Christian Kopkow

Nonallergic comorbidities of atopic eczema: an overview of systematic reviews

The aims of this overview are to synthesize the current evidence of published systematic reviews (SRs) on nonallergic comorbidities of atopic eczema (AE). EMBASE and MEDLINE were searched for SRs published from inception to November 2012. SRs were selected independently based on predefined inclusion criteria. Methodological quality of SRs included was assessed by two independent reviewers using the Revised Assessment of Multiple Systematic Reviews (R‐AMSTAR) checklist. Nine SRs met all inclusion criteria. Six reviews addressing the association between AE and cancer suggest a decreased risk of glioma, meningioma, and acute lymphoblastic leukemia in patients with current or previous AE. One SR reported a consistent positive association of AE with attention‐deficit hyperactivity disorder (ADHD). Diabetes mellitus type 1 and multiple sclerosis (MS) were not significantly related to AE in reviews based on cross‐sectional and case–control studies. Patients with AE appear to be at decreased risk of brain tumors. The relationship of AE with Th1‐ and Th17‐mediated (auto‐)inflammatory conditions such as diabetes mellitus type 1 and MS should be clarified in prospective observational studies. Children with AE are at increased risk of ADHD. SRs on the risk of depression and Th17‐mediated disorders such as inflammatory bowel disease of patients with AE are missing.

Physical Examination Tests for the Diagnosis of Posterior Cruciate Ligament Rupture: A Systematic Review

STUDY DESIGN Systematic literature review. OBJECTIVES To summarize and evaluate research on the accuracy of physical examination tests for diagnosis of posterior cruciate ligament (PCL) tear. BACKGROUND Rupture of the PCL is a severe knee injury that can lead to delayed rehabilitation, instability, or chronic knee pathologies. To our knowledge, there is currently no systematic review of studies on the diagnostic accuracy of clinical examination tests to evaluate the integrity of the PCL. METHODS A comprehensive systematic literature search was conducted in MEDLINE from 1946, Embase from 1974, and the Allied and Complementary Medicine Database from 1985 until April 30, 2012. Studies were considered eligible if they compared the results of physical examination tests performed in the context of a PCL physical examination to those of a reference standard (arthroscopy, arthrotomy, magnetic resonance imaging). Methodological quality assessment was performed by 2 independent reviewers using the revised version of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. RESULTS The search strategy revealed 1307 articles, of which 11 met the inclusion criteria for this review. In these studies, 11 different physical examination tests were identified. Due to differences in study types, different patient populations, and methodological quality, meta-analysis was not indicated. Presently, most physical examination tests have not been evaluated sufficiently enough to be confident in their ability to either confirm or rule out a PCL tear. CONCLUSIONS The diagnostic accuracy of physical examination tests to assess the integrity of the PCL is largely unknown. There is a strong need for further research in this area. Level of Evidence Diagnosis, level 3a.

A systematic review of the outcomes reported in multimodal pain therapy for chronic pain

There are no recommendations provided for the outcome domains of chronic pain that should be explicitly considered in each clinical trial to describe the efficacy and effectiveness of multimodal pain therapy (MPT). Our aims were to summarize all reported outcome domains in studies assessing the effects of MPT for chronic pain, and to subsequently inform a consensus‐based development of a core outcome set of domains in this field.

Core outcome set to assess effectiveness in multimodal pain therapy – preliminary results of an interdisciplinary online survey

Background For multimodal pain therapy (MPT), a bio-psycho-social therapy approach for patients suffering from chronic pain, a core outcome set (COS) is currently lacking. Following the recommendations from initiatives such as Outcome Measures in Rheumatology (OMERACT) and Harmonizing Outcome Measures for Eczema (HOME), the study “Validation and Application of a patient relevant core set of outcome domains to assess multimodal PAIN therapy” (VAPAIN) aims to develop an accepted and valid COS for MPT.

