Use of Reporting Guidelines in Scientific Writing: PRISMA, CONSORT, STROBE, STARD and Other Resources

Common Critiques and Recommendations for Studies in Neurology Using Machine Learning Methods

Machine learning (ML) methods are becoming more prevalent in the neurology literature as alternatives to traditional statistical methods to address challenges in the analysis of modern data sets. Despite the increase in the popularity of ML methods in neurology studies, some authors do not fully address all items recommended in reporting guidelines. The authors of this Research Methods article are members of the Neurology® editorial board and have reviewed many studies using ML methods. In their review reports, several critiques often appear, which could be avoided if guidance were available. In this article, we detail common critiques found in ML research studies and make recommendations for how to avoid them. The first critique involves misalignment of the study goals and the analysis conducted. The second critique focuses on ML terminology being appropriately used. Critiques 3-6 are related to the study design: justifying sample sizes and the suitability of the data set for the study goals, describing the ML analysis pipeline sufficiently, quantifying the amount of missing data and providing information about missing data handling, and including uncertainty estimates for key metrics. The seventh critique focuses on fairly describing both strengths and limitations of the ML study, including the analysis methodology and results. We provide examples in neurology for each critique and guidance on how to avoid the critique. Overall, we recommend that authors use ML-specific checklists developed by research consortia for designing and reporting studies using ML. We also recommend that authors involve both a statistician and an ML expert in work that uses ML. Although our list of critiques is not exhaustive, our recommendations should help improve the quality and rigor of ML studies. ML has great potential to revolutionize neurology, but investigators need to conduct and report the results in a way that allows readers to fully evaluate the benefits and limitations of ML approaches.

Comprehensive Criteria for Reporting Qualitative Research (CCQR): Reporting Guideline for Global Health Qualitative Research Methods

Globally, the demand for qualitative research has risen, driven by the health sector's need for in-depth investigation of complex issues behind any phenomenon that may be inadequately comprehended and that other research methods cannot explore, uncover, or describe. The authors aimed to improve the accessibility and comprehensiveness of reporting guidelines for qualitative research. A comprehensive review of scientific articles was conducted on PubMed, Medline, CINAHL, and Embase, and it retrieved 1989 articles plus 13 more articles through the snowball method. After screening, 17 key articles were identified, which led to the development of Comprehensive Criteria for Reporting Qualitative Research that comprises 14 categories, offering key elements in an organized table. This novel guideline complements the two widely used guidelines, Consolidated Criteria for Reporting Qualitative Research and Standards for Reporting Qualitative Research, by including additional aspects like objectives, existing knowledge, rationale behind methodologies, conclusions, recommendations, and reference citations. The study responds to the rising need for improved qualitative research reporting guidelines in global health.

The Health Narratives Research Group (HeNReG): A self-direction process offered to help decrease burnout in public health nurse practitioners

Founded in accordance with 19th century sex roles and public health concerns, nursing evolved as other-directed, dependent on physician-focused diagnosis, prescription decisions, and public health advancements. The result of this other direction is that public health nurse practitioners have endured significant workplace stress resulting in burnout, especially during COVID-19. To help decrease their burnout, nurses require development of self-direction. The Health Narratives Research Group (HeNReG) has the potential to reduce burnout in nurse practitioners by encouraging the development of self-direction. The HeNReG process is presented through historically analyzed documents regarding reducing burnout in health researchers by developing self-direction including: (1) three years of archived year-end feedback results provided by participants, (2) archived participant responses to specific HeNReG-related writing prompts, and (3) a comparison of HeNReG results with the outcomes of resilience programs. The conclusion-the HeNReG offers an effective option for reducing burnout in health researchers that has the potential to decrease nurse practitioner burnout in a way that resilience programs do not. Tailoring the HeNReG process to public health nurses is discussed, inviting future research for reducing burnout in public health nurses.

