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Completed Systematic Reviews




Multi-factorial interventions to prevent falls in older adults (Topic 1 in Data Abstraction Assistant [DAA] Trial)


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Statistics: 0 Studies, 1 Key Question, 1 Extraction Form,
Date Published: Jun 28, 2018 07:14PM
Description: This SRDR project was created to house the data abstraction forms (as PDFs) for the systematic review on multi-factorial interventions to prevent falls in older adults. This systematic review was used as Topic 1 to identify studies for data abstraction during the Data Abstraction Assistant (DAA) Trial. The DAA Trial is registered with the National Information Center on Health Services Research and Health Care Technology (NICHSR) HSRP20152269. Registered November 9, 2015. https://wwwcf.nlm.nih.gov/hsr_project/view_hsrproj_record.cfm?NLMUNIQUE_ID=20152269&SEARCH_FOR=Tianjing%20Li
Contributor(s): None Provided
DOI: DOI pending.
Funding Source: None Provided
Methodology Description: None Provided

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Nonpharmacological Versus Pharmacological Treatments for Adult Patients With Major Depressive Disorder - Psychotherapy Interventions


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Statistics: 20 Studies, 10 Key Questions, 7 Extraction Forms,
Date Published: Jun 27, 2018 04:52PM
Description: Comparison of the benefits and harms of second-generation antidepressants (SGAs), psychological treatment options as first-step interventions for adult outpatients with acute -phase major depressive disorder (MDD), and as second-step interventions for patients with MDD who did not achieve remission after a first treatment attempt with SGAs.
Contributor(s): Gerald Gartlehner, M.D., M.P.H. Bradley N. Gaynes, M.D., M.P.H. Halle R. Amick, M.S.P.H. Gary Asher, M.D., M.P.H. Laura C. Morgan, M.A. Emmanuel Coker-Schwimmer, M.P.H. Catherine Forneris, Ph.D., ABPP Erin Boland, B.A. Linda J. Lux, M.P.A. Susan Gaylord, Ph.D. Carla Bann, Ph.D. Christiane Barbara Pierl, Ph.D., M.P.H. Kathleen N. Lohr, Ph.D., M.Phil., M.A.
DOI: DOI pending.
Funding Source: Agency for Heatlhcare Quality and Research
Methodology Description: For the Systematic Review, we worked with a Technical Expert Panel representing the consumer perspective and professional organizations, researchers, and payers with expertise in psychopharmacology, psychotherapy, complementary and alternative medicine (CAM), and exercise therapies for depression, to finalize our methodological approach. Five literature databases were searched and dually screened following established inclusion/exclusion criteria. Individual trials were abstracted and dually rated for risk of bias. We qualitatively synthesized the data by each individual comparison eligible within each Key Question, and when data were sufficient we augmented findings with quantitative analyses. We graded the strength of evidence for outcomes deemed as important or critical for decisionmaking.

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Nonpharmacological Versus Pharmacological Treatments for Adult Patients With Major Depressive Disorder - CAM Interventions


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Statistics: 21 Studies, 10 Key Questions, 6 Extraction Forms,
Date Published: Jun 27, 2018 04:52PM
Description: Comparison of the benefits and harms of second-generation antidepressants (SGAs), psychological treatment options as first-step interventions for adult outpatients with acute -phase major depressive disorder (MDD), and as second-step interventions for patients with MDD who did not achieve remission after a first treatment attempt with SGAs.
Contributor(s): Gerald Gartlehner, M.D., M.P.H. Bradley N. Gaynes, M.D., M.P.H. Halle R. Amick, M.S.P.H. Gary Asher, M.D., M.P.H. Laura C. Morgan, M.A. Emmanuel Coker-Schwimmer, M.P.H. Catherine Forneris, Ph.D., ABPP Erin Boland, B.A. Linda J. Lux, M.P.A. Susan Gaylord, Ph.D. Carla Bann, Ph.D. Christiane Barbara Pierl, Ph.D., M.P.H. Kathleen N. Lohr, Ph.D., M.Phil., M.A.
DOI: DOI pending.
Funding Source: Agency for Heatlhcare Quality and Research
Methodology Description: For the Systematic Review, we worked with a Technical Expert Panel representing the consumer perspective and professional organizations, researchers, and payers with expertise in psychopharmacology, psychotherapy, complementary and alternative medicine (CAM), and exercise therapies for depression, to finalize our methodological approach. Five literature databases were searched and dually screened following established inclusion/exclusion criteria. Individual trials were abstracted and dually rated for risk of bias. We qualitatively synthesized the data by each individual comparison eligible within each Key Question, and when data were sufficient we augmented findings with quantitative analyses. We graded the strength of evidence for outcomes deemed as important or critical for decisionmaking.

