CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials

Nonpharmaceutical treatment of distal sensorimotor polyneuropathy in diabetic patients: an unblinded randomized clinical trial

BACKGROUND

For Diabetic polyneuropathy, the most prevalent form of polyneuropathy, there is a lack of evidence-based treatment options. Current approaches include pain management, alpha-lipoic acid, and antidepressants. Physical interventions, such as electrical stimulation (four-chamber galvanic bath) have been suggested but have limited supporting evidence. Heated granular stone therapy is another option to consider.

METHODS

An unblinded randomized controlled trials was conducted in 68 diabetic patients with distal sensorimotor polyneuropathy undergoing rehabilitation for diabetes mellitus as a primary or secondary diagnosis in the Paracelsus-Harz-Clinic (Quedlinburg, Germany). Patients were randomized into either the intervention group receiving heated granulated stone footbaths, or the control group receiving four-chamber galvanic baths. The primary endpoint was the assessment of any change in polyneuropathy using a vibration sensation test (Rydel-Seiffer scale, 8/8) from admission to discharge, analyzed by t-test and multivariable regression. Additionally, serum TNF-α and IL-6 as potential markers for polyneuropathy were compared over time using paired t-test.

RESULTS

The mean age of the patients was 66.8 ± 7.8 years; 63.2% were male and mean BMI was 32.2 ± 6.4 kg/m2. Of the patients, 98.5% suffered from type 2 diabetes (one patient with type I diabetes); 82.4% were receiving oral antidiabetic medication; and 58.8% were insulin dependent. Distal sensorimotor polyneuropathy improved in both groups. The sum score increased from 16.7 to 22.6 in the study group and from 20.3 to 23.6 in the control group. A t-test showed a non-significant difference in the change of sum score between the treatment groups (2.6 points, p = 0.092), but adjusting for potential risk factors favors the intervention group (p = 0.043). Both analyzed markers decreased over time in each treatment group with IL-6 showing a clinical and significant reduction in the control group (p = 0.03).

CONCLUSION

Diabetic patients with distal sensorimotor polyneuropathy benefit from physical treatment with administration of electrical stimulation (four-chamber galvanic bath) or a therapy with heated granulated stones three times a week. Our results indicate that heated stone therapy may be a potential treatment option. However, further research is required to understand the underlying biological processes.

TRIAL REGISTRATION

The study was registered in clinical trials.gov (identifier: NCT05622630, registration date: 18/11/2022).

The acute effects of whole-body vibration exercise on cortical activation in young adults: An fNIRS study

BACKGROUND

Whole-body vibration (WBV) training has emerged as an alternative exercise modality for individuals unable to participate in regular physical activity. While previous studies demonstrated positive effects of WBV on physical outcomes, its impact on cognition remains relatively unexplored, despite studies suggesting cognitive benefits. This study aims to investigate the cortical activation patterns in the primary somatosensory cortex (S1) and dorsolateral prefrontal cortex (DLPFC) during WBV and a subsequent cognitive task.

METHODS

Oxygenated hemoglobin (HbO2) levels in the brain were measured using functional near-infrared spectroscopy (fNIRS). Cognitive functioning was assessed using the Stroop Color-Word Interference (CWIT) and Color-Block test (CBT). Twenty-four participants (21.50 ± 1.59 years, 11 female) were randomly assigned to one of twelve balanced orders, involving different frequencies (24 Hz, 12 Hz, control) and postures (sitting or standing) on a side-alternating vibration plate.

RESULTS

HbO2 levels were lower at 12 and 24 Hz versus control, most prominently in the left DLPFC. During the CWIT, HbO2 levels tended to be higher after WBV versus control. CWIT performance significantly improved after WBV versus control at 12 Hz in sitting posture, and at 12 and 24 Hz in standing posture.

CONCLUSION

Our results point towards decreased cortical activation during WBV, especially in the left DLPFC, but beneficial effects as a consequence of WBV expressed in increased activation during the CWIT and improved cognitive performance, indicating cognitive readiness. These results underscore the potential efficacy of WBV as a cognitive-enhancing therapy. Replicating these findings in older adults would enhance the study's generalizability and practical implications.

An asthma self-management program based on WeChat to improve asthma control and quality of life: a randomized controlled trial

Background

Few studies have tested the feasibility and efficacy of WeChat-based asthma self-management, which supports patients in managing their asthma via mobile phone. We developed an intervention program based on the WeChat Mini program to support self-management. We evaluated the effectiveness and feasibility of improving asthma control and quality of life in patients with asthma.

Methods

Fifty and 53 patients were randomized into the control and WeChat groups, respectively, to receive traditional interventions and interventions based on the WeChat Mini program. We conducted the intervention for three months and then observed for three months.

Results

At the end of the third month, the Asthma Control Test (ACT) scores of the WeChat group were greater than those of the control group (P = 0.003), and the ACT scores of the two groups were significantly higher than those at baseline (P = 0.028; P < 0.001). At the end of the sixth month, the control group was not significantly different from the baseline group (P = 1.000), but the WeChat group was significantly different (P < 0.001). The ACT scores of the WeChat group were higher than those of the control group (P = 0.001). The ACT scores of the WeChat group were lower than those of the third month, but the difference was insignificant (P = 0.214). For asthma self-management and quality of life, the WeChat group improved more at the end of the third and sixth months (all P < 0.001).

Conclusion

Implementing an asthma self-management program based on the WeChat application is effective in helping patients with asthma improve their asthma control and quality of life.

Short-term load restriction after autologous whole-blood injection enhances early recovery in Plantar Fasciitis: A prospective randomized single-blinded trial

This study evaluates the effect of short-term load restriction following autologous whole-blood injection (AWBI) in plantar fasciitis patients. Given that AWBI induces an inflammatory healing response, restricting weight-bearing in the initial phase may optimize recovery. A prospective, single-blind randomized controlled trial was conducted with 149 patients unresponsive to two months of conservative treatment. Patients were randomized into two groups: a load restriction group (n = 75) instructed to avoid weight-bearing for three days, and a non-load restriction group (n = 74) who resumed normal walking immediately. Visual Analog Scale (VAS) pain scores and Pressure Pain Threshold (PPT) were assessed at baseline, days 3, 30, 90, and 1 year post-treatment. Analgesic use and return to daily activities were also recorded. At day 3, the load restriction group reported significantly lower VAS pain scores (8.23±0.7 vs. 8.49±0.5, p = 0.010) and higher PPT values (238.9 ± 36.9 vs. 216.4 ± 45.4, p = 0.001) than the non-restricted group. At day 30, these differences remained significant (VAS: 5.53±0.9 vs. 5.99±0.9, p = 0.002; PPT: 432.6 ± 43.5 vs. 411.4 ± 58.8, p = 0.014). The load restriction group required fewer analgesics (p < 0.001) and returned to daily activities sooner (4.2 ± 0.4 vs. 5.9 ± 1.5 days, p < 0.001). By day 90 and 1 year, no significant differences remained. A three-day weight-bearing restriction post-AWBI significantly enhances early pain relief and functional recovery, reduces analgesic dependence, and accelerates return to daily activities. Given its ease of implementation and cost-free nature, this approach can be readily integrated into routine clinical practice for plantar fasciitis patients undergoing AWBI to fasten recovery. LEVEL OF CLINICAL EVIDENCE: Level 1.

Wound healing and pain evaluation following diode laser surgery vs. conventional scalpel surgery in the surgical treatment of oral leukoplakia: a randomized controlled trial

Objectives

This study aimed to compare patient-reported pain scores and clinician-assessed healing outcomes following the treatment of oral leukoplakia (OL) with a diode laser vs. a conventional scalpel.

Methods

A randomized, double-blind clinical trial (Brazilian Clinical Trials Registry (RBR-7pgcyq) was conducted involving histopathologically confirmed OL patients. Participants were randomly allocated to undergo treatment with either a diode laser or a scalpel. Pain was assessed at 24 h, 48 h, and 7 days using the Visual Analog Scale (VAS), while healing outcomes were clinically evaluated at 7 days, 1-month, and 3-months post-treatment using the Vancouver Scar Scale. Statistical analyses included the Mann-Whitney U-test for comparing pain and healing scores between interventions. Friedman test also was used to analyze healing progress over time.

Results

64 patients were analyzed (33 in diode laser and 31 in scalpel group). No significant differences in pain scores were observed between the treatment groups at 24 h (p = 0.75), 48 h (p = 0.92), or 7 days (p = 0.44). Overall, pain levels varied significantly by OL location at 24 h (p = 0.001), 48 h (p = 0.01), and 7 days (p = 0.03), with tongue lesions associated with significantly higher pain compared to gingival lesions at 24 h (p = 0.005) and 48 h (p = 0.01), as well as compared to palatal lesions at 24 h (p = 0.01). Laser group showed significantly better healing compared to the scalpel group at 7 days (p = 0.01), with no significant differences observed at 1 month (p = 0.67) or 3 months (p = 0.25). Healing outcomes improved significantly over time in both arms (p < 0.001).

Conclusions

There was no significant difference between the diode laser and scalpel treatment arms regarding post operative pain scores. Diode lasers represent better healing at the first week post treatment, but with no differences over time. These findings support the use of either modality as viable management options for OL.

Clinical Trial Registration

Brazilian Clinical Trials Registry, identifier (RBR-7pgcyq).

Completion of tuberculosis preventive treatment with 300 mg vs. 100 mg isoniazid tablets: a pragmatic randomized clinical trial

BACKGROUND

Monotherapy with the drug isoniazid (INH) was for a long time the main therapeutic regimen used for tuberculosis preventive treatment (TPT). Research is progressing into the use of new therapeutic regimens that provide more complete TPT. The objective was to analyze the completion and safety of TPT with the drug INH in the form of 300 mg tablets.

METHODS

Pragmatic, randomized, non-blinded, multicenter clinical trial conducted in Brazil from January 2019 to December 2022. Subjects over the age of 18 years with an indication for TPT was included and those whose index case of active tuberculosis was in retreatment, multidrug-resistant and extremely resistant, transferred, and people deprived of their liberty was excluded. The intervention was TPT with 1 INH 300 mg tablet and the control group with 3 INH 100 mg tablets. The primary outcome was TPT completion. Pearson's chi-square test was used to analyze the association of TPT completion. The risk of TPT completion was estimated by Poisson regression. The mean treatment effect was calculated. The results were expressed as a risk ratio (RR) with a 95% confidence interval (95%CI).

RESULTS

A total of 207 individuals were included, 103 (49.7%) in the intervention group. Seventy-two (69.9%) of the individuals who used INH 300 mg completed TPT. The risk ratio for completing TPT was 1.39 times higher in the group that used the INH 300 mg treatment (RR 1.39, 95%CI 1.08 to 1.79). The mean effect of the intervention was 19% (Coefficient 0.19, 95%CI 0.06 to 0.32). There was no significant difference in adverse events between the groups.

CONCLUSION

The pragmatic use of INH 300 mg in TPT showed a positive effect on the treatment completion rate and is a safe presentation for use in INH monotherapy regimens.

TRIAL REGISTRATION

The protocol is registered in the Brazilian Registry of Clinical Trials under the code RBR-2wsdt6 in September 2019 10th.

Effect of integrating traditional and modern healthcare systems on tuberculosis case detection in Ethiopia: a cluster randomized controlled study

BACKGROUND

Low tuberculosis (TB) case detection remains a major challenge in achieving the End TB targets. New strategies that consider local contexts are needed in countries with high TB burdens like Ethiopia. This study examined the effect of integrating traditional and modern TB care to increase the TB case detection rate.

