Comparative efficacy of treatments for a first-time traumatic anterior shoulder dislocation: a systematic review and network meta-analysis.

BACKGROUND: First-time traumatic anterior shoulder dislocation (FASD) is a common trauma associated with shoulder dysfunction. Although several randomized controlled trials have compared conservative and surgical treatments for FASD, the comparative efficacy of these treatments is poorly understood. In this network meta-analysis (NMA), we compared the available evidence on the efficacy of various interventions in patients with FASD. METHODS: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE databases in March 2023. This NMA included randomized controlled trials comparing conservative and surgical treatments for FASD, including arthroscopic Bankart repair, arthroscopic lavage, external rotation (ER) immobilization, and internal rotation (IR) immobilization. The primary outcomes were redislocation rates, Western Ontario Shoulder Instability Index (WOSI) scores, and adverse events (AEs). We conducted random-effects NMA within the frequentist framework. To rank the treatments, the Surface Under the Cumulative Ranking curve was calculated using a Bayesian framework. We evaluated confidence in each outcome using the CINeMA tool. RESULTS: Of the 2999 reviewed studies, 15 were included and analyzed. Regarding the primary outcomes, arthroscopic Bankart repair likely results in a large reduction in redislocation rates compared to IR immobilization (risk ratio [RR], 0.15; 95% confidence interval [CI], 0.07-0.33). Both arthroscopic lavage (RR, 0.47; 95% CI, 0.20-1.11) and ER immobilization (RR 0.70; 95% CI, 0.50-1.00) may reduce the redislocation rates slightly compared with IR immobilization. According to these results, arthroscopic Bankart repair ranked first in terms of reducing the redislocation rate, followed by arthroscopic lavage, ER and IR immobilization. Regarding the WOSI score, no substantial differences were observed in the WOSI scores among the four treatments. AEs showed that ER immobilization tended to cause greater shoulder stiffness than IR immobilization, and postoperative erythema, swelling, and adhesive capsulitis were observed after arthroscopic Bankart repair and lavage. However, a meta-analysis was not performed because the definitions of AEs differed between the studies. CONCLUSION: Arthroscopic Bankart repair showed a significant effect in reducing the redislocation rate compared to IR immobilization. Although both arthroscopic lavage and ER immobilization seemed to be effective in reducing the redislocation rates, it was not statistically significant. Moreover, these four treatments may result in little to no difference in disease-specific quality of life and there is no clear evidence of AEs.

Association between a history of major osteoporotic fractures and subsequent hip fracture: a systematic review and meta-analysis.

PURPOSE: A history of fractures involving the distal radius, proximal humerus, spine, and hip may be associated with the incidence of subsequent hip fractures in older people. However, a comprehensive summary of this association using a rigorous methodology is lacking. Our objective was to systematically review the literature and examine the association between four major osteoporotic fractures and subsequent hip fractures in individuals aged ≥ 50 years. METHODS: We searched MEDLINE, Embase, CENTRAL, ICTRP, and ClinicalTrials.gov on February 15, 2023. The search included cohort or case-control studies investigating the association between these four types of osteoporotic fractures and subsequent hip fractures. We pooled the hazard ratios (HRs) with 95% confidence intervals (CI) using the random-effects model. We used the Quality In Prognosis Studies tool to assess the risk of bias in the included studies, and the grading of recommendations assessment, development, and evaluation approach to determine the certainty of evidence. RESULTS: The selection process identified 48 studies for qualitative synthesis and 23 studies (2,239,217 participants) for meta-analysis. The overall methodological quality had a low risk of bias in 65% of the included studies. The association between a history of major osteoporotic fractures and subsequent hip fracture varied, with a high certainty of evidence for a history of proximal humerus and hip fractures (HR 2.02, 95% CI 1.75-2.33 and 2.86, 95% CI 1.92-4.25, respectively), moderate certainty for distal radius fractures (HR 1.66, 95% CI 1.53-1.81), and low certainty for spine fractures (HR 1.53, 95% CI 1.38-1.69). CONCLUSIONS: In conclusion, a history of major osteoporotic fractures, particularly distal radius, proximal humerus, and hip fractures, is associated with subsequent hip fractures in older adults. Further research is needed to verify the association between a history of spine fracture and subsequent hip fractures. PROTOCOL REGISTRATION: Open Science Framework ( https://osf.io/7fjuc ).

