| 1. |
- Oeding, Jacob, et al.
(författare)
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Platelet-Rich Plasma Versus Alternative Injections for Osteoarthritis of the Knee: A Systematic Review and Statistical Fragility Index-Based Meta-analysis of Randomized Controlled Trials
- 2024
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Ingår i: AMERICAN JOURNAL OF SPORTS MEDICINE. - 0363-5465 .- 1552-3365.
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Tidskriftsartikel (refereegranskat)abstract
- Background: Based in part on the results of randomized controlled trials (RCTs) that suggest a beneficial effect over alternative treatment options, the use of platelet-rich plasma (PRP) for the management of knee osteoarthritis (OA) is widespread and increasing. However, the extent to which these studies are vulnerable to slight variations in the outcomes of patients remains unknown.Purpose: To evaluate the statistical fragility of conclusions from RCTs that reported outcomes of patients with knee OA who were treated with PRP versus alternative nonoperative management strategies.Study Design: Systematic review and meta-analysis; Level of evidence, 2.Methods: All RCTs comparing PRP with alternative nonoperative treatment options for knee OA were identified. The fragility index (FI) and reverse FI were applied to assess the robustness of conclusions regarding the efficacy of PRP for knee OA. Meta-analyses were performed to determine the minimum number of patients from >= 1 trials included in the meta-analysis for which a modification on the event status would change the statistical significance of the pooled treatment effect.Results: In total, this analysis included outcomes from 1993 patients with a mean +/- SD age of 58.0 +/- 3.8 years. The mean number of events required to reverse significance of individual RCTs (FI) was 4.57 +/- 5.85. Based on random-effects meta-analyses, PRP demonstrated a significantly higher rate of successful outcomes when compared with hyaluronic acid (P = .002; odds ratio [OR], 2.19; 95% CI, 1.33-3.62), as well as higher rates of patient-reported symptom relief (P = .019; OR, 1.55; 95% CI, 1.07-2.24), not requiring a reintervention after the initial injection treatment (P = .002; OR, 2.17; 95% CI, 1.33-3.53), and achieving the minimal clinically important difference (MCID) for pain improvement (P = .007; OR, 6.19; 95% CI, 1.63-23.42) when compared with all alternative nonoperative treatments. Overall, the mean number of events per meta-analysis required to change the statistical significance of the pooled treatment effect was 8.67 +/- 4.50.Conclusion: Conclusions drawn from individual RCTs evaluating PRP for knee OA demonstrated slight robustness. On meta-analysis, PRP demonstrated a significant advantage over hyaluronic acid as well as improved symptom relief, lower rates of reintervention, and more frequent achievement of the MCID for pain improvement when compared with alternative nonoperative treatment options. Statistically significant pooled treatment effects evaluating PRP for knee OA are more robust than approximately half of all comparable meta-analyses in medicine and health care. Future RCTs and meta-analyses should consider reporting FIs and fragility quotients to facilitate interpretation of results in their proper context.
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| 2. |
- Pareek, A., et al.
(författare)
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Long-Term Outcomes after Autologous Chondrocyte Implantation: A Systematic Review at Mean Follow-Up of 11.4 Years
- 2016
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Ingår i: Cartilage. - : SAGE Publications. - 1947-6035 .- 1947-6043. ; 7:4, s. 298-308
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Autologous chondrocyte implantation (ACI) has not been proven to be durable over the long-term. The purpose of this systematic review was (1) to evaluate activity level and knee function, (2) to evaluate reoperation and failure rates, and (3) to analyze risk factors for reoperation and failure of ACI at minimum long-term follow-up. Design. A comprehensive review was performed for studies with long-term outcomes after ACI for cartilage defect repair. Studies reported outcome scores such as Tegner score, Lysholm score, and International Knee Documentation Society (IKDC) score along with rates of failure and reoperation. Modified Coleman Methodology Scores were calculated to assess study methodological quality. Results. Nine studies with a total of 771 patients with a mean age of 33.4 +/- 2.5 years, mean defect size of 5.9 +/- 1.6 cm(2), and mean follow-up of 11.4 years were included. Tegner score, Lysholm score, and IKDC score change from preoperative to final follow-up was 1.1 (95% CI 0.8-1.4, P < 0.001), 24.9 points (95% CI 18.8-31, P < 0.001), and 16.5 points (95% CI 5.4-27.5, P < 0.01), respectively. The mean failure and reoperation rates were 18% and 37%, respectively. Increased age and lesion size (>4.5 cm(2)) were significantly correlated with increased risk of reoperation and failure. Conclusions. Overall, ACI demonstrated successful outcomes in 82% of patients over the long-term. Increased patient age and lesion size greater than 4.5 cm(2) were risk factors for a higher reoperation and failure rate. Nonetheless, this review is limited by heterogeneity in surgical technique, and lesion and patient characteristics.
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| 3. |
- Vuholm, S., et al.
(författare)
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Whole-grain rye and wheat affect some markers of gut health without altering the fecal microbiota in healthy overweight adults: A 6-week randomized trial
- 2017
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Ingår i: Journal of Nutrition. - : Elsevier BV. - 1541-6100 .- 0022-3166. ; 147:11, s. 2067-2075
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Tidskriftsartikel (refereegranskat)abstract
- Whole grains have shown potential for improving gut health, but evidence comparing different whole-grain types is lacking. Objective:We investigated whether whole-grain wheat (WGW) and whole-grain rye (WGR) improve gut health in different ways compared to refined wheat (RW), with the primary outcomes of microbiota composition and gastrointestinal (GI) symptoms. Methods: In a randomized parallel trial, 70 healthy adults (in means ± SDs; aged 51.0 ± 9.4 y, body mass index [BMI (in kg/m2)] 27.8 ± 1.9, 32:38 men:women) replaced cereal foods from their habitual diet with WGR, WGW, or RW (control). Before and after a 6-wk intervention, a spot stool sample was collected and analyzed for short-chain fatty acids and microbiota composition through the use of 16S ribosomal RNA gene-targeted high-throughput amplicon sequencing. GI symptoms and stool regularity were evaluated by questionnaires at baseline and after weeks 2, 4, and 6. Results: Intakes of whole grains were 145.2 ± 75.9, 124.2 ± 57.3, and 5.4 ± 3.2 g/d in the WGW, WGR, and RW groups, respectively. Gut microbiota composition was not affected by diet. The relative change in fecal butyrate decreased in the RW (238%) group compared to the WGW (25%, P = 0.014) and WGR groups (21%, P = 0.037). Other short-chain fatty acids were unaffected. Flatulence was more frequent following intake of WGW (OR: 2.06, 95% CI: 1.03, 4.17) and WGR (OR: 2.62, 95% CI: 1.35, 5.22) compared to RW, whereas bloating was less frequent following WGW (OR: 0.38, 95% CI: 0.18, 0.80) and WGR (OR: 0.34, 95% CI: 0.16, 0.72). Stool frequency increased following WGR but not WGW, compared to RW in weeks 2 (0.4 defecations/d, P = 0.049) and 4 (0.5 defecations/d, P = 0.043), but not in week 6. The WGW and WGR groups did not differ from each other in any of the variables tested. Conclusion: Regular consumption ofWGR andWGWaffected fecal butyrate concentration and gastrointestinal symptoms in healthy overweight adults, supporting the hypothesis thatWGR andWGWcan be included in the diet equally tomaintain gut health.
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