American Institutes for Research

KT Update

An e-newsletter from the Center on Knowledge Translation for Disability and Rehabilitation Research

Vol. 4, No. 8 - September 2016


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The contents of this newsletter were developed under grant number 90DP0027 from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this newsletter do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.

Copyright © 2016 by American Institutes for Research

Upcoming Webcast:
Finding and Using International Research Resources

September 29, 2016 POSTPONED (New date TBD)

This webcast will guide users through the expanded REHABDATA database, highlighting new features with the integration of resources originally identified through the Center for International Rehabilitation Research Information and Exchange (CIRRIE). The collection of international research abstracts from CIRRIE included more than 115,000 citations of research in disability and rehabilitation. NARIC’s Media and Information Services Manager, Jessica Chaiken, will also cover how the collection will grow moving forward and demonstrate how to stay up to date on new additions.

Register here:
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KT Conference Agenda Updated!
2016 Online KT Conference:
Communication Tools for Moving
Research to Practice

The Center on KTDRR's annual Online KT Conference is designed to address strategies in the planning and implementation of effective and efficient KT approaches. The 4th Online Conference will take place on October 24, 26, and 28, 2016. We will continue to add presentation abstracts and more details to our agenda as we get closer to the event. Check out the 2016 Conference Home Page for daily topics, presenters, the agenda, and more.


Archived Workshop Available:
Scoping Review Methods for Producing Research Syntheses

This two-part online workshop introduces disability and rehabilitation researchers to the methodology of Scoping Reviews. The first session provides a state-of-the-art overview on current approaches for conducting scoping reviews. The second session provides an in-depth presentation of the steps for conducting a scoping review, including framing the research question; evidence retrieval; study classification; assessing quality of evidence; data extraction and organization; and collating, summarizing, and reporting the results.

View the Online Workshop:

This workshop has been pre-approved for 3 CRC-CEUs through 08-29-17. In order to receive a Verification of Completion form, please watch both sessions in full and complete an evaluation.

SAVE THE DATE: April 5, 2017

The Center on KTDRR will sponsor a pre-NARRTC Conference workshop, “Communicating Science: Tools for Disability and Rehabilitation Researchers” on April 5 (12-5 p.m. Eastern). Presenters from the American Association for the Advancement of Science (AAAS) will lead an interactive workshop focusing on researcher involvement in public communication of science and how to connect with specific audiences. A special one-hour session will focus on strategic social media and online science communication. As in the past, NARRTC will co-sponsor the workshop prior to the Annual NARRTC Conference on April 6-7, 2017, Hilton Alexandria Old Town, Alexandria, VA. Watch for registration information soon!

Listing of Recent Systematic Reviews in Disability and Rehabilitation

Agostini, M., Moja, L., Banzi, R., Pistotti, V., Tonin, P., Venneri, A., & Turolla, A. (2015). Telerehabilitation and recovery of motor function: a systematic review and meta-analysis. Journal of Telemedicine and Telecare, 21(4), 202-213. doi:10.1177/1357633X15572201
Aims to determine whether telerehabilitation is more effective than other modes of delivering rehabilitation to regain motor function, in different populations of patients. Based on 12 studies involving different populations determines that there are inconclusive findings for neurological patients, while for both cardiac and total knee arthroplasty patients results in favor of telerehabilitation were found. A strong positive effect on function was found for patients following orthopedic surgery. Concludes that the increased intensity provided by telerehabilitation is a promising option to be offered to patients.

Alexanders, J., Anderson, A., & Henderson, S. (2015). Musculoskeletal physiotherapists' use of psychological interventions: a systematic review of therapists' perceptions and practice. Physiotherapy, 101(2), 95-102. doi:10.1016/
Reviews musculoskeletal physiotherapists' perceptions regarding the use of psychological interventions within physical therapy practice. Based on the findings of 6 qualitative, quantitative and mixed methodology studies finds that PTs appreciate the importance of using psychological interventions in their practice, but report inadequate understanding and consequent underutilization of these interventions.

Bochkezanian, V., Raymond, J., de Oliveira, C. Q., & Davis, G. M. (2015). Can combined aerobic and muscle strength training improve aerobic fitness, muscle strength, function and quality of life in people with spinal cord injury? A systematic review. Spinal Cord, 53(6), 418-431. doi:10.1038/sc.2015.48
Analyzes 9 studies of various design to determine whether combined aerobic training and muscle strength training is effective in improving aerobic fitness, muscle strength, function and/or quality of life (QoL) in people with spinal cord injury (SCI). 7 trials reported aerobic outcomes, of which 2 showed an improvement in aerobic fitness. 5 studies reported muscle strength outcomes, of which 4 showed an improvement on at least one outcome measure. Of 2 studies evaluating QoL, 1 found a statistically significant between-group difference. Concludes that further RCTs with larger number of participants are needed to make a definite conclusion possible.

Bullo, V., Bergamin, M., Gobbo, S., Sieverdes, J. C., Zaccaria, M., Neunhaeuserer, D., & Ermolao, A. (2015). The effects of Pilates exercise training on physical fitness and wellbeing in the elderly: A systematic review for future exercise prescription. Preventive Medicine, 75, 1-11. doi:10.1016/j.ypmed.2015.03.002
Reviews 10 studies (6 RCTs and 4 uncontrolled) of the effects of Pilates exercise training (PET) on physical fitness, balance and fall prevention in the elderly, and its effects on mood states, quality of life (QoL) and independence in ADLs. Finds large effect sizes (ESs) for muscle strength, walking and gait, ADLs, mood and QoL, a moderate to high ES for dynamic balance, and small ESs for static balance, flexibility and cardio-metabolic outcomes. Suggests that PET be prescribed as exercise for the elderly.