Comparison of Postoperative outcomes Among Patients Treated by Male Versus Female Surgeons: A Systematic Review and Meta-analysis.

OBJECTIVE: To compare clinical outcomes of patients treated by female surgeons versus those treated by male surgeons. SUMMARY BACKGROUND DATA: It remains unclear as to whether surgical performance and outcomes differ between female and male surgeons. METHODS: We conducted a meta-analysis to compare patients' clinical outcomes-including patients' postoperative mortality, readmission, and complication rates-between female versus male surgeons. MEDLINE, Embase, CENTRAL, ICTRP, and ClinicalTrials.gov were searched from inception to September 8, 2022. The update search was conducted on July 19, 2023. We used random-effects models to synthesize data and GRADE to evaluate the certainty. RESULTS: A total of 15 retrospective cohort studies provided data on 5,448,121 participants. We found that patients treated by female surgeons experienced a lower post-operative mortality compared with patients treated by male surgeons (8 studies; adjusted odds ratio [aOR], 0.93; 95%CI, 0.88 - 0.97; I2=27%; moderate certainty of the evidence). We found a similar pattern for both elective and non-elective (emergent or urgent) surgeries, although the difference was larger for elective surgeries (test for subgroup difference P=0.003). We found no evidence that female and male surgeons differed for patient readmission (3 studies; aOR, 1.20; 95%CI, 0.83 - 1.74; I2=92%; very low certainty of the evidence) or complication rates (8 studies; aOR, 0.94; 95%CI, 0.88 - 1.01: I2=38%; very low certainty of the evidence). CONCLUSIONS: This systematic review and meta-analysis suggests that patients treated by female surgeons have a lower mortality compared with those treated by male surgeons.

Association between Conflicts of Interest Disclosure and Quality of Clinical Practice Guidelines in Japan: A Meta-Epidemiological Study.

Accurate disclosure of financial conflicts of interest (COI) among clinical practice guideline (CPG) developers is critical to ensure the quality of CPGs. However, there is limited evidence on the impact of underreporting COIs on the quality of CPGs. This study aimed to examine the proportion of underreported COI disclosures in the development of Japanese CPGs and to estimate the association between underreported COIs and CPG quality using the Appraisal of Guidelines for Research & Evaluation (AGREE) II. Twenty-three Japanese CPGs published in 2019 and their 1114 developers were included in the study. The results show that underreporting of COIs occurred in 52% of the included CPGs and 8% of all CPG developers. Underreporting COI disclosures was negatively associated with low-quality CPG (Odds ratio [OR], 0.57; 95% confidence interval [CI]: 0.11, 3.04). On the other hand, CPGs that had more than 13% of CPG developers with voting rights on recommendation decisions and underreporting of COI disclosures were positively associated with low quality (OR, 1.78; 95% CI: 0.25, 12.45). For individual CPG developers with voting rights for recommendation decisions, the presence of a COI was positively associated with low quality (OR, 1.11; 95% CI: 0.71, 1.75). This study demonstrates that the involvement and underreporting of COIs did not seriously distort the CPG development process. However, the COI-related factors of CPG developers with voting rights for recommendation decisions may be associated with low CPG quality.

Efficacy of neuromuscular electrical stimulation for thoracic and abdominal surgery: A systematic review and meta-analysis.

