Methodological quality of studies on the measurement properties of neck pain and disability questionnaires: a systematic review

Objective

The aim of this study was to obtain an overview of the methodological quality of studies on the measurement properties of neck pain and disability questionnaires and to describe how well various aspects of the design and statistical analyses of studies on measurement properties are performed.

Methods

A systematic review was performed of published studies on the measurement properties of neck pain and disability questionnaires. Two reviewers independently rated the quality of the studies using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. This checklist was developed in an international Delphi consensus study.

Results

A total of 47 articles were included on the measurement properties of 8 different questionnaires. The methodological quality of the included studies was adequate on some aspects (often, adequate statistical analyses are used for assessing reliability, measurement error, and construct validity) but can be improved on other aspects. The most important methodological aspects that need to be improved are as follows: assessing unidimensionality in internal consistency analysis, stable patients and similar test conditions in studies on reliability and measurement error, and more emphasis on the relevance and comprehensiveness of the items in content validity studies. Furthermore, it is recommended that studies on construct validity and responsiveness should be based on predefined hypotheses and that better statistical methods should be used in responsiveness studies.

Conclusion

Considering the importance of adequate measurement properties, it is concluded that, in the field of measuring neck pain and disability, there is room for improvement in the methodological quality of studies measurement properties.     

The measurement properties of pediatric observational pain scales: A systematic review of reviews

BackgroundValid observational pain scales are needed to assess pain and ensure sufficient treatment of pain in children that lack the verbal ability to self-report pain. Published reviews attempt to synthesize results from primary studies validating these scales and based on the findings recommendations may be given, for example which pain scales are the most appropriate for use in different pediatric populations.ObjectivesThe aims of this review were to describe how systematic reviews have evaluated and recommended observational pain scales for use in children aged 0–18 years and appraise the evidence underlying these recommendations.DesignSystematic review of reviews.Data sourcesThe Cochrane Library, PubMed/MEDLINE, CINAHL, Web of Science, and PsychINFO were searched from inception to September 2016. Reference lists and gray literature were searched for additional studies.Review methodsStudy selection and data extraction were performed by two reviewers independently with a disagreement procedure in place. Methodological quality or study validity was measured using the Assessment of Multiple Systematic Reviews checklist and risk of bias or internal validity was measured using the Risk of Bias in Systematic Reviews tool. The review protocol was registered with PROSPERO: registration number CRD42016035264.ResultsTwelve reviews met the inclusion criteria. Together; they included 65 different observational pain scales for use in children, of which 28 were recommended at least once. Face, Legs, Activity, Cry, Consolability/revised version of Face, Legs, Activity, Cry, Consolability, COMFORT/COMFORT behavioral scale and Children’s Hospital of Eastern Ontario Pain Scale were evaluated and recommended most frequently. Few of the included reviews assessed the methodological quality of the studies included in the review. The narrative analysis consisted mostly of a reiteration of the results from the primary studies. In general, more recent reviews showed a lower risk of bias than older ones.ConclusionsIncluded reviews exhibited low quality of evidence; thus, their recommendations regarding pain scales for use in clinical practice or research with children that lack the verbal ability to self-report pain should be interpreted with caution.     

Measurement properties of patient-reported outcome measures (PROMS) in Patellofemoral Pain Syndrome: A systematic review

This systematic review investigated the measurement properties of disease-specific patient-reported outcome measures used in Patellofemoral Pain Syndrome. Two independent reviewers conducted a systematic search of key databases (MEDLINE, EMBASE, AMED, CINHAL+ and the Cochrane Library from inception to August 2013) to identify relevant studies. A third reviewer mediated in the event of disagreement. Methodological quality was evaluated using the validated COSMIN (Consensus-based Standards for the Selection of Health Measurement Instruments) tool. Data synthesis across studies determined the level of evidence for each patient-reported outcome measure. The search strategy returned 2177 citations. Following the eligibility review phase, seven studies, evaluating twelve different patient-reported outcome measures, met inclusion criteria. A ‘moderate’ level of evidence supported the structural validity of several measures: the Flandry Questionnaire, Anterior Knee Pain Scale, Functional Index Questionnaire, Eng and Pierrynowski Questionnaire and Visual Analogue Scales for ‘usual’ and ‘worst’ pain. In addition, there was a ‘Limited’ level of evidence supporting the test–retest reliability and validity (cross-cultural, hypothesis testing) of the Persian version of the Anterior Knee Pain Scale. Other measurement properties were evaluated with poor methodological quality, and many properties were not evaluated in any of the included papers. Current disease-specific outcome measures for Patellofemoral Pain Syndrome require further investigation. Future studies should evaluate all important measurement properties, utilising an appropriate framework such as COSMIN to guide study design, to facilitate optimal methodological quality.     

