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.
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.051 | 0.204 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.009 | 0.013 |
| Bibliometrics | 0.014 | 0.009 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.006 | 0.005 |
| Open science | 0.006 | 0.004 |
| Research integrity | 0.008 | 0.005 |
| Insufficient payload (model declined to judge) | 0.009 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".