Systematic Reviews最新文献

Background: Cognitive Behavioral Social Skills Training (CBSST) is a targeted psychological intervention designed to improve daily functioning and to address negative symptoms in individuals diagnosed with schizophrenia. Despite evidence from clinical trials suggesting beneficial effects of CBSST on functioning and negative symptoms, the overall efficacy of CBSST remains to be quantified. Furthermore, potential moderators and mediators of treatment outcomes remain elusive. This protocol outlines an individual participant data meta-analysis (IPD-MA) with the objective to examine the efficacy of CBSST on psychosocial functioning in schizophrenia.

Method: In accordance with the Preferred Reporting Items for a Systematic review and Meta-Analysis of Individual Participant Data (PRISMA-IPD) guidelines, we will conduct a systematic literature search and employ two-stage and one-stage meta-analytical approaches. The meta-analytical models will evaluate the overall effect of CBSST relative to control treatments in randomized-control trials, identify participant-level (e.g., age, cognitive impairment) and study-level (e.g., individual vs. group settings) predictors of change, and explore the mechanisms that mediate improvement in functioning, such as skills acquisition and cognitive restructuring of defeatist attitudes. Furthermore, the analysis will attempt to determine the optimal amount of CBSST sessions required to enhance functioning and evaluate the impact of patient-level factors driving delivered dosage.

Discussion: The objective of this study is to contribute to the existing literature by addressing the current gaps in understanding the efficacy of CBSST and identifying critical factors for treatment success. Our findings will have the potential to inform personalized treatment planning and the development of clinical guideline recommendations focusing on functional outcomes and negative symptoms in people with schizophrenia.

Systematic review registration: PROSPERO CRD42024605353.

Background: Process mining is increasingly utilized in healthcare to analyze and optimize clinical pathways, offering opportunities to enhance care efficiency and patient outcomes. This systematic review aims to synthesize evidence on the application of process mining to clinical pathways, focusing on its impact on patient outcomes, operational efficiency, and pathway structure.

Methods: A systematic search will be conducted in MEDLINE, Embase, Google Scholar, Web of Science, and ABI/Inform for studies published from 1999 onward. Eligible studies include observational studies, case reports, conference papers, and meta-analyses focusing on process mining applications to clinical pathways in hospital settings. Two independent reviewers will screen studies, extract data, and assess quality using the Mixed Methods Appraisal Tool (MMAT). Data will be extracted considering several pieces of information such as clinical pathway, settings, health outcomes, costs, and indicators, and will be presented in a structured format. A narrative synthesis will be conducted, and findings will be categorized and thematically analysed where possible. Disagreements will be resolved through consensus. Primary outcomes include improvements in care efficiency, patient flow, compliance with clinical guidelines, and reduction in delays or resource use. Secondary outcomes include challenges and limitations in applying process mining techniques.

Discussion: This review will provide a comprehensive synthesis of process mining applications in clinical pathways, highlighting successful strategies, key challenges, and future opportunities. Findings will inform healthcare professionals, policymakers, and researchers on leveraging process mining to optimize clinical care.

Systematic review registration: PROSPERO CRD42024584540.

Background: Chronic diseases (cardiovascular, cancer, respiratory, diabetes and chronic kidney disease) account for over 80% of global mortality and remain a leading public health challenge. Although water intake is essential to physiological function and homeostasis, its role in the long-term prevention of chronic diseases remains underexplored. Current guidelines are vague, inconsistent, and aimed at preventing acute dehydration, without robust evidence supporting benefits for chronic disease prevention. This study outlines a preliminary systematic review designed to synthesise existing literature on plain water intake and chronic disease risk, with the aim of laying the groundwork for future public health recommendations.

