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Objective Spinal manual therapy (SMT) is often used to treat patients with spinal disorders; however, the underlying mechanisms of SMT are not fully understood. This systematic review and meta-analysis investigates the effect of SMT compared with sham treatment or no intervention on local or remote (segmental or non-segmental) pressure pain thresholds (PPTs) in patients with chronic musculoskeletal conditions and people who are pain free. Methods A systematic search was conducted in the PubMed, Cochrane Library, Web of Science, and CINAHL databases. Randomized controlled trials investigating the effect of SMT on PPTs in patients with chronic musculoskeletal conditions and in people who were pain free were included. Quality assessment and evidence synthesis were performed according to Cochrane Handbook recommendations. A meta-analysis was performed using standardized mean difference and 95% CIs. Results Twenty-two reports were included in the present review. There were no significant results for an immediate effect of SMT on local (low certainty of evidence), remote (segmental) (low certainty of evidence), and remote (non-segmental) (low certainty of evidence) PPTs in patients with chronic pain as well as on local (moderate certainty of evidence) and remote (segmental) (low certainty of evidence) PPTs in people who were pain free. A small but significant effect (standardized mean difference = 0.26; 95% CI = 0.01 to 0.51; low certainty of evidence) was observed on remote (non-segmental) PPTs in people who were pain free, which was not considered a meaningful effect size. Conclusion No immediate, consistent, or meaningful hypoalgetic effect of SMT was shown on PPTs on various body areas. Involvement of spinal or supraspinal underlying mechanisms were, therefore, not confirmed via PPTs but should still be investigated using methods designed to assess central nervous pain processing. Impact No consistent and meaningful hypoalgesic effects of spinal manual therapy were demonstrated on PPTs in participants who were pain free and in patients with chronic musculoskeletal disorders.

Background This systematic review assesses the effectiveness of physiotherapy on headache parameters and quality of life of patients with tension-type headache using network meta-analysis. Methods A systematic search was conducted in the databases Web of Science, Medline, Cochrane Library and Physiotherapy Evidence Database up to August 2021. Randomised controlled trials investigating the effect of physiotherapy on tension-type headache were included. Risk of bias assessment was performed using the Risk of bias tool 2.0. Results were presented according to the Cochrane handbook and the PRISMA statement. Results Twenty reports were eligible and 15 were included in network meta-analysis for pain intensity and frequency. Transcutaneous electrical stimulation combined with physiotherapy was the most effective approach to reduce pain intensity compared to control (mean difference (MD): −4.18, moderate confidence) and usual care (MD: −3.8, moderate confidence) Manual therapy (joint mobilisation) plus exercise was the most effective intervention to reduce headache frequency compared to control (MD: −13.03, low confidence) and usual care (MD: −13.95, moderate confidence). Conclusion Results suggest a combination of passive physiotherapy techniques with exercise and/or transcutaneous electrical stimulation as the most effective physiotherapy intervention to reduce pain intensity and frequency in the short term. More research is needed to investigate mid-term and long-term effects. Trial registration: This review was prospectively registered in www.aspredicted.org under the registration number #46098 and an updated protocol was registered in the Open Science Framework (OSF) with the registration DOI: https://doi.org/10.17605/OSF.IO/RVUEY

