Elbow tendinopathy and occupational biomechanical overload: A systematic review with best‐evidence synthesis

ObjectiveTo produce a best evidence synthesis of the clinical effects of topical glyceryl trinitrate (GTN) in the treatment of tendinopathies.DesignA systematic review of published randomised controlled trials (RCTs) of the use of GTN in patients with tendinopathy.Data sourcesMEDLINE, Embase, Scopus and CINAHL from database inception to January 2018.MethodsWe examined RCTs comparing the effects of topical GTN with either placebo or other treatments on tendinopathy. Overall quality of each eligible study was determined based on a combined assessment of internal validity, external validity and precision. The level of evidence for each assessed parameter was rated based on the system by van Tulderet al.ResultsA total of 10 eligible RCTs were identified including patients with tendinopathy of the rotator cuff (n=4), wrist extensors (n=3), Achilles (n=2) and patellar (n=1) tendons. For all tendinopathies, improvements in pain were significant when comparing GTN versus placebo in the short term (<8 weeks; poor evidence). Significant improvements in midterm outcomes for treatment with GTN versus placebo included the following: patient satisfaction (strong evidence); chances of being asymptomatic with activities of daily living (strong evidence); range of movement (moderate evidence); strength (moderate evidence); pain (at night and with activity; poor evidence) and local tenderness (poor evidence). Patients treated with topical GTN reported a higher incidence of headaches than those who received placebo (moderate evidence).Conclusions and relevanceTreatment of tendinopathies with topical GTN for up to 6 months appears to be superior to placebo and may therefore be a useful adjunct to the treating healthcare professions.

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The effect of a single-session of non-invasive brain stimulation on balance in healthy individuals: A systematic review and best evidence synthesis

Brain Connectivity ◽

10.1089/brain.2020.0872 ◽

2021 ◽

Author(s):

Shabnam Behrangrad

Keyword(s):

Systematic Review ◽

Brain Stimulation ◽

Evidence Synthesis ◽

Healthy Individuals ◽

Single Session ◽

Non Invasive ◽

Best Evidence Synthesis

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Risk factors for, and prevention of, shoulder injuries in overhead sports: a systematic review with best-evidence synthesis

British Journal of Sports Medicine ◽

10.1136/bjsports-2017-098254 ◽

2018 ◽

Vol 52 (20) ◽

pp. 1312-1319 ◽

Cited By ~ 23

Author(s):

Martin Asker ◽

Hannah L Brooke ◽

Markus Waldén ◽

Ulrika Tranaeus ◽

Fredrik Johansson ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Injury Prevention ◽

Evidence Synthesis ◽

Shoulder Injuries ◽

Prevention Measures ◽

Shoulder Injury ◽

Limited Evidence ◽

Best Evidence Synthesis ◽

Overhead Sports

ObjectiveTo assess the evidence for risk factors and prevention measures for shoulder injuries in overhead sports.DesignSystematic review with best-evidence synthesis.Data sourcesMedline (Ovid), PubMed (complementary search), Embase (Elsevier), Cochrane (Wiley), SPORTDiscus (Ebsco) and Web of Science Core Collection (Thomson Reuters), from 1 January 1990 to 15 May 2017.Eligibility criteria for selecting studiesRandomised controlled trials, cohort studies and case-control studies on risk factors or prevention measures for shoulder injuries in overhead sports. The eligible studies were quality assessed using the Scottish Intercollegiate Guidelines Network criteria.ResultsOf 4778 studies identified, 38 were eligible for quality review and 17 met the quality criteria to be included in the evidence synthesis. One additional quality study presented a shoulder injury prevention programme. Most studies focused on baseball, lacrosse or volleyball (n=13). The risk factors examined included participation level (competition vs training) (n=10), sex (n=4), biomechanics (n=2) and external workload (n=2). The evidence for all risk factors was limited or conflicting. The effect of the prevention programme within the subgroup of uninjured players at baseline was modest and possibly lacked statistical power.ConclusionsAll investigated potential risk factors for shoulder injury in overhead sports had limited evidence, and most were non-modifiable (eg, sex). There is also limited evidence for the effect of shoulder injury prevention measures in overhead sports.PROSPERO trial registration numberCRD42015026850.

