ORCID Profile
0000-0002-8534-195X
Current Organisation
University of Sydney
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Publisher: Elsevier BV
Date: 06-2022
DOI: 10.1016/J.MSKSP.2022.102555
Abstract: Most people who suffer an anterior cruciate ligament (ACL) injury search for information online. Summarise the proportion of webpages on ACL rupture management that present evidence-based information. Content analysis. We examined webpage information on ACL ruptures identified through (1) Google searches using terms synonymous with 'anterior cruciate ligament rupture' and searching 'knee surgeon' linked to each Australian capital city, and (2) websites of professional associations. The primary outcome was the proportion of webpages that suggest people can return to at least some form of sport with non-surgical management. Secondary outcomes included webpage information on return to sport with ACL reconstruction (ACLR) and non-surgical management, benefits, harms, and risk of osteoarthritis related to these options, and activity modification. Out of 115 webpages analysed, 48% suggested people can return to at least some form of sport with non-surgical management. Almost half of webpages suggested most people will return to some form of sport following ACLR (41%) and mentioned benefits of ACLR (43%). Fewer webpages mentioned benefits of non-surgical management (14%), approximately two in three people return to pre-injury level of sport following ACLR (4%), risk of re-injury following ACLR (23%), most people return to sport within 9 months of ACLR (27%), activity modification as a management approach (20%), and ACLR will reduce the risk of osteoarthritis (23%). Most online information on ACL rupture management isn't aligned with the best available evidence. Inaccurate information could mislead patients' treatment choices and create unrealistic expectations for return to sport.
Publisher: Copernicus GmbH
Date: 23-03-2020
DOI: 10.5194/EGUSPHERE-EGU2020-12043
Abstract: & & The Northern Apennines of Italy are a young orogen comprised of mixed siliciclastic and carbonate lithologies. Young orogens are typically characterized by marine sedimentary sequences that contain important volumes of carbonate, which can dominate chemical weathering, as carbonate weathers a factor of 3 times faster than silicates. However, most models that address the interplay between erosion and weathering have focused on silicate lithologies. & Carbonate weathering is typically limited by the availability of acid rather than dissolution kinetics, and more tightly linked to soil and sub-surface CO& sub& & /sub& concentrations than silicate weathering. Therefore, it remains unclear if the same processes that control the partitioning of denudation between erosion and weathering in actively uplifting, silicate-rich lithologies are also active in orogens comprised of mixed carbonate-silicate lithologies. The partitioning of denudation between physical erosion and chemical weathering in mixed silicate-carbonate landscapes remains a fundamental knowledge gap that has implications for landscape development and the carbon cycle. Here we address two key questions: (1) how is the total denudation separated into carbonate and silicate fluxes, and (2) how is carbonate denudation partitioned into erosion and weathering in an active orogenic setting? We partition denudation fluxes from & sup& & /sup& Be concentrations into carbonate and silicate chemical weathering and physical erosion fluxes, using major dissolved ions from water chemistry, the percent of carbonate sand from each catchment, and annual discharge measurements. Denudation fluxes in the Northern Apennines are dominated by physical erosion of both silicate and carbonate lithologies. Chemical weathering fluxes are 1-2 orders of magnitude lower than physical erosion fluxes and are dominated by carbonate dissolution. Despite a number of studies that have shown a strong positive correlation between denudation and chemical weathering fluxes, we find only a weakly positive correlation. Relative to a global dataset from silicate-rich orogenic settings, the Northern Apennines have similar denudation fluxes as the eastern side of the New Zealand Southern Alps. However, rivers from the Northern Apennines generally have higher total weathering fluxes relative to the Southern Alps, consistent with the exposure of a large volume of carbonate lithologies in the Northern Apennines.& &
Publisher: JMIR Publications Inc.
Date: 10-01-2019
Abstract: ow back pain (LBP) affects millions of people worldwide, and misconceptions about effective treatment options for this condition are very common. Websites sponsored by organizations recognized as trustworthy by the public, such as government agencies, hospitals, universities, professional associations, health care organizations and consumer organizations are an important source of health information for many people. However, the content of these websites regarding treatment recommendations for LBP has not been fully evaluated. his study aimed to determine the credibility, accuracy, and comprehensiveness of treatment recommendations for LBP in noncommercial, freely accessible websites. e conducted a systematic review of websites from government agencies, hospitals, universities, professional associations, health care organizations and consumer organizations. We conducted searches on Google. Treatment recommendations were coded based on the 2016 National Institute for Health and Care Excellence (NICE) guidelines and the 2017 American College of Physicians guideline on LBP. Primary outcomes were credibility of the website (4-item Journal of the American Medical Association benchmark), accuracy (proportion of website treatment recommendations that were appropriate), and comprehensiveness of website treatment recommendations (proportion of guideline treatment recommendations that were appropriately covered by a website). e included 79 websites from 6 English-speaking countries. In terms of credibility, 31% (25/79) of the websites clearly disclosed that they had been updated after the publication of the NICE guidelines. Only 43.28% (487/1125) website treatment recommendations were judged as accurate. Comprehensiveness of treatment recommendations correctly covered by websites was very low across all types of LBP. For acute LBP, an average of 28% (4/14) guideline recommendations were correctly covered by websites. Websites for radicular LBP were the least comprehensive, correctly covering an average of 16% (2.3/14) recommendations. oncommercial freely accessible websites demonstrated low credibility standards, provided mostly inaccurate information, and lacked comprehensiveness across all types of LBP.
Publisher: Elsevier BV
Date: 2021
DOI: 10.1016/J.JSAMS.2020.06.013
Abstract: To determine the effectiveness of hip arthroscopic surgery for the treatment of femoroacetabular impingement syndrome (FAI). Systematic review with meta-analysis. We performed electronic database searches in MEDLINE, Embase, SPORTDiscus, CINAHL, Cochrane Central Register for Controlled Trials (CENTRAL), Web of Science, Scopus, the WHO International Clinical Trials Registry Platform and ClinicalTrials.gov from their inception to July 10th 2019. We included randomised controlled trials (RCTs) comparing hip arthroscopic surgery to a placebo/sham surgery and other non-operative comparators (e.g. no intervention, physiotherapy, etc.). Two authors independently selected studies, rated risk of bias, extracted data, and judged overall certainty of evidence using GRADE. Hip-specific quality of life (QoL) at 12 months was the primary outcome. We identified three RCTs (n = 650 participants). There is high certainty evidence from three RCTs (n = 574 participants) that hip arthroscopic surgery provided superior outcomes compared to non-operative care for hip-specific QoL at 12 months (mean difference (MD): 11.02 points, 95% CI 4.83-17.21). Low quality evidence suggests that arthroscopic surgery provided similar outcomes to non-operative care for hip-specific QoL at 24 months (MD: 6.3, 95% CI -6.1 to 18.7). Hip arthroscopic surgery for FAI provides superior outcomes compared to non-operative care at 12 months, but not at 24 months. Placebo trials are needed to establish the efficacy of hip arthroscopic surgery.
Publisher: Springer Science and Business Media LLC
Date: 31-07-2020
Publisher: Springer Science and Business Media LLC
Date: 05-10-2022
DOI: 10.1007/S00586-022-07365-X
Abstract: An online randomised experiment found that the labels lumbar sprain , non-specific low back pain (LBP), and episode of back pain reduced perceived need for imaging, surgery and second opinions compared to disc bulge , degeneration , and arthritis among 1447 participants with and without LBP. They also reduced perceived seriousness of LBP and increased recovery expectations. In this study we report the results of a content analysis of free-text data collected in our experiment. We used two questions: 1. When you hear the term [one of the six labels], what words or feelings does this make you think of? and 2. What treatment (s) (if any) do you think a person with [one of the six labels] needs? Two independent reviewers analysed 2546 responses. Ten themes emerged for Question1. Poor prognosis emerged for disc bulge, degeneration, and arthritis , while good prognosis emerged for lumbar sprain, non-specific LBP, and episode of back pain . Thoughts of tissue damage were less common for non-specific LBP and episode of back pain . Feelings of uncertainty frequently emerged for non-specific LBP . Twenty-eight treatments emerged for Question2. Surgery emerged for disc bulge, degeneration , and arthritis compared to lumbar sprain , non-specific LBP , and episode of back pain . Surgery did not emerge for non-specific LBP and episode of back pain . Our results suggest that clinicians should consider avoiding the labels disc bulge , degeneration and arthritis and opt for labels that are associated with positive beliefs and less preference for surgery, when communicating with patients with LBP.
Publisher: Elsevier BV
Date: 07-2020
Publisher: American Geophysical Union (AGU)
Date: 05-2022
DOI: 10.1029/2021PA004392
Abstract: We explore the effects of the Pliensbachian–Toarcian Boundary Event (P–ToBE) on tropical carbonate productivity in the interior to margin and slope of the Venetian Platform (Northern Italy). We document the P–ToBE for the first time in the shallow‐water platform margin, and we bio‐ and chemostratigraphically tie it to transgressive/regressive cycles. Following the latest Pliensbachian sea‐level drop and emersion, transgressive grainstones at the platform edge record the P–ToBE negative carbon isotope excursion (CIE) of 1–1.5‰, also found in marl/limestone couplets on the slope. Recovery of platform productivity was ephemeral, as the platform drowned right after the peak negative CIE and was covered by deep‐sea thin‐bedded micritic limestones. The end of the P–ToBE correlates with a regression and renewed recovery of carbonate productivity. The negative CIE of the subsequent Toarcian Oceanic Anoxic Event is recorded in open‐sea cherty limestones both at the marginal and interior platform. These limestones document an even wider transgression and the renewed partial drowning of the platform in the Serpentinus Zone. We investigate the causes of the carbon perturbation at the P–ToBE, using a simple carbon cycle model. The duration and magnitude of the CIE suggest a rapid release of methane in driving the CIE, perhaps related to the preceding sea‐level drop and associated cryosphere perturbation, or to thermogenic alteration of coals near the Karoo‐Ferrar Large Igneous Province (LIP). The extent of the warming and the magnitude of the P–ToBE CIE implies a contribution of volcanogenic carbon dioxide from the Karoo‐Ferrar LIP.
