Conservative management following closed reduction of traumatic anterior dislocation of the shoulder.

BACKGROUND: Acute anterior shoulder dislocation, which is the most common type of dislocation, usually results from an injury. Subsequently, the shoulder is less stable and is more susceptible to re-dislocation or recurrent instability (e.g. subluxation), especially in active young adults. After closed reduction, most of these injuries are treated with immobilisation of the injured arm in a sling or brace for a few weeks, followed by exercises. This is an update of a Cochrane Review first published in 2006 and last updated in 2014. OBJECTIVES: To assess the effects (benefits and harms) of conservative interventions after closed reduction of traumatic anterior dislocation of the shoulder. These might include immobilisation, rehabilitative interventions or both. SEARCH METHODS: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, PEDro and trial registries. We also searched conference proceedings and reference lists of included studies. Date of last search: May 2018. SELECTION CRITERIA: We included randomised or quasi-randomised controlled trials comparing conservative interventions with no treatment, a different intervention or a variant of the intervention (e.g. a different duration) for treating people after closed reduction of a primary traumatic anterior shoulder dislocation. Inclusion was regardless of age, sex or mechanism of injury. Primary outcomes were re-dislocation, patient-reported shoulder instability measures and return to pre-injury activities. Secondary outcomes included participant satisfaction, health-related quality of life, any instability and adverse events. DATA COLLECTION AND ANALYSIS: Both review authors independently selected studies, assessed risk of bias and extracted data. We contacted study authors for additional information. We pooled results of comparable groups of studies. We assessed risk of bias with the Cochrane 'Risk of bias' tool and the quality of the evidence with the GRADE approach. MAIN RESULTS: We included seven trials (six randomised controlled trials and one quasi-randomised controlled trial) with 704 participants; three of these trials (234 participants) are new to this update. The mean age across the trials was 29 years (range 12 to 90 years), and 82% of the participants were male. All trials compared immobilisation in external rotation (with or without an additional abduction component) versus internal rotation (the traditional method) following closed reduction. No trial evaluated any other interventions or comparisons, such as rehabilitation. All trials provided data for a follow-up of one year or longer; the commonest length was two years or longer.All trials were at some risk of bias, commonly performance and detection biases given the lack of blinding. Two trials were at high risk of selection bias and some trials were affected by attrition bias for some outcomes. We rated the certainty of the evidence as very low for all outcomes.We are uncertain whether immobilisation in external rotation makes a difference to the risk of re-dislocation after 12 months' or longer follow-up compared with immobilisation in internal rotation (55/245 versus 73/243; risk ratio (RR) 0.67, 95% confidence interval (CI) 0.38 to 1.19; 488 participants; 6 studies; I² = 61%; very low certainty evidence). In a moderate-risk population with an illustrative risk of 312 per 1000 people experiencing a dislocation in the internal rotation group, this equates to 103 fewer (95% CI 194 fewer to 60 more) re-dislocations after immobilisation in external rotation. Thus this result covers the possibility of a benefit for each intervention.Individually, the four studies (380 participants) reporting on validated patient-reported outcome measures for shoulder instability at a minimum of 12 months' follow-up found no evidence of a clinically important difference between the two interventions.We are uncertain of the relative effects of the two methods of immobilisation on resumption of pre-injury activities or sports. One study (169 participants) found no evidence of a difference between interventions in the return to pre-injury activity of the affected arm. Two studies (135 participants) found greater return to sports in the external rotation group in a subgroup of participants who had sustained their injury during sports activities.None of the trials reported on participant satisfaction or health-related quality of life.We are uncertain whether there is a difference between the two interventions in the number of participants experiencing instability, defined as either re-dislocation or subluxation (RR 0.84, 95% CI 0.62 to 1.14; 395 participants, 3 studies; very low certainty evidence).Data on adverse events were collected only in an ad hoc way in the seven studies. Reported "transient and resolved adverse events" were nine cases of shoulder stiffness or rigidity in the external rotation group and two cases of axillary rash in the internal rotation group. There were three "important" adverse events: hyperaesthesia and moderate hand pain; eighth cervical dermatome paraesthesia; and major movement restriction between 6 and 12 months. It was unclear to what extent these three events could be attributed to the treatment. AUTHORS' CONCLUSIONS: The available evidence from randomised trials is limited to that comparing immobilisation in external versus internal rotation. Overall, the evidence is insufficient to draw firm conclusions about whether immobilisation in external rotation confers any benefit over immobilisation in internal rotation.Considering that there are several unpublished and ongoing trials evaluating immobilisation in external versus internal rotation, the main priority for research on this question consists of the publication of completed trials and the completion and publication of ongoing trials. Meanwhile, evaluation of other interventions, including rehabilitation, is warranted. There is a need for sufficiently large, good-quality, well-reported randomised controlled trials with long-term follow-up. Future research should aim to determine the optimal immobilisation duration, precise indications for immobilisation, optimal rehabilitation interventions, and the acceptability of these different interventions.

