Comparative effects on pain arising from injury to the knee meniscus in adults: A systematic review and network meta-analysis.

OBJECTIVE: To identify the most effective pain management method for meniscus injuries by comparing pain relief observed with several common interventions including combined different combinations of surgery and exercise, surgery alone, supervised exercise alone and home exercise alone. METHODS: PubMed, Embase, CINAHL, Cochrane Library, Web of Science, SportDiscus, and PEDro were searched from database inception through October 15, 2020. Randomized controlled trials investigating the effect of surgery and exercise for meniscus injuries by using the visual analogue scale (VAS) assessment were eligible for inclusion. Primary outcome was mean change in VAS score from baseline. Comparisons between interventions were made through use of random-effects network meta-analysis over the short-term (three months) and mid-term (12 months). Relative ranking of therapies was assessed by the surface-under-the-cumulative ranking possibilities. All reference lists of included studies were hand-searched. RESULTS: We investigated six RCTs (total n = 796 patients). No significant difference was found between different treatments of pain control in three months and 12 months. The surface under the cumulative ranking curves suggested that supervised exercise combined with surgery was considered most likely to overshadow other treatments in reducing short-term pain (surface under cumulative ranking curve (SUCRA) values: 98.1; mean ranks: 1.1) and mid-term pain (SUCRA values: 97.2; mean rank: 1.1). CONCLUSION: There is not sufficient evidence to identify any preferred or more effective surgical and/or exercise-based treatment program.

Use of Patient-Reported Outcome Measures in Lower Extremity Research.

Background: A large number of patient reported outcome measures (PROMs) have been developed for specific lower extremity orthopaedic pathologies. However, a consensus as to which PROMs are recommended for use in evaluating treatment outcomes for patients with hip, knee, ankle and/or foot pathology based on the strength of their psychometric properties is lacking. Objective: To identify PROMs that are recommended in systematic reviews (SRs) for those with orthopaedic hip, knee, foot, and ankle pathologies or surgeries and identify if these PROMs are used in the literature. Study design: Umbrella Review. Methods: PubMed, Embase, Medline, Cochrane, CINAHL, SPORTDisucs and Scopus were searched for SRs through May 2022. A second search was done to count the use of PROMs in seven representative journals from January 2011 through May 2022.SRs that recommended the use of PROMs based on their psychometric properties were included in the first search. SRs or PROMs not available in the English were excluded. The second search included clinical research articles that utilized a PROM. Case reports, reviews, and basic science articles were excluded. Results: Nineteen SRs recommended 20 PROMs for 15 lower extremity orthopaedic pathologies or surgeries. These results identified consistency between recommended PROMs and utilization in clinical research for only two of the 15 lower extremity pathologies or surgeries. This included the use of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Copenhagen Hip and Groin Outcome Score to assess outcomes (HAGOS) for those with knee osteoarthritis and groin pain, respectively. Conclusion: A discrepancy was found between the PROMs that were recommended by SRs and those used to assess clinical outcomes in published research. The results of this study will help to produce more uniformity with the use of PROMs that have the most appropriate psychometric properties when the reporting treatment outcomes for those with extremity pathologies. Level of evidence: 3a.

Cross-Culturally Adapted Versions of Patient Reported Outcome Measures for the Lower Extremity.

Background: A large number of patient reported outcome measures (PROMs) have been developed in the English language for various lower extremity orthopaedic pathologies. Twenty different PROMs were recommended for 15 specific musculoskeletal lower extremity pathologies or surgeries. However, the availability of cross-culturally adapted versions of these recommended PROMs is unknown. Purpose: The purpose of this study was to identify the cross-culturally adapted versions of recommended PROMs for individuals experiencing orthopedic lower extremity pathologies or undergoing surgeries, and to identify the psychometric evidence that supports their utilization. Study design: Literature Review. Methods: PubMed, Embase, Medline, Cochrane, CINAHL, SPORTDisucs and Scopus were searched for cross-culturally adapted translated studies through May 2022. The search strategy included the names of the 20 recommended PROMs from previous umbrella review along with the following terms: reliability, validity, responsiveness, psychometric properties and cross-cultural adaptation. Studies that presented a non-English language version of the PROM with evidence in at least one psychometric property to support its use were included. Two authors independently evaluated the studies for inclusion and independently extracted data. Results: Nineteen PROMS had cross-culturally adapted and translated language versions. The KOOS, WOMAC, ACL-RSL, FAAM, ATRS, HOOS, OHS, MOXFQ and OKS were available in over 10 different language versions. Turkish, Dutch, German, Chinese and French were the most common languages, with each language having more than 10 PROMs with psychometric properties supporting their use. The WOMAC and KOOS were both available in 10 languages and had all three psychometric properties of reliability, validity, and responsiveness supporting their use. Conclusion: Nineteen of the 20 recommended instruments were available in multiple languages. The PROM most frequently cross-culturally adapted and translated were the KOOS and WOMAC. PROMs were most frequently cross-culturally adapted and translated into Turkish. International researchers and clinicians may use this information to more consistently implement PROMs with the most appropriate psychometric evidence available to support their use. Level of evidence: 3a.