中国人癌症疼痛评估工具效度与信度的分析

目的 探讨香港钟慧仪博士研制适合中国文化背景的多层面的疼痛评估表,《中国人癌症疼痛评估工具》（Chinese Cancer Pain Assesment tool,CCPAT)的效度与信度。方法 测查319名癌痛患者,其中30名同时用CCPAT和马克盖尔疼痛调查表（The Mcgill Pain Quesionnaire,MPQ) 进行问卷,使用因素分析寻找量度疼痛概念有多少因素;通过集中癌痛组的CCPAT和MPQ有关项目进行相关总分计算测试,确立CCPAT的效度。另抽出30名患者由两名调查员用CCPAT量表同时进行问卷,将CCPAT每一项目作半机率选择,计算其信度系数,然后将其他患者用CCPAT进行问卷,计算其系数的平均值,测试在内部的一致性。结果 测查319名癌痛患者,CCPA与MPQ的变数相连,建立一致的效度,比率信度是0．96,内部一致性系数0．88。结论 验证该癌痛评估工具信度、效度良好。对临床评估癌痛病人的疼痛强度有较好的参考价值。     

Measurement properties of the pressure biofeedback unit in the evaluation of transversus abdominis muscle activity: a systematic review

Background

Measurements from pressure biofeedback units (PBUs) can be used to evaluate the activity of the transversus abdominis (TrA) muscle indirectly. These measurements can classify patients or monitor the progress of treatment programmes for people with low back pain.

Objective

To systematically review studies on the measurement properties of PBUs for the assessment of TrA activity.

Data sources

Eligible studies were identified through searches of PUBMED, CINAHL and BIREME (1990 to 2009). In addition, hand searches of journals and citation tracking were performed.

Study selection

Full-text studies involving any type of clinimetric tests of PBU measurement for the assessment of TrA activity were selected.

Data extraction

Two independent reviewers selected the studies, extracted the data and assessed methodological quality.

Data synthesis

Due to the heterogeneity of study designs and statistical analysis, it was not possible to pool the data for a meta-analysis.

Results

Six studies met the inclusion criteria. These studies were typically of low quality and recruited healthy subjects rather than patients with low back pain. The studies found moderate to good reproducibility (intra-class correlation coefficients from 0.47 to 0.82) and acceptable construct validity (intra-class correlation coefficients from 0.48 to 0.90).

Conclusions

The current evidence about the measurement properties of PBUs for the assessment of TrA activity is mainly based on studies with suboptimal designs, and the findings from these studies are likely to be overly optimistic. The most important clinical questions about the measurement properties of PBUs for the assessment of TrA activity are yet to be answered.     

Instruments evaluating the quality of the clinical learning environment in nursing education: A systematic review of psychometric properties

