Courtney Lee

The effectiveness of acupuncture research across components of the trauma spectrum response (tsr): a systematic review of reviews

BackgroundCo-morbid symptoms (for example, chronic pain, depression, anxiety, and fatigue) are particularly common in military fighters returning from the current conflicts, who have experienced physical and/or psychological trauma. These overlapping conditions cut across the boundaries of mind, brain and body, resulting in a common symptomatic and functional spectrum of physical, cognitive, psychological and behavioral effects referred to as the ‘Trauma Spectrum Response’ (TSR). While acupuncture has been shown to treat some of these components effectively, the current literature is often difficult to interpret, inconsistent or of variable quality. Thus, to gauge comprehensively the effectiveness of acupuncture across TSR components, a systematic review of reviews was conducted using the Samueli Institute’s Rapid Evidence Assessment of the Literature (REAL©) methodology.MethodsPubMed/MEDLINE, the Cochrane Database of Systematic Reviews, EMBASE, CINAHL, and PsycInfo were searched from inception to September 2011 for systematic reviews/meta-analyses. Quality assessment was rigorously performed using the Scottish Intercollegiate Guidelines Network (SIGN 50) checklist and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. Adherence to the Standards for Reporting Interventions in Clinical Trials in Acupuncture (STRICTA) criteria was also assessed.ResultsOf the 1,480 citations identified by our searches, 52 systematic reviews/meta-analyses, all high quality except for one, met inclusion criteria for each TSR component except post-traumatic stress disorder (PTSD) and sexual function. The majority of reviews addressed most STRICTA components, but did not describe safety.ConclusionsBased on the results of our review, acupuncture appears to be effective for treating headaches and, although more research is needed, seems to be a promising treatment option for anxiety, sleep disturbances, depression and chronic pain. It does not, however, demonstrate any substantial treatment benefit for substance abuse. Because there were no reviews on PTSD or sexual function that met our pre-defined inclusion criteria, we cannot comment on acupuncture’s effectiveness in treating these conditions. More quality data are also needed to determine whether acupuncture is appropriate for treating fatigue or cognitive difficulties. Further, while acupuncture has been shown to be generally safe, safety was not described in the majority of studies, making it difficult to provide any strong recommendations. Future research should address safety reporting in detail in order to increase our confidence in acupuncture’s efficacy across the identified TSR components.

Warm-ups for military fitness testing: rapid evidence assessment of the literature.

INTRODUCTION Warm-up exercises are commonly used before exercise as a method to physiologically prepare for strenuous physical activity. Various warm-up exercises are often implemented but without scientific merit and, at times, may be detrimental to performance. PURPOSE/OBJECTIVE To date, no systematic reviews have examined the effectiveness of warm-up exercises for military physical fitness test (PFT) or combat fitness test (CFT). The purpose of this rapid evidence assessment of the literature was to examine the quantity, quality, and effectiveness of warm-up exercises for PFT and identify those that might increase PFT and/or CFT scores, as reported in the literature. METHODS Literature searches of randomized controlled trials were performed across various databases from database inception to May 2011. Methodological quality of included studies was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) 50 criteria for randomized controlled trial designs, and studies were individually described. Subject matter experts summarized the results applicable or generalizable to military testing. RESULTS The search yielded a total of 1177 citations, with 37 fitting our inclusion criteria. Cardiovascular warm-ups increased sprint/running time, but dynamic stretching and dynamic warm-ups had the most positive outcome for the various exercise tests examined. Systematically, static stretching had no beneficial or detrimental effect on exercise performance but did improve range of movement exercises. CONCLUSIONS Selected warm-up exercise may increase PFT and possibly CFT scores. Further research is needed to investigate the efficacy of dynamic stretching and dynamic warm-ups.

Tyrosine for Mitigating Stress and Enhancing Performance in Healthy Adult Humans, a Rapid Evidence Assessment of the Literature

BACKGROUND Tyrosine, a precursor of catecholamine neurotransmitters, may help alleviate physical/cognitive performance decrements in humans under conditions of high physical/psychological stress. OBJECTIVE Determine whether supplemental tyrosine mitigates stress-induced decrements in cognitive and/or physical performance in healthy individuals using Samueli Institutes Rapid Evidence Assessment of the Literature methodology. METHODS Key databases (PubMed/MEDLINE, CINAHL, Embase, PsycInfo, and Agricola) were searched for randomized controlled trials from inception to October 2012. Scottish Intercollegiate Guidelines 50 criteria and Grading of Recommendation Assessment, Development, and Evaluation framework were used to assess the quality of individual studies and the overall literature pool, respectively. Controlled clinical trials were included later in the overall methodology. RESULTS 10 randomized controlled trials and 4 controlled clinical trials met our inclusion criteria. On the basis of the available evidence, no recommendation could be made for the effect of tyrosine on physical performance under stressful physical conditions. However, a weak recommendation in favor of tyrosine was made for cognitive stress as all studies showed a positive effect. CONCLUSIONS This review indicates that the available evidence is insufficient to make confident recommendations on the effectiveness of tyrosine for mitigating stress effects on physical/cognitive performance. However, tyrosine may benefit cognitive performance and is worthy of further study.