scholarly journals Systematic Review on Barriers and Facilitators for Access to Diabetic Retinopathy Screening Services

2018 ◽  
Author(s):  
M.M. Prabhath Nishantha Piyasena ◽  
Gudlavalleti Venkata S. Murthy ◽  
Jennifer L.Y. Yip ◽  
Clare Gilbert ◽  
Maria Zuurmond ◽  
...  
Keyword(s):  
Systematic Review ◽  
Diabetic Retinopathy ◽  
Human Resources ◽  
Vision Loss ◽  
Screening Program ◽  
Cochrane Library ◽  
Related Factors ◽  
Barriers And Enablers ◽  
Barriers To Access ◽  
Screening Services

AbstractObjectivesThe aim of this systematic review is to identify the barriers/enablers for the people with diabetes (PwDM) in accessing DRS services (DRSS) and challenges/facilitators for the providers.BackgroundDiabetic retinopathy (DR) can lead to visual impairment and blindness if not detected and treated in time. Achievement of an acceptable level of screening coverage is a challenge in any setting. Both patient-related and provider-related factors affect provision of DR screening (DRS) and uptake of services.MethodsWe searched MEDLINE, Embase, CENTRAL in the Cochrane Library from the databases start date to September 2016. We included the studies reported on barriers and enablers to access DRS by PwDM and studies which have assessed barriers or facilitators experienced by the providers in provision of DRSS. We identified and classified the studies that used quantitative or qualitative methods for data collection and analysis in reporting themes of barriers and enablers.Main ResultsWe included 63 studies primarily describing the barriers and enablers. The findings of these studies were based on PwDM from different socio-economic backgrounds and different levels of income settings. Most of the studies were from high income settings (48/63, 76.2%) and cross sectional in design (49/63, 77.8%). From the perspectives of users, lack of knowledge, attitude, awareness and motivation were identified as major barriers to access DRSS. The enablers to access DRSS were fear of blindness, proximity of screening facility, experiences of vision loss and being concerned of eye complications. Providers often mentioned that lack of awareness and knowledge among the PwDM was the main barrier to access. In their perspective lack of skilled human resources, training programs and infrastructure of retinal imaging and cost of services were the main obstacles in provision of screening services.ConclusionKnowing the barriers to access DRS is a pre-requisite in development of a successful screening program. The awareness, knowledge and attitude of the consumers, availability of skilled human resources and infrastructure emerged as the major barriers to access to DRS in any income setting.

scholarly journals Systematic review on barriers and enablers for access to diabetic retinopathy screening services in different income settings

PLoS ONE ◽  
2019 ◽  
Vol 14 (4) ◽  
pp. e0198979 ◽  
Author(s):  
Mapa Mudiyanselage Prabhath Nishantha Piyasena ◽  
Gudlavalleti Venkata S. Murthy ◽  
Jennifer L. Y. Yip ◽  
Clare Gilbert ◽  
Maria Zuurmond ◽  
...  
Keyword(s):  
Systematic Review ◽  
Diabetic Retinopathy ◽  
Diabetic Retinopathy Screening ◽  
Barriers And Enablers ◽  
Screening Services ◽  
Retinopathy Screening

scholarly journals Prevalence of retinopathy in prediabetes: protocol for a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e040997
Author(s):  
Varo Kirthi ◽  
Paul Nderitu ◽  
Uazman Alam ◽  
Jennifer Evans ◽  
Sarah Nevitt ◽  
...  
Keyword(s):  
Systematic Review ◽  
Diabetic Retinopathy ◽  
Data Extraction ◽  
Meta Analysis ◽  
International Diabetes Federation ◽  
Current Data ◽  
Risk Of Bias ◽  
Fundus Photography ◽  
Primary Data ◽  
Cochrane Library

