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Foot (Edinburgh, Scotland) Mar 2018The calf muscles are one of the muscle groups that have the most need for adequate flexibility since they are deeply related to normal lower limb function. When the goal... (Meta-Analysis)
Meta-Analysis Review
The calf muscles are one of the muscle groups that have the most need for adequate flexibility since they are deeply related to normal lower limb function. When the goal is to increase flexibility, the most commonly used technique is stretching. However, it remains unknown which stretching technique and parameters are the most effective to increase flexibility. Hence, the aim of the current review was to investigate the influence of chronic stretching on ankle dorsiflexion range of motion (DFROM) of healthy individuals. The search strategy included MEDLINE, PEDro, Cochrane CENTRAL, LILACS, and manual search from inception to February 2017. Randomized and controlled clinical trials that have analyzed the influence of chronic stretching on DFROM were included. On the other hand, studies with special populations (children, and people with any dysfunction/disease), and articles with no control group were excluded. Twenty studies were included out of 493 identified. The meta-analysis was performed according to the stretching technique used in the study. The results show that static stretching (5.17°; 95% CI: 4.39-5.95; I: 0%) and proprioceptive neuromuscular facilitation (4.32°; 95% CI: 1.59-7.04; I: 46%) are effective in increasing DFROM. Ballistic stretching did not show positive results to increase DFROM (3.77°; 95% CI: -0.03 to 7.56; I: 46%). In conclusion, chronic stretching is an effective way of improving ankle mobility in healthy individuals, especially when it contains a static component.
Topics: Ankle Joint; Exercise Therapy; Female; Healthy Volunteers; Humans; Male; Muscle Stretching Exercises; Range of Motion, Articular; Reference Values; Time Factors
PubMed: 29223884
DOI: 10.1016/j.foot.2017.09.006 -
British Journal of Anaesthesia Jan 2018The QoR-15 is a patient-reported outcome questionnaire that measures the quality of recovery after surgery and anaesthesia. We aimed to perform a systematic review and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The QoR-15 is a patient-reported outcome questionnaire that measures the quality of recovery after surgery and anaesthesia. We aimed to perform a systematic review and meta-analysis of the measurement properties of the QoR-15.
METHODS
Studies reporting measurement properties or interpretability of the QoR-15 after surgery were eligible for inclusion. All languages were included in the PubMed and Embase search. The COSMIN guidelines for systematic reviews of patient-reported outcome measurements were followed. Criteria for good measurement properties outlined in the consensus-based guidelines for selecting outcome measurement instruments for clinical trials were applied. A metaanalysis and synthesis of data across studies was performed.
RESULTS
Nine hundred and thirty-three titles were identified, and six articles were included in the study. The study population comprised 1548 patients undergoing a variety of surgical elective procedures. The QoR-15 was validated in English, Danish, Chinese, and Portuguese. High-quality evidence for good content validity, good internal consistency (Cronbach's α of 0.836), and essential unidimensionality of the QoR-15 as a measurement of postoperative quality of recovery was found. There was at least moderate-quality evidence of good reliability of the QoR-15 (intraclass correlation of 0.989) and good error of measurement (standard error of measurement of 1.85). The upper 95% confidence limit of the smallest detectable change was 3.63, and the minimal clinical important difference was 8.0.
CONCLUSIONS
The QoR-15 fulfils requirements for outcome measurement instruments in clinical trials and is the first measurement instrument of postoperative quality of recovery to undergo a systematic review according to the COSMIN checklist.
Topics: Anesthesia; Anesthesia Recovery Period; Humans; Outcome Assessment, Health Care; Psychometrics; Reproducibility of Results; Self Report; Surveys and Questionnaires; Treatment Outcome
PubMed: 29397134
DOI: 10.1016/j.bja.2017.11.013 -
Brazilian Journal of Physical Therapy 2018Muscle strength is an important component of health.
BACKGROUND
Muscle strength is an important component of health.
