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Osteoporosis International : a Journal... Aug 2020This systematic review and meta-analysis set out to determine the effect of dynamic resistance exercise (DRT) on areal bone mineral density (aBMD) in postmenopausal... (Meta-Analysis)
Meta-Analysis
Effects of dynamic resistance exercise on bone mineral density in postmenopausal women: a systematic review and meta-analysis with special emphasis on exercise parameters.
This systematic review and meta-analysis set out to determine the effect of dynamic resistance exercise (DRT) on areal bone mineral density (aBMD) in postmenopausal women and derive evidence-based recommendations for optimized training protocols. A systematic review of the literature according to the PRISMA statement included (a) controlled trials, (b) of isolated DRT with at least one exercise and one control group, (c) with intervention durations ≥ 6 months, (d) aBMD assessments at lumbar spine or proximal femur, (e) in cohorts of postmenopausal women. We searched eight electronic databases up to March 2019 without language restrictions. The meta-analysis was performed using a random-effects model. Standardized mean differences (SMD) for BMD changes at lumbar spine (LS), femoral neck (FN), and total hip (TH) were defined as outcome measures. Moderators of the exercise effects, i.e., "intervention length," "type of DRT," "training frequency," "exercise intensity," and "exercise volume," were addressed by sub-group analyses. The study was registered in the international prospective register of systematic reviews (PROSPERO) under ID: CRD42018095097. Seventeen articles with 20 exercise and 18 control groups were eligible. SMD average is 0.54 (95% CI 0.22-0.87) for LS-BMD, 0.22 (0.07-0.38) for FN-BMD, and 0.48 (0.22-0.75) for TH-BMD changes (all p ≤ 0.015). While sub-group analysis for FN-BMD revealed no differences within categories of moderators, lower training frequency (< 2 sessions/week) resulted in significantly higher BMD changes at LS and TH compared to higher training frequency (≥ 2 sessions/week). Additionally, free weight training was significantly superior to DRT devices for improving TH-BMD. This work provided further evidence for significant, albeit only low-moderate, effects of DRT on LS-, FN-, and TH-BMD. Unfortunately, sub-analysis results did not allow meaningful exercise recommendations to be derived. This systematic review and meta-analysis observed a significant low-moderate effect of dynamic resistance exercise on bone mineral density changes in postmenopausal women. However, sub-group analyses focusing on exercise characteristics found no results that enable the derivation of meaningful exercise recommendations in the area of exercise and osteoporosis prevention or therapy.
Topics: Aged; Bone Density; Exercise; Female; Femur Neck; Humans; Lumbar Vertebrae; Middle Aged; Osteoporosis, Postmenopausal; Postmenopause; Resistance Training
PubMed: 32399891
DOI: 10.1007/s00198-020-05441-w -
Sports (Basel, Switzerland) Feb 2023Knowledge of muscular forces and adaptations with hamstring-specific exercises can optimize exercise prescription and tendon remodeling; however, studies investigating... (Review)
Review
Knowledge of muscular forces and adaptations with hamstring-specific exercises can optimize exercise prescription and tendon remodeling; however, studies investigating the effectiveness of the current conservative management of proximal hamstring tendinopathy (PHT) and outcomes are lacking. The purpose of this review is to provide insights into the efficacy of conservative therapeutic interventions in the management of PHT. In January 2022, databases including PubMed, Web of Science, CINAHL, and Embase were searched for studies assessing the effectiveness of conservative intervention compared with that of a placebo or combination of treatments on functional outcomes and pain. Studies that performed conservative management (exercise therapy and/or physical therapy modalities) in adults 18-65 years were included. Studies that performed surgical interventions or whose subjects had complete hamstring rupture/avulsion greater than a 2 cm displacement were excluded. A total of 13 studies were included: five studies compared exercise interventions, while eight studies investigated a multimodal approach of either shockwave therapy and exercise or a hybrid model incorporating exercise, shockwave therapy, and other modalities, such as ultrasound, trigger point needling, or instrument-assisted soft tissue mobilization. This review supports the notion that the conservative management of PHT may best be optimized through a multimodal approach incorporating a combination of tendon-specific loading at an increased length, lumbopelvic stabilization exercises, and extracorporeal shockwave therapy. With regard to hamstring-specific exercise selection, PHT may be optimally managed by including a progressive loading program at combined angles of the hip flexion at 110 degrees and the knee flexion between 45 and 90 degrees.
