British medical bulletin最新文献

Introduction: The National Institute for Health and Care Excellence guidelines for post-traumatic stress disorder (PTSD) were published in 2018, based on research up until that point. In this review, we summarize the current state of the evidence and discuss the findings of systematic reviews and meta-analyses published between 2019 and 2024.

Sources of data: We include peer-reviewed systematic reviews and meta-analyses published within the last 5 years.

Areas of agreement: Reviews and meta-analyses continue to support the efficacy, and cost-effectiveness, of trauma-focused psychological interventions, particularly Trauma-Focused Cognitive-Behavioural Therapy and Eye Movement Desensitization and Reprocessing.

Areas of controversy: Despite their demonstrated efficacy, dropout rates from psychological interventions for PTSD remain high. There has also been a rapid proliferation of research into novel interventions for treating PTSD. However, much of this research is of low quality and lacks head-to-head comparisons with established interventions.

Growing points: Novel methods of delivery of established treatments are being developed, including using virtual reality, intensive forms of treatment, and digital and remote methods of delivery.

Areas timely for developing research: More qualitative research to explore recipients' experiences of interventions. More good-quality research and head-to-head comparisons of treatments.

Introduction or background: Hypertension is a critical health risks that significantly affect the quality of life in older adults. Physical activity programs tailored to the needs of specific populations have proven effective in mitigating these risks.

Sources of data: The study employed a single-group pretest-posttest design to evaluate the effects of recreational football interventions on body composition and blood pressure (BP). The independent variable was time (pretest, midtest, and posttest), and the dependent variables were body composition and BP. Nineteen male participants (mean ± SD age: 65.9 ± 2.85 years) were included in the study and participated in a 24-week recreational soccer (RS) program consisting of 1-hour sessions twice a week. Body composition parameters [body mass, fat mass, and body mass index (BMI)] were assessed using dual-energy X-ray absorptiometry, while BP was measured using a semi-automated monitor following guidelines. Statistical analyses, including the Friedman and Wilcoxon signed-rank tests with Bonferroni correction, revealed significant improvements in body mass (${mathrm{chi}}^2(2)=22.73,Ple .001$), fat mass (${mathrm{chi}}^2(2)=22.88,Ple .001$), and BMI $ ({mathrm{chi}}^2(2)=22.73,Ple .001$). Additionally, reductions in systolic BP (${mathrm{chi}}^2(2)=9.08,Ple .011$), diastolic BP (${mathrm{chi}}^2(2)=15.62,Ple .001$), and mean BP (${mathrm{chi}}^2(2)=16.33,Ple .001$) were observed.

Areas of agreement: The results support previous findings that aerobic and group-based physical activity can improve cardiovascular and metabolic health in older adults.

Areas of controversy: The single-group design and small sample size limit the ability to generalize findings. Future randomized controlled trials are needed to establish causality.

Growing points: This study provides new evidence on the use of RS as a feasible, enjoyable, and effective intervention to improve body composition and BP in older adults.

Areas timely for developing research: Future studies should focus on the long-term effects of RS, its impact on bone mineral density, and its comparative efficacy versus other exercise modalities for aging populations.

Introduction: To improve patient satisfaction after total knee arthroplasty (TKA), retention of the infrapatellar fat pad (IPFP) is advocated.

Source of data: Recently published literature identified from PubMed, EMBASE, Scopus, and Google Scholar.

Areas of agreement: TKA is routinely performed in patients with end-stage joint osteoarthritis, but 18% to 11% of patients are unsatisfied after surgery.

Areas of controversy: Clinical investigations that compared IPFP resection versus retention are limited.

Growing points: Following the 2020 PRISMA statement, the present systematic review compared resection versus retention of the IPFP in TKA in range of motion (ROM), patellar height, patient-reported outcome measures (PROMs), and complications.

Areas timely for developing research: At a mean duration of 18.4 ± 6.6 months of follow-up, no difference was found in ROM, patellar height, PROMs, and the rate of pain in the anterior aspect of the knee. The outcomes of TKA are not influenced by IPFP retention or excision. Based on the available scientific literature, surgeons could retain the IPFP if suitable visibility and exposure are possible, but resect it if necessary to facilitate exposure during TKA. Further high-level randomized controlled trials with sustained follow-up periods are required to prove the superiority of one surgical technique over the other.

Introduction: Acute type 3b injuries of the hamstring muscle complex (HMC) are prevalent in sports, often lead to prolonged recovery, and demonstrate a high recurrence. Conservative rehabilitation is standard, and adjunct therapies such as radial extracorporeal shock wave therapy (rESWT) may offer additional benefits.

