A dose response analysis of exercise prescription variables for lateral abdominal muscle thickness and activation: A systematic review.

BACKGROUND: Various exercise programs are used to treat lateral abdominal muscle (LAM) impairments in people with low back pain. Factors comprising these programs include exercise type, session time, frequency, and program duration. However, specific clinical guidance about optimal exercise prescription is lacking. OBJECTIVES: To perform a dose-response analysis on exercise prescription variables for LAM thickness and activation as measured by ultrasound imaging. DESIGN: Systematic review METHOD: Databases were searched from their inception for studies examining the association between exercise interventions and LAM thickness/activation measured by ultrasound imaging in healthy individuals. Risk of bias was assessed using the Joanna Brigg's Institute critical appraisal tools. For each muscle, subgroup analyses were performed to determine the dose response of exercise prescription variables for LAM thickness and activation. Where there was insufficient data for subgroup analyses, data was narratively synthesised. RESULTS: Fourteen studies comprising 395 participants were included. Statistical and narrative synthesis revealed specific local abdominal exercises, programs from four weeks duration, three sessions per week and sessions of ≥30 min were associated with greatest improvements to LAM thickness. Only the variables exercise type, program duration and session frequency showed a significant between groups difference for the subgroup analysis. The main limitation was inability to perform subgroup analyses for all variables across all muscles measured at rest and during contraction, due to non-reporting of data. CONCLUSION: This review provides preliminary guidance to practitioners on how the LAM respond to different exercise dosages. Future research should trial these findings.

Does changing the Functional Movement Screen composite score threshold influence injury risk estimation in junior Australian football players?

This study aimed to identify whether a revised lower Functional Movement Screen (FMS) composite score threshold would be associated with a greater injury risk for junior athletes than the common threshold of≤14. This prospective cohort study included tracking of 809 elite junior male Australian football players for injuries that resulted in a missed game. All athletes completed pre-season FMS testing and a 12-month self-reported retrospective injury questionnaire. Analyses examined the relationship between composite score thresholds of≤14, ≤13, and≤12 and the risk of injury. The relationship between prospective injury and the common composite threshold score of ≤ 14 was dependent on the presence of a recent injury history (relative risk [RR] = 1.45, p = 0.004) in comparison to no recent injury history (RR = 0.98, p = 0.887). Scoring≤12 in the presence of a recent injury history had the greatest diagnostic accuracy but only a trivial increase in injury risk (RR = 1.59, p = 0.001, sensitivity = 0.35, specificity = 0.80, negative and positive likelihood ratios = 0.81 and 1.75). Whilst some small statistical relationships existed between prospective injury and the FMS composite score thresholds, all three thresholds were not associated with a clinically meaningful relationship with prospective injury and were no more effective than retrospective injury for determining athletes at risk of injury.

Exploring what matters to residents of Australian aged care facilities with the Happy Life Index: comparison of qualitative responses between pre- and mid-Covid-19 pandemic time points.

PURPOSE: This study analysed data from a national survey of people living in Australian Residential Aged Care Facilities (RACFs) reporting on what is the best thing about where they live and suggestions for improvement. Data from prior to the Covid-19 pandemic were compared with data during the Covid-19 pandemic. METHODS: Qualitative data from the Happy Life Index Survey were analysed using summative content analysis to code the responses in the data sets and then organise them into categories. Once categorised, the pre-Covid-19 and mid-Covid-19 data sets were compared using descriptive statistics. RESULTS: A total of 4745 residents, from over 100 RACFs, provided 8512 open-text responses to at least one of the two survey questions. Pre-Covid-19 responses were compared with mid-Covid-19 responses and those trending towards relevance (5-10% change) were identified. There were both positive and negative relevant percent changes for staff number, food (general comments), and friendliness. A trending positive percentage change was observed for staff quality and the internal environment. There was a trending negative relevant percentage change for lifestyle activities, staff generally, level of contentedness, the general environment, general choice, and general views about the service. CONCLUSION: People living in RACFs notice the changes in staffing levels and visitors during restrictions imposed during infectious outbreaks. During these times, they appreciate the quality of the staff attending to their needs and the quality of their food. Further exploration is needed of the value of lifestyle activities and strategies to promote feelings of contentedness and general wellbeing during times of restriction.

Intrinsic foot muscle size and associations with strength, pain and foot-related disability in people with midfoot osteoarthritis.