OBJECTIVE
To describe and evaluate the studies which have established the reference values for muscle strength on healthy individuals and to synthesize these values with a descriptive meta-analysis approach.
METHODS
A systematic review was performed in MEDLINE, LILACS, and SciELO databases. Studies that investigated the reference values for muscle strength of two or more appendicular/axial muscle groups of health individuals were included. Methodological quality, including risk of bias was assessed by the QUADAS-2. Data extracted included: country of the study, sample size, population characteristics, equipment/method used, and muscle groups evaluated.
RESULTS
Of the 414 studies identified, 46 were included. Most of the studies had adequate methodological quality. Included studies evaluated: appendicular (80.4%) and axial (36.9%) muscles; adults (78.3%), elderly (58.7%), adolescents (43.5%), children (23.9%); isometric (91.3%) and isokinetic (17.4%) strength. Six studies (13%) with similar procedures were synthesized with meta-analysis. Generally, the coefficient of variation values that resulted from the meta-analysis ranged from 20.1% to 30% and were similar to those reported by the original studies. The meta-analysis synthesized the reference values of isometric strength of 14 muscle groups of the dominant/non-dominant sides of the upper/lower limbs of adults/elderly from developed countries, using dynamometers/myometer.
CONCLUSIONS
Most of the included studies had adequate methodological quality. The meta-analysis provided reference values for the isometric strength of 14 appendicular muscle groups of the dominant/non-dominant sides, measured with dynamometers/myometers, of men/women, of adults/elderly. These data may be used to interpret the results of the evaluations and establish appropriate treatment goals.
Topics: Humans; Muscle Strength; Reference Values
PubMed: 29764761
DOI: 10.1016/j.bjpt.2018.02.006 -
The Cochrane Database of Systematic... Dec 2018Point-of-care sonography (POCS) has emerged as the screening modality of choice for suspected body trauma in many emergency departments worldwide. Its best known... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Point-of-care sonography (POCS) has emerged as the screening modality of choice for suspected body trauma in many emergency departments worldwide. Its best known application is FAST (focused abdominal sonography for trauma). The technology is almost ubiquitously available, can be performed during resuscitation, and does not expose patients or staff to radiation. While many authors have stressed the high specificity of POCS, its sensitivity varied markedly across studies. This review aimed to compile the current best evidence about the diagnostic accuracy of POCS imaging protocols in the setting of blunt thoracoabdominal trauma.
OBJECTIVES
To determine the diagnostic accuracy of POCS for detecting and excluding free fluid, organ injuries, vascular lesions, and other injuries (e.g. pneumothorax) compared to a diagnostic reference standard (i.e. computed tomography (CT), magnetic resonance imaging (MRI), thoracoscopy or thoracotomy, laparoscopy or laparotomy, autopsy, or any combination of these) in patients with blunt trauma.
SEARCH METHODS
We searched Ovid MEDLINE (1946 to July 2017) and Ovid Embase (1974 to July 2017), as well as PubMed (1947 to July 2017), employing a prospectively defined literature and data retrieval strategy. We also screened the Cochrane Library, Google Scholar, and BIOSIS for potentially relevant citations, and scanned the reference lists of full-text papers for articles missed by the electronic search. We performed a top-up search on 6 December 2018, and identified eight new studies which may be incorporated into the first update of this review.
SELECTION CRITERIA
We assessed studies for eligibility using predefined inclusion and exclusion criteria. We included either prospective or retrospective diagnostic cohort studies that enrolled patients of any age and gender who sustained any type of blunt injury in a civilian scenario. Eligible studies had to provide sufficient information to construct a 2 x 2 table of diagnostic accuracy to allow for calculating sensitivity, specificity, and other indices of diagnostic test accuracy.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened titles, abstracts, and full texts of reports using a prespecified data extraction form. Methodological quality of individual studies was rated by the QUADAS-2 instrument (the revised and updated version of the original Quality Assessment of Diagnostic Accuracy Studies list of items). We calculated sensitivity and specificity with 95% confidence intervals (CI), tabulated the pairs of sensitivity and specificity with CI, and depicted these estimates by coupled forest plots using Review Manager 5 (RevMan 5). For pooling summary estimates of sensitivity and specificity, and investigating heterogeneity across studies, we fitted a bivariate model using Stata 14.0.
