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Background: The study investigated the incidence of chronic pain as well as causes and mechanisms of pain chronification in orchestra musicians. Aims: Chronic pain is a serious problem in the study group due to very specific playing techniques and body positions while playing, with a high impact on professional and private life. Methods: 8,645 professional musicians from 132 German cultural orchestras were contacted and asked about chronic pain via an online questionnaire. The study group comprised orchestra musicians suffering from pain. The control group consisted of musicians playing the same type of instruments (same working conditions) who reported to be free of pain. Results: The response rate was 8.6% (740 musicians). 66.2% (n=490) out of 740 musicians who completed the questionnaire reported chronic pain. The most frequently reported localizations of pain were the body parts which are mostly involved in instrumental playing such as back (70%), shoulders (67.8%), neck (64.1%), hands and wrists (39.8%). 27.4% of the investigated musicians suffered from pain with a high degree of impairment. Conclusions: These results appear conclusive and indicate a need to continue research into chronic pain in musicians.

[english] The World Health Organization states that in a widespread report that “in developed countries, adherence among patients suffering chronic diseases averages only 50%”. We followed the quoted references to this statement. The data basis for this statement is one randomized controlled trial (RCT) on hypertensive steel workers in Canada published in 1975 and one study dealing with neurotic outpatients in Pennsylvania, USA published in 1965. Both studies are not suitable to assume such generalized adherence estimation and are not for different reasons transferable to today’s patient care.[german] Die Weltgesundheitsorganisation (WHO) gibt in einem sehr verbreiteten Bericht an, dass die Therapietreue bei Patienten mit chronischen Erkrankungen bei durchschnittlich 50% in entwickelten Ländern liegt. Wir haben anhand der Literaturhinweise die Basis dieser Aussage verfolgt. Die Basis dieser Aussage ist lediglich eine randomisierte kontrollierte Studie (RCT) an kanadischen Stahlarbeitern mit Hypertension von 1975 sowie eine US-amerikanische Studie an neurotischen Patienten von 1965. Beide Studien sind nicht geeignet eine derart generalisierte Aussage zu treffen und darüber hinaus nicht auf die gegenwärtige Patientenversorgung übertragbar.

Cochrane reviews are known to be a high-quality source of evidence synthesis supporting health care decisions. In a recently conducted study, we analyzed the trends in epidemiology and reporting of published systematic reviews over the last 20 years. This sample of 1132 systematic reviews included 84 Cochrane reviews. We have learned several peculiarities of Cochrane reviews that are worth being discussed in more detail due to their practical implications. Methodologists, clinicians and health care professionals should be aware of these limitations: (1) Cochrane reviews are not identified as systematic reviews in title, (2) Cochrane reviews do not always follow PRISMA reporting guidelines, (3) Some updates are only available via the Cochrane Library, and (4) Indexing of Cochrane reviews in PubMed may be suboptimal.

Some Cochrane reviews were declared stable or closed, that is, not in need of updating. For some of them, it has been declared that conclusions will not (or it is unlikely they will) change with further studies. We explored whether there is a discernable decision-making pattern for decisions about the conclusiveness and stabilization of these reviews. We analyzed Cochrane reviews published until April 2020 labeled as stable or closed. We extracted the rationale leading to the decision declaring that the conclusion is not expected to change with further studies. Furthermore, we assessed whether the reviews used GRADE analysis. We extracted data from summary of findings (SoF) tables on the direction of effect, statistical significance, and I[superscript 2] values for the first and primary outcomes in SoFs, conclusions in the abstract and review, and implications for practice and future research. We included 40 stable/closed Cochrane reviews. Rationales for their stabilization did not enable any insight into the Cochrane's decision-making algorithm for considering the evidence as conclusive. Among 191 outcomes presented in the SoFs, 70% were rated with either low or very low certainty evidence. None of the reviews mentioned in the text that the review should be stabilized or closed, or that there is sufficient evidence on the subject. Reasons for stabilizing/closing Cochrane reviews were unclear, and we could not discern any pattern of "conclusive review" traits. Definition of systematic review conclusiveness is still lacking, which may contribute to research waste.

