Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
hiperactividad o hipercintico
Coulter MK, Dean ME
Reproduccin de una revisin Cochrane, traducida y publicada en La Biblioteca Cochrane Plus, 2008, Nmero 2
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NDICE DE MATERIAS
RESUMEN...................................................................................................................................................................1
RESUMEN EN TRMINOS SENCILLOS....................................................................................................................2
ANTECEDENTES........................................................................................................................................................2
OBJETIVOS.................................................................................................................................................................3
CRITERIOS PARA LA VALORACIN DE LOS ESTUDIOS DE ESTA REVISIN......................................................3
ESTRATEGIA DE BSQUEDA PARA LA IDENTIFICACIN DE LOS ESTUDIOS....................................................4
MTODOS DE LA REVISIN.....................................................................................................................................5
DESCRIPCIN DE LOS ESTUDIOS..........................................................................................................................6
CALIDAD METODOLGICA.......................................................................................................................................8
RESULTADOS.............................................................................................................................................................9
DISCUSIN...............................................................................................................................................................12
CONCLUSIONES DE LOS AUTORES......................................................................................................................13
AGRADECIMIENTOS................................................................................................................................................13
POTENCIAL CONFLICTO DE INTERS...................................................................................................................13
FUENTES DE FINANCIACIN..................................................................................................................................13
REFERENCIAS.........................................................................................................................................................13
TABLAS......................................................................................................................................................................16
Characteristics of included studies.....................................................................................................................16
Characteristics of excluded studies....................................................................................................................18
Table 02 Risk of Bias (Lamont 1997)..................................................................................................................18
Table 03 Risk of Bias (Frei 2005)........................................................................................................................18
Table 04 Risk of Bias (Jacobs 2005)...................................................................................................................19
Table 05 Risk of Bias (Strauss 2000)..................................................................................................................19
CARTULA................................................................................................................................................................20
RESUMEN DEL METANLISIS.................................................................................................................................21
GRFICOS Y OTRAS TABLAS..................................................................................................................................22
01 Homeopata versus placebo (calificaciones por los padres)..........................................................................22
01 Conners Global Index Scores (padres) CGI-P.......................................................................................22
02 ndice TDAH (padres).............................................................................................................................23
03 Hiperactividad (padre)............................................................................................................................23
04 Falta de atencin (padre)........................................................................................................................23
05 Agitacin/impulsividad (padres)..............................................................................................................24
06 Negativismo/conducta (padres)..............................................................................................................24
07 Labilidad emocional (padres).................................................................................................................24
08 Ansiedad (padres)..................................................................................................................................25
09 Global Index Scores (padres).................................................................................................................25
02 Homeopata versus placebo (calificaciones por los profesores)....................................................................25
01 Global Index Total...................................................................................................................................25
02 Agitacin/impulsividad............................................................................................................................26
Homeopata para el trastorno por dficit de atencin, de hiperactividad o hipercintico
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NDICE DE MATERIAS
03 Labilidad emocional................................................................................................................................26
03 Homeopata versus placebo (pruebas completadas por el nio)...................................................................27
01 Falta de atencin....................................................................................................................................27
02 Impulsividad............................................................................................................................................27
ii
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RESUMEN
Antecedentes
La homeopata es una forma de medicina complementaria/alternativa y se promueve por ser una forma segura y eficaz de
tratamiento para nios y adultos. El uso de la homeopata en el Reino Unido se calcula en 1,9% de la poblacin adulta (Thomas
2004), y alrededor del 11% para los nios menores de 16 aos (Simpson 2001). Hubo mayor inters en la homeopata como
posible intervencin no farmacolgica para el trastorno por dficit de atencin/de hiperactividad como opcin al uso de frmacos
estimulantes como Ritalin. La homeopata es un sistema de medicina basada en el principio de tratar "lo similar con lo similar"
con diversas diluciones de sustancias naturales o producidas por el hombre. La homeopata se centra en las caractersticas nicas
de experiencia y sintomatologa de cada paciente y usa esta informacin para determinar la prescripcin apropiada para cada
paciente.
Objetivos
Evaluar la seguridad y la efectividad de la homeopata como tratamiento para el trastorno por dficit de atencin/de hiperactividad.
Estrategia de bsqueda
Se hicieron bsquedas en un amplio grupo de bases de datos, desde su inicio hasta marzo 2006 incluyendo: CENTRAL, MEDLINE,
AMED, BIOSIS, CISCOM, CINAHL, Dissertation Abstracts, ECH (European Committee for Homeopathy thesis database),
EMBASE, ERIC, HomInform (Glasgow Homeopathic Hospital Library), LILACS, PsycINFO, Science Citation Index, SIGLE,
GIRI - International congress on ultra-low doses, Liga Medicorum Homeopathica Internationalis.
Se estableci contacto con los expertos en el tema para obtener informacin sobre estudios actuales o en curso.
