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Broad synthesis / Overview of systematic reviews

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A Systematic Overview of Reviews for Complementary and Alternative Therapies in the Treatment of the Fibromyalgia Syndrome

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Journal Evidence-based complementary and alternative medicine : eCAM
Year 2015
Links Pubmed DOI PubMed Central

This article includes 24 Systematic reviews Systematic reviews (24 references)

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Objectives. This systematic overview of reviews aimed to summarize evidence and methodological quality from systematic reviews of complementary and alternative medicine (CAM) for the fibromyalgia syndrome (FMS). Methods. The PubMed/MEDLINE, Cochrane Library, and Scopus databases were screened from their inception to Sept 2013 to identify systematic reviews and meta-analyses of CAM interventions for FMS. Methodological quality of reviews was rated using the AMSTAR instrument. Results. Altogether 25 systematic reviews were found; they investigated the evidence of CAM in general, exercised-based CAM therapies, manipulative therapies, Mind/Body therapies, acupuncture, hydrotherapy, phytotherapy, and homeopathy. Methodological quality of reviews ranged from lowest to highest possible quality. Consistently positive results were found for tai chi, yoga, meditation and mindfulness-based interventions, hypnosis or guided imagery, electromyogram (EMG) biofeedback, and balneotherapy/hydrotherapy. Inconsistent results concerned qigong, acupuncture, chiropractic interventions, electroencephalogram (EEG) biofeedback, and nutritional supplements. Inconclusive results were found for homeopathy and phytotherapy. Major methodological flaws included missing details on data extraction process, included or excluded studies, study details, and adaption of conclusions based on quality assessment. Conclusions. Despite a growing body of scientific evidence of CAM therapies for the management of FMS systematic reviews still show methodological flaws limiting definite conclusions about their efficacy and safety.

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Efficacy of Non-Pharmacological Interventions to Prevent and Treat Delirium in Older Patients: A Systematic Overview. The SENATOR project ONTOP Series.

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Journal PloS one
Year 2015
Links Pubmed DOI PubMed Central www.epistemonikos.org

This article includes 24 Systematic reviews Systematic reviews (24 references) 34 Primary studies Primary studies (34 references)

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BACKGROUND: Non-pharmacological intervention (e.g. multidisciplinary interventions, music therapy, bright light therapy, educational interventions etc.) are alternative interventions that can be used in older subjects. There are plenty reviews of non-pharmacological interventions for the prevention and treatment of delirium in older patients and clinicians need a synthesized, methodologically sound document for their decision making. METHODS AND FINDINGS: We performed a systematic overview of systematic reviews (SRs) of comparative studies concerning non-pharmacological intervention to treat or prevent delirium in older patients. The PubMed, Cochrane Database of Systematic Reviews, EMBASE, CINHAL, and PsychINFO (April 28th, 2014) were searched for relevant articles. AMSTAR was used to assess the quality of the SRs. The GRADE approach was used to assess the quality of primary studies. The elements of the multicomponent interventions were identified and compared among different studies to explore the possibility of performing a meta-analysis. Risk ratios were estimated using a random-effects model. Twenty-four SRs with 31 primary studies satisfied the inclusion criteria. Based on the AMSTAR criteria twelve reviews resulted of moderate quality and three resulted of high quality. Overall, multicomponent non-pharmacological interventions significantly reduced the incidence of delirium in surgical wards [2 randomized trials (RCTs): relative risk (RR) 0.71, 95% Confidence Interval (CI) 0.59 to 0.86, I2=0%; (GRADE evidence: moderate)] and in medical wards [2 CCTs: RR 0.65, 95%CI 0.49 to 0.86, I2=0%; (GRADE evidence: moderate)]. There is no evidence supporting the efficacy of non-pharmacological interventions to prevent delirium in low risk populations (i.e. low rate of delirium in the control group)[1 RCT.: RR 1.75, 95%CI 0.50 to 6.10 (GRADE evidence: very low)]. For patients who have developed delirium, the available evidence does not support the efficacy of multicomponent non-pharmacological interventions to treat delirium. Among single component interventions only staff education, reorientation protocol (GRADE evidence: very low)] and Geriatric Risk Assessment MedGuide software [hazard ratio 0.42, 95%CI 0.35 to 0.52, (GRADE evidence: moderate)] resulted effective in preventing delirium. CONCLUSIONS: In older patients multi-component non-pharmacological interventions as well as some single-components intervention were effective in preventing delirium but not to treat delirium.

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Efficacy of pharmacotherapy and psychotherapy for adult psychiatric disorders: A systematic overview of meta-analyses.

