-
Journal of Cachexia, Sarcopenia and... Jun 2024The use of patient-reported outcomes (PROMs) of quality of life (QOL) is common in cachexia trials. Patients' self-report on health, functioning, wellbeing, and... (Review)
Review
The use of patient-reported outcomes (PROMs) of quality of life (QOL) is common in cachexia trials. Patients' self-report on health, functioning, wellbeing, and perceptions of care, represent important measures of efficacy. This review describes the frequency, variety, and reporting of QOL endpoints used in cancer cachexia clinical trials. Electronic literature searches were performed in Medline, Embase, and Cochrane (1990-2023). Seven thousand four hundred thirty-five papers were retained for evaluation. Eligibility criteria included QOL as a study endpoint using validated measures, controlled design, adults (>18 years), ≥40 participants randomized, and intervention exceeding 2 weeks. The Covidence software was used for review procedures and data extractions. Four independent authors screened all records for consensus. Papers were screened by titles and abstracts, prior to full-text reading. PRISMA guidance for systematic reviews was followed. The protocol was prospectively registered via PROSPERO (CRD42022276710). Fifty papers focused on QOL. Twenty-four (48%) were double-blind randomized controlled trials. Sample sizes varied considerably (n = 42 to 469). Thirty-nine trials (78%) included multiple cancer types. Twenty-seven trials (54%) featured multimodal interventions with various drugs and dietary supplements, 11 (22%) used nutritional interventions alone and 12 (24%) used a single pharmacological intervention only. The median duration of the interventions was 12 weeks (4-96). The most frequent QOL measure was the EORTC QLQ-C30 (60%), followed by different FACIT questionnaires (34%). QOL was a primary, secondary, or exploratory endpoint in 15, 31 and 4 trials respectively, being the single primary in six. Statistically significant results on one or more QOL items favouring the intervention group were found in 18 trials. Eleven of these used a complete multidimensional measure. Adjustments for multiple testing when using multicomponent QOL measures were not reported. Nine trials (18%) defined a statistically or clinically significant difference for QOL, five with QOL as a primary outcome, and four with QOL as a secondary outcome. Correlation statistics with other study outcomes were rarely performed. PROMs including QOL are important endpoints in cachexia trials. We recommend using well-validated QOL measures, including cachexia-specific items such as weight history, appetite loss, and nutritional intake. Appropriate statistical methods with definitions of clinical significance, adjustment for multiple testing and few co-primary endpoints are encouraged, as is an understanding of how interventions may relate to changes in QOL endpoints. A strategic and scientific-based approach to PROM research in cachexia trials is warranted, to improve the research base in this field and avoid the use of QOL as supplementary measures.
Topics: Humans; Cachexia; Quality of Life; Neoplasms; Clinical Trials as Topic; Patient Reported Outcome Measures
PubMed: 38553255
DOI: 10.1002/jcsm.13453 -
Gait & Posture May 2024Backward walking is an indispensable component of activities of daily living. The backward walk test has been used to assess balance, mobility, and fall risk in... (Review)
Review
BACKGROUND
Backward walking is an indispensable component of activities of daily living. The backward walk test has been used to assess balance, mobility, and fall risk in different populations. This systematic review aimed to identify and synthesize measurement properties of the backward walk test in people with balance and mobility deficits.
METHODS
Three bibliographic databases, PubMed, Embase, and Scopus, were searched on June 18th, 2023. Cross-sectional or cohort studies assessing the measurement properties (reliability, validity, responsiveness) of the backward walk test were included. The COSMIN risk of bias checklist was used for methodological quality assessment. Study selection, data extraction, and quality assessment were completed by two reviewers independently and in duplicate.
RESULTS
A total of 786 records were identified from three databases. Fourteen studies published from 2019 to 2023 with a total of 853 participants were included. Two studies were rated inadequate in quality assessment, all other studies demonstrated adequate to very good quality. The participants population included patients with cerebral palsy, stroke, multiple sclerosis, Parkinson's disease, fibromyalgia, hip and knee arthroplasty, dementia, and community-dwelling older adults. Good interrater and intrarater reliability, and moderate to good concurrent validity of the backward walk test were demonstrated.
