USE OF GRADED EVIDENCE AND CLINICAL OUTCOMES TO MAKE AN INFORMED RECOMMENDATION REGARDING USE OF MONCHROMATIC NEAR-INFRARED PHOTOTHERAPY TO IMPROVE IMPAIRMENTS IN OLDER ADULTS WITH DIABETIC PERIPHERAL NEUROPATHY.
Notice bibliographique
Résumé
Purpose: The primary purpose was to grade evidence for monochromatic near-infrared phototherapy (MIRE) for treatment of decreased foot sensation, impaired balance, and neuropathic pain in older adults with diabetic peripheral neuropathy (DPN). The secondary purpose was to compare graded evidence to clinical outcomes of 35 older adults with DPN who received MIRE. Description: Eight papers were identified. The Modified Canadian Task Force on Health Examination grading system was used to assign each paper a grade of evidence. The papers included one Grade I (well-designed randomized placebo controlled trial [RPCT]), one Grade II-1 (RPCT with limitations), and six Grade III (observational) studies. The grading system was also used to determine strength of the recommendation for MIRE for improving sensation and balance and decreasing pain. Summary of Use: MIRE procedures were similar in all studies. Foot sensation documented by Semmes Weinstein monofilament (SWM) improved in all studies. However, in the Grade I RPCT improvements were similar for the MIRE and placebo groups. An intermediate strength grade was made with the caveat that the recommendation for MIRE might change with new evidence. Neuropathic foot pain documented by the Visual Analog Scale (VAS) was an outcome in two Grade III studies and the Grade II-1 RPCT. Neuropathic pain decreased in all three studies. Subjects in the Grade II-1 study received active MIRE on one limb and placebo MIRE on the other but evaluation of foot pain was limited to the active limb. Because none of the studies employed a placebo group, the assigned grade was a very weak recommendation. Balance was documented by the Tinetti Scale in two Grade III studies and by questionnaire in the Grade II-1 study. Since subjects in the Grade II-1 study received active MIRE on one limb and placebo MIRE on the other there was no placebo group for balance. Although MIRE improved balance in all three studies the grade of recommendation was very weak. The graded evidence indicated weak or insufficient evidence to recommend MIRE. Clinicians may initially deal with this quandary by comparing their clinical outcomes to the literature. Here, the medical records of 35 older adults (69.6 + 11.0 yrs) with DPN who received MIRE were examined to determine if MIRE was associated with increased foot sensitivity and reduced pain. Prior to treatment with MIRE 7.98+ 2.53 sites were insensitive to the 5.07 SWM. After treatment the number of insensate sites decreased to 2.56 + 3.40 (p <.001). Neuropathic pain measured by the VAS was 5.85 + 3.32 prior to treatment with MIRE and 2.15 + 2.83 after treatment (p <.001). Importance to Members: This project showed insufficient evidence to recommend for or against the use of MIRE to improve common impairments in older adults with DPN. Our clinical outcomes are supportive of the use of MIRE in this population, but more RPCTs are needed to better inform practice.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,051 | 0,204 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,002 |
| Méta-épidémiologie (sens large) | 0,009 | 0,013 |
| Bibliométrie | 0,014 | 0,009 |
| Études des sciences et des technologies | 0,002 | 0,002 |
| Communication savante | 0,006 | 0,005 |
| Science ouverte | 0,006 | 0,004 |
| Intégrité de la recherche | 0,008 | 0,005 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,009 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».