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• PEDro is a free global resource to support evidence-based physical therapy • PEDro indexes trials, reviews, and guidelines of physical therapy interventions • PEDro web-site, newsletter, videos, and social media are available in Portuguese • Trials are pre-appraised with the PEDro scale (Portuguese version available) • Keep up to date in 15 areas of practice with PEDro's 'Evidence in your inbox' The Physiotherapy Evidence Database (PEDro) is a free, preeminent, global resource to support evidence-based physical therapy. PEDro provides rapid access to randomized controlled trials, systematic reviews, and clinical practice guidelines evaluating physical therapy interventions. This paper describes the PEDro scale, PEDro contents, who uses PEDro, searching, browsing the latest content, and developing skills in evidence-based physical therapy. Strategies specifically developed to break down barriers for Portuguese-speaking physical therapists are emphasized. All trials indexed in PEDro are assessed for methodological quality using the 10-point PEDro scale. These ratings are used to rank search results. In August 2019 PEDro indexed 44,309 articles: 34,619 trials, 9004 reviews, and 686 guidelines. The number of trials is predicted to double by 2025. PEDro users come from 214 countries. Physical therapists in Brazil are the largest users (23% of all searches). Physical therapists are encouraged to use the PEDro advanced search page to find answers for their clinical questions. PEDro's 'Evidence in your inbox' allows physical therapists to browse the latest content. To assist users develop skills in evidence-based physical therapy, PEDro includes tutorials and a series of 'how to' videos. PEDro web-site is fully available in Portuguese and English. PEDro facilitates the use of high-quality clinical research by physical therapy clinicians, educators, students, and researchers. In 2019 PEDro celebrated its twentieth anniversary. Some enhancements to mark this milestone include launching a new database called DiTA (Diagnostic Test Accuracy) that focuses on the accuracy of diagnostic tests used by physical therapists. [ABSTRACT FROM AUTHOR]

Objectives To investigate the methodologic quality and statistical reporting of reports of trials indexed on the Physiotherapy Evidence Database (PEDro) classified in the musculoskeletal subdiscipline, and to analyze the characteristics of the trials that can predict trial report quality. Design Cross-sectional study based on a collection of randomized controlled trials. We randomly selected 19% of trials coded as musculoskeletal from PEDro. Methodologic quality was assessed using the PEDro scale. We assessed aspects of the trial using 9 items from the Consolidated Standards of Reporting Trials (CONSORT) statement. We performed multivariate linear regression analysis models to predict the total PEDro score. Setting Not applicable. Participants Not applicable. Interventions Not applicable. Main Outcome Measures Not applicable. Results A total of 1404 articles were included in the analysis. The mean total PEDro scale score was 5.27±1.63 points, which reflects low methodologic quality. There was a slight improvement in the quality of articles over time. The characteristics that predicted the total PEDro scale score were endorsement of the CONSORT statement, sample size calculation, lower number of primary outcomes, evaluation of electrotherapy as intervention, if the trial reported the research design in the title, reporting of participant flow diagram, years since publication (most recent trials), and trials published in English. Conclusions The quality of the trials in musculoskeletal physical therapy is suboptimal. The use of reporting checklists (eg, CONSORT statement) should be mandatory in all journals. Journal reviewers and journal editors should also use the CONSORT statement during the review process. [ABSTRACT FROM AUTHOR]

Background: It is unclear whether the Physiotherapy Evidence Database (PEDro) is widely and equally used by physical therapists in Brazil. As PEDro is considered a key resource to support evidence-based physical therapy, analyses of PEDro usage could reflect the extent of dissemination of evidence-based practice. Objective: To describe the usage of PEDro among the five regions of the World Confederation for Physical Therapy (WCPT) and, in more detail, in the South American region and Brazil over a 5-year period. Method: PEDro home-page sessions and the number of searches performed were logged for a 5-year period (2010-2014). Absolute usage and relative usage were calculated for each region of the WCPT, each country in the South American region of WCPT, and each Regional Council (CREFITO) in Brazil. Results: Europe had the highest absolute and relative usage among the five regions of the WCPT (971 searches per million-population per year), with the South American region ranked 4th in absolute terms and 3rd in relative terms (486). Within the South American region, Brazil accounted for nearly 60% of searches (755). Analysis at a national level revealed that usage per physical therapist in Brazil is very low across all CREFITOs. The highest usage occurred in CREFITO 6 with 1.3 searches per physical therapist per year. Conclusions: PEDro is not widely and equally used throughout Brazil. Strategies to promote PEDro and to make PEDro more accessible to physical therapists speaking Portuguese are needed. [ABSTRACT FROM AUTHOR]