BACKGROUND: To compare intrinsic foot muscle size between people with and without symptomatic midfoot osteoarthritis, and examine the association between muscle size and strength, pain and foot-related disability. METHODS: Twenty-three participants with symptomatic midfoot osteoarthritis and 23 age, sex and BMI matched controls were included. Intrinsic foot muscle cross-sectional area was measured using MRI. Hand-held dynamometry was used to assess foot and ankle muscle strength, and foot-related pain and disability was measured using Manchester Foot Pain & Disability Index. FINDINGS: Small and non-statistically significant differences were found in intrinsic foot muscle cross-sectional area between the two groups (effect sizes 0.15-0.26, p > 0.05). Muscle strength was reduced in the midfoot osteoarthritis group, with differences of 12-33% (effect sizes 0.47-1.2). In the control group, moderate positive associations) existed between foot muscle cross-sectional area and lesser digits flexor strength (r = 0.5 to 0.7, p < 0.05). Conversely, in the midfoot osteoarthritis group, negligible positive associations were found (r < 0.3, p > 0.05). Associations between foot muscle cross-sectional with and pain and disability scores in the midfoot osteoarthritis group were negligible (r < -0.3, p > 0.05). INTERPRETATION: Despite reductions in maximal isometric muscle strength, midfoot osteoarthritis does not appear to be associated with reduced intrinsic foot muscle cross-sectional area measured by MRI. Muscle compositional or neural factors may explain the reductions in muscle strength and variation in symptoms in people with midfoot osteoarthritis and should be investigated.

Pitching mechanics and performance of adult baseball pitchers: A systematic review and meta-analysis for normative data.

OBJECTIVES: The aim of this systematic review was to critically review and synthesise the findings from primary studies on pitching mechanics and performance of healthy adult baseball pitchers. DESIGN: Systematic review with meta-analysis. METHODS: Eight English- and Japanese-language databases were systematically searched from inception to 22nd July 2022. RESULTS: In total, 29 descriptive biomechanical studies were included. Overall study quality was moderate. In subgroup analyses, professional pitchers showed significantly higher stride length, peak shoulder internal rotation velocity, peak shoulder proximal force and ball velocity compared to collegiate pitchers. Conversely, collegiate pitchers were found to have significantly higher peak pelvis rotation velocity. CONCLUSIONS: Available normative data suggested potentially heterogeneous pitching mechanics and performance between professional and collegiate pitchers. However, the findings in this review should be interpreted cautiously. Since statistical heterogeneity was significant within most data sets, more detailed subgroup analyses are required. Additionally, more high-quality studies utilising measurement systems with established reliability are required to obtain accurate data in baseball pitching mechanics and performance.

A comparison of physiotherapy students' perception about blended learning with online learning during COVID-19 pandemic: A mixed method of study.

BACKGROUND: The COVID-19 pandemic has affected face-to-face teaching across the globe. The sudden shift in learning methods has impacted learning experiences significantly. Students' perception about online compared to blended learning might affect learning. The objective of this study was to evaluate physiotherapy students' perception of blended compared to online learning. MATERIALS AND METHODS: This mixed-method study documents physiotherapy students' perception about the courses delivered through blended learning (BL) mode during the COVID-19 pandemic. Physiotherapy graduates and postgraduate students who completed their evidence-based physiotherapy practice courses at Sri Ramachandra Institute of Higher Education and Research, Chennai (N = 68) participated in this study. The participants' perceived experience about synchronous online mode and BL during the pandemic was assessed using a questionnaire and focus group discussion. RESULTS: All the participants felt that the course outcomes were met and that they gained knowledge and skills in evidence-based practice. Most of the students (93%) recommended a blended mode of learning compared to online learning alone. Thematic analysis of the focus group discussion (FGD) identified enhanced learning experience, collaborative learning as enablers to BL, and availability of gadgets and quality of online contents as barriers. CONCLUSION: Participants showed par preference for blended learning over online learning as it provided flexibility and facilitated active learning compared to online learning alone.

The Relationship Between Performance and Injury in Junior Australian Football Athletes.