Risk Factors to Persistent Pain Following Musculoskeletal Injuries: A Systematic Literature Review

Background: Musculoskeletal (MSK) injury is one of the major causes of persistent pain. Objective: This systematic literature review explored the factors that lead to persistent pain following a MSK injury in the general population, including athletes. Methods: A primary literature search of five electronic databases was performed to identify cohort, prospective, and longitudinal trials. Studies of adults who diagnosed with a MSK injury, such as sprains, strains or trauma, were included. Results: Eighteen studies involving 5372 participants were included in this review. Participants’ ages ranged from 18–95 years. Most of the included studies were of prospective longitudinal design. Participants had a variety of MSK injuries (traumatic and non-traumatic) causing persistent pain. Multiple factors were identified as influencing the development of persistent pain following a MSK injury, including high pain intensity at baseline, post-traumatic stress syndrome, presence of medical comorbidities, and fear of movement. Scarcity of existing literature and the heterogeneity of the studies made meta-analysis not possible. Conclusions: This systematic review highlighted factors that might help predict persistent pain and disability following MSK injury in the general population, including athletes. Identification of these factors may help clinicians and other health care providers prevent the development of persistent pain following a MSK injury.

Comparison of Biomechanical Factors Before and After UCL Surgery in Baseball Athletes: A Systematic Review With Meta-analysis

BACKGROUND

Ulnar collateral ligament (UCL) reconstruction (UCLR) and repair (UCLr) are the gold standards in the treatment of UCL injuries. Although return-to-play timelines after UCLR have been established, pitching biomechanical variables are speculated to change after surgical intervention.

PURPOSE/HYPOTHESIS

To synthesize the literature and investigate changes in pitching biomechanics in baseball pitchers after UCLR or UCLr. We hypothesized that differences in pitching biomechanics would be observed for both intra- and interpatient comparisons.

STUDY DESIGN

Systematic review; Level of evidence, 3.

METHODS

We searched 4 electronic databases (PubMed, Web of Science, SCOPUS, and Sports Medicine & Education Index) from inception to February 2020. Data extracted included author and year of publication, study design, sample size, study population, and primary outcome variables. Meta-analysis was performed to produce random pooled effect sizes (▵).

RESULTS

We identified 1010 original articles for inclusion. A total of 5 studies were included in the systematic review; of these, 3 studies were included in the meta-analysis. No differences were found in shoulder range of motion (ROM) between post-UCLR and control pitchers (dominant arm external rotation ▵, 0.13°; 95% CI, -0.15° to 4.02°; P = .36); dominant arm internal rotation ▵, -0.20°; 95% CI, -0.74° to 0.35°; P = .48). Mean fastball velocity as well as pitches thrown decreased after UCLR in professional pitchers. Significant differences in elbow extension, elbow extension velocity, and shoulder internal rotation velocity were found among amateur pitchers.

CONCLUSION

The results of this systematic review and meta-analysis show that limited differences exist in pitchers before and after UCLR as well as in post-UCLR pitchers and healthy, age-matched controls. UCLR may influence throwing velocity, but it had no effect on either the throwing biomechanics or theROM of baseball pitchers. Although trends appear to be forming, further evidence is needed to understand the effect of UCLR on throwing biomechanics.

Integrating intra-individual and dyadic factors in examining health among gay and bisexual men: A narrative review of recent literature

Gay and bisexual men (GBM) experience disproportionate rates of mental health and other negative health outcomes. For GBM in relationships, contextualizing the myriad of negative outcomes as a dyadic process may provide insight into the mechanisms through which these adverse outcomes develop. The objective of this review is to examine the current state of the relationship science literature using a health framework, Relationship Process and Health. We conducted a search for articles using PubMed, PsycInfo, and Web of Science for empirical articles in English published in the past 15 years on GBM in a relationship, assessing attachment, and relationship functioning as predictors of health outcomes. We found 649 articles. After screening, 23 articles were identified and reviewed. Findings overwhelming identified HIV risk as the primary health outcome. Attachment was associated with relationship functioning and sexual risk behaviors. Relationship-specific components were largely used as predictors of sexual HIV transmission risk behaviors. Together, these studies suggest that relationship functioning is a prospective link between attachment and health-related outcomes. The literature has yet to examine empirically dyadic-level mechanisms that may explain the association between individual attachment and health outcomes aside from HIV risk, and needs more examination of other health disparities affecting GBM.

Strengthening the quality of longitudinal research into cognitive-communication recovery after traumatic brain injury: A systematic review

PURPOSE

(i) To systematically review longitudinal and prognostic studies relating to the trajectory of cognitive-communication recovery after TBI and (ii) to provide recommendations to strengthen future research.

