scholarly journals Effectiveness of isometric exercise in the management of tendinopathy: a systematic review and meta-analysis of randomised trials

2020 ◽  
Vol 6 (1) ◽  
pp. e000760
Author(s):  
Christopher Clifford ◽  
Dimitris Challoumas ◽  
Lorna Paul ◽  
Grant Syme ◽  
Neal L Millar
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Meta Analysis ◽  
Isometric Exercise ◽  
Limited Evidence ◽  
Short Term ◽  
Level Of Evidence ◽  
Isotonic Exercise ◽  
Evidence Level ◽  
Level 3

ObjectiveTo systematically review and critically appraise the literature on the effectiveness of isometric exercise in comparison with other treatment strategies or no treatment in tendinopathy.DesignA systematic review and meta-analysis of randomised controlled trials.Data sourcesElectronic searches of Medline, Cumulative Index to Nursing and Allied Health Literature, EMBASE and Cochrane were undertaken from inception to May 2020.MethodsOverall quality of each study was determined based on a combined assessment of internal validity, external validity and precision. For each outcome measure, level of evidence was rated based on the system by van Tulder et al.ResultsTen studies were identified and included in the review, including participants with patellar (n=4), rotator cuff (n=2), lateral elbow (n=2), Achilles (n=1) and gluteal (n=1) tendinopathies. Three were of good and seven were of poor overall quality. Based on limited evidence (level 3), isometric exercise was not superior to isotonic exercise for chronic tendinopathy either immediately following treatment or in the short term (≤12 weeks) for any of the investigated outcome measures. Additionally, for acute rotator cuff tendinopathy, isometric exercise appears to be no more effective than ice therapy in the short term (limited evidence; level 3).SummaryIsometric exercise does not appear to be superior to isotonic exercise in the management of chronic tendinopathy. The response to isometric exercise is variable both within and across tendinopathy populations. Isometric exercise can be used as part of a progressive loading programme as it may be beneficial for selected individuals.PROSPERO registration numberCRD42019147179.

scholarly journals Conservative treatment of partial-thickness rotator cuff tears and tendinopathy with platelet-rich plasma: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Xiao-Na Xiang ◽  
Jie Deng ◽  
Yan Liu ◽  
Xi Yu ◽  
Biao Cheng ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Platelet Rich Plasma ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Rotator Cuff Tears ◽  
Short Term ◽  
Partial Thickness ◽  
And Function

AbstractPurposeTo assess the effect of platelet-rich plasma (PRP) as a conservative therapy on individuals with partial-thickness rotator cuff tears (PTRCs) or tendinopathy in terms of pain, and function.MethodsA systematic review and meta-analysis of randomized controlled trials were conducted. Short-term (6±1 months) and long-term (≥1 year) outcomes were analysed, including the visual analogue scale (VAS), Constant-Murley score (CMS), Shoulder Pain and Disability Index (SPADI), as well as American Shoulder and Elbow Surgeons (ASES) score. The weighted mean difference (MD) with 95% confidence interval (CI) was used.ResultsTen studies were eligible in this review, nine studies with 561 patients were included in this meta-analysis. The meta-analysis showed statistically significant differences in the decrease in short-term VAS (MD=-1.56; 95% CI -2.82 to -0.30), and increase in CMS (MD=16.48; 95% CI 12.57 to 20.40), and SPADI (MD=-18.78 95% CI -36.55 to -1.02). Nonetheless, no long-term effect was observed on pain and function, except CMS (MD=24.30). The results of mean important differences (MIDs) reached the minimal clinically important differences, except ASES. For subgroup analysis, short-term VAS scores were decreased in PRP-treated patients with double centrifugation (MD=-1.99), single injection (MD=-0.71) and post-injection rehabilitation (MD=-1.59).ConclusionPRP-treated patients with PTRCs and rotator cuff tendinopathy demonstrated improvements in pain and function, although the effect may not last for a long time. Overall, our results suggest that PRP may have positive clinical outcomes, but limited data, and study heterogeneity hinder firm conclusions.

