90%) of patients with LBP suffer from non-specific LBP (NSLBP). Acupuncture has been...
Dose-response relationship between acupuncture time parameters and the effects on chronic non-specific low back pain: a systematic review and Bayesian model-based network meta-analysis protocol.
INTRODUCTION
Low back pain (LBP) is a major global public health problem and the majority (nearly 90%) of patients with LBP suffer from non-specific LBP (NSLBP). Acupuncture has been widely used for relieving pain and is recommended as a first-line treatment in LBP guidelines. However, the guidelines do not recommend a specific acupuncture temporal dosage. A Bayesian model-based network meta-analysis (MBNMA) will be conducted to optimise the dosages of time parameters (session, frequency and duration).
METHODS AND ANALYSIS
The following databases will be searched from their inception until 1 July 2023: MEDLINE (via PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Web of Science, Cumulative Index to Nursing & Allied Health Literature (CINAHL), alternative health research database (Alt HealthWatch), China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database for Chinese Technical Periodicals, ClinicalTrials.gov, the WHO's International Clinical Trial and Chinese Clinical Registry. RCTs assessing the effects of acupuncture on chronic NSLBP will be selected. The primary outcome measure will be the improvement in pain intensity at different acupuncture time points. The MBNMA will be performed using R V.4.2.1 with related R packages. Risk of Bias V.2.0 and Confidence in Network Meta-Analysis will be used to assess the evidence quality.
ETHICS AND DISSEMINATION
Ethical approval is not required for literature-based studies. The results will be published in peer-reviewed journals or conferences.
PROSPERO REGISTRATION NUMBER
CRD42022336056.
Topics: Humans; Low Back Pain; Bayes Theorem; Network Meta-Analysis; Acupuncture Therapy; China; Research Design; Systematic Reviews as Topic; Meta-Analysis as Topic
PubMed: 37813535
DOI: 10.1136/bmjopen-2023-071554 -
Radiology. Imaging Cancer Mar 2024
Topics: Humans; Radiography; Radiology; Meta-Analysis as Topic
PubMed: 38456788
DOI: 10.1148/rycan.240018 -
BMJ Open Jun 2022Patients with inflammatory bowel diseases (IBD) often report psychological problems, unemployment, disability, sick leave and compromised quality of life. The effect of...
INTRODUCTION
Patients with inflammatory bowel diseases (IBD) often report psychological problems, unemployment, disability, sick leave and compromised quality of life. The effect of psychological interventions on health-related outcomes in IBD is controversial as previous reviews faced the obstacle of high heterogeneity among provided multimodular interventions. The heterogeneity can be addressed with network meta-analysis (NMA) and (multi)component NMA (CNMA). We aim to investigate whether psychological interventions can improve quality of life, clinical and social outcomes in IBD using NMA and CNMA. This is the study protocol.
METHODS AND ANALYSIS
We will consider randomised, quasi-randomised and non-randomised controlled trials, including cluster randomised and cross-over trials with 2 months of minimum follow-up. The conditions to be studied comprise Crohn's disease and ulcerative colitis in children, adolescents and adults. We will include any psychological intervention aiming to change the health status of the study participant.We will search Medline, Embase, Web of Science, CENTRAL, LILACS, Psyndex, PsycINFO, Google Scholar and trial registries from inception (the search will be updated before the review completion). Two authors will independently screen all references based on titles and abstracts. For data extraction, standard forms are developed and tested before extraction. All information will be assessed independently by at least two reviewers, and disagreements solved by consensus discussion or a third rater if necessary.The data synthesis will include a pairwise meta-analysis supported by meta-regression. We will conduct NMA (all treatments will constitute single nodes of the network) and CNMA (we will define all treatments as sums of core components, eg, cognitive +behaviour, or cognitive +behaviour + relaxation, and additionally consider interactions) using the R Package netmeta.
ETHICS AND DISSEMINATION
No ethical approval is required. Reports will include the final report to the funder, conference presentation, peer-reviewed publication and a patient report.
PROSPERO REGISTRATION NUMBER
CRD42021250446.