PubMed: 36976939
DOI: 10.3390/sports11030053 -
The Japanese Dental Science Review Nov 2022There has been a debate about the use of Hall Technique (HT), whether it can be considered as a standard technique for the management of carious primary molars. (Review)
Review
BACKGROUND
There has been a debate about the use of Hall Technique (HT), whether it can be considered as a standard technique for the management of carious primary molars.
AIM
To summarise the evidence on HT for managing dentine caries in primary teeth.
DESIGN
MEDLINE, Embase, CENTRAL and Epistemonikos databases were searched for clinical studies conducted from 2007 to 2021 evaluating HT in primary teeth. Two reviewers independently screened, data extracted and quality assessed the studies.
RESULTS
Eleven publications from eight unique studies were included. Four were of low risk of bias overall and five studies were included in a meta-analysis. Overall, HT was 49 % (RR 1.49 [95 % CI: 1.15-1.93], I =89.5 %, p < 0.001) more likely to succeed. When compared to direct restorations, HT was 80 % more likely to succeed; while similar success was found when compared to conventional preformed metal crowns. HT was also over 6 times (RR 0.16 [95 %CI: 0.10-0.27], I =0 %, p < 0.001) less likely to fail. Most of the studies included proximal or multi-surface lesions.
CONCLUSIONS
HT is successful option for the management of caries in primary teeth, particularly for proximal or multi-surface dentine lesions. It is well-tolerated by children and acceptable to parent, with mild adverse effects reported.
PubMed: 36185501
DOI: 10.1016/j.jdsr.2022.09.003 -
Chiropractic & Manual Therapies Dec 2022Clinicians rely on certain physical examination tests to diagnose and potentially grade ankle sprains and ankle instability. Diagnostic error and inaccurate prognosis...
INTRODUCTION
Clinicians rely on certain physical examination tests to diagnose and potentially grade ankle sprains and ankle instability. Diagnostic error and inaccurate prognosis may have important repercussions for clinical decision-making and patient outcomes. Therefore, it is important to recognize the diagnostic value of orthopaedic tests through understanding the reliability and validity of these tests.
OBJECTIVE
To systematically review and report evidence on the reliability and validity of orthopaedic tests for the diagnosis of ankle sprains and instability.
METHODS
PubMed, CINAHL, Scopus, and Cochrane databases were searched from inception to December 2021. In addition, the reference list of included studies, located systematic reviews, and orthopaedic textbooks were searched. All articles reporting reliability or validity of physical examination or orthopaedic tests to diagnose ankle instability or sprains were included. Methodological quality of the reliability and the validity studies was assessed with The Quality Appraisal for Reliability studies checklist and the Quality Assessment of Diagnostic Accuracy Studies-2 respectively. We identified the number of times the orthopaedic test was investigated and the validity and/or reliability of each test.
RESULTS
Overall, sixteen studies were included. Three studies assessed reliability, eight assessed validity, and five evaluated both. Overall, fifteen tests were evaluated, none demonstrated robust reliability and validity scores. The anterolateral talar palpation test reported the highest diagnostic accuracy. Further, the anterior drawer test, the anterolateral talar palpation, the reverse anterior lateral drawer test, and palpation of the anterior talofibular ligament reported the highest sensitivity. The highest specificity was attributed to the anterior drawer test, the anterolateral drawer test, the reverse anterior lateral drawer test, tenderness on palpation of the proximal fibular, and the squeeze test.
CONCLUSION
Overall, the diagnostic accuracy, reliability, and validity of physical examination tests for the assessment of ankle instability were limited. Physical examination tests should not be used in isolation, but rather in combination with the clinical history to diagnose an ankle sprain. Preliminary evidence suggests that the overall validity of physical examination for the ankle may be better if conducted five days after the injury rather than within 48 h of injury.
