Search

An editorial is presented on expecting manuscripts for using estimation methods instead of null hypothesis statistical tests. Topics include statistical inference being the process of making inferences about populations using data from samples; and availability of alternative methods of statistical inference and promotion of the methods in statistical, medical, and physiotherapy journals.

• 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]

• 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]

• 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]

Background Systematic reviews provide the best evidence about the effectiveness of healthcare interventions. Although systematic reviews are conducted with explicit and transparent methods, discrepancies might occur between the protocol and the publication. Objectives To estimate the proportion of systematic reviews of physical therapy interventions that are registered, the methodological quality of (un)registered systematic reviews and the prevalence of outcome reporting bias in registered systematic reviews. Methods A random sample of 150 systematic reviews published in 2015 indexed on the PEDro database. We included systematic reviews written in English, Italian, Portuguese and Spanish. A checklist for assessing the methodological quality of systematic reviews tool was used. Relative risk was calculated to explore the association between meta-analysis results and the changes in the outcomes. Results Twenty-nine (19%) systematic reviews were registered. Funding and publication in a journal with an impact factor higher than 5.0 were associated with registration. Registered systematic reviews demonstrated significantly higher methodological quality (median = 8) than unregistered systematic reviews (median = 5). Nine (31%) registered systematic reviews demonstrated discrepancies between protocol and publication with no evidence that such discrepancies were applied to favor the statistical significance of the intervention (RR = 1.16; 95% CI: 0.63–2.12). Conclusion A low proportion of systematic reviews in the physical therapy field are registered. The registered systematic reviews showed high methodological quality without evidence of outcome reporting bias. Further strategies should be implemented to encourage registration. [ABSTRACT FROM AUTHOR]

A correction to the article "Statistical Inference Through Estimation: Recommendations From the International Society of Physiotherapy Journal Editors," by M. R. Elkins et al, that was published in a 2022 issue is presented.

Background: The mucoactive effects of hypertonic saline should promote exacerbation resolution in people with cystic fibrosis (CF).Objectives: To determine the effects of hypertonic saline inhalation during hospitalisation for exacerbation of CF on length of stay, lung function, symptoms, oxygenation, exercise tolerance, quality of life, bacterial load and time to next hospitalisation.Methods: 132 adults with an exacerbation of CF were randomised to inhale three nebulised doses a day of either 4 mL 7% saline or a taste-masked control of 0.12% saline, throughout the hospital admission. The primary outcome measure was length of hospital stay.Results: All participants tolerated their allocated saline solution. There was no significant difference in length of stay, which was 12 days in the hypertonic saline group and 13 days in controls, with a mean between-group difference (MD) of 1 day (95% CI 0 to 2). The likelihood of regaining pre-exacerbation FEV1 by discharge was significantly higher in the hypertonic saline group (75% vs 57%), and the number needed to treat was 6 (95% CI 3 to 65). On a 0-100 scale, the hypertonic saline group had significantly greater reduction in symptom severity than the control group at discharge in sleep (MD=13, 95% CI 4 to 23), congestion (MD=10, 95% CI 3 to 18) and dyspnoea (MD=8, 95% CI 1 to 16). No significant difference in time to next hospitalisation for a pulmonary exacerbation was detected between groups (HR=0.86 (CI 0.57 to 1.30), p=0.13). Other outcomes did not significantly differ.Conclusions: Addition of hypertonic saline to the management of a CF exacerbation did not reduce the length of hospital stay. Hypertonic saline speeds the resolution of exacerbation symptoms and allows patients to leave hospital with greater symptom resolution.Trial Registration Number: ACTRN12605000780651. [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]

The article presents the recommendations from the "International Society of Physiotherapy Journal" on the use of statistical inference through estimation.