METHODS

A cluster randomized controlled trial was conducted from February 2023 to January 2024 in six districts of South Gondar Zone, Northwest Ethiopia, where districts were randomly assigned to intervention or control groups. The interventions included training, screening, and referral of presumptive TB patients, delivered over one year, while the control group continued with the standard passive case detection approach. A paired t-test and two sample independent t-test were used to compare baseline and end line data for both groups. Cohen's d was also used to compare the effect size between the intervention and the control groups. A mixed-effect Poisson regression was employed to determine the association between the dependent variable and the exposure variables.

RESULTS

In the intervention group, a total of 620 TB cases were identified post-intervention, compared with 473 cases pre-intervention, including 14 cases identified through referrals by traditional care providers. In contrast, the control group identified 298 TB cases post-intervention and 279 pre-intervention. The TB detection rate increased to 93 cases per 100,000 population in the intervention group, making an approximate 29.2% improvement, compared to a 2.9% increase in the control group. Integrating traditional care with the modern healthcare system significantly increased case detection, with a standardized mean difference of 2.6 (95% confidence interval CI: (1.8, 3.5; t = 8.3; P < 0.001) in a two-sample independent t-test.

CONCLUSIONS

Integrating traditional care with the modern healthcare system significantly increased TB case detection in high-burden settings. This approach not only enhances current TB control strategies but also has potential applications in managing other chronic diseases in resource-limited areas. Future research should evaluate the cost-effectiveness, scalability, and sustainability of this integrative model. Trial registration Unique Protocol ID: 353/2021.

CLINICALTRIALS

gov ID: NCT05236452. The date recruitment began: July 1, 2022. Registration date: July 22, 2022.

Managers and Hygiene Representatives' Perceptions of a Patient Safety Initiative to Reduce Healthcare-Associated Infections: A Mixed-Methods Study

Background and Aims

More knowledge about perceptions of implementing new ways of working to prevent organism transmission and create safety engagement in health care are needed. This study aimed to explore managers and hygiene representatives', in the role as facilitators, perceptions of safety engagement and factors of importance when implementing measures to reduce healthcare-associated infections.

Methods

Data were collected using both a quantitative and qualitative approach. A total of 24 facilitators were involved in the implementation process (12 managers, and 12 hygiene representatives, all female). The facilitators responded to the Sustainable Safety Engagement Index at three occasions, and 13 of the facilitators participated in open-ended semi-structured interviews.

Results

The results displayed that both internal and external organizational factors affected the implementation process as well as the interactions between individuals within the organization. The Sustainable Safety Engagement Index did not indicate any deviations before and during the implementation process.

Conclusion

To create a patient safety culture and get healthcare personnel engaged, it is important for healthcare managers to be aware of the complexity of healthcare and adapt organizational factors and specific elements in the caring chain. A systematic implementation approach, and reliable measurements along with use of single or multiple strategies is recommended. Furthermore, dedicated facilitators who creates an environment of support and cooperation between different professions and provides inspiration is crucial to maintain the improvement work. Prevailing behaviors should also be considered when planning and implementing patient safety interventions.

Proximal versus distal tenotomy of the iliopsoas tendon in the surgical treatment of developmental dysplasia of the hip: a randomized clinical trial

PURPOSE

This study aimed to compare the release of the iliopsoas tendon at two levels: proximally at the pelvic brim and distally near the lesser trochanter.

METHODS

The study was a randomized clinical trial. It was done to check the equivalence between two parallel groups of patients with DDH of grade 2 or more who underwent open reduction operations for their hips: Group 1, division of the iliopsoas tendon at the pelvic brim, and Group 2, division of the tendon at the lesser trochanter level. All the operations were done through the anterior approach.

RESULTS

Thirty-eight patients (24 females and 14 males) with 54 hips (cases) operated, 27 cases in each group. The mean follow-up period of the cases was 2.4 years (SD 0.6). In the third month postoperatively, children of both groups had grade 2 hip flexion strength. Later, a statistically significant difference (p-value 0.007) occurred between them in the 24th month (Group 1 reached grade 5 and Group 1 to grade 4). More complications, 13 out of 27 (48.2%%), were recorded in Group 2. The complications were active bleeding due to injury to medial circumflex femoral vessels (5 cases) and avascular necrosis of the femoral epiphysis (8 cases). Group 1 had only four cases of avascular necrosis of the femoral epiphysis.

CONCLUSION

Patients who underwent a DDH operation with a division of the iliopsoas tendon proximally at the pelvic brim regained hip flexion strength earlier and achieved a better grade with fewer complications.

A Randomized Controlled Trial Comparing the Efficacy of Bilateral Percutaneous Tibial Nerve Stimulation Versus Biofeedback Pelvic Floor Muscle Training in the Management of Obstructed Defecation Syndrome

Introduction Obstructed defecation syndrome (ODS) is a common disorder in developed countries. This study aims to compare the efficacy of bilateral percutaneous tibial nerve stimulation (Bi-PTNS) to biofeedback therapy (BFT) in adult patients with ODS. Methods A prospective randomised control study was conducted on patients aged ≥18 years, diagnosed with ODS, who were referred to the Colorectal Surgery Department at a main university hospital between 2018 and 2020. Computerized 1:1 block randomization allocated patients into two groups: the bi-PTNS group and the BFT group. The Constipation Scoring System and Patient Assessment of Constipation Quality of Life Score (PAC-QoL) were used to assess the severity of the patient's symptoms prior to and after treatment. The primary outcome was the improvement of the Constipation Scoring System. The secondary outcome was the PAC-QoL score. Results In total, 60 patients, with 38 females (mean of 43 years in the BFT group and 48 years in the Bi-PTNS group), were studied. Statistically significant differences were achieved in patients who underwent bi-PTNS compared to the BFT group (p < 0.001). The average improvement in the Constipation Scoring System score for the bi-PTNS group was 66.66% ± 8.44 compared to 47.36% ± 10.44 for the BFT group. The bi-PTNS group showed improvement in the PAC-QoL score (60.41% ± 4.03) compared with 42.59% ±6.25 in the BFT group. Conclusion The Bi-PTNS intervention was more effective than BFT in alleviating symptoms of OD compared to BFT, evidenced by improvements in both the Constipation Scoring System and PAC-QoL scores.

Vibration therapy as an intervention for trochanteric hip fractures - A randomized double-blinded, placebo-controlled trial

Background

Hip fractures are one of the most serious forms of fragility fractures. Low-magnitude high-frequency vibration (LMHFV) is a biophysical intervention that provides non-invasive, systemic mechanical stimulation. The objectives of this study were to investigate the efficacy of LMHFV in trochanteric hip fracture elderly patients to (i) accelerate trochanteric fracture healing and (ii) improve clinical and functional outcomes.

Methods

A randomized double-blinded, placebo-controlled clinical trial was conducted. Participants were randomly assigned into LMHFV or placebo intervention for 14 days. Primary outcome assessments were fracture healing assessed with CT scan and X-rays. Dual X-ray Absorptiometry (DXA) scan was performed to assess bone mineral density change. Secondary outcome assessments were clinical and functional outcomes with quadriceps muscle strength, balancing ability, handgrip strength, Time Up and Go (TUG) test, quality of life outcomes, pain, falls, and mortality.

Results

237 patients were screened for eligibility by the inclusion and exclusion criteria. 62 patients were recruited and randomly assigned to placebo group (n = 32, mean age: 83.6 ± 7.0 years, women: 71.9 %) or LMHFV group (n = 30, mean age: 81.5 ± 5.7 years, women: 73.3 %). For fracture healing, CT scan at 6 weeks showed improved osseous union for the LMHFV group at 71.5 ± 19.4 % compared to placebo group at 58.8 ± 30.5 %, but no statistical significance detected. X-rays showed fractures healed at 12 months. LMHFV group had significantly higher quadriceps muscle strength compared to placebo group on affected leg using maximum reading (week 26: 8.8 ± 3.6 kg vs. 6.1 ± 4.1 kg; p = 0.011) and average reading (week 26: 8.0 ± 3.7 kg vs. 5.2 ± 3.3 kg; p = 0.008) amongst 3 trials. The balancing ability test could not be performed in most of the subjects at the baseline measurement. However, from week 6 to week 26, LMHFV group had significantly improved balancing compared to placebo group for overall stability index (week 26: 1.6 ± 1.1 vs. 3.4 ± 2.6; p = 0.006), anteroposterior stability index (week 26: 1.1 ± 0.7 vs. 2.1 ± 1.9; p = 0.048) and medial-lateral stability index (week 26: 0.9 ± 0.7 vs. 2.2 ± 2.2; p = 0.008). There was a significant increase in success in performing TUG test in LMHFV group from baseline (13.3 %) to 26 weeks (57.1 %) (p = 0.004). Quality-of-life outcomes by SF-36 showed LMHFV group had a significant improvement at a score of 62.1 ± 18.9 compared to control group at a score of 48.5 ± 18.9 after adjusting for the baseline measurement (p = 0.044).

Conclusion

A short duration of LMHFV during in-patient stay can improve clinical outcomes and can potentially be incorporated as a practical measure during the recovery of fragility hip fractures.

The translational potential of this article

14 days of LMHFV treatment is generally within the common in-patient stay period for hip fracture patients and therefore can potentially be incorporated into clinical practice with physiotherapy to facilitate recovery of hip fracture patients.

Clinical trial registration number

NCT04063891.

The Bobath concept (NDT) in adult neurorehabilitation: a scoping review of conceptual literature

PURPOSE

This scoping review aims to describe how Bobath concept is conceptualized, operationalized, and studied in adult neurorehabilitation.

METHODS

The Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR) guidelines were adopted. Non-scientific and research articles were searched in electronic databases PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science, ScienceDirect, and Physiotherapy Evidence Database (PEDro), with the keywords "Bobath" or "Neurodevelopmental Treatment", published in English, Spanish, and Portuguese, between 2013 and 2023.

RESULTS

Of the 78 publications identified, 31 articles addressed the conceptual underpinnings of Bobath concept (seven theoretical papers, seven Delphi/surveys/mixed methods studies, four qualitative studies, one scoping review, 10 letters to the editor, and two editorials), comprising five themes: (a) theoretical principles; (b) clinical principles; (c) clinical reasoning; (d) conceptualizing movement; and, current (e) evidence debate. The revised definition and the Model of Bobath Clinical Practice provide a clarification of the unique aspects of Bobath concept. A new clinical skill was identified beyond facilitation - visuospatial kinesthetic perception - as well as how Bobath experts conceptualize movement, which are all integral to clinical reasoning.

CONCLUSIONS

This review provides an updated Bobath clinical framework that gathers the theoretical foundations and clinical practice principles that require careful consideration in the design of future intervention studies. Implications for rehabilitationThis scoping review consolidates the clinical and theoretical principles of contemporary Bobath practice, providing a clear framework for clinicians.The Model of Bobath Clinical Practice (MBCP) framework enables detailed documentation of movement analysis and movement diagnosis, guiding clinical reasoning and interventions.This review identifies fundamental principles and practices to inform future Bobath intervention studies, ensuring their clinical relevance.A framework with specific recommendations has been developed to guide Bobath intervention studies, enhancing the integration of clinical practice, education, and research.

Eight weeks of Pilates Method improves physical fitness and sleep quality of individuals with post-COVID-19 syndrome: A randomized clinical trial blinded

OBJECTIVES

To evaluate the impact of eight weeks of Pilates Method on physical fitness and sleep quality of individuals with post-COVID-19 syndrome.

