Effectiveness of neural mobilisation for the treatment of nerve-related cervicobrachial pain: a systematic review with subgroup meta-analysis
Ion Lascurain‐AguirrebeñaLaura DomínguezIker Villanueva-RuizJavier BallesterosMikel Rueda-EtxeberriaJosé-Ramón RuedaXabat Casado-ZumetaMaialen Araolaza-ArrietaAne Arbillaga‐EtxarriBrigitte Tampin
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Abstract Neural mobilisations (NM) have been advocated for the treatment of nerve-related cervicobrachial pain; however, it is unclear what types of patients with nerve-related cervicobrachial pain (if any) may benefit. Medline, Web of Science, Scopus, PeDro, Cinahl, and Cochrane databases were searched from inception until December 2022. Randomised controlled trials were included if they assessed the effectiveness of NM in nerve-related cervicobrachial pain, and outcome measures were pain intensity and/or disability. Studies were classified according to their inclusion/exclusion criteria as radiculopathy , Wainner cluster , Hall , and Elvey cluster or other . Meta-analyses with subgroup analyses were performed. Risk of bias was assessed using Cochrane Rob2 tool. Twenty-seven studies were included. For pain and disability reduction, NM was found to be more effective than no treatment (pooled pain mean difference [MD] = −2.81, 95% confidence interval [CI] = −3.81 to −1.81; pooled disability standardized mean difference = −1.55, 95% CI = −2.72 to −0.37), increased the effectiveness of standard physiotherapy as an adjuvant when compared with standard physiotherapy alone (pooled pain MD = −1.44, 95% CI = −1.98 to −0.89; pooled disability MD = −11.07, 95% CI = −16.38 to −5.75) but was no more effective than cervical traction (pooled pain MD = −0.33, 95% CI = −1.35 to 0.68; pooled disability MD = −10.09, 95% CI = −21.89 to 1.81). For disability reduction, NM was found to be more effective than exercise (pooled MD = −18.27, 95% CI = −20.29 to −17.44). In most comparisons, there were significant differences in the effectiveness of NM between the subgroups. Neural mobilisations was consistently more effective than all alternative interventions (no treatment, traction, exercise, and standard physiotherapy alone) in 13 studies classified as Wainner cluster . PROSPERO registration: CRD42022376087.Keywords:
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The aim of the study was to examine how well aggregate data meta-analyses (ADMAs) and individual patient data meta-analyses (IPDMAs) agree in their overall results and how frequently interactions are detected in IPDMAs and ADMAs.ADMA articles immediately published before the IPDMA and matching the research topic were identified. Agreement in the overall result was achieved if the estimate was in the same direction. The number of subgroup analyses, in particular that of significant interactions, was compared between the 2 types of meta-analyses.A total of 829 IPDMA articles were identified; 129 (15.6%) were found to have a matched ADMA article and 204 paired meta-analyses were identified. Agreement in the overall effect was observed in 187 (91.7%) of the 204 paired meta-analyses. Fifty-three (26.0%) ADMAs and 121 (59.3%) IPDMAs conducted subgroup analyses and presented 150 and 634 subgroup analyses, respectively. The IPDMAs conducted 7 times more subgroup analyses on interaction (544 in IPDMAs vs 68 in ADMAs) and identified 14 times more potential interactions (44 in IPDMAs vs 3 in ADMAs).ADMAs will almost always agree with their corresponding IPDMAs in the overall result if greater efforts are made to improve the methodology in conducting ADMAs. The IPDMA is required mostly if interactions are suspected.
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To explore the role and application of Meta-regression and subgroup analyses to recognize and control the heterogeneity in Meta-analysis, Meta-regression models were established by secondary data to screen the factors resulting heterogeneity,and subgroup analyses were used to compare the change of heterogeneity before and after.The heterogeneity was found in the Meta-analysis(Q=44.71,df=27,P=0.017).Sample size and region were selected(P=0.012 and P=0.091,respectively)by Meta-regression from many possible factors such as sample size,year,region and case/contml ratio.The Q values were lowered from 44.71 to 32.11 after subgroup analyses.Thus,Metaregression method was convenient and reliable to screen the affected factors of heterogeneity,and subgroup analyses based on the hypothesis that could significantly lower the heterogeneity.It was recommended to a combined use when an obvious heterogeneity existed but was in need to get an overall result in Metaanalysis.We could correctly judge and lower the heterogeneity to increase the robustness and rationality of results from Meta-analysis.
