Systematic Review and Synthesis of Mechanism-based Classification Systems for Pain Experienced in the Musculoskeletal System

ABSTRACT This study aims to present a systematic review and synthesized evidence on the epidemiological factors, diagnostic methods and treatment options available for this phenomenon. A multi-database search (OVID Medline, EMBASE and PubMed) was performed according to PRISMA guidelines on 18 June 2019. All studies of any study design discussing on the epidemiological factors, diagnostic methods, classification systems and treatment options of the wave sign were included. The Newcastle–Ottawa quality assessment tool was used to appraise articles. No quantitative analysis could be performed due to heterogeneous data reported; 11 studies with a total of 501 patients with the wave sign were included. Three studies examined risk factors for wave sign and concluded that cam lesions were most common. Other risk factors include alpha angle >65° (OR=4.00, 95% CI: 1.26–12.71, P=0.02), male gender (OR 2.24, 95% CI: 1.09–4.62, P=0.03) and older age (OR=1.04, 95% CI: 1.01–1.07, P=0.03). Increased acetabular coverage in setting of concurrent cam lesions may be a protective factor. Wave signs most commonly occur at the anterior, superior and anterosuperior acetabulum. In terms of staging accuracy, the Haddad classification had the highest coefficients in intraclass correlation (k=0.81, 95% CI: 0.23–0.95, P=0.011), inter-observer reliability (k=0.88, 95% CI: 0.72–0.97, P<0.001) and internal validity (k=0.89). One study investigated the utility of quantitative magnetic imaging for wave sign, concluding that significant heterogeneity in T1ρ and T2 values (P<0.05) of acetabular cartilage is indicative of acetabular debonding. Four studies reported treatment techniques, including bridging suture repair, reverse microfracture with bubble decompression and microfracture with fibrin adhesive glue, with the latter reporting statistically significant improvements in modified Harris hip scores at 6-months (MD=19.2, P<0.05), 12-months (MD=22.0, P<0.05) and 28-months (MD=17.5, P<0.001). No clinical studies were available for other treatment options. There is a scarcity of literature on the wave sign. Identifying at risk symptomatic patients is important to provide prompt diagnosis and treatment. Diagnostic techniques and operative options are still in early developmental stages. More research is needed to understand the natural history of wave sign lesions after arthroscopic surgery and whether intervention can improve long-term outcomes. Level IV, Systematic review of non-homogeneous studies.

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Toward the Development of a Comprehensive Clinically Oriented Patient Profile: A Systematic Review of the Purpose, Characteristic, and Methodological Quality of Classification Systems of Adult Spinal Deformity

Neurosurgery ◽

10.1093/neuros/nyab023 ◽

2021 ◽

Author(s):

Kenny Yat Hong Kwan ◽

J Naresh-Babu ◽

Wilco Jacobs ◽

Marinus de Kleuver ◽

David W Polly ◽

...

Keyword(s):

Systematic Review ◽

Decision Making ◽

Classification System ◽

Methodological Quality ◽

Literature Search ◽

Adult Spinal Deformity ◽

Classification Systems ◽

Systematic Literature Search ◽

Patient Profile

Abstract BACKGROUND Existing adult spinal deformity (ASD) classification systems are based on radiological parameters but management of ASD patients requires a holistic approach. A comprehensive clinically oriented patient profile and classification of ASD that can guide decision-making and correlate with patient outcomes is lacking. OBJECTIVE To perform a systematic review to determine the purpose, characteristic, and methodological quality of classification systems currently used in ASD. METHODS A systematic literature search was conducted in MEDLINE, EMBASE, CINAHL, and Web of Science for literature published between January 2000 and October 2018. From the included studies, list of classification systems, their methodological measurement properties, and correlation with treatment outcomes were analyzed. RESULTS Out of 4470 screened references, 163 were included, and 54 different classification systems for ASD were identified. The most commonly used was the Scoliosis Research Society-Schwab classification system. A total of 35 classifications were based on radiological parameters, and no correlation was found between any classification system levels with patient-related outcomes. Limited evidence of limited quality was available on methodological quality of the classification systems. For studies that reported the data, intraobserver and interobserver reliability were good (kappa = 0.8). CONCLUSION This systematic literature search revealed that current classification systems in clinical use neither include a comprehensive set of dimensions relevant to decision-making nor did they correlate with outcomes. A classification system comprising a core set of patient-related, radiological, and etiological characteristics relevant to the management of ASD is needed.

