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

Can an app designed to reduce repetitive negative thinking decrease depression and anxiety in young people? Results from a randomized controlled prevention trial

BACKGROUND AND OBJECTIVES

Rates of mental health disorders are rising among adolescents and young adults. Therefore, scalable methods for preventing psychopathology in these age groups are needed. As repetitive negative thinking (RNT) is a risk factor for depression and anxiety disorders, targeting RNT via smartphone app promises to be an effective, scalable strategy. The current three-arm, parallel group, randomized controlled trial tested whether a self-help app designed to reduce RNT decreased psychopathological symptoms and RNT in adolescents and young adults at risk for mental disorders.

METHOD

A sample of 16-22-year-olds with elevated levels of RNT (N = 365) were randomly allocated to either use a one of two self-help apps designed to reduce RNT for 6 weeks or to a waitlist. The full RNT-focused intervention app encompassed a variety of RNT-reducing strategies, whereas the concreteness training app focused on one of these strategies, namely, concrete thinking.

RESULTS

The apps did not decrease depressive symptoms, anxiety symptoms and RNT relative to the waitlist. However, exploratory analyses using a minimum dose criterion showed that participants who used the full-RNT-focused intervention app more often, reported greater baseline to follow-up decreases in depressive symptoms compared to waitlist.

LIMITATIONS

Include decreased power due to slightly more dropout than expected and limited generalizability due to the mostly female and highly educated sample.

CONCLUSIONS

RNT-focused prevention via a self-help app did not decrease depression and anxiety, presumably due to too little engagement with the app content provided.

A randomized controlled trial of online mindfulness and cognitive-behavioral interventions for sexual interest/arousal disorder in women: eSense

OBJECTIVE

Sexual interest/arousal disorder (SIAD) is a common and distressing sexual dysfunction in women. Although efficacious psychological treatments for SIAD exist, they are generally underutilized and inaccessible. eSense is a feasible and useable online intervention containing Cognitive-Behavioral Therapy (CBT) and Mindfulness-Based Therapy (MBT) programs. Our goal was to test the efficacy of the CBT and MBT arms of eSense relative to a waitlist control condition.

METHOD

Women with SIAD were randomized to eSense-CBT (n = 43), eSense-MBT (n = 43), or a waitlist (n = 43). Both interventions consisted of 8 modules with a recommended completion time of 8-12 weeks. Participants also met remotely with non-expert "navigators" for up to 12 weeks. Participants completed validated self-report measures of primary outcomes (sexual desire/arousal and distress) and secondary outcomes (sexual satisfaction, dissatisfaction, and overall sexual function) at baseline, mid-treatment, posttreatment, and 6-month posttreatment.

RESULTS AND CONCLUSIONS

Compared to waitlist, both active treatment groups reported significant improvements in primary outcomes at post-treatment (desire/arousal d > .90; sexual distress d < -0.62) and these improvements were generally maintained at follow-up. The two active treatments did not differ in terms of primary outcomes. Effects on sexual satisfaction were also significant (d = 0.70-0.81) and MBT resulted in slightly greater improvements. There was no effect on sexual dissatisfaction. For overall sexual function, the effect was large (d = 1.20 to 1.23) with no between-arm differences. Future steps to improve engagement and increase access are discussed.

Impact of Exergames on the Rehabilitation of Cancer Patients Undergoing Major Abdominal Surgery: A Randomized Controlled Trial

BACKGROUND

Exergames can be an appealing strategy that is integrated into post-abdominal surgery rehabilitation.

OBJECTIVE

The aim of this study was to assess the effectiveness of exergame rehabilitation in improving independence in activities of daily living (ADLs) and patient balance after abdominal cancer surgery.

METHODS

A randomized control-group study was carried out in an oncological hospital in Portugal. Seventy postoperative patients were included, and data collection took place between January 2023 and May 2023. The patients were randomly assigned to either an exergame rehabilitation program (n = 35) or a traditional rehabilitation program (n = 35). The assessed outcomes were the Barthel and Berg scales, and data collection occurred at 3 different time points: admission, 48 hours postoperatively, and on the seventh day after surgery.

RESULTS

At the third assessment, a statistically significant difference was observed between the 2 groups for both indicators, ADLs and balance.

CONCLUSIONS

There was an improvement in ADLs and balance in the exergames group. By the seventh day after surgery, the intervention group showed improvement in balance and ADLs compared with the control group.

IMPLICATIONS FOR PRACTICE

The use of exergames can be a solution to the challenges of traditional rehabilitation methods after abdominal surgery for cancer for postoperative patients. This is the first study carried out in this specific population.

Effects of carbohydrate reduced diet associated with strength training on clinical signs of women with polycystic ovary syndrome: Randomized clinical trial

OBJECTIVE

To evaluate the effects of a low-carbohydrate diet associated with strength training on the clinical signs of polycystic ovary syndrome (PCOS).

RESEARCH METHODS AND PROCEDURES

A randomized clinical trial was carried out including 29 women over 18 years old diagnosed with PCOS, randomized into two groups, with follow-up for 12 weeks: the low-carbohydrate diet group associated with strength exercise (LCDE); and the standard diet group associated with strength exercise (SDE). We evaluated manifestations of acne, hirsutism by the Ferriman-Gallwey scale and alopecia by the Ludwig-Savin scale, and assessed laboratory tests for total and free testosterone, dehydroepiandrosterone, follicle-stimulating hormone, and luteinizing hormone. The collected data were analyzed using IBM-SPSS software version 21.

RESULTS

The study showed statistically significant differences in the hormonal levels of dehydroepiandrosterone (P = 0.045), luteinizing hormone (P = 0.017) and follicle-stimulating hormone (P = 0.014) when comparing the LCDE and SDE groups.

CONCLUSIONS

the intervention used can promote an improvement in the clinical presentation of PCOS, especially in hormonal parameters. The clinical trial was registered on the REBEC platform (Brazilian Registry of Clinical Trials) under number RBR4wjqxcv (Carbohydrate Reduction and Exercise in Women with PCOS) and is available on the website: https://ensaiosclinicos.gov.br/rg/RBR-4wjqxcv.

Photobiomodulation for the prevention of oral side effects secondary to head and neck cancer therapy: results of a randomised, single-blind clinical trial

INTRODUCTION

A significant increase of 61.6 % in new cases of head and neck cancer (HNC) worldwide is projected by 2050. Multimodal treatments for HNC often result in debilitating oral side effects like oral mucositis (OM). Photobiomodulation (PBM) therapy shows promise in managing these side effects, yet standardized protocols are lacking. This randomized clinical trial aims to evaluate PBM's effectiveness in preventing and treating oral side effects and related symptoms in HNC patients.

METHODS

We compared PBM with standard treatment in HNC patients at a single centre. PBM efficacy was evaluated on OM, pain, dysgeusia, hyposalivation, dry mouth, and trismus. Additionally, we controlled for analgesic use and fungal infection presence. The study adhered to the CONSORT checklist, is registered on the ClinicalTrials platform, and statistical analysis was performed using SPSS.

RESULTS

The study included 53 patients. The PBM group experienced a significant reduction in OM progression, better salivary function preservation, and lower severity of pain and dysgeusia by the end of treatment. However, no significant differences were found between the PBM and standard treatment groups regarding xerostomia, trismus, analgesic use, or oral candidiasis incidence.

CONCLUSION

PBM showed effectiveness in delaying onset and reducing the severity of oral mucositis and hyposalivation, as well as alleviating pain and dysgeusia at critical moments. However, it had no significant impact on xerostomia, trismus, analgesic use, or oral candidiasis.

A sport-for-protection program reduces anxiety and depression in youth affected by displacement: A randomized controlled trial of the Game Connect program in Uganda

INTRODUCTION

Youth affected by displacement are at risk for anxiety and depression. Supervised sport programs are a potentially effective strategy, however trials from displacement contexts are lacking.

METHODS

Displaced youth and youth from host communities in five humanitarian settings across Uganda aged 15 to 24 years, and with at least mild anxiety and/or depression, were randomized to a 16-week sport-for-protection program or a wait-list control condition. The Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9, adolescent version (PHQ-9-A) were assessed pre- and post-intervention. Linear mixed modelling was conducted.

RESULTS

834 young people were randomized (421 in the experimental and 413 in the control condition; median age = 19.0 years; 46.9 % boys; 14.7 % with self-reported or observed disability; 29.5 % from host community and 70.5 % displaced youth). Large effect sizes were found for the anxiolytic (Cohen d = 1.21, 95%CI = 1.06-1.36) and antidepressant (Cohen d = 1.32, 95%CI = 1.17-1.47) effects of sport-for-protection in comparison with a wait-list control condition. In subgroup analyses, large effect sizes were observed in displaced youth (Cohen d GAD-7 = 1.15, 95%CI = 1.0-1.32; Cohen d PHQ-9-A = 1.33, 95%CI = 1.16-1.51) and youth from host communities (Cohen d GAD-7 = 1.34, 95%CI = 1.06-1.61; Cohen d PHQ-9-A = 1.30, 95%CI = 1.03-1.58); in boys (Cohen d GAD-7 = 1.23, 95%CI = 1.03-1.43; Cohen d PHQ-9-A = 1.36, 95%CI = 1.14-1.58) and girls (Cohen d GAD-7 = 1.11, 95%CI = 0.89-1.33; Cohen d PHQ-9-A = 1.26, 95%CI = 1.05-1.47); and in those with (Cohen d GAD-7 = 0.99, 95%CI = 0.61-1.37.; Cohen d PHQ-9-A = 1.53, 95%CI = 1.12-1.94) and without disability (Cohen d GAD-7 = 1.24, 95%CI = 1.08-1.49; Cohen d PHQ-9-A = 1.28, 95%CI = 1.12-1.44).

CONCLUSION

Sport-for-protection is an effective stand-alone or adjunctive intervention to reduce symptoms of anxiety and depression among young people affected by displacement within humanitarian settings.

Internet-based exercise and physical activity promotion for persons with multiple sclerosis: a randomized controlled trial

BACKGROUND

We evaluated the effects of a 12-week internet-based exercise and physical activity promotion program for persons with multiple sclerosis.

METHODS

We performed a multicenter, randomized, waitlist-controlled study. The intervention group (IG) received the 12-week program, followed by 12 weeks with usual care. The control group (CG) received usual care only. The main components of the 12-week program were: (1) a tailored home-based exercise prescription, (2) e-learning resources, (3) telephone and video meetings with an exercise therapist, (4) the provision of a consumer-based PA monitor. Measurements were taken at baseline, postintervention, and after 24 weeks. The primary outcome was device-measured steps/day. Other outcomes were device-measured moderate-to-vigorous physical activity, subjectively measured leisure-time and transportation physical activity and sport/exercise, physical activity-related health competence, walking ability, quality of life, fatigue, depression, and PA-related self-concordance. We compared changes from baseline to postintervention between groups and analyzed changes in the IG during the follow-up.

RESULTS

Analysis of 56 persons with multiple sclerosis (IG: n = 29, CG: n = 27, age: 45.6 ± 10.9) revealed no significant intervention effect on steps/day. However, significant improvements were observed in moderate-to-vigorous physical activity, sport/exercise, control competence, fatigue, and quality of life (physical). During the follow-up, sport/exercise and quality of life decreased significantly. Leisure-time and transportation physical activity increased significantly.

CONCLUSIONS

Our study provides first evidence that the developed program can increase control competence, aspects of physical activity and health in persons with multiple sclerosis. A trial with a larger sample is recommended to confirm our results and examine intervention mechanisms.

TRIAL REGISTRATION

Registry: Clinicaltrials.gov; registration number: NCT04367389; date of registration: 2020-04-21 (retrospectively registered).

Health Coaching Enhanced Older Adults' Self-Efficacy in Managing Their Chronic Diseases: A Randomized Controlled Trial

Although health coaching is a well-known self-management intervention for individuals with chronic diseases, the research on its effect on older adults is limited. A total of 414 older Hong Kong adults were randomly assigned to the intervention group, which received 12-week health coaching sessions, and the control group without intervention. Participants in the intervention group completed assessments at three time points (baseline, postintervention, and three-month follow-up), and those in the control group completed baseline and three-month follow-up assessments. Generalized estimating equations first revealed a significant improvement in self-efficacy and blood pressures among the intervention group participants, and such improvements were maintained at follow-up. In addition, the self-efficacy of the intervention group significantly increased while that of the control group significantly decreased from baseline to follow-up. Thus, the overall results demonstrate the effectiveness of the health coaching intervention in improving the self-efficacy of older adults in managing their chronic diseases and health risks.