IntroductionThere is growing evidence of a higher than expected prevalence of retinopathy in prediabetes. This paper presents the protocol of a systematic review and meta-analysis of retinopathy in prediabetes. The aim of the review is to estimate the prevalence of retinopathy in prediabetes and to summarise the current data.Methods and analysisThis protocol is developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines. A comprehensive electronic bibliographic search will be conducted in MEDLINE, EMBASE, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Google Scholar and the Cochrane Library. Eligible studies will report prevalence data for retinopathy on fundus photography in adults with prediabetes. No time restrictions will be placed on the date of publication. Screening for eligible studies and data extraction will be conducted by two reviewers independently, using predefined inclusion criteria and prepiloted data extraction forms. Disagreements between the reviewers will be resolved by discussion, and if required, a third (senior) reviewer will arbitrate.The primary outcome is the prevalence of any standard features of diabetic retinopathy (DR) on fundus photography, as per International Clinical Diabetic Retinopathy Severity Scale (ICDRSS) classification. Secondary outcomes are the prevalence of (1) any retinal microvascular abnormalities on fundus photography that are not standard features of DR as per ICDRSS classification and (2) any macular microvascular abnormalities on fundus photography, including but not limited to the presence of macular exudates, microaneurysms and haemorrhages. Risk of bias for included studies will be assessed using a validated risk of bias tool for prevalence studies. Pooled estimates for the prespecified outcomes of interest will be calculated using random effects meta-analytic techniques. Heterogeneity will be assessed using the I2 statistic.Ethics and disseminationEthical approval is not required as this is a protocol for a systematic review and no primary data are to be collected. Findings will be disseminated through peer-reviewed publications and presentations at national and international meetings including Diabetes UK, European Association for the Study of Diabetes, American Diabetes Association and International Diabetes Federation conferences.PROSPERO registration numberCRD42020184820.

scholarly journals Prevalence of Syphilis among Pregnant Women in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Siraj Hussen ◽  
Birkneh Tilahun Tadesse
Keyword(s):  
Systematic Review ◽  
Pregnant Women ◽  
Screening Program ◽  
Meta Analysis ◽  
Relevant Literature ◽  
Sub Saharan Africa ◽  
Cochrane Library ◽  
Forest Plot ◽  
Pooled Prevalence ◽  
Sub Saharan

Objective. Syphilis is one of the most imperative STIs, caused by the spirochete Treponema pallidum. During pregnancy it is associated with disastrous health outcomes in the newborn. In sub-Saharan Africa, study findings on the prevalence of syphilis among pregnant women are highly dispersed and inconsistent. The aim of the current review is to conduct a systematic review and meta-analysis of syphilis in sub-Saharan Africa among pregnant women. Design. Systematic review and meta-analysis. Data Sources. Databases including MEDLINE, PubMed, Cochrane Library, Google Scholar, and HINARI and reference lists of previous prevalence studies were systematically searched for relevant literature from January 1999 to November 2018. Results were presented in forest plot, tables, and figures. Random-effects model was used for the meta-analysis. For the purpose of this review, a case of syphilis was defined as positive treponemal or nontreponemal tests among pregnant women. Data Extraction. Our search gave a total of 262 citations from all searched databases. Of these, 44 studies fulfilling the inclusion criteria and comprising 175,546 subjects were finally included. Results. The pooled prevalence of syphilis among pregnant women in sub-Saharan Africa was 2.9% (95%CI: 2.4%-3.4%). East and Southern African regions had a higher syphilis prevalence among pregnant women (3.2%, 95% CI: 2.3%-4.2% and 3.6%, 95%CI: 2.0%-5.1%, respectively) than the sub-Saharan African pooled prevalence. The prevalence of syphilis among pregnant women in most parts of the region seemed to have decreased over the past 20 years except for the East African region. However, prevalence did not significantly differ by region and time period. Conclusion. This review showed a high prevalence of syphilis in sub-Saharan Africa among pregnant women. The evidence suggests strengthening the screening program during pregnancy as part of the care package during antenatal care visits. Programs focusing on primary prevention of syphilis in women should also be strengthened.

scholarly journals Andalusian program for early detection of diabetic retinopathy: implementation and 15-year follow-up of a population-based screening program in Andalusia, Southern Spain

2020 ◽  
Vol 8 (1) ◽  
pp. e001622 ◽  
Author(s):  
Rafael Rodriguez-Acuña ◽  
Eduardo Mayoral ◽  
Manuel Aguilar-Diosdado ◽  
Reyes Rave ◽  
Beatriz Oyarzabal ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Early Detection ◽  
Vision Loss ◽  
Screening Program ◽  
Target Population ◽  
Population Based ◽  
Annual Incidence ◽  
Population Coverage ◽  
Visual Disability ◽  
The Impact

