Do not make clinical decisions based on abstracts of healthcare research: A systematic review.

OBJECTIVE: To summarize the reporting quality of healthcare abstracts and inconsistencies between abstracts and full texts. STUDY DESIGN AND SETTING: This systematic review included overviews of randomized controlled trials (RCTs) and systematic reviews (SRs) that summarized data of healthcare abstracts on reporting of abstracts and consistency of abstracts with the full text. Searches were performed in PubMed, CENTRAL, Cochrane Library and EMBASE databases from 1900 to February 2019. Two authors screened the overviews and extracted the data. All analyses were descriptive and divided into two main groups: abstracts' reporting quality and abstracts' consistency with the full text. Abstracts were considered poorly reported and inconsistent with the full text if more than 5% of abstracts' information was not fully reported or not consistent with the full text. RESULTS: 27 overviews analyzing 5,194 RCTs and 866 SRs were retrieved for reporting quality of abstracts. A total of 22 overviews analyzing 2,025 RCTs and 551 SRs were included for consistency of abstracts with the full text. Abstracts across all healthcare areas presented poor reporting quality and were inconsistent with the full texts, with results and conclusions as the most inconsistent sections. CONCLUSION: Abstracts of healthcare RCTs and SRs have shown a large room for improvement in reporting quality and consistency with the full text. Authors, journal editors and reviewers need to give the highest priority to this matter.

Reliability of heart rate recovery indexes after maximal incremental tests / Reproducibilidad de los índices de recuperación de la frecuencia cardiaca después de las pruebas de esfuerzo máximas

INTRODUCTION: The relationship between heart rate (HR) recovery (HRR) and cardiovascular diseases (CAD) is well stablished, being that slower HRR is associated with an increased risk of sudden death and overall death, and it has been demonstrated to be independent predictor for both healthy and cardiac diseases individuals. However, it is not clear about which indexes from fast and slow phase of HRR have greater reliability after maximal exercise. This study aimed to verified which of the HRR indexes (T30 and DeltaHR60s for fast phase of recovery; DeltaHR300s and HR off-kinetics for slow phase) have better reliability in adults after maximal exercise test. MATERIAL AND METHOD: Twelve healthy and moderate physical active young men without heart diseases performed three maximal treadmill tests with an interval of at least 48 h. Treadmill test started with speed of 4 km.h-1, with increase of 1 km.h-1every minute until exhaustion. Beat-to-beat HR was recorded during exercise and 5 min of seated recovery to verify relative and absolute reliability of the T30, DeltaHR60s, DeltaHR300 and HR off-kinetics. RESULTS: It was found very high reproducibility in T30 (ICC = 0.91; SEM = 17.19s; CV = 13.51%), DeltaHR60s (ICC = 0.91; SEM = 2.40 bpm; CV = 9.08%), DeltaHR300s (ICC = 0.90; SEM = 2.69 bpm; CV = 5.42%) and HR off-kinetics parameters (ICC = 0.91-0.94; SEM = 2.43-3.63; CV = 4.06-8.10%), without difference for the variables among the tests (p > 0.05). CONCLUSION: The DeltaHR60s presented better reliability (higher ICC and lower CV) when compared to the T30, being both for fast phase of recovery. For slow phase, ΔHR300s and HR off-kinetics presented equivalent reliability

INTRODUCCIÓN: La relación entre la recuperación de la frecuencia cardíaca (RFC) y las enfermedades cardiovasculares está bien establecida, siendo que la RFC más lenta se asocia con un mayor riesgo de muerte súbita y muerte en general, y se ha demostrado que es un factor predictivo independiente tanto para las personas sanas como para las personas con enfermedades cardíacas. Sin embargo, no está claro qué índices de la fase rápida y lenta de la RFC tienen mayor confiabilidad después del ejercicio máximo. Este estudio tuvo como objetivo verificar cuál de los índices de RFC (T30, DeltaFC60s, DeltaFC300s y cinética de FC) tienen mayor confiabilidad en adultos después de las pruebas máximas de ejercicio. MATERIAL Y MÉTODO: Doce hombres con actividad física saludable y moderada sin enfermedades del corazón realizaron tres pruebas máximas en cinta rodante con un intervalo de al menos 48 h. La prueba en cinta rodante comenzó con una velocidad de 4 km.h-1, con un aumento de 1 km.h-1 cada minuto hasta el agotamiento. La FC de latido a latido se registró durante el ejercicio y 5 minutos de recuperación sentada para verificar la confiabilidad absoluta y relativa del T30, DeltaFC60s, DeltaFC300s y cinética de FC. RESULTADOS: Se encontró una reproducibilidad muy alta en T30 (CCI = 0,91; SEM = 17,19 s; CV = 13,51%), DeltaFC60s (CCI = 0,91; EEM = 2,40 lpm; CV = 9.08%), DeltaHR300s (CCI = 0,90; EEM = 2.69 lpm; CV = 5.42%) y los parámetros de cinética de FC (CCI = 0,91-0,94; EEM = 2,43-3,63; CV = 4,06-8,10%). CONCLUSIÓN: Los DeltaFC60s presentaron mejor confiabilidad (mayor ICC y menor CV) en comparación con el T30 para una rápida fase de recuperación. Para la fase lenta, DeltaFC300s y la cinética de FC fueron equivalentes

Effectiveness of interventions for non-specific low back pain in older adults. A systematic review and meta-analysis.