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.JMPT.2018.12.005
Abstract: The purpose of this study was to systematically review the effects of spinal manipulative therapy (SMT) on autonomic nervous system (ANS)-mediated outcomes, in both symptomatic and healthy populations, and to assess the quality of evidence for the most prevalent outcomes with the Grading of Recommendations, Assessment, Development and Evaluation approach. PubMed, Cochrane Library, PEDro, Web of Science, and EMBASE were searched from their inception to March 2014. Randomized controlled trials involving SMT, such as mobilization and manipulation, that reported at least 1 outcome related to the ANS, with placebo, control groups, or other SMT techniques as comparators, with either healthy or symptomatic s les were included. The Physiotherapy Evidence Database scale and the Grading of Recommendations, Assessment, Development and Evaluation approach were used to assess risk of bias and the quality of evidence, respectively. Eighteen trials were included in this systematic review. Passive accessory intervertebral mobilization produced sympathoexcitation independently of the treated region (cervical, thoracic, or lumbar spine) although sustained natural apophyseal glides did not influence the ANS, conflicting results were observed regarding manipulation techniques. The overall quality of evidence for all analyzed outcomes ranged from low to very low quality. There is evidence pointing toward the existence of sympathoexcitatory short-term effects following passive accessory intervertebral mobilization mobilizations, but not for sustained natural apophyseal glide mobilizations. There is conflicting evidence regarding the ability of manipulation to elicit sympathoexcitation. However, the low quality of the evidence precludes a definitive conclusion of such effects. Based on the current evidence, there is uncertainty regarding the true effect estimates of SMT on ANS-mediated outcomes.
Publisher: Walter de Gruyter GmbH
Date: 13-09-2021
Abstract: We aim to determine the effectiveness of meditation for adults with non-specific low back pain. We searched PubMed, EMBASE, PEDro, Scopus, Web of Science, Cochrane Library, and PsycINFO databases for randomized controlled trials that investigated the effectiveness of meditation in adults with non-specific low back pain. Two reviewers rated risk of bias using the PEDro scale and the certainty of the evidence using the GRADE approach. Primary outcomes were pain intensity and disability. We included eight trials with a total of 1,234 participants. Moderate-certainty evidence shows that meditation is better than usual care for disability at short-term (SMD = −0.22 95% CI = −0.42 to −0.02). We also found that meditation is better than usual care for pain intensity at long-term (SMD = −0.28 95% CI = −0.54 to −0.02). There is no significant difference for pain intensity between meditation and minimal intervention or usual care at short and intermediate-term. We did not find differences between meditation and minimal intervention for disability at intermediate-term or usual care in any follow-up period. We found small effect sizes and moderate-certainty evidence that meditation is slightly better than minimal intervention in the short-term for disability. Low-certainty of evidence suggests that meditation is slightly better than usual care for pain in the long-term. Meditation appears to be safe with most trials reporting no serious adverse events.
Publisher: Wiley
Date: 22-02-2021
Abstract: To determine whether rates of ED presentations because of low back pain (LBP) have increased from 2016 to 2019 in New South Wales and map the geographical distribution of ED presentations because of LBP across New South Wales. We sourced data from the New South Wales Emergency Department Records for Epidemiology. We included all ED presentations aged 15 years and older with a diagnosis of LBP to the 178 public EDs across New South Wales from 1 January 2016 to 31 December 2019. We calculated the ratio (95% confidence interval) between the 2016 and 2019 age‐standardised rates to determine whether an increase in the rate of ED LBP presentations has occurred. To assess geographical variation, we aggregated presentations by their home postcode. We calculated age‐standardised rates per 100 000 person year for each of those areas using data from 2016 to 2019. We included 188 275 LBP presentations for patients aged 15 years or older. Their mean (standard deviation) age was 51.3 (20.0) years. From 2016 to 2019, we observed a 5.3% increase in the age‐adjusted LBP ED presentation rates (age‐standardised ratio 1.05, 95% confidence interval 1.04–1.06). We found a 20‐fold variation in LBP ED age‐standardised presentation rates across the different local government areas of New South Wales. Higher rates were mostly observed in rural and regional areas. The demand for ED services because of LBP has increased in New South Wales over time, and we observed a 20‐fold variation in presentation rates across different regions.
Publisher: Elsevier BV
Date: 05-2019
Publisher: BMJ
Date: 06-2019
DOI: 10.1136/BMJOPEN-2019-029540
Abstract: Nudge-interventions aimed at health professionals are proposed to reduce the overuse and underuse of health services. However, little is known about their effectiveness at changing health professionals’ behaviours in relation to overuse or underuse of tests or treatments. The aim of this study is to systematically identify and synthesise the studies that have assessed the effect of nudge-interventions aimed at health professionals on the overuse or underuse of health services. We will perform a systematic review. All study designs that include a control comparison will be included. Any qualified health professional, across any specialty or setting, will be included. Only nudge-interventions aimed at altering the behaviour of health professionals will be included. We will examine the effect of choice architecture nudges (default options, active choice, framing effects, order effects) and social nudges (accountable justification and pre-commitment or publicly declared pledge/contract). Studies with outcomes relevant to overuse or underuse of health services will be included. Relevant studies will be identified by a computer-aided search of the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, CINAHL, Embase and PsycINFO databases. Two independent reviewers will screen studies for eligibility, extract data and perform the risk of bias assessment using the criteria recommended by the Cochrane Effective Practice and Organisation of Care (EPOC) group. We will report our results in a structured synthesis format, as recommended by the Cochrane EPOC group. No ethical approval is required for this study. Results will be presented at relevant scientific conferences and in peer-reviewed literature.
Publisher: Springer Science and Business Media LLC
Date: 29-09-2020
Publisher: Elsevier BV
Date: 10-2022
Publisher: Informa UK Limited
Date: 20-08-2021
Publisher: Elsevier BV
Date: 11-2021
Publisher: Elsevier BV
Date: 04-2015
Publisher: Research Square Platform LLC
Date: 18-06-2021
DOI: 10.21203/RS.3.RS-611374/V1
Abstract: Background: Second opinions have the goal of clarifying uncertainties around diagnosis or management, particularly when healthcare decisions are complex, unpleasant, and carry considerable risks. Second opinions might be particularly useful for people recommended surgery for their back pain as surgery has at best a limited role in the management of back pain. No studies have attempted to summarise the available evidence for second opinion services designed for people with back pain that have been recommended to have surgery. Methods: We conducted a scoping review. Two independent researchers screened PubMed, EMBASE and Cochrane CENTRAL from their inception to May 6 th , 2021. Studies of any design were eligible provided that they described a second opinion intervention for people with spinal pain (low back or neck pain with or without radicular pain) either considering surgery or to whom surgery had been recommended. We assessed the methodological quality of studies with the Downs & Black scale. Outcomes were: i) characteristics of second opinion services for people considering or who have been recommended spinal surgery, ii) agreement between first and second opinions in terms of diagnoses, need for surgery and type of surgery, iii) their effectiveness in reducing surgery rates and improving patient –reported outcomes and iv) the costs and healthcare use associated with these services. Outcomes were presented descriptively. Results: We included 12 studies (11 had poor methodological quality one had fair). Studies described patient, doctor, and insurance-initiated second opinion services. Diagnostic agreement between first and second opinions varied from 53% to 96% across studies. Agreement for need for surgery between first and second opinions ranged from 0% to 83%. There is some very-low quality evidence that second opinion services may reduce surgery rates in the short-term, but it is unclear whether these reductions are sustained in the long-term or if patients only delay surgery. Second opinion services may reduce costs and some healthcare use (e.g. imaging), but might increase others (e.g. injections, prescription drugs). Conclusions: There is a need for high-quality studies to determine the value of second opinion services for reducing spinal surgery.
Publisher: Elsevier BV
Date: 03-2019
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.JPHYS.2018.08.001
Abstract: What are staff and patients' perceptions of physiotherapists working in the emergency department (ED)? Systematic review of qualitative studies. Staff working in EDs and patients presenting to the ED and managed by ED physiotherapists. Perceptions of ED staff and patients were synthesised using a three-stage thematic analysis consisting of extraction, grouping (codes), and abstraction of findings. Eight studies, which had sought the perceptions of 138 patients and 122 ED staff members, were included. Three main themes emerged: role of physiotherapists in the ED, positive perceptions of ED physiotherapists, and concerns about physiotherapists in the ED. Patients and ED staff both considered physiotherapists to be experts in musculoskeletal care. The role of ED physiotherapists was seen as providing thorough patient education, non-pharmacological pain management and activity resumption, especially through exercise therapy. Having broad knowledge to assess and treat different health conditions was seen as facilitating the work of physiotherapists in the ED. Patients and ED staff felt that ED physiotherapists had good interpersonal communication skills. ED staff expressed concerns regarding the additional time that physiotherapists spent with patients. Some patients felt that performing exercises in the ED was inappropriate and painful. ED physiotherapists were mostly well accepted by patients and ED staff, and their work was perceived to improve the ED. Concerns included restricted availability, lack of awareness of the role undertaken by physiotherapists in the ED, and increased treatment time in some settings. [Ferreira GE, Traeger AC, O'Keeffe M, Maher CG (2018) Staff and patients have mostly positive perceptions of physiotherapists working in emergency departments: a systematic review. Journal of Physiotherapy 64: 229-236].
Publisher: Elsevier BV
Date: 10-2016
DOI: 10.1016/J.JPHYS.2016.08.007
Abstract: In people with nerve-related leg pain, does adding neurodynamic treatment to advice to remain active improve leg pain, disability, low back pain, function, global perceived effect and location of symptoms? Randomised trial with concealed allocation and intention-to-treat analysis. Sixty participants with nerve-related leg pain recruited from the community. The experimental group received four sessions of neurodynamic treatment. Both groups received advice to remain active. Leg pain and low back pain (0, none, to 10, worst), Oswestry Disability Index (0, none, to 100, worst), Patient-Specific Functional Scale (0, unable to perform, to 30, able to perform), global perceived effect (-5 to 5) and location of symptoms were measured at 2 and 4 weeks after randomisation. Continuous outcomes were analysed by linear mixed models. Location of symptoms was assessed by relative risk (95% CI). At 2 weeks, the experimental group did not have significantly greater improvement than the control group in leg pain (MD -1.1, 95% CI -2.3 to 0.1) or disability (MD -3.3, 95% CI -9.6 to 2.9). At 4 weeks, the experimental group experienced a significantly greater reduction in leg pain (MD -2.4, 95% CI -3.6 to -1.2) and low back pain (MD -1.5, 95% CI -2.8 to -0.2). The experimental group also improved significantly more in function at 2 weeks (MD 5.2, 95% CI 2.2 to 8.2) and 4 weeks (MD 4.7, 95% CI 1.7 to 7.8), as well as global perceived effect at 2 weeks (MD 2.5, 95% CI 1.6 to 3.5) and 4 weeks (MD 2.9, 95% CI 1.9 to 3.9). No significant between-group differences occurred in disability at 4 weeks and location of symptoms. Adding neurodynamic treatment to advice to remain active did not improve leg pain and disability at 2 weeks. NCT01954199. [Ferreira G, Stieven F, Araujo F, Wiebusch M, Rosa C, Plentz R, et al. (2016) Neurodynamic treatment did not improve pain and disability at two weeks in patients with chronic nerve-related leg pain: a randomised trial.Journal of Physiotherapy62: 197-202].
