Why methods matter in a meta-analysis: a reappraisal showed inconclusive injury preventive effect of Nordic hamstring exercise.

Impellizzeri, FM; McCall, A; van Smeden, M

Why methods matter in a meta-analysis: a reappraisal showed inconclusive injury preventive effect of Nordic hamstring exercise.

Impellizzeri, FM McCall, A

van Smeden, M

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Publisher:: Elsevier
Publication Type:: Journal Article
Citation:: Journal of Clinical Epidemiology, 2021, 140, pp. 111-124
Issue Date:: 2021-09-11

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Field	Value	Language
dc.contributor.author	Impellizzeri, FM
dc.contributor.author	McCall, A https://orcid.org/0000-0003-3780-8153
dc.contributor.author	van Smeden, M
dc.date.accessioned	2021-11-05T02:54:56Z
dc.date.available	2021-09-07
dc.date.available	2021-11-05T02:54:56Z
dc.date.issued	2021-09-11
dc.identifier.citation	Journal of Clinical Epidemiology, 2021, 140, pp. 111-124
dc.identifier.issn	0895-4356
dc.identifier.issn	1878-5921
dc.identifier.uri	http://hdl.handle.net/10453/151354
dc.description.abstract	Objectives The Nordic hamstring exercise (NHE) has been strongly recommended to reduce hamstring injuries in previous meta-analyses (50% reduction in risk of injury). To underline the importance and impact of adopting appropriate methodology for evidence synthesis, we revisited the study selection, reanalyzed and updated the findings of the most recent meta-analysis. Study Design and Setting Only randomized control trials (RCT) using NHE as one of the prevention arms were selected. Summary effects for risk ratios (RR) for original studies included in the earlier meta-analysis, and new studies identified (update), were re-estimated under the random-effects model and presented with 95% confidence intervals (CI) and prediction intervals (PI). Tentative recommendations were provided according to the Grading of Recommendations Assessment, Development and Evaluation. Results Only five RCTs out of the 15 studies included in the earlier meta-analysis randomized to NHE. Our update revealed one additional RCT. The point estimate (RR) for the five RCTs previously considered RCTs was 0.56 (95% CI, 0.20–1.52; 95% PI, 0.06–5.14, parametric, and 0.13–1.80, nonparametric). After the update, the RR was 0.59 (95% CI, 0.27–1.29; 95% PI 0.10–3.29, parametric, and 0.17–1.52, nonparametric). Conclusion Contrary to the conclusions of a recent meta-analysis, as well as earlier meta-analyses, by using more appropriate methodology, the evidence underpinning the protective effect of NHE so far remains inconclusive and mostly derived from high risk of bias RCTs. At best, only conditional recommendation can be provided (for soccer) and future RCTs are warranted.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Elsevier
dc.relation.ispartof	Journal of Clinical Epidemiology
dc.relation.isbasedon	10.1016/j.jclinepi.2021.09.007
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	01 Mathematical Sciences, 11 Medical and Health Sciences
dc.subject.classification	Epidemiology
dc.title	Why methods matter in a meta-analysis: a reappraisal showed inconclusive injury preventive effect of Nordic hamstring exercise.
dc.type	Journal Article
utslib.citation.volume	140
utslib.location.activity	United States
utslib.for	01 Mathematical Sciences
utslib.for	11 Medical and Health Sciences
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
utslib.copyright.status	closed_access	*
pubs.consider-herdc	false
dc.date.updated	2021-11-05T02:54:53Z
pubs.publication-status	Published
pubs.volume	140

Abstract:

Objectives The Nordic hamstring exercise (NHE) has been strongly recommended to reduce hamstring injuries in previous meta-analyses (50% reduction in risk of injury). To underline the importance and impact of adopting appropriate methodology for evidence synthesis, we revisited the study selection, reanalyzed and updated the findings of the most recent meta-analysis. Study Design and Setting Only randomized control trials (RCT) using NHE as one of the prevention arms were selected. Summary effects for risk ratios (RR) for original studies included in the earlier meta-analysis, and new studies identified (update), were re-estimated under the random-effects model and presented with 95% confidence intervals (CI) and prediction intervals (PI). Tentative recommendations were provided according to the Grading of Recommendations Assessment, Development and Evaluation. Results Only five RCTs out of the 15 studies included in the earlier meta-analysis randomized to NHE. Our update revealed one additional RCT. The point estimate (RR) for the five RCTs previously considered RCTs was 0.56 (95% CI, 0.20–1.52; 95% PI, 0.06–5.14, parametric, and 0.13–1.80, nonparametric). After the update, the RR was 0.59 (95% CI, 0.27–1.29; 95% PI 0.10–3.29, parametric, and 0.17–1.52, nonparametric). Conclusion Contrary to the conclusions of a recent meta-analysis, as well as earlier meta-analyses, by using more appropriate methodology, the evidence underpinning the protective effect of NHE so far remains inconclusive and mostly derived from high risk of bias RCTs. At best, only conditional recommendation can be provided (for soccer) and future RCTs are warranted.

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http://hdl.handle.net/10453/151354