MAIN RESULTS
We included 34 studies with 8635 participants in this review. Summary estimates of sensitivity and specificity were 0.74 (95% CI 0.65 to 0.81) and 0.96 (95% CI 0.94 to 0.98). Pooled positive and negative likelihood ratios were estimated at 18.5 (95% CI 10.8 to 40.5) and 0.27 (95% CI 0.19 to 0.37), respectively. There was substantial heterogeneity across studies, and the reported accuracy of POCS strongly depended on the population and affected body area. In children, pooled sensitivity of POCS was 0.63 (95% CI 0.46 to 0.77), as compared to 0.78 (95% CI 0.69 to 0.84) in an adult or mixed population. Associated specificity in children was 0.91 (95% CI 0.81 to 0.96) and in an adult or mixed population 0.97 (95% CI 0.96 to 0.99). For abdominal trauma, POCS had a sensitivity of 0.68 (95% CI 0.59 to 0.75) and a specificity of 0.95 (95% CI 0.92 to 0.97). For chest injuries, sensitivity and specificity were calculated at 0.96 (95% CI 0.88 to 0.99) and 0.99 (95% CI 0.97 to 1.00). If we consider the results of all 34 included studies in a virtual population of 1000 patients, based on the observed median prevalence (pretest probability) of thoracoabdominal trauma of 28%, POCS would miss 73 patients with injuries and falsely suggest the presence of injuries in another 29 patients. Furthermore, in a virtual population of 1000 children, based on the observed median prevalence (pretest probability) of thoracoabdominal trauma of 31%, POCS would miss 118 children with injuries and falsely suggest the presence of injuries in another 62 children.
AUTHORS' CONCLUSIONS
In patients with suspected blunt thoracoabdominal trauma, positive POCS findings are helpful for guiding treatment decisions. However, with regard to abdominal trauma, a negative POCS exam does not rule out injuries and must be verified by a reference test such as CT. This is of particular importance in paediatric trauma, where the sensitivity of POCS is poor. Based on a small number of studies in a mixed population, POCS may have a higher sensitivity in chest injuries. This warrants larger, confirmatory trials to affirm the accuracy of POCS for diagnosing thoracic trauma.
Topics: Abdominal Injuries; Adult; Age Factors; Child; Female; Focused Assessment with Sonography for Trauma; Humans; Male; Point-of-Care Systems; Reference Standards; Sensitivity and Specificity; Thoracic Injuries; Wounds, Nonpenetrating
PubMed: 30548249
DOI: 10.1002/14651858.CD012669.pub2 -
JPEN. Journal of Parenteral and Enteral... Jul 2020The aim of this study was to determine the efficacy of immunonutrition vs standard nutrition in cancer patients treated with surgery. Cochrane Central Register of... (Meta-Analysis)
Meta-Analysis
The aim of this study was to determine the efficacy of immunonutrition vs standard nutrition in cancer patients treated with surgery. Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, EBSCOhost, and Web of Science were searched. Sixty-one randomized controlled trials were included. Immunonutrition was associated with a significantly reduced risk of postoperative infectious complications (risk ratio [RR] 0.71 [95% CI, 0.64-0.79]), including a reduced risk of wound infection (RR 0.72 [95% CI, 0.60-0.87]), respiratory tract infection (RR 0.70 [95% CI, 0.59-0.84]), and urinary tract infection (RR 0.69 [95% CI, 0.51-0.94]) as well as a decreased risk of anastomotic leakage (RR 0.70 [95% CI, 0.53-0.91]) and a reduced hospital stay (MD -2.12 days [95% CI -2.72 to -1.52]). No differences were found between the 2 groups with regard to sepsis or all-cause mortality. Subgroup analyses revealed that receiving arginine + nucleotides + ω-3 fatty acids and receiving enteral immunonutrition reduced the rates of wound infection and respiratory tract infection. The application of immunonutrition at 25-30 kcal/kg/d for 5-7 days reduced the rate of respiratory tract infection. Perioperative immunonutrition reduced the rate of wound infection. For malnourished patients, immunonutrition shortened the hospitalization time. Therefore, immunonutrition reduces postoperative infection complications and shortens hospital stays but does not reduce all-cause mortality. Patients who are malnourished before surgery who receive arginine + nucleotides + ω-3 fatty acids (25-30 kcal/kg/d) via the gastrointestinal tract during the perioperative period (5-7 days) may show better clinical efficacy.
