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The American Journal of Sports Medicine Nov 2014The role of evidence-based medicine in sports medicine and orthopaedic surgery is rapidly growing. Systematic reviews and meta-analyses are also proliferating in the... (Review)
Review
BACKGROUND
The role of evidence-based medicine in sports medicine and orthopaedic surgery is rapidly growing. Systematic reviews and meta-analyses are also proliferating in the medical literature.
PURPOSE
To provide the outline necessary for a practitioner to properly understand and/or conduct a systematic review for publication in a sports medicine journal.
STUDY DESIGN
Review.
METHODS
The steps of a successful systematic review include the following: identification of an unanswered answerable question; explicit definitions of the investigation's participant(s), intervention(s), comparison(s), and outcome(s); utilization of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines and PROSPERO registration; thorough systematic data extraction; and appropriate grading of the evidence and strength of the recommendations.
RESULTS
An outline to understand and conduct a systematic review is provided, and the difference between meta-analyses and systematic reviews is described. The steps necessary to perform a systematic review are fully explained, including the study purpose, search methodology, data extraction, reporting of results, identification of bias, and reporting of the study's main findings.
CONCLUSION
Systematic reviews or meta-analyses critically appraise and formally synthesize the best existing evidence to provide a statement of conclusion that answers specific clinical questions. Readers and reviewers, however, must recognize that the quality and strength of recommendations in a review are only as strong as the quality of studies that it analyzes. Thus, great care must be used in the interpretation of bias and extrapolation of the review's findings to translation to clinical practice. Without advanced education on the topic, the reader may follow the steps discussed herein to perform a systematic review.
Topics: Evidence-Based Medicine; Humans; Medical Writing; Meta-Analysis as Topic; Orthopedics; Publishing; Review Literature as Topic; Sports Medicine
PubMed: 23925575
DOI: 10.1177/0363546513497567 -
JAMA Network Open Apr 2023Prehabilitation programs for patients undergoing orthopedic surgery have been gaining popularity in recent years. However, the current literature has produced varying... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Prehabilitation programs for patients undergoing orthopedic surgery have been gaining popularity in recent years. However, the current literature has produced varying results.
OBJECTIVE
To evaluate whether prehabilitation is associated with improved preoperative and postoperative outcomes compared with usual care for patients undergoing orthopedic surgery.
DATA SOURCES
Bibliographic databases (MEDLINE, CINAHL [Cumulative Index to Nursing and Allied Health Literature], AMED [Allied and Complementary Medicine], Embase, PEDRO [Physiotherapy Evidence Database], and Cochrane Central Register of Controlled Trials) were searched for published trials, and the Institute for Scientific Information Web of Science, System for Information on Grey Literature in Europe, and European clinical trials registry were searched for unpublished trials from January 1, 2000, to June 30, 2022.
STUDY SELECTION
Randomized clinical trials (RCTs) comparing prehabilitation with standard care for any orthopedic surgical procedure were included.
DATA EXTRACTION AND SYNTHESIS
Two independent reviewers screened trials. Data were pooled using a random-effects model. Recommendations were determined using the Grading of Recommendations Assessment, Development and Evaluation system and the study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline.
MAIN OUTCOMES AND MEASURES
Pain, function, muscle strength, and health-related quality of life (HRQOL).
RESULTS
Forty-eight unique trials involving 3570 unique participants (2196 women [61.5%]; mean [SD] age, 64.1 [9.1] years) were analyzed. Preoperatively, moderate-certainty evidence favoring prehabilitation was reported for patients undergoing total knee replacement (TKR) for function (standardized mean difference [SMD], -0.70 [95% CI, -1.08 to -0.32]) and muscle strength and flexion (SMD, 1.00 [95% CI, 0.23-1.77]) and for patients undergoing total hip replacement (THR) for HRQOL on the 36-item Short Form Health Survey (weighted mean difference [WMD], 7.35 [95% CI, 3.15-11.54]) and muscle strength and abduction (SMD, 1.03 [95% CI, 0.03-2.02]). High-certainty evidence was reported for patients undergoing lumbar surgery for back pain (WMD, -8.20 [95% CI, -8.85 to -7.55]) and moderate-certainty evidence for HRQOL (SMD, 0.46 [95% CI, 0.13-0.78]). Postoperatively, moderate-certainty evidence favoring prehabilitation was reported for function at 6 weeks in patients undergoing TKR (SMD, -0.51 [95% CI, -0.85 to -0.17]) and at 6 months in those undergoing lumbar surgery (SMD, -2.35 [95% CI, -3.92 to -0.79]). Other differences in outcomes favoring prehabilitation were of low to very low quality of evidence.
