Quality analysis of prior systematic reviews of carpal tunnel syndrome: an overview of the literature

ABSTRACT BACKGROUND: Carpal tunnel syndrome (CTS) is a common condition greatly affects patients' quality of life and ability to work. Systematic reviews provide useful information for treatment and health decisions. OBJECTIVE: This study aimed to assess the methodological quality of previously published systematic reviews on the treatment of CTS. DESIGN AND SETTING: Overview of systematic reviews conducted at the Brazilian public higher education institution, São Paulo, Brazil METHODS: We searched the MEDLINE and Cochrane Library database for systematic reviews investigating the treatment of CTS in adults. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and measurement tool to assess systematic reviews (AMSTAR) were applied by two independent examiners. RESULTS: Fifty-five studies were included. Considering the stratification within the AMSTAR measurement tool, we found that more than 76% of the analyzed studies were "low" or "very low". PRISMA scores were higher when meta-analysis was present (15.61 versus 10.40; P = 0.008), while AMSTAR scores were higher when studies performed meta-analysis (8.43 versus 5.59; P = 0.009) or when they included randomized controlled trials (7.95 versus 6.06; P = 0.043). The intra-observer correlation demonstrated perfect agreement (> 0.8), a Spearman's correlation coefficient of 0.829, and an ICC of0.857. The inter-observer correlation indicated that AMSTAR was more reliable than PRISMA. CONCLUSION: Overall, systematic reviews of the treatment of CTS are of poor quality. Reviews with better-quality conducted meta-analysis and included randomized controlled trials. AMSTAR is a better tool than PRISMA because it has a better performance and should be recommended in future studies. REGISTRATION NUMBER IN PROSPERO: CRD42020172328 (https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42020172328)

Quality analysis of prior systematic reviews of carpal tunnel syndrome: an overview of the literature.

BACKGROUND: Carpal tunnel syndrome (CTS) is a common condition greatly affects patients' quality of life and ability to work. Systematic reviews provide useful information for treatment and health decisions. OBJECTIVE: This study aimed to assess the methodological quality of previously published systematic reviews on the treatment of CTS. DESIGN AND SETTING: Overview of systematic reviews conducted at the Brazilian public higher education institution, São Paulo, Brazil. METHODS: We searched the MEDLINE and Cochrane Library database for systematic reviews investigating the treatment of CTS in adults. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and measurement tool to assess systematic reviews (AMSTAR) were applied by two independent examiners. RESULTS: Fifty-five studies were included. Considering the stratification within the AMSTAR measurement tool, we found that more than 76% of the analyzed studies were "low" or "very low". PRISMA scores were higher when meta-analysis was present (15.61 versus 10.40; P = 0.008), while AMSTAR scores were higher when studies performed meta-analysis (8.43 versus 5.59; P = 0.009) or when they included randomized controlled trials (7.95 versus 6.06; P = 0.043). The intra-observer correlation demonstrated perfect agreement (> 0.8), a Spearman's correlation coefficient of 0.829, and an ICC of0.857. The inter-observer correlation indicated that AMSTAR was more reliable than PRISMA. CONCLUSION: Overall, systematic reviews of the treatment of CTS are of poor quality. Reviews with better-quality conducted meta-analysis and included randomized controlled trials. AMSTAR is a better tool than PRISMA because it has a better performance and should be recommended in future studies. REGISTRATION NUMBER IN PROSPERO: CRD42020172328 (https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42020172328).

DEMOGRAPHIC ANALYSIS OF ACETABULAR FRACTURES TREATED IN A QUATERNARY CARE HOSPITAL FROM 2005 TO 2016.

OBJECTIVE: Analyze the clinical and sociodemographic data on acetabular fractures in a Brazilian quaternary care hospital and compare with data reported in the literature. METHODS: A descriptive, analytical cross-sectional epidemiological study analyzing 87 patients with acetabular fractures at Hospital São Paulo (UNIFESP/EPM) between 2005 and 2016. Demographic variables such as age, sex, occupation, educational level and color were investigated. Acetabular fractures were classified according to the AO/OTA group and Judet and Letournel classification. Therapeutic approach, hospital length of stay and waiting time for surgery as well as complications were analyzed. Associations were established among the various variables obtained. RESULTS: The mean age of patients with acetabulum fractures was 39.8 years (SD 13.1 years). There was a predominance of posterior wall (34.5%) and dual-column (14.9%) fractures. The average hospital length of stay was 14.4 days. More than 90% of patients underwent a surgical procedure. One-fourth of patients had complications, the main one being infection (12.6%). CONCLUSIONS: Unimodal age distribution was obtained with a predominance of white male economically active patients. There was a predominance of posterior wall fractures. More than 90% of patients underwent surgery before they had been in hospital for 14 days. A statistically significant association was found between complications and exceeded length of hospital stay. Level of evidence II, Retrospective study.