Topics: Adolescent; Adult; Child; Chronic Disease; Humans; Inflammatory Bowel Diseases; Meta-Analysis as Topic; Network Meta-Analysis; Psychosocial Intervention; Quality of Life; Systematic Reviews as Topic
PubMed: 35732389
DOI: 10.1136/bmjopen-2021-056982 -
PloS One 2022Although several non-pharmacological interventions have been tested in the management of Fibromyalgia (FM), there is little consensus regarding the best options for the...
INTRODUCTION
Although several non-pharmacological interventions have been tested in the management of Fibromyalgia (FM), there is little consensus regarding the best options for the treatment of this health condition. The purpose of this network meta-analysis (NMA) is to investigate the comparative efficacy and acceptability of non-pharmacological interventions for FM, in order to assist clinical decision making through a ranking of interventions in relation to the most important clinical outcomes in these patients.
METHODS AND ANALYSIS
We will perform a systematic search to identify randomised controlled trials of non-pharmacological interventions endorsed in guidelines and systematic reviews. Information sources searched will include major bibliographic databases without language or date restrictions (MEDLINE, Cochrane Library, EMBASE, AMED, PsycINFO and PEDro). Our primary outcomes will be pain intensity, patient-reported quality of life (QoL), and acceptability of treatment will be our secondary outcome. Risk of bias of the included trials will be assessed using the Cochrane risk of bias tool (RoB2). For each pairwise comparison between the different interventions, we will present mean differences (MDs) for pain intensity and QoL outcomes and Relative Risks (RRs) for acceptability, both with respective 95% confidence intervals (CIs). Initially, standard pairwise meta-analyses will be performed using a DerSimonian-Laird random effects model for all comparisons with at least two trials and then we will perform a frequentist NMA using the methodology of multivariate meta-analysis assuming a common heterogeneity parameter, using the mvmeta command and network suite in STATA. In the NMA, two different types of control group, such as placebo/sham and no intervention/waiting list will be combined as one node called "Control". The competing interventions will be ranked using the P-score, which is the frequentist analogue of surface under the cumulative ranking curve (SUCRA) for the outcomes of interest at immediate- (intervention duration of up to 2 weeks), short- (over 2 weeks up to 12 weeks) and long-terms (over 12 weeks). The confidence in the results from NMA will be assessed using the Confidence in Network Meta-analysis (CINeMA) framework.
ETHICS AND DISSEMINATION
This work synthesises evidence from previously published studies and does not require ethics review or approval. A manuscript describing the findings will be submitted for publication in a peer-reviewed scientific journal.
REGISTRATION
OSF (DOI: 10.17605/OSF.IO/7MS25) and registered in the PROSPERO database (CRD42020216374).
Topics: Fibromyalgia; Humans; Meta-Analysis as Topic; Network Meta-Analysis; Quality of Life
PubMed: 36191010
DOI: 10.1371/journal.pone.0274406 -
In Vivo (Athens, Greece) 2023Network meta-analysis (NMA) as the quantification of pairwise meta-analysis in a network format has been of particular interest to medical researchers in recent years.... (Meta-Analysis)
Meta-Analysis Review
Network meta-analysis (NMA) as the quantification of pairwise meta-analysis in a network format has been of particular interest to medical researchers in recent years. As a powerful tool with which direct and indirect evidence from multiple interventions can be synthesized simultaneously in the study and design of clinical trials, NMA enables inferences to be drawn about the relative effect of drugs that have never been compared. In this way, NMA provides information on the hierarchy of competing interventions for a given disease concerning clinical effectiveness, thus giving clinicians a comprehensive picture for decision-making and potential avoidance of additional costs. However, estimates of treatment effects derived from the results of network meta-analyses should be interpreted with due consideration of their uncertainty, because simple scores or treatment probabilities may be misleading. This is particularly true where, given the complexity of the evidence, there is a serious risk of misinterpretation of information from aggregated data sets. For these reasons, NMA should be performed and interpreted by both expert clinicians and experienced statisticians, while a more comprehensive search of the literature and a more careful evaluation of the body of evidence can maximize the transparency of the NMA and potentially avoid errors in its interpretation. This review provides the key concepts as well as the challenges we face when studying a network meta-analysis of clinical trials.
