Background It is unclear whether femoroacetabular impingement syndrome (FAIS) affect hip range of... more Background It is unclear whether femoroacetabular impingement syndrome (FAIS) affect hip range of motion (ROM). Sources of data We performed a systematic review with meta-analysis searching six electronic databases from inception to March 21, 2022. We included studies assessing hip ROM in FAIS, FAI morphology without symptoms (FAIm), and healthy controls. Mean differences between groups were measured in ROM degrees with 95% confidence interval (CI). Areas of agreement A total of 17 studies (1702 hips) were included. Comparison of FAIS patients versus healthy controls showed that hip ROM was clinically and statistically reduced in FAIS for internal rotation (90° hip flexion, −8.01°, 95% CI: –11.21, −4.90; 0° hip flexion −6.38°, 95% CI: –9.79, −2.97); adduction (90° hip flexion, −4.74°, 95% CI: –8.13, −1.34); flexion (−5.41°, 95% CI: –7.05, −3.49), abduction (0° hip flexion, −5.76°, 95% CI: –8.38, −3.23), and external rotation (90° hip flexion, −3.5°, 95% CI: –5.32, −1.67) ranging fro...
ABSTRACTBackground and ObjectivesRisk of bias is a critical issue to consider when appraising stu... more ABSTRACTBackground and ObjectivesRisk of bias is a critical issue to consider when appraising studies. Generally, the higher the risk of bias of a study, the less confidence there will be that the results are valid. Considering that low back pain is recognized to have an extremely high disease burden; exercise therapy is one of the most frequently prescribed interventions for chronic low back pain (CLBP) and that most low back pain trials have methodological limitations that could bias treatment effect estimates; the objective of this study is to explore causal pathways between the sources of risk of bias and estimates of the treatment effect of exercise therapy interventions in CLBP trials.MethodsThe 249 RCTs included in the 2021 Cochrane review publication “Exercise therapy for chronic low back pain” will be included. The risk of bias will be evaluated with the Cochrane Risk of Bias 2 tool (ROB 2). Causal pathways between the exposure (risk of bias domains) and our outcomes of int...
Supplementary material â S1. Clinical rating performances between physically active and non- phys... more Supplementary material â S1. Clinical rating performances between physically active and non- physically active groups. (DOCX 14 kb)
BACKGROUND Early detection of critical bleeding by accurate tools can help ensure rapid delivery ... more BACKGROUND Early detection of critical bleeding by accurate tools can help ensure rapid delivery of blood products to improve outcomes in major trauma patients. We conducted a systematic review to evaluate the accuracy of risk tools to predict critical bleeding in patients with major trauma. METHODS PubMed, Embase and CENTRAL were searched up to February 2021 for studies investigating risk tools to predict critical bleeding for major trauma people in pre-hospital and emergency department. We followed the PRISMA-DTA guidelines. Two independent authors included studies, extracted data, appraised the quality using the Quality Assessment of Diagnostic Accuracy Studies-2 and assessed the certainty of evidence using thee Grading of Recommendations Assessment, Development and Evaluation methodology. Sensitivity, specificity and the Receiver Operating Characteristics curve for all selected triage tools. RESULTS Eighty-nine observational studies for adults and 12 observational studies for children met our inclusion criteria. In adults, we found 23 externally validated and 28 un-validated tools; in children, 3 externally validated tools and 5 un-validated. In the externally validated tools, we identified those including clinical, laboratory and ultrasound assessments. Among tools including only a clinical assessment, the Shock Index showed high sensitivity and specificity with the Certainty of Evidence ranging from very low to moderate in adults, as well as Shock Index Pediatric Age-adjusted (SIPA) with a moderate Certainty of Evidence. We found that tools using clinical, laboratory and ultrasound assessments were overall more accurate than those tools without all three components. CONCLUSIONS Clinicians should consider risk tools to predict critical bleeding in a time-sensitive setting like major life threatening trauma. The Shock index and SIPA are easy and handy tools to predict critical bleeding in the pre-hospital setting. In the emergency department, however, many other tools can be utilized which include laboratory and ultrasound assessments, depending on staff experience and resources. LEVEL OF EVIDENCE Systematic review, diagnostic Level III.