This systematic review and meta-analysis examined the efficacy of neuromuscular electrical stimulation (NMES) on lower limb muscle strength and health-related quality of life (HR-QOL) after thoracic and abdominal surgery. We searched the Cochrane Central Register of Controlled Trials, MEDLINE via PubMed, Excerpta Medica Database via Elsevier, Physiotherapy Evidence Database, Cumulative Index to Nursing and Allied Health Literature, World Health Organization International Clinical Trials Registry Platform via their dedicated search portal, and ClinicalTrials.gov on November 2021 and updated in April 2023 to identify randomized controlled trials that examined the effects of NMES after thoracic and abdominal surgery. The primary outcomes were lower limb muscle strength, HR-QOL, and adverse events. We used the Cochrane Risk of Bias Tool and the Grading of Recommendations, Assessment, Development, and Evaluation approach to assess the certainty of evidence. A total of 18 randomized control trials involving 915 participants, including 10 on cardiovascular surgery, two on pulmonary surgery, five on digestive system surgery, and one on other surgery, were included. NMES slightly increased lower limb muscle strength and adverse events in cardiovascular surgery. Adverse events (hypotension, pain, and muscle discomfort) occurred in seven patients. HR-QOL was measured in two studies on cardiovascular surgery, but these were not pooled due to concept heterogeneity. Overall, NMES slightly increases lower limb muscle strength after cardiovascular surgery without serious adverse events. However, higher-quality randomized control trials in thoracic and abdominal surgeries are needed.

Epidemiology and Reporting Characteristics of Systematic Reviews in Orthopedic Journals: A Meta-Epidemiological Study.

Systematic reviews (SRs) with complete reporting or rigorous methods can lead to less biased recommendations and decisions. A comprehensive analysis of the epidemiological and reporting characteristics of SRs in orthopedics is lacking. We evaluated 360 SRs, including 165 and 195 published in orthopedic journals in 2012 and 2022. According to the established reporting guidelines, we examined these SRs for key epidemiological characteristics, including focus areas, type of meta-analysis (MA), and reporting characteristics. Most SRs (71%) were therapy-related, with a significant proportion originating from authors in the USA, UK, and China. Pairwise MA was performed on half of the SRs. The proportion of protocol registrations improved by 2022 but remained low (33%). Despite a formal declaration of adherence to the reporting guidelines (68%), they were often not used and reported enough. Only 10% of the studies used full search strategies, including trial registries. Publication bias assessments, subgroup analyses, and sensitivity analyses were not even planned. The risk of bias assessment improved in 2022; however, the certainty of the evidence remained largely unassessed (8%). The use and reporting of standard methods in orthopedic SRs have remained suboptimal. Thus, authors, peer reviewers, journal editors, and readers should criticize the results more.

Prediction Models for Intravenous Immunoglobulin Resistance in Kawasaki Disease: A Meta-analysis.

CONTEXT: Approximately 10% to 20% of patients with Kawasaki disease (KD) are refractory to initial intravenous immunoglobulin (IVIG) therapy. KD is mainly associated with coronary artery abnormalities. OBJECTIVES: To identify and evaluate all developed prediction models for IVIG resistance in patients with KD and synthesize evidence from external validation studies that evaluated their predictive performances. DATA SOURCES: PubMed Medline, Dialog Embase, the Cochrane Central Register of Controlled Trials, the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov were searched from inception until October 5, 2021. STUDY SELECTION: All cohort studies that reported patients diagnosed with KD who underwent an initial IVIG of 2 g/kg were selected. DATA EXTRACTION: Study and patient characteristics and model performance measures. Two authors independently extracted data from the studies. RESULTS: The Kobayashi, Egami, Sano, Formosa, and Harada scores were the only prediction models with 3 or more external validation of the161 model analyses in 48 studies. The summary C-statistics were 0.65 (95% confidence interval [CI]: 0.57-0.73), 0.63 (95% CI: 0.55-0.71), 0.58 (95% CI: 0.55-0.60), 0.50 (95% CI: 0.36-0.63), and 0.63 (95% CI: 0.44-0.78) for the Kobayashi, Egami, Sano, Formosa, and Harada models, respectively. All 5 models showed low positive predictive values (0.14-0.39) and high negative predictive values (0.85-0.92). LIMITATIONS: Potential differences in the characteristics of the target population among studies and lack of assessment of calibrations. CONCLUSIONS: None of the 5 prediction models with external validation accurately distinguished between patients with and without IVIG resistance.

The effectiveness of exercise with behavior change techniques in people with knee osteoarthritis: A systematic review with meta-analysis.

