Person: Chu, Paula
Loading...
Email Address
AA Acceptance Date
Birth Date
Research Projects
Organizational Units
Job Title
Last Name
Chu
First Name
Paula
Name
Chu, Paula
3 results
Search Results
Now showing 1 - 3 of 3
Publication Standardised Mindfulness-Based Interventions in Healthcare: An Overview of Systematic Reviews and Meta-Analyses of RCTs(Public Library of Science, 2015) Gotink, Rinske A.; Chu, Paula; Busschbach, Jan J. V.; Benson, Herbert; Fricchione, Gregory; Hunink, M. G. MyriamBackground: Mindfulness-based therapies are being used in a wide range of common chronic conditions in both treatment and prevention despite lack of consensus about their effectiveness in different patient categories. Objective: To systematically review the evidence of effectiveness MBSR and MBCT in different patient categories. Methods: A systematic review and meta-analysis of systematic reviews of RCTs, using the standardized MBSR or MBCT programs. We used PRISMA guidelines to assess the quality of the included reviews and performed a random effects meta-analysis with main outcome measure Cohen’s d. All types of participants were considered. Results: The search produced 187 reviews: 23 were included, covering 115 unique RCTs and 8,683 unique individuals with various conditions. Compared to wait list control and compared to treatment as usual, MBSR and MBCT significantly improved depressive symptoms (d=0.37; 95%CI 0.28 to 0.45, based on 5 reviews, N=2814), anxiety (d=0.49; 95%CI 0.37 to 0.61, based on 4 reviews, N=2525), stress (d=0.51; 95%CI 0.36 to 0.67, based on 2 reviews, N=1570), quality of life (d=0.39; 95%CI 0.08 to 0.70, based on 2 reviews, N=511) and physical functioning (d=0.27; 95%CI 0.12 to 0.42, based on 3 reviews, N=1015). Limitations include heterogeneity within patient categories, risk of publication bias and limited long-term follow-up in several studies. Conclusion: The evidence supports the use of MBSR and MBCT to alleviate symptoms, both mental and physical, in the adjunct treatment of cancer, cardiovascular disease, chronic pain, depression, anxiety disorders and in prevention in healthy adults and children.Publication Comparative Effectiveness of Personalized Lifestyle Management Strategies for Cardiovascular Disease Risk Reduction(Ovid Technologies (Wolters Kluwer Health), 2016) Chu, Paula; Pandya, Ankur; Salomon, Joshua; Goldie, Sue; Hunink, MariaBACKGROUND: Evidence shows that healthy diet, exercise, smoking interventions, and stress reduction reduce cardiovascular disease risk. We aimed to compare the effectiveness of these lifestyle interventions for individual risk profiles and determine their rank order in reducing 10-year cardiovascular disease risk. METHODS AND RESULTS: We computed risks using the American College of Cardiology/American Heart Association Pooled Cohort Equations for a variety of individual profiles. Using published literature on risk factor reductions through diverse lifestyle interventions-group therapy for stopping smoking, Mediterranean diet, aerobic exercise (walking), and yoga-we calculated the risk reduction through each of these interventions to determine the strategy associated with the maximum benefit for each profile. Sensitivity analyses were conducted to test the robustness of the results. In the base-case analysis, yoga was associated with the largest 10-year cardiovascular disease risk reductions (maximum absolute reduction 16.7% for the highest-risk individuals). Walking generally ranked second (max 11.4%), followed by Mediterranean diet (max 9.2%), and group therapy for smoking (max 1.6%). If the individual was a current smoker and successfully quit smoking (ie, achieved complete smoking cessation), then stopping smoking yielded the largest reduction. Probabilistic and 1-way sensitivity analysis confirmed the demonstrated trend. CONCLUSIONS: This study reports the comparative effectiveness of several forms of lifestyle modifications and found smoking cessation and yoga to be the most effective forms of cardiovascular disease prevention. Future research should focus on patient adherence to personalized therapies, cost-effectiveness of these strategies, and the potential for enhanced benefit when interventions are performed simultaneously rather than as single measures.Publication Identifying High-Value Lifestyle Interventions for Cardiovascular Disease Prevention(2016-05-14) Chu, Paula; Goldie, Sue J.; Hunink, MG Myriam; Salomon, Joshua A.This dissertation evaluates lifestyle strategies for the management of cardiovascular risk factors and prevention of cardiovascular disease (CVD). In Chapter 1, I systematically review and summarize the evidence of the effect of yoga, a popular mind-body practice, on cardiovascular disease and metabolic syndrome risk factors. I perform a narrative systematic review and a random-effects meta-analysis of randomized controlled trials (RCTs) of posture-based yoga practice. I find that yoga showed significant improvement in a variety of risk factors for CVD and metabolic syndrome, including body mass index, systolic blood pressure, and total cholesterol when compared to no or minimal intervention control groups. When compared to active exercise controls, yoga produced similar risk factor level reduction. Promising evidence supports yoga’s role in improving cardio-metabolic health. Findings are limited, however, by small trial sample sizes, heterogeneity, and moderate RCT quality. In Chapter 2, I evaluate the comparative effectiveness of four different lifestyle strategies for reducing 10-year CVD risk. I used published literature on risk factor reductions associated with group therapy for smoking cessation, Mediterranean diet, aerobic exercise (walking), and yoga together with the Pooled Cohort risk algorithms to calculate a personalized optimal strategy for risk reduction based on different risk profiles. I find that for smokers, successful smoking cessation is an optimal strategy for reducing risk whereas for non-smokers or for smokers who do not quit successfully, stress reduction through yoga produces the greatest risk reductions. In Chapter 3, I examine the cost-effectiveness of aerobic exercise and yoga compared to current medical practice for primary prevention of CVD in US adults. I use a subset of RCTs from Chapter 1, along with published literature on utilities, costs, and other parameters as inputs into a validated disease microsimulation model. I calculate the costs per quality-adjusted life year ($/QALY) of aerobic exercise and yoga with an exercise on prescription approach from the societal and healthcare perspective as well as if the activities were reimbursed. Results suggest that both interventions are not cost-effective using a threshold of $100,000/QALY due to high patient time costs in the societal perspective; when the activities are reimbursed and gains in quality of life are taken into account, then the activities can be cost-effective. Future research can explore patient preference and adherence and utility gains from physical activity.