Effects of an e-Learning Program (Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis [PEAK]) on Chinese Physical Therapists' Confidence and Knowledge: Randomized Controlled Trial

BACKGROUND

Knee osteoarthritis (OA) presents a significant burden in China due to its high prevalence, aging population, and rising obesity rates. Despite clinical guidelines recommending evidence-based care, limited practitioner training and inadequate telehealth integration hinder effective OA management.

OBJECTIVE

The aim of this study was to evaluate the effectiveness of an e-learning program in improving the confidence and knowledge of Chinese physical therapists in managing knee OA and to explore their perceptions of the program.

METHODS

This was a randomized controlled trial with 2 parallel arms involving 81 rehabilitation practitioners from 18 Chinese provinces. The intervention group completed a 4-week web-based training program (Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis [PEAK]-Chinese), while the control group received no training. The primary outcome was self-reported confidence in OA management (11-point scale). Secondary outcomes included knowledge (Chinese Knee Osteoarthritis Knowledge Scale [KOAKS]) and likelihood of clinical application of core OA treatments. Process measures and semistructured interviews captured participants' training perceptions. Quantitative data were analyzed using regression models, 2-sided t tests, and descriptive statistics, while thematic analysis was performed on the interview data of 10 participants.

RESULTS

A total of 80 participants completed the outcome measures at 4 weeks. The intervention group demonstrated significant improvements in confidence compared to the control group, including managing OA with exercise-based programs (adjusted mean difference=3.27, 95% CI 2.72-3.81), prescribing exercise (adjusted mean difference=3.13, 95% CI 2.55-3.72), and delivering telehealth (adjusted mean difference=4.41, 95% CI 3.77-5.05). KOAKS scores also improved significantly (mean change=9.46); however, certain belief bias related to OA concepts and the use of scans remained unchanged (25/41, 61% and 27/41, 66%, respectively). Approximately 73% (30/41) of the intervention participants rated the course as extremely useful. Interviews emphasized the need for cultural adaptation and practical telehealth training with real-life scenarios to enhance program applicability.

CONCLUSIONS

The PEAK program improved Chinese practitioners' confidence and knowledge in managing knee OA, underscoring e-learning's potential to support evidence-based OA care in China. To optimize future implementations, further research strategies could include enhancing cultural relevance, addressing misconceptions, and incorporating practical, real-world training.

TRIAL REGISTRATION

Chinese Clinical Trial Register ChiCTR2400091007; https://www.chictr.org.cn/showproj.html?proj=239680.

Photobiomodulation before blood flow restriction exercises: a randomized clinical trial

This study investigate the effects of photobiomodulation therapy applied before exercises with blood flow restriction during low-load or high-load exercises on muscle adaptations, muscle damage, and redox status. Forty-five untrained men were randomly assigned to four groups: photobiomodulation therapy-blood flow restriction (30% of maximal isometric voluntary contraction), placebo-blood flow restriction (30% of maximal isometric voluntary contraction), photobiomodulation therapy-high-load exercise (80% of maximal isometric voluntary contraction), and placebo-high-load exercise (80% of maximal isometric voluntary contraction). Elbow flexion exercises were performed twice weekly for 8 weeks, followed by a 4-week detraining period. After 8 weeks, photobiomodulation therapy-blood flow restriction, photobiomodulation therapy-high-load exercises, and placebo-blood flow restriction groups significantly increased muscle strength (p<0.05) with non-significant increases in the placebo-high-load exercise group. The photobiomodulation therapy-blood flow restriction group demonstrated a superior magnitude of effects compared to the placebo-high-load exercise (+10.2%) and placebo-blood flow restriction (+7%; p<0.008) groups. Only the placebo-blood flow restriction group reduced the fatigue index post-intervention. During the detraining period, both blood flow restriction groups maintained superior muscle strength compared to baseline levels. The placebo-high-load exercise group exhibited higher creatine kinase activity post-exercise compared to the other groups. No significant changes were observed in nitric oxide, thiobarbituric acid reactive substances, carbonylated proteins, or total antioxidant capacity immediately post-exercise. However, the total antioxidant capacity levels were increased in all groups after 8 weeks of exercise and following a 4-week detraining period. Overall, the photobiomodulation therapy-blood flow restriction group promoted greater gains in muscle strength compared to the placebo-high-load exercise and placebo-blood flow restriction groups.

Explanation & Elaboration document of the COSMIN Reporting Guideline 2.0 for studies on measurement properties of patient-reported outcome measures

PURPOSE

We aimed to develop an Explanation & Elaboration document to provide explanations, rationales, and good examples of reporting for each item in the COSMIN Reporting Guideline 2.0.

METHODS

The development of the Explanation & Elaboration document was conducted in four phases. In phase 1, experts on measurement properties were invited as writers to draft explanations and examples for each item. The original COSMIN Reporting Guideline items into 22 clusters, each containing two to six items, which were self-assigned by writers based on expertise. In phase 2, a draft of the Explanation & Elaboration document was created. For each item, an 'Explanation', 'Essential elements', and 'Item examples' were written. The draft was reviewed by a team of reviewers for grammar, conciseness, and consistency with other COSMIN tools. In phase 3, the Explanation & Elaboration document was extensively revised considering the newly created COSMIN reporting guidelines 2.0. In phase 4, the final version incorporated feedback from all writers and final approval.

RESULTS

Eighteen writers drafted the item explanations and provided examples of good reporting. The Explanation & Elaboration document contains explanations of the General and Specific items. We explain the reasons why reporting of the item is recommended and how to report the items with examples of good reporting.

CONCLUSION

The Explanation & Elaboration document of the COSMIN Reporting Guideline 2.0 facilitates comprehensive reporting of studies on measurement properties of PROMs and should be used in conjunction with the COSMIN Reporting Guideline 2.0.

Integration of sleep and emotion treatment: a randomized trial of transdiagnostic CBT for comorbid insomnia

BACKGROUND

Insomnia frequently co-occurs with emotional disorders, yet integrated treatment approaches remain understudied. This study examined the efficacy of Transdiagnostic Cognitive Behavior Therapy (TCBT) for treating comorbid insomnia in patients with emotional disorders.

METHODS

In this double-blind randomized controlled trial, 32 university students with comorbid insomnia and emotional disorders were randomly assigned to either TCBT (n = 16) or waitlist control (n = 16). The TCBT group received 20 one-hour sessions of treatment. Insomnia severity was assessed using the Insomnia Severity Index (ISI) at baseline, post-treatment, and three-month follow-up.

RESULTS

Mixed-model ANOVA revealed significant main effects for time (F = 52.18, p < .001, Eta-Squared = 0.635) and group (F = 45.55, p < .001, Eta-Squared = 0.603), and a significant time × group interaction (F = 61.66, p < .001, Eta-Squared = 0.673). The TCBT group showed large effect sizes for insomnia reduction from pre- to post-treatment (Hedges' g = 3.75) and pre-treatment to follow-up (g = 3.07), with benefits maintained at three months. The waitlist group showed no significant changes.

CONCLUSIONS

TCBT demonstrated robust efficacy in treating comorbid insomnia among university students with emotional disorders, with effects maintained at follow-up. These findings suggest TCBT as a promising integrated treatment approach for this population.

TRIAL REGISTRATION

This randomized clinical trial comprised an intervention and a waitlist that was registered in the Iranian Registry of Clinical Trials (IRCT Id: IRCT20200112046097N1). (Registration Date: 26/07/2020).

Language Interventions for School-Aged Children Who Are d/Deaf and Hard of Hearing: A Systematic Review and Meta-Analysis

PURPOSE

The main aim of the systematic review and meta-analysis was to evaluate the effectiveness of language interventions for school-aged children who are d/Deaf and hard of hearing (DHH). We focused on studies targeting meaning-based aspects of language, such as vocabulary, grammar, and narrative skills. We included randomized controlled trials and quasi-experiments with a control group and a pre-post design. A secondary aim was to describe the characteristics of effective interventions identified in the systematic review.

METHOD

The review was preregistered in PROSPERO (ID CRD42021236085). We searched 10 academic databases for peer-reviewed journal articles reporting language interventions for children who are DHH aged 6-12 years. We assessed the quality of included studies using Critical Appraisal Skills Programme checklists. A meta-analysis was conducted on the overall effect of interventions. In addition, we calculated separate effect sizes for vocabulary and morphosyntactic knowledge.

RESULTS

We identified 14 studies totaling 794 children. Quality assessment revealed concerns of risk of bias in most studies because study characteristics were not comprehensively reported. The meta-analyses of language interventions revealed a large main effect of g = 0.79. Subdomain analyses revealed similar effects for morphosyntactic knowledge g = 0.81 and vocabulary g = 0.71.

CONCLUSIONS

Few high-quality studies examine the effects of language interventions for children who are DHH. However, the studies that exist reveal robust effects, especially for morphosyntactic abilities. Intervention approaches were diverse, and the largest intervention effects were found in studies with a randomized controlled design and near-transfer outcome measures closely aligned with the intervention content. Future studies should adhere to established guidelines for reporting results from controlled experimental study designs.

Randomised controlled trial of a nurse coordination intervention for people living with dementia and their carers: study protocol

INTRODUCTION

The multifaceted impact of dementia means that people living with dementia require multidisciplinary care across different services and settings; however, these care transitions pose a risk of fragmented care. Models that improve integration and coordination of care in the community are needed.

METHODS AND ANALYSIS

This randomised control trial will test the effectiveness and cost effectiveness of a dementia nurse-led intervention to: (1) increase days lived in the community at 12-month follow-up (primary outcome) among people living with dementia and (2) improve quality of life for people living with dementia and their carers, compared with usual care. Participants are recruited from several sources including private and public geriatric medicine clinics, carer support groups and self-referral. People living with dementia and their carers are randomised as a dyad to (1) usual care or (2) dementia nurse-led care-coordination. The dementia nurse will provide care coordination and direct support through a tailored, integrated and patient-centred approach. The needs of people living with dementia will be identified and addressed, with a focus on improving the management of comorbidities, risk reduction and symptoms. Carers will also receive support. The model for people living with dementia will focus on days lived in their community as the outcome variable. Differences between groups in quality of life at 12-month follow-up will be assessed using linear mixed effects regression. Analysis will follow the intention to treat principles. People living with dementia and carers' data will be analysed separately and collectively for the economic study.

ETHICS AND DISSEMINATION

The trial has been approved by the Hunter New England Research Ethics Committee (2023/ETH01221) and the University of Newcastle Ethics Committee (R-2024-0021). Trial findings will be disseminated via peer-reviewed publications and conference presentations. If the intervention is effective, the research team aims to further implement the intervention as usual care within the participating services and beyond.

TRIAL REGISTRATION NUMBER

The trial was prospectively registered via the Australian New Zealand Clinical Trials Registry: ACTRN12624000235505. Registration date: 11 March 2024.

Effectiveness of kinesiotaping for lymphatic drainage after bilateral total knee arthroplasty: A randomized controlled trial

BACKGROUND

The effectiveness of kinesiotape for lymphatic drainage has been studied by comparing groups of patients with unilateral total knee arthroplasty (TKA). Studying its impact on persons with bilateral TKA may give a more accurate assessment of effectiveness. The purpose of this study was to evaluate the effectiveness of kinesiotaping for lymphatic drainage in reducing postoperative edema and pain and improving the knee range of motion (ROM) of adults with bilateral TKA.

METHODS

Using a randomized controlled trial, mixed-model design, 52 eligible adults began standard inpatient rehabilitation 3 to 13 days after bilateral TKA. Kinesiotape for lymphatic drainage was applied to 1 randomly selected leg of 52 consenting participants (mean age = 68.1 years, standard deviation = 7.6; 62% female). Leg circumferences, active and active-assistive knee ROM, and Numerical Pain Rating were measured bilaterally at baseline (before kinesiotaping) and on study days 1, 2, 4, 6, and 8 with kinesiotape. A mixed-model analysis of variance examined interactions among within-subjects (day, leg taped) and between-subjects (time between surgery and kinesiotape application) factors.

