Antonia Gómez-Conesa

Psychological treatment of obsessive–compulsive disorder: A meta-analysis ☆

The benefits of cognitive-behavioral treatment for obsessive-compulsive disorder (OCD) have been evidenced by several meta-analyses. However, the differential effectiveness of behavioral and cognitive approaches has shown inconclusive results. In this paper a meta-analysis on the effectiveness of psychological treatment for OCD is presented by applying random- and mixed-effects models. The literature search enabled us to identify 19 studies published between 1980 and 2006 that fulfilled our selection criteria, giving a total of 24 independent comparisons between a treated and a control group. The effect size index was the standardized mean difference in the posttest. The effect estimates for exposure with response prevention (ERP) alone (d(+)=1.127), cognitive restructuring (CR) alone (d(+)=1.090), and ERP plus CR (d(+)=0.998) were very similar, although the effect estimate for CR alone was based on only three comparisons. Therapist-guided exposure was better than therapist-assisted self-exposure, and exposure in vivo combined with exposure in imagination was better than exposure in vivo alone. The relationships of subject, methodological and extrinsic variables with effect size were also examined, and an analysis of publication bias was carried out. Finally, the implications of the results for clinical practice and for future research in this field were discussed.

Psychological treatment of panic disorder with or without agoraphobia: a meta-analysis

Although the efficacy of psychological treatment for panic disorder (PD) with or without agoraphobia has been the subject of a great deal of research, the specific contribution of techniques such as exposure, cognitive therapy, relaxation training and breathing retraining has not yet been clearly established. This paper presents a meta-analysis applying random- and mixed-effects models to a total of 65 comparisons between a treated and a control group, obtained from 42 studies published between 1980 and 2006. The results showed that, after controlling for the methodological quality of the studies and the type of control group, the combination of exposure, relaxation training, and breathing retraining gives the most consistent evidence for treating PD. Other factors that improve the effectiveness of treatments are the inclusion of homework during the intervention and a follow-up program after it has finished. Furthermore, the treatment is more effective when the patients have no comorbid disorders and the shorter the time they have been suffering from the illness. Publication bias and several methodological factors were discarded as a threat against the validity of our results. Finally the implications of the results for clinical practice and for future research are discussed.

Prevalence of low back pain in children and adolescents: a meta-analysis

BackgroundLow back pain (LBP) is common in children and adolescents, and it is becoming a public health concern. In recent years there has been a considerable increase in research studies that examine the prevalence of LBP in this population, but studies exhibit great variability in the prevalence rates reported. The purpose of this research was to examine, by means of a meta-analytic investigation, the prevalence rates of LBP in children and adolescents.MethodsStudies were located from computerized databases (ISI Web of Knowledge, MedLine, PEDro, IME, LILACS, and CINAHL) and other sources. The search period extended to April 2011. To be included in the meta-analysis, studies had to report a prevalence rate (whether point, period or lifetime prevalence) of LBP in children and/or adolescents (≤ 18 years old). Two independent researchers coded the moderator variables of the studies, and extracted the prevalence rates. Separate meta-analyses were carried out for the different types of prevalence in order to avoid dependence problems. In each meta-analysis, a random-effects model was assumed to carry out the statistical analyses.ResultsA total of 59 articles fulfilled the selection criteria. The mean point prevalence obtained from 10 studies was 0.120 (95% CI: 0.09 and 0.159). The mean period prevalence at 12 months obtained from 13 studies was 0.336 (95% CI: 0.269 and 0.410), whereas the mean period prevalence at one week obtained from six studies was 0.177 (95% CI: 0.124 and 0.247). The mean lifetime prevalence obtained from 30 studies was 0.399 (95% CI: 0.342 and 0.459). Lifetime prevalence exhibited a positive, statistically significant relationship with the mean age of the participants in the samples and with the publication year of the studies.ConclusionsThe most recent studies showed higher prevalence rates than the oldest ones, and studies with a better methodology exhibited higher lifetime prevalence rates than studies that were methodologically poor. Future studies should report more information regarding the definition of LBP and there is a need to improve the methodological quality of studies.