BackgroundThe clinical learning environment is fundamental to nursing education paths, capable of affecting learning processes and outcomes. Several instruments have been developed in nursing education, aimed at evaluating the quality of the clinical learning environments; however, no systematic review of the psychometric properties and methodological quality of these studies has been performed to date.ObjectivesThe aims of the study were: 1) to identify validated instruments evaluating the clinical learning environments in nursing education; 2) to evaluate critically the methodological quality of the psychometric property estimation used; and 3) to compare psychometric properties across the instruments available.DesignA systematic review of the literature (using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines) and an evaluation of the methodological quality of psychometric properties (using the COnsensus-based Standards for the selection of health Measurement INstruments guidelines).Data sourcesThe Medline and CINAHL databases were searched. Eligible studies were those that satisfied the following criteria: a) validation studies of instruments evaluating the quality of clinical learning environments; b) in nursing education; c) published in English or Italian; d) before April 2016.Review methodsThe included studies were evaluated for the methodological quality of the psychometric properties measured and then compared in terms of both the psychometric properties and the methodological quality of the processes used.ResultsThe search strategy yielded a total of 26 studies and eight clinical learning environment evaluation instruments. A variety of psychometric properties have been estimated for each instrument, with differing qualities in the methodology used. Concept and construct validity were poorly assessed in terms of their significance and rarely judged by the target population (nursing students). Some properties were rarely considered (e.g., reliability, measurement error, criterion validity), whereas others were frequently estimated, but using different coefficients and statistical analyses (e.g., internal consistency, structural validity), thus rendering comparison across instruments difficult. Moreover, the methodological quality adopted in the property assessments was poor or fair in most studies, compromising the goodness of the psychometric values estimated.ConclusionsClinical learning placements represent the key strategies in educating the future nursing workforce: instruments evaluating the quality of the settings, as well as their capacity to promote significant learning, are strongly recommended. Studies estimating psychometric properties, using an increased quality of research methodologies are needed in order to support nursing educators in the process of clinical placements accreditation and quality improvement.     

动态系统评价简介

系统评价作为循证医学中较高等级证据,其制作方法相对成熟,但更新机制尚不完善。动态系统评价通过周期性获取临床证据,及时更新系统评价结果,能有效提高系统评价的时效性。本文从动态系统评价的产生、特点、适用情况、实施过程、应用现状等几个方面对其进行简要介绍。     

Reliability and validity of non-radiographic methods of thoracic kyphosis measurement: A systematic review

BackgroundA wide array of instruments are available for non-invasive thoracic kyphosis measurement. Guidelines for selecting outcome measures for use in clinical and research practice recommend that properties such as validity and reliability are considered. This systematic review reports on the reliability and validity of non-invasive methods for measuring thoracic kyphosis.MethodsA systematic search of 11 electronic databases located studies assessing reliability and/or validity of non-invasive thoracic kyphosis measurement techniques. Two independent reviewers used a critical appraisal tool to assess the quality of retrieved studies. Data was extracted by the primary reviewer. The results were synthesized qualitatively using a level of evidence approach.Results27 studies satisfied the eligibility criteria and were included in the review. The reliability, validity and both reliability and validity were investigated by sixteen, two and nine studies respectively. 17/27 studies were deemed to be of high quality. In total, 15 methods of thoracic kyphosis were evaluated in retrieved studies. All investigated methods showed high (ICC ≥ .7) to very high (ICC ≥ .9) levels of reliability. The validity of the methods ranged from low to very high.ConclusionThe strongest levels of evidence for reliability exists in support of the Debrunner kyphometer, Spinal Mouse and Flexicurve index, and for validity supports the arcometer and Flexicurve index. Further reliability and validity studies are required to strengthen the level of evidence for the remaining methods of measurement. This should be addressed by future research.     

Reliability of physical examination tests used in the assessment of patients with shoulder problems: a systematic review

Background

Shoulder pain is a common clinical problem, and numerous tests are used to diagnose structural pathology.

Objectives

To systematically review the reliability of physical examination procedures used in the clinical examination of patients with shoulder pain.

Data sources

MEDLINE, PEDro, AMED, PsychInfo, Cochrane Library (2009) and CINAHL were searched from the earliest record on the database to June 2009.

Study eligibility criteria

Reliability studies that included any patients with shoulder pain were analysed for their quality and reliability results.

Study appraisal and synthesis methods

Pre-established criteria were used to judge the quality of the studies (high quality >60% methods score) and satisfactory levels of reliability (kappa or intraclass correlation coefficient ≥0.85, sensitivity analysis 0.70). A qualitative synthesis was performed based on levels of evidence.

Results

Thirty-six studies were included with a mean methods score of 57%. Seventeen studies were deemed to be of high quality; high-quality studies were less likely to meet the pre-agreed level of reliability. The majority of studies indicated poor reliability for all procedures investigated.

