This systematic review synthesizes empirical evidence on the development, effectiveness, patient experience, and implementation of decision aids (DAs) for postmastectomy breast reconstruction (PMBR) and to evaluate the role of pre-consultation educational interventions in supporting shared decision-making (SDM). Following PRISMA guidelines and a preregistered protocol (OSF: https://osf.io/mu9hv), six electronic databases and gray literature sources were searched for studies on PMBR DAs through November 2025. Eligible studies were categorized using a five-domain framework aligned with IPDAS and MRC guidance: (1) DA development and early evaluation, (2) randomized controlled trials (RCTs), (3) qualitative/mixed-methods studies, (4) implementation and practice-improvement studies, and (5) pre-consultation educational interventions. Study quality was assessed using the QualSyst tool. Thirty-two studies met the inclusion criteria, comprising 16 RCTs, 10 observational designs, and 6 qualitative or mixed-methods investigations. Across formats (digital, paper-based, and multimedia), DAs consistently improved patient knowledge (mean increase 15%-30%), reduced decisional conflict (20%-50% reduction), and enhanced values clarification, with high acceptability. Effects on SDM behaviors, consultation dynamics, and long-term outcomes were more variable, often constrained by workflow integration challenges and heterogeneity in clinician engagement. Implementation studies demonstrated feasibility and usability but emphasized the need for structured incorporation into clinical encounters. Qualitative findings highlighted persistent informational gaps, expectation misalignment, and psychosocial influences on decision satisfaction. In conclusion, PMBR DAs reliably enhance knowledge, reduce decisional conflict, and support value-concordant decision-making. Despite strong evidence from high-quality RCTs, further research is needed to optimize implementation, integrate DAs into routine workflows, and tailor interventions to psychosocial and equity-related patient needs.

Muscle dysfunction is a critical construct in dysphagia. Despite the availability of diverse techniques to evaluate muscle function, a comprehensive synthesis of measurement items and their properties is lacking. A systematic review of studies examining the measurement techniques used to directly evaluate oropharyngeal muscle function was performed. Studies investigating the use of surface electromyography, tongue dynamometry, ultrasound, high-resolution pharyngeal manometry, magnetic resonance imaging and computed tomography and reporting measurement properties in line with the COnsensus-based Standards for the selection of health Measurement InstrumeNts (COSMIN) were included. Measurement outcomes derived from these techniques were operationalised as single-item measures. Methodological quality was evaluated using the QualSyst tool. From the 6279 records, 125 eligible studies were identified. The breakdown of techniques was surface electromyography (n = 33), tongue dynamometry (n = 34), ultrasound (n = 17), high-resolution pharyngeal manometry (n = 15), magnetic resonance imaging (n = 5), computed tomography (n = 4) and combined techniques (n = 17). Single-item measures were heterogenous, covering a range of domains including muscle activation, coordination, strength, endurance, composition, thickness, and kinematics. Studies focused predominantly on oral rather than pharyngeal musculature. Validity (n = 117) was widely reported, primarily via known-group validity or hypothesis testing. Fewer studies examined reliability (n = 20) and responsiveness (n = 25); however, where reported, results indicated excellent intra- and inter-rater reliability and responsiveness to therapeutic interventions. A diverse range of single-item measures were identified across included measurement techniques. Measurement properties were sparsely reported. Future research should focus on rigorous measurement instrument design and standardisation to comprehensively evaluate the underlying mechanisms of dysphagia.

Empowering women in breast cancer surgery: A systematic review of shared decision-making between mastectomy and breast conservation.