OBJECTIVE: The purpose of this systematic review with meta-analysis was to examine the effectiveness of exercise with behavior change techniques (BCTs) on core outcome sets in people with knee osteoarthritis. LITERATURE SURVEY: We searched randomized controlled trials (RCTs) in eight databases (MEDLINE, Embase, CENTRAL, CINAHL, PsycINFO, PEDro, ICTRP, and ClinicalTrials.gov) up to November 4, 2021. METHODOLOGY: Eligible participants were people with knee osteoarthritis. The intervention was exercise with BCTs. Primary outcomes included physical function, quality of life (QOL) 6 to 12 months after intervention, and adverse events. Secondary outcomes were knee pain, exercise adherence, mobility, and self-efficacy 3 months or more after intervention. The bias risk was assessed using the Risk of Bias 2 tool. The random-effects model was used for the meta-analysis. SYNTHESIS: We found 16 individual BCTs, and 37.7% of trials used a single BCT. For meta-analysis, we included 21 RCTs (n = 1623). Most outcomes had a very low certainty of evidence, and the risk of bias was the consistent reason for downgrading evidence levels. The standardized mean difference (SMD) with 95% confidence interval (95% CI) was 0.00 (-0.24, 0.24) in physical function, 0.33 (-0.51, 1.17) in exercise adherence, and 0.04 (-0.39, 0.47) in self-efficacy. The risk ratio (95% CI) of adverse events was 3.6 (0.79, 16.45). QOL was not pooled due to insufficient data (very low certainty of evidence). In contrast, the SMD (95% CI) for knee pain reduction and mobility improvement was -0.33 (-0.53, -0.13) and 0.21 (-0.05, 0.47) with moderate and low certainty of evidence, respectively. CONCLUSION: The evidence is inconclusive regarding the effectiveness of BCTs with exercises on core outcome sets. Further research should explore the effectiveness of BCTs with valid design. PROTOCOL REGISTRATION: PROSPERO (CRD42020212904).

Methodological Quality of Physical Therapy-Related Trials Published in Open Access and Subscription Journal: A Cross-sectional Meta-Epidemiological Study.

OBJECTIVE: We aimed to compare the methodological quality of physical therapy-related trials published in open access with that of trials published in subscription-based journals, adjusting for subdiscipline, intervention type, endorsement of the Consolidated Standards of Reporting Trials, impact factor, and publication language. DESIGN: In this meta-epidemiological study, we searched the Physiotherapy Evidence Database on May 8, 2021, to include any physical therapy-related trials published from January 1, 2020. We extracted variables such as Consolidated Standards of Reporting Trials endorsement, the Physiotherapy Evidence Database score, and publication type. We compared the Physiotherapy Evidence Database score between the publication types using a multivariable generalized estimating equation by adjusting for covariates. RESULTS: A total of 2743 trials were included, with a mean total Physiotherapy Evidence Database score (standard deviation) of 5.8 (±1.5). Trials from open access journals had a lower total Physiotherapy Evidence Database score than those from subscription-based journals (5.5 ± 1.5 vs. 5.9 ± 1.5, mean difference = -0.4; 95% confidence interval = 0.3-0.5). Generalized estimating equation revealed that open access publication was significantly associated with the total Physiotherapy Evidence Database score (mean difference = -0.42; P < 0.001). CONCLUSIONS: In the recent physical therapy-related trials, open access publications demonstrated lower methodological quality than subscription-based publications, although with a small difference.

Beta-lactam allergy and drug challenge test in children: a systematic review and meta-analysis.

BACKGROUND: Most cases of beta-lactam allergy in children are likely to be mislabeled. This study aimed to assess the prevalence of true positives, as determined by drug challenge tests, and the rate of false negatives in children with suspected allergies and confirm the safety of the drug challenge test. METHODS: We conducted a systematic review and meta-analysis according to established procedures. Study participants were children with suspected beta-lactam allergy who underwent a drug challenge. PubMed MEDLINE, Dialog EMBASE, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform, and clinicaltrials.gov were searched from inception until March 5, 2021. RESULTS: The pooled prevalence of (a) positive results in the first challenge was 0.049 (95% CI, 0.041-0.057; I2 = 71%) from 78 studies; (b) serious adverse events was 0.00 (95% CI, 0.00-0.00; I2 = 0.0%) from 62 studies; and (c) positive results in the second challenge after the first negative result was 0.028 (95% CI, 0.016-0.043; I2 = 38%) from 18 studies. CONCLUSIONS: The prevalence of children with suspected beta-lactam allergy with true-positive results and false-negative results from the drug challenge test was very low. Serious adverse events resulting from drug challenge tests were also very rare. IMPACT: Most children with suspected beta-lactam allergy were likely to be mislabeled. Serious adverse events caused by the drug challenge test were rare. Few false-negative results were obtained from the drug challenge test.

