Limited-quality Patient-oriented Evidence Research Articles

Effectiveness of Platelet-Rich Plasma in Reducing Pain and Increasing Function After Acute Lateral Ankle Sprain: A Critically Appraised Topic.

Ankle sprains are one of the most common injuries in athletics, and many lead to recurrent sprains, chronic ankle instability, and persistent symptoms. Treatment improvements are needed. Platelet-rich plasma (PRP) involves formulating autologous plasma with higher platelet concentration to be injected in the desired tissue. There is currently high-quality evidence supporting the use of PRP with lateral epicondylitis and knee osteoarthritis to accelerate the healing process and decrease pain. Does the injection of PRP relieve pain faster and improve function compared with no injection or placebo in patients with a lateral ankle sprain? A computerized search yielded 191 studies; of these, 3 studies fit the inclusion and exclusion criteria. PRP injection reduces pain and increases function after lateral ankle sprain 5 to 8weeks after intervention. The use of PRP after lateral ankle sprain to decrease pain and increase function is supported with moderate evidence. Based on the Strength of Recommendation Taxonomy, evidence from the included studies is considered as level B, reflecting limited quality patient-oriented evidence.

The effects of mindfulness-based interventions on alleviating academic burnout in medical students: a systematic review and meta-analysis

BackgroundMindfulness-based interventions have been tested to be the effective approach for preventing/reducing burnout in medical students. Therefore, this systematic review and meta-analysis aimed to synthesize the scientific evidence and quantify the pooled effect of MBIs on the burnout syndrome in medical students.MethodsA comprehensive literature search was conducted in the databases, including PubMed, Embase, ERIC, PsycINFO, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), China National knowledge Information Database (CNKI) and WanFang Database from database inception to February 2023 using the terms of “mindfulness”, “burnout” and “medical students”. Two reviewers independently reviewed the studies, and extracted the data of the eligible studies, as well as assessed the risk of bias. A random-effects model was employed to calculate the standardized mean differences (SMD) with 95% confidence intervals (CI) of overall burnout and its sub-domains of burnout (i.e., emotional exhaustion, cynicism, and academic efficacy).ResultsOf 316 records in total, nine studies (with 810 medical students) were ultimately included. The four RCT studies demonstrated an overall judgment of some concerns risk of bias, and the overall risk of biases of the five qRCT studies were judged as serious. In term of the SORT, the RCT and qRCT studies were evaluated as level 2 evidence, and the overall strength of recommendation was classified as B (limited-quality patient-oriented evidence). The pooled analysis showed that MBIs were associated with significant small to moderate improvements for medical students’ overall burnout (SMD=-0.64; 95% CI [-1.12, -0.16]; P = 0.009) in the included four RCTs, emotional exhaustion (SMD=-0.27; 95% CI [-0.50, -0.03]; P = 0.03) and academic efficacy (SMD = 0.43; 95% CI [0.20, 0.66]; P<0.001) in the four qRCTs.ConclusionsMBIs can serve as an effective approach for reducing burnout symptoms in medical students. Future high-quality studies with a larger sample size and robust randomized controlled trial methodologies should be obtained to reinforce the effectiveness of MBIs for reducing academic burnout in medical students.

Effects of COVID-19 Sport Suspension on Injury Rates in Elite Athletes: A Critically Appraised Topic

Clinical Scenario: With the enforcement of COVID-19 lockdown restrictions, sports teams worldwide were required to make drastic adjustments to their training regimen. This prolonged sport suspension resulted in a significant decrease in off-season and preseason training periods. Clinical Question: Are professional athletes who experienced a sport suspension during the COVID-19 pandemic at a higher risk of injury once they return to competition compared with pre-COVID-19 seasons? Summary of Key Findings: The literature was searched for articles examining the effects of COVID-19 sport suspension on athletic injury rates in elite athletes. A total of 240 articles were retrieved, and after exclusion criteria and removal of duplicates, four retrospective cohort studies remained. An increase in injury rates across studies after their sport suspension compared with pre-COVID-19 seasons was found. Clinical Bottom Line: The extended suspension from physical activity increased the risk of injury as players returned to sport training post-COVID-19 restrictions. While these studies demonstrated the effects on elite-level athletes, prolonged sport suspension may impact different patient populations. Strength of Recommendation: Based on the Strength of Recommendation Taxonomy Scale, this critically appraised topic received a B grade for consistent but limited-quality patient-oriented evidence, with a low number of articles included.