Publisher: BMJ
Date: 26-02-2021
Publisher: Elsevier BV
Date: 09-2022
DOI: 10.1016/J.PEC.2022.05.005
Abstract: To evaluate the effects of a patient decision aid for people considering shoulder surgery. Participants with shoulder pain considering shoulder surgery (n = 425) were recruited online and randomised to (i) a decision aid outlining the benefits and harms of shoulder surgery and non-surgical options (then randomised to a side-by-side vs. top-and-bottom display of options) and (ii) general information about shoulder pain from the NHS. Outcomes included treatment intention (primary), knowledge, attitudes, informed choice, and decisional conflict. Linear and logistic regression models were used to evaluate between-groups differences in outcomes. 409 participants (96%) had post-intervention data. Mean age was 41.3 years, 44.2% were female. There was no between-group difference in post-intervention treatment intention (MD -0.2, 95% CI: -3.3 to 2.8) and likelihood of intending to have shoulder surgery (OR 0.7, 95% CI: 0.3-1.5). The decision aid slightly improved knowledge (MD 4.4, 95% CI: 0.2-8.6), but not any other secondary outcomes. The display of options did not influence any outcome. In this online trial, a co-designed patient decision aid had no effect on treatment intention, attitudes, informed choice, and decisional conflict, but a small effect on improving knowledge. Research is needed to understand reasons for the lack of anticipated effects. Australia New Zealand Clinical Trials Registry (ACTRN12621000992808).
Publisher: Research Square Platform LLC
Date: 16-03-2022
DOI: 10.21203/RS.3.RS-1432664/V1
Abstract: Background One in 6 patients with low back pain (LBP) presenting to emergency departments (EDs) are subsequently admitted to hospital each year, making LBP the ninth most common reason for hospital admission in Australia. No studies have investigated and quantified the extent of clinical variation in hospital admission following an ED presentation for LBP. Methods We used routinely collected ED data from public hospitals within the state of New South Wales, Australia, to identify presentations of patients aged between 18 and 111 with a discharge diagnosis of LBP. We fitted a series of random effects multilevel logistic regression models adjusted by case-mix and hospital variables. The main outcome was the hospital-adjusted admission rate (HAAR). Data were presented as funnel plots with 95% and 99.8% confidence limits. Hospitals with a HAAR outside the 95% confidence limit were considered to have a HAAR significantly different to the state average. Results We identified 176,729 LBP presentations across 177 public hospital EDs and 44,549 hospital admissions (25.2%). The mean (SD) age was 51.8 (19.5) and 52% were female. Hospital factors explained 10% of the variation (ICC = 0.10), and the MOR was 2.03. We identified marked variation across hospitals, with HAAR ranging from 6.9–65.9%. After adjusting for hospital variables, there was still marked variation between hospitals with similar characteristics. Conclusion We found substantial variation in hospital admissions following a presentation to the ED due to LBP even after controlling by case-mix and hospital characteristics. Given the substantial costs associated with these admissions, our findings indicate the need to investigate sources of variation and to determine instances where the observed variation is warranted or unwarranted.
Publisher: Wiley
Date: 17-04-2019
Abstract: To provide an overview of the literature that considers physiotherapists working in the ED in relation to their roles, training levels, patient profile, safety, effectiveness, efficiency, cost-effectiveness and the provision of low-value care. We performed a scoping review of the literature. Four databases (PubMed, EMBASE, CINAHL and Cochrane CENTRAL) were searched from their inception to December 2016 and we updated searches on PubMed in September 2017. Two reviewers independently screened studies for eligibility. We performed a narrative synthesis of quantitative data. We included 27 studies: five randomised controlled trials (n = 1434), 12 prospective observational studies (n = 153 767), six retrospective studies (n = 9968), two survey studies (n = 61), one case report (n = 3) and one qualitative study (n = 11). Physiotherapists primarily managed patients with low urgency musculoskeletal conditions. Physiotherapists appeared to have similar clinical effectiveness and costs compared to other health providers (four randomised controlled trials). Physiotherapists were associated with increased efficiency (eight observational studies) and reduced low-value care (one observational study). Three observational studies reported very low adverse event rates. However, none of the studies followed participants to measure adverse events that became apparent after the ED visit, nor did they consider unsafe discharge decisions or suboptimal follow-up care. The available evidence suggests that physiotherapists may be as effective as other health providers in managing low urgency musculoskeletal conditions in the ED. There is uncertainty about appropriate training and a lack of robust studies investigating the efficiency, safety and cost-effectiveness of this model of care.
Publisher: Springer Science and Business Media LLC
Date: 18-03-2022
DOI: 10.1186/S12913-022-07771-3
Abstract: Second opinions have the goal of clarifying uncertainties around diagnosis or management, particularly when healthcare decisions are complex, unpleasant, and carry considerable risks. Second opinions might be particularly useful for people recommended surgery for their back pain as surgery has at best a limited role in the management of back pain. We conducted a scoping review. Two independent researchers screened PubMed, EMBASE, Cochrane CENTRAL and CINAHL from inception to May 6th, 2021. Studies of any design published in any language were eligible provided they described a second opinion intervention for people with spinal pain (low back or neck pain with or without radicular pain) either considering surgery or to whom surgery had been recommended. We assessed the methodological quality with the Downs & Black scale. Outcomes were: i) characteristics of second opinion services for people considering or who have been recommended spinal surgery, ii) agreement between first and second opinions in terms of diagnoses, need for surgery and type of surgery, iii) whether they reduce surgery and improve patient outcomes and iv) the costs and healthcare use associated with these services. Outcomes were presented descriptively. We screened 6341 records, read 27 full-texts, and included 12 studies (all observational 11 had poor methodological quality one had fair). Studies described patient, doctor, and insurance-initiated second opinion services. Diagnostic agreement between first and second opinions varied from 53 to 96%. Agreement for need for surgery between first and second opinions ranged from 0 to 83%. Second opinion services may reduce surgery rates in the short-term, but it is unclear whether these reductions are sustained in the long-term or if patients only delay surgery. Second opinion services may reduce costs and healthcare use (e.g. imaging), but might increase others (e.g. injections). Second opinion services typically recommend less surgical treatments compared to first opinions and may reduce surgery rates in the short-term, but it is unclear whether these reductions are sustained in the long-term or if patients only delay surgery. There is a need for high-quality randomised trials to determine the value of second opinion services for reducing spinal surgery.
Publisher: Wiley
Date: 15-04-2018
Publisher: The Journal of Rheumatology
Date: 15-04-2023
Abstract: Amiri et al 1 provide extensive burden of disease estimates for gout in the Middle East and North Africa (MENA) region sourced from the Global Burden of Disease (GBD) 2019 study. We would like to draw attention to the considerable uncertainty with these estimates and advise readers to interpret the estimates cautiously.
Publisher: Elsevier BV
Date: 10-2022
DOI: 10.1016/J.JPHYS.2022.09.005
Abstract: What are the effects of diagnostic labels and advice, and interactions between labels and advice, on perceived need for shoulder surgery for rotator cuff disease? 2×2 factorial online randomised experiment. People with shoulder pain. Participants read a scenario describing a patient with rotator cuff disease and were randomised to bursitis label plus guideline-based advice, bursitis label plus treatment recommendation, rotator cuff tear label plus guideline-based advice, and rotator cuff tear label plus treatment recommendation. Guideline-based advice included encouragement to stay active and positive prognostic information. Treatment recommendation stressed that treatment is needed for recovery. Perceived need for surgery (primary outcome), imaging, an injection, a second opinion and to see a specialist and perceived seriousness of the condition, recovery expectations, impact on work performance and need to avoid work. A total of 2,024 responses (99.8% of 2,028 randomised) were analysed. Labelling as bursitis (versus rotator cuff tear) decreased perceived need for surgery (mean effect -0.5 on a 0-to-10 scale, 98.3% CI -0.7 to -0.2), imaging and to see a specialist, and perceived seriousness of the condition and need to avoid work. Guideline-based advice (versus treatment recommendation) decreased perceived need for surgery (mean effect -1.0, 98.3% CI -1.3 to -0.7), imaging, an injection, a second opinion and to see a specialist, and perceived seriousness of the condition and recovery expectations. There was little to no evidence of an advice label interaction for any outcome. Labels and advice influenced perceived need for surgery and other secondary outcomes in people with rotator cuff disease, with larger effects for advice. There was evidence of little or no interaction between labels and advice for any outcome, but the additive effect of labels and advice appeared large for some outcomes (eg, perceived need for imaging and perceived seriousness of the condition). ACTRN12621001370897.
Publisher: Springer Science and Business Media LLC
Date: 14-09-2022
DOI: 10.1186/S12909-022-03744-6
Abstract: Understanding how people use infographics and their opinion on them has important implications for the design of infographics but has not been investigated. The aim of this study was to describe people’s use of and opinions about infographics summarising health and medical research, preferences for information to include in infographics, and barriers to reading full-text articles. We conducted an online cross-sectional survey of consumers of infographics that summarise health or medical research. Demographic and outcome data were collected and summarised using descriptive statistics. A sensitivity analysis explored whether being a researcher/academic influenced the findings. Two hundred fifty-four participants completed the survey (88% completion rate). Participants included health professionals (66%), researchers (34%), academics (24%), and patients/the public (13%). Most used Twitter (67%) and smartphones (89%) to access and view infographics, and thought infographics were useful tools to communicate research (92%) and increase the attention research receives (95%). Although most participants were somewhat/extremely likely (76%) to read the full-text article after viewing an infographic, some used infographics as a substitute for the full text at least half of the time (41%), thought infographics should be detailed enough so they do not have to read the full text (55%), and viewed infographics as tools to reduce the time burden of reading the full text (64%). Researchers/academics were less likely to report behaviours/beliefs suggesting infographics can reduce the need to read the full-text article. Given many people use infographics as a substitute for reading the full-text article and want infographics to be detailed enough so they don’t have to read the full text, a checklist to facilitate clear, transparent, and sufficiently detailed infographics summarising some types of health and medical research may be useful.