Evaluating Functional Performance Tests in those with Non-arthritic Intra-articular Hip Pain: An International Consensus Statement.

Background: Non-arthritic intra-articular hip pain, caused by various pathologies, leads to impairments in range of motion, strength, balance, and neuromuscular control. Although functional performance tests offer valuable insights in evaluating these patients, no clear consensus exists regarding the optimal tests for this patient population. Purpose: This study aimed to establish expert consensus on the application and selection of functional performance tests in individuals presenting with non-arthritic intra-articular hip pain. Study Design: A modified Delphi technique was used with fourteen physical therapy experts, all members of the International Society for Hip Arthroscopy (ISHA). The panelists participated in three rounds of questions and related discussions to reach full consensus on the application and selection of functional performance tests. Results: The panel agreed that functional performance tests should be utilized at initial evaluation, re-evaluations, and discharge, as well as criterion for assessing readiness for returning to sports. Tests should be as part of a multimodal assessment of neuromuscular control, strength, range of motion, and balance, applied in a graded fashion depending on the patient's characteristics. Clinicians should select functional performance tests with objective scoring criteria and prioritize the use of tests with supporting psychometric evidence. A list of recommended functional performance tests with varying intensity levels is provided. Low-intensity functional performance tests encompass controlled speed in a single plane with no impact. Medium-intensity functional performance tests involve controlled speed in multiple planes with low impact. High-intensity functional performance tests include higher speeds in multiple planes with higher impact and agility requirements. Sport-specific movement tests should mimic the patient's particular activity or sport. Conclusion: This international consensus statement provides recommendations for clinicians regarding selection and utilization of functional performance tests for those with non-arthritic intra-articular hip pain. These recommendations will encourage greater consistency and standardization among clinicians during a physical therapy assessment.

Effects of Sacral Nerve Stimulation on Neuronal Nitric Oxide Synthase in the Colon and Sacral Cord of Rats With Defecation Disorder After Spinal Cord Injury.

OBJECTIVE: This study aimed to determine the effects of sacral nerve electrical stimulation (SNS) on neuronal nitric oxide synthase (nNOS) in the colon and sacral cord of rats with defecation disorder after spinal cord injury (SCI). METHODS: Rats with severe SCI (T10) were used as models and randomly divided into an SCI group and an SNS group. After 14 days of treatment, the intestinal transport function was assessed. Finally, the differences in nNOS immunoreactive cells, protein levels, nNOS mRNA, and NO content in the colon and sacral cord tissues were estimated using immunohistochemistry, Western blot, real-time polymerase chain reaction, and nitrate reductase method. RESULTS: The intestinal transport function of the SNS group was superior to that of the SCI group (P < 0.05). The average optical density of nNOS immunoreactive positive cells in the SCI group were significantly increased compared with those in the sham group. The content of NO of the SCI group significant increased compared with those of the sham group and the SNS group (both P < 0.01). The nNOS mRNA and protein expression was higher in the SCI group than in the sham group (P < 0.01), while that in the SNS group was significantly lower than that in the SCI group. CONCLUSIONS: SNS could reduce nNOS expression in the colon and sacral cord of SCI rats. This reduction may be an important neuromodulation mechanism for SNS to improve defecation reflex and promote the recovery of intestinal transit function.

Repetitive Transcranial Magnetic Stimulation for Neuropathic Pain on the Non-Motor Cortex: An Evidence Mapping of Systematic Reviews.