The Effectiveness of a Psychoeducational Program in Increasing Mental Health Knowledge in Collegiate Athletes: A Critically Appraised Topic

Focused Clinical Question: Does the implementation of a psychoeducational program increase mental health knowledge among collegiate student-athletes? Clinical Bottom Line: There is consistent, limited-quality patient-oriented evidence to suggest that implementation of a psychoeducational program is effective in increasing mental health knowledge in collegiate student-athletes based on the guidelines of the strength of recommendation taxonomy.

Effects of Blood Flow Restriction Training on Clinical Outcomes for Patients With ACL Reconstruction: A Systematic Review.

Knee muscle atrophy and weakness are common impairments after anterior cruciate ligament (ACL) reconstruction. Blood flow restriction (BFR) training represents a new approach to treat such impairments. However, limited evidence currently exists to support this intervention in related patients. To appraise literature comparing the effects of BFR training with conventional therapy on knee muscle morphological and strength properties in ACL-reconstructed patients. PubMed, SPORTDiscus, CINAHL, and Cochrane Central Register databases were searched for relevant articles from January 1991 through April 2021. Articles were minimum Level 3 evidence focusing on knee muscle morphologic as well as extensor and flexor strength outcomes in ACL-reconstructed patients of all graft types. Systematic review. Level 2. Critical appraisal instruments (Downs and Black checklist, Cochrane Collaboration tool, ROBINS-1 tool) were used to evaluate study quality. We independently calculated effect sizes (ESs) (Cohen d) between groups in each study. The Strength of Recommendation Taxonomy grading scale was used for clinical recommendations. Six articles (4 randomized control studies, 1 nonrandomized study, and 1 case-control study) met inclusion criteria. Exercises paired with BFR training included open kinetic chain, closed kinetic chain, and passive applications. Diverse assessments and time of intervention were observed across studies. ESs ranged from trivial to large in favor of BFR training for muscle morphological (d = 0.06 to 0.81) and strength assessments (d = -0.12 to 1.24) with CIs spanning zero. At this time, grade B or inconsistent and limited-quality patient-oriented evidence exists to support using BFR training to improve or maintain thigh muscle size as well as knee extensor and flexor strength in ACL-reconstructed patients. ESs indicated no consistent clinically meaningful differences when compared with conventional therapy. Subsequent analyses should be repeated as new evidence emerges to update practice guidelines.

Intraarticular injections of hyaluronic acid in arthrocentesis and arthroscopy as a treatment of temporomandibular joint disorders: A systematic review

ABSTRACT Objective To evaluate the benefits of hyaluronic acid intraarticular injection (HA IAI), in conjunction with minimally invasive surgery (arthrocentesis or arthroscopy), as a therapeutic option for temporomandibular joint disorders. Methods An electronic search in PubMed, Cochrane Library, and Scopus databases was conducted in order to answer the following PICOS question: “In clinical trials with patients treated with arthroscopy or arthrocentesis, did the subsequent use of HA IAI provide a better control of postoperative pain and temporomandibular joint function compared to those patients who did not receive it?” Results Following PRISMA criteria, six randomized controlled clinical trials were selected. HA IAI showed significant differences in terms of pain reduction in three of them and improvement of mandibular function in two, compared to the control group. Conclusion Based on scientific evidence, the level of recommendation found regarding this type of intervention is type B (recommendation based on inconsistent or limited-quality patient-oriented evidence).