Criterios de seleccin
Se seleccionaron todos los estudios donde se haba usado homeopata individualizada, clnica o de frmula para tratar participantes
con TDAH o THC, con asignacin aleatoria o cuasialeatoria al tratamiento o al control. Los grupos control podan incluir
intervenciones de lista de espera, ningn tratamiento, medicacin, de homeopata placebo, educativas o conductuales.
Recopilacin y anlisis de datos
Los datos de cuatro estudios elegibles (total n = 168) fueron extrados e introducidos en RevMan. Se sintetizaron los resultados
y los clculos del tamao del efecto se calcularon y se presentaron segn corresponda (mediante diferencias de medias
estandarizadas), tanto en forma grfica como narrativa (la forma narrativa slo se us cuando no poda calcularse el tamao del
efecto).
Resultados principales
Las formas de homeopata evaluadas hasta la fecha no indican efectos de tratamiento significativos para los sntomas globales,
los sntomas centrales de falta de atencin, hiperactividad o impulsividad o resultados relacionados como la ansiedad en el trastorno
por dficit de atencin/de hiperactividad.
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ANTECEDENTES
Trastorno de hiperactividad y dficit de atencin
El trastorno por dficit de atencin/hiperactividad (TDAH)
existe como categora de diagnstico slo desde 1980, con la
publicacin del Diagnostic and Statistical Manual (DSM)
Versin III (Barkley 1990). El sndrome de hiperactividad
empez a distinguirse de los sndromes de dao cerebral en los
aos sesenta. A partir de la dcada de 1970, el sndrome de
hiperactividad comenz a asociarse estrechamente con el dficit
de atencin, con una amplia aceptacin en algunos crculos de
que el TDAH es un trastorno complejo con bases biolgicas y
del desarrollo. El debate actual se centra en la construccin
social del TDAH como una categora de enfermedad (Brady
2004Cooper 1999) y no hay hasta el momento ningn consenso
claro sobre la etiologa de base. La imaginologa cerebral y la
investigacin gentica son las reas actuales de inters, pero la
observacin del comportamiento sigue siendo la base del
diagnstico a falta de pruebas fiables de los marcadores
biolgicos.
Los criterios de diagnstico del DMS-IV para TDAH incluyen
los signos "centrales" de falta de atencin, hiperactividad e
impulsividad. Tambin reconocen tres subgrupos de TDAH: i)
el tipo predominantemente hiperactivo impulsivo (no muestra
falta de atencin significativa); ii) el tipo con falta de atencin
predominante
(no
muestra
un
comportamiento
hiperactivo-impulsivo significativo); y iii) el tipo combinado
(muestra sntomas hiperactivos impulsivos y de falta de
atencin) (APA 2000). Trastorno hipercintico (THC) es el
trmino usado en ICD-10 (WHO 1992), y se refiere a un
subgrupo ms seriamente afectado, similar a los pacientes con
diagnstico del "tipo combinado" del DSM-IV.
El diagnstico es determinado generalmente por los psiquiatras
de nios o adolescentes o los pediatras segn el DSM-IV o
ICD-10. Ambos grupos de criterios de diagnstico establecen
que para un diagnstico de TDAH/THC los sntomas estan
presentes durante al menos seis meses, causando dificultad y
conflicto con el nivel de desarrollo del nio, y la deficiencia
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AGRADECIMIENTOS
Recursos internos
University of York UK
Se desea dar las gracias al Dr. Leon Strauss, Dr. Heiner Frei y
Dra. Jennifer Jacobs por su ayuda al aclarar los detalles de los
ensayos a los que estn asociados.
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* El asterisco seala los documentos ms importantes para este estudio
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TABLAS
Characteristics of included studies
Study
Frei 2005
Methods
Participants
Interventions
Outcomes
Screening stage: CRS-R Parent and Teacher forms, Kinsbourne Attention Questionnaire
Baseline of trial: Conners Global Index-Parent form, Questionnaire of Change of
Behaviour (QCB), VLMT (auditory learning test), sub-tests of WISC (Wechsler
intelligence test), K-ABC Kaufman Assessment Battery for Children, TAP Test
Assessment battery for Attention Performance.
Final outcomes: CGI-Parent, VLMT, QCB, WISC
Notes
Allocation concealment
D - Not used
Study
Jacobs 2005
Methods
Participants
Interventions
Outcomes
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Allocation concealment
D - Not used
Study
Lamont 1997
Methods
Participants
43 children with TDAH confirmed by psychological testing, mean age of 10 years. 35%
Black, 47% Hispanic, 18% Caucasian. All children were in foster homes, in care or
under the supervision of a social worker.
Interventions
Outcomes
Notes
Parents/carers and children were not informed about the use of placebo in this study
although they were aware of taking part in research about homeopathy for TDAH.
Allocation concealment
D - Not used
Study
Strauss 2000
Methods
Participants
20 children with previously diagnosed TDAH (no confirmation) aged between 7-10
years. Half of the participants (n=10) were already taking Ritalin.
18 boys, 2 girls.
Interventions
Outcomes
Notes
Allocation concealment
D - Not used
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Frei 2001
Lamont 1998
This paper is a reprint of Lamont (1997) which is included in the review. No additional
information was presented in this version.