SIGNIFICANCE
The review demonstrates that the backward walk test appears to be a valid and reliable tool in different patient populations. The 3-meter backward walk time and 3-meter backward walk speed can be used as outcome measures in clinical practice to assess balance and mobility and track progress throughout the course of physical rehabilitation. Future studies with a prospective cohort design are required to provide information regarding the predictive validity of the backward walk test for fall risk assessment.
Topics: Humans; Postural Balance; Walk Test; Reproducibility of Results; Mobility Limitation; Accidental Falls
PubMed: 38458049
DOI: 10.1016/j.gaitpost.2024.02.018 -
Phytotherapy Research : PTR May 2024Sarcopenia has become important to the public health with the increase in the aging population in society. However, the therapeutic effects of conventional approaches,... (Meta-Analysis)
Meta-Analysis Review
Sarcopenia has become important to the public health with the increase in the aging population in society. However, the therapeutic effects of conventional approaches, including pharmacotherapy, exercise, and nutritional intervention, are far from satisfactory. Chinese herbal medicine is a new treatment format with interesting possibilities in sarcopenia has been widely practiced. The study aims to explore the effectiveness of Chinese herbal medicine in sarcopenia. We comprehensively searched the following electronic databases: Medline, EMBASE, APA PsycInfo, Cochrane Library, Web of Science, PubMed, and Chinese database from the establishment of the database to December 2022 (no language restrictions). Randomized controlled clinical studies on the use of Chinese herbal medicine in sarcopenia were selected in compliance with PRISMA guidelines. Review Manager and Stata were used for statistical analysis and the mean difference and standardized mean difference were adopted. Of 277 identified studies, 17 were eligible and included in our analysis (N = 1440 participants). The results showed that Chinese herbal medicine can improve total efficiency (RR = 1.29, 95% CI [1.21, 1.36], p < 0.00001) in sarcopenia and enhance muscle mass (SMD = 1.02, 95% CI [0.55, 1.50], p < 0.0001), and muscle strength measured by grip strength (SMD = 0.66, 95% CI [0.36, 0.96], p < 0.0001), measured by 60°/s knee extension peak TQ (MD = 5.63, 95% CI [-0.30, 11.57], p = 0.06) and muscle function measured by 6-meter walking speed (SMD = 1.34, 95% CI [0.60, 2.08], p = 0.0004), measured by the short physical performance battery of 1.50%, 95% CI (1.05, 1.95), measured by the EuroQoL 5-dimension of (SMD = 0.27, 95% CI [-0.10, 0.65], p = 0.16), suggesting that Chinese herbal medicine alone or combined with conventional treatment has ameliorating effect on sarcopenia. Chinese herbal medicine is a potential therapeutic strategy in sarcopenia. The funnel plot and Egger's test indicated publication bias. To confirm our conclusions, further high-quality studies should be conducted.
Topics: Sarcopenia; Humans; Drugs, Chinese Herbal; Randomized Controlled Trials as Topic; Muscle Strength; Muscle, Skeletal
PubMed: 38419525
DOI: 10.1002/ptr.8154 -
Ear and HearingThe purpose of this systematic review of publications was to evaluate existing evidence on the accuracy and precision of alternative occupational noise assessment... (Comparative Study)
Comparative Study
OBJECTIVES
The purpose of this systematic review of publications was to evaluate existing evidence on the accuracy and precision of alternative occupational noise assessment methods, with personal noise dosimetry as the reference.
DESIGN
A structured literature search was performed in Ovid MEDLINE(R) and Embase in July 2021 and 2022. The Covidence software was used for importing articles, screening titles and abstracts, full-text review, and study selection. Two reviewers independently conducted the title, abstract, and full-text screening of eligible studies. The reporting of this systematic review was guided by the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. The quality of selected articles was assessed using the Joanna Briggs Institute checklist for analytical cross-sectional studies.