RESULTS

Interactions of day by taped leg by time group for knee active flexion (F = 4.32, P =.006, η2 =0.076) were attributed to higher baseline knee flexion of the taped leg for persons with 7 days or more between surgery and kinesiotaping (n = 25; mean knee flexion = 74.9°, standard deviation = 17.8) compared with the taped legs of the 6 days or less group (n = 27; mean knee flexion = 66.9°, standard deviation = 16.3). This interaction also reflects significant improvements from days 1 to 2 for the taped leg of the 6-day or less group (MeanDiffDay1-2 = 5.6°, standard error = 1.5, P =.008) and improvement of the untaped leg of the 7-day or more group (MeanDiffDay1-2 = 6.7°, standard error = 1.7, P =.005). No significant day-by-leg or day-by-leg-by-time group interactions occurred for circumferences, Numerical Pain Rating, and active knee extension and active-assistive knee flexion and extension.

CONCLUSIONS

Kinesiotaping for lymphatic drainage does not augment standard inpatient rehabilitation for edema control, ROM improvement, and pain remission after bilateral TKA.

Technology-based comprehensive cardiac rehabilitation therapy for women in a middle-income setting: a randomized controlled trial

AIMS

Women are under-represented in cardiac rehabilitation (CR), especially in lower-income settings. This study tested Technology-bAsed Cardiac rehabilitation Therapy (TaCT) on functional capacity, risk factors, quality of life (QoL; MacNew), heart-health behaviours (e.g. Global Physical Activity Questionnaire), cardiac symptoms (e.g. angina), and morbidity (e.g. hospitalization and procedure) in women.

METHODS AND RESULTS

Single-centre, single-blind, two parallel arms (1:1 SNOSE) randomized superiority trial, undertaken in an Indian outpatient cardiology department, where women with stable cardiac disease and smartphone access were recruited. TaCT was compared with standard care (CR rare), with assessments conducted before the intervention, and 6 months later. The 6-month comprehensive intervention was delivered via several technologies. Exercise prescriptions were based on an Incremental Shuttle Walk Test (ISWT; primary outcome). Analyses were based on intention-to-treat. Fifty women were randomized to intervention, and 50 to control (n = 89; 89.0% retained). There were few tobacco users. Results for the following outcomes favoured intervention: functional capacity [ISWT effect size = 0.3 (95% confidence interval = 1.0 to -0.2), P = 0.002; Duke Activity Status Index P < 0.001; Sit-to-Stand P = 0.003], QoL (global and all subscale P's < 0.001), and heart-health behaviours (exercise P < 0.001; medication adherence P = 0.02), and anxiety (P = 0.002). There were no significant differences in blood pressure, waist circumference, or cardiac symptoms. Three participants in the intervention group experienced morbidity and 1 suffered mortality and 9 in controls experienced morbidity only.

CONCLUSION

The TaCT program significantly improved functional capacity, QoL, heart-health behaviours and anxiety in women with cardiovascular disease in a middle-income country, demonstrating the potential of technology-based CR tailored for women in these settings.

REGISTRATION

CTRI/2021/07/035197 URL: https://ctri.nic.in/Clinicaltrials/rmaindet.php?trialid=51810&EncHid=79231.15408&modid=1&compid=19.

Cognitive Behavioral Therapy Alone or in Combination with Eszopiclone in Comorbid Insomnia and Obstructive Sleep Apnea in Veterans with Posttraumatic Stress Disorder: A Randomized Trial

We sought to assess the augmentation of brief behavioral therapy for insomnia (BBTI) with eszopiclone (ESZ) over BBTI alone for the treatment of chronic insomnia on sleep quality, sleep indices, and continuous positive airway pressure (CPAP) adherence in PTSD veterans with COMISA. The pilot trial involved 53 PTSD patients (46 males and 7 females, mean age 48.2±8.3 years) with COMISA randomized to combination therapy of BBTI plus 2 weeks of eszopiclone (2 mg/d) or BBTI alone with follow-up visits conducted at 6 and 24 weeks. The main outcome measure was sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI). A significant decrease in PSQI scores was observed between baseline and 24 weeks for BBTI plus ESZ (-5.24 [95% CI, -6.55 to -3.94]; p < 0.001) and BBTI-only (-5.45 [95%CI, -6.75 to -4.14]; p < 0.001). No significant group allocation effects x time interactions were detected. Similar improvements were recorded for ISI between baseline and 24 weeks (BBTI plus ESZ (-8.32 [95%CI, -10.51 to -6.14]; p < 0.001) and BBTI-only (-8.64 [95%CI, -10.88 to -6.41]; p < 0.001)) with no interaction effect between treatment groups x time. Combination therapy produced a higher remission rate of insomnia at 6 weeks, with both interventions achieving comparable rates at 24 weeks. Results of the mixed effect models for CPAP use revealed no group x time interaction effects. In patients with COMISA, the combination of eszopiclone with BBTI resulted in comparable improvement in sleep quality of life to that achieved with BBTI-only therapy. Although the addition of eszopiclone to BBTI conferred an early benefit in remission rate of insomnia relative to BBTI, both modalities achieved similar outcomes at long-term follow-up. Clinical Trial Registration This study was registered with ClinicalTrials.gov (Identifier NCT03937713).

A Randomized Controlled Trial for Dual-Agent Local Analgesic in Sling Surgery

IMPORTANCE

Narcotic use after retropubic suburethral sling surgery is not unusual. Surgeons may consider using topical analgesics to minimize narcotic use.

OBJECTIVES

The aim of the study was to determine if using bupivacaine-meloxicam (Zynrelef) reduces narcotic use in the first 3 days after surgery, measured as morphine milligram equivalents (MME). Secondary aims were to compare, postoperatively, average and worst pain, satisfaction with pain control and quality of recovery between groups.

STUDY DESIGN

This was a single-center prospective single-blinded randomized controlled trial for women undergoing retropubic sling surgery. The intervention arm received Zynrelef at the suprapubic incisions, no placebo was used in controls. Participants tracked pain levels, medication use, satisfaction with pain control and Quality of Recovery surveys in the first 3 postoperative days. Appropriate statistical analyses were applied.

RESULTS

A total of 119 women were randomized. For primary outcome, totalmedian MME from postoperative days 0-3, the control group used 37.5 MME compared to 30 MME in the Zynrelef group (interquartile range [IQR] 5.63-71.25; P = 0.61). Pain scores were low in both groups, participants were satisfied or very satisfied with pain control. Quality of recovery scores were similar between groups, with improvement by postoperative day 3 to near baseline scores. Patients with anxiety/depression used more oxycodone; 10 mg (IQR 0-30) vs 0 mg (IQR 0-15), P = 0.0027.

CONCLUSIONS

Use of Zynrelef during retropubic sling surgery does not reduce narcotic use in the first 3 days postoperatively. Patients can be reassured that pain and narcotic use after surgery are low and recovery is quick.

Efficacy and safety of adjunctive therapy with lumateperone in major depressive disorder: a randomized-, double-blind, placebo-controlled clinical trial

This study aimed to investigate the effects of lumateperone as a combination therapy with sertraline in major depressive disorder (MDD). The 8-week, double-blind, placebo-controlled trial was registered with the Iranian Registry of Clinical Trials (registration date: 2022-03-01, registration number: IRCT20090117001556N141). Patients with MDD were randomized to receive either sertraline (100 mg/day) combined with lumateperone (42 mg/day) or sertraline (100 mg/day) with placebo. The Hamilton Depression Rating Scale (HDRS) was used to assess treatment efficacy. Fifty-eight patients with MDD were analyzed (age: 36.91 ± 9.81 and male: 69.0%). The two groups were comparable across baseline sociodemographic and clinical characteristics except for marital status. There was a significant time × treatment interaction on HDRS (P = 0.027), suggesting greater improvement in depressive symptoms following the lumateperone adjuvant therapy. Compared with the placebo group, a significantly larger proportion of individuals receiving lumateperone experienced an HDRS reduction rate greater than or equal to 50% at weeks 4 (90.0 vs. 60.7%, P = 0.014) and 8 (100 vs. 82.1, P = 0.021). However, the remission rate was not different. No serious adverse events were reported. This study suggests that lumateperone can be considered an effective and safe adjuvant treatment for MDD. Future larger clinical trials with extended follow-up periods are needed to confirm its efficacy for clinical use.

Denosumab for treating periprosthetic osteolysis: a feasibility study

OBJECTIVE

Wear-induced osteolysis is a leading cause of late failure in total hip arthroplasty (THA). Denosumab, a RANKL inhibitor, suppresses osteoclast activity and may slow osteolytic progression. This feasibility study aimed to assess the practicality of conducting a randomized, double-blind, placebo-controlled trial evaluating Denosumab's effect on periprosthetic osteolysis in asymptomatic THA patients.

RESULTS

Twelve patients were enrolled; ten completed follow-up. No significant difference in lesion volume change was observed between groups (Denosumab: +1.53 cm³; Placebo: +0.49 cm³). Secondary clinical outcomes also showed no notable differences. The trial protocol, recruitment, treatment, and follow-up were feasible, though slow enrollment limited statistical power. This study demonstrates the feasibility of a larger trial investigating Denosumab for osteolysis prevention.

TRIAL REGISTRATION

Clinicaltrails.gov, NCT02299817. Registered 20 November 2014. https://www.

CLINICALTRIALS

gov/study/NCT02299817?term=Denosumab%20for%20Treating%20Periprosthetic%20Osteolysis.%26;rank=1.

Urologists' Estimation of Online Support Group Utilization Behavior of Their Patients With Newly Diagnosed Nonmetastatic Prostate Cancer in Germany: Predefined Secondary Analysis of a Randomized Controlled Trial

BACKGROUND

Due to its high incidence, prostate cancer (PC) imposes a burden on Western societies. Individualized treatment decision for nonmetastatic PC (eg, surgery, radiation, focal therapy, active surveillance, watchful waiting) is challenging. The range of options might make affected persons seek peer-to-peer counseling. Besides traditional face-to-face support groups (F2FGs), online support groups (OSGs) became important, especially during COVID-19.

OBJECTIVE

This study aims to investigate utilization behavior and physician advice concerning F2FGs and OSGs for patients with newly diagnosed PC. We hypothesized greater importance of OSGs to support treatment decisions. We assumed that this form of peer-to-peer support is underestimated by the treating physicians. We also considered the effects of the COVID-19 pandemic.

METHODS

This was a secondary analysis of data from a randomized controlled trial comparing an online decision aid versus a printed brochure for patients with nonmetastatic PC. We investigated 687 patients from 116 urological practices throughout Germany before primary treatment. Of these, 308 were included before and 379 during the COVID-19 pandemic. At the 1-year follow-up visit, patients filled an online questionnaire about their use of traditional or online self-help, including consultation behaviors or attitudes concerning initial treatment decisions. We measured secondary outcomes with validated questionnaires such as Distress Thermometer and the Patient Health Questionnaire-4 items to assess distress, anxiety, and depression. Physicians were asked in a paper-based questionnaire whether patients had accessed peer-to-peer support. Group comparisons were made using chi-square or McNemar tests for nominal variables and 2-sided t tests for ordinally scaled data.

RESULTS

Before COVID-19, 2.3% (7/308) of the patients attended an F2FG versus none thereafter. The frequency of OSG use did not change significantly: OSGs were used by 24.7% (76/308) and 23.5% (89/308) of the patients before and during COVID-19, respectively. OSG users had higher levels of anxiety and depression; 38% (46/121) reported OSG as helpful for decision-making. Although 4% (19/477) of OSG nonusers regretted treatment decisions, only 0.7% (1/153) of OSG users did (P=.03). More users than nonusers reported that OSGs were mentioned by physicians (P<.001). Patients and physicians agreed that F2FGs and OSGs were not mentioned in conversations or visited by patients. For 86% (6/7) of the patients, the physician was not aware of F2FG attendance. Physicians underestimated OSG usage by 2.6% (18/687) versus 24% (165/687) of actual use (P<.001).

CONCLUSIONS

Physicians are more aware of F2FGs than OSGs. Before COVID-19, F2FGs played a minor role. One out of 4 patients used OSGs. One-third considered them helpful for treatment decision-making. OSG use rarely affects the final treatment decision. Urologists significantly underestimate OSG use by their patients. Peer-to-peer support is more likely to be received by patients with anxiety and depression. Comparative interventional trials are needed to recommend peer-to-peer interventions for suitable patients.

TRIAL REGISTRATION

German Clinical Trials Register DRKS-ID DRKS00014627; https://drks.de/search/en/trial/DRKS00014627.

Effects of aerobic dance on systolic blood pressure in stage one hypertensive adults in Uganda

Objective

To investigate the effects of a 12-week aerobic dance programme on systolic blood pressure (SBP) in stage one hypertensive adults.