OBJECTIVE: This study was aimed to summarize and analyze the quality of the available evidence in systematic reviews (SRs) of repetitive transcranial magnetic stimulation (rTMS) on the non-motor cortex (non-M1) for neuropathic pain (NP) through an evidence mapping approach. METHODS: We follow the Global Evidence Mapping (GEM) methodology. Searches were conducted in PubMed, EMBASE, Epistemonikos, and the Cochrane Library. The study type was restricted to SRs with or without meta-analysis. All literature published before January 23, 2021, were included. The methodological quality of the included SRs was assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR-2). Data were extracted according to a defined population-intervention-comparison-outcome (PICO) framework from primary studies that included SRs. The same PICO was categorized into PICOs according to interventions (stimulation target, frequency, number of sessions (short: 1-5 sessions, medium: 5-10 sessions, and long: >10 sessions)) and comparison (sham rTMS or other targets). The evidence mapping was presented in tables and a bubble plot. RESULTS: A total of 23 SRs were included. According to the AMSTAR-2, 20 SRs scored "very low" in terms of methodological quality, 2 SRs scored "low," and 1 SR scored "high." A total of 17 PICOs were extracted. The dorsolateral prefrontal cortex (DLPFC) is the most studied of the non-motor cortex targets. PICOs of DLPFC, premotor cortex (PMC), frontal cortex, and secondary somatosensory cortex (S2) were mainly categorized with a "potentially better" conclusion. High-frequency (5-20 Hz) rTMS of non-M1 usually lead to "potentially better" conclusions. CONCLUSIONS: DLPFC, PMC, frontal cortex, and S2 seem to be promising new targets for rTMS treatment of certain NP. Evidence mapping is a useful and reliable methodology to identify and present the existing evidence gap that more research efforts are necessary in order to highlight the optimal stimulation protocols for non-M1 targets and standardize parameters to fill the evidence gaps of rTMS. Further investigation is advised to improve the methodological quality and the reporting process of SRs.

Evidence Mapping Based on Systematic Reviews of Repetitive Transcranial Magnetic Stimulation on the Motor Cortex for Neuropathic Pain.

BACKGROUND AND OBJECTIVE: There is vast published literature proposing repetitive transcranial magnetic stimulation (rTMS) technology on the motor cortex (M1) for the treatment of neuropathic pain (NP). Systematic reviews (SRs) focus on a specific problem and do not provide a comprehensive overview of a research area. This study aimed to summarize and analyze the evidence of rTMS on the M1 for NP treatment through a new synthesis method called evidence mapping. METHODS: Searches were conducted in PubMed, EMBASE, Epistemonikos, and The Cochrane Library to identify the studies that summarized the effectiveness of rTMS for NP. The study type was restricted to SRs with or without meta-analysis. All literature published before January 23, 2021, was included. Two reviewers independently screened the literature, assessed the methodological quality, and extracted the data. The methodological quality of the included SRs was assessed by using the A Measurement Tool to Assess Systematic Reviews (AMSTAR-2). Data were extracted following a defined population, intervention, comparison, and outcome (PICO) framework from primary studies that included SRs. The same PICO was categorized into PICOs according to interventions [frequency, number of sessions (short: 1-5 sessions, medium: 5-10 sessions, and long: >10 sessions)] and compared. The evidence map was presented in tables and a bubble plot. RESULTS: A total of 38 SRs met the eligibility criteria. After duplicate primary studies were removed, these reviews included 70 primary studies that met the scope of evidence mapping. According to the AMSTAR-2 assessment, the quality of the included SRs was critically low. Of these studies, 34 SRs scored "critically low" in terms of methodological quality, 2 SR scored "low," 1 SR scored "moderate," and 1 SR scored "high." CONCLUSION: Evidence mapping is a useful methodology to provide a comprehensive and reliable overview of studies on rTMS for NP. Evidence mapping also shows that further investigations are necessary to highlight the optimal stimulation protocols and standardize all parameters to fill the evidence gaps of rTMS. Given that the methodological quality of most included SRs was "critically low," further investigations are advised to improve the methodological quality and the reporting process of SRs.

Electroacupuncture at Zusanli (ST36) Repairs Interstitial Cells of Cajal and Upregulates c-Kit Expression in Rats with SCI-Induced Neurogenic Bowel Dysfunction.

BACKGROUND: Electroacupuncture (EA) could improve colonic transit activity in rats with neurogenic bowel dysfunction (NBD) caused by spinal cord injury (SCI). The function of interstitial cells of Cajal (ICCs) and c-Kit expression may play essential roles in this process. Material and Methods. Thirty-six Sprague Dawley rats were randomized to the sham group, the SCI group, or the SCI + EA group (bilateral Zusanli, 30 min/day, 14 days). Changes in the ultrastructural morphology of ICCs were observed. The c-Kit expression on different levels was analyzed by immunohistochemistry, Western blotting, and RT-qPCR, respectively. RESULTS: Abnormal morphology of ICCs and downregulation of the c-Kit expression occurred after SCI. While the number of ICCs was increased, the ultrastructural morphology was improved significantly in EA rats. They also showed better improvement in c-Kit expression at both protein and gene levels. CONCLUSION: Abnormal ICCs in colon tissues and the downregulated expression of c-Kit could be observed after SCI. EA at Zusanli (ST36) could improve the colon function by repairing the morphology and increasing the number of ICCs and upregulating c-Kit expression.