Predicting the outcome of conservative treatment with physiotherapy in adults with shoulder pain associated with partial-thickness rotator cuff tears - a prognostic model development study.

BACKGROUND: Rotator cuff disorders represent the commonest type of painful shoulder complaints in clinical practice. Although conservative treatment including physiotherapy is generally recommended as first-line treatment, little is known about the precise treatment indications for subgroups of rotator cuff disorders, particularly people with shoulder pain associated with partial-thickness tears of the rotator cuff, PTTs: "symptomatic PPTs". The aim of this study was to develop a prognostic model for predicting the outcome of a phase of conservative treatment primarily with physiotherapy in adults with symptomatic PTTs. METHODS: A prospective observational cohort study was conducted in an outpatient setting in Germany. Ten baseline factors were selected to evaluate nine pre-defined multivariable candidate prognostic models (each including between two and nine factors) in a cohort of adults with symptomatic atraumatic PTTs undergoing a three-month phase of conservative treatment primarily with physiotherapy. The primary outcome was change in the Western Ontario Rotator Cuff Index. The models were developed using linear regression and an information-theoretic analysis approach: Akaike's Information Criterion (AICC). RESULTS: Eight candidate models were analyzed using data from 61 participants. Two "best models" were identified: smoking & pain catastrophizing and disability & pain catastrophizing. However, none of the models had a satisfactory performance or precision. CONCLUSIONS: We could not determine a prognostic model with satisfactory performance and precision. Further high-quality prognostic model studies with larger samples are needed, but should be underpinned, and thus preceded, by robust research that enhances knowledge of relevant prognostic factors. STUDY REGISTRATION: DRKS00004462 . Registered 08 April 2014; retrospectively registered (prior to the analysis).

Experiment-Driven Modeling of Crystalline Phosphorus Nitride P3 N5 : Wide-Ranging Implications from a Unique Structure.

Nitridophosphates have emerged as advanced materials due to their structural variability and broad technical applicability. Their binary parent compound P3 N5 , a polymeric network of corner- and edge-sharing PN4 tetrahedra with N and N sites, is a particularly interesting example. We present a study of the band gap and electronic structure of α-P3 N5 by using soft X-ray spectroscopy measurements and DFT calculations. The band gap, which is crucial for all applications, is measured to be 5.87±0.20 eV. This agrees well with the calculated, indirect band gap of 5.21 eV. The density of states are found to show dramatic variation between the nonequivalent N sites and a high degree of covalency. Coupled to these results is what is, to our knowledge, the largest core hole shift reported to date for a soft X-ray absorption spectrum. We propose an intuitive bonding scheme for α-P3 N5 that explains the observed band gap and unique density of states, while providing a framework for predicting these properties in known and yet to be discovered PN compounds. We briefly consider the implications of these results for new low-dimensional P and PN materials, which alongside graphene, could become important materials for nanoelectronics.

Guidance on how to efficiently find, choose, and use available systematic reviews was developed.

OBJECTIVE: The aim of this paper is to provide clinicians and authors of clinical guidelines or patient information with practical guidance on searching and choosing systematic reviews(s) (SR[s]) and, where adequate, on making use of SR(s). STUDY DESIGN AND SETTING: At the German conference of the EBM-Network a workshop on the topic was held to identify the most important areas where guidance for practice appears necessary. After the workshop, we established working groups. These included SR users with different backgrounds (e. g. information specialists, epidemiologists) and working areas. Each working group developed and consented a draft guidance based on their expert knowledge and experiences. The results were presented to the entire group and finalized in an iterative process. RESULTS: We developed a practical guidance that answers questions that usually arise when choosing and using SR(s). 1: How to efficiently find high-quality SRs? 2: How to choose the most appropriate SR? 3: What to do if no SR of sufficient quality could be identified? In addition, we developed an algorithm that links these steps and accounts for their interaction. The resulting guidance is primarily directed at clinicians and developers of clinical practice guidelines or patient information resources. CONCLUSION: We suggest practical guidance for making the best use of SRs when answering a specific research question. The guidance may contribute to the efficient use of existing SRs. Potential benefits when using existing SRs should be always weighted against potential limitations.

