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As commissioned by the WHO, we updated and expanded the scope of four systematic reviews to inform its (in development) clinical practice guideline for the management of CPLBP in adults, including older adults. Methodological details and results of each review are described in the respective articles in this series. In the last article of this series, we discuss methodological considerations, clinical implications and recommendations for future research. [ABSTRACT FROM AUTHOR]

Chronic primary low back pain (CPLBP) is a prevalent and disabling condition that often requires rehabilitation interventions to improve function and alleviate pain. This paper aims to advance future research, including systematic reviews and randomized controlled trials (RCTs), on CPLBP management. We provide methodological and reporting recommendations derived from our conducted systematic reviews, offering practical guidance for conducting robust research on the effectiveness of rehabilitation interventions for CPLBP. Our systematic reviews contributed to the development of a WHO clinical guideline for CPLBP. Based on our experience, we have identified methodological issues and recommendations, which are compiled in a comprehensive table and discussed systematically within established frameworks for reporting and critically appraising RCTs. In conclusion, embracing the complexity of CPLBP involves recognizing its multifactorial nature and diverse contexts and planning for varying treatment responses. By embracing this complexity and emphasizing methodological rigor, research in the field can be improved, potentially leading to better care and outcomes for individuals with CPLBP. [ABSTRACT FROM AUTHOR]

Purpose: Evaluate benefits and harms of structured exercise programs for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline. Methods: We searched for randomized controlled trials (RCTs) in electronic databases (inception to 17 May 2022). Eligible RCTs targeted structured exercise programs compared to placebo/sham, usual care, or no intervention (including comparison interventions where the attributable effect of exercise could be isolated). We extracted outcomes, appraised risk of bias, conducted meta-analyses where appropriate, and assessed certainty of evidence using GRADE. Results: We screened 2503 records (after initial screening through Cochrane RCT Classifier and Cochrane Crowd) and 398 full text RCTs. Thirteen RCTs rated with overall low or unclear risk of bias were synthesized. Assessing individual exercise types (predominantly very low certainty evidence), pain reduction was associated with aerobic exercise and Pilates vs. no intervention, and motor control exercise vs. sham. Improved function was associated with mixed exercise vs. usual care, and Pilates vs. no intervention. Temporary increased minor pain was associated with mixed exercise vs. no intervention, and yoga vs. usual care. Little to no difference was found for other comparisons and outcomes. When pooling exercise types, exercise vs. no intervention probably reduces pain in adults (8 RCTs, SMD = − 0.33, 95% CI − 0.58 to − 0.08) and functional limitations in adults and older adults (8 RCTs, SMD = − 0.31, 95% CI − 0.57 to − 0.05) (moderate certainty evidence). Conclusions: With moderate certainty, structured exercise programs probably reduce pain and functional limitations in adults and older people with CPLBP. [ABSTRACT FROM AUTHOR]

Purpose Low back pain is associated with disability and lost productivity due to inability of workers to return to work. Personal recovery expectation beliefs may be associated with return to work outcomes in those with low back pain at high risk for chronic disability. We aimed to (1) assess whether workers' expectations for return to work, following a low back pain episode, are associated with subsequent return to work; and (2) explore the relationships between return to work expectations and other prognostic factors in their association with work outcomes. Methods We conducted an Individual Participant Data (IPD) meta-analysis using data from five prospective cohort studies identified by a Cochrane prognostic factor review. A one-stage IPD meta-analysis approach was applied. Multi-level mixed effects models were used to determine the unadjusted and adjusted associations between expectations and return to work (logistic regression) and time to return to work (parametric survival models with Weibull distribution). Results The final dataset included 2302 participants. Positive expectations for return to work were associated with return to work at follow-up in both unadjusted (Odds Ratio (OR) 2.95; 95% Confidence Interval (CI) 2.21, 3.95) (n = 2071) and comprehensively adjusted (OR 2.01; 95% CI 1.46, 2.77) (n = 1109) models. Similar findings were identified for shorter length of time to return to work in both unadjusted (HR 2.40; 95% CI 2.09, 2.75) (n = 1156) and minimally adjusted (HR 2.43; 95% CI 2.12, 2.79) (n = 1154) models. Conclusions Results suggest workers with low expectations for return to work are at increased risk for long-term work disability. [ABSTRACT FROM AUTHOR]

