scholarly journals Diagnosis, prevention and treatment of common lower extremity muscle injuries in sport – grading the evidence: a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF)

2020 ◽  
Vol 54 (9) ◽  
pp. 528-537 ◽  
Author(s):  
Lasse Ishøi ◽  
Kasper Krommes ◽  
Rasmus Skov Husted ◽  
Carsten B Juhl ◽  
Kristian Thorborg
Keyword(s):  
Effect Size ◽  
Injury Risk ◽  
Return To Play ◽  
Hamstring Injury ◽  
Muscle Injuries ◽  
Quality Of Evidence ◽  
Moderate Quality ◽  
Lower Extremity Muscle ◽  
Prevention And Treatment

This statement summarises and appraises the evidence on diagnosis, prevention and treatment of the most common lower extremity muscle injuries in sport. We systematically searched electronic databases, and included studies based on the highest available evidence. Subsequently, we evaluated the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework, grading the quality of evidence from high to very low. Most clinical tests showed very low to low diagnostic effectiveness. For hamstring injury prevention, programmes that included the Nordic hamstring exercise resulted in a hamstring injury risk reduction when compared with usual care (medium to large effect size; moderate to high quality of evidence). For prevention of groin injuries, both the FIFA 11+programme and the Copenhagen adductor strengthening programme resulted in a groin injury risk reduction compared with usual care (medium effect size; low to moderate quality of evidence). For the treatment of hamstring injuries, lengthening hamstring exercises showed the fastest return to play with a lower reinjury rate compared with conventional hamstring exercises (large effect size; very low to low quality of evidence). Platelet-rich plasma had no effect on time to return-to-play and reinjury risk (trivial effect size; moderate quality of evidence) after a hamstring injury compared with placebo or rehabilitation. At this point, most outcomes for diagnosis, prevention and treatment were graded as very low to moderate quality of evidence, indicating that further high-quality research is likely to have an important impact on the confidence in the effect estimates.

scholarly journals Acute Gastrocnemius-Soleus Complex Injuries in National Football League Athletes

2017 ◽  
Vol 5 (1) ◽  
pp. 232596711668034 ◽  
Author(s):  
Brian C. Werner ◽  
Nicole S. Belkin ◽  
Steve Kennelly ◽  
Leigh Weiss ◽  
Ronnie P. Barnes ◽  
...  
Keyword(s):  
Relative Frequency ◽  
National Football League ◽  
Fluid Collection ◽  
Magnetic Resonance Images ◽  
Calf Muscle ◽  
Return To Play ◽  
Imaging Findings ◽  
Muscle Injuries ◽  
Lower Extremity Muscle ◽  
Imaging Characteristics

Background: Lower extremity muscle injuries are common in professional football. Although less common than hamstring or quadriceps injuries in National Football League (NFL) athletes, calf injuries occur with relative frequency and have not previously been studied. Purpose: To evaluate gastrocnemius-soleus complex muscle injuries over the past 13 years from a single NFL team to determine the incidence of such injuries, their imaging characteristics, and return to play after such injuries and any correlation between imaging findings and prolonged return to play. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of all acute calf muscle injuries on a single NFL team from 2003 to 2015 was performed. Player demographics and return-to-play data were obtained from the medical records. All available magnetic resonance images (MRIs) were reviewed by a musculoskeletal radiologist for specific imaging findings that correlated with return to play. Results: A total of 27 calf injuries in 24 NFL players were reviewed, yielding an incidence of 2.3 acute calf injuries per year on a single NFL team. Of these 27 injuries, 20 (74%) were isolated injuries to the gastrocnemius muscle, 4 (15%) were isolated injuries to the soleus muscle, and the remaining 3 injuries (11%) involved both. Defensive players were more likely to sustain injuries ( P = .043). The mean time to return to play for all 27 players was 17.4 ± 14.6 days (range, 3-62 days). MRIs were available in 14 of the 27 injuries. The average size of the fascial defect ( P = .032) and the presence of a fluid collection ( P = .031) both correlated with return to play of longer than 2 weeks. Conclusion: Although less common than hamstring or quadriceps muscle injuries, calf muscle injuries occur with relative frequency in the NFL, and more so in defensive players. The majority of these injuries occur in the gastrocnemius and result in significant disability, with at least 2 weeks of missed playing time on average. MRI may have an important role in the evaluation of calf injuries in NFL players, as certain injury imaging characteristics, including the anteroposterior size of any fascial tear and the presence of a fluid collection, are associated with longer return-to-play times after injury.

