Quantity and quality are increasing but there's room for improvement: A scoping review of physical activity intervention trials.

BACKGROUND: Observing trends in research publications helps to identify the quantity and quality of research produced, as well as reveal evidence gaps. No comprehensive review of the quality and quantity of physical activity intervention trials has been conducted. OBJECTIVE: We aimed to investigate i) the volume and quality (and changes in these over time) of randomized controlled trials evaluating physical activity interventions, and ii) the association between journal ranking and trial quality. METHODS: We searched the Physiotherapy Evidence Database (PEDro) for trials investigating physical activity interventions (no restrictions for population, comparison, or language). Descriptive statistics were used to describe the volume and quality of trials. The association between journal ranking (Journal Impact Factor) and trial quality (PEDro Scale) was examined using Spearman's rho correlation. RESULTS: We identified 1779 trials, of which 40% (n = 710) were published between 2016 and 2020. The mean (SD) total PEDro score was 5.3 (1.5) points out of 10, increasing over time from 2.5 (0.7) points in 1975-1980 to 5.6 (1.4) points in 2016-2020. Quality criteria that were least reported included blinding of intervention deliverers (therapists) (n = 3, 0.2%), participants (n = 21, 1.2%), or assessors (n = 541, 31%); concealed allocation to groups (n = 526, 30%); and intention to treat analysis (n = 764, 43%). There was a small correlation between trial quality and Journal Impact Factor (0.21, p < 0.001). CONCLUSION: A large volume of trials has investigated physical activity interventions. The quality of these trial reports is suboptimal but improving over time. Journal ranking should not be used for selecting high quality trials.

Effects of sport or physical recreation for adults with physical or intellectual disabilities: a systematic review with meta-analysis.

OBJECTIVES: To evaluate the effects of sport or physical recreation on participation, mobility and quality of life for adults living with disabilities. DESIGN: Systematic review with meta-analysis. DATA SOURCES: Six databases searched from inception to May 2022. ELIGIBILITY CRITERIA: Randomised controlled trials including adults living with a physical or intellectual disability, comparing sport or physical recreation to non-active control. RESULTS: Seventy-four trials (n=2954; mean age 55 years) were included. Most (70) trials included people with physical disabilities, none evaluated sport and the most common physical recreation activities tested were traditional Chinese exercise (35%), yoga (27%) and dance (18%). Mean frequency and duration was 65 min/session, two times per week for 13 weeks. Most (86%) interventions were led by people with experience and/or training in the recreation activity, and only 37% reported leader experience and/or training working with people with disabilities. Participation was measured as attendance (mean 81%, 30 intervention groups). Physical recreation improved mobility (standardised mean difference (SMD) 0.38, 95% CI 0.07 to 0.69, n=469) and walking endurance (mean difference (MD) 40.3 m, 95% CI 19.5 to 61.1, n=801) with low certainty evidence and balance (Berg Balance Scale, range 0-56 points; MD 3.4 points, 95% CI 2.3 to 4.4, n=906) and quality of life (physical health; SMD 0.37, 95% CI 0.02 to 0.72, n=468) with very low certainty evidence, but not walking speed (MD 0.03 m/s, 95% CI -0.05 to 0.11, n=486). CONCLUSION: Physical recreation may confer multiple benefits for people living with disabilities regardless of the activity chosen, thus offering a potentially enjoyable and scalable strategy to increase physical activity. PROSPERO REGISTRATION NUMBER: CRD42018104379.

Evolution of the thematic structure and main producers of physical therapy interventions research: A bibliometric analysis (1986 to 2017).