scholarly journals Comparative Efficacy and Tolerability of Nonsurgical Therapies for the Treatment of Midportion Achilles Tendinopathy: A Systematic Review With Network Meta-analysis

2020 ◽  
Vol 8 (7) ◽  
pp. 232596712093056 ◽  
Author(s):  
Hye Chang Rhim ◽  
Min Seo Kim ◽  
Seungil Choi ◽  
Adam S. Tenforde
Keyword(s):  
Systematic Review ◽  
Safety Profile ◽  
Meta Analysis ◽  
High Volume ◽  
Achilles Tendinopathy ◽  
Comparative Efficacy ◽  
Short Term ◽  
Level Of Evidence ◽  
Shockwave Therapy ◽  
High Level

Background: Achilles tendinopathy (AT) is a common cause of overuse injury in both athletes and nonactive individuals, especially at older ages. Due to the limited number of direct comparisons among interventions, determining the best treatment option can be difficult. Purpose: To evaluate the comparative efficacy and tolerability of nonsurgical therapies for midportion AT. Study Design: Systematic review; Level of evidence, 1. Methods: PubMed, MEDLINE, EMBASE, and Google Scholar were searched from database inception through June 20, 2019. Randomized controlled trials investigating the effect of nonsurgical therapies for midportion AT using the Victorian Institute of Sports Assessment–Achilles (VISA-A) assessment were eligible for inclusion. Primary outcome was mean change in VISA-A score from baseline. Comparisons between interventions were made through use of random-effects network meta-analysis over the short term (≤3 months) and longer term (>3 to <12 months). A safety profile was defined for each intervention by rate of all-cause discontinuation (dropout) during follow-up. Relative ranking of therapies was assessed by the surface-under-the–cumulative ranking possibilities. Results: A total of 22 studies with 978 patients met the inclusion criteria. In short-term studies, high-volume injection with corticosteroid (HVI+C) along with eccentric exercise (ECC) significantly improved the change of VISA-A score compared with that of ECC alone (standardized mean difference [SMD], 1.08; 95% CI, 0.58-1.58). Compared with ECC, acupuncture showed benefits over both the short term (SMD, 1.57; 95% CI, 1.00-2.13) and longer term (SMD, 1.23; 95% CI, 0.69-1.76). In longer-term studies, the wait-and-see approach resulted in unfavorable outcomes compared with ECC (SMD, −1.51; 95% CI, −2.02 to −1.01). Improvement was higher when ECC was combined with HVI+C (SMD, 0.53; 95% CI, 0.05-1.02) and extracorporeal shockwave therapy (ESWT) (SMD, 0.99; 95% CI, 0.48-1.49). All interventions had a similar safety profile. Conclusion: From available high-level studies, HVI+C and ESWT may be possible interventions to add along with ECC to improve longer-term outcomes.

scholarly journals Effects of mirror training on motor performance in healthy individuals: a systematic review and meta-analysis

2019 ◽  
Vol 5 (1) ◽  
pp. e000590 ◽  
Author(s):  
Yinglun Chen ◽  
Pu Wang ◽  
Yulong Bai ◽  
Yuyuan Wang
Keyword(s):  
Systematic Review ◽  
Motor Function ◽  
Motor Performance ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Healthy Individuals ◽  
Limited Evidence ◽  
Short Term ◽  
Mirror Training ◽  
Randomised Controlled