The reliability of physical examination tests for the diagnosis of anterior cruciate ligament rupture – A systematic review

STUDY DESIGN Systematic literature review. BACKGROUND Despite their frequent application in routine care, a systematic review on the reliability of clinical examination tests to evaluate the integrity of the ACL is missing. OBJECTIVES To summarize and evaluate intra- and interrater reliability research on physical examination tests used for the diagnosis of ACL tears. METHODS A comprehensive systematic literature search was conducted in MEDLINE, EMBASE and AMED until May 30th 2013. Studies were included if they assessed the intra- and/or interrater reliability of physical examination tests for the integrity of the ACL. Methodological quality was evaluated with the Quality Appraisal of Reliability Studies (QAREL) tool by two independent reviewers. RESULTS 110 hits were achieved of which seven articles finally met the inclusion criteria. These studies examined the reliability of four physical examination tests. Intrarater reliability was assessed in three studies and ranged from fair to almost perfect (Cohens k = 0.22-1.00). Interrater reliability was assessed in all included studies and ranged from slight to almost perfect (Cohens k = 0.02-0.81). The Lachman test is the physical tests with the highest intrarater reliability (Cohens k = 1.00), the Lachman test performed in prone position the test with the highest interrater reliability (Cohens k = 0.81). Included studies were partly of low methodological quality. A meta-analysis could not be performed due to the heterogeneity in study populations, reliability measures and methodological quality of included studies. CONCLUSION Systematic investigations on the reliability of physical examination tests to assess the integrity of the ACL are scarce and of varying methodological quality.

Validation and application of a core set of patient-relevant outcome domains to assess the effectiveness of multimodal pain therapy (VAPAIN): a study protocol

Introduction Multimodal pain therapy (MPT) has been established accounting for biopsychosocial consideration in diagnostic and therapy. MPT seems to be effective, but comparability of studies is limited due to diversity of study designs and outcome measurements. The presented study aims to develop a core outcome set consisting of a minimum of outcome measures deemed necessary for medical and therapeutic decision-making, which must be measured in all clinical trials and non-randomised intervention studies. Methods and analysis The study consists of several parts. First, the development and recommendation of preliminary core outcome domains will be based on results of a systematic review and structured online surveys. Participants of the expert panel are representatives of methodological, medical, physiotherapeutic, psychotherapeutic profession and patients suffering from chronic pain (n=25). Subsequently, candidate instruments to measure preliminary core outcome domains will be recommended by these experts. Therefore, systematic reviews on measurement properties of preliminary outcome measures will be conducted and finalised in a consensus meeting. Consented instruments and lacking psychometric properties of relevant instruments will be addressed and validated in the following part, a prospective multicentre study in multimodal pain centres on approximately 300 patients with chronic pain. Based on all previous results, a core outcome set for MPT measured in effectiveness studies and daily recordkeeping will be finalised by consensus. Statistical analyses will be performed according to methodological standards (COSMIN). Ethics and dissemination The methods and procedure of the study are developed in compliance with the ethical principles of the Helsinki Declaration and Good Epidemiologic Practice. Recruitment of study participants will require approval of the study by the responsible ethics committee and signed informed consent from each participant. Pseudonymised data will be used for statistical analysis.

Interrater reliability of the modified scapular assistance test with and without handheld weights

STUDY DESIGN Prospective, blinded interrater reliability study. OBJECTIVE To determine the interrater reliability of the modified Scapular Assistance Test (mSAT) with and without the use of additional handheld weights. METHODS 110 Shoulder patients with various shoulder pathologies were consecutively recruited. Tests were performed independently and randomly on each participant by 2 different examiners, which were blinded to further clinical information (e.g. patient history, former diagnostic results). Percent agreement, Cohens kappa (Κ), proportion of positive/negative agreement, maximum Κ, prevalence and bias indexes and prevalence-adjusted-bias-adjusted kappa (PABAK) were calculated as estimates of interrater reliability of the mSAT with and without additional handheld weights. Weights were chosen according to body weight. RESULTS The reliability measures for the mSAT (Cohens Κ: 0.68, confidence interval (CI): 0.51-0.85; PABAK: 0.78, CI: 0.67-0.90) as well as for the mSAT with handheld weights (Cohens Κ: 0.63, CI: 0.44-0.81; PABAK: 0.76, CI: 0.64-0.88) showed substantial agreement according to the classification system proposed by Landis and Koch. CONCLUSIONS Based on the results of this study, the mSAT with and without additional weights can be considered as reliable for clinical use. Since both tests showed substantial agreement, the use of additional handheld weights might not be necessary in case of obvious scapula dyskinesis. However, to perform the mSAT with/without additional weights should depend not only on its reliability values. Name of the public trials registry and the registration number: German Clinical Trials Register, protocol number DRKS00005377.