Background. Clinical trial registration has several putative benefits: prevention of selective reporting, avoidance of duplication, encouragement of participation, and facilitation of reviews. Previous surveys suggest that most trials are registered. However, these surveys examined only trials in journals with high impact factors, which may bias the results. Purpose. This study examined the completeness of clinical trial registration and the extent of selective reporting of outcomes in a random sample of published randomized trials in physical therapy. Data Sources. This was a retrospective cohort study in which 200 randomized trials of physical therapy interventions were randomly selected from those published in 2009 and indexed in the Physiotherapy Evidence Database (PEDro), regardless of the publishing journal. Data Extraction. Evidence of registration was sought for each trial in the study, on clinical trial registers, and by contacting authors. Data Synthesis. The proportion of randomized trials that were registered was 67/200 (34%). This proportion was significantly lower than among the trials in journals with high impact factors, where the proportion was 75% (odds ratio_7.4, 95% confidence interval_2.6 -21.4). Unambiguous primary outcomes (ie, method and time points of measurement clearly defined in the trial registry entry) were registered for 32 trials, and registration was adequate (ie, prospective with unambiguous primary outcomes) for 5/200 (2.5%) trials. Selective outcome reporting occurred in 23 (47%) of the 49 trials in which selective reporting was assessable. Limitations. The inclusion of only English-language trials prevents generalization of the results to non-English-language trials. Conclusions. Registration of randomized trials of physical therapy interventions is rarely adequate. Consequently, the putative benefits of registration are not being fully realized. [ABSTRACT FROM AUTHOR]

The article presents an overview of the ways in which hypertonic saline, a strong sterile solution of water that can be inhaled as nebulized medication, can be used to treat patients with cystic fibrosis. A discussion of the mechanisms by which hypertonic saline affects the disease process of cystic fibrosis, and of the medical outcomes which it influences, is presented.

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]

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]

The article presents a study which investigated whether the frequency, intensity and duration of exercise influence HbA1c among people with type 2 diabetes. Topics discussed include an assessment of such relationships for aerobic exercise, resistance exercise or combined aerobic and resistance exercise, as well as the prevention and treatment of diabetes. The absolute changes in HbA1c are cited.

A letter to the editor is presented in response to a statement by S. Armijo-Olivo and colleagues that the Physiotherapy Evidence Database (PEDro) scale was not adequately developed or tested for reliability and validity.

The article focuses on a study which determines the effect of supervised progressive walking training on maximum walking distance and pain-free walking distance in people with intermittent claudication. Topics discussed include the influence of training duration, use of treadmills and pain threshold. Also mentioned is the appropriateness of using meta-regression given the large number of trials that were eligible for inclusion and their variation in the training factors used in the analysis.

A review of the article "Goal Setting, Problem Solving and Feedback Improve Short-Term Adherence to Physical Activity in People With Stable Heart Failure" by S. Tierney and colleagues, which appeared in the periodical "Heart Failure Review" in 2012.

The article discusses a review of studies which suggest that warm-up exercises can reduce exercise-induced bronchoconstriction. The review included several studies that assessed multiple warm-up regimens, with 11 warm-up regimens being tested altogether. The results indicated that warm-up exercise may appear to attenuate EIB, but the refractory period does not occur in all patients with EIB. It is suggested that anti-inflammatory medication may be useful in patients with significant EIB alone.

The article reports that ultrasound may help in bone fracture healing in North America. It mentions that mineral density of bone, smoking and underlying disease can affect the healing time. It mentions that the radiographic healing of bone is 34 percent faster in the ultrasound group. It mentions that delayed and non-union increase the morbidity, dependence and lost productivity related to fracture.

The authors describe the growth in use of the physiotherapy evidence database (PEDro). It was shown that the number of records on the bibliographic database had doubled every 3.5 years, and now indexes reports of over 18,000 randomised trials and 3,500 systematic reviews. The usability of the database scale improved through translations and psychometric validation. The authors also describe the number of systemic reviews indexed on the Cochrane Library that searched PEDro for eligible trials.