Topics: Network Meta-Analysis; Reproducibility of Results; Treatment Outcome
PubMed: 37103082
DOI: 10.21873/invivo.13171 -
Assessing the robustness of results from clinical trials and meta-analyses with the fragility index.American Journal of Obstetrics and... Mar 2023The fragility index has been increasingly used to assess the robustness of the results of clinical trials since 2014. It aims at finding the smallest number of event... (Review)
Review
The fragility index has been increasingly used to assess the robustness of the results of clinical trials since 2014. It aims at finding the smallest number of event changes that could alter originally statistically significant results. Despite its popularity, some researchers have expressed several concerns about the validity and usefulness of the fragility index. It offers a comprehensive review of the fragility index's rationale, calculation, software, and interpretation, with emphasis on application to studies in obstetrics and gynecology. This article presents the fragility index in the settings of individual clinical trials, standard pairwise meta-analyses, and network meta-analyses. Moreover, this article provides worked examples to demonstrate how the fragility index can be appropriately calculated and interpreted. In addition, the limitations of the traditional fragility index and some solutions proposed in the literature to address these limitations were reviewed. In summary, the fragility index is recommended to be used as a supplemental measure in the reporting of clinical trials and a tool to communicate the robustness of trial results to clinicians. Other considerations that can aid in the fragility index's interpretation include the loss to follow-up and the likelihood of data modifications that achieve the loss of statistical significance.
Topics: Humans; Network Meta-Analysis; Probability; Meta-Analysis as Topic; Clinical Trials as Topic
PubMed: 36084702
DOI: 10.1016/j.ajog.2022.08.053 -
Medicine Dec 2022Alzheimer disease (AD) is the most common cause of dementia worldwide. Despite the publication of numerous systematic reviews and meta-analyses that have summarized the...
BACKGROUND
Alzheimer disease (AD) is the most common cause of dementia worldwide. Despite the publication of numerous systematic reviews and meta-analyses that have summarized the evidence associated with pharmacotherapies (PTs) and non-pharmacotherapies (NPTs) for the wide range of interventions available for AD treatment, their comparative safety and efficacy remains insufficiently defined.
METHODS
Systematic reviews of randomized controlled trials (RCTs) will be selected according to the following criteria: conducted in elderly patients aged 60 years or older with AD living in community or institutionalized settings, applied pairwise meta-analysis (PMA) or network meta-analysis (NMA) approaches providing pooled relative treatment effects for at least 1 pair of PTs or NPTs, and providing at least 1 of the following outcomes for patients/caregivers: cognitive, functional status, behavior, quality of life (QoL), and caregiver stress or burden. All article screening, data extraction, and risk of bias assessment will be completed independently by 2 reviewers. Relative treatment rankings will be reported with mean ranks and surface under the cumulative ranking curves.
RESULTS AND CONCLUSION
We will determine the most efficacious treatment strategies for AD patients from the most highly ranked treatments. These results will help to guide clinical decision-making and improve patient care.
Topics: Aged; Humans; Alzheimer Disease; Systematic Reviews as Topic; Meta-Analysis as Topic; Treatment Outcome; Network Meta-Analysis
PubMed: 36550893
DOI: 10.1097/MD.0000000000032382 -
Medicine Feb 2022Autism spectrum disorder (ASD) is a widespread developmental disorder of the nervous system with an unclear etiology and pathogenesis. Its global incidence is currently...
BACKGROUND
Autism spectrum disorder (ASD) is a widespread developmental disorder of the nervous system with an unclear etiology and pathogenesis. Its global incidence is currently increasing, and no effective drugs are available to improve its core symptoms. Nonpharmaceutical therapy can effectively relieve the core symptoms of autism, has fewer side effects than drugs, and is easily accepted by patients. This systematic and network meta-analysis aimed to evaluate the impact of non-pharmaceutical therapy on autism to explore preferable therapeutic options for autism.
METHODS
Online databases, including the China National Knowledge Infrastructure [CNKI], SinoMed, Wanfang Database [WF], China Science and Technology Journal Database [VIP], MEDLINE, Web of Science, EMBASE, and the Cochrane Library will be searched for randomized controlled trials of nonpharmacological interventions for autism published before October 2021. Two researchers will be independently responsible for the literature screening, data extraction, and quality assessment. Standard paired and Bayesian network meta-analyses will be performed using RevMan 5.3 Software and GEMTC 0.14.3, to compare the efficacy and safety of different nonpharmacological regimens.
