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A research note published in the latest issue of the escoliosis consecuencias journal of physiotherapy argues the case for moving away from escoliosis consecuencias significance tests and hypothesis tests in health research. The central reason is that p-values and claims of statistical significance (that is, the products of null hypothesis statistical tests), have some inherent flaws and are often misused and misinterpreted. The problems are difficult to describe succinctly. The research note addresses each of them under the headings: p-values do not indicate the probability that a hypothesis is escoliosis consecuencias true (or not), p-values are not evidence, significance findings are not replicable, and the null hypothesis is false in most clinical research.

For a long time, leading statisticians have argued that the concept of statistical significance escoliosis consecuencias should be abandoned. However, researchers in laboratory and clinical settings have continued to use escoliosis consecuencias null hypothesis statistical tests – presumably because it was what they are taught, it is what many journals expect, and because they were unaware of the benefits of alternative escoliosis consecuencias approaches to analysis. This year, however, articles in the american statistician and nature have strongly recommended escoliosis consecuencias that it is time to stop using ‘statistically significant’ and related terms.

One widely recommended alternative to significance tests and hypothesis tests escoliosis consecuencias in randomised controlled trials is to report the size of escoliosis consecuencias the effect (or point estimate) and the precision of the effect (or confidence interval). Trialists could then interpret the size of the point estimate, that is, is the point estimate large enough to be clinically worthwhile. The lower and upper values for the confidence interval can escoliosis consecuencias then be considered in the same way. For example, if both the lower and upper values for the confidence escoliosis consecuencias interval are large enough to be clinically important, the trial provides a clear answer.

The migration to confidence intervals has already begun in many escoliosis consecuencias journals. The proportion of physiotherapy trials that are using confidence intervals escoliosis consecuencias instead of (or as well as) reporting statistical significance and p-values has been increasing steadily over the past few decades. The migration from p-values to confidence intervals is more common among higher quality escoliosis consecuencias trials. This increases the need for physiotherapists to understand confidence intervals escoliosis consecuencias if they are to keep abreast of the available evidence.)

Stopping using ‘statistically significant’ and related terms has implications for many groups. These include journal editors and editorial policies, reporting checklists (eg, CONSORT checklist), and critical appraisal tools that include a reporting component (eg, pedro scale). A group of member journals of the international society of escoliosis consecuencias physiotherapy journal editors will soon be releasing their new policy escoliosis consecuencias on this issue. We will keep pedro users informed of developments in this escoliosis consecuencias area.

This systematic review evaluated how different types and intensities of escoliosis consecuencias exercise compared against different classes and doses of antihypertensive medications escoliosis consecuencias in lowering systolic blood pressure levels. The review included randomised controlled trials that were conducted in escoliosis consecuencias adults with or without hypertension but no cardiovascular disease, cerebrovascular disease, diabetes or other chronic condition such as cancer. Any form of structured exercise and antihypertensive medication was considered escoliosis consecuencias to be included as the experimental intervention. Interventions were compared against usual practice (no exercise), other exercise regimens, or medications. Risk of bias was evaluated with the cochrane risk of escoliosis consecuencias bias tool. A network meta-analysis was performed to compare the multiple interventions simultaneously.

The review included 197 trials of exercise (n = 10,461 participants) and 194 trials testing antihypertensive drugs (n = 29,281), totalling 391 trials included in the analysis (n = 39,742). No trials directly compared exercise and antihypertensive drugs. The average systolic blood pressure at baseline was 132 mmhg escoliosis consecuencias for participants in trials of exercise interventions, whereas in trials of antihypertensive medications it was consistently over escoliosis consecuencias 150 mmhg. The majority of trials tested endurance interventions (n = 135), such as walking, running, cycling or aquatic exercise.

Across all populations, both exercise interventions (mean difference -5 mmhg, 95% confidence interval -6 to -4) and antihypertensive medications (-9 mmhg, -10 to -8) were effective in lowering systolic blood pressure compared with control. Populations receiving medications achieved greater reductions in systolic blood pressure escoliosis consecuencias compared with those participating in exercise interventions (-4 mmhg, -5 to -3). All types of exercise lowered blood pressure in a similar escoliosis consecuencias fashion, with exception of the combination of endurance and resistance training escoliosis consecuencias which was more effective than dynamic resistance exercise alone (-3 mmhg, -5 to -1). A dose-response effect was observed for medications, but there was substantial uncertainty for effects of different intensities escoliosis consecuencias of exercise.

This review showed that the effect of exercise on lowering escoliosis consecuencias systolic blood pressure appears to be similar to that of escoliosis consecuencias commonly used antihypertensive medications across diverse populations and settings. The possibility of confounding due by the observed differences in escoliosis consecuencias trial populations and characteristics cannot be ruled out.

Naci H, et al. How does exercise treatment compare with antihypertensive medications? A network meta-analysis of 391 randomised controlled trials assessing exercise and medication escoliosis consecuencias effects on systolic blood pressure. Br J sports med 2019;53(14):859-69

The lancet recently published a series of five papers on escoliosis consecuencias ‘ gender equality, norms, and health’. The series provides in depth analysis about health inequalities related escoliosis consecuencias to gender, with calls to action for governments and institutions, leaders in the health sector, researchers, and the community.

Gender inequity and restrictive gender norms (ie, the often unspoken rules that govern the attributes and behaviours escoliosis consecuencias that are valued and considered acceptable for men, women, and gender minorities) are determinants of health. However, the relationship between gender and health is complex because gender escoliosis consecuencias interacts with other social determinants (including race, class, age, and ability), and these interactions are commonly multiplicative rather than additive. The series illustrates several examples of this. Families living in poverty are less likely to seek treatment escoliosis consecuencias for daughters for communicable diseases, and adolescent women in developing countries are at particularly increased escoliosis consecuencias risk of maternal mortality due to inadequate access to healthcare.

