Systematic reviews included in this broad synthesis

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Systematic review

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Systematic review of randomised controlled trials of interventions for painful shoulder: selection criteria, outcome assessment, and efficacy.

Journal BMJ (Clinical research ed.)
Year 1998
Links Pubmed DOI PubMed Central

This article is included in 1 Structured summary of systematic reviews 31 Structured summaries of systematic reviews (1 reference) 1 Broad synthesis 31 Broad syntheses (1 reference)

This article includes 31 Primary studies 31 Primary studies (31 references)

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OBJECTIVE: To review the efficacy of common interventions for shoulder pain. DESIGN: All randomised controlled trials of non-steroidal anti-inflammatory drugs, intra-articular and subacromial glucocorticosteroid injection, oral glucocorticosteroid treatment, physiotherapy, manipulation under anaesthesia, hydrodilatation, and surgery for shoulder pain that were identified by computerised and hand searches of the literature and had a blinded assessment of outcome were included. MAIN OUTCOME MEASURES: Methodological quality (score out of 40), selection criteria, and outcome measures. Effect sizes were calculated and combined in a pooled analysis if study population, end point, and intervention were comparable. RESULTS: Thirty one trials met inclusion criteria. Mean methodological quality score was 16.8 (9.5-22). Selection criteria varied widely, even for the same diagnostic label. There was no uniformity in the outcome measures used, and their measurement properties were rarely reported. Effect sizes for individual trials were small (range -1.4 to 3.0). The results of only three studies investigating "rotator cuff tendinitis" could be pooled. The only positive finding was that subacromial steroid injection is better than placebo in improving the range of abduction (weighted difference between means 35 degrees (95% confidence interval 14 to 55)). CONCLUSIONS: There is little evidence to support or refute the efficacy of common interventions for shoulder pain. As well as the need for further well designed clinical trials, more research is needed to establish a uniform method of defining shoulder disorders and developing outcome measures which are valid, reliable, and responsive in affected people.

Systematic review

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Efficacy of non-steroidal anti-inflammatory drugs for low back pain: a systematic review of randomised clinical trials.

Journal Annals of the rheumatic diseases
Year 1997
Links Pubmed DOI PubMed Central

This article is included in 1 Structured summary of systematic reviews 26 Structured summaries of systematic reviews (1 reference) 1 Broad synthesis 26 Broad syntheses (1 reference)

This article includes 26 Primary studies 26 Primary studies (26 references)

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PURPOSE: To assess the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) for low back pain. DATA SOURCES: Computer aided search of published randomised clinical trials and assessment of the methods of the studies. STUDY SELECTION: 26 randomised clinical trials evaluating NSAIDs for low back pain were identified. DATA EXTRACTION: Score for quality (maximum = 100 points) of the methods based on four categories: study population; interventions; effect measurement; data presentation and analysis. Determination of success rate per study group and evaluation of different contrasts. Statistical pooling of placebo controlled trials in similar patient groups and using similar outcome measures. RESULTS: The methods scores of the trials ranged from 27 to 83 points. NSAIDs were compared with placebo treatment in 10 studies. The pooled odds ratio in four trials comparing NSAIDs with placebo after one week was 0.53 (95% confidence intervals 0.32 to 0.89) using the fixed effect model, indicating a significant effect in favour of NSAIDs compared with placebo. In nine studies NSAIDs were compared with other (drug) therapies. Of these, only two studies reported better results of NSAIDs compared with paracetamol with and without dextropropoxyphene. In the other trials NSAIDs were not better than the reference treatment. In 11 studies different NSAIDs were compared, of which seven studies reported no differences in effect. CONCLUSIONS: There are flaws in the design of most studies. The pooled odds ratio must be interpreted with caution because the trials at issue, including the high quality trials, did not use identical outcome measures. The results of the 26 randomised trials that have been carried out to date, suggest that NSAIDs might be effective for short-term symptomatic relief in patients with uncomplicated low back pain, but are less effective or ineffective in patients with low back pain with sciatica and patients with sciatica with nerve root symptoms.

Systematic review

Unclassified

Conservative treatment of acute and chronic nonspecific low back pain: a systematic review of randomized controlled trials of the most common interventions.

