La qualità delle revisioni sistematiche in fisioterapia muscoloscheletrica è criticamente bassa: uno studio meta-epidemiologico

Quality of systematic reviews on musculoskeletal physiotherapy is critically low: a meta-epidemiological study

Autori

Ferri Nicola [Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy]

Ravizzotti Elisa [Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health (DINOGMI), University of Genoa, Genoa, Italy]

Bracci Alessandro [Department for Life Quality Studies (QUVI), University of Bologna, Rimini, Italy]

Carreras Giulia [Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy]

Pillastrini Paolo [Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy]

Di Bari Mauro [Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy]

Introduction

Clinicians implement the best scientific evidence to support decision-making, according to the Evidence-Based Practice paradigm. Systematic reviews with meta-analysis of RCTs (SRs) represent the best evidence for questions of intervention effectiveness. These studies have been growing exponentially for decades now, with the paradox that in recent years, the secondary literature has overcome the primary literature in relative growth. This resulted in the emergence of overlapping SRs on the same question, with sometimes conflicting results or conclusions. A recent survey reported that most decision-makers find it difficult to choose the best evidence out of many. This study aims to investigate musculoskeletal physiotherapy literature assessing the methodological quality of SRs over the past 10 years and to analyze possible quality predictors.

Methods

This is an observational study in the meta-research field. We searched four scientific databases (MEDLINE, CDSR, CINAHL, PEDro) using both free text and MeSH terms. Two independent assessors selected only the SRs concerning treatment effectiveness on musculoskeletal conditions, published between 2012 and 2022. A random list of included full texts was generated, and the first 100 SRs were included. The study outcomes included the SRs type (Cochrane or non-Cochrane), the Journal Impact Factor (JIF), the Journal Quartile, the h-index of the first and last author, the publication policy, the total number of studies, and the direction of results and conclusions. Each SR was then qualitatively assessed using the AMSTAR-2 tool by two independent assessors, leading to a four-level score (critically low, low, moderate, and high). Descriptive analyses were performed, followed by multivariable ordinal logistic regression. The STROBE checklist for conference abstracts was followed.

Results

A total of 2078 records were retrieved, and 395 full texts were included, from which the random sample of 100 SRs was obtained. Ninety SRs (90%) are of critically low quality, 4 of low quality (4%), 2 of moderate quality (2%) and 4 of high quality (4%). The overall methodological quality has not increased over the past 10 years, and the high-quality SRs are all Cochrane SRs. Quality seemed to differ according to the JIF; however, after performing a sensitivity analysis, Cochrane SRs proved to be a confounding factor. Thus, in our sample, JIF is not associated with SR quality. The h-index of the first and last authors are significantly different across SR quality, and the last author’s h-index is the only weak predictor (OR 1.04; 95% CI: 1.01, 1.06) among all the variables considered.

Discussion and Conclusion

This study confirms previous research on different topics and highlights how the quality of current literature is extremely low while there is a staggering increase in publications. The physiotherapy profession has ethical and legal responsibilities through an obligation of means. But what if the best evidence is of low methodological quality? How should it be used to support clinical practice? In the first instance, the recommendation for the clinician is to always assess the quality of SRs carefully and not to trust the prestige of the journal, the most recent publication, or the one that included the more primary studies. The study design alone (i.e., SRs) is not enough to support a clinical choice. We suggest that researchers strictly follow the existing methodological recommendations for conducting a SR and that editors implement a thorough quality assessment during peer-review processes; this could improve the quality of the scientific literature and, finally, patient care.

REFERENCES

Ferri N, Ravizzotti E, Bracci A, Carreras G, Pillastrini P, Di Bari M. The confidence in the results of physiotherapy systematic reviews in the musculoskeletal field is not increasing over time: a meta-epidemiological study using AMSTAR 2 tool. J Clin Epidemiol. 2024 Feb 24;169:111303. doi: 10.1016/j.jclinepi.2024.111303. Epub ahead of print. PMID: 38402999.