Methods

This study employed an experimental research design. 36 out of 58 stage one hypertensive adults randomly assigned into experimental and control groups completed the programme. SBP was measured using a mercury sphygmomanometer at baseline and post programme. The experimental group participants trained thrice a week, 45 min per session, and at a moderate intensity, but the control group continued doing their daily routines. Data were analysed using SPSS V.20. A two-tailed t-test was used to compare the mean differences of the two groups. A p value of <0.05 was considered statistically significant.

Results

The experimental group had a mean SBP of 143.83±6.382 mm Hg at baseline, while the control had 137.61±6.400 mm Hg. After a 12-week aerobic dance programme, the mean SBP of the experimental group reduced to 136.33±9.191 mm Hg, while that of the control group increased to 139.56±9.954 mm Hg. This implies that the 12-week aerobic dance programme reduced the SBP of the experimental group by -7.50 mm Hg while that of the control group remained more or less the same by having a marginal increment of 1.50 mm Hg. The changes were statistically significant (p<0.002) after a 12-week aerobic dance programme.

Conclusion

The aerobic dance programme effectively manages the SBP of stage one hypertensive adults. In Uganda, stakeholders and policymakers should consider incorporating aerobic dance as a non-pharmacological method for hypertension management protocols.

A randomized open label pilot study evaluating the efficacy of two dosing regimens of rifamycin SV MMX in the treatment of small intestinal bacterial overgrowth

Antibiotics have demonstrated efficacy in the eradication of the underlying overgrowth bacteria and improvement of symptoms of small intestinal bacterial overgrowth (SIBO). The use of standard antibiotics may cause intolerable side effects such as development of multidrug-resistant enteric bacteria, Clostridioides difficile infections and dysbiosis. Nonabsorbable antibiotics have the advantage of minimized side effects. Rifaximin, an antibiotic of the ansamycin class has been shown to be effective in the treatment of SIBO. We evaluated the use of another ansamycin antibiotic, rifamycin SV MMX (AEMCOLO) in the treatment of SIBO. One difference from rifaximin is the site of delivery of AEMCOLO which appears to be the distal small intestine and colon. Hence by maintaining the microbial milieu of the proximal small intestine, the clearance of the overgrowth bacteria might be enhanced. The side effect profile of Rifamycin SV MMX has been described elsewhere in the pivotal trials; there were no safety signals noted in this study. This randomized open label pilot study evaluated the efficacy of two dosing regimens of AEMCOLO in treating SIBO. We used a simple randomization method to assign participants into study groups. The participants included 31 patients, split between two treatment arms: one receiving the medication twice daily and the other - three times daily. The outcomes were assessed based on symptom improvement and breath test normalization. The results indicated a beneficial response with both dosing regimens leading to symptom improvement and breath test normalization. Further evaluation revealed that in the three-time daily regimen, greater symptomatic improvement was observed. For clinicians treating SIBO, this study suggests that AEMCOLO is a viable treatment option. A double-blind, placebo-controlled design will probably be necessary to ascertain the true efficacy of different dosing regimens of AEMCOLO in treating SIBO.

Perioperative lifestyle and nutritional interventions' details reporting in bariatric surgery trials according to the Template for Intervention Description and Replication (TIDieR) checklist: a cross-sectional study

BACKGROUND

Metabolic and bariatric surgery (MBS) is considered the most effective treatment for people with severe obesity, and certain interventions could enhance its long-term results. The complete reporting of interventions' details is necessary for their replication in clinical settings.

OBJECTIVES

To investigate the completeness of reporting of lifestyle and nutritional interventions applied in immediate perioperative period (30-days preoperatively and postoperatively) in patients undergoing MBS using the 12-item Template for Intervention Description and Replication (TIDieR) checklist, and to explore factors associated with compliant reporting.

SETTING

A cross-sectional study.

METHODS

We searched MEDLINE, Embase, and CENTRAL up to April 14 2024. The screening, extraction, and assessments were performed independently by 2 authors.

RESULTS

Information from the manuscript, protocol, and supplementary materials in 72 trials comprising 76 interventions satisfied a mean of the 70.4% (standard deviation 16.5) of TIDieR items. Altogether, 6.6% of the interventions fulfilled all items. The lowest scoring items were adherence to intervention (item 12, reported in 51.3% of the interventions), modes of delivery (item 6, 42.1%), intervention provider (item 5, 38.3%), and fidelity assessment and maintenance planning (item 11, 23.7%). A total of 6.9% of the trials contained relevant information in the protocol or supplementary materials and 93.1% required contacting authors for clarifications. We identified the number of authors, availability of a study protocol, availability of supplementary materials, reporting of the compliance with the Consolidated Standards of Reporting Trials (CONSORT) guidelines, and reporting of a plan for dealing with missing outcome data as predictors of better reporting, while the Asian country of the corresponding author implied less compliant reporting.

CONCLUSIONS

The completeness of reporting of lifestyle and nutritional interventions applied in immediate perioperative period in patients undergoing MBS is suboptimal and, consequently, impedes their replication in clinical practice. A wider adoption of the TIDieR checklist by authors, reviewers, and journal editors should enhance the transparency, clarity, and transferability of research.

Adjunctive ivermectin mass drug administration for malaria control on the Bijagos Archipelago of Guinea-Bissau (MATAMAL): a quadruple-blinded, cluster-randomised, placebo-controlled trial

BACKGROUND

Arthropod vectors feeding on the blood of individuals treated with ivermectin have substantially increased mortality. Whether this effect will translate into a useful tool for reducing malaria burden at scale is not clear. Our trial aimed to assess whether using ivermectin as an adjunct to mass drug administration (MDA) with dihydroartemisinin-piperaquine would further reduce malaria prevalence.

METHODS

MATAMAL was a quadruple-blinded, cluster-randomised, placebo-controlled trial, conducted on the Bijagos Archipelago, Guinea-Bissau, an area of seasonal malaria transmission. All residents were invited to participate, with exclusions for drug safety. 24 clusters were randomised in a 1:1 ratio, using restriction randomisation, to either MDA with three daily oral doses of dihydroartemisinin-piperaquine and ivermectin (300 μg/kg per day) in three sequential months during the transmission season in 2021 and 2022, or MDA with dihydroartemisinin-piperaquine and placebo in the same schedule. The primary outcome was quantitative PCR prevalence of Plasmodium falciparum parasitaemia in all age groups, during peak transmission, after the second year of intervention. The primary entomological outcome was anopheline parity rate. The trial is registered with ClinicalTrials.gov (NCT04844905).

FINDINGS

Participants were recruited between June 7, 2021 and Sept 21, 2022. The baseline population was 25 882 (12 634 [50·6%] were female individuals and 12 317 [49·4%] were male individuals): 13 832 were in the intervention group and 12 050 in the control group. Cluster-level coverage for dihydroartemisinin-piperaquine ranged from 60·4% to 78·7%, and for ivermectin or ivermectin-placebo from 58·1 to 77·1%. Following the intervention, the prevalence of P falciparum infection was 118 (5·05%) of 2300 in the control group and 141 (6·64%) of 2083 in the intervention group. The adjusted risk difference was 1·67% (95% CI -1·44 to 4·78; p=0·28). There were 124 adverse events in the control group (1·0% of participants) and 267 in the intervention group (1·9% of participants). Two serious adverse events were reported, neither related to the intervention, and no treatment-related deaths. The anopheline parity rate was 1679 (67·8%) of 2475 in control clusters and 1740 (72·3%) of 2414 in intervention clusters. The adjusted risk difference was -1·32 (95% CI -14·77 to 12·12; p=0·84).

INTERPRETATION

Adding ivermectin to dihydroartemisinin-piperaquine MDA had no additional effect on reducing malaria prevalence or vector parity in this setting. The intervention was well tolerated. To our knowledge, this trial is the first to be designed to assess whether ivermectin has an additive effect on malaria when coadministered with dihydroartemisinin-piperaquine MDA.

FUNDING

The National Institute for Health and Care Research, Medical Research Council, Wellcome, and Foreign, Commonwealth & Development Office.

A Smaller Sample Size Is Associated With Lower Rates of Reporting of Harms in Randomized Controlled Trials Cited in the AAOS Clinical Practice Guidelines for Anterior Cruciate Ligament Injuries

BACKGROUND

Randomized controlled trials (RCTs) significantly influence clinical decision-making, necessitating comprehensive reporting of trial outcomes. However, previous studies have demonstrated that reporting of harms among RCTs is often inadequate.

PURPOSE/HYPOTHESIS

The purpose of this study was to evaluate reporting of harms among RCTs cited within the American Academy of Orthopaedic Surgeons (AAOS) clinical practice guidelines (CPGs) for anterior cruciate ligament (ACL) injuries, with an emphasis on study characteristics associated with adherence. We hypothesized that >50% of these trials would have incomplete adherence to the checklist items outlined in the Consolidated Standards of Reporting Trials (CONSORT) extension for harms and that a larger sample size would be associated with greater compliance.

STUDY DESIGN

Cross-sectional study.

METHODS

We identified RCTs cited in the AAOS CPGs for the management of ACL injuries and assessed compliance with the 18-item CONSORT extension for harms checklist. Descriptive statistics were used to summarize overall adherence to the checklist items, and linear regression analysis evaluated adherence over time.

RESULTS

Our analysis included 116 RCTs, the majority of which were single-center studies (81.0%). Most trials had sample sizes of 50-100 patients (45.7%) or 101-500 patients (37.9%). On average, trials adhered to 9.25 of 18 CONSORT items (51.4%), with the most compliant study meeting 15 of 18 items (83.3%) and the least compliant meeting 3 of 18 items (16.7%). Overall, 18 RCTs (15.5%) reported ≤33% of items, and 22 RCTs (19.0%) reported ≥67% of items. Studies with >500 patients had significantly higher adherence compared with studies with <50 patients (P = .046). There was no significant difference in adherence based on the disclosure of funding sources (P = .85) or the implementation of blinding (P = .37). Interrupted time series regression analysis demonstrated no significant change in reporting both before (R2 = 0.017; P = .62) and after (R2 = 0.21; P = .16) the release of the checklist in 2004.

CONCLUSION

On average, RCTs cited within the AAOS CPGs for the management of ACL injuries adhered to 51.4% of CONSORT checklist requirements, with considerable variability across studies. Improvements in reporting practices are warranted to support evidence-based treatment decisions.

A video clip detailing the patient journey on the day of oocyte retrieval in addition to the standard of care: a randomized controlled trial

STUDY QUESTION

Can a video clip detailing the patient journey decrease women's anxiety on the day of their first oocyte retrieval?

SUMMARY ANSWER

The video clip does not affect women's anxiety on the day of their first oocyte retrieval.

WHAT IS KNOWN ALREADY

IVF triggers anxious reactions in women and men, with peaks of anxiety on the day of (especially the first) oocyte retrieval as shown by reliable questionnaires and biomarkers of distress. Several trials showed that videos with preparatory information reduce women's and men's anxiety for out-patient procedures.

STUDY DESIGN, SIZE, DURATION

This monocentric open-label randomized controlled trial (RCT) randomized (computerized 1:1 allocation) 190 heterosexual couples about to start their first IVF cycle during a 24 months' recruitment period (2018-2020). In addition to the standard of care offered to both the intervention group and the control group, the intervention group received a video clip, the day prior to their first oocyte retrieval, detailing the patient journey on the day of oocyte retrieval. After completion of the RCT, 35 additional couples were recruited as part of a qualitative process evaluation (QPE).

PARTICIPANTS/MATERIALS, SETTING, METHODS

Upon arrival at a private secondary care fertility centre in Belgium for their first oocyte retrieval, women and men independently filled out the State module of the 'State-Trait Anxiety Inventory' (STAI) and the 'Infertility-Specific Distress Scale' (IDS) and evaluated the novel intervention, if applicable. In addition, clinical and discontinuation outcomes were extracted from couples' electronic medical records 24 months later. The data of 155 couples (76-79/group) were subjected to an intention-to-treat analysis. The 35 couples taking part in the QPE filled out two questionnaires assessing knowledge and, if applicable, took part in an in-depth interview on their experience watching the video clip, immediately before their first oocyte retrieval.