RESULTS
In total, 11 studies consistent with the study selection criteria were identified out of 327 articles from the initial search. The noise-measurement methods identified in the selected studies included subjective rating through a questionnaire, expert opinion, smartwatch, sound level meter, sound level meter combined with a radio-frequency identification system, smart devices, workgroup dosimetry sampling, task-based measurement (TBM), and hybrid TBM. The hybrid method (a combination of task-based, subjective rating, and trade mean measurements) was the best alternative to full-shift personal noise-dosimetry with a negligible bias of 0.1 dB, precision of 2.4 dBA, and accuracy of 2.4 dBA.
CONCLUSION
A variety of lower-cost TBM methods had relatively high accuracy and precision levels comparable to personal dosimetry. These findings are particularly relevant for low-income countries where occupational noise measurements should be obtained with minimal work disruptions and costs. However, it should also be noted that TBMs are greatly affected by job variation, multiple tasks, or mobile tasks.
Topics: Humans; Noise, Occupational; Occupational Exposure; Environmental Monitoring
PubMed: 38389130
DOI: 10.1097/AUD.0000000000001479 -
The Cochrane Database of Systematic... Feb 2024Peripheral arterial disease (PAD) is the obstruction or narrowing of the large arteries of the lower limbs, which can result in impaired oxygen supply to the muscle and... (Review)
Review
BACKGROUND
Peripheral arterial disease (PAD) is the obstruction or narrowing of the large arteries of the lower limbs, which can result in impaired oxygen supply to the muscle and other tissues during exercise, or even at rest in more severe cases. PAD is classified into five categories (Fontaine classification). It may be asymptomatic or various levels of claudication pain may be present; at a later stage, there may be ulceration or gangrene of the limb, with amputation occasionally being required. About 20% of people with PAD suffer from intermittent claudication (IC), which is muscular discomfort in the lower extremities induced by exertion and relieved by rest within 10 minutes; IC causes restriction of movement in daily life. Treatment for people with IC involves addressing lifestyle risk factors. Exercise is an important part of treatment, but supervised exercise programmes for individuals with IC have low engagement levels and high attrition rates. The use of mobile technologies has been suggested as a new way to engage people with IC in walking exercise interventions. The novelty of the intervention, low cost for the user, automation, and ease of access are some of the advantages mobile health (mhealth) technologies provide that give them the potential to be effective in boosting physical activity in adults.
OBJECTIVES
To assess the benefits and harms of mobile health (mhealth) technologies to improve walking distance in people with intermittent claudication.
SEARCH METHODS
The Cochrane Vascular Information Specialist conducted systematic searches of the Cochrane Vascular Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and CINAHL, and also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov. The most recent searches were carried out on 19 December 2022.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) in people aged 18 years or over with symptomatic PAD and a clinical diagnosis of IC. We included RCTs comparing mhealth interventions to improve walking distance versus usual care (no intervention or non-exercise advice), exercise advice, or supervised exercise programmes. We excluded people with chronic limb-threatening ischaemia (Fontaine III and IV).
DATA COLLECTION AND ANALYSIS
We used standard Cochrane methods. Our primary outcomes were change in absolute walking distance from baseline, change in claudication distance from baseline, amputation-free survival, revascularisation-free survival. Our secondary outcomes were major adverse cardiovascular events, major adverse limb events, above-ankle amputation, quality of life, and adverse events. We used GRADE to assess the certainty of the evidence.