[Development of criteria for the prospective assessment of the need for updating guideline recommendations: The AGIL criteria]. / Entwicklung von Kriterien für die prospektive Einschätzung des Aktualisierungsbedarfs von Leitlinienempfehlungen: AGIL-Kriterien.

BACKGROUND: Evidence-based guideline and vaccination recommendations should continuously be updated to appropriately support health care decisions. However, resources for updating guidelines are often limited. The aim of this project was to develop a list of criteria for the prospective assessment of the need for updating individual guideline or vaccination recommendations, which can be applied from the time a guideline or guideline update is finalised. METHODS: In this article we describe the development of the AGIL criteria (Assessment of Guidelines for Updating Recommendations). The AGIL criteria were developed by experienced scientists and experts in the field of guideline development in a multi-step process. The five steps included: 1) development of an initial list of criteria by the project team; 2) online survey of guideline experts on the initial version of the criteria list; 3) revision of the criteria list based on the results of the online survey; 4) workshop on the criteria list at the EbM Congress 2023; 5) creation of version 1.0 of the AGIL criteria based on the workshop results. RESULTS: The initial list included the following three criteria: 1) relevance of the question 2) availability of new relevant evidence, and 3) impact of potentially new evidence. The response rate of the online survey for fully completed questionnaires was 31.0% (N=195; 630 guideline experts were contacted by email). For 90.3% (n=176) of the respondents, the criteria list included all essential aspects for assessing the need for updating guideline recommendations. More than three quarters of respondents rated the importance of the three criteria as "very important" or "important" (criteria 1-3: 75.3%, 86.1%, 85.2%) and - with the exception of criterion 1 - comprehensibility as "very comprehensible" or "comprehensible" (criteria 1-3: 58.4%, 75.9%, 78.5%). The results of the online survey and the workshop generally confirmed the three criteria with their two sub-questions. The incorporation of all feedback resulted in the AGIL criteria (version 1.0), recapping: 1) relevance of the question regarding a) PICO components and b) other factors, e.g. epidemiological aspects; 2) availability of new evidence a) on health-related benefits and harms and b) on other decision factors, e.g. feasibility, acceptability; 3) impact of new evidence a) on the certainty of evidence on which the recommendation is based and b) on the present recommendation, e.g. DISCUSSION: The moderate response rate of the online survey may have limited its representativeness. Nevertheless, we consider the response rate to be satisfactory in this research context. The inclusion of many experts in the online survey and the EbM Congress workshop is a strength of the project and supports the quality of the results. CONCLUSIONS: The AGIL criteria provide a structured guidance for the prospective assessment of the need for updating individual guideline recommendations and other evidence-based recommendations. The implementation and evaluation of the AGIL criteria 1.0 in a field test is planned.

Interventions for preventing back pain among office workers - a systematic review and network meta-analysis.

OBJECTIVE: Back pain is common in the working population. This systematic review with network meta-analysis (NMA) aimed to compare the effects of interventions for preventing back pain among office workers. METHODS: We searched eight databases and additional sources up to March 2021. We included randomized controlled trials (RCT) and cluster RCT focusing on office workers, comparing work-related interventions aimed at preventing back pain (defined as pain in any part of the spine) to a control condition and assessing back pain and/or work absence. Further outcomes considered were adverse events and participants' satisfaction. We performed both frequentist and component NMA. Risk of bias (RoB) was evaluated using RoB 2 and certainty of the evidence (CoE) was assessed using GRADE. RESULTS: We screened 9809 records and included 24 studies with a total of 7080 participants. RoB was assessed as "some concerns" or "high" for all studies and outcomes. Included studies investigated multicomponent interventions, ergonomics, physical activity, education, behavioral interventions and no/minimal interventions. Effects were mostly not statistically significant and based on low/very low CoE. Physical activity probably reduces days of work absence slightly [mean difference (MD) -1.10, 95% confidence interval (CI) -2.07- -0.13], and combining physical activity and ergonomics may reduce back pain intensity (standardized MD -0.41, 95% CI -0.80- -0.02) when compared to no/minimal intervention. A large proportion of participants were satisfied with the interventions, adverse events were rarely assessed. CONCLUSIONS: We observed mostly minor effects of interventions on back pain and work absence among office workers. The practical relevance of these effects is questionable.

Safety and effectiveness of vaccines against COVID-19 in children aged 5-11 years: a systematic review and meta-analysis.