Systematic Review of the Benefits of Physical Therapy Within a Multidisciplinary Care Approach for People With Schizophrenia

Background Although schizophrenia is the fifth leading cause of disability-adjusted life years worldwide in people aged 15 to 44 years, the clinical evidence of physical therapy as a complementary treatment remains largely unknown. Purpose The purpose of this study was to systematically review randomized controlled trials (RCTs) evaluating the effectiveness of physical therapy for people with schizophrenia. Data Sources EMBASE, PsycINFO, PubMed, ISI Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Physiotherapy Evidence Database (PEDro), and the Cochrane Library were searched from their inception until July 1, 2011, for relevant RCTs. In addition, manual search strategies were used. Study Selection Two reviewers independently determined study eligibility on the basis of inclusion criteria. Data Extraction Reviewers rated study quality and extracted information about study methods, design, intervention, and results. Data Synthesis Ten RCTs met all selection criteria; 6 of these studies addressed the use of aerobic and strength exercises. In 2 of these studies, yoga techniques also were investigated. Four studies addressed the use of progressive muscle relaxation. There is evidence that aerobic and strength exercises and yoga reduce psychiatric symptoms, state anxiety, and psychological distress and improve health-related quality of life, that aerobic exercise improves short-term memory, and that progressive muscle relaxation reduces state anxiety and psychological distress. Limitations The heterogeneity of the interventions and the small sample sizes of the included studies limit overall conclusions and highlight the need for further research. Conclusions Physical therapy offers added value in the multidisciplinary care of people with schizophrenia.

Factores de riesgo de caídas en ancianos: revisión sistemática

OBJETIVO: Sistematizar los hallazgos de los estudios de cohorte prospectivos sobre los multiples factores de riesgo de caidas en ancianos y valorar la calidad metodologica de los mismos. METODOS: Revision sistematica de estudios epidemiologicos en las bases de datos Medline, SciELO y Lilacs. Fueron incluidos estudios con numero de sujetos >100, con edad >64 anos, de ambos sexos, residentes en la comunidad o en instituciones para ancianos. RESULTADOS: De 726 publicaciones encontradas, 15 estudios cumplieron con los criterios de inclusion, habiendo sido publicados entre 1988 y 2005. Los estudios presentaron heterogeneidad metodologica. Los principales factores asociados a un aumento del riesgo de caida son: antecedente de caida, alteracion de la marcha, incapacidad funcional, deterioro cognitivo, consumo de medicacion psicotropica y exceso de actividad fisica. A pesar de hallazgos contradictorios, ser del sexo femenino y tener edad avanzada, tambien pueden ser predictores de caida. CONCLUSIONES: Se identifican algunas carencias metodologicas de los estudios de cohorte prospectivo sobre caidas: carencia de estudios sobre determinantes extrinsecos, necesidad de enmascaramiento del evaluador durante el seguimiento y de un mejor control del seguimiento con menores intervalos entres las recogidas de datos.OBJECTIVE To systematize results of prospective cohort studies on multiple risk factors for falls in the elderly and to assess their methodological quality. METHODS Systematic review of epidemiological studies from Medline, SciELO and Lilacs database. We included prospective cohort studies with samples of more than 100 subjects of both sexes, older than 64 years, and living either in the community or a nursing home. RESULTS Of 726 studied identified, 15 met the inclusion criteria of being published between 1988 and 2005. The methodology of the studies varied. The main factors associated with increased risk of falls include: previous falls, altered gait, functional impairment, cognitive impairment, psychotropic medication use and excessive physical activity. Despite contradictory findings, being a woman at an advanced age may also be a predictor of falls. CONCLUSIONS Methodological limitations were identified in prospective cohort studies on falls. There is a need for further studies on extrinsic determinants, including evaluator blinding and closer monitoring during follow-up with reduced time of recall.