The International Journal of Health Planning and Management, 2021
AimTo analyse the amount of Human Resources for Health (HRH) research publication trends [1990–20... more AimTo analyse the amount of Human Resources for Health (HRH) research publication trends [1990–2019], compared to the broader health policy, systems, and services research (HPSSR).MethodsPubMed and its indexation system with Medical Subject Headings (MeSH) are used for this time‐trend study. Searches combine MeSH terms for research publications and HPSSR or HRH subjects, except education. Sub‐group searches are conducted on: funding support, and high‐ versus low‐ and middle‐income countries (HICs vs. LMICs). Linear regressions are used for the analysis.ResultsHRH research publications rose exponentially (r2 = 0.94; p < 0.001) from 129 yearly publications in 1990, to 867 in 2018. Yet, HRH research publications had a logarithmic decrease (p < 0.001) in percentage of broader HPSSR publications, from 2.5% to 1.5% [1990–2018]. Funding support increased significantly and linearly (p < 0.001 r2 = 0.88), up to 44% in 2018. The percentage of HRH research publications addressing LMIC...
database underlying the findings of the study "Reliability and applicability of the revised ... more database underlying the findings of the study "Reliability and applicability of the revised Cochrane risk-of-bias tool for randomised trials (RoB 2): low inter-rater reliability and challenges in application" submitte to the Journal of Clinical Epidemiology
Acupuncture and dry needling in the management of myofascial trigger point pain: a systematic rev... more Acupuncture and dry needling in the management of myofascial trigger point pain: a systematic review and meta-analysis of randomised controlled trials.
Background Influenza is one of the most common respiratory viral infections worldwide. Numerous v... more Background Influenza is one of the most common respiratory viral infections worldwide. Numerous vaccines are used to prevent influenza. Their selection should be informed by the best available evidence. We aimed to estimate the comparative efficacy and safety of seasonal influenza vaccines in children, adults and the elderly. Methods We conducted a systematic review and network meta-analysis (NMA). We searched the Cochrane Library Central Register of Controlled Trials, MEDLINE and EMBASE databases, and websites of regulatory agencies, through December 15th, 2020. We included placebo-or no vaccination-controlled, and head-to-head randomized clinical trials (RCTs). Pairs of reviewers independently screened the studies, abstracted the data, and appraised the risk of bias in accordance to the Cochrane Handbook for Systematic Reviews of Interventions. The primary outcome was laboratory-confirmed influenza. We also synthesized data for hospitalization, mortality, influenza-like illness (ILI), pneumonia or lower respiratory-tract disease, systemic and local adverse events (AEs). We estimated summary risk ratios (RR) using pairwise and NMA with random effects. This study is registered with PROSPERO, number CRD42018091895. Findings We identified 13,439 citations. A total of 231 RCTs were included after screening: 11 studies did not provide useful data for the analysis; 220 RCTs [100,677 children (< 18 years) and 329,127 adults (18−60 years) and elderly (≥ 61 years)] were included in the NMA. In adults and the elderly, all vaccines, except the trivalent inactivated intradermal vaccine (3-IIV ID), were more effective than placebo in reducing the risk of laboratory-confirmed influenza, with a RR between 0.33 (95% credible interval [CrI] 0.21−0.55) for trivalent inactivated high-dose (3-IIV HD) and 0.56 (95% CrI 0.41−0.74) for trivalent live-attenuated vaccine (3-LAIV). In adults and the elderly, compared with trivalent inactivated vaccine (3-IIV), no significant differences were found for any, except 3-LAIV, which was less efficacious [RR 1.41 (95% CrI 1.04−1.88)]. In children, compared with placebo, RR ranged between 0.13 (95% CrI 0.03 −0.51) for trivalent inactivated vaccine adjuvanted with MF59/AS03 and 0.55 (95% CrI 0.36−0.83) for trivalent inactivated vaccine. Compared with 3-IIV, 3-LAIV and trivalent inactivated adjuvanted with MF59/AS03 were more efficacious [RR 0.52 (95% CrI 0.32−0.82) and RR 0.23 (95% CrI 0.06−0.87)] in reducing laboratory-confirmed influenza. With regard to safety, higher systemic AEs rates after vaccination with 3-IIV, 3-IIV HD, 3-IIV ID, 3-IIV Abbreviations: AE, adverse event; CI, confidence interval; CrI, credible interval; IIV, inactivated influenza vaccine; ILI, influenza-like illness; LAIV, live-attenuated influenza vaccine; NMA, network meta-analysis; RCT, randomized controlled trial; RIV, recombinant influenza vaccine; RR, risk ratio; SUCRA, surface under the cumulative ranking curve; 3-IIV, trivalent inactivated influenza vaccine; 3-IIV HD, trivalent inactivated high-dose influenza vaccine; 3-IIV ID, trivalent inactivated intradermal influenza vaccine; 3-IIV MF59/AS03-adj, trivalent inactivated influenza vaccine adjuvanted with MF59/AS03; 3-IIV vir/lip-adj, trivalent inactivated influenza vaccine adjuvanted with virosome/liposome; 3-RIV, trivalent recombinant influenza vaccine; 4-IIV, quadrivalent inactivated influenza vaccine; 4-IIV HD, quadrivalent inactivated high-dose influenza vaccine; 4-IIV ID, quadrivalent inactivated intradermal influenza vaccine; 4-IIV MF59/AS03-adj, quadrivalent inactivated influenza vaccine adjuvanted with MF59/AS03; 4-IIV vir/lip-adj, quadrivalent inactivated influenza vaccine adjuvanted with virosome/liposome; 4-RIV, quadrivalent recombinant influenza vaccine; 3-LAIV, trivalent live-attenuated influenza vaccine; 4-LAIV, quadrivalent live-attenuated influenza vaccine
Background: Muscular dystrophy causes weakness and muscle loss. The effect of muscular exercise i... more Background: Muscular dystrophy causes weakness and muscle loss. The effect of muscular exercise in these patients remains controversial. Objective: To assess the effects of muscular exercise vs. no exercise in patients with muscular dystrophy. Methods: We performed a comprehensive systematic literature search in the Medline, Embase, Web of Science, Scopus, and Pedro electronic databases, as well as in the reference literature. We included randomized clinical trials (RCTs) that reported the effect of muscular exercise on muscle strength, endurance during walking, motor abilities, and fatigue. Data were extracted independently by two reviewers. Mean difference (MD) and 95% confidence intervals (CI) were used to quantify the effect associated with each outcome. We performed pairwise meta-analyses and trial sequential analyses (TSA) and used GRADE to rate the overall certainty of evidence. Results: We identified 13 RCTs involving 617 patients. The median duration of exercise interventions was 16 weeks [interquartile range [IQR] 12-24]. In the patients with facio-scapulo-humeral dystrophy and myotonic dystrophy, no significant difference in extensor muscle strength was noted between the exercise and the control groups [four studies, 115 patients, MD 4.34, 95% CI −4.20 to 12.88, I 2 = 69%; p = 0.32; minimal important difference [MID] 5.39 m]. Exercise was associated with improved endurance during walking [five studies, 380 patients, MD 17.36 m, 95% CI 10.91-23.81, I 2 = 0; p < 0.00001; MID 34 m]. TSA excluded random error as a cause of the findings for endurance during walking. Differences in fatigue and motor abilities were small. Not enough information was found for other types of dystrophy. Conclusions: Muscular exercise did not improve muscle strength and was associated with modest improvements in endurance during walking in patients with facio-scapulo-humeral and myotonic dystrophy. Future trials should explore which type of muscle exercise could lead to better improvements in muscle strength.