What are the effects of specific types of exercise treatments on pain intensity and functional limitation outcomes for adults with chronic low back pain? Systematic review with network meta-analysis of randomised controlled trials. Adults with non-specific low back pain for ≥ 12 weeks. Exercise treatments prescribed or planned by a health professional that involved conducting specific activities, postures and/or movements with a goal to improve low back pain outcomes. Pain intensity (eg, visual analogue scale or numerical rating scale) and back-related functional limitations (eg, Roland Morris Disability Questionnaire or Oswestry Disability Index), each standardised to range from 0 to 100. This review included 217 randomised controlled trials with 20,969 participants and 507 treatment groups. Most exercise types were more effective than minimal treatment for pain and functional limitation outcomes. Network meta-analysis results were compatible with moderate to clinically important treatment effects for Pilates, McKenzie therapy, and functional restoration (pain only) and flexibility exercises (function only) compared with minimal treatment, other effective treatments and other exercise types. The estimated mean differences for these exercise types compared with minimal treatment ranged from −15 to −19 for pain and from −10 to −12 for functional limitation. This review found evidence that Pilates, McKenzie therapy and functional restoration were more effective than other types of exercise treatment for reducing pain intensity and functional limitations. Nevertheless, people with chronic low back pain should be encouraged to perform the exercise that they enjoy to promote adherence. DOI: 10.1002/14651858.CD009790. [ABSTRACT FROM AUTHOR]

Objective: The present systematic review aimed to evaluate the association between childhood maltreatment and chronic pain, with specific attention to the temporal nature of the relationship and putative moderators, including, the nature (type), timing of occurrence, and magnitude of maltreatment; whether physical harm or injury occurred; and whether post-traumatic stress disorder (PTSD) subsequently developed. Method: We included studies that measured the prospective relationship between child maltreatment and pain. Medline, EMBASE, PsycINFO, and CINAHL were searched electronically up to 28 July 2019. We used accepted methodological procedures common to prognosis studies and preregistered our review (PROSPERO record ID 142169) as per Cochrane review recommendations. Results: Nine studies (17,340 participants) were included in the present review. Baseline participant age ranged from 2 years to more than 65 years. Follow-up intervals ranged from one year to 16 years. Of the nine studies included, three were deemed to have a high risk of bias. With the exception of one meta-analysis of three studies, results were combined using narrative synthesis. Results showed low to very low quality and conflicting evidence across the various types of maltreatment, with the higher quality studies pointing to the absence of direct (nonmoderated and non-mediated) associations between maltreatment and pain. PTSD was revealed to be a potential mediator and/or moderator. Evidence was not found for other proposed moderators. Conclusions: Overall, there is an absence of evidence from high quality studies of an association between maltreatment and pain. Our results are limited by the small number of studies reporting the relationship between child maltreatment and pain using a prospective design. High quality studies, including prospective cohort studies and those that assess and report on the moderators described above, are needed to advance the literature. [ABSTRACT FROM AUTHOR]

Objective To synthesize the literature on the proportion of health care providers who access and use prescription monitoring program data in their practice, as well as associated barriers to the use of such data. Design We performed a systematic review using a standard systematic review method with meta-analysis and qualitative meta-summary. We included full-published peer-reviewed reports of study data, as well as theses and dissertations. Methods We identified relevant quantitative and qualitative studies. We synthesized outcomes related to prescription monitoring program data use (i.e. ever used, frequency of use). We pooled the proportion of health care providers who had ever used prescription monitoring program data by using random effects models, and we used meta-summary methodology to identify prescription monitoring program use barriers. Results Fifty-three studies were included in our review, all from the United States. Of these, 46 reported on prescription monitoring program use and 32 reported on barriers. The pooled proportion of health care providers who had ever used prescription monitoring program data was 0.57 (95% confidence interval: 0.48–0.66). Common barriers to prescription monitoring program data use included time constraints and administrative burdens, low perceived value of prescription monitoring program data, and problems with prescription monitoring program system usability. Conclusions Our study found that health care providers underutilize prescription monitoring program data and that many barriers exist to prescription monitoring program data use. [ABSTRACT FROM AUTHOR]

