Hospital Practices and Research

Abstract Background: Knee Osteoarthritis (OA) is a common degenerative joint disease characterized by ongoing pain and reduced physical function.
Objectives: We aimed to systematically review and meta-analyze the clinical trials that evaluated the impact of transcranial Direct Current Stimulation (tDCS) on knee OA pain.
Methods: A comprehensive search was performed on Scopus, Web of Science, PubMed/MEDLINE, EMBASE, ProQuest, CENTRAL via Cochrane, and PEDro from the inception of these databases until May 31, 2023 with no language restrictions. The objective of the search was to find publications that examined the impact of active tDCS compared to sham tDCS or other interventions in individuals with knee OA.
Results: The meta-analysis comprised ten studies including 517 patients with knee OA. Active tDCS resulted in significantly lower pain scores compared to sham tDCS/ Transcutaneous Electrical Nerve Stimulation (TENS) immediately (effect sizes from pre-test–post-test-control design (dppc2) = -0.83, I² = 61.8%), short-term (dppc2 = -0.74, I² = 43.5%), and mid-term (dppc2 = -1.94, I² = 87.8%) follow-ups, but not in the long term (dppc2 = -0.25, I² = 29.6%). However, the certainty of the evidence was assessed as low to very low.  Moreover, function was significantly improved with active tDCS immediately after the last treatment session either by McMaster Universities Osteoarthritis Index (WOMAC) or Knee Injury and Osteoarthritis Outcome Score (KOOS) (dppc2 = -0.38, I² = 6.6% and dppc2 = 0.87, I² = 60.1%, respectively). The certainty of the evidence was very low. No serious adverse effects of tDCS were reported by the majority of studies.
Conclusion: More than half of the included trials had unclear or high risk of bias and there were no patient follow-ups beyond three months. Given the criteria of reduced I² and sufficient number of studies, no potential sources of heterogeneity were identified. Further high-quality randomized clinical trials with extended follow-up periods are required to determine the true effects of tDCS on knee OA.

Abstract Background: In recent years in Iran, several studies have examined the effectiveness of therapeutic interventions based on the second and third psychological waves on academic burnout.
Objectives: The aim of this study was to integrate the results of these studies and compare the impact of these interventions on academic burnout.
Methods: The research method is meta-analysis. The study population includes all scientific research articles published in Iran that have been performed in the field of effectiveness of second and third wave psychological interventions for academic burnout. The sample size includes scientific research articles that have been published between 2016 and 2021 and have the necessary conditions in terms of methodology. The research tool is a content analysis checklist by examining the magnitude of the effect of each of the second and third wave psychotherapies. The effect size scale was the mean difference and the statistical analysis was performed with Comprehensive Meta-Analysis software (CMA-2).
Results: The results showed that the average size of Cohen's effect in the second wave studies was d= 2.460 and in the third wave studies was d = 2.080 (p <0.01). According to Cohen's interpretation table means the size of the effect is large or high. Also, the results did not show a significant difference between the effect size of second wave studies and third wave studies (p >0.05).
Conclusion: Therefore, it can be stated that based on the results of this meta-analysis, therapeutic interventions based on the second and third psychological waves is effective in improving the learners' academic burnout.

Abstract Background: Seeking local evidence on treatment efficacy is necessary if cultural factors are involved, as in psychotherapy for Chronic Pain (CP). Yet, local evidence is known to be prone to bias, making it difficult to reach reliable conclusions.
Objectives: This study aimed to critically evaluate our local evidence on the efficacy of psychotherapy on quality of life and disability in CP. It has been elaborated that, with some requirements, common meta-analytic tools can be utilized to detect and correct local evidence bias.
Methods: The protocol was registered on PROSPERO, Record [deleted for blind review]. Elmnet, Pubmed, and ProQuest were searched for randomized trials. A multilevel meta-analysis was used to capture the hierarchical structure of the data, and robust variance estimation was used for inference. Several moderation analyses were conducted, and publication and other related sources of bias were examined.
Results: Forty-two trials were initially included. Six were excluded before the analysis due to serious reporting problems undermining their validity. The SMD from 185 effect sizes was 1.08 [.87, 1.3]. The funnel plot showed a strong bias. The bias-corrected estimate from a regression-based method was 0.45 [0.04, 0.87], and from the trim-and-fill was 0.75 [0.48, 1.0].
Conclusion: While our original estimate was large, the corrected estimation showed a medium effect, fairly comparable to the international estimates. Current evidence on different sources of bias in our literature suggests low quality and questionable research practice as the first suspects for our local evidence bias.