Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 14 appraisals
The Knee
Artificial intelligence in the management of sports knee injuries: a narrative review.
INTRODUCTION: Sports-related knee injuries are common and debilitating, often leading to chronic pain, early osteoarthritis, and reduced performance. Artificial Intelligence (AI) has emerged as a promising tool to improve their prevention, diagnosis, prognosis, and rehabilitation. This review summarises current evidence on the clinical applications, limitations, and future directions of AI and machine learning in sports-related knee injuries. METHODS: A narrative review of PubMed, Embase, Medline and Web of Science was conducted, examining recent literature on AI-based models in musculoskeletal and sports medicine. The review was categorised into key domains: injury prediction and prevention, diagnostic imaging performance, AI-enabled clinical workflows, alongside postoperative and rehabilitation outcome modelling. RESULTS: AI algorithms demonstrate strong potential across the sports knee injury continuum. Predictive models analysing biomechanical and physiological data have achieved high area under the curve (AUC) values, in some cases above 0.90, in experimental and pilot setting when identifying athletes at risk of ACL rupture or overuse injuries, while machine learning approaches have been used to predict graft failure, revision surgery, and return-to-sport. However, most remain investigational rather than clinically deployable, with limited explainability, insufficient external validation, and training datasets that are often narrow or unrepresentative of broader athletic populations. CONCLUSION: AI has the potential to transform the management of sports-related knee injuries through more predictive, personalised, and precise care. However, wider clinical adoption will require multicentre validation, improved interpretability, and robust ethical and regulatory oversight. With further development, AI may enhance injury prevention, recovery, and improve long-term joint health outcomes in athletes.
3 Aug 2026
Read appraisal →Archives of orthopaedic and trauma surgery
Shoulder injuries in rugby union: a systematic review and meta-analysis
Shoulder injuries are common in Rugby Union, resulting in prolonged absence and considerable burden. Reported incidence, severity, and mechanisms vary widely, reflecting the multiple high-impact actions in the sport. Various management approaches exist to treat a wide range of pathologies. This systematic review and meta-analysis aimed to synthesise evidence on the epidemiology, mechanisms, and treatment of shoulder injuries in rugby. PUBMED, SCOPUS, and WEB OF SCIENCE were searched from database inception until 1st June 2025. From 1,099 abstracts screened, 37 studies were included. The pooled match incidence was 11.02 injuries/1,000 player-hours (95% CI 7.23-16.82), though heterogeneity was very high (I² = 97%) and the 95% prediction interval was wide (2.11-57.61 injuries/1,000 player-hours), indicating the pooled rate should be read as an average across diverse populations rather than a single representative value. Higher rates were seen in male elite (13.74/1,000 h) and high school/university players (12.28/1,000 h). Training incidence was considerably lower (0.20/1,000 h). Substantial between-study heterogeneity was observed across all incidence analyses, reflecting genuine variation across playing levels, sex, and surveillance methods. Tackling was the predominant injury mechanism, most often affecting the tackler. Bankart, Latarjet, and Bristow procedures all produced favourable reported outcomes for surgical management of anterior shoulder instability. These were indirect comparisons drawn from observational cohorts, however, and comparative effectiveness between techniques cannot be determined from the available evidence. Shoulder injuries in rugby occur far more often in matches than in training, result in prolonged time loss, and are most sustained in tackling. Surgical stabilisation is associated with favourable reported outcomes, though the comparative findings should be regarded as hypothesis-generating, and high-quality comparative studies are warranted. Greater attention to prevention, improved reporting of mechanisms, and focused research on female players should be prioritised.
