Recently Published Projects

Published on June 27, 2021
Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update. Comparative Effectiveness Review No. 227. [Entered Retrospectively]
250 Studies • 10 Key Questions • 250 Extraction Forms
Project created on June 27, 2021
Last updated on June 27, 2021
Objectives: Structured Abstract Objectives. We updated the evidence from our 2018 report assessing persistent improvement in outcomes following completion of therapy for noninvasive nonpharmacological treatment for selected chronic pain conditions. Data sources. Electronic databases (Ovid MEDLINE®, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews), through November 2017 (for priorAHRQreport) and from September 2017 through September 2019 (for this update report), reference lists, ClinicalTrials.gov, and our previous report. Review methods. Using predefined criteria, we selected randomized controlled trials (RCTs) of noninvasive nonpharmacological treatments for five common chronic pain conditions (chronic low back pain; chronic neck pain; osteoarthritis of the knee, hip, or hand; fibromyalgia; and tension headache) that reported results for a at least 1 month postintervention. We analyzed effects and assessed strength of evidence (SOE) at short term (1 to <6 months following treatment completion), intermediate term (≥6 to <12 months), and long term (≥12 months).Results. We included 233 RCTs (31 new to this update). Many were small (N<70), and evidence beyond 12 months after treatment completion was sparse. The most common comparison was with usual care. Evidence on harms was limited, with no evidence suggesting increased risk for serious treatment-related harms for any intervention. Effect sizes were generally small for function and pain. Chronic low back pain: Psychological therapies were associated with small improvements compared with usual care or an attention control for both function and pain at short-term, intermediate-term, and long-term followup (SOE: moderate). Function improved over short and/or intermediate term for exercise, low-level laser therapy, spinal manipulation, massage, yoga, acupuncture, and multidisciplinary rehabilitation (SOE moderate at short term for exercise, massage, and yoga; low for all others). Improvements in pain at short term were seen for massage, mindfulness-based stress reduction, acupuncture,and multidisciplinary rehabilitation (SOE: moderate), and exercise, low-level laser therapy, and yoga (SOE: low). At intermediate term, spinal manipulation, yoga, multidisciplinary rehabilitation (SOE: moderate) and exercise and mindfulness-based stress reduction (SOE: low) were associated with improved pain. Compared with exercise, multidisciplinary rehabilitation improved both function and pain at short and intermediate terms (small effects, SOE: moderate.) Chronic neck pain: In the short-term, low-level laser therapy (SOE: moderate) and massage (SOE: low) improved function and pain. Exercise in general improved function long term, and combination exercise improved function and pain both short and long term compared with usual care (SOE: low). Acupuncture improved function short and intermediate term, but there was no pain improvement compared with sham acupuncture (SOE: low). Compared with acetaminophen, Pilates improved both function and pain (SOE: low). Osteoarthritis pain: Exercise resulted in small improvements in function and pain at short-term(SOE: moderate) and long-term, and moderate improvement at intermediate-term (SOE: low) followup for knee osteoarthritis versus nonactive comparators. Small improvements in function and pain with exercise were seen for hip osteoarthritis short term (SOE: low). Functional improvement persisted into intermediate term, but pain improvement did not (SOE: low). Fibromyalgia: Functional improvements were seen with exercise, mind-body practices, multidisciplinary rehabilitation (SOE: low) and acupuncture (SOE: moderate) short term compared with usual care, attention control, or sham treatment. At intermediate term, there was functional improvement with exercise and acupuncture (SOE: moderate), cognitive-behavioral therapy (CBT), mindfulness-basdedstress reduction, myofascial release,and multidisciplinary rehabilitation (SOE: low). LLong term, functional improvements persisted for multidisciplinary rehabilitation without improvement in pain (SOE: low). Compared with exercise, tai chiconferred improvement in function short and intermediate term (SOE: low). Pain was improved with exercise (short and intermediate term, SOE moderate), and for CBT (shortterm),mindfulness practices,and multidisciplinary rehabilitation (MDR) (intermediate term)(SOE lowfor these three). Chronic tension headache: Evidence was sparse and the majority of trials were of poor quality. Spinal manipulation resulted in moderate improvement in pain short term. Conclusions. Trials identified subsequent to the earlier report largely support previous findings, —namely that exercise, multidisciplinary rehabilitation, acupuncture, CBT, mindfulness practices, massage,and mind-body practices most consistently improve function and/or pain beyond the course of therapy for specific chronic pain conditions. Additional research, including comparisons with pharmacological and other active controls, on effects beyond the immediate post-treatment period is needed, particularly for conditions other than low back pain
Published on June 27, 2021
Opioid Treatments for Chronic Pain
175 Studies • 4 Key Questions • 175 Extraction Forms
Project created on June 27, 2021
Last updated on June 27, 2021
Objectives: To assess the effectiveness and harms of opioid therapy for chronic noncancer pain; alternative opioid dosing strategies; and risk mitigation strategies
Published on June 27, 2021
Primary Care Relevant Interventions for Tobacco and Nicotine Use Prevention and Cessation in Children and Adolescents: A Systematic Review for the U.S. Preventive Services Task Force
26 Studies • 3 Key Questions • 26 Extraction Forms
Project created on June 27, 2021
Last updated on June 27, 2021
Objectives: Structured Abstract Background: Interventions to discourage use of tobacco products among children and adolescents may help decrease tobacco-related illness. Tobacco products for this review include electronic nicotine delivery systems, often referred to as e-cigarettes. Purpose: To systematically update the 2013 U.S. Preventive Services Task Force (USPSTF) review on primary care relevant interventions for tobacco use prevention and cessation in children and adolescents. Data Sources: We searched the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, MEDLINE, PsycINFO, and EMBASE (September 1, 2012 to June 25, 2019) with surveillance through February 7, 2020. Study Selection: We selected primary care relevant studies based on inclusion and exclusion criteria developed for each key question. We included randomized and nonrandomized controlled trials of children and adolescents up to 18 years of age for cessation and 25 years of age for prevention. Trials that compared behavioral or pharmacological interventions with a no or minimal smoking intervention control group (e.g., usual care, attention control, wait list) were included. Data Extraction: One investigator abstracted data and a second investigator checked data abstraction for accuracy. Two investigators independently assessed study quality using methods developed by the USPSTF. Data Synthesis (Results): Twenty-six trials met inclusion criteria. Behavioral interventions were associated with decreased likelihood of smoking initiation compared with control interventions (k=13, n=21,700; 7.4% vs. 9.2%; relative risk [RR] 0.82, 95% confidence interval [CI] 0.73 to 0.92). In trials restricted to smokers, behavioral interventions had no effect on smoking prevalence (k=9, n=2,516, 80.7% vs. 84.1% continued smoking, RR 0.97, 95% CI, 0.93 to 1.01). Behavioral interventions were more effective than control interventions at decreasing smoking prevalence in trials of smokers and nonsmokers (k=7, n=10,533; 16.8% vs. 20.1%; RR 0.91, 95% CI, 0.83 to 0.995). However, these results were sensitive to inclusion of two trials of very intensive interventions. Two trials of bupropion and one trial of nicotine replacement therapy found no significant benefits of medication on likelihood of smoking cessation. One trial each found no evidence for a beneficial intervention effect on health outcomes or on adult smoking. Limitations: Few trials addressed the prevention or cessation of tobacco products other than cigarettes; no trials evaluated effects of interventions on e-cigarette use. Trials of pharmacotherapy were few and had small sample sizes. Conclusions: Behavioral interventions can reduce the likelihood of smoking initiation in nonsmoking youth and young adults. Research is needed to identify effective behavioral interventions for youth who smoke or who use other tobacco products and to understand the effectiveness of pharmacotherapy on cessation. Due to the rapid escalation of e-cigarette use among youth, both prevention and cessation trials that target and/or include e-cigarettes are imminently needed.
