Bruno Tirotti Saragiotto

How completely are physiotherapy interventions described in reports of randomised trials

BACKGROUND Incomplete descriptions of interventions are a common problem in reports of randomised controlled trials. To date no study has evaluated the completeness of the descriptions of physiotherapy interventions. OBJECTIVES To evaluate the completeness of the descriptions of physiotherapy interventions in a random sample of reports of randomised controlled trials (RCTs). DATA SOURCES A random sample of 200 reports of RCTs from the PEDro database. STUDY SELECTION OR ELIGIBILITY CRITERIA We included full text papers, written in English, and reporting trials with two arms. We included trials evaluating any type of physiotherapy interventions and subdisciplines. DATA EXTRACTION AND DATA SYNTHESIS The methodological quality was evaluated using the PEDro scale and completeness of intervention description using the Template for Intervention Description and Replication (TIDieR) checklist. The proportion and 95% confidence interval were calculated for intervention and control groups, and used to present the relationship between completeness and methodological quality, and subdisciplines. RESULTS Completeness of intervention reporting in physiotherapy RCTs was poor. For intervention groups, 46 (23%) trials did not describe at least half of the items. Reporting was worse for control groups, 149 (75%) trials described less than half of the items. There was no clear difference in the completeness across subdisciplines or methodological quality. LIMITATIONS Our sample were restricted to trials published in English in 2013. CONCLUSION AND IMPLICATIONS OF KEY FINDINGS Descriptions of interventions in physiotherapy RCTs are typically incomplete. Authors and journals should aim for more complete descriptions of interventions in physiotherapy trials.

Motor Control Exercise for Nonspecific Low Back Pain: A Cochrane Review

Study Design. A systematic review. Objective. The aim of this review was to evaluate the effectiveness of motor control exercise (MCE) in patients with nonspecific low back pain (LBP). Summary of Background Data. MCE is a common form of exercise used for managing LBP. MCE focuses on the activation of the deep trunk muscles and targets the restoration of control and coordination of these muscles, progressing to more complex and functional tasks integrating the activation of deep and global trunk muscles. Methods. We conducted electronic searches of CENTRAL, MEDLINE, EMBASE, five other databases, and two trials registers from their inception up to April 2015. Two independent review authors screened the search results, assessed risk of bias, and extracted the data. A third reviewer resolved any disagreement. We included randomized controlled trials comparing MCE with no treatment, another treatment, or as a supplement to other interventions in patients with nonspecific LBP. Primary outcomes were pain intensity and disability. We assessed risk of bias using the Cochrane Back and Neck (CBN) Review Group 12-item criteria. We combined results in a meta-analysis expressed as mean difference and 95% confidence interval. We assessed the overall quality of the evidence using the GRADE approach. Results. We included 32 trials (n = 2628). Most included trials had a low risk of bias. For acute LBP, low to moderate quality evidence indicates no clinically important differences between MCE and spinal manipulative therapy or other forms of exercise. There is very low-quality evidence that the addition of MCE to medical management does not provide clinically important improvements. For recurrence at one year, there is very low-quality evidence that MCE and medical management decrease the risk of recurrence. For chronic LBP, there is low to moderate quality evidence that MCE is effective for reducing pain compared with minimal intervention. There is low to high-quality evidence that MCE is not clinically more effective than other exercises or manual therapy. There is very low to low quality evidence that MCE is clinically more effective than exercise and electrophysical agents (EPAs) or telerehabilitation for pain and disability. Conclusion. MCE is probably more effective than a minimal intervention for reducing pain, but probably does not have an important effect on disability, in patients with chronic LBP. There was no clinically important difference between MCE and other forms of exercises or manual therapy for acute and chronic LBP. Level of Evidence: 1

Is the rearfoot pattern the most frequently foot strike pattern among recreational shod distance runners

OBJECTIVE To determine the distribution of the foot strike patterns among recreational shod runners and to compare the personal and training characteristics between runners with different foot strike patterns. DESIGN Cross-sectional study. SETTING Areas of running practice in São Paulo, Brazil. PARTICIPANTS 514 recreational shod runners older than 18 years and free of injury. OUTCOMES MEASURES Foot strike patterns were evaluated with a high-speed camera (250 Hz) and photocells to assess the running speed of participants. Personal and training characteristics were collected through a questionnaire. RESULTS The inter-rater reliability of the visual foot strike pattern classification method was 96.7% and intra-rater reliability was 98.9%. 95.1% (n = 489) of the participants were rearfoot strikers, 4.1% (n = 21) were midfoot strikers, and four runners (0.8%) were forefoot strikers. There were no significant differences between strike patterns for personal and training characteristics. CONCLUSION This is the first study to demonstrate that almost all recreational shod runners were rearfoot strikers. The visual method of evaluation seems to be a reliable and feasible option to classify foot strike pattern.