BACKGROUND: Bibliometric studies are used to analyse and map scientific areas, and study the scientific output and impact of institutes and countries. OBJECTIVES: Describe the thematic structure and evolution of the field of physical therapy interventions using articles indexed in Physiotherapy Evidence Database (PEDro). Also, identify and compare the main producers (countries, institutions) over time (research output, citation impact). METHODS: Eligible articles were those indexed in PEDro (1986-2017) and matched to Web of Science. VOSviewer software, bibliometric text mining, and visualisation techniques were used to evaluate the thematic structure of the included articles. We collected data about authors' country and institutional affiliation, and calculated bibliometric indicators (production, citation impact). RESULTS: A total of 29 090 articles were analysed. Eight topics were identified: "neurological rehabilitation"; "methods"; "exercise for prevention and rehabilitation of lifestyle diseases"; "assessment and treatment of musculoskeletal pain"; "physical activity", "health promotion and behaviour change"; "respiratory physical therapy"; "hospital, primary care and health economics"; "cancer and complementary therapies". The most productive countries were United States, United Kingdom, Australia, and Canada. The most impactful countries were United States, France, Finland, and Canada. The most productive institutions were University of Sydney, VU University of Amsterdam, University of Queensland, and University of Toronto. CONCLUSIONS: The thematic structure of physical therapy interventions has evolved over time with "neurological rehabilitation", "methods", "exercise related to lifestyle diseases", and "physical activity" becoming increasingly important. Main producers of this research were traditionally located in North America and Europe but now include countries like China and Brazil.

The Physiotherapy Evidence Database (PEDro) has better free full-text access than PubMed: An observational study.

BACKGROUND: Access to full-text articles is an essential element of evidence-based practice. OBJECTIVE: Estimate the percentage of articles in the Physiotherapy Evidence Database (PEDro) that have free full-text access and compare free access between PEDro and PubMed. Secondary objectives for access via PEDro: determine if publication year and geographic location impact on free access; determine if adding a link to a portable document format (PDF) locator website would improve free access; and evaluate the association between article characteristics and free access. METHODS: This observational study used a random sample of 200 articles published in 2000-2019 and indexed in PEDro. Data collectors in Australia, Brazil, Nepal, and Spain attempted to access free full text for each article via PEDro. One data collector attempted to access free full text via PubMed. One data collector attempted to access full text via a PDF locator (http://www.pdfsearchengine.net/). The percentage (95% confidence interval [CI]) of articles with free full-text access from PEDro, PubMed, and the PDF locator website were calculated. Logistic regression was used to evaluate the association between free full-text access and article characteristics. RESULTS: Free full text could be accessed via PEDro for 51% of the articles (95% CI: 44, 58). PEDro had 4% higher free access than PubMed (95% CI: 1, 7). Access via PEDro did not vary systematically with time, geographic location, or article characteristics. Access improved by 9% (95% CI: 6, 14) by adding a PDF locator website. CONCLUSIONS: PEDro is a good source of free full-text articles for physical therapists and other rehabilitation professionals. Evidence resources, professional organisations, employers, researchers, and research agencies could all help to increase access to free full text.

Knowledge, skills and barriers to evidence-based practice and the impact of a flipped classroom training program for physical therapists: An observational study.

OBJECTIVE: To evaluate the knowledge, skills and barriers to evidence-based practice and the impact of evidence-based practice training for physical therapy clinicians. METHODS: Physical therapists from a health district in Sydney, Australia were invited to participate. The primary outcome was the Assessing Competency in Evidence-based Medicine scale (range 0-15; 15 is high knowledge and skill) to quantify knowledge and skills. The secondary outcomes were the four subscales of the BARRIERS scale (range 1-4; 4 is high barrier) to quantify barriers. Outcomes were collected at baseline and post an evidence-based practice training program (flipped classroom approach that addressed the core competencies for teaching evidence-based practice) of 3 months duration. Registration: Australian and New Zealand Clinical Trial Register (ACTRN12619000038190). RESULTS: 104 participants completed baseline data and 94 completed post-training data. The mean score for the Assessing Competency in Evidence-based Medicine scale for knowledge and skills at baseline was 9.5 (standard deviation 1.6). The mean BARRIERS subscale scores at baseline were: Healthcare Provider 1.9 (0.5); Research 2.2 (0.5); Setting 2.6 (0.5); and Presentation 2.6 (0.5). On average, training increased the Assessing Competency in Evidence-based Medicine scale score by 0.1 points (95% confidence interval -0.2 to 0.5) and reduced barriers by -0.1 (-0.2 to 0.0; Setting subscale) to -0.2 (-0.3 to -0.1; Healthcare Provider subscale). CONCLUSIONS: Physical therapists have knowledge and skill in evidence-based practice that is comparable to other allied health professionals, medical students and medical doctors, and encountered barriers to using high-quality clinical research to guide practice. Training did not change knowledge and skills but did reduce barriers.