According to the current guidelines preventive treatment of migraine should consist of a combination of pharmacological and nonpharmacological forms of treatment. Physiotherapeutic modalities could be an option for nonpharmacological migraine management.The aim was to assess the efficacy of physiotherapeutic interventions on pain intensity, duration and frequency as well as the quality of life of patients with migraine.A systematic literature search was carried out in four databases: the Physiotherapy Evidence Database (PEDro), Web of Science, Medline via PubMed and the Cochrane Library. Randomized controlled trials (RCTs) that were published up to the end of July 2021 and examined the effectiveness of physiotherapeutic treatment in migraine patients were eligible for inclusion. Studies that did not examine an adult population, interventions not carried out by a physiotherapist or not reporting an appropriate outcome were excluded. The assessment of the risk of bias was carried out with the revised version of the Cochrane risk of bias tool 2.0. A descriptive and quantitative synthesis using mean difference with a random effects model and 95% confidence intervals were used.The present review included 13 RCTs reporting on a total of 595 patients. The risk of bias was high for four studies, low for two studies and the remaining seven studies had some concerns. The interventions examined were multimodal physiotherapy programs, various mobilization techniques, trigger point therapy, manual lymphatic drainage, massage and various stretching techniques. All interventions examined had a significantly positive effect on the selected parameters compared to the baseline values. Especially combinations of various physiotherapeutic modalities showed clinically relevant results.The evidence suggests that multimodal physiotherapy treatment is a good supplement to medication and should therefore be considered as a nonpharmacological treatment for patients with migraine; however, further RCTs with a low risk of bias are necessary in order to confirm the effectiveness with high quality evidence.HINTERGRUND: Die präventive Behandlung von Migräne besteht nach aktuellen Leitlinien in einer Kombination medikamentöser und nichtmedikamentöser Behandlungen. Physiotherapie könnte eine Option für das nichtmedikamentöse Migränemanagement darstellen.Ziel war es, die Effektivität physiotherapeutischer Maßnahmen in Bezug auf die Schmerzintensität, -dauer und -frequenz sowie Lebensqualität von Patient*innen mit Migräne zu untersuchen.Eine systematische Literaturrecherche wurde in vier Datenbanken durchgeführt: Physiotherapy Evidence Database (PEDro), Web of Science, MEDLINE via PubMed und Cochrane Library. Es wurde nach randomisierten, kontrollierten Studien (RCT) gesucht, die bis Ende Juli 2021 publiziert wurden und die Effektivität von physiotherapeutischen Behandlungsmaßnahmen bei Migränepatient*innen erforschten. Studien, die keine Erwachsenenpopulation, keine von Physiotherapeut*innen durchgeführte Maßnahmen oder keine geeigneten Endpunkte untersuchten, wurden ausgeschlossen. Die Bewertung des Biasrisikos erfolgte mit der überarbeiteten Version des Cochrane Risk of Bias Tool 2.0. Eine deskriptive und quantitative Synthese mittels Mittelwertdifferenz mit einem Random-effects-Modell und 95 %-Konfidenzintervall wurde durchgeführt.Es wurden 13 RCT mit einer Gesamtzahl von 595 Patient*innen eingeschlossen. Vier dieser Studien wiesen ein hohes Biasrisiko, 2 ein niedriges Biasrisiko und die restlichen 7 Studien „einige Bedenken“ bezüglich des Biasrisikos auf. Untersuchte Interventionen waren multimodale Behandlungsmaßnahmen, verschiedene Mobilisationstechniken, Triggerpunkttherapie, manuelle Lymphdrainage, Massage und verschiedene Dehntechniken. Alle untersuchten Interventionen hatten einen signifikant positiven Effekt auf die ausgewählten Parameter im Vergleich zu den Ausgangswerten. Klinisch relevant waren die Effekte aber v. a. bei multimodalen physiotherapeutischen Therapiemaßnahmen.Die Studienlage legt nahe, dass physiotherapeutische, multimodale Behandlungsmaßnahmen eine gute Ergänzung zur Medikation sind und somit als nichtmedikamentöse Behandlung für Patient*innen mit Migräne geeignet sind. Es sind jedoch weitere RCT mit einem niedrigen Biasrisiko notwendig, um die Effektivität mit qualitativ hochwertiger Evidenz zu stützen.