Carroll, M., Parmar, P., Dalbeth, N., Boocock, M., & Rome, K. (2015). Gait characteristics associated with the foot and ankle in inflammatory arthritis: a systematic review and meta-analysis. BMC Musculoskeletal Disorders, 16, 134-015-0596-0. doi:10.1186/s12891-015-0596-0
Summarizes the findings of 36 studies of gait characteristics associated with the foot and ankle in inflammatory arthritis (IA). Finds that gait patterns in rheumatoid arthritis is characterized by decreased walking speed, cadence, stride length, ankle power and increased double limb support time and peak plantar pressures at the forefoot. Walking velocity was reduced in psoriatic arthritis and gout, while there were no differences in ankylosing spondylitis. No studies were found in polymyalgia rheumatica, systemic sclerosis or systemic lupus erythematosus.

Casartelli, N. C., Leunig, M., Maffiuletti, N. A., & Bizzini, M. (2015). Return to sport after hip surgery for femoroacetabular impingement: a systematic review. British Journal of Sports Medicine, 49(12), 819-824.
Based on a review of 18 case series finds that 87% of athletes return to sport after hip surgery for femoroacetabular impingement (FAI) and 82% return to the same sport level as before FAI. Concludes that the level of competition, time of evaluation after hip surgery and presence of articular cartilage lesions at the time of surgery may influence return to sport.

Chang, W. D., Chen, F. C., Lee, C. L., Lin, H. Y., & Lai, P. T. (2015). Effects of Kinesio Taping versus McConnell Taping for Patellofemoral Pain Syndrome: A Systematic Review and Meta-Analysis. Evidence-Based Complementary and Alternative Medicine : ECAM, 2015, 471208. doi:10.1155/2015/471208
Reviews 11 papers on the effects of Kinesio taping vs McConnell taping for conservative management of patients with patellofemoral pain syndrome (PFPS). Concludes that Kinesio taping can reduce pain and increase the muscular flexibility of PFPS patients, and McConnell taping also has effects in pain relief and patellar alignment. There were small effects on pain reduction and motor function improvement and moderate effects on muscle activity of PFPS patients using Kinesio taping. Conclusions. Concludes that Kinesio taping for muscles can relieve pain but cannot change patellar alignment, unlike McConnell taping.

Chen, L., Zhang, G., Hu, M., & Liang, X. (2015). Eye movement desensitization and reprocessing versus cognitive-behavioral therapy for adult posttraumatic stress disorder: systematic review and meta-analysis. The Journal of Nervous and Mental Disease, 203(6), 443-451. doi:10.1097/NMD.0000000000000306
Summarizes 11 studies of eye movement desensitization and reprocessing (EMDR) and cognitive-behavioral therapy (CBT) for posttraumatic stress disorder (PTSD).  Finds that EMDR is slightly superior to CBT. Meta-analysis for subscale scores of PTSD symptoms indicated that EMDR was better for decreased intrusion and arousal severity, but that impact on avoidance is not significantly different.

Creemers, H., Grupstra, H., Nollet, F., van den Berg, L. H., & Beelen, A. (2015). Prognostic factors for the course of functional status of patients with ALS: a systematic review. Journal of Neurology, 262(6), 1407-1423. doi:10.1007/s00415-014-7564-8
Assesses factors predicting functional status in amyotrophic lateral sclerosis (ALS) as measured with the ALS Functional Rating Scale (ALSFRS). Finds that the prognostic value of age at onset, site of onset, time from symptom onset to diagnosis, and ALSFRS-Revised baseline score was low, while the prognostic value of initial rate of disease progression, age at diagnosis, forced vital capacity, frontotemporal dementia, body mass index, and comorbidity remains unclear. Concludes that current evidence on prognostic factors for functional decline in ALS is insufficient to allow the development of a prediction tool that can support clinical decisions.

De Groef, A., Van Kampen, M., Dieltjens, E., Christiaens, M. R., Neven, P., Geraerts, I., & Devoogdt, N. (2015). Effectiveness of postoperative physical therapy for upper-limb impairments after breast cancer treatment: a systematic review. Archives of Physical Medicine and Rehabilitation, 96(6), 1140-1153. doi:10.1016/j.apmr.2015.01.006
Based on a review of 18 RCTs of the effectiveness of various postoperative physical therapy modalities and timing of physical therapy (within 6 weeks of surgery) after treatment of breast cancer on pain and impaired range of motion (ROM) of the upper limb. 3 studies investigated the effect of multifactorial therapy, of which 2 found that the combination of general exercises and stretching is effective for the treatment of impaired ROM and 1 showed that passive mobilization combined with massage had no beneficial effects on pain and impaired ROM. Of 15 studies investigating the effectiveness of a single physical therapy modality, 1 (of poor quality) found evidence supporting the beneficial effects of passive mobilization. The only study investigating the effect of stretching did not find any beneficial effects. 5 studies found that active exercises were more effective than no therapy or information on the treatment of upper limb impairments, and 3 supported the early start of exercises for recovery of shoulder ROM, whereas 4 studies supported the delay of exercises to avoid prolonged wound healing. Concludes that multifactorial physical therapy and active exercises are effective to treat postoperative pain and impaired ROM after treatment for breast cancer.

Dewar, R., Love, S., & Johnston, L. M. (2015). Exercise interventions improve postural control in children with cerebral palsy: a systematic review. Developmental Medicine and Child Neurology, 57(6), 504-520. doi:10.1111/dmcn.12660
Summarizes 45 studies reporting on 13 exercise interventions that may improve postural control in children with cerebral palsy (CP). 5 interventions showed a moderate level of evidence: gross motor task training, hippotherapy, treadmill training with no body weight support (no-BWS), trunk-targeted training, and reactive balance training. 6 interventions had weak or conflicting evidence: functional electrical stimulation (FES), hippotherapy simulators, neurodevelopmental therapy (NDT), treadmill training with body weight support, virtual reality, and visual biofeedback. Progressive resistance exercise was an ineffective intervention, and upper limb interventions lacked high-level evidence.

