Saudi Cultural Missions Theses & Dissertations
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Item Restricted Is there a Relationship between the Number of Consultations with a Clinician or Exercise Provider and Outcomes of Pain and Physical Function Following an Exercise Program for People with Knee Osteoarthritis?(Saudi Digital Library, 2025) Alhjjaji, Nouf; Lawford, Belinda1. Abstract 1.1 Background Knee osteoarthritis (OA) is a common disease that presents a significant health burden, causing chronic joint pain and physical function limitation. Given that there is no cure, exercise therapy is recommended as the first-line treatment by all current international clinical guidelines. 1.2 Objectives This systematic review aimed to investigate whether the number of consultations with a clinician or exercise provider is associated with changes in pain and physical function following an exercise intervention in individuals with knee OA. 1.3 Methods We conducted a systematic review with meta-regression and subgroup meta- analyses. A comprehensive literature search was performed using three electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase, from inception until 26 February 2025, with no language restrictions. We included randomised controlled trials (RCTs) comparing exercise interventions for knee OA to no treatment, usual care, attention control/placebo, or co- interventions. The primary outcomes were changes in self-reported pain and physical function. Meta-regression were used to evaluate associations between the number of consultations and outcome changes. Additionally, subgroup meta-analyses were conducted across eight consultation-frequency groups (0, 1–3, 4–6, 7–9, 10–15, 16– 20, 21–25, and 26+ sessions). Sensitivity analyses were conducted to address potential outliers and reduce heterogeneity. 1.4 Results A total of 145 RCTs involving 12,633 participants were included. The number of consultations across studies ranged from zero to over 26 sessions. Meta-regression analyses revealed no statistically significant association between the number of consultations and changes in pain (slope coefficient = −0.003 standardised mean difference [SMD], 95% CI: −0.008 to 0.002; p = 0.203) or physical function (slop coefficient = −0.003 SMD, 95% CI: −0.008 to 0.002; p = 0.250). Subgroup meta- analyses similarly found no meaningful differences in outcomes across the different consultation-frequency groups. Substantial between-study heterogeneity was observed, and evidence of publication bias was detected. Sensitivity analyses, which excluded outliers (20 trials for pain and 24 for function with SMD > ±2), did not alter the overall findings. 1.5 Conclusion There was no association between the number of consultations and changes in pain or function following an exercise program for people with knee osteoarthritis (OA). Given the overall poor quality of the included studies, as well as the heterogeneity among studies, the findings should be interpreted with caution.15 0Item Restricted Does Integrating Cognitive Behavioural Therapy into Cardiac Rehabilitation Improve Depression and Quality of Life in Adults with Cardiovascular Disease? A Systematic Review.(Cardiff University, 2025) Alqahtani, Ola; Gale, NicholaDoes Integrating Cognitive Behavioural Therapy into Cardiac Rehabilitation Improve Depression and Quality of Life in Adults with Cardiovascular Disease? A Systematic Review. Background & Rationale Cardiovascular disease (CVD) is the world’s leading cause of death and disability, placing significant clinical and economic burdens on healthcare systems. While cardiac rehabilitation (CR) encompassing exercise, education, and routine psychosocial support has been shown to improve clinical outcomes, up to thirty percent of cardiac patients experience clinically meaningful depressive symptoms which reduce CR adherence and long-term success. Cognitive behavioural therapy (CBT) offers a structured approach to modifying maladaptive thoughts and behaviours, potentially addressing psychological barriers more effectively than generic psychosocial support. However, many reviews have evaluated heterogeneous ‘psychological interventions’ rather than isolating CBT’s specific impact. This systematic review set out to determine whether CBT, when integrated into CR, alleviates depression and enhances health-related quality of life (HRQoL) more effectively than CR alone. Methods A systematic literature search was conducted across five major databases (Medline, EMBASE, CINAHL, Cochrane CENTRAL, and PsycINFO) from inception to the most recent feasible date, adhering to PRISMA guidelines for study selection and reporting. Six randomised controlled trials, totalling 708 participants, satisfied the inclusion criteria by focusing on adults (≥18 