CONCLUSIONS AND RELEVANCE
In this systematic review and meta-analysis of RCTs, moderate-certainty evidence supported prehabilitation over usual care in improving preoperative function and strength in TKR and HRQOL and muscle strength in THR, high-certainty evidence in reducing back pain, and moderate-certainty evidence in improving HRQOL in lumbar surgery. Postoperatively, moderate-certainty evidence supported prehabilitation for function following TKR at 6 weeks and lumbar surgery at 6 months. Prehabilitation showed promising results for other outcomes, although high risk of bias and heterogeneity affected overall quality of evidence. Additional RCTs with a low risk of bias investigating preoperative and postoperative outcomes for all orthopedic surgical procedures are required.
Topics: Female; Humans; Middle Aged; Preoperative Exercise; Orthopedic Procedures; Quality of Life; Europe
PubMed: 37052919
DOI: 10.1001/jamanetworkopen.2023.8050 -
Journal of Shoulder and Elbow Surgery Dec 2020There is no consensus on the treatment of irreparable massive rotator cuff tears. The goal of this systematic review and meta-analysis was to (1) compare... (Meta-Analysis)
Meta-Analysis
BACKGROUND
There is no consensus on the treatment of irreparable massive rotator cuff tears. The goal of this systematic review and meta-analysis was to (1) compare patient-reported outcome scores, (2) define failure and reoperation rates, and (3) quantify the magnitude of patient response across treatment strategies.
METHODS
The MEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and Scopus databases were searched for studies including physical therapy and operative treatment of massive rotator cuff tears. The criteria of the Methodological Index for Non-randomized Studies were used to assess study quality. Primary outcome measures were patient-reported outcome scores as well as failure, complication, and reoperation rates. To quantify patient response to treatment, we compared changes in the Constant-Murley score and American Shoulder and Elbow Surgeons (ASES) score with previously reported minimal clinically important difference (MCID) thresholds.
RESULTS
No level I or II studies that met the inclusion and exclusion criteria were found. Physical therapy was associated with a 30% failure rate among the included patients, and another 30% went on to undergo surgery. Partial repair was associated with a 45% retear rate and 10% reoperation rate. Only graft interposition was associated with a weighted average change that exceeded the MCID for both the Constant-Murley score and ASES score. Latissimus tendon transfer techniques using humeral bone tunnel fixation were associated with a 77% failure rate. Superior capsular reconstruction with fascia lata autograft was associated with a weighted average change that exceeded the MCID for the ASES score. Reverse arthroplasty was associated with a 10% prosthesis failure rate and 8% reoperation rate.
CONCLUSION
There is a lack of high-quality comparative studies to guide treatment recommendations. Compared with surgery, physical therapy is associated with less improvement in perceived functional outcomes and a higher clinical failure rate.
Topics: Arthroplasty; Arthroplasty, Replacement, Shoulder; Arthroscopy; Humans; Patient Reported Outcome Measures; Physical Therapy Modalities; Reoperation; Rotator Cuff; Rotator Cuff Injuries; Shoulder Joint; Tendon Transfer; Treatment Outcome
PubMed: 32763381
DOI: 10.1016/j.jse.2020.07.030 -
Journal of Bodywork and Movement... Oct 2020Orthopedic injuries in conjunction with extensive damage to tissues, bones and blood vessels, usually require a long recovery. Associated consequences are pain, movement... (Review)
Review
BACKGROUND
Orthopedic injuries in conjunction with extensive damage to tissues, bones and blood vessels, usually require a long recovery. Associated consequences are pain, movement limitations, decreased function and occasionally, prolonged edema, which can delay or interfere with the healing process. Lymphatic and compression therapy have become increasingly common, intending to reduce edema and pain, thus, promoting the recovery process.
AIMS
To examine the efficacy of methods commonly used to reduce edema after orthopedic injury or surgery, i.e. decongestive therapy, manual lymphatic drainage, and compression bandaging.