ObjectiveMirror training (MTr) is a rehabilitation technique for patients with neurological diseases. There is no consensus on its effects on motor function in healthy individuals. This systematic review and meta-analysis considers the effects of MTr on motor function in healthy individuals.DesignThis is a systematic review and meta-analysis.Data sourcesWe searched six databases for studies assessing the effects of MTr on motor function in healthy individuals, published between January 1995 and December 2018. The Cochrane risk of bias was used to assess the quality of the studies. A meta-analysis was conducted with narrative synthesis.Eligibility criteria for selecting studiesEnglish-language randomised controlled trials reporting the behavioural results in healthy individuals were included.ResultsFourteen randomised controlled trials involving 538 healthy individuals were eligible. Two short-term studies showed MTr was inferior to passive vision pattern (standardised mean difference 0.57 (95% CI 0.06 to 1.08), I2=0%, p=0.03). The methods varied and there is limited evidence supporting the effectiveness of MTr compared with three alternative training patterns, with insufficient evidence to support analyses of age, skill level or hand dominance.ConclusionThe limited evidence that MTr affects motor performance in healthy individuals is weak and inconsistent among studies. It is unclear whether the effects of MTr on motor performance are more pronounced than the direct vision pattern, passive vision pattern or action observation. Further studies are needed to explore the short-term and long-term benefits of MTr and its effects on motor learning in healthy individuals.PROSPERO registration numberCRD42019128881.

scholarly journals Toxic effect of khat (Catha edulis) on memory: Systematic review and meta-analysis

2017 ◽  
Vol 08 (01) ◽  
pp. 030-037 ◽  
Author(s):  
Birhane Alem Berihu ◽  
Gebrekidan Gebregzabher Asfeha ◽  
Abadi Leul Welderufael ◽  
Yared Godefa Debeb ◽  
Yibrah Berhe Zelelow ◽  
...  
Keyword(s):  
Systematic Review ◽  
Short Term Memory ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Long Term Memory ◽  
Short Term ◽  
Level Of Evidence ◽  
Catha Edulis ◽  
Term Memory

ABSTRACT Background: People use khat (Catha edulis) for its pleasant stimulant effect of physical activity, consciousness, motor, and mental functions. Although there are reports assessing the effect of khat on memory, there was no study based on formal systematic review and meta-analysis. Objective: We have therefore conducted this meta-analysis to determine the level of evidence for the effect of khat (C. edulis Forsk) on memory discrepancy. Methods: MEDLINE, Cochrane Library, PubMed, Academic Search Complete, SPORTDiscus, ScienceDirect, Scopus, Web of Science, and Google Scholar were searched to retrieve the papers for this review. Keywords utilized across database search were khat, cat, chat, long-term memory, short-term memory, memory deficit, randomized control trial, and cross-sectional survey. The search was limited to studies in humans and rodents; published in English language. Result: Finding of various studies included in our meta-analysis showed that the effect of acute, and subchronic exposure to khat showed that short-term memory appears to be affected depending on the duration of exposure. However, does not have any effect on long-term memory. Conclusion: Although a number of studies regarding the current topic are limited, the evidenced showed that khat (C. edulis) induced memory discrepancy.

Early Versus Delayed Motion After Rotator Cuff Repair: A Systematic Review of Overlapping Meta-analyses

2017 ◽  
Vol 45 (12) ◽  
pp. 2911-2915 ◽  
Author(s):  
Darby A. Houck ◽  
Matthew J. Kraeutler ◽  
Hayden B. Schuette ◽  
Eric C. McCarty ◽  
Jonathan T. Bravman
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Meta Analysis ◽  
Level Of Evidence ◽  
Decision Algorithm ◽  
Early Motion ◽  
Meta Analyses ◽  
Cuff Repair ◽  
Tear Size