years) undergoing CR for various cardiac conditions (such as myocardial infarction, heart failure, or post-cardiac surgery). Studies which integrated structured CBT sessions into standard CR were compared to CR alone or other forms of standard care. The primary outcome was the reduction in depressive symptoms, measured by validated scales (e.g., the Hamilton Rating Scale for Depression or the Hospital Anxiety and Depression Scale (HADS)). Secondary outcomes involved changes in HRQoL, assessed by either generic or cardiac-specific instruments (such as the Minnesota Living with Heart Failure Questionnaire). Quality appraisal followed the Joanna Briggs Institute guidelines and due to heterogeneity in intervention formats, population characteristics, and outcome measures, a narrative synthesis approach was applied rather than a meta-analysis. Key Findings and Discussion Although the six trials varied in terms of sample size, intervention intensity, and follow-up duration, they shared an overarching conclusion that integrating CBT within CR can lead to notable reductions in depressive symptoms and meaningful improvements in HRQoL. The degree of benefit was generally greater in patients presenting with moderate-to-severe baseline depression. Face-to-face CBT delivery typically achieved better adherence (often exceeding 75%) and larger effect sizes, whereas fully digital CBT programmes suffered from low engagement (approximately 15% module completion). These findings suggest that the personal interaction and therapeutic alliance inherent in face-to-face sessions remain critical for maximising CBT’s clinical impact in cardiac populations, particularly those facing multiple stressors related to their disease. CBT combined with exercise, in several trials, appeared to deliver synergistic benefits for depression and HRQoL, possibly through complementary behavioural (cognitive restructuring and skill-building) and physiological (improved cardiovascular function) mechanisms. The interplay between exercise encouragement and cognitive-behavioural strategies against fear-avoidance thinking also emerged as an important determinant of enhanced functional capacity and sustained improvements in mood. Limitations Several limitations may constrain the generalisability of these results. First, the overall sample predominantly comprised of male participants (approximately two-thirds were male), leaving questions regarding whether women, who often exhibit different depressive symptom profiles and a greater prevalence of depression post-myocardial infarction, would experience similar outcomes. Second, varied measures of depression and HRQoL, along with wide differences in the intervention ‘dose’ (ranging from five-session brief interventions to twelve-week combined programmes), precluded direct quantitative comparisons across studies. Some trials were also underpowered and only a few extended follow-up beyond six to twelve months. Digital CBT approaches did not yield strong results in this review but that may reflect poor adherence rather than intrinsic ineffectiveness, highlighting a need for more engaging and personalised technological platforms. Finally, these RCTs spanned multiple healthcare settings in Europe and the United States where infrastructural and cultural factors might influence both the feasibility of CBT delivery and participant engagement. Conclusions and Recommendations This review provides evidence that structured CBT, when delivered in tandem with cardiac rehabilitation, can significantly alleviate depressive symptoms and promote better quality of life. The most robust outcomes were observed in trials that targeted moderate-to-severe depression, employed face-to-face group or individual CBT sessions, and ensured consistent patient follow-up. These findings strengthen the case for systematically screening CR entrants for depressive symptoms and offering a dedicated CBT component to those above a certain severity threshold. Practical feasibility can be enhanced by training nurses, physiotherapists, or other allied professionals in CBT skills, as illustrated in studies where task shifting maintained strong outcomes. Policy-making bodies, such as national cardiac societies and health agencies, may wish to recommend CBT as a priority psychological intervention in CR programmes, particularly for patients with moderate or severe depression. Future research should further refine the optimal ‘dose’ of CBT, compare blended or stepped-care digital and in-person models, and evaluate the cost-effectiveness to guide broader adoption. By focusing on cognitive restructuring and behaviour change within the supportive framework of CR, healthcare systems can potentially improve both the mental health and functional recovery of individuals with CVD.7 