OBJETIVO: Analisar os dados clínicos e sociodemográficos das fraturas acetabulares em um hospital quaternário brasileiro e comparar com dados relatados na literatura. MÉTODOS: Estudo epidemiológico, descritivo, analítico transversal, em que foram analisados 87 pacientes com fraturas acetabulares no Hospital São Paulo (UNIFESP/EPM) entre 2005 e 2016. Variáveis demográficas como idade, sexo, profissão, escolaridade e cor foram pesquisadas. As fraturas acetabulares foram classificadas conforme o grupo AO/OTA e conforme Judet e Letournel. A terapêutica, o tempo de internação e de espera para cirurgia bem como as complicações foram analisadas. Foram feitas associações entre as diversas variáveis obtidas. RESULTADOS: A média de idade dos pacientes vítimas de fraturas do acetábulo foi de 39,8 anos (DP 13,1 anos). Houve predomínio das fraturas da parede posterior (34,5%) e dupla coluna (14,9%). Os pacientes ficaram, em média, 14,4 dias internados. Mais de 90% dos pacientes foram submetidos à abordagem cirúrgica. Um quarto dos pacientes tiveram complicações, sendo a principal, infecção (12,6%). CONCLUSÕES: Foi obtida uma amostra etária unimodal com predomínio de pacientes do sexo masculino, brancos e economicamente ativos. Houve um predomínio das fraturas da parede posterior. Mais de 90% dos pacientes foram operados antes dos 14 dias de internação. Constatou-se uma associação estatisticamente significante entre complicações e tempo excedido de permanência hospitalar. Nível de evidência II, Estudo retrospectivo.

Demographic analysis of acetabular fractures treated in a quaternary care hospital from 2005 to 2016 / Análise demográfica das fraturas do acetábulo tratadas em um hospital quaternário de 2005 a 2016

ABSTRACT Objective: Analyze the clinical and sociodemographic data on acetabular fractures in a Brazilian quaternary care hospital and compare with data reported in the literature. Methods: A descriptive, analytical cross-sectional epidemiological study analyzing 87 patients with acetabular fractures at Hospital São Paulo (UNIFESP/EPM) between 2005 and 2016. Demographic variables such as age, sex, occupation, educational level and color were investigated. Acetabular fractures were classified according to the AO/OTA group and Judet and Letournel classification. Therapeutic approach, hospital length of stay and waiting time for surgery as well as complications were analyzed. Associations were established among the various variables obtained. Results: The mean age of patients with acetabulum fractures was 39.8 years (SD 13.1 years). There was a predominance of posterior wall (34.5%) and dual-column (14.9%) fractures. The average hospital length of stay was 14.4 days. More than 90% of patients underwent a surgical procedure. One-fourth of patients had complications, the main one being infection (12.6%). Conclusions: Unimodal age distribution was obtained with a predominance of white male economically active patients. There was a predominance of posterior wall fractures. More than 90% of patients underwent surgery before they had been in hospital for 14 days. A statistically significant association was found between complications and exceeded length of hospital stay. Level of evidence II, Retrospective study.