PURPOSE: Determine the impact of preseason and between-seasons changes in individual physical performance on injury risk in elite junior Australian football players and if injuries sustained during a season impact subsequent-season performance improvement. METHODS: This prospective cohort study assessed individual performance measures (sprint speed, jump, agility, and aerobic endurance) during preseason over 4 consecutive seasons. Injury status (injured/not injured) was tracked weekly to determine the relationship between individual performance and in-season injury occurrence. Mixed models were used to determine the relationship between physical performance and injury, and the effect of injury on physical performance improvement. RESULTS: A total of 206 players played 2 consecutive seasons and were included (17.6 y, 181.9 cm, 75.7 kg). Faster players during preseason experienced higher injury incidence (injuries/season) during that playing season (incidence rate ratio = 0.127; P = .034). Injury incidence was not influenced by between-seasons change in any performance measure. Players injured during their first season maintained their aerobic fitness, which declined in noninjured players (d = 0.39; P = .013). Players who sustained a lower-limb injury during their first season saw smaller improvements in sprint speed than players who did not get injured (d = 0.39; P = .035). CONCLUSION: Faster players experience higher injury incidence than slower players and may require specific prevention interventions. Players who experience a lower-limb injury during the playing season do not improve sprint speed between seasons to the same extent as players who do not get injured, highlighting the need for targeted high-speed running ability development as part of rehabilitation.

Relationship Between Movement Quality and Physical Performance in Elite Adolescent Australian Football Players.

ABSTRACT: Bennett, H, Fuller, J, Milanese, S, Jones, S, Moore, E, and Chalmers, S. The relationship between movement quality and physical performance in elite adolescent Australian football players. J Strength Cond Res 36(10): 2824-2829, 2022-The assessment of movement quality is commonplace in competitive sport to profile injury risk and guide exercise prescription. However, the relationship between movement quality scores and physical performance measures is unclear. Moreover, whether improvements in these measures are associated remain unknown. Over a 4-year period, 918 individual elite adolescent Australian Rules Footballers completed the Functional Movement Screen (FMS) and physical performance testing (5- and 20-m sprint, vertical jump, planned agility, and 20-m shuttle run test), allowing the analysis of relationships between FMS parameters and performance measures. In addition, 235 athletes completed testing over 2 consecutive years, allowing the analysis of relationships between changes in these outcomes. Small associations were observed between FMS composite score, hurdle step performance, in-line lunge performance, trunk stability push-up performance, rotary stability, and measures of speed, power, agility, and aerobic fitness (ρ = 0.071-0.238). Across consecutive seasons, significant improvements were observed in the deep squat subtest ( d = 0.21), FMS composite score ( d = 0.17), and 5- ( d = 0.16) and 20-m sprint times ( d = 0.39). A negative association between change in rotary stability and change in jump height (ρ = -0.236) from one season to the next was detected. Results suggest FMS scores have limited relationships with measures of performance in footballers. To optimize athletic performance, once acceptable movement capabilities have been established, training should not prioritize improving movement quality over improvements in strength, power, and change of direction ability.

The association between Y-balance test scores, injury, and physical performance in elite adolescent Australian footballers.

OBJECTIVES: Identify how modified Lower-Quarter Y-Balance Test (mYBT-LQ) and Upper-Quarter Balance Test (mYBT-UQ) scores relate to injury risk and measures of physical performance in elite adolescent Australian Football (AF) athletes. DESIGN: Prospective cohort study. METHODS: Pre-season mYBT-LQ, mYBT-UQ, and physical performance measures (speed, jump height, and agility) were obtained in 257 elite adolescent male AF athletes. Injury status was tracked across the 18-game season to determine the relationship between mYBT scores and injury risk based on time-to-event analysis. Cross-sectional analysis of mYBT-LQ scores and performance measures determined the relationships between these variables. RESULTS: There were no significant associations between injury risk and any single mYBT parameter. However, athletes with high posteromedial asymmetry and good agility performance (top 25% of the cohort) had moderately increased injury risk with and tended to without a previous injury history (Hazard Ratio = 3.26 [95% Confidence Interval: 1.01, 10.54; p = 0.048] and 2.69 [95% Confidence Interval = 0.92, 7.82; p = 0.069], respectively). There were significant correlations between faster agility times and higher composite limb-length normalised mYBT-LQ (r = -0.210; CI = -0.324, -0.090), limb-length normalised average posteromedial reach score (r = -0.227; CI = -0.340, -0.108), and limb-length normalised average posterolateral reach score (r = -0.250: CI = -0.361, -0.132). CONCLUSION: In isolation, the mYBT is not useful for identifying injury risk in junior AF athletes, and only small correlations between mYBT-LQ and physical performance variables were identified. However, high mYBT-LQ posteromedial asymmetry is associated with increased injury risk for athletes with good agility performance. This should be considered within athlete preparation programs.

Entry level nursing graduate students' perception and readiness toward online component of blended learning: A mixed method study.