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Dietary Interventions in the Management of Fibromyalgia: A Systematic Review and Best-Evidence Synthesis

Nutrients ◽

10.3390/nu12092664 ◽

2020 ◽

Vol 12 (9) ◽

pp. 2664

Author(s):

Ethan Lowry ◽

Joanne Marley ◽

Joseph G. McVeigh ◽

Emeir McSorley ◽

Philip Allsopp ◽

...

Keyword(s):

Systematic Review ◽

Small Sample Size ◽

Evidence Synthesis ◽

Nutritional Intervention ◽

Poor Quality ◽

Chronic Widespread Pain ◽

Small Sample ◽

Vegan Diet ◽

Poor Sleep ◽

Best Evidence Synthesis

Fibromyalgia syndrome (FMS) is characterised by chronic widespread pain alongside fatigue, poor sleep quality and numerous comorbidities. It is estimated to have a worldwide prevalence of 1.78%, with a predominance in females. Treatment interventions for fibromyalgia have limited success, leading to many patients seeking alternative forms of treatment, including modifications to their diet and lifestyle. The effectiveness of dietary changes in fibromyalgia has not been widely researched or evaluated. This systematic review identified twenty-two studies, including 18 randomised control trials (RCTs) and four cohort studies which were eligible for inclusion. In total these studies investigated 17 different nutritional interventions. Significant improvements in reported pain were observed for those following a vegan diet, as well as with the low fermentable oligo di-mono-saccharides and polyols (FODMAP) diets. Supplementation with Chlorella green algae, coenzyme Q10, acetyl-l-carnitine or a combination of vitamin C and E significantly improved measures of pain. Interpretation of these studies was limited due to the frequent poor quality of the study design, the wide heterogeneity between studies, the small sample size and a high degree of bias. Therefore, there is insufficient evidence to recommend any one particular nutritional intervention for the management of fibromyalgia and further research is needed.

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Do dissatisfied patients have unrealistic expectations? A systematic review and best-evidence synthesis in knee and hip arthroplasty patients

EFORT Open Reviews ◽

10.1302/2058-5241.5.190015 ◽

2020 ◽

Vol 5 (4) ◽

pp. 226-240 ◽

Cited By ~ 2

Author(s):

Frederique J. Hafkamp ◽

Taco Gosens ◽

Jolanda de Vries ◽

Brenda L. den Oudsten

Keyword(s):

Systematic Review ◽

Study Design ◽

Clinical Success ◽

Evidence Synthesis ◽

Outcome Expectations ◽

Future Research ◽

Success Rates ◽

Best Evidence Synthesis ◽

Almost All ◽

The Relationship

End-stage osteoarthritis is commonly treated with joint replacement. Despite high clinical success rates, up to 28% of patients are dissatisfied with the outcome. This best-evidence synthesis aimed to review studies with different forms of study design and methodology that examined the relationship between (fulfilment of) outcome expectations of hip and knee patients and satisfaction with outcome. A literature search was performed in PubMed, Web of Science, PsycInfo, Cochrane, and Google Scholar to identify studies conducted up to November 2017. The methodological quality of studies was assessed using the Newcastle-Ottawa Scale. In this best-evidence synthesis systematic review, the following main results could be seen. In only half of all studies were preoperative expectations associated with level of satisfaction, while in almost all studies (93%), fulfilment of expectations was related to satisfaction. The effect of met expectations did not differ between hip and knee patients or study design. Fulfilment of expectations seems to be consistently associated with patient satisfaction with outcome. Emphasis in future research must be placed on the operationalization and measurement of expectations and satisfaction to determine the (strength of the) influence of these different forms of assessment on the (existence of the) relationship. Cite this article: EFORT Open Rev 2020;5:226-240. DOI: 10.1302/2058-5241.5.190015