Journal JAMA psychiatry
Year 2014
Links Pubmed DOI

This article includes 61 Systematic reviews Systematic reviews (61 references)

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Importance: There is debate about the effectiveness of psychiatric treatments and whether pharmacotherapy or psychotherapy should be primarily used. OBJECTIVES: To perform a systematic overview on the efficacy of pharmacotherapies and psychotherapies for major psychiatric disorders and to compare the quality of pharmacotherapy and psychotherapy trials. Evidence Review: We searched MEDLINE, EMBASE, PsycINFO, and the Cochrane Library (April 2012, with no time or language limit) for systematic reviews on pharmacotherapy or psychotherapy vs placebo, pharmacotherapy vs psychotherapy, and their combination vs either modality alone. Two reviewers independently selected the meta-analyses and extracted efficacy effect sizes. We assessed the quality of the individual trials included in the pharmacotherapy and psychotherapy meta-analyses with the Cochrane risk of bias tool. FINDINGS: The search yielded 45 233 results. We included 61 meta-analyses on 21 psychiatric disorders, which contained 852 individual trials and 137 126 participants. The mean effect size of the meta-analyses was medium (mean, 0.50; 95%CI, 0.41-0.59). Effect sizes of psychotherapies vs placebo tended to be higher than those of medication, but direct comparisons, albeit usually based on few trials, did not reveal consistent differences. Individual pharmacotherapy trials were more likely to have large sample sizes, blinding, control groups, and intention-to-treat analyses. In contrast, psychotherapy trials had lower dropout rates and provided follow-up data. In psychotherapy studies, wait-list designs showed larger effects than did comparisons with placebo. Conclusions and Relevance: Many pharmacotherapies and psychotherapies are effective, but there is a lot of room for improvement. Because of the multiple differences in the methods used in pharmacotherapy and psychotherapy trials, indirect comparisons of their effect sizes compared with placebo or no treatment are problematic. Well-designed direct comparisons, which are scarce, need public funding. Because patients often benefit from both forms of therapy, research should also focus on how both modalities can be best combined to maximize synergy rather than debate the use of one treatment over the other. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Broad synthesis / Overview of systematic reviews

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Delirium in hospitalized patients: implications of current evidence on clinical practice and future avenues for research--a systematic evidence review.

Journal Journal of hospital medicine : an official publication of the Society of Hospital Medicine
Year 2012
Links Pubmed DOI PubMed Central

This article includes 35 Systematic reviews Systematic reviews (35 references)

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BACKGROUND: Despite the significant burden of delirium among hospitalized adults, critical appraisal of systematic data on delirium diagnosis, pathophysiology, treatment, prevention, and outcomes is lacking. PURPOSE: To provide evidence-based recommendations for delirium care to practitioners, and identify gaps in delirium research. DATA SOURCES: Medline, PubMed, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) information systems from January 1966 to April 2011. STUDY SELECTION: All published systematic evidence reviews (SERs) on delirium were evaluated. DATA EXTRACTION: Three reviewers independently extracted the data regarding delirium risk factors, diagnosis, prevention, treatment, and outcomes, and critically appraised each SER as good, fair, or poor using the United States Preventive Services Task Force criteria. DATA SYNTHESIS: Twenty-two SERs graded as good or fair provided the data. Age, cognitive impairment, depression, anticholinergic drugs, and lorazepam use were associated with an increased risk for developing delirium. The Confusion Assessment Method (CAM) is reliable for delirium diagnosis outside of the intensive care unit. Multicomponent nonpharmacological interventions are effective in reducing delirium incidence in elderly medical patients. Low-dose haloperidol has similar efficacy as atypical antipsychotics for treating delirium. Delirium is associated with poor outcomes independent of age, severity of illness, or dementia. CONCLUSION: Delirium is an acute, preventable medical condition with short- and long-term negative effects on a patient's cognitive and functional states.

Broad synthesis / Overview of systematic reviews

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An integrative review of systematic reviews related to the management of breathlessness in respiratory illnesses.