METHODS

Randomized clinical trial blinded conducted with fifty-nine individuals with post-COVID-19 syndrome. The participants were randomly allocated to the Pilates group (PG; n = 20), supervised physical exercise group (SPEG; n = 20) and control group (CG; n = 19). The intervention occurred twice a week for eight weeks in a total of 16 sessions. The primary outcome was distance covered in the 6-min walk test and the secondary outcomes were the profile of the sample, post-exercise fatigue and sleep quality.

RESULTS

After the intervention, only the PG increased the distance covered in the 6-min walk test (p < 0.001; d = 0.762) and reduced the score on the modified BORG scale after exercise (p < 0.010; d = -0.835) and the Pittsburgh Sleep Quality Index (p < 0.005; d = -0.699). Furthermore, the PG covered a greater distance compared to the SPEG in the 6-min walk test [95%CI (26.129-179.770); p < 0.010; d = 1.021] and exhibited a greater reduction in fatigue levels compared to the CG [95%CI (-2.352 to -0.162); p < 0.050; d = 0.919].

CONCLUSION

Eight weeks of Pilates Method improve the physical fitness and sleep quality of individuals with post-COVID-19 syndrome.

Trends of Publication of Negative Trials Over Time

Studies with negative results are less likely to be published than others, potentially leading to publication bias. Introduced in 2000, trial registration could have participated in decreasing the proportion of unpublished studies. We assessed the proportion of negative randomized controlled trials (RCT) over the last 20 years. We searched Medline for RCT published in 2000, 2005, 2010, 2015, and 2020 in the British Medical Journal, the Journal of the American Medical Association, the Lancet, and the New England Journal of Medicine. The primary endpoint was the proportion of negative (final comparison on the primary study-endpoint without statistical significance or favoring the control arm) studies published in 2000 and 2020. Factors independently associated with the publication of negative studies were identified using multivariable analysis. A total of 1,542 studies were included. The proportion of negative RCT significantly increased between 2000 and 2020 (from 27.6% to 37.4%; P = 0.01), however, the trend over time was not significant (P = 0.203). In multivariable analysis, the following factors were associated with a higher proportion of published negative studies: superiority (P < 0.001), two-group trials (P < 0.001), number of patients ≥510 (P < 0.001), cardiology trials (P = 0.003), emergency/critical care trials (P < 0.001), obstetrics trials (P = 0.032), surgery trials (P = 0.006), pneumology trials (P = 0.029). Exclusive industry funding was associated with a lower proportion of published negative studies (P < 0.001). The proportion of published negative studies in 2020 was higher only when compared to 2000. During the two decades, no trend was noticeable. There is no clear relationship between trial registration and the publication of negative results over time.

Efficacy of metacognitive interventions for psychiatric disorders: a systematic review and meta-analysis

Metacognitive interventions have received increasing interest the last decade and there is a need to synthesize the evidence of these type of interventions. The current study is an updated systematic review and meta-analysis where we investigated the efficacy of metacognitive interventions for adults with psychiatric disorders. We included randomized controlled trials that investigated either metacognitive therapy (MCT; developed by Wells) or metacognitive training (MCTraining; developed by Moritz). Ovid MEDLINE, Embase OVID, and PsycINFO were searched for articles published until May 2024. The final analyses included 21 MCT- and 28 MCTraining studies (in total 3239 individuals). Results showed that MCT was more efficacious than both waiting-list control conditions (g = 1.84) as well as other forms of cognitive behavior therapies (g = 0.43). MCTraining was superior to treatment as usual (g = 0.45), other psychological treatments (g = 0.46) and placebo conditions (g = 0.15). Many of the included studies lacked data on blinding procedures, reporting of inter-rater reliability, treatment adherence, competence, treatment expectancy and pre-registration procedures. We conclude that both MCT and MCTraining are probably efficacious treatments but that future studies need to incorporate more quality aspects in their trial designs.

Elective Induction of Labor May Have Negative Effects at the Hospital Level

Labor induction increased in the United States after the publication of A Randomized Trial of Induction Versus Expectant Management (ARRIVE) in 2018. During this trial, investigators found that elective induction at 39 weeks in low-risk nulliparous women led to similar perinatal outcomes when compared to expectant management. However, other researchers have since linked rising labor induction rates to worse hospital- and population-level outcomes. It is possible that elective induction of labor has a neutral effect on patients who are induced while at the same time lessening hospital capacity to care for other maternity patients, which leads to a negative effect on patient outcomes overall. During a trial, this represents a form of negative spillover, in which an intervention indirectly harms the comparison group and leads to overestimation of intervention benefit. Although further research is needed, evidence from ARRIVE and subsequent studies provides preliminary support for this possibility.

Sexual dimorphism in exercise-induced response on steroid hormones to a 24-week supervised concurrent training intervention

BACKGROUND

Steroid hormones are key mediators of adaptative responses to exercise, a stimulus that may concurrently affect their blood concentrations. However, the chronic endocrine adaptations and whether these potential changes are dependent on exercise intensity remain undetermined. Moreover, it is also unknown if the exercise-induced effects on steroid hormonal status are related to the participant' sex.

METHODS

This study aimed to investigate the intensity effects of a 24-week supervised concurrent training intervention on steroid hormones in sedentary young men and women. A total of 106 untrained young adults (68% women) aged 18-25 years were randomly assigned to one of the three groups: (I) Control group (no exercise; n = 35); (II) Ex-Moderate group (concurrent training at moderate intensity; n = 36); (III) Ex-Vigorous group (concurrent training at vigorous intensity; n = 35). Steroid hormones (i.e. cortisol, testosterone and dehydroepiandrosterone sulfate (DHEAS)) were measured in plasma through a chemiluminescent method. Body composition parameters were determined using a dual-energy X-ray absorptiometry scanner.

RESULTS

No significant changes in steroid hormones levels were observed after the intervention (all p ≥ .129). However, a time x group interaction was noted in the testosterone/cortisol ratio (T/C ratio) only in women (p = .044). Concretely, our data showed a significant decrement of T/C ratio in both the Ex-Moderate group and in the Ex-Vigorous compared with the control group (Δ = -24.2 ± 2.0% and Δ = -38.9 ± 45.4%, respectively).

CONCLUSION

Our 24-week supervised concurrent training intervention showed no significant changes in steroid hormone levels. However, a significant decrement of T/C ratio was observed only in women, indicating a sexual dimorphism in the effect on T/C ratio.

Effects of balance and hamstring training on nonspecific low back pain: A randomized controlled trial

Low back pain is a prevalent musculoskeletal disorder and affects approximately 70% of the adults in the world. To explore how balance and hamstring training improve individuals with nonspecific lower back pain (NSLBP). A total of 26 NSLBP people were randomly allocated into either the experimental group (EG) (n = 13) or the control group (CG) (n = 13). The EG was given balance and hamstring training for 45 min, 3 times per week, for up to 6 weeks, while the CG maintained daily life without any intervention. The primary outcome, the Visual Analog Scale for pain intensity, and the secondary outcomes, including the TOGU balance test for balance ability, hamstring and lumbar muscle strength and endurance, and the sit-and-reach test for hamstring flexibility, were assessed at baseline and after 6 weeks of training. For the primary outcome, the EG significantly improved pain intensity (p < 0.001) compared with CG. For secondary outcomes, the EG showed significant improvements in back strength (p = 0.015), abdominal endurance (p = 0.032), back endurance (p = 0.027), and hamstring strength (p = 0.007 left) (p = 0.005 right) following 6 weeks of training compared with the CG. However, the two groups had no significant difference in balance ability, abdominal strength, and hamstring extensibility (p ≥ 0.05). Six weeks of balance and hamstring training effectively reduces pain intensity and improves back strength, abdominal and back endurance, and hamstring strength.Trial registration International Standard Registered Clinical/Social Study Number (ISRCTN) registry, ISRCTN14488937 (28/05/2024).

Effects of 12-week whole-body vibration training versus resistance training in older people with sarcopenia

Sarcopenia is a syndrome commonly found in older people. The aim of this study was to evaluate the effects of whole-body vibration training (WBVT) and resistance training (RT) on body composition, muscle strength, physical performance and blood biomarkers in older people with sarcopenia. We conducted a 12-week, 3-times-weekly assessor-blinded, randomized controlled trial of 27 older people with sarcopenia aged ≥ 65 years. Subjects were randomized into WBVT group (n = 14) and RT group (n = 13). The primary outcome was knee extension strength (KES). Secondary outcomes were body composition [body weight, body mass index (BMI), percentage of body fat (PBF), and appendicular skeletal muscle mass index (ASMI)], muscle strength [handgrip strength (HS)], physical performance [gait speed (GS), 5-time chair stand test (5CST), and short physical performance battery (SPPB)], blood biomarkers (inflammatory factors, hormones, growth factors, and muscle injury biomarker), and quality of life questionnaire [medical outcomes study short-form 36 (SF-36)]. After 12-week intervention, in the WBVT group, we observed significant improvements in body composition (weight, BMI, PBF and ASMI), muscle strength (KES), physical performance (GS, SPPB and 5CST), blood biomarkers [insulin-like growth factor 1 (IGF-1), growth hormone, follistatin (FST) and creatine kinase (CK)] and quality of life. In the RT group, we observed significant improvements in body composition (weight, BMI and PBF), muscle strength (KES), physical performance (GS and SPPB), blood biomarkers (growth hormone, FST and CK) and quality of life. Between-group comparisons were only significant for KES (P = 0.007) and the role-physical (RP) dimension of the SF-36 (P = 0.007). WBVT and RT both improved the physical condition of older people with sarcopenia. RT excelled in muscle strength, but WBVT offered an alternative for those with restrictions. WBVT's low risk and flexibility suited diverse conditions, providing a new rehabilitation option for patients with sarcopenia.

Outcomes from the Victorian Healthy Homes Program: a randomised control trial of home energy upgrades

OBJECTIVES

The Victorian Healthy Homes Program investigated the impact of thermal home upgrades on energy and health outcomes in vulnerable, older individuals over winter in Victoria, Australia.

DESIGN

A staggered parallel-group randomised control trial design of 984 (764 per protocol (PP)) vulnerable households and 1313 (1015 PP) individuals. The intervention group received their upgrade prior to their winter of recruitment, and the control group received their upgrade after the winter of their recruitment.

SETTING

Western Melbourne (metropolitan) and the Goulburn Valley (regional) in Victoria, Australia.

PARTICIPANTS

1000 households were recruited: 800 from western Melbourne (metropolitan) and 200 from the Goulburn Valley (regional).

INTERVENTION

A thermal comfort and home energy efficiency upgrade of up to $AUD3500 per household.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was the change in indoor temperature over winter and the secondary outcomes were changes in quality of life, healthcare use and costs, self-reported health measures, energy use and costs and humidity.

RESULTS

A relatively low-cost and simple home upgrade (average cost $A2809) resulted in reduced gas consumption (-25.5 MJ/day) and increased indoor winter temperatures (average daily increase of 0.33°C), and a reduction of exposure to cold conditions (<18°C) by an average of 0.71 hours (43 min) per day. The intervention group experienced improved mental health as measured by the short-form 36 mental component summary and social care related quality of life measured by the Adult Social Care Outcomes Toolkit, less breathlessness and lower overall healthcare costs (an average of $A887 per person) over the winter period.

CONCLUSIONS

The home upgrades significantly increased average winter indoor temperature, improved mental health and social care-related quality of life and made householders more comfortable while yielding reductions in overall healthcare use and costs.