Background: In 2014-2015, the Physiotherapy Evidence Database (PEDro) was searched poorly by users; few search commands used sophisticated features and ∼20% contained errors. To improve the quality of PEDro searches, users now receive error messages when using incorrect search commands and have access to video tutorials.Objectives: To determine whether search quality has improved since error messages and tutorials were implemented; and evaluate the content of PEDro searches.Methods: Google Analytics was used to access all search commands on PEDro (between 1 August 2017 and 31 January 2018) and extract the following data: total number of search commands; 25 most common simple and advanced search commands; and frequency of search errors (e.g. Boolean operators) or use of sophisticated features (e.g. truncation/wildcards). Two researchers independently coded the subdiscipline (e.g. musculoskeletal, neurology) and PICO elements (Population; Intervention; Comparison; Outcome) from a random sample of 200 simple and 200 advanced search commands. Data were compared to an identical analysis performed in 2014-2015 to determine whether the content or quality of search commands had changed.Results: There has been a very small increase in the use of truncation/wildcards since 2014-2015 (1.4% increase in simple and 1.9% in advanced search commands; p < 0.001) and small reductions in search errors (Boolean operators: 3.7% reduction in simple and 3.2% in advanced; brackets: 0.9% and 0.4%; non-ASCII characters: 3.1% and 1.6%; p < 0.001 for all analyses). Overall, only 6% of simple and 9% of advanced search commands used sophisticated features, while 16% of simple and 12% of advanced search commands contained errors. The content of PEDro search commands was largely similar to searches from 2014 to 2015.Conclusion: There has been a small reduction in the number of search commands containing errors, and only a very small increase in the use of sophisticated features. These improvements may be explained by video tutorials on how to optimise searching and warnings that appear when users enter search commands containing errors. However, with 16% of simple and 12% of advanced search commands still containing errors, additional strategies to further improve the quality of searches are needed. [ABSTRACT FROM AUTHOR]

The article presents a systematic review aimed at determining the effects of aerobic exercise on pain, disease activity, functional ability and quality of life in people with rheumatoid arthritis. It offers information on resources that were searched, as well as the criteria for determining the eligibility for inclusion in the review. Based on a meta-analysis, a significant reduction in pain was produced by aerobic training. Limitations of this review are also noted.

A response by Mark R. Elkins and colleagues to a letter to the editor about their article "Reliability of the PEDro Scale for Rating Quality of Randomized Controlled Trials" in the 2003 issue is presented.

A response from Peter T.P. Bye and Mark R. Elkins to several letters to the editor on the use of hypertonic saline for the treatment of cystic fibrosis is presented.

Background: Inhaled hypertonic saline acutely increases mucociliary clearance and, in short-term trials, improves lung function in people with cystic fibrosis. We tested the safety and efficacy of inhaled hypertonic saline in a long-term trial. Methods: In this double-blind, parallel-group trial, 164 patients with stable cystic fibrosis who were at least six years old were randomly assigned to inhale 4 ml of either 7 percent hypertonic saline or 0.9 percent (control) saline twice daily for 48 weeks, with quinine sulfate (0.25 mg per milliliter) added to each solution to mask the taste. A bronchodilator was given before each dose, and other standard therapies were continued during the trial. Results: The primary outcome measure, the rate of change (slope) in lung function (reflected by the forced vital capacity [FVC], forced expiratory volume in one second [FEV1], and forced expiratory flow at 25 to 75 percent of FVC [FEF25–75]) during the 48 weeks of treatment, did not differ significantly between groups (P=0.79). However, the absolute difference in lung function between groups was significant (P=0.03) when averaged across all post-randomization visits in the 48-week treatment period. As compared with the control group, the hypertonic-saline group had significantly higher FVC (by 82 ml; 95 percent confidence interval, 12 to 153) and FEV1 (by 68 ml; 95 percent confidence interval, 3 to 132) values, but similar FEF25–75 values. The hypertonic-saline group also had significantly fewer pulmonary exacerbations (relative reduction, 56 percent; P=0.02) and a significantly higher percentage of patients without exacerbations (76 percent, as compared with 62 percent in the control group; P=0.03). Hypertonic saline was not associated with worsening bacterial infection or inflammation. Conclusions: Hypertonic saline preceded by a bronchodilator is an inexpensive, safe, and effective additional therapy for patients with cystic fibrosis. (ClinicalTrials.gov number, NCT00271310.) N Engl J Med 2006;354:229-40. [ABSTRACT FROM AUTHOR]