Background: Previous meta-analyses have been conducted to compare outcomes of early versus delayed motion after rotator cuff repair. Purpose: To conduct a systematic review of overlapping meta-analyses comparing early versus delayed motion rehabilitation protocols after rotator cuff repair to determine which meta-analyses provide the best available evidence. Study Design: Systematic review. Methods: A systematic review was performed by searching PubMed and Cochrane Library databases. Search terms included “rotator cuff repair,” “early passive motion,” “immobilization,” “rehabilitation protocol,” and “meta-analysis.” Results were reviewed to determine study eligibility. Patient outcomes and structural healing were extracted from these meta-analyses. Meta-analysis quality was assessed using the Oxman-Guyatt and Quality of Reporting of Meta-analyses (QUOROM) systems. The Jadad decision algorithm was then used to determine which meta-analyses provided the best level of evidence. Results: Seven meta-analyses containing a total of 5896 patients met the eligibility criteria (1 Level I evidence, 4 Level II evidence, 2 Level III evidence). None of these meta-analyses found immobilization to be superior to early motion; however, most studies suggested that early motion would increase range of motion (ROM), thereby reducing time of recovery. Three of these studies suggested that tear size contributed to the choice of rehabilitation to ensure proper healing of the shoulder. A study by Chan et al in 2014 received the highest QUOROM and Oxman-Guyatt scores, and therefore this meta-analysis appeared to have the highest level of evidence. Additionally, a study by Riboh and Garrigues in 2014 was selected as the highest quality study in this systematic review according to the Jadad decision algorithm. Conclusion: The current, best available evidence suggests that early motion improves ROM after rotator cuff repair but increases the risk of rotator cuff retear. Lower quality meta-analyses indicate that tear size may provide a better strategy in determining the correct rehabilitation protocol.

Changes From Baseline in Patient- Reported Outcomes at 1 Year Versus 2 Years After Rotator Cuff Repair: A Systematic Review and Meta-analysis

2021 ◽  
pp. 036354652110239
Author(s):  
Sambit Sahoo ◽  
Martina Stojanovska ◽  
Peter B. Imrey ◽  
Yuxuan Jin ◽  
Richard J. Bowles ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Cohort Studies ◽  
Rotator Cuff Repair ◽  
Constant Score ◽  
Meta Analysis ◽  
Level Of Evidence ◽  
Patient Reported ◽  
The Mean ◽  
Cuff Repair

Background: Most orthopaedic journals currently require reporting outcomes of surgical interventions for at least 2 postoperative years, but there have been no rigorous studies on this matter. Various patient-reported outcome (PRO) measures (PROMs) have been used to assess the status of the shoulder after rotator cuff repair (RCR). Hypothesis: We hypothesized that the mean shoulder-specific PROMs at 1 year improve substantially over baseline but that there is no clinically meaningful difference between the mean 1- and 2-year PROMs after RCR. Study Design: Meta-analysis; Level of evidence, 2. Methods: We conducted a systematic review of published randomized controlled trials (RCTs) and prospective cohort studies (level of evidence 1 and 2) reporting the shoulder-specific American Shoulder and Elbow Surgeons (ASES), the Constant, or the Western Ontario Rotator Cuff (WORC) Index scores at baseline, 1 year, and 2 years after RCR. The methodologic quality of studies was assessed. Also, the random effects meta-analyses of changes in PROMs for each of the first and second postoperative years were conducted. Results: Fifteen studies (n = 11 RCTs; n = 4 cohort studies) with a total of 1371 patients were included. Studies were highly heterogeneous, but no visual evidence of major publication bias was observed. The weighted means of the baseline PROMs were 46.2 points for the ASES score, 46.4 points for the Constant score, and 38.8 points for the WORC Index. The first-year summary increments were 41.1 (95% CI, 36.0-46.2) points for the ASES score, 34.2 (95% CI, 28.8-39.6) points for the Constant score, and 42.9 (95% CI, 37.3-48.4) points for the WORC Index. In contrast, the second-year summary increments were 2.3 (95% CI, 1-3.6) points for the ASES score, 3.2 (95% CI, 1.9-4.4) points for the Constant score, and 2 (95% CI, -0.1 to 4) points for the WORC Index. Conclusion: All PROMs improved considerably from baseline to 1 year, but only very small gains that were below the minimal clinically important differences were observed between 1 year and 2 years after RCR. This study did not find any evidence for requiring a minimum of 2 years of follow-up for publication of PROs after RCR. Our results suggest that focusing on 1-year PROMs after RCR would foster more timely reporting, better control of selection bias, and better allocation of research resources.

scholarly journals Effects of applying platelet-rich plasma during arthroscopic rotator cuff repair: a systematic review and meta-analysis of randomised controlled trials