Description
Judgement
Sequence generation
adequate?
not met
Allocation concealment
adequate?
not met
Blinding of participants,
personnel and outcomes
adequate?
Participants (children) and their families/carers were blinded met for patients but
to the treatment allocation since they were not informed of
not investigator
the use of placebos in this trial. The study investigator who
also collected the outcomes data was unblinded.
Description
Judgement
Sequence generation
adequate?
met
Allocation concealment
adequate?
The randomisation tables were generated at the University of Berne, the met
treatment assignments were then sealed in consecutively numbered
envelopes before being passed to the medication manufacturers. The
manufacturers were informed by writing when a child was eligible to enter
the cross-over trial with no other contact between any of the study
personnel. Assignments are unlikely to have been predicted.
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During the screening phase all medications were sent straight from the met
manufacturer. On entering the cross-over phase the relevant medicine or
placebo was sent out according to treatment assignment. Medication and
placebo were indistinguishable. Neither child/family, clinician or
investigators knew of the treatment allocation. Blinding was not assessed
during this study.
Incomplete outcome
reporting adequately
addressed?
Description
Judgement
Sequence generation
adequate?
Allocation concealment
adequate?
The sequence was passed to the distributing pharmacy. As each child met
began treatment, the homeopath would send in their prescription to the
pharmacy to be posted out. The pharmacy filled the prescription with
verum or placebo according to the randomisation sequence. There was
no further contact between physician and medicine distribution or
treatment allocation. Assignments are unlikely to have been predicted.
Blinding of participants,
personnel and outcomes
adequate?
Incomplete outcome
reporting adequately
addressed?
Description
Judgement
Sequence generation
adequate?
met
Allocation concealment
adequate?
Fellow researcher carried out the randomisation and then made up the unclear
verum or placebo medications appropriately (personal communication).
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Incomplete outcome reporting Published paper reported 20 patients randomised to the study with no not met
adequately addressed?
data on attrition or exclusion. Communication with author: of an original
22, one was withdrawn due to lack of compliance and a second was
advised by their general practitioner to drop-out (Strauss 2007). No
data have been presented on these patients, and they were excluded
from all analyses.
CARTULA
Titulo
Autor(es)
2006/1
2007/4
Fecha de la modificacin ms
reciente"
03 agosto 2008
"Fecha de la modificacin
SIGNIFICATIVA ms reciente
20 agosto 2007
Cambios ms recientes
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Fecha de modificacin de la
seccin conclusiones de los
autores
Direccin de contacto
Ms Morag Coulter
Hull York Medical School
University of York
Second Floor, Hull York Medical School
Heslington
York
YO10 5DD
UK
Tlefono: 44 1904 321912
E-mail: mkc500@york.ac.uk
Facsimile: 44 1904 321920
CD005648
Grupo editorial
HM-BEHAV
N de
estudios
N de
participantes
63
03 Hiperactividad (padre)
Mtodo estadstico
Diferencia de medias
(efectos fijos) IC del 95%
Diferencia de medias
0.06 [-0.43, 0.56]
estandarizada (efectos fijos)
IC del 95%
Diferencia de medias
estandarizada (efectos
aleatorios) IC del 95%
Subtotales
nicamente
43
Diferencia de medias
0.39 [-0.21, 1.00]
estandarizada (efectos fijos)
IC del 95%
05 Agitacin/impulsividad (padres)
63
Diferencia de medias
-0.03 [-0.52, 0.46]
estandarizada (efectos fijos)
IC del 95%
06 Negativismo/conducta (padres)
63
Diferencia de medias
-0.01 [-0.51, 0.48]
estandarizada (efectos fijos)
IC del 95%
43
Diferencia de medias
0.21 [-0.39, 0.81]
estandarizada (efectos fijos)
IC del 95%
Pgina 21
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20
Diferencia de medias
-0.55 [-1.45, 0.34]
estandarizada (efectos fijos)
IC del 95%
43
Diferencia de medias
0.13 [-0.47, 0.73]
estandarizada (efectos fijos)
IC del 95%
N de
estudios
N de
participantes
Mtodo estadstico
43
Diferencia de medias
0.41 [-0.20, 1.01]
estandarizada (efectos fijos)
IC del 95%
02 Agitacin/impulsividad
43
Diferencia de medias
0.39 [-0.21, 1.00]
estandarizada (efectos fijos)
IC del 95%
03 Labilidad emocional
43
Diferencia de medias
0.41 [-0.19, 1.02]
estandarizada (efectos fijos)
IC del 95%
N de
estudios
N de
participantes
01 Falta de atencin
02 Impulsividad
Mtodo estadstico
Diferencia de medias
Subtotales
estandarizada (efectos fijos) nicamente
IC del 95%
1
43
Diferencia de medias
-0.07 [-0.67, 0.53]
estandarizada (efectos fijos)
IC del 95%
Pgina 22
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Pgina 23
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Pgina 24
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Pgina 25
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02.02 Agitacin/impulsividad
Pgina 26
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03.02 Impulsividad
Pgina 27
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