Eastwood, C., Madill, C., & Mccabe, P. (2015). The behavioural treatment of muscle tension voice disorders: A systematic review. International Journal of Speech-Language Pathology, 17(3), 287-303. doi:10.3109/17549507.2015.1024169
Reviews 7 investigations behavioral intervention for the treatment of adults with muscle tension voice disorders (MTVD). Significant improvement on at least one outcome measure was reported for all studies, with small to large effect sizes. The specific "active ingredients" for therapeutic change were not identified. Concludes that there is a need for systematic and high quality research to expand the evidence base for the behavioral treatment of MTVD.

Fernandes Oliveira, E., Nacif, S. R., Alves Pereira, N., Fonseca, N. T., Urbano, J. J., Perez, E. A., . . . Oliveira, L. V. (2015). Sleep disorders in patients with myasthenia gravis: a systematic review. Journal of Physical Therapy Science, 27(6), 2013-2018. doi:10.1589/jpts.27.2013
Evaluates the presence of sleep-disordered breathing (SDB), sleep quality and sleep disorders in patients with myasthenia gravis (MG) and aims to clarify the role of physical therapy. Based on 17 observational, cross-sectional, and “clinical” studies finds that some studies show poor sleep quality, excessive daytime sleepiness, presence of restless syndrome, and a higher incidence of SDB in MG, but other investigations do no. Concludes that further study of sleep disturbances in patients with MG is needed.

Gilmore, S. J., McClelland, J. A., & Davidson, M. (2015). Physiotherapeutic interventions before and after surgery for degenerative lumbar conditions: a systematic review. Physiotherapy, 101(2), 111-118. doi:10.1016/
Identifies only 4 studies of physical therapy management of patients immediately following lumbar spinal surgery.  Finds that there is very low quality evidence that pre- and post-operative exercise in addition to standard PT may reduce pain, time taken to achieve post-operative functional milestones, and post-operative time off work. Results of 1 study indicated that there is no clear benefit or harm from performing either prone or side-lying transfers.

Groah, S. L., Schladen, M., Pineda, C. G., & Hsieh, C. H. (2015). Prevention of Pressure Ulcers Among People With Spinal Cord Injury: A Systematic Review. PM & R: The Journal of Injury, Function, and Rehabilitation, 7(6), 613-636. doi:10.1016/j.pmrj.2014.11.014
Evaluates the effectiveness of bed and wheelchair positioning and repositioning as well as pressure relief maneuvers for the prevention of pressure ulcers (PUs) in both the spinal cord injury (SCI) and non-SCI populations. Finds, in 49 studies, conflicting results and insufficient evidence for optimal bed and seated positioning and turning and pressure relief maneuvers to prevent PUs. Cites evidence that suggests avoiding the 90 degrees lateral position because of high pressures and PU risk over the trochanters, and that reclining during sitting carries an increased risk of shear forces on the skin. Concludes that the current evidence does not support definite guidelines on positioning or repositioning techniques for PU prevention in bed or during sitting, and that PU risk is highly individualized.

Heapy, A. A., Higgins, D. M., Cervone, D., Wandner, L., Fenton, B. T., & Kerns, R. D. (2015). A Systematic Review of Technology-assisted Self-Management Interventions for Chronic Pain: Looking Across Treatment Modalities. The Clinical Journal of Pain, 31(6), 470-492. doi:10.1097/AJP.0000000000000185
Examines evidence (44 studies) for 3 technology-assisted treatment modalities for chronic pain: telephone, interactive voice response, and internet. Finds that technology-assisted psychological interventions are efficacious for improving self-management of chronic pain in adults, with none of the 3 being clearly superior. Concludes that future research should focus on direct comparisons of these technology-assisted interventions with in-person treatment, as well as on head-to-head comparisons of the various technology-assisted modalities.

Kelley, G. A., & Kelley, K. S. (2015). Meditative Movement Therapies and Health-Related Quality-of-Life in Adults: A Systematic Review of Meta-Analyses. PloS One, 10(6), e0129181. doi:10.1371/journal.pone.0129181
Reviews systematically existing meta-analyses of the effects of meditative movement therapies (yoga, tai chi and qigong) on health-related quality of life (HRQoL) in adults. In the 10 meta-analyses identified, the majority of results (79%) favored statistically significant improvements in HRQoL, with standardized mean differences between 0.18 and 2.28 and a number needed to treat varying between 2 and 10. Concludes that meditative movement therapies may improve HRQoL in adults with selected conditions, yet argues that a need exists for a large, more inclusive meta-analysis.

Lepard, M. G., Joseph, A. L., Agne, A. A., & Cherrington, A. L. (2015). Diabetes self-management interventions for adults with type 2 diabetes living in rural areas: a systematic literature review. Current Diabetes Reports, 15(6), 608-015-0608-3. doi:10.1007/s11892-015-0608-3
Reviews 15 studies (10 RCTs) of the impact of diabetes self-management education interventions for patients living in rural areas, on their glycemic control and other diabetes outcomes. Intervention strategies included in-person diabetes (n = 9) and telehealth (n = 6) interventions. Four investigations showed between-group differences on biologic outcomes, 4 found changes in behavior, and 3 changes in knowledge. Intervention dose was associated with improved A1c or weight loss in 2 and with session attendance in 1. Interventions that included collaborative goal-setting were associated with improved metabolic outcomes and self-efficacy. Concludes that telehealth and face-to-face diabetes interventions are promising strategies for rural communities.