TRIAL REGISTRATION NUMBER

Australian and New Zealand Clinical Trials Registry: ACTRN12618000160235.

Effects of Short Preoperative Warming Time on Transurethral Lithotripsy Surgery: A Randomized Controlled Trial

PURPOSE

Preoperative warming prevents inadvertent perioperative hypothermia (IPH). The aim of this study was to investigate the effect of preoperative warming (prewarming) on patient thermal protection and to explore the appropriate duration of preoperative warming for clinical practice.

DESIGN

Randomized controlled clinical trial.

METHODS

117 urological patients were randomized into no prewarming (NP), prewarming 15 minutes (P-15), and prewarming 30 minutes (P-30) groups. Patients' core temperature was monitored and the incidence of IPH, incidence of postoperative shivering, extubation time, length of stay in the postanesthesia care unit, and length of stay in hospital were recorded. The Consolidated Standards of Reporting Trials (CONSORT) checklist was followed.

FINDINGS

The intraoperative core temperature at all time points and the rise in temperature before induction of anesthesia were higher in the P-15 and P-30 groups than in the NP group, but there was no statistically significant difference between the P-15 and P-30 groups. The incidence of IPH was lower in the P-15 (33.3%) and P-30 (37.8%) groups than in the NP group (65.8%), but there was no statistically significant difference between the P-15 and P-30 groups. The incidence of shivering, extubation time, length of stay in the postanesthesia care unit, and length of stay in hospital did not differ between groups.

CONCLUSIONS

Prewarming can effectively maintain intraoperative core temperature in patients undergoing transurethral lithotripsy, and reduce the incidence of IPH. Prewarming 15 minutes before surgery can achieve beneficial clinical effects.

Synergic Efficacy of a Multicomponent Nutraceutical Add-On Therapy in Seasonal Allergic Rhinitis in Children: A Prospective, Randomized, Parallel-Group Study

Background: Emerging evidence suggests that nutraceuticals, alongside standard therapy, may benefit children with allergic rhinitis (AR). This study aimed to compare the efficacy of Quertal® (Neopharmed Gentili S.p.A., Milano, Italy), a nutraceutical supplement based on Perilla frutescens, Quercetin, and vitamin D3, combined antihistamines per os versus antihistamines alone, in improving AR symptoms considering respiratory functional and laboratory biomarkers in pediatric age. Materials and Method: This study included 100 children, 50 in the case group (Quertal® plus antihistamines) and 50 in the control group (antihistamines alone), with mild/moderate AR sensitized to grass pollens. They underwent assessments of respiratory function (rhinomanometry-AAR, spirometry), inflammation markers (Nasal Nitric Oxide [nFeNO]; exhaled Nitric Oxide [eFeNO]; nasal cytology), and laboratory assays (blood eosinophils, total IgE and specific IgE to Phl p1). Results: After three months of treatment, the case group showed statistically significant improvement in nFeNO and eFeNO values compared to controls (p < 0.001), as well as a reduction in nasal eosinophils (p < 0.001). Conclusions: Adding Quertal® to standard antihistamine therapy may reduce nasal inflammation and improve AR symptoms in pediatric patients. This combination therapy shows promise as a practical, well-tolerated approach to managing AR and may have broader implications for enhancing long-term outcomes.

EMMATKA trial: the effects of mobilization with movement following total knee arthroplasty in women: a single-blind randomized controlled trial

BACKGROUND

Mobilization with Movement (MWM) is an examination and management approach for correcting the intra-articular translational and rotational movements to facilitate the active physiological movement. The study aimed to determine the effects of MWM on Total Knee Arthroplasty (TKA) using a randomized controlled trial (RCT) design.

METHODS

The trial is registered (ISRCTN ref: 13,028,992). A blinded examiner assessed patients at pre-surgical (before TKA), post-surgical (at 3-weeks post-TKA), 6-weeks and 6-months post-TKA. Participants were randomly assigned to receive MWM (six sessions, between 3 and 6 weeks post-TKA) plus standard rehabilitation (intervention group) or standard rehabilitation alone (control group) of outpatient rehabilitation including range of motion and strengthening exercises, cycling, gait and stair training. Outcome measures were range of motion (goniometer), pain (visual analogue scales), physical function (Timed Up and Go (TUG)), a 15-m walk test, and health status (Western Ontario and McMaster (WOMAC) Osteoarthritis Index). Change in outcome measures from post-surgical to 6 weeks and 6 months post-TKA were compared between groups. The primary outcome was change in knee flexion range of motion at 6 weeks.

RESULTS

84 women scheduled for TKA were randomly allocated to intervention (n = 42) or control (n = 42); mean ± (SD) age 65.1 ± 7.4 and 66.8 ± 8.9 years, respectively. The intervention group demonstrated significantly greater increase in knee flexion at both 6 weeks (median (IQR) + 10.000 (20.000) compared with + 2.500 (6.250) in the control group) and 6 months (+ 12.500 (15.000) and + 5.000 (10.000) respectively) (both p < 0.05). There were no differences between groups in secondary outcomes.

CONCLUSION

Introducing MWM for TKA rehabilitation has greater benefits for women post-TKA in increasing knee joint flexion range of motion than the standard rehabilitation programs in the short and medium-term. This evidence-based approach offers a promising adjunctive intervention for optimizing recovery and rehabilitation process following TKA in women. Clinicians should consider including MWM approach in post-TKA rehabilitation programs.

LEVEL OF EVIDENCE

I.

Effectiveness of referral to a population-level telephone coaching service for improving health risk behaviours in people with a mental health condition: a randomised controlled trial

BACKGROUND

Telephone support services are a viable means of providing population-level support to reduce health risk behaviours. While research exists on the effectiveness of Quitlines to reduce smoking, there is limited other research investigating whether telephone services can provide effective behaviour change support for people with a mental health condition for behaviours including physical activity, healthy eating, and weight management. The aims of this trial were to evaluate the effectiveness of referral of people with a mental health condition to a population-level telephone coaching service to improve health risk behaviours and increase attempts to do so.

METHODS

A parallel-group randomised controlled trial was conducted. Participants with a mental health condition (N = 681) were assigned to a control (health information pack) or intervention group (information pack and referral by the research team to a coaching program). Data were collected via telephone surveys at baseline and six months post-recruitment. Primary outcomes were: (1) weekly minutes of moderate-to-vigorous physical activity, (2) daily fruit serves, (3) daily vegetable serves, and (4) attempted behaviour change/weight loss (yes/no; composite measure). Secondary outcomes included weight, Body Mass Index (BMI), and attempts to change each health behaviour individually.

RESULTS

Intention-to-treat analyses found no significant differential change between groups from baseline to six months for primary or secondary outcomes. By follow-up, 242/549 (44%) of intervention participants had enrolled in coaching and completed at least one call, with 16/242 having completed the program, 79 ongoing, and 147 withdrawn. Per-protocol analyses found attempting to improve at least one health behaviour/lose weight was significantly greater in enrolees (OR = 3.7, 95% CI 1.03-13.23) than the control group.

CONCLUSIONS

Referral to the program did not improve risk behaviours or weight/BMI but did support behaviour change attempts. Contributing factors may include low program completion by follow-up and impact of COVID-19. Further research is required to better understand participation in and benefits of telephone coaching services for people with a mental health condition.

TRIAL REGISTRATION

Registered retrospectively with the Australian New Zealand Clinical Trials Registry (ACTRN12620000351910).

The need for further guidance on the handling of multiple outcomes in randomized controlled trials: a scoping review of the methodological literature

OBJECTIVES

To review current methodological guidance for handling and reporting of multiple outcomes (MOCs) in randomized controlled trials (RCTs).

STUDY DESIGN AND SETTING

A scoping review with bibliographic database searches including Embase, PubMed, and Web of Science up to January 16, 2025 was conducted. Inclusion criteria were articles that: (1) provide advice on the design, analysis, or reporting of RCTs using MOCs; and/or (2) discuss statistical approaches for handling MOCs in RCTs. Six specific websites were also checked for formal and reporting guidelines. Included articles were summarized using thematic analysis.

RESULTS

Searches retrieved 1716 articles of which 123 were included with additional 25 articles from updated search. Eight additional articles were identified by the specific website search. Six main subthemes on methodological recommendations for using MOCs were identified from 74 of 123 articles (60%): (1) need to prespecify outcomes and analysis, (2) multiplicity adjustment, (3) power and sample size implications, (4) secondary outcomes multiplicity, (5) considerations of MOCs correlation, and (6) specific applications of MOCs. Recommendations on coprimary and composite outcomes were also identified, including their features, analyses methods, reporting, and challenges. Statistical methods for analyzing MOCs were discussed in 53 of 123 articles (43%), with the majority describing modifications of pre-existing statistical approaches.

CONCLUSION

Current recommendations on using MOCs in RCTs focus primarily on statistical considerations and trials of licensing drugs or medical devices. Areas for further methodological research and guidance include reporting of the rationale for the use and selection of MOCs in RCTs and considerations for trials undertaken in nonregulatory setting, including complex interventions.

Improving retrospective data on recent household deaths: a multi-arm randomized trial in Guinea-Bissau

BACKGROUND

In countries with limited civil registration and vital statistics systems, assessing the impact of health crises requires precise retrospective mortality data. We tested whether calendar methods improve survey or census data on dates of recent household deaths registered in a Health and Demographic Surveillance System (HDSS).

METHODS

Between April and June 2023, we randomized 578 households with HDSS-registered deaths in Guinea-Bissau to interviews by using (i) a standard questionnaire with close-ended questions about dates of deaths, or similar questionnaires supplemented with (ii) a physical calendar of local events printed on paper or (iii) a digital calendar implemented on tablets. We evaluated the accuracy of reported dates through record linkages to HDSS data.

RESULTS

No deaths were reported in 11.8% of the 508 participating households. In other households (n = 448), informants reported 574 deaths since January 2020. Relative to the standard questionnaire, neither the physical calendar nor the digital calendar improved the proportion of deaths reported in the same month and year as recorded by using surveillance data. The physical and digital calendars reduced the share of missing data on dates of deaths (6.1% and 3.2%, respectively, versus 13.1% with the standard questionnaire). Reported dates of deaths obtained by using the digital calendar were more weakly correlated with surveillance data than those collected in other arms. Using the digital calendar also added 1.15 minutes to the data collection.

CONCLUSION

Digital calendars do not improve the reporting of dates of deaths in surveys or censuses. Further trials of the use of a physical calendar in retrospective interviews about recent household deaths are warranted.

Effect of double duty interventions on dietary diversity score of adolescents using a cluster randomized controlled trial in Debre Berhan Regiopolitan City, Ethiopia

Improving the dietary quality of adolescents is crucial in public health, especially in low-income countries like Ethiopia. Despite numerous nutritional interventions, those interventions targeting adolescents were inconsistent due to fragmented implementation. Thus, this study aimed to evaluate the effect of selected double-duty interventions on the dietary diversity scores (DDS) of adolescents in Debre Berhan Regiopolitan City, Central Ethiopia. A two-arm parallel cluster randomized controlled study involved 708 adolescents (356 for intervention group (IG) and 352 for control group (CG)) was conducted from October 13, 2022 to June 30, 2023. The study found a 30.4% reduction in the proportion of adolescents with low DDS in the IG along with an 18.4% increase in high DDS compared to the CG as measured by the minimum dietary diversity score indicator. The generalized estimating equation (GEE) model revealed that adolescents in the IG were nearly twice as likely to achieve a high DDS compared to the CG [AOR = 1.91, 95% CI (1.85, 1.97)]. This study highlights the effectiveness of double-duty interventions supported by behavioral models in enhancing dietary diversity and advocates for their integration into nutritional policies.Clinical Trials: The trial was prospectively registered at ClinicalTrials.gov (NCT05574842) and was first posted on October 12, 2022.