Published on June 27, 2021
Screening for Hepatitis C Virus Infection in Adolescents and Adults: A Systematic Review Update for the U.S. Preventive Services Task Force [Entered Retrospectively]
94 Studies • 9 Key Questions • 94 Extraction Forms
Project created on June 27, 2021
Last updated on June 27, 2021
Objectives: Background: Prior reviews on hepatitis C (HCV) infection screening and treatment used by the U.S. Preventive Services Task Force (USPSTF) to inform its 2013 recommendation found interferon-containing antiviral therapies associated with sustained virologic response (SVR) rates of 68 percent to 78 percent and an association between SVR after antiviral therapy and improved clinical outcomes. Interferon-containing regimens were associated with a high rate of harms. Since the prior reviews, interferon-containing antiviral therapies have been replaced by all-oral direct acting antiviral (DAA) regimens. Purpose: To systematically review the evidence on screening for HCV infection in asymptomatic adults and adolescents, including effects of DAA regimens and interventions to prevent mother-to-child transmission. Data Sources: We searched the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, Ovid MEDLINE and ClinicalTrials.gov through February 2019, manually reviewed reference lists, and conducted literature surveillance through November 22, 2019. Study Selection: Randomized controlled trials (RCTs), non-randomized trials, and cohort studies of HCV screening, antiviral therapy, and interventions to prevent mother-to-child transmission of HCV infection on SVR and clinical outcomes; and cohort studies on the association between an SVR after antiviral therapy versus no SVR and clinical outcomes. Treatment studies focused on populations without cirrhosis who are more likely to be asymptomatic and identified by screening. Data Extraction: One investigator abstracted data, and a second investigator checked data abstraction for accuracy. Two investigators independently assessed study quality using methods developed by the USPSTF. Data Synthesis (Results): No study evaluated the benefits of HCV screening versus no screening, or the yield of repeat versus one-time screening. Previously reviewed studies found that HCV screening might be associated with negative psychological and social consequences, but had important methodological limitations; no new studies were identified. One new study found similar diagnostic yield of risk-based and birth cohort screening, but it was retrospective and assumed perfect implementation of risk-based screening. Ten trials reported improvements in some quality of life and functional outcomes following DAA treatment compared with prior to treatment, but differences were small, studies were open-label, and there was no non-DAA comparison group. Forty-nine trials found DAA regimens associated with pooled SVR rates that ranged from 95.5 percent to 98.9 percent across genotypes; rates of serious adverse events (1.9%) and withdrawal due to adverse events (0.4%) were low. Seven trials reported SVR rates in adolescents with DAA therapy similar to those observed in adults. An SVR after antiviral therapy was associated with decreased risk of all-cause mortality (13 studies, pooled hazard ratio [HR] 0.40, 95% confidence interval [CI] 0.28 to 0.56), liver mortality (4 studies, pooled HR 0.11, 95% CI, 0.04 to 0.27), cirrhosis (4 cohorts in 3 studies, pooled HR 0.36, 95% CI, 0.33 to 0.40), and hepatocellular carcinoma (20 studies, pooled HR 0.29, 95% CI, 0.23 to 0.38) versus no SVR, after adjustment for potential confounders. New evidence on interventions to reduce the risk of mother-to-infant transmission was limited and did not change the conclusion from the prior review that no intervention has been clearly demonstrated to reduce risk. Limitations: Most DAA trials were not randomized and did not have a non-DAA comparison group, almost all DAA trials relied on SVR as the main efficacy outcome, observational studies varied in how well they adjusted for confounders, and few studies evaluated the effectiveness of DAA regimens in adolescents. Conclusions: The USPSTF previously determined that HCV screening is highly accurate. Currently recommended all-oral DAA regimens are associated with very high SVR rates (95.5% to 98.9% across genotypes) and few harms relative to older antiviral therapies. An SVR after antiviral therapy is associated with improved clinical outcomes compared with no SVR, after adjusting for potential confounders. Direct evidence on the benefits of HCV screening remains unavailable, and direct evidence on the effects of antiviral therapy on clinical outcomes remains limited but indicates improved long-term outcomes.
Published on June 27, 2021
Maternal, Fetal, and Child Outcomes of Mental Health Treatments in Women: A Systematic Review of Perinatal Pharmacological Interventions
168 Studies • 4 Key Questions • 168 Extraction Forms
Project created on June 27, 2021
Last updated on June 27, 2021
Objectives: A systematic review to assess the efficacy and comparative effectiveness of pharmacological interventions for pregnant and postpartum women with psychiatric disorders.