Journal impact factor is associated with PRISMA endorsement, but not with the methodological quality of low back pain systematic reviews: a methodological review.

PURPOSE: To analyze the association of impact factor of the journals publishing low back pain systematic reviews with whether these journals endorsed the PRISMA recommendations and the reviews methodological quality. METHODS: We searched the Physiotherapy Evidence Database on January 2018 for all low back pain systematic reviews, published between 2015 and 2017. Our primary outcomes were PRISMA recommendations endorsement by the journal and 2017 journal impact factor. We assessed systematic review methodological quality using the AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews) and reported descriptive statistics. A multivariate linear regression model was built. We assessed 66 systematic reviews published in 42 journals. Thirty-seven journals had an impact factor (mean 4.0, SD 4.8). 55% journals endorsed the PRISMA recommendations. The methodological quality of 75.8% systematic reviews was critically low. Journals with higher impact factor were associated with journals endorsing the PRISMA recommendations (ß 3.7; 95% CI 1.2, 6.3), but were not associated with the reviews' methodological quality (ß - 0.3; 95% CI - 4.8, 4.3). LIMITATIONS: Our findings may not be generalized to other study populations and interventions such as medical devices, surgery and medication. CONCLUSIONS: Three out of every four published low back pain systematic reviews had critically low methodological quality. Journals with higher impact factor were associated with journals endorsing the PRISMA recommendations. Clinicians must know how to critically appraise reviews. Journals' editorial policies should include the assessment of study methodological quality and reporting in the review process of an article. These slides can be retrieved under Electronic Supplementary Material.

Methodologic Quality and Statistical Reporting of Physical Therapy Randomized Controlled Trials Relevant to Musculoskeletal Conditions.

OBJECTIVES: To investigate the methodologic quality and statistical reporting of reports of trials indexed on the Physiotherapy Evidence Database (PEDro) classified in the musculoskeletal subdiscipline, and to analyze the characteristics of the trials that can predict trial report quality. DESIGN: Cross-sectional study based on a collection of randomized controlled trials. We randomly selected 19% of trials coded as musculoskeletal from PEDro. Methodologic quality was assessed using the PEDro scale. We assessed aspects of the trial using 9 items from the Consolidated Standards of Reporting Trials (CONSORT) statement. We performed multivariate linear regression analysis models to predict the total PEDro score. SETTING: Not applicable. PARTICIPANTS: Not applicable. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Not applicable. RESULTS: A total of 1404 articles were included in the analysis. The mean total PEDro scale score was 5.27±1.63 points, which reflects low methodologic quality. There was a slight improvement in the quality of articles over time. The characteristics that predicted the total PEDro scale score were endorsement of the CONSORT statement, sample size calculation, lower number of primary outcomes, evaluation of electrotherapy as intervention, if the trial reported the research design in the title, reporting of participant flow diagram, years since publication (most recent trials), and trials published in English. CONCLUSIONS: The quality of the trials in musculoskeletal physical therapy is suboptimal. The use of reporting checklists (eg, CONSORT statement) should be mandatory in all journals. Journal reviewers and journal editors should also use the CONSORT statement during the review process.

Impact of Low Back Pain Clinical Trials Measured by the Altmetric Score: Cross-Sectional Study.

BACKGROUND: There is interest from authors and publishers in sharing the results of their studies over the Internet in order to increase their readership. In this way, articles tend to be discussed and the impact of these articles tends to be increased. In order to measure this type of impact, a new score (named Altmetric) was created. Altmetric aims to understand the individual impact of each article through the attention attracted online. OBJECTIVE: The primary objective of this study was to analyze potential factors related with the publishing journal and the publishing trial that could be associated with Altmetric scores on a random sample of low back pain randomized controlled trials (RCTs). The secondary objective of this study was to describe the characteristics of these trials and their Altmetric scores. METHODS: We searched for all low back pain RCTs indexed on the Physiotherapy Evidence Database (PEDro; www.pedro.org.au) published between 2010 and 2015. A total of 200 articles were randomly selected, and we extracted data related to the publishing trial, the publishing journal, methodological quality of the trials (measured by the 0-10 item PEDro scale), and total and individual scores of Altmetric mentioned and Altmetric reader. The study was a cross-sectional study, and multivariate regression models and descriptive statistics were used. RESULTS: A total of four variables were associated with Altmetric mentioned score: impact factor (ß-coefficient=3.4 points), number of years since publication (ß-coefficient=-4.9 points), number of citations divided by years since publication (ß-coefficient=5.2 points), and descriptive title (ß-coefficient=-29.4 points). Only one independent variable was associated with Altmetric reader score: number of citations divided by years since publication (ß-coefficient=10.1 points, 95% CI 7.74-12.46). We also found that the majority of articles were published in English, with a descriptive title, and published in open access journals endorsing the Consolidated Standards of Reporting Trials (CONSORT) statement. CONCLUSIONS: Researchers should preferably select high impact factor journals for submission and use declarative or interrogative titles, as these factors are likely to increase the visibility of their studies in social media.