METHOD

Thirteen health literature databases were accessed up until July 2014.

MAIN MEASURES

Articles were screened systematically against pre-determined inclusion and exclusion criteria. Quality reviews were performed on the selected articles using a modified Downs & Black Rating Scale. Two independent reviewers performed the reviews.

RESULT

Sixteen longitudinal and prognostic articles met the inclusion criteria. There was evidence of either maintenance or improvement of cognitive-communication skills during the first 3 years post-injury. However, the studies did not provide detailed recovery trajectories, by failing to evaluate numerous data points over time. No studies evaluated recovery beyond 3 years post-injury. Injury severity, lesion location, brain volume loss and conversation skills may predict specific cognitive-communication outcomes. There was high variability in study characteristics and measures.

CONCLUSION

There is currently scarce evidence regarding cognitive-communication recovery and prognosis. People with TBI may recover or maintain pre-morbid cognitive-communication skills during the early rehabilitation stage. Further research detailing the recovery trajectory with a view to evaluating predictive factors is strongly indicated. Guidelines for future research are provided.

Prospective Memory After Stroke: A Scoping Review

The aim of this paper was to review the limited, but growing, literature on prospective memory (PM) following stroke using a scoping study methodology. Multiple databases were systematically searched and yielded 11 studies that were classified as observational (n = 7) or intervention studies (n = 4) and reviewed for quality. PM impairment after stroke was more commonly identified using behavioural measures compared to self-report measures. There were mixed findings regarding the extent and nature of PM impairment poststroke; however, more studies reported impairment for time-based PM, compared to both event- and activity-based PM. Studies examining rehabilitative techniques for PM resulted in mixed findings and were limited as most were case studies of poor methodological quality. Overall previous research in this area was limited as most studies were often underpowered due to small sample sizes, or used single-item measures which may not be robust enough to reliably measure PM impairment. Additionally, the methods used to measure PM were varied and many studies did not control for retrospective memory impairment, which could impact the results, as PM has both a retrospective (remembering both the action and when it needs to be completed) and prospective component (remembering to perform the action when appropriate). In conclusion, PM impairment is apparent poststroke, specifically for time-based PM. However, more research is needed to determine why PM impairment occurs, and how it can be improved.

A Neuropsychologist's Guide To Undertaking a Systematic Review for Publication: Making the most of PRISMA Guidelines

There is increasing impetus to improve the quality of research and scientific writing. Systematic reviews provide Class 1 research evidence, are based upon an established rigor and communicate results in a comprehensive manner, and are therefore particularly relevant to clinicians and researchers. Clinician requirements for quality systematic reviews are twofold: to keep up to date with research and to make informed decisions including those required for diagnoses, disease or risk assessment, and treatment. Researchers rely upon quality systematic reviews to compete for diminishing research funds, prove efficacy for intervention trials, and to meet increasing demand for evidence based intervention. However, insufficient systematic reviews are undertaken, and the methodological rigor and quality are often variable. The aim of this article is to guide researchers through the iterative systematic review process in order to improve quality and thereby increase publication rates. The step by step guide provides a road map through the EQUATOR network and practical suggestions in order to meet the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (Moher et al. 2009) as well as encouraging high standards through the use of quality rating scales. Lastly, information is provided to encourage quantitative analysis to improve the synthesis of results and qualitative interpretation, such as calculating effect sizes or conducting a meta-analyses as the ultimate goal of a systematic review.

Issues affecting the level of prosthetics research evidence: Secondary analysis of a systematic review

BACKGROUND

Systematic reviews of scientific literature are valuable sources of synthesized knowledge. Systematic review results may also be used to inform readers about challenges inherent to an area of research, guide future research efforts, and facilitate improvements in evidence quality.

OBJECTIVES

To identify methodological issues that affected the overall level of scientific evidence reported in a contemporary systematic review and to offer suggestions for enhancing publications' contribution to the overall evidence.

STUDY DESIGN

Secondary analysis of a systematic review.

METHODS

Publications included in a systematic review related to microprocessor-controlled prosthetic knees were analyzed with respect to established methodological quality criteria. Common issues were identified and discussed.