Topics: Humans; Ankle; Reproducibility of Results; Ankle Joint; Physical Examination; Joint Instability; Ankle Injuries
PubMed: 36536446
DOI: 10.1186/s12998-022-00470-0 -
PloS One 2020Phantom limb pain (PLP)-pain felt in the amputated limb-is often accompanied by significant suffering. Estimates of the burden of PLP have provided conflicting data. To... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Phantom limb pain (PLP)-pain felt in the amputated limb-is often accompanied by significant suffering. Estimates of the burden of PLP have provided conflicting data. To obtain a robust estimate of the burden of PLP, we gathered and critically appraised the literature on the prevalence and risk factors associated with PLP in people with limb amputations.
METHODS
Articles published between 1980 and July 2019 were identified through a systematic search of the following electronic databases: MEDLINE/PubMed, PsycINFO, PsycArticles, Cumulative Index to Nursing and Allied Health Literature, Africa-Wide Information, Health Source: Nursing/Academic Edition, SCOPUS, Web of Science and Academic Search Premier. Grey literature was searched on databases for preprints. Two reviewers independently conducted the screening of articles, data extraction and risk of bias assessment. The meta-analyses were conducted using the random effects model. A statistically significant level for the analyses was set at p<0.05.
RESULTS
The pooling of all studies demonstrated a prevalence estimate of 64% [95% CI: 60.01-68.05] with high heterogeneity [I2 = 95.95% (95% CI: 95.10-96.60)]. The prevalence of PLP was significantly lower in developing countries compared to developed countries [53.98% vs 66.55%; p = 0.03]. Persistent pre-operative pain, proximal site of amputation, stump pain, lower limb amputation and phantom sensations were identified as risk factors for PLP.
CONCLUSION
This systematic review and meta-analysis estimates that six of every 10 people with an amputation report PLP-a high and important prevalence of PLP. Healthcare professionals ought to be aware of the high rates of PLP and implement strategies to reduce PLP by addressing known risk factors, specifically those identified by the current study.
Topics: Amputation, Surgical; Clinical Decision-Making; Humans; Phantom Limb; Prevalence; Risk Factors
PubMed: 33052924
DOI: 10.1371/journal.pone.0240431 -
Healthcare (Basel, Switzerland) Dec 2022(1) Background and purpose: Muscular control and motor function in a patient with Patellofemoral pain syndrome (PFPS) have not yet been investigated systematically.... (Review)
Review
(1) Background and purpose: Muscular control and motor function in a patient with Patellofemoral pain syndrome (PFPS) have not yet been investigated systematically. Therefore, this review synthesis the previous results about the association of PFPS with gluteus muscle activation, hip strength, and kinematic characteristic of the hip and knee joint, to deepen understanding of the PFPS etiology and promote the establishment of an effective treatment strategy. (2) Methods: A literature search was conducted from January 2000 to July 2022 in four electronic databases: Medline, Embase, Google scholar, and Scopus. A total of 846 articles were initially identified, and after the screening process based on the inclusion criteria, 12 articles were eventually included. Means and SDs of gluteus medius (GMed), gluteus maximus (GMax), hip strength, and kinematic variation of hip and knee were retrieved from the present study. (3) Results and conclusion: Regarding kinematic variation, moderate evidence indicates that an increased peak hip adduction was found in PFPS groups during running and single leg (SL) squat activities. There is no difference in the GMed and GMax activation levels between the two groups among the vast majority of functional activities. Most importantly, strong evidence suggests that hip strength is weaker in individuals with PFPS, showing less strength of hip external rotation and hip abduction compared to the control group. However, without prospective studies, it is difficult to determine whether hip strength weakness is a cause or a result of PFPS. Therefore, further research is needed to evaluate the hip strength level in identifying individuals most likely to associated with PFPS development is needed.
PubMed: 36611559
DOI: 10.3390/healthcare11010099 -
The Knee Mar 2022Primary repair of anterior cruciate ligament (ACL) ruptures has re-emerged as a treatment option for proximal tears, with internal brace augmentation often utilised. The... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Primary repair of anterior cruciate ligament (ACL) ruptures has re-emerged as a treatment option for proximal tears, with internal brace augmentation often utilised. The aim of this study is to provide an overview of the current evidence presenting outcomes of ACL repair with internal bracing to assess the safety and efficacy of this technique.
METHODS
All studies reporting outcomes of arthroscopic primary repair of proximal ACL tears, augmented with internal bracing from 2014-2021 were included. Primary outcome was failure rate and secondary outcomes were subjective patient reported outcome measures (PROMs) and objective assessment of anteroposterior knee laxity.