Cognitive function and decision-making ability are crucial for participation in advance care planning (ACP). People with different degrees of cognitive impairment face considerable difficulty and exhibit significant heterogeneity in their participation in ACP. Six English electronic databases (Embase, PubMed, Cochrane Library, PsycINFO, CINAHL, and Web of Science) and four Chinese databases (CNKI, CBM, Wanfang, and VIP) were searched from inception to February 18, 2024. The QualSyst tool was used to evaluate the study quality. Thematic synthesis was used to analyze the data. Thirty-seven papers were included, comprising 21 qualitative, 9 quantitative, and 7 mixed studies. Factors related to ACP antecedents (sociodemographic characteristics, ACP perception, prior ACP experience, disease-related factors, and socio-cultural context) and ACP attributes (ACP procedural elements and ACP supportive mechanisms) influenced the participation of people with different degrees of cognitive impairment in ACP, but some differences were also found. Difficulty in accepting the disease and decision conflicts were not found to have an effect on mild cognitive impairment. Care network relationship was not found to influence mild to moderate dementia. Relying on surrogate decisions, decision conflicts, ACP data storage and informal social support were not found to influence moderate to severe dementia. This study determined common and specific factors influencing the ACP participation of people with different degrees of cognitive impairment. The results could provide evidence for developing targeted interventions for promoting people with different degrees of cognitive impairment to participate in ACP.

Depict football players' average times to return to sports (RTS) after non-contact lower limb soft-tissue injuries. Systematic review with meta-analysis. PubMed, WoS, Scopus, PEDro, Google Scholar and Cochrane Central Register of Controlled. We included records investigating time to return to sports in football players suffering from non-contact lower limb soft-tissue injuries. Time to return to sports was the main outcome. We appraised the quality of the included studies with the QualSyst tool for quantitative research. A random-effects model was wielded for the meta-analyses. 39 studies were included. Time to return to match (RTM) for ligament injuries ranged from 43 days (lateral collateral ligament) to 249.6 days (ACL rupture and repair (ACLR); RTM for muscle injuries ranged from 21 days (hamstring muscle injury) to 69.1 days (soleus); RTM for tendon injuries ranged from 29.4 days (patella tendinopathy) to 220.4 days (Achilles tendon rupture). Time to return to training (RTT) for ligament injuries is also longest for ACLR (212.9 days) and lowest for lateral ankle sprain (19.9 days); RTT for muscle injuries ranged from 8 days (hamstring muscle injury grade 0 to 65.3 days (HMI grade 3)); popliteus tendinopathy (11 days) had lowest RTT among tendon injuries, groin pain had the longest (45 days). This review provides an overview of RTS times-expressed as RTT and RTM-for lower limb injuries in football players. Our results also underscore the existing variability in wielded RTS definitions and injury classifications.

Assessing communication in individuals with intellectual disabilities is essential yet challenging because of the complexity of the construct and limited availability of psychometrically robust tools. This review aimed to evaluate the validity and reliability of communication questionnaires used with this population. A systematic review was conducted following PRISMA 2020 guidelines and COSMIN definitions for validity and reliability. Five databases (Cinahl, Embase, Eric, PsycINFO and PubMed) were searched for studies published from 2000 to 2024. Inclusion criteria required questionnaires to assess communication in individuals with intellectual disabilities and report on validity or reliability. Methodological quality was appraised using the QualSyst tool. Six questionnaires described in five studies and three manuals met the inclusion criteria. Validity evidence was more frequently reported than reliability, though both were inconsistently documented. No questionnaire demonstrated a comprehensive evaluation of validity or reliability. Content validity was often limited by a lack of stakeholder involvement. Current questionnaires show promise but require further validation. Future research should prioritise stakeholder engagement, content and structural validity to ensure an inclusive, reliable communication assessment. Prospero Id: CRD42023413902.

Despite national policies promoting inclusion in Saudi Arabia, a significant gap between policy and practice persists, with many students with disabilities educated in segregated settings. Collaborative learning is an evidence-based strategy known to support inclusion; however, there is a lack of synthesized evidence on its effectiveness in the Saudi context. Hence, this study aimed to systematically identify, appraise, and synthesize all available evidence on the effects of collaborative learning strategies on academic and/or social-emotional outcomes for students with disabilities in Saudi Arabia. A systematic review was conducted following PRISMA guidelines. Key databases, including ERIC, Scopus, and PsycINFO, were searched using a predefined strategy. Studies were selected based on PICOS criteria, with data extracted and methodological quality appraised using the QualSyst tool. The search yielded 80 records, from which three studies met the full inclusion criteria. The evidence was positive instead although some limitations. The studies included a quasi-experiment, a qualitative case study, and a mixed-methods design. These studies reported improvements in academic outcomes. Perceived benefits for social-emotional skills, including self-confidence and collaboration, were also noted. However, the methodological quality of the evidence base was moderate, limited by small sample sizes and a lack of controlled trials. The study concluded that there is a profound scarcity of high-quality research on this topic in Saudi Arabia. While the limited available evidence is promising, it must be interpreted with caution. This review highlights an urgent need for more rigorous primary research, particularly studies that objectively measure the impact of collaborative learning on the self-confidence of students with mild intellectual disabilities.