IntroductionDiabetic retinopathy (DR) is a preventable cause of vision loss and blindness worldwide. We aim at analyzing the impact of a population-based screening program of DR using retinal photography with remote reading in terms of population coverage, diagnosis of asymptomatic DR and impact on visual disability, in the region of Andalusia, Spain, in the period 2005–2019.Research design and methodsDescriptive study. Sociodemographic and clinical features included in the Andalusian program for early detection of diabetic retinopathy (APDR) were analyzed. Population coverage, annual incidence of DR, and DR severity gradation were analyzed. Estimated data on prevalence and incidence of legal blindness due to DR were included.Results407 762 patients with at least one successful DR examination during the study period were included. Most of the performed retinographies (784 584, 84.3%) were ‘non-pathological.’ Asymptomatic DR was detected in 52 748 (5.9%) retinographies, most of them (94.2%) being classified as ‘mild to moderate non-proliferative DR.’ DR was detected in 44 815 patients, while sight-threatening DR (STDR) in 6256 patients; cumulative incidence of DR was 11.0% and STDR was 1.5%, as DR and STDR was detected in 44 815 and 6256 patients, respectively. Annual incidence risk per patient recruitment year progressively decreased from 22.0% by January 2005 to 3.2% by June 2019.ConclusionsImplementation of a long-term population-based screening program for early detection of DR is technically feasible and clinically viable. Thus, after 15 years of existence, the program has enabled the screening of the vast majority of the target population allowing the optimization of healthcare resources and the identification of asymptomatic DR.

scholarly journals Assessing the Performance of Artificial Intelligence Systems for the Screening of Diabetic Retinopathy: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Ryan Sadjadi
Keyword(s):  
Artificial Intelligence ◽  
Systematic Review ◽  
Diabetic Retinopathy ◽  
Vision Loss ◽  
Meta Analysis ◽  
External Validation ◽  
Healthcare Providers ◽  
Vitreoretinal Surgery ◽  
Retinal Fundus ◽  
Screening Systems

Diabetic retinopathy is the most common microvascular complication of diabetes mellitus and one of the leading causes of blindness globally. Due to the progressive nature of the disease, earlier detection and timely treatment can lead to substantial reductions in the incidence of irreversible vision-loss. Artificial intelligence (AI) screening systems have offered clinically acceptable and quicker results in detecting diabetic retinopathy from retinal fundus and optical coherence tomography (OCT) images. Thus, this systematic review and meta-analysis of relevant investigations was performed to document the performance of AI screening systems that were applied to fundus and OCT images of patients from diverse geographic locations including North America, Europe, Africa, Asia, and Australia. A systematic literature search on Medline, Global Health, and PubMed was performed and studies published between October 2015 and January 2020 were included. The search strategy was based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines, and AI-based investigations were mandatory for studies inclusion. The abstracts, titles, and full-texts of potentially eligible studies were screened against inclusion and exclusion criteria. Twenty-one studies were included in this systematic review; 18 met inclusion criteria for the meta-analysis. The pooled sensitivity of the evaluated AI screening systems in detecting diabetic retinopathy was 0.93 (95% CI: 0.92-0.94) and the specificity was 0.88 (95% CI: 0.86-0.89). The included studies detailed training and external validation datasets, criteria for diabetic retinopathy case ascertainment, imaging modalities, DR-grading scales, and compared AI results to those of human graders (e.g., ophthalmologists, retinal specialists, trained nurses, and other healthcare providers) as a reference standard. The findings of this study showed that the majority AI screening systems demonstrated clinically acceptable levels of sensitivity and specificity for detecting referable diabetic retinopathy from retinal fundus and OCT photographs. Further improvement depends on the continual development of novel algorithms with large and gradable sets of images for training and validation. If cost-effectiveness ratios can be optimized, AI can become a financially sustainable and clinically effective intervention that can be incorporated into the healthcare systems of low-to-middle income countries (LMICs) and geographically remote locations. Combining screening technologies with treatment interventions such as anti-VEGF therapy, acellular capillary laser treatment, and vitreoretinal surgery can lead to substantial reductions in the incidence of irreversible vision-loss due to proliferative diabetic retinopathy.