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Meta-analysis; Heterogeneity; Meta-regression; Subgroup analyses
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Background: A recent systematic review reported very high pooled estimates of blood lead levels (BLLs) for Indian children, igniting the need for remedial action by national stakeholders. Current study aimed at systematically pooling the BLLs of Indian children (aged ≤ 14 years) available from the literature. Further, explore the time trend of BLLs with respect to implementing the ban on the use of Pb petrol (i.e. 2000) and a decade later (2010) to the implementation.Methods: Observational studies documenting the BLL in Indian children (aged ≤ 14 years) available from current literature were systematically searched from PubMed-Medline, Scopus, and Embase digital databases from inception to December 2022. The protocol was earlier registered at PROSPERO (ID: CRD42022382835) and executed adhering to PRISMA 2020 guidelines. Pooled mean BLL was estimated using the random-effects model. Conventional I2 statistics was employed to assess the heterogeneity, while the risk for various biases was assessed using Newcastle Ottawa Scale. Sub-group, sensitivity, and meta-regression analyses were performed where data permitted.Findings: 59 reports from 45 original studies were part of the present study. It observed pooled BLL of 10.7 (95% CI: 9.87 to 11.5) µg/dL with a trend of gradual reduction during the last 3 decades. Subgroup analysis revealed that the children with high risk of Pb had BLL as 14.8 (95% CI: 13.8 to 16.6) µg/dL, while the children with no known (low risk of) Pb exposure Pb is 7.95 (95% CI: 7.11 to 8.79) µg/dL. Children with no known (low-risk) Pb exposure exhibited a time trend of a gradual reduction in blood Pb levels, while no such time trend was observed among the participants with a high risk of Pb exposure. The current review observed high heterogeneity among the included studies.Interpretation: Current observations suggest the gradual decline in Pb burden with respect to the national ban on leaded petrol. However, considering the significant public health problem present observations emphasize the need for strict remedial actions toward non-occupational Pb exposure. The children with high risk Pb exposure require stronger interventions to reduce Pb exposure. Further, periodic BLL surveys are needed using high-quality, longitudinal study designs with adequately larger samples.Funding: None.Declaration of Interest: We declare no competing interest.
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In meta-analyses involving a few trials, appropriate measures should be employed to assess between-study heterogeneity. When the number of studies is less than five and heterogeneity is evident, the Hartung and Knapp (HK) correction should be used. The aim of this study was to compare the reported estimates of published orthodontic meta-analyses with the pooled effect size estimates and prediction intervals (PI) calculated using eight heterogeneity estimators and corrected using the HK correction.
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Atrial fibrillation (AF) is one of the most common persistent arrhythmia, and its complications include cerebral embolism, arterial embolism and heart failure. Some studies have found that elevated Homocysteine (HCY) levels is a new risk factor for AF. Currently, there is no meta-analysis to explore whether the HCY levels is related to AF. Therefore, a meta-analysis was conducted to evaluate the relationship between the HCY levels and AF, in order to draw the attention of clinicians to the HCY levels. A meta-analysis was performed in the study to evaluated the association between the HCY levels and AF. In order to identify eligible original articles, The EMBASE, PubMed, and web of science were systematically searched until November 2020. All data were analyzed with Review Manager 5.3. The meta-analysis results were evaluated depending on standardized mean differences (SMD) with 95% confidence intervals (CI). Moreover, the subgroup analysis and sensitivity analysis were also analyzed. The HCY levels was significantly associated with AF (WMD = 0.81, 95% CI: 0.58 to 1.03; P < .00001). In the analysis, there was a medium degree of heterogeneity (I2 = 73%). Subgroup analysis showed that female < 60, BMI≥25, BMI <25, age ≥60 and publication year ≥2010 were identified as possible sources of heterogeneity. Sensitivity analysis showed that the main results remained unchanged after omitting any single study or converting the random effects model (REM) to fixed effects model (FEM). The meta-analysis showed that there is a significant correlation between the HCY levels and AF, and the role of HCY in AF patients should not be ignored in clinical.