Dose or content? Effectiveness of pain rehabilitation programs for patients with chronic low back pain: A systematic review. Waterschoot et al., Pain 155 (2014) 179-189.

of studies with heterogeneous groups of treatments, patient populations, follow-up times, outcomes and measurements per outcome. In the absence of standardized outcome measurements, we categorized the measurements related to disability, work participation, and quality of life. However, in this systematic review, we reported data and outcomes of a heterogeneous source of studies in the literature. Factors such as patient compliance and motivation are known to affect outcome [2,3]. However, data regarding these factors are rarely reported in randomized controlled trials (RCTs) in general, and were not reported in our source literature; therefore, we could not report on these and other relevant issues. As we described, in the Discussion section of our review, it is difficult to disentangle dose and content aspects of PRPs; but, from our point of view, it is very important to include all aspects of a study in order to analyze the effects of PRPs. We agree with Williams [5] that our review has laid some groundwork for further research to disentangle dose and content factors in PRPs so as to improve these programs. Finally, we disagree with Beckmann and Schiltenwolf that discussing dose of treatment appears to be premature. Our review has demonstrated that dose issues have been neglected in PRP research, and we believe that studying dose in PRPs is necessary and long overdue.

A preliminary core domain set for clinical trials of shoulder disorders: A report from the OMERACT 2016 shoulder core outcome set special interest group

Objective. The Outcome Measures in Rheumatology (OMERACT) Shoulder Core Outcome Set Special Interest Group (SIG) was established to develop a core outcome set (COS) for clinical trials of shoulder disorders. Methods. In preparation for OMERACT 2016, we systematically examined all outcome domains and measurement instruments reported in 409 randomized trials of interventions for shoulder disorders published between 1954 and 2015. Informed by these data, we conducted an international Delphi consensus study including shoulder trial experts, clinicians, and patients to identify key domains that should be included in a shoulder disorder COS. Findings were discussed at a stakeholder premeeting of OMERACT. At OMERACT 2016, we sought consensus on a preliminary core domain set and input into next steps. Results. There were 13 and 15 participants at the premeeting and the OMERACT 2016 SIG meeting, respectively (9 attended both meetings). Consensus was reached on a preliminary core domain set consisting of an inner core of 4 domains: pain, physical function/activity, global perceived effect, and adverse events including death. A middle core consisted of 3 domains: emotional well-being, sleep, and participation (recreation and work). An outer core of research required to inform the final COS was also formulated. Conclusion. Our next steps are to (1) analyze whether participation (recreation and work) should be in the inner core, (2) conduct a third Delphi round to finalize definitions and wording of domains and reach final endorsement for the domains, and (3) determine which instruments fulfill the OMERACT criteria for measuring each domain.

The reliability of physical examination tests for the clinical assessment of scapular dyskinesis in subjects with shoulder complaints: A systematic review

STUDY DESIGN Systematic review. OBJECTIVES The aim of this systematic review was to summarize and evaluate intra- and interrater reliability research of physical examination tests used for the assessment of scapular dyskinesis. BACKGROUND Scapular dyskinesis, defined as alteration of normal scapular kinematics, is described as a non-specific response to different shoulder pathologies. METHODS A systematic literature search was conducted in MEDLINE, EMBASE, AMED and PEDro until March 20th, 2015. Methodological quality was assessed with the Quality Appraisal of Reliability Studies (QAREL) by two independent reviewers. RESULTS The search strategy revealed 3259 articles, of which 15 met the inclusion criteria. These studies evaluated the reliability of 41 test and test variations used for the assessment of scapular dyskinesis. CONCLUSION This review identified a lack of high-quality studies evaluating intra- as well as interrater reliability of tests used for the assessment of scapular dyskinesis. In addition, reliability measures differed between included studies hindering proper cross-study comparisons. The effect of manual correction of the scapula on shoulder symptoms was evaluated in only one study, which is striking, since symptom alteration tests are used in routine care to guide further treatment. Thus, there is a strong need for further research in this area. LEVEL OF EVIDENCE Diagnosis, level 3a.