What makes a great clinical trial in physiotherapy?

OBJECTIVE: To identify common characteristics of landmark physiotherapy clinical trials. METHODS: The Physiotherapy Evidence Database (PEDro) top five trials were compared to 91 physiotherapy trials published in top medical journals and 99 trials randomly selected from PEDro on the following characteristics: PEDro score, sample size, number of trial sites, use of prospective registration, positive or negative trial, citations, citations in guidelines, Altmetric score, impact factor, publications and citations of first and last author, and PEDro codes (sub-discipline, topic, problem, therapy, and body part). Trials were published from 2014 to 2019. One-way independent ANOVA and Chi-squared test evaluated between-group differences. RESULTS: Compared to a random sample of physiotherapy trials, the PEDro top five trials and trials in top medical journals have higher PEDro scores, larger sample sizes, more study sites, more citations (including in guidelines), higher Altmetric scores, more likely to be prospectively registered, less likely to be positive trials, and have first and last authors with more citations and publications. The problem was the only PEDro code was distributed differently across the trial groups. CONCLUSION: The PEDro top five trials and physiotherapy trials published in the top medical journals have characteristics that may inform the design, conduct, and reporting of future physiotherapy trials.

Factors associated with the reporting quality of low back pain systematic review abstracts in physical therapy: a methodological study.

BACKGROUND: Abstracts of systematic reviews (SR) are frequently used to guide clinical decision-making. However, if the abstract is inadequately reported, key information may be missing and it may not accurately summarize the results of the review. OBJECTIVE: We aimed to investigate 1) if abstracts are fully reported; 2) if abstract reporting is associated with review/journal characteristics in physical therapy for low back pain (LBP); and 3) if these abstracts are consistent with the corresponding full texts. METHODS: We searched the Physiotherapy Evidence Database for SRs in physical therapy for LBP published between 2015 and 2017. Associations between abstract reporting quality and review/journal characteristics were explored with linear regression. Abstract reporting was assessed with the 12 item Preferred Reporting Items for Systematic Reviews and Meta-Analyses for abstracts (PRISMA-A) checklist. Consistency of reporting between abstracts and the full text was evaluated by comparing responses to each item of the PRISMA-A using Kappa coefficients. Methodological quality of the reviews was assessed with A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2). RESULTS: We included 66 SRs, 9 Cochrane and 57 non-Cochrane. Review methodological quality ranged from 'high' (8%) to 'critically low' (76%). The mean ± SD of the "total number of PRISMA-A fully reported items" (range 0-12 points for fully reported items) was 4.1 ±â€¯1.9 points for non-Cochrane review abstracts and 9.9 ±â€¯1.1 points for Cochrane abstracts. Factors associated with reporting quality of abstracts were: journal impact factor (ß 0.20; 95% CI: 0.06, 0.35), number of words in abstract (ß 0.01; 95% CI: 0.00, 0.01) and review methodological quality ('critically low' with ß -3.06; 95% CI: -5.30, -0.82; with 'high' as reference variable). There was typically inconsistent reporting between abstract and full text, with most Kappa values lower than 0.60. CONCLUSIONS: The abstracts of SRs in physical therapy for LBP were poorly reported and inconsistent with the full text. The reporting quality of abstracts was higher in journals with a higher impact factor, in abstracts with a greater number of words, and when the review was of higher methodological quality.

Exercise to Reduce Mobility Disability and Prevent Falls After Fall-Related Leg or Pelvic Fracture: RESTORE Randomized Controlled Trial.