Methods: This review will include English-language randomised controlled trials, cross-sectional studies, case-control studies, and cohort studies assessing the relationship between plain water intake and the incidence of chronic diseases in healthy adults. Only studies measuring oral plain water consumption will be included. Adequate water intake is defined as 2 to 3.7 l daily, based on current international and national recommendations. Eligible studies must report on the risk of developing one or more major chronic diseases and provide quantifiable outcomes (e.g. odds ratios, or relative risks with 95% confidence intervals). A meta-analysis will be conducted where appropriate, and subgroup and sensitivity analyses will explore potential sources of heterogeneity.

Discussion: This systematic review is the first to collate evidence on the collective relationship between plain water intake and multiple chronic disease outcomes. By adopting a binary classification (adequate versus inadequate intake), this preliminary synthesis aims to generate practical and actionable insights that are accessible to the general public. Recognising the fragmented nature of existing research, the findings will serve as a foundation for future studies to refine thresholds and inform clinical and public health guidelines. Limitations such as self-reported data, residual confounding, exclusion of non-English studies, and variability in intake measurement, will be transparently addressed in the interpretations of results.

Systematic review registration: PROSPERO; CRD420251021321. It can be accessed from https://www.crd.york.ac.uk/PROSPERO/view/CRD420251021321.

Background: Place-based initiatives (PBIs) are increasingly being used to address complex and multi-faceted issues that cannot be resolved using conventional policy and service delivery approaches. PBIs are interventions designed and delivered to address the unique circumstances of a place that cannot be resolved using conventional, one-size-fits-all policy approaches. Based on the premise that health and social needs coexist within a community, PBIs adopt people-centred and integrated health and social care approaches. With the emergence of hybrid in-person and remote service delivery approaches, there is an increasing policy mandate to incorporate hybrid service delivery in PBIs. The WHO's integrated and people-centred approach to delivering complex inter-related health and social issues encourages the adoption of these approaches during the implementation of PBI. Nevertheless, there is a limited appreciation of whether and how these approaches are integrated. This research, therefore, takes a novel approach by exploring the implementation of people-centred, integrated, hybrid service delivery approaches in PBIs. The review protocol outlines a plan for exploring community-led, integrated health and social, and hybrid in-person and face-to-face service delivery models in PBIs.

Methods: The proposed scoping review will follow the Joanna Briggs Institute approach for conducting scoping reviews and report it according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review-PRISMA-ScR. A search of electronic databases (MEDLINE, EMBASE, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Social Work Abstracts, Social Services Abstracts, AJOL, and African Medicus Index). Articles will be included if they discuss PBIs that have two or all three service delivery approaches: (1) community-led, (2) health and social care integrated approach, and (3) hybrid in-person and remote service delivery. The READ (readying material, extracting data, analyzing data, and distilling findings) approach will be used to analyse the selected data sources. A framework thematic approach will be applied to identify the adoption of the relevant approaches to implementing PBIs.

Significance: We anticipate this review will help researchers, programme designers, and implementers understand how existing tools better address health equity considerations in intersectoral partnerships and pave the way for developing new, comprehensive tools suitable for designing PBIs.

Background: In ptotic/macromastic breasts, nipple-sparing mastectomy (NSM) risks ischemic complications. Staging with nipple repositioning (mastopexy or breast reduction) may improve perfusion, but uncertainty remains regarding safety and optimal timing.

Methods: PRISMA guidelines will be followed. The database search will be conducted using MEDLINE (PubMed), Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.org targeting studies from inception to search date. Meta-analysis will be performed using Review Manager 5.4 software; forest plots will be used for two-arm studies to calculate pooled risk ratios, heterogeneity using I² statistics, and p-value for overall effect.

Discussion: Due to the conflicting studies regarding the optimal timing and safety of nipple-repositioning before NSM, a systematic review and meta-analysis is required to provide more definitive evidence-based recommendations regarding the optimal timing and safety of this staged approach. Limitations may include the predominance of observational studies, heterogeneity in intervals, and inconsistent reporting that may limit the certainty of our conclusions.

Systematic review registration: ROSPERO CRD42024513738.