RESULTS
The results of this systematic and network meta-analysis will be submitted to a peer-reviewed journal for publication.
CONCLUSION
This study provides a comprehensive and reliable evidence-based reference for the efficacy and safety of different non-pharmacological interventions for autism.
PROSPERO REGISTRATION NUMBER
CRD 42021275571.
Topics: Autism Spectrum Disorder; Bayes Theorem; China; Humans; Meta-Analysis as Topic; Network Meta-Analysis; Systematic Reviews as Topic
PubMed: 35363171
DOI: 10.1097/MD.0000000000028811 -
Studies in History and Philosophy of... Feb 2022Literature-based meta-analysis is a standard technique applied to pool results of individual studies used in medicine and social sciences. It has been criticized for...
Literature-based meta-analysis is a standard technique applied to pool results of individual studies used in medicine and social sciences. It has been criticized for being too malleable to constrain results, averaging incomparable values, lacking a measure of evidence's strength, and problems with a systematic bias of individual studies. We argue against using literature-based meta-analysis of RCTs to assess treatment efficacy and show that therapeutic decisions based on meta-analytic average are not optimal given the full scope of existing evidence. The argument proceeds with discussing examples and analyzing the properties of some standard meta-analytic techniques. First, we demonstrate that meta-analysis can lead to reporting statistically significant results despite the treatment's limited efficacy. Second, we show that meta-analytic confidence intervals are too narrow compared to the variability of treatment outcomes reported by individual studies. Third, we argue that literature-based meta-analysis is not a reliable measurement instrument. Finally, we show that meta-analysis averages out the differences among studies and leads to a loss of information. Despite these problems, literature-based meta-analysis is useful for the assessment of harms. We support two alternative approaches to evidence amalgamation: meta-analysis of individual patient data (IPD) and qualitative review employing mechanistic evidence.
Topics: Bias; Humans; Meta-Analysis as Topic; Treatment Outcome
PubMed: 34922183
DOI: 10.1016/j.shpsa.2021.11.007 -
The Journal of Prosthetic Dentistry Sep 2023The implant abutment connection interface has been considered one of the major factors affecting the outcome of implant therapy. However, drawbacks of traditional... (Meta-Analysis)
Meta-Analysis Review
Comparison of external, internal flat-to-flat, and conical implant abutment connections for implant-supported prostheses: A systematic review and network meta-analysis of randomized clinical trials.
STATEMENT OF PROBLEM
The implant abutment connection interface has been considered one of the major factors affecting the outcome of implant therapy. However, drawbacks of traditional meta-analyses are the inability to compare more than 2 treatments at a time, which complicates the decision-making process for dental clinicians, and the lack of a network meta-analysis.
PURPOSE
The purpose of this network meta-analysis was to assess whether the implant abutment connection influences the outcome of implant-supported prostheses.
MATERIAL AND METHODS
An electronic search was undertaken to identify all randomized clinical trials comparing the effect of at least 2 different implant abutment connection designs published from 2009 up to May 2020. Outcome variables were implant survival rate, peri-implant marginal bone loss, and biologic and prosthetic complication rates at 12 months after prosthetic loading. Relevant information was extracted, and quality and risk of bias assessed. Pairwise meta-analyses and network meta-analyses based on a multivariate random-effects meta-regression were performed to assess the comparisons (α=.05 for all analyses).
RESULTS
For peri-implant marginal bone loss and prosthetic complications, conical interfaces were determined to be the most effective, with significant differences when compared with external hexagonal connections (P=.011 and P=.038, respectively). No significant differences were found among the implant abutment connections in terms of survival and biologic complications (P>.05 in all direct, indirect, and mixed comparisons).
CONCLUSIONS
After 1 year of loading, conical connections showed lower marginal bone loss and fewer prosthetic complications than external hexagonal connections. However, the implant abutment connection design had no influence on the implant survival and biologic complication rates.
Topics: Dental Implants; Network Meta-Analysis; Dental Implant-Abutment Design; Dental Prosthesis, Implant-Supported; Randomized Controlled Trials as Topic; Biological Products
PubMed: 34776267
DOI: 10.1016/j.prosdent.2021.09.029