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Doxycycline plus ivermectin versus ivermectin alone for treatment of patients with onchocerciasis (2016)


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Statistics: 3 Studies, 1 Key Question, 1 Extraction Form,
Date Published: Jun 27, 2018 04:51PM
Description: OBJECTIVES: The primary aim of this review was to assess the effectiveness of doxycycline plus ivermectin versus ivermectin alone for prevention and treatment of onchocerciasis. The secondary aim was to assess the effectiveness of doxycycline plus ivermectin versus ivermectin alone for prevention and treatment of onchocercal ocular lesions in communities co-endemic for onchocerciasis and Loa loa (loiasis) infection.
Contributor(s): Abegunde AT, Ahuja RM, Okafor NJ. Doxycycline plus ivermectin versus ivermectin alone for treatment of patients with onchocerciasis. Cochrane Database of Systematic Reviews 2016, Issue 1. Art. No.: CD011146. DOI: 10.1002/14651858.CD011146.pub2.
DOI: DOI pending.
Funding Source: Grant 1 U01 EY020522, National Eye Institute, National Institutes of Health, USA
Methodology Description: SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (Issue 7, 2015), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to July 2015), EMBASE (January 1980 to July 2015), PubMed (1948 to July 2015), Latin American and Caribbean Health Sciences Literature Database (LILACS) (1982 to July 2015), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) (last searched 1 July 2014), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 15 July 2015. SELECTION CRITERIA: We included randomized controlled trials (RCTs) that had compared doxycycline plus ivermectin versus ivermectin alone. Participants with or without one or more characteristic signs of ocular onchocerciasis resided in communities where onchocerciasis was endemic. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial eligibility and extracted data. We used standard methodological procedures as expected by Cochrane.

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Noninvasive, Nonpharmacological Treatment for Chronic Pain: A Systematic Review [Entered Retrospectively]