Objectives: To investigate whether the methodological quality is influenced by language of publication in reports of randomized controlled trials and controlled clinical trials of physiotherapy interventions. Study Design and Setting: Bibliometric and methodological quality data from all reports of trials indexed on the Physiotherapy Evidence Database (PEDro) up to February 2011 were extracted. Descriptive statistics on the total PEDro score and the 11 individual PEDro items were calculated for each language of publication and for all none English-language reports combined. Regression models were calculated to predict the total PEDro score and the presence of each of the 11 items of the PEDro scale using the language of publication as an independent variable. Results: A total of 13,392 reports of trials were used for this study, 12,532 trials published in English and 860 published in other languages. Overall methodological quality was better for English reports than reports written in other languages (β=50.15, 95% confidence interval 50.04, 0.25). Specifically, reporting was better for items relating to random allocation, concealed allocation, and blinding of assessors, worse for more than 85% follow-up and intention-to-treat analysis, and no different for eligibility criteria and source specified, baseline comparability, blinding of subjects and therapists, reporting of between-group statistical comparisons, and reporting of point measures and measures of variability. Conclusion: Language of publication is associated with the methodological quality of reports of physiotherapy trials. Although English reports are more likely to have better methodological quality than reports written in other languages, the magnitude of this influence is small. @2013 Elsevier Inc. All rights reserved. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To describe the change with time of the reported methodological quality of randomized controlled trials of physiotherapy interventions. Study Design and Setting: For all trials of physiotherapy interventions indexed on the Physiotherapy Evidence Database (PEDro), year of publication, and methodological quality scores (11-item PEDro scale and total PEDro score [range, 0–10]) were extracted. The relationship between trial quality and time was evaluated using regression analyses for the PEDro total score and individual quality items. The study was carried out in a university research center. Results: Data from 10,025 trials published since 1960 were analyzed. The total PEDro score was related to time (year of publication), with the total score increasing by an average of ∼0.6 points each decade between 1960 and 2009. The reported use of eight of the 11 individual items from the PEDro scale (intention-to-treat analysis, concealed allocation, groups similar at baseline, reporting of results of between-group statistical comparisons, point measures and measures of variability reported, subjects randomly allocated to groups, eligibility criteria specified, and blinding of assessors) also improved with time. Conclusion: The reported methodological quality of randomized controlled trials of physiotherapy interventions has improved over time. Further improvement is still necessary. [Copyright &y& Elsevier]

Abstract: Objective: To describe the quality and methods of systematic reviews of physiotherapy interventions, compare Cochrane and non-Cochrane reviews, and establish the interrater reliability of the Overview Quality Assessment Questionnaire (OQAQ) quality assessment tool. Study Design and Setting: A survey of 200 published systematic reviews was done. Two independent raters assessed the search strategy, assessment of trial quality, outcomes, pooling, conclusions, and overall quality (OQAQ). The study was carried out in the University research center. Results: In these reviews, the five most common databases searched were MEDLINE, EMBASE, Cochrane Library, CINAHL, and Cochrane Review Group Registers. The Cochrane allocation concealment system and Jadad Scale were most frequently used to assess trial quality. Cochrane reviews searched more databases and were more likely to assess trial quality, report dichotomous outcomes for individual trials, and conduct a meta-analysis than non-Cochrane reviews. Non-Cochrane reviews were more likely to conclude that there was a beneficial effect of treatment. Cochrane reviews were of higher quality than non-Cochrane reviews. There has been an increase in the quality of systematic reviews over time. The OQAQ has fair to good interrater reliability. Conclusion: The quality of systematic reviews in physiotherapy is improving, and the use of Cochrane Collaboration procedures appears to improve the methods and quality. [Copyright &y& Elsevier]