BACKGROUND: Disability and falls are common following fall-related lower limb and pelvic fractures. OBJECTIVE: To evaluate the impact of an exercise self-management intervention on mobility-related disability and falls after lower limb or pelvic fracture. DESIGN: Randomized controlled trial. PARTICIPANTS: Three hundred thirty-six community dwellers aged 60+ years within 2 years of lower limb or pelvic fracture recruited from hospitals and community advertising. INTERVENTIONS: RESTORE (Recovery Exercises and STepping On afteR fracturE) intervention (individualized, physiotherapist-prescribed home program of weight-bearing balance and strength exercises, fall prevention advice) versus usual care. MAIN MEASURES: Primary outcomes were mobility-related disability and rate of falls. KEY RESULTS: Primary outcomes were available for 80% of randomized participants. There were no significant between-group differences in mobility-related disability at 12 months measured by (a) Short Physical Performance Battery (continuous version, baseline-adjusted between-group difference 0.08, 95% CI - 0.01 to 0.17, p = 0.08, n = 273); (b) Activity Measure Post Acute Care score (0.18, 95% CI - 2.89 to 3.26, p = 0.91, n = 270); (c) Late Life Disability Instrument (1.37, 95% CI - 2.56 to 5.32, p = 0.49, n = 273); or in rate of falls over the 12-month study period (incidence rate ratio 0.96, 95% CI 0.69 to 1.34, n = 336, p = 0.83). Between-group differences favoring the intervention group were evident in some secondary outcomes: balance and mobility, fall risk (Physiological Profile Assessment tool), physical activity, mood, health and community outings, but these should be interpreted with caution due to risk of chance findings from multiple analyses. CONCLUSIONS: No statistically significant intervention impacts on mobility-related disability and falls were detected, but benefits were seen for secondary measures of balance and mobility, fall risk, physical activity, mood, health, and community outings. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12610000805077.

Eight in Every 10 Abstracts of Low Back Pain Systematic Reviews Presented Spin and Inconsistencies With the Full Text: An Analysis of 66 Systematic Reviews.

STUDY DESIGN: Overview study. BACKGROUND: Abstracts of systematic reviews have presented 'spin' (i.e. overstated interpretation of study results) and inconsistency with the full text. OBJECTIVES: 1. Do abstracts of low back pain reviews contain spin? 2. Do these abstracts consistently represent the full text? 3. Is abstract spin associated with the type of conclusion? METHODS: We searched the Physiotherapy Evidence Database (PEDro) on 10th January 2018. Data were extracted from systematic reviews of physiotherapy interventions for low back pain, published between 2015 and 2017. Spin was assessed using a 7-item checklist. We evaluated consistency by comparing information contained in the abstract and the full text using the 7-item checklist with Kappa coefficient analysis. We used logistic regression analysis to evaluate the association between spin in the abstract and type of conclusion. We evaluated methodological quality using the AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews). RESULTS: We included 66 eligible systematic reviews, subdivided into Cochrane (n=9) and non-Cochrane (n=57) reviews. There was some form of spin in 80% of abstracts. Abstracts of non-Cochrane reviews were not consistent with the full text (fair to moderate agreement). Cochrane review abstracts had substantial to almost perfect agreement with the full text. Spin was not associated with the type of conclusion in all systematic reviews (P < 0.05). The methodological quality ranged from 'high' to 'critically low'. CONCLUSIONS: The abstracts of systematic reviews evaluating physiotherapy interventions for low back pain need improvement. J Orthop Sports Phys Ther, Epub 23 Aug 2019. doi:10.2519/jospt.2020.8962.

Tackling the language barrier to implementing research into practice: A survey of usage of the Physiotherapy Evidence Database.

BACKGROUND: Language is a barrier to implementing research evidence into practice. Whilst the majority of the world's population speak languages other than English, English has become the dominant language of publication for research in healthcare. OBJECTIVE: The aim of this study was to quantify the usage of the Physiotherapy Evidence Database (PEDro) web-site (www.pedro.org.au) and training videos by language, including the use of online translation, and to calculate relative usage of the different sections of the web-site. METHODS: Google Analytics was used to track usage of the PEDro web-site for July 2017 to June 2018. The number of views of each of the PEDro training videos was downloaded from YouTube for January 2015 to August 2018. The pageviews and videos were categorized by language and, for pageviews, web-site section. RESULTS: 2,828,422 pageviews were included in the analyses. The English-language sections had the largest number of pageviews (58.61%), followed by Portuguese (15.57%), and Spanish (12.02%). Users applied online translation tools to translate selected content of the PEDro web-site into 41 languages. The PEDro training videos had been viewed 78,150 times. The three most commonly viewed languages were English (58.80%), Portuguese (19.83%), and Spanish (6.13%). CONCLUSIONS: There was substantial use of some of the translated versions of the resources offered by PEDro. Future efforts could focus on region-specific promotion of the language resources that are underutilized in PEDro. The developers of PEDro and PEDro users can work collaboratively to facilitate uptake and translate resources into languages other than English to reduce the language barrier in using research to guide practice.

