Editor's Note: In this sixth column in partnership with the Cochrane Complementary Medicine Field, co-Director of the Field L. Susan Wieland, PhD, shares synopses of seven Cochrane reviews that illustrate that the field of integrative health and medicine is operating within the larger context of a healthy lifestyle. In addition to a review on acupuncture, the reviews address broader intervention categories such as nutrition or exercise, and assess how integrative approaches (e.g., Tai Chi, yoga) compare with conventional ones. Complementary and integrative methods are now routinely included in Cochrane Reviews when nonpharmacologic approaches are reviewed and are allowed to prove their effectiveness compared with conventional methods. However, even if the effectiveness appears to be relatively equivalent, many of the studies included in the reviews are again preliminary, methodologically weak, and underpowered, so that it is often said: “More research is needed.” JICM is pleased to play a role in disseminating these reviews and the lessons learned.—Holger Cramer, PhD, Editor-in-Chief, Journal of Integrative and Complementary Medicine. Translated with www.DeepL.com/Translator (free version)
Acupuncture for Treating Overactive Bladder in Adults
Citation: Hargreaves E, Baker K, Barry G, Harding C, Zhang Y, Kandala N-B, Zhang X, Kernohan A, Clarkson CE. Acupuncture for treating overactive bladder in adults. Cochrane Database of Systematic Reviews 2022, Issue 9. Art. No.: CD013519. DOI: 10.1002/14651858.CD013519.pub2
There is a growing body of literature suggesting that acupuncture treatment may help relieve symptoms of overactive bladder. This review found 15 randomized controlled trials (1395 participants) testing acupuncture for overactive bladder. When compared with no treatment or with sham acupuncture, the effects of acupuncture on improving overactive bladder symptoms were uncertain. When compared with medication, acupuncture may have the same effect on urinary frequency and may slightly reduce the number of times people wake at night to urinate (nocturia), but differences for urinary urgency and incontinence were uncertain. Most studies were small and many had methodological problems. Larger and better studies are needed.
Probiotics for Preventing Acute Upper Respiratory Tract Infections
Citation: Zhao Y, Dong BR, Hao Q. Probiotics for preventing acute upper respiratory tract infections. Cochrane Database of Systematic Reviews 2022, Issue 8. Art. No.: CD006895. DOI: 10.1002/14651858.CD006895.pub4
Research suggests that probiotics may improve local and systemic immunity, and reviewers sought to clarify this for acute upper respiratory infections (URIs). Based on 24 randomized controlled trials (6950 participants) testing probiotics for preventing URIs in healthy children or adults, reviewers concluded that probiotics may reduce the risk of an URI by 24%, reduce the mean length of an URI episode by 1.22 days, and reduce the number of people using antibiotics for an URI by 42%. There may be no difference in the number of people with adverse events with probiotics versus placebo or no treatment. More research on the effects of probiotics for reducing absences from school or work is needed.
Replacing Salt with Low-Sodium Salt Substitutes for Cardiovascular Health in Adults, Children, and Pregnant Women
Citation: Brand A, Visser ME, Schoonees A, Naude CE. Replacing salt with low-sodium salt substitutes (LSSS) for cardiovascular health in adults, children and pregnant women. Cochrane Database of Systematic Reviews 2022, Issue 8. Art. No.: CD015207. DOI: 10.1002/14651858.CD015207
Diets high in sodium contribute to high blood pressure, which is a risk factor for cardiovascular morbidity and mortality. Reviewers examined whether replacing dietary sodium with low sodium salt substitutes could improve cardiovascular health. They found 26 randomized trials (34,961 adults and 92 children) and concluded that in adults, salt substitutes probably slightly reduce systolic and diastolic blood pressure and slightly reduce the risk of stroke, acute coronary syndrome, and death from heart disease. Salt substitutes probably slightly increase blood potassium but may make little or no difference in abnormal potassium levels. There is less or no information on adults without high blood pressure, children, and pregnant women.