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Recalibrating the risk of hamstring strain injury (HSI): A 2020 systematic review and meta-analysis of risk factors for index and recurrent hamstring strain injury in sport

British Journal of Sports Medicine ◽

10.1136/bjsports-2019-100983 ◽

2020 ◽

Vol 54 (18) ◽

pp. 1081-1088 ◽

Cited By ~ 7

Author(s):

Brady Green ◽

Matthew N Bourne ◽

Nicol van Dyk ◽

Tania Pizzari

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Evidence Synthesis ◽

Meta Analysis ◽

Significant Risk ◽

Older Age ◽

Future Research ◽

Hamstring Strain ◽

Best Evidence Synthesis ◽

History Of

ObjectiveTo systematically review risk factors for hamstring strain injury (HSI).DesignSystematic review update.Data sourcesDatabase searches: (1) inception to 2011 (original), and (2) 2011 to December 2018 (update). Citation tracking, manual reference and ahead of press searches.Eligibility criteria for selecting studiesStudies presenting prospective data evaluating factors associated with the risk of index and/or recurrent HSI.MethodSearch result screening and risk of bias assessment. A best evidence synthesis for each factor and meta-analysis, where possible, to determine the association with risk of HSI.ResultsThe 78 studies captured 8,319 total HSIs, including 967 recurrences, in 71,324 athletes. Older age (standardised mean difference=1.6, p=0.002), any history of HSI (risk ratio (RR)=2.7, p<0.001), a recent HSI (RR=4.8, p<0.001), previous anterior cruciate ligament (ACL) injury (RR=1.7, p=0.002) and previous calf strain injury (RR=1.5, p<0.001) were significant risk factors for HSI. From the best evidence synthesis, factors relating to sports performance and match play, running and hamstring strength were most consistently associated with HSI risk. The risk of recurrent HSI is best evaluated using clinical data and not the MRI characteristics of the index injury.Summary/conclusionOlder age and a history of HSI are the strongest risk factors for HSI. Future research may be directed towards exploring the interaction of risk factors and how these relationships fluctuate over time given the occurrence of index and recurrent HSI in sport is multifactorial.

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Feet positioning in the semi-static postural evaluation through photogrammetry: a systematic review

Motricidade ◽

10.6063/motricidade.9495 ◽

2018 ◽

Vol 13 (4) ◽

pp. 62

Author(s):

Arthur Antoniolli Arthur ◽

Liliane Martini Araújo Ducati Liliane ◽

Emanuelle Francine Detogni Schmit Emanuelle ◽

Cláudia Tarragô Candotti Cláudia

Keyword(s):

Systematic Review ◽

Methodological Quality ◽

Evidence Synthesis ◽

Evaluation Methodology ◽

Eligibility Criteria ◽

Scientific Databases ◽

Strength Of Evidence ◽

Best Evidence Synthesis ◽

Black Scale ◽

Quantitative Results

Photogrammetry is a relatively simple and objective instrument of evaluation that provides accurate and reproducible quantitative results, if applied rigorously, existing nowadays several protocols. The main purpose was to systematically review the utilized feet positioning to conduct a semi-static postural evaluation through photogrammetry. It was performed a systematic review of observational studies and clinic trials using the keywords “photogrammetry” and “spinal postural evaluation” to conduct searches on scientific databases. The eligibility criteria adopted were: utilize the photogrammetry to evaluate children, teenagers, adults or elders with or without pathologies; explicit the utilized feet positioning to conduct the evaluation; and be written in English, Portuguese or Spanish. The methodological quality was assessed by Downs and Black scale and the strength of evidence by the best evidence synthesis. It was found 1.786 articles and 40 were included in this review. The main feet positioning found were: self-referred, separated and in parallel, united and in parallel and standard self-referred. The review exhibited strong strength of evidence in the methodological quality assessment. Considering the main feet positioning found, it is considered primordial that the selection of evaluation methodology respects the specific instructions of each analysis protocol or software.

