Strength Of Recommendation Taxonomy Research Articles

Making Sense of Topical Pain Relief Options: Comparing Topical Analgesics in Efficacy and Safety.

In patients with musculoskeletal (MSK) conditions, pain is the leading contributor to disability and significantly limits mobility and dexterity. This narrative review describes the efficacy and safety of topical analgesics in common use today. Secondary literature gained via a literature search using PubMed.gov and the Cochrane library were used. Recent literature (2000-2023) on several major classes of topical analgesics and topical delivery systems were reviewed to provide strength of recommendation taxonomy (SORT) levels. A total of 86 articles were reviewed. Level 2. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) and cabbage leaf wraps (CLW) appear to be best suited for multiple types of acute MSK pain, and topical nitroglycerin is helpful when used specifically for rotator cuff pain in patients seeking relief while performing activities of daily living and willing to treat for long periods of time. For compounded topical formulations, it may be better to offer single agent creams based on patient preferences. Little data support the use of cryotherapy. Traumeel could be a promising natural analgesic that compares with diclofenac. Topical lidocaine appears best suited for postherpetic neuropathic pain. O24 is a reasonable alternative with a low risk profile to treat pain in patients with fibromyalgia syndrome. Choice of topical agents should be guided by current evidence accounting for type of pain, medication side effects, patient comorbidities, as well as patient preference, convenience, and cost. Of the topical analgesics and modalities reviewed, SORT level A evidence was found for topical NSAID use in decreasing MSK pain, topical lidocaine for postherpetic neuralgia, and nitroglycerin patches for treating rotator cuff pain if used for prolonged periods of time. Alternative treatments such as CLW and Traumeel show promising results (SORT level B).

Blood Flow Restriction Training Improves Muscular Outcomes in Patients With Chronic Ankle Instability: A Critically Appraised Topic

Clinical Scenario: The high recurrence of lateral ankle sprains progresses to chronic ankle instability (CAI) and can affect many athletes in all sports. CAI is often associated with a decrease in muscle strength, an increase in pain, a decrease in the range of motion, and a decrease in balance or neuromuscular control. The use of blood flow restriction (BFR) with CAI can increase muscular outcomes and be used as a rehabilitation tool. Clinical Question: Is there evidence to suggest that BFR improves strength, muscle activation, and/or cross-sectional area of the lower leg musculature in those with CAI? Clinical Bottom Line: There is moderate evidence to support therapeutic exercise with low-intensity BFR in patients with CAI. The evidence concluded a significant improvement in BFR to increase muscle activation of the fibularis longus, anterior tibialis, vastus lateralis, and soleus. There is moderate evidence suggesting BFR can induce strength gains in the muscles of the lower extremity in patients with CAI. Strength of Recommendation: The comprehensive evidence is a Strength of Recommendation Taxonomy (SORT) Grade B, with a level of evidence of 2, according to the Centre for Evidence-Based Medicine (CEBM) for the studies included.

Increasing Hamstring Range of Motion via Plantar Myofascial Release: A Critically Appraised Topic

Context: The concept of anatomical fascial trains and myofascial release are heavily researched topics independently. However, few studies have determined if myofascial release of remote areas can cause lengthening throughout more distal aspects of these fascial trains. Clinical Question: In healthy individuals, what is the effect of myofascial release on the plantar aspect of the foot in improving flexibility and hamstring length as determined by a sit-and-reach test? Clinical Bottom Line: The usage of myofascial release on the plantar aspect of the foot via a firm object has been shown to improve sit-and-reach distance. Each article included for analysis utilized similar methods of instructing self-myofascial release with regard to time as well as type of object used for the intervention. Though this was consistent between studies, the authors should have implemented secondary outcome measures. Despite the limitations to each of the studies analyzed, there is a Strength of Recommendation Taxonomy (SORT) Level B evidence to support the implementation self-myofascial release to the plantar fascia. This intervention should be considered a concurrent option for individuals with range of motion deficits or fascial restrictions in the upper thigh.