The impact of low back pain systematic reviews and clinical practice guidelines measured by the Altmetric score: Cross-Sectional study.

BACKGROUND: Although Altmetric has been widely used by researchers to monitor the audience of their articles, there are no studies that have analysed factors associated with Altmetric score for systematic reviews and clinical practice guidelines. OBJECTIVES: 1) To analyse factors that could be associated with Altmetric scores for low back pain systematic reviews and clinical practice guidelines. 2) To describe the characteristics of these articles and their Altmetric scores. METHODS: We searched for all low back pain systematic reviews and guidelines indexed on the Physiotherapy Evidence Database published between 2015 and 2017. We extracted data related to the published paper, the publishing journal, and Altmetric scores. RESULTS: A total of 66 systematic reviews and 5 guidelines were included. The variable impact factor (independent variable) was associated with Altmetric mentioned score (dependent variable) with a ß coefficient of 15.4 (95% CI: 0.97, 29.7) ajusted to all remaining variables. The variable number of citations normalized by year of publication (independent variable) was associated with Altmetric reader score (dependent variable) with a ß coefficient of 6.4 (95% CI: 4.03, 8.72) ajusted to all remaining variables. We also found that the majority of the systematic reviews and guidelines were published in English, had a descriptive title, were published as open access, included multicenter studies, and had media release generated by the publishing journal. CONCLUSION: Metrics related to the number of citations, such as the impact factor are associated with Altmetric scores.

What are the variables associated with Altmetric scores?

BACKGROUND: Social media has been used to disseminate the contents of scientific articles. To measure the impact of this, a new tool called Altmetric was created. Altmetric aims to quantify the impact of each article through online media. This systematic review aims to describe the associations between the publishing journal and published article variables and Altmetric scores. METHODS: Searches on MEDLINE, EMBASE, CINAHL, CENTRAL, and Cochrane Library were conducted. We extracted data related to both the publishing article and the publishing journal associated with Altmetric scores. The methodological quality of included articles was analyzed by the Appraisal Tool for Cross-sectional Studies. RESULTS: A total of 19 articles were considered eligible. These articles summarized a total of 573,842 studies. Citation counts, journal impact factor, access counts, papers published as open access, and press releases generated by the publishing journal were associated with Altmetric scores. The magnitude of these associations ranged from weak to strong. CONCLUSION: Citation counts and journal impact factor are the most common variables associated with Altmetric scores. Other variables such as access counts, papers published in open access journals, and the use of press releases are also likely to be associated with online media attention. SYSTEMATIC REVIEW REGISTRATION: This review does not contain health-related outcomes. Therefore, it is not eligible for registration.

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.

Photobiomodulation therapy is not better than placebo in patients with chronic nonspecific low back pain: a randomised placebo-controlled trial.

ABSTRACT: Photobiomodulation therapy (PBMT) has been used in several musculoskeletal disorders to reduce pain, inflammation, and promoting tissue regeneration. The current evidence about the effects of PBMT on low back pain (LBP) is still conflicting. We aimed to evaluate the effects of PBMT against placebo on pain intensity and disability in patients with chronic nonspecific LBP. This was a prospectively registered, randomised placebo-controlled trial, with blinded patients, therapists, and assessors. The study was conducted on an outpatient physical therapy clinic in Brazil, between April 2017 and May 2019. A total of 148 patients with chronic nonspecific LBP were randomised to either active PBMT (n = 74) or placebo (n = 74). Patients from both groups received 12 treatment sessions, 3 times a week, for 4 weeks. Patients from both groups also received an educational booklet based on "The Back Book." Clinical outcomes were measured at baseline and at follow-up appointments at 4 weeks, 3, 6, and 12 months after randomisation. The primary outcomes were pain intensity and disability measured at 4 weeks. We estimated the treatment effects using linear mixed models following the principles of intention-to-treat. There was no clinical important between-group differences in terms of pain intensity (mean difference = 0.01 point; 95% confidence interval = -0.94 to 0.96) and disability (mean difference = -0.63 points; 95% confidence interval = -2.23 to 0.97) at 4 weeks. Patients did not report any adverse events. Photobiomodulation therapy was not better than placebo to reduce pain and disability in patients with chronic nonspecific LBP.

Commentary on: Kinesio taping in treatment of chronic non-specific low back pain: A systematic review and meta-analysis.

Missing (Letter).

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.

Description of low back pain clinical trials in physical therapy: a cross sectional study.

