Systematic Reviews最新文献

Background: Early intervention for psychotic spectrum disorders can improve long-term outcomes, but service availability and quality can vary globally. Mobile apps have the potential to provide personalised and accessible support for people with psychotic disorders via features such as symptom monitoring, medication reminders, and self-management interventions. Existing reviews have provided an overview of such apps and their feasibility but lack a synthesis of their efficacy, safety, and acceptability. Addressing this gap would guide future app designs and facilitate their implementation by informing clinical and policy decisions. The purpose of this systematic review will be to synthesise the evidence about existing mobile apps for psychotic disorders, including their types and features, feasibility of implementation, usability, clinical impact, and safety.

Methods: This protocol has been structured using the PRISMA-P checklist, and the PICOS framework will guide the search strategy. Six electronic databases (PubMed, Embase, CINAHL, Scopus, Web of Science, and PsycInfo) will be searched. Evaluations of mobile apps for psychotic disorders published in English will be included. Reviews will be excluded but their bibliographies will be searched for relevant articles. Two independent reviewers will conduct the title and abstract screening, full-text review, data extraction into a predetermined form, and risk of bias analysis; with any disagreements discussed until consensus at each stage. The risk of bias analysis will be conducted using the Cochrane Collaboration Risk of Bias 2 and Mixed Methods Appraisal Tool. Meta-analyses will summarise data on feasibility, impact, and safety (where applicable), and app characteristics and user experience will be descriptively analysed.

Discussion: While current reviews synthesise information about apps for psychotic disorders, most of them have a narrow focus on specific app types (e.g., monitoring), outcomes (e.g., engagement), or study types. This systematic review will update previous reviews and add a comprehensive synthesis of app features, their safety, and their overall impact. This review will inform future app development and evaluations and facilitate their implementation in clinical services. It will also address the potential negative impacts associated with these apps and propose ways to mitigate them.

Systematic review registration: PROSPERO CRD42024615781.

Background: Heart rate control is one of the cornerstones of atrial fibrillation (AF) management and is recommended in all AF patients, even as background therapy for rhythm control. Both non-dihydropyridine calcium channel blockers and beta blockers are recommended as first choice rate control drugs, but no preference is given. Even though there are important differences in pharmacological mechanisms and side effects between these drugs, large randomized controlled trials are lacking. We aim to critically evaluate and synthesize the scientific evidence comparing calcium channel blockers and beta blockers.

Methods: A systematic review is conducted in four databases: MEDLINE, Embase, Web of Science, and Cochrane Central, collecting all original research published up until March 2025. Studies including patients with AF (P) treated with non-dihydropyridine calcium channel blockers (I) or beta blockers (C) reporting heart rate (O) or other key secondary outcomes such as major adverse cardiac and cerebrovascular events or mortality will be included. Titles and abstracts, as well as full texts, will be screened by two reviewers, and results will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Assessment of risk of bias is evaluated using the Cochrane Risk-of-Bias (RoB 2) tool for randomized controlled trials and the Risk Of Bias In Non-Randomized Studies - of Interventions (ROBINS-I) tool for non-randomized studies. If sufficient homogeneous data are available, meta-analyses are performed.

Discussion: Current systematic reviews on rate control in AF have primarily focused on acute rate control using the intravenous administration of calcium channel blockers and beta blockers. However, systematic reviews comparing these two drug classes for long-term rate control are lacking, and current guidelines offer little guidance for choosing one drug over the other. This systematic review with meta-analysis will compare the effects of calcium channel blockers and beta blockers on heart rate and provide a comprehensive overview of clinical outcomes and side effects in the treatment of AF. It aims to provide a comprehensive overview, helping clinicians tailor rate control for individual patients.

Systematic review registration: PROSPERO CRD42024526695.

Background: Dysphagia is a common health problem that affects the quality of life of millions of people. Several studies have shown that gamified swallowing exercise has a demonstrated potential to improve training adherence and swallowing function among adults with dysphagia. However, this evidence has not been fully systematically synthesized. This systematic review and meta-analysis aims to systematically examine the effectiveness of gamified swallowing exercise in improving swallowing function among adults with dysphagia.