Objective: This study retroactively investigated the search used in a 2019 review by Hayden et al., one of the first systematic reviews of prognostic factors that was published in the Cochrane Library. The review was designed to address recognized weaknesses in reviews of prognosis by using multiple supplementary search methods in addition to traditional electronic database searching. Methods: The authors used four approaches to comprehensively assess aspects of systematic review literature searching for prognostic factor studies: (1) comparison of search recall of broad versus focused electronic search strategies, (2) linking of search methods of origin for eligible studies, (3) analysis of impact of supplementary search methods on meta-analysis conclusions, and (4) analysis of prognosis filter performance. Results: The review's focused electronic search strategy resulted in a 91% reduction in recall, compared to a broader version. Had the team relied on the focused search strategy without using supplementary search methods, they would have missed 23 of 58 eligible studies that were indexed in MEDLINE; additionally, the number of included studies in 2 of the review's primary outcome meta-analyses would have changed. Using a broader strategy without supplementary searches would still have missed 5 studies. The prognosis filter used in the review demonstrated the highest sensitivity of any of the filters tested. Conclusions: Our study results support recommendations for supplementary search methods made by prominent systematic review methodologists. Leaving out any supplemental search methods would have resulted in missed studies, and these omissions would not have been prevented by using a broader search strategy or any of the other prognosis filters tested. [ABSTRACT FROM AUTHOR]

Background: Low back pain is one of the leading causes of disability worldwide. Exercise therapy is widely recommended to treat persistent non-specific low back pain. While evidence suggests exercise is, on average, moderately effective, there remains uncertainty about which individuals might benefit the most from exercise.Methods: In parallel with a Cochrane review update, we requested individual participant data (IPD) from high-quality randomised clinical trials of adults with our two primary outcomes of interest, pain and functional limitations, and calculated global recovery. We compiled a master data set including baseline participant characteristics, exercise and comparison characteristics, and outcomes at short-term, moderate-term and long-term follow-up. We conducted descriptive analyses and one-stage IPD meta-analysis using multilevel mixed-effects regression of the overall treatment effect and prespecified potential treatment effect modifiers.Results: We received IPD for 27 trials (3514 participants). For studies included in this analysis, compared with no treatment/usual care, exercise therapy on average reduced pain (mean effect/100 (95% CI) -10.7 (-14.1 to -7.4)), a result compatible with a clinically important 20% smallest worthwhile effect. Exercise therapy reduced functional limitations with a clinically important 23% improvement (mean effect/100 (95% CI) -10.2 (-13.2 to -7.3)) at short-term follow-up. Not having heavy physical demands at work and medication use for low back pain were potential treatment effect modifiers-these were associated with superior exercise outcomes relative to non-exercise comparisons. Lower body mass index was also associated with better outcomes in exercise compared with no treatment/usual care. This study was limited by inconsistent availability and measurement of participant characteristics.Conclusions: This study provides potentially useful information to help treat patients and design future studies of exercise interventions that are better matched to specific subgroups. PROTOCOL PUBLICATION: https://doi.org/10.1186/2046-4053-1-64. [ABSTRACT FROM AUTHOR]