MAIN RESULTS
We included four RCTs involving a total of 614 participants with a clinical diagnosis of IC. The duration of intervention of the four included RCTs ranged from 3 to 12 months. Participants were randomised to either mhealth or control (usual care or supervised exercise programme). All four studies had an unclear or high risk of bias in one or several domains. The most prevalent risk of bias was in the area of performance bias, which was rated high risk as it is not possible to blind participants and personnel in this type of trial. Based on GRADE criteria, we downgraded the certainty of the evidence to low, due to concerns about risk of bias, imprecision, and clinical inconsistency. Comparing mhealth with usual care, there was no clear evidence of an effect on absolute walking distance (mean difference 9.99 metres, 95% confidence interval (CI) -27.96 to 47.93; 2 studies, 503 participants; low-certainty evidence). None of the included studies reported on change in claudication walking distance, amputation-free survival, or revascularisation-free survival. Only one study reported on major adverse cardiovascular events (MACE) and found no clear difference between groups (risk ratio 1.37, 95% CI 0.07 to 28.17; 1 study, 305 participants; low-certainty evidence). None of the included studies reported on major adverse limb events (MALE) or above-ankle amputations.
AUTHORS' CONCLUSIONS
Mobile health technologies can be used to provide lifestyle interventions for people with chronic conditions, such as IC. We identified a limited number of studies that met our inclusion criteria. We found no clear difference between mhealth and usual care in improving absolute walking distance in people with IC; however, we judged the evidence to be low certainty. Larger, well-designed RCTs are needed to provide adequate statistical power to reliably evaluate the effects of mhealth technologies on walking distance in people with IC.
Topics: Adult; Humans; Intermittent Claudication; Peripheral Arterial Disease; Exercise Therapy; Walking; Lower Extremity; Randomized Controlled Trials as Topic
PubMed: 38353263
DOI: 10.1002/14651858.CD014717.pub2 -
NeuroRehabilitation 2024Electrical stimulation techniques are widely utilized for rehabilitation management in individuals with stroke patients. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Electrical stimulation techniques are widely utilized for rehabilitation management in individuals with stroke patients.
OBJECTIVES
This review aims to summarize the rehabilitative effects of electrical stimulation therapy on gait performance in stroke patients.
METHODS
This review included randomized controlled trials (RCT) investigating the therapeutic effects of electrical stimulation in stroke patients throughout five databases. This review qualitatively synthesized 20 studies and quantitatively analyzed 11 RCTs.
RESULTS
Functional electrical stimulation (FES) was the most commonly used electrical stimulation type to improve postural stability and gait performance in stroke patients. The clinical measurement tools commonly used in the three studies to assess the therapeutic effects of FES were Berg balance scale (BBS), 10-meter walk test (10MWT), 6-minute walk test (6mWT), and gait velocity. The BBS score and gait velocity had positive effects in the FES group compared with the control group, but the 10MWT and 6mWT showed the same effects between the two groups. The heterogeneity of BBS scores was also high.
CONCLUSION
The results of this review suggest that electrical stimulation shows little evidence of postural stability and gait performance in stroke patients, although some electrical stimulations showed positive effects on postural stability and gait performance.
Topics: Humans; Stroke Rehabilitation; Gait Disorders, Neurologic; Stroke; Gait; Physical Therapy Modalities; Electric Stimulation Therapy; Postural Balance
PubMed: 38306066
DOI: 10.3233/NRE-230360 -
Frontiers in Psychology 2023Sustainability research has emerged as an interdisciplinary area of knowledge about how to achieve sustainable development, while political actions toward the goal are... (Review)
Review
Sustainability research has emerged as an interdisciplinary area of knowledge about how to achieve sustainable development, while political actions toward the goal are still in their infancy. A sustainable world is mirrored by a healthy environment in which humans can live without jeopardizing the survival of future generations. The main aim of this contribution was to carry out a systematic mapping (SM) of the applications of digital technologies in promoting environmental sustainability. From a rigorous search of different databases, a set of more than 1000 studies was initially retrieved and then, following screening criteria based on the ROSES (RepOrting standards for Systematic Evidence Syntheses) procedure, a total of = 37 studies that met the eligibility criteria were selected. The studies were coded according to different descriptive variables, such as digital technology used for the intervention, type of sustainable behavior promoted, research design, and population for whom the intervention was applied. Results showed the emergence of three main clusters of Digital Technologies (i.e., virtual/immersive/augmented reality, gamification, and power-metering systems) and two main Sustainable Behaviors (SBs) (i.e., energy and water-saving, and pollution reduction). The need for a clearer knowledge of which digital interventions work and the reasons why they work (or do not work) does not emerge from the outcomes of this set of studies. Future studies on digital interventions should better detail intervention design characteristics, alongside the reasons underlying design choices, both behaviourally and technologically. This should increase the likelihood of the successful adoption of digital interventions promoting behavioral changes in a more sustainable direction.