Methods: The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol (PRISMA-P) 2015 checklist was followed to report the protocol. We will conduct the first retrieval in PubMed, Web of Science, Embase, CINAHL, Scopus, the Cochrane Library, JBI, SinoMed, CNKI, and Wanfang on March 1, 2025. Before completing the systematic review, all target databases will be re-searched to capture the relevant publications, and the timing of the secondary retrieval will be reported in the final review. This systematic review aims to synthesize evidence from randomized controlled trials (RCTs) evaluating the effectiveness of gamified swallowing exercise in adult dysphagia populations. The primary outcomes of interest include swallowing function, while the secondary outcomes encompass adherence, nutritional status, and quality of life. Methodological quality will be rigorously assessed using the Cochrane Risk of Bias tool 2.0. Data analyses will be conducted using RevMan 5.4 software, with the random-effects model being prioritized. The protocol will incorporate three analytical approaches: (1) subgroup analysis to explore heterogeneity sources, with the Instrument for the Credibility of Effect Modification ANalyses (ICEMAN) applied to evaluate subgroup effect credibility; (2) iterative sensitivity analyses, including leave-one-out meta-analyses, to examine the robustness of the results; and (3) evidence certainty grading using the GRADEpro GDT software. To ensure methodological rigor, all procedures-including study selection, data extraction, quality assessment, and evidence evaluation-will be independently performed by two reviewers.

Discussion: This review will synthesize existing studies to evaluate the effects of gamified swallowing exercise on adults with dysphagia, thereby providing valuable reference for healthcare providers to promote the clinical practice of swallowing rehabilitation.

Systematic review registration: PROSPERO CRD42024617169.

Background and objectives: Although Pilates exercises are widely practiced worldwide, the available evidence regarding their metabolic intensity and energy cost remains limited and inconsistent. This study aimed to explore the metabolic equivalent (MET) and energy cost of Pilates exercises. As a secondary objective, we examined other measures commonly used in professional practice to monitor exercise intensity, such as heart rate and the rating of perceived exertion (RPE).

Methods: A systematic search was conducted in PubMed, CENTRAL, Embase, Web of Science, SPORTDiscus, and CINAHL (May 2024). The methodological quality of the studies was assessed using the Rosendal scale. For the meta-analysis, weighted averages were calculated for the following outcomes: METs, energy cost (kcal·min⁻¹), oxygen consumption (V̇O₂, ml·kg⁻¹·min⁻¹), heart rate (bpm), and RPE (Borg 6-20). The certainty of the evidence was assessed using the GRADE approach.

Results: Six studies met the inclusion criteria. Very low- to low-certainty evidence suggests that a typical Pilates session elicits, on average, 3.7 (95% CI: 3.1-4.3) METs, 3.8 (95% CI: 3.1-4.5) kcal·min⁻¹, V̇O₂ of 10.3 (95% CI: 8.1-12.6) ml·kg⁻¹·min⁻¹, heart rate of 108.6 (95% CI: 104.1-113.0) bpm, and RPE of 10.6 (95% CI: 9.3-12.0). However, sensitivity analyses excluding two studies with high risk of bias and without indirect calorimetry yielded lower and more conservative estimates of 3.0 (95% CI: 2.3-3.6) METs and 2.9 (95% CI: 2.3-3.6) kcal·min⁻¹, which should be considered the most methodologically reliable estimates available to date. The rest interval between sets and exercises emerged as a potential moderator, with durations ≤ 60 s associated with higher metabolic intensity.

Conclusion: Within the limits of the current and highly heterogeneous evidence base, Pilates appears to elicit light-to-moderate metabolic intensity. These conclusions are exploratory, and the estimates require confirmation through future well-controlled primary studies.

Systematic review registration: Prospero registration number: CRD42022370937.

Background: Cracked tooth syndrome (CTS) is challenging to diagnose and manage due to its variable clinical presentation, resulting in inconsistent conclusions across existing reviews. Although several systematic reviews have investigated interventions independently, the evidence remains disparate, highlighting the need for an umbrella review to consolidate the different pieces of evidence and address any inconsistencies, thereby informing clinical recommendations.

Methods: This umbrella review will include published systematic reviews and meta-analyses focusing on treatment for CTS. Various databases like PubMed, Cochrane Library, Scopus, Embase, and Web of Science will be searched till June 01, 2025. Two reviewers will independently perform the article screening, study identification, data extraction, and risk of bias assessment using the AMSTAR-2 tool. Overlap between relevant primary sources will be evaluated with the Corrected Covered Area (CCA) method. Certainty of evidence will be determined using the GRADE approach. The results will be reported as a narrative synthesis accompanied by summary tables. There will be an inclusion of only English-language publications, and the possibility of language bias will be recognized.