• Full-text access is essential for evidence-based practice. • Free full text is available for 51% (95% CI: 44, 58) of articles in PEDro. • PEDro provides 4% better access (95% CI: 1, 7) to free full text than PubMed. • Free full-text access via PEDro did not change with year or location. • A PDF locator website increased access to free full text by 9% (95% CI: 6, 14). Access to full-text articles is an essential element of evidence-based practice. Estimate the percentage of articles in the Physiotherapy Evidence Database (PEDro) that have free full-text access and compare free access between PEDro and PubMed. Secondary objectives for access via PEDro: determine if publication year and geographic location impact on free access; determine if adding a link to a portable document format (PDF) locator website would improve free access; and evaluate the association between article characteristics and free access. This observational study used a random sample of 200 articles published in 2000–2019 and indexed in PEDro. Data collectors in Australia, Brazil, Nepal, and Spain attempted to access free full text for each article via PEDro. One data collector attempted to access free full text via PubMed. One data collector attempted to access full text via a PDF locator (http://www.pdfsearchengine.net/). The percentage (95% confidence interval [CI]) of articles with free full-text access from PEDro, PubMed, and the PDF locator website were calculated. Logistic regression was used to evaluate the association between free full-text access and article characteristics. Free full text could be accessed via PEDro for 51% of the articles (95% CI: 44, 58). PEDro had 4% higher free access than PubMed (95% CI: 1, 7). Access via PEDro did not vary systematically with time, geographic location, or article characteristics. Access improved by 9% (95% CI: 6, 14) by adding a PDF locator website. PEDro is a good source of free full-text articles for physical therapists and other rehabilitation professionals. Evidence resources, professional organisations, employers, researchers, and research agencies could all help to increase access to free full text. [ABSTRACT FROM AUTHOR]

Abstract: Moseley AM, Herbert RD, Nightingale EJ, Taylor DA, Evans TM, Robertson GJ, Gupta SK, Penn J. Passive stretching does not enhance outcomes in patients with plantarflexion contracture after cast immobilization for ankle fracture: a randomized controlled trial. Arch Phys Med Rehabil 2005;86:1118–26. Objective: To compare the efficacy of short- and long-duration passive stretches with a control treatment for the management of plantarflexion contracture after cast immobilization for ankle fracture. Design: Assessor-blinded, randomized controlled trial. Setting: Hospital physical therapy outpatient departments. Participants: Adults with plantarflexion contracture (N=150) after cast immobilization for ankle fracture. All subjects were weight bearing or partial weight bearing. Interventions: Exercise only, exercise plus short-duration passive stretch, and exercise plus long-duration passive stretch. All subjects had a 4-week course of exercises. In addition, subjects in the short-duration stretch plus exercise group completed 6 minutes of stretching per day, and subjects in the long-duration stretch plus exercise group completed 30 minutes of stretching per day. Main Outcome Measures: Lower Extremity Functional Scale and passive dorsiflexion range of motion with the knee bent and straight at baseline, and at 4 weeks and 3 months postintervention. Results: One hundred thirty-nine (93%) subjects completed the 4-week assessment and 134 (89%) subjects completed the 3-month assessment. There were no statistically significant or clinically important between-group differences for the primary outcomes. Conclusions: The addition of passive stretching confers no benefit over exercise alone for the treatment of plantarflexion contracture after cast immobilization for ankle fracture. [Copyright &y& Elsevier]

The effect of widely differing but normal passive ankle flexibility on function was investigated by using able-bodied males selected from the upper and lower tails of a group normally distributed for passive dorsiflexion (DF) flexibility. Ankle, knee and hip kinematics, and kinetics were quantified during stair descent, walking and standing up. The effect of DF flexibility was apparent during stair descent, but not in standing up or walking. Mean peak DF in stance phase of stair descent was 11.5° lower for ‘inflexible’ compared with ‘flexible’ subjects, but the net moment about the ankle at peak DF and the timing of peak DF were comparable between groups. [Copyright &y& Elsevier]