BACKGROUND: Blended learning (BL), the integration of online with face to face teaching, is established as a teaching method in higher education. Understanding the learner's readiness toward online component of BL is important in designing and delivering BL. Nursing students require proficiency in interpersonal relationship and social interaction apart from knowledge and skills. BL may provide an opportunity to acquire the professional skills better than the traditional face to face sessions. The objectives of this study were to identify the nursing student's readiness toward BL and perceptions about the online learning component of BL. MATERIALS AND METHODS: First- and second-year entry level graduate nursing students of Sri Ramachandra Institute of Higher Education, Chennai, India, were the participants of the study. This study used a mixed method approach. An online questionnaire, developed based on the literature and expert consensus, was used in the first phase. A focus group discussion (FGD) with ten random participants of the survey was conducted to understand the perceptions and readiness to adopt the online component of BL. The present study was conducted from December 2019 to January 2020. Survey results were analyzed through descriptively. Content analysis was carried to summarize FGD results. RESULTS: A total 158 students of entry level nursing graduate programme participated in the survey. 53.8% of felt BL will have positive effect on their learning and 70% of the respondents were ready to adopt BL. The FGD identified two themes: (I) Readiness to adopt online learning as a component of BL and (II) perceived barriers and challenges in adopting online contents. CONCLUSION: Entry level nursing graduate students had a positive perception about the online components. Majority of them are confident in accessing the online contents. Willingness to learn through online, previous experience with online learning, and perceived advantages of online component might influence the learner's readiness. Availability of internet and absence of teachers were perceived as the barriers to online learning by the participants.

The effectiveness of implementation strategies for promoting evidence informed interventions in allied healthcare: a systematic review.

BACKGROUND: Evidence based practice in health care has become increasingly popular over the last decades. Many guidelines have been developed to improve evidence informed decision making in health care organisations, however it is often overlooked that the actual implementation strategies for these guidelines are as important as the guidelines themselves. The effectiveness of these strategies is rarely ever tested specifically for the allied health therapy group. METHODS: Cochrane, Medline, Embase and Scopus databases were searched from 2000 to October 2019. Level I and II studies were included if an evidence informed implementation strategy was tested in allied health personnel. The SIGN method was used to evaluate risk of bias. The evidence was synthesised using a narrative synthesis. The National Health and Medical Research Council (NHMRC) model was applied to evaluate the grade for recommendation. RESULTS: A total of 490 unique articles were identified, with 6 primary studies meeting the inclusion criteria. Three different implementation strategies and three multi-faceted components strategies were described. We found moderate evidence for educational meetings, local opinion leaders and patient mediated interventions. We found stronger evidence for multi-faceted components strategies. CONCLUSION: Few studies describe the effectiveness of implementation strategies for allied healthcare, but evidence was found for multi-faceted components for implementing research in an allied health therapy group population. When considering implementation of evidence informed interventions in allied health a multi-pronged approach appears to be more successful.

Myofascial release versus Mulligan sustained natural apophyseal glides' immediate and short-term effects on pain, function, and mobility in non-specific low back pain.

BACKGROUND: Myofascial release (MFR) and Mulligan Sustained Natural Apophyseal Glides (SNAGs) are manual therapy techniques routinely practiced in the management of non-specific low back pain (NSLBP). As a solo intervention or along with other therapies, both methods have reported positive results for individuals with NSLBP. However, which technique improves NSLBP-related pain, restricted range of motion (ROM) and disability, warrants further research. OBJECTIVE: To study the comparative effects of MFR and SNAGs on pain, disability, functional ability, and lumbar ROM in NSLBP. METHOD: A parallel-group study was conducted at tertiary care hospitals. Sixty-five Sub-acute or chronic NSLBP patients were allocated to receive strengthening exercises along with either MFR (n = 33) or SNAGs (n = 32) for six treatment sessions over one week. An independent assessor evaluated outcome measures such as the Visual Analog Scale (VAS), Patient-Specific Function Scale (PSFS), and ROM at baseline, immediate (after 1st treatment), and short-term (post-sixth day of the intervention). The Modified Oswestry disability index (MODI) was assessed at baseline and short-term. RESULTS: Within-group analysis found clinically and statistically significant (p < 0.05) changes for VAS and PSFS at immediate and short-term for both the groups. The lumbar extension also showed improvement immediately and in the short-term. Improvement in Lumbar flexion was seen only in the SNAGs group over the short-term. A statistically significant improvement was seen for MODI in both the groups but was not clinically significant in the MFR group. The analysis observed no statistically significant difference (p < 0.05) between the groups at both the immediate and short-term. CONCLUSIONS: Pain and restricted function associated with NSLBP can be improved using SNAGs or MFR, along with strengthening exercises. For limited lumbar flexion ROM, Mulligan SNAGs have a better outcome than MFR over the short-term. Hence, both manual therapy techniques can be incorporated along with exercises for immediate and short-term management of sub-acute to chronic NSLBP.Clinical Trial Registration. CTRI/2018/12/016787 (http://ctri.nic.in/Clinicaltrials/).

