Efficacy of pharmacological and non-pharmacological therapy on pain intensity and disability of older people with chronic nonspecific low back pain: a protocol for a network meta-analysis.

BACKGROUND: The purpose of this network meta-analysis (NMA) is to investigate the efficacy of pharmacological and non-pharmacological therapy on pain intensity and disability of older people with chronic nonspecific low back pain, providing comprehensive evidence for an informed decision-making. METHODS: We will perform a systematic search to identify randomized controlled trials of pharmacological and non-pharmacological interventions for older people with chronic nonspecific low back pain. MEDLINE, Cochrane Library, Embase, AMED, PsycINFO, and PEDro will be searched without language or date restrictions. Our primary outcomes are pain intensity and disability. Risk of bias will be assessed for all studies using the revised Cochrane risk-of-bias (RoB) tool 2.0. For each pairwise comparison between the different interventions, estimated mean differences and their 95% confidence intervals will be presented. Standard pairwise meta-analyses will be performed using random effects models in STATA version 16. The competing interventions will be ranked using the surface under the cumulative ranking curve (SUCRA) for the outcomes of interest at short and long terms. The confidence in the results from NMA will be assessed using the Confidence in Network Meta-Analysis (CINeMA) framework. DISCUSSION: This NMA compares efficacy of interventions for nonspecific chronic low back pain in older people. It will provide reliable evidence for patients, clinicians, stakeholders, and researchers in this field where competing therapies, many of extraordinarily little value, are commonly used in clinical practice. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022312565.

Recent Advance Analysis of Recovery in Hospitalized People with COVID-19: A Systematic Review.

INTRODUCTION: COVID-19 is a public health emergency all around the world. Severe illness occurred in about 14% of patients and 5% of patients developed critical illness, but the prognosis for these patients remains unclear. OBJECTIVE: To describe the prognosis in hospitalized adults with COVID-19. METHODS: The MEDLINE, EMBASE, AMED, and COCHRANE databases were searched for studies published up to 28 June 2021 without language restrictions. Descriptors were related to "COVID-19" and "prognosis". Prospective inception cohort studies that assessed morbidity, mortality and recovery in hospitalized people over 18 years old with COVID-19 were included. Two independent reviewers selected eligible studies and extracted the available data. Acute respiratory distress syndrome (ARDS) and multiple organ failure (MOFS) were considered as outcomes for morbidity and discharge was considered for recovery. The Quality in Prognosis Studies (QUIPS) tool was used to assess risk of bias. Analyses were performed using Comprehensive Meta-Analysis (version 2.2.064). RESULTS: We included 30 inception cohort studies investigating 13,717 people hospitalized with COVID-19 from different countries. The mean (SD) age was 60.90 (21.87) years, and there was high proportion of males (76.19%) and people with comorbidities (e.g., 49.44% with hypertension and 29.75% with diabetes). Findings suggested a high occurrence of morbidity, mainly related to ARDS. Morbidity rates varied across studies from 19% to 36% in hospital wards, and from 13% to 90% in Intensive Care Units-ICU. Mortality rates ranged from 4% to 38% in hospital wards and from 8% to 51% in ICU. Recovery rates ranged up to 94% and 65% in hospital wards and ICU, respectively. The included studies had high risk of bias in the confounding domain. CONCLUSIONS: The prognosis of people hospitalized with COVID-19 is an issue for the public health system worldwide, with high morbidity and mortality rates, mainly in ICU and for patients with comorbidities. Its prognosis emphasizes the need for appropriate prevention and management strategies.

The ESCAPE trial for older people with chronic low back pain: Protocol of a randomized controlled trial.

BACKGROUND: Low-back pain is one of the most common health conditions worldwide. It is defined as pain below the costal margin and above the inferior gluteal folds. Current guidelines recommend management of chronic health (e.g., low back pain) conditions in older people at primary health care settings using active strategies (e.g., exercise). In non-specific low back pain, high quality evidence supports active strategies for general population. However, the management of non-specific low back pain in the older people has been overlooked and evidence is limited to a small number of low powered randomized controlled trials with high risk of bias. METHODS: This is a prospectively registered, open, two-arm randomised controlled trial comparing the group-based exercise and waiting list in pain intensity (11-item Pain Numerical Rating Scale) and disability (Roland Morris questionnaire) of older people (i.e., 60 years old or over) with chronic non-specific low back pain. One hundred and twenty patients will be recruited from Diamantina, Brazil. Follow-ups will be conducted in post-treatment (8 week) and 6- and 12-months post-randomisation. DISCUSSION: Our hypothesis is that group-based exercise will be better than waiting list in reducing pain intensity and disability in older people with chronic non-specific low back pain. IMPACT: The practice of individualized exercise has been studied for the management of chronic non-specific low back pain in older people. However, the group exercise, even showing high quality evidence for the improvement of several important outcomes in this population, has been ignored until now. Thus, the results of this study have the potential to indicate a viable and accessible strategy for managing chronic non-specific low back pain in the older people. TRIAL REGISTRATION: The study was prospectively registered at www.ensaiosclinicos.gov.br (RBR-9j5pqs). Date-11/18/2020.

Association of Therapies With Reduced Pain and Improved Quality of Life in Patients With Fibromyalgia: A Systematic Review and Meta-analysis.