Efficacy of Pelvic Floor Muscle Training for Postoperative Patients With Rectal Cancer: A Systematic Review and Meta-Analysis.

This study aimed to assess the effectiveness of pelvic floor muscle training (PFMT) for fecal incontinence (FI) and health-related quality of life (HR-QOL) after colorectal cancer surgery. This systematic review (SR) and meta-analysis included randomized controlled trials (RCTs) that examined the effects of PFMT after colorectal cancer surgery, which were extracted from several databases in January 2023. The primary outcomes were FI (Wexner scores), HR-QOL, and adverse events. We used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of evidence (CoE). A total of seven RCTs were included. Our SR results suggested that PFMT showed little to no difference in FI (mean difference 0.62 higher; 95% CI: -1.26 to 2.5, low CoE) and adverse events (risk ratio 5.78; 95% CI: 0.28-117.22, low CoE). Two adverse events occurred in the PFMT group (anastomotic stenosis, suboptimal use of laxatives) and were not observed in controls. HR-QOL was measured in two RCTs using 12-item Short Form Survey (SF-12) and fecal incontinence quality of life (FIQL). Two RCTs found no trend toward a positive impact on HR-QOL. Higher quality RCTs on colorectal cancer after surgery are required. Furthermore, extending the duration of the PFMT intervention may be necessary to ensure its success.

Diagnostic accuracy of pelvic imaging for acute pelvic inflammatory disease in an emergency care setting: a systematic review and meta-analysis.

The aim of this review is to investigate the diagnostic accuracy or performance of contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) for acute pelvic inflammatory disease (PID) in an emergency care setting. We searched for studies on the diagnostic test accuracy of contrast-enhanced CT or MRI for women of reproductive age with acute abdominal pain using MEDLINE, Embase, Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform, and ClinicalTrials.gov. The reference standard was gynecological examinations by gynecologists using standard diagnostic criteria with or without laparoscopy or transcervical endometrial biopsy. Two reviewers undertook screening of records, data extraction, and assessment of the risk of bias in each included study using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A bivariate model was used for the meta-analysis. Of 2,619 screened studies, three studies investigating contrast-enhanced CT and one study investigating MRI were eligible, including a total 635 patients and with a median prevalence of acute PID of 29%. All of the included studies had a high risk of bias for a reference standard and had some applicability concerns. Contrast-enhanced CT had a pooled sensitivity of 0.79 (95% confidence interval [CI], 0.52-0.93) and specificity of 0.99 (95% CI, 0.94-1.00). Magnetic resonance imaging had a sensitivity of 0.95 (95% CI, 0.76-1.00) and specificity of 0.89 (95% CI, 0.52-1.00). Contrast-enhanced CT might serve as a practical alternative to gynecological examination in the diagnosis of acute PID in an emergency care setting, however, the evidence was uncertain. The evidence on MRI was also very uncertain.

Retracted randomized controlled trials were cited and not corrected in systematic reviews and clinical practice guidelines.