IUI for unexplained infertility—a network meta-analysis

2019 ◽  
Vol 26 (1) ◽  
pp. 1-15 ◽  
Author(s):  
N A Danhof ◽  
R Wang ◽  
M van Wely ◽  
F van der Veen ◽  
B W J Mol ◽  
...  
Keyword(s):  
Live Birth ◽  
Ovarian Stimulation ◽  
Meta Analysis ◽  
Multiple Pregnancy ◽  
Pregnancy Rates ◽  
Natural Cycle ◽  
Ongoing Pregnancy ◽  
Quality Of Evidence ◽  
Moderate Quality

ABSTRACT BACKGROUND IUI for unexplained infertility can be performed in a natural cycle or in combination with ovarian stimulation. A disadvantage of ovarian stimulation is an increased risk of multiple pregnancies with its inherent maternal and neonatal complication risks. Stimulation agents for ovarian stimulation are clomiphene citrate (CC), Letrozole or gonadotrophins. Although studies have compared two or three of these drugs to each other in IUI, they have never been compared to one another in one analysis. OBJECTIVE AND RATIONALE The objective of this network meta-analysis was to compare the effectiveness and safety of IUI with CC, Letrozole or gonadotrophins with each other and with natural cycle IUI. SEARCH METHODS We searched PubMed, MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, CENTRAL and the Clinical Trial Registration Database indexed up to 16 August 2018. We included randomized controlled trials that compared a stimulation regimen with CC, Letrozole or gonadotrophins to each other or to natural cycle IUI among couples with unexplained infertility. We performed the network meta-analysis within a multivariate random effects model. OUTCOMES We identified 26 studies reporting on 5316 women. The relative risk (RR) for live birth/ongoing pregnancy rates comparing IUI with CC to natural cycle IUI was 1.05 (95% CI 0.63–1.77, low quality of evidence), while comparing IUI with Letrozole to natural cycle IUI was 1.15 (95% CI 0.63–2.08, low quality of evidence) and comparing IUI with gonadotrophins to natural cycle IUI was 1.46 (95% CI 0.92–2.30, low quality of evidence). The RR for live birth/ongoing pregnancy rates comparing gonadotrophins to CC was 1.39 (95% CI 1.09–1.76, moderate quality of evidence), comparing Letrozole to CC was 1.09 (95% CI 0.76–1.57, moderate quality of evidence) and comparing Letrozole to gonadotrophins was 0.79 (95% CI 0.54–1.15, moderate quality of evidence). We did not perform network meta-analysis on multiple pregnancy due to high inconsistency. Pairwise meta-analyses showed an RR for multiple pregnancy rates of 9.11(95% CI 1.18–70.32) comparing IUI with gonadotrophins to natural cycle IUI. There was no data available on multiple pregnancy rates following IUI with CC or Letrozole compared to natural cycle IUI. The RR for multiple pregnancy rates comparing gonadotrophins to CC was 1.42 (95% CI 0.68–2.97), comparing Letrozole to CC was 0.97 (95% CI 0.47–2.01) and comparing Letrozole to gonadotrophins was 0.29 (95% CI 0.14–0.58). In a meta-analysis among studies with adherence to strict cancellation criteria, the RR for live births/ongoing pregnancy rates comparing gonadotrophins to CC was 1.20 (95% CI 0.95–1.51) and the RR for multiple pregnancy rates comparing gonadotropins to CC was 0.80 (95% CI 0.38–1.68). WIDER IMPLICATIONS Based on low to moderate quality of evidence in this network meta-analysis, IUI with gonadotrophins ranked highest on live birth/ongoing pregnancy rates, but women undergoing this treatment protocol were also at risk for multiple pregnancies with high complication rates. IUI regimens with adherence to strict cancellation criteria led to an acceptable multiple pregnancy rate without compromising the effectiveness. Within a protocol with adherence to strict cancellation criteria, gonadotrophins seem to improve live birth/ongoing pregnancy rates compared to CC. We, therefore, suggest performing IUI with ovarian stimulation using gonadotrophins within a protocol that includes strict cancellation criteria. Obviously, this ignores the impact of costs and patients preference.

scholarly journals Overview of evidence-based clinical practice guidelines for preoperative care: a systematic review.