BACKGROUND: To date, more than 761 million confirmed SARS-CoV-2 infections have been recorded globally, and more than half of all children are estimated to be seropositive. Despite high SARS-CoV-2 infection incidences, the rate of severe COVID-19 in children is low. We aimed to assess the safety and efficacy or effectiveness of COVID-19 vaccines approved in the EU for children aged 5-11 years. METHODS: In this systematic review and meta-analysis, we included studies of any design identified through searching the COVID-19 L·OVE (living overview of evidence) platform up to Jan 23, 2023. We included studies with participants aged 5-11 years, with any COVID-19 vaccine approved by the European Medicines Agency-ie, mRNA vaccines BNT162b2 (Pfizer-BioNTech), BNT162b2 Bivalent (against original strain and omicron [BA.4 or BA.5]), mRNA-1273 (Moderna), or mRNA-1273.214 (against original strain and omicron BA.1). Efficacy and effectiveness outcomes were SARS-CoV-2 infection (PCR-confirmed or antigen-test confirmed), symptomatic COVID-19, hospital admission due to COVID-19, COVID-19-related mortality, multisystem inflammatory syndrome in children (MIS-C), and long-term effects of COVID-19 (long COVID or post-COVID-19 condition as defined by study investigators or per WHO definition). Safety outcomes of interest were serious adverse events, adverse events of special interest (eg, myocarditis), solicited local and systemic events, and unsolicited adverse events. We assessed risk of bias and rated the certainty of evidence (CoE) using the Grading of Recommendations Assessment, Development and Evaluation approach. This study was prospectively registered with PROSPERO, CRD42022306822. FINDINGS: Of 5272 screened records, we included 51 (1·0%) studies (n=17 [33%] in quantitative synthesis). Vaccine effectiveness after two doses against omicron infections was 41·6% (95% CI 28·1-52·6; eight non-randomised studies of interventions [NRSIs]; CoE low), 36·2% (21·5-48·2; six NRSIs; CoE low) against symptomatic COVID-19, 75·3% (68·0-81·0; six NRSIs; CoE moderate) against COVID-19-related hospitalisations, and 78% (48-90, one NRSI; CoE very low) against MIS-C. Vaccine effectiveness against COVID-19-related mortality was not estimable. Crude event rates for deaths in unvaccinated children were less than one case per 100 000 children, and no events were reported for vaccinated children (four NRSIs; CoE low). No study on vaccine effectiveness against long-term effects was identified. Vaccine effectiveness after three doses was 55% (50-60; one NRSI; CoE moderate) against omicron infections, and 61% (55-67; one NRSI; CoE moderate) against symptomatic COVID-19. No study reported vaccine efficacy or effectiveness against hospitalisation following a third dose. Safety data suggested no increased risk of serious adverse events (risk ratio [RR] 0·83 [95% CI 0·21-3·33]; two randomised controlled trials; CoE low), with approximately 0·23-1·2 events per 100 000 administered vaccines reported in real-life observations. Evidence on the risk of myocarditis was uncertain (RR 4·6 [0·1-156·1]; one NRSI; CoE low), with 0·13-1·04 observed events per 100 000 administered vaccines. The risk of solicited local reactions was 2·07 (1·80-2·39; two RCTs; CoE moderate) after one dose and 2·06 (1·70-2·49; two RCTs; CoE moderate) after two doses. The risk of solicited systemic reactions was 1·09 (1·04-1·16; two RCTs; CoE moderate) after one dose and 1·49 (1·34-1·65; two RCTs; CoE moderate) after two doses. The risk of unsolicited adverse events after two doses (RR 1·21 [1·07-1·38]; CoE moderate) was higher among mRNA-vaccinated compared with unvaccinated children. INTERPRETATION: In children aged 5-11 years, mRNA vaccines are moderately effective against infections with the omicron variant, but probably protect well against COVID-19 hospitalisations. Vaccines were reactogenic but probably safe. Findings of this systematic review can serve as a basis for public health policy and individual decision making on COVID-19 vaccination in children aged 5-11 years. FUNDING: German Federal Joint Committee.

Closing the yellow gap with Eu- and Tb-doped GaN: one luminescent host resulting in three colours.