Objective: To conduct a systematic review synthesizing the evidence for the effectiveness of the Wheelchair Skills Training Program (WSTP). Data Sources: We searched PubMed, the Cochrane Library, CINAHL and Embase databases, as well as grey literature, up to 10 October 2017. Study Selection: Randomized controlled trials (RCTs) assessing the effectiveness of the WSTP. Data Extraction: Two independent reviewers screened articles and extracted data. Methodological quality was assessed using Cochrane's Risk of Bias Tool. Data Synthesis: Meta-analyses (including sub-group analyses) were conducted for the Wheelchair Skills Test (WST) and WST Questionnaire (WST-Q) total capacity scores. We qualitatively assessed retention, WST/WST-Q subtotal and individual-skill capacity scores and other identified outcomes. The quality of evidence was determined using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Thirteen articles (581 participants) were included for analysis. The level of evidence was of moderate quality. The WSTP increased the post-training WST/WST-Q total capacity scores by 14.0% (95% CI: 7.4, 20.8; p <.0001) compared to no treatment, standard care or educational controls, a relative increase over baseline of 21.2%. Subgroup analyses showed that training was more effective for new wheelchair users. Retention of training effects was suggested by the absence of significant declines between tests post-training and at follow-up. The WSTP was found to have positive effects on some other outcomes. No serious adverse events were reported. Conclusions: There is moderate quality evidence that the WSTP is a safe intervention that has a clinically meaningful effect on WST/WST-Q capacity scores and some other outcomes. A systematic review and meta-analysis of 13 randomized controlled trials on a total of 581 participants, using the Wheelchair Skills Training Program (WSTP) as the intervention, found that the WSTP increased Wheelchair Skills Test (WST) and WST Questionnaire (WST-Q) total capacity scores by 21.2% relative to baseline. Subgroup analyses showed that training was more effective for new wheelchair users. The WSTP was found to have positive effects on some other outcomes and no serious adverse events were reported. The WSTP warrants cautious implementation in clinical and educational settings. [ABSTRACT FROM AUTHOR]

* BACKGROUND: Mechanical Diagnosis and Therapy (MDT) is a treatment-based classification system founded on 3 core principles: classification into diagnostic syndromes, classification-based intervention, and appropriate application of force. Many randomized controlled trials have investigated the efficacy of MDT for low back pain; however, results have varied. The inconsistent delivery of MDT across trials may explain the different findings. * OBJECTIVES: To compare treatment effect sizes for pain or disability between trials that delivered MDT consistent with the core principles of the approach and trials that met some or none of these principles. * METHODS: In this systematic review, databases were searched from inception to June 2018 for studies that delivered MDT compared to nonpharmacological, conservative control interventions in patients with low back pain and reported outcomes of pain or disability. Studies were classified as "adherent" (meeting the core principles of MDT) or "nonadherent" (using some or none of the principles of MDT). Data were extracted by 2 independent reviewers. Meta-regression procedures were used to analyze the effect of delivery mode on clinical outcomes, adjusting for covariates of symptom duration (less than or greater than 3 months) and control intervention (minimal or active). * RESULTS: Studies classified as adherent to the MDT approach showed greater reductions in pain and disability of 15.0 (95% confidence interval: 7.3,22.7) and 11.7 (95% confidence interval: 5.4, 18.0) points, respectively, on a 100-point scale compared to nonadherent trials. * CONCLUSION: This review provides preliminary evidence that treatment effects of MDT are greater when the core principles are followed. * LEVEL OF EVIDENCE: Therapy, level 1a. [ABSTRACT FROM AUTHOR]

Objective: Online training for systematic review methodology is an attractive option due to flexibility and limited availability of in-person instruction. Librarians often direct new reviewers to these online resources, so they should be knowledgeable about the variety of available resources. The objective for this project was to conduct an environmental scan of online systematic review training resources and evaluate those identified resources. Methods: The authors systematically searched for electronic learning resources pertaining to systematic review methods. After screening for inclusion, we collected data about characteristics of training resources and assigned scores in the domains of (1) content, (2) design, (3) interactivity, and (4) usability by applying a previously published evaluation rubric for online instruction modules. We described the characteristics and scores for each training resource and compared performance across the domains. Results: Twenty training resources were evaluated. Average overall score of online instructional resources was 61%. Online courses (n=7) averaged 73%, web modules (n=5) 64%, and videos (n=8) 48%. The top 5 highest scoring resources were in course or web module format, featured high interactivity, and required a longer (>5hrs) time commitment from users. Conclusion: This study revealed that resources include appropriate content but are less likely to adhere to principles of online training design and interactivity. Awareness of these resources will allow librarians to make informed recommendations for training based on patrons' needs. Future online systematic review training resources should use established best practices for e-learning to provide high-quality resources, regardless of format or user time commitment. [ABSTRACT FROM AUTHOR]

