BackgroundCombined cognitive and physical intervention is commonly used as a non-pharmacological therapy to improve cognitive function in older adults, but it is uncertain whether combined intervention can produce stronger cognitive gains than either single cognitive or sham intervention. To address this uncertainty, we performed a systematic review and meta-analysis to evaluate the effects of combined intervention on cognition in older adults with and without mild cognitive impairment (MCI).MethodsWe systematically searched eight databases for relevant articles published from inception to November 1, 2021. Randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) were used to compare the effects of the combined intervention with a single cognitive or sham intervention on cognition in older adults with and without MCI aged ≥ 50 years. We also searched Google Scholar, references of the included articles, and relevant reviews. Two independent reviewers performed the article screening, data extraction, and bias assessment. GRADEpro was used to rate the strength of evidence, and RevMan software was used to perform the meta-analysis.ResultsSeventeen studies were included in the analysis, comprising eight studies of cognitively healthy older adults and nine studies of older adults with MCI. The meta-analysis showed that the combined intervention significantly improved most cognitive functions and depression (SMD = 0.99, 95% CI 0.54–1.43, p < 0.0001) in older adults compared to the control groups, but the intervention effects varied by cognition domains. However, there was no statistically significant difference in the maintenance between the combined and sham interventions (SMD = 1.34, 95% CI −0.58–3.27, p = 0.17). The subgroup analysis also showed that there was no statistical difference in the combined intervention to improve global cognition, memory, attention, and executive function between cognitive healthy older adults and older adults with MCI.ConclusionsCombined intervention improves cognitive functions in older adults with and without MCI, especially in global cognition, memory, and executive function. However, there was no statistical difference in the efficacy of the combined intervention to improve cognition between cognitive healthy older adults and older adults with MCI. Moreover, the maintenance of the combined intervention remains unclear due to the limited follow-up data and high heterogeneity. In the future, more stringent study designs with more follow-ups are needed further to explore the effects of combined intervention in older adults.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier: CRD42021292490.

BACKGROUND Feeding intolerance (FI) is usually a consequence of gastrointestinal immaturity (GI) and commonly occurs in premature infants, and it affects lots of premature infants, many studies have investigated pediatric Tui na for treating FI in premature infants, but to our knowledge, no systematic review, meta-analysis, or review protocol relevant to TCM-based pediatric Tui na for premature infants with FI has been published thus far. OBJECTIVE To develop a protocol for a systematic review and meta-analysis for evaluating the safety and efficacy of pediatric Tui na for premature infants with feeding intolerance (FI) METHODS We will conduct a thorough electronic literature search of Embase, Clarivate Analytics, PubMed, Cochrane Library, MEDLINE, Scopus, Springer, CINAHL, Physiotherapy Evidence Database (PEDro), World Health Organization International Clinical Trials Registry Platform, and Chinese biomedical databases (Wanfang database, the China National Knowledge Infrastructure database, Chinese Biomedical Literature Database, and Chinese Scientific Journals Database). Two reviewers will independently screen the studies based on titles and abstracts, and full-text reading of the eligible studies will be performed thereafter. Studies include any non-randomized controlled trials, non-randomized clinical studies, randomized controlled trials, and quasi-experimental studies wherein the treatment group involves premature infants with FI given pediatric Tui na. Primary outcomes will be necrotizing enterocolitis, gastric residual volume, emesis, blood in the stool, and abdominal distension. Secondary outcomes will be weight gain, time to achieve full enteral feeding, any adverse events associated with pediatric Tui na, and length of hospital stay. The Cochrane Collaboration Risk of Bias Tool will be used for risk of bias and methodological quality assessments. A meta-analysis of the efficacy will be performed if the studies included are sufficient, and publication bias evaluation using funnel plots will be performed, if possible. Subgroup analyses will be performed if the studies are sufficient and show substantial heterogeneity. RESULTS We will initiate review database searches in January 2023 and expect to have some findings by July 2023. CONCLUSIONS This protocol will help establish a framework of a high-quality literature synthesis on the impact of pediatric Tui na treatment for premature infants with FI. The efficacy and safety of pediatric Tui na for premature infants with FI will be determined by the proposed review. CLINICALTRIAL PROSPERO CRD 42023390021.

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