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Recent KSR Critical Appraisals

  • 1

    Leisure-time physical activity and sciatica: a systematic review and meta-analysis

    Shiri, R. ; Falah-Hassani, K. ; Viikari-Juntura, E. ; Coggon, D.

    Risk of Bias Assessment: Unclear

    The authors had acknowledged that the selection of studies was carried out by a single reviewer and heterogeneity of clinical outcomes. No information was provided regarding the number of authors involved in the data extraction process.

    Bottom line The available evidence suggests that a moderate to high level of leisure-time physical activity reduces the risk of developing lumbar radicular pain. Appropriate efforts were not made to minimise errors in the study selection process. The authors did not state whether the data extraction was undertaken in duplicate, so reviewer error and bias could not be ruled out. The results should be interpreted cautiously due to high heterogeneity between the studies.

    Eur J Pain 2016;20(10);1563-72

  • 2

    Percutaneous endoscopic lumbar discectomy for recurrent lumbar disc herniation

    Li, X. ; Hu, Z. ; Cui, J. ; Han, Y. ; Pan, J. ; Yang, M. ; Tan, J. ; Sun, G. ; Li, L.

    Risk of Bias Assessment: Unclear

    Search terms were provided but a full search strategy was not reported, therefore it was not possible to judge if all relevant studies had been retrieved.

    Bottom line The evidence indicated that operative time, blood loss and complication rates were significantly reduced with percutaneous endoscopic lumbar discectomy in patients with recurrent lumbar disc herniation in comparison with open lumbar microdiscectomy. Whereas, the difference between the treatment groups were similar in terms of pain reduction, global perceived effect (MacNab score), re-operation and recurrence rate. Hence, percutaneous endoscopic lumbar discectomy could be used as an alternative to the conventional procedure in the treatment of recurrent lumbar disc herniation. Search terms were provided, but a full search strategy was not reported, therefore it was not possible to judge if all relevant studies had been retrieved. Further high-quality randomised controlled trials were required to address the present review question.

    Int J Surg 2016;27();8-16

  • 3

    Comparison of effects of seven treatment methods for distal radius fracture on minimizing complex regional pain syndrome

    Wang, J. H. ; Sun, T.

    Risk of Bias Assessment: High

    A restriction to the Chinese and English language means that some relevant studies may have been missed. The search terms were reported, but full details of the search strategy were not reported. No information was provided regarding the number of authors involved in the study selection process.

    Bottom line The current evidence indicates that bridging external fixation, K-wire fixation, dorsal plating, volar plating, dorsal and volar plating, plaster fixation and non-bridging external fixation can have no marked difference in risk of complex regional pain syndrome in distal radius fracture patients. A restriction to the Chinese and English language means that some relevant studies may have been missed. The search terms were reported, but full details of the search strategy were not reported. No information was provided regarding the number of authors involved in the study selection process.

    Arch Med Sci 2017;13(1);163-73

  • 4

    Can screening instruments accurately determine poor outcome risk in adults with recent onset low back pain? A systematic review and meta-analysis

    Karran, E. L. ; McAuley, J. H. ; Traeger, A. C. ; Hillier, S. L. ; Grabherr, L. ; Russek, L. N. ; Moseley, G. L.

    Risk of Bias Assessment: High

    The search terms were reported, but full details of the search strategy were not reported, so it was not possible to judge if it was appropriate. Only English language publications were eligible. Robustness of the findings was not addressed.

    Bottom line The evidence indicates that lower back pain screening instruments used in primary care perform poorly by assigning higher risk scores to individuals with chronic pain than to those who do not. Whereas risks of a poor disability outcome and prolonged absenteeism are likely to be estimated with greater accuracy. A restriction to English language studies and absence of a full search strategy means that some relevant studies might have been missed. In addition, the robustness of the findings was not demonstrated. Further studies on these screening instruments for determining risk of poor outcome in adults with lower back pain are needed to support the current findings.

    BMC Med 2017;15(1);

  • 5

    Liposomal bupivacaine infiltration at the surgical site for the management of postoperative pain

    Hamilton, Thomas W. ; Athanassoglou, Vassilis ; Mellon, Stephen ; Strickland, Louise H. ; Trivella, Marialena ; Murray, David ; Pandit, Hemant G.

    Risk of Bias Assessment: Low

    All domains were considered at low concern.

    Bottom line The evidence suggested that liposomal bupivacaine appeared to reduce postoperative pain when compared to placebo at the site of surgery. The findings were likely to be reliable. Furthermore, large randomised controlled trials on the role of liposomal bupivacaine in this area were needed to support the current findings.

    Cochrane Database Syst Rev 2017, 2, CD011419, 10.1002/14651858.CD011419.pub2

  • 6

    Fructose intake and risk of gout and hyperuricemia: a systematic review and meta-analysis of prospective cohort studies

    Jamnik, J. ; Rehman, S. ; Blanco Mejia, S. ; De Souza, R. J. ; Khan, T. A. ; Leiter, L. A. ; Wolever, T. M. S. ; Kendall, C. W. C. ; Jenkins, D. J. A. ; Sievenpiper, J. L.

    Risk of Bias Assessment: Low

    All domains were considered at low concern. The authors have already acknowledged that publication bias could not be assessed as the number of studies included was small.

    Bottom line The available evidence supports the association between fructose intake and increased risk of incidence of gout. However, there is a lack of evidence to determine the association between intake and increased risk of hyperuricemia. All domains were considered at low concern. The authors have already acknowledged that publication bias could not be assessed as the number of studies included was small. Further research with more prospective studies is needed to understand better the role of fructose and its food sources in the development of gout and hyperuricemia.

    BMJ OPEN 2016;6(10);