0Item Restricted Exploring Factors Influencing Nurse Attrition in Intensive Care Unit in Critical Care in Saudi Arabia: A Systematic Review(Queens University Belfast, 2025-02-10) McKenna, Niall; Brown, MichaelBackground Methodology & search strategy Result Discussion conclusion15 0Item Restricted Systematic Review The Impact of Sedentary Behaviour on Health Outcomes in Chronic Obstructive Pulmonary(Galway University, 2024-08-25) Alshareef, Ibrahim; Said, Marwa; Marah, FeghaliThe Impact of Sedentary Behaviour on Health Outcomes in Chronic Obstructive Pulmonary6 0Item Restricted Enhancing Colorectal Cancer Screening Participation via Text Message Interventions(King's College London, 2024-09) Almoallem, Ghader; Round, Thomas; Hamad, WasimBackground: Colorectal cancer (CRC) ranks as the third most frequently diagnosed cancer globally and is a significant contributor to cancer-related deaths. Early detection through regular screening is crucial, as it greatly improves treatment outcomes and survival rates. However, screening participation for CRC remains insufficient, especially among minority groups. Text message interventions have been proposed as a cost-efficient and scalable solution to increase screening adherence. Objective: This systematic review and meta-analysis aimed to assess the effectiveness of text messaging interventions in enhancing CRC screening participation. Methods: A comprehensive search was conducted across four major databases Embase, PubMed, MEDLINE, and Cochrane up to August 2024. The review included randomized controlled trials (RCTs), observational studies, mixed-methods studies, and qualitative research that evaluated the impact of text message reminders on CRC screening rates. Data were extracted on study characteristics, intervention specifics, and screening outcomes. Meta-analyses were carried out to calculate pooled effect sizes of text message interventions compared to usual care. Results: Eighteen studies met the inclusion criteria, consisting of 12 RCTs, two observational studies, two mixed-methods studies, and two qualitative studies. The meta-analysis indicated that text message interventions significantly improved CRC screening uptake compared to usual care (pooled relative risk: 1.23, 95% CI: 1.12–1.36, p < 0.001). Sensitivity analyses validated the robustness of these results across different study designs and populations. Text message interventions were especially effective in low-income and underserved groups, where traditional outreach methods tend to be less successful. Furthermore, cost analysis from the reviewed studies highlighted that text messaging is a highly cost-effective method for promoting CRC screening. Conclusion: Text message interventions offer a scalable and effective approach to increasing participation in CRC screening programs. Their affordability, wide reach, and simplicity make them an ideal tool for public health systems, particularly those operating in resource-constrained settings. Despite these encouraging results, further research is needed to refine the content, timing, and cultural relevance of messages to ensure maximum impact across diverse populations. Incorporating text messaging into broader public health strategies could be crucial in alleviating the global burden of colorectal cancer.48 0Item Restricted Restrictive Versus Liberal or Standard Intravenous Fluid Administration in Patients with Sepsis or Septic Shock: A Systematic Review(Queen Mary University of London, 2024-07-31) Khogeer, Tariq; Prowle, JohnSepsis and septic shock are leading causes of morbidity and mortality worldwide, with effective management being critical to improving patient outcomes. Intravenous (IV) fluid resuscitation is a cornerstone of treatment in septic patients; however, the optimal fluid management strategy remains controversial. This systematic review examines the impact of restrictive versus liberal or standard fluid resuscitation strategies on mortality in patients with sepsis or septic shock. The review included eight randomized controlled trials (RCTs) involving 2,375 patients. The primary outcome was mortality within 90 days. Secondary outcomes included the use of mechanical ventilation, vasopressor requirements, renal replacement therapy, and the occurrence of adverse events such as limb ischemia and acute kidney injury. The findings suggest no significant difference in mortality between restrictive and liberal fluid administration. However, restrictive strategies may reduce the need for mechanical ventilation and vasopressor support. These results highlight the need for individualized fluid resuscitation strategies in septic patients, tailored to clinical circumstances. Further large-scale studies are recommended to confirm these findings and optimize fluid management