Background: Cerebral palsy (CP) is the leading cause of childhood motor disability, often requiring intensive, long-term rehabilitation to improve motor function and independence in daily activities. Robot-assisted therapy has emerged as a promising intervention, as it can deliver high-intensity, task-specific, and motivating treatment. However, evidence for its superiority over conventional rehabilitation interventions (CRIs) is inconsistent, and a comprehensive quantitative synthesis is lacking. This protocol details a systematic review and meta-analysis to evaluate the effectiveness of robot-assisted therapy on motor outcomes in children with CP.

Methods: This protocol has been developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement. We will conduct a comprehensive search of five electronic databases (PubMed, Embase, Web of Science, CINAHL, and the Cochrane Library) from their inception to June 2025. The review will include randomized controlled trials (RCTs) comparing robot-assisted therapy with CRIs in children with CP. Two independent reviewers will screen titles, abstracts, and full texts and extract relevant data. Primary outcomes will include measures of gross motor function, activities of daily living (ADL), gait, and balance. Secondary outcomes will include upper limb function and quality of life. Where appropriate, we will perform a meta-analysis using a random-effects model in Stata 14.0. We will investigate sources of heterogeneity using subgroup and sensitivity analyses. Publication bias will be assessed with funnel plots and Egger's test. Furthermore, Trial Sequential Analysis will be employed to assess the robustness of the findings and control for risks of random error. The overall quality of evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework.

Systematic review registration: PROSPERO CRD420250652267.

Background: The number of positive psychological interventions, including hope interventions to foster well-being and decrease the huge burden of mental conditions, has exponentially increased. Consequently, the number of hope outcome measures has also increased. The Hope Index (HI) is an extensively used hope outcome measure, but the evidence of its psychometric performance is fragmented. This systematic review and meta-analysis aims to critically appraise the psychometric properties of the Hope Index and assess its utility.

Methods/design: Two independent and blinded reviewers will search articles in PubMed, Scopus, Web of Science, CINAHL, PsychINFO, ProQuest Dissertations, and Google Scholar. Thereafter, three independent reviewers will then screen the retrieved articles. The risk of bias across studies will then be evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. The quality of the psychometric properties will be rated using a pre-set criterion and, after that, synthesized using the modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) checklist.

Discussion: The proposed systematic review will appraise the collective evidence of the psychometric robustness of the HI. The review will also assist in identifying psychometrics that may require further evaluation and make recommendations on the feasibility and utility of the HI.

Systematic review registration: PROSPERO CRD42024511130.

Background: Chronic low back pain (CLBP) is among the most disabling musculoskeletal disorders worldwide. Traditional in-person rehabilitation is often limited by time, geographic, and financial barriers. Telerehabilitation, which delivers personalized interventions through digital technologies (e.g., mobile apps, video coaching, wearable devices, virtual reality, and artificial intelligence feedback systems), is emerging as a complementary and alternative approach to conventional rehabilitation. However, there is currently no consensus on its efficacy and safety. Therefore, this study aims to evaluate the effectiveness of various forms of telerehabilitation in improving pain intensity, physical function, psychological symptoms, and quality of life in patients with CLBP. In addition, the study will assess intervention adherence, patient satisfaction, and safety (as measured by the incidence of adverse events) through systematic review and network meta-analysis.

Methods: A systematic search will be conducted in the following databases: PubMed/MEDLINE, EMBASE, Cochrane Library, Scopus, and Web of Science, covering all records from database inception to 31 December 2025. Eligible studies will include randomized controlled trials (RCTs) involving adults (≥ 18 years) with CLBP, comparing telerehabilitation interventions to any control intervention. The primary outcome will be pain intensity, while secondary outcomes will include physical function, psychological status, quality of life, and adverse events. The risk of bias for the included studies will be assessed using the revised Cochrane Risk of Bias 2.0 tool. The certainty of evidence will be evaluated using the CINeMA (Confidence in Network Meta-Analysis) web application. All network meta-analyses will be conducted within a frequentist framework using Stata 15 software and will apply random-effects models. Intervention rankings will be estimated using Surface Under the Cumulative Ranking (SUCRA) curves and illustrated with forest plots showing both individual and pooled effect sizes. Additional analyses will include assessments of statistical inconsistency, publication bias, heterogeneity, sensitivity, and subgroup differences.

