| 1. |
- Howick, Jeremy, et al.
(författare)
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Positive "framing" as a powerful medication for pain : A meta-analysis of randomized trials
- 2016
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Ingår i: European Journal of Integrative Medicine. - : Elsevier. - 1876-3820 .- 1876-3839. ; 8, s. 57-59
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: A growing body of evidence suggests that positive framing–inducing positive expectations about the outcome of treatments can reduce pain symptoms. However there is no pooled estimate of the effect size of positive framing for treating pain. Such an estimate is useful to understand the extent to which positive expectations can enhance usual care.Methods: We extracted data from a recent systematic review of interventions that modified all "context factors" (including but not limited to) inducing positive expectations) in adults suffering from pain. The systematic review concluded that positive expectations were effective, but did not pool the results so no effect size was provided. Two authors independently extracted data from the studies and conducted the analysis. Our primary outcome was patient self-reported pain.Results: 10 randomized trials were eligible for meta-analysis. In the trials with continuous outcomes the standardized effect size was −0.39 (95% confidence interval −0.68 to −0.10, p = 0.009, I2 = 79%), suggesting reduced pain on average in groups in which positive expectations were induced. The effect size was similar in magnitude but was not statistically significant when we excluded studies deemed to have a high risk of bias (standard effect size −0.31, 95% CI −0.65 to 0.02, p = 0.07, I2 = 77%).Conclusion: The effect of inducing positive expectations is comparable to the effects of some pharmacological drugs. However many of the studies had a high risk of bias, and heterogeneity was significant. Future research is warranted including investigating ways to implement this evidence into patient care in an ethical way.
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| 2. |
- Howick, Jeremy, et al.
(författare)
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Randomized trials and observational studies : the current philosophical controversy
- 2016
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Ingår i: Handbook of the Philosophy of Medicine. - Dordrecht : Springer. - 9789401786874 ; , s. 873-886
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Bokkapitel (refereegranskat)abstract
- The supposed superiority of randomized over non-randomized studies is used to justify claims about therapeutic effectiveness of medical interventions and also inclusion criteria for many systematic reviews of therapeutic interventions. However, the view that randomized trials provide better evidence has been challenged by philosophers of science. In addition, empirical evidence for average differences between randomized trials and observational studies (which we would expect if one method were superior) has proven difficult to find. This chapter reviews the controversy surrounding the relative merits of randomized trials and observational studies. It is concluded that while (well-conducted) observational can often provide the same level of evidential support as randomized trials, merits of (well-conducted) randomized trials warrant claims about their superiority, especially where results from the two methods are contradictory.
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| 3. |
- Mebius, Alexander, et al.
(författare)
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Research gaps in the philosophy of evidence-based medicine
- 2016
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Ingår i: Philosophy Compass. - : John Wiley & Sons. - 1747-9991. ; 11:11, s. 757-771
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Tidskriftsartikel (refereegranskat)abstract
- Increasing philosophical attention is being directed to the rapidly growing discipline of evidence-based medicine (EBM). Philosophical discussions of EBM, however, remain narrowly focused on randomization, mechanisms, and the sociology of EBM. Other aspects of EBM have been all but ignored, including (a) the nature of clinical reasoning and the question of whether it can be standardized; (b) the application of EBM principles to the logic, value, and ethics of diagnosis and prognosis; (c) evidence synthesis (systematic reviews and meta-analyses); and (d) the nature and ethics of placebo controls. Philosophical analysis in each of these areas has the potential to enhance the discussion of EBM methodology and practice.
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