Risk Factors of Shoulder and Elbow Injuries in Baseball: A Scoping Review of 3 Types of Evidence.

BACKGROUND: Shoulder and elbow overuse injuries are the most common problems in baseball players. No scoping review has compared the findings from different types of evidence. PURPOSE: To map the broad evidence from 3 types of evidence (epidemiological, biomechanical, and narrative) on potential risk factors for shoulder and elbow injuries in baseball and identify gaps in the existing literature to guide future research. STUDY DESIGN: Scoping review. METHODS: Eight electronic databases were searched from inception to May 14, 2020. Any peer-reviewed papers that investigated or discussed potential risk factors for shoulder and elbow injuries in baseball were included. RESULTS: A total of 302 studies (107 epidemiological studies, 85 biomechanical studies, and 110 narrative reviews) were included. Risk factors were categorized into 9 domains: sports profiles, physical characteristics/functions, pitching mechanics, performance, behavioral, psychosocial, biological and developmental, injury/sports profiles, and environmental factors. Studies were consistent in supporting limited shoulder range of motion (ROM) and player positions (pitchers or catchers) as risk factors for shoulder injuries. For elbow injuries, the majority of the included studies suggested that being pitchers or catchers and working with higher ball velocity can be risk factors. CONCLUSION: Findings were consistent in some risk factors, such as limited shoulder ROM and positions. However, findings were inconsistent or limited for most factors, and substantial research gaps were identified. Research assessing those factors with inconsistent or limited evidence in the current literature were recognized to be priorities for future studies.

Blended learning and health professional education: Protocol for a mixed-method systematic review.

Blended learning (BL) refers to a systematic teaching method, which combines the aspects of face-to-face and online interactions using appropriate Information and Communication Technologies. This mixed-method systematic review (SR) protocol is developed with the objective to determine the effectiveness and appropriateness of BL in the health-care professional education. Mixed-method SR protocol: For the purpose of this SR, PICO is defined as P-entry level graduate students of health sciences program; I-BL; C-traditional face-to-face training; and O-achievement of learning outcomes, learner's and teacher's perception (primary). The search will be done through possible database using predetermined search strategy. Eligible studies will be appraised independently by authors. Joanna Briggs Institute's mixed-method protocol will be used to assess and synthesis the data. This protocol is registered with the International Register of Systematic Reviews (PROSPERO) with the registration number CRD42018082699.

Reliability of a portable fixed frame dynamometry system used to test lower limb strength in elite Australian Football League players.

OBJECTIVES: Deficits in strength of lower limb musculature have been associated with increased injury risk in a variety of athletic populations. As medical and performance staff seek to better understand the association between hip and knee strength measures and injury risk, measurement tools with high reliability and utility are required to profile and manage athletes effectively. The purpose of this study was to investigate the test-retest reliability of a portable fixed frame dynamometry system used to assess hip and knee strength of an elite Australian Football League team. DESIGN: Case series. METHODS: Maximum voluntary isometric strength of the hip abductors, hip adductors and knee flexors of 41 elite male Australian Football League footballers (mean age=23.7±4.1 years, height=189.2±7.0cm, weight=88.6±8.4kg) were tested during preseason training. Tests were performed one week apart on the same training day of a standard preseason week. RESULTS: Test-retest reliability was very high for left hip adduction (ICC 0.958), right hip adduction (ICC 0.955), left hip abduction (ICC 0.957), right hip abduction (ICC 0.945), left knee flexion (ICC 0.927) and right knee flexion (ICC 0.923). Furthermore, standard errors of measurement in per cent (SEM%) ranged from 3.21 to 5.03%, and minimal detectable change (MDC) from 3.93 to 6.65kg for the different hip and thigh strength measures, making it possible to determine small changes in strength at the individual level. CONCLUSIONS: This study demonstrated very high reliability when testing maximal voluntary isometric hip and knee strength using a portable fixed dynamometry system (KangaTech) in an elite male Australian Football League setting.