Journal BMC pulmonary medicine
Year 2010
Links Pubmed DOI PubMed Central

This article includes 147 Systematic reviews Systematic reviews (147 references)

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BACKGROUND: Breathlessness is a debilitating and distressing symptom in a wide variety of diseases and still a difficult symptom to manage. An integrative review of systematic reviews of non-pharmacological and pharmacological interventions for breathlessness in non-malignant disease was undertaken to identify the current state of clinical understanding of the management of breathlessness and highlight promising interventions that merit further investigation. METHODS: Systematic reviews were identified via electronic databases between July 2007 and September 2009. Reviews were included within the study if they reported research on adult participants using either a measure of breathlessness or some other measure of respiratory symptoms. RESULTS: In total 219 systematic reviews were identified and 153 included within the final review, of these 59 addressed non-pharmacological interventions and 94 addressed pharmacological interventions. The reviews covered in excess of 2000 trials. The majority of systematic reviews were conducted on interventions for asthma and COPD, and mainly focussed upon a small number of pharmacological interventions such as corticosteroids and bronchodilators, including beta-agonists. In contrast, other conditions involving breathlessness have received little or no attention and studies continue to focus upon pharmacological approaches. Moreover, although there are a number of non-pharmacological studies that have shown some promise, particularly for COPD, their conclusions are limited by a lack of good quality evidence from RCTs, small sample sizes and limited replication. CONCLUSIONS: More research should focus in the future on the management of breathlessness in respiratory diseases other than asthma and COPD. In addition, pharmacological treatments do not completely manage breathlessness and have an added burden of side effects. It is therefore important to focus more research on promising non-pharmacological interventions.

Broad synthesis / Guideline

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Chronic Obstructive Pulmonary Disease: Management of Chronic Obstructive Pulmonary Disease in Adults in Primary and Secondary Care

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Report National Institute for Health and Clinical Excellence: Guidance
Year 2010
Links Pubmed

This article includes 422 Primary studies Primary studies (422 references) 108 Systematic reviews Systematic reviews (108 references)

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This guideline offers best practice advice on the identification and care of patients with chronic obstructive pulmonary disease (COPD). It aims to define the symptoms, signs and investigations required to establish a diagnosis of COPD. It also aims to define the factors that are necessary to assess its severity, provide prognostic information and guide best management. It gives guidance on the pharmacological and non-pharmacological treatment of patients with stable COPD, and on the management of exacerbations. The interface with surgery and intensive therapy units (ITU) are also discussed.

Broad synthesis / Overview of systematic reviews

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The effects of psychosocial interventions in cancer and heart disease: a review of systematic reviews

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Report York: Centre for Reviews and Dissemination (CRD)
Year 2005
Links york.ac.uk

This article includes 34 Systematic reviews Systematic reviews (34 references)

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Broad synthesis / Overview of systematic reviews

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Multidisciplinary pain programs for chronic pain: evidence from systematic reviews

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Authors Ospina, M , Harstall, C
Report Alberta Heritage Foundation for Medical Research: Edmonton, Alberta, Canada
Year 2003
Links Google Scholar

This article includes 5 Systematic reviews Systematic reviews (5 references)

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• The approach taken to evaluate the current published scientific evidence on the efficacy, effectiveness and economic consequences of multidisciplinary pain programs (MPPs) for patients with chronic pain (CP) not related to cancer, was to analyze and synthesize the findings from systematic reviews (SRs) including meta-analyses. Given the cost and consequences of CP, whether MPPs are therapeutically and financially effective are important issues of consideration. • MPPs in this report are defined as being a comprehensive approach that involves coordinated interventions among a variety of disciplines working together in the same facility in an integrated way with joint goals and with ongoing communication. The patient is considered to be an active participant who assumes significant responsibility within the rehabilitation process with the staff playing a teaching and consulting role. • The rationale for MPPs as a therapeutic approach is to provide simultaneous assessment and management of somatic, behavioural and psychosocial components of CP. MPPs aim to improve quality of life outcomes, to increase patient independence and to restore physical, psychological, social, and occupational functioning. • Treatment strategies available at MPPs usually vary from centre to centre in terms of the setting (inpatient versus outpatient), number of hours and days involved, and type, intensity, and nature of treatment modalities offered. Patients seen at MPPs are often not representative of all those with CP and alternatively, not all CP patients should attend MPPs. As tertiary centres, MPPs are generally selected for patients with complex and long-standing pain problems. • From the twelve SRs on the effectiveness of MPPs, five met the inclusion criteria. Four of these SRs focused on MPPs as the primary intervention of interest, whereas one SR considered MPPs among several other interventions. • The results from a recent good quality SR tend to support the effectiveness of intensive MPPs for chronic low back pain patients in terms of their effects on functional improvement and pain reduction. The results from one clinical trial included in one of the SRs support the use of MPPs in patients with chronic pelvic pain in terms of daily activity level and self-rating scales. • The other SRs found limited evidence and therefore the findings were considered to be inconclusive regarding the effectiveness of MPPs in managing CP in other conditions such as fibromyalgia and widespread musculoskeletal pain, and shoulder and neck pain.