Background: Mental health literacy is important to improve help-seeking behaviors. However, the quality of mental health help-seeking tools remains unknown. Aims: We conducted a systematic review to appraise the quality of such tools. Methods: We searched databases for English publications addressing psychometrics of help-seeking tools. We included help-seeking tools addressing mental health in general and tools on four mental disorders: anxiety, depression, attention deficit hyperactivity disorder (ADHD) and schizophrenia. We determined the methodological quality of studies as “excellent”, “good”, “fair”, or “indeterminate”. We ranked the level of evidence of each measurement property as “strong”, “moderate”, “limited”, “conflicting” or “unknown”. Results: We found 12 help-seeking tools in 24 studies that assessed related psychometrics. The methodological quality of included studies ranged from “poor” to “excellent” with four studies on the content validity, structural validity or internal consistency demonstrating “excellent” quality. Three tools demonstrated overall strong evidence (content or structural validity); eight tools demonstrated moderate evidence (internal consistency, structural or construct validity); and eight tools demonstrated limited evidence (reliability, construct validity or internal consistency). Conclusions: We recommend the application of tools with strong or moderate evidence for their psychometric properties. Future research may focus on the generalizability of the tools across diverse settings. [ABSTRACT FROM PUBLISHER]

Background: Low back pain may be having a significant impact on emergency departments around the world. Research suggests low back pain is one of the leading causes of emergency department visits. However, in the peer-reviewed literature, there has been limited focus on the prevalence and management of back pain in the emergency department setting. The aim of the systematic review was to synthesize evidence about the prevalence of low back pain in emergency settings and explore the impact of study characteristics including type of emergency setting and how the study defined low back pain.Methods: Studies were identified from PubMed and EMBASE, grey literature search, and other sources. We selected studies that presented prevalence data for adults presenting to an emergency setting with low back pain. Critical appraisal was conducted using a modified tool developed to assess prevalence studies. Meta-analyses and a meta-regression explored the influence of study-level characteristics on prevalence.Results: We screened 1187 citations and included 21 studies, reported between 2000 and 2016 presenting prevalence data from 12 countries. The pooled prevalence estimate from studies of standard emergency settings was 4.39% (95% CI: 3.67-5.18). Prevalence estimates of the included studies ranged from 0.9% to 17.1% and varied with study definition of low back pain and the type of emergency setting. The overall quality of the evidence was judged to be moderate as there was limited generalizability and high heterogeneity in the results.Conclusion: This is the first systematic review to examine the prevalence of low back pain in emergency settings. Our results indicate that low back pain is consistently a top presenting complaint and that the prevalence of low back pain varies with definition of low back pain and emergency setting. Clinicians and policy decisions makers should be aware of the potential impact of low back pain in their emergency settings. [ABSTRACT FROM AUTHOR]