Publisher: Elsevier BV
Date: 12-2013
Publisher: Elsevier BV
Date: 03-2022
Publisher: FapUNIFESP (SciELO)
Date: 06-2016
Publisher: Wiley
Date: 04-2021
DOI: 10.1111/IMJ.15254
Publisher: JMIR Publications Inc.
Date: 07-05-2019
DOI: 10.2196/13357
Publisher: Oxford University Press (OUP)
Date: 06-07-2023
Publisher: Elsevier BV
Date: 07-2022
DOI: 10.1016/J.JBMT.2022.03.011
Abstract: Although widely used in clinical practice, evidence on the effectiveness of the Pilates method in people with neck pain has not been adequately summarised yet. To systematically review the literature on the effectiveness of the Pilates method on improving pain and disability in patients with neck pain. We performed searches in multiple databases from their inception to October 2021. We included randomised controlled trials comparing the effects of the Pilates method with other treatments on pain and disability in patients with neck pain. Two authors independently selected studies, rated risk of bias, extracted data, and judged the overall certainty of evidence using GRADE. We included five RCTs (n = 224 participants). There is low certainty evidence that Pilates method did not significantly improve pain compared to other treatments at short-term (mean difference (MD): MD: 9.29 points, 95% CI -25.84 to 7.26 I2 = 93%). Low certainty evidence suggested that the Pilates method did not significantly improve disability compared to other treatments at short-term (MD: 3.20 points, 95% CI -7.70 to 1.30 I Based on low certainty evidence, the Pilates method is not better than other treatments at 3 months to reduce pain and disability. High quality trials are required.
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 08-2020
Publisher: Public Library of Science (PLoS)
Date: 28-11-2022
DOI: 10.1371/JOURNAL.PONE.0276685
Abstract: Health care has significant environmental impact. We performed a scoping review to map what is known about the environmental impact of health care for musculoskeletal conditions. We included published papers of any design that measured or discussed environmental impact of health care or health support services for any musculoskeletal condition in terms of climate change or global warming (e.g., greenhouse gas emissions it produces). We searched MEDLINE and Embase from inception to 2 May 2022 using keywords for environmental health and musculoskeletal conditions, and performed keyword searches using Google and Google Scholar. Two independent reviewers screened studies. One author independently charted data, verified by a second author. A narrative synthesis was performed. Of 12,302 publications screened and 73 identified from other searches, 122 full-text articles were assessed for eligibility, and 49 were included (published 1994 to 2022). Of 24 original research studies, 11 measured environmental impact relating to climate change in orthopaedics (n = 10), and medical aids for the knee (n = 1), one measured energy expenditure of laminar versus turbulent airflow ventilation systems in operating rooms during simulated hip replacements and 12 measured waste associated with orthopaedic surgery but did not relate waste to greenhouse gas emissions or environmental effects. Twenty-one editorials described a need to reduce environmental impact of orthopaedic surgery (n = 9), physiotherapy (n = 9), podiatry (n = 2) or occupational therapy (n = 1). Four narrative reviews discussed sustainability relating to hand surgery (n = 2), orthopaedic surgery (n = 1) and orthopaedic implants (n = 1). Despite an established link between health care and greenhouse gas emissions we found limited empirical data estimating the impact of musculoskeletal health care on the environment. These data are needed to determine whether actions to lower the carbon footprint of musculoskeletal health care should be a priority and to identify those aspects of care that should be prioritised.
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 04-2021
Publisher: BMJ
Date: 19-04-2023
Abstract: To investigate the effectiveness and safety of surgery compared with non-surgical treatment for sciatica. Systematic review and meta-analysis. Medline, Embase, CINAHL, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the World Health Organisation International Clinical Trials Registry Platform from database inception to June 2022. Randomised controlled trials comparing any surgical treatment with non-surgical treatment, epidural steroid injections, or placebo or sham surgery, in people with sciatica of any duration due to lumbar disc herniation (diagnosed by radiological imaging). Two independent reviewers extracted data. Leg pain and disability were the primary outcomes. Adverse events, back pain, quality of life, and satisfaction with treatment were the secondary outcomes. Pain and disability scores were converted to a scale of 0 (no pain or disability) to 100 (worst pain or disability). Data were pooled using a random effects model. Risk of bias was assessed with the Cochrane Collaboration’s tool and certainty of evidence with the grading of recommendations assessment, development, and evaluation (GRADE) framework. Follow-up times were into immediate term (≤six weeks), short term ( six weeks and ≤three months), medium term ( three and months), and long term (at 12 months). 24 trials were included, half of these investigated the effectiveness of discectomy compared with non-surgical treatment or epidural steroid injections (1711 participants). Very low to low certainty evidence showed that discectomy, compared with non-surgical treatment, reduced leg pain: the effect size was moderate at immediate term (mean difference −12.1 (95% confidence interval −23.6 to −0.5)) and short term (−11.7 (−18.6 to −4.7)), and small at medium term (−6.5 (−11.0 to −2.1)). Negligible effects were noted at long term (−2.3 (−4.5 to −0.2)). For disability, small, negligible, or no effects were found. A similar effect on leg pain was found when comparing discectomy with epidural steroid injections. For disability, a moderate effect was found at short term, but no effect was observed at medium and long term. The risk of any adverse events was similar between discectomy and non-surgical treatment (risk ratio 1.34 (95% confidence interval 0.91 to 1.98)). Very low to low certainty evidence suggests that discectomy was superior to non-surgical treatment or epidural steroid injections in reducing leg pain and disability in people with sciatica with a surgical indication, but the benefits declined over time. Discectomy might be an option for people with sciatica who feel that the rapid relief offered by discectomy outweighs the risks and costs associated with surgery. PROSPERO CRD42021269997.
Publisher: Elsevier BV
Date: 07-2023
Publisher: Elsevier BV
Date: 2017
Publisher: Elsevier BV
Date: 09-2021
Publisher: Elsevier BV
Date: 12-2022
DOI: 10.1016/J.JCLINEPI.2022.09.007
Abstract: The objective of the study was to examine the characteristics of randomized controlled trials (RCTs) evaluating physiotherapy interventions for low back pain (LBP) that specified a language-grounded eligibility criterion and the proportion of people being excluded consequently. This is a meta-epidemiological study of RCTs evaluating at least one type of physiotherapy intervention for treatment or prevention of LBP. Records were retrieved from Physiotherapy Evidence Database (PEDro), LILACS, and SciELO from inception to May 2021. We retrieved metadata of each record from PEDro and extracted from included studies: country of recruitment, language-grounded eligibility criterion, and the number of consequent exclusions (if specified). This study included 2,555 trials. A language-grounded eligibility criterion was specified in 463 trials (18.1%) the proportion was higher in trials conducted in North America and Europe, published after 2000, investigating cognitive and behavioral interventions, and including large s le size. Of these 463 trials, 75 trials (16.2%) reported a total number of 2,152 people being excluded due to lack of language proficiency, equivalent to 12.5% of randomized participants. Nearly one in five physiotherapy clinical trials on LBP excludes people based on language proficiency, compromising the evidence to manage LBP in minority populations.
Publisher: Wiley
Date: 21-06-2022
DOI: 10.1002/EJP.1981
Abstract: Diagnostic labels may influence treatment intentions. We examined the effect of labelling low back pain (LBP) on beliefs about imaging, surgery, second opinion, seriousness, recovery, work, and physical activities. Six-arm online randomized experiment with blinded participants with and without LBP. Participants received one of six labels: 'disc bulge', 'degeneration', 'arthritis', 'lumbar sprain', 'non-specific LBP', 'episode of back pain'. The primary outcome was the belief about the need for imaging. A total of 1375 participants (mean [SD] age, 41.7 years [18.4 years] 748 women [54.4%]) were included. The need for imaging was rated lower with the labels 'episode of back pain' (4.2 [2.9]), 'lumbar sprain' (4.2 [2.9]) and 'non-specific LBP' (4.4 [3.0]) compared to the labels 'arthritis' (6.0 [2.9]), 'degeneration' (5.7 [3.2]) and 'disc bulge' (5.7 [3.1]). The same labels led to higher recovery expectations and lower ratings of need for a second opinion, surgery and perceived seriousness compared to 'disc bulge', 'degeneration' and 'arthritis'. Differences were larger amongst participants with current LBP who had a history of seeking care. No differences were found in beliefs about physical activity and work between the six labels. 'Episode of back pain', 'lumbar sprain' and 'non-specific LBP' reduced need for imaging, surgery and second opinion compared to 'arthritis', 'degeneration' and 'disc bulge' amongst public and patients with LBP as well as reducing the perceived seriousness of LBP and enhancing recovery expectations. The impact of labels appears most relevant amongst those at risk of poor outcomes (participants with current LBP who had a history of seeking care).
Publisher: Springer Science and Business Media LLC
Date: 20-05-2020
Publisher: Oxford University Press (OUP)
Date: 20-04-2020
DOI: 10.1093/PTJ/PZAA072
Abstract: Patients with neck pain commonly have altered activity of the neck muscles. The craniocervical flexion test (CCFT) is used to assess the function of the deep neck flexor muscles in patients with musculoskeletal neck disorders. Systematic reviews summarizing the measurement properties of the CCFT are outdated. The objective of this study was to systematically review the measurement properties of the CCFT for assessing the deep neck flexor muscles. The data sources MEDLINE, EMBASE, Physiotherapy Evidence Database, Cochrane Central Register of Controlled Trials, Scopus, and Science Direct were searched in April 2019. Studies of any design that reported at least 1 measurement property of the CCFT for assessing the deep neck flexor muscles were selected. Two reviewers independently extracted data and rated the risk of bias of in idual studies using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) risk-of-bias checklist. The overall rating for each measurement property was classified as “positive,” “indeterminate,” or “negative.” The overall rating was accompanied with a level of evidence. Fourteen studies were included in the data synthesis. The ratings were positive, and the level of evidence was moderate for interrater and intrarater reliability and convergent validity. There was conflicting rating and level of evidence for discriminative validity. Measurement error was indeterminate, with an unknown level of evidence. Responsiveness was negative, with a limited level of evidence. A limitation of this study was that only papers published in English were included. The CCFT is a valid and reliable test that can be used in clinical practice as an assessment test. Because of the conflicting and low-quality evidence, caution is advised when using the CCFT as a discriminative test and as an outcome measure. Future better-designed studies are warranted.