2020 ◽  
Author(s):  
Agustín Ciapponi ◽  
Tapia-López Elena ◽  
Virgilio Sacha ◽  
Ariel Bardach
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Cochrane Library ◽  
Evidence Based ◽  
Agree Ii ◽  
Quality Of Evidence ◽  
Moderate Quality

Abstract Background Our aim was to summarize and compare relevant recommendations from evidence-based CPGs (EB-CPGs). Methods Systematic review of clinical practice guidelines. Data sources: PubMed, EMBase, Cochrane Library, LILACS, Tripdatabase and additional sources. In July 2017, we searched CPGs that were published in the last 10 years, without language restrictions, in electronic databases, and also searched specific CPG sources, reference lists and consulted experts. Pairs of independent reviewers selected EB-CPGs and rated their methodological quality using the AGREE-II instrument. We summarized recommendations, its supporting evidence and strength of recommendations according to the GRADE methodology. Results We included 16 EB-CPGs out of 2262 references identified. Only nine of them had searches within the last five years and seven used GRADE. The median (percentile 25-75) AGREE-II scores for rigor of development was 49% (35-76%) and the domain ‘applicability’ obtained the worst score: 16% (9-31%). We summarized 31 risk stratification recommendations, 21.6% of which were supported by high/moderate quality of evidence (41% of them were strong recommendations), and 16 therapeutic/preventive recommendations, 59% of which were supported by high/moderate quality of evidence (75.7% strong). We found inconsistency in ratings of evidence level. ‘Guidelines’ applicability’ and ‘monitoring’ were the most deficient domains. Only half of the EB-CPGs were updated in the past five years. Conclusions We present many strong recommendations that are ready to be considered for implementation as well as others to be interrupted, and we reveal opportunities to improve guidelines’ quality.

scholarly journals Efficacy of Longdan Xiegan Decoction on the Treatment of Eczema: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-13
Author(s):  
Ziteng Hu ◽  
Lidong Gao ◽  
Chengxian Li ◽  
Alberto Cucco ◽  
Shang Wang ◽  
...  
Keyword(s):  
Clinical Efficacy ◽  
Total Effective Rate ◽  
Meta Analysis ◽  
Effective Rate ◽  
Biomedical Literature ◽  
Cure Rate ◽  
Quality Of Evidence ◽  
Moderate Quality ◽  
Quality Evidence

Background. Longdan Xiegan decoction (LDXGD) has been widely used in the treatment of eczema. In recent years, randomized controlled trials (RCTs) of LDXGD for the treatment of eczema have gradually increased. Most of the results show that LDXGD is effective in treating eczema. However, whether these conclusions are reliable or not requires meta-analysis. Objective. This study aimed to systematically evaluate the clinical efficacy of LDXGD in the treatment of eczema. Materials and Methods. Seven electronic databases, including PubMed, Excerpta Medica Database (EMBASE), Cochrane Library, Chinese Biomedical Literature on Disc (CBM), China National Knowledge Infrastructure (CNKI), WanFang, and Chinese Science and Technology Periodical Database (VIP) were systematically searched from their inception until January 2021. Risk of bias was assessed using criteria from the Cochrane Collaboration and meta-analysis was conducted on the screened literature data using Review Manage (RevMan 5.3). Then, to assess the quality of evidence, the GRADE criteria was adopted. Results. 14 RCTs with 1080 participants were identified. Meta-analysis indicated that compared with western medicine (WM), the cure rate and the total effective rate of LDXGD in treating eczema were higher. Meanwhile, the recurrence rate and the levels of interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor (TNF-α) after treatment were lower. The adverse reaction was reported in 5 out of 14 studies without significant statistical difference. According to GRADE criteria, the quality of evidence was low for all outcomes except for the cure rate (moderate-quality evidence) and the total effective rate (moderate-quality evidence). Conclusion. The clinical efficacy of LDXGD in the treatment of eczema was more effective compared with the one of conventional WM alone. However, due to the limitation of the quality of the included studies, additional studies are required to further confirm these results.