METHODS
English literature search was undertaken in January 2019, in the following databases: Cochrane Library, MEDLINE, PEDro.
INCLUSION CRITERIA
randomized controlled or quasi-controlled trials in adults who have edema or pain after recent limb trauma or surgery. Two independent assessors rated study quality and risk of bias using the PRISMA recommendations and PEDro score.
RESULTS
We evaluated 71 papers. After excluding duplicated and irrelevant papers, 15 met the eligibility criteria (6 on lymphatic treatment and 9 on compression). Quality of papers ranged from 3 to 7 on PEDro score; of them, 13 were 1b Level of Evidence and two were 1c.
CONCLUSION
After elective surgeries, when the significant edema appears or persists beyond recovery time, complex decongestive therapy and manual edema mobilization should be recommended in addition to conventional physical therapy. In acute injuries such as ankle or distal radius fractures, lymphatic treatments and compression bandaging should be considered as part of the therapeutic protocol. Nine studies evaluated different compression modalities found that only multilayer and long stretch compression significantly reduce edema.
Topics: Adult; Edema; Humans; Massage; Orthopedic Procedures; Orthopedics; Physical Therapy Modalities
PubMed: 33218497
DOI: 10.1016/j.jbmt.2020.06.034 -
Knee Surgery, Sports Traumatology,... Aug 2022The use of virtual reality (VR) based rehabilitation has increased substantially within orthopedic surgery, particularly in the field of total knee arthroplasty (TKA).... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The use of virtual reality (VR) based rehabilitation has increased substantially within orthopedic surgery, particularly in the field of total knee arthroplasty (TKA). The objective of this systematic review and meta-analysis was to compare patient-reported outcomes and cost analyses from randomized controlled trials (RCT) utilizing VR-based rehabilitation in patients following TKA.
METHODS
MEDLINE, EMBASE, and Cochrane databases were searched for RCTs involving VR-based rehabilitation following TKA. Quantitative synthesis was conducted for pain scores and functional outcomes. Narrative outcomes were reported for results not amenable to quantitative synthesis.
RESULTS
A total of 9 RCTs with 835 patients were included with follow-up ranging from 10 days to 6 months postoperatively. No differences in pain scores were demonstrated between VR-based and traditional rehabilitation at 2 weeks and 3 months postoperatively. VR-based rehabilitation demonstrated improved functional outcomes at 12 weeks (n = 353) postoperatively [mean difference (MD) - 3.32, 95% confidence interval (CI) - 5.20 to - 1.45, moderate certainty evidence] and 6 months (n = 66) postoperatively [MD - 4.75, 95% CI - 6.69 to - 2.81, low certainty evidence], compared to traditional rehabilitation. One trial demonstrated significant cost savings with the use of VR-based rehabilitation.
CONCLUSIONS
VR-based rehabilitation for patients undergoing TKA represents an evolving field that may have advantages over traditional therapy for some patients. The current review is limited by the low quality of evidence in the literature. This is a rapidly evolving field with more trials needed to determine the impact of VR-based rehabilitation on patients undergoing TKA.
LEVEL OF EVIDENCE
Level I; meta-analysis of randomized controlled trials.
Topics: Arthroplasty, Replacement, Knee; Humans; Orthopedics; Pain; Randomized Controlled Trials as Topic; Virtual Reality
PubMed: 35182172
DOI: 10.1007/s00167-022-06910-x -
The Journal of the American Academy of... Oct 2022Fragility hip fractures are a major public health problem with a notable effect on quality of life for patients and their families. Management of Hip Fractures in Older...
Fragility hip fractures are a major public health problem with a notable effect on quality of life for patients and their families. Management of Hip Fractures in Older Adults: Evidence-Based Clinical Practice Guideline serves as current evidence-based practice guidelines for orthopaedic surgeons in the management of this common fracture and is based on a systematic review of published studies examining the surgical treatment of hip fractures in adults aged 55 years and older (older adults). The lower age limit for the patient population was set at 55 years but was also required to have a median age of 65 years. All aspects of care for older patients at risk of hip fracture or who have sustained a hip fracture could not be addressed within the scope of this guideline, including important topics of prevention of primary or secondary hip fractures or posthospital rehabilitation. This guideline contains 16 recommendations and three options to assist orthopaedic surgeons and all qualified physicians managing patients older than 55 years with hip fractures based on the best current available evidence. It is also intended to serve as an information resource for professional healthcare practitioners and developers of practice guidelines and recommendations. In addition to providing pragmatic practice recommendations, this guideline also highlights gaps in the literature and informs areas for future research and quality measure development.