Using research to guide practice: The Physiotherapy Evidence Database (PEDro).

BACKGROUND: The Physiotherapy Evidence Database (PEDro) is a free, preeminent, global resource to support evidence-based physical therapy. PEDro provides rapid access to randomized controlled trials, systematic reviews, and clinical practice guidelines evaluating physical therapy interventions. METHODS: This paper describes the PEDro scale, PEDro contents, who uses PEDro, searching, browsing the latest content, and developing skills in evidence-based physical therapy. Strategies specifically developed to break down barriers for Portuguese-speaking physical therapists are emphasized. RESULTS: All trials indexed in PEDro are assessed for methodological quality using the 10-point PEDro scale. These ratings are used to rank search results. In August 2019 PEDro indexed 44,309 articles: 34,619 trials, 9004 reviews, and 686 guidelines. The number of trials is predicted to double by 2025. PEDro users come from 214 countries. Physical therapists in Brazil are the largest users (23% of all searches). Physical therapists are encouraged to use the PEDro advanced search page to find answers for their clinical questions. PEDro's 'Evidence in your inbox' allows physical therapists to browse the latest content. To assist users develop skills in evidence-based physical therapy, PEDro includes tutorials and a series of 'how to' videos. PEDro web-site is fully available in Portuguese and English. CONCLUSION: PEDro facilitates the use of high-quality clinical research by physical therapy clinicians, educators, students, and researchers. In 2019 PEDro celebrated its twentieth anniversary. Some enhancements to mark this milestone include launching a new database called DiTA (Diagnostic Test Accuracy) that focuses on the accuracy of diagnostic tests used by physical therapists.

Agreement between the Cochrane risk of bias tool and Physiotherapy Evidence Database (PEDro) scale: A meta-epidemiological study of randomized controlled trials of physical therapy interventions.

BACKGROUND: The Cochrane risk of bias (CROB) tool and Physiotherapy Evidence Database (PEDro) scale are used to evaluate risk of bias of randomized controlled trials. We assessed the level of agreement between the instruments. METHODS: We searched the Cochrane Library to identify trials included in systematic reviews evaluating physical therapy interventions. For trials that met our inclusion criteria (primary reference in Cochrane review, review used CROB (2008 version), indexed in PEDro), CROB items were extracted from the reviews and PEDro items and total score were downloaded from PEDro. Kappa statistics were used to determine the agreement between CROB and PEDro scale items that evaluate similar constructs (e.g., randomization). The total PEDro score was compared to the CROB summary score (% of items met) using an Intraclass Correlation Coefficient. Sensitivity analyses explored the impact of the CROB "unclear" category and variants of CROB blinding items. Kappa statistics were used to determine agreement between different thresholds for "acceptable" risk of bias between CROB and PEDro scale summary scores. RESULTS: We included 1442 trials from 108 Cochrane reviews. Agreement was "moderate" for three of the six CROB and PEDro scale items that evaluate similar constructs (allocation concealment, participant blinding, assessor blinding; Kappa = 0.479-0.582). Agreement between the summary scores was "poor" (Intraclass Correlation Coefficient = 0.285). Agreement was highest when the CROB "unclear" category was collapsed with "high" and when participant, personnel and assessor blinding were evaluated separately in CROB. Agreement for different thresholds for "acceptable" risk of bias between CROB and PEDro summary scores was, at best, "fair". CONCLUSION: There was moderate agreement for half of the PEDro and CROB items that evaluate similar constructs. Interpretation of the CROB "unclear" category and variants of the CROB blinding items substantially influenced agreement. Either instrument can be used to quantify risk of bias, but they can't be used interchangeably.

Investigating causal mechanisms in randomised controlled trials.

