Rapid reviews versus full systematic reviews: An inventory of current methods and practice in health technology assessment

Objectives: This review assessed current practice in the preparation of rapid reviews by health technology assessment (HTA) organizations, both internationally and in the Australian context, and evaluated the available peer-reviewed literature pertaining to the methodology used in the preparation of these reviews. Methods: A survey tool was developed and distributed to a total of fifty International Network of Agencies for Health Technology Assessment (INAHTA) members and other selected HTA organizations. Data on a broad range of themes related to the conduct of rapid reviews were collated, discussed narratively, and subjected to simple statistical analysis where appropriate. Systematic searches of the Cochrane Library, EMBASE, MEDLINE, and the Australian Medical Index were undertaken in March 2007 to identify literature pertaining to rapid review methodology. Comparative studies, guidelines, program evaluations, methods studies, commentaries, and surveys were considered for inclusion. Results: Twenty-three surveys were returned (46 percent), with eighteen agencies reporting on thirty-six rapid review products. Axiomatic trends were identified, but there was little cohesion between organizations regarding the contents, methods, and definition of a rapid review. The twelve studies identified by the systematic literature search did not specifically address the methodology underpinning rapid review; rather, many highlighted the complexity of the area. Authors suggested restricted research questions and truncated search strategies as methods to limit the time taken to complete a review. Conclusions: Rather than developing a formalized methodology by which to conduct rapid reviews, agencies should work toward increasing the transparency of the methods used for each review. It is perhaps the appropriate use, not the appropriate methodology, of a rapid review that requires future consideration.Amber Watt, Alun Cameron, Lana Sturm, Timothy Lathlean, Wendy Babidge, Stephen Blamey, Karen Facey, David Hailey, Inger Norderhaug and Guy Madder

Physiological and Performance Effects of Altitude Training for Elite Athletes: A Systematic Review and Meta-Analysis

Background: At the elite level, minute variances in performance can be the difference between a podium finish and competing in a final. As such, coaches are continuously looking at developing ways to improve performance. One strategy used by athletes in order to facilitate physiologic and exercise performance improvement is through hypoxic exposure. Two models appear to dominate the discussion: live high, train low (LHTL) and live high, train high (LHTH). The former proposes living at altitude (2000m – 3000m) but training at or near sea level (600m – 1200m). Whilst the LHTH model requires athletes to live and train at altitude ranges beyond (1250 to 3000m) Objectives: To identify the physiological and performance adaptations associated with LHTL or LHTH for elite endurance athletes. Methods: 1) A narrative review of the literature was carried out to address and explore current literature within altitude training. 2) A systematic review and meta-analysis were performed to determine how altitude training (both LHTL and LHTH) influences the physiological and performance effects in elite and high performing athletes, contrasting different models of altitude exposure. Results: 1) Narrative review: key results for physiological and performance adaptations for the narrative review seem to indicate that an optimal height of 2000 – 2500m for 3 – 4 weeks for LHTH, while under models adopting a train low component (LHTL), optimal adaptation height should range between 2500 – 3000m for 3 – 4 weeks (>12 h·day-1). 12 h·day-1). 2) Systematic review and meta-analysis: 24 studies were included in the final analysis. Improvements in tHbmass, HCT and lactate were found. For hemoglobin mass, a small increase was found following altitude training (g = 0.23; 95% CI = 0.09 to 0.36; P P = 0.07). Finally, in relation to lactate, following altitude training, athletes produced moderately more favourable lactate responses to exercise than control (g = 0.55; 95% CI = -0.01 to 1.10; P = 0.05). Despite moderate improvements in some physiological markers (tHbmass, HCT and lactate), results did not demonstrate enhanced exercise performance improvements (TT: g = 0.12; 95% CI = -0.13 to 0.37; P = 0.35; Oxygen consumption: g = 0.13; 95% CI = -0.08 to 0.35; P = 0.22; PPO: g = 0.09; 95% CI = -0.13 to 0.32; P = 0.42). Conclusion Improvements in tHbmass, HCT and lactate were found. Altitude training modalities (LHTL and LHTH) should be used by well-trained and elite athletes to enhance physiological adaptations. However, the degree to which these physiological markers improve performance outcomes needs further investigation. The moderate number of studies examined within the current meta-analysis limits the confidence of these findings, and it is likely this training modality has a broader effect on physiology and hence performance than this

Quadriceps muscle size changes following exercise in anterior cruciate ligament reconstructed limbs: A systematic review