Topics: Aged; Hip Fractures; Humans; Orthopedic Surgeons; Quality of Life
PubMed: 36200817
DOI: 10.5435/JAAOS-D-22-00125 -
Physical Therapy Oct 2019Virtual reality (VR) is an interactive technology that allows customized treatment and may help in delivering effective person-centered rehabilitation. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Virtual reality (VR) is an interactive technology that allows customized treatment and may help in delivering effective person-centered rehabilitation.
PURPOSE
The purpose of this review was to systematically review and critically appraise the controlled clinical trials that investigated VR effectiveness in orthopedic rehabilitation.
DATA SOURCES
Pubmed, CINAHL, Embase, PEDro, REHABDATA, and Sage publications were searched up to September 2018. In addition, manual searching and snowballing using Scopus and Web of Science were done.
STUDY SELECTION
Two reviewers screened studies for eligibility first by title and abstract and then full text.
DATA EXTRACTION
Articles were categorized into general or region-specific (upper limbs, lower limbs, and spine) orthopedic disorders. Study quality was assessed using the Evaluation Guidelines for Rating the Quality of an Intervention Study scoring. Meta-analysis quantified VR effectiveness, compared with no treatment, in back pain.
DATA SYNTHESIS
Nineteen studies were included in the quality assessment. The majority of the studies were of moderate quality. Fourteen studies showed that VR did not differ compared with exercises. Compared with the no-treatment control, 5 studies favored VR and 3 other studies showed no differences. For low back pain, the meta-analysis revealed no significant difference between VR and no-treatment control (n = 116; standardized mean difference = -0.21; 95% confidence interval = -0.58 to 0.15).
LIMITATIONS
Limitations included heterogeneity in interventions and the outcome measures of reviewed studies. Only articles in English were included.
CONCLUSION
The evidence of VR effectiveness is promising in chronic neck pain and shoulder impingement syndrome. VR and exercises have similar effects in rheumatoid arthritis, knee arthritis, ankle instability, and post-anterior cruciate reconstruction. For fibromyalgia and back pain, as well as after knee arthroplasty, the evidence of VR effectiveness compared with exercise is absent or inconclusive.
Topics: Exercise Therapy; Humans; Musculoskeletal Pain; Orthopedics; Rehabilitation; Virtual Reality
PubMed: 31343702
DOI: 10.1093/ptj/pzz093 -
World Journal of Orthopedics Nov 2022Although the impact of microbial infections on orthopedic clinical outcomes is well recognized, the influence of viral infections on the musculoskeletal system might...
BACKGROUND
Although the impact of microbial infections on orthopedic clinical outcomes is well recognized, the influence of viral infections on the musculoskeletal system might have been underestimated.
AIM
To systematically review the available evidence on risk factors and musculoskeletal manifestations following viral infections and to propose a pertinent classification scheme.
METHODS
We searched MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), the Reference Citation Analysis (RCA), and Scopus for completed studies published before January 30, 2021, to evaluate risk factors and bone and joint manifestations of viral infection in animal models and patient registries. Quality assessment was performed using SYRCLE's risk of bias tool for animal studies, Moga score for case series, Wylde score for registry studies, and Newcastle-Ottawa Scale for case-control studies.
RESULTS
Six human and four animal studies were eligible for inclusion in the qualitative synthesis. Hepatitis C virus was implicated in several peri- and post-operative complications in patients without cirrhosis after major orthopedic surgery. Herpes virus may affect the integrity of lumbar discs, whereas Ross River and Chikungunya viruses provoke viral arthritis and bone loss.
CONCLUSION
Evidence of moderate strength suggested that viruses can cause moderate to severe arthritis and osteitis. Risk factors such as pre-existing rheumatologic disease contributed to higher disease severity and duration of symptoms. Therefore, based on our literature search, the proposed clinical and pathogenetic classification scheme is as follows: (1) Viral infections of bone or joint; (2) Active bone and joint inflammatory diseases secondary to viral infections in other organs or tissues; and (3) Viral infection as a risk factor for post-surgical bacterial infection.