Topics: Enteral Nutrition; Humans; Length of Stay; Neoplasms; Nutritional Status; Postoperative Complications; Reference Standards
PubMed: 31709584
DOI: 10.1002/jpen.1736 -
Critical Care (London, England) Nov 2020Clinical practice guidelines recommend performing a cuff leak test in mechanically ventilated adults who meet extubation criteria to screen those at high risk for... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Clinical practice guidelines recommend performing a cuff leak test in mechanically ventilated adults who meet extubation criteria to screen those at high risk for post-extubation stridor. Previous systematic reviews demonstrated excellent specificity of the cuff leak test but disagreed with respect to sensitivity. We conducted a systematic review and meta-analysis to assess the diagnostic accuracy of the cuff leak test for predicting post-extubation airway complications in intubated adult patients in critical care settings.
METHODS
We searched Medline, EMBASE, Scopus, ISI Web of Science, the Cochrane Library for eligible studies from inception to March 16, 2020, without language restrictions. We included studies that examined the diagnostic accuracy of cuff leak test if post-extubation airway obstruction after extubation or reintubation was explicitly reported as the reference standard. Two authors in duplicate and independently assessed the risk of bias using the Quality Assessment for Diagnostic Accuracy Studies-2 tool. We pooled sensitivities and specificities using generalized linear mixed model approach to bivariate random-effects meta-analysis. Our primary outcomes were post-extubation airway obstruction and reintubation.
RESULTS
We included 28 studies involving 4493 extubations. Three studies were at low risk for all QUADAS-2 risk of bias domains. The pooled sensitivity and specificity of cuff leak test for post-extubation airway obstruction were 0.62 (95% CI 0.49-0.73; I = 81.6%) and 0.87 (95% CI 0.82-0.90; I = 97.8%), respectively. The pooled sensitivity and specificity of the cuff leak test for reintubation were 0.66 (95% CI 0.46-0.81; I = 48.9%) and 0.88 (95% CI 0.83-0.92; I = 87.4%), respectively. Subgroup analyses suggested that the type of cuff leak test and length of intubation might be the cause of statistical heterogeneity of sensitivity and specificity, respectively, for post-extubation airway obstruction.
CONCLUSIONS
The cuff leak test has excellent specificity but moderate sensitivity for post-extubation airway obstruction. The high specificity suggests that clinicians should consider intervening in patients with a positive test, but the low sensitivity suggests that patients still need to be closely monitored post-extubation.
Topics: Adult; Airway Extubation; Humans; Predictive Value of Tests; Pressure; Sensitivity and Specificity; Weights and Measures
PubMed: 33160405
DOI: 10.1186/s13054-020-03358-8 -
Journal of Medical Internet Research Jan 2022Metadata are created to describe the corresponding data in a detailed and unambiguous way and is used for various applications in different research areas, for example,... (Review)
Review
BACKGROUND
Metadata are created to describe the corresponding data in a detailed and unambiguous way and is used for various applications in different research areas, for example, data identification and classification. However, a clear definition of metadata is crucial for further use. Unfortunately, extensive experience with the processing and management of metadata has shown that the term "metadata" and its use is not always unambiguous.