Publisher: Elsevier BV
Date: 04-2021
Publisher: Wiley
Date: 30-01-2022
Abstract: We aimed to determine, in those who present to the ED with low back pain (LBP): (i) the prevalence of four key diagnostic categories, (ii) trends in lumbar imaging from 2015 to 2019 and (iii) the effect of a new model of care on lumbar imaging in the ED. We conducted a retrospective analysis of routinely collected medical data of four tertiary hospitals in Sydney, Australia. We analysed ED presentations for LBP between January 2012 and October 2019. Outcomes were the prevalence of four key diagnostic categories of LBP and use of lumbar imaging. We examined trends in lumbar imaging over time and used interrupted time series analysis to determine the impact of model of care implementation on imaging use. There were 31 168 presentations for LBP of which 64.5% were non‐specific LBP, 27.2% were problems beyond the spine, 5.3% were LBP with neurological signs and 2.3% were serious spinal conditions. 28.9% received lumbar imaging use did not change substantially between 2012 and 2019. Patients diagnosed with serious spinal conditions were more likely to receive imaging (59%) than those diagnosed with non‐specific LBP (29%). Implementation of a state‐wide model of care in November 2016 did not appear to influence imaging use. Most presentations to the ED for LBP are for non‐specific LBP. Around 2% will have specific spinal pathology. Use of imaging in those diagnosed with non‐specific LBP remains high and was unaffected by implementation of a state‐wide model of care.
Publisher: Wiley
Date: 11-01-2023
DOI: 10.1002/EJP.2075
Abstract: There is a substantial gap between evidence and clinical care for low back pain (LBP) worldwide despite recommendations of best practice specified in clinical practice guidelines. The aim of this systematic review was to identify disparities associated with race or ethnicity in the use of lumbar imaging, opioid analgesics, and spinal surgery in people with LBP. We included observational studies which compared the use of lumbar imaging, opioid analgesics, and spinal surgery for the management of non‐serious LBP between people from different racial/ethnic populations. We searched in MEDLINE, EMBASE and CINAHL from January 2000 to June 2021. Risk of bias of included studies was appraised in six domains. For each type of care, we pooled data stratified by race and ethnicity using random effects models. We identified 13 eligible studies all conducted in the United States. Hispanic/Latino (OR 0.69, 95%CI 0.49–0.96) and Black/African American (OR 0.59, 95%CI 0.46–0.75) people with LBP were less likely to be prescribed opioid analgesics than White people. Black/African Americans were less likely to undergo or be recommended spinal surgery for LBP (OR 0.47, 95%CI 0.33–0.67) than White people. There was a lack of high certainty evidence on racial/ethnic disparities in the use of lumbar imaging. This review reveals lower rate of the use of guideline‐discordant care, especially opioid prescription and spinal surgery, in racial/ethnic minority populations with LBP in the United States. Future studies in other countries evaluating care equity for LBP are warranted. PROSPERO Registration ID : CRD42021260668. This systematic review and meta‐analysis revealed that people with low back pain from the minority racial/ethnic backgrounds were less likely to be prescribed opioid analgesics and undergo spinal surgery than the majority counterparts. Strategic interventions to improve the access to, and the value of, clinical care for minority populations with low back pain are warranted.
Publisher: AMPCo
Date: 30-03-2021
DOI: 10.5694/MJA2.50992
Publisher: Elsevier BV
Date: 10-2020
Publisher: Elsevier BV
Date: 08-2019
DOI: 10.1016/J.JCRC.2019.04.014
Abstract: The present systematic review and meta-analysis aimed to synthesize data on subject outcomes associated with post-ICU follow-up. MEDLINE, PsycINFO, CINAHL, Cochrane CENTRAL, and EMBASE databases were searched according to pre-specified criteria (PROSPERO- CRD42017074734). Non-randomized and randomized studies assessing patient and family outcomes associated with post-ICU follow-up were included. Twenty-six studies were included. Sixteen (61%) were randomized trials of these, 15 were meta-analyzed. Non-randomized studies reported benefits in survival, functional status, anxiety, depression, and posttraumatic stress disorder (PTSD) symptoms, and satisfaction. In randomized trials, post-ICU follow-up models focusing on physical therapy were associated with fewer depression symptoms (mean difference [MD], -1.21 (see Fig. 2) 95% confidence interval [CI], -2.31 to -0.11 I Post-ICU follow-up may improve depression symptoms and mental health-related quality of life in the short term for models focusing on physical therapy and PTSD symptoms in the medium term for models focusing on psychological or medical management interventions.
Publisher: Center for Open Science
Date: 10-08-2022
Abstract: Objectives: To provide a comprehensive overview of the efficacy, safety, and tolerability of antidepressants for pain conditions.Design: Overview of systematic reviews.Data sources: PubMed, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled Trials from inception to June 20, 2022.Eligibility criteria: Systematic reviews comparing any antidepressant to placebo for any pain condition in adults.Data extraction and synthesis: Two reviewers independently extracted data. Pain was our primary outcome for headache disorders it was headache frequency. When reviews reported pain on a continuous scale, we converted scores to a scale of 0 (no pain) to 100 (worst pain) and presented results as mean differences (MD) and 95% confidence intervals (95% CI). We converted dichotomous outcomes to risk ratios (RR) (95% CI). We extracted data from the time point closest to the end of treatment. When end of treatment was too variable across trials for a pain condition review, we extracted data from the outcome or time point with the largest number of trials and participants. Safety and tolerability (withdrawals because of adverse events) were secondary outcomes. We classified findings from each comparison as either efficacious, not efficacious, or inconclusive. Certainty of evidence was assessed with the GRADE framework.Results: We included 26 reviews (158 unique trials and over 26,000 participants). These reviews reported on the efficacy of 8 antidepressant classes covering 22 pain conditions (43 distinct comparisons). 46% of trials had industry ties. No review provided high certainty evidence on the efficacy of antidepressants for pain for any condition. We found 11 comparisons (10 conditions) where antidepressants were efficacious, five with moderate certainty evidence: serotonin-norepinephrine reuptake inhibitors (SNRI) for back pain (MD: -5.3, 95% CI -7.3 to -3.3), postoperative pain (MD: -7.2, 95% CI -12.2 to -2.2), neuropathic pain (MD: -6.9, 95% CI -9 to -4.8), and fibromyalgia (RR: 1.4, 95% CI 1.3 to 1.6) and selective serotonin reuptake inhibitors (SSRI) for people with depression and comorbid chronic pain (standardised mean difference: -0.24, 95% CI -0.36 to -0.13). For the other 32 comparisons presented in this review, antidepressants were either not efficacious (5 comparisons) or the evidence was inconclusive (27 comparisons).Conclusions: Some antidepressants, particularly SNRIs, are efficacious in selected pain conditions. For most comparisons in this review, antidepressants were either inefficacious or there was inconclusive evidence on their efficacy. Our findings suggest a more nuanced approach to prescribing antidepressants for pain is needed.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 24-01-2022
Publisher: Elsevier BV
Date: 03-2023
Publisher: Elsevier BV
Date: 11-2021
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 08-2021
Publisher: Elsevier BV
Date: 07-2019
Publisher: BMJ
Date: 20-01-2021
DOI: 10.1136/BMJ.M4825
Abstract: To investigate the efficacy and safety of antidepressants for back and osteoarthritis pain compared with placebo. Systematic review and meta-analysis. Medline, Embase, Cochrane Central Register of Controlled Trials, CINAHL, International Pharmaceutical Abstracts, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform from inception to 15 November and updated on 12 May 2020. Randomised controlled trials comparing the efficacy or safety, or both of any antidepressant drug with placebo (active or inert) in participants with low back or neck pain, sciatica, or hip or knee osteoarthritis. Two independent reviewers extracted data. Pain and disability were primary outcomes. Pain and disability scores were converted to a scale of 0 (no pain or disability) to 100 (worst pain or disability). A random effects model was used to calculate weighted mean differences and 95% confidence intervals. Safety (any adverse event, serious adverse events, and proportion of participants who withdrew from trials owing to adverse events) was a secondary outcome. Risk of bias was assessed with the Cochrane Collaboration’s tool and certainty of evidence with the grading of recommendations assessment, development and evaluation (GRADE) framework. 33 trials (5318 participants) were included. Moderate certainty evidence showed that serotonin-noradrenaline reuptake inhibitors (SNRIs) reduced back pain (mean difference −5.30, 95% confidence interval −7.31 to −3.30) at 3-13 weeks and low certainty evidence that SNRIs reduced osteoarthritis pain (−9.72, −12.75 to −6.69) at 3-13 weeks. Very low certainty evidence showed that SNRIs reduced sciatica at two weeks or less (−18.60, −31.87 to −5.33) but not at 3-13 weeks (−17.50, −42.90 to 7.89). Low to very low certainty evidence showed that tricyclic antidepressants (TCAs) did not reduce sciatica at two weeks or less (−7.55, −18.25 to 3.15) but did at 3-13 weeks (−15.95, −31.52 to −0.39) and 3-12 months (−27.0, −36.11 to −17.89). Moderate certainty evidence showed that SNRIs reduced disability from back pain at 3-13 weeks (−3.55, −5.22 to −1.88) and disability due to osteoarthritis at two weeks or less (−5.10, −7.31 to −2.89), with low certainty evidence at 3-13 weeks (−6.07, −8.13 to −4.02). TCAs and other antidepressants did not reduce pain or disability from back pain. Moderate certainty evidence shows that the effect of SNRIs on pain and disability scores is small and not clinically important for back pain, but a clinically important effect cannot be excluded for osteoarthritis. TCAs and SNRIs might be effective for sciatica, but the certainty of evidence ranged from low to very low. PROSPERO CRD42020158521.
Publisher: Cold Spring Harbor Laboratory
Date: 05-05-2020
DOI: 10.1101/2020.04.30.20086827
Abstract: Objectives: To systematically review the efficacy and safety of antidepressants for patients with spinal pain (including sciatica) and osteoarthritis of the hip and knee. Eligibility criteria: We will include randomised placebo-controlled trials published as full-text in peer-reviewed journals enrolling Participants with a diagnosis of non-specific spinal pain (low back and/or neck pain), spinal pain with radicular symptoms and/or radiculopathy and hip and/or knee OA. Studies with mixed populations will be included. Studies that include participants with serious spinal pathologies (e.g. cauda equina syndrome, cervical myelopathy, spinal tumours, spinal infection) will be excluded. We will exclude studies including participants with inflammatory arthritis eg axial spondyloarthritis, rheumatoid arthritis unless data for knee and/or hip OA is reported separately. Studies where participants received previous spinal or OA surgery are eligible, but studies evaluating immediate post-operative pain management (ie within past month) will not be included. We will include trials testing any type of antidepressant drug prescribed at any dose, as treatment for spinal pain and/or hip and/or knee OA. Studies testing drug combinations (e.g. antidepressants in addition to other analgesics) will only be included if the treatment contrast is other analgesic in addition to placebo Types of antidepressants drugs to be included. Comparators will include both inert (e.g. an inert substance that does not contain an active drug treatment) and active placebos (i.e. drugs that have no known effect on pain but may mimic the adverse effects of antidepressants). Outcomes: Primary outcomes will be Pain intensity and disability. Secondary outcomes will include adverse events (serious and any adverse event), as well as the number and proportion of participants who stopped the study medicicine due to adverse events and who dropped out because of adverse events. Data synthesis: All outcomes will be converted to a 0-100 scale. We will group studies by condition and antidepressant class. If studies are considered to be sufficiently homogenous, results will be pooled. The I2 statistics will be used to analyse the between-trial heterogeneity, and a random effects model will be used among trials when I2 0%.
