What are the Differences in Injury Proportions Between Different Populations of Runners?:A Systematic Review and Meta-Analysis

_Background:_ Many runners suffer from injuries. No information on high-risk populations is available so far though. _Objectives:_ The aims of this study were to systematically review injury proportions in different populations of runners and to compare injury locations between these populations. _Data Sources:_ An electronic search with no date restrictions was conducted up to February 2014 in the PubMed, Embase, SPORTDiscus and Web of Science databases. The search was limited to original articles written in English. The reference lists of the included articles were checked for potentially relevant studies. _Study Eligibility Criteria:_ Studies were eligible when the proportion of running injuries was reported and the participants belonged to one or more homogeneous populations of runners that were clearly described. Study selection was conducted by two independent reviewers, and disagreements were resolved in a consensus meeting. _Study Appraisal and Synthesis Methods:_ Details of the study design, population of runners, sample size, injury definition, method of injury assessment, number of injuries and injury locations were extracted from the articles. The risk of bias was assessed with a scale consisting of eight items, which was specifically developed for studies focusing on musculoskeletal complaints. _Results:_ A total of 86 articles were included in this review. Where possible, injury proportions were pooled for each identified population of runners, using a random-effects model. Injury proportions were affected by injury definitions and durations of follow-up. Large differences between populations existed. The number of medical-attention injuries during an event was small for most populations of runners, except for ultra-marathon runners, in which the pooled estimate was 65.6 %. Time-loss injury proportions between different populations of runners ranged from 3.2 % in cross-country runners to 84.9 % in novice runners. Overall, the proportions were highest among short-distance track runners and ultra-marathon runners. _Limitations:_ The results were pooled by stratification of studies according to the population, injury definition and follow-up/recall period; however, heterogeneity was high. _Conclusions:_ Large differences in injury proportions between different populations of runners existed. Injury proportions were affected by the duration of follow-up. A U-shaped pattern between the running distance and the time-loss injury proportion seemed to exist. Future prospective studies of injury surveillance are highly recommended to take running exposure and censoring into account

Effectiveness of a newly developed online self-management program for male patients with uncomplicated lower urinary tract symptoms

AIMS: To explore the effect of an online self-management program in secondary care for men with lower urinary tract symptoms (LUTS). METHODS: We performed a prospective nonrandomized double-cohort pilot study of consecutive adult men referred with uncomplicated LUTS to three urology outpatient departments. Men in both cohorts received care as usual from a urologist, but men in the intervention cohort also had access to an online self-management program. Outcomes were assessed after 6 and 12 weeks: LUTS severity was assessed with the International Prostate Symptom Score (IPSS), the Overactive Bladder Questionnaire (OABq), and the Perceived Global Impression of Improvement (PGI-I). The main outcome of interest was a clear improvement in the PGI-I scores ("much better" or "very much better"). RESULTS: Age, symptom severity, and quality of life scores were comparable between the intervention (n = 113) and standard care (n = 54) cohorts. Clear improvement in the PGI-I scores was reported after 12 weeks in 19.4% and 26.1% of men in the intervention and standard care cohorts, respectively. However, logistic regression analysis indicated that the difference between cohorts was not significant. Multivariable linear regression analysis also indicated no significant differences between cohorts for the IPSS or the OABq score at either assessment point. Notably, the uptake of the intervention was low (53%). CONCLUSIONS: We found no significant benefit from adding an online self-management program to standard care for men with LUTS, probably due to the low uptake of the intervention that may have resulted from the timing in the care pathway

Effect of patellar strap and sports tape on jumper's knee symptoms:Protocol of a randomised controlled trial

AbstractIntroductionPatellar straps or sports tapes are commonly used by athletes with patellar tendinopathy in order to reduce pain and to continue sports participation. Currently, there is no scientific evidence for the effectiveness of a patellar strap or sports tape in the management of this common injury.AimTo investigate the effect of the use of a patellar strap and sports tape on pain and sports participation in subjects with patellar tendinopathy.DesignThe study is divided into two parts: a randomised controlled crossover experiment and a randomised controlled trial (parallel group design).Participants and setting140 patients diagnosed with patellar tendinopathy recruited from sports medical centres and physiotherapist practices.InterventionIn the first part of the study, participants serve as their own control by performing three functional tests under four different conditions (patellar strap, sports tape, placebo tape, and no orthosis). In the second part, participants keep a log for two weeks (control week and intervention week) about the pain experienced during and after sports and their level of sports participation. In the intervention week participants will use the orthosis assigned to them during training and competition.MeasurementsThe amount of pain (both parts of the study) and sports participation (second part only) will be measured.AnalysisTo analyse the effects of the orthoses a Linear Mixed Model will be used.DiscussionThe knowledge gained in this study can be used by practitioners in their advice for athletes with patellar tendinopathy about using patellar strap and sports tape during sports

Determining the minimal important differences in the International Prostate Symptom Score and Overactive Bladder Questionnaire:results from an observational cohort study in Dutch primary care