Discussion: This umbrella review will offer a broad and detailed summary of the available evidence pertaining to the management of CTS to facilitate the implementation of more uniform, evidence-based clinical decisions. The review, through assessing the quality of the methods used, locating the points of agreement or dispute, and indicating the gaps in the research, will be a guide for both the present practice and the next research directions.

Systematic review registration: PROSPERO CRD420250648720.

Background: Chronic pain is a prevalent condition that severely impacts patients' quality of life and poses a substantial burden on global healthcare systems. Digital health technologies (DHTs) have emerged as a potential solution for chronic pain management by improving accessibility, self-management, and personalized care. However, existing studies report inconsistent results regarding the efficacy of these technologies, and no clear consensus has been reached on their clinical effectiveness and safety. Given the current uncertainty in the evidence, this study aims to comprehensively evaluate the therapeutic effects of digital health technologies in patients with chronic pain through a systematic review.

Objectives: This protocol for a systematic review and meta-analysis aims to evaluate the efficacy of digital health technologies in improving pain management, functional status, and mental health in patients with chronic pain.

Methods: A systematic search will be conducted in PubMed, Web of Science, CINAHL, Cochrane Library, and Embase from inception to August 30, 2025. Individual randomized controlled trials (iRCTs) evaluating the efficacy of digital health interventions in patients with chronic pain will be included. The primary outcome is pain intensity, assessed using standardized tools such as the visual analog scale (VAS). Secondary outcomes include physical function, sleep quality, quality of life, and adverse events. Two researchers will independently perform study selection, data extraction, risk-of-bias assessment, and evidence quality evaluation. Data analysis will be conducted using RevMan 5.3 software. Meta-analysis will be performed if heterogeneity is low; otherwise, a qualitative synthesis will be provided.

Discussion: This study will be the first comprehensive systematic review evaluating digital health technologies for chronic pain management. The findings will provide evidence-based support for clinical practice and health policy formulation, promoting the standardized application of these technologies in pain management.

Systematic review registration: PROSPERO CRD420251061767.

Background: Systematic reviews (SRs) are pivotal in vaccination recommendation development. However, the reliability of their findings relies on methodological rigor. This study examines the methodological quality of vaccination-related SRs and aims to identify influencing factors.

Methods: We used the SYSVAC registry to draw 120 SRs on the efficacy or effectiveness of vaccination using a randomized block design. SRs published from 2011 to 2023 were considered. SR characteristics were extracted, and methodological quality was assessed by two reviewers using AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews 2). SRs were scored between 0 and 16 and categorized as high, moderate, low, or critically low quality. Mann-Whitney U test, chi-squared test, Fisher's exact test, and multivariable linear regression analysis were used to assess the influence of SR characteristics on AMSTAR 2 score. Secondary analysis of critically low-rated SRs was conducted to identify limitations in critical items.

Results: Out of 120 SRs, 110 SRs were rated as of critically low-quality. The majority of critically low-rated SRs lacked the justification for excluding individual studies (n = 103, 93.6%) and protocol registration (n = 85, 77.3%). Median AMSTAR 2 score across all SRs was 10 (range 2-16). SRs published after 2017, Cochrane reviews, and SRs from authors with no conflicts of interest (CoI) had higher methodological quality than those published before 2017, non-Cochrane reviews, and SRs from authors with CoI (mean difference AMSTAR 2 score 2, 6, and 2, respectively; all p < 0.05). SRs published before 2017 had significant limitations in protocol registration, study selection in duplicate, and risk of bias assessment; and non-Cochrane reviews in protocol registration, justification for excluding individual studies, funding sources of studies, and impact of risk of bias assessment of individual studies (all p < 0.05). Management of conflicts was described only in a quarter of SRs with CoI (n = 9/43, 20.9%). The adjusted analysis showed that only publication year after 2017 and Cochrane review status had a significant independent relation on the AMSTAR 2 score (R² = 0.26; adjusted R² = 0.17).

Conclusion: The findings underscore the critical methodological shortcomings in vaccination-related SRs. Future efforts should prioritize adherence to established methodological standards and transparency, to enhance the impact of SRs in individual and decision-making.

Background: Systematic reviews are fundamental to evidence-based medicine, but the process of screening studies is time-consuming and prone to errors, especially when conducted by a single reviewer. False exclusions of relevant studies can significantly impact the quality and reliability of reviews. Artificial intelligence (AI) tools have emerged as secondary reviewers in detecting these false exclusions, yet empirical evidence comparing their performance is limited.