Limitations

Overall, the evidence regarding reliability was contradictory.

Conclusions and implications

There is no consistent evidence that any examination procedure used in shoulder assessments has acceptable levels of reliability. Alternate methods of classification which are reliable should be used to classify patients with shoulder problems.     

Clinical effects of Zingiber cassumunar (Plai): A systematic review

Zingiber cassumunar Roxb. known locally as “Plai” in Thai, has been used for treating bruise, sprain and musculoskeletal pain. Several pre-clinical studies demonstrated the anti-inflammatory effect of Plai. However, current evidence of clinical effects of Plai is still unclear. This study aimed to determine the clinical efficacy and safety of Plai among all identified indications. Of the 808 articles identified by a systematic review, six studies were included. Four studies were randomized controlled trials, while two studies were quasi-experimental studies involving 178 patients in intervention group and 177 patients in control group. Duration of treatment ranged from 7 days to 2 months. Our findings showed that 14% Plai cream had a strong trend of benefits in pain reduction for muscle pain and ankle sprain. However, evidence supporting the effects of Plai on acne vulgaris treatment and anti-histamine effect are still unclear.     

Acupuncture and moxibustion for endometriosis: A systematic review and analysis

ObjectivesThis study aimed to examine the effect of acupuncture on symptoms and health-related quality of life in patients with endometriosis.MethodsNine biomedical databases were searched to April 2022 to identify randomized controlled trials of acupuncture and/or moxibustion used alone or as adjunct to guideline-recommended pharmacotherapy for the treatment of endometriosis. One reviewer extracted data and another verified the data. A random effects model was used to calculate mean differences.ResultsFifteen trials involving 1018 patients met the inclusion criteria, but diversity in comparisons and outcome measures prevented meta-analysis. Compared to sham acupuncture, manual acupuncture was more effective at reducing dysmenorrhea VAS pain score (mean difference [MD] − 2.40, 95 % CI [− 2.80, − 2.00]; moderate certainty evidence), pelvic pain VAS score (MD − 2.65, 95 % CI [− 3.40, − 1.90]; high certainty evidence) and dyspareunia VAS scores (MD − 2.88, [− 3.83, − 1.93]), lessened the size of ovarian cyst (MD − 3.88, 95 % CI [− 7.06, − 0.70]), and improved quality of life. Compared to conventional therapy, manual acupuncture plus conventional therapy and warm needle alone resulted in greater improvements in quality of life than conventional therapy. Among the six studies that reported safety, fewer adverse events were reported in participants who received acupuncture or moxibustion.ConclusionsLow to moderate certainty evidence from single studies showed that manual acupuncture may improve pain-related symptoms and quality of life; however, there is insufficient evidence on the overall effectiveness of acupuncture and moxibustion for endometriosis.     

Effect of aromatherapy on cancer complications: A systematic review

PurposeThe aim of this study was to determine the effect of aromatherapy on cancer complications.MethodsIn this systematic review, international (PubMed, Web of Science, Scopus, EMBASE and CENTRAL) and national databases (SID and Magiran) were searched from inception of the databases to April 31, 2019. JBI and Jadad scales were used to assess the quality of the studies included.Resultsof 43 Studies conducted on 3239 cancer patients in 13 countries from 1995 to 2019, entered the final stage. The results showed that the aromatherapy improves the various physical and psychological complications, although few studies have shown that aromatherapy had no effect on skin reactions.ConclusionConsidering the various complications and costs in cancer patients, it seems that the aromatherapy can be used as a proper supplemental treatment to improve complications, although further studies are needed to determine the protocol and the standard dosage.     