scholarly journals The critical role of infection prevention overlooked in Ethiopia, only one-half of health-care workers had safe practice: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Biniyam Sahiledengle ◽  
Yohannes Tekalegn ◽  
Demelash Woldeyohannes
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Healthcare Workers ◽  
Infection Prevention ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Infection Prevention And Control ◽  
Related Factors ◽  
Safe Practice ◽  
Pooled Prevalence

AbstractBackgroundEffective infection prevention and control measures, such as such hand hygiene, the use of personal protective equipment, instrument processing, safe injection, and safe disposal of infectious wastes in the healthcare facilities maximize patient outcomes and are essential to providing effective, efficient, and quality health care services. In Ethiopia, findings regarding infection prevention practices among healthcare workers have been highly variable and uncertain. Therefore, this systematic review and meta-analysis estimate the pooled prevalence of safe infection prevention practices and summarize the associated factors among healthcare workers in Ethiopia.MethodsPubMed, Science Direct, Google Scholar, and the Cochrane library were systematically searched. We included all observational studies reporting the prevalence of safe infection prevention practices among healthcare workers in Ethiopia. Two authors independently extracted all necessary data using a standardized data extraction format. Qualitative and quantitative analyses were employed. The Cochrane Q test statistics and I2 tests were used to assess the heterogeneity of the studies. A random-effects meta-analysis model was used to estimate the pooled prevalence of safe infection prevention practice.ResultsOf the 187 articles identified through our search, 10 studies fulfilled the inclusion criteria and were included in the meta-analysis. The pooled prevalence of safe infection prevention practice in Ethiopia was 52.2% (95%CI: 40.9-63.4). The highest prevalence of safe practice was observed in Addis Ababa (capital city) 66.2% (95%CI: 60.6-71.8), followed by Amhara region 54.6% (95%CI: 51.1-58.1), and then Oromia region 48.5% (95%CI: 24.2-72.8), and the least safe practices were reported from South Nation Nationalities and People (SNNP) and Tigray regions with a pooled prevalence of 39.4% (95%CI: 13.9-64.8). In our qualitative syntheses, healthcare workers socio-demographic factors (young age, female gender), behavioral-related factors (being knowledgeable and having a positive attitude towards infection prevention), and healthcare facility-related factors (presence of running water supply, availability of infection prevention guideline, and receiving training) were important variables associated with safe infection prevention practice.ConclusionsOnly half of the healthcare workers in Ethiopia practiced safe infection prevention. Furthermore, the study found out that there were regional and professional variations in the prevalence of safe infection prevention practices. Therefore, the need to step-up efforts to intensify the current national infection prevention and patient safety initiative as key policy direction is 41 strongly recommended, along with more attempts to increase healthcare worker’s adherence towards infection prevention guidelines.

scholarly journals Direct and Indirect Therapeutic Effect of Traditional Chinese Medicine as an Add-on for Non-proliferative Diabetic Retinopathy: A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Xuedong an ◽  
de jin ◽  
liyun duan ◽  
shenghui zhao ◽  
rongrong zhou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Diabetic Retinopathy ◽  
Chinese Medicine ◽  
Traditional Chinese Medicine ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Random Effect Model ◽  
Small Sample ◽  
Cochrane Library

Abstract Background：Diabetic retinopathy (DR) is the leading cause of blindness in many countries. The current treatment for non-proliferative DR (NPDR) using Western medicine (WM) alone is insufficient. At present, the combination of NPDR treatment with traditional Chinese medicine (TCM) and WM is universally applied. We aimed to evaluate the effectiveness and safety of TCM as an add-on for NPDR using a systematic review and meta-analysis.Method: Data from randomized controlled trials (RCTs) of TCM for NPDR treatment along with WM before July 6, 2019, were collected from the China National Knowledge Infrastructure, Wanfang Database, China Biomedical Database, Pubmed, Embase, and Cochrane Library. Relevant data were extracted by two reviewers. I2 statistics was adopted to appraise heterogeneity. If I2<50% the fixed-effects model was employed, otherwise a random-effect model was employed. (PROSPERO: CRD42019134947)Result: Eighteen RCTs (1522 patients) were included based on the inclusion and exclusion criteria. The results showed that compared with WM alone, TCM (including Compound Xueshuantong Capsule, Qiming Granule, and others) combined with WM for NPDR could improve the overall effiicacy [n=1686，RR1.24(1.18,1.30), P<0.00001, I2=0%], and reduce the influence of risk factors related to NPDR, such as glycated hemoglobin level [n=360, MD -0.85(-1.28, -0.41), P=0.0001, I2=72%], triglyceride (P<0.00001), and total cholesterol (P=0.0008). Moreover, no serious adverse events were reported.Conclusion: Compared with WM alone, TCM+WM could significantly improve NPDR and also reduce the correlation levels of risk factors, such as hyperglycemia, dyslipidemia. However, the small sample included in the study might lead to a publication bias, and therefore, our results should be treated with caution.