Journal Spine
Year 1997
Links Pubmed DOI

Without references

This article is included in 1 Structured summary of systematic reviews 0 Structured summaries of systematic reviews (1 reference) 2 Broad syntheses 0 Broad syntheses (2 references)

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STUDY DESIGN: A systematic review of randomized controlled trials. OBJECTIVES: To assess the effectiveness of the most common conservative types of treatment for patients with acute and chronic nonspecific low back pain. SUMMARY OF BACKGROUND DATA: Many treatment options for acute and chronic low back pain are available, but little is known about the optimal treatment strategy. METHODS: A rating system was used to assess the strength of the evidence, based on the methodologic quality of the randomized controlled trials, the relevance of the outcome measures, and the consistency of the results. RESULTS: The number of randomized controlled trials identified varied widely with regard to the interventions involved. The scores ranged from 20 to 79 points for acute low back pain and from 19 to 79 points for chronic low back pain on a 100-point scale, indicating the overall poor quality of the trials. Overall, only 28 (35%) randomized controlled trials on acute low back pain and 20 (25%) on chronic low back pain had a methodologic score of 50 or more points, and were considered to be of high quality. Various methodologic flaws were identified. Strong evidence was found for the effectiveness of muscle relaxants and nonsteroidal anti-inflammatory drugs and the ineffectiveness of exercise therapy for acute low back pain; strong evidence also was found for the effectiveness of manipulation, back schools, and exercise therapy for chronic low back pain, especially for short-term effects. CONCLUSIONS: The quality of the design, execution, and reporting of randomized controlled trials should be improved, to establish strong evidence for the effectiveness of the various therapeutic interventions for acute and chronic low back pain. (C) 1997 Lippincott-Raven Publishers. Reprinted from Spine by permission.

Systematic review

Unclassified

Conservative management of mechanical neck pain: systematic overview and meta-analysis.

Journal BMJ (Clinical research ed.)
Year 1996
Links Pubmed PubMed Central

Without references

This article is included in 1 Structured summary of systematic reviews 0 Structured summaries of systematic reviews (1 reference) 1 Broad synthesis 0 Broad syntheses (1 reference)

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OBJECTIVE: To review the efficacy of conservative management of mechanical neck disorders. METHODS: Published and unpublished reports were identified through computerised and manual searches of bibliographical databases, reference lists from primary articles, and letters to authors, agencies, foundations, and content experts. Selection criteria were applied to blinded articles, and selected articles were scored for methodological quality. Effect sizes were calculated from raw pain scores and combined by using meta-analytic techniques when appropriate. RESULTS: Twenty four randomised clinical trials met the selection criteria and were categorised by type of intervention: nine used manual treatments; 12 physical medicine methods; four drug treatment; and three education of patients (four trials investigated more than one form of intervention). The intervention strategies were summarised separately. Pooling of studies was considered only within each category. Five of the nine trials that used manual treatment in combination with other treatments were combined. One to four weeks after treatment the pooled effect size was -0.6 (95% confidence interval -0.9 to -0.4), equivalent to an improvement of 16 (6.9 to 23.1) points on a 100 point scale. Sensitivity analyses on study quality, chronicity, and data imputation did not alter this estimate. For other interventions, studies could not be combined to arrive at pooled estimates of effect. CONCLUSIONS: There is little information available from clinical trials to support many of the treatments for mechanical neck pain. In general, conservative interventions have not been studied in enough detail to assess efficacy or effectiveness adequately.

Systematic review

Unclassified

Do antidepressant medications relieve chronic low back pain?

Authors Turner JA , Denny MC
Journal The Journal of family practice
Year 1993
Links Pubmed

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This article is included in 1 Broad synthesis 0 Broad syntheses (1 reference)

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BACKGROUND: Antidepressant medications are commonly prescribed for patients with chronic low back pain. A literature synthesis was performed to determine whether antidepressants are more effective than placebos in decreasing pain, disability, depression, and analgesic medication use in such patients. METHODS: English-language journal articles were identified from MEDLINE and PsycLIT databases, bibliographies, and inquiries to researchers and drug companies. Articles were included if they reported data from placebo-controlled or drug comparison trials of antidepressants for patients with low back pain. Six articles met these criteria. RESULTS: Three studies compared the effects of antidepressants and placebos on pain; two found no difference and one found a trend toward superiority of imipramine for patient-rated symptoms but no difference in investigator ratings. Effects on functional disability were examined in three antidepressant-placebo comparisons; only one found the antidepressant to be more effective. Antidepressant effects of an antidepressant vs placebo were compared in three studies; none found a significant difference. Effects on analgesic medication use were compared in three studies; one found amitriptyline to be superior and the others found no difference. Serious methodologic flaws characterized all six studies, and insufficient reporting of data precluded meta-analysis. CONCLUSIONS: The literature has not demonstrated that antidepressants are superior to placebos in improving low back pain or related problems. However, further randomized controlled trials are needed to determine whether antidepressants are useful for low back pain.