Sources of data: This randomized controlled trial, with blinding of patients and assessors, included 36 semi-professional athletes with ultrasound-confirmed acute type 3b HMC injuries. Participants received either real or sham rESWT in combination with an 8-week structured rehabilitation program. The primary outcome was time to return to sport; secondary outcomes included post-treatment muscle strength, patient satisfaction, and re-injury rate.

Areas of agreement: Progressive rehabilitation is effective for muscle injuries. rESWT is a safe, non-invasive modality with high therapeutic potential in musculoskeletal conditions.

Areas of controversy: Questions remain regarding the ideal rESWT protocol for acute muscle injuries, including optimal dosing, frequency, and timing relative to injury onset.

Growing points: The addition of rESWT resulted in a statistically significant reduction in return-to-sport time [25.4 ± 3.5 (mean ± SD) days with rESWT vs 28.3 ± 4.5 days with sham rESWT; P = .037]. In elite and semi-professional athletes, even modest reductions in downtime can carry meaningful performance and economic benefits. Furthermore, only the rESWT group avoided strength deficits in the previously injured leg, suggesting improved functional recovery.

Areas timely for developing research: Future studies should explore the comparative effectiveness of individualized versus standardized rESWT protocols and investigate its broader applicability across sports disciplines and levels of play.

Introduction or background: Anterior cruciate ligament (ACL) injuries from the accumulated micro-trauma that precedes non-contact mechanical fatigue-related failure in adolescent athletes are increasing. This commentary aims to increase the understanding about how boredom may provide a self-control development stimulus which, in addition to modified sport training, may decrease non-contact ACL injuries.

Sources of data: PubMed, Google Scholar.

Areas of agreement: With improved ACL load monitoring and less frequent use of rigid, unchanging practice tasks, the incidence of these injuries should decrease.

Areas of controversy: Because of boredom, however, adolescent athletes may continue to over train, not complying with neuromuscular control and active rest and recovery activities.

Growing points: This dilemma provides an opportunity to enhance adolescent athlete self-control through adjusted coaching and training strategies using guided autonomy to increase injury prevention program efficacy through improved compliance. In addition to greater global physical, mental, and behavioral health development, improved self-control may also benefit the classroom.

Areas timely for developing research: The conceptual theory that follows should be tested for these context-specific self-control examples: (i) improved compliance with neuromuscular control training, active rest and recovery interventions; (ii) better adherence to modified sports training program intensity, frequency and total volume; and (iii) decreased non-contact, mechanical fatigue-related ACL injury rates.

Background: Sport and health science are undergoing a transformative shift driven by interdisciplinary approaches, technological innovations, and data-driven strategies.

Sources of data: This invited editorial explores key advancements in precision athletic monitoring, holistic well-being, population health initiatives, and innovative training and rehabilitation techniques. The integration of wearable technology, real-time analytics, and psychological interventions enables more personalized and effective strategies to optimize performance and promoting overall health. Additionally, the role of physical activity in mitigating lifestyle-related diseases underscores the importance of tailored public health initiatives.

Areas of agreement: Current consensus in sport and health science highlights that interdisciplinary collaboration-blending physiology, psychology, nutrition, and data analytics-significantly improves both athletic performance and public health outcomes. This progress is driven by precision monitoring technologies, holistic well-being strategies, innovative training methods, and a shared commitment to ethical standards ensuring equitable, responsible application of new health, and performance innovations.

Areas of controversy: As the field progresses, ethical considerations regarding data privacy, accessibility, and equitable application of emerging technologies remain central.

Growing points: Future directions include leveraging artificial intelligence, machine learning, and big data to refine personalized interventions, ensuring that both athletic and public health advancements are sustainable and inclusive.

Areas timely for developing research: Emerging research in sport and health science focuses on harnessing artificial intelligence, machine learning, and big data to develop predictive models and personalized interventions, while tailoring physical activity programmes to diverse population needs based on age, gender, socioeconomic, and cultural factors. Simultaneously, priorities include advancing psychological and mindfulness-based strategies in athletic care, integrating cutting-edge rehabilitation technologies, promoting inclusive public health frameworks for ageing and chronically ill populations, and establishing ethical guidelines for the responsible use of innovative performance and health technologies.

Introduction: Periodized rehabilitation for tendinopathies integrates principles of athletic training into structured protocols to optimize tendon healing and functional recovery minimizing recurrence. This review explores the role of concurrent and phasic periodization strategies in tendon rehabilitation, focusing on optimizing strength, power, and neuromuscular control.

Areas of agreement: Early phases prioritize pain management and load capacity through prolonged isometric contractions, to improve neuromuscular engagement without exacerbating symptoms. Heavy, slow resistance exercises, central to progressive loading, facilitate tendon remodeling and strength development. Subsequent phases incorporate energy storage and release, sport-specific exercises tailored to individual goals, using externally paced movements to enhance motor control and corticospinal drive. Neuroplastic training is promising, aligning physical rehabilitation with cognitive engagement to optimize motor learning and reduce maladaptive patterns.