protocols.13 0Item Restricted Evaluating C-reactive protein (CRP) and Interferon gamma-induced protein 10 (IP-10) as Biomarkers for Tuberculosis Treatment Monitoring: A Systematic Review on Adult Pulmonary Tuberculosis Treatment(Keele University, 2023-09-05) Alkhelaiwi, Weaam; Harrison, RebeccaBackground: Tuberculosis (TB) is an enduring global health menace that predominantly affects low- and middle-income nations. Despite medical advancements, TB continues to claim numerous lives every year, necessitating innovative solutions to enhance treatment and monitoring. Conventional strategies for monitoring the progress and outcomes of TB treatment often face challenges, especially in resource-limited settings. These limitations include delayed results, invasive procedures, and the need for sophisticated equipment. Consequently, the medical community is in dire need of efficient and reliable biomarkers that can serve as indicators of treatment response and disease progression. Objectives: The primary aim of this review was to meticulously investigate the potential effectiveness of C-reactive protein (CRP) and Interferon gamma-induced protein 10 (IP-10) as biomarkers for TB treatment monitoring. Specifically, this review sought to answer: "How effective are CRP and IP-10 in tracking treatment response in adults undergoing therapy for active pulmonary tuberculosis?" Methods: Guided by the stringent PRISMA 2020 statement guidelines, an exhaustive search of the literature was conducted, focusing on studies that shed light on CRP and IP-10 as prospective biomarkers for TB treatment tracking. Multiple databases were scoured, and a rigorous selection protocol was established, filtering out studies based on relevance, language, and other criteria. This meticulous approach ensured the inclusion of only the most pertinent studies that contribute significantly to the research question. Results: Out of an initial pool of 39 articles, six pivotal studies were selected for in depth review. These studies spanned a diverse range of geographical territories, from South Korea and Uganda to India and Gambia, offering a broad spectrum of insights. The collated results indicated that biomarker concentrations, notably IP-10 and CRP, exhibited significant fluctuations in sync with TB treatment stages and overall disease diagnosis. The consistency of IP-10 levels in monitoring therapeutic response was particularly pronounced in patients diagnosed with active TB. On the other hand, CRP levels displayed a discernible downward trend as the treatment progressed, underscoring its potential as a reliable indicator of therapeutic effectiveness. However, certain studies also illuminated the circumscribed role of IP-10 as a biomarker in regions heavily burdened with TB. This highlighted the imperative for context-specific evaluation before the widespread adoption of these biomarkers. Conclusions: The findings of this review underscore the promising potential of both CRP and IP-10 as innovative biomarkers for TB treatment monitoring. While IP-10 exhibits a pronounced capability in differentiating between active and latent TB infections, CRP's consistent decline during treatment suggests its pivotal role in evaluating therapeutic efficacy. Nevertheless, the practical adoption of these biomarkers in real-world scenarios mandates further extensive research, comprehensive validation trials, and tailored evaluations to account for regional and demographic variations. The incorporation of such biomarkers could revolutionize TB treatment monitoring, offering rapid, reliable, and non-invasive methods that could be particularly beneficial in resource-constrained settings.10 0Item Restricted Using Continuous Positive Airway Pressure with Hypoxemic Acute Respiratory Failure: A Systematic Review and Meta-Analysis of Randomised Controlled Trials(Saudi Digital Library, 2023-11-25) Alenazi, Bushra; Parekh, Dhruv; Grudzinska, FrancesBackground: Hypoxemic acute respiratory failure (hARF) is a common cause of emergency room and intensive care unit (ICU) admissions. Although the use of continuous positive airway pressure (CPAP) in this group of patients generally has steadily increased, the evidence supporting its use remains sparse. This systematic review and meta-analysis aims to summarise the findings of randomized controlled trials (RCTs) that have evaluated the need for intubation, and in-hospital mortality rate in patients with hARF treated specifically with CPAP compared to any other interventions. Method: CENTRAL, Embase, PubMed, CINAHL and Medline databases were searched. Studies including adults aged ≥ 18 years with hARF and RCTs that compared CPAP to any comparator/control were included. The studies were narratively and statistically analysed, and the outcomes assessed are