A systematic review on physical therapy interventions for patients with binge eating disorder

Abstract Purpose: Since a distorted body experience and a sedentary lifestyle are central in the course of binge eating disorder (BED), physical therapy might be an interesting add-on treatment. The aim of this study was to systematically review randomised controlled trials (RCTs) evaluating physical therapy on binge eating and physical and mental health in BED patients. Method: EMBASE, PsycINFO, PubMed, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database and Cochrane Library were searched from their inception until 15 August 2012 for relevant RCTs comparing physical therapy with a placebo condition, control intervention or standard care. Results: Three RCTs involving 211 female community patients (age range: 25–63 years) met all selection criteria. Review data demonstrate that aerobic and yoga exercises reduce the number of binges and the body mass index (BMI) of BED patients. Aerobic exercise also reduces depressive symptoms. Only combining cognitive behavioural therapy (CBT) with aerobic exercise and not CBT alone reduces BMI. Combining aerobic exercise with CBT is more effective in reducing depressive symptoms than CBT alone. Conclusions: The limited number of available studies and the heterogeneity of the interventions limit overall conclusions and highlight the need for further research. Implications for Rehabilitation Because of severe co-morbid psychiatric and physical conditions, binge eating disorder is one of the most difficult psychiatric conditions to treat. Both yoga and aerobic exercise have shown promise in reducing binge eating pathology and weight. Combining aerobic exercise with cognitive behavioural therapy seems more effective in reducing depressive symptoms than cognitive behavioural therapy alone.

A systematic review of physical therapy interventions for patients with anorexia and bulemia nervosa.

Abstract Purpose: The purpose of this systematic review was to summarise the evidence from randomised controlled trials examining the effectiveness of physical therapy compared with care as usual or a wait-list condition on eating pathology and on physiological and psychological parameters in patients with anorexia and bulimia nervosa. Method: EMBASE, PsycINFO, PubMed, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database and The Cochrane Library were searched from their inception until February, 2013. Articles were eligible if they utilised a randomised controlled trial design, compared physical therapy with a placebo condition, control intervention, or standard care and included patients with anorexia and bulimia nervosa. The methodological quality was assessed with the Jadad scale. Results: Eight randomised controlled trials involving 213 patients (age range: 16–36 years) met all selection criteria. Three of the 8 included studies were of strong methodological quality (Jadad score≥3). Major methodological weaknesses were attrition and selection bias. The main results demonstrate that aerobic and resistance training result in significantly increased muscle strength, body mass index and body fat percentage in anorexia patients. In addition, aerobic exercise, yoga, massage and basic body awareness therapy significantly lowered scores of eating pathology and depressive symptoms in both anorexia and bulimia nervosa patients. No adverse effects were reported. Conclusions: The paucity and heterogeneity of available studies limits overall conclusions and highlights the need for further research. Implications for Rehabilitation Supervised physical therapy might increase weight in anorexia nervosa patients. Aerobic exercise, massage, basic body awareness therapy and yoga might reduce eating pathology in patients with anorexia and bulimia nervosa. Aerobic exercise, yoga and basic body awareness therapy might improve mental and physical quality of life in patients with an eating disorder.

Physical therapy treatments for low back pain in children and adolescents: a meta-analysis

BackgroundLow back pain (LBP) in adolescents is associated with LBP in later years. In recent years treatments have been administered to adolescents for LBP, but it is not known which physical therapy treatment is the most efficacious. By means of a meta-analysis, the current study investigated the effectiveness of the physical therapy treatments for LBP in children and adolescents.MethodsStudies in English, Spanish, French, Italian and Portuguese, and carried out by March 2011, were selected by electronic and manual search. Two independent researchers coded the moderator variables of the studies, and performed the effect size calculations. The mean effect size index used was the standardized mean change between the pretest and posttest, and it was applied separately for each combination of outcome measures, (pain, disability, flexibility, endurance and mental health) and measurement type (self-reports, and clinician assessments).ResultsEight articles that met the selection criteria enabled us to define 11 treatment groups and 5 control groups using the group as the unit of analysis. The 16 groups involved a total sample of 334 subjects at the posttest (221 in the treatment groups and 113 in the control groups). For all outcome measures, the average effect size of the treatment groups was statistically and clinically significant, whereas the control groups had negative average effect sizes that were not statistically significant.ConclusionsOf all the physical therapy treatments for LBP in children and adolescents, the combination of therapeutic physical conditioning and manual therapy is the most effective. The low number of studies and control groups, and the methodological limitations in this meta-analysis prevent us from drawing definitive conclusions in relation to the efficacy of physical therapy treatments in LBP.