Addressing Sensory Challenges in Athletes with Autism Spectrum Disorder: A Clinical Commentary.

Athletes with autism spectrum disorder (ASD) experience lesser care for injuries and athletic trainers (ATs) report feeling unprepared to provide care competently for this population. Provision of sports-related care can be impacted by sensory differences associated with ASD such as hyper-reactivity to sensation or poor integration of sensory information. An in-depth review of the literature using the Strength of Recommendation Taxonomy (SORT) guidelines was used to identify articles that address the sensory features of autism for athletic trainers with the purpose of informing athletic trainers about the sensory features of ASD and to present the most current evidence-based recommendations for providing care to athletes with ASD and other neurodivergent individuals who present with sensory differences. Relevant articles were reviewed by four independent researchers and organized by theme. Key themes included use of sensory friendly or adapted environments, sensory kits, and informed communication strategies that acknowledge sensory differences. Providing individualized care for athletes with ASD and sensory features can improve the quality of and participation in sports for autistic persons.

Evaluation and management of cardiovascular disease and metabolic syndrome in pediatric-adolescent patients with psoriasis

Psoriasis is strongly associated with cardiovascular disease (CVD) and metabolic syndrome, with pediatric and adolescent patients having an increased risk of each compared to the general population. This increased risk is based on shared underlying genetic and cytokine profiles, as well as similar environmental risks. Many screening guidelines do not address the development of CVD and metabolic syndrome in these predisposed patients, particularly in the adolescent population. These deficits are evidenced by the absence of validated 10-year CVD risk calculators for pediatric and adolescent patients with chronic inflammatory diseases, as well as insufficient screening guidelines for insulin resistance in patients with psoriasis. This manuscript aims to contribute literature regarding allopathic and lifestyle recommendations to the most recent 2017 consensus guideline for the pediatric/adolescent population with psoriasis. PubMed, COCHRANE Database of Systematic Reviews and Google Scholar were reviewed by a panel of clinicians with clinical and research expertise in psoriasis and pediatric subspecialties. The patient-centered Strength of Recommendation Taxonomy (SORT) method was utilized to grade the quality of the evidence available. Updates in management surrounding the role of lipoprotein(a) in lipid panels, recommendations for exercise and weight management to decrease insulin resistance, as well as guidance for heart rate and blood pressure management were discussed. Screening and managing pediatric and adolescent patients with psoriasis for the associated comorbidities of CVD and metabolic syndrome is imperative. Future high-quality studies are needed to strengthen the evidence provided throughout this review, which acts as a framework for clinical practice. Key words: Psoriasis, Comorbidity, Exercise, Treatment, Coronary heart disease

In Physicians and Athletic Trainers, Is Burnout Associated With Self-Reported Medical Errors: A Critically Appraised Topic

Clinical Question: In physicians and athletic trainers, is burnout associated with self-reported medical errors (MEs)? Clinical Bottom Line: Burnout directly increased the odds of self-reported ME. Physicians and surgeons with burnout had a higher risk of an self-reported ME than athletic trainers with burnout. This disparity may reflect the different definitions, oversight, and opportunities to commit MEs in the respective fields. Emotional exhaustion and personnel accomplishment appear to drive MEs within clinically practicing athletic trainers, whereas emotional exhaustion and depersonalization are indicative of MEs within practicing physicians. Understanding the mechanism behind burnout within practice settings may provide insights into mitigation strategies to reduce MEs and improve patient outcomes. Strength of Recommendation Taxonomy B.

A systematic review of manual therapy modalities and anxiety.