intubation and in-hospital mortality rate. The risk of bias was assessed using the Cochrane risk of bias checklist for randomized control trials. Studies were reviewed in accordance with PRISMA guidelines. Results: Among 3488 studies identified. Six studies were eligible for inclusion involving 2,966 participants included in the meta-analyses and were descriptively synthesised. Results from the meta-analysis suggest reductions in intubation rate with CPAP compared to standard oxygen therapy (SOT) and high-flow nasal cannula (HFNC) (RR= 0.81, CI= 0.70 to 0.95, P-value=0.007). When doing subgroup analysis, CPAP suggests a reduction in the intubation rate with non-COVID-19 compared to COVID-19 studies. (P-value= 0.0010, 0.10, respectively). This study also suggests that helmet CPAP decreases the intubation rate in comparison to face mask CPAP (P-value <0.00001, 0.08, respectively). On the other hand, the study found that there was no significant difference in the in-hospital mortality rate between CPAP and other comparators (SOT and HFNC), (RR= 0.86, CI= 0.71 to 1.05) and a P-value of 0.13. This lack of significance was observed also in subgroup analysis in COVID-19 and non-COVID-19 studies. However, when looking at CPAP interventions using different interfaces, the risk ratio for face mask studies was not statically significant (RR=0.92, P-value=0.43), but the use of helmet CPAP was found to have a significant effect (risk ratio=0.23, P-value=0.0009). Conclusion: This systematic review highlights the available evidence to support the use of CPAP with hARF patients. Findings suggest that CPAP may reduce the need for intubation, especially in non-COVID-19 patients. However, CPAP has not been shown to have an effect on the in-hospital mortality rate. Using CPAP therapy with a helmet has shown to be a promising approach to lowering intubation and in-hospital mortality rates among this group of patients (hARF). Further studies are needed for a higher certainty of evidence. Other: This systematic review is registered with PROSPERO, CRD420234520237 0Item Restricted Osteoradionecrosis Prophylaxis by Pentoxifylline and Tocopherol Prior to Dental Extractions: A Systematic Review(Saudi Digital Library, 2022) Alleft, Abdullah; Leeson, RachelBackground and Objectives: Osteoradionecrosis (ORN) remains one of the most abysmal complications of head and neck radiotherapy (XRT). The advantageous and welcoming news of increased survivability for head and neck cancer patients came at the expense of increased risks of complications in general, including ORN. Consequently, this positive survival outcome provides plentiful of time for dental deterioration to occur, which may lead to more dental extractions, the main propagator for ORN. Therefore, preventing ORN became a pivotal matter for head and neck cancer patients. From the numerous preventative measures for ORN, prophylactic administration of Pentoxifylline and Tocopherol (PVe) appears promising, especially since many publications have demonstrated its success in treating ORN. However, recently multiple studies investigating PVe prophylactic use to prevent ORN came to fruition. This study aims to assess reported publications by employing a systematic review to investigate whether the prophylactic administration of PVe can prevents or reduces the incidence of ORN. Methods: The systematic review was done according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. An electronic database search on Medline (Ovid), Embase (Ovid), Cochrane Library, Web of Science and Google Scholar focusing on the prophylactic use of PVe to prevent ORN was conducted. Results: Out of two thousand five hundred and thirty-six (2536) publications, five (5) were included based on the patient/population, intervention, comparison, outcomes and studies type (PICOS) design for the prophylactic use of PVe before extraction and/or oral surgical procedure. This systematic review revealed out of 440 individuals, 19 developed ORN representing an incidence rate of 4.3%. However, when control groups and studies that were deemed high risk of bias or poor design were excluded, the incidence of ORN dropped to 2.5 % (9 out of 359 individuals). Both outcomes reveal a lower incidence of ORN compared to the established benchmark without any preventive measures of 7% and lower than the controlled group incidence of 11.5 % in one of the reviewed studies. Conclusion: This systematic review shows that current literature supports the prophylactic use of PVe to prevent ORN prior to dental extraction and other oral surgical intervention. Nevertheless, additional well-designed and prospective randomised controlled trial studies are needed to further validate the efficacy of PVe prophylaxis to prevent ORN before any oral surgical intervention.22 0