Efficacy of platelet‐rich plasma for non‐transfusion use: Overview of systematic reviews
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Introduction Platelet-rich plasma (PRP) is a blood component therapy with a supraphysiological concentration of platelets derived from allogenic or, more commonly, autologous blood. PRP has been used in different non-transfusion indications because of its role in the promotion of tissue repair and healing, in fields such as Traumatology, Dermatology and Dentistry. Objective To provide a synthesis of the efficacy of PRP for different clinical situations. Methods Systematic searches were carried out in MEDLINE, Embase, Cochrane Library and LILACS in July 2018 to identify systematic reviews (SRs) of randomized clinical trials (RCTs) focusing on PRP for non-transfusion use. Two authors independently screened all retrieved references in two stages (titles and abstracts at a first stage and full texts at a second stage). The methodological quality of SRs that met the eligibility criteria was appraised by AMSTAR 2. Conclusions were based on the most recent SRs with highest quality. Results One thousand two hundred and forty references were retrieved. After checking the inclusion criteria, 29 SRs of RCTs related to three different fields (wound care, Orthopedics and Dentistry) were included. The results suggest the benefit of PRP for different clinical situations, such as diabetic wounds, acute lesions of musculoskeletal system, rotator cuff lesions, tendinopathies, knee and hip osteoarthritis, total knee arthroplasty, allogenic bone graft for dental implants and periodontal intrabony defects. Conclusion There is low to moderate quality evidence supporting the efficacy of PRP for specific clinical situations. The low quality of the evidence limits the certainty of these findings. Well-planned and well-conducted RCTs are still needed to further assess the efficacy of PRP.Keywords:
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The objectives of this work were to fill the gap in the scientific literature and to evaluate the results of physical therapy treatments in individuals affected by chronic fatigue syndrome, considering only studies that employed a randomized controlled trial.A systematic review was carried out according to PRISMA guidelines. Three bibliographic databases were searched: MEDLINE, Cochrane Library, and PEDro. The minimum prerequisites for papers to be included in the systematic review were that they had to (a) employ a randomized controlled trial; (b) be published in English; and (c) be published during the last ten years (2007-2017). The studies were evaluated according to Jadad score.Four studies were included. This systematic review suggests that a treatment that is more effective than all the others cannot be defined. This conclusion is related to the low number of investigated studies; therefore, the collected results cannot be generalized.Chronic fatigue syndrome is not yet a well-understood pathology, and the physical mechanisms that influence the outcomes still need more study. Rehabilitation programs that promote physiotherapy techniques such as exercise, mobilization, and body awareness (e.g., MRT and GET) are the most effective in reducing medium and long-term fatigue severity in CFS patients.
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Decision-making based on reliable evidence is more likely to lead to effective and efficient treatments. Evidence-based dentistry was developed, similarly to evidence-based medicine, to help clinicians apply current and valid research findings into their own clinical practice. Interpreting and appraising the literature is fundamental and involves the development of evidence-based dentistry (EBD) skills. Systematic reviews (SRs) of randomized controlled trials (RCTs) are considered to be evidence of the highest level in evaluating the effectiveness of interventions. Furthermore, the assessment of the report of a RCT, as well as a SR, can lead to an estimation of how the study was designed and conducted.
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The basic condition of practising evidence-based medicine is the knowledge of the evidence. Strongest of all evidences are the conclusions drawn from systematic reviews of randomized controlled trials. The over 2 million papers published annually in the biomedical literature is neither available nor possible to read for any individual, therefore it is necessary to identify and collect all relevant clinical trials, to make them available in databases, and to produce, to publish and to update systematic reviews based on the best evidence. The Cochrane Collaboration was established for these purposes in 1993. The activity of the Collaboration is summarized by a database The Cochrane Library which is updated quarterly. The user friendly Cochrane Library currently contains bibliographic data of over 218 thousand controlled trials (Cochrane Controlled Trials Register, CC-TR), and 1014 systematic reviews (Cochrane Database of Systematic reviews, CDSR) prepared by reviewers in 49 Review Groups. As the Cochrane Library contains information on much more controlled trials than any other databases including MEDLINE, decision makers in health care should be aware of this source of information. In addition to the application of the Cochrane Library as a source of information, active participation by identifying controlled trials in the Hungarian medical literature and registering them in the CCTR is another important task.
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This umbrella review systematically appraised published systematic reviews on Minimal Intervention Dentistry interventions carried out to manage dentine carious primary teeth to determine how best to translate the available evidence into practice, and to provide recommendations for what requires further research.