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Statistics: 206 Studies, 5 Key Questions, 5 Extraction Forms,
Date Published: Jun 18, 2018 06:34PM
Description: Structured Abstract Objectives. Many interventions are available to manage chronic pain; understanding the durability of treatment effects may assist with treatment selection. We sought to assess which noninvasive, nonpharmacological treatment for selected chronic pain conditions are associated with persistent improvement in function and pain outcomes at least 1 month after the completion of treatment. Data sources. Electronic databases (Ovid MEDLINE®, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews), through November 2017, reference lists, and ClinicalTrials.gov. Review methods. Using predefined criteria, we selected randomized controlled trials of noninvasive, nonpharmacological treatments for five common chronic pain conditions (chronic low back pain, chronic neck pain, osteoarthritis of the knee, hip, or hand, fibromyalgia, and tension headache) that addressed efficacy or harms compared with usual care, no treatment, waitlist, placebo, or sham intervention; compared with pharmacological therapy; or compared with exercise. Study quality was assessed, data extracted, and results summarized for function and pain. Only trials reporting results for at least 1 month post-intervention were included. We focused on the persistence of effects at short term (1 to < 6 months following treatment completion), intermediate term (≥6 to <12 months), and long term (≥12 months). Results. 218 publications (202 trials) were included. Many included trials were small. Evidence on outcomes beyond 1 year after treatment completion was sparse. Most trials enrolled patients with moderate baseline pain intensity (e.g., >5 on a 0 to 10 point numeric rating scale) and duration of symptoms ranging from 3 months to >15 years. The most common comparison was against usual care. Chronic low back pain: At short term, massage, yoga, and psychological therapies (primarily cognitive behavioral therapy [CBT]) (Strength of evidence [SOE]: Moderate) and exercise, acupuncture, spinal manipulation, and multidisciplinary rehabilitation (SOE: Low) were associated with slight improvements in function compared with usual care or inactive controls. Except for spinal manipulation, these interventions also improved pain. Effects on intermediate term function were sustained for yoga, spinal manipulation, multidisciplinary rehabilitation (SOE: Low), and psychological therapies (SOE: Moderate). Improvements in pain continued into intermediate term for exercise, massage and yoga (moderate effect, SOE: Low), mindfulness-based stress reduction (small effect, SOE: Low), spinal manipulation, psychological therapies, and multidisciplinary rehabilitation (small effects, SOE: Moderate). For acupuncture, there was no difference in pain at intermediate term, but a slight improvement at long term (SOE: Low). Psychological therapies were associated with slightly greater improvement than usual care or an attention control on both function and pain at short-term, intermediate-term, and long-term followup (SOE: Moderate). At short and intermediate term, multidisciplinary rehabilitation slightly improved pain compared with exercise (SOE: Moderate). High-intensity multidisciplinary rehabilitation (≥20 hours/week or >80 hours total) was not clearly better than nonhigh-intensity programs. Chronic neck pain: At short- and intermediate-terms, acupuncture and Alexander Technique were associated with slightly improved function compared with usual care (both interventions), sham acupuncture, or sham laser (SOE: Low), but no improvement in pain was seen at any time (SOE: Low). Short-term, low-level laser therapy was associated with moderate improvement in function and pain (SOE: Moderate). Combination exercise (any 3 of the following: muscle performance, mobility, muscle re-education, aerobic) demonstrated a slight improvement in pain and function short and long-term (SOE: Low). Osteoarthritis: For knee osteoarthritis, at short-term exercise and ultrasound demonstrated small short-term improvements in function compared with usual care, an attention control or sham procedure (SOE: Moderate for exercise, Low for ultrasound), which persisted into the intermediate term only for exercise (SOE: Low). Exercise was also associated with moderate improvement in pain (SOE: Low). Long term, the small improvement in function seen with exercise persisted, but there was no clear effect on pain (SOE: Low). Evidence was sparse on interventions for hip and hand osteoarthritis. Exercise for hip osteoarthritis was associated with slightly greater function and pain improvement than usual care short term (SOE: Low). The effect on function was sustained intermediate term (SOE: Low). Fibromyalgia: In the short term, acupuncture (SOE: Moderate), CBT, tai chi, qigong, and exercise (SOE: Low) were associated with slight improvements in function compared with an attention control, sham, no treatment or usual care. Exercise (SOE: Moderate) and CBT improved pain slightly and tai chi and qigong (SOE: Low) improved pain moderately in the short term. At intermediate term for exercise (SOE: Moderate), acupuncture and CBT (SOE: Low), slight functional improvements persisted and were also seen for myofascial release massage and multidisciplinary rehabilitation (SOE: Low); pain was improved slightly with multidisciplinary rehabilitation in the intermediate-term (SOE: Low). In the long term, small improvements in function continued for multidisciplinary rehabilitation but not for exercise or massage (SOE: Low for all); massage (SOE: Low) improved long-term pain slightly but no clear impact on pain for exercise (SOE: Moderate) or multidisciplinary rehabilitation (SOE: Low) was seen. Short-term CBT was associated with a slight improvement in function but not pain compared with pregabalin. Chronic tension headache: Evidence was sparse and the majority of trials were of poor quality. Spinal manipulation slightly improved function and moderately improved pain short-term versus usual care and laser acupuncture was associated with slight pain improvement short term compared with sham (SOE Low). There was no evidence suggesting increased risk for serious treatment-related harms for any of the interventions, although data on harms were limited. Conclusions. Exercise, multidisciplinary rehabilitation, acupuncture, cognitive behavioral therapy, and mind-body practices were most consistently associated with durable slight to moderate improvements in function and pain for specific chronic pain conditions. Our findings provided some support for clinical strategies that focused on use of nonpharmacological therapies for specific chronic pain conditions. Additional comparative research on sustainability of effects beyond the immediate post-treatment period is needed, particularly for conditions other than low back pain.
Contributor(s): Andrea Skelly, Ph.D., M.P.H., Roger Chou, M.D., Joseph Dettori, Ph.D., M.P.H., M.P.T., Judith Turner, Ph.D., Janna Friedly, M.D., Sean Rundell, Ph.D., D.P.T., Rochelle Fu, Ph.D., Erika Brodt, B.S., Ngoc Wasson, M.P.H., Cassandra Winter, B.S., Aaron Ferguson, B.S.
Funding Source: Agency for Healthcare Research and Quality. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. HHSA290201500009I.) AHRQ Publication No. XXX.
Methodology Description: Using predefined criteria, we selected randomized controlled trials of noninvasive, nonpharmacological treatments for five common chronic pain conditions (chronic low back pain, chronic neck pain, osteoarthritis of the knee, hip, or hand, fibromyalgia, and tension headache) that addressed efficacy or harms compared with usual care, no treatment, waitlist, placebo, or sham intervention; compared with pharmacological therapy; or compared with exercise. Study quality was assessed, data extracted, and results summarized for function and pain. Only trials reporting results for at least 1 month post-intervention were included. We focused on the persistence of effects at short term (1 to < 6 months following treatment completion), intermediate term (≥6 to <12 months), and long term (≥12 months).

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