Background: Western publicly funded health care systems increasingly rely on interdisciplinary teams to support primary care delivery and management of chronic conditions. This knowledge synthesis focuses on what is known in the academic and grey literature about optimal structural characteristics of teams. Its goal is to assess which factors contribute to the effective functioning of interdisciplinary primary care teams and improved health system outcomes, with specific focus on (i) team structure contribution to team process, (ii) team process contribution to primary care goals, and (iii) team structure contribution to primary care goals. Methods and design: The systematic search of academic literature focuses on four chronic conditions and co-morbidities. Within this scope, qualitative and quantitative studies that assess the effects of team characteristics (funding, governance, organization) on care process and patient outcomes will be searched. Electronic databases (Ovid MEDLINE, Embase, CINAHL, PAIS, Web of Science) will be searched systematically. Online web-based searches will be supported by the Grey Matters Tool. Studies will be included, if they report on interdisciplinary primary care in publicly funded Western health systems, and address the relationships between team structure, process, and/or patient outcomes. Studies will be selected in a three-stage screening process (title/abstract/full text) by two independent reviewers in each stage. Study quality will be assessed using the Mixed Methods Assessment Tool. An a priori framework will be applied to data extraction, and a narrative framework approach is used for the synthesis. Discussion: Using an integrated knowledge translation approach, an electronic decision support tool will be developed for decision makers. It will be searchable along two axes of inquiry: (i) what primary care goals are supported by specific team characteristics and (ii) how should teams be structured to support specific primary care goals? The results of this evidence review will contribute directly to the design of interdisciplinary primary care teams. The optimized design will support the goals of primary care, contributing to the improved health of populations. [ABSTRACT FROM AUTHOR]

Background: Mental health literacy has received great attention recently to improve mental health knowledge, decrease stigma and enhance help-seeking behaviors. We conducted a systematic review to critically appraise the qualities of studies evaluating the measurement properties of mental health knowledge tools and the quality of included measurement properties. Methods: We searched PubMed, PsycINFO, EMBASE, CINAHL, the Cochrane Library, and ERIC for studies addressing psychometrics of mental health knowledge tools and published in English. We applied the COSMIN checklist to assess the methodological quality of each study as "excellent", "good", "fair", or "indeterminate". We ranked the level of evidence of the overall quality of each measurement property across studies as "strong", "moderate", "limited", "conflicting", or "unknown". Results: We identified 16 mental health knowledge tools in 17 studies, addressing reliability, validity, responsiveness or measurement errors. The methodological quality of included studies ranged from "poor" to "excellent" including 6 studies addressing the content validity, internal consistency or structural validity demonstrating "excellent" quality. We found strong evidence of the content validity or internal consistency of 6 tools; moderate evidence of the internal consistency, the content validity or the reliability of 8 tools; and limited evidence of the reliability, the structural validity, the criterion validity, or the construct validity of 12 tools. Conclusions: Both the methodological qualities of included studies and the overall evidence of measurement properties are mixed. Based on the current evidence, we recommend that researchers consider using tools with measurement properties of strong or moderate evidence that also reached the threshold for positive ratings according to COSMIN checklist. [ABSTRACT FROM AUTHOR]

Background: Successful management of cardiovascular disease (CVD) is impaired by poor adherence to clinical practice guidelines. The objective of our review was to synthesize evidence about the effectiveness of interventions that target healthcare providers to improve adherence to CVD guidelines and patient outcomes. Methods: We searched PubMed, EMBASE, Cochrane Library, PsycINFO, Web of Science and CINAHL databases from inception to June 2014, using search terms related to adherence and clinical practice guidelines. Studies were limited to randomized controlled trials testing an intervention to improve adherence to guidelines that measured both a patient and adherence outcome. Descriptive summary tables were created from data extractions. Meta-analyses were conducted on clinically homogeneous comparisons, and sensitivity analyses and subgroup analyses were carried out where possible. GRADE summary of findings tables were created for each comparison and outcome. Results and Discussion: We included 38 RCTs in our review. Interventions included guideline dissemination, education, audit and feedback, and academic detailing. Meta-analyses were conducted for several outcomes by intervention type. Many comparisons favoured the intervention, though only the adherence outcome for the education intervention showed statistically significant improvement compared to usual care (standardized mean difference = 0.58 [95 % confidence interval 0.35 to 0.8]). Conclusions: Many interventions show promise to improve practitioner adherence to CVD guidelines. The quality of evidence and number of trials limited our ability to draw conclusions. [ABSTRACT FROM AUTHOR]