Marine-Derived n-3 Fatty Acids Therapy for Stroke
Citation: Alvarez Campano CG, Macleod MJ, Aucott L, Thies F. Marine-derived n-3 fatty acids therapy for stroke. Cochrane Database of Systematic Reviews 2022, Issue 6. Art. No.: CD012815. DOI: 10.1002/14651858.CD012815.pub3
Animal studies have shown that omega-3 fatty acids may help brain cells immediately after stroke, but the effects in humans are unclear. This review found 30 randomized controlled trials testing marine-derived n-3 fatty acids in participants after stroke or transient ischemic attack (TIA), and relevant data were available from nine of the studies (3339 participants). Few studies reported on the primary outcome of stroke recovery, and the evidence was uncertain. The review authors state there is an overall lack of studies focused on stroke recovery, particularly during the acute phase, and call for more studies evaluating vascular-related death, recurrence, adverse events, quality of life, and mood in populations with stroke or TIA.
Interventions for Preventing Falls in Parkinson's Disease
Citation: Allen NE, Canning CG, Almeida LRS, Bloem BR, Keus SHJ, Löfgren N, Nieuwboer A, Verheyden GSAF, Yamato TP, Sherrington C. Interventions for preventing falls in Parkinson's disease. Cochrane Database of Systematic Reviews 2022, Issue 6. Art. No.: CD011574. DOI: 10.1002/14651858.CD011574.pub2
People with Parkinson's disease (PD) are at high risk of falls. Reviewers found 32 randomized controlled trials (3370 participants) testing interventions to prevent falls in people with PD. Twelve studies compared exercise with usual care. The exercise in these studies was primarily gait, balance, and functional training, although resistance training and Tai Chi were also tested. Exercise probably reduces the rate of falls by 26% and reduces the number of people experiencing one or more falls by 10%. Reviewers did not find a difference in effects between exercise types, but they found that fully supervised exercise may be more effective than partially supervised evidence. More research is needed into people with more severe PD and a higher risk of falls.
Physical Activity for Treatment of Irritable Bowel Syndrome
Citation: Nunan D, Cai T, Gardener AD, Ordóñez-Mena JM, Roberts NW, Thomas ET, Mahtani KR. Physical activity for treatment of irritable bowel syndrome. Cochrane Database of Systematic Reviews 2022, Issue 6. Art. No.: CD011497. DOI: 10.1002/14651858.CD011497.pub2
Guidelines recommend physical activity as part of managing irritable bowel syndrome (IBS), but the underlying evidence base is limited. Reviewers found 11 randomized controlled trials (622 participants) comparing physical activity interventions with usual care or another intervention in people with IBS. Compared with usual care, physical activity may improve IBS symptoms, but the evidence is uncertain (six studies). There may be no difference for IBS symptoms between yoga and a walking intervention (two studies) or between yoga and medication (two studies), but all evidence was uncertain. Based on one study, there may be no difference in effects between yoga and a dietary intervention (low certainty evidence). Further research is needed.
Nonpharmacologic Interventions for Sleep Promotion in Hospitalized Children
Citation: Kudchadkar SR, Berger J, Patel R, Barnes S, Twose C, Walker T, Mitchell R, Song J, Anton B, Punjabi NM. Non-pharmacological interventions for sleep promotion in hospitalized children. Cochrane Database of Systematic Reviews 2022, Issue 6. Art. No.: CD012908. DOI: 10.1002/14651858.CD012908.pub2
Sleep is important for the health and development of children but may be impaired during hospitalization. Reviewers examined whether nonpharmacologic treatments could improve sleep in hospitalized children. They found 10 randomized controlled studies (528 children and young people) testing several interventions, including relaxation, massage, and exercise. Reviewers found that multicomponent relaxation therapies and exercise may make little or no difference on the amount or quality of sleep, but touch therapy may improve total sleep time and sleep quality in children with burns. Massage and bedtime stories may also improve sleep. However, all findings are uncertain and better trials with standardized outcomes are needed.