A Comparison of Neuromuscular Electrical Stimulation Parameters for Postoperative Quadriceps Strength in Patients After Knee Surgery: A Systematic Review.

Postoperative quadriceps strength weakness after knee surgery is a persistent issue patients and health care providers encounter. To investigate the effect of neuromuscular electrical stimulation (NMES) parameters on quadriceps strength after knee surgery. CINAHL, MEDLINE, SPORTDiscus, and PubMed were systematically searched in December 2018. Studies were excluded if they did not assess quadriceps strength or if they failed to report the NMES parameters or quadriceps strength values. Additionally, studies that applied NMES to numerous muscle groups or simultaneously with other modalities/treatments were excluded. Study quality was assessed with the Physiotherapy Evidence Database (PEDro) scale for randomized controlled trials. Systematic review. Level 1. Treatment parameters for each NMES treatment was extracted for comparison. Quadriceps strength means and standard deviations were extracted and utilized to calculate Hedge g effect sizes with 95% CIs. Eight RCTs were included with an average Physiotherapy Evidence Database scale score of 5 ± 2. Hedge g effect sizes ranged from small (-0.37; 95% CI, -1.00 to 0.25) to large (1.13; 95% CI, 0.49 to 1.77). Based on the Strength of Recommendation Taxonomy Quality of Evidence table, the majority of the studies included were low quality RCTs categorized as level 2: limited quality patient-oriented evidence. Because of inconsistent evidence among studies, grade B evidence exists to support the use of NMES to aid in the recovery of quadriceps strength after knee surgery. Based on the parameters utilized by studies demonstrating optimal treatment effects, it is recommended to implement NMES treatment during the first 2 postoperative weeks at a frequency of ≥50 Hz, at maximum tolerable intensity, with a biphasic current, with large electrodes and a duty cycle ratio of 1:2 to 1:3 (2- to 3-second ramp).

Effectiveness of PRP Injection in Reducing Recovery Time of Acute Hamstring Injury: A Critically Appraised Topic.

Clinical Scenario: Hamstring strains are common athletic injuries, with a high-recurrence rate (34%). Recently, platelet-rich plasma (PRP) injections have gained popularity as a potential treatment option to accelerate healing of hamstring injury. Focused Clinical Question: Does the combination of PRP injection and rehabilitation decrease recovery time of acute hamstring injury as compared to rehabilitation alone in college athletes? Summary of Key Findings: A literature search resulted in 3 randomized controlled trials. One study showed benefits in various outcome measures with PRP, compared to rehabilitation alone, while 2 showed no benefits. One study reported improved pain, ultrasonography regenerative indications, and recovery time with PRP injection following acute hamstring injury; however, larger studies have shown no benefits. The literature demonstrates conflicting evidence regarding benefits of PRP injections in hamstring injuries. Clinical Bottom Line: At this time, PRP injections cannot be recommended as having value for hamstring injuries, compared to rehabilitation alone. Strength of Recommendation: Due to inconsistent or limited quality patient-oriented evidence in existing literature, the strength of this recommendation is grade B, based on the strength of recommendation taxonomy.

How good is the evidence to support primary care practice?

Our goal was to determine the extent to which recommendations for primary care practice are informed by high-quality research-based evidence, and the extent to which they are based on evidence...

Recent Advances in Pharmacotherapeutic Paradigm of Mild to Recalcitrant Atopic Dermatitis.