BACKGROUND AND OBJECTIVES: To investigate whether and when the correction is done in Systematic Reviews (SRs) and Clinical Practice Guidelines (CPGs) when included Randomized Controlled Trials (RCTs) have been retracted. METHODS: In this meta-epidemiological study, we included SRs and CPGs citing the retracted RCTs from the Retraction Watch Database. We investigated how often the retracted RCTs were cited in SRs and CPGs. We also investigated whether and when such SRs and CPGs corrected themselves. RESULTS: We identified 587 articles (525 SRs and 62 CPGs) citing retracted RCTs. Among the 587 articles, 252 (43%) were published after retraction, and 335 (57%) were published before retraction. Among 127 articles published citing already retracted RCTs in their evidence synthesis without caution, none corrected themselves after publication. Of 335 articles published before retraction, 239 included RCTs that were later retracted in their evidence synthesis. Among them, only 5% of SRs (9/196) and 5% of CPGs (2/43) corrected or retracted their results. CONCLUSION: Many SRs and CPGs included already or later retracted RCTs without caution. Most of them were never corrected. The scientific community, including publishers and researchers, should make systematic and concerted efforts to remove the impact of retracted RCTs.

Gender Differences in Life-space Mobility-associated Factors and Structures in Community-dwelling Older People.

Objectives: This cross-sectional study sought to examine gender dissimilarities in factors and structures associated with life-space mobility (LSM) in community-dwelling older people. Methods: This study included a total of 294 older people living in Okawa, Fukuoka Prefecture, Japan. The subjects' body mass index (BMI) and skeletal muscle mass index (SMI) were evaluated. Furthermore, the age, gender, and LSM of the participants were assessed. LSM was assessed using a framework based on social isolation, fall self-efficacy, mobility, cognitive function, and lower limb muscle strength. Path analysis was performed to assess LSM-associated factors and their respective effect sizes (ESs), and male and female LSM models were established. Results: Path analysis identified SMI and social isolation as direct factors and cognitive function as an indirect factor associated with LSM in both men and women. In the male LSM model, the direct factors in descending order of ES were BMI, social isolation, SMI, and lower limb muscle strength. In the female model, the direct factors in descending order of ES were age, fall self-efficacy, mobility, social isolation, and SMI; age was noted as having an indirect effect on the remaining associated factors. Conclusions: This study clarified the gender differences in factors influencing LSM and the underlying structure of LSM mediation by these factors. Therefore, gender differences should be considered when planning interventions aimed at improving the LSM and general well-being of older people, particularly for community-dwelling individuals.

Relationship between single-leg stance test with light touch and hip muscle strength in healthy young adults.

[Purpose] This study investigated the relationship between the single-leg stance test with light touch and hip rotator muscle strength. [Participants and Methods] Thirty-one healthy young adults participated in the study. A single leg stance test with light touch was performed to evaluate the participants' static balance ability. The duration that an individual could successfully perform the single leg stance test with light touch in the eyes open was measured. The participants were instructed to slightly touch their right index fingertip on the digital scale. The hip muscle strength of the internal rotators and external rotators were measured by the isometric peak torque. The internal/external rotator strength ratio was calculated by dividing the strength of the internal rotator by that of the external rotator. [Results] The hip external rotator muscle strength was higher in males than in females. Moreover, there was a significant correlation between the single-leg stance test with light touch and hip external rotator muscle strength in males and between the single leg stance test with light touch and hip internal rotator muscle strength in females. Furthermore, a significant positive correlation was found between the single leg stance test with light touch and hip internal rotator/external rotator ratio in males. [Conclusion] We concluded that the single leg stance test with light touch is a useful tool to evaluate static hip muscle strength.

Physical Therapists' Perception and Educational Opportunities to Improve Exercise Adherence in Older Patients and Clients: A Qualitative Study.

OBJECTIVES: : The aim of the study was to understand the physical therapist's experience and perception of the support they give to their older patients or clients to continue exercising. METHODS: : Using purposive sampling, we recruited fifteen physical therapists with more than 5 years of clinical experience and conducted semi-structured interviews. We analyzed the transcribed data using thematic analysis. RESULTS: : Three main themes emerged: (1) the expected results as healthcare professionals, (2) clinical experience and continuing professional development, and (3) limited educational opportunities. Physical therapists struggled to achieve a certain level of exercise adherence in their patients, and the low success rate decreased their confidence. We found that physical therapists needed not only to rely on clinical experience but also to integrate scientific evidence to implement better behavioral change techniques; they would also appreciate receiving appropriate educational opportunities. CONCLUSIONS: : This study revealed a possibility of educational insufficiency for physical therapist to support of behavior change to improve exercise adherence in the older population.