Effects of Individualized Follow-Up With an App Postcardiac Rehabilitation: Five-Year Follow-Up of a Randomized Controlled Trial

BACKGROUND

Adherence to healthy behaviors initiated or adapted during cardiac rehabilitation (CR) remains a significant challenge, with few patients meeting guideline standards for secondary prevention. The use of mobile health (mHealth) interventions has been proposed as a potential solution to improve adherence to healthy behaviors after CR. In particular, app-based interventions have shown promise due to their ability to provide monitoring and feedback anytime and anywhere. Growing evidence supports the use of apps in post-CR settings to enhance adherence. In 2020, we demonstrated that individualized follow-up via an app increased adherence to healthy behaviors 1 year after CR. However, it remains uncertain whether these effects persist once the follow-up is discontinued.

OBJECTIVE

This study aims to evaluate the long-term effects of individualized follow-up using an app, assessed 4 years after the intervention.

METHODS

A single-blinded multicenter randomized controlled trial was conducted. Patients were recruited from 2 CR centers in eastern Norway. The intervention group (IG) received individualized follow-up through an app for 1 year, while the control group (CG) received usual care. After the 1-year follow-up, the app-based follow-up was discontinued for the IG, and both groups were encouraged to maintain or improve their healthy behaviors based on their individual risk profiles. The primary outcome was the difference in peak oxygen uptake (VO2peak). The secondary outcomes included exercise performance, body weight, blood pressure, lipid profile, exercise habits, health-related quality of life, health status, cardiac events, and physical activity. Linear mixed models for repeated measurements were used to analyze differences between groups. All tests were 2-sided, and P values ≤0.05 were considered statistically significant.

RESULTS

At the 5-year follow-up, 101 out of the initial 113 randomized participants were reassessed. Intention-to-treat analyses, using a mixed model for repeated measurements, revealed a statistically significant difference (P=.04) in exercise habits in favor of the IG, with a mean difference of 0.67 (95% CI 0.04-1.29) exercise sessions per week. Statistically significant differences were also observed in triglycerides (mean difference 0.40, 95% CI 0.00-0.79 mmol/l, P=.048) and walking (P=.03), but these were in favor of the CG. No differences were found between the groups for other evaluated outcomes.

CONCLUSIONS

Most of the benefits derived from the app-based follow-up diminished by 4 years after the intervention. Although the IG reported statistically significantly higher levels of exercise, this did not translate into improved VO2peak or exercise performance. Our study highlights the need for follow-up from health care providers to enhance adherence to healthy behaviors in the long term following CR.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03174106; https://clinicaltrials.gov/ct2/show/NCT03174106 (original study protocol) and NCT05697120; https://clinicaltrials.gov/ct2/show/NCT05697120 (updated study protocol).

Health-promoting text messages to patients with hypertension-A randomized controlled trial in Swedish primary healthcare

Due to the high prevalence and great cardiovascular risks of hypertension, we need effective and evidence-based treatment strategies. Health-promoting one-way text messages could be a beneficial complement to antihypertensive drugs. However, this has yet to be proven in a primary healthcare setting. The purpose of this study was to investigate if health-promoting text messages could improve patients' blood pressure in primary care. The PUSHME (Primary care Usage of Health promoting Messages) randomized controlled trial included 401 patients from 10 primary health care centers in southern Sweden. Patients in the intervention group received four text messages weekly for six months along with treatment as usual. The PUSHME study was registered on clinicaltrials.gov (NCT04407962). Patients in both the control group and the intervention group lowered their blood pressure during the study, but there was no significant difference in change between the groups. However, subgroup analyses showed that there was a significantly larger reduction in diastolic blood pressure favoring the intervention for patients with poor self-rated health: -4.5 mmHg vs -1.4 mmHg (p = 0.019), and patients with a sedentary lifestyle: -5.2 mmHg vs -2.4 mmHg (p = 0.034). Our findings indicate that text messages with lifestyle advice to a general hypertensive population do not have any significant effect on blood pressure. However, it could be an effective complement to conventional antihypertensive drug treatment for specific patient groups.

High Intensity Interval Training and Arterial Hypertension: Quality of Reporting

The benefits of exercise have been well described for the treatment of hypertension. Poor reporting quality impairs quality appraisal and replicability. High intensity interval training (HIIT) has been shown to be an effective alternative to traditional aerobic exercise in patients with hypertension. We evaluated the completeness of reporting of randomized controlled trials (RCTs) with HIIT for hypertension and to compare both exercise modes in reporting quality. RCTs of HIIT with a minimum duration of 6 weeks in adults with at least high normal blood pressure (≥130 mmHg/≥85 mmHg) were evaluated using the Consensus on Exercise Reporting Template (CERT). Nine RCTs conducting HIIT in hypertensive patients (N=718; 51.8 years) were evaluated. A mean of 62.6% of items were sufficiently described, compared with 49.2% in moderate intensity training interventions. Exercise dose was adequately reported in 8 out of 9 studies. Only one study reported information on adverse events. In a small sample of RCTs with HIIT in patients with hypertension we found a better reporting quality than in moderate intensity training interventions. However, reporting completeness is not optimal for a good replicability in clinical practice. The lack of reporting of adverse events in interventions using high intensities is particularly unfavourable.

Kinetic Oscillation Stimulation for the Preventive Treatment of Chronic Migraine: A Randomized, Double-Blind, Sham-Controlled Trial

BACKGROUND AND OBJECTIVES

The Chordate System administers kinetic oscillation stimulation (K.O.S) into the nasal cavity thereby potentially modulating the activity of trigemino-autonomic reflex. Modulation of this reflex has been proposed as a potential therapeutic target in migraine. The aim of this clinical trial was to evaluate the efficacy of K.O.S for the preventive treatment of chronic migraine (CM).

METHODS

In this randomized, double-blind, sham-controlled, multicenter clinical trial, patients with CM were treated with K.O.S once per week over a period of 6 weeks. The primary performance endpoint was the mean change in monthly headache days with moderate to severe intensity (MHDs) from the 28-day pretreatment baseline period to the performance assessment period (days 14-42 of treatment). Mean change from baseline in monthly migraine days (MMDs), proportion of participants with 30% and 50% or greater reduction in moderate to severe headache days compared with baseline, and change in the use of abortive medications from baseline were also assessed during the performance assessment period. Headache-related disability and quality-of-life measures were evaluated up to 70-day posttreatment.

RESULTS

The primary endpoint showed a significantly larger reduction of MHD across the performance assessment period with active treatment (-3.5 days, n = 67) compared with sham (-1.2 days, n = 65) (p = 0.0132). Compared with sham, active treatment consistently also led to significant reduction of MHD during the follow-up period (-2.7 [-4.3; -1.0, p = 0.0014]) as well as of mean MMDs during the assessment (-2.4 [-4.1; -0.7, p = 0.0048]) and follow-up (-2.9 [-4.5; -1.2, p = 0.0008]) periods. 61.8% of participants reported treatment-emergent adverse events (TEAEs) with similar incidences among treatment groups (63.2% [active], 60.3% [sham]), with nasopharyngitis (8.3%), dizziness (6.3%), and epistaxis (6.3%) being the most common TEAEs. Treatment-related serious adverse events were not observed.

DISCUSSION

The Chordate System provides significant benefits to patients with CM by reducing the number of MHDs. The nonpharmacologic nature of the treatment option positions K.O.S as a valuable addition to the current therapeutic portfolio for the management of CM.

TRIAL REGISTRATION INFORMATION

The trial was registered on ClinicalTrials.gov (NCT03400059) on January 17, 2018. The first patient was enrolled on March 22, 2018, and the last patient completed the study on October 1, 2022. The trial registration initially described the timing of the secondary endpoints incorrectly due to clerical error, and this was corrected to match the protocol and analysis plan once discovered.

CLASSIFICATION OF EVIDENCE

This study provides Class I evidence that weekly intranasal K.O.S is associated with a reduced number of headache days per month in patients with CM.

Piano level laser therapy versus epidermal growth factor injection for painful myogenic temporomandibular disorder (a randomized clinical trial)

OBJECTIVE

The aim of this clinical trial was to evaluate the effectiveness of Piano level laser therapy using Nd-YAG laser and intramuscular EGF injection in pain alleviation, function, and quality of life improvement in patients suffering from myogenic TMD.

MATERIALS AND METHODS

A randomized clinical trial was performed on 29 patients suffering from chronic painful myogenic TMD based on diagnostic criteria for temporomandibular disorders. Group I (n = 13patients) was treated using 1064 nm Nd-YAG Laser (4 sessions once/week). Group II (n = 14 patients) was treated by intramuscular injection of EGF. Pain using numerical rating score, pain free opening and unassisted maximum opening were measured at baseline, 7,14,21 days, 1 and 3 months. Quality of life using OHIP-14 was assessed at baseline, 1 and 3 months.

RESULTS

Results showed that there was a significant pain reduction (P < 0.000) and increase in pain free opening (P < 0.0001) in both test groups. However, only group I showed a significant increase in maximum opening (P = 0.007). Quality of life significantly improved in both groups (P = 0.0001). There was no significant difference between the two treatments in pain scores, pain free opening, maximum opening nor quality of life.

CONCLUSION

Both treatment modalities offered effective and cost-effective non- to minimally invasive treatment options for myogenic TMD with no side effects.

CLINICAL RELEVANCE

Myogenic TMD forms a public health issue and is a common musculoskeletal problem causing pain and disability. The proposal of effective, non-invasive, and affordable treatment options can help solve this issue.

Non-Immersive Virtual Reality Exercise Can Increase Exercise in Older Adults Living in the Community and in Long-Term Care: A Randomized Controlled Trial

Purpose

To assess the impact of an 8-week non-immersive virtual reality exercise program for older adults on 1) balance, physical function, community integration and quality of life; 2) falls, emergency room visits, hospital and long-term care admissions; 3) quantity of exercise performed; and 4) acceptance of non-immersive virtual reality.

Patients and Methods

This prospective, assessor-blinded, randomized controlled trial was carried out on two separate samples of older adults: those living in their own homes ("home-based") and those living in long-term care ("facility-based"). Participants were randomized to non-immersive virtual reality or usual activity. Non-immersive virtual reality consisted of 20-30 minutes of customized, gamified exercises for balance, stepping, strengthening, and aerobic conditioning, performed 3-5x/week for 8 weeks. Outcomes were measured before the intervention, immediately after, and 1 month later. Physical testing and questionnaires addressed objective 1). Counts for objectives 2) and 3) were reported by the participants and retrieved from the non-immersive virtual reality platform. Logbooks and a short interview addressed objective 4).

Results

Recruitment was substantially impacted by the COVID-19 pandemic. The facility-based sample had 31 participants; the home-based sample had 16. There were no statistically-significant benefits to non-immersive virtual reality in either sample for objective 1), although the facility-based non-immersive virtual reality group showed a clinically-significant improvement in functional walking. Effect sizes were small (≤ 0.16). No falls occurred during non-immersive virtual reality exercise. The facility-based non-immersive virtual reality group did an average of 14.1 sessions (average 20.1 minutes/session) and the home-based non-immersive virtual reality group did an average of 17.2 sessions (22.6 minutes/session). Participants enjoyed the non-immersive virtual reality, found it challenging and motivating and felt that it improved balance and walking. Most were interested to continue beyond the study.