PubMed: 38239482
DOI: 10.3389/fpsyg.2023.1234349 -
JAMA Pediatrics Mar 2024Concerns have been raised that frequent consumption of 100% fruit juice may promote weight gain. Current evidence on fruit juice and weight gain has yielded mixed... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Concerns have been raised that frequent consumption of 100% fruit juice may promote weight gain. Current evidence on fruit juice and weight gain has yielded mixed findings from both observational studies and clinical trials.
OBJECTIVE
To synthesize the available evidence on 100% fruit juice consumption and body weight in children and adults.
DATA SOURCES
MEDLINE, Embase, and Cochrane databases were searched through May 18, 2023.
STUDY SELECTION
Prospective cohort studies of at least 6 months and randomized clinical trials (RCTs) of at least 2 weeks assessing the association of 100% fruit juice with body weight change in children and adults were included. In the trials, fruit juices were compared with noncaloric controls.
DATA EXTRACTION AND SYNTHESIS
Data were pooled using random-effects models and presented as β coefficients with 95% CIs for cohort studies and mean differences (MDs) with 95% CIs for RCTs.
MAIN OUTCOMES AND MEASURES
Change in body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) was assessed in children and change in body weight in adults.
RESULTS
A total of 42 eligible studies were included in this analysis, including 17 among children (17 cohorts; 0 RCTs; 45 851 children; median [IQR] age, 8 [1-15] years) and 25 among adults (6 cohorts; 19 RCTs; 268 095 adults; median [IQR] age among cohort studies, 48 [41-61] years; median [IQR] age among RCTs, 42 [25-59]). Among cohort studies in children, each additional serving per day of 100% fruit juice was associated with a 0.03 (95% CI, 0.01-0.05) higher BMI change. Among cohort studies in adults, studies that did not adjust for energy showed greater body weight gain (0.21 kg; 95% CI, 0.15-0.27 kg) than studies that did adjust for energy intake (-0.08 kg; 95% CI, -0.11 to -0.05 kg; P for meta-regression <.001). RCTs in adults found no significant association of assignment to 100% fruit juice with body weight but the CI was wide (MD, -0.53 kg; 95% CI, -1.55 to 0.48 kg).
CONCLUSION AND RELEVANCE
Based on the available evidence from prospective cohort studies, in this systematic review and meta-analysis, 1 serving per day of 100% fruit juice was associated with BMI gain among children. Findings in adults found a significant association among studies unadjusted for total energy, suggesting potential mediation by calories. Further trials of 100% fruit juice and body weight are desirable. Our findings support guidance to limit consumption of fruit juice to prevent intake of excess calories and weight gain.
Topics: Adolescent; Adult; Child; Child, Preschool; Humans; Infant; Middle Aged; Body Mass Index; Body Weight; Fruit and Vegetable Juices; Randomized Controlled Trials as Topic; Weight Gain
PubMed: 38227336
DOI: 10.1001/jamapediatrics.2023.6124 -
International Journal of Surgery... Jan 2024Prostate cancer (PCa) is a prevalent cancer with significant morbidity and mortality rates. In most cases, prostate cancer remains asymptomatic until advanced disease...
BACKGROUND
Prostate cancer (PCa) is a prevalent cancer with significant morbidity and mortality rates. In most cases, prostate cancer remains asymptomatic until advanced disease manifests with symptoms, such as benign prostate hyperplasia (BPH). Timely detection and better management have improved overall survival in patients with prostate cancer, and fatigue, reduced physical activity, and impaired quality of life (QoL) remain major challenges that impact daily life.