scholarly journals European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia

2021 ◽  
pp. 239698732110397
Author(s):  
Rainer Dziewas ◽  
Emilia Michou ◽  
Michaela Trapl-Grundschober ◽  
Avtar Lal ◽  
Ethem Murat Arsava ◽  
...  
Keyword(s):  
Treatment Options ◽  
Standard Operating Procedure ◽  
Dietary Interventions ◽  
Stroke Patients ◽  
Pharmacological Agents ◽  
Quality Of Evidence ◽  
Post Stroke ◽  
Moderate Quality ◽  
Grade Approach

Post-stroke dysphagia (PSD) is present in more than 50% of acute stroke patients, increases the risk of complications, in particular aspiration pneumonia, malnutrition and dehydration, and is linked to poor outcome and mortality. The aim of this guideline is to assist all members of the multidisciplinary team in their management of patients with PSD. These guidelines were developed based on the European Stroke Organisation (ESO) standard operating procedure and followed the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. An interdisciplinary working group identified 20 relevant questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence and wrote evidence-based recommendations. Expert opinion was provided if not enough evidence was available to provide recommendations based on the GRADE approach. We found moderate quality of evidence to recommend dysphagia screening in all stroke patients to prevent post-stroke pneumonia and to early mortality and low quality of evidence to suggest dysphagia assessment in stroke patients having been identified at being at risk of PSD. We found low to moderate quality of evidence for a variety of treatment options to improve swallowing physiology and swallowing safety. These options include dietary interventions, behavioural swallowing treatment including acupuncture, nutritional interventions, oral health care, different pharmacological agents and different types of neurostimulation treatment. Some of the studied interventions also had an impact on other clinical endpoints such as feedings status or pneumonia. Overall, further randomized trials are needed to improve the quality of evidence for the treatment of PSD.

scholarly journals Hamstring Injuries Prevention in Soccer: A Narrative Review of Current Literature

Joints ◽  
2020 ◽  
Author(s):  
Gian Nicola Bisciotti ◽  
Karim Chamari ◽  
Emanuele Cena ◽  
Giulia Carimati ◽  
Alessandro Bisciotti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Injury Risk ◽  
Epidemiological Data ◽  
Return To Play ◽  
Hamstring Injury ◽  
Apparent Paradox ◽  
Hamstring Injuries ◽  
High Incidence ◽  
Sport Activities ◽  
Injury Risk Factors

AbstractHamstring injuries and reinjuries are one of the most important sport lesions in several sport activities including soccer, Australian football, track and field, rugby, and in general in all sport activities requiring sprinting and acceleration. However, it is important to distinguish between the lesions of the biceps femoris and semitendinosus and semimembranosus. Indeed, three muscles representing the hamstring complex have a very different injury etiology and consequently require different prevention strategies. This fact may explain, at least in part, the high incidence of reinjuries. In soccer, hamstring injuries cause an important rate of time loss (i.e., in average 15–21 matches missed per club per season). The hamstring injury risk factors may be subdivided in three categories: “primary injury risk factors” (i.e., the risk factors mainly causing a first lesion), “recurrent injury risk factors” (i.e., the risk that can cause a reinjury), and bivalent injury risk factors” (i.e., the risk factors that can cause both primary injuries and reinjuries). The high incidence of hamstring lesions caused consequently an important increase in hamstring injury research. However, although the prevention has increased paradoxically, epidemiological data do not show a loss in injuries and/or reinjuries but, on the contrary, they show an increase in hamstring injuries. This apparent paradox highlights the importance both of the improvement in the prevention programs quality and the criteria for return to play after hamstring injury.

scholarly journals Systematic Review and Meta-analysis on Oral azoles for the Treatment of Pityriasis Versicolor

2019 ◽  
Vol 53 (1) ◽  
Author(s):  
Rowena Natividad S. Flores-Genuino ◽  
Belen L. Dofitas ◽  
Leonila F. Dans ◽  
Ma. Lourdes E. Amarillo
Keyword(s):  
Adverse Effects ◽  
Meta Analysis ◽  
Pityriasis Versicolor ◽  
Efficacy And Safety ◽  
Quality Of Evidence ◽  
Randomized Controlled ◽  
Moderate Quality ◽  
Mycologic Cure ◽  
Dosing Regimens

