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The Effectiveness of Pilates Exercise in People with Chronic Low Back Pain: A Systematic Review  [PDF]
Cherie Wells, Gregory S. Kolt, Paul Marshall, Bridget Hill, Andrea Bialocerkowski
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0100402
Abstract: Objective To evaluate the effectiveness of Pilates exercise in people with chronic low back pain (CLBP) through a systematic review of randomised controlled trials (RCTs). Data Sources A search for RCTs was undertaken using Medical Search Terms and synonyms for “Pilates” and “low back pain” within the maximal date range of 10 databases. Databases included the Cumulative Index to Nursing and Allied Health Literature; Cochrane Library; Medline; Physiotherapy Evidence Database; ProQuest: Health and Medical Complete, Nursing and Allied Health Source, Dissertation and Theses; Scopus; Sport Discus; Web of Science. Study Selection Two independent reviewers were involved in the selection of evidence. To be included, relevant RCTs needed to be published in the English language. From 152 studies, 14 RCTs were included. Data Extraction Two independent reviewers appraised the methodological quality of RCTs using the McMaster Critical Review Form for Quantitative Studies. The author(s), year of publication, and details regarding participants, Pilates exercise, comparison treatments, and outcome measures, and findings, were then extracted. Data Synthesis The methodological quality of RCTs ranged from “poor” to “excellent”. A meta-analysis of RCTs was not undertaken due to the heterogeneity of RCTs. Pilates exercise provided statistically significant improvements in pain and functional ability compared to usual care and physical activity between 4 and 15 weeks, but not at 24 weeks. There were no consistent statistically significant differences in improvements in pain and functional ability with Pilates exercise, massage therapy, or other forms of exercise at any time period. Conclusions Pilates exercise offers greater improvements in pain and functional ability compared to usual care and physical activity in the short term. Pilates exercise offers equivalent improvements to massage therapy and other forms of exercise. Future research should explore optimal Pilates exercise designs, and whether some people with CLBP may benefit from Pilates exercise more than others.
Efficacy and safety of atypical antipsychotic drugs (quetiapine, risperidone, aripiprazole and paliperidone) compared with placebo or typical antipsychotic drugs for treating refractory schizophrenia: overview of systematic reviews
Melnik, Tamara;Soares, Bernardo Garcia;Puga, Maria Eduarda dos Santos;Atallah, álvaro Nagib;
Sao Paulo Medical Journal , 2010, DOI: 10.1590/S1516-31802010000300007
Abstract: context and objective: according to some cohort studies, the prevalence of refractory schizophrenia (rs) is 20-40%. our aim was to evaluate the effectiveness and safety of aripiprazole, paliperidone, quetiapine and risperidone for treating rs. methods: this was a critical appraisal of cochrane reviews published in the cochrane library, supplemented with reference to more recent randomized controlled trials (rcts) on rs. the following databases were searched: medical literature analysis and retrieval system online (medline) (1966-2009), controlled trials of the cochrane collaboration (2009, issue 2), embase (excerpta medica) (1980-2009), literatura latino-americana e do caribe em ciências da saúde (lilacs) (1982-2009). there was no language restriction. randomized controlled trials, systematic reviews and meta-analyses evaluating atypical antipsychotics for treating rs were included. results: seven cochrane systematic reviews and 10 additional rcts were included in this review. the data generally showed minor differences between the atypical antipsychotics evaluated and typical antipsychotics, regarding improvement in disease symptoms, despite better adherence to treatment with atypical antipsychotics. risperidone was specifically evaluated in patients with rs in one of the systematic reviews included, with favorable outcomes, but without definitive superiority compared with other drugs of proven efficacy, like amisulpride, clozapine and olanzapine. conclusions: the findings underscore the difficulty in treating these patients, with high dropout rates and treatment patterns of modest improvement in assessments of effectiveness. atypical antipsychotics have advantages over typical antipsychotics mainly through their better safety profile, which leads to better adherence to treatment. a combination of antipsychotics may also be an option for some refractory patients.