MAIN RESULTS AND THE ROLE OF CHANCE

The video clip did not affect women's anxiety on the day of oocyte retrieval (mean STAI-State score intervention group = 42.7 ± 8.1 vs control group = 42.1 ± 8.5, P = 0.68). Men who watched the video clip were, however, significantly less anxious than men who did not watch it (35.8 (±6.4) vs 38.2 (±7.6), P = 0.034). Surprisingly, infertility-specific distress was higher among women and men who watched the video clip, as compared to women and men who did not watch the video clip (mean Infertility-specific Distress (IDS) scale score for women, 25.8 (±4.9) vs 24.3 (±4.6), P = 0.051; men, 22.6 (±5.0) vs 20.8 (±4.7), P = 0.023). The QPE clarified that watching the video clip did not increase knowledge about what would happen but that some women and men found the visualization of invasive procedural steps more confrontational than the earlier received, abstract, written, and verbal information. All but one woman and all men in the intervention group would recommend the video clip to friends and family going through IVF. The intervention and control groups did not differ regarding secondary clinical and discontinuation outcomes.

LIMITATIONS, REASONS FOR CAUTION

Due to the nature of the intervention it was not possible to blind the participants. Furthermore, we did not have an attention control group, which could have separated plausible benefits of the intervention from attentional effects, although limiting performance bias in educational intervention studies is difficult as study personnel cannot be blinded. Of note, this RCT was partially conducted during the COVID-19 pandemic; thus, postponement of the oocyte retrieval and plausible side effects of the pandemic itself might have impacted our results, but group differences are corrected by the randomized controlled design of our trial.

WIDER IMPLICATIONS OF THE FINDINGS

Providing additional procedural information is interesting for clinics as patients recommended the video clip and as it decreased men's anxiety on the day of couples' first oocyte retrieval. The effect of the intervention was observed in a Dutch-speaking population, and investigating beneficial effects of the video clip in non-native speakers and patients with a lower education or literacy level may be of interest, as they are more prone to health information overload and often benefit from visual rather than verbal or written information.

STUDY FUNDING/COMPETING INTEREST(S)

This research was supported by the Research Council of the KU Leuven (C14/18/106; project of J.V., K.P., and E.A.F.D.) and it is an Investigator Sponsored Study for Merck N.V./S.A., an affiliate of Merck KGaA, Darmstadt, Germany. Merck N.V./S.A. had no ultimate authority nor any other role in the design, data collection, data management, data analysis, data processing, data interpretation, and on the decision to submit this study for publication. T.M.D. is vice president and Head of Global Medicine Affairs Fertility, Research and Development, Merck Healthcare KGaA, Darmstadt, Germany. He is also a visiting professor in Reproductive Medicine and Biology at KU Leuven, Belgium and an adjunct professor at the Department of Obstetrics and Gynecology at the University of Yale, New Haven, USA. Neither his corporate role nor his academic roles represent a conflict of interest with respect to the work done by him for this study. The other co-authors have no conflict of interest.

TRIAL REGISTRATION NUMBER

This trial is registered at clinicaltrials.gov as NCT03717805.

TRIAL REGISTRATION DATE

10 October 2018.

DATE OF FIRST PATIENT’S ENROLMENT

29 October 2018.

Use of a drug-related problem oriented medical record in the medication review of critically ill patients - Randomized clinical trial

BACKGROUND

The identification and reduction of drug-related problems (DRPs) through DRP-oriented medical records during the hospitalization of critically impatients can optimize health indicators, such as length of hospital stay.

OBJECTIVE

To determine the effect of medical records focused on drug-related problems on the duration of stay for patients in intensive care units.

METHOD

A randomized controlled clinical trial was conducted with patients assigned to intervention or the usual care groups involving clinical pharmacists. This trial occurred between March 2018 and March 2019 and was completed in two intensive care units within two hospitals in Brazil. Exploratory secondary outcomes included the mortality rate and reductions in Sequential Organ Failure Assessment (SOFA) and Δ SOFA scores.

RESULTS

A total of 150 patients participated-54.6 % were women, most being white (77.3 %). Further, the main diagnosis was Acute Coronary Syndrome (22.6 %), followed by Congestive Heart Failure (12.6 %) and Heart Failure (10 %). A significant difference was observed in the length of stay between the intervention group and the control group, respectively 7.08 days (±4.38) and 10.7 days (±6.32). Among the secondary outcomes, a significant difference was observed in the mortality rates between the two groups: (6.58 %) in the intervention group and 25.68 % in the control group. Regarding Δ SOFA, the intervention group exhibited a reduction of 4.63 in the SOFA score during hospitalization. The control group showed an increase of 1.88 in the score during the same period.

CONCLUSION

This study demonstrated that the use of Diagnoses - Adverse Clinical Findings - Medications (DAM), a medical record model aimed at resolving drug-related problems, reduced the length of hospital stay and mortality rates among patients. Furthermore, this model proved to be more effective than the usual care provided by clinical pharmacists.

User journey method: a case study for improving digital intervention use measurement

BACKGROUND

Many digital mental health interventions meet low levels of use. However, current use measurement methods do not necessarily help identify which intervention elements are associated with dropout, despite this information potentially facilitating iterative intervention development. Here, we suggest improving the comprehensiveness of intervention use measurement with the user journey method, which evaluates every intervention element to identify intervention-specific use barriers.

METHODS

We applied user journey method in a clinical trial that investigated the efficacy of a novel game-based intervention, Meliora, for adult Major Depressive Disorder. We modelled the intervention for its four technological (Recruitment, Website, Questionnaires, Intervention Software) and two interpersonal elements (Assessment, Support). We then applied the user journey method to measure how many users proceeded from one element to the next combining social media analytics, website use data, signup data, clinical subject coordinator interview data, symptom questionnaire data, and behavioral intervention use data. These measurements were complemented with the qualitative analysis of the study discovery sources and email support contacts.

RESULTS

Recruitment: The intervention recruitment reached at least 145,000 Finns, with social media, word-of-mouth, and news and web sources being the most effective recruitment channels. Website: The study website received 16,243 visitors, which led to 1,007 sign-ups.

ASSESSMENT

895 participants were assessed and 735 were accepted. Intervention Software: 498 participants were assigned to the active intervention or comparator, of whom 457 used them at least once: on average, for 17.3 h (SD = 20.4 h) on 19.7 days (SD = 20.7 d) over a period of 38.9 days (SD = 31.2 d). The 28 intervention levels were associated with an average dropout rate of 2.6%, with two sections exhibiting an increase against this baseline. 150 participants met the minimum adherence goal of 24 h use. Questionnaires: 116 participants completed the post-intervention questionnaire.

SUPPORT

313 signed-up participants contacted the researchers via email.

CONCLUSION

The user journey method allowed for the comprehensive evaluation of the six intervention elements, and enabled identifying use barriers expediting iterative intervention development and implementation.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT05426265. Registered 28 June 2022, https://clinicaltrials.gov/ct2/show/NCT05426265 .

Clinical Trial Notifications Triggered by Artificial Intelligence-Detected Cancer Progression: A Randomized Trial

Importance

Historically, fewer than 10% of adults with cancer have enrolled in clinical trials. Computational tools have been developed to match patients to trials, but these tools are relevant only when patients need new treatment.

Objective

To evaluate whether notifying oncologists about genomically targeted clinical trials for patients with cancer progression, as detected by artificial intelligence (AI), impacts clinical trial participation.

Design, Setting, and Participants

This single-center randomized trial was conducted from January 30, 2023, to June 30, 2024, at a tertiary academic cancer center. Participants were patients aged at least 18 years in a precision oncology clinical trial matching database who had solid tumors that underwent next-generation sequencing from July 2013 to December 2022, and were alive as of January 30, 2023.

Intervention

Patients were randomly assigned 2:1 to the intervention or control arm. In the intervention arm, when patients had cancer progression and an elevated probability of starting new treatment based on AI applied to their imaging reports, notifications about genomically matched clinical trials were sent to their oncologists. In the control arm, no such notifications were sent.

Main Outcomes and Measures

The primary outcome was enrollment in any therapeutic clinical trial. Prespecified secondary outcomes included consent to any therapeutic trial, consent and enrollment among patients ever ascertained as trial ready, the proportion of new systemic therapies that were given as part of clinical trials, and survey responses from clinicians who received notifications.

Results

Of 20 707 patients randomized (57.26% female; median age at the time of sequencing, 60 years [IQR, 50-69 years]), 13 802 were randomized to the intervention arm and 6905 to the control arm. The intervention had no significant impact on the trial enrollment rate (intervention, 2.20% [95% CI, 1.97%-2.46%]; control, 2.03% [95% CI, 1.72%-2.39%]; difference, 0.18 [95% CI, -0.25 to 0.58] percentage points; P = .41). Similarly, there were no significant differences in trial enrollment between the intervention and control arms among the 2127 patients ever ascertained as trial ready (18.05% [95% CI, 16.15%-20.12%] vs 18.50% [95% CI, 15.78%-21.56%]; difference, -0.45 [95% CI, -4.01 to 3.02] percentage points; P = .80) or among the 2036 patients who ever started new systemic therapy (22.67% [95% CI, 20.51%-24.99%] vs 20.14% [95% CI, 17.33%-23.29%]; difference, 2.53 [95% CI, -1.25 to 6.21] percentage points; P = .19).

Conclusions and Relevance

In this randomized trial, prompting academic medical oncologists with information about genomically matched therapeutic clinical trials for patients with tumor progression based on AI interpretation of imaging reports did not increase therapeutic trial enrollment. The findings suggest that future use of AI to optimize enrollment in cancer clinical trials should include tasks beyond predicting treatment change and/or populations beyond those whose tumors have undergone comprehensive genetic sequencing.

Trial Registration

ClinicalTrials.gov Identifier: NCT06888089.

No increased complication rate with the use of soft tissue quadriceps tendon autograft for primary ACL reconstruction - a systematic review

BACKGROUND

The autograft of choice for anterior cruciate ligament reconstruction (ACLR) remains debateable. Recently there has been increased popularity of soft tissue quadriceps tendon (s-QT) autograft due to less donor site morbidity, reduced anterior knee pain and comparable re-operation and complication rates. The aim of this review was to analyse functional outcomes of primary ACLR using s-QT in adult population without the bone plug and to report its complication profile against other autografts.

PATIENT AND METHODS

This systematic review was performed in accordance with PRISMA guidelines and a review of literature was conducted on four online databases (Medline, EMBASE, Cochrane and Google Scholar). Clinical studies reporting on patients undergoing primary ACLR with s-QT autograft or in comparison to BPTB or HS autografts with a minimum of 6 months follow-up were included. The studies were inclusive of only all soft tissue QT autograft regardless of the implants or fixation method used. Critical appraisal of studies was conducted using the Methodological Index for Non-Randomized Studies (MINORS) tool.

RESULTS

Fourteen studies were eligible. There were three randomised control studies (RCT) and 11 non-randomised comparative studies with 1543 patients who underwent ACLR. 682 underwent s-QT, 498 had hamstring tendon (HT) and 174 had bone-patellar tendon-bone (BPTB). 60% (n = 930) were males and mean follow up was 23.6 months (6-65). Eight studies reported post-operative patient reported outcome measures (PROMs). The mean International Knee Documentation Committee (IKDC) score was 91.5 ± 15.1 whereas mean Lysholm score was 90 ± 3.9. Five studies reported on laxity with mean anterior tibial translation (ATT) of 1.28 ± 1.09 mm. Overall complication rate of s-QT ACLR was 6% with 3% graft failure, 0.52% arthrofibrosis, 0.2% infection, 0.75% revision ACLR. There was no significant difference in functional outcome scores, knee stability and range of motion (ROM) between s-QT, HT and BPTB.

CONCLUSION

s-QT for ACLR has a comparable functional outcome, laxity, failure and with overall graft failure rate of 3%.

LEVEL OF EVIDENCE

III; Systematic review and meta-analysis.

Speech Therapy Combined With Cerebrolysin in Enhancing Nonfluent Aphasia Recovery After Acute Ischemic Stroke: ESCAS Randomized Pilot Study

BACKGROUND

Stroke-induced aphasia significantly impacts communication and quality of life. Despite the standard treatment being speech and language therapy, outcomes vary, highlighting the need for additional therapies. Cerebrolysin, a neuroprotective and neurotrophic agent, has shown potential in stroke management. This study addresses the notable gap in research about the combined use of Cerebrolysin and speech therapy, evaluating their synergistic potential in the treatment of aphasia.