Anxiety disorders have a far-reaching impact on society, with profound implications on both mental and physical health. In response, there is growing interest in manual therapy modalities, with emerging research suggesting their potential to alleviate related symptoms. To establish a consensus regarding manual therapy modalities for addressing anxiety symptoms, a systematic review of current literature was conducted. A literature search was conducted between May and August 2023, utilizing a systematic search on both PubMed and Google Scholar, adhering to the defined inclusion criteria. In addition, information was gathered utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Both authors (KLW and TH) conducted the literature review. The inclusion criteria include articles written in English, peer-reviewed, anxiety conditions documented, and manual therapy delivered by a respectfully qualified professional. Manual therapy modalities include massage therapy, osteopathic manipulative treatment (OMT), foot reflexology, acupressure, manual therapy, healing touch, therapeutic touch, and gentle touch. After initial data collection, both researchers independently screened articles utilizing two metrics: a level of evidence (LOE) table and a screening criterion incorporating unique elements from the search process. The quality of the included articles was assessed utilizing Strength of Recommendation Taxonomy (SORT). When reviewer discrepancies arose, authors reread full-text studies and discussed the inclusion and exclusion criteria to achieve consensus. The data searches identified 8,979 articles, with 239 articles remaining after duplicates and nonapplicable articles were removed. A total of 42 articles met the inclusion criteria, with only 40 articles able to be obtained for full-article review. After full review and the exclusion of articles with invalid author conclusions, meta-analysis, or systematic reviews, 34 articles were included in the review. All articles received an LOE rating of 2 or better and aligned with our specific screening criteria. Based on SORT, each modality was assigned a "B" rating. Among the included articles, n=27 demonstrated statistical significance in favor of manual therapy modalities as an anxiety treatment. The positive results for the aforementioned manual therapies on anxiety symptom improvement are shown: 15/18 (83 %) massage therapy, 2/6 (33 %) OMT, 5/5 (100 %) foot reflexology, 1/1 (100 %) acupressure, 1/1 (100 %) manual therapy, 0/2 (0 %) healing touch, 1/1 (100 %) therapeutic touch, and 1/1 (100 %) gentle touch. A pattern emerged, wherein individuals receiving manual therapy interventions displayed a statistically significant reduction in anxiety intensity. Considering the positive results, manual therapy should be considered an effective strategy for anxiety management.

AAPM&R consensus guidance on spasticity assessment and management.

The American Academy of Physical Medicine and Rehabilitation (AAPM&R) conducted a comprehensive review in 2021 to identify opportunities for enhancing the care of adult and pediatric patients with spasticity. A technical expert panel (TEP) was convened to develop consensus-based practice recommendations aimed at addressing gaps in spasticity care. To develop consensus-based practice recommendations to identify and address gaps in spasticity care. The Spasticity TEP engaged in a 16-month virtual meeting process, focusing on formulating search terms, refining research questions, and conducting a structured evidence review. Evidence quality was assessed by the AAPM&R Evidence, Quality and Performance Committee (EQPC), and a modified Delphi process was employed to achieve consensus on recommendation statements and evidence grading. The Strength of Recommendation Taxonomy (SORT) guided the rating of individual studies and the strength of recommendations. The TEP approved five recommendations for spasticity management and five best practices for assessment and management, with one recommendation unable to be graded due to evidence limitations. Best practices were defined as widely accepted components of care, while recommendations required structured evidence reviews and grading. The consensus guidance statement represents current best practices and evidence-based treatment options, intended for use by PM&R physicians caring for patients with spasticity. This consensus guidance provides clinicians with practical recommendations for spasticity assessment and management based on the best available evidence and expert opinion. Clinical judgment should be exercised, and recommendations tailored to individual patient needs, preferences, and risk profiles. The accompanying table summarizes the best practice recommendations for spasticity assessment and management, reflecting principles with little controversy in care delivery.