Discussion: This study aimed to compare and rank the available evidence on various forms of telerehabilitation for the management of CLBP, as well as to assess its safety. The findings offer valuable insights for healthcare professionals and policymakers, supporting the advancement of patient-centered rehabilitation strategies.

Systematic review registration: PROSPERO CRD420251015478.

Background: Traditionally, monocular interventions, like patching, have been the gold standard in amblyopia treatment. However, the current understanding that amblyopia is a binocular rather than monocular condition has inspired a surge in binocular treatments, which encourage the simultaneous use of both eyes.

Objectives: This systematic review aims to evaluate the effects of binocular treatment for amblyopia among children (9 years and younger) versus standard monocular interventions (patching or atropine eye drops) in terms of best corrected visual acuity (BCVA), treatment adherence, and patient/caregiver-reported outcomes. Secondary outcomes include change in other visual outcomes (stereoacuity and contrast sensitivity), reported barriers to treatment, reported side effects, and sustained improvement in BCVA on follow up.

Methods: A comprehensive search will be conducted on three databases (PubMed, Embase, and CENTRAL) and two trial registries (ClinicalTrials.gov and WHO ICTRP). A previous search will be updated to include results since inception through March 2026. Two blinded, independent reviewers will screen titles and abstracts against predetermined criteria. Eligible studies will undergo full-text screening by two blinded, independent reviewers. Randomized controlled trials that compare binocular and monocular interventions for amblyopia among children younger than 9 years of age will be included. The quality of included studies will be evaluated using the Cochrane risk of bias tool for randomized trials (RoB-2). Data analysis will be carried out using Revman software. Continuous variables will be summarized using mean difference (MD) and 95% confidence intervals [CI]. Meta-analyses will be performed employing random-effects models.

Discussion: Although similar reviews exist, binocular therapy is a fairly novel and nuanced treatment. As such, new research continues to add to the growing body of evidence. Furthermore, existing reviews mainly focus on post-interventional visual outcomes, while this review will also shine light on outcomes like adherence, patient or caregiver reported outcomes, reported barriers and side effects, and sustained improvement after treatment cessation. These outcomes will be important to all stakeholders involved: patients, caregivers, healthcare providers, and policy makers, especially with such a pervasive condition that can affect multiple aspects of a child's life, in addition to their family's lives, with possible consequences carried into adulthood.

Systematic review registration: PROSPERO CRD42024502274.

Background: Children and adolescents with autism spectrum disorder (ASD) frequently experience sleep problems. Although various pharmacological, behavioral, and physical interventions have demonstrated efficacy in improving sleep among children with ASD, the relative effectiveness of these interventions remains unclear.

Methods: We will conduct a systematic literature search to identify randomized controlled trials that evaluate the efficacy of pharmacological (e.g., melatonin), psychological (e.g., cognitive behavioral therapy), and physical (e.g., bright light therapy) interventions for sleep problems in children with ASD. We will search PubMed, PsycINFO, Cochrane CENTRAL, major trial registries, and regulatory agency websites. We will assess the Cochrane Risk of Bias 2.0 (RoB 2.0) tool for primary outcome and the Risk Of Bias due to Missing Evidence in Network meta-analysis (ROB-MEN) tool for the bias due to missing network evidence. A network meta-analysis (NMA) will be performed to compare the included interventions. The primary outcome will be sleep onset latency, while secondary outcomes will include other sleep variables, all-cause dropouts, and sleep disturbances assessed using standardized measures. We will assess confidence in NMA(CINeMA).

Discussion: Our NMA aims to provide evidence-based insights into the effectiveness of sleep interventions for clinicians, children with ASD, and their caregivers. This information will help guide treatment decisions and improve the quality of life for children with ASD and their families.

Systematic review registration: PROSPERO CRD42024592795.