Levinger, I., Shaw, C. S., Stepto, N. K., Cassar, S., McAinch, A. J., Cheetham, C., & Maiorana, A. J. (2015). What Doesn't Kill You Makes You Fitter: A Systematic Review of High-Intensity Interval Exercise for Patients with Cardiovascular and Metabolic Diseases. Clinical Medicine Insights Cardiology, 9, 53-63. doi:10.4137/CMC.S26230
Examines the impact of high-intensity interval exercise (HIIE) (>/=80% peak power output or >/=85% peak aerobic power, VO2peak) on patients with cardiovascular and metabolic diseases, including the safety of the acute response (during or shortly after exercise). Finds 11 studies, with 13 adverse responses reported (~8% of individuals). Concludes that the rate of adverse responses is somewhat higher than the risk during/after moderate-intensity exercise as previously reported, and that caution must be taken when prescribing HIIE to patients with cardiometabolic disease.

Lewis, Z. H., Lyons, E. J., Jarvis, J. M., & Baillargeon, J. (2015). Using an electronic activity monitor system as an intervention modality: A systematic review. BMC Public Health, 15, 585-015-1947-3. doi:10.1186/s12889-015-1947-3
Aims to synthesize the efficacy and feasibility results of electronic activity monitor systems (EAMSs) as reported in 11 studies. Significant pre-post improvements in the EAMS group were found in 5 of 9 studies for physical activity and in 4 of 5 studies for weight. Of controlled studies, 1 found a significant increase in physical activity and 2 significant weight loss in the intervention group compared with the comparator group. Most studies report continual wear of the device during waking hours and a higher retention rate of participants in the EAMS groups. Concludes that EAMSs can increase physical activity and decrease weight significantly, but their efficacy compared to other interventions has not yet been demonstrated.

Littlewood, C., Malliaras, P., & Chance-Larsen, K. (2015). Therapeutic exercise for rotator cuff tendinopathy: a systematic review of contextual factors and prescription parameters. International Journal of Rehabilitation Research, 38(2), 95-106. doi:10.1097/MRR.0000000000000113
Systematically reviews the contextual factors and prescription parameters of exercise programs for rotator cuff tendinopathy as reported in 14 studies, which suggested that these programs are widely applicable and can be successfully designed by PTs with varying experience. Notes that exercise completion at home or in the clinic does not seem to make a difference, nor does pain production vs. avoidance. Remarks that inclusion of some level of resistance does seem to matter, but that the optimal level and number of repetitions is unclear, although there are suggestions that 3 sets of exercise are better than 1 or 2.

Marshall, Z., Dechman, M. K., Minichiello, A., Alcock, L., & Harris, G. E. (2015). Peering into the literature: A systematic review of the roles of people who inject drugs in harm reduction initiatives. Drug and Alcohol Dependence, 151, 1-14. doi:10.1016/j.drugalcdep.2015.03.002
Reviews the peer reviewed 127 papers) and grey (39) literature on the role people who inject drugs can play in the development of harm reduction initiatives as peer workers, peer helpers, or natural helpers. Concludes that research on harm reduction programs that involve people with lived experience can help understand these approaches and demonstrate their value. Claims that the current evidence provides good descriptive content but that the field lacks consensus on approaches to documenting the ways peers contribute to harm reduction initiatives.

Meneses-Echavez, J. F., Gonzalez-Jimenez, E., & Ramirez-Velez, R. (2015). Effects of Supervised Multimodal Exercise Interventions on Cancer-Related Fatigue: Systematic Review and Meta-Analysis of Randomized Controlled Trials. BioMed Research International, 2015, 328636.  doi:10.1155/2015/328636
Meta-analyzes 9 studies of supervised multimodal exercise interventions for cancer-related fatigue (CRF). Finds that multimodal interventions including aerobic exercise, resistance training, and stretching improved CRF symptoms, including in patients undergoing chemotherapy. Nonsignificant differences were found for resistance training interventions. Concludes that these exercise protocols should be included as a key part of rehabilitation programs for cancer survivors and patients undergoing anticancer treatments.

Menlove, L., Crayton, E., Kneebone, I., Allen-Crooks, R., Otto, E., & Harder, H. (2015). Predictors of anxiety after stroke: a systematic review of observational studies. Journal of Stroke and Cerebrovascular Diseases: The Official Journal of National Stroke Association, 24(6), 1107-1117. doi:10.1016/j.jstrokecerebrovasdis.2014.12.036
Based on a review of 18 studies concludes that prestroke depression, stroke severity, early anxiety, and dementia or cognitive impairment after stroke are the main predictors of poststroke anxiety. Older age, physical disability or impairment, and use of antidepressant drugs were not associated with anxiety.

Nugteren, W., van der Zalm, Y., Hafsteinsdottir, T. B., van der Venne, C., Kool, N., & van Meijel, B. (2015). Experiences of Patients in Acute and Closed Psychiatric Wards: A Systematic Review. Perspectives in Psychiatric Care. doi:10.1111/ppc.12125
Reviews 10 papers on patients' experiences during treatment in an acute, closed psychiatric ward. Finds 4 main themes: (a) inappropriate use of the ward rules, (b) nurses' lack of time for interacting with patients, (c) feelings of humiliation, and (d) involvement of significant others. Claims that nurses can use the findings to improve quality of care in acute psychiatric units.