The Role of Field Cancerization in Selecting Therapies for Actinic Keratosis: An Expert Consensus Panel

Background: Actinic keratosis is a very common disease that affects over 40 million people in the United States. In addition to the clinically visible lesion, patients may present with surrounding field cancerization based on their history of ultraviolet exposure. While lesion-directed therapy such as cryosurgery can effectively treat individual actinic keratoses it does not treat subclinical lesions or field cancerization. Objective: To create consensus recommendations on the role of field cancerization in selecting appropriate therapy for actinic keratoses. Methods: A comprehensive literature search of PubMed, Google Scholar, and Embase was conducted using the keywords “actinic keratos*,” “treatment,” and “field cancerization” for English-language original research articles without date restrictions. Articles were included that either discussed the role of FC in treating AKs or compared various AK field therapies. The relevant articles were then distributed to a panel of nine dermatologists with significant expertise in managing AKs. Each panelist reviewed the articles and assigned them a level of evidence based on Strength of Recommendation Taxonomy (SORT) criteria. The panel then convened on to discuss the studies and develop consensus statements on the role of FC in selecting AK therapy. The panel utilized a modified Delphi process to approve the adoption of each statement and gave each one a strength of recommendation based on SORT criteria. Results: The initial literature search produced 243 articles that met search criteria. After a thorough screening of these articles for relevance to the research question, 21 articles were chosen to be reviewed by the panel and assigned a level of evidence. Of the 21 articles that were reviewed, the panel assigned level 1 evidence to three articles, level 2 evidence to six articles, and level 3 evidence to twelve articles. The panel created seven consensus statements related to AK management and FC. All seven statements received a unanimous (9/9) vote for adoption. Each of the statements was given a strength of recommendation according to sort criteria Conclusion: Field cancerization due to chronic ultraviolet exposure leads to subclinical AK lesions in addition to lesions that are clinically apparent. In order to address these lesions, field therapy is an important component of an adequate regimen and can be used in conjunction with lesion-directed therapy for optimal results.

Evaluating the Efficacy and Safety of Bimekizumab for Plaque Psoriasis and Psoriatic Arthritis: An Expert Consensus Panel Report

Background: While there are numerous effective therapies for psoriasis, there remains an unmet need as some patients still suffer from inadequate response with available medications. Bimekizumab is a first-in-class monoclonal antibody that inhibits both interleukin (IL)-17A and IL-17F and was recently approved by the Food and Drug Administration. The aim of this study was for a panel of experts in psoriasis management to review the available data on bimekizumab and create consensus statements on its use in clinical practice.
 Methods: A comprehensive literature search of PubMed, Scopus, and Google Scholar was conducted for English-language original research articles, systematic reviews, and meta-analyses discussing the safety and efficacy of bimekizumab for moderate to severe plaque psoriasis and psoriatic arthritis. A panel of nine dermatology physician assistants and one dermatology nurse practitioner with significant expertise in the management of psoriasis convened virtually on December 16, 2023, to review the studies and create recommendations for their peers on the use of bimekizumab. A modified Delphi process was implemented to reach a consensus on these statements and the Strength of Recommendation Taxonomy was used to assign each one a strength of recommendation.
 Results: The literature search resulted in 92 articles that met search criteria. After a thorough screening of these studies for relevance to the discussion questions, 20 articles remained and were distributed to each panelist prior to the meeting. The panel unanimously voted to adopt 10 consensus recommendations and assigned all 10 statements a strength of recommendation of “A.”
 Conclusion: Bimekizumab has a very high efficacy in the treatment of moderate to severe psoriasis and psoriatic arthritis. It also has a favorable safety profile that is consistent with that of other biologics, except for an increased risk of oral candidiasis.

Changes in Hip and Knee Strength Are Not Associated With Improved Clinical Outcomes After Rehabilitation in Individuals With Patellofemoral Pain: A Critically Appraised Topic.