Atopic dermatitis (AD) is a common, chronic skin inflammatory disorder characterized by perivascular infiltration of immunoglobulin E (IgE), T lymphocytes, and mast cells. The key factors responsible for the pathophysiology of this disease are immunological disorders and defects in epidermal barrier properties. Pruritus, intense itching, psychological stress, deprived physical and mental performance, and sleep disturbance are the hallmark features of this dermatological disorder. Preventive interventions such as educational programs, avoidance of allergens, and exclusive care toward the skin could play a partial role in suppressing the symptoms. Based on the available clinical evidence, topical corticosteroids (TCs) are among the most commonly prescribed agents; however, these should be selected with care. In cases of steroid phobia, persistent adverse effects or chronic use, topical calcineurin inhibitors can be considered as a promising adjunct to TCs. Recent advances in the pharmacotherapeutic paradigm of atopic diseases exploring the therapeutic dominance of nanocarrier-mediated delivery is also discussed in this evidence-based review with regard to the treatment of AD. The present review summarizes the available clinical evidence, highlighting the current and emerging trends in the treatment of AD and providing evidence-based recommendations for the clinicians and health care professionals. Available evidence for the management of pediatric and adult atopic dermatitis (AD; atopic eczema) of all severities is explored. The management of other types of dermatitis, such as irritant contact dermatitis, seborrheic dermatitis, neurodermatitis, perioral dermatitis, stasis dermatitis, and allergic contact dermatitis are outside the scope of current review article. The presented studies were appraised using a unified system called the "Strength of Recommendation Taxonomy (SORT)", which was developed by the editors of several US family medicine and primary care journals (i.e., American Family Physician, Family Medicine, Journal of Family Practice, and BMJ USA).1 The searched studies were graded using a 3-point scale based on the quality of methodology (e.g., randomized control trial, case control series, clinical cohort studies, case series, etc.) and key emphasis of the trial (i.e., diagnosis, treatment/prevention/ screening, or prognosis) as follows: I. Good-quality patient-oriented evidence (i.e., evidence assessing consequences that matter to patients: mortality, morbidity, improvement in signs and symptom, quality of life, and socioeconomic factors); II. Limited-quality patient-oriented evidence; and III. Other evidence such as consensus guidelines, expert opinion, case control trial, or disease-related information. Recommendations for nonpharmacological and pharmacological approaches were established based on the best available evidence and are graded as follows: A. Recommendations based on consistent and good-quality patient-oriented evidence; B. Recommendations based on inconsistent or limited-quality patient-oriented evidence; and C. Recommendations based on consensus, expert opinion, case control evidence, or disease-related information.

The Effectiveness of Custom Foot Orthotics in Treating Chronic Low Back Pain: A Critically Appraised Topic

Clinical Scenario:Chronic low back pain is one of the most common causes of pain and disability. Currently, there is a need for more effective interventions to treat low back pain.Clinical Question:Does the use of custom foot orthotics improve self-reported measures of pain and function in adults with chronic low back pain?Summary of Key Findings:A comprehensive and systematic search was conducted for studies of level 2 evidence or higher that pertained to the clinical question. The search yielded 11 studies, of which one randomized control trial and two prospective cohorts fit the inclusion and exclusion criteria. The articles examined the effectiveness of custom foot orthotics in isolation compared with no treatment as well as custom foot orthotics in combination with usual care compared with usual care alone. The included studies all demonstrated that the use of custom foot orthotics reduce chronic low back pain after seven weeks of use. One included study was considered high-quality evidence while two were deemed low-quality evidence using the PEDro.Clinical Bottom Line:There is moderate evidence to support the use of custom foot orthotics to improve self-reported measures in adults with chronic low back pain after seven weeks of use.Strength of Recommendation:The Strength of Recommendation Taxonomy recommends a grade of B for consistent limited-quality patient-oriented evidence.

Limited Evidence Suggests High Risk of Implant Failure Rates Among People With Generalized Aggressive Periodontitis

Generalized aggressive periodontitis as a risk factor for dental implant failure: a systematic review and meta-analysis. Monje A, Alcoforado G, Padial-Molina M, Suarez F, Lin GH, Wang HL.J Periodontol 2014;85(10):1398-1407. Ahmed Yaseen Alqutaibi, BDS, MDSc, PhD(c), Radhwan saleh Algabri, BDS, MDSc, PhD(c) In patients with dental implants, what are the differences in implant survival rate (SR), and marginal bone loss (MBL) between people with or without generalized aggressive periodontitis (AgP)? University of Michigan Periodontal Graduate Student Research Fund and the Talentia Scholarship Program, Junta de Andalucia, Spain Systematic review and meta-analysis Level 2: Limited-quality, patient-oriented evidence Grade B: Inconsistent, limited quality patient-oriented evidence.