Musculoskeletal pain is prevalent among recreational runners who are about to compete: an observational study of 1049 runners.

QUESTION What is the prevalence and nature of musculoskeletal pain in recreational runners immediately before a race? DESIGN Cross-sectional survey. PARTICIPANTS Adults intending to compete in a recreational running race between 5000 and 10 000 metres. MEASURES Demographic data collected about the respondents included: age, gender, height, weight, duration of running experience, distance run per week, number of training sessions per week, training surface, and use of coaching. Respondents were asked if they had any pain. If pain was present, data were collected regarding its location, duration, current intensity, and behaviour. All data were self-reported. RESULTS Data were collected from 1049 runners at five recreational races in São Paulo, Brazil. Of these respondents, 227 (22%) reported musculoskeletal pain before the race. Male respondents reported a greater running experience, a higher distance run per week, and a greater body mass index. Despite this, the prevalence of pain was 20% among the 796 male respondents and 27% among the 253 female respondents (RR 1.35, 95% CI 1.05 to 1.72). Where pain was present, it was typical of overuse injuries and its duration, intensity, and behaviour were similar between male and female respondents. CONCLUSION The prevalence of musculoskeletal pain in recreational runners about to compete is substantial. Physiotherapists might be able to circumvent worsening of existing overuse injuries in this population with advice and preventive interventions.

Descriptors used to define running-related musculoskeletal injury: a systematic review.

STUDY DESIGN Systematic review. OBJECTIVES To systematically review the descriptors used to define running-related musculoskeletal injury and to analyze the implications of different definitions on the results of studies. BACKGROUND Studies have developed their own definitions of running-related musculoskeletal injuries based on different criteria. This may affect the rates of injury, which can be overestimated or underestimated due to the lack of a standard definition. METHODS Searches were conducted in the Embase, PubMed, CINAHL, SPORTDiscus, LILACS, and SciELO databases, without limits on date of publication and language. Only articles that reported a definition of running-related injury were included. The definitions were classified according to 3 domains and subcategories: (1) presence of physical complaint (symptom, body system involved, region), (2) interruption of training or competition (primary sports involved, extent of injury, extent of limitation, interruption, period of injury), and (3) need for medical assistance. Spearman rank correlation was performed to evaluate the correlation between the completeness of definitions and the rates of injury reported in the studies. RESULTS A total of 48 articles were included. Most studies described more than half of the subcategories, but with no standardization between the terms used within each category, showing that there is no consensus for a definition. The injury rates ranged between 3% and 85%, and tended to increase with less specific definitions. CONCLUSION The descriptors commonly used by researchers to define a running-related injury vary between studies and may affect the rates of injuries. The lack of a standardized definition hinders comparison between studies and rates of injuries.

Subgrouping Patients With Nonspecific Low Back Pain: Hope or Hype?

Clinicians and clinical researchers share a common goal of achieving better outcomes for patients with low back pain (LBP). For that, randomized controlled trials and systematic reviews are the most reliable study designs to determine the effects of interventions. Subgroup analyses in these research designs have been used to examine treatment-effect modification across subgroups defined by patient characteristics. In this Viewpoint, the authors present supporting and opposing arguments for the subgrouping approach in nonspecific LBP, considering the progress made so far in the LBP field and the relevant literature in adjacent fields. J Orthop Sports Phys Ther 2017;47(2):44-48. doi:10.2519/jospt.2017.0602.