OBJECTIVES: To determine the minimal important difference (MID) of the International Prostate Symptom Score (IPSS) and the Overactive Bladder Questionnaire short form (OAB-q SF) assessed in primary care among patients treated for lower urinary tract symptoms (LUTS).DESIGN: Single-arm, open-label observational cohort study with a 6-week follow-up.SETTING: Twenty-two pharmacies in the Netherlands.PARTICIPANTS: We enrolled Dutch men with uncomplicated LUTS who received a new alpha-blocker prescription from their general practitioner or urologist.PRIMARY AND SECONDARY OUTCOMES: The IPSS and OAB-q SF were completed before and after 6 weeks of therapy. At 6 weeks, men also completed the Patient Global Impression of Improvement (PGI-I). The mean change scores of the IPSS and OAB-q SF were calculated for each PGI-I outcome category, with the category 'a little better' used to determine the MID. The SE of measurement (SEM) was calculated for each questionnaire.RESULTS: In total, 165 men completed follow-up. The MID was 5.2 points (95% CI 3.9 to 6.4; SEM 3.6) for the IPSS and 11.0 points (95% CI 7.1 to 14.9; SEM 9.7) for the OAB-q SF. For both questionnaires, CIs showed an overlap with the no-change categories. However, the MID for the IPSS was higher in men with severe baseline symptoms (7.1; 95% CI 5.3 to 9.0) than in men with moderate baseline symptoms (3.2; 95% CI 1.7 to 4.8).CONCLUSION: In this study, the MID for the IPSS was considerably higher than the MID of 3.1 reported in the only other study on this topic, but may be due to methodological differences. Interpretation of the MID for the OAB-q SF is hampered by the overlap with the SEM. Future studies are needed to confirm our results because correlations between the PGI-I and symptom questionnaires were suboptimal.</p

Discontinuation of alpha-blocker therapy in men with lower urinary tract symptoms:a systematic review and meta-analysis

OBJECTIVES: We aimed to synthesise the available data for the effect of stopping alpha-blocker therapy among men with lower urinary tract symptoms. The focus was on symptom, uroflowmetry and quality of life outcomes, but we also reviewed the adverse events (AEs) and the number of patients who restarted therapy.DATA SOURCES: We searched MEDLINE/PubMed, EMBASE/Ovid and The Cochrane Central Register of Controlled Trials from inception to May 2018.ELIGIBILITY CRITERIA: We selected studies regardless of study design in which men were treated with an alpha-blocker for at least 3 months and in which the effects of alpha-blocker discontinuation were subsequently studied. Only controlled trials were used for the primary objective.DATA EXTRACTION AND SYNTHESIS: Two reviewers independently extracted data and assessed the risk of bias for the controlled studies only using the Cochrane Collaboration's tool for assessing risk of bias. Data were pooled using random-effects meta-analyses.RESULTS: We identified 10 studies (1081 participants) assessing the primary objective. Six studies (733 participants) assessed differences in AEs between continuation and discontinuation, and six studies (501 participants) reported the numbers of subjects that restarted treatment after discontinuation. No studies in primary care were identified. After discontinuing monotherapy, symptom scores increased and peak flow rates decreased at 3 and 6 months, but not at 12 months; however, neither parameter changed when alpha-blockers were stopped during combination therapy. Small differences in post-void residual volumes and quality of life scores were considered clinically irrelevant. We also found that 0%-49% of patients restarted after stopping alpha-blocker therapy and that AEs did not increase with discontinuation.CONCLUSIONS: Discontinuing alpha-blocker monotherapy leads to a worsening compared with continuing therapy. Discontinuing the alpha-blocker after combination therapy had no significant effects on outcomes in either the short or long term. Discontinuation may be appropriate for the frail, elderly or those with concomitant illness or polypharmacy. However, studies in primary care are lacking.PROSPERO REGISTRATION NUMBER: CRD42016032648.</p

Validity and reliability of a smartphone motion analysis app for lower limb kinematics during treadmill running

Objective: To investigate the validity and reliability of a smartphone application for selected lower-limb kinematics during treadmill running. Design: Validity and reliability study. Setting: Biomechanics laboratory. Participants: Twenty healthy female runners. Main outcome measure(s): Sagittal-plane hip, knee, and ankle angle and rearfoot eversion were assessed using the Coach's Eye Smartphone application and a 3D motion capture system. Paired t-test and intraclass correlation coefficients (ICC) established criterion validity of Coach's Eye; ICC determined test-retest and intrarater/interrater reliability. Standard error of measurement (SEM) and minimal detectable change (MDC) were also reported. Results: Significant differences were found between Coach's Eye and 3D measurements for ankle angle at touchdown and knee angle at toe-off (p < 0.05). ICCs for validity of Coach's Eye were excellent for rearfoot eversion at touchdown (ICC = 0.79) and fair-to-good for the other kinematics (range 0.51–0.74), except for hip at touchdown, which was poor (ICC = 0.36). Test-retest (range 0.80–0.92), intrarater (range 0.95–0.99) and interrater (range 0.87–0.94) ICC results were excellent for all selected kinematics. Conclusion: Coach's Eye can be used as a surrogate for 3D measures of knee and rearfoot in/eversion at touchdown, and hip, ankle, and rearfoot in/eversion at toe-off, but not for hip and ankle at touchdown or knee at toe-off. Reliable running kinematics were obtained using Coach's Eye, making it suitable for repeated measures