scholarly journals Diabetic Retinopathy Screening in Patients with Diabetes Using a Handheld Fundus Camera: The Experience from the South-Eastern Region in Hungary

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Dóra Júlia Eszes ◽  
Dóra Júlia Szabó ◽  
Greg Russell ◽  
Csaba Lengyel ◽  
Tamás Várkonyi ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Health Behavior ◽  
Vision Loss ◽  
Significant Proportion ◽  
Eastern Region ◽  
Related Factors ◽  
Cross Sectional ◽  
Screening Programs ◽  
Fundus Camera ◽  
South Eastern

Purpose. Diabetic retinopathy (DR) is the leading cause of vision loss among active adults in industrialized countries. We aimed to investigate the prevalence of diabetes mellitus (DM), DR and its different grades, in patients with DM in the Csongrád County, South-Eastern region, Hungary. Furthermore, we aimed to detect the risk factors for developing DR and the diabetology/ophthalmology screening patterns and frequencies, as well as the effect of socioeconomic status- (SES-) related factors on the health and behavior of DM patients. Methods. A cross-sectional study was conducted on adults (>18 years) involving handheld fundus camera screening (Smartscope Pro Optomed, Finland) and image assessment using the Spectra DR software (Health Intelligence, England). Self-completed questionnaires on self-perceived health status (SPHS) and health behavior, as well as visual acuity, HbA1c level, type of DM, and attendance at healthcare services were also recorded. Results. 787 participants with fundus camera images and full self-administered questionnaires were included in the study; 46.2% of the images were unassessable. T1D and T2D were present in 13.5% and 86.5% of the participants, respectively. Among the T1D and T2D patients, 25.0% and 33.5% had DR, respectively. The SES showed significant proportion differences in the T1D group. Lower education was associated with a lower DR rate compared to non-DR (7.7% vs. 40.5%), while bad/very bad perceived financial status was associated with significantly higher DR proportion compared to non-DR (63.6% vs. 22.2%). Neither the SPHS nor the health behavior showed a significant relationship with the disease for both DM groups. Mild nonproliferative retinopathy without maculopathy (R1M0) was detected in 6% and 23% of the T1D and T2D patients having DR, respectively; R1 with maculopathy (R1M1) was present in 82% and 66% of the T1D and T2D groups, respectively. Both moderate nonproliferative retinopathy with maculopathy (R2M1) and active proliferative retinopathy with maculopathy (R3M1) were detected in 6% and 7% of the T1D and T2D patients having DR, respectively. The level of HbA1c affected the attendance at the diabetology screening ( HbA 1 c > 7 % associated with >50% of all quarter-yearly attendance in DM patients, and with 10% of the diabetology screening nonattendance). Conclusion. The prevalence of DM and DR in the studied population in Hungary followed the country trend, with a slightly higher sight-threatening DR than the previously reported national average. SES appears to affect the DR rate, in particular, for T1D. Although DR screening using handheld cameras seems to be simple and dynamic, much training and experience, as well as overcoming the issue of decreased optic clarity is needed to achieve a proper level of image assessability, and in particular, for use in future telemedicine or artificial intelligence screening programs.

scholarly journals Prevalence of Vascular Trauma and Related Factors in Iran: A Systematic Review