The effectiveness of acupuncture in treating chronic non-specific low back pain: a systematic review of the literature  [cached]
Hutchinson Amanda J P,Ball Simon,Andrews Jeremy C H,Jones Gareth G
Journal of Orthopaedic Surgery and Research , 2012, DOI: 10.1186/1749-799x-7-36
Abstract: Background Low back pain is a common musculoskeletal disorder defined as pain and soreness, muscle tension, or stiffness in the lumbosacral area of the spine which does not have a specific cause. Low back pain results in high health costs and incapacity to work causing an economic burden to society. The optimal management of non-specific low back pain appears to be undecided. Recently published guidelines support the use of acupuncture for treating non-specific low back pain and it has become a popular alternative treatment modality for patients with low back pain. Methods A comprehensive systematic literature search was conducted through Medline using Ovid and Medical Subject Headings for randomized controlled trials published in the last 10 years. The outcomes scored were subjective pain scores and functional outcome scores. Results Eighty two randomized studies were identified, of which 7 met our inclusion criteria. Three studies found a significant difference in pain scores when comparing acupuncture, or sham acupuncture, with conventional therapy or no care. Two studies demonstrated a significant difference between acupuncture treatment and no treatment or routine care at 8 weeks and 3 months. Three studies demonstrated no significant difference between acupuncture and minimal/sham acupuncture with no difference in pain relief or function over 6 to 12 months. Conclusions This review provides some evidence to support acupuncture as more effective than no treatment, but no conclusions can be drawn about its effectiveness over other treatment modalities as the evidence is conflicting.
How Current Clinical Practice Guidelines for Low Back Pain Reflect Traditional Medicine in East Asian Countries: A Systematic Review of Clinical Practice Guidelines and Systematic Reviews  [PDF]
Hyun-Woo Cho, Eui-Hyoung Hwang, Byungmook Lim, Kwang-Ho Heo, Jian-Ping Liu, Kiichiro Tsutani, Myeong Soo Lee, Byung-Cheul Shin
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0088027
Abstract: Objectives The aims of this study were to investigate whether there is a gap between evidence of traditional medicine (TM) interventions in East-Asian countries from the current Clinical Practice Guidelines (CPGs) and evidence from current systematic reviews and meta-analyses (SR-MAs) and to analyze the impact of this gap on present CPGs. Methods We examined 5 representative TM interventions in the health care systems of East-Asian countries. We searched seven relevant databases for CPGs to identify whether core CPGs included evidence of TM interventions, and we searched 11 databases for SR-MAs to re-evaluate current evidence on TM interventions. We then compared the gap between the evidence from CPGs and SR-MAs. Results Thirteen CPGs and 22 SR-MAs met our inclusion criteria. Of the 13 CPGs, 7 CPGs (54%) mentioned TM interventions, and all were for acupuncture (only one was for both acupuncture and acupressure). However, the CPGs did not recommend acupuncture (or acupressure). Of 22 SR-MAs, 16 were for acupuncture, 5 for manual therapy, 1 for cupping, and none for moxibustion and herbal medicine. Comparing the evidence from CPGs and SR-MAs, an underestimation or omission of evidence for acupuncture, cupping, and manual therapy in current CPGs was detected. Thus, applying the results from the SR-MAs, we moderately recommend acupuncture for chronic LBP, but we inconclusively recommend acupuncture for (sub)acute LBP due to the limited current evidence. Furthermore, we weakly recommend cupping and manual therapy for both (sub)acute and chronic LBP. We cannot provide recommendations for moxibustion and herbal medicine due to a lack of evidence. Conclusions The current CPGs did not fully reflect the evidence for TM interventions. As relevant studies such as SR-MAs are conducted and evidence increases, the current evidence on acupuncture, cupping, and manual therapy should be rigorously considered in the process of developing or updating the CPG system.
Systematic reviews (I)
Miguel Araujo Alonso
Medwave , 2011,
Abstract: Systematic reviews are the best way to bring together and synthesize scientific evidence on a subject by applying a method that ensures minimization of bias and study shortcomings. This was mentioned in a previous article of this series. This goal can be achieved by recurring to the principles of the scientific method. The research subjects are not patients but published clinical trials and other sources from which data are extracted. In the beginning, these studies were limited to therapeutic effectiveness and other forms of intervention. Currently, systematic reviews on prognostic and etiological issues are commonly done. Systematic reviews are comprised by the following steps: formulation of the review question; definition of sources and search methods; definition and application of the trial selection criteria; critical analysis of selected studies; pooling and synthesis of trial data; and conclusions by inference. Lastly, a meta-analysis is a systematic review in which primary trial results are combined with statistical methods.