This randomized controlled trial (RCT) aimed to test the efficacy of enhanced access to Cochrane Handbook (Handbook) recommendations for judging the 2011 Cochrane risk of bias (RoB) domains for improving the adequacy of RoB judgments. Parallel-group RCT with a 1:1 allocation ratio (N = 2271 per group) was conducted. Eligible participants were corresponding authors of all published Cochrane reviews and protocols. After allocation by a random number generator, participants received 20 scenarios for assessing RoB. The intervention group was shown tables from the Handbook with instructions for assessing 2011 RoB tool together with scenarios they were supposed to assess--enhanced access to the Handbook. The control group was shown only a general link to the Handbook. The primary outcome was the proportion of participants that made an adequate judgment of RoB scenarios for analyzed domains. There were 240 responses out of 2020 delivered e-mail invitations in the intervention and 197/2254 in the control group. Only five participants from the intervention group judged RoB adequately in all the 20 scenarios and no one in the control group. The proportion of participants who adequately assessed all the scenarios within a domain was significantly higher in the intervention than in the control group. The frequency of adequate RoB judgments was 7.1% (95% CI: 5.0-9.3%, p < 0.001) higher in the intervention group (76.2%) than in the control group (69.0%). The enhanced access yields more adequate RoB assessments and could be incorporated in software supporting the RoB tool.

Background: It is challenging to keep systematic reviews (SR) current and updated. Cochrane designated some of its SRs as "stable," that is, not in need of updating. The issue of stabilizing an SR is an important in research synthesis, because it could help reduce research waste. The aim of this study was to analyze publicly available justifications for stabilizing a Cochrane review, with the ultimate goal of helping to make decisions about whether the update of any SR is warranted. Methods: We analyzed Cochrane reviews labeled as stable in Archie, Cochrane's system for managing the editorial/publishing process. From the "What's new" section of the reviews in the Cochrane Library, we extracted justification for stabilization. Results: We included 545 Cochrane reviews labeled in Archie as stable on October 28, 2019. The most common of the five reasons for stabilization was that "last search did not identify any potentially relevant studies likely to change conclusions" (N=99; 18%), followed by "research area no longer active" (N=86; 16%), "review is or will be superseded" (N=41; 7.5%), "evidence is conclusive" (N=35; 6.4%), and "intervention no longer in general use" (N=34; 6.2%). For the 269 (49%) Cochrane reviews, we considered that the justification for stabilization was not clearly described, that is, sufficiently informative. Conclusions: Cochrane reviews would benefit from more transparency and consistency in publicly available justifications for stabilizing reviews. Further work in this field will help make decisions about the futility of further research and deciding on enough evidence in the field of research synthesis.

Background: Evidence syntheses provide the basis for evidence-based decision making in healthcare. To judge the certainty of findings for the specific decision context evidence syntheses should consider context suitability (ie, generalizability, external validity, applicability or transferability). Our objective was to determine the status quo and to provide a comprehensive overview of existing methodological recommendations of Health Technology Assessment (HTA) and Systematic Review (SR) producing organizations in assessing context suitability of evidence on effectiveness of health care interventions. Additionally, we analyzed similarities and differences between the recommendations. Methods: In this Integrative Review we performed a structured search for methods documents from evidence synthesis producing organizations that include recommendations on appraising context suitability in effectiveness assessments. Two reviewers independently selected documents according to predefined eligibility criteria. Data were extracted in standardized and piloted tables by one reviewer and verified by a second reviewer. We performed a thematic analysis to identify and summarize the main themes and categories regarding recommended context suitability assessments. Results: We included 14 methods documents of 12 organizations in our synthesis. Assessment approaches are very heterogeneous both regarding the general concepts (eg, integration in the evidence synthesis preparation process) and the content of assessments (eg, assessment criteria). Conclusion: Some heterogeneity seems to be justified because of the need to tailor the assessment to different settings and medical areas. However, most differences were inexplicable. More harmonization is desirable and appears possible.