OBJECTIVE
This study aimed to understand the definition of metadata and the challenges resulting from metadata reuse.
METHODS
A systematic literature search was performed in this study following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for reporting on systematic reviews. Five research questions were identified to streamline the review process, addressing metadata characteristics, metadata standards, use cases, and problems encountered. This review was preceded by a harmonization process to achieve a general understanding of the terms used.
RESULTS
The harmonization process resulted in a clear set of definitions for metadata processing focusing on data integration. The following literature review was conducted by 10 reviewers with different backgrounds and using the harmonized definitions. This study included 81 peer-reviewed papers from the last decade after applying various filtering steps to identify the most relevant papers. The 5 research questions could be answered, resulting in a broad overview of the standards, use cases, problems, and corresponding solutions for the application of metadata in different research areas.
CONCLUSIONS
Metadata can be a powerful tool for identifying, describing, and processing information, but its meaningful creation is costly and challenging. This review process uncovered many standards, use cases, problems, and solutions for dealing with metadata. The presented harmonized definitions and the new schema have the potential to improve the classification and generation of metadata by creating a shared understanding of metadata and its context.
Topics: Humans; Metadata; Publications; Reference Standards
PubMed: 35014967
DOI: 10.2196/25440 -
BMJ Quality & Safety Feb 2016Patient participation in healthcare is recognised internationally as essential for consumer-centric, high-quality healthcare delivery. Its measurement as part of... (Review)
Review
INTRODUCTION
Patient participation in healthcare is recognised internationally as essential for consumer-centric, high-quality healthcare delivery. Its measurement as part of continuous quality improvement requires development of agreed standards and measurable indicators.
AIM
This systematic review sought to identify strategies to measure patient participation in healthcare and to report their reliability and validity. In the context of this review, patient participation was constructed as shared decision-making, acknowledging the patient as having critical knowledge regarding their own health and care needs and promoting self-care/autonomy.
METHODS
Following a comprehensive search, studies reporting reliability or validity of an instrument used in a healthcare setting to measure patient participation, published in English between January 2004 and March 2014 were eligible for inclusion.
RESULTS
From an initial search, which identified 1582 studies, 156 studies were retrieved and screened against inclusion criteria. Thirty-three studies reporting 24 patient participation measurement tools met inclusion criteria, and were critically appraised. The majority of studies were descriptive psychometric studies using prospective, cross-sectional designs. Almost all the tools completed by patients, family caregivers, observers or more than one stakeholder focused on aspects of patient-professional communication. Few tools designed for completion by patients or family caregivers provided valid and reliable measures of patient participation. There was low correlation between many of the tools and other measures of patient satisfaction.
CONCLUSION
Few reliable and valid tools for measurement of patient participation in healthcare have been recently developed. Of those reported in this review, the dyadic Observing Patient Involvement in Decision Making (dyadic-OPTION) tool presents the most promise for measuring core components of patient participation. There remains a need for further study into valid, reliable and feasible strategies for measuring patient participation as part of continuous quality improvement.
Topics: Decision Making; Delivery of Health Care; Evaluation Studies as Topic; Female; Humans; Male; Patient Participation; Patient Satisfaction; Physician-Patient Relations; Qualitative Research; Reproducibility of Results
PubMed: 26415751
DOI: 10.1136/bmjqs-2015-004357 -
The Journal of Sexual Medicine Mar 2021Penile length measurement techniques vary widely in published studies leading to inaccurate and nonstandardized measurements.
BACKGROUND
Penile length measurement techniques vary widely in published studies leading to inaccurate and nonstandardized measurements.
AIM
To review the methodology used to report data in studies evaluating penile length and provide a detailed recommendation in conducting future high-quality research.