Systematic reviews on leptospirosis
GUIDUGLI, Fabio;CASTRO, Aldemar Araujo;ATALLAH, álvaro Nagib;
Revista do Instituto de Medicina Tropical de S?o Paulo , 2000, DOI: 10.1590/S0036-46652000000100008
Abstract: objectives: to find the existing clinical evidence on interventions for leptospirosis. the objective is to evaluate the effectiveness and safety of any intervention on leptospirosis through systematic reviews of randomized controlled trials (rcts). data source: the sources of studies used (where there were no limitations concerning language, date, or other restrictions) were: embase, lilacs, medline, the cochrane controlled clinical trials database, and the cochrane hepato-biliary group randomized trials register. selection of studies: type of study: all systematic reviews of randomized controlled trials. participants: patients with clinical and/or laboratorial diagnosis of leptospirosis, and subjects potencially exposed to leptospirosis as defined by the authors interventions: any intervention for leptospirosis (as antibiotics or vaccines for prevention or treatment). data collection: the assessment will be independently made by the reviewers and cross-checked. the external validity was assessed by analysis of: studies, interventions, and outcomes. data synthesis: located 163 studies using the search strategy described above, at the electronic databases above. only 2 hits were selected, which are protocols of systematic reviews of cochrane collaboration, and not full reviews. one of the protocols evaluates antibiotics for treatment, and the other evaluates antibiotics for prevention of leptospirosis. conclusions: there were not complete systematic reviews on interventions for leptospirosis. any interventions for leptospirosis, such as prevention and treatment remains unclear for guidelines and practice.
Systematic reviews on leptospirosis  [cached]
GUIDUGLI Fabio,CASTRO Aldemar Araujo,ATALLAH álvaro Nagib
Revista do Instituto de Medicina Tropical de S?o Paulo , 2000,
Abstract: OBJECTIVES: To find the existing clinical evidence on interventions for leptospirosis. The objective is to evaluate the effectiveness and safety of any intervention on leptospirosis through systematic reviews of randomized controlled trials (RCTs). DATA SOURCE: The sources of studies used (where there were no limitations concerning language, date, or other restrictions) were: EMBASE, LILACS, MEDLINE, the Cochrane Controlled Clinical Trials Database, and the Cochrane Hepato-Biliary Group Randomized Trials register. SELECTION OF STUDIES: Type of Study: All systematic reviews of randomized controlled trials. Participants: patients with clinical and/or laboratorial diagnosis of leptospirosis, and subjects potencially exposed to leptospirosis as defined by the authors Interventions: any intervention for leptospirosis (as antibiotics or vaccines for prevention or treatment). DATA COLLECTION: The assessment will be independently made by the reviewers and cross-checked. The external validity was assessed by analysis of: studies, interventions, and outcomes. DATA SYNTHESIS: Located 163 studies using the search strategy described above, at the electronic databases above. Only 2 hits were selected, which are protocols of systematic reviews of Cochrane Collaboration, and not full reviews. One of the protocols evaluates antibiotics for treatment, and the other evaluates antibiotics for prevention of leptospirosis. CONCLUSIONS: There were not complete systematic reviews on interventions for leptospirosis. Any interventions for leptospirosis, such as prevention and treatment remains unclear for guidelines and practice.