31 July 2026
Read appraisal →JMIR mHealth and uHealth
Perceptions of Adults Aged 50 Years and Older Regarding the Use of Wearable mHealth Technologies to Promote Physical Activity: Systematic Review and Meta-Ethnography
BACKGROUND: Despite advances in wearable mobile health (mHealth) technologies and their associated apps designed to promote physical activity, and the importance of adapting them to users, little is known about older adults' perceptions of these technologies. OBJECTIVE: This review aimed to synthesize and analyze qualitative evidence exploring the perceptions of adults aged 50 years and older regarding areas to improve, barriers to, and facilitators of wearable mHealth technologies (activity trackers and companion apps) to promote physical activity. METHODS: A qualitative systematic review and meta-ethnography was conducted. Comprehensive searches were performed across 8 databases (MEDLINE, Scopus, Web of Science, CINAHL, The Cochrane Library Plus, PsycINFO, ProQuest, and ÍnDICEs-CSIC) for articles published in English or Spanish between January 2013 and January 2024. The synthesis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) guidelines. RESULTS: Ten articles met the inclusion criteria and were synthesized using meta-ethnography. Three main themes emerged: (1) barriers to promoting physical activity caused by wearable mHealth technologies: personal barriers (physical aspects, perceptions about technology, and personal preferences), technological barriers (functionality, content, design, alarms, availability, and accessibility), and environmental barriers (season of the year); (2) personal facilitators (consideration that these apps improve health, perceptions about technology, and personal preferences), technological facilitators (functionality, content, and design), relational facilitators (technological and social support), environmental facilitators (seasonal variations), and health care professionals (support and monitoring by health care services); and (3) personal areas (perceptions about technology and personal preferences), technological areas (functionality, content, and design), and relational areas (technological support). CONCLUSIONS: Although older adults acknowledge the potential of wearable mHealth technologies to promote physical activity, their effective engagement is hindered by distinct personal, technological, and environmental barriers. Bridging the digital divide requires designers to prioritize user-centered, age-friendly interfaces that are integrated with continuous support from health care professionals. To promote genuine health equity, future research must rigorously report intersectional demographics to ensure that mHealth interventions mitigate, rather than inadvertently exacerbate, existing disparities.
30 July 2026
Read appraisal →Lasers in medical science
Effect of photobiomodulation on trapezius myofascial pain: a randomized, sham-controlled, double-blind clinical trial.
To investigate the effect of 16 J of 808 nm low-level laser therapy (LLLT) on pain in individuals with trapezius trigger points (TPs). Randomized, double-blind, controlled trial conducted with 52 adults (≥ 18 years) with chronic trapezius pain and TPs. Participants were assigned to the LLLT group (808 nm, 16 J per TP) or the sham group (same protocol without emission). Both received eight sessions over four weeks. Outcomes included pain perception, number of TPs, cervical function, skin temperature, global perceived effect, and adverse events. Randomization was concealed from evaluators and participants. Repeated measures ANOVA (SPSS 21) was used for analysis. No significant differences were found between groups for pain [F(2,100) = 1.21; p = 0.30, η2 = 0.024], TPs [F(1.09,54.27) = 0.35; p = 0.57, η2 = 0.007], cervical skin temperature [F(1.79,89.65) = 0.79; p = 0.45, η2 = 0.042], trapezius temperature [F(2,100) = 1.09; p = 0.34, η2 = 0.021], or global perceived effect [F(1.44) = 1.91; p = 0.17, η2 = 0.029]. Cervical function improved significantly in the LLLT group [F(1.36,67.73) = 3.75; p = 0.04, η2 = 0.070]. Adverse effects were mild and infrequent, mainly warmth. Both groups reported clinically relevant pain reduction. LLLT at 16 J per TP with 808 nm was not superior to placebo for pain, TP count, or skin temperature. However, it improved cervical function, suggesting a functional benefit. Registration: july 18, 2022 on the Brazilian Clinical Trials Registry (REBEC - RBR-10m474jv).