Background. Oral azole drugs are a second-line option for the treatment of pityriasis versicolor but evidence on their efficacy and safety is unclear. Objectives. To determine the efficacy and safety of oral azoles in the treatment of patients with pityriasis versicolor. Methods: We searched MEDLINE, CENTRAL, EMBASE, LILACS, and HERDIN, from inception to the period between January to February 2014. We did not restrict the search by language or publication status.We included randomized controlled trials (RCTs) that compared the efficacy of oral azoles with placebo or no treatment, with topical agents, other oral azoles or dosing regimens in the treatment of pityriasis versicolor, and that measured any of the pre-specified outcomes (mycologic cure, clinical cure, recurrence, duration to cure, timeto-cure, and quality of life). For adverse effects, we also included non-randomized studies (NRS). We used Cochrane methods to select studies, extract data, assess risk of bias, pool studies, and calculate for treatment effects. Results. We included 38 RCTs (n=2894) and 56 NRS (n=3452). Overall, there were few pooled studies and evidence was low to moderate quality. Oral azoles were more effective than placebo (mycologic cure, RR 11.34, 95% CI 4.90, 26.28; 3 RCTs, n=131; I2=0%; low quality of evidence) and as effective as topical agents (mycologic cure, RR 1.02, 95% CI 0.86, 1.21; 4 RCTs, n=232; I2=60%; moderate quality of evidence).There were few adverse effects and were mostly minor and transient. Conclusions. Oral azoles may be more effective than placebo, and are probably as effective as topical agents in the treatment of PV. Triazoles are probably as effective as ketoconazole. Adverse effects were few, mostly minor, and transient.

scholarly journals Femoroacetabular impingement syndrome and labral injuries: grading the evidence on diagnosis and non-operative treatment—a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF)

2021 ◽  
pp. bjsports-2021-104060
Author(s):  
Lasse Ishøi ◽  
Mathias Fabricius Nielsen ◽  
Kasper Krommes ◽  
Rasmus Skov Husted ◽  
Per Hölmich ◽  
...  
Keyword(s):  
Effect Size ◽  
Hip Arthroscopy ◽  
Clinical Information ◽  
Quality Of Evidence ◽  
Post Test ◽  
Fai Syndrome ◽  
Post Test Probability ◽  
Test Probability ◽  
Evidence Interpretation

This statement summarises and appraises the evidence on diagnostic tests and clinical information, and non-operative treatment of femoroacetabular impingement (FAI) syndrome and labral injuries. We included studies based on the highest available level of evidence as judged by study design. We evaluated the certainty of evidence using the Grading of Recommendations Assessment Development and Evaluation framework. We found 29 studies reporting 23 clinical tests and 14 different forms of clinical information, respectively. Restricted internal hip rotation in 0° hip flexion with or without pain was best to rule in FAI syndrome (low diagnostic effectiveness; low quality of evidence; interpretation of evidence: may increase post-test probability slightly), whereas no pain in Flexion Adduction Internal Rotation test or no restricted range of motion in Flexion Abduction External Rotation test compared with the unaffected side were best to rule out (very low to high diagnostic effectiveness; very low to moderate quality of evidence; interpretation of evidence: very uncertain, but may reduce post-test probability slightly). No forms of clinical information were found useful for diagnosis. For treatment of FAI syndrome, 14 randomised controlled trials were found. Prescribed physiotherapy, consisting of hip strengthening, hip joint manual therapy techniques, functional activity-specific retraining and education showed a small to medium effect size compared with a combination of passive modalities, stretching and advice (very low to low quality of evidence; interpretation of evidence: very uncertain, but may slightly improve outcomes). Prescribed physiotherapy was, however, inferior to hip arthroscopy (small effect size; moderate quality of evidence; interpretation of evidence: hip arthroscopy probably increases outcome slightly). For both domains, the overall quality of evidence ranged from very low to moderate indicating that future research on diagnosis and treatment may alter the conclusions from this review.

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