METHODS
The MEDLINE database was searched for randomized clinical trials and open-label prospective or retrospective studies.
OUTCOMES
The panel reviewed the modality of data reporting on these specific areas: patients' age and assessment, patient position, type of measurement instrument used, penile length technique description, examination conditions, and actual examiner.
RESULTS
Overall, 70 studies investigating penile length were selected; among these, 72.85% included at least 50 patients: 16 prospective studies, 5 randomized clinical trials, and 49 retrospective cross-sectional studies. Amongst all studies, 90% reported to measure penile length by health care practitioners in clinical settings. Penile length was assessed in all 70 studies, whereas penile girth was measured in 57.14% of patients. A semi-rigid ruler was the most commonly used measurement aid to assess penile length/girth in 62.86% of studies. Penile measurements were reportedly obtained: (i) stretched state, 60%; (ii) flaccid state only, 52.68%; and (iii) during erection, 27.43%. All studies investigating the penile length in an erect state were simultaneously assessing penile length in the flaccid state. About 90% of studies investigated penile length in adults, whereas 10% were conducted in adolescents.
CLINICAL IMPLICATIONS
The use of shared methodology to assess penile length in both adults and adolescents allows more accurate and standardized measurements.
STRENGTH & LIMITATIONS
A systematic review of the published literature allowed proper data interpretation in order to provide accurate recommendations. Main limitations of the study relied on a relatively limited number of databases for the identification of potentially eligible studies.
CONCLUSION
The methodology used in studies measuring penile length should be precise and standardized in order to provide accurate data to both clinicians and researchers. Cakir OO, Pozzi E, Castiglione F, et al. Penile Length Measurement: Methodological Challenges and Recommendations, a Systematic Review. J Sex Med 2021;18:433-439.
Topics: Adolescent; Adult; Cross-Sectional Studies; Humans; Male; Penile Erection; Penis; Prospective Studies; Retrospective Studies
PubMed: 33648901
DOI: 10.1016/j.jsxm.2020.11.012 -
BMJ Open Sep 2022Physical literacy (PL) is a comprehensive concept covering motivation, confidence, physical competence, knowledge and understanding of individuals' physical activity... (Review)
Review
UNLABELLED
Physical literacy (PL) is a comprehensive concept covering motivation, confidence, physical competence, knowledge and understanding of individuals' physical activity throughout life. PL has three overlapping domains, such as: an affective, a physical and a cognitive domain. So far, PL has not been measured in the adults and no complete measurement has been developed to date.
OBJECTIVES
The aim of this scoping review was to review existing self-reported instruments measuring different elements of domains of PL.
METHOD
We reviewed Education Research Complete, Cochrane, Medline, ScienceDirect, Scopus and SPORTDiscus. The reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Studies were coded using a thematic framework, which was based on the three domains of PL. The eligibility criteria were as follows: (1) age groups between 18 and 60 years; (2) meta-analyses, reviews or quantitative studies focusing on the measurement of at least one of the three domains of PL and (3) instrument that was self-reported. We finalised search on 1 August 2021 RESULTS: In total, 67 articles were identified as studies describing instruments reflecting the three domains of PL. Following full-text reading, 21 articles that met our inclusion criteria were included. Several instruments of relevance to PL are available for assessing motivation, confidence and the physical domain. However, few instruments exist that measure elements of the cognitive domain.
CONCLUSION
This review showed that a range of existing and validated instruments exists, covering two out of the three domains of PL, namely affective and physical domains. However, for the knowledge domain no valid measurement tools could be found. This scoping review has identified gaps in the research (namely the cognitive domain) and also a gap in the research as no measures that consider the inter-relatedness of the three domains (holistic nature of the concept).
Topics: Adolescent; Adult; Durable Medical Equipment; Exercise; Humans; Literacy; Middle Aged; Motivation; Self Report; Young Adult
PubMed: 36123090
DOI: 10.1136/bmjopen-2021-058351