28 July 2026
Read appraisal →Scandinavian journal of pain
Exercise prescription and monitoring of heart rate parameters in people with chronic pain: a systematic review
INTRODUCTION: Chronic pain affects over 50 million adults in the United States and is associated with autonomic nervous system dysfunction assessed through measurements of heart rate variability (HRV). While exercise has been shown to improve HRV in healthy individuals, the effects of different exercise protocols in chronic pain populations on HRV remain underexplored. CONTENT: The purpose of this systematic review investigated how exercise interventions influence HRV and pain in individuals with chronic pain. A literature search was conducted in accordance with PRISMA guidelines across four electronic databases. Six randomized controlled trials met the inclusion criteria and were critically appraised for methodological quality. Studies were included if they involved an exercise intervention and reported HRV. If pain was assessed, it was included as an outcome measure. SUMMARY AND OUTLOOK: Six randomized controlled trials were identified with 283 participants. All studies measured HRV, while four reported pain outcomes. Five studies reported significant improvements in HRV following exercise interventions (p <0.05), while findings related to pain outcomes were mixed. Methodological reporting of HRV procedures was generally insufficient. Due to heterogeneity across studies, it remains unclear whether exercise improves pain or HRV sufficiently. While pain outcomes are commonly reported, HRV is the only measure specific to \autonomic function, and its reliability as a clinical metric in individuals with chronic pain remains uncertain. Limited research across diverse chronic conditions, sexes, and methodological approaches restricts generalizability. This highlights the need for greater methodological rigor and broader inclusion to strengthen the use of HRV metrics in chronic pain populations.
25 July 2026
Read appraisal →PloS one
Hamstring strength assessment methods in sport: A systematic review and meta-analysis of post-activity strength decrements, asymmetry benchmarks, and measurement reliability.
Hamstring strain injuries (HSI) represent one of the most prevalent and recurrent injuries in sport, making reliable strength assessment essential for neuromuscular monitoring in athletic populations. Despite the breadth of available testing modalities, no comprehensive synthesis of assessment methods, their reliability, post-activity strength responses, or normative asymmetry values has been undertaken. This systematic review and meta-analysis aims to evaluate the reliability of hamstring strength assessment methods, quantify the time-course of strength decrements following competition, establish normative inter-limb asymmetry benchmarks, and identify gaps to guide future assessment practices. PubMed, Scopus, SPORTDiscus, and Web of Science were searched from inception to November 1, 2025 following PRISMA guidelines. Methodological quality was assessed using a modified version of the Downs and Black checklist. A total of 161 studies were included in qualitative synthesis and 106 in quantitative analysis. Isokinetic dynamometry was the most frequently used modality, followed by force platform assessments and Nordic hamstring-based devices, with a clear upward trend in field-based testing observed after 2010. Multiple modalities demonstrate good reliability, sensitivity to post-activity fatigue, and comparable patterns to detect inter-limb asymmetries, supporting their use across varied applied settings. Hamstring strength deficits persisted for 24-72 hours following on-field activity, identifying a critical vulnerability window during congested schedules. Minor inter-limb asymmetries of approximately 3-4% appear normative and should not be considered clinically meaningful in isolation. Practitioners should establish individualized baselines and integrate routine monitoring with evidence-based recovery strategies to mitigate HSI risk throughout competitive seasons.
23 July 2026
Read appraisal →Scientific reports
Integrating skeleton based representations for robust yoga pose classification using deep learning models
Yoga is a popular form of exercise worldwide due to its spiritual and physical health benefits, but incorrect postures can lead to injuries. Automated yoga pose classification has therefore gained importance to reduce reliance on expert practitioners. While human pose keypoint extraction models have shown high potential in action recognition, systematic benchmarking for yoga pose recognition remains limited, as prior works often focus solely on raw images or a single pose extraction model. In this study, we introduce a curated dataset, "Yoga-16", which addresses limitations of existing datasets, and systematically evaluate three deep learning architectures-VGG16, ResNet50, and Xception-using three input modalities: direct images, MediaPipe Pose skeleton images, and YOLOv8 Pose skeleton images. Our experiments demonstrate that skeleton-based representations outperform raw image inputs, with the highest accuracy of 96.09% achieved by VGG16 with MediaPipe Pose skeleton input. Additionally, we provide interpretability analysis using Grad-CAM, offering insights into model decision-making for yoga pose classification with cross validation analysis.