Anterior cruciate ligament (ACL) injury and reconstructive surgery is known to cause long-term negative impacts on quadriceps muscle size. With the known link between reduced muscle size and the health and functioning of the knee joint, it is important rehabilitation programs aim to restore quadriceps mass as safely and quickly as possible. However, a comprehensive review of interventions investigating the impact of training interventions on quadriceps muscle size in ACL-reconstructed individuals has yet to be undertaken. Therefore, this article systematically reviews the evidence investigating training interventions that aim to improve quadriceps size in ACL-reconstructed individuals. A literature search was performed in MEDLINE, SPORTDiscus, CINAHL, and Web of Science. Observational and experimental studies investigating training interventions impact on quadriceps muscle size in ACL-reconstructed individuals were included. Risk-of-bias assessment (Downs and Black) was completed on included studies, data was extracted, and a best evidence synthesis was undertaken. 718 articles were returned in the initial search; following screening, six articles were included in this review. Results from the best evidence synthesis suggest there is moderate evidence for eccentrically biased training to increase quadriceps size. Both traditional resistance training and blood flow restriction training showed conflicting results for improving quadriceps size. However, the results for traditional resistance training and blood flow restriction training may have been limited by differing imaging methods across included studies. This review highlights the positive changes in quadriceps size seen following traditional, eccentrically biased and blood flow restriction exercise interventions in ACL-reconstructed limbs, despite the limited number of studies. Further work is needed to identify and optimize the best practice for hypertrophic training in these individuals

Strength and conditioning practices for the optimisation of speed and accuracy in cricket fast bowlers: A systematic review and meta-analysis

The most important determinants of a cricket fast bowler’s performance are bowling speed and accuracy. Even though various strength and conditioning practices (resistance, plyometric and modified-implement training) have been employed to improve these parameters, there is still ambiguity as to the effectiveness of such training programmes. This systematic review and meta-analysis examined the influence of various training interventions on fast bowling speed and accuracy. Searches were conducted across PubMed, Web of science, SPORTDiscus, Scopus and CINAHL. Inclusion criteria were studies that: were original research or conference presentations; recruited fast bowlers as participants; involved a physical training intervention; written in English; and included bowling speed or accuracy as outcome measures. Ten articles met our inclusion criteria for qualitative and eight for quantitative analysis. The quality of the studies assessed using Downs and Black checklist ranged from low to moderate with a mean ± SD of 64.5 ± 8.14%. There was a moderate and significant effect of plyometric training intervention on bowling speed (SMD = 0.75; Z = 2.98; p = 0.003). Further, a small and non-significant effect of resistance training on bowling speed was observed in our study (SMD = 0.40; Z = 1.39; p = 0.164). A small but non-significant difference was found in the ball speed post modified ball weight training intervention (SMD = 0.30; Z = 1.14; p = 0.252). The findings from our study are useful for strength and conditioning coaches in helping to design and implement fast-bowling specific training programmes for improved bowling speed

Elite Junior Australian Football Players With Impaired Wellness Are at Increased Injury Risk at High Loads

Background: Elite junior Australian football players experience high training loads across levels of competition and training. This, in conjunction with impaired wellness, can predispose athletes to injury. Hypothesis: Elite junior Australian football players exposed to high loads with poor wellness are more likely to be at risk of injury than those with improved wellness. Study Design: Longitudinal prospective cohort study. Level of Evidence: Level 3. Methods: Data were collected and analyzed from 280 players across the 2014 season. Internal load was measured via session rating of perceived exertion. Player wellness was reported according to ratings of sleep quality, fatigue, soreness, stress, and mood. Week- and month-based training load measures were calculated, representing a combination of absolute and relative load variables. Principal component analysis factor loadings, based on 17 load and wellness variables, were used to calculate summed variable covariates. Injury was defined as "any injury leading to a missed training session or competitive match." Associations between covariates and injury risk (yes/no) were determined via logistic generalized estimating equations. Results: A significant interaction term between load and wellness on injury was found [odds ratio (OR) 0.76; 95% CI 0.62-0.92; P P Conclusions: Subjective measures of training load are associated with injury risk through a nonlinear relationship. This relationship is further influenced by player wellness, which can amplify the risk of injury. There is evidence that higher stress is linked with injury and that soreness and sleep mediate any stress-injury relationship. Clinical Relevance: Coaching efforts to manage training load and player adaptive responses, including wellness, may reduce the risk of injury, with stress, soreness, and sleep particularly relevant at this level

Elite junior Australian football players experience significantly different loads across levels of competition and training modes

Well-developed physical qualities such as high jumping ability, running endurance, acceleration, and speed can help aspiring junior elite Australian football (AF) players transition to the Australian Football League competition. To do so, players need to experience sufficient load to enhance their physical resilience without increasing their risk of negative outcomes in terms of impaired wellness or injury. The aim of this study was to investigate the differences in load for different levels of competition and training modes across one competitive season. Elite junior AF players (n = 562, aged 17.7 ± 0.3, range: 16-18 years) were recruited from 9 teams across the under-18 state league competition in Victoria. All players recorded their training and match intensities according to the session rating of perceived exertion method. Training sessions were categorized according to skills, strength, conditioning, and other activities, whereas matches were identified according to level of competition. The loads in U18 state league matches (656.7 ± 210.9 au) were significantly higher (p = 0.027) than those in school matches (643.3 ± 260.9 au) and those in U18 representative matches (617.2 ± 175.4). Players, who undertook more than one match per week, experienced significantly less load in subsequent matches (p \u3c 0.001). Furthermore, U18 state league training sessions carried the most load when compared with other training modes. This article highlights that different combinations of training and match involvement affect overall player load, which may predispose players to negative outcomes such as impaired wellness or increased injury risk