Description of research design of articles published in four Brazilian physical therapy journals

Background While the research design of articles published in medical journals and in some physical therapy journals has already been evaluated, this has not been investigated in Brazilian physical therapy journals. Objective To describe the research design used in all articles published in Brazilian scientific journals that are freely available, have high Qualis rankings, and are relevant to physical therapy over a 7-year period. Method We extracted the bibliometric data, research design, research type (human or animal), and clinical area for all articles published. The articles were grouped into their level of evidence, and descriptive analyses were performed. We calculated the frequency, proportions of articles, and 95% confidence interval of these proportions with each research design in each journal. We cross-tabulated the clinical areas with research designs (expressed as number and percentages). Results A total of 1,458 articles from four Brazilian journals were found: Revista Brasileira de Fisioterapia, Revista Fisioterapia em Movimento, Revista Fisioterapia e Pesquisa, and Revista Acta Fisiátrica. The majority of articles were classified as level II of evidence (60%), followed by level III (29%) and level I (10%). The most prevalent research designs were cross-sectional studies (38%), single-case or case-series studies, and narrative reviews. Most articles reported human research and were in the musculoskeletal, neurologic, and cardiothoracic areas. Conclusions Most of the research published in Brazilian physical therapy journals used levels II and III of evidence. Increasing the publication rate of systematic reviews and randomized controlled trials would provide more high-quality evidence to guide evidence-based physical therapy practice.

Pilates for Low Back Pain: Complete Republication of a Cochrane Review

Study Design. Systematic review. Objective. To determine the effects of the Pilates method for patients with nonspecific acute, subacute, or chronic low back pain. Summary of Background Data. The Pilates method is one of the most common forms of intervention based on exercise used for treating patients with low back pain. However, its effectiveness is not well established. Methods. We conducted searches on CENTRAL, MEDLINE, EMBASE, CINAHL, PEDro, and SPORTDiscus up to March 2014. We included randomized controlled trials examining the effectiveness of Pilates in patients with acute, subacute, or chronic nonspecific low back pain. The outcomes evaluated were pain, disability, function, and global impression of recovery. Two independent reviewers screened for potentially eligible studies, assessed risk of bias, and extracted the data. We evaluated the overall quality of evidence using the GRADE approach and treatment effect sizes were described using mean differences and 95% confidence intervals. Results. Searches retrieved 126 trials, of which 10 were included in the review (n = 510 participants). Seven studies were considered to have low risk of bias, and three were considered at high risk of bias. When compared to minimal intervention, Pilates reduces pain at short and intermediate term with low- to moderate-quality evidence and medium effect sizes. For disability, there is also a significant difference in favor to Pilates with low- to moderate-quality evidence and small effect size for short term and medium effect size for intermediate term compared with minimal intervention. It is unclear whether Pilates is better than other exercises for short-term pain, but there is low-quality evidence that Pilates reduces pain at intermediate term. For disability, there is moderate-quality evidence that there is no significant difference between Pilates and other exercises in either the short term or the intermediate term. Conclusion. There is low- to moderate-quality evidence that Pilates is more effective than minimal intervention with most of the effect sizes being considered medium. However, there is no conclusive evidence that Pilates is superior to other forms of exercises. Level of Evidence: 1

The TIDieR checklist will benefit the physical therapy profession.

The Editorial was originally published in Journal of Physiotherapy, 2016, however, this article contains a modified author list and amendments to the description about Pediatric Physical Therapy’s incorporation of the TIDieR checklist into its manuscript processing. It is republished with the kind permission of the Australian Physiotherapy Association. For citation purposes, please use the original publication details: Yamato T, Maher C, Saragiotto B, et al. The TIDieR checklist will benefit the physiotherapy profession. J. Physiother. 2016;62:57-58. DOI of original article: http://dx.doi.org/10.1016/j.jphys.2016.02.015

The TIDieR Checklist Will Benefit the Physical Therapy Profession

Evidence-based practice involves physical therapists incorporating high-quality clinical research on treatment efficacy into their clinical decision-making.1 However, if clinical interventions are not adequately reported in the literature, physical therapists face an important barrier to using effective interventions for their patients. Previous studies have reported that incomplete description of interventions is a problem in reports of randomized controlled trials in many health areas.2–4 One of these studies examined 133 trials of nonpharmacological interventions.4 The experimental intervention was inadequately described in over 60% of the trials, and descriptions of the control interventions were even worse. A recent study5 evaluated the completeness of descriptions of the physical therapist interventions in a sample of 200 randomized controlled trials published in 2013. Overall, the interventions were poorly described. For the intervention groups, about one quarter of the trials did not fulfill at least half of the criteria. Reporting for the control groups was even worse, with around three quarters of trials not fulfilling at least half of the criteria. In other words, for the majority of the physical therapy trials, clinicians and …