A History of Periodontitis Suggests a Higher Risk for Implant Loss

Periodontitis, implant loss and peri-implantitis. A meta-analysis. Sgolastra F, Petrucci A, Severino M, Gatto R, Monaco A.Clin Oral Implants Res 2015;26(4):e8-16. Bruno Ramos Chrcanovic, DDS, MSc, PhD student To compare the risks of implant loss, implant bone loss, and peri-implantitis between subjects with and without a history of periodontal disease. The authors reported that no external funding sources directly supported this study Systematic review with meta-analysis of data Level 2: Limited-quality, patient-oriented evidence Grade B: Inconsistent or limited-quality patient-oriented evidence.

There is No Evidence on the Effect of the Attachment System on Implant Survival Rate, Overdenture Maintenance, or Patient Satisfaction

Attachment systems for mandibular implant overdentures: a systematic review. Kim HY, Lee JY, Shin SW, Bryant SR.J Advanced Prosthodont 2012;4(4):197-203. Ahmed Yaseen Alqutaibi, BDS, MDSc, PhD(c) To address treatment outcomes depending on attachment systems for two-implant mandibular-supported overdentures in terms of (1) implant survival rate, (2) prosthetic maintenance and complications, and (3) patient satisfaction. Systematic review Level 2: Limited-quality, patient-oriented evidence Grade B: Inconsistent, limited-quality patient-oriented evidence.

Studies on the Accuracy of Visual Inspection Failed to Show Data on Its Clinical Applicability in Detecting Coronal Caries Lesions

Article Title and Bibliographic Information Clinical relevance of studies on the accuracy of visual inspection for detecting caries lesions: a systematic review. Gimenez T, Piovesan C, Braga MM, Raggio DP, Deery C, Ricketts DN, Ekstrand KR, Mendes FMM.Caries Res 2015;49(2):91-8. Reviewer Jonas Almeida Rodrigues, DDS, DMD, MSc, PhD Purpose/Question What aspects related to clinical relevance and methodological quality are considered when studies on the accuracy of visual examination are conducted? Source of Funding The authors reported that they were directly supported by three Brazilian grant agencies (CNPq, FAPESP and CAPES) Type of Study/Design Systematic review Level of Evidence Level 2: Limited-quality patient-oriented evidence Strength of Recommendation Grade Grade B: Inconsistent or limited-quality patient-oriented evidence

There is No Clear Evidence of Superiority Concerning the Platform-switching in the Preservation of the Marginal Bone Level

Article Title and Bibliographic Information Impact of platform switching on marginal peri-implant bone level changes. A systematic review and meta-analysis. Strietzel FP, Neumann K, Hertel M Clin Oral Implants Res 2014;26(3):342-58. Reviewer Ahmed Yaseen Al-Qutaib, BDS, MDSc, PhD(c) Purpose/Question Is there an impact of platform switching (PS) on marginal bone level (MBL) changes around endosseous implants compared to implants with platform matching (PM) implant abutment configurations? Type of Study/Design Systematic review and meta-analysis Level of Evidence Level 2: Limited-quality, patient-oriented evidence Strength of Recommendation Grade Grade B: Inconsistent, limited-quality patient-oriented evidence

Regenerative Approaches in the Treatment of Furcation Lesions are Predictable in Class II Maxillary Facial or Interproximal and Mandibular Facial or Lingual Class II Furcation Defects