PubMed: 36439372
DOI: 10.5312/wjo.v13.i11.1015 -
The American Journal of Sports Medicine Feb 2016The number of systematic reviews published in the orthopaedic literature has increased, and these reviews can help guide clinical decision making. However, the quality... (Review)
Review
BACKGROUND
The number of systematic reviews published in the orthopaedic literature has increased, and these reviews can help guide clinical decision making. However, the quality of these reviews can affect the reader's ability to use the data to arrive at accurate conclusions and make clinical decisions.
PURPOSE
To evaluate the methodological and reporting quality of systematic reviews and meta-analyses in the sports medicine literature to determine whether such reviews should be used to guide treatment decisions. The hypothesis was that many systematic reviews in the orthopaedic sports medicine literature may not follow the appropriate reporting guidelines or methodological criteria recommended for systematic reviews.
STUDY DESIGN
Systematic review.
METHODS
All clinical sports medicine systematic reviews and meta-analyses from 2009 to 2013 published in The American Journal of Sports Medicine (AJSM), The Journal of Bone and Joint Surgery (JBJS), Arthroscopy, Sports Health, and Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA) were reviewed and evaluated for level of evidence according to the guidelines from the Oxford Centre for Evidence-Based Medicine, for reporting quality according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, and for methodological quality according to the Assessment of Multiple Systematic Reviews (AMSTAR) tool. Analysis was performed by year and journal of publication, and the levels of evidence included in the systematic reviews were also analyzed.
RESULTS
A total of 200 systematic reviews and meta-analyses were identified over the study period. Of these, 53% included evidence levels 4 and 5 in their analyses, with just 32% including evidence levels 1 and 2 only. There were significant differences in the proportion of articles with high levels of evidence (P < .001) and low levels of evidence (P = .005) by journal. The average PRISMA score was 87% and the average AMSTAR score was 73% among all journals. The average AMSTAR and PRISMA scores were significantly different by journal (P = .002 and .001, respectively) and by year (P = .046 and .019, respectively). Arthroscopy, AJSM, and JBJS all scored higher than Sports Health and KSSTA on the PRISMA and AMSTAR. The average PRISMA score by year varied from 85% to 89%, and the average AMSTAR score varied from 70% to 76%.
CONCLUSION
Systematic reviews and meta-analyses in orthopaedics sports medicine literature relied on evidence levels 4 and 5 in 53% of studies over the 5-year study period. Overall, PRISMA and AMSTAR scores are high and may be better than those in other disciplines. Readers need to be conscious of potential shortcomings when reading systematic reviews and using them in practice.
Topics: Arthroscopy; Evidence-Based Medicine; Humans; Meta-Analysis as Topic; Orthopedics; Periodicals as Topic; Research Design; Review Literature as Topic; Sports Medicine
PubMed: 25899433
DOI: 10.1177/0363546515580290 -
Acta Ortopedica Mexicana 2020This is a systematic literature review for COVID-19, SARS-CoV-2 with Orthopedic and Spine Surgery relevance.
STUDY DESIGN
This is a systematic literature review for COVID-19, SARS-CoV-2 with Orthopedic and Spine Surgery relevance.
OBJECTIVES
It is to determine in Orthopedic surgery and Spine Surgery and its branches the new required safety protocols when attending patients with risk of infection, or transmission for COVID-19 and comorbidities in the outpatient and inpatient hospital setting.
METHODS
A systematic literature review.
RESULTS
Recent knowledge for this disease has changed the Virus affects ORF-8 protein of the Hemoglobin destroying B-Hemoglobin, and IDC (intravascular disseminated coagulation) is found to happen in many patients, together with its capsular capability to adhere to metallic and plastic surfaces, pneumonic pattern associated with ventilator use, and the relapse in some patients, changes the view, preventative measures and treatment of this disease. Publication of global statistics show that patients with hypertension tend to have a higher rate of suffering the disease. Some new measures are proposed.
CONCLUSIONS
New care guidelines for COVID-19 patients are proposed based on the new research on SARS-CoV-2 clinical pathologic findings are necessary.
Topics: COVID-19; Humans; Orthopedic Procedures; Orthopedics; SARS-CoV-2
PubMed: 33417752
DOI: No ID Found