Publisher: Elsevier BV
Date: 08-2022
Publisher: Wiley
Date: 08-06-2022
DOI: 10.1002/EJP.1974
Abstract: Low back pain is common and remains one of the leading causes of disability globally. This study aimed to develop an evidence map of the quantity of available evidence assessing approaches to manage low back pain, to identify potential redundancies or gaps in the synthesized data, and guide future research focus. MEDLINE, Embase, CENTRAL and CINAHL were searched to March 2022 for systematic reviews assessing the effectiveness of 10 guideline‐recommended approaches to manage low back pain. For each management strategy, the number of systematic reviews, date of publication, eligibility criteria and included primary trials were extracted and descriptive data presented. Substantial evidence, including both systematic reviews and primary trials, was available for each management approach except for patient reassurance. The quantity of available evidence has continued to increase over time. Cochrane reviews have been performed for all 10 treatments, except reassurance of the benign nature of low back pain however, many of the Cochrane reviews were performed prior to 2015. Substantial heterogeneity in the eligibility criteria between systematic reviews exists however, some age ranges (children and older adults), clinical settings (emergency), and conditions (radiculopathy) were infrequently assessed. Based on systematic reviews, there is a large body of evidence assessing the effectiveness of common approaches to manage low back pain. Justification of the need for further systematic reviews and primary trials should consider the available evidence and is essential to avoid potential research redundancy when investigating effective management of low back pain. Substantial evidence (systematic reviews and primary trials) exists for 10 approaches to manage low back pain. The quantity of available evidence has continued to increase over time. The quantity and large heterogeneity of inclusion criteria in available systematic reviews may influence conflicting recommendations in clinical practice guidelines. Justification of the need for further systematic reviews and primary trials is essential to avoid potential research redundancy.
Publisher: Wiley
Date: 09-02-2022
DOI: 10.5694/MJA2.51392
Abstract: To evaluate the efficacy and safety of opioids for analgesic therapy for people with osteoarthritis. Systematic review and meta-analysis of randomised, placebo-controlled trials of opioid therapies for treating the pain of osteoarthritis. The primary outcome was medium term pain relief (six weeks to less than 12 months). Quality of evidence was assessed with GRADE criteria. MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews and Central Register of Controlled Trials, CINAHL, PsycINFO, AMED, and the WHO International Clinical Trials Registry trials published to 31 October 2020. We extracted pain, disability, health-related quality of life, and adverse events data for 36 eligible trials (overall dose range: 10-210 oral morphine milligram equivalents [MME] per day). Continuous pain and disability outcomes were converted to common 0-100-point scales changes of less than ten points were deemed to be very small effects. Differences in dichotomous outcomes were expressed as risk ratios. Data were pooled for meta-analysis in random effects models. The evidence from 19 trials (8965 participants dose range, 10-126 MME/day) for very small medium term pain relief (mean difference [MD], -4.59 points 95% CI, -7.17 to -2.02 points) was low quality, as was that from 16 trials (6882 participants dose range, 10-126 MME/day) for a very small effect on disability (MD, -4.15 points 95% CI, -6.94 to -1.35 points). Opioid dose was not statistically significantly associated with either degree of pain relief or incidence of adverse events in a meta-regression analysis. Evidence that opioid therapy increased the risk of adverse events (risk ratio, 1.43 95% CI, 1.29-1.59) was of very low quality. Opioid medications may provide very small pain and disability benefits for people with osteoarthritis, but may also increase the risk of adverse events. CRD42019142813 (prospective).
Publisher: Elsevier BV
Date: 09-2023
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.JBMT.2017.09.005
Abstract: To compare the effects of two different mobilization techniques and a placebo intervention applied to the thoracic spine on heart rate variability (HRV) and pressure pain threshold (PPT) in asymptomatic in iduals. Sixty healthy asymptomatic subjects aged between 18 and 40 years old were randomized to a single session of one of the three interventions: posterior-to-anterior (PA) rotatory thoracic passive accessory intervertebral mobilization (PAIVM) (PA group), unilateral thoracic PA in slump position (SLUMP group) or placebo intervention (Placebo group). HRV and PPT at C7 and T4 spinous process, first dorsal interossei muscles bilaterally, and muscle belly of tibialis anterior bilaterally were measured before and immediately after the intervention. A univariate analysis of covariance (ANCOVA) adjusted for baseline values assessed the effect of "Group". Pairwise comparisons with Bonferroni adjustment for multiple comparisons were performed. There were no significant between-group differences for HRV. A significant between-group difference for PPT in the ipsilateral tibia was found favoring the SLUMP group in comparison with the PA group. There were no significant between-group differences for PPT in the other landmarks. A single treatment of thoracic PAIVM in prone lying and slump position did not alter PPT and HRV compared to placebo in asymptomatic subjects.
Publisher: Elsevier BV
Date: 10-2016
DOI: 10.1016/J.JBMT.2016.02.012
Abstract: To investigate if neurodynamic treatment is more effective than advice to remain active in patients with nerve-related leg pain. Parallel-group randomized controlled trial blinded to the outcome assessor conducted in Porto Alegre, Brazil. Sixty patients recruited from the community and private practices. Patients will be randomly assigned to receive four sessions of neurodynamic treatment over two weeks comprising passive lumbar foramen opening and neurodynamic sliders plus home exercises or advice to remain active. Leg pain intensity, disability, low back pain intensity, functional ability, symptoms distribution and global impression of recovery will be assessed at two and four weeks after randomization. A linear mixed model will be employed for each outcome following intention to treat principles.
Publisher: BMJ
Date: 12-2021
DOI: 10.1136/BMJOPEN-2021-052092
Abstract: Explore how people perceive different labels for rotator cuff disease in terms of words or feelings evoked by the label and treatments they feel are needed. We performed a content analysis of qualitative data collected in a six-arm, online randomised controlled experiment. 1308 people with and without shoulder pain read a vignette describing a patient with rotator cuff disease and were randomised to one of six labels: subacromial impingement syndrome, rotator cuff tear, bursitis, rotator-cuff-related shoulder pain, shoulder sprain and episode of shoulder pain . Participants answered two questions (free-text response) about: (1) words or feelings evoked by the label (2) what treatments they feel are needed. Two researchers iteratively developed coding frameworks to analyse responses. Results 1308/1626 (80%) complete responses for each question were analysed. Psychological distress (21%), uncertainty (22%), serious condition (15%) and poor prognosis (9%) were most often expressed by those labelled with subacromial impingement syndrome . For those labelled with a rotator cuff tear, psychological distress (13%), serious condition (9%) and poor prognosis (8%) were relatively common, while minor issue was expressed least often compared with the other labels (5%). Treatment/investigation and surgery were common among those labelled with a rotator cuff tear (11% and 19%, respectively) and subacromial impingement syndrome (9% and 10%) compared with bursitis (7% and 5%). Words or feelings evoked by certain labels for rotator cuff disease and perceived treatment needs may explain why some labels drive management preferences towards surgery and imaging more than others.
Publisher: BMJ
Date: 10-2023
Publisher: Wiley
Date: 20-12-2022
DOI: 10.1111/DAR.13590
Abstract: The increasing number of gabapentinoid (pregabalin and gabapentin) harms, including deaths observed across countries is concerning to health‐care professionals and policy makers. However, it is unclear if the public shares these concerns. This study aimed to describe posts related to gabapentinoids, conduct a content analysis to identify common themes and describe adverse events or symptoms. Keywords of ‘pregabalin’ or ‘Lyrica’ or ‘gabapentin’ or ‘Neurontin’ were used to search for related tweets posted by people in the community between 8 March and 7 May 2021. Eligible tweets included a keyword in the post. We extracted de‐identified data which included descriptive data of the total number of posts over time and data on in idual tweets including date, number of re‐tweets and post content. Data were exported separately for pregabalin‐ and gabapentin‐related tweets. A 20% random s le was used for the thematic analysis. There were 2931 pregabalin‐related tweets and 2736 gabapentin‐related tweets. Thematic analysis revealed three themes (sharing positive experiences and benefits of taking gabapentinoids, people voicing their negative experiences, and people seeking opinions and sharing information). Positive experiences of gabapentinoids were related to sharing stories and giving advice. This was contrasted to negative experiences including ineffectiveness, withdrawals, side effects and frustration related to cost and insurance coverage. Brain fog was the most common adverse symptom reported. Gabapentinoid‐related deaths were only mentioned in three tweets. The increasing public health concern of gabapentinoid‐related deaths was not translated to Twitter discussions.
Publisher: Elsevier BV
Date: 07-2015
DOI: 10.1016/J.CLINBIOMECH.2015.03.028
Abstract: Exercise therapy is an evidence-based intervention for the conservative management of knee osteoarthritis. It is hypothesized that exercise therapy could reduce the knee adduction moment. A systematic review was performed in order to verify the effects of exercise therapy on the knee adduction moment in in iduals with knee osteoarthritis in studies that also assessed pain and physical function. A comprehensive electronic search was performed on MEDLINE, Cochrane CENTRAL, EMBASE, Google scholar and OpenGrey. Inclusion criteria were randomized controlled trials with control or sham groups as comparator assessing pain, physical function, muscle strength and knee adduction moment during walking at self-selected speed in in iduals with knee osteoarthritis that underwent a structured exercise therapy rehabilitation program. Two independent reviewers extracted the data and assessed risk of bias. For each study, knee adduction moment, pain and physical function outcomes were extracted. For each outcome, mean differences and 95% confidence intervals were calculated. Due to clinical heterogeneity among exercise therapy protocols, a descriptive analysis was chosen. Three studies, comprising 233 participants, were included. None of the studies showed significant differences between strengthening and control/sham groups in knee adduction moment. In regards to pain and physical function, the three studies demonstrated significant improvement in pain and two of them showed increased physical function following exercise therapy compared to controls. Muscle strength and torque significantly improved in all the three trials favoring the intervention group. Clinical benefits from exercise therapy were not associated with changes in the knee adduction moment. The lack of knee adduction moment reduction indicates that exercise therapy may not be protective in knee osteoarthritis from a joint loading point of view. Alterations in neuromuscular control, not captured by the knee adduction moment measurement, may contribute to alter dynamic joint loading following exercise therapy. To conclude, mechanisms other than the reduction in knee adduction moment might explain the clinical benefits of exercise therapy on knee osteoarthritis.