17 July 2026
Read appraisal →Blood advances
I-STRONG: an integrative, multicomponent treatment approach for chronic pain in pediatric sickle cell disease
Chronic pain affects ∼20% of adolescents living with sickle cell disease (SCD). There is a critical unmet need for evidence-based interdisciplinary approaches for chronic SCD pain treatment. We aimed to (1) use community engagement to adapt an integrative multicomponent treatment program designed to meet the unique needs of chronic SCD pain (ie, Integrative Strong Body and Mind Training [I-STRONG] for SCD), and (2) optimize feasibility and acceptability of I-STRONG through a proof-of-concept trial. Modifications to an existing cognitive behavioral therapy (CBT) and neuromuscular treatment program for chronic widespread pain were informed by semistructured qualitative interviews with adolescents (aged 12-18 years) with chronic SCD pain (n = 12) and their caregivers (n = 12), community advisory boards, and interdisciplinary experts to develop I-STRONG. I-STRONG is a virtual 8-week, 16-session, group intervention combining CBT and neuromuscular exercise training, co-led by experts in psychology and physical therapy. A pilot clinical trial of I-STRONG (n = 12 adolescents; n = 9 caregivers) was conducted to iteratively optimize intervention feasibility and acceptability. Community engagement strategies informed systematic adaptations for access, engagement, relevance, satisfaction, and sense of belonging to meet the unique needs of youth experiencing chronic SCD pain. Pilot testing demonstrated high levels of feasibility (95% completion, 97% intervention fidelity, 92% retention), moderate to high acceptability, and safety. Over 82% of adolescents reported improvements in pain after treatment and at 3-month follow-up. Preliminary evidence suggests that I-STRONG is a promising approach for management of chronic pain in pediatric SCD. A planned multicenter, randomized controlled trial will evaluate I-STRONG's efficacy for pain reduction. This trial was registered at www.clinicaltrials.gov as #NCT06110754.
14 July 2026
Read appraisal →BMJ open
Association of wearable device-based perioperative physical activity with recovery outcomes in patients undergoing lung cancer surgery: a systematic review and meta-analysis protocol.
INTRODUCTION: Lung cancer surgery is a cornerstone of curative treatment for resectable disease, but postoperative recovery is often prolonged and may be complicated by impaired pulmonary function, reduced physical activity, symptom burden and delayed functional restoration. Wearable devices may support perioperative physical activity through objective monitoring and activity promotion; however, existing evidence remains fragmented and has not been synthesised in a focused review. This protocol describes a systematic review and meta-analysis to evaluate the association of wearable device-based perioperative physical activity with recovery outcomes in patients undergoing lung cancer surgery. METHODS AND ANALYSIS: We will include randomised controlled trials, non-randomised interventional studies and prospective or retrospective cohort studies involving adults undergoing surgery for suspected or confirmed primary lung cancer. Eligible studies must examine wearable device-based perioperative physical activity during the preoperative period, postoperative period or both. The primary outcomes will be postoperative pulmonary complications, length of hospital stay and physical function or exercise capacity. Secondary outcomes will include overall postoperative complications, pulmonary function, symptom burden, health-related quality of life, chest tube duration, readmission and postoperative mortality. We will search PubMed, EMBASE, Web of Science, CINAHL and the Cochrane Library from inception to the final search date, supplemented by reference screening, forward citation tracking, grey literature and trial registry searches. Two reviewers will independently perform study selection, data extraction and risk-of-bias assessment. Where appropriate, meta-analysis will be performed using random-effects models; otherwise, findings will be synthesised narratively. ETHICS AND DISSEMINATION: Ethical approval is not required because this review will use data from published studies and publicly accessible sources only and will not involve individual participants or identifiable personal data. The findings will be disseminated through publication in a peer-reviewed journal and presentation at relevant academic or professional conferences. PROSPERO REGISTRATION NUMBER: CRD420261375254.
11 July 2026
Read appraisal →International journal of medical informatics
Beyond the conventional: Artificial intelligence in identifying risk factors in sports injuries. A scoping review.