Patellofemoral pain (PFP) is a widespread knee disorder encountered in clinical practice. Clinicians have often focused on strengthening hip and knee musculature to improve pain and disability, which are the ultimate clinical goals of PFP treatment. However, PFP literature has shown improvement in pain and disability without concurrent changes in lower-extremity strength after rehabilitation. Although some researchers have achieved a significant increase in strength after rehabilitation in PFP cohorts, there was no association with improved pain and disability. The inconsistent improvements in strength and the lack of association with clinical outcomes call for a critical appraisal of the available evidence to better understand the association between changes in hip and knee strength and improved clinical outcomes in individuals with PFP. Are changes in hip and knee strength associated with improved pain and disability after rehabilitation in individuals with PFP? Four studies met the inclusion criteria and were included in the appraisal. Following rehabilitation, one study achieved strength improvements in knee extension. One study achieved strength improvements in knee extension, but not in hip external rotation and hip abduction. Two studies did not achieve strength improvements in hip external rotation, hip abduction, hip extension, or knee extension. All included studies achieved improvements in pain or disability after rehabilitation. None of the studies found a significant association between changes in hip and knee strength (either improved or not) and improved pain and disability. There is consistent evidence that changes in hip and knee strength are not associated with improved clinical outcomes after rehabilitation in adults with PFP. Collectively, the body of evidence included is to answer the clinical question aligns with the strength of recommendation of B based on the Strength of Recommendation Taxonomy.

Topical Cycling: The Obstacles to Moving Forward with Systemic Psoriasis Therapies and How to Characterize the Systemic Ready Patient

Background: Psoriasis is a chronic, inflammatory disease with numerous negative physical and psychosocial impacts. Topicals are a mainstay of treatment, particularly for disease with minimal skin involvement, but they are limited due to an inability to target systemic symptoms and a lack of convenience, patient adherence, and patient satisfaction. Given its systemic implications, many patients with psoriasis are undertreated including those with limited body surface area (BSA) involvement. With a growing role in providing dermatological services, physician assistants and nurse practitioners can benefit from additional guidance on how to appropriately treat these patients, as the current clinical recommendations require further expansion, and the criteria for what qualifies as adequate treatment and response are incomplete. Methods: Two comprehensive literature searches of PubMed, Scopus, and Google Scholar were completed for English-language original research articles on the use of topical versus systemic medications for psoriasis and its comorbidities. A panel of 11 dermatology physician assistants and nurse practitioners with expertise in managing psoriatic disease gathered to review the selected literature and form consensus statements with clinical recommendations for treating psoriasis. A modified Delphi process was employed to approve each statement and a strength of recommendation was assigned to each statement using the Strength of Recommendation Taxonomy (SORT) criteria. Results: The two literature searches produced 98 and 76 articles, respectively, that met search criteria. After screening the articles for relevance to the discussion topic, 19 articles were distributed to the panelists for review prior to the roundtable discussion. The panel unanimously voted to adopt 10 consensus statements and recommendations, 4 of which were given a strength of “A”, 1 of which was given a strength of “B”, and 5 of which were given a strength of “C”. Conclusion: Psoriasis is a systemic disease with cutaneous manifestations and should be considered as such for adequate treatment. The 10 consensus statements created by the experts provide clinical recommendations on the systemic effects of psoriasis and important treatment considerations that can help guide clinicians on how to appropriately treat psoriasis of all severities. Furthermore, an emphasis is placed on recognizing treatment goals and making the next appropriate clinical decision for patients with mild to moderate disease who fail topical therapy.

Incorporating a Prognostic Gene Expression Profile Test into the Management of Cutaneous Squamous Cell Carcinoma: An Expert Consensus Panel Report.

 Cutaneous squamous cell carcinoma (cSCC) is a growing health concern with a rapidly increasing incidence. Disease-specific mortality is typically preceded by a metastasis, but current staging systems have significant limitations in predicting this event. The 40-gene expression profile (40-GEP) test is a validated method of further stratifying patients based on the risk of regional or distant metastasis, but limited guidelines exist for incorporating this test into clinical practice.  To review the available literature on the use of gene expression profile (GEP) testing to assess prognosis in cSCC and create consensus statements to guide dermatology clinicians on its use.  A comprehensive literature search of PubMed, EMBASE, and Scopus was completed for English-language original research articles on the use of GEP testing to assess cSCC prognosis. A panel of 8 dermatologists with significant expertise in diagnosing and managing cSCC gathered to review the articles and create consensus statements. A modified Delphi process was used to approve each statement and a strength of recommendation was assigned using the Strength of Recommendation Taxonomy (SORT) criteria.  The literature search produced 157 articles that met the search criteria. A thorough screening of the studies for relevance to the research question resulted in 21 articles that were distributed to the panelists for review prior to the roundtable discussion. The panel unanimously voted to adopt 7 consensus statements and recommendations, 6 of which were given a strength of "A" and 1 of which was given a strength of "C".  The 40-GEP test provides accurate and independent prognostic information beyond standard staging systems that only incorporate pathologic data. Incorporation of GEP testing into national guidelines can help further stratify patients based on risk of metastasis and thus may improve morbidity and mortality. J Drugs Dermatol. 2023;22(12):54-60.   doi:10.36849/JDD.7691.