Publisher: BMJ
Date: 02-2023
Abstract: To provide a comprehensive overview of the efficacy, safety, and tolerability of antidepressants for pain according to condition. Overview of systematic reviews. PubMed, Embase, PsycINFO, and the Cochrane Central Register of Controlled Trials from inception to 20 June 2022. Systematic reviews comparing any antidepressant with placebo for any pain condition in adults. Two reviewers independently extracted data. The main outcome measure was pain for headache disorders it was frequency of headaches. Continuous pain outcomes were converted into a scale of 0 (no pain) to 100 (worst pain) and were presented as mean differences (95% confidence intervals). Dichotomous outcomes were presented as risk ratios (95% confidence intervals). Data were extracted from the time point closest to the end of treatment. When end of treatment was too variable across trials in a review, data were extracted from the outcome or time point with the largest number of trials and participants. Secondary outcomes were safety and tolerability (withdrawals because of adverse events). Findings were classified from each comparison as efficacious, not efficacious, or inconclusive. Certainty of evidence was assessed with the grading of recommendations assessment, development, and evaluation framework. 26 reviews (156 unique trials and 000 participants) were included. These reviews reported on the efficacy of eight antidepressant classes covering 22 pain conditions (42 distinct comparisons). No review provided high certainty evidence on the efficacy of antidepressants for pain for any condition. 11 comparisons (nine conditions) were found where antidepressants were efficacious, four with moderate certainty evidence: serotonin-norepinephrine reuptake inhibitors (SNRIs) for back pain (mean difference −5.3, 95% confidence interval −7.3 to −3.3), postoperative pain (−7.3, −12.9 to −1.7), neuropathic pain (−6.8, −8.7 to −4.8), and fibromyalgia (risk ratio 1.4, 95% confidence interval 1.3 to 1.6). For the other 31 comparisons, antidepressants were either not efficacious (five comparisons) or the evidence was inconclusive (26 comparisons). Evidence of efficacy of antidepressants was found in 11 of the 42 comparisons included in this overview of systematic reviews—seven of the 11 comparisons investigated the efficacy of SNRIs. For the other 31 comparisons, antidepressants were either inefficacious or evidence on efficacy was inconclusive. The findings suggest that a more nuanced approach is needed when prescribing antidepressants for pain conditions. PROSPERO CRD42022311073.
Publisher: American Geophysical Union (AGU)
Date: 08-2021
DOI: 10.1029/2021JF006064
Abstract: Mixed siliciclastic‐carbonate active orogens are common on Earth's surface, yet most studies have focused on erosion and weathering in silicate‐rich landscapes. Relative to purely siliciclastic landscapes, the response of erosion and weathering to uplift may differ in mixed‐lithology regions. However, our knowledge of weathering and erosion in mixed carbonate‐silicate lithologies is limited and, thus, so is our understanding of the mechanistic coupling between uplift, weathering, and the carbon cycle. Here, we partition denudation fluxes into erosion and weathering fluxes of carbonates and silicates in the Northern Apennines—a mixed carbonate‐siliciclastic active orogen—using dissolved solutes, the carbonate sand fraction, and existing 10 Be denudation rates. Erosion generally dominates total denudation fluxes relative to weathering by an order of magnitude. Carbonate and silicate contributions to erosion vary between lithologic units, but weathering fluxes are systematically dominated by carbonates. Silicate weathering may be kinetically limited, whereas carbonate weathering may be limited by acid supply. Carbonate re‐precipitation estimated by comparing ion ratios (Sr, Ca, Na) from rivers and bedrock suggests that up to 90% of dissolved Ca 2+ is lost from carbonate‐rich catchments. Corresponding [Ca 2+ ] estimates for the weathering zone are high, likely driven by high soil CO 2 partial pressures ( p CO 2 ) however, re‐equilibration with atmospheric p CO 2 in rivers converts solutes back into grains that become part of the physical denudation flux. Weathering limits in this landscape therefore differ between the subsurface weathering zone and riverine exports, and our findings suggest that carbon cycle models may overestimate the sensitivity to erosion of solute exports (Ca 2+ and HCO 3 − ) derived from carbonate weathering.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 19-12-2022
Publisher: Elsevier BV
Date: 07-2020
Publisher: Informa UK Limited
Date: 04-01-2022
DOI: 10.1080/09593985.2020.1870252
Abstract: To identify common characteristics of landmark physiotherapy clinical trials. The Physiotherapy Evidence Database (PEDro) top five trials were compared to 91 physiotherapy trials published in top medical journals and 99 trials randomly selected from PEDro on the following characteristics: PEDro score, s le size, number of trial sites, use of prospective registration, positive or negative trial, citations, citations in guidelines, Altmetric score, impact factor, publications and citations of first and last author, and PEDro codes (sub-discipline, topic, problem, therapy, and body part). Trials were published from 2014 to 2019. One-way independent ANOVA and Chi-squared test evaluated between-group differences. Compared to a random s le of physiotherapy trials, the PEDro top five trials and trials in top medical journals have higher PEDro scores, larger s le sizes, more study sites, more citations (including in guidelines), higher Altmetric scores, more likely to be prospectively registered, less likely to be positive trials, and have first and last authors with more citations and publications. The problem was the only PEDro code was distributed differently across the trial groups. The PEDro top five trials and physiotherapy trials published in the top medical journals have characteristics that may inform the design, conduct, and reporting of future physiotherapy trials.
Publisher: BMJ
Date: 28-09-2021
Publisher: American Medical Association (AMA)
Date: 06-2021
Publisher: Oxford University Press (OUP)
Date: 26-01-2021
DOI: 10.1093/RHEUMATOLOGY/KEAB025
Abstract: To describe the proportion of national health surveys that contain questions on the prevalence and consequences of musculoskeletal conditions. We used a comprehensive search strategy to obtain national health surveys from the 218 countries listed by the World Bank. Two authors independently extracted information from each national health survey. Outcomes were the proportion of surveys that contained questions on the prevalence of musculoskeletal conditions using the Global Burden of Disease categorization of RA, OA, low back pain, neck pain, gout and other and contained condition-specific questions about activity limitation, severity of pain and work absence. We also measured how frequently the prevalence of low back pain was measured using a consensus-based standard definition for low back pain prevalence studies. We identified national health surveys from 170 countries. Sixty-two (36.4%), the majority from high-income countries (n = 43), measured the prevalence of at least one musculoskeletal condition. OA [53 (85.4%)], low back pain [39 (62.9%)] and neck pain [37 (59.7%)] were most commonly measured, while RA and gout prevalence were only measured in 10 (5.9%) and 3 (1.8%) surveys, respectively. A minority of surveys assessed condition-specific activity limitations [6 (3.6%)], pain severity [5 (2.9%)] and work absence [1 (0.6%)]. Only one survey used the consensus-based standard definition for low back pain. Musculoskeletal conditions are neglected in the majority of national health surveys. Monitoring musculoskeletal conditions through ongoing surveys is crucial for the development and evaluation of health policies to reduce their burden.
Publisher: BMJ
Date: 05-2021
DOI: 10.1136/BMJGH-2021-005847
Abstract: Completeness of Global Burden of Disease (GBD) Study data is acknowledged as a limitation. To date, no study has evaluated this issue for low back pain, a leading contributor to disease burden globally. We retrieved reports, in any language, based on citation details from the GBD 2017 study website. Pairs of raters independently extracted the following data: number of prevalence reports tallied across countries, age groups, gender and years from 1987 to 2017. We also considered if studies enrolled a representative s le and/or used an acceptable measure of low back pain. We retrieved 488 country-level reports that provide prevalence data for 103 of 204 countries (50.5%), with most prevalence reports (61%) being for high-income countries. Only 16 countries (7.8%) have prevalence reports for each of the three decades of the GBD. Most of the reports (79%) did not use an acceptable measure of low back pain when estimating prevalence. We found incomplete coverage across countries and time, and limitations in the primary prevalence studies included in the GBD 2017 study. This means there is considerable uncertainty about GBD estimates of low back pain prevalence and the disease burden metrics derived from prevalence.
Publisher: BMJ
Date: 05-2023
DOI: 10.1136/BMJOPEN-2022-069779
Abstract: To explore how people perceive different advice for rotator cuff disease in terms of words/feelings evoked by the advice and treatment needs. We performed a content analysis of qualitative data collected in a randomised experiment. 2028 people with shoulder pain read a vignette describing someone with rotator cuff disease and were randomised to: bursitis label plus guideline-based advice, bursitis label plus treatment recommendation, rotator cuff tear label plus guideline-based advice and rotator cuff tear label plus treatment recommendation. Guideline-based advice included encouragement to stay active and positive prognostic information. Treatment recommendation emphasised that treatment is needed for recovery. Participants answered questions about: (1) words/feelings evoked by the advice (2) treatments they feel are needed. Two researchers developed coding frameworks to analyse responses. 1981 (97% of 2039 randomised) responses for each question were analysed. Guideline-based advice (vs treatment recommendation ) more often elicited words/feelings of reassurance, having a minor issue, trust in expertise and feeling dismissed, and treatment needs of rest, activity modification, medication, wait and see, exercise and normal movements. Treatment recommendation (vs guideline-based advice ) more often elicited words/feelings of needing treatment/investigation, psychological distress and having a serious issue, and treatment needs of injections, surgery, investigations, and to see a doctor. Words/feelings evoked by advice for rotator cuff disease and perceived treatment needs may explain why guideline-based advice reduces perceived need for unnecessary care compared to a treatment recommendation .