Gallium nitride (GaN) is a key material when it comes to light-emitting diodes (LEDs) and has pushed the LED revolution in lighting and displays. The concept of down-conversion of a GaN-based blue LED offers the possibility to provide efficient generation of monochromatic, high-color purity light resulting in a highly efficient warm-white all-nitride phosphor-converted light emitting diode (pc-LED). Although the down conversion of blue light from InGaN LEDs has become a dominant technique for producing white light, there are still some technical challenges, e.g. the immiscibility of GaN and InN and the lattice mismatch between the substrate and InGaN, that have to be overcome. Here we demonstrate the doping of bulk GaN with europium, terbium and the combination of both resulting in intriguing luminescence properties, pushing the role of GaN:Eu,Tb as a chief component in future light emitting diodes. This colour tuning proves that one luminescence host can provide three colours (red, green and orange) and that even the so called "yellow gap" could be closed with a III-nitride. By using one material for all colours, it will be possible to overcome the technical challenges in building up LED devices, which will open up new capabilities for modern highly efficient phosphors.

Eu- and Tb-adsorbed Si3N4 and Ge3N4: tuning the colours with one luminescent host.

Phosphor-converted white light emitting diodes (pc-LEDs) are efficient light sources for applications in lighting and electronic devices. Nitrides, with their wide-ranging applicability due to their intriguing structural diversity, and their auspicious chemical and physical properties, represent an essential component in industrial and materials applications. Here, we present the successful adsorption of Eu and Tb at the grain boundaries of bulk ß-Si3N4 and ß-Ge3N4 by a successful combustion synthesis. The adsorption of europium and terbium, and the synergic combination of both, resulted in intriguing luminescence properties of all compounds (red, green, orange and yellow). In particular, the fact that one host can deliver different colours renders Eu,Tb-ß-M3N4 (M = Si, Ge) a prospective chief component for future light emitting diodes (LEDs). For the elucidation of the electronic properties and structure of ß-Si3N4 and ß-Ge3N4, Mott-Schottky (MS) measurements and density functional theory (DFT) computations were conducted for the bare and RE adsorbed samples.

Ca3N2 and Mg3N2: unpredicted high-pressure behavior of binary nitrides.

High-pressure synthesis allows both fundamental and materials science research to gain unprecedented insight into the inner nature of materials properties at extreme environment conditions. Here, we report on the high-pressure synthesis and characterization of γ-Ca(3)N(2) and the high-pressure behavior of Mg(3)N(2). Investigation of M(3)N(2) (M = Ca, Mg) at high-pressure has been quite challenging due to the high reactivity of these compounds. Ex situ experiments have been performed using a multianvil press at pressures from 8 to 18 GPa (1000-1200 °C). Additional in situ experiments from 0 to 6 GPa (at RT) at the multianvil press MAX 80 (HASYLAB, Beamline F.2.1, Hamburg) have been carried out. The new cubic high-pressure phase γ-Ca(3)N(2) with anti-Th(3)P(4) defect structure exhibits a significant increase in coordination numbers compared to α-Ca(3)N(2). Contrary, Mg(3)N(2) shows decomposition starting at surprisingly low pressures, thereby acting as a precursor for Mg nanoparticle formation with bcc structure. Soft X-ray spectroscopy in conjunction with first principles DFT calculations have been used to explore the electronic structure and show that γ-Ca(3)N(2) is a semiconductor with inherent nitrogen vacancies.

Work-related interventions for preventing back pain-protocol for a systematic review and network meta-analysis.

BACKGROUND: Back pain is a widespread health problem that accounts for substantial disability and high costs. The workplace is considered to critically affect the occurrence and persistence of back pain and therefore offers an important opportunity for preventive interventions. Various work-related intervention strategies including both single- and multicomponent interventions have been developed and evaluated so far. To determine their effectiveness, a method of analysis is needed that particularly meets the challenges of the multidimensionality and diversity of these interventions. This planned systematic review and network meta-analysis aims to compare the effects of different work-related interventions for preventing non-specific back pain in people within a formal employment-related context. METHODS: We will search the following databases: CENTRAL, MEDLINE, Web of Science, CINAHL, PsycINFO, PEDro, SPORTDiscus, and Academic Search Premier from their inception onwards, as well as additional sources. Randomized controlled trials (RCTs) and cluster-RCTs will be considered if they (1) include people within a formal employment-related context, (2) include people without back pain or mixed samples (i.e., people with and without back pain), (3) compare one or more work-related preventive intervention(s) to a control condition, and (4) assess non-specific back pain (incidence or/and pain intensity), ability to work (numbers of participants or/and numbers of days absent from work), intervention-related adverse events or/and self-reported satisfaction with the intervention. Random-effects pairwise meta-analyses and frequentist network meta-analyses will be conducted where appropriate. We will calculate summary effect sizes for each comparison of interventions and rank interventions according to their P scores. If feasible, we will conduct additional component network meta-analyses. We plan to conduct subgroup analyses for job exposure, intervention duration, baseline back pain, different localizations of back pain, and gender. Risk of bias will be assessed using RoB 2 and the certainty of the evidence will be rated using the GRADE approach. DISCUSSION: This systematic review aims to identify work-related intervention strategies as well as components within work-related interventions that are effective for preventing back pain. We expect the results to provide guidance for selecting the most promising interventions and foster the purposeful use of resources. Additionally, they may inform the development and implementation of work-related interventions as well as the design of future research in this field. TRIAL REGISTRATION: PROSPERO CRD42021232469.