Background It is unclear whether femoroacetabular impingement syndrome (FAIS) affect hip range of... more Background It is unclear whether femoroacetabular impingement syndrome (FAIS) affect hip range of motion (ROM). Sources of data We performed a systematic review with meta-analysis searching six electronic databases from inception to March 21, 2022. We included studies assessing hip ROM in FAIS, FAI morphology without symptoms (FAIm), and healthy controls. Mean differences between groups were measured in ROM degrees with 95% confidence interval (CI). Areas of agreement A total of 17 studies (1702 hips) were included. Comparison of FAIS patients versus healthy controls showed that hip ROM was clinically and statistically reduced in FAIS for internal rotation (90° hip flexion, −8.01°, 95% CI: –11.21, −4.90; 0° hip flexion −6.38°, 95% CI: –9.79, −2.97); adduction (90° hip flexion, −4.74°, 95% CI: –8.13, −1.34); flexion (−5.41°, 95% CI: –7.05, −3.49), abduction (0° hip flexion, −5.76°, 95% CI: –8.38, −3.23), and external rotation (90° hip flexion, −3.5°, 95% CI: –5.32, −1.67) ranging fro...
ABSTRACTBackground and ObjectivesRisk of bias is a critical issue to consider when appraising stu... more ABSTRACTBackground and ObjectivesRisk of bias is a critical issue to consider when appraising studies. Generally, the higher the risk of bias of a study, the less confidence there will be that the results are valid. Considering that low back pain is recognized to have an extremely high disease burden; exercise therapy is one of the most frequently prescribed interventions for chronic low back pain (CLBP) and that most low back pain trials have methodological limitations that could bias treatment effect estimates; the objective of this study is to explore causal pathways between the sources of risk of bias and estimates of the treatment effect of exercise therapy interventions in CLBP trials.MethodsThe 249 RCTs included in the 2021 Cochrane review publication “Exercise therapy for chronic low back pain” will be included. The risk of bias will be evaluated with the Cochrane Risk of Bias 2 tool (ROB 2). Causal pathways between the exposure (risk of bias domains) and our outcomes of int...
Supplementary material â S1. Clinical rating performances between physically active and non- phys... more Supplementary material â S1. Clinical rating performances between physically active and non- physically active groups. (DOCX 14 kb)
BACKGROUND Early detection of critical bleeding by accurate tools can help ensure rapid delivery ... more BACKGROUND Early detection of critical bleeding by accurate tools can help ensure rapid delivery of blood products to improve outcomes in major trauma patients. We conducted a systematic review to evaluate the accuracy of risk tools to predict critical bleeding in patients with major trauma. METHODS PubMed, Embase and CENTRAL were searched up to February 2021 for studies investigating risk tools to predict critical bleeding for major trauma people in pre-hospital and emergency department. We followed the PRISMA-DTA guidelines. Two independent authors included studies, extracted data, appraised the quality using the Quality Assessment of Diagnostic Accuracy Studies-2 and assessed the certainty of evidence using thee Grading of Recommendations Assessment, Development and Evaluation methodology. Sensitivity, specificity and the Receiver Operating Characteristics curve for all selected triage tools. RESULTS Eighty-nine observational studies for adults and 12 observational studies for children met our inclusion criteria. In adults, we found 23 externally validated and 28 un-validated tools; in children, 3 externally validated tools and 5 un-validated. In the externally validated tools, we identified those including clinical, laboratory and ultrasound assessments. Among tools including only a clinical assessment, the Shock Index showed high sensitivity and specificity with the Certainty of Evidence ranging from very low to moderate in adults, as well as Shock Index Pediatric Age-adjusted (SIPA) with a moderate Certainty of Evidence. We found that tools using clinical, laboratory and ultrasound assessments were overall more accurate than those tools without all three components. CONCLUSIONS Clinicians should consider risk tools to predict critical bleeding in a time-sensitive setting like major life threatening trauma. The Shock index and SIPA are easy and handy tools to predict critical bleeding in the pre-hospital setting. In the emergency department, however, many other tools can be utilized which include laboratory and ultrasound assessments, depending on staff experience and resources. LEVEL OF EVIDENCE Systematic review, diagnostic Level III.