Background: Theory is often recommended as a framework for guiding hypothesized mechanisms of treatment effect. However, there is limited guidance about how to use theory in intervention development. Methods: We conducted a systematic review to provide an exemplar review evaluating the extent to which use of theory is identified and incorporated within existing interventions. We searched electronic databases PubMed, PsycINFO, CENTRAL, and EMBASE from inception to May 2014. We searched clinicaltrials.gov for registered protocols, reference lists of relevant systematic reviews and included studies, and conducted a citation search in Web of Science. We included peer-reviewed publications of interventions that referenced the social cognitive theory of self-regulation as a framework for interventions to manage chronic health conditions. Two reviewers independently assessed articles for eligibility. We contacted all authors of included studies for information detailing intervention content. We describe how often theory mechanisms were addressed by interventions, and report intervention characteristics used to address theory. Results: Of 202 articles that reported using the social cognitive theory of self-regulation, 52% failed to incorporate self-monitoring, a main theory component, and were therefore excluded. We included 35 interventions that adequately used the theory framework. Intervention characteristics were often poorly reported in peer-reviewed publications, 21 of 35 interventions incorporated characteristics that addressed each of the main theory components. Each intervention addressed, on average, six of eight self-monitoring mechanisms, two of five self-judgement mechanisms, and one of three self-evaluation mechanisms. The self-monitoring mechanisms ‘Feedback’ and ‘Consistency’ were addressed by all interventions, whereas the self-evaluation mechanisms ‘Self-incentives’ and ‘External rewards’ were addressed by six and four interventions, respectively. The present review establishes that systematic review is a feasible method of identifying use of theory as a conceptual framework for existing interventions. We identified the social cognitive theory of self-regulation as a feasible framework to guide intervention development for chronic health conditions. [ABSTRACT FROM AUTHOR]

Aim: Conduct a systematic review for the effectiveness of school mental health literacy programs to enhance knowledge, reduce stigmatizing attitudes and improve help-seeking behaviours among youth (12-25 years of age). Methods: Reviewers independently searched PubMed, PsycINFO, Cochrane Library, CINAHL, ERIC, grey literature and reference lists of included studies. They reached a consensus on the included studies, and rated the risk of bias of each study. Studies that reported three outcomes: knowledge acquisition, stigmatizing attitudes and help-seeking behaviours; and were randomized controlled trials ( RCTs), cluster RCTs, quasi-experimental studies, and controlled-before-and-after studies, were eligible. Results: This review resulted in 27 articles including 5 RCTs, 13 quasi-experimental studies, and 9 controlled-before-and-after studies. Whereas most included studies claimed school-based mental health literacy programs improve knowledge, attitudes and help-seeking behaviour, 17 studies met criteria for high risk of bias, 10 studies for moderate risk of bias, and no studies for low risk of bias. Common limitations included the lack of randomization, control for confounding factors, validated measures and report on attrition in most studies. The overall quality of the evidence for knowledge and help-seeking behaviour outcomes was very low, and low for the attitude outcome. Conclusions: Research into school-based mental health literacy is still in its infancy and there is insufficient evidence to claim for positive impact of school mental health literacy programs on knowledge improvement, attitudinal change or help-seeking behaviour. Future research should focus on methods to appropriately determine the evidence of effectiveness on school-based mental health literacy programs, considering the values of both RCTs and other research designs in this approach. Educators should consider the strengths and weaknesses of current mental health literacy programs to inform decisions regarding possible implementation. [ABSTRACT FROM AUTHOR]