Conclusion

Non-immersive virtual reality for home-based and facility-based older adults is safe, enjoyable and feasible and may increase users' weekly levels of physical activity leading to clinical benefits for functional walking in facility-based users.

Trial Registration

ClinicalTrials.gov (NCT04083885; registered 2019-09-06).

Effectiveness of the Modified WHO Labour Care Guide to Detect Prolonged and Obstructed Labour Among Women Admitted at Eight Publicly Funded, Midwife-Led Community Health Facilities in Rural Mbarara District, Southwestern Uganda: An Ambispective Cohort Study

Background

Obstructed labour, a sequel of prolonged labour, remains a significant contributor to maternal and perinatal deaths in low resource settings.

Objective

We evaluated the modified WHO labour care guide (LCG) in detecting prolonged/obstructed labour compared to the traditional partograph at publicly funded maternity centers in Southwestern Uganda.

Methods

LCG was deployed to monitor labour by trained health care providers in 2023. We reviewed all patient labour monitoring records for the first quarter of 2024 (LCG-intervention) and 2023 (partograph-before LCG introduction) from eight randomized maternity centers. Our primary outcome was the proportion of women diagnosed with prolonged and or obstructed labour. Secondary outcomes included: mode of delivery, labour augmentation, stillbirths, maternal deaths, Apgar score, uterine rupture, postpartum haemorrhage and tool completion. Data was collected in REDcap and analyzed using STATA v17; statistical significance was p < 0.05.

Results

A total of 991 (49.3%) and 1020 (50.7%) women were monitored using the LCG and partograph, respectively. The mean maternal and gestation ages were similar between the two groups, reported at 25.9 (SD=5.6) years, and 39.4 (SD=1.8) weeks, respectively. Overall, 120 (12.4%) cases of prolonged/obstructed labour were diagnosed (100 for LCG versus 20 for partograph); LCG had six times higher odds of diagnosing prolonged/obstructed labour compared to the partograph (aOR = 5.94;CI 95%3.63-9.73, P < 0.001). Detection of obstructed labour alone using LCG increased 12-fold compared to the partograph (aOR = 11.74;CI 95%3.55-38.74, P < 0.001). We observed increased Caesarean section rates (aOR=6.12;CI 95%4.32-8.67, P < 0.001), augmentation of labour (aOR = 3.11;CI 95%1.81-5.35, P < 0.001), Apgar Score at 5 minutes (aOR = 2.29;CI 95%1.11-5.77, P = 0.025) and tool completion rate (aOR = 2.11;CI 95%1.08-5.44, P < 0.001). We observed no differences in stillbirths, maternal deaths, postpartum haemorrhage and uterine rupture.

Conclusion

Our data shows that LCG diagnosed more cases of prolonged and obstructed labour compared to the partograph among women delivering at rural publicly funded midwife-led facilities in Southwestern Uganda. More controlled and powered studies should evaluate the two tools in different facilities and sub-populations.

Trial Registration

This trial registration was registered with clinical trials.gov number NCT05979194 on 2023-08-07, and the protocol was published by BMJ open, as 10.1136/bmjopen-2023-079216 on 15 April 2024.21 Trial registration number NCT05979194 clinical trials.gov.

Interpreter Communication Quality in Cognitive Assessments for Dementia: The MINDSET Randomized Clinical Trial

Importance

With increasing dementia prevalence due to population aging, interpreters are needed to facilitate timely dementia diagnosis by supporting the complex verbal and nonverbal interplay between clinicians and patients during cognitive assessments. However, to our knowledge, no randomized clinical trials have previously evaluated interventions to improve interpreter communication during cognitive assessments for dementia.

Objective

To assess whether online training codesigned by interpreters, clinicians, and multilingual family carers improves the quality of interpreter communication during cognitive assessments for dementia.

Design, Setting, and Participants

The Improving Interpreting for Dementia Assessments (MINDSET) study was a single-blind, parallel-group randomized clinical trial including certified interpreters and certified provisional interpreters of Arabic, Cantonese, Greek, Italian, Mandarin, or Vietnamese with at least 6 months' experience. The trial was community based and conducted online across Australia between June 26, 2022, and April 2, 2023, with follow-up at 3 and 6 months after baseline.

Intervention

Participants were randomized 1:1 to receive interpreter training during the study or, if assigned to the waiting list control, after their 6-month assessment.

Main Outcomes and Measures

The primary outcome was change in the quality of interpreted communication, as measured by a weighted score comprising 5 domains: (1) knowledge of dementia, (2) cross-cultural communication, (3) briefings and debriefings, (4) interpreting skills for cognitive assessments, and (5) ethical principles relevant during a cognitive assessment. Mixed-effects generalized linear regression was conducted with random effects accounting for repeated measures from participating interpreters. Secondary analyses were conducted for differences in individual interpreting domains. A secondary per-protocol analysis included only participants who completed at least 70% of the training in the intervention group.

Results

At baseline, there were 126 participants (106 [84.1%] women); mean (SD) age was 44.13 (12.71) years, mean years of interpreting experience was 8.57 (8.48) years, and 106 of 120 (88.3%) lived in an urban area. A total of 22 (17.5%) were Arabic interpreters; 14 (11.1%), Cantonese; 6 (4.8%), Greek; 14 (11.1%), Italian; 64 (50.8%), Mandarin; and 6 (4.8%), Vietnamese. The primary outcome of communication quality in the main analysis did not significantly improve in the intervention group compared with controls (mean score difference, 2.10; 95% CI, -0.43 to 4.62; P = .10). Per-protocol findings showed a significant intervention effect (mean score difference, 2.73; 95% CI, 0.14-5.31; P = .04), suggesting that the MINDSET-trained interpreters benefited in the primary outcome when they completed at least 70% of the training. Of the 5 domains, a significant intervention effect was shown in only domain 1 (knowledge of dementia) in the main analysis (mean score difference, 1.15; 95% CI, 0.54-1.77; P < .001) and per-protocol analysis (1.03; 95% CI, 0.27-1.79; P = .008) at 3 months.

Conclusions and Relevance

In this randomized clinical trial, results of the primary, intention-to-treat analysis showed that interpreters' overall interpreting communication quality did not improve in the intervention group compared with controls, but in the secondary, per-protocol analysis, it was improved when at least 70% of the training was completed. These findings suggest that an online training intervention can improve interpreters' communication quality during cognitive assessments for dementia if at least 70% of training is completed.

Trial Registration

ANZCTR Identifier: ACTRN12621001281886.

Open challenges for the automatic synthesis of clinical trials

OBJECTIVE

An important criterion for selecting clinical trials to be compared in systematic reviews and meta-analyses is that they measure the same outcomes. However, this represents a challenge as there is a wide variety of outcomes, and it is difficult to standardize them for comparing clinical trials containing them. To address this challenge, we utilized our annotated dataset, which includes 211 abstracts of clinical trials related to glaucoma and type 2 diabetes mellitus. We then developed a tool that provides an overview of the annotated clinical trial information and enables users to group them by outcomes.

RESULTS

Using our visualization tool, we formed groups of outcomes and their respective clinical trials. We were able to determine the most common outcomes in clinical trials for these diseases. As a case study on diabetes, we compared our outcomes with those consented by diabetes stakeholders and found that many of the grouped outcomes are aligned with the consented ones. This demonstrates that tools such as the one presented can help standardize clinical outcomes, which in turn help in the synthesis of clinical trials. Finally, we also offer some recommendations that could help in the automation of clinical trials based on outcome standardization.

Impact evaluation of a digital health platform empowering Kenyan women across the pregnancy-postpartum care continuum: A cluster randomized controlled trial

BACKGROUND

Accelerating improvements in maternal and newborn health (MNH) care is a major public health priority in Kenya. While use of formal health care has increased, many pregnant and postpartum women do not receive the recommended number of maternal care visits. Even when they do, visits are often short with many providers not offering important elements of evaluation and counseling, leaving gaps in women's knowledge and preparedness. Digital health tools have been proposed as a complement to care that is provided by maternity care facilities, but there is limited evidence of the impact of digital health tools at scale on women's knowledge, preparedness, and the content of care they receive. We evaluated a digital health platform (PROMPTS (Promoting Mothers in Pregnancy and Postpartum Through SMS)) composed of informational messages, appointment reminders, and a two-way clinical helpdesk, which had enrolled over 750,000 women across Kenya at the time of our study, on 6 domains across the pregnancy-postpartum care continuum.

METHODS AND FINDINGS

We conducted an unmasked, 1:1 parallel arm cluster randomized controlled trial in 40 health facilities (clusters) across 8 counties in Kenya. A total of 6,139 pregnant individuals were consented at baseline and followed through pregnancy and postpartum. Individuals recruited from treatment facilities were invited to enroll in the PROMPTS platform, with roughly 85% (1,453/1,700) reporting take-up. Our outcomes were derived from phone surveys conducted with participants at 36 to 42 weeks of gestation and 7 to 8 weeks post-childbirth. Among eligible participants, 3,399/3,678 women completed antenatal follow-up and 5,509/6,128 women completed postpartum follow-up, with response rates of 92% and 90%, respectively. Outcomes were organized into 6 domains: knowledge, birth preparedness, routine care seeking, danger sign care seeking, newborn care, and postpartum care content. We generated standardized summary indices to account for multiple hypothesis testing but also analyzed individual index components. Intention-to-treat analyses were conducted for all outcomes at the individual level, with standard errors clustered by facility. Participants recruited from treatment facilities had a 0.08 standard deviation (SD) (95% CI [0.03, 0.12]; p = 0.002) higher knowledge index, a 0.08 SD (95% CI [0.02, 0.13]; p = 0.018) higher birth preparedness index, a 0.07 SD (95% CI [0.03, 0.11]; p = 0.003) higher routine care seeking index, a 0.09 SD (95% CI [0.07, 0.12]; p < 0.001) higher newborn care index, and a 0.06 SD (95% CI [0.01, 0.12]; p = 0.043) higher postpartum care content index than those recruited from control facilities. No significant effect on the danger sign care seeking index was found (95% CI [-0.01, 0.08]; p = 0.096). A limitation of our study was that outcomes were self-reported, and the study was not powered to detect effects on health outcomes.

CONCLUSIONS

Digital health tools indicate promise in addressing shortcomings in pregnant and postpartum women's health care, amidst systems that do not reliably deliver a minimally adequate standard of care. Through providing women with critical information and empowering them to seek recommended care, such tools can improve individuals' preparation for safe childbirth and receipt of more comprehensive postpartum care. Future work is needed to ascertain the impact of at-scale digital platforms like PROMPTS on health outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT05110521; AEA RCT Registry ID: R-0008449.

Clinical performance of an ormocer-based single-shade resin composite for the restoration of non-carious cervical lesions: 18-month randomized clinical trial

OBJECTIVE

This double-blind, split-mouth, randomized equivalence clinical trial aimed to evaluate the 18-month clinical performance of an ormocer-based single-shade resin composite compared with an ormocer-based multi-shade resin composite in non-carious cervical lesions (NCCLs).

METHODS

One hundred and twenty restorations were performed on NCCLs with two restorative materials (n = 60): Admira Fusion X-tra resin composite (ormocer-based single-shade), and Admira Fusion resin composite (ormocer-based multi-shade). After rubber dam isolation, a universal adhesive was applied in the selective enamel etching strategy. For both groups, restorations were inserted incrementally and light-cured. The restorations were clinically evaluated at 6, 12, and 18 months according to the updated FDI (World Dental Federation) criteria. Statistical analysis was performed using Friedman repeated measures ANOVA by rank and Mann-Whitney test for pairwise significance (α = 0.05).