The International Journal of Health Planning and Management, 2021
AimTo analyse the amount of Human Resources for Health (HRH) research publication trends [1990–20... more AimTo analyse the amount of Human Resources for Health (HRH) research publication trends [1990–2019], compared to the broader health policy, systems, and services research (HPSSR).MethodsPubMed and its indexation system with Medical Subject Headings (MeSH) are used for this time‐trend study. Searches combine MeSH terms for research publications and HPSSR or HRH subjects, except education. Sub‐group searches are conducted on: funding support, and high‐ versus low‐ and middle‐income countries (HICs vs. LMICs). Linear regressions are used for the analysis.ResultsHRH research publications rose exponentially (r2 = 0.94; p < 0.001) from 129 yearly publications in 1990, to 867 in 2018. Yet, HRH research publications had a logarithmic decrease (p < 0.001) in percentage of broader HPSSR publications, from 2.5% to 1.5% [1990–2018]. Funding support increased significantly and linearly (p < 0.001 r2 = 0.88), up to 44% in 2018. The percentage of HRH research publications addressing LMIC...
database underlying the findings of the study "Reliability and applicability of the revised ... more database underlying the findings of the study "Reliability and applicability of the revised Cochrane risk-of-bias tool for randomised trials (RoB 2): low inter-rater reliability and challenges in application" submitte to the Journal of Clinical Epidemiology
Acupuncture and dry needling in the management of myofascial trigger point pain: a systematic rev... more Acupuncture and dry needling in the management of myofascial trigger point pain: a systematic review and meta-analysis of randomised controlled trials.
Background Influenza is one of the most common respiratory viral infections worldwide. Numerous v... more Background Influenza is one of the most common respiratory viral infections worldwide. Numerous vaccines are used to prevent influenza. Their selection should be informed by the best available evidence. We aimed to estimate the comparative efficacy and safety of seasonal influenza vaccines in children, adults and the elderly. Methods We conducted a systematic review and network meta-analysis (NMA). We searched the Cochrane Library Central Register of Controlled Trials, MEDLINE and EMBASE databases, and websites of regulatory agencies, through December 15th, 2020. We included placebo-or no vaccination-controlled, and head-to-head randomized clinical trials (RCTs). Pairs of reviewers independently screened the studies, abstracted the data, and appraised the risk of bias in accordance to the Cochrane Handbook for Systematic Reviews of Interventions. The primary outcome was laboratory-confirmed influenza. We also synthesized data for hospitalization, mortality, influenza-like illness (ILI), pneumonia or lower respiratory-tract disease, systemic and local adverse events (AEs). We estimated summary risk ratios (RR) using pairwise and NMA with random effects. This study is registered with PROSPERO, number CRD42018091895. Findings We identified 13,439 citations. A total of 231 RCTs were included after screening: 11 studies did not provide useful data for the analysis; 220 RCTs [100,677 children (< 18 years) and 329,127 adults (18−60 years) and elderly (≥ 61 years)] were included in the NMA. In adults and the elderly, all vaccines, except the trivalent inactivated intradermal vaccine (3-IIV ID), were more effective than placebo in reducing the risk of laboratory-confirmed influenza, with a RR between 0.33 (95% credible interval [CrI] 0.21−0.55) for trivalent inactivated high-dose (3-IIV HD) and 0.56 (95% CrI 0.41−0.74) for trivalent live-attenuated vaccine (3-LAIV). In adults and the elderly, compared with trivalent inactivated vaccine (3-IIV), no significant differences were found for any, except 3-LAIV, which was less efficacious [RR 1.41 (95% CrI 1.04−1.88)]. In