RESULTS

Internal validity was commonly affected by variable comparison conditions, limited justification of accommodation time, potential fatigue and learning effects, lack of blinding, small sample sizes, limited evidence of measurement reliability, subject attrition, and limited descriptions of selection criteria. Similarly, external validity was affected by limited descriptions of the study sample, indeterminate representativeness, and suboptimal description of the interventions.

CONCLUSION

Results suggest that efforts to address methodological limitations, educate evidence consumers, and improve research reporting are needed to advance the quality and use of evidence in the field of prosthetics.

CLINICAL RELEVANCE

Critical analysis of the strengths and limitations of publications included in a systematic review can inform evidence consumers and contributors about challenges inherent to a field of research. Results of this analysis suggest that efforts to address identified limitations are needed to enhance the overall level of prosthetics evidence.

I’m Losing the ‘Me’: Partners’ Experiences of Engagement with Parkinson's Health Professionals

Background: Partners of people with Parkinson's disease (PD) have first-hand knowledge relevant to the management of the person with Parkinson's (PwP). If captured, this knowledge may improve effective care for the PwP. However, there is a lack of research focusing primarily on partners’ experiences of engagement with health professionals working in PD (HPPs).

Methods: Interpretative Phenomenological Analysis (IPA) was used to investigate the meaning of partners’ experiences of engagement with HPPs. Semi-structured interviews with 15 partners of PwP provided primary data. Each interview was digitally recorded, transcribed verbatim and analysed for emerging themes.

Results: Three themes emerged: (i) partners’ lack of entitlement for their own needs to be met; (ii) submersion of self in the partnership and (iii) health professionals as agents of support. Additionally, sub-themes were identified, such as barriers to feeling entitled, setting up a premise for entitlement, and lost identity. Together, these themes highlight the current lack of focus on the partners of PwP. A process model was developed to describe partners’ cyclic progression through the various stages of their experience, and in the process, identifying initiatives for intervention.

Conclusion: Given a lack of focus on the needs of partners of PwP, these preliminary insights could inform the delivery of improved services that support partners. This will ultimately benefit the PwP.

Duration of post-traumatic amnesia as a predictor of functional outcome in school-age children: a systematic review

AIM

In adults, duration of post-traumatic amnesia (PTA) is a powerful early predictor of functional outcomes in traumatic brain injury. The aim of this work was to assess the predictive validity of PTA duration for outcomes in children (6-18y).

METHOD

PsycINFO, MEDLINE, Web of Science, and Embase were searched for papers published to January 2014. Ten studies met inclusion criteria: they used standardized instruments to assess PTA and functional outcomes, and examined relationships between the two. Outcomes were classified according to (1) the International Classification of Functioning, Disability and Health (ICF) core sets for neurological conditions for post-acute care and (2) global functioning and quality of life. Methodological quality was rated for each study.

RESULTS

The search identified 10 studies of moderate mean quality (M=11.8 out of 18). Longer PTA duration related to worse functional outcomes: global functioning and in the two ICF categories ('body function', 'activities and participation'). Relationships between PTA duration and quality of life and the ICF category of 'body structure' were not examined. PTA duration was, in 46 out of 60 (76.67%) instances, a stronger predictor of outcomes than other indices of injury severity.

CONCLUSION

Longer PTA duration is a valid predictor of worse outcomes in school-age children. Thus, PTA should be routinely assessed in children after traumatic brain injury.

Editorial

The first editorial for Brain Impairment was entitled ‘Landmark development’. Published in May 2000, the editorial both told a story and painted a context. In two paragraphs it recounted the pioneering work of Professor John Walsh and the history of the first two decades of the Australian Society for the Study of Brain Impairment (ASSBI), culminating in the foundation of the journal. In telling this story, the context for the journal was also outlined. Reflecting the nature of ASSBI, the journal would aim to be multidisciplinary and to address the full range of conditions that affect brain function across the lifespan.

Speech and swallow rehabilitation following partial glossectomy: a systematic review

PURPOSE

Tongue cancer is known to negatively affect both speech and swallowing function; however this is the first review to report speech-language pathology (SLP) intervention for both functions following partial glossectomy.

METHOD

Using a PRISMA approach, systematic screening of nine databases was undertaken. Original studies reporting SLP rehabilitation for speech and/or swallowing dysfunction with participants following partial glossectomy as primary cancer treatment were included.