Taste Alterations in Pediatric Oncology Patients Undergoing Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-Analysis.

The effect of walking interventions on biomechanical knee osteoarthritis outcomes: A systematic review and meta-analysis.

Medicinal cannabis in the management of anxiety disorders: A systematic review.

This systematic review and meta-analysis aimed to systematically examine and summarize recent evidence on the effects of soccer-based training (SBT) on anthropometric measures in children and adolescents with overweight/obesity. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines, a thorough literature search across 7 electronic databases was conducted on October 11, 2023. The studies' methodological quality was evaluated using the QualSyst tool, followed by conducting a meta-analysis with a random-effects model, and the certainty of evidence was assessed. Six studies were included, with 4 studies of strong methodological quality and 2 studies of moderate methodological quality. The results of the meta-analysis revealed SBT decreases fat mass percentage (effect size [ES] = 0.47 [small]; P = .002), with no significant effect of SBT on body mass index (ES = 0.180 [small]; P = .275), body mass (ES = 0.183 [trivial]; P = .212), fat-free mass (ES = 0.074 [trivial]; P = .635), or waist circumference (ES = 0.358 [small]; P = .053). The certainty of evidence was moderate for all outcomes. SBT appears to decrease fat mass percentage, without affecting body mass, body mass index, fat-free mass, or waist circumference in obese/overweight children and adolescents. These findings require further investigation given the moderate certainty of evidence. The protocol of this review was registered in the Open Science Framework database (https://doi.org/10.17605/OSF.IO/8P4V2).

Movement therapy using Rhythmic Auditory Stimulation (RAS) has been proven beneficial in Parkinson’s disease (PD). However, research regarding RAS-therapy using wearable devices in all neurological disorders is needed. The aim of this study is to investigate the effectiveness of RAS-therapy using wearable devices on movement in individuals with neurological disorders. Systematic review and meta-analysis. Data sources June 27, 2024. PubMed, Web of Science, Medline, PEDro and ScienceDirect were searched. Following PRISMA-guidelines 2020. Inclusion criteria: all neurological disorders, Rhythmic auditory stimulation, wearable devices, movement parameters, studies written in Dutch or English. Exclusion criteria: non-neurological disorders, children, animals, healthy individuals, other interventions, EMG and EEG outcome parameters, patient reported outcome parameters, systematic reviews, meta-analyses, and other languages besides Dutch or English. Risk of bias was assessed using the QualSyst tool. 7993 articles after double-blind screening; thirty studies were included in the review and fifteen in the meta-analysis. Results showed improvements in stride length, step length, gait velocity, double support time, arm swing peak velocity and arm swing ROM. The meta-analysis confirmed significant improvements in gait velocity and stride length within a longitudinal design as well as when compared to a control group. Improvement in cadence was only significant in a longitudinal design but non-significant when compared to a control group (p = 0.247). RAS-therapy can be implemented for rehabilitation of PD, MS and stroke.

What works for whom? A systematic review on personalized speech intervention in children and adolescents with a cleft palate.