Objectives: A cuffed tracheostomy tube facilitates prolonged mechanical ventilation and weaning but usually leads to prolonged voicelessness, which can be one of the most negative experiences of hospitalization. No randomized trials have examined the effects of targeted early communication intervention for the restoration of voice in ventilated tracheostomy patients in the ICU.Design: A prospective randomized clinical trial.Setting: The trial was conducted in the ICU of an urban tertiary level hospital.Patients: Thirty adult participants enrolled, with 15 randomly allocated to the intervention and control groups.Interventions: The early intervention group received early cuff deflation and insertion of an in-line speaking valve during mechanical ventilation. The control group received standard cuff deflation and a speaking valve during self-ventilation. A speech-language pathologist provided all treatments.Measurements and Main Results: The primary outcome measure was time from tracheostomy insertion to phonation. Early intervention significantly hastened return to phonation (median difference = 11 d; hazard ratio = 3.66; 95% CI, 1.54-8.68) with no significant effect on duration of tracheostomy cannulation (hazard ratio = 1.40; 95% CI, 0.65-3.03), duration of mechanical ventilation in days from tracheostomy insertion (hazard ratio = 1.19; 95% CI, 0.58-2.51), length of stay in ICU (hazard ratio = 1.16; 95% CI, 0.54-2.52), or time to return to oral intake (hazard ratio = 2.35; 95% CI, 0.79-6.98). Adverse events were low and equal in both groups. There was no significant change in measures of quality of life.Conclusions: Focused early intervention for communication during mechanical ventilation allows the restoration of phonation significantly sooner than standard treatment, with no increase in complications in a small patient cohort. Although these results are favorable, further research is needed to determine whether the effects on any of the secondary outcomes are statistically significant and clinically important. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the effectiveness of preoperative inspiratory muscle training in reducing length of hospital stay and preventing postoperative pulmonary complications in people undergoing cardiothoracic or upper abdominal surgery. Preoperative inspiratory muscle training was compared with sham or no inspiratory muscle training through a systematic review and a meta analysis. The results of study were discussed.

The article discusses the importance of clinical trials in evaluating physical therapy in sports medicine. Topics included are the eligibility criteria and source of study participants, allocationa concealment and outcomes from group studies. The studies that met Physiotherapy Evidence Database (PEDro) criteria by subdiscipline of physiotherapy are cited.

• 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]

The author reflects on the clinical trial registration. He discusses several advantages of a prospective registration and the International Committee of Medical Journal Editors (ICMJE) endorsed clinical trial registration. He states that Physical Therapy has implemented a policy of mandatory prospective clinical trial registration and advices educators, clinicians, and administrators of clinical trials to ensure that clinical trial registration achieves its benefits.

The article discusses the recent recommendations by the International Society of Physiotherapy Journal Editors with respect to clinical trial registration in physical therapy journals, for placing the protocol for a clinical trial on a free, publicly available and electronically searchable register. The advantages of registration include tackling the main problems of selective reporting and publication bias. It also suggests that the procedure to be followed for trial registration is included.

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]