PURPOSE: To map contemporary uses of artificial intelligence (AI) to identify conventional and unconventional risk factors for sports injuries in athletes. METHODS: Following Joanna Briggs Institute guidance and PRISMA-ScR, we conducted an open-access search (January 2015-September 2025) in PubMed/MEDLINE, Scopus, and ScienceDirect using MeSH/DeCS terms for AI and injury risk. Records were managed in Rayyan with de-duplication, independent triple screening, standardized data extraction, and narrative synthesis to address heterogeneity. RESULTS: Fifty-nine studies met inclusion criteria. Frequently modelled predictors included sleep quality and psychological state, external and internal load metrics, and prior injury. AI approaches spanned classical machine learning and deep learning applied to multimodal sensor and clinical data. Across studies, generalizability was limited by heterogeneous populations, outcomes, and measurement/reporting practices; few works reported consistent measurement standards or external validation. Where assessed, observer agreement and classification performance were acceptable but variable. CONCLUSION: AI for sports-injury risk is expanding rapidly, led by classical machine learning on multimodal sensor data. Key gaps are external validity and reproducibility. Progress will require multicenter prospective cohorts, standardized measurement and reporting, sport-specific meta-analyses, transparent model sharing, and deliberate clinical integration into athlete care pathways.
4 July 2026
Read appraisal →Physiotherapy theory and practice
Physical therapists' perspectives on a large language model-powered knowledge translation tool for guideline adherence: A qualitative focus group study.
BACKGROUND: Clinical practice guidelines support healthcare professionals in making evidence-based decisions, yet guideline adherence among physical therapists remains inconsistent. To address this gap, a prototype digital knowledge translation tool powered by a large language model (LLM) was developed, with content based on two exemplary high-quality German national guidelines. OBJECTIVE: To (1) explore the experiences of German physical therapists using the tool, (2) assess their perspectives on its utilization in clinical practice, and (3) compare perceptions between outpatient and inpatient settings. METHODS: Six focus group interviews were conducted: three in a university hospital inpatient setting and three in outpatient physical therapy practices. Discussions were analyzed using qualitative content analysis with inductive and deductive coding. RESULTS: Twenty physical therapists (11 inpatient, 9 outpatient) participated. Overall experiences were positive, though prolonged response times were criticized. Utilization was thought to depend on time availability and workplace digitization. The tool's potential assisting with clinical questions was highlighted. No considerable differences in experiences across settings were noted. Inpatient therapists envisioned using the tool between sessions for personal knowledge enhancement, whereas outpatient therapists anticipated utilization during sessions for patient education. CONCLUSION: LLM-based knowledge translation tools may contribute to improving guideline adherence among physical therapists. Successful implementation requires assessment of digital infrastructure, relevance to clinical needs, and users' digital literacy. Further research should evaluate the quality of LLM-generated summaries to ensure validity and trustworthiness, and optimize the tools' usability regarding speed and content. Development should also prompt ethical considerations about their role in clinical decision-making and patient care.
2 July 2026
Read appraisal →Lasers in medical science
Effect of photobiomodulation on pain and quality of life in fibromyalgia syndrome: a systematic review
Fibromyalgia Syndrome (FMS) is a chronic pain disorder characterized by widespread pain and central sensitization that significantly impacts the quality of life (QoL). For management to be effective, a multidisciplinary approach to care is typically required. Photobiomodulation therapy (PBMT), a non-pharmacological treatment, has garnered attention lately, though its clinical relevance and applications are not well defined. The objective of this review was to assess the effectiveness of PBMT in reducing FMS symptoms. This systematic review was registered at PROSPERO (CRD420251084730) and conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. A total of seven randomized controlled trials were identified following an extensive literature search across various databases, including PubMed, Scopus, Web of Science, the Cochrane Library, Embase, Ovid and ProQuest. To evaluate the methodological quality of these studies, the Cochrane Risk of Bias (RoB 2.0) tool was applied. PBMT demonstrated consistent short-term reductions in pain intensity and improvements in QoL. Additional positive effects on sleep quality and psychological well-being were observed, indicating that PBMT may provide additional therapeutic benefits beyond pain reduction, including improvements in sleep quality and psychological well-being. PBMT has shown promise as a safe, non-pharmacological adjunct therapy that may provide short-term improvements in pain levels and QoL, but substantial heterogeneity limits generalizability. Clinical trials with large samples and standardized methodologies should be conducted to better clarify the role of PBMT in multidisciplinary therapy for FMS.