Food insecurity (FI) is a serious public health concern in economically developed countries, mainly due to unequal resource distribution. Identifying social vulnerability factors [i.e., characteristics of a person or group regarding their capacity to anticipate, cope with, resist, and recover from the effects of child FI (CFI)] and their positive or negative relationship with CFI is important to support targeted action with a scale and intensity that is proportionate to the level of disadvantage. This review aimed to systematically and comprehensively identify key social vulnerability contributors to CFI in economically developed countries and discuss the factors in the context of the socio-ecological model. Five research databases were searched for observational studies published in 2000 assessing social vulnerability factors related to FI in children residing in developed countries. Data screening and extraction were independently conducted by 2 reviewers who recorded factors related to CFI. The QualSyst tool was used to assess risk of bias. From the studies identified (N = 5689), 49 articles, predominantly from the United States and Canada, met the inclusion criteria. The identified social vulnerability factors associated with CFI were grouped into 5 based on the socio-ecological model: 1) individual child, 2) parental, 3) household, 4) community, and 5) societal factors. The most frequently reported contributors to CFI were income (household factor). Other social vulnerability factors were identified, including the child's age, parental depression, household crowdedness, social connection, poverty, and residential instability. The lack of consistent measures to define both social vulnerability and CFI in diverse population subgroups impeded meaningful pooling and interpretation of factors interacting with CFI. Recommendations for future studies are to use comparable measures to estimate the extent and severity of CFI and to investigate the relation between social vulnerability, severity, and trajectories of CFI in developed countries. This trial was registered at PROSPERO as CRD42022291638.

Multiple sclerosis (MS) is a demyelinating autoimmune condition, in which body image may be altered due to a range of biopsychosocial factors. The aim of this review was to examine whether there is a relationship between body image and psychological outcomes in MS, in order to guide clinical intervention development. PsycINFO, Medline, CINAHL and Scopus databases were searched systematically in November 2023 for eligible studies, using terms relating to MS and body image. Quantitative studies, published in English, that examined the relationship between body image and psychological outcomes in adults with MS were included. The QualSyst tool was used to assess risk of bias across studies. Screening and quality appraisal was verified by the third author. A narrative synthesis was used to report patterns in findings. Thirteen studies (ten cross-sectional and three intervention studies) met inclusion criteria and were included in the final review. The sample size across all included studies totalled 1533. The results suggested that positive body image was associated with improved mood, lower anxiety, increased self-esteem, and better quality of life. However, the causal nature of these relationships was unclear. The findings offer preliminary evidence to suggest that a more negative body image is associated with higher levels of psychological distress in MS, indicating that body image may be a target for intervention. Further research is necessary to provide a greater understanding of this association, and to inform future clinical practice.

ObjectivesThis study aims to comprehensively explore the consequences of edentulism on community-dwelling adults in low-income, middle-income and high-income countries.DesignSystematic review and Synthesis Without Meta-Analysis (SWiM).Data sourcesMEDLINE, Embase, Scopus, Web of...

(1) Background: The rise in sedentary lifestyles has led to more spinal malformations in the population. These malformations are connected to the body’s autonomic function, which can negatively impact long-term health. Heart rate variability can be used as a marker to measure how different postures affect autonomic health. This systematic review aims to explore the link between posture and heart rate variability and evaluate potential interventions to address the consequences of sedentary lifestyles. (2) Methods: Data sources: Studies exploring the relationship between posture and heart rate variability were found using PubMed, Embase, Web of Science, and Cochrane on 1 July 24. Eligibility criteria: People aged 18 years or above with a sedentary lifestyle were included. Studies involving children or participants with spinal/musculoskeletal conditions impacting their ability to walk or sit were excluded as they would not accurately reflect posture analysis. PRISMA guidelines were followed throughout, and the quality assessment was achieved using the QualSyst tool. (3) Results: Out of the 753 papers identified, only five met the eligibility criteria. These studies exhibited heterogeneity regarding interventions, aims, and participant populations. All five studies were prospective case series, enabling analysis and comparisons. (4) Conclusions: According to this study, the seated position, especially the forward truncal flexion, had the most significant impact on heart rate variability and sympathetic tone. It may be inferred that sedentary behavior encourages this stress on the body, which can affect one’s health, increasing the mortality rate.