To investigate trials abstracts evaluating treatments for low back pain with regard to completeness of reporting, spin (ie, interpretation of study results that overemphasizes the beneficial effects of the intervention), and inconsistencies in the data with the full text. The search was performed on the Physiotherapy Evidence Database (PEDro) in February 2016. This is an overview study of a random sample of 200 low back pain trials published between 2010 and 2015. The languages of publication were restricted to English, Spanish, and Portuguese. Completeness of reporting was assessed using the Consolidated Standards of Reporting Trials (CONSORT) for abstracts checklist (CONSORT-A). Spin was assessed using a spin checklist. Consistency between abstract and full text was assessed by applying the assessment tools to both the abstract and full text of each trial and calculating inconsistencies in the summary score (paired t test) and agreement in the classification of each item (kappa statistics). Methodologic quality was analyzed using the total PEDro score. The mean number of fully reported items ± SD for abstracts using the CONSORT-A was 5.1±2.4 out of 15 points. The mean number of items ± SD with spin was 4.9±2.6 out of 7 points. Abstract and full text scores were statistically inconsistent (P =.01). There was slight to moderate agreement between items of the CONSORT-A in the abstracts and full text (mean kappa ± SD, 0.20±0.13) and fair to moderate agreement for items of the spin checklist (mean kappa ± SD, 0.47±0.09). The abstracts were incomplete, with evidence of spin and inconsistent with the full text. We advise health care professionals to avoid making clinical decisions based solely upon abstracts. Journal editors, reviewers, and authors are jointly responsible for improving abstracts, which could be guided by amended editorial policies. • Abstract reporting quality in low back pain trials was poor. • Ninety-eight percent of abstracts contained spin of information. • Several inconsistencies were found between abstracts and full texts. • Actions should be taken to change journals' editorial policies. [ABSTRACT FROM AUTHOR]

• There are 1779 physical activity trials in the physiotherapy evidence database (PEDro). • The mean (SD) PEDro score was 5.3 (1.5) points out of 10, reflecting 'fair to poor' quality. • Journal impact factor is weakly correlated with trial quality (0.21, p < 0.001). • We make five recommendations to improve future trial quality. Observing trends in research publications helps to identify the quantity and quality of research produced, as well as reveal evidence gaps. No comprehensive review of the quality and quantity of physical activity intervention trials has been conducted. We aimed to investigate i) the volume and quality (and changes in these over time) of randomized controlled trials evaluating physical activity interventions, and ii) the association between journal ranking and trial quality. We searched the Physiotherapy Evidence Database (PEDro) for trials investigating physical activity interventions (no restrictions for population, comparison, or language). Descriptive statistics were used to describe the volume and quality of trials. The association between journal ranking (Journal Impact Factor) and trial quality (PEDro Scale) was examined using Spearman's rho correlation. We identified 1779 trials, of which 40% (n = 710) were published between 2016 and 2020. The mean (SD) total PEDro score was 5.3 (1.5) points out of 10, increasing over time from 2.5 (0.7) points in 1975–1980 to 5.6 (1.4) points in 2016–2020. Quality criteria that were least reported included blinding of intervention deliverers (therapists) (n = 3, 0.2%), participants (n = 21, 1.2%), or assessors (n = 541, 31%); concealed allocation to groups (n = 526, 30%); and intention to treat analysis (n = 764, 43%). There was a small correlation between trial quality and Journal Impact Factor (0.21, p < 0.001). A large volume of trials has investigated physical activity interventions. The quality of these trial reports is suboptimal but improving over time. Journal ranking should not be used for selecting high quality trials. [ABSTRACT FROM AUTHOR]