Combining physical performance and Functional Movement Screen testing to identify elite junior Australian Football athletes at risk of injury.

The Functional Movement Screen (FMS) and physical performance testing are often suggested to be related to sports injury risk. This study explored if the combination of FMS and physical performance testing improved identification of non-contact injury risk over FMS testing alone in an elite junior Australian football cohort. Over a 3-year period, 573 players completed pre-season injury history questionnaires, FMS, physical performance testing (20-m sprint, vertical jump, planned agility testing, and shuttle run test), and subsequent in-season injury surveillance. Results: Neither previous injury or FMS score <14 were related to an increased risk of subsequent injury in isolation. The combination of FMS composite score ≤14 and previous injury moderately increased the risk of injury (Hazard ratio [HR] = 2.22 [1.09-4.54]). None of the physical performance measures improved the ability to predict injuries based on FMS composite score. FMS asymmetry was only associated with injury when combined with previous injury and vertical jump performance. Players with ≥1 FMS asymmetry and history of previous injury experienced a large increase in injury risk when vertical jump was poor (HR = 4.26 [1.35-13.42]) or good (HR = 3.17 [1.08-9.29]). Players with a combination of a good vertical jump, no previous injury, and no FMS asymmetries were also at moderately increased risk of injury (HR = 3.41 [1.11-10.42]). No physical performance tests improved the ability to identify non-contact injury risk using an FMS composite score threshold. However, a U-shaped relationship between vertical jump and injury risk was identified with both poor and good vertical jump height associated with a moderate-large increase in non-contact injury risk in the presence of ≥1 asymmetrical FMS sub-test.

Hamstring injuries and Australian Rules football: over-reliance on Nordic hamstring exercises as a preventive measure?

Nordic hamstring exercises (NHE) are promoted as an evidence-based strategy for reducing the prevalence of hamstring injuries in football, with a number of studies showing a significant reduction in hamstring injury rates following implementation of a NHE-based program. However, most of the research to date has been undertaken in soccer with less research carried out in other football codes. Despite this lack of relevant evidence, NHE has recently become popular as a preventative measure in Australian Rules football (ARF) teams; however, hamstring injuries remain high. This paper reviews the literature associated with the use of NHE for ARF players and questions the appropriateness of this exercise approach as a preventative measure for hamstring injuries in this sport. When considering the use of a preventative exercise program, such as the NHE, the specific risks associated with the sporting activity should be considered and the evidence reviewed in light of this. Whilst NHE provides an easy way to do eccentric exercises, the movement does not replicate what is needed in the real world for ARF and should therefore be included in a hamstring injury prevention program in this code with caution.

Sources of information used by patients prior to elective surgery: a scoping review.

OBJECTIVE: To describe the range and nature of available research regarding sources of information that patients access to inform their decisions about elective surgery. DESIGN: Scoping review. DATA SOURCES: Peer-reviewed studies published until February 2019 from the six scientific literature databases were searched and included in the study: Medline, PubMed, CINAHL, Academic Search Premier, EMBASE and SCOPUS. Web searches for grey literature were conducted in Google, South Australia Department of Health, Commonwealth Department of Health (Australia) and My Aged Care from the Department of Social Services (Australia). ELIGIBILITY CRITERIA: Studies with a focus on elective surgery information sources oriented to patients were eligible for inclusion. Only studies written in English were sought and no publication date or study restrictions were applied. DATA EXTRACTION AND SYNTHESIS: Included literature was described by National Health and Medical Council hierarchy of evidence, and data were extracted on country and year of publication, type of literature, who provided it and any information on end users. Information sources were categorised by type and how information was presented. RESULTS: A pool of 1039 articles was reduced to 26 after screening for duplicates and non-relevant studies. Face-to-face exchanges were the most likely source of information prior to elective surgery (59.3%), printed information (55.6%) followed by e-learning (51.9%) and multimedia (14.8%). The face-to-face category included information provided by the physician/general practitioners/specialists, and family and friends. Printed information included brochures and pamphlets, e-learning consisted of internet sites or videos and the use of multimedia included different mixed media format. CONCLUSION: There is considerable variability regarding the types of information patients use in their decision to undergo elective surgery. The most common source of health information (face-to-face interaction with medical personnel) raises the question that the information provided could be incomplete and/or biased, and dependent on what their health provider knew or chose to tell them.