INTRODUCTION: In some randomised trials, the primary interest is in the mechanisms by which an intervention exerts its effects on health outcomes. That is, clinicians and policy-makers may be interested in how the intervention works (or why it does not work) through hypothesised causal mechanisms. In this article, we highlight the value of understanding causal mechanisms in randomised trials by applying causal mediation analysis to two randomised trials of complex interventions. MAIN BODY: In the first example, we examine a potential mechanism by which an exercise programme for rheumatoid arthritis of the hand could improve hand function. In the second example, we explore why a rehabilitation programme for ankle fractures failed to improve lower-limb function through hypothesised mechanisms. We outline critical assumptions that are required for making valid causal inferences from these analyses, and provide results of sensitivity analyses that are used to assess the degree to which the estimated causal mediation effects could have been biased by residual confounding. CONCLUSION: This paper demonstrates how the application of causal mediation analyses to randomised trials can identify the mechanisms by which complex interventions exert their effects. We discuss methodological issues and assumptions that should be considered when mediation analyses of randomised trials are used to inform clinical practice and policy decisions.

Abstracts of low back pain trials are poorly reported, contain spin of information and are inconsistent with the full text: An overview study.

OBJECTIVE: To investigate trials abstracts evaluating treatments for low back pain with regards to completeness of reporting, spin (i.e., interpretation of study results that overemphasizes the beneficial effects of the intervention), and inconsistencies in data with the full text. DATA SOURCES: The search was performed on Physiotherapy Evidence Database (PEDro) in February 2016. STUDY SELECTION: This is an overview study of a random sample of 200 low back pain trials published between 2010 and 2015. The languages of publication were restricted to English, Spanish and Portuguese. DATA EXTRACTION: Completeness of reporting was assessed using the CONSORT for Abstracts checklist (CONSORT-A). Spin was assessed using a SPIN-checklist. Consistency between abstract and full text were assessed by applying the assessment tools to both the abstract and full text of each trial and calculating inconsistencies in the summary score (paired t test) and agreement in the classification of each item (Kappa statistics). Methodological quality was analyzed using the total PEDro score. DATA SYNTHESIS: The mean number of fully reported items for abstracts using the CONSORT-A was 5.1 (SD 2.4) out of 15 points and the mean number of items with spin was 4.9 (SD 2.6) out of 7 points. Abstract and full text scores were statistically inconsistent (P=0.01). There was slight to moderate agreement between items of the CONSORT-A in the abstracts and full text (mean Kappa 0.20 SD 0.13) and fair to moderate agreement for items of the SPIN-checklist (mean Kappa 0.47 SD 0.09). CONCLUSIONS: The abstracts were incomplete, with spin and inconsistent with the full text. We advise health care professionals to avoid making clinical decisions based solely upon abstracts. Journal editors, reviewers and authors are jointly responsible for improving abstracts, which could be guided by amended editorial policies.

A methodological survey on reporting of pilot and feasibility trials for physiotherapy interventions: a study protocol.

INTRODUCTION: Pilot and feasibility trials aim to test whether a full trial can be conducted or if any procedures must be changed for the full trial. Pilot trials must be reported in a transparent, accurate and complete way. In this report, we present a protocol for a methodological survey with the following aims: (1) to determine the percentage of physiotherapy trial reports which claim to be pilot or feasibility trials that evaluate feasibility, (2) to determine the aspect of feasibility evaluated in the primary objectives of the pilot or feasibility trials, (3) to describe the completeness of reporting of abstracts and full articles of pilot or feasibility trials using the Consolidated Standards of Reporting Trials (CONSORT) extension to randomised pilot and feasibility trials and (4) to investigate factors associated with completeness of reporting of pilot or feasibility trials. METHODS AND ANALYSIS: Reports of randomised controlled trials indexed in the Physiotherapy Evidence Database (PEDro) that claim to be pilot or feasibility trials and published in 2011-2017 will be included. Two independent reviewers will confirm eligibility and classify the aspect of feasibility being evaluated in the objectives of the included pilot or feasibility trials. Completeness of reporting of both the abstract and the full article will be evaluated using the CONSORT extension to randomised pilot and feasibility trials. The primary analysis will be a descriptive analysis about the reporting quality of abstracts and full texts of pilot and feasibility trials. We will use generalised estimating equation analysis to explore factors associated with completeness of reporting. ETHICS AND DISSEMINATION: The results of this study will be disseminated by presentation at conferences and will be submitted for publication in a peer-reviewed journal. Ethical approval is not necessary for this study.