RESULTS

All restorations were evaluated after 18 months, and nine restorations were lost. Fracture of the material and retention rates (95 % confidence interval [CI]) were 93 % (84-97 CI) for the ormocer-based single-shade and 91 % (82-96 CI) for the ormocer-based multi-shade, with no statistical differences between them (p > 0.05). The absolute risk (95 % CI) was 0.8 (0.2 to 3.1).

CONCLUSIONS

The updated FDI evaluation criteria showed equivalent results for ormocer-based single-shade and ormocer-based multi-shade after 18 months.

CLINICAL SIGNIFICANCE

Using an ormocer-based single-shade resin composite in NCCLs is advisable due to its convenience, ease of application, and lower cost compared to ormocer-based multi-shade composites without compromising clinical performance.

Comparative Analysis of Adhesive Retention and Denture Weight in Different Residual Ridge Morphologies: A Cross-Over Randomized-Controlled Trial

AIM

The aim of this study was to compare the retentive strengths of various forms of denture adhesives (paste, powder, and strips) on different types of mandibular residual alveolar ridges, considering their respective denture weights.

MATERIALS AND METHODS

In this crossover randomized-controlled trial, the patients were randomly and equally divided into 3 groups based on clinical features and radiographic findings according to the Wical-Swoope classification. Three forms of denture adhesives were used, including powder, cream, and strips, for three residual ridge types. Quantification of retention without adhesive was carried out as a control. The retentive strength of adhesives was compared in each ridge pattern and correlated with the denture weight. The study was registered at https://clinicaltrials.gov (identifier number: NCT05063422).

RESULTS

The mean retentive strengths of dentures without adhesive (control) were relatively low across all ridge classifications, ranging from 0.27 to 0.69 lb. In contrast, the experimental groups utilizing Fittydent and Polygrip adhesive products showed significantly improved retentive strengths, with Fittydent cream and Polygrip cream showed the highest enhancement, ranging from 1.01 to 2.57 lb across different ridge types. Furthermore, significant mean differences were observed between ridge classes and the retentive strength of each adhesive product.

CONCLUSION

The study highlights the crucial role of tailored denture adhesive selection in optimizing retention for denture wearers. Polygrip cream demonstrated superior effectiveness across various ridge classifications compared to Fittydent cream, powder, and strips. These findings emphasize the importance of personalized treatment approaches based on ridge types and denture weight.

Treatment of periodontitis ameliorates the severity and extent of psoriasis-A randomized clinical trial

AIM

To assess the impact of non-surgical periodontitis treatment over conventional dermatological treatment on the severity and extent of psoriasis in patients affected by comorbid psoriasis and periodontitis.

METHODS

Seventy-four patients affected by both psoriasis and Stages I-IV periodontitis were randomized to receive either Steps 1-2 (non-surgical) of periodontal therapy (test group; n = 37) or no treatment (control group; n = 37). The two groups were balanced in terms of psoriasis medications, with the majority of the included patients undergoing biologics (74.0%) as monotherapy, while minor proportions were under systemic medications (13.7%) or none/topical/phototherapy (12.3%). The psoriasis area severity index (PASI) was regarded as the primary outcome. The Body Surface Area (BSA) and the Dermatology Life Quality Index (DLQI) were additionally considered as dermatological outcomes. Probing pocket depth, recession depth, clinical attachment level, periodontal inflamed surface area, and full-mouth plaque and bleeding scores were also measured. [Correction added on July 5, 2024, after first online publication: The preceding sentence has been revised].

RESULTS

Periodontal therapy in the test group led to statistically significant lower PASI scores at 10 weeks (mean = 3.15; standard deviation [SD] = 3.78) compared to the control group (mean = 7.11; SD = 6.09) (mean difference [MD] = -4.0; 95% confidence interval [CI]: -6.3, -1.6; p = .001). The test group also showed improvements in BSA (MD = -4.3) and periodontal parameters compared to the control group. DLQI only showed a non-statistically significant tendency (MD = -2.0).

CONCLUSION

Steps 1-2 of periodontal therapy showed an additional effect over conventional dermatological treatment in reducing the severity and extent of psoriasis (Clinicaltrials.gov: NCT05311501).

Psychosocial effects of a humanoid robot on informal caregivers of people with dementia: A randomised controlled trial with nested interviews

BACKGROUND

Dementia rates are rising globally, impacting healthcare systems and society. The care of people with dementia is largely provided by informal caregivers (e.g., family, friends), which can present significant challenges and increase caregivers' burden. New technologies, such as humanoid socially assistive robots, show promise in reducing this burden, as such robots were considered to be supportive devices for both informal caregivers and people with dementia.

OBJECTIVE

To explore the psychosocial effects of the humanoid social assistive robot Coach Pepper (equipped with functions like tablet-based multimodal training for people with dementia) compared to exclusively tablet-based multimodal training for people with dementia on informal caregivers. Additionally, informal caregivers' attitudes and experiences with Coach Pepper were examined.

DESIGN

A randomised controlled parallel two-arm trial with a nested qualitative study was conducted.

SETTING

The study took place in the home setting (i.e. private households).

PARTICIPANTS

Thirty-two informal caregivers of people with dementia participated in the study.

METHODS

Informal caregivers (and their loved one with dementia) were randomly assigned to Coach Pepper (n = 16) or a solely tablet-based multimodal training (n = 16) for a three-week period. Data for caregivers were collected at baseline and after the intervention by standardised questionnaires for caregiver burden (primary outcome), quality of life, depressive symptoms and affect. Additionally, acceptance was measured in both groups and semi-structured interviews were conducted in the Coach Pepper group post-interventionally.

RESULTS

No significant differences in mean changes between groups were identified in the outcomes, except that two domains of acceptance (usefulness and accessibility) were rated significantly higher for the control group. Qualitative findings showed mostly positive attitudes towards Coach Pepper in dementia care and neutral feelings on caregiver burden. Caregivers reported usefulness of Coach Pepper on being assistive in six components of human needs: 'learning ability', 'recreational activities', 'contact with others', 'mobility/body posture', 'communication' and 'avoiding danger'. However, they recommended further improvement in all fourteen components of human needs.

CONCLUSIONS

Coach Pepper had no significant psychosocial effects on informal caregivers of people with dementia. Qualitative findings demonstrated the participants' positive attitudes but highlighted a need for improvements regarding Coach Pepper's usability.

REGISTRATION

NCT03818217 (date of registration: 09.01.2019; date of first recruitment: 04.02.2019).

Efficacy and Safety of Different Atropine Regimens for the Treatment of Myopia in Children: Three-Year Results of the MOSAIC Randomized Clinical Trial

Importance

Additional data are required regarding atropine treatment regimens for control of myopia progression.

Objective

To investigate the efficacy and safety of different atropine regimens for myopia in children.

Design, Setting, and Participants

This was a secondary analysis of the 3-year results of the 24-Month Myopia Outcome Study of Atropine in Children (MOSAIC) trial, called the MOSAIC2 trial. The MOSAIC trial was an investigator-led, double-masked, randomized clinical trial of different atropine concentrations and regimens. The MOSAIC2 study took place at the Centre for Eye Research Ireland, in Dublin, Ireland, and included children and adolescents with myopia from the MOSAIC trial. Data analysis was conducted from November 2023 to February 2024.

Interventions

Participants were randomly assigned to the following cohorts: group 1, nightly placebo for 2 years then 0.05% atropine eye drops for 1 year and group 2, nightly 0.01% atropine eye drops for 2 years then rerandomization to placebo nightly, tapering placebo, or tapering of 0.01% atropine eye drops for 1 year.

Main Outcomes and Measures

Observed changes in cycloplegic spherical equivalent refraction and axial length from month 24, or baseline, to month 36.

Results

A total of 199 children with myopia (mean [SD] age, 13.9 [2.4] years; 121 female [60.8%]) of the 250 children and adolescents from the MOSAIC trial were included in the MOSAIC2 trial analysis. Of 83 participants assigned to group 1, 66 (79.5%) reconsented to year 3, and 61 (73.5%) completed the trial. Of 167 participants assigned to group 2, 133 (79.6%) continued to year 3, and 121 (72.5%) completed the trial (0.01% atropine, then nightly placebo: n = 31 and n = 29 [93.5%]; 0.01% atropine, then tapering placebo: n = 29 and n = 25 [86.2%]; 0.01% atropine then tapering 0.01% atropine: n = 73 and n = 67 [91.8%], respectively). Compared with the group taking placebo then 0.05% atropine, the combined atropine then placebo groups had more spherical equivalent progression (adjusted difference, -0.13 diopters [D]; 95% CI, -0.22 to -0.04 D; P = .01) and axial elongation (adjusted difference, 0.06 mm; 95% CI, 0.02-0.09 mm; P = .008), and the group taking 0.01% atropine then tapering 0.01% atropine had more axial elongation (adjusted difference, 0.04 mm; 95% CI, 0.009-0.07 mm; P = .04). In the group taking placebo then 0.05% atropine, 15% (n = 10) and 8% (n = 5) reported blurred near vision and photophobia, respectively, during year 3, compared with 3% (n = 2) and 0%, respectively, in the group taking 0.01% atropine then tapering 0.01% atropine, and no reports in both placebo groups.

Conclusions and Relevance

Despite more adverse events, participants using 0.05% atropine during year 3 had no differences in treatment completion rates and exhibited 0.13-D less myopia progression and 0.06-mm less axial elongation, compared with participants using placebo, supporting consideration of treatment as given to the group taking 0.05% atropine in this European population.

Trial Registration

isrctn.org Identifier: ISRCTN36732601.

Arterial Collaterals and Endovascular Treatment Effect in Acute Ischemic Stroke with Large Infarct: A Secondary Analysis of the TENSION Trial

Background Randomized clinical trials have demonstrated that endovascular thrombectomy reduces functional disability in patients with large ischemic stroke; arterial collateral status might be used to select these patients for endovascular thrombectomy. Purpose To investigate whether arterial collateral status modifies the treatment effect of endovascular thrombectomy in patients with large ischemic stroke. Materials and Methods The Efficacy and Safety of Thrombectomy in Stroke with Extended Lesion and Extended Time Window (TENSION) trial was a prospective, multicenter, randomized study investigating participants with acute large ischemic stroke due to anterior circulation large-vessel occlusion. Participants with an Alberta Stroke Program Early CT Score of 3-5 were enrolled at 41 participating centers between July 2018 and February 2023. Participants were randomly assigned to undergo either endovascular thrombectomy with best medical treatment or best medical treatment alone within 12 hours from stroke onset. Collateral status was graded on pretreatment single-phase CT angiography (CTA) images using the Tan score and dichotomized into poor (grade, 0-1) or good (grade, 2-3) based on the extent of collateral supply filling the affected middle cerebral artery territory. The primary outcome was the shift on the 90-day modified Rankin Scale (mRS). Results Of 253 randomized patients, 201 with pretreatment CTA were included (median age, 74 years; IQR, 66-80 years; 103 [51.2%] female patients; 103 [51.2%] patients underwent endovascular thrombectomy). Endovascular thrombectomy compared with best medical treatment (adjusted common odds ratio [OR], 3.69; 95% CI: 2.12, 6.54; P < .001) and good collaterals compared with poor collaterals (adjusted common OR, 2.88; 95% CI: 1.63, 5.11; P < .001) were independently associated with a shift in the 90-day mRS scores toward better functional outcomes. The treatment effect of endovascular thrombectomy over best medical treatment was not modified by collateral status (interaction, P = .88). The treatment effect of endovascular thrombectomy versus best medical treatment was found in patients with good collaterals (adjusted common OR, 3.93; 95% CI: 1.65, 9.69; P = .002) and poor collaterals (adjusted common OR, 3.92; 95% CI: 1.86, 8.52; P < .001). Conclusion In this secondary analysis of data from the TENSION trial, endovascular thrombectomy reduced 90-day functional disability compared with best medical treatment in patients with good and poor collaterals. These findings suggest that patients with large ischemic stroke manifesting within 12 hours after onset should undergo endovascular thrombectomy irrespective of single-phase CTA collateral status. ClinicalTrials.gov Identifier: NCT03094715 © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Benomar and Raymond in this issue.