Background: To provide valid assessments of answers to prognostic questions, systematic reviews must appraise the quality of the available evidence. However, no standard quality assessment method is currently available. Purpose: To appraise how authors assess the quality of individual studies in systematic reviews about prognosis and to propose recommendations for these quality assessments. Data Sources: English-language publications listed in MEDLINE from 1966 to October 2005 and review of cited references. Study Selection: 163 systematic reviews about prognosis that included assessments of the quality of studies. Data Extraction: A total of 882 distinct quality items were extracted from the assessments that were reported in the various reviews. Using an iterative process, 2 independent reviewers grouped the items into 25 domains. The authors then specifically identified domains necessary to assess potential biases of studies and evaluated how often those domains had been addressed in each review. Data Synthesis: Fourteen of the domains addressed 6 sources of bias related to study participation, study attrition, measurement of prognostic factors, measurement of and controlling for confounding variables, measurement of outcomes, and analysis approaches. Reviews assessed a median of 2 of the 6 potential biases; only 2 (1%) included criteria aimed at appraising all potential sources of bias. Few reviews adequately assessed the impact of confounding (12%), although more than half (59%) appraised the methods used to measure the prognostic factors of interest. Limitations: Reviews may have been missed by the search or misclassified because of incomplete reporting. Validity and reliability testing of the authors' recommendations are required. Conclusions: Quality appraisal, a necessary step in systematic reviews, is incomplete in most reviews of prognosis studies. Adequate quality assessment should include judgments about 6 areas of potential study biases. Authors should incorporate these quality assessments into their synthesis of evidence about prognosis. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the effects of acjute cannabis consumption on the risk of motor vehicle collision. The study performs systematic review of observational studies, meta-analysis, and epidemiology studies of motor vehicle collisions and measures cannabis use among drivers through self reports and toxicological analysis of blood. Result shows the increase of collision risk when driving under cannabis influence.

Pediatric surgeries are common and painful for children. Postoperative pain is commonly managed with analgesics; however, pain is often still problematic. Despite evidence for psychological interventions for procedural pain, there is currently no evidence synthesis for psychological interventions in managing postoperative pain in children. The purpose of this review was to assess the efficacy of psychological interventions for postoperative pain in youth. Psychological interventions included Preparation/education, distraction/imagery, and mixed. Four databases (PsycINFO, PubMed, EMBASE, and Certified Index to Nursing and Allied Health Literature) were searched to July 2015 for published articles and dissertations. We screened 1401 citations and included 20 studies of youth aged 2 to 18 years undergoing surgery. Two reviewers independently screened articles, extracted data, and assessed risk of bias. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated using RevMan 5.3. Fourteen studies (1096 participants) were included in meta-analyses. Primary outcome was pain intensity (0-10 metric). Results indicated that psychological interventions as a whole were effective in reducing children's self-reported pain in the short term (SMD = -0.47, 95% CI = -0.76 to -0.18). Subgroup analysis indicated that distraction/imagery interventions were effective in reducing self-reported pain in the short term (24 hours, SMD = -0.63, 95% CI = -1.04 to -0.23), whereas preparation/education interventions were not effective (SMD = -0.27, 95% CI = -0.61 to 0.08). Data on the effects of interventions on longer term pain outcomes were limited. Psychological interventions may be effective in reducing short-term postoperative pain intensity in children, as well as longer term pain and other outcomes (eg, adverse events) require further study. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to systematically review the evidence for the effectiveness of core stability exercises for treating athletes with low back pain (LBP). Data Sources: We searched several databases (Medline, AMED, CINAHL, SportDiscus, and EMBASE). Our eligibility criteria consisted of articles published in a peer-reviewed journal in English, using any prospective clinical study design, where athletes with nonspecific LBP were treated with core stability exercises in at least 1 study arm, and back pain intensity and/or disability were used as outcome measures. All included randomized controlled trials (RCTs) were assessed for risk of bias using the Cochrane Risk of Bias tool, whereas non-RCT studies were assessed for quality using the Downs and Black checklist. Main Results: Five studies including 151 participants met the inclusion criteria, including 2 RCTs. The quality of the literature on this topic was deemed to be low overall, with only 1 non-RCT having a moderate quality score, and 1 RCT having a lower risk of bias. Four studies reported statistically significant decreases in back pain intensity in their core stability intervention group. Conclusions: The quantity and quality of literature on the use of core stability exercises for treating LBP in athletes is low. The existing evidence has been conducted on small and heterogeneous study populations using interventions that vary drastically with only mixed results and short-term follow-up. This precludes the formulation of strong conclusions, and additional high quality research is clearly needed. [ABSTRACT FROM AUTHOR]