RESULTS
Nine studies were included, consisting of 347 patients, mean age 32.5 years, mean minimum follow up 2 years. There were 36 failures (10.4%, CI 7.4% - 14.1%). PROMs reporting was variable across studies. KOOS, Lysholm and IKDC scores were most frequently used with mean scores > 87%. The mean Tegner and Marx scores at follow-up were 6.1 and 7.8 respectively. The mean side to side difference measured for anteroposterior knee laxity was 1.2mm.
CONCLUSIONS
This systematic review with meta-analysis shows that ACL repair with internal bracing is a safe technique for treatment of proximal ruptures, with a failure rate of 10.4%. Subjective scores and clinical laxity testing also revealed satisfactory results. This suggests that ACL repair with internal bracing should be considered as an alternative to ACL reconstruction for acute proximal tears, with the potential benefits of retained native tissue and proprioception, as well as negating the need for graft harvest.
Topics: Adult; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Follow-Up Studies; Humans; Knee Joint; Treatment Outcome
PubMed: 35366618
DOI: 10.1016/j.knee.2022.03.009 -
BMC Musculoskeletal Disorders Feb 2023The incidence of Achilles tendinopathy has risen over the past decades. Insertional Achilles tendinopathy is characterised by tissue degeneration of the Achilles tendon... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The incidence of Achilles tendinopathy has risen over the past decades. Insertional Achilles tendinopathy is characterised by tissue degeneration of the Achilles tendon from its insertion in the calcaneus to up to 2 cm proximally. This clinical condition is accompanied by pain, loss of function and diminished exercise tolerance. Numerous conservative treatment modalities are available to participants with insertional Achilles tendinopathy, including eccentric exercises, extracorporeal shockwave therapy, laser therapy, cryotherapy, therapeutic ultrasound, and orthotics. Eccentric exercise and extracorporeal shockwave therapy may reduce pain in participants with non-calcified insertional Achilles tendinopathy. However, no specific treatment is recommended over another due to the low methodological quality of trials. Given the lack of standard or preferred non-surgical treatment and the potential risks of surgical treatment, there is an imminent need to reassess different non-surgical treatments based on the newest evidence. Thus, this systematic review aims to evaluate the clinical effectiveness of the various non-surgical treatments for insertional Achilles tendinopathy.
METHODS
AMED EBSCOhost, CINAHL, EBSCOhost, EMBASE, PEDro, PubMed, Web of Science, and Clinicaltrials.gov were searched from 1992 to 14th October 2022, randomised controlled trials of adults with insertional Achilles tendinopathy investigating non-surgical treatments compared with each other or no treatment, placebo/sham control. Two reviewers independently screened and extracted the data. Random effects of network meta-analysis immediately after treatments were used to report comparative treatment effects. The surface under the cumulative ranking probabilities was calculated to assess the relative ranking of treatments.
RESULTS
Nine trials (total n = 464 participants) were included. This review recommended the combination of eccentric exercise and soft tissue therapy to manage insertional Achilles tendinopathy. With the highest SUCRA values of 84.8, and the best mean rank of 1.9, Eccentric exercise plus soft tissue treatment ranked as the most effective treatment for short-term pain.
CONCLUSIONS
This is the first NMA of non-surgical treatment focusing on short-term pain control for IAT which eccentric exercise plus soft-tissue therapy was found to be the most effective treatment combination. However, the overall confidence in non-surgical treatments from all included trials was very low. No recommendation of the best treatment option can be made from this review.
Topics: Adult; Humans; Achilles Tendon; Network Meta-Analysis; Tendinopathy; Exercise Therapy; Pain; Treatment Outcome; Musculoskeletal Diseases
PubMed: 36750789
DOI: 10.1186/s12891-023-06170-x -
International Journal of Sports... 2021Blood flow restriction (BFR) training has been reported to have significant benefits on local skeletal muscle including increasing local muscle mass, strength, and...
BACKGROUND
Blood flow restriction (BFR) training has been reported to have significant benefits on local skeletal muscle including increasing local muscle mass, strength, and endurance while exercising with lower resistance. As a result, patients unable to perform traditional resistance training may benefit from this technique. However, it is unclear what effects BFR may have on other body systems, such as the cardiovascular and pulmonary systems. It is important to explore the systemic effects of BFR training to ensure it is safe for use in physical therapy.