OBJECTIVES: Systematically review the literature about all available interventions to manage non-specific low back pain (NSLBP) in older adults (≥60 years). DESIGN: We searched the Medline, EMBASE, CINAHL, LILACS, PEDro, and Cochrane CENTRAL databases reference lists for randomized controlled trials (RCTs) testing interventions for NSLBP. Two independent reviewers extracted data, assessed the risk of bias and completeness of the description of interventions. RESULTS: Eighteen (RCTs) fulfilled the eligibility criteria. Evidence about interventions to manage NSLBP in older adults is weak. Very low to moderate quality evidence showed that complementary health approach (i.e., manual therapy, acupuncture, mindfulness, yoga), percutaneous electrical nerve stimulation (PENS), education, exercise or pharmacological agents were not effective to produce a clinically significant reduction in pain and disability at short-term and intermediate-term compared to sham, usual care or minimal intervention. Interventions were moderately well-described according to the template for intervention description and replication (TIDieR) and the risk of bias was moderate 6.4 points on the 10-point PEDro Scale (SD=1.44). CONCLUSION: Evidence about interventions for NSLP in older adults is limited and new studies are highly likely to change these results. This result may impact healthcare providers due to the lack of effective evidence based interventions, patients, and policy makers that will expend financial resources with interventions that provide in the best scenario a not significant improvement of the clinical symptoms. Researchers need to consider the importance of designing clinical trials targeting older adults and examine possible outcome modifiers present in this population allowing the recommendation of more efficacious evidence-based interventions. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO (CRD42016036686).

Psychometric Properties of the Deep Muscle Contraction Scale for Assessment of the Drawing-in Maneuver in Patients With Chronic Nonspecific Low Back Pain.

Study Design A prospective cohort study. Background Motor control dysfunctions have been commonly reported in patients with chronic nonspecific low back pain (LBP). Physical therapists need clinical tools with adequate psychometric properties to assess such patients in clinical practice. The deep muscle contraction (DMC) scale is a clinical rating scale for assessing patients' ability to voluntarily contract deep abdominal muscles. Objectives To investigate the intrarater reliability, floor and ceiling effects, internal and external responsiveness, and correlation analysis (with ultrasound measures) of the DMC scale in patients with chronic nonspecific LBP undergoing a lumbar stabilization exercise program. Methods Sixty-two patients with chronic nonspecific LBP were included. At baseline, self-report questionnaires were administered to patients and a trained assessor evaluated abdominal muscle recruitment with the DMC scale and ultrasound imaging. Four ratios of the change in abdominal muscle thickness between the resting and contracted states were calculated through the ultrasound measures. After 1 week, the same ultrasound measures and DMC scale were collected again for the reliability analysis. The proportions of patients with the lowest and highest scores on the DMC scale were calculated to investigate floor and ceiling effects. All patients underwent a lumbar stabilization program, administered twice a week for 8 weeks. After the treatment period, all measures were collected again, with the addition of the global perceived effect scale, to assess the internal and external responsiveness of the measures. Correlation coefficients between ultrasound ratios and DMC scale total and subscale scores were also calculated. Results The intrarater reliability of the DMC scale and the 4 ratios of abdominal muscle thickness varied from moderate to excellent. The DMC scale showed no floor or ceiling effects. Results for internal responsiveness of the DMC scale showed large effect sizes (2.26; 84% confidence interval [CI]: 2.06, 2.45), whereas the external responsiveness was below the proposed threshold (area under the curve = 0.54; 95% CI: 0.39, 0.68). Fair and significant correlations between some ultrasound ratios and DMC subscales were found. Conclusion The DMC scale was demonstrated to be a reliable tool, with no ceiling and floor effects, and to detect change in the ability to contract the deep abdominal muscles after a lumbar stabilization exercise program, but with low accuracy for estimating patient-perceived clinical outcome. J Orthop Sports Phys Ther 2017;47(6):432-441. doi:10.2519/jospt.2017.7140.

Physical Activity Interventions for Increasing Objectively Measured Physical Activity Levels in Patients With Chronic Musculoskeletal Pain: A Systematic Review.

OBJECTIVE: To investigate whether physical activity interventions increase objectively measured physical activity levels of patients with chronic musculoskeletal pain (e.g., osteoarthritis, low back pain) compared to no/minimal intervention. METHODS: We performed a systematic review with meta-analysis searching the Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, SportDiscus, and Physiotherapy Evidence Database (PEDro) databases, and the main clinical trials registries. Quasirandomized or randomized controlled trials investigating the effect of physical activity interventions on objectively measured physical activity levels (e.g., using accelerometers or pedometers) of patients with chronic musculoskeletal pain compared with no/minimal intervention were considered eligible. Analyses were conducted separately for short-term (≤3 months), intermediate (>3 months and <12 months), and long-term (≥12 months) followups. Pooled effects were calculated using the standardized mean difference (SMD), and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used in summary conclusions. RESULTS: Eight published trials and 6 registered trials were included. For the short-term followup, pooling of 6 trials showed no significant effect (SMD 0.34, 95% confidence interval -0.09, 0.77) between a physical activity intervention and no/minimal intervention. Similarly nonsignificant results were found for the intermediate and long-term followups. The overall evidence according to the GRADE approach was classified as low quality. CONCLUSION: Our findings suggest that physical activity-based interventions may lead to little or no difference in objectively measured physical activity levels of patients with chronic musculoskeletal pain compared with no/minimal interventions. Given the number of registered trials, the pooled effect found in this review is likely to change once the results of these trials become available.