OBJECTIVE
This study aimed to systematically review and conduct a meta-analysis to evaluate the impact of aerobic and resistance training on fatigue, quality of life, and physical activity in prostate cancer patients undergoing treatment.
MATERIAL METHODS
A comprehensive literature search was conducted using the PubMed, Cochrane Library, and clinicaltrials.gov databases, adhering to the PRISMA guidelines. Twenty studies, involving 1393 participants, were included in the final analysis. The inclusion criteria were Studies that evaluated the effects of exercise interventions relative to passive controls in patients with prostate cancer were included. The primary outcomes of interest were fatigue, QoL, and PA.. Data from eligible studies were extracted, and a meta-analysis was performed using RevMan 5.40.
RESULTS
Twenty studies met our inclusion criteria. Data Analysis of the included studies demonstrated a significant improvement in quality of life among prostate cancer patients in the exercise group compared to the control group (SMD=0.20, 95% CI=0.07 to 0.34, P=0.003). However, there was no significant association between exercise and fatigue (SMD=0.07, 95% CI=-0.13, 0.26, P=0.51). Sensitivity analysis did not alter these findings. Regarding physical activity outcomes, the control group exhibited superior performance in the 400-meter walk test (P<0.05). No significant associations were found between exercise and the 6-meter walk test or up-and-go time.
CONCLUSION
This systematic review revealed that aerobic and resistance training enhance the quality of life of patients with prostate cancer, although it has a limited impact on fatigue and physical activity levels. These findings advocate a shift in clinical practice and positioning exercise as a core component of comprehensive cancer care. Tailoring exercise regimens according to individual patient needs and treatment stages should become the norm in treatment planning. This approach goes beyond physical wellness and addresses the psychological and emotional facets of cancer management. Moreover, there is an evident need for further research to develop holistic exercise interventions that effectively address the complex dynamics of fatigue, physical activity, and QoL in this patient group.
PubMed: 38224407
DOI: 10.1097/JS9.0000000000000982 -
Journal of Neurogastroenterology and... Jan 2024We performed a systematic review and meta-analysis evaluating the symptomatic response rate to antibiotics in patients with small intestinal bacterial overgrowth (SIBO).... (Meta-Analysis)
Meta-Analysis
BACKGROUND/AIMS
We performed a systematic review and meta-analysis evaluating the symptomatic response rate to antibiotics in patients with small intestinal bacterial overgrowth (SIBO). Similarly, we performed a meta-analysis on the symptomatic response to antibiotics in irritable bowel syndrome (IBS) patients with and without SIBO.
METHODS
MEDLINE, EMBASE, Web of Science, and Cochrane databases were searched from inception to March 2021. Randomized controlled trials and prospective studies reporting dichotomous outcomes were included.
RESULTS
There were 6 studies included in the first meta-analysis comparing the efficacy of antibiotics to placebo or no antibiotic. This included 196 patients, of whom 101 received antibiotics and 95 received placebo or no antibiotics. Significantly more patients improved with antibiotics (relative risk [95% CI] = 2.46 [1.33-4.55], = 0.004). There were 4 studies included in the analysis comparing symptomatic response rates in IBS patients with or without SIBO with 266 IBS patients, of whom 172 had SIBO and 94 did not. The pooled response rate for symptomatic response was 51.2% in the SIBO group vs 23.4% in the no SIBO group, respectively. Significantly more IBS patients with SIBO responded to antibiotics compared to those without SIBO (relative risk [95% CI] = 2.07 [1.40-3.08], = 0.0003).
CONCLUSIONS
Antibiotics appear to be efficacious in treating SIBO, although small sample sizes and poor data quality limit this interpretation. Symptomatic response rates also appear to be higher in IBS patients with SIBO. This may be the first example of precision medicine in IBS as opposed to our current empiric treatment approach. Large-multicenter studies are needed to verify the results.
PubMed: 38173154
DOI: 10.5056/jnm22187