Article Title and Bibliographic Information Periodontal regeneration – furcation defects: a systematic review from the AAP regeneration workshop. Avila-Ortiz G, De Buitrago JG, Reddy MS.J Periodontol. 2015;86(2 Suppl):S108-30. Reviewers Fernanda Vieira Ribeiro, DDS, MS, PhD, Professor, Marcio Zaffalon Casati, DDS, MS, PhD, Professor Purpose/Question The authors conducted a systematic review of clinical studies on the effectiveness of various regenerative approaches for the treatment of furcation defects in specific clinical scenarios compared with conventional surgical therapy. Source of Funding As described by the authors, Dr. Avila-Ortiz has received research funding from Osteogenics Biomedical (Lubbock, Texas), Geistlich Pharma (Wolhusen, Switzerland), DENTSPLY (York, Pennsylvania), and BioHorizons (Birmingham, Alabama) and lecture honoraria from Laboratorios INIBSA (Barcelona, Spain). Dr. Reddy has received grant support and other funding through his institution, the University of Alabama at Birmingham; from BioDLogics (Memphis, Tennessee), Biomet 3i (Palm Beach Gardens, Florida), Procter & Gamble (Cincinnati, Ohio), Institute Straumann (Basel, Switzerland), Sunstar Americas (Chicago, Illinois), Zimmer Dental (Carlsbad, California), BioHorizons, National Institutes of Health, and National Institute of Dental and Craniofacial Research. Dr. De Buitrago reports no conflicts of interest related to this review. The 2014 Regeneration Workshop was hosted by the American Academy of Periodontology (AAP) and supported in part by the AAP Foundation, Geistlich Pharma North America, Colgate-Palmolive, and the Osteology Foundation. Type of Study/Design Systematic review Level of Evidence Level 2: Limited quality, patient-oriented evidence Strength of Recommendation Grade Grade B: Inconsistent or limited quality patient-oriented evidence

Effects of Orthodontic Movement on the Dental Pulp

Article Title and Bibliographic Information Influence of orthodontic forces on human dental pulp: a systematic review. Javed F, Al-Keraif AA, Romanos EB, Romanos GE.Arch Oral Biol 2015;60(2):347-56. Reviewer Kathleen G. Neiva, DDS, PhD Purpose/Question Do orthodontic forces affect human dental pulp? Source of Funding The authors reported that no external funding sources directly supported this study. Type of Study/Design Systematic review Level of Evidence Level 2: Limited-quality, patient-oriented evidence Strength of Recommendation Grade Grade B: Inconsistent or limited-quality patient-oriented evidence

MTA, Formocresol, and Ferric Sulfate Have Significantly Better Clinical and Radiographic Outcomes Than Calcium Hydroxide and Laser Therapies in Primary Molar Pulpotomies After 18–24 Months

Article Title and Bibliographic Information Primary molar pulpotomy: a systematic review and network meta-analysis. Lin PY, Chen H-S, Wang Y-H, Tu Y-K. J Dent 2014;42(9):1060–77 Reviewer Samah Omar, BDS, DDS, MSD Purpose/Question The aim of this study is to undertake a systematic review and network meta-analysis, comparing the clinical and radiographic outcomes in primary molar pulpotomy among different dressing materials. Source of Funding This project was partly supported by a grant from the National Science Council in Taiwan (grant number: NSC 101-2314-B-002-197-MY2). Type of Study/Design Systematic review with meta-analysis of data. Level of Evidence Level 2: Limited-quality, patient-oriented evidence Strength of Recommendation Grade Grade B: Inconsistent, limited-quality patient-oriented evidence

Existing Screening Methods for Oral Cancer are Generally Acceptable to Patients in Non-dental Settings

Article Title and Bibliographic Information A systematic review of patient acceptance of screening for oral cancer outside of dental care settings. Paudyal P, Flohr FD, Llewellyn CD. Oral Oncol 2014 50(10):956–62. Reviewer Virginia J. Dodd, PhD, MPH, RDH Purpose/Question To determine the acceptability of screening for oral cancer outside of dental settings Source of Funding Information not available Type of Study/Design Systematic review Level of Evidence Level 2: Limited quality, patient-oriented evidence Strength of Recommendation Grade Grade B: Inconsistent or limited-quality patient-oriented evidence