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Abstract Introduction: Several pharmacological treatments are beneficial for patients with irritable bowel syndrome (IBS), and there are numbers of systematic reviews evaluating the effectiveness of these treatments. However, the overall quality of the evidence has not been quantitatively assessed. The aim of this study is to evaluate the possible biases in the published systematic reviews and determine the treatments with reliable evidence. Methods and analysis: We will perform an umbrella review to identify eligible systematic reviews. A comprehensive literature search will be conducted in MEDLINE, EMBASE, and the Cochrane library for systematic reviews. We will describe the general information such as participants, interventions, outcome measurements, and conclusion. Additionally, the heterogeneity and inconsistency between trials will be assessed by the I 2 statistical test and Cochrane Q test. We will assess risk of bias, and summarize the strength evidence. Conclusion: The umbrella reviews will assess the reliability of the evidence so that doctors and patients can make better medical choices. PROSPERO registration number: CRD42018109597
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t is increasingly recognized that health care decision-making around the world needs to be informed by high quality and timely research evidence. The randomized controlled trial (RCT) has long been considered the “gold standard” in the hierarchy of evidence; randomized trials, involving sufficient numbers of participants, are essential to distinguish reliably between the effects of health care interventions and the effects of bias or chance. The synthesis of the results of these trials in systematic reviews can provide reliable evidence about the effects of these interventions. The Cochrane Collaboration is an international organization dedicated to improving health care for the world’s population by preparing, maintaining, and promoting the accessibility of Cochrane systematic reviews of the evidence of the effects of health care interventions. The validity of the results of a systematic review is highly dependent on the data included and a prerequisite is to include as unbiased and complete a set of relevant studies as possible. The Cochrane Collaboration has focused on the systematic electronic searching of MEDLINE and EMBASE and the systematic handsearching of currently over 2000 general and specialized health
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Atypical odontalgia (AO) is a severe and persistent pain involving controversial pathophysiological mechanisms and clinical management. Presented here is a systematic review of the literature on AO, using the SORT criteria (Strength of Recommendation Taxonomy) to assess the level of evidence and the quality of randomized clinical trials (RCT). A total of 54 articles were obtained of which 34 belonged to level 3 evidence, 17 to level 2, and 3 to level 1. Of these, only 8 RCT had an average quality of four points. The main finding of this systematic review is that only a few studies have systematically evaluated AO. It also determines a strength recommendation of level B to the theory of neuropathic origin of pain in AO and strength of recommendation level C for the pharmacological management of this condition. The aim of this study was to carry out a systematic review of the published literature on AO in order to determine the physiopathology and treatment based on the level of scientific evidence and following the evidence-based principles of dentistry.
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This paper attempts to explain why systematic reviews of randomized controlled trials, based on as high a proportion as possible of the relevant studies, are so important in generating reliable information for evidence-based decision making within health care. The preparation, maintenance and dissemination of such reviews is the challenge which has been taken up by the Cochrane Collaboration. The first phase of data collection is the identification of relevant studies. Currently, bibliographic databases are inadequate for this task. MEDLINE searches identify on average only about half of the relevant studies, and until 1994 there were no suitable indexing terms in EMBASE to identify randomized controlled trials. Co-operation between the Cochrane Collaboration and both the National Library of Medicine and Elsevier, however, is already transforming this situation. From January 1994 a new indexing term has been added to EMBASE to help identify randomized controlled trials. From January 1995 a new indexing term will be added to MEDLINE to help identify controlled trials where the method of allocation to treatment or control cannot be described with certainty as being randomized. Also from January 1995 an additional 20,000 reports will be identifiable as randomized controlled trials in MEDLINE. Progress during the first 2 years of the Cochrane Collaboration has been encouraging, but much remains to be done if users of health services are to benefit from the evidence-based health care which they deserve.
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Background Lateral elbow tendinopathy (LET) is a common complaint causing characteristic pain in the lateral elbow and upper forearm, and tenderness of the forearm extensor muscles. It is thought to be an overuse injury and can have a major impact on the patient’s social and professional life. The condition is challenging to treat and prone to recurrent episodes. The average duration of a typical episode ranges from 6 to 24 months, with most (89%) reporting recovery by 1 year. Objectives This systematic review aims to summarise the evidence concerning the clinical effectiveness and cost-effectiveness of conservative interventions for LET. Data sources A comprehensive search was conducted from database inception to 2012 in a range of databases including MEDLINE, EMBASE and Cochrane Databases. Methods and outcomes We conducted an overview of systematic reviews to summarise the current evidence concerning the clinical effectiveness and a systematic review for the cost-effectiveness of conservative interventions for LET. We identified additional randomised controlled trials (RCTs) that could contribute further evidence to existing systematic reviews. We searched MEDLINE, EMBASE, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, Web of Science, The Cochrane Library and other important databases from inception to January 2013. Results A total of 29 systematic reviews published since 2003 matched our inclusion criteria. These were quality appraised using the Assessment of Multiple Systematic Reviews (AMSTAR) checklist; five were considered high quality and evaluated using a Grading of Recommendations, Assessment, Development and Evaluation approach. A total of 36 RCTs were identified that were not included in a systematic review and 29 RCTs were identified that had only been evaluated in an included systematic review of intermediate/low quality. These were then mapped to existing systematic reviews where further evidence could provide updates. Two economic evaluations were identified. Limitations The summary of findings from the review was based only on high-quality evidence (scoring of > 5 AMSTAR). Other limitations were that identified RCTs were not quality appraised and dichotomous outcomes were also not considered. Economic evaluations took effectiveness estimates from trials that had small sample sizes leading to uncertainty surrounding the effect sizes reported. This, in turn, led to uncertainty of the reported cost-effectiveness and, as such, no robust recommendations could be made in this respect. Conclusions Clinical effectiveness evidence from the high-quality systematic reviews identified in this overview continues to suggest uncertainty as to the effectiveness of many conservative interventions for the treatment of LET. Although new RCT evidence has been identified with either placebo or active controls, there is uncertainty as to the size of effects reported within them because of the small sample size. Conclusions regarding cost-effectiveness are also unclear. We consider that, although updated or new systematic reviews may also be of value, the primary focus of future work should be on conducting large-scale, good-quality clinical trials using a core set of outcome measures (for defined time points) and appropriate follow-up. Subgroup analysis of existing RCT data may be beneficial to ascertain whether or not certain patient groups are more likely to respond to treatments. Study registration This study is registered as PROSPERO CRD42013003593. Funding The National Institute for Health Research Health Technology Assessment programme.
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