Material properties and structural characterization of M3Si6O12N2:Eu2+ (M = Ba, Sr)--a comprehensive study on a promising green phosphor for pc-LEDs.

The efficient green phosphor Ba(3)Si(6)O(12)N(2):Eu(2+) and its solid-solution series Ba(3-x)Sr(x)Si(6)O(12)N(2) (with x approximately = 0.4 and 1) were synthesized in a radio-frequency furnace under nitrogen atmosphere at temperatures up to 1425 degrees C. The crystal structure (Ba(3)Si(6)O(12)N(2), space group P3 (no. 147), a = 7.5218(1), c = 6.4684(1) A, wR2 = 0.048, Z = 1) has been solved and refined on the basis of both single-crystal and powder X-ray diffraction data. Ba(3)Si(6)O(12)N(2):Eu(2+) is a layer-like oxonitridosilicate and consists of vertex-sharing SiO(3)N-tetrahedra forming 6er- and 4er-rings as fundamental building units (FBU). The nitrogen atoms are connected to three silicon atoms (N3), while the oxygen atoms are either terminally bound (O1) or bridge two silicon atoms (O2) (numbers in superscripted square brackets after atoms indicate the coordination number of the atom in question). Two crystallographically independent Ba(2+) sites are situated between the silicate layers. Luminescence investigations have shown that Ba(3)Si(6)O(12)N(2):Eu(2+) exhibits excellent luminescence properties (emission maximum at approximately 527 nm, full width at half maximum (FWHM) of approximately 65 nm, low thermal quenching), which provides potential for industrial application in phosphor-converted light-emitting diodes (pc-LEDs). In-situ high-pressure and high-temperature investigations with synchrotron X-ray diffraction indicate decomposition of Ba(3)Si(6)O(12)N(2) under these conditions. The band gap of Ba(3)Si(6)O(12)N(2):Eu(2+) was measured to be 7.05+/-0.25 eV by means of X-ray emission spectroscopy (XES) and X-ray absorption near edge spectroscopy (XANES). This agrees well with calculated band gap of 6.93 eV using the mBJ-GGA potential. Bonding to the Ba atoms is highly ionic with only the 4p(3/2) orbitals participating in covalent bonds. The valence band consists primarily of N and O p states and the conduction band contains primarily Ba d and f states with a small contribution from the N and O p states.

Surgical and Non-Surgical Interventions in Complete Rotator Cuff Tears.

BACKGROUND: This systematic review compares the efficacy and safety of surgical and non-surgical interventions for full- thickness rotator cuff tears. METHODS: A systematic literature search was conducted in five databases. Randomized (RCTs) and non-randomized controlled trials of interventions (non-RCTs) for the surgical or non-surgical treatment of patients with traumatic or atraumatic full-thickness rotator cuff tears were included. The review protocol was published in the PROSPERO registry (CRD42018100343). RESULTS: Ten studies (three RCTs with 332 participants; seven non-RCTs with 650 participants) met the inclusion criteria. One year after treatment, shoulder function, measured with the 100-point Constant score, had improved by 6.7 points (95% confidence interval [2.3; 11.0]) and pain, measured with the 10-cm visual analog scale, by 1.1 cm (0.5; 1.7] in the full-thickness rotator cuff tears treated surgically compared with non-surgical treatment. In one study the difference in favor of surgery persisted after 10 years' follow-up. For other outcomes, such as range of motion, muscle strength, quality of life, and adverse events, the data were sparse and the group differences were similar. The findings of the non-RCTs were comparable with those of the RCTs. CONCLUSION: With regard to functional improvement and pain reduction, surgical treatment of full-thickness rotator cuff tears was superior to non-surgical treatment in the short and the long term. Whether the differences between the groups are relevant for individual cases is uncertain, as the measured results were distributed below and above the threshold of clinical relevance. The conclusions may not be applicable to rotator cuff tears over 3 cm in size or to young persons.