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Abstract Current reports on the changes in peripheral blood regulatory T cell (Tregs) to CD4 + T cell ratio in systemic sclerosis (SSc) patients are varied in their conclusions. We therefore performed a meta-analysis to identify the actual change in the proportion of peripheral Tregs in SSc. Three databases, namely EMBASE, ISI web of knowledge, and Pubmed were systematically searched for relevant literature. Approximately 250 SSc patients and controls from several studies were included in this analysis. Comprehensive Meta Analysis Version 2.0 software was used to conduct the meta-analysis. Six studies were included in the meta-analysis. Results of the meta-analysis showed high degree of heterogeneity ( I 2 = 96.98), and a random-effect model was used in the subsequent analysis. The ratio of circulating Tregs to CD4 + T cell in SSc was lower than in controls, but not statistically significantly so (−0.61 ± 0.94, P = 0.52). Subgroup analysis did not identify any potential source of heterogeneity. This meta-analysis indicated that Tregs might play a less prominent immunosuppressive role in the immune system in SSc patients, but needs further confirmation.
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Many studies suggest that the Gln261Arg polymorphism in 12-lipoxygenase gene is assicated with cancer susceptibility, but the results are inconclusive. This meta-analysis aimed to investigate the overall association between the Gln261Arg polymorphism in 12-lipoxygenase gene and cancer risk.Literature search was performed in Pubmed, Embase and other databases for studies evaluating the association between the Gln261Arg polymorphism in 12-lipoxygenase gene and cancer risk. Data were extracted and statistical analysis was performed using STATA 12.0 software.A total of eight publications involving 8,379 subjects were included in this meta-analysis. Combined analysis revealed a significant association between this polymorphism and cancer susceptibility with an OR of 1.19 (95% CI: 1.09-1.31, P=0.000 for Gln/Gln vs. Arg/Gln + Arg/Arg). Subgroup analysis by ethnicity showed that the cancer risk associated with the Gln261Arg polymorphism in 12-lipoxygenase gene was significantly elevated among Asians (OR=1.21, 95% CI: 1.10-1.34, P=0.000 for Gln/Gln vs. Arg/Gln + Arg/Arg), but not among Caucasians. Subgroup analysis by cancer type suggested that the Gln261Arg polymorphism in 12-lipoxygenase gene is not a risk factor for colon cancer or rectal cancer.This meta-analysis suggests that the Gln261Arg polymorphism in 12-lipoxygenase gene contributes to cancer susceptibility, specifically in Asian populations. More studies are needed to validate our findings.
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To perform a systematic review and meta-analysis on the efficacy and safety of sialendoscopy in the treatment of obstructive diseases of the major salivary glands.
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Abstract Background Mild behavioral impairment (MBI) is a neurobehavioral syndrome characterized by later life emergent neuropsychiatric symptoms (NPS). There has not been any systematic review or meta‐analysis on the prevalence of MBI. Main aim of the study is to calculate the pooled prevalence of MBI. Method A search of the literature on MBI in mild cognitive impairment (MCI), cognitively normal (CN), and subjective cognitive impairment (SCI) and cognitively normal but at risk (CN‐AR) subjects published between 1 January 2003 and 28 September 2020 was conducted. Meta‐analysis using a random effects model was performed to determine the pooled estimate of the prevalence of MBI. Meta‐regression was performed to identify factors contributing to the variance of prevalence rate. A systematic review was also performed to study the impact of MBI in cognitive outcomes and its correlation to pathology and genetics of Alzheimer’s Disease (AD). Result Eleven studies conducting among all 15689 subjects were subjected into meta‐analysis revealing a pooled prevalence of MBI at 33.5% (95% CI 22.6‐46.6%). Seven studies conducting among 1358 MCI subjects were subjected into meta‐analysis revealing a pooled prevalence at 45.5% (95% CI 36.1‐55.3%). Four studies conducting among 13153 CN subjects were subjected into meta‐analysis revealing a pooled prevalence at 17% (95% CI 7.2‐34.9%). Five studies conducting on 1158 SCI or CN‐AR subjects were subjected into meta‐analysis revealing a pooled prevalence at 35.8% (95% CI 21.4‐53.2%). Systematic review of 13 studies showed MBI has a significant impact on cognitive deterioration, and it is associated with pathology and genetics of AD. Conclusion MBI is common in MCI, CN, and SCI and CN‐AR subjects. Our finding is potentially useful in planning future clinical trials.
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