Reaction Time Across the Menstrual Cycle: A Critically Appraised Topic

Clinical Scenario: Reaction time is integral in many tasks during work, sport, and life, thus, alterations in reaction time may impact performance and injury risk. There are various factors that can influence reaction time, such as the physical state of the individual, including their age or sex. When comparing males and females, there is a major physiological difference to their physical state as hormones fluctuate during menstrual cycle phases, which not only affects the reproductive system, but females may experience physiological, cardiovascular, respiratory, or metabolic changes throughout their menstrual cycle phases. Therefore, this goal of this critically appraised topic is to examine whether reaction time changes during menstrual cycle phases. Focused Clinical Question: In healthy, eumenorrheic females, does reaction time change from one menstrual cycle phase to other menstrual cycle phases? Summary of Key Findings: Among the five studies evaluated in this CAT, all found significant changes to reaction time during phases of the menstrual cycle. Most studies found that reaction time was inversely related to sex hormone levels, indicating that phases with low hormone levels had longer reaction time than those phases with higher hormone levels; however, one study found reaction time to be prolonged or slower during the luteal phase, when hormone levels are higher. Clinical Bottom Line: Both auditory and visual reaction times vary across the menstrual cycle in healthy females with regular menstrual cycles (frequency and length). Given these findings, it is important to incorporate reaction time training across all phases of the menstrual cycle in female athletes. Strength of Clinical Recommendation: Based on the Strength of Recommendation Taxonomy, a Grade C is the strength of recommendation.

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.

Integrative Approaches to Sleep Management in Skin Disease: Systematic Review.

Dermatological conditions, especially when severe, can lead to sleep disturbances that affect a patient's quality of life. However, limited research exists on the efficacy of treatments for improving sleep parameters in skin conditions. The objective was to perform a systematic review of the literature on dermatological conditions and the treatments available for improving sleep parameters. A literature review was performed using the PubMed, Ovid MEDLINE, Embase, Cochrane, and ClinicalTrials.gov databases from 1945 to 2021. After filtering based on our exclusion criteria, studies were graded using the SORT (Strength of Recommendation Taxonomy) algorithm, and only those receiving a grade of "2" or better were included. In total, 25 treatment studies (n=11,025) assessing sleep parameters related to dermatological conditions were found. Dupilumab appeared to be the best-supported and most effective treatment for improving sleep in atopic dermatitis (AD) but had frequent adverse effects. Topical treatments for AD were mostly ineffective, but procedural treatments showed some promise. Treatments for other conditions appeared efficacious. The evaluation of sleep parameter changes in dermatological treatments is predominantly restricted to AD. Systemic interventions such as dupilumab and procedural interventions were the most efficacious. Sleep changes in other dermatoses were limited by a paucity of available studies. The inclusion of a sleep assessment component to a broader range of dermatological treatment studies is warranted.