RESUMO Objetivo Analisar os dados clínicos e sociodemográficos das fraturas acetabulares em um hospital quaternário brasileiro e comparar com dados relatados na literatura. Métodos: Estudo epidemiológico, descritivo, analítico transversal, em que foram analisados 87 pacientes com fraturas acetabulares no Hospital São Paulo (UNIFESP/EPM) entre 2005 e 2016. Variáveis demográficas como idade, sexo, profissão, escolaridade e cor foram pesquisadas. As fraturas acetabulares foram classificadas conforme o grupo AO/OTA e conforme Judet e Letournel. A terapêutica, o tempo de internação e de espera para cirurgia bem como as complicações foram analisadas. Foram feitas associações entre as diversas variáveis obtidas. Resultados: A média de idade dos pacientes vítimas de fraturas do acetábulo foi de 39,8 anos (DP 13,1 anos). Houve predomínio das fraturas da parede posterior (34,5%) e dupla coluna (14,9%). Os pacientes ficaram, em média, 14,4 dias internados. Mais de 90% dos pacientes foram submetidos à abordagem cirúrgica. Um quarto dos pacientes tiveram complicações, sendo a principal, infecção (12,6%). Conclusões: Foi obtida uma amostra etária unimodal com predomínio de pacientes do sexo masculino, brancos e economicamente ativos. Houve um predomínio das fraturas da parede posterior. Mais de 90% dos pacientes foram operados antes dos 14 dias de internação. Constatou-se uma associação estatisticamente significante entre complicações e tempo excedido de permanência hospitalar. Nível de evidência II, Estudo retrospectivo.

Treatment of Acute Thigh Muscle Injury with or without Hematoma Puncture in Athletes.

OBJECTIVES: To correlate the mean time of return of athletes to sport after acute injury of the thigh muscle with hematoma that was punctured or not. METHODS: Study based on clinical intervention, controlled and non-randomized with 20 amateur and professional athletes, divided into moderate and total or subtotal thighs lesions, according with the Munich Consensus Statement. Nine athletes were included in the intervention group and 11 athletes in the control group. In the intervention group, the athletes were submitted to a puncture of the hematoma, associated to physical therapy; the control group did only physical therapy. The variable mean time of return to sport was analyzed using the Mann-Whitney test and a significance level of 5% ( p < 0.05; 95% confidence interval [CI]) was established. RESULTS: The mean group was composed mostly of men, eight of them were amateur athletes. There were three women, two of whom were amateur athletes. The average age of participants was 34.70 ± 12.79 years. There were 13 patients with posterior thigh lesions, 5 with anterior lesions and two with adductor lesions. Considering all injuries, the mean time of return to sport was of 48.50 ± 27.50 days in the intervention group. In the control group, this period was of 102.09 ± 52.02 days, showing a statistically significant difference between them ( p = 0.022). CONCLUSION: In the present study, hematoma drainage in athletes with moderate and total or subtotal muscle injuries associated with hematomas decreased their return time to sport.

Treatment of Acute Thigh Muscle Injury with or without Hematoma Puncture in Athletes / Tratamento das lesões musculares agudas da coxa com ou sem punção do hematoma em atletas

Abstract Objectives To correlate the mean time of return of athletes to sport after acute injury of the thigh muscle with hematoma that was punctured or not. Methods Study based on clinical intervention, controlled and non-randomized with 20 amateur and professional athletes, divided into moderate and total or subtotal thighs lesions, according with the Munich Consensus Statement. Nine athletes were included in the intervention group and 11 athletes in the control group. In the intervention group, the athletes were submitted to a puncture of the hematoma, associated to physical therapy; the control group did only physical therapy. The variable mean time of return to sport was analyzed using the Mann-Whitney test and a significance level of 5% (p < 0.05; 95% confidence interval [CI]) was established. Results The mean group was composed mostly of men, eight of them were amateur athletes. There were three women, two of whom were amateur athletes. The average age of participants was 34.70 ± 12.79 years. There were 13 patients with posterior thigh lesions, 5 with anterior lesions and two with adductor lesions. Considering all injuries, the mean time of return to sport was of 48.50 ± 27.50 days in the intervention group. In the control group, this period was of 102.09 ± 52.02 days, showing a statistically significant difference between them (p = 0.022). Conclusion In the present study, hematoma drainage in athletes with moderate and total or subtotal muscle injuries associated with hematomas decreased their return time to sport.