OBJECTIVE: To describe the main characteristics of low back pain randomized controlled trials on the Physiotherapy Evidence Database, and to rank the journals where these trials were published according to their Impact Factor. METHODS: This is a cross sectional study based on a collection of randomized controlled trials. A random sample of 200 low back pain trials published between 2010 and 2015 were selected from Physiotherapy Evidence Database in February 2016. We collected the following main characteristics of trials: 2015 journal Impact Factor; if the paper was published as open access; CONSORT recommendations endorsement by the journal; methodological quality and statistical reporting measured by the 0-10 items Physiotherapy Evidence Database scale. Data was analyzed descriptively. RESULTS: Trials were published in journals with a mean Impact Factor of 2.5 (SD 2.5), from which 55.5% endorsed the CONSORT recommendations. The methodological quality was moderate with 5.8 points (SD 1.6). The top 3 journals according to Impact Factor were: (1) British Medical Journal; (2) Annals of Internal Medicine; and (3) BMC Medicine. Only 6 out of 97 journals publishing low back pain trials combined the following factors: journal Impact Factor higher than 2.0, mean trial methodological quality higher than 6.0 points, endorse CONSORT recommendations and offering papers as open access. CONCLUSION: Clinicians interested in low back pain trials must look for a wide variety of healthcare journals. A substantial number of low back pain randomized controlled trials did not follow adequate reporting and methodological recommendations.

Effects of photobiomodulation therapy in patients with chronic non-specific low back pain: protocol for a randomised placebo-controlled trial.

INTRODUCTION: Low back pain (LBP) is one of the largest and most frequent public health problems worldwide. Photobiomodulation therapy (PBMT) is a frequently used non-pharmacological therapy for the treatment of musculoskeletal disorders. However, there is little high-quality scientific evidence that demonstrates the effectiveness of PBMT in the treatment of patients with chronic LBP in the short, medium and long term. Therefore, the objective of this clinical trial is to evaluate the effects of PBMT in patients with chronic non-specific LBP in the short, medium and long term. METHODS AND ANALYSES: This is a prospectively registered, two-arm randomised placebo-controlled trial with blinded patients, assessors and treatment providers. One hundred and forty-eight patients with chronic non-specific LBP will be recruited. Treatment sessions will be provided three times a week for 4 weeks (totaling 12 sessions) with patients receiving either placebo or active PBMT. For ethical reasons, all patients, regardless of treatment allocation, will also receive an information booklet based on 'The Back Book'. Clinical outcomes will be measured at baseline, at the end of treatment, as well as 3, 6 and 12 months after randomisation. The primary outcomes will be pain intensity and disability measured after 12 sessions of treatment. The secondary outcomes will be pain intensity and disability measured at 3, 6 and 12 months after randomisation, in addition to specific disability and global perceived effect in all time points. ETHICS AND DISSEMINATION: The study was approved by the Research Ethics Committee of Universidade Cidade de São Paulo. The results will be disseminated through scientific publications and presentations at national and international scientific meetings. TRIAL REGISTRATION NUMBER: NCT03089424.

Do people with recurrent back pain constrain spinal motion during seated horizontal and downward reaching?

BACKGROUND: Although the effect of symptomatic back pain on functional movement has been investigated, changes to spinal movement patterns in essentially pain-free people with a history of recurrent back pain are largely unreported. Reaching activities, important for everyday and occupational function, often present problems to such people, but have not been considered in this population. The purpose of this study was to compare the amplitude and timing of spinal and hip motions during two, seated reaching activities in people with and without a history of recurrent low back pain (RLBP). METHODS: Spinal and hip motions during reaching downward and across the body, in both directions, were tracked using electromagnetic sensors. Analyses were conducted to explore the amplitudes, velocities and timings of 3D segmental movements and to compare controls with subjects with recurrent, but asymptomatic lumbar or lumbosacral pain. FINDINGS: We detected significant differences in the amplitude and timing of movement in the lower thoracic region, with the RLBP group restricting movement and demonstrating compensatory increased motion at the hip. The lumbar region displayed no significant between-group differences. The order in which the spinal segments achieved peak velocity in cross-reaching was reversed in RLBP compared to controls, with lumbar motion leading in controls and lagging in RLBP. INTERPRETATION: Subjects with a history of RLBP show a number of altered kinematic features during reaching activities which are not related to the presence or intensity of pain, but which suggest adaptive changes to movement control.

Coordination of spinal motion in the transverse and frontal planes during walking in people with and without recurrent low back pain.

STUDY DESIGN: Observational cohort study. OBJECTIVE: To investigate spinal coordination during preferred and fast speed walking in pain-free subjects with and without a history of recurrent low back pain (LBP). SUMMARY OF BACKGROUND DATA: Dynamic motion of the spine during walking is compromised in the presence of back pain (LBP), but its analysis often presents some challenges. The coexistence of significant symptoms may change gait because of pain or adaptation of the musculoskeletal structures or both. A history of LBP without the overlay of a current symptomatic episode allows a better model in which to explore the impact on spinal coordination during walking. METHODS: Spinal and lower limb segmental motions were tracked using electromagnetic sensors. Analyses were conducted to explore the synchrony and spatial coordination of the segments and to compare the control and subjects with LBP. RESULTS: We found no apparent differences between the groups for either overall amplitude of motion or most indicators of coordination in the lumbar region; however, there were significant postural differences in the mid-stance phase and other indicators of less phase locking in controls compared with subjects with LBP. The lower thoracic spinal segment was more affected by the history of back pain than the lumbar segment. CONCLUSION: Although small, there were indicators that alterations in spinal movement and coordination in subjects with recurrent LBP were due to adaptive changes rather than the presence of pain.