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Musculoskeletal pain and sedentary behaviour in occupational and non-occupational settings: a systematic review with meta-analysis

International Journal of Behavioral Nutrition and Physical Activity ◽

10.1186/s12966-021-01191-y ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Francis Q. S. Dzakpasu ◽

Alison Carver ◽

Christian J. Brakenridge ◽

Flavia Cicuttini ◽

Donna M. Urquhart ◽

...

Keyword(s):

Systematic Review ◽

Shoulder Pain ◽

Evidence Synthesis ◽

Meta Analysis ◽

Insufficient Evidence ◽

Cross Sectional ◽

Experimental Intervention ◽

Best Evidence Synthesis ◽

Cross Sectional Studies ◽

Full Day

Abstract Background Sedentary behaviour (SB; time spent sitting) is associated with musculoskeletal pain (MSP) conditions; however, no prior systematic review has examined these associations according to SB domains. We synthesised evidence on occupational and non-occupational SB and MSP conditions. Methods Guided by a PRISMA protocol, eight databases (MEDLINE, CINAHL, PsycINFO, Web of Science, Scopus, Cochrane Library, SPORTDiscus, and AMED) and three grey literature sources (Google Scholar, WorldChat, and Trove) were searched (January 1, 2000, to March 17, 2021) for original quantitative studies of adults ≥ 18 years. Clinical-condition studies were excluded. Studies’ risk of bias was assessed using the QualSyst checklist. For meta-analyses, random effect inverse-variance pooled effect size was estimated; otherwise, best-evidence synthesis was used for narrative review. Results Of 178 potentially-eligible studies, 79 were included [24 general population; 55 occupational (incuding15 experimental/intervention)]; 56 studies were of high quality, with scores > 0.75. Data for 26 were meta-synthesised. For cross-sectional studies of non-occupational SB, meta-analysis showed full-day SB to be associated with low back pain [LBP – OR = 1.19(1.03 – 1.38)]. Narrative synthesis found full-day SB associations with knee pain, arthritis, and general MSP, but the evidence was insufficient on associations with neck/shoulder pain, hip pain, and upper extremities pain. Evidence of prospective associations of full-day SB with MSP conditions was insufficient. Also, there was insufficient evidence on both cross-sectional and prospective associations between leisure-time SB and MSP conditions. For occupational SB, cross-sectional studies meta-analysed indicated associations of self-reported workplace sitting with LBP [OR = 1.47(1.12 – 1.92)] and neck/shoulder pain [OR = 1.73(1.46 – 2.03)], but not with extremities pain [OR = 1.17(0.65 – 2.11)]. Best-evidence synthesis identified inconsistent findings on cross-sectional association and a probable negative prospective association of device-measured workplace sitting with LBP-intensity in tradespeople. There was cross-sectional evidence on the association of computer time with neck/shoulder pain, but insufficient evidence for LBP and general MSP. Experimental/intervention evidence indicated reduced LBP, neck/shoulder pain, and general MSP with reducing workplace sitting. Conclusions We found cross-sectional associations of occupational and non-occupational SB with MSP conditions, with occupational SB associations being occupation dependent, however, reverse causality bias cannot be ruled out. While prospective evidence was inconclusive, reducing workplace sitting was associated with reduced MSP conditions. Future studies should emphasise prospective analyses and examining potential interactions with chronic diseases. Protocol registration PROSPERO ID #CRD42020166412 (Amended to limit the scope)

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A Multivariable Prediction Model for the Chronification of Non-traumatic Shoulder Pain: A Systematic Review

January 2018 - Pain Physician ◽

10.36076/ppj/2016.19.1 ◽

2016 ◽

Vol 19 (2;2) ◽

pp. 1-10 ◽

Cited By ~ 13

Author(s):

Filip Struyf

Keyword(s):