• Language is a barrier to implementing research evidence into practice. • Physiotherapy Evidence Database (PEDro) content is available in 13 languages. • English, Portuguese, Spanish, German, and French PEDro content is used the most. • Region-specific promotion of the underused PEDro content may facilitate global usage. • Awareness and collaboration between stakeholders could reduce the language barrier. Language is a barrier to implementing research evidence into practice. Whilst the majority of the world's population speak languages other than English, English has become the dominant language of publication for research in healthcare. The aim of this study was to quantify the usage of the Physiotherapy Evidence Database (PEDro) web-site (www.pedro.org.au) and training videos by language, including the use of online translation, and to calculate relative usage of the different sections of the web-site. Google Analytics was used to track usage of the PEDro web-site for July 2017 to June 2018. The number of views of each of the PEDro training videos was downloaded from YouTube for January 2015 to August 2018. The pageviews and videos were categorized by language and, for pageviews, web-site section. 2,828,422 pageviews were included in the analyses. The English-language sections had the largest number of pageviews (58.61%), followed by Portuguese (15.57%), and Spanish (12.02%). Users applied online translation tools to translate selected content of the PEDro web-site into 41 languages. The PEDro training videos had been viewed 78,150 times. The three most commonly viewed languages were English (58.80%), Portuguese (19.83%), and Spanish (6.13%). There was substantial use of some of the translated versions of the resources offered by PEDro. Future efforts could focus on region-specific promotion of the language resources that are underutilized in PEDro. The developers of PEDro and PEDro users can work collaboratively to facilitate uptake and translate resources into languages other than English to reduce the language barrier in using research to guide practice. [ABSTRACT FROM AUTHOR]

• Less than one-third of physical therapy trials reported confidence intervals. • The prevalence observed is lower than equivalent analyses in other disciplines. • Analysis showed consistent increases in the proportion of trials that used confidence intervals with time. To assess the prevalence of the use of 95% confidence intervals in the reporting of between-group differences in randomized controlled trials of physical therapy interventions and to determine if the prevalence is changing over time. Observational study, including an analysis of 200 trials from the Physiotherapy Evidence Database: 50 from each of the years 1986, 1996, 2006, and 2016. The primary outcome used was the prevalence of the between-group difference presented with 95% confidence intervals. We also extracted trial characteristics for descriptive purposes (i.e., number of participants, number of sites involved in recruitment, country(ies) of data collection, funding, subdiscipline of physical therapy, publication language and total Physiotherapy Evidence Database score). Most commonly, the trials were published in English (89%) and classified in the musculoskeletal subdiscipline (23%). The overall prevalence of use of confidence intervals was 29% and there was a consistent increase in reporting between 1986 and 2016, with peak usage in the 2016 cohort (42%). Confidence intervals were more likely to be used in trials that had received funding, were conducted in Europe and Oceania, and in trials with a Physiotherapy Evidence Database score of at least 6/10. Most trials of physical therapy interventions do not report confidence intervals around between-group differences. However, use of confidence intervals is increasing steadily, especially among high-quality trials. Physical therapists must understand confidence intervals so that they can understand a growing number of trials in physical therapy. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "PEDro's Bias: Summary Quality Scores Should Not Be Used in Meta-Analysis" by B. R. da Costa and colleagues in the 2013 issue.

This article discusses the editorial policy regarding the publication of randomized controlled trials in the "Revista Brasileira de Fisioterapia" magazine. It requires clinical trial authors to register their trials before publication. The journal also requires authors to endorse the recommendations from the Consolidated Standards Reporting Trials statement.

• Physical therapy field (producers, impact) was characterised using bibliometrics. • Eight topics describe the physical therapy research indexed in PEDro. • The thematic structure of physical therapy was found to change from 1986 to 2017. • Growth in scientific output from emerging countries e.g. China and Brazil. • Most productive producers do not always have the highest average citation impact. Bibliometric studies are used to analyse and map scientific areas, and study the scientific output and impact of institutes and countries. Describe the thematic structure and evolution of the field of physical therapy interventions using articles indexed in Physiotherapy Evidence Database (PEDro). Also, identify and compare the main producers (countries, institutions) over time (research output, citation impact). Eligible articles were those indexed in PEDro (1986-2017) and matched to Web of Science. VOSviewer software, bibliometric text mining, and visualisation techniques were used to evaluate the thematic structure of the included articles. We collected data about authors' country and institutional affiliation, and calculated bibliometric indicators (production, citation impact). A total of 29 090 articles were analysed. Eight topics were identified: "neurological rehabilitation"; "methods"; "exercise for prevention and rehabilitation of lifestyle diseases"; "assessment and treatment of musculoskeletal pain"; "physical activity", "health promotion and behaviour change"; "respiratory physical therapy"; "hospital, primary care and health economics"; "cancer and complementary therapies". The most productive countries were United States, United Kingdom, Australia, and Canada. The most impactful countries were United States, France, Finland, and Canada. The most productive institutions were University of Sydney, VU University of Amsterdam, University of Queensland, and University of Toronto. The thematic structure of physical therapy interventions has evolved over time with "neurological rehabilitation", "methods", "exercise related to lifestyle diseases", and "physical activity" becoming increasingly important. Main producers of this research were traditionally located in North America and Europe but now include countries like China and Brazil. [ABSTRACT FROM AUTHOR]