METHODS

The ESCAS trial (The Efficacy and Safety of Cerebrolysin in the Treatment of Aphasia After Acute Ischemic Stroke), a prospective, randomized-controlled, double-blinded study was conducted in 2 Romanian stroke centers. Participants included those with left middle cerebral artery territory ischemic stroke and nonfluent aphasia, enrolled 3 to 5 days poststroke. Inclusion criteria were right-handedness and Romanian as the mother tongue. Participants received Cerebrolysin or a placebo combined with speech and language therapy in 10-day cycles over 3 intervals, and evaluations were done at baseline, 30, 60, and 90 days respectively. The main outcome measure was Western Aphasia Battery for language function. Changes at days 30, 60, and 90 compared with baseline were quantified, and the effect estimand used was the difference in means between groups. Secondary outcome measurements were the National Institutes of Health Stroke Scale for neurological deficit, the modified Rankin Scale for global disability, and the Barthel Index for activities of daily living.

RESULTS

Out of 132 enrolled patients, 123 were included in the intention-to-treat analysis, and 120 in the per-protocol analysis. Overall, both groups showed improvement at subsequent visits compared with the baseline for Western Aphasia Battery and the National Institutes of Health Stroke Scale. The Cerebrolysin group showed greater improvements in Western Aphasia Battery (visit 4 mean increase of 35.579±16.316 [95% CI, 31.289-39.869] points; P<0.001) compared with the placebo group (20.774±12.486 [95% CI, 17.603-23.945] points; P<0.001), a difference in means of 14.805 (95% CI, 9.521-20.089) points (P<0.001). The Cerebrolysin group also showed significant improvements (higher decreases) in National Institutes of Health Stroke Scale scores compared with the placebo group (2.085 [95% CI, 1.076-3.094] points; P<0.001). Safety analysis raised no concerns (number of patients with adverse events P=0.105, number of adverse events per patient P=0.134). Additionally, the Cerebrolysin group showed greater improvements in functional independence (Barthel Index) and a trend toward reduced disability (modified Rankin Scale) compared with the placebo group.

CONCLUSIONS

Cerebrolysin combined with speech and language therapy offers promising potential for enhancing recovery in poststroke nonfluent aphasia. Significant improvements were observed in language and neurological deficits, underscoring the importance of adjunctive therapies in nonfluent aphasia rehabilitation. Further research with larger cohorts is needed to fully establish the efficacy of this combination therapy.

REGISTRATION

URL: https://www.isrctn.com; Unique identifier: ISRCTN54581790.

High-intensity and low-intensity Pilates have similar effects on pain and disability in people with chronic non-specific low back pain: a randomised trial

QUESTION

In people with chronic non-specific low back pain, what is the effect of high-intensity Pilates exercise compared with low-intensity Pilates exercise on pain, disability, patient-specific function, kinesiophobia and isometric hip strength?

DESIGN

Randomised trial with concealed allocation, blinded assessors and intention-to-treat analysis.

PARTICIPANTS

One hundred and sixty-eight people with chronic non-specific low back pain and aged between 18 and 60 years.

INTERVENTIONS

Participants were allocated to undertake 1-hour sessions of clinical Pilates at either high-intensity or low-intensity, twice per week for 6 weeks.

OUTCOME MEASURES

The primary outcomes were the numerical pain scale and the Roland Morris Disability Questionnaire at the end of the 6-week intervention period. The secondary outcomes were the Patient-Specific Functional Scale, the Tampa Scale for Kinesiophobia and isometric hip strength at 6 weeks. Pain and disability were also re-measured 6 and 12 months after the intervention.

RESULTS

The two Pilates regimens had negligible differences in effects on all outcomes at the end of the intervention period. At 6 and 12 months, the between-group differences in pain intensity were still negligible but the confidence intervals around those estimates spanned from around no effect to a worthwhile benefit (≥ 1.4) from low-intensity Pilates compared with high-intensity Pilates: 6-month MD 0.6 (95% CI -0.2 to 1.4) and 12-month MD 0.8 (95% CI 0.0 to 1.6). The effect on disability remained negligible at 6 and 12 months. Adverse events were less common in the low-intensity group: absolute risk reduction 0.20 (95% CI 0.10 to 0.31).

CONCLUSION

High-intensity and low-intensity Pilates had very similar effects on pain, disability and other outcomes in people with chronic non-specific low back pain. Physiotherapists should endorse low-intensity Pilates exercises for managing chronic non-specific low back pain because the effects on most outcomes are very similar to high-intensity Pilates exercise but there are fewer side effects.

REGISTRATION

RBR-2d2vb9.

Progression of Pilot Trials to Completed Randomized Controlled Trials in Plastic Surgery: A Systematic Review

PURPOSE

Well-designed pilot trials are essential in determining feasibility prior to initiating definitive randomized controlled trials (RCTs) and their implementation into clinical practice. The primary outcome of this study was to identify the number of pilot or feasibility studies in Plastic Surgery that progressed to a definitive RCT. Secondary outcomes included a) number of pilot studies expressing feasibility statements and outcomes and b) reporting quality.

METHODS

MEDLINE, Embase, Web of Science, and clinicaltrials.gov were searched for all pilot RCTs and definitive RCTs in plastic surgery between 2012-2023. Pilot trials were matched to definitive RCTs by keyword, author, and citation report. Feasibility outcomes were presented using descriptive statistics. Reporting quality was evaluated using the Consolidated Standards of Reporting Trials 2010 randomized pilot and feasibility trials extension.

RESULTS

Among 11,540 and 6035 citations screened in 2 separate literature searches, 171 pilot studies and 779 definitive RCTS were included, respectively. Ten (5.8%) pilot studies were associated with a completed RCT, 4 (2.3%) were in progress, and 2 (1.2%) were stopped. For studies that did not progress to a definitive RCT, "inadequate funding" (n = 11, 41.4%) was the most cited reason followed by "insufficient efficacy to justify study progression" (n = 5, 17.3%). The average reporting adherence to the Consolidated Standards of Reporting Trials items was 65.6% (SD 16). Fifty (29.2%) pilot RCTs reported a feasibility statement and 30 (17.5%) reported feasibility outcomes.

CONCLUSIONS

Few pilot trials in plastic surgery progressed to a definitive RCT, and most did not present feasibility statements or outcomes. Pilot studies should precede RCTs and include clear feasibility statements and outcomes.

The ESCAPE Trial for Older People With Chronic Low Back Pain: A Feasibility Study of a Clinical Trial of Group-Based Exercise in Primary Health Care

Low back pain is a highly disabling health condition that generates high costs for patients and healthcare systems. For this reason, it is considered a serious public health problem worldwide. This pilot study aimed to assess the feasibility of a future randomized controlled trial (RCT) by evaluating adherence to treatment, contamination between groups, satisfaction with treatment, and understanding of the exercise instructions provided by the physiotherapist. Additionally, we sought to identify and implement necessary modifications to the exercise protocol for better suitability in older people. We conducted a prospective, registered pilot RCT comparing an 8-week group-based exercise program with a waiting list in older people (≥60 years old) with chronic low back pain. Sixty participants were recruited through social media, pamphlets, and invitations at community referral centers. The study demonstrated the feasibility of a full RCT. Participants reported high satisfaction with the treatment (i.e., 100% indicated willingness to return for future services) and a high understanding of the exercise instructions (i.e., 81.8% reported "very easy" comprehension). Adherence to the exercise program exceeded the average reported for group exercise interventions in older adults (i.e., 82.58%). Dropout was associated solely with preexisting physical activity levels. The exercise protocol was successfully adapted to better suit the needs of the older adult population. This pilot RCT demonstrates the feasibility of a full-scale RCT to evaluate the effectiveness of group exercise in improving pain intensity and disability in older adults with chronic low back pain. The implemented adjustments to the exercise protocol and overall study approach strengthen the methodological foundation and expected accuracy of the future RCT.

Bulevirtide Monotherapy Is Safe and Well Tolerated in Chronic Hepatitis Delta: An Integrated Safety Analysis of Bulevirtide Clinical Trials at Week 48

BACKGROUND AND AIMS

The safety and tolerability of bulevirtide (BLV), a novel entry inhibitor of hepatitis delta virus, were evaluated in an integrated analysis of clinical trial results from patients with chronic hepatitis delta (CHD).

METHODS

Week 48 on-treatment clinical and laboratory results from two Phase 2 trials (MYR203 [NCT02888106] and MYR204 [NCT03852433]) and one Phase 3 trial (MYR301 [NCT03852719]) were pooled (N = 269). Patients were grouped as follows: BLV 2 mg (n = 64), BLV 10 mg (n = 115), pegylated interferon-alfa (n = 39) and control (n = 51). The control group consisted of patients assigned to the delayed treatment group in Study MYR301.

RESULTS

Adverse events (AEs) that occurred more frequently with BLV 2 mg and BLV 10 mg versus control included increased total bile acid levels (20% and 17% vs. 0%), injection-site reactions (16% and 20% vs. 0%), headache (16% and 17% vs. 0%), pruritus (11% and 10% vs. 0%) and eosinophilia (9% and 4% vs. 0%). Increases in total bile acid levels were observed with BLV without clear correlation with AEs, such as pruritus, eosinophilia or vitamin D deficiency. Grade 3 or 4 study drug-related AEs occurred in a higher proportion of patients receiving pegylated interferon-alfa (51%) than with BLV 2 or 10 mg (3% and 4%, respectively). There were no serious AEs related to BLV, and no patients discontinued BLV due to an AE. Neither hepatic decompensation nor death occurred.

CONCLUSIONS

BLV monotherapy was safe and well tolerated through 48 weeks of treatment in patients with CHD.

TRIAL REGISTRATION

NCT02888106, NCT03852433 and NCT03852719.

Improving type 2 diabetes detection among at-risk individuals - comparing the effectiveness of active opportunistic screening using spot capillary-HbA1c testing and venous HbA1c testing: a cluster randomized controlled trial

BACKGROUND

Delayed diagnosis and treatment of type 2 diabetes increases diabetes-related complications, making the high prevalence of undiagnosed type 2 diabetes in Hong Kong an important concern. Point-of-care capillary HbA1c (POC-cHbA1c) testing holds promise as a comparably accurate, convenient, and timely alternative to venous HbA1c (vHbA1c) for type 2 diabetes screening, yet randomized trials are lacking. This study compared the effectiveness of a 2-step active opportunistic screening strategy using POC-cHbA1c versus usual practice employing vHbA1c and multiple clinic visits in detecting type 2 diabetes among at-risk primary care patients. The primary outcomes were to identify the difference in the proportion of type 2 diabetes detected between intervention (POC-cHbA1c) and control (vHbA1c) groups and the uptake rate of POC-cHbA1c versus vHbA1c testing among consenting participants.

METHODS

A cluster randomized controlled trial was conducted in 8 General Out-Patient Clinics between June 2022 and January 2024 using 2-step active opportunistic screening. In step 1, risk factor count, 852 at-risk patients were identified through consecutive sampling during their primary care consultation by specific inclusion and exclusion criteria. In step 2, these at-risk patients then underwent POC-cHbA1c (intervention) or vHbA1c (control) testing. If preliminary HbA1c was ≥ 5.6%, a confirmatory oral glucose tolerance test was offered. Randomization occurred at the clinic level using a random allocation sequence generated by statistical software. Multilevel logistic regression analyses were employed to evaluate the effect of the intervention on the uptake rate, adjusting for patient characteristics and clinic clustering.

RESULTS

POC-cHbA1c had a higher uptake rate than vHbA1c (76.0% vs 37.5%; OR = 7.06, 95% CI [2.47-20.18], p < 0.001). A greater proportion of type 2 diabetes (4.2% vs 1.4%; p = 0.016) and pre-diabetes (11.8% vs 6.9%; p = 0.015) were detected using POC-cHbA1c versus vHbA1c. POC-cHbA1c was more likely to detect type 2 diabetes/pre-diabetes combined (OR = 1.99, 95% CI [1.01-3.95], p = 0.048). The number-needed-to-screen to detect one additional type 2 diabetes patient with POC-cHbA1c was 61 versus vHbA1c.

CONCLUSIONS

POC-cHbA1c testing was associated with a higher uptake rate and detection of type 2 diabetes versus vHbA1c, underscoring its potential as an effective type 2 diabetes screening strategy in primary care.

TRIAL REGISTRATION

NCT06382363 (retrospectively registered: 2024-04-19).

Non-pharmacological and non-surgical treatments for low back pain in adults: an overview of Cochrane reviews

BACKGROUND

Low back pain (LBP) is a significant public health issue due to its high prevalence and associated disability burden. Clinical practice guidelines recommend non-pharmacological/non-surgical interventions for managing pain and function in people with LBP.