Systematic Review ◽

Prognostic Factors ◽

Shoulder Pain ◽

Evidence Synthesis ◽

Complete Recovery ◽

International Classification Of Functioning ◽

Large Variability ◽

Poor General Health ◽

Moderate Evidence ◽

Best Evidence Synthesis

Background: Shoulder pain is the third most common musculoskeletal complaint and many patients have an unfavorable outcome with long-term disability. Only 50% of all new episodes of shoulder pain show complete recovery within 6 months. Little is known about factors that contribute to chronicity of shoulder pain, although such information is needed for the management of patients with acute and sub-acute shoulder pain. Objective: To systematically review the literature for prognostic factors which are potential predictors for either recovery or chronification in patients with acute and sub-acute nontraumatic shoulder pain. Study Design: Systematic review. Setting: This systematic review examined all studies involving the prognosis of shoulder pain patients. Methods: This systematic review was reported following the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Two reviewers independently scored the methodological quality of the selected studies. Due to heterogeneity of studies, a best-evidence synthesis of the available prognostic factors was provided. Results: Nine studies met our inclusion criteria and were included in this systematic review. There is strong evidence that high scores on the Shoulder Pain and Disability Index (SPADI), high scores on shoulder pain severity, and a long duration of complaints are factors that contribute to the chronification of shoulder pain. Moderate evidence was found supportive for other prognostic factors that enhance chronification, like being male, being over 55 years of age, having poor general health, having a gradual onset of complaints, a large amount of sick leave, the perception of high job demand, the perception of low social support, and the amount of visits to a health care professional. Also moderate evidence exists regarding factors that contributed to a reduced possibility of chronification: an active treatment policy and not taking medication on regular basis. Limitations: The large variability in definitions of shoulder pain, and patient selection bias. In addition, there is a paucity of strong longitudinal prospective studies. Conclusion: This systematic review found evidence that high scores on the SPADI questionnaire, more shoulder pain, and a longer duration of complaints are associated with chronification of shoulder pain. In order to reduce chronification, clinicians can use the International Classification of Functioning based model presented here that could aid their decision-making. Key words: Shoulder pain, prognostic factors, systematic review, prognosis, assessment

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Quality of primary care from the patient’s point of view. A systematic review. There is currently no acceptable tool for practice or research purposes.

10.21203/rs.2.14226/v1 ◽

2019 ◽

Author(s):

Jeremy Derriennic ◽

Patrice Nabbe ◽

Marie Barais ◽

Sophie Lalande ◽

Delphine Le Goff ◽

...

Keyword(s):

Systematic Review ◽

Primary Care ◽

Evidence Synthesis ◽

Assessment Tools ◽

Level Of Evidence ◽

Measurement Quality ◽

Cosmin Checklist ◽

Best Evidence Synthesis ◽

Psychometric Quality

Abstract Background To run an inventory of instruments which assess quality of care from the patients’ experiences in primary care, in the context of multi-disciplinary health-care centres and which appraise their measurement quality, taking into account the methodological quality of their validation studies. Method Systematic review using Medline, Pascal, PsycINFO, Google Scholar, Cochrane, Scopus and CAIRN. For each instrument identified, the level of evidence was assessed using the COnsensus-based Standards for the selection of health status Measurement Instruments (COSMIN) checklist; the appraisal of the psychometric quality of the measurement property using three possible quality scores and the best-evidence synthesis based on the number of studies, their methodological and psychometric quality, and the direction and consistency of the results. Details of the subscales used to capture patients’ experiences of primary care were extracted and synthesized by grouping them into 9 dimensions defined by the Institute Of Medicine (IOM). Results 29 articles describing 29 instruments were found. Constructs captured by the assessment tools included illustrated a diversity of conceptualizations of patients’ experiences of primary care. There was no clear consensus across the assessment tools included about what patient experience in primary care ought to measure. There is an overall lack of evidence of their measurement quality, either because validation is missing or because methods are poor. Conclusion Due to the lack of evidence, the choice for the most appropriate instrument is difficult. Improvement and validation of existing instruments, and the use of COSMIN-guidelines could help make evaluations more effective.

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