O'Connor, S. R., Tully, M. A., Ryan, B., Bradley, J. M., Baxter, G. D., & McDonough, S. M. (2015). Failure of a numerical quality assessment scale to identify potential risk of bias in a systematic review: a comparison study. BMC Research Notes, 8, 224-015-1181-1. doi:10.1186/s13104-015-1181-1
Compares assessments of the methodological quality of primary studies (20 randomized and quasi-randomized controlled trials examining an exercise intervention for chronic musculoskeletal pain) using a domain-based system, that of the United States Preventative Services Task Force (USPSTF)] vs. that of the Downs and Black (D&B) numerical rating scale.  Finds substantial levels of inter-rater reliability agreement for the USPSTF system and the Downs and Black scale. The overall level of agreement between the tools was also good. However, the USPSTF system identified 3 of 20 studies as "poor" due to potential risks of bias, which indeed had greater pooled effect sizes than the studies rated "fair" or "good". Concludes that the D&B fails to identify studies at increased risk of bias, and can lead to imprecise estimates of treatment effect.

Outermans, J., van de Port, I., Wittink, H., de Groot, J., & Kwakkel, G. (2015). How strongly is aerobic capacity correlated with walking speed and distance after stroke? Systematic review and meta-analysis. Physical Therapy, 95(6), 835-853. doi:10.2522/ptj.20140081
Summarizes the evidence on the correlation between Vo(2)peak and walking capacity after stroke offered by 13 studies involving 454 participants. Meta-analyses showed combined correlation coefficients for Vo(2)peak and walking speed and for Vo(2)peak and walking distance of .42 and .52, respectively. Concludes that factors other than Vo(2)peak determine walking capacity after stroke.

Pinnock, H., Epiphaniou, E., Pearce, G., Parke, H., Greenhalgh, T., Sheikh, A., . . . Taylor, S. J. (2015). Implementing supported self-management for asthma: a systematic review and suggested hierarchy of evidence of implementation studies. BMC Medicine, 13, 127-015-0361-0. doi:10.1186/s12916-015-0361-0
Conducts a narrative synthesis studies of self-management support interventions, informed by Kennedy's whole systems theoretical approach (considering patient, practitioner and organizational components and the interaction between these). Based on 18 studies with varying designs finds that targeting professionals (2 studies) improved process, but had no clinically significant effect on clinical outcomes. Targeting patients (6 studies) improved some process measures, but had an inconsistent impact on clinical outcomes. Targeting the organization (3 papers) improved process measures, but had little effect on clinical outcomes. However, interventions that explicitly addressed patient, professional and organizational factors (7 studies) showed the most consistent improvement in both process and clinical outcomes. Concludes that using these multi-targeted interventions we can promote a culture of actively supporting self-management as a normal, expected, monitored and remunerated aspect of the provision of care.

Porto, E. F., Castro, A. A., Schmidt, V. G., Rabelo, H. M., Kumpel, C., Nascimento, O. A., & Jardim, J. R. (2015). Postural control in chronic obstructive pulmonary disease: a systematic review. International Journal of Chronic Obstructive Pulmonary Disease, 10, 1233-1239. doi:10.2147/COPD.S63955
Evaluates whether impaired postural control is more prevalent in COPD patients than in healthy age-matched controls, and the main characteristics the patients present that contribute to impaired postural control. Of 7 studies (of which 1 with a control group) allowed the conclusion that patients with COPD present postural control impairment when compared with their age-matched healthy peers. Muscle weakness, physical inactivity, higher age, need for supplemental oxygen, and limited mobility contribute to impaired postural control.

Reiman, M. P., Goode, A. P., Cook, C. E., Holmich, P., & Thorborg, K. (2015). Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: a systematic review with meta-analysis. British Journal of Sports Medicine, 49(12), 811-2014-094302. doi:10.1136/bjsports-2014-094302
Summarizes and evaluates (using the QUADAS-2 tool) the diagnostic accuracy of various clinical tests of hip femoroacetabular impingement/ acetabular labral tear (FAI/ALT) as reported in 9 studies. Meta-analysis showed that flexion-adduction-internal rotation and flexion-internal rotation tests possess only screening accuracy. Concludes that more and high-quality studies across a wider spectrum of hip pathology patients are needed to establish the clinical utility of these tests.

Sanchis, M. N., Lluch, E., Nijs, J., Struyf, F., & Kangasperko, M. (2015). The role of central sensitization in shoulder pain: A systematic literature review. Seminars in Arthritis and Rheumatism, 44(6), 710-716. doi:10.1016/j.semarthrit.2014.11.002
Evaluates the evidence for the presence of central sensitization in patients with unilateral shoulder pain of different etiologies, including those with chronic subacromial impingement syndrome. Studies addressing neuropathic pain were not considered. Based on 10 cross-sectional (case-control) or longitudinal studies finds that different subjective and objective parameters, considered manifestations of central sensitization, are established in these patients. Suggests that, although peripheral mechanisms are involved, hypersensitivity of the central nervous system plays a role in a subgroup within the shoulder pain population.

Saquetto, M., Carvalho, V., Silva, C., Conceicao, C., & Gomes-Neto, M. (2015). The effects of whole body vibration on mobility and balance in children with cerebral palsy: a systematic review with meta-analysis. Journal of Musculoskeletal & Neuronal Interactions, 15(2), 137-144.
Reviews evidence for the effects of whole-body vibration (WBV) on physiologic and functional outcomes of children with cerebral palsy (CP). Based on 6 studies (176 patients) comparing WBV to exercise and/or control finds that WBV results in improvement in gait speed, gross motor function dimension E and femur bone density. Meta-analysis also showed a nonsignificant difference in muscle strength and gross motor function dimension D. Concludes that WBV could be considered for inclusion in rehabilitation programs.