Methods: This study protocol outlines a comprehensive evaluation of four AI tools (ASReview, DistillerSR Artificial Intelligence System [DAISY], Evidence for Policy and Practice Information [EPPI]-Reviewer, and Rayyan) in their capacity to act as secondary reviewers during single-reviewer title and abstract screening for systematic reviews. Utilizing a database of single-reviewer screening decisions from two published systematic reviews, we will assess how effective AI tools are at detecting false exclusions while assisting single-reviewer screening compared to the dual-reviewer reference standard. Additionally, we aim to determine the overall screening performance of AI tools in assisting single-reviewer screening.

Discussion: This research seeks to provide valuable insights into the potential of AI-assisted screening for detecting falsely excluded studies during single screening. By comparing the performance of multiple AI tools, we aim to guide researchers in selecting the most effective assistive technologies for their review processes.

Systematic review registration: (Open Science Framework): https://osf.io/dky26.

Background: Advancements in artificial intelligence (AI) are transforming employment and working conditions in ways that shape the safety, health, and well-being of workers. We describe a protocol for a living systematic review (LSR) that will examine the interrelationship between AI systems, employment and working conditions, and worker safety, health, and well-being. Research questions are: 1. What types of AI systems are being used within workplaces and how do their design and adoption impact worker safety, health, and well-being? 2. How do a worker's employment and working conditions affect the relationship between the adoption of AI systems and worker safety, health, and well-being? 3. How does a worker's social position (e.g., age, gender, race, disability) shape the interrelationship between AI systems at work, employment and working conditions, and their safety, health, and well-being?

Methods: A comprehensive search of primary qualitative and quantitative research will be conducted. MEDLINE, Embase (OVID), PsycINFO (OVID), and Web of Science will be searched every six to twelve months using database-specific terms and keywords. Title/abstract and full-text screening will be completed independently by two reviewers. Relevant articles will be quality appraised using a mixed method assessment tool adapted for studies of AI. Medium and high-quality studies will be synthesized using a best evidence synthesis approach. To ensure relevancy, applied workplace and AI stakeholders will provide feedback at all stages of the LSR process through dissemination excluding quality appraisal. Annually, we will evaluate the appropriateness of the review process (e.g., frequency of searches, requirement to refine research questions, utility of continuing LSR). Any amendments to protocols will be documented.

Discussion: This LSR will provide timely and evolving evidence on the implications of AI in the workplace that will be disseminated through a publicly available living review dashboard. We will capture the emerging impact AI has on workers. Findings can be used to develop strategies to minimize AI's potential workplace harms while amplifying its potential benefits, address emerging worker inequities, and inform ongoing discussions regarding responsible and safe AI adoption.

Systematic review registration: PROSPERO CRD42024625501.

Background: Advanced practice nurses play a vital role in healthcare innovation, delivering high-quality care and improving patient outcomes. Leadership is a core competency of advanced practice nurses, empowering them to drive systemic improvements and foster collaboration. However, these master-level educated nurses often encounter challenges in assuming leadership roles, including limited recognition and competing demands on their time. The growing volume of healthcare-related research, combined with the lack of a comprehensive evidence base on the determinants and outcomes of their leadership behaviours, complicates the development of effective programmes. This protocol outlines a systematic approach to addressing these challenges, using an AI tool to efficiently manage the expanding evidence base and provide a detailed understanding of the factors influencing advanced practice nurses' leadership behaviours.

Methods: This protocol follows the PRISMA-P 2015 guidelines to outline a systematic review investigating the determinants and outcomes of advanced practice nurses' leadership behaviours. It employs the SPIDER tool for eligibility criteria, encompassing studies that explore advanced practice nursing leadership behaviours and their determinants and outcomes. Eligible studies include quantitative, qualitative and mixed-methods research, focusing on advanced practice nursing roles. The protocol also outlines a workflow for AI-aided title and abstract screening using ASReview LAB, incorporating multi-phase human validation to ensure accuracy and reliability. Data synthesis will utilise narrative synthesis for quantitative data and meta-aggregation for qualitative findings, integrating results through narrative weaving.

Discussion: This protocol addresses a critical gap in nursing research by systematically exploring the determinants influencing advanced practice nurses' leadership behaviours and their outcomes. It provides evidence to inform the development of tailored programmes aimed at empowering advanced practice nurses to maximise their leadership potential. Additionally, the protocol demonstrates how AI tools can enhance systematic review efficiency while maintaining methodological rigour. The findings will not only contribute to advancing nursing practice but also highlight the transformative potential of AI in research synthesis, ensuring timely and robust evidence generation amidst the expanding volume of healthcare-related research.

Systematic review registration: PROSPERO CRD42025644174.