OBJECTIVES

To provide accessible, high-quality evidence on the effects of non-pharmacological and non-surgical interventions for people with LBP and to highlight areas of remaining uncertainty and gaps in the evidence regarding the effects of these interventions for people with LBP.

METHODS

We searched the Cochrane Database of Systematic Reviews from inception to 15 April 2023, to identify Cochrane reviews of randomised controlled trials testing the effect of non-pharmacological/non-surgical interventions, unrestricted by language. Major outcomes were pain intensity, function and safety. Two authors independently assessed eligibility, extracted data and assessed the quality of the reviews using AMSTAR 2 (A MeaSurement Tool to Assess Systematic Reviews) and the certainty of the evidence using GRADE. The primary comparison was placebo/sham.

MAIN RESULTS

We included 31 Cochrane reviews of 644 trials that randomised 97,183 adults with LBP. We have high confidence in the findings of 19 reviews, moderate confidence in the findings of two reviews, and low confidence in the findings of 10 reviews. We present results for non-pharmacological/non-surgical interventions compared to placebo/sham or no treatment/usual care at short-term (≤ three months) follow-up. Placebo/sham comparisons Acute/subacute LBP Compared to placebo, there is probably no difference in function (at one-week follow-up) for spinal manipulation (standardised mean difference (SMD) -0.08, 95% confidence interval (CI) -0.37 to 0.21; 2 trials, 205 participants; moderate-certainty evidence). Data for safety were reported only for heated back wrap. Compared to placebo, heated back wrap may result in skin pinkness (6/128 participants versus 1/130; 2 trials; low-certainty evidence). Chronic LBP Compared to sham acupuncture, acupuncture probably provides a small improvement in function (SMD -0.38, 95% CI -0.69 to -0.07; 3 trials, 957 participants; moderate-certainty evidence). Compared to sham traction, there is probably no difference in pain intensity for traction (0 to 100 scale, mean difference (MD) -4, 95% CI -17.7 to 9.7; 1 trial, 60 participants; moderate-certainty evidence). Data for safety were reported only for acupuncture. There may be no difference between acupuncture and sham acupuncture for safety outcomes (risk ratio (RR) 0.68, 95% CI 0.42 to 1.10; I2 = 0%; 4 trials, 465 participants; low-certainty evidence). No treatment/usual care comparisons Acute/subacute LBP Compared to advice to rest, advice to stay active probably provides a small reduction in pain intensity (SMD -0.22, 95% CI -0.02 to -0.41; 2 trials, 401 participants; moderate-certainty evidence). Compared to advice to rest, advice to stay active probably provides a small improvement in function (SMD -0.29, 95% CI -0.09 to -0.49; 2 trials, 400 participants; moderate-certainty evidence). Data for safety were reported only for massage. There may be no difference between massage and usual care for safety (risk difference 0, 95% CI -0.07 to 0.07; 1 trial, 51 participants; low-certainty evidence). Chronic LBP Compared to no treatment, acupuncture probably provides a medium reduction in pain intensity (0 to 100 scale, mean difference (MD) -10.1, 95% CI -16.8 to -3.4; 3 trials, 144 participants; moderate-certainty evidence), and a small improvement in function (SMD -0.39, 95% CI -0.72 to -0.06; 3 trials, 144 participants; moderate-certainty evidence). Compared to usual care, acupuncture probably provides a small improvement in function (MD 9.4, 95% CI 6.15 to 12.65; 1 trial, 734 participants; moderate-certainty evidence). Compared to no treatment/usual care, exercise therapies probably provide a small to medium reduction in pain intensity (0 to 100 scale, MD -15.2, 95% CI -18.3 to -12.2; 35 trials, 2746 participants; moderate-certainty evidence), and probably provide a small improvement in function (0 to 100 scale, MD -6.8, 95% CI -8.3 to -5.3; 38 trials, 2942 participants; moderate-certainty evidence). Compared to usual care, multidisciplinary therapies probably provide a medium reduction in pain intensity (SMD -0.55, 95% CI -0.83 to -0.28; 9 trials, 879 participants; moderate-certainty evidence), and probably provide a small improvement in function (SMD -0.41, 95% CI -0.62 to -0.19; 9 trials, 939 participants; moderate-certainty evidence). Compared to no treatment, psychological therapies using operant approaches probably provide a small reduction in pain intensity (SMD -0.43, 95% CI -0.75 to -0.11; 3 trials, 153 participants; moderate-certainty evidence). Compared to usual care, psychological therapies (including progressive muscle relaxation and behavioural approaches) probably provide a small reduction in pain intensity (0 to 100 scale, MD -5.18, 95% CI -9.79 to -0.57; 2 trials, 330 participants; moderate-certainty evidence), but there is probably no difference in function (SMD -0.2, 95% CI -0.41 to 0.02; 2 trials, 330 participants; moderate-certainty evidence). It is uncertain whether there is a difference between non-pharmacological/non-surgical interventions and no treatment/usual care for safety (very low-certainty evidence).

AUTHORS' CONCLUSIONS

Spinal manipulation probably makes no difference to function compared to placebo for people with acute/subacute LBP. Acupuncture probably improves function slightly for people with chronic LBP, compared to sham acupuncture. There is probably no difference between traction and sham traction for pain intensity in people with chronic LBP. Compared to advice to rest, advice to stay active probably reduces pain intensity slightly and improves function slightly for people with acute LBP. Acupuncture probably reduces pain intensity, and improves function slightly for people with chronic LBP, compared to no treatment. Acupuncture probably improves function slightly for people with chronic LBP, compared to usual care. Exercise therapies probably reduce pain intensity, and improve function slightly for people with chronic LBP, compared to no treatment/usual care. Multidisciplinary therapies probably reduce pain intensity, and improve function slightly for people with chronic LBP, compared to usual care. Compared to usual care, psychological therapies probably reduce pain intensity slightly, but probably make no difference to function for people with chronic LBP.

Effect of the online module on leadership in knowledge acquisition among nursing students: A randomized controlled study protocol

Leadership is an essential skill for success in nursing practice, influencing the nursing team's organization, the quality of health services and decision-making in complex situations. The COVID-19 pandemic has further highlighted the need for leadership in nursing, with nurses playing a crucial role in addressing the crisis. However, there are challenges in leadership training, with conventional expository class methods often neglecting this skill. This study proposes to evaluate the impact of an online educational module focused on leadership for Nursing students, recognizing the importance of training future professionals from the beginning of their careers. To present a study protocol to evaluate the effect of an online educational module in comparison with a conventional expository class related to knowledge acquisition by Nursing students on the topic of Leadership. A Randomized Controlled Study, single-blind, two-arm will be conducted. Sixth semester students regularly enrolled in the nursing course will take part in the study. Participants will be randomly distributed into two groups, namely the Control Group, which will undergo a conventional class, and the Experimental Group, which will undergo an online educational module. Two important moments will be considered to evaluate the results of the intervention. A pesquisa, em fase de design, terá resultados, conclusões e análises definidos após a coleta de dados. The primary outcome is expected to demonstrate that the online module is equal to or superior to the conventional module in the acquisition of knowledge about leadership, addressing topics such as team involvement, organizational culture, conflict management and feedback. The secondary outcome will assess the acquisition of knowledge about leadership through an adaptation of the Nursing Student Self-Perception Questionnaire in the Exercise of Leadership.

Retracted vs non-retracted obstetrical randomized trials: Which quality criteria are most associated with retraction for untrustworthiness?

BACKGROUND

Randomized control trials (RCTs) are an essential pillar of scientific knowledge and medical practice, and their integrity has important implications for reliable systemic reviews and meta-analyses. However, the number of article retractions due to falsified data and scientific misconduct has increased in recent years. In response, the scientific community has pursued the creation of quality criteria that can be utilized to promote trustworthiness.

METHODS

After a quality criteria checklist was created by a team of experts, retracted and nonretracted studies were evaluated for adherence to assess the checklist's usefulness and identify potential pitfalls. Retracted studies published in obstetric literature and retracted between 1994-2024 were identified using the online Retraction Watch Database. A previously created database of non-retracted obstetric RCTs published between 2018-2020 was used for the control group.

RESULTS

A total of 173 studies were identified, 136 non-retracted and 37 retracted. Overall, 13 of 17 (76.5 %) criteria were statistically different between retracted and non-retracted articles. A cutoff of ≤ 11 total quality criteria granted 94.9 % (95 % CI, 89.7 - 97.9) sensitivity and 78.4 % (95 % CI, 61.8 - 90.2) specificity in distinguishing non-retracted from retracted studies.

CONCLUSIONS

Retracted studies were significantly less likely to adhere to the 17-quality criteria checklist compared to non-retracted studies, providing useful insight to peer-reviewed scientific journals about what to evaluate for in an RCT manuscript prior to publication. The authors recommend that journal editors play close attention to criteria related to research ethics, data falsification, and risk of bias.

Effectiveness at long-term of a multidisciplinary intervention in the reduction of overuse of benzodiazepine prescriptions: A cluster controlled trial

BACKGROUND

The overuse of Benzodiazepines (BZD) has become an area of concern because of its consequences on patients' health and healthcare costs.

OBJECTIVE

to determine whether a multicomponent intervention based on a multidisciplinary education program is effective in withdrawal from BZD long-term use, compared to usual care.

METHODS

Cluster-randomized, parallel-group trial with health centres as units of randomization and patients as units of analysis.

INCLUSION CRITERIA

adults with more than 4 weeks of BZD use, without serious mental disorder, non-terminal, without alcohol dependence or dementia.

INTERVENTION

(i) discussion with the patient describing the advantages, disadvantages and alternatives of BZD use accompanied by tapering protocol with educational material, (ii) the offer of a brief consultation, and (iii) a letter addressed to the patient supported by 6 scientific societies. The primary outcome was dispensing of BZD. Socioeconomic variables and others related with the consumption of BZD (Indication, previously attempted to cease and duration of use).

ANALYSIS

The effect of the intervention on the rate of dispensing of BZD using the multivariable generalized-estimating-equations (GEE) extension of logistic regression.

RESULTS

Complete cessation of dispensing BZD at six months after the intervention was achieved in 108 of 333 participants (32,4 %) compared to 27 of 139 controls (19,4 %). This decrease was maintained over 5 years (41,7 % vs. 33,8 %). Adjusted absolute risk difference was -14.3 (-19.6 to -9.5). An adjusted OR 2.11 (95 % CI, 1.24-3.59). Those with high income were more likely to quit using BZD with the intervention as those with a lower income (OR 1.81, IC 95 % 1.13-2.9, p = 0.012). Similarly, those who had previously tried to withdraw from BZD were more likely to stop using with the intervention (OR 1.8, IC 95 % 1.17-2.8, p = 0.007). Those with high income were more likely to quit using BZD with the intervention as those with a lower income (OR 1.81, IC 95 % 1.13-2.9, p = 0.012). Similarly, those who had previously tried to withdraw from BZD were more likely to stop using with the intervention (OR 1.8, IC 95 % 1.17-2.8, p = 0.007).

CONCLUSIONS

The intervention was effective at 6 months and its effects persist up to 5 years. The factors favouring interruption BZD seem to be having a high income and a previously tried to withdraw from BZD.

GPT for RCTs? Using AI to determine adherence to clinical trial reporting guidelines

OBJECTIVES

Adherence to established reporting guidelines can improve clinical trial reporting standards, but attempts to improve adherence have produced mixed results. This exploratory study aimed to determine how accurate a large language model generative artificial intelligence system (AI-LLM) was for determining reporting guideline compliance in a sample of sports medicine clinical trial reports.

DESIGN

This study was an exploratory retrospective data analysis. OpenAI GPT-4 and Meta Llama 2 AI-LLM were evaluated for their ability to determine reporting guideline adherence in a sample of sports medicine and exercise science clinical trial reports.

SETTING

Academic research institution.

PARTICIPANTS

The study sample included 113 published sports medicine and exercise science clinical trial papers. For each paper, the GPT-4 Turbo and Llama 2 70B models were prompted to answer a series of nine reporting guideline questions about the text of the article. The GPT-4 Vision model was prompted to answer two additional reporting guideline questions about the participant flow diagram in a subset of articles. The dataset was randomly split (80/20) into a TRAIN and TEST dataset. Hyperparameter and fine-tuning were performed using the TRAIN dataset. The Llama 2 model was fine-tuned using the data from the GPT-4 Turbo analysis of the TRAIN dataset.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was the F1-score, a measure of model performance on the TEST dataset. The secondary outcome was the model's classification accuracy (%).