Smith, M. E., Haney, E., McDonagh, M., Pappas, M., Daeges, M., Wasson, N.,…Nelson, H. D. (2015). Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop. Annals of Internal Medicine, 162(12), 841-850.  doi:10.7326/M15-0114
Aims to determine benefits and harms of treatments for adults with myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS). Among 35 treatment trials 2 found that rintatolimod improved some measures of exercise performance compared with placebo (low strength of evidence). Trials of galantamine, hydrocortisone, IgG, valganciclovir, isoprinosine, fluoxetine, and various complementary medicines were inconclusive (insufficient evidence). Counseling therapies and graded exercise therapy compared with no treatment, relaxation, or support improved fatigue, function, global improvement, and work impairment in some trials; counseling therapies also improved quality of life (low to moderate strength of evidence). Harms were rarely reported across studies (insufficient evidence).

Street, T. D., & Lacey, S. J. (2015). A systematic review of studies identifying predictors of poor return to work outcomes following workplace injury. Work (Reading, Mass.), 51(2), 373-381. doi:10.3233/WOR-141980
Evaluates evidence on the injury, demographic and psychosocial characteristics associated with extended absenteeism from the workforce due to a workplace injury. Older age, female gender, divorced marital status, two or more dependent family members, lower education levels, reduced labor market desirability of the job, severity or sensitive injury locations, negative attitudes and outcome perceptions of the participant were found to be predictors of poor return to work rates.

Swanson, L. R., & Whittinghill, D. M. (2015). Intrinsic or Extrinsic? Using Videogames to Motivate Stroke Survivors: A Systematic Review. Games for Health Journal, 4(3), 253-258. doi:10.1089/g4h.2014.0074
Explores the effectiveness of videogame-based rehabilitation interventions on the motivation and health outcomes of stroke patients. Three motivational frameworks and principles were used in the 18 studies identified: self-determination theory, flow theory, and operant conditioning. Finds that videogame-based interventions likely are effective at improving a variety of health-related outcomes, including motor functioning, energy expenditure, muscle strength, and recovery time.

Teo, K., & Slark, J. (2015). A systematic review of studies investigating the care of stroke survivors in long-term care facilities. Disability and Rehabilitation, 1-9. doi:10.3109/09638288.2015.1059496
Aims to integrate the existing knowledge from the literature and elucidate themes around the care of stroke survivors in long-term care (LTC) facilities. In 22 articles (5 interventional and 17 observational), three themes were identified: rehabilitation, stroke specific care and secondary stroke drug prevention. These were found to be lacking within LTC facilities. Also finds that there is a shortage of interventional studies of stroke survivors in LTC facilities. Concludes that stroke survivors, who make up almost a quarter of residents in LTC facilities, suffer from functional impairments and many other disabilities as a result of more severe stroke, precluding them from living in their own homes. Rehabilitation, stroke-specific care and secondary stroke prevention for stroke survivors are lacking in these facilities despite strong evidence showing benefits for these interventions in stroke survivors living in the community.

Thorborg, K., Tijssen, M., Habets, B., Bartels, E. M., Roos, E. M., Kemp, J., . . . Holmich, P. (2015). Patient-Reported Outcome (PRO) questionnaires for young to middle-aged adults with hip and groin disability: a systematic review of the clinimetric evidence. British Journal of Sports Medicine, 49(12), 812-2014-094224. doi:10.1136/bjsports-2014-094224
Evaluates the methodological quality Patient-Reported Outcome (PRO) questionnaires to measure hip and groin disability in young and middle-aged adults using the COnsensus-based Standards for the selection of health Measurement INstruments list (COSMIN). Finds 20 studies using 9 different questionnaires for hip disability, and 1 for hip and groin disability. Finds that these studies reported key aspects of the COSMIN checklist for these PROs: Hip And Groin Outcome Score (HAGOS), Hip Outcome Score (HOS), International Hip Outcome Tool-12 (IHOT-12) and IHOT-33 and all contain adequate measurement qualities for content validity (except HOS), test-retest reliability, construct validity, responsiveness and interpretability. Concludes that HAGOS, HOS, IHOT-12 and IHOT-33 can be recommended for assessment of hip joint-related disability in these age groups, undergoing non-surgical treatment or hip arthroscopy. HAGOS is the only PRO for groin pain.

Vados, L., Ferreira, A., Zhao, S., Vercelino, R., & Wang, S. (2015). Effectiveness of acupuncture combined with rehabilitation for treatment of acute or subacute stroke: a systematic review. Acupuncture in Medicine: Journal of the British Medical Acupuncture Society, 33(3), 180-187. doi:10.1136/acupmed-2014-010705
Compares outcomes of rehabilitation combined with acupuncture vs rehabilitation alone in acute and subacute stroke. Of 17 trials, 14 had results favorable to acupuncture combined with rehabilitation. Concludes that acupuncture in combination with rehabilitation may have benefits for the treatment of acute and subacute stroke sequelae, even though many of the studies were at risk of bias.

van Loon, E. M., Heijenbrok-Kal, M. H., van Loon, W. S., van den Bent, M. J., Vincent, A. J., de Koning, I., & Ribbers, G. M. (2015). Assessment methods and prevalence of cognitive dysfunction in patients with low-grade glioma: A systematic review. Journal of Rehabilitation Medicine, 47(6), 481-488. doi:10.2340/16501977-1975
Reviews the literature on cognitive functioning in patients with low-grade glioma to evaluate assessment methods and prevalence of cognitive dysfunction. Finds that 17 relevant studies used 46 different instruments to assess cognitive functioning, and that there was variability in the definition of cognitive dysfunction. Likely as a consequence, the reported prevalence of cognitive dysfunction ranged from 19% to 83%.