Exercise Immunology Applied to Pediatric Sport and the Importance of Monitoring Stages of Puberty and Biological Maturation

Context: Exercise immunology is aimed at understanding how exercise sessions can affect the immune system in athletic subjects of different age groups. The objective of the current study was to discuss in which stage of biological maturation (BM) young athletes may be more vulnerable in relation to the immune system, and whether there is a BM range in which it is safer to perform sports training with strenuous exercise loads. Evidence Acquisition: Evidence from scientific research from several scientific disciplines (eg, immunology, sport immunology, pediatrics, sports medicine, human development) was gathered to holistically examine the main particularities of exercise immunology as applied to pediatric sport. Study Design: Narrative review. Level of Evidence: Level 5. Results: In pediatric patients, lymphoid tissue expands during puberty and involutes after puberty until it returns to pre-expansion values. This suggests that there is a specific period in which the immune system may be stronger, which may provide opportunities for strenuous exercise in pediatric athletes. However, the chronological period when puberty occurs will be determined by BM, which is the rate at which the biological systems of the human body improves. This may affect the period of lymphoid tissue expansion and, consequently, the behavior of the immune system in pediatric subjects of the same age category. Conclusion: During puberty, there is a significant increase in the proinflammatory profile; to compensate for this, there is an expansion of lymphoid tissue that may favor the efficiency of the immune system. The period in which puberty is reached may vary according to the stages of BM. Therefore, in exercise immunology applied to pediatric sports, in addition to external and internal training loads, it is necessary to consider BM and puberty, which have been shown to be safer biomarkers than chronological age for determining immune system behavior in pediatric athletes. Strength-of-Recommendation Taxonomy (SORT): Evidence B level 3.

Integrating Mindfulness to Reduce Injury Rates in Athletes: A Critically Appraised Topic

Clinical Question: Is there evidence to support the use of mindfulness to reduce injury risk in athletic populations? Clinical Bottom Line: There is currently inconsistent, good-quality evidence to support that mindfulness interventions are effective in decreasing injury rates in athletes compared to the standard of care. Future research should investigate the effectiveness of mindfulness in other populations and types of sports activity (e.g., basketball, gymnastics, etc.). Additionally, future research should investigate different mindfulness delivery techniques in addition to the Mindfulness–Acceptance–Commitment (MAC) approach. Due to the inconsistent, good-quality evidence to support the use of mindfulness to reduce injury rates, the grade of B is recommended by the Strength of Recommendation Taxonomy. Mindfulness interventions should be incorporated into clinical practice but stakeholders (e.g., coaches, athletes, administration) should be included in the decision to implement these programs.

Supplementation With Bifidobacterium and Symptomatic Control in Irritable Bowel Syndrome: An Evidence-Based Review.

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder, with a global prevalence of around 11%. Family doctors should be aware of the diagnosis and treatment of this pathology. The benefit of using probiotics is questionable. The purpose of this review is to establish the evidence of the association between Bifidobacterium supplementation and symptomatic control in patients with IBS. The research was conducted using the National Guideline Clearinghouse, National Electronic Library for Health of the British NHS, Canadian Medical Association Practice Guidelines InfoBase, Cochrane Library, Database of Abstracts of Reviews of Effectiveness, Bandolier, Evidence-Based Medicine Online, and PubMed. Articles published between March 2017 and March 2022in humans and written in Portuguese, Spanish, and Englishusing the terms IBS and Bifidobacterium were included. To stratify the level of evidence (LOE), the Strength of Recommendation Taxonomy (SORT), from the American Academy of Family Physicians, was used. Thirty-seven articles were found corresponding to the search terms, and a total of seven articles were selected. Three clinical trials and a simple review have demonstrated improvement in symptoms, although further studies are needed. The guideline and the systematic review did not demonstrate superiority in symptomatic relief when compared to other species of probiotics. The meta-analysis did not show the efficacy of the isolated use of Bifidobacterium.The evidence of an association between supplementation with Bifidobacterium and symptomatic control in patients with IBS is not clear. Some studies seem to demonstrate benefits in improving symptoms (SORT C).

Beyond acute concussion assessment to office management: a systematic review informing the development of a Sport Concussion Office Assessment Tool (SCOAT6) for adults and children

ObjectivesTo systematically review the scientific literature regarding the assessment of sport-related concussion (SRC) in the subacute phase (3–30 days) and provide recommendations for developing a Sport Concussion Office Assessment Tool...