Importance: Fibromyalgia is a chronic condition that results in a significant burden to individuals and society. Objective: To investigate the effectiveness of therapies for reducing pain and improving quality of life (QOL) in people with fibromyalgia. Data Sources: Searches were performed in the MEDLINE, Cochrane, Embase, AMED, PsycInfo, and PEDro databases without language or date restrictions on December 11, 2018, and updated on July 15, 2020. Study Selection: All published randomized or quasi-randomized clinical trials that investigated therapies for individuals with fibromyalgia were screened for inclusion. Data Extraction and Synthesis: Two reviewers independently extracted data and assessed risk of bias using the 0 to 10 PEDro scale. Effect sizes for specific therapies were pooled using random-effects models. The quality of evidence was assessed using the Grading of Recommendations Assessment (GRADE) approach. Main Outcomes and Measures: Pain intensity measured by the visual analog scale, numerical rating scales, and other valid instruments and QOL measured by the Fibromyalgia Impact Questionnaire. Results: A total of 224 trials including 29 962 participants were included. High-quality evidence was found in favor of cognitive behavioral therapy (weighted mean difference [WMD], -0.9; 95% CI, -1.4 to -0.3) for pain in the short term and was found in favor of central nervous system depressants (WMD, -1.2 [95% CI, -1.6 to -0.8]) and antidepressants (WMD, -0.5 [95% CI, -0.7 to -0.4]) for pain in the medium term. There was also high-quality evidence in favor of antidepressants (WMD, -6.8 [95% CI, -8.5 to -5.2]) for QOL in the short term and in favor of central nervous system depressants (WMD, -8.7 [95% CI, -11.3 to -6.0]) and antidepressants (WMD, -3.5 [95% CI, -4.5 to -2.5]) in the medium term. However, these associations were small and did not exceed the minimum clinically important change (2 points on an 11-point scale for pain and 14 points on a 101-point scale for QOL). Evidence for long-term outcomes of interventions was lacking. Conclusions and Relevance: This systematic review and meta-analysis suggests that most of the currently available therapies for the management of fibromyalgia are not supported by high-quality evidence. Some therapies may reduce pain and improve QOL in the short to medium term, although the effect size of the associations might not be clinically important to patients.

Duathlon training model adapted for female rats: blood glucose-lactate correlations / Modelo de treinamento de duathlon adaptado para ratas: correlação de glicose-lactato no sangue / Modelo de entrenamiento de duatlón adaptado para ratones: correlación de glucosa-lactato en la sangre

ABSTRACT Objective: To propose a duathlon model adapted for rats (associated swimming and running training) and compare it with the individual activities carried out separately, considering the glucose uptake and serum lactate production mechanism. Methods: Twenty-eight 90-day-old Wistar rats with a mean weight of 150-200 g were used. The animals were divided into four groups: control group, swimming group, running group, and swimming/running group. These animals were adapted to their respective training programs for three days and underwent the 4-week training protocol soon afterwards. Pre- and post-training blood lactate and blood glucose analyses were performed at the end of each week. Statistical difference was considered when the p value was less than 0.01 (p <0.01). Results: There was a decrease in glycemic levels and an increase in lactate levels in the swimming and swimming/running groups throughout the training period, which did not occur in the running group. Conclusion: The duathlon model adapted for rats proved satisfactory in terms of the production and stabilization of blood lactate levels. Level of evidence II; Therapeutic Studies - Investigating the Results of Treatment.

RESUMO Objetivo: Propor um modelo de duathlon adaptado para ratos (treinamento associado de natação e corrida) e compará-lo com as modalidades praticadas isoladamente, considerando o mecanismo de consumo de glicose e produção de lactato sérico. Métodos: Foram utilizados vinte e oito ratos Wistar, com 90 dias de vida e peso médio de 150-200 g. Os animais foram divididos em quatro grupos: grupo controle, grupo de natação, grupo de corrida e grupo de natação/corrida. Esses foram adaptados aos seus respectivos treinos durante três dias e, logo depois, foram submetidos ao protocolo de treinamento com duração de quatro semanas. No final de cada semana, foram realizadas análises de lactato e glicose sanguínea pré- e pós- treinamento. A diferença estatística foi considerada quando o valor p era inferior a 0,01 (p <0,01). Resultados: Houve diminuição nos níveis de glicemia e aumento nos níveis de lactato nos grupos de natação e natação/corrida ao longo do período de treinamento, o que não ocorreu no grupo de corrida. Conclusão: Pode-se verificar que o modelo duathlon adaptado para ratos foi satisfatório em relação à produção e estabilização dos níveis sanguíneos de lactato. Nível de evidência II; Estudos terapêuticos - Investigação dos resultados de tratamento.

RESUMEN Objetivo: Proponer un modelo de duatlón adaptado para ratones (entrenamiento asociado de natación y carrera) y compararlo con las modalidades practicadas aisladamente, considerando el mecanismo de consumo de glucosa y producción de lactato sérico. Métodos: Fueron utilizados veintiocho ratones Wistar, con 90 días de vida y peso promedio de 150-200 g. Los animales fueron divididos en cuatro grupos: grupo control, grupo de natación, grupo de carrera y grupo de natación/carrera. Esos fueron adaptados a sus respectivos entrenamientos durante tres días y, luego después, fueron sometidos al protocolo de entrenamiento con duración de cuatro semanas. Al final de cada semana, fueron realizados análisis de lactato y glucosa sanguínea pre y post entrenamiento. La diferencia estadística fue considerada cuando el valor p era inferior a 0,01 (p <0,01). Resultados: Hubo disminución en los niveles de glucemia y aumento en los niveles de lactato en los grupos de natación y natación/carrera a lo largo del período de entrenamiento, lo que no ocurrió en el grupo de carrera. Conclusión: Se puede verificar que el modelo duatlón adaptado para ratones fue satisfactorio con relación a la producción y estabilización de los niveles sanguíneos de lactato. Nivel de evidencia II; Estudios terapéuticos - Investigación de los resultados del tratamento.