2021 ◽  
Vol 11 (2) ◽  
pp. 31441.1-31441.8
Author(s):  
Mohammad Karimian ◽  
◽  
Atieh Okhli ◽  
Abdollah Noormohammadi-Dehbalaee ◽  
Ali Gholami ◽  
...  
Keyword(s):  
Systematic Review ◽  
Penetrating Trauma ◽  
Vascular Trauma ◽  
Library Science ◽  
Cochrane Library ◽  
Related Factors ◽  
Study Results ◽  
Life Threatening ◽  
Ulnar Nerve Injury ◽  
English Articles

Background: Managing patients with Vascular Trauma (VT) is essential. This study aimed to determine the prevalence of VT and its related factors in Iran. Methods: This systematic review was performed by two skilled researchers. To access all the Persian and English articles on VT and its influencing factors (from 2000 to August 2019), in addition to Google Scholar search engine, other international databases, such as PubMed/ Medline, Scopus, Embase, Cochrane Library, Science Direct, Web of Science (ISI), and domestic databases, such as Magiran, IranDoc, National Library of Iran Organization, SID, and Barakatkns were used. Data analysis was conducted by MA (CMA) software. Results: The incidence of lower Lower Vascular Trauma (LVI) trauma was equal to 58.4 (95%CI: 41.1-73.8) (I2= 94.67, Q=112.57, P<0.001); the prevalence of upper LVI trauma was measured to be 31.5 (95%CI: 17.7-49.7) (I2=94.48, Q=108.70, P<0.001); the prevalence of penetrating trauma was calculated as 61.3 (95% CI: 49.5-71.9); the prevalence of ulnar nerve injury equaled 9.8 (95%CI: 2.8-28.6); the prevalence of radial nerve trauma was equal to 7.7 (95%CI: 1.2-35.4); the prevalence of death cases was reported as 12.3 (95%CI: 5.1-26.9); the prevalence of amputation rate was observed as 8.8 (95%CI: 5.7-13.4); the prevalence of fasciotomy rate was equal to 22.2 (95%CI: 13.2-34.5); the prevalence of complete artery cutting equaled 55.7 (95% CI: 35.4-74.3),and the prevalence of incomplete artery cutting was measured as 25.5 (95%CI: 12.1-45.9). Conclusion: According to the study results, VT has led to various complications in patients; thus, it is critical to provide the necessary conditions to preserve the patient’s life and prevent life-threatening complications. Such goals could be achieved by preventing this type of trauma and its related complications.

scholarly journals Pain Trajectories in Knee Osteoarthritis—A Systematic Review and Best Evidence Synthesis on Pain Predictors

2020 ◽  
Vol 9 (9) ◽  
pp. 2828
Author(s):  
Davide Previtali ◽  
Luca Andriolo ◽  
Giorgio Di Laura Frattura ◽  
Angelo Boffa ◽  
Christian Candrian ◽  
...  
Keyword(s):  
Systematic Review ◽  
Knee Osteoarthritis ◽  
Evidence Synthesis ◽  
Grey Literature ◽  
Cochrane Library ◽  
Related Factors ◽  
Knee Oa ◽  
Experienced Pain ◽  
Best Evidence Synthesis ◽  
Pain Trajectories

Different profiles of pain progression have been reported in patients with knee osteoarthritis (OA), but the determinants of this heterogeneity are still to be sought. The aim of this systematic review was to analyze all studies providing information about knee OA pain trajectories to delineate, according to patients’ characteristics, an evidence-based evolution pattern of this disabling disease, which is key for a more personalized and effective management of knee OA. A literature search was performed on PubMed, Web of Science, Cochrane Library, and grey literature databases. The Cochrane Collaboration’s tool for assessing risk of bias was used, and a best-evidence synthesis was performed to define the predictors of pain evolution. Seven articles on 7747 patients affected by knee OA (mainly early/moderate) were included. Daily knee OA pain trajectories were unstable in almost half of the patients. In the mid-term, knee OA had a steady pain trajectory in 85% of the patients, 8% experienced pain reduction, while 7% experienced pain worsening. Low education, comorbidities, and depression were patient-related predictors of severe/worsening knee OA pain. Conversely, age, alcohol, smoking, pain coping strategies, and medications were unrelated to pain evolution. Conflicting/no evidence was found for all joint-related factors, such as baseline radiographic severity.

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