PURPOSE
The purpose of this study was to systematically review the systemic effects of blood flow restriction training when combined with exercise intervention.
STUDY DESIGN
Systematic review.
METHODS
Three literature searches were performed: June 2019, September 2019, and January 2020; using MedLine, ScienceDirect, PubMed, Cochrane Reviews and CINAHL Complete. Inclusion criteria included: at least one outcome measure addressing a cardiovascular, endocrinological, systemic or proximal musculoskeletal, or psychosocial outcome, use of clinically available blood flow restriction equipment, use of either resistance or aerobic training in combination with BFR, and use of quantitative measures. Exclusion criteria for articles included only measuring local or distal musculoskeletal changes due to BFR training, examining only passive BFR or ischemic preconditioning, articles not originating from a scholarly peer-reviewed journal, CEBM level of evidence less than two, or PEDro score less than four. Articles included in this review were analyzed with the CEBM levels of evidence hierarchy and PEDro scale.
RESULTS
Thirty-five articles were included in the review. PEDro scores ranged between 4 and 8, and had CEBM levels of evidence of 1 and 2. Common systems studied included cardiovascular, musculoskeletal, endocrine, and psychosocial. This review found positive or neutral effects of blood flow restriction training on cardiovascular, endocrinological, musculoskeletal, and psychosocial outcomes.
CONCLUSIONS
Although BFR prescription parameters and exercise interventions varied, the majority of included articles reported BFR training to produce favorable or non-detrimental effects to the cardiovascular, endocrine, and musculoskeletal systems. This review also found mixed effects on psychosocial outcomes when using BFR. Additionally, this review found no detrimental outcomes directly attributed to blood flow restriction training on the test subjects or outcomes tested. Thus, BFR training may be an effective intervention for patient populations that are unable to perform traditional exercise training with positive effects other than traditional distal muscle hypertrophy and strength and without significant drawbacks to the individual.
LEVEL OF EVIDENCE
1b.
PubMed: 34386277
DOI: 10.26603/001c.25791 -
Blood Advances Apr 2020Deep vein thrombosis (DVT) of the lower extremities can be associated with significant morbidity and may progress to pulmonary embolism and postthrombotic syndrome.... (Meta-Analysis)
Meta-Analysis
Deep vein thrombosis (DVT) of the lower extremities can be associated with significant morbidity and may progress to pulmonary embolism and postthrombotic syndrome. Early diagnosis and treatment are important to minimize the risk of these complications. We systematically reviewed the accuracy of diagnostic tests for first-episode and recurrent DVT of the lower extremities, including proximal compression ultrasonography (US), whole leg US, serial US, and high-sensitivity quantitative D-dimer assays. We searched Cochrane Central, MEDLINE, and EMBASE for eligible studies, reference lists of relevant reviews, registered trials, and relevant conference proceedings. Two investigators screened and abstracted data. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. We pooled estimates of sensitivity and specificity. The review included 43 studies. For any suspected DVT, the pooled estimates for sensitivity and specificity of proximal compression US were 90.1% (95% confidence interval [CI], 86.5-92.8) and 98.5% (95% CI, 97.6-99.1), respectively. For whole-leg US, pooled estimates were 94.0% (95% CI, 91.3-95.9) and 97.3% (95% CI, 94.8-98.6); for serial US pooled estimates were 97.9% (95% CI, 96.0-98.9) and 99.8% (95% CI, 99.3-99.9). For D-dimer, pooled estimates were 96.1% (95% CI, 92.6-98.0) and 35.7% (95% CI, 29.5-42.4). Recurrent DVT studies were not pooled. Certainty of evidence varied from low to high. This systematic review of current diagnostic tests for DVT of the lower extremities provides accuracy estimates. The tests are evaluated when performed in a stand-alone fashion, and in a diagnostic pathway. The pretest probability of DVT often assessed by a clinical decision rule will influence how, together with sensitivity and specificity estimates, patients will be managed.
Topics: Humans; Lower Extremity; Pulmonary Embolism; Sensitivity and Specificity; Ultrasonography; Venous Thrombosis
PubMed: 32227213
DOI: 10.1182/bloodadvances.2019000960