Background. Many bibliographic databases index research studies evaluating the effects of health care interventions. One study has concluded that the Physiotherapy Evidence Database (PEDro) has the most complete indexing of reports of randomized controlled trials of physical therapy interventions, but the design of that study may have exaggerated estimates of the completeness of indexing by PEDro. Objective. The purpose of this study was to compare the completeness of indexing of reports of randomized controlled trials of physical therapy interventions by 8 bibliographic databases. Design. This study was an audit of bibliographic databases. Methods. Prespecified criteria were used to identify 400 reports of randomized controlled trials from the reference lists of systematic reviews published in 2008 that evaluated physical therapy interventions. Eight databases (AMED, CENTRAL, CINAHL, EMBASE, Hooked on Evidence, PEDro, PsycINFO, and PubMed) were searched for each trial report. The proportion of the 400 trial reports indexed by each database was calculated. Results. The proportions of the 400 trial reports indexed by the databases were as follows: CENTRAL, 95%; PEDro, 92%; PubMed, 89%; EMBASE, 88%; CINAHL, 53%; AMED, 50%; Hooked on Evidence, 45%; and PsycINFO, 6%. Almost all of the trial reports (99%) were found in at least 1 database, and 88% were indexed by 4 or more databases. Four trial reports were uniquely indexed by a single database only (2 in CENTRAL and 1 each in PEDro and PubMed). Limitations. The results are only applicable to searching for English-language published reports of randomized controlled trials evaluating physical therapy interventions. Conclusions. The 4 most comprehensive databases of trial reports evaluating physical therapy interventions were CENTRAL, PEDro, PubMed, and EMBASE. Clinicians seeking quick answers to clinical questions could search any of these databases knowing that all are reasonably comprehensive. PEDro, unlike the other 3 most complete databases, is specific to physical therapy, so studies not relevant to physical therapy are less likely to be retrieved. Researchers could use CENTRAL, PEDro, PubMed, and EMBASE in combination to conduct exhaustive searches for randomized trials in physical therapy. [ABSTRACT FROM AUTHOR]

Objective. The objective of this study was to identify core journals in physical therapy by identifying those that publish the most randomized controlled trials of physical therapy interventions, provide the highest-quality reports of randomized controlled trials, and have the highest journal impact factors. Design. This study was an audit of a bibliographic database. Methods. All trials indexed in the Physiotherapy Evidence Database (PEDro) were analyzed. Journals that had published at least 80 trials were selected. The journals were ranked in 4 ways: number of trials published; mean total PEDro score of the trials published in the journal, regardless of publication year; mean total PEDro score of the trials published in the journal from 2000 to 2009; and 2008 journal impact factor. Results. The top 5 core journals in physical therapy, ranked by the total number of trials published, were Archives of Physical Medicine and Rehabilitation, Clinical Rehabilitation, Spine, British Medical Journal (BMJ), and Chest. When the mean total PEDro score was used as the ranking criterion, the top 5 journals were Journal of Physiotherapy, Journal of the American Medical Association (JAMA), Stroke, Spine, and Clinical Rehabilitation. When the mean total PEDro score of the trials published from 2000 to 2009 was used as the ranking criterion, the top 5 journals were Journal of Physiotherapy, JAMA, Lancet, BMJ, and Pain. The most highly ranked physical therapy-specific journals were Physical Therapy (ranked eighth on the basis of the number of trials published) and Journal of Physiotherapy (ranked first on the basis of the quality of trials). Finally, when the 2008 impact factor was used for ranking, the top S journals were JAMA, Lancet, BMJ, American Journal of Respiratory and Critical Care Medicine, and Thorax. There were no significant relationships among the rankings on the basis of trial quality, number of trials, or journal impact factor. Conclusions. Physical therapists who are trying to keep up-to-date by reading the best available evidence on the effects of physical therapy interventions have to read more broadly than just physical therapy-specific journals. Readers of articles on physical therapy trials should be aware that high-quality trials are not necessarily published in journals with high impact factors. [ABSTRACT FROM AUTHOR]

This perspective provides an overview of the randomized controlled trials, systematic reviews, and evidence-based clinical practice guidelines in physical therapy. Data from the Physiotherapy Evidence Database (PEDro) are used to describe key events in the history of physical therapy research and the growth of evidence of effects of interventions used in the various subdisciplines of physical therapy. The 11,494 records that were identified reveal a rich history of physical therapy research dating back to the first trial in 1929. Most of the randomized controlled trials, systematic reviews, and evidence-based clinical practice guidelines in physical therapy have been published since the year 2000. This rapid growth presents a challenge for physical therapists who want to keep up to date in clinical practice. [ABSTRACT FROM AUTHOR]

The authors reflect on 15 years of existence of the Physiotherapy Evidence Database (PEDro), a free resource that indexes published randomised controlled trials (RCT), systematic reviews and clinical practice guidelines relevant to physiotherapy. Topics discussed include the growth in the number of published RCTs and systematic reviews relevant to physiotherapy, the key features of PEDro, and enhancement projects to increase access and uptake of the database.

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.