Background: Internal and external validity are the most relevant components when critically appraising randomized controlled trials (RCTs) for systematic reviews. However, there is no gold standard to assess external validity. This might be related to the heterogeneity of terminology as well as to unclear evidence of the measurement properties of available tools. The aim of this review was to identify tools to assess the external validity of RCTs in systematic reviews and to evaluate the quality of evidence regarding their measurement properties.Methods: A two-phase systematic literature search was performed in four databases: MEDLINE via PubMed, Scopus, PsycINFO via OVID, and CINAHL via EBSCO. First, tools to assess the external validity of RCTs were identified. Second, studies aiming to investigate the measurement properties of these tools were selected. The measurement properties of each included tool were appraised using an adapted version of the COnsensus based Standards for the selection of health Measurement INstruments (COSMIN) guidelines.Results: 34 publications reporting on the development or validation of 26 included tools were included. For 62% of the included tools, there was no evidence of any measurement property. For the remaining tools, reliability was assessed most frequently. Reliability was judged as “sufficient” for three tools (very low quality of evidence). Content validity was rated as “sufficient” for one tool (moderate quality of evidence).Conclusions: Based on these results, no available tool can be fully recommended to assess the external validity of RCTs in systematic reviews. Several steps are required to overcome the identified difficulties to either adapt and validate available tools or to develop a new one. There is a need for more research for this purpose.Trial registration: Prospective registration at Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/PTG4D

Background Internal and external validity are the most relevant components when critically appraising randomized controlled trials (RCTs) for systematic reviews. However, there is no gold standard to assess external validity. This might be related to the heterogeneity of the terminology as well as to unclear evidence of the measurement properties of available tools. The aim of this review was to identify tools to assess the external validity of RCTs. It was further, to evaluate the quality of identified tools and to recommend the use of individual tools to assess the external validity of RCTs in future systematic reviews. Methods A two-phase systematic literature search was performed in four databases: PubMed, Scopus, PsycINFO via OVID, and CINAHL via EBSCO. First, tools to assess the external validity of RCTs were identified. Second, studies investigating the measurement properties of these tools were selected. The measurement properties of each included tool were appraised using an adapted version of the COnsensus based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. Results 38 publications reporting on the development or validation of 28 included tools were included. For 61% (17/28) of the included tools, there was no evidence for measurement properties. For the remaining tools, reliability was the most frequently assessed property. Reliability was judged as “sufficient” for three tools (very low certainty of evidence). Content validity was rated as “sufficient” for one tool (moderate certainty of evidence). Conclusions Based on these results, no available tool can be fully recommended to assess the external validity of RCTs in systematic reviews. Several steps are required to overcome the identified difficulties to either adapt and validate available tools or to develop a better suitable tool. Trial registration Prospective registration at Open Science Framework (OSF): 10.17605/OSF.IO/PTG4D.

It is widely acknowledged that young ventures and fast growing firms have a strong impact on economic growth and employment creation. It is not only entrepreneurial dynamics associated to entry and exit of new ventures, but also the ability of firms to survive and grow, that is important for economic development. Fast growing firms (not necessarily new), are the most dynamic agents in the economy and play a key role in job creation. Despite the economic impact of fast growing ventures, knowledge about the factors driving their growth path is unclear. A better understanding about how these factors work is important for developing countries, particularly for Latin American economies. Our study intends to contribute to entrepreneurship literature in two ways: a) integrating firm level factors associated to growth, with the local or sectorial environment within which those firms operate, in a small Latin American economy (Uruguay); b) framing that analysis within the context of a regional trade block (Mercosur). Entrepreneurship literature about these issues is scarce for developing economies, and our conjecture is that factors associated to micro and meso level of analysis, in this regional context, matter for how firms overcome the growth barriers they face. In our study, we analyze how firm and context level factors interact so as to explain employment growth of a sample of Uruguayan SMEs, during 2003-2007, period of strong economic expansion that followed a deep recession. Uruguay is a small and relatively open economy, located between Argentina and Brazil, partners in a regional trade agreement (Mercosur). We intend also to analyze how being part of this trade block has influence on firm growth. Preliminary results show, as expected, that small, young and internationalized firms tend to grow faster. Also, that regional and sectorial characteristics influence the ability of SMEs to surmount barriers to growth. Finally, some characteristics of the integration of the regional trade block into the world economy seem to be relevant to explain firm growth in Uruguay.