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Protocol for a systematic review on classification, outcomes and follow-up of patients undergoing reconstructive surgery after Noma disease-

10.21203/rs.3.rs-89911/v1 ◽

2020 ◽

Author(s):

Sophie Speiser ◽

Benjamin Langridge ◽

Moira Melina Birkl ◽

Harald Kubiena ◽

Will Rodgers

Keyword(s):

Systematic Review ◽

Reconstructive Surgery ◽

Time Pressure ◽

Outcome Measurement ◽

Developed Countries ◽

Classification Systems ◽

Least Developed Countries ◽

High Quality Research ◽

Meta Analyses

Abstract Background: NOMA is a significant yet neglected disease which affects children in some of the least developed countries in the world. Surgical reconstructive missions for patients affected by NOMA are undertaken regularly by surgeons from more developed countries. However, the long-term benefit and safety of these missions have recently been criticized due to a perceived lack of measurable outcomes and appropriate follow-up. We are conducting a systematic review to critically evaluate the classification systems, outcome measurement tools, and follow-up periods reported in the literature for NOMA disease. Methods: This systematic review is undertaken following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (“PRISMA”) guidelines. The databases MEDLINE, Embase and Web of Science are searched from infinity to 24th of April 2019. All original publications of studies undertaken on reconstructive surgery for NOMA disease, reporting data on outcome after surgery, follow-up time and complications are eligible for inclusion. The primary outcome of interest are the outcome measurement methods used for assessing successful reconstructive surgery after NOMA disease. Other outcomes we are assessing are methods for classification of disease severity and time to last follow-up. The quality of evidence for each summary outcome measure is assessed using the MINORS criteria. Discussion: Given the precarious situations in the countries where mission surgeons often undertake reconstructive surgery, time pressure and the lack of infrastructure on site prevent them from being able to measure the effect of their surgical outcomes. Our goal is to express the key points of debate and make recommendations for how future surgical missions can be improved. We aim to do so by comparing the current best standards of practice Publishing this protocol will help future NOMA surgeons plan their missions in a standardised and reproducible way, striving towards a future of worldwide high-quality research.Systematic review registrations: This protocol was submitted to PROSPERO on the 02.10.2020 and is currently under assessment. (ID 181931)

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Partial articular supraspinatus tendon avulsion: Should we repair? A systematic review of the evidence

Shoulder & Elbow ◽

10.1177/1758573219864101 ◽

2019 ◽

Vol 12 (4) ◽

pp. 253-264

Author(s):

Duncan Tennent ◽

Gemma Green

Keyword(s):

Systematic Review ◽

Grey Literature ◽

Case Series ◽

Supraspinatus Tendon ◽

Classification Systems ◽

Rotator Cuff Tears ◽

Single Plane ◽

Functional Scores ◽

Level I ◽

Tendon Avulsion

Introduction Partial articular sided rotator cuff tears are described as being a common cause of shoulder pain and to have a significant impact of patient quality of life. The natural history of partial articular supraspinatus tendon avulsion lesions is not clearly defined and there is limited evidence to determine optimal management. Aims To perform a systematic review of the literature regarding the evidence for partial articular supraspinatus tendon avulsion repair and to determine whether there is any difference between operative and non-operatively managed patients. Methods Conventional and grey literature were searched with defined terms to identify studies in human adults concerning management of partial articular sided supraspinatus avulsions. Results Out of 86 papers identified by the search terms, 28 were deemed eligible for review including 1966 shoulders. 4/28 papers were of level I–II evidence but all were comparing techniques. 4/28 papers were biomechanical cadaveric studies, assessing strength of repair and effect on stability. The remaining 20 studies were level IV–V evidence and consisted of case series and technical notes identifying varying techniques of repair and their outcomes. Conclusion Current literature suggests that all techniques used to repair partial articular supraspinatus tendon avulsion lesions give increased functional scores and reduced pain. However, this represents a heterogeneous group of patients with variable degrees of tear and is not reproducible. There are limited controlled studies to determine whether partial articular supraspinatus tendon avulsion lesions require repair. Current classification systems represent a single plane and are open to user variation. No evidence exists to determine which tears are stable and which may progress.

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Prevalence and incidence of age-related macular degeneration in Europe: a systematic review and meta-analysis

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2019-314422 ◽

2019 ◽

Vol 104 (8) ◽

pp. 1077-1084 ◽

Cited By ~ 11

Author(s):

Jeany Q Li ◽

Thomas Welchowski ◽

Matthias Schmid ◽

Matthias Marten Mauschitz ◽

Frank G Holz ◽

...