Societá Italiana de Fisioterapia and the Physiotherapy Evidence Database (PEDro).

This paper provides an overview of a free resource that can be used by physiotherapists to assist their efforts to undertake evidence-based practice. The resource is the Physiotherapy Evidence Database (PEDro; www.pedro.org.au) - a searchable online database that in February 2019 indexes the details of over 42,000 pieces of published evidence about the effects of physiotherapy interventions. PEDro is searched millions of times each year by users worldwide. Societá Italiana de Fisioterapia (SIF; www.sif-fisioterapia.it) has entered into a collaboration with the developers of PEDro. In addition to describing the evidence available on PEDro and who uses it, this paper also summarises the features of PEDro that can facilitate evidence-based physiotherapy. This paper concludes by outlining the collaboration between SIF and PEDro.

Use of 95% confidence intervals in the reporting of between-group differences in randomized controlled trials: analysis of a representative sample of 200 physical therapy trials.

OBJECTIVES: To assess the prevalence of the use of 95% confidence intervals in the reporting of between-group differences in randomized controlled trials of physical therapy interventions and to determine if the prevalence is changing over time. METHODS: Observational study, including an analysis of 200 trials from the Physiotherapy Evidence Database: 50 from each of the years 1986, 1996, 2006, and 2016. The primary outcome used was the prevalence of the between-group difference presented with 95% confidence intervals. We also extracted trial characteristics for descriptive purposes (i.e., number of participants, number of sites involved in recruitment, country(ies) of data collection, funding, subdiscipline of physical therapy, publication language and total Physiotherapy Evidence Database score). RESULTS: Most commonly, the trials were published in English (89%) and classified in the musculoskeletal subdiscipline (23%). The overall prevalence of use of confidence intervals was 29% and there was a consistent increase in reporting between 1986 and 2016, with peak usage in the 2016 cohort (42%). Confidence intervals were more likely to be used in trials that had received funding, were conducted in Europe and Oceania, and in trials with a Physiotherapy Evidence Database score of at least 6/10. CONCLUSIONS: Most trials of physical therapy interventions do not report confidence intervals around between-group differences. However, use of confidence intervals is increasing steadily, especially among high-quality trials. Physical therapists must understand confidence intervals so that they can understand a growing number of trials in physical therapy.

PEDro searching has improved over time: A comparison of search commands from two six-month periods three years apart.

BACKGROUND: In 2014-2015, the Physiotherapy Evidence Database (PEDro) was searched poorly by users; few search commands used sophisticated features and ∼20% contained errors. To improve the quality of PEDro searches, users now receive error messages when using incorrect search commands and have access to video tutorials. OBJECTIVES: To determine whether search quality has improved since error messages and tutorials were implemented; and evaluate the content of PEDro searches. METHODS: Google Analytics was used to access all search commands on PEDro (between 1 August 2017 and 31 January 2018) and extract the following data: total number of search commands; 25 most common simple and advanced search commands; and frequency of search errors (e.g. Boolean operators) or use of sophisticated features (e.g. truncation/wildcards). Two researchers independently coded the subdiscipline (e.g. musculoskeletal, neurology) and PICO elements (Population; Intervention; Comparison; Outcome) from a random sample of 200 simple and 200 advanced search commands. Data were compared to an identical analysis performed in 2014-2015 to determine whether the content or quality of search commands had changed. RESULTS: There has been a very small increase in the use of truncation/wildcards since 2014-2015 (1.4% increase in simple and 1.9% in advanced search commands; p < 0.001) and small reductions in search errors (Boolean operators: 3.7% reduction in simple and 3.2% in advanced; brackets: 0.9% and 0.4%; non-ASCII characters: 3.1% and 1.6%; p < 0.001 for all analyses). Overall, only 6% of simple and 9% of advanced search commands used sophisticated features, while 16% of simple and 12% of advanced search commands contained errors. The content of PEDro search commands was largely similar to searches from 2014 to 2015. CONCLUSION: There has been a small reduction in the number of search commands containing errors, and only a very small increase in the use of sophisticated features. These improvements may be explained by video tutorials on how to optimise searching and warnings that appear when users enter search commands containing errors. However, with 16% of simple and 12% of advanced search commands still containing errors, additional strategies to further improve the quality of searches are needed.