Are plain-language summaries included in published reports of evidence about physiotherapy interventions? Analysis of 4421 randomised trials,systematic reviews and guidelines on the Physiotherapy Evidence Database (PEDro)

BackgroundA plain-language summary is a short and clearly stated version of a study’s results using non-scientific vocabulary that provide many advantages for patients and clinicians in the process of shared decision-making.ObjectivesThe primary objective was to investigate the extent to which published reports of physiotherapy interventions provide plain-language summaries. We investigate as the secondary objectives if the available plain-language summaries are at a suitable reading level for a lay person and if inclusion of plain-language summaries in these reports is increasing over time and is associated with trial quality (i.e. PEDro score).Data sourcesAll 4421 randomised controlled trials (RCT), systematic reviews and clinical practice guidelines that included plain-language summaries indexed on Physiotherapy Evidence Database (PEDro) were included.Main outcome measuresProportion of published reports with plain-language summaries, Flesch Reading Ease Score (FRES) and the Flesch–Kincaid Grade Level (FKGL).ResultsThe number of published reports with a plain-language summary doubled in the last 6 years. From a total of 34,444 reports indexed on PEDro, only 4421 reports had English plain-language summaries. RCTs with plain-language summaries had higher PEDro scores than RCTs without plain-language summaries (mean difference = 0.8 points, 95%CI 0.7 to 0.8). Only 2% of reports were considered at a suitable reading level by the FKGL formula and 0.1% by the FRES formula.ConclusionsAlthough the publication of plain-language summaries is increasing over time, the current number corresponds to only 13% of all published reports. In addition the majority of plain-language summaries are written at an advanced reading level.     

Cerebrovascular risks with rapid blood pressure lowering in the absence of hypertensive emergency

Study objectiveIn the Emergency Department (ED) setting, clinicians commonly treat severely elevated blood pressure (BP) despite the absence of evidence supporting this practice. We sought to determine if this rapid reduction of severely elevated BP in the ED has negative cerebrovascular effects.MethodsThis was a prospective quasi-experimental study occurring in an academic emergency department. The study was inclusive of patients with a systolic BP (SBP) > 180 mm Hg for whom the treating clinicians ordered intensive BP lowering with intravenous or short-acting oral agents. We excluded patients with clinical evidence of hypertensive emergency. We assessed cerebrovascular effects with measurements of middle cerebral artery flow velocities and any clinical neurological deterioration.ResultsThere were 39 patients, predominantly African American (90%) and male (67%) and with a mean age of 50 years. The mean pre-treatment SBP was 210 ± 26 mm Hg. The mean change in SBP was ?38 mm Hg (95% CI ?49 to ?27) mm Hg. The average change in cerebral mean flow velocity was ?5 (95% CI ?7 to ?2) cm/s, representing a ?9% (95% CI ?14% to ?4%) change. Two patients (5.1%, 95% CI 0.52–16.9%) had an adverse neurological event.ConclusionWhile this small cohort did not find an overall substantial change in cerebral blood flow, it demonstrated adverse cerebrovascular effects from rapid BP reduction in the emergency setting.