Keyword(s):

Systematic Review ◽

Macular Degeneration ◽

Meta Analysis ◽

Resource Planning ◽

Classification Systems ◽

Age Related Macular Degeneration ◽

Population Projections ◽

Age Related ◽

Pooled Prevalence ◽

Incidence Studies

Background/AimsAge-related macular degeneration (AMD) is the main cause of visual impairment and blindness in Europe. A further increase in the number of affected persons is expected and current European data are needed for healthcare resource planning.MethodsWe performed a systematic review on the prevalence and incidence of AMD based on the meta-analysis of observational studies in epidemiology guideline. Meta-analysis and meta-regression on time-trends, age, countries, regions, sex and classification systems for AMD were performed. Based on Eurostat population projections, the pooled prevalence estimates were extrapolated to the year 2050.ResultsTwenty-two prevalence and four incidence studies published since 1996 were included. Our pooled prevalence estimate of early or intermediate AMD and any late AMD in those 60 years and older was 25.3% (95% CI 18.0% to 34.4%) and 2.4% (95% CI 1.8% to 3.3%), respectively. A significant increase in prevalence was seen in older populations. In the meta-analysis of incidence, the pooled annual incidence of any late AMD was 1.4 per 1 000 individuals (95% CI 0.8 to 2.6). Overall, the number of EU inhabitants with any AMD is expected to increase from 67 to 77 million until 2050. Incident late AMD is estimated to increase from 400 000 per year today to 700 000 per year in 2050.ConclusionsApproximately 67 million people in the EU are currently affected by any AMD and, due to population ageing, this number is expected to increase by 15% until 2050. Monitoring and treatment of people with advanced disease stages will require additional healthcare resources and thorough healthcare planning in the years and decades to come.

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Drug-induced sedation endoscopy (DISE) classification systems: a systematic review and meta-analysis

Sleep And Breathing ◽

10.1007/s11325-017-1521-6 ◽

2017 ◽

Vol 21 (4) ◽

pp. 983-994 ◽

Cited By ~ 16

Author(s):

Esuabom Dijemeni ◽

Gabriele D’Amone ◽

Israel Gbati

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Classification Systems ◽

Drug Induced

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Reliability and Validity of Acetabular and Femoral Bone Loss Classification Systems in Total Hip Arthroplasty: A Systematic Review

HSS Journal ® ◽

10.1007/s11420-020-09766-4 ◽

2020 ◽

Vol 16 (3) ◽

pp. 288-295

Author(s):

Alex Gu ◽

Marco Adriani ◽

Michael-Alexander Malahias ◽

Safa C. Fassihi ◽

Allina A. Nocon ◽

...

Keyword(s):

Systematic Review ◽

Total Hip Arthroplasty ◽

Bone Loss ◽

Hip Arthroplasty ◽

Reliability And Validity ◽

Classification Systems ◽

Femoral Bone ◽

Total Hip

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Variability in the Reporting Terminology of Adverse Events and Complications in Ankle Fracture Fixation: A Systematic Review

Foot & Ankle International ◽

10.1177/1071100719879930 ◽

2019 ◽

Vol 41 (2) ◽

pp. 170-176

Author(s):

Stefan A. St George ◽

Hooman Sadr ◽

Chayanin Angthong ◽

Murray Penner ◽

Peter Salat ◽

...

Keyword(s):