24 June 2026
Read appraisal →BMJ open
Workplace interventions for chronic musculoskeletal disorders: a systematic review
OBJECTIVES: To provide an updated systematic review of the effectiveness of workplace interventions for chronic musculoskeletal disorders, identify key intervention components and assess their impact on health and work-related outcomes. DESIGN: Systematic review of randomised controlled trials. DATA SOURCES: MEDLINE, EMBASE, CINAHL, PsycINFO, Scopus and Web of Science were searched for studies published between 2018 and 2024. Grey literature sources were also consulted. ELIGIBILITY CRITERIA: Randomised controlled trials and cluster-randomised trials evaluating workplace interventions targeting adults with chronic musculoskeletal disorders were included. Outcomes of interest included pain, functional outcomes, quality of life and work-related outcomes (eg, work ability, productivity, presenteeism and absenteeism). DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened studies, extracted data and assessed risk of bias using the Cochrane Risk of Bias 2 tool. Due to heterogeneity, only a narrative synthesis was conducted. RESULTS: 23 studies involving 2456 participants were included and classified into physical exercise, ergonomic and multicomponent interventions. Physical exercise interventions consistently improved pain and functional outcomes. Digital delivery of exercise interventions demonstrated comparable effectiveness to face-to-face or workplace-based approaches. Multicomponent interventions, combining exercise with ergonomic strategies, demonstrated the most consistent benefits across outcomes. Evidence for work-related outcomes was limited and inconsistent, and quality of life was assessed in only a small number of studies. CONCLUSIONS: Workplace interventions, particularly multicomponent approaches combining exercise, ergonomics and education, can be effective in improving health outcomes in chronic musculoskeletal disorders. However, evidence on work-related outcomes remains limited and inconsistent. PROSPERO REGISTRATION NUMBER: CRD420261289218.
24 June 2026
Read appraisal →Acta orthopaedica
Registration and reporting characteristics of trials investigating exercise therapy following total knee arthroplasty: a systematic review.
BACKGROUND AND PURPOSE: Prospectively registering the primary trial outcome is important to reduce selective outcome reporting and increase the trustworthiness of findings, which guide clinical practice. The objectives of our systematic review were to explore and compare the reporting characteristics of prospectively and non-prospectively registered trials investigating exercise therapy following total knee arthroplasty. METHODS: Randomized trials comparing effects of exercise therapy after total knee arthroplasty for osteoarthritis were identified in 4 databases from 2000 to August 12, 2024. One primary outcome per trial was extracted, using a pre-specified hierarchical algorithm, irrespective of outcome domain. Pooled standardized mean differences (SMDs) were calculated on pre-specified outcome domains, and risk-of-bias assessed using the Cochrane Risk-of-Bias tool v2. RESULTS: 94 trials, comprising 9,396 participants, were included, of which 13 were prospectively registered, 33 retrospectively registered, and 48 unregistered. A single primary outcome was defined in 44% of the 94 trials, and 4 trials reported a primary outcome consistent with a prospective registration. The pooled SMD of primary outcomes was 0.06 (95% confidence interval [CI] -0.03 to 0.16) for prospectively registered trials, 0.67 (CI 0.22-1.11) for retrospectively registered trials, and 0.59 (CI 0.32-0.86) for unregistered trials. Lower risk-of-bias ratings and higher proportions of intention-to-treat adherence, dropout reporting, and adverse event reporting were observed among prospectively registered trials. CONCLUSION: Among prospectively registered trials we showed smaller effect size estimates between interventions with lower risk-of-bias ratings, and higher proportions of intention-to-treat adherence, dropout reporting, and adverse event reporting in contrast to trials without prospective registration; furthermore, clear specification of a single primary outcome was uncommon among trials evaluating exercise therapy after total knee arthroplasty.
23 June 2026
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