Prevention of low back and pelvic girdle pain during pregnancy: a systematic review and meta-analysis of randomised controlled trials with GRADE recommendations.

BACKGROUND: Low back (LBP) and pelvic girdle pain (PGP) during pregnancy are related to high direct and indirect costs. It is important to clarify evidence regarding interventions to manage and prevent these conditions. OBJECTIVE: Investigate the efficacy and acceptability of the interventions to prevent LBP and PGP during pregnancy. DATA SOURCES: Searches were conducted up to January 6th, 2021 in the MEDLINE, PEDro, Cochrane Library, SPORTDiscus, CINAHL, AMED, Embase and PsycInfo databases STUDY ELIGIBILITY CRITERIA: (1) Pregnant women without LBP and/or PGP; (2) any prevention strategy on incidence of LBP and PGP and sick leave; (3) comparison to control; (4) quasi and randomised controlled trial. STUDY APPRAISAL AND SYNTHESIS METHODS: Two reviewers performed screening, data extraction and methodological quality assessments. Meta-analysis was performed and Relative Risks (RRs) and 95% confidence intervals (CIs) were reported. RESULTS: Six randomised controlled trials involving 2231 participants were included in the review. Evidence of moderate quality was found that "stand-alone" exercise is acceptable to pregnant women with lumbopelvic pain (LBPP) (RR 0.60 [95%CI 0.42-0.84]) and prevents episodes of LBP (RR 0.92 [95%CI 0.85-0.99]) in the long-term. Moderate to very-low quality evidence was found detailing the lack of efficacy of other interventions in the prevention of these problems in the short and long-term. LIMITATIONS: Small number of trials included. CONCLUSIONS: Efficacy of prevention strategies for episodes of LBPP and the use of sick leave during pregnancy is not supported by evidence of high quality. Current evidence suggests that exercise is acceptable and promising for the prevention of LBP in the long-term. However, further high-quality trials with larger samples are needed. CONTRIBUTION ON PAPER.

Comparative efficacy and acceptability of non-pharmacological interventions in fibromyalgia: Protocol for a network meta-analysis.

INTRODUCTION: Although several non-pharmacological interventions have been tested in the management of Fibromyalgia (FM), there is little consensus regarding the best options for the treatment of this health condition. The purpose of this network meta-analysis (NMA) is to investigate the comparative efficacy and acceptability of non-pharmacological interventions for FM, in order to assist clinical decision making through a ranking of interventions in relation to the most important clinical outcomes in these patients. METHODS AND ANALYSIS: We will perform a systematic search to identify randomised controlled trials of non-pharmacological interventions endorsed in guidelines and systematic reviews. Information sources searched will include major bibliographic databases without language or date restrictions (MEDLINE, Cochrane Library, EMBASE, AMED, PsycINFO and PEDro). Our primary outcomes will be pain intensity, patient-reported quality of life (QoL), and acceptability of treatment will be our secondary outcome. Risk of bias of the included trials will be assessed using the Cochrane risk of bias tool (RoB2). For each pairwise comparison between the different interventions, we will present mean differences (MDs) for pain intensity and QoL outcomes and Relative Risks (RRs) for acceptability, both with respective 95% confidence intervals (CIs). Initially, standard pairwise meta-analyses will be performed using a DerSimonian-Laird random effects model for all comparisons with at least two trials and then we will perform a frequentist NMA using the methodology of multivariate meta-analysis assuming a common heterogeneity parameter, using the mvmeta command and network suite in STATA. In the NMA, two different types of control group, such as placebo/sham and no intervention/waiting list will be combined as one node called "Control". The competing interventions will be ranked using the P-score, which is the frequentist analogue of surface under the cumulative ranking curve (SUCRA) for the outcomes of interest at immediate- (intervention duration of up to 2 weeks), short- (over 2 weeks up to 12 weeks) and long-terms (over 12 weeks). The confidence in the results from NMA will be assessed using the Confidence in Network Meta-analysis (CINeMA) framework. ETHICS AND DISSEMINATION: This work synthesises evidence from previously published studies and does not require ethics review or approval. A manuscript describing the findings will be submitted for publication in a peer-reviewed scientific journal. REGISTRATION: OSF (DOI: 10.17605/OSF.IO/7MS25) and registered in the PROSPERO database (CRD42020216374).

Popular videos related to low back pain on YouTube™ do not reflect current clinical guidelines: a cross-sectional study.