Gender norms result in differential exposure to disease, disability, and injury. Men are more likely to experience work-related and road accidents, as well as traumatic injuries. They are more likely to experience substance abuse and develop escoliosis consecuencias lung cancer, due to a perceived sense of masculinity related to alcohol, smoking, and risk-taking behaviour. Health promotion activities aimed at dispelling these stereotypes are essential escoliosis consecuencias in reducing harm to the individual and burden on healthcare escoliosis consecuencias systems.

As physiotherapists, it is important to be aware of our own gender escoliosis consecuencias biases in how we interact with our patients, as well as the systemic gender bias in our healthcare escoliosis consecuencias systems. The series provides evidence that women around the world receive escoliosis consecuencias poorer pain management, are screened for disease less often, receive less aggressive treatment, and substandard follow-up. It is our role as physiotherapists to advocate for adequate escoliosis consecuencias assessment and treatment of women in pain, and promote appropriate screening for neglected conditions such as heart escoliosis consecuencias disease in women.

Research supports the notion that more equal and diverse societies escoliosis consecuencias result in better health outcomes and life expectancy for both escoliosis consecuencias men and women. This should inform the design and implementation of healthcare programs escoliosis consecuencias worldwide. Increasing equitable gender representation in positions of leadership and governance, as well as integrating modules of sex and gender-based medical concepts in medical and public health training would escoliosis consecuencias contribute to the united nation’s goal of gender equality.

Researchers also need to consider gender bias in health research escoliosis consecuencias at various stages. Sampling, design and analysis of randomised controlled trials as well as escoliosis consecuencias population-based surveys needs to ensure equitable representation, unbiased framing of survey questions, and consideration of gender as a significant variable in health escoliosis consecuencias research.

Lou james (MNZM) is a new zealand physiotherapist with expertise in oncology. The number of people surviving or living longer after a escoliosis consecuencias cancer diagnosis is increasing and is projected to rise to escoliosis consecuencias 21.7 million by 2029. While cancer treatments are lengthening lives, they are also creating a whole host of new problems escoliosis consecuencias that can affect a person’s ability to work, their emotional and social well-being, and their long-term health. In response to this, lou founded PINC & STEEL international in 2008 to develop a world-class program for cancer survivorship. In collaboration with international experts she has created the PINC escoliosis consecuencias & STEEL, next steps and paddleon cancer rehabilitation programs plus the cancer escoliosis consecuencias rehabilitation physiotherapy education program. The programs are now available in 12 counties and have escoliosis consecuencias supported thousands of people. In 2017 lou was recognised for her pioneering work in escoliosis consecuencias this field, being appointed a member of the new zealand order of escoliosis consecuencias merit (MNZM) for services to people with cancer.

This article reports the results of two systematic reviews. The first included 32 cohort studies and four randomised controlled escoliosis consecuencias trials that evaluated the impact of exercise on cancer mortality escoliosis consecuencias and recurrence. The second included 40 meta-analyses and 23 randomised controlled trials that assessed the impact escoliosis consecuencias of exercise on cancer treatment-related adverse effects. The cohort studies indicate a reduced risk of cancer mortality escoliosis consecuencias and recurrence in people who exercise more. This was not supported by the randomised controlled trials, but the trials were not designed or powered to evaluate escoliosis consecuencias mortality and recurrence. Some of the randomised controlled trials concluded that exercise participation escoliosis consecuencias reduced cancer treatment-related adverse effects (including bone health, cognitive health, bowel and bladder function, and hot flushes and anaemia). The included systematic reviews indicated that exercise reduces fatigue and escoliosis consecuencias psychosocial distress. Lou says: “this article supports the view that exercise is an important escoliosis consecuencias adjunct therapy in the management of cancer. This is significant for physiotherapists as many people affected by escoliosis consecuencias cancer are not meeting physical activity guidelines and this has escoliosis consecuencias implications for not only their quantity, but also their quality of life.”

Hilfiker R, exercise and other non-pharmaceutical interventions for cancer-related fatigue in patients during or after cancer treatment: a systematic review incorporating an indirect-comparisons meta-analysis. Br J sports med 2018;52(10):651-8

Cancer-related fatigue is a common problem (prevalence 25% to 99%) and can persist for years after completion of cancer treatment. This large (245 randomised controlled trials) network meta-analysis evaluated the impact of exercise and other non-pharmacological interventions on cancer-related fatigue during or after cancer treatment for any type escoliosis consecuencias of cancer. The types of exercise evaluated included aerobic (34 trials), combined aerobic and resistance (23), yoga (10), resistance training (10), multimodal training (exercise and psychosocial combined; 6), and dance (2). All forms of exercise reduced fatigue compared to the control escoliosis consecuencias conditions. For example, aerobic exercise reduced fatigue compared to control by a standardised escoliosis consecuencias mean difference of 0.53 (95% confidence interval 0.26 to 0.80) during cancer treatment, and by 0.33 (0.16 to 0.51) after cancer treatment. Lou says: “this is important for physiotherapists as we have a significant escoliosis consecuencias role in addressing fatigue management for the individual’s impacted. We can have a really positive impact on the management escoliosis consecuencias of fatigue symptoms and improving functional status and quality of escoliosis consecuencias life for people diagnosed with curable or incurable cancer.”

Many physiotherapists have taken up the #myptarticleofthemonth challenge and have been sharing their reading with the escoliosis consecuencias global physiotherapy community. Most posts have been articles reporting the results of randomised escoliosis consecuencias controlled trials. There have also been posts about reviews, large cohort studies, and diagnostic studies. The importance of evaluating treatment fidelity and the reporting of escoliosis consecuencias 95% confidence intervals in trials.

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