RESULTS

Across all questions about the article text, the GPT-4 Turbo AI-LLM demonstrated acceptable performance (F1-score=0.89, accuracy (95% CI) = 90% (85% to 94%)). Accuracy for all reporting guidelines was >80%. The Llama 2 model accuracy was initially poor (F1-score=0.63, accuracy (95% CI) = 64% (57% to 71%)) and improved with fine-tuning (F1-score=0.84, accuracy (95% CI) = 83% (77% to 88%)). The GPT-4 Vision model accurately identified all participant flow diagrams (accuracy (95% CI) = 100% (89% to 100%)) but was less accurate at identifying when details were missing from the flow diagram (accuracy (95% CI) = 57% (39% to 73%)).

CONCLUSIONS

Both the GPT-4 and fine-tuned Llama 2 AI-LLMs showed promise as tools for assessing reporting guideline compliance. Next steps should include developing an efficient, open-source AI-LLM and exploring methods to improve model accuracy.

The effect of Mulligan and Maitland techniques on pain, functionality, proprioception, and quality of life in individuals with rotator cuff lesions

BACKGROUND

Rotator cuff disease treatment typically involves manual therapy and exercise as part of physical therapy.

PURPOSE

This study aims to investigate the effects of Mulligan and Maitland mobilization methods on pain, functionality, quality of life, and proprioception in individuals with rotator cuff lesions. STUDY DESIGN: This was a single-blinded randomized clinical trial.

METHODS

The study included 45 individuals with rotator cuff lesions. Participants were randomly divided into three groups: conventional exercise, Maitland mobilization, and Mulligan mobilization. All participants were assessed pretreatment and post treatment using the Visual Analog Scale, Disabilities of the Arm, Shoulder, and Hand, Rotator Cuff Quality of Life, range of motion (ROM), and proprioception.

RESULTS

All parameters, except proprioception, improved significantly in all three groups post treatment (p < 0.05). Mulligan group (MG) and Maitland mobilization group (MMG) had higher improvements to the conventional exercise group (CG) in terms of flexion ROM (p = 0.05, effect size = 0.22), abduction ROM (p = 0.02, effect size = 0.26), Disabilities of the Arm, Shoulder, and Hand (p < 0.001, effect size = 0.56). Also, the MG group had greater improvements to the MMG and CG groups in terms of Rotator Cuff Quality of Life/symptoms (p < 0.001, effect size = 0.43), job (p < 0.001, effect size = 0.61), lifestyle (p < 0.001, effect size = 0.42), emotional parameters (p < 0.001, effect size = 0.29). MG was more effective than the MMG in Visual Analog Scale activity (p < 0.001, effect size = 0.32), external rotation (p = 0.012, effect size = 0.19), and abduction ROM (p = 0.002, effect size = 0.26). However, no improvement in proprioception was observed across all groups (p > 0.05).

CONCLUSIONS

This study concluded that, in addition to conventional treatment, both Mulligan and Maitland mobilization therapy effectively improve range of motion, functionality, and quality of life.

Transdiagnostic internet cognitive behavioural therapy for anxiety and depressive symptoms in postnatal women: protocol of a randomized controlled trial

BACKGROUND

Nearly 20% of women will be confronted with anxiety or depressive disorders during the perinatal period and this may lead to adverse outcomes for both mother and child. Cognitive behavioural therapy (CBT) is the psychological intervention with the most empirical support for the clinical management of anxiety and depressive disorders. Anxiety and depression frequently occur in women during the perinatal period, and there is growing evidence that internet-delivered CBT (iCBT) could be an acceptable and effective intervention. THIS WAY UP, an Australian digital mental health service, has developed a program for postnatal anxiety and depression. This study protocol aims to examine the acceptability and efficacy of a French-Canadian adaptation of the program.

METHODS/DESIGN

The research team propose to conduct a mixed hybrid type 1 pragmatic randomized clinical trial and implementation study to replicate the findings of the trial conducted in Australia by Loughnan et al. (2019), as well as explore barriers and facilitators to potential large-scale implementation. TREATMENT AND CONTROL CONDITIONS: a) postnatal anxiety and depression iCBT program with three lessons to complete in a six-week period, added to treatment-as-usual (TAU); b) TAU. Participants will include French-speaking women with probable postnatal depression or anxiety as per the Generalized Anxiety Disorder-7 (GAD-7) or the Edinburgh Postnatal Depression Scale (EPDS). The primary outcome measures will be the GAD-7 and the EPDS. Secondary outcome measures will comprise self-reported instruments to evaluate psychological distress, quality of life, mother-child experience, and treatment experience. Qualitative interviews with participants and health professionals will provide insights on acceptability and delivery of the iCBT program.

STATISTICAL ANALYSIS

Statistical analysis will follow intent-to-treat principles. A mixed model regression approach will be used to account for between- and within-subject variations in the analysis of the effects of iCBT compared to TAU only intervention.

DISCUSSION

The study will generate important data of efficacy and acceptability to patients, clinicians, and decision-makers to inform the scaling-up of the postnatal iCBT intervention in Canada.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT06778096, prospectively registered on 2025/01/16.

Acute effects of resistance exercise intensity and repetition at a predetermined volume on inhibitory control: a randomized controlled trial

Background

This study explores the effects of acute resistance exercise (RE) on inhibitory control (IC), emphasizing exercise volume.

Methods

In total, 78 young adults were randomly assigned to one of three groups: the moderate-intensity group [MI; 60% one repetition maximum (1RM), 3 × 10 reps], the low-intensity group (LI; 30% 1RM, 3 × 20 reps), or the control group (CON; 35 min reading). The exercise groups were volume-matched. Baseline equivalence was assessed via one-way analysis of variance (ANOVA) for demographic variables and chi-square for gender. One-way analysis of covariance examined post-test interreference inverse efficiency score scores, controlling for pre-test values. Two-way ANOVA assessed Group (MI, LI, CON) × Time effects on heart rate (resting; pre-test, during intervention, and post-test), rate of perceived exertion (pre-test, during intervention, and post-test), and lactate (pre-test, mid-test, and post-test). Mean differences and 95% confidence intervals supplemented p-values.

Results

IC was assessed using the Stroop Task, revealing better performance in both the MI (p = 0.026) and LI (p = 0.040) groups compared to CON, though no significant difference was found between the two exercise groups. Blood lactate levels significantly increased post-exercise in both the MI (p = 0.012) and LI (p < 0.001) groups, but again, there was no significant difference between them.

Conclusions

These findings highlight that acute RE, regardless of intensity, enhances IC and raises blood lactate when exercise volume is controlled. Practitioners might tailor RE protocols by adjusting the intensity to match individuals' capabilities without compromising the cognitive and physiological benefits.

Clinical Trial Registration

identifier (NCT05311202).

Five-year Follow-up of the Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods-A Noninferiority Randomised Controlled Trial of Urodynamics

BACKGROUND AND OBJECTIVE

Lower urinary tract symptoms (LUTS) are a key indication for surgery in older men. The Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM) study evaluated the diagnostic pathway for men considering surgery to treat LUTS and reported the outcomes at 18 mo. This long-term follow-up study reports the symptoms and rates of prostate surgery at 5 yr.

METHODS

UPSTREAM participants who had consented to long-term follow-up received postal questionnaires at 5 yr after randomisation (October 2019-December 2021). The primary outcome was the patient-reported International Prostate Symptom Score (IPSS, scale 0-35). Rates of surgery, derived from the National Health Service (NHS) England routine data, were a key secondary outcome. An intention-to-treat analytic approach was utilised.

KEY FINDINGS AND LIMITATIONS

At 5 yr, 211/427 (49.4%) participants in the intervention group and 204/393 (51.9%) in the routine care group completed the questionnaires, with routine data obtained for 801/820 (97.7%). The mean IPSS at 5 yr did not differ between randomised groups (adjusted difference 0.41, 95% confidence interval -1.10, 1.93), nor did the rates of surgery (0.96 [0.71, 1.28]). Urinary and sexual symptoms also showed no differences between the randomised groups. The main limitation is the reduced numbers of men in follow-up. In UPSTREAM, men were randomised to routine care diagnostic tests plus invasive urodynamics (intervention) or routine care only for LUTS. Treatment choice was made by the participants, advised by their clinicians.

CONCLUSIONS AND CLINICAL IMPLICATIONS

Five-year follow-up does not support the routine use of invasive urodynamics in reducing LUTS or rates of prostate surgery. Urodynamics should be used selectively in the evaluation of uncomplicated LUTS.

Effect of virtual reality therapy on pain relief in sports rehabilitation for young adults: A systematic review and meta-analysis

BACKGROUND

Virtual reality is an emerging technology that intends to promote motor and perceptual-cognitive skills, which could benefit people with sports injuries. However, there is a lack of meta-analyses on its effectiveness in sports injury rehabilitation for young adults.

OBJECTIVE

This systematic review and meta-analysis of randomised controlled trials evaluated the effectiveness of virtual reality therapy (VRT) on sports-related musculoskeletal rehabilitation in reducing pain and improving functional levels and balance among young adults.

METHODS

Studies and relevant reviews were searched using PubMed, CINAHL, EMBASE, CENTRAL, Web of Science, Scopus, grey literature in Google Scholar, ProQuest Dissertation and Theses, and manual searching of reference lists. Studies published up to 19 March 2024 involving young adults aged 18-40 with sports-related injuries undergoing VRT were included. The comparator was conventional rehabilitation. Meta-analysis was done by pooling standardised mean differences (SMD) or mean differences (MD) of pain, functional levels, and balance outcomes using the random-effects model. Quality appraisal was done using the Cochrane Risk of Bias Tool and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE).

RESULTS

Eleven studies (n = 507 participants) were included. VRT seems significantly superior to conventional therapy in improving pain post-intervention (pooled SMD -5.16, 95% CI -7.36 to -2.97) and at long-term follow-up (pooled SMD -10.08, 95% CI -12.46 to -8.01). However, outcomes for functional levels and balance measured using the Star Excursion Balance Test were non-significant. Five trials had a low risk of bias, 3 were at high risk, and 3 had an unclear risk of bias. Outcomes were of very low to low certainty.

CONCLUSION

VRT seems able to significantly improve pain among young adults with sports-related musculoskeletal injuries. Therapists and clinicians can consider incorporating VRT in rehabilitation to engage participants and improve outcomes. Limited research has investigated the effect of VRT on function and balance.

Effects of couple-based violence prevention education on male partners' knowledge, attitudes and controlling behavior related to intimate partner violence in rural Ethiopia: a cluster randomized controlled trial

Background

Supportive attitudes toward wife-beating and the experience of controlling behavior from husbands have been known to increase the risks of intimate partner violence (IPV). The aim of this study was to determine the effects of couple-based violence prevention education in addressing IPV-related knowledge, attitudes, and controlling behavior among male partners in rural Ethiopia.

Method

A cluster randomized controlled trial was conducted using a two-arm parallel group design. The 16 clusters were randomly allocated into 8 intervention groups and 8 control groups. A total of 432 couples (432 male partners and 432 pregnant wives) participated in the trial. Couple-based violence prevention education (CBVPE) was provided to the participants in the intervention group, while the control group received routine or standard care. Difference-in-difference analysis and the Generalized Estimating Equation (GEE) model were used to assess the effectiveness of the intervention.

Result

At the endline, 94.4% of male partners in the intervention group and 94.9% in the control group were available for the intention-to-treat analysis. Male partners in the intervention group were 3.7 times more likely to have good knowledge about IPV compared to male partners in the control group (AOR = 3.7; 95% CI 2.6-5.4). Male partners in the intervention group were 67.6% less likely to report supportive attitudes toward wife-beating compared to those in the control group (AOR = 0.324; 95% CI 0.229-0.459). Also, the proportion of controlling behavior exhibited by male partners in the intervention group was 56.4% less compared to the control group (AOR = 0.436; 95% CI 0.317-0.600).

Conclusion

The intervention proved effective in enhancing knowledge about IPV, reducing supportive attitudes toward wife-beating, and curbing controlling behaviors among male partners in the study setting. This approach holds promise for scaling up and adapting to similar contexts in Ethiopia.

Trial registration

The trial was registered on ClinicalTrials.gov with the identifier NCT05856214 on May 4, 2023.

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.