Does evidence support physiotherapy management of adult Complex Regional Pain Syndrome Type One? A systematic review

Objective: To source and critically evaluate the evidence on the effectiveness of Physiotherapy to manage adult CRPS‐1. Design: Systematic literature review. Methods: Electronic databases, conference proceedings, clinical guidelines and text books were searched for quantitative studies on CRPS‐1 in adults where Physiotherapy was a sole or significant component of the intervention. Data were extracted according to predefined criteria by two independent reviewers. Methodological quality was assessed using the Critical Review Form. Results: The search strategy identified 1320 potential articles. Of these, 14 articles, representing 11 studies, met inclusion criteria. There were five randomised controlled trials, one comparative study and five case series. Methodological quality was dependent on study type, with randomised controlled trials being higher in quality. Physiotherapy treatments varied between studies and were often provided in combination with medical management. This did not allow for the ‘stand‐alone’ value of Physiotherapy to be determined. Heterogeneity across the studies, with respect to participants, interventions evaluated and outcome measures used, prevented meta‐analysis. Narrative synthesis of the results, based on effect size, found there was good to very good quality level II evidence that graded motor imagery is effective in reducing pain in adults with CRPS‐1, irrespective of the outcome measure used. No evidence was found to support treatments frequently recommended in clinical guidelines, such as stress loading. Conclusions: Graded motor imagery should be used to reduce pain in adult CRPS‐1 patients. Further, the results of this review should be used to update CRPS‐1 clinical guidelines.     

Triangulation for the assessment of clinical nursing skills: A review of theory, use and methodology

Aim

To review the use and usefulness of the methodological strategy of triangulation in the assessment of skill in nursing curricula.

Design

Systematic search of the literature relevant to the definition and assessment of skill, reliability and validity of assessment methods and triangulation of assessment strategies.

Data sources

One hundred and twenty papers from nursing, medical, educational and social scientific databases, relevant websites and relevant books were reviewed. Forty papers were included based on their relevance to the theory and methodology of clinical skills assessment of health care professionals, particularly nurses. Papers concerning vocational skills assessment and the assessment of skill in school children were excluded.

Results

There is a current imperative within the field of health care professional education to assess clinical skills and to quantify this assessment. However, clinical skill, as it relates to cognition, is poorly defined concept and may be viewed as a quality of the practitioner and, as such, is difficult to quantify. Very many methods of assessing clinical skill have been documented and there are inherent issues in ensuring both reliability and validity of these assessment strategies for clinical skill. This has led commentators to suggest that the process of triangulation should be employed.

Conclusions

The paper fundamentally questions whether the concept of triangulation can be applied to skills assessment without dependable measures of reliability and validity of the tools of assessment and concludes that the process of applying multiple modes of assessment should not be confused with the process of triangulation.     

The effect of lavender on stress in individuals: A systematic review and meta-analysis

BackgroundLavender is considered as one of the medicinal plants to manage stress. Although many preliminary studies evaluated the effect of lavender on individuals’ stress level, to the best of our knowledge, we did not find a study that summarizes the results. Therefore, the present study aimed to estimate the Pooled effect of lavender on the stress level of individuals using systematic review and meta-analysis.MethodA systematic literature review based on PRISMA 2020 was performed on the SID, MagIran, Embase, PubMed, Scopus, Web of Science (WoS) databases, and Google Scholar motor engine using related MeSH/Emtree and ‎Free Text words,‎ including “Lavender*”, “Lavandula*”, “Stress*”, “Stress Disorders, Traumatic”, and “Stress, Psychological” with no time limitation until August 2021: We also searched two Iranain free local resourses including MagIran https://www.magiran.com and Scientific Information Database (SID) https://www.sid.ir. The quality assessment of studies was performed using JBI checklist. Heterogeneity among studies was quantified using I² index and Random Effects model was used to combine the data and perform the meta-analysis.ResultsIn the initial search, 1520 articles were found. After excluding the irrelevant studies, finally, 21 articles with a sample size of 791 in the intervention group and 804 in the control group were included in the meta-analysis. As a result of combining the studies, stress score after using lavender in the intervention group showed a significant decrease of 0.63 ± 0.13 (95% CI) more than that in the control group (P < 0.001). The results of subgroup analysis demonstrated that the highest standardized mean difference (SMD) before and after the intervention in the intervention group compared to the control group was related to L. angustifolia species with 0.73 ± 0.22, student groups with 2.27 ± 1.34, and diagnostic tool of Perceived Stress Scale (PSS) with 0.82 ± 0.42, indicating that the difference between the groups was statistically significant (P < 0.001).ConclusionThe pooled estimation of this systematic reiew and meta-analysis revealed that lavender significantly reduces individuals’ stress. Therefore, it seems that the use of lavender can be considered as a part of a stress management programs, especially in student groups.     