Effectiveness of mat Pilates or equipment-based Pilates in patients with chronic non-specific low back pain: a protocol of a randomised controlled trial  [cached]
da Luz Maurício Ant?nio,Costa Leonardo Oliveira Pena,Fuhro Fernanda Ferreira,Manzoni Ana Carolina Taccolini
BMC Musculoskeletal Disorders , 2013, DOI: 10.1186/1471-2474-14-16
Abstract: Background Chronic low back pain is an expensive and difficult condition to treat. One of the interventions widely used by physiotherapists in the treatment of chronic non-specific low back pain is exercise therapy based upon the Pilates principles. Pilates exercises can be performed with or without specific equipment. These two types of Pilates exercises have never been compared on a high-quality randomised controlled trial. Methods/design This randomised controlled trial with a blinded assessor will evaluate eighty six patients of both genders with chronic low back pain, aged between 18 and 60 years, from one Brazilian private physiotherapy clinic. The patients will be randomly allocated into two groups: Mat Group will perform the exercises on the ground while the Equipment-based Group will perform the Pilates method exercises on the following equipment: Cadillac, Reformer, Ladder Barrel, and Step Chair. The general and specific disability of the patient, kinesiophobia, pain intensity and global perceived effect will be evaluated by a blinded assessor before randomisation and at six weeks and six months after randomisation. In addition, the expectation of the participants and their confidence with the treatment will be evaluated before randomisation and after the first treatment session, respectively. Discussion This will be the first study aiming to compare the effectiveness of Mat and Equipment-based Pilates exercises in patients with chronic non-specific low back pain. The results may help health-care professionals in clinical decision-making and could potentially reduce the treatment costs of this condition. Trial registration Brazilian Registry of Clinical Trials RBR-7tyg5j
Applicability and generalisability of the results of systematic reviews to public health practice and policy: a systematic review
Nizar Ahmad, Isabelle Boutron, Agnès Dechartres, Pierre Durieux, Philippe Ravaud
Trials , 2010, DOI: 10.1186/1745-6215-11-20
Abstract: All systematic reviews of interventions aimed at reducing or stopping tobacco use and treating or preventing HIV infection published in the Cochrane database of systematic reviews and in journals indexed in MEDLINE between January 1997 and December 2007 were selected. We used a standardized data abstraction form to extract data related to applicability in terms of the context of the trial, (country, centres, settings), participants (recruitment, inclusion and exclusion criteria, baseline characteristics of participants such as age, sex, ethnicity, coexisting diseases or co-morbidities, and socioeconomic status), treatment (duration, intensity/dose of treatment, timing and delivery format), and the outcomes assessment from selected reviews.A total of 98 systematic reviews were selected (57 Cochrane reviews and 41 non-Cochrane reviews); 49 evaluated interventions aimed at reducing or stopping tobacco use and 49 treating or preventing HIV infection. The setting of the individual studies was reported in 45 (46%) of the systematic reviews, the number of centres in 21 (21%), and the country where the trial took place in 62 (63%). Inclusion and exclusion criteria of the included studies were reported in 16 (16%) and 13 (13%) of the reviews, respectively. Baseline characteristics of participants in the included studies were described in 59 (60%) of the reviews. These characteristics concerned age in about half of the reviews, sex in 46 (47%), and ethnicity in 9 (9%).Applicability of results was discussed in 13 (13%) of the systematic reviews. The reporting was better in systematic reviews by the Cochrane Collaboration than by non-Cochrane groups.Our study highlighted the lack of consideration of applicability of results in systematic reviews of research into 2 public health priorities: tobacco consumption and HIV infection.Systematic reviews are an important source of valid evidence [1] because they identify, appraise and synthesize all the available evidence on a particula
Expediting systematic reviews: methods and implications of rapid reviews
Rebecca Ganann, Donna Ciliska, Helen Thomas
Implementation Science , 2010, DOI: 10.1186/1748-5908-5-56
Abstract: A comprehensive search strategy--including five electronic databases, grey literature, hand searching of relevant journals, and contacting key informants--was undertaken. All titles and abstracts (n = 1,989) were reviewed independently by two reviewers. Relevance criteria included articles published between 1995 and 2009 about conducting rapid reviews or addressing comparisons of rapid reviews versus traditional reviews. Full articles were retrieved for any titles deemed relevant by either reviewer (n = 70). Data were extracted from all relevant methodological articles (n = 45) and from exemplars of rapid review methods (n = 25).Rapid reviews varied from three weeks to six months; various methods for speeding up the process were employed. Some limited searching by years, databases, language, and sources beyond electronic searches. Several employed one reviewer for title and abstract reviewing, full text review, methodological quality assessment, and/or data extraction phases. Within rapid review studies, accelerating the data extraction process may lead to missing some relevant information. Biases may be introduced due to shortened timeframes for literature searching, article retrieval, and appraisal.This review examined the continuum between diverse rapid review methods and traditional systematic reviews. It also examines potential implications of streamlined review methods. More of these rapid reviews need to be published in the peer-reviewed literature with an emphasis on articulating methods employed. While one consistent methodological approach may not be optimal or appropriate, it is important that researchers undertaking reviews within the rapid to systematic continuum provide detailed descriptions of methods used and discuss the implications of their chosen methods in terms of potential bias introduced. Further research comparing full systematic reviews with rapid reviews will enhance understanding of the limitations of these methods.Healthcare increasingly
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