Comparison of Digitally Delivered Gut-Directed Hypnotherapy Program With an Active Control for Irritable Bowel Syndrome

INTRODUCTION

Gut-directed hypnotherapy (GDH) treats irritable bowel syndrome (IBS), but its accessibility is limited. This problem may be overcome by digital delivery. The aim of this study was to perform a randomized control trial comparing the efficacy of a digitally delivered program with and without GDH in IBS.

METHODS

Adults with IBS were randomized to a 42-session daily digital program with the GDH Program (Nerva) or without (Active Control). Questionnaires were completed to assess gastrointestinal symptoms through IBS Symptom Severity Scale (IBS-SSS), quality of life, and psychological symptoms (Depression Anxiety and Stress Scale-21) at regular intervals during the program and 6 months following the conclusion on the intervention. The primary end point was the proportion of participants with ≥50-point decrease in IBS-SSS between the interventions at the end of the program.

RESULTS

Of 240/244 randomized participants, 121 received GDH Program-the median age 38 (range 20-65) years, 90% female, IBS-SSS 321 (interquartile range 273-367)-and 119 Active Control-36 (21-65), 91% female, IBS-SSS 303 (255-360). At program completion, 81% met the primary end point with GDH Program vs 63% Active Control ( P = 0.002). IBS-SSS was median 208 (interquartile range 154-265) with GDH and 244 (190-308) with control ( P = 0.004), 30% reduction in pain was reported by 71% compared with 35% ( P < 0.001), and IBS quality of life improved by 14 (6-25) compared with 7 (1-15), respectively ( P < 0.001). Psychological status improved similarly in both groups.

DISCUSSION

A digitally delivered GDH Program provided to patients with IBS was superior to the active control, with greater improvement in both gastrointestinal symptoms and quality of life and provides an equitable alternative to face-to-face behavioral strategies.

Age differences in pedestrian navigational skills and performance: A systemic review and meta-analysis

OBJECTIVES

This study summarized current findings on age differences (young vs. older adults) in pedestrian navigational performance, spatial learning, and examined moderating effects of experimental environment (e.g., real-world vs. virtual environments).

METHODS

Two reviewers independently screened studies from PubMed, Web of Science, PsychInfo, and AgeLine until December 2022.

INCLUSION CRITERIA

(1) empirical navigational study; (2) healthy older adults (mean age above 60); (3) age as a categorical variable; (4) peer-reviewed paper in English.

EXCLUSION CRITERIA

(1) overly simplified environments; (2) tasks performed with transportation; (3) small sample size (n < 10).

RESULTS

5981 studies were screened, 18 were eligible with 406 total participants. Three-level meta-analysis estimated standardized mean age difference of 1.15 (95 % CI: [0.64, 1.65]) in navigational performance, and 0.97 (95 % CI: [0.81, 1.13]) in spatial learning. Study environments were found to marginally moderate age differences in navigational performance, but not in spatial learning.

DISCUSSION

Older adults have poorer navigational performance and spatial learning outcomes compared to their younger counterparts, with marginally greater performance differences in virtual environments than in the real world. Findings were limited by low number eligible studies, especially real-world experiments. Future studies should continue to test generalizability of high-fidelity VR and identify spatial design elements that can mitigate age differences.

On-site physiotherapy in older emergency department patients following a fall: a randomized controlled trial

PURPOSE

Greater fear of falling (FOF) is associated with an increased risk of falling in patients aged 65 and older. This study aims to assess the impact of physiotherapy on FOF in older patients and investigates the feasibility of such an intervention in the emergency department (ED) setting.

METHODS

All patients aged 65 or older, who presented to the ED of the University Hospital Basel after a fall between January 2022 and June 2023 were screened for inclusion. Participants were assigned to an intervention or control group depending on the randomized presence or absence of a physiotherapist at inclusion. Both groups received the same fall prevention booklet. Physiotherapists instructed and performed exercises with patients in the intervention group. The primary outcome was the difference in FOF between groups 7 days post inclusion, assessed by short Falls Efficacy Scale International (sFES-I). Secondary outcomes included feasibility, overall reduction of FOF, patient satisfaction, the occurrence of falls post inclusion and the use of medical resources.

RESULTS

Of the 1204 patients screened for inclusion, 104 older adults with a recent fall were enrolled (intervention: n = 44, control: n = 60); median age was 81 years and 59.1% were female. There was no between-group difference in FOF as measured by sFES-I within a week of inclusion (p = 0.663, effect size = 0.012 [95% confidence interval (CI) - 0.377 to 0.593]). Despite the intervention being deemed feasible from the physiotherapist's perspective, the study encountered challenges, such as low recruitment (with the planned sample size not being reached) and a notable dropout rate before the first follow-up.

CONCLUSION

A physiotherapy intervention in the ED showed no improvement in FOF when compared to a control group.

TRIAL REGISTRATION

Trial registration number and date NCT05156944, 01.12.2021.

Comparison of the clinical and radiological outcomes of Puddu and TomoFix plates for medial opening-wedge high tibial osteotomy: A two-year follow-up of a randomized controlled trial

PURPOSE

Opening-wedge high tibial osteotomy (OWHTO) requires fixation devices for stabilization of the osteotomy gap. The two most commonly used fixation devices are the Puddu and the TomoFix plates. Based on its design, each implant generates a characteristic stability profile. The aim of this randomized controlled trial (RCT) was to investigate the short-term clinical and radiological outcomes of OWHTO using the Puddu and TomoFix plating systems. We hypothesized that the TomoFix plate would achieve superior clinical and radiographic results compared to the Puddu plate.

METHODS

A total of 60 patients were randomly allocated to undergo OWHTO either using the Puddu plate or the TomoFix plate if conservative treatment failed with symptomatic medial compartment knee osteoarthritis (OA) stage I or II according to Ahlbäck classification, and varus malalignment. All patients underwent clinical and radiological assessment preoperatively, and at 3, 6, 12, and 24months postoperatively. Radiological measurement of the hip-knee-ankle (HKA) angle, and posterior tibial slope (PTS) was performed. Functional assessment was carried out using the Hospital for Special Surgery Knee-Rating Scale (HSS) and the Western Ontario McMaster Universities (WOMAC) Osteoarthritis Index. Patients were also evaluated for intraoperative and postoperative complications throughout the follow-up period.

RESULTS

The mean angular correction was 9.6±4°, and 10.5±4.8° in the Puddu and TomoFix groups, respectively (p=0.488). The mean PTS change was significantly higher in the Puddu group (3.4±1.1°) compared to the TomoFix group (0.8±0.7°) (p<0.001). There was a statistically significant improvement in the mean HSS and WOMAC in both groups until one year postoperatively. Neither HSS nor WOMAC showed a statistically significant difference between the Puddu and TomoFix groups at any time during the first two postoperative years. The overall complication rate was not significantly different between the Puddu and TomoFix groups. However, the TomoFix group demonstrated higher incidence of symptomatic hardware (23% vs. 3.3%) and removal of metalwork (17% vs. 0%) than the Puddu group (p=0.023 and 0.020, respectively).

CONCLUSION

This RCT suggests that the implant choice for OWHTO has no significant impact on functional outcomes during the first 2years postoperatively. While the Puddu plate was associated with an unintentional increase in the PTS during the surgery, both implants allowed coronal and sagittal plane corrections to be preserved postoperatively. The overall complication rates were similar, but the TomoFix required more material to be removed because it is more cumbersome. However, these results need to be confirmed on a larger scale.

LEVEL OF EVIDENCE

II; randomized controlled trial.

Comparative accuracy of dCAIS and freehand techniques for immediate implant placement in the maxillary aesthetic zone: An in vitro study

OBJECTIVE

To evaluate the accuracy of immediate implant placement in fresh extraction sockets in the maxillary aesthetic zone using a dynamic computer-assisted implant surgery system (dCAIS), with the evaluation of possible deviations versus freehand placement.

METHODS

A total of 18 implants were placed by an experienced surgeon in fresh extraction sockets of anterior teeth in 6 maxillary models. Nine implants were placed using the dCAIS system and 9 implants were placed using the conventional freehand technique. The following outcome parameters were measured and compared: positional deviation at entry, apex point and angular deviations between planned and placed implant position. Surgery time was measured for each procedure. Descriptive and statistical analyses were performed on all outcome parameters.

RESULTS

Global entry deviations were not significantly different between the two techniques (p = 0.078). dCAIS resulted in significantly more accurate implant placement in terms of global apex deviation with values of 1.28±0.36 mm and angular deviations with values of 1.29±0.64°, compared to 2.06±0.60 mm and 5.05±2.54° with freehand placement (p < 0.001). The dental implant placement time was approximately three times longer when using dCAIS (10.99 ± 3.43 min) versus freehand (3.25± 0.63 min) (p < 0.001).

CONCLUSIONS

dCAIS achieved more precise immediate implant placement in terms of apex deviation and angulation than freehand placement, but increased the surgery time.

CLINICAL SIGNIFICANCE

dCAIS provides greater accuracy in the placement of immediate implants in the maxillary aesthetic zone following prosthetic-driven digital planning compared to freehand surgery.

Increasing parent help-seeking for child mental health: A study protocol for the growing minds check-in, an online universal screening tool

BACKGROUND

Early identification and intervention for mental health (MH) problems in childhood offers lifelong benefits. Many children with MH problems do not receive appropriate help. To address this need, an online universal MH screening tool, the Growing Minds Check-In for parents/caregivers (GMCI-P), was developed to provide feedback to parents on their children's MH, identify children at risk of MH problems, and link parents to evidence-based online programs/information, with the goal of facilitating parent help-seeking, and ultimately reducing the prevalence of child MH problems.

METHODS/DESIGN

A randomised controlled trial (RCT) with 440 parents/caregivers will be conducted to 1) examine the efficacy of GMCI-P for increasing parent help-seeking; 2) explore acceptability; and 3) cost-effectiveness. Participants will be Australian parents/caregivers with a child aged from birth to 17 years, 6 months, who will be randomly allocated to GMCI-P (intervention) or waitlist control (WLC) group, and complete baseline measures. The intervention group will complete the GMCI-P immediately, the post-GMCI-P intervention questions, a three-month and six-month follow-up. The WLC group will receive access to GMCI-P after their three-month follow-up but will not be followed up further. The primary outcome is parent help-seeking behaviour for child MH, and secondary outcomes include child MH, parenting, parent wellbeing, acceptability, cost-effectiveness, and unintended negative effects.

DISCUSSION

The results from this study will provide efficacy, acceptability and cost-effectiveness data on a universal online, parent-report child MH Check-In. These results can be used to inform public policy on universal screening for child MH.

TRIAL REGISTRATION

ACTRN12624000098538.