Absolute and relative load and injury in Elite Junior Australian football players over 1 season

Purpose: To investigate the association between training and match loads and injury in elite junior Australian football players over 1 competitive season. Methods: Elite junior Australian football players (n = 290, age 17.7 [0.3] y, range 16-18 y) were recruited from the under-18 state league competition in Victoria to report load and injury information. One-week load (session rating of perceived exertion multiplied by duration) and all time-loss injuries were reported using an online sport-injury surveillance system. Absolute load measures (weekly sums) enabled the calculation of relative measures such as the acute: chronic workload ratio. Load measures were modeled against injury outcome (yes/no) using a generalized estimating equation approach, with a 1-wk lag for injury. Results: Low ( \u3c 300 arbitrary units [au]) and high ( \u3e 4650 au) 1-wk loads were associated with significantly higher risk of injury. Furthermore, low ( \u3c 100 au) and high ( \u3e 850 au) session loads were associated with a higher risk of injury. High strain values ( \u3e 13,000) were associated with up to a 5-fold increase in the odds of injury. There was a relatively flat-line association between the acute:chronic workload ratio and injury. Conclusions: This study is the first investigation of elite junior athletes demonstrating linear and nonlinear relationships between absolute and relative load measures and injury. Coaches should focus player loads on, or at least close to, the point at which injury risk starts to increase again (2214 au for 1-wk load and 458 au for session load) and use evidence-based strategies across the week and month to help reduce the risk of injury. © 2020 Human Kinetics, Inc

A Prospective Cohort Study of Load and Wellness (Sleep, Fatigue, Soreness, Stress, and Mood) in Elite Junior Australian Football Players

Purpose: To investigate associations between load (training and competition) and wellness in elite junior Australian Football players across 1 competitive season. Methods: A prospective cohort study was conducted during the 2014 playing season in 562 players from 9 teams. Players recorded their training and match intensities according to the session-rating-of-perceived-exertion (sRPE) method. Based on sRPE player loads, a number of load variables were quantified, including cumulative load and the change in load across different periods of time (including the acute-to-chronic load ratio). Wellness was quantified using a wellness index including sleep, fatigue, soreness, stress, and mood on a Likert scale from 1 to 5. Results: Players spent an average of 85 (21) min in each match and 65 (31) min per training session. Average match loads were 637 (232) arbitrary units, and average training loads were 352 (233) arbitrary units. Over the 24 wk of the 2014 season, overall wellness had a significant linear negative association with 1-wk load (B = −0.152; 95% confidence interval, −0.261 to −0.043; P = .006) and an inverse U-curve relationship with session load (B = −0.078; 95% confidence interval, 0.143 to 0.014; P = .018). Mood, stress, and soreness were all found to have associations with load. Conclusions: This study demonstrates that load (within a session and across the week) is important in managing the wellness of elite junior Australian Football players. Quantifying loads and wellness at this level will help optimize player management and has the potential to reduce the risk of adverse events such as injury

Player wellness (soreness and stress) and injury in elite junior Australian football players over 1 season

© 2020 Human Kinetics, Inc. Purpose: To investigate the association between player wellness and injury in elite junior Australian football players over 1 competitive season. Methods: Prospective cohort study. Elite junior Australian football players (N = 196, average age = 17.7 y, range = 16–18 y) were recruited in the under-18 state league competition in Victoria, Australia. They recorded their wellness (sleep, fatigue, soreness, stress, and mood) according to a 5-point Likert scale 3 times weekly, with injuries (missed match/ training session) entered into an online sport-injury surveillance system. A logistic generalized estimating equation was used to examine the association (expressed as odds ratio [OR]) between wellness and injury (yes/no). Results: Soreness was associated with injury at each time point across the week, with the strongest association evident for soreness reported 6 d postmatch (OR = 1.30; 95% confidence interval [CI], 1.17–1.44; P \u3c .001). Stress and injury were associated with injury for average stress values across the week, as well as specifically on day 1 postmatch (OR = 1.10; 95% CI, 1.01–1.21; P = .038). Mood reported in the middle of the week (3 d postmatch) was associated with injury (OR = 0.87; 95% CI, 0.78–0.97; P = .014), as was fatigue (OR = 1.10; 95% CI, 1.00–1.22; P = .044). Conclusions: This study demonstrates key associations between wellness and injury in elite junior Australian football, specifically soreness, stress, fatigue, and mood. Monitoring strategies help identify injury-risk profiles, which can help decision makers (coaches or medical staff) intervene when relevant to reduce injury risk