Abstract: Background: Ankle plantarflexion contractures are common in adults with neurological disorders and known to cause secondary gait deviations. However, their impact on the knee joint is not fully understood. The aims of this study are to describe the effect of simulated plantarflexion contractures on knee biomechanics during the stance phase and on the spatiotemporal characteristics of gait. Methods: Mild (10–degree plantarflexion) and severe (20–degree plantarflexion) ankle contractures were simulated in thirteen able-bodied adults using an ankle-foot-orthosis. A no contracture condition was compared with two simulated contracture conditions. Findings: There was an increase in knee extension, sometimes resulting in hyperextension, throughout stance for the two contracture conditions compared to the no contracture condition (mean increase in knee extension ranged from 5° to 9°; 95% CI 0° to 17°). At the same time, there were reductions in extension moment and power generation at the knee. Simulated plantarflexion contractures also reduced gait velocity, bilateral step length and cadence. All these changes were more pronounced in the severe contracture condition than mild contracture condition. While the majority of participants adopted a foot-flat pattern on landing and exhibited an increase in knee extension during stance, two participants used a toe-walking pattern and exhibited an increase in knee flexion. Interpretation: Ankle plantarflexion contractures are associated with an increase in knee extension during stance phase. However, some people with simulated ankle contractures may walk with an increase in knee flexion instead. Ankle plantarflexion contractures also adversely affect gait velocity, step length and cadence. [Copyright &y& Elsevier]

Background: While the research design of articles published in medical journals and in some physical therapy journals has already been evaluated, this has not been investigated in Brazilian physical therapy journals. Objective: To describe the research design used in all articles published in Brazilian scientific journals that are freely available, have high Qualis rankings, and are relevant to physical therapy over a 7-year period. Method: We extracted the bibliometric data, research design, research type (human or animal), and clinical area for all articles published. The articles were grouped into their level of evidence, and descriptive analyses were performed. We calculated the frequency, proportions of articles, and 95% confidence interval of these proportions with each research design in each journal. We cross-tabulated the clinical areas with research designs (expressed as number and percentages). Results: A total of 1,458 articles from four Brazilian journals were found: Revista Brasileira de Fisioterapia, Revista Fisioterapia em Movimento, Revista Fisioterapia e Pesquisa, and Revista Acta Fisiátrica. The majority of articles were classified as level II of evidence (60%), followed by level III (29%) and level I (10%). The most prevalent research designs were cross-sectional studies (38%), single-case or case-series studies, and narrative reviews. Most articles reported human research and were in the musculoskeletal, neurologic, and cardiothoracic areas. Conclusions: Most of the research published in Brazilian physical therapy journals used levels II and III of evidence. Increasing the publication rate of systematic reviews and randomized controlled trials would provide more high-quality evidence to guide evidence-based physical therapy practice. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the convergent and construct validity of the Physiotherapy Evidence Database (PEDro) scale used to rate the methodological quality of randomized trials in physiotherapy. Study Design and Setting: PEDro total scores and individual-item scores were extracted from 9,456 physiotherapy trials indexed on PEDro. Convergent validity was tested by comparing PEDro total scores with three other quality scales. Construct validity was tested by regressing the PEDro score and individual-item scores with the Institute for Scientific Information Web of Knowledge impact factors (IF) and SCImago journal rankings (SJR) for the journals in which the trials were published. Results: Testing of convergent validity revealed correlations with the other quality scales ranging from 0.31 to 0.69. The PEDro total score was weakly but significantly associated with IF and SJR (P < 0.0001). Eight of the 10 individual scale items that contribute to the PEDro total score were significantly associated with IF. Conclusion: This study provides preliminary evidence of the convergent and construct validity of the PEDro total score and the construct validity of eight individual scale items. [Copyright &y& Elsevier]