Vemulapalli, S., Dolor, R. J., Hasselblad, V., Schmit, K., Banks, A., Heidenfelder, B., . . . Jones, W. S. (2015). Supervised vs unsupervised exercise for intermittent claudication: A systematic review and meta-analysis. American Heart Journal, 169(6), 924-937.e3. doi:10.1016/j.ahj.2015.03.009
Investigates the comparative effectiveness of supervised exercise (SE) vs unsupervised exercise (UE) as treatment for intermittent claudication (IC). Finds that in 27 studies (including 24 RCTs) SE was associated with a moderate improvement in maximal walking distance at 6 months and 12 months. SE also improved claudication distance to a moderate extent compared with UE at 6 months and 12 months. There was no difference in the Short Form-36 quality of life at 6 months or walking impairment questionnaire distance or speed. Concludes that further studies are needed to investigate the relationship between functional gain and disease-specific quality of life.

Listing of Recent Papers on Methodology of
Systematic Reviewing and Meta-Analysis

Alonso-Coello, P., Carrasco-Labra, A., Brignardello-Petersen, R., Neumann, I., Akl, E. A., Vernooij, R. W.,…Guyatt, G. H. (2016). Systematic reviews experience major limitations in reporting absolute effects. Journal of Clinical Epidemiology, 72, 16-26. doi:10.1016/j.jclinepi.2015.11.002
Reviews 202 Cochrane and non-Cochrane systematic reviews (SRs) to assess the methods used for calculating absolute effect estimates. Finds that most SRs do not report absolute effects, and that those that do often report them inadequately, which forces users of SRs to generate their own estimates of absolute effects. Claims that for any apparently effective or harmful intervention, SR authors should report both absolute and relative estimates to make their findings optimally useful.

Booth, A. (2016). Searching for qualitative research for inclusion in systematic reviews: a structured methodological review. Systematic Reviews, 5(1), 74-016-0249-x. doi:10.1186/s13643-016-0249-x
Argues that qualitative evidence syntheses (QES) are increasingly recognized as a way to enhance the value of systematic reviews (SRs) of clinical trials, by explaining the mechanisms by which interventions might achieve their effect. QES also can be used to investigate differences in effects between different population groups, and to identify which outcomes are most important to patients, carers and other stakeholders. Based on primary papers, offers a review of QES methodology in eight domains: overviews and methodological guidance, sampling, sources, structured questions, search procedures, search strategies and filters, supplementary strategies and standards. Concludes that poor empirical evidence underpins current information practice in information retrieval of qualitative research.

Bryce, S., Sloan, E., Lee, S., Ponsford, J., & Rossell, S. (2016). Cognitive remediation in schizophrenia: A methodological appraisal of systematic reviews and meta-analyses. Journal of Psychiatric Research, 75, 91-106. doi:10.1016/j.jpsychires.2016.01.004
Reviews 21 systematic reviews (SRs) of cognitive remediation in schizophrenia. Finds “consistent areas of potential weakness” in most reviews, including: lack of protocol registration, uncertainty regarding independent data extraction and consensus procedures, and the minimal assessment of publication bias. Argues that the quality of SRs in this area needs to be improved in order for this research literature to be interpreted with confidence.

Burda, B. U., Holmer, H. K., & Norris, S. L. (2016). Limitations of A Measurement Tool to Assess Systematic Reviews (AMSTAR) and suggestions for improvement. Systematic Reviews, 5(1), 58-016-0237-1. doi:10.1186/s13643-016-0237-1
Based on their own and others experience with the tool, offers suggestions for improving utility, validity and reliability A Measurement Tool to Assess Systematic Reviews (AMSTAR): modify a number of individual items and their instructions to make them more congruent with assessment of the methodologic quality of systematic reviews; add new items and modify existing ones to assess the quality of the body of evidence and to address subgroup and sensitivity analyses; provide more detailed instructions for scoring individual items.

Fischer, F., Lange, K., Klose, K., Greiner, W., & Kraemer, A. (2016). Barriers and Strategies in Guideline Implementation-A Scoping Review. Healthcare (Basel, Switzerland), 4(3), 10.3390/healthcare4030036. doi:10.3390/healthcare4030036
Based on 69 articles, this scoping review aims to categorize the most important barriers (personal factors, guideline-related factors, and external factors) to guideline implementation, as well as different strategies tailored to overcome them (dissemination, education and training, social interaction, decision support systems and standing orders). Concludes that a structured implementation can improve adherence to guidelines.

Gates, N. J., & March, E. G. (2016). A Neuropsychologist's Guide To Undertaking a Systematic Review for Publication: Making the most of PRISMA Guidelines. Neuropsychology Review, 26(2), 109-120. doi:10.1007/s11065-016-9318-0
Aims to guide researchers through the iterative systematic review process in order to improve quality and thereby increase publication rates. Provides a road map through the EQUATOR network and offers suggestions to meet Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Howard, B. E., Phillips, J., Miller, K., Tandon, A., Mav, D., Shah, M. R.,…Thayer, K. (2016). SWIFT-Review: a text-mining workbench for systematic review. Systematic Reviews, 5(1), 87-016-0263-z. doi:10.1186/s13643-016-0263-z
Based on 15 existing data sets assesses the performance of the SWIFT-Review priority ranking algorithm for identifying studies relevant to a given research question, and explores the use of SWIFT-Review during problem formulation to identify, categorize, and visualize research areas that are data rich/data poor within a large literature corpus. Finds that using machine learning to triage documents for screening has the potential to save, on average, more than 50 % of the screening effort ordinarily required. Concludes that text-mining and machine learning software can be valuable tools to reduce the human screening burden and assist in problem formulation.