RESULT

These studies are discussed in terms of SLP assessment and intervention trends as well as quality according to current research method standards (levels of evidence, Pedro-P, SCED) in order to determine suitability for guiding current clinical practice.

CONCLUSION

Publications were few (n = 7) and mostly of non-experimental design. This review highlights the gap in evidence and questions the rationale of current SLP rehabilitation following partial glossectomy.

Efficacy of electronic portable assistive devices for people with acquired brain injury: a systematic review

A systematic review was conducted to evaluate the efficacy of electronic portable assistive devices (EPADs) for people with acquired brain injury. A systematic database search (OVID, CINAHL) found 541 citations published between 1989 and the end of 2012. A total of 23 reports met the inclusion/exclusion criteria, namely intervention studies (group, n-of-1) testing the efficacy of EPADs as compensatory devices for cognitive impairment for people with acquired brain injury aged 16-65 years. Study quality was rated by the PEDro (Physiotherapy Evidence Database) scale, (randomised controlled trials), the Downes and Black tool (other group intervention studies), and the Single Case Experimental Design tool (single participant studies). Levels of evidence were determined using five levels of classification based on the Spinal Cord Injury Rehabilitation Evidence table. Results found no Level 1 studies (RCTs with PEDro score ≥ 6), four Level 2 studies and 10 Level 3 studies. There was insufficient evidence to recommend any practice standards, but sufficient evidence to recommend the use of electronic reminder systems in supporting the everyday functioning of people with acquired brain injury as a practice guideline. Higher quality studies are required to support a broader range of compensatory roles that EPADs have the potential to play in neurorehabilitation and the long-term support of people with acquired brain injury.

The reliability of methodological ratings for speechBITE using the PEDro-P scale

BACKGROUND

speechBITE (http://www.speechbite.com) is an online database established in order to help speech and language therapists gain faster access to relevant research that can used in clinical decision-making. In addition to containing more than 3000 journal references, the database also provides methodological ratings on the PEDro-P (an adapted version of the PEDro) scale to assist clinicians in identifying the scientific quality of randomized (RCTs) and non-randomized control trials (NRCTs). While reliability of the PEDro scale has been established by similar allied health databases, the reliability of the PEDro-P scale has yet to be reported.

AIMS

To examine the reliability of PEDro-P scale ratings undertaken by raters on the speechBITE database and benchmark these results to the published reliability for the original PEDro scale. Both the total score (out of ten) as well as each of the 11 scale items were included in this analysis.

METHODS & PROCEDURES

speechBITE's volunteer rater network of 17 members rated the first 100 RCTs and NRCTs on the website. The criterion and overall scores for these ratings were compared with previously published reliability studies using the PEDro scale. Intra-class correlations and per cent agreement measures were used to establish and benchmark reliability.

OUTCOMES & RESULTS

The speechBITE PEDro-P ratings ranged from fair to excellent for both the total score and for each of the 11 scale items. Furthermore, reliability was equal to that of other databases.

CONCLUSIONS & IMPLICATIONS

speechBITE users can be confident of the reliability of ratings published on the website. Further analysis of differences between this study and previous PEDro scale reliability studies are discussed.

Acceptance and Commitment Therapy (ACT) for Psychological Adjustment after Traumatic Brain Injury: Reporting the Protocol for a Randomised Controlled Trial

Following a severe traumatic brain injury (TBI) there is a complex presentation of psychological symptoms which may impact on recovery. Validated treatments addressing these symptoms for this group of people are limited. This article reports on the protocol for a single-centre, two-armed, Phase II Randomised Control Trial (RCT) to address the adjustment process following a severe TBI. Participants will be recruited from Liverpool Brain Injury Rehabilitation Unit and randomly allocated to one of two groups, Acceptance and Commitment Therapy (ACT) or an active control (Befriending). The active treatment group utilises the six core processes of ACT with the intention of increasing participation and psychological flexibility and reducing psychological distress. A number of primary and secondary outcome measures, administered at assessment, post-treatment and 1-month follow-up, will be used to assess clinical outcomes. The publication of the protocol before the trial results are available addresses fidelity criterion (intervention design) for RCTs. This ensures transparency in the RCT and that it meets the guidelines according to the CONSORT statement. The protocol has also been registered on the Australian New Zealand Clinical Trials Registry ACTRN12610000851066.