Risk factors for falls in the elderly: systematic review

OBJETIVO: Sistematizar los hallazgos de los estudios de cohorte prospectivos sobre los multiples factores de riesgo de caidas en ancianos y valorar la calidad metodologica de los mismos. METODOS: Revision sistematica de estudios epidemiologicos en las bases de datos Medline, SciELO y Lilacs. Fueron incluidos estudios con numero de sujetos >100, con edad >64 anos, de ambos sexos, residentes en la comunidad o en instituciones para ancianos. RESULTADOS: De 726 publicaciones encontradas, 15 estudios cumplieron con los criterios de inclusion, habiendo sido publicados entre 1988 y 2005. Los estudios presentaron heterogeneidad metodologica. Los principales factores asociados a un aumento del riesgo de caida son: antecedente de caida, alteracion de la marcha, incapacidad funcional, deterioro cognitivo, consumo de medicacion psicotropica y exceso de actividad fisica. A pesar de hallazgos contradictorios, ser del sexo femenino y tener edad avanzada, tambien pueden ser predictores de caida. CONCLUSIONES: Se identifican algunas carencias metodologicas de los estudios de cohorte prospectivo sobre caidas: carencia de estudios sobre determinantes extrinsecos, necesidad de enmascaramiento del evaluador durante el seguimiento y de un mejor control del seguimiento con menores intervalos entres las recogidas de datos.OBJECTIVE To systematize results of prospective cohort studies on multiple risk factors for falls in the elderly and to assess their methodological quality. METHODS Systematic review of epidemiological studies from Medline, SciELO and Lilacs database. We included prospective cohort studies with samples of more than 100 subjects of both sexes, older than 64 years, and living either in the community or a nursing home. RESULTS Of 726 studied identified, 15 met the inclusion criteria of being published between 1988 and 2005. The methodology of the studies varied. The main factors associated with increased risk of falls include: previous falls, altered gait, functional impairment, cognitive impairment, psychotropic medication use and excessive physical activity. Despite contradictory findings, being a woman at an advanced age may also be a predictor of falls. CONCLUSIONS Methodological limitations were identified in prospective cohort studies on falls. There is a need for further studies on extrinsic determinants, including evaluator blinding and closer monitoring during follow-up with reduced time of recall.

Effectiveness of two modalities of physiotherapy in the treatment of haemophilic arthropathy of the ankle: a randomized pilot study

Although different techniques of physiotherapy have been described for the treatment of haemophilic arthropathy (HA) of ankle, hardly any studies have been applied manual therapy or educational physiotherapy and home exercises. The aim of this study was to assess the effectiveness of manual therapy and educational physiotherapy in the treatment of HA of the ankle. Thirty‐one patients with HA of the ankle with a mean age of 35.29 (SD: 12.877) years randomized to manual therapy group (n = 11), educational group (n = 10) and a control group (n = 10). The two physiotherapy programmes were one with manual therapy articular traction, passive stretching of the gastrocnemius muscles, and exercises for muscle strength and proprioception (MT group) and the other with educational sessions and home exercises (E group). The study lasted for 12 weeks. The treatment with manual therapy improved the gastrocnemius muscle circumference, and the pain of ankle (P < 0.05). Six months later, MT group still enjoyed improvement. In the educational group there were improvements, but not significant, in the measured variables. No patient had ankle haemarthrosis during the study. The treatment with manual therapy improved the circumference of gastrocnemius and lessened pain in the patients with haemophilic arthropathy of the ankle.