Resumo Objetivos Comparar o tempo médio de retorno dos atletas ao esporte após lesão muscular aguda da coxa com hematoma que foi ou não puncionado. Métodos Estudolongitudinal de intervenção clínica, controlado e não randomizado, com participação de 20 atletas amadores e profissionais com lesão muscular aguda do tipo parcial moderada ou (sub)total na região da coxa, segundo a classificação do Consenso de Munique. Nove atletas foram incluídos no grupo intervenção e 11 no grupo controle. Os atletas do grupo intervenção foramsubmetidos a punção do hematoma e fisioterapia e os do grupo controle, apenas a fisioterapia. A variável tempo de retorno ao esporte foi analisada como teste deMann-Whitney e o nível de significância usado foi 95% (p < 0,05). Resultados A população estudada foi composta principalmente por homens, dos quais oito eram praticantes de esportes no nível amador. Três mulheres, das quais duas eram amadoras, foram incluídas no estudo. A média de idade dos participantes foi de 34,70 ± 12,79 anos. Houve 13 indivíduos com lesões na região posterior da coxa, cinco comlesões na região anterior e dois com lesões na região adutora. Considerando todas as lesões, o tempo médio de retorno ao esporte foi de 48,50 ± 27,50 dias no grupo intervenção. Já no grupo controle, esse intervalo foi de 102,09 ± 52,02 dias (p = 0,022). Conclusão No presente estudo, a punção do hematoma muscular mostrou-se efetiva em abreviar o tempo de retorno ao esporte dos atletas com lesões musculares parciais moderadas e (sub)totais associadas a hematomas. Abstract Objectives To correlate the mean time of return of athletes to sport after acute injury of the thigh muscle with hematoma that was punctured or not.

Evidence hierarchies relating to hand surgery: current status and improvement. A bibliometric analysis study

ABSTRACT BACKGROUND: Hierarchy of evidence is an important measurement for assessing quality of literature. Information regarding quality of evidence within the Brazilian hand surgery setting is sparse, especially regarding whether research has improved in either quality or quantity. This study aimed to identify and classify hand surgery studies published in the two most important Brazilian orthopedics journals based on hierarchy of evidence, with comparisons with previously published data. DESIGN AND SETTING: Bibliometric analysis study performed in a federal university. METHODS: Two independent researchers conducted an electronic database search for hand surgery studies published between 2010 and 2016 in Acta Ortopédica Brasileira and Revista Brasileira de Ortopedia. Eligible studies were subsequently classified according to methodological design, based on the Haynes pyramid model (HP) and the JBJS/AAOS levels of evidence and grades of recommendations (LOR). Qualitative and quantitative data were gathered regarding all studies. Previous data were considered to assess whether the proportion of high-quality studies had improved over time (2000-2009 versus 2010-2016). RESULTS: The final analysis included 123 studies, mostly originating from the southeastern region (78.8%) and private institutions (65%), with self-funding (91.8%). Methodological assessment showed that 15.4% were classified as level I/II using HP and 16.4% using LOR. No significant difference in proportions of high-quality studies was found between the two periods of time assessed (5% versus 12%; P = 0.13). CONCLUSION: Approximately 15% of hand surgery studies published in two major Brazilian journals were likely to be classified as high-quality through two different systems. Moreover, no trend towards quality-of-evidence improvement was found over the last 15 years.

Evidence hierarchies relating to hand surgery: current status and improvement. A bibliometric analysis study.

BACKGROUND: Hierarchy of evidence is an important measurement for assessing quality of literature. Information regarding quality of evidence within the Brazilian hand surgery setting is sparse, especially regarding whether research has improved in either quality or quantity. This study aimed to identify and classify hand surgery studies published in the two most important Brazilian orthopedics journals based on hierarchy of evidence, with comparisons with previously published data. DESIGN AND SETTING: Bibliometric analysis study performed in a federal university. METHODS: Two independent researchers conducted an electronic database search for hand surgery studies published between 2010 and 2016 in Acta Ortopédica Brasileira and Revista Brasileira de Ortopedia. Eligible studies were subsequently classified according to methodological design, based on the Haynes pyramid model (HP) and the JBJS/AAOS levels of evidence and grades of recommendations (LOR). Qualitative and quantitative data were gathered regarding all studies. Previous data were considered to assess whether the proportion of high-quality studies had improved over time (2000-2009 versus 2010-2016). RESULTS: The final analysis included 123 studies, mostly originating from the southeastern region (78.8%) and private institutions (65%), with self-funding (91.8%). Methodological assessment showed that 15.4% were classified as level I/II using HP and 16.4% using LOR. No significant difference in proportions of high-quality studies was found between the two periods of time assessed (5% versus 12%; P = 0.13). CONCLUSION: Approximately 15% of hand surgery studies published in two major Brazilian journals were likely to be classified as high-quality through two different systems. Moreover, no trend towards quality-of-evidence improvement was found over the last 15 years.