Areas of controversy: At present, no randomized controlled trials have tested the periodization concept in the management of tendinopathy conditions.

Growing points: Systematic evaluation, including range of motion, tissue flexibility, and limb biomechanics, is necessary to identify and address kinetic chain dysfunctions in patients with tendon ailments. Reintegration into sport or activity should follow clear benchmarks, such as symmetrical strength, pain-free function, and tolerance for high-intensity loads.

Source of data: Analysis of the current literature, and expert opinion.

Areas timely for developing research: This evidence-based framework offers clinicians a practical roadmap for tendon rehabilitation, combining physiological and biomechanical considerations to support safe return to sport or activity. A structured individualized approach ensures optimal recovery by addressing movement dysfunctions, monitoring load tolerance, and reducing the risk of re-injury.

Background: All-inside arthroscopic procedures are now frequently employed to manage chronic lateral ankle instability (CLAI) with satisfactory functional outcomes. Currently, no evidence-based guidelines exist for all-inside arthroscopic procedures for CLAI. Many surgical decisions remain uncertain and challenging.

Sources of data: Published scientific literature in PubMed, MEDLINE, Web of Science, EMBASE, and Cochrane databases.

Areas of agreement: All-inside arthroscopic repair and reconstruction procedures are reliable treatments for CLAI.

Areas of controversy: The all-inside arthroscopic procedures for CLAI present significant challenges, particularly in the following aspects.

Growing points: Given the lack of guidelines for the all-inside arthroscopic procedures for CLAI, this evidence-based clinical practice guideline provides 11 recommendations to address the controversy.

Areas timely for developing research: In patients with CLAI undergoing all-inside arthroscopic procedures, comparative studies are urgently needed to establish the optimal timing for weight-bearing, as well as return to work and sports.

Introduction: Extracorporeal shock wave therapy (ESWT) for erectile dysfunction (ED) presents a challenging paradox. While numerous clinical studies, systematic reviews, and meta-analyses have been published, indicating a substantial body of evidence supporting the efficacy and safety of ESWT, significant questions remain. Notably, the American Urological Association (AUA) continues to classify ESWT for ED as investigational (Evidence Level: Grade C), suggesting that the true therapeutic effect of ESWT may differ considerably from current estimates. This review aims to critically assess the evidence and propose strategies to address this unresolved discrepancy.

Source of data: We systematically searched two electronic databases (PubMed and Ovid/Embase) and published systematic reviews on ESWT for ED and compiled a systematic literature review and meta-analysis based on 87 relevant studies.

Areas of agreement: There is clear evidence that ESWT for ED is effective and can therefore be a valuable treatment modality in the management of ED.

Areas of controversy: Current assessments of ESWT for ED as investigational by, e.g. the AUA may not stem from a lack of clinical studies, insufficient related basic science, or an inadequate number of systematic reviews and meta-analyses. Instead, the deficits lie in the area of the scientific quality of the clinical studies published to date.

Growing points: We hypothesize that this unfortunate situation will only change if the following aspects are rigorously considered in future clinical studies on ESWT for ED: adequate characterization and reporting of extracorporeal shock waves, appropriate handling of missing data and intercurrent events, and comprehensive classification of ESWT in the overall context of the available treatment options for ED.

Areas timely for developing research: We are convinced that the consistent implementation of these aspects will significantly contribute to establishing ESWT as the first truly regenerative therapy in the management of ED. This overall aim justifies the corresponding efforts for the benefit of our patients.

Background: Loaded ruck marching is a common workout and selection tool for military schools.

Source of data: Analysis of the current literature and expert opinion.

Areas of agreement: Soldiers performing loaded marches are prone to overuse injuries such as stress fractures, foot blisters, foot infections, brachial plexus lesions, digitalgia paresthetica, and meralgia paresthetica, knee pain, back pain, metatarsalgia.

Areas of controversy: At present, risk factors needed to be addressed to reduce the rate of injuries.

Growing points: Speed of march, terrain grade, and task type and duration, together with safety risk checks, such as administrative checks and physical conditioning, may all impact injury risks and have to be evaluated in military training programs.

Areas timely for developing research: Although noncombat injuries in the military have historically been a hidden epidemic, they are now being recognized as a major health problem for the military services. Risks for soldier health, tactical performance, and mission success related to military load carriage have been analyzed. Risk modifiers have been also addressed.Speed and load combinations of military marches have to be analysed to optimize marching pace and reduce energy expenditure. Load and speed should be managed to maintain an exercise intensity of ~45% VO2 max to delay the time to fatigue during prolonged marches.