BACKGROUND: Quality of low back pain (LBP) information offered on YouTube ™ is unclear. OBJECTIVE: To describe the current low back pain information available on YouTube ™ and determine if these videos report information that aligns with clinical guidelines. Further analysis explored whether specific features of the videos explain their popularity. METHODS: A cross-sectional observational study was conducted on videos related to LBP on YouTube™ with the 200 most viewed videos using the term "low back pain." The videos were independently viewed and assessed by two researchers for specific video characteristics, LBP specific content, and compliance with guidelines. The association between video characteristics or content with popularity (i.e., views, likes, dislikes, and comments) was investigated using regression models. RESULTS: The median number of views was 2 018 167. Only 59 (29.5%) of the videos reported at least one diagnostic recommendation from clinical guidelines, and only 100 (50%) reported a treatment recommendation that aligned with clinical guidelines. Apart from year of upload, no variables were identified that were independently associated with popularity or engagement of the videos. CONCLUSION: The information related to LBP offered on YouTube™ is often not evidence-based and there is the tendency to prioritize information on interventions rather than understanding the LBP process. Factors related to engagement with content about LBP on YouTube™ remains uncertain, indicating further need for knowledge translation in this field.

Efficacy of conservative therapy in older people with nonspecific low back pain: A systematic review with meta-analysis and GRADE recommendations.

PURPOSE: This systematic review aimed to investigate the effectiveness of conservative therapy in older people with nonspecific low back pain. MATERIALS AND METHODS: Searches were conducted on Medline, Amed, Embase, Cochrane, Psycinfo and Pedro databases up to 2020. Risk of bias were assessed using the 0-10 PEDro scale. Weighted mean differences (WMDs) or mean differences (MDs) with 95 % confidence intervals (CIs) were reported for each conservative therapy, and strength of the current evidence was assessed using the GRADE approach. RESULTS: Eleven original trials were included investigating effects on disability, pain, coping, quality of life, strength, balance, depression, falls, sleep quality, mobility, body mass index, percentage body fat, trunk muscle mass and waist-to-hip ratio. Moderate quality evidence showed short-term effects of trigger point acupuncture on disability (WMD = 5.0 points [95 % CI 3.5-6.4] on a 25-point scale) and pain (WMD = 35.9 points [95 % CI 22.2-49.7] on a 101-point scale), and of exercise on disability (WMD = 1.7 points [95 % CI 0.3-3.0]) when compared with control (placebo, sham, waiting list or no intervention). Moderate quality evidence showed no short-term effect of exercise on coping (95 % CI -5.0 to 14.6). Moreover, evidence for other important outcomes in older people is scarce and we did not find any trial investigating pharmacological therapies. CONCLUSION: Findings support partially exercise and trigger point acupuncture to improve disability and/or pain. Future trials with appropriate sample sizes are likely to impact on the estimates and need to clarify medium- and long-term effects.

Epidemiology and associated factors for CrossFit-related musculoskeletal injuries: a cross-sectional study.

BACKGROUND: CrossFit® is usually composed of high intensity workout routines and is executed quickly, repetitively and with limited rest time. Previous studies have identified a high prevalence of injuries in CrossFit®. This study aimed to determine the prevalence of CrossFit-related musculoskeletal injuries and to identify potential associated factors. METHODS: A cross-sectional study was conducted with 413 CrossFitters. Participants completed a questionnaire containing personal data, training characteristics and injury history in the last 12 months. Data were analyzed by descriptive statistics and logistic regression models. RESULTS: The prevalence of CrossFit-related musculoskeletal injuries was 24.0%; and the injury rate was of 0.80 injuries per 1,000 hours of exposure. The regions of the body most affected were the lumbar spine (33.3%), shoulders (31.3%) and knees (14.1%). The majority of CrossFitters participated in competitions (74.6%), had more than 12 months of experience in CrossFit® (62.7%), and trained up to 90 minutes a day (82.3%) for more than 4 days a week (76.8%). The variables that showed a significant association with CrossFit®-related musculoskeletal injuries were weekly training frequency (OR=2.25; 95% CI: 1.13-4.48) and regular physiotherapeutic care (OR=1.85; 95% CI: 1.11-3.07). CONCLUSIONS: The prevalence of musculoskeletal injury was 24.0%, and the most affected regions of the body were the lumbar spine, shoulders and knees. Training more than four days a week and do not receive regular physiotherapeutic care were associated with CrossFit-related musculoskeletal injuries.