[Treatment of non-specific low back pain: Evidence map of systematic reviews from 2015 to 2019]. / Behandlung nicht-spezifischer Kreuzschmerzen: Evidence Map über systematische Reviews von 2015 bis 2019.

BACKGROUND: Low back pain represents a major healthcare challenge in Germany and worldwide. The research field is highly dynamic. The aim of this evidence map was to create a compact overview of current systematic reviews on interventions for non-specific low back pain. METHODS: Medline (PubMed), the Cochrane Database of Systematic Reviews and Epistemonikos were systematically searched from March 2015 to March 2019 for systematic reviews addressing any interventions for acute, subacute or chronic non-specific low back pain and reporting at least one patient-relevant outcome. Key information on the characteristics and conclusions of the included reviews were extracted and aspects of the methodological quality of the included reviews were assessed independently by two reviewers. The data were tabulated. RESULTS: The search identified 1,436 records. 53 systematic reviews were included in the evidence map. The quality of the reviews and of the studies included therein varied. The reviews addressed a variety of different interventions, with considerable heterogeneity of their characteristics and methodological aspects. Many reviews found evidence for positive effects of the studied interventions, some found evidence for no effect, but the quantity and quality of the evidence were often judged as insufficient for formulating robust conclusions. Relatively few data were available on adverse events. CONCLUSION: This evidence map provides a compact resource for the use of current systematic reviews on interventions for non-specific low back pain. The methodological deficits of many reviews require a careful approach towards their findings and conclusions and suggest a need for methodologically rigorous reviews.

Estimating the Minimal Important Difference for the Western Ontario Rotator Cuff Index (WORC) in adults with shoulder pain associated with partial-thickness rotator cuff tears.

BACKGROUND: Knowledge about Minimal Important Differences (MIDs) is essential for the interpretation of continuous outcomes, especially patient-reported outcome measures (PROMS). OBJECTIVE: The aim of this study was to estimate the MID for the Western Ontario Rotator Cuff Index (WORC: score 0 (best) to 2100 (worst disability)) in adults with shoulder pain associated with partial-thickness rotator cuff tears, 'symptomatic PTTs', undergoing conservative treatment with physiotherapy. DESIGN: A prospectively-designed anchor-based MID analysis using data from a prospective prognostic study with a three-month follow-up conducted within an outpatient care setting in Germany. METHODS: The MID was estimated using data from 64 adults with atraumatic symptomatic PTTs who underwent three months of conservative treatment with physiotherapy. The anchor was a seven-point Global Perceived Change (GPC) scale. RESULTS: Based on a definition of the MID being the threshold of "being (at least slightly) improved" with a probability nearest to 0.90 (i.e. 9 of 10 patients achieving the MID), the MID for the WORC was estimated as -300 for 'improved' shoulder-related disability in 9 out of 10 patients (95% CI 8 out of 10 patients to everyone) undergoing three months of exercise-based physiotherapy for symptomatic PTTs. CONCLUSIONS: This is the first published MID estimate for the WORC in adults with symptomatic PTTs of the rotator cuff undergoing typical treatment comprising conservative treatment with physiotherapy. The conceptual framework for interpretation facilitates its use in similar clinical contexts.

Prognostic Models in Adults Undergoing Physical Therapy for Rotator Cuff Disorders: Systematic Review.

BACKGROUND: Rotator cuff-related disorders represent the largest subgroup of shoulder complaints. Despite the availability of various conservative and surgical treatment options, the precise indications for these options remain unclear. PURPOSE: The purpose of this systematic review was to synthesize the available research on prognostic models for predicting outcomes in adults undergoing physical therapy for painful rotator cuff disorders. DATA SOURCES: The MEDLINE, EMBASE, CINAHL, Cochrane CENTRAL, and PEDro databases and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) up to October 2015 were searched. STUDY SELECTION: The review included primary studies exploring prognostic models in adults undergoing physical therapy, with or without other conservative measures, for painful rotator cuff disorders. Primary outcomes were pain, disability, and adverse events. Inclusion was limited to prospective investigations of prognostic factors elicited at the baseline assessment. Study selection was independently performed by 2 reviewers. DATA EXTRACTION: A pilot-tested form was used to extract data on key aspects of study design, characteristics, analyses, and results. Risk of bias and applicability were independently assessed by 2 reviewers using the Prediction Study Risk of Bias Assessment tool (PROBAST). DATA SYNTHESIS: Five studies were included in the review. These studies were extremely heterogeneous in many aspects of design, conduct, and analysis. The findings were analyzed narratively. LIMITATIONS: All included studies were rated as at high risk of bias, and none of the resulting prognostic models was found to be usable in clinical practice. CONCLUSIONS: There are no prognostic models ready to inform clinical practice in the context of the review question, highlighting the need for further research on prognostic models for predicting outcomes in adults who undergo physical therapy for painful rotator cuff disorders. The design and conduct of future studies should be receptive to developing methods.