Effectiveness of yoga on arterial stiffness: A systematic review

ObjectivesArterial stiffness is a major cardiovascular (CV) risk and an independent strong predictor of CV morbidity and mortality. The aim of this systematic review is to evaluate the clinical or interventional studies that assessed the effectiveness of yoga on arterial stiffness in participants of any age or sex, healthy or with any conditions.DesignSystematic review of clinical trials or interventional studies.Data sourcesCochrane Library, Medline/PubMed, Scopus, and Google Scholar databases.Review methodsDatabases were searched till July 2019 for clinical trials or interventional studies whether controlled or uncontrolled, randomized or non-randomized studies assessing the effects of yoga on arterial stiffness. Quality of the studies was assessed by using Physiotherapy Evidence Database (PEDro) Scale.ResultsSeven full-text articles (total number of participants = 362) that evaluated the effect of yoga on arterial stiffness were included in this review. There were three randomized controlled studies and four were non-controlled studies (single group studies). Four studies have shown significant reduction in arterial stiffness, while three studies did not find any significant change in arterial stiffness. The beneficial effects of yoga intervention on arterial stiffness in young adults and elderly hypertensive patients are encouraging. Methodological quality was good for one study, moderate for two studies and poor for four studies.ConclusionsThis review shows that yoga practice is effective in preventing or reducing the arterial stiffness in young healthy and obese, and elderly hypertensive patients. As the methodology of many studies is of low quality and safety measures were not reported, there is a need of quality randomized controlled trials of yoga effects on arterial stiffness among high risk individuals.     

Effects of reflexology on child health: A systematic review

BackgroundIt is known that the parents of one of every two children who need health care seek at least one complementary health-care approach. Reflexology, which is one of these, increases well-being while maintaining the continuity of homeostasis. As studies with children are limited, there is a need for evidence that includes the positive as well as the negative effects of reflexology that can be transferred to clinical practice and recommendations for future studies.AimThe aim of this study was to examine the effects of reflexology on child health by systematically summarizing the results obtained.MethodIn this study, which was structured as a systematic review, data were obtained by scanning CINAHL, Cochrane Library, Academic Search Complete, WoS, Scopus, Science Direct, PubMed, and ProQuest. According to MeSH terminology, (zone therapy OR reflexology OR foot massage OR hand massage) AND (pediatrics OR child OR infant OR baby) were used. Randomized controlled studies (RCTs), systematic reviews, and meta-analyses conducted with a pediatric population and accessible in English and full text up to 07.08.2019 (with no time limitation) were included. Exclusion criteria for the present study included applying a massage procedure different from reflexology, the inclusion of an adult sample, or publication of the article in a predatory journal. The Cochrane guidelines (Handbook for Systematic Reviews of Interventions Version 5.2.0, 2017) were applied and the article reported on according to the PRISMA checklist.ResultsIn all six of the RCTs, which included a total of 277 infants and children, the only method used was foot reflexology. Regarding the results of nine investigated outcomes, reflexology was found to be effective in infancy for reducing pain level and regulating heart rate, for increasing oxygen saturation, for relieving infantile colic symptoms, and neonatal abstinence symptoms. Reflexology was also found to decrease spasticity and improve motor skills in children with cerebral palsy, but it failed to produce positive change in regard to constipation and quality of life. Four of the studies were performed in a nursing context, one in midwifery, and one in physiotherapy.ConclusionAs a common result of the studies conducted with different sample groups, it is possible that reflexology had positive effects on children. However, the absence of standardization related to reflexology, inadequate use of a study protocol and guidelines, the heterogeneity of the data, and the determination that half the studies were conducted with high-risk groups according to the bias analysis with RoB 2.0 indicate that it is too soon to generalize the results. Well-structured, randomized controlled double-blind trials are required.