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Fu-An Yang ◽  
Chun-De Liao ◽  
Chin-Wen Wu ◽  
Ya-Chu Shih ◽  
Lien-Chen Wu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Mean Difference ◽  
Arthroscopic Rotator Cuff Repair ◽  
Short Term ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Abstract Because of its healing properties, platelet-rich plasma (PRP) has been applied to the bone–tendon interface during arthroscopic rotator cuff repair to improve surgical outcomes. However, its effects remain ambiguous. Therefore, we conducted this systematic review and meta-analysis to assess the effects of PRP on retear rate and functional outcomes. Randomised control trials were identified and extracted. Data collection was completed on 15 February 2020. The results are expressed as the risk ratio (RR) for the categorical variables and weighted mean difference for the continuous variables, with 95% confidence intervals (CIs). Analyses were performed using RevMan 5.3 software. Seven randomised controlled trials published from 2013 to 2018, with 541 patients in total, were included. The results revealed a significant decrease in retear rate [RR 0.38, 95% CI (0.22, 0.68), P = 0.0009). Furthermore, a significant improvement was observed regarding short-term Constant score [mean difference = 3.28, 95% CI (1.46, 5.11), P = 0.0004), short-term University of California at Los Angeles activity score [mean difference = 1.60, 95% CI (0.79, 2.42), P = 0.0001], and short-term visual analogue scale score [mean difference =  − 0.14, 95% CI (− 0.23, − 0.05), P = 0.002]. This systematic review indicates the efficacy of PRP when applied to the bone–tendon interface during arthroscopic rotator cuff repair.

scholarly journals Recurrence in traumatic anterior shoulder dislocations increases the prevalence of Hill–Sachs and Bankart lesions: a systematic review and meta-analysis

2022 ◽  
Author(s):  
Cain Rutgers ◽  
Lukas. P. E. Verweij ◽  
Simone Priester-Vink ◽  
Derek F. P. van Deurzen ◽  
Mario Maas ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Meta Analysis ◽  
Rotator Cuff Tears ◽  
Level Of Evidence ◽  
Associated Lesions ◽  
Bony Bankart ◽  
Significant Difference ◽  
First Time ◽  
Bankart Lesions

Abstract Purpose The extent of shoulder instability and the indication for surgery may be determined by the prevalence or size of associated lesions. However, a varying prevalence is reported and the actual values are therefore unclear. In addition, it is unclear whether these lesions are present after the first dislocation and whether or not these lesions increase in size after recurrence. The aim of this systematic review was (1) to determine the prevalence of lesions associated with traumatic anterior shoulder dislocations, (2) to determine if the prevalence is higher following recurrent dislocations compared to first-time dislocations and (3) to determine if the prevalence is higher following complete dislocations compared to subluxations. Methods PubMed, EMBASE, Cochrane and Web of Science were searched. Studies examining shoulders after traumatic anterior dislocations during arthroscopy or with MRI/MRA or CT published after 1999 were included. A total of 22 studies (1920 shoulders) were included. Results The proportion of Hill–Sachs and Bankart lesions was higher in recurrent dislocations (85%; 66%) compared to first-time dislocations (71%; 59%) and this was statistically significant (P < 0.01; P = 0.05). No significant difference between recurrent and first-time dislocations was observed for SLAP lesions, rotator-cuff tears, bony Bankart lesions, HAGL lesions and ALPSA lesions. The proportion of Hill–Sachs lesions was significantly higher in complete dislocations (82%) compared to subluxations (54%; P < 0.01). Conclusion Higher proportions of Hill–Sachs and Bankart were observed in recurrent dislocations compared to first-time dislocations. No difference was observed for bony Bankart, HAGL, SLAP, rotator-cuff tear and ALPSA. Especially when a Hill–Sachs or Bankart is present after first-time dislocation, early surgical stabilization may need to be considered as other lesions may not be expected after recurrence and to limit lesion growth. However, results should be interpreted with caution due to substantial heterogeneity and large variance. Level of evidence IV.

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