Jorgensen, L., Paludan-Muller, A. S., Laursen, D. R., Savovic, J., Boutron, I., Sterne, J. A.,… Hrobjartsson, A. (2016). Evaluation of the Cochrane tool for assessing risk of bias in randomized clinical trials: overview of published comments and analysis of user practice in Cochrane and non-Cochrane reviews. Systematic Reviews, 5(1), 80-016-0259-8. doi:10.1186/s13643-016-0259-8
Reviews 68 published comments of Cochrane tool for assessing risk of bias in randomized clinical trials (CTAR-RCT) and offers a study of 100 Cochrane and 100 non-Cochrane reviews use the tool. Finds that the published challenges of CTAR-RCT were mainly its choice of core bias domains and issues to do with implementation and terminology. Finds that CTAR-RCT was used in all Cochrane reviews and 31% of non-Cochrane reviews, but that both frequently implemented the tool in non-recommended ways. Calls for further improvement of the tool by a revised structure and more focused guidance.

Kahwati, L., Jacobs, S., Kane, H., Lewis, M., Viswanathan, M., & Golin, C. E. (2016). Using qualitative comparative analysis in a systematic review of a complex intervention. Systematic Reviews, 5(1), 82-016-0256-y. doi:10.1186/s13643-016-0256-y
Describes and evaluates qualitative comparative analysis (QCA) as a potential method to complement traditional evidence synthesis in reviews of complex interventions to identify key intervention components or implementation features that might explain effectiveness or ineffectiveness. A first analysis seeks to identify combinations of nine behavior change techniques (BCTs) found among effective interventions, and the second seeks to identify combinations of five implementation features (agent, target, mode, time span, exposure) found among effective interventions. Aims to use QCA to identify necessary and/or sufficient combinations of BCTs and implementation features found in effective interventions. Finds QCA suitable for use within a systematic review of medication adherence interventions, but states that more use of QCA is needed to determine the optimal way to efficiently integrate it into existing approaches to evidence synthesis of complex interventions.

Kelly, S. E., Moher, D., & Clifford, T. J. (2016). Quality of conduct and reporting in rapid reviews: an exploration of compliance with PRISMA and AMSTAR guidelines. Systematic Reviews, 5(1), 79-016-0258-9. doi:10.1186/s13643-016-0258-9
Evaluates the quality of conduct and reporting of 66 heterogeneous rapid reviews using the A Measurement Tool to Assess Systematic Reviews (AMSTAR) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklists. Compliance with each checklist item was examined, and the sum of adequately reported items was used to describe overall compliance. Rapid reviews were stratified to explore differences in compliance related to publication status. The association between compliance and time to completion or length of publication was explored through univariate regression. Finds that most reviews scored poorly on AMSTAR and PRISMA. Claims that further research is needed to explore reporting and conduct guidelines specific to rapid reviews.

Page, M. J., Shamseer, L., Altman, D. G., Tetzlaff, J., Sampson, M., Tricco, A. C.,…Moher, D. (2016). Epidemiology and Reporting Characteristics of Systematic Reviews of Biomedical Research: A Cross-Sectional Study. PLoS Medicine, 13(5), e1002028. doi:10.1371/journal.pmed.1002028
Reviews the quality of a random sample of 300 systematic reviews (SRs) published in 2014, and compares the results with those of a 2004 sample. Finds that a study risk of bias/quality assessment was performed in 70% but was rarely incorporated into the analysis (16%). Few SRs (7%) searched for unpublished studies, and the risk of publication bias was considered in less than 50%. Reporting quality is judged highly variable, with Cochrane SRs having more complete reporting. Concludes that reporting has generally improved since 2004, but remains suboptimal for many characteristics.

Paynter, R., Banez, L. L., Berliner, E., Erinoff, E., Lege-Matsuura, J., Potter, S., & Uhl, S. (2016). EPC Methods: An Exploration of the Use of Text-Mining Software in Systematic Reviews. Rockville (MD): Agency for Healthcare Research and Quality (US); Report No.: 16-EHC023-EF. doi:NBK362044
Summarizes research (122 articles) on the use of text-mining tools within the systematic review context, and reports on telephone interviews with Key Informants in this area. Provides a list of 121 text-mining tools in use or proposed for systematic review methods and evaluates the tools using an informal descriptive appraisal tool. Concludes that a number outstanding questions remain for future empirical research to address regarding the reliability and validity of using this technology across a variety of review processes and whether these generalize across the scope of review topics.

Tricco, A. C., Antony, J., Soobiah, C., Kastner, M., Cogo, E., MacDonald, H.,…Straus, S. E. (2016). Knowledge synthesis methods for generating or refining theory: a scoping review reveals that little guidance is available. Journal of Clinical Epidemiology, 73, 36-42. doi:10.1016/j.jclinepi.2015.11.021
Based on 287 papers, describes and compares 9 emerging knowledge synthesis methods (concept synthesis, critical interpretive synthesis, integrative review, meta-ethnography, meta-interpretation, meta-study, meta-synthesis, narrative synthesis, and realist review) for generating and refining theory, in terms of expertise required, similarities, differences, strengths, limitations, and steps involved in using the method. Concludes that in this literature guidance for conducting the steps was often vague and sometimes absent, and that further work is needed on operationalizing these methods.

Tricco, A. C., Soobiah, C., Antony, J., Cogo, E., MacDonald, H., Lillie, E.,…Kastner, M. (2016). A scoping review identifies multiple emerging knowledge synthesis methods, but few studies operationalize the method. Journal of Clinical Epidemiology, 73, 19-28. doi:10.1016/j.jclinepi.2015.08.030
Reports on 25 knowledge synthesis methods described or used in 66 methodological articles, mostly published after 2005, and typically used in the fields of nursing, health care science and services, and health policy. Concludes that there is a lack of guidance on how to select a knowledge synthesis method.

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