Evidence-based Urology:Understanding Heterogeneity in Systematic Reviews

Variability in the results of randomized trials presents challenges to the interpretation and application of the evidence to patient care. Understanding how systematic reviews deal with this problem of "heterogeneity" will help clinicians in applying results in their patient management. This manuscript offers a review of heterogeneity from the clinical urological perspective.  PATIENT SUMMARY: Systematic reviews of the literature are necessary to accurately summarize the available evidence to inform clinical decisions. In this mini-review, we explain how to understand and deal with the differences between studies-which we call heterogeneity-included in these types of reviews

Impact of digital interdisciplinary consultation on secondary care referrals by general practitioners:a protocol for a stepped-wedge cluster randomised controlled trial

INTRODUCTION: Optimal collaboration between general practice and hospital care is crucial to maintain affordable and sustainable access to healthcare for the entire population. General practitioners (GPs) are the gatekeepers to specialist care and patients will visit hospitals mostly only after referral. However, a substantial part of these referrals may be inappropriate, as communication between GPs and medical specialists can be challenging and referring patients may be the most obvious action for a GP to perform.A new digital platform (Prisma) connects GPs and specialists in interdisciplinary groups and facilitates asynchronous, accessible and fast teleconsultation within the group. No previous research has been done to evaluate the impact of this new platform on the referral rates to the hospital. METHODS AND ANALYSIS: A stepped-wedge randomised controlled trial (RCT) will be performed in Zwolle region in the Netherlands to analyse the effect of introduction of the platform on rate of inappropriate referrals to orthopaedic surgery. In four steps, GPs in the region will be given access to the platform. GPs will be part of the control condition until randomisation to the intervention. According to our sample size calculation, we need to include 18 practices with 1008 patients presenting with hip and knee symptoms. Routine care data of hospital registrations will be analysed to calculate the rate of inappropriate referrals (primary outcome). Secondary outcome are costs, primary and secondary care workload, posted cases and user satisfaction. Alongside this quantitative analysis, we will evaluate patient experience, facilitators and barriers for use of the platform. ETHICS AND DISSEMINATION: The medical ethics review board of University Medical Center Groningen (UMCG), the Netherlands (METc-number: 2021/288) has confirmed that the Medical Research Involving Human Subjects Act (WMO) does not apply to the process evaluation because the study does not involve randomisation of patients or different medical treatments (letter number: M21.275351). TRIAL REGISTRATION NUMBER: NL9704

Reporting Multiple Individual Injuries in Studies of Team Ball Sports:A Systematic Review of Current Practice

Background To identify and prioritise targets for injury prevention efforts, injury incidence studies are widely reported. The accuracy and consistency in calculation and reporting of injury incidence is crucial. Many individuals experience more than one injury but multiple injuries are not consistently reported in sport injury incidence studies. Objective The aim of this systematic review was to evaluate current practice of how multiple injuries within individuals have been defined and reported in prospective, long-term, injury studies in team ball sports. Data Sources A systematic search of three online databases for articles published before 2016. Study Selection Publications were included if (1) they collected prospective data on musculoskeletal injuries in individual participants; (2) the study duration was >1 consecutive calendar year/season; and (3) individuals were the unit of analysis. Data Extraction Key study features were summarised, including definitions of injury, how multiple individual injuries were reported and results relating to multiple injuries. Results Of the 71 publications included, half did not specifically indicate multiple individual injuries; those that did were largely limited to reporting recurrent injuries. Eight studies reported the number/proportion of athletes with more than one injury, and 11 studies presented the mean/number of injuries per athlete. Conclusions Despite it being relatively common to collect data on individuals across more than one season, the reporting of multiple injuries within individuals is much more limited. Ultimately, better addressing of multiple injuries will improve the accuracy of injury incidence studies and enable more precise targeting and monitoring of the effectiveness of preventive interventions

Recruitment through media and general practitioners resulted in comparable samples in an RCT on incontinence

Objectives: The objective of the study was to assess the impact of recruitment strategy on the baseline characteristics of patients recruited in a randomized controlled trial for treating women with urinary incontinence. Study Design and Setting: We conducted a cross-sectional analysis of baseline data from an earlier trial. Women were recruited through the media (including social media) or from participating general practices. Baseline characteristics were compared by univariate testing. Logistic regression analysis was performed to study the association between recruitment type and multiple baseline characteristics. Results: The only differences between recruitment methods were in patient age, with those recruited through the media being significantly older than those recruited through general practice. The mean age difference was 5.0 years (95% confidence interval: 2.2–7.9). Conclusion: Samples recruited through the media and through case identification were largely comparable. Therefore, recruitment through the media may be a viable alternative to recruitment through primary care. This may be especially relevant for research on eHealth treatment for conditions with which patients experience barriers when seeking health care