Valutazione della funzione vestibolare in persone con ictus tramite l’utilizzo del video Head Impulse Test: uno studio cross-sectional

Vestibular function assessment in people with stroke using the video Head Impulse Test: a cross-sectional study

Autori

Ferri Nicola [Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy]

Casagrande Conti Laura [Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy]

Turolla Andrea [Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy]

Orejel Bustos Amaranta Soledad [Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy]

Sorge Chiara [Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy]

Pillastrini Paolo [Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy]

Manzari Leonardo [MSA ENT Academy Center, Cassino, Italy]

Tramontano Marco [Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy]

Introduction

Rehabilitation of persons with stroke (PwS) involves multidisciplinary care as defined in the most recent guidelines. Posture and balance disturbance are prevalent aspects that impact function and autonomy and are a primary focus of physiotherapy treatment in PwS. Indeed, the vestibular system plays a central role in balance disorders, and some studies assessed the peripheral semicircular canal’s function in CNS pathologies using the video Head Impulse Test (vHIT). The vHIT is a safe, valid and reliable tool, but current literature reported heterogeneous findings in the CNS population, leading to uncertainty in clinical implications. In this context, an objective assessment of peripheral vestibular function in a neurorehabilitation setting has never been published. The aim of the present study is to fill this gap by providing some preliminary data on semicircular canal function among PwS.

Methods

This is a cross-sectional study, conducted at the neurorehabilitation service of the Santa Lucia Foundation in Rome from January 2023 to September 2023. PwS were consecutively recruited based on the following inclusion criteria: first-time strokes with hemiparesis and Functional Ambulation Classification score > 3. PwS were excluded if they had severe cognitive impairment, unilateral spatial neglect, or aphasia. The peripheral vestibular function was the primary outcome, objectively assessed using the vHIT through both HIMP (Head Impulse Paradigm) and SHIMP (Suppression Head Impulse Paradigm) paradigms. Then, the participants were assessed for balance function using the Berg Balance Scale and Mini-BESTest. STATA 17 was used for statistical analyses; the Shapiro-Wilk test was performed to test data normality, and Spearman’s rank correlation tests were used to investigate correlations between outcomes. The STROBE checklist for conference abstracts was followed.

Results

A total of 36 PwS were recruited (11 women; age range: 18-78 years); twenty-two were in the subacute stage (< 6 months from stroke), and 14 were in the chronic stage. Overall, 288 semicircular canals were assessed using the vHIT, of which 216 through HIMP, and 72 through the SHIMP paradigm. The mean VOR (vestibulo-ocular reflex) gain showed confidence intervals lower than the expected functional value of 1 in the overall analyses for almost every canal and paradigm. Applying the normative cut-offs for canal function, the left anterior and the right posterior were the canals with the highest prevalence of dysfunctional VOR gain in the analyzed sample, affecting 38.9% and 33.3% of the participants, respectively. No differences were found according to the disease stage (subacute vs chronic) or functional balance outcomes (Berg Balance Scale and Mini-BESTest).

Discussion and Conclusion

This study is the first to objectively analyze the vestibular canal function in PwS in a neurorehabilitation setting. Isolated canal dysfunction was very prevalent in our sample, involving 75% of participants; this indicates that patients with central lesions may present peripheral vestibular dysfunction that does not necessarily involve the entire vestibular system and does not follow a clearly defined pattern. Furthermore, the VOR gain confidence intervals lower than the expected value imply a general peripheral vestibular hypofunction in our sample. Our findings suggest that routinely assessing vestibular function in PwS could give valuable information about a crucial sensory input for the balance system and thus provide new insights for neurosensory integration modalities.

REFERENCES

Tramontano M, Ferri N, Turolla A, Orejel Bustos AS, Casagrande Conti L, Sorge C, Pillastrini P, Manzari L. Video head impulse test in subacute and chronic stroke survivors: new perspectives for implementation of assessment in rehabilitation. Eur Arch Otorhinolaryngol. 2024 May 17. doi: 10.1007/s00405-024-08721-x. Epub ahead of print. PMID: 38758244.