Publisher: Elsevier BV
Date: 02-2021
Publisher: Elsevier BV
Date: 12-2013
DOI: 10.1016/J.MATH.2013.03.001
Abstract: Manual therapy is an important tool for the treatment of musculoskeletal disorders of mechanical origin. Since the hip is an important structure for weight bearing as well as static and dynamic balance, it is suggested that hip impairments may affect weight distribution. Both static and dynamic balance are dependent on adequate joint mobility which in the presence of any kind of alteration can lead to modifications of plantar pressure distribution patterns which, in turn, can be detected by computerized baropodometry. The aim of this study was to verify clinical and baropodometric immediate effects of a single session of hip mobilization in a patient with chronic anterior hip pain. A physically active 21-year old patient underwent a pre-intervention assessment which included pain rating, active and passive range of movement, passive accessory movement as well as static and dynamic barodometry. The intervention consisted of an anteroposterior grade III + mobilization of the right hip, which was conducted with patient in left side-lying with the right hip flexed at approximately 45°. After the intervention, the patient's pain was reduced and there was an improvement in the active movement related to the pain generation. Baropodometric assessment showed plantar peak pressures shift on both feet, from forefoot to rear foot, and there was also reduction in anteroposterior center of pressure displacement on static recording.
Publisher: Elsevier BV
Date: 10-2021
Publisher: Springer Science and Business Media LLC
Date: 27-04-2022
DOI: 10.1186/S12909-022-03404-9
Abstract: Infographics have become an increasingly popular method to present research findings and increase the attention research receives. As many scientific journals now use infographics to boost the visibility and uptake of the research they publish, infographics have become an important tool for medical education. It is unknown whether such infographics convey the key characteristics that are needed to make useful interpretations of the data such as an adequate description of the study population, interventions, comparators and outcomes methodological limitations and numerical estimates of benefits and harms. This study described whether infographics published in peer-reviewed health and medical research journals contain key characteristics that are needed to make useful interpretations of clinical research. In this cross-sectional study, we identified peer-reviewed journals listed in the top quintile of 35 unique fields of medicine and health research listed in the Journal Citation Reports database. Two researchers screened journals for the presence of infographics. We defined an infographic as a graphical visual representation of research findings. We extracted data from a s le of two of the most recent infographics from each journal. Outcomes were the proportion of infographics that reported key characteristics such as study population, interventions, comparators and outcomes, benefits, harms, effect estimates with measures of precision, between-group differences and conflicts of interest acknowledged risk of bias, certainty of evidence and study limitations and based their conclusions on the study’s primary outcome. We included 129 infographics from 69 journals. Most infographics described the population (81%), intervention (96%), comparator (91%) and outcomes (94%), but fewer contained enough information on the population (26%), intervention (45%), comparator (20%) and outcomes (55%) for those components of the study to be understood without referring to the main paper. Risk of bias was acknowledged in only 2% of infographics, and none of the 69 studies that had declared a conflict of interest disclosed it in the infographics. Most infographics do not report sufficient information to allow readers to interpret study findings, including the study characteristics, results, and sources of bias. Our results can inform initiatives to improve the quality of the information presented in infographics.
Publisher: Elsevier BV
Date: 09-2020
Publisher: BMJ
Date: 04-06-2019
DOI: 10.1136/BMJQS-2019-009383
Abstract: To describe the diagnoses of people who present to the emergency department (ED) with low back pain (LBP), the proportion of people with a lumbar spine condition who arrived by ambulance, received imaging, opioids and were admitted to hospital and to explore factors associated with these four outcomes. In this retrospective study, we analysed electronic medical records for all adults presenting with LBP at three Australian EDs from January 2016 to June 2018. Outcomes included discharge diagnoses and key aspects of care (ambulance transport, lumbar spine imaging, provision of opioids, admission). We explored factors associated with these care outcomes using multilevel mixed-effects logistic regression models and reported data as ORs. There were 14 024 presentations with a ‘visit reason’ for low back pain, of which 6393 (45.6%) had a diagnosis of a lumbar spine condition. Of these, 31.4% arrived by ambulance, 23.6% received lumbar imaging, 69.6% received opioids and 17.6% were admitted to hospital. Older patients (OR 1.79, 95% CI 1.56 to 2.04) were more likely to be imaged. Opioids were less used during working hours (OR 0.81, 95% CI 0.67 to 0.98) and in patients with non-serious LBP compared with patients with serious spinal pathology (OR 1.65, 95% CI 1.07 to 2.55). Hospital admission was more likely to occur during working hours (OR 1.74, 95% CI 1.48 to 2.05) and for those who arrived by ambulance (OR 2.98, 95% CI 2.53 to 3.51). Many ED presentations of LBP were not due to a lumbar spine condition. Of those that were, we noted relatively high rates of lumbar imaging, opioid use and hospital admission.
Publisher: Georg Thieme Verlag KG
Date: 13-10-2021
Abstract: Objetivo Avaliar os níveis de intensidade da dor, litude de movimento, pico de torque isométrico do quadril e desempenho da tarefa funcional em pacientes 6 meses após a artroplastia total do quadril (ATQ), e comparar estes valores com os de participantes assintomáticos do grupo controle (GC). Métodos Recrutamos participantes com ATQ unilateral devida a osteoartrite (OA) do quadril, dentro de uma mediana de tempo de 6 meses, que não tinham desenvolvido complicações pós-operatórias. Os participantes foram avaliados quanto à intensidade da dor, à litude de movimento do quadril, ao pico de torque isométrico, à autoavaliação (questionário de avaliação do quadril Harris Hip Score [HHS, na sigla em inglês) e à função medida objetivamente por meio do teste Timed Up and Go (TUG, na sigla em inglês). O grupo ATQ foi comparado com um grupo de participantes assintomáticos com idade ≥ 50 anos recrutados na comunidade. As comparações são apresentadas como diferenças médias (DMs) e intervalos de confiança (ICs) de 95%. Resultados Cada grupo contou com 23 participantes. A intensidade da dor foi baixa no grupo ATQ (1,48 [1,60]), sendo que 91,3% dos pacientes relataram estar satisfeitos com o procedimento cirúrgico. Os participantes do grupo ATQ relataram uma função medida objetivamente significativamente menor (ATQ 12,2 [10,0-21,6] GC 9,0 [6,7-12,2]) e a função autoavaliação (ATQ 78,5 [43,8-93,9] GC 100,0 [95,8-100,0]), em comparação com o GC. O grupo ATQ também teve reduzida de forma significativa a litude de movimento para flexão (p 0,001), os movimentos internos (p 0,001) e de rotação externa (p = 0,003). O grupo ATQ também apresentou pico de torque reduzido para flexão (p 0,001), extensão (p ,001), movimentos de abdução (p 0,001) e adução (p = 0,024) em comparação com os participantes do GC. Conclusões Apesar de informarem escores gerais de dor de baixa intensidade e satisfação com a cirurgia, os pacientes apresentaram limitações funcionais, litude de movimento limitada e redução da força muscular após 6 meses do procedimento cirúrgico de ATQ. Nível de Evidência 3B.
Publisher: Elsevier BV
Date: 07-2022
DOI: 10.1016/J.JSAMS.2022.02.008
Abstract: To systematically review the literature on the effects of ankle supports on lower extremity biomechanics during functional tasks. Systematic review with meta-analysis. Eight electronic databases were searched from inception to July 2019. Studies of biomechanical outcomes during functional tasks that used a within-participant (repeated measures) design were included. Two independent reviewers screened studies, extracted data, assessed the methodological quality of the included studies and rated the quality of evidence. Meta-analysis was performed and reported as standardised mean differences and 95% confidence intervals. A total of 8350 studies were identified in the electronic search and 42 studies involving a total of 761 participants were included in the review (21 studies included for qualitative reporting and 21 studies in the meta-analysis). Most in idual studies and the meta-analyses demonstrated no effect of ankle supports on ground reaction force or ankle inversion angle. However, there was high quality evidence that ankle taping decreased plantarflexion angle at initial contact during landing from a height (P = 0.0009, standerdised mean differences = 0.72, 95% confidence intervals = 1.15, 0.03, I Ankle taping only decreased plantarflexion angle at initial contact during landing from a jump. Ankle supports did not affect inversion angle or forces in linear and multiplanar tasks. There was insufficient evidence on the effect of ankle supports on ankle transverse plane biomechanics.
Publisher: Imprensa da Universidade de Coimbra
Date: 2022
DOI: 10.14195/978-989-26-2298-9_118
Abstract: In the current work, a numerical study is performed to investigate the effect on the downslope field by a wind driven surface fire in the presence of an idealised building structure. Fires burning with an intensity of 15 MW/m on inclined terrain with various downslope angles of 0, -10, -20, and -30°, and under a constant wind speed of 12 m/s are simulated using a large eddy simulation (LES) solver, implemented in open-source platform FireFOAM. The results are validated with experimental measurements of a full-scale cubic building model. The presented outcomes highlight the physical effect of sloped terrain on a building in the vicinity of a line-fire. The results show that at a constant fire intensity and wind speed, an increase in downslope angle leads to an increase in the surface temperature of the structure downstream of the fire source. In addition, it is shown that increasing the downslope angle from 0˚ to -30°, results in a reduction of the average air density around the structure downstream of the fire. Furthermore, by increasing the downslope inclination of the terrain from 0˚ to -30° increases the average temperature of the building surface by 30%, and increases the temperature of zone downstream of the fire by 9%.
Publisher: BMJ
Date: 02-2018
DOI: 10.1136/BMJOPEN-2017-019486
Abstract: Neck pain is the leading cause of years lived with disability worldwide and it accounts for high economic and societal burden. Altered activation of the neck muscles is a common musculoskeletal impairment presented by patients with neck pain. The craniocervical flexion test with pressure biofeedback unit has been widely used in clinical practice to assess function of deep neck flexor muscles. This systematic review will assess the measurement properties of the craniocervical flexion test for assessing deep cervical flexor muscles. This is a protocol for a systematic review that will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. MEDLINE (via PubMed), EMBASE, PEDro, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus and Science Direct will be systematically searched from inception. Studies of any design that have investigated and reported at least one measurement property of the craniocervical flexion test for assessing the deep cervical flexor muscles will be included. All measurement properties will be considered as outcomes. Two reviewers will independently rate the risk of bias of in idual studies using the updated COnsensus-based Standards for the selection of health Measurement Instruments risk of bias checklist. A structured narrative synthesis will be used for data analysis. Quantitative findings for each measurement property will be summarised. The overall rating for a measurement property will be classified as ‘positive’, ‘indeterminate’ or ‘negative’. The overall rating will be accompanied with a level of evidence. Ethical approval and patient consent are not required since this is a systematic review based on published studies. Findings will be submitted to a peer-reviewed journal for publication. CRD42017062175 .
Location: Brazil
Start Date: 2021
End Date: 2022
Funder: University of Sydney
View Funded ActivityStart Date: 2022
End Date: 2026
Funder: National Health and Medical Research Council
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