[Potential analysis for research on physiotherapy-led treadmill training in Parkinson's disease]. / Potenzialanalyse zur physiotherapeutischen Laufbandtherapie bei Morbus Parkinson.

HEALTH PROBLEM: Parkinson's disease is one of the major neurodegenerative disorders with prevalence rates between 0.1 and 0.2 % in the global population and 1.8 % in people aged 64 years and over. Future incidence rates are estimated to increase within aging societies. The progressive course of Parkinson's disease is clinically characterised by bradykinesia, rigidity and tremor. These limitations in motor functioning reduce the capacity to work, social participation and the clients' quality of life. Parkinson's disease causes incapacity to work and a large number of days off from work. The benefits clients expect from physiotherapy-led treatment include an improvement of gait, a better speed of motion and the decrease of fatigue and rigidity. CORPUS OF EVIDENCE: A recent Cochrane review (Mehrholz et al., 2010) analysed seven randomised comparisons with 153 participants and found that treadmill training compared with no treatment improved gait speed (SMD 0.50; 95 % confidence interval [0.17 to 0.84]). A lack of evidence exists on how to reduce fatigue and rigidity. There is also need to evaluate long-term effects and cost-effectiveness. Furthermore, an updated meta-analysis should include eleven new randomised trials on treadmill training after 2009. Physiotherapy-led treadmill training can easily be transferred into the German healthcare context since the environmental and educational preconditions are met by German physiotherapeutic care. IMPLICATION FOR RESEARCH: Within the German context, there is need to prepare a randomised clinical trial evaluating the impact of physiotherapy-led treadmill training on motor functioning, quality of life, costs, adverse events und long-term effects. Prior to this, a feasibility study should explore the acceptance and intensity of treadmill training as well as the access of private physiotherapy practices to people suffering from early- to mid-stage Parkinson's disease.

HP-Ca2Si5N8--a new high-pressure nitridosilicate: synthesis, structure, luminescence, and DFT calculations.

HP-Ca2Si5N8 was obtained by means of high-pressure high-temperature synthesis utilizing the multianvil technique (6 to 12 GPa, 900 to 1200 degrees C) starting from the ambient-pressure phase Ca2Si5N8. HP-Ca2Si5N8 crystallizes in the orthorhombic crystal system (Pbca (no. 61), a=1058.4(2), b=965.2(2), c=1366.3(3) pm, V=1395.7(7)x10(6) pm3, Z=8, R1=0.1191). The HP-Ca2Si5N8 structure is built up by a three-dimensional, highly condensed nitridosilicate framework with N[2] as well as N[3] bridging. Corrugated layers of corner-sharing SiN4 tetrahedra are interconnected by further SiN4 units. The Ca2+ ions are situated between these layers with coordination numbers 6+1 and 7+1, respectively. HP-Ca2Si5N8 as well as hypothetical orthorhombic o-Ca2Si5N8 (isostructural to the ambient-pressure modifications of Sr2Si5N8 and Ba2Si5N8) were studied as high-pressure phases of Ca2Si5N8 up to 100 GPa by using density functional calculations. The transition pressure into HP-Ca2Si5N8 was calculated to 1.7 GPa, whereas o-Ca2Si5N8 will not be adopted as a high-pressure phase. Two different decomposition pathways of Ca2Si5N8 (into Ca3N2 and Si3N4 or into CaSiN2 and Si3N4) and their pressure dependence were examined. It was found that a pressure-induced decomposition of Ca2Si5N8 into CaSiN2 and Si3N4 is preferred and that Ca2Si5N8 is no longer thermodynamically stable under pressures exceeding 15 GPa. Luminescence investigations (excitation at 365 nm) of HP-Ca2Si5N8:Eu2+ reveal a broadband emission peaking at 627 nm (FWHM=97 nm), similar to the ambient-pressure phase Ca2Si5N8:Eu2+.