Out-of-pocket costs are burdensome for breast cancer patients. Cost-reducing interventions, though implemented, have unclear comparative efficacy. This study aimed to critically evaluate characteristics of successful versus unsuccessful interventions designed to decrease out-of-pocket costs for breast cancer patients. A systematic review was conducted in accordance with the PRISMA checklist. Embase, PubMed, Global Index Medicus, and Global Health were queried from inception to February 2021. Articles describing a financial intervention targeting costs for breast cancer screening, diagnosis, or treatment and addressing clinical or patient-level financial outcomes were included. Methodological quality was evaluated using the QualSyst tool. Interventions were organized in accordance with timing of implementation, with narrative description of intervention type, success, and outcomes. Of the 11,086 articles retrieved, 21 were included in this review. Of these, 14 consisted of interventions during screening, and seven during diagnosis or treatment. Free/subsidized screening mammography was the most common screening intervention; 91% of these programs documented successful outcomes. Patient navigation and gift voucher programs demonstrated mixed success. The most successful intervention implemented during diagnosis/treatment was reducing medication costs. Low-cost programs and direct patient financial assistance were also successful. Limitations included lack of standardization in outcome metrics across studies. Financial interventions reducing prices through free screening mammography and decreasing medication costs were most successful. Less successful interventions were not contextually tailored, including gift card incentivization and low-cost treatment modalities. These findings can facilitate implementation of broader, more generalizable programs to reduce costs and improve outcomes during evaluation and management of breast cancer.

Research examining general practice supervisor wellbeing has often been conducted within the context of trainee wellbeing and educational outcomes. To consolidate the current literature regarding the wellbeing of GP supervisors through a 'supervisor-wellbeing' lens. Literature review of original research studies on Embase, Ovid MEDLINE, and Ovid PsycINFO from inception to December 2022. The Embase, Ovid MEDLINE, and Ovid PsycINFO databases were systematically searched from inception to December 2022. Original research studies were eligible if they explored any aspect of wellbeing or burnout (that is, construct conceptualisations, risk and protective factors, implications, or interventions) among GPs involved in educating GP trainees. Reporting quality of included studies was assessed using the QualSyst tool. Results from included studies were narratively synthesised. Data from 26 independent samples were reviewed. Burnout was generally conceptualised using the Leiter and Maslach model. Wellbeing was poorly defined in the literature, largely being conceptualised in personal psychological terms and, to a lesser extent, professional satisfaction. Risk and protective factors were identified and grouped as individual (for example, satisfaction with capacity to teach) and external (for example, autonomy, collegial relationships, resource availability) factors. GP supervisors' wellbeing appeared to affect their job performance and retention. This review identified only two studies evaluating interventions to support GP supervisors' wellbeing. The present review highlights a lack of conceptual clarity and research examining interventions for GP supervisor wellbeing. It provides guidance for future research designed to maximise the wellbeing of GP supervisors and support the wellbeing of trainees.

Caregivers of children with a neurodevelopmental disorder report increased mental health difficulties but also barriers to accessing professional support. Psychological interventions via telehealth offer an accessible method of service delivery for these families. This review is the first to quantitatively evaluate available telehealth trials designed to promote caregivers' mental health. The PubMed, PsycINFO, CINAHL, Embase and Cochrane databases (from inception until 20th May 2023) were searched for telehealth trials targeting caregiver mental health. Hedges' g effect sizes were calculated, and findings reported by symptom domain (depression, anxiety, stress, distress), telehealth format (individual vs. group), and modality (webpage, text-messaging, video). Reporting bias (QualSyst tool) and publication bias (Doi plot) were also assessed. Twelve independent studies (N = 769 caregivers), including eight controlled trials and four quasi-experimental (pre-post, single group) designs, were included. Most studies were of acceptable methodological quality. Evidence for improved mental health was found for telehealth (g range = 0.394-1.955), regardless of the method of delivery. The longevity of these effects could not, however, be determined. The present findings suggest that psychological interventions delivered by telephone and/or the internet can be used to effectively manage caregivers' mental health symptoms, although consideration must be given to an individual's treatment preferences and requirements. Further non-inferiority trials, with a diverse sample, can determine whether telehealth interventions provide a comparable alternative to face-to-face treatment. Protocol registration on Open Science Framework: https://osf.io/ctqne/ .