Systematic Review ◽

Adverse Events ◽

Fracture Fixation ◽

Ankle Fracture ◽

Soft Tissue Injuries ◽

Classification Systems ◽

Level Of Evidence ◽

Implant Complications ◽

Frequency Of Use ◽

Standardized Reporting

Background: Classification systems for the reporting of surgical complications have been developed and adapted for many surgical subspecialties. The purpose of this systematic review was to examine the variability and frequency of reporting terms used to describe adverse events and complications in ankle fracture fixation. We hypothesized that the terminology used would be highly variable and inconsistent, corroborating previous results that have suggested a need for standardized reporting terminology in orthopedics. Methods: Ankle fracture outcome studies meeting predetermined inclusion and exclusion criteria were selected for analysis by 2 independent observers. Terms used to define adverse events and complications were identified and recorded. Discrepancies were resolved by consensus with the aid of a third observer. All terms were then compiled and assessed for variability and frequency of use throughout the studies involved. Reporting terminology was subsequently grouped into 10 categories. Results: In the 48 studies analyzed, 301 distinct terms were utilized to describe complications or adverse events. Of these terms, 74.4% (224/301) were found in a single study each. Only 1 term, “infection,” was present in 50% of studies, and only 19 of 301 terms (6.3%) were used in at least 10% of papers. The category that was most frequently reported was “infection,” with 89.6% of studies reporting on this type of adverse event using 25 distinct terms. Other categories were “wound healing complications” (72.9% of papers, 38 terms), “bone/joint complications” (66.7% of papers, 35 terms), “hardware/implant complications” (56.3% of papers, 47 terms), “revision” (56.3% of papers, 35 terms), “cartilage/soft tissue injuries” (45.8% of papers, 31 terms), “reduction/alignment issues” (45.8% of papers, 29 terms), “medical complications” (43.8% of papers, 32 terms), “pain” (29.2% of papers, 16 terms), and “other complications” (20.8% of papers, 13 terms). There was a 78.6% interobserver agreement in the identification of terms across the 48 studies included. Conclusion: The reporting terminology utilized to describe complications and adverse events in ankle fracture fixation was found to be highly variable and inconsistent. This variability prevents accurate reporting of complications and adverse events and makes the analysis of potential outcomes difficult. The development of standardized reporting terminology in orthopedics would be instrumental in addressing these challenges and allow for more accurate and consistent outcome reporting. Level of Evidence: Level III; systematic review of Level III studies and above.

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Assessment of Functional Capacity of the Musculoskeletal System in the Context of Work, Daily Living, and Sport: A Systematic Review

Journal of Occupational Rehabilitation ◽

10.1007/s10926-005-1223-y ◽

2005 ◽

Vol 15 (2) ◽

pp. 253-272 ◽

Cited By ~ 53

Author(s):

Haije Wind ◽

Vincent Gouttebarge ◽

P. Paul F. M. Kuijer ◽

Monique H. W. Frings-Dresen

Keyword(s):

Systematic Review ◽

Functional Capacity ◽

Musculoskeletal System ◽

Daily Living

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CURRENTLY AVAILABLE CLASSIFICATION SYSTEMS FOR LOWER CERVICAL SPINE INJURIES. PART 2. SYSTEMATIC REVIEW OF STUDIES ON THE RELIABILITY AND REPRODUCIBILITY OF EXISTING SCALES

Russian journal of neurosurgery ◽

10.17650/1683-3295-2019-21-2-28-38 ◽

2019 ◽

Vol 21 (2) ◽

pp. 28-38

Author(s):

А. А. Grin ◽

I. S. Lvov ◽

S. L. Arakelyan ◽

А. E. Talypov ◽

А. Yu. Kordonsky ◽

...

Keyword(s):

Systematic Review ◽

Cervical Spine ◽

Classification System ◽

Small Sample ◽

Classification Systems ◽

Lower Cervical Spine ◽

Study Objective ◽

Cervical Spine Injuries ◽

Spine Injuries ◽

Injury Classification

The study objective is to review the Russian and foreign studies and to identify an optimal classification system for lower cervical spine injuries. Materials and methods. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We conducted a search for articles published in English (PubMed database) and Russian (eLIBRARY.ru). The inclusion criteria were as follows: available full text, patient age ≥18 years, and information on one of the validation phases for classifications according to L. Audige et al. Results. A total of 30 articles were eligible. Of them, 3 studies were published in Russian (by one group of authors); however, they didn’t contain required statistical parameters and had duplicated data; therefore, they were excluded from the analysis. Out of 27 articles published in English, 8 articles met all the criteria and were included into the systematic review. The AOSpine and Subaxial Injury Classification Systems demonstrated the highest reliability and reproducibility of the results. The Allen–Fergusson classification has lower intraobserver and interobserver agreement coefficients, but it can give a clearer visual representation of injuries. We also assessed J. Harris classification system. The reliability of the scale developed by С. Argenson et al. was not evaluated. The analyzed publications contained no data for full evaluation of the Cervical Spine Injury Severity Score. Our analysis clearly demonstrated the need for a more thorough evaluation of all available scales and classifications. This study should be multicenter and involve experts with different levels of experience (from residents to experienced spinal surgeons). Moreover, it should analyze not only the reproducibility of individual classifications, but also the aspects of learning and the relationship between individual scales and systems. The main study limitations included insufficient number of publications, small sample sizes, heterogeneity of groups, and differences in the experience of experts. Conclusion. The AOSpine and Subaxial Injury Classification Systems are the most reliable classification systems. However, the data available in literature is not sufficient for a full comparison of all existing scales and systems. Further multicenter studies on the reliability of classifications are needed to select an optimal one.

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