children, compared with placebo, RR ranged between 0.13 (95% CrI 0.03 −0.51) for trivalent inactivated vaccine adjuvanted with MF59/AS03 and 0.55 (95% CrI 0.36−0.83) for trivalent inactivated vaccine. Compared with 3-IIV, 3-LAIV and trivalent inactivated adjuvanted with MF59/AS03 were more efficacious [RR 0.52 (95% CrI 0.32−0.82) and RR 0.23 (95% CrI 0.06−0.87)] in reducing laboratory-confirmed influenza. With regard to safety, higher systemic AEs rates after vaccination with 3-IIV, 3-IIV HD, 3-IIV ID, 3-IIV Abbreviations: AE, adverse event; CI, confidence interval; CrI, credible interval; IIV, inactivated influenza vaccine; ILI, influenza-like illness; LAIV, live-attenuated influenza vaccine; NMA, network meta-analysis; RCT, randomized controlled trial; RIV, recombinant influenza vaccine; RR, risk ratio; SUCRA, surface under the cumulative ranking curve; 3-IIV, trivalent inactivated influenza vaccine; 3-IIV HD, trivalent inactivated high-dose influenza vaccine; 3-IIV ID, trivalent inactivated intradermal influenza vaccine; 3-IIV MF59/AS03-adj, trivalent inactivated influenza vaccine adjuvanted with MF59/AS03; 3-IIV vir/lip-adj, trivalent inactivated influenza vaccine adjuvanted with virosome/liposome; 3-RIV, trivalent recombinant influenza vaccine; 4-IIV, quadrivalent inactivated influenza vaccine; 4-IIV HD, quadrivalent inactivated high-dose influenza vaccine; 4-IIV ID, quadrivalent inactivated intradermal influenza vaccine; 4-IIV MF59/AS03-adj, quadrivalent inactivated influenza vaccine adjuvanted with MF59/AS03; 4-IIV vir/lip-adj, quadrivalent inactivated influenza vaccine adjuvanted with virosome/liposome; 4-RIV, quadrivalent recombinant influenza vaccine; 3-LAIV, trivalent live-attenuated influenza vaccine; 4-LAIV, quadrivalent live-attenuated influenza vaccine
Background: Muscular dystrophy causes weakness and muscle loss. The effect of muscular exercise i... more Background: Muscular dystrophy causes weakness and muscle loss. The effect of muscular exercise in these patients remains controversial. Objective: To assess the effects of muscular exercise vs. no exercise in patients with muscular dystrophy. Methods: We performed a comprehensive systematic literature search in the Medline, Embase, Web of Science, Scopus, and Pedro electronic databases, as well as in the reference literature. We included randomized clinical trials (RCTs) that reported the effect of muscular exercise on muscle strength, endurance during walking, motor abilities, and fatigue. Data were extracted independently by two reviewers. Mean difference (MD) and 95% confidence intervals (CI) were used to quantify the effect associated with each outcome. We performed pairwise meta-analyses and trial sequential analyses (TSA) and used GRADE to rate the overall certainty of evidence. Results: We identified 13 RCTs involving 617 patients. The median duration of exercise interventions was 16 weeks [interquartile range [IQR] 12-24]. In the patients with facio-scapulo-humeral dystrophy and myotonic dystrophy, no significant difference in extensor muscle strength was noted between the exercise and the control groups [four studies, 115 patients, MD 4.34, 95% CI −4.20 to 12.88, I 2 = 69%; p = 0.32; minimal important difference [MID] 5.39 m]. Exercise was associated with improved endurance during walking [five studies, 380 patients, MD 17.36 m, 95% CI 10.91-23.81, I 2 = 0; p < 0.00001; MID 34 m]. TSA excluded random error as a cause of the findings for endurance during walking. Differences in fatigue and motor abilities were small. Not enough information was found for other types of dystrophy. Conclusions: Muscular exercise did not improve muscle strength and was associated with modest improvements in endurance during walking in patients with facio-scapulo-humeral and myotonic dystrophy. Future trials should explore which type of muscle exercise could lead to better improvements in muscle strength.
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