Diagnostic criteria and outcome measures in randomized clinical trials on carpal tunnel syndrome: a systematic review

ABSTRACT BACKGROUND: The diagnostic criteria for carpal tunnel syndrome (CTS) lack uniformity. Moreover, because CTS is a syndrome, there is no consensus as to which signs, symptoms, clinical and complementary tests are more reproducible and accurate for use in clinical research. This heterogeneity is reflected in clinical practice. Thus, establishing effective and comparable care protocols is difficult. OBJECTIVE: To identify the diagnostic criteria and outcome measures used in randomized clinical trials (RCTs) on CTS. DESING AND SETTING: Systematic review of randomized clinical trials carried out at the Federal University of São Paulo, São Paulo, Brazil. METHODS: We searched the Cochrane Library, PubMed, and Embase databases for RCTs with surgical intervention for CTS published between 2006 and 2019. Two investigators independently extracted relevant data on diagnosis and outcomes used in these studies. RESULTS: We identified 582 studies and 35 were systematically reviewed. The symptoms, paresthesia in the median nerve territory, nocturnal paresthesia, and special tests were the most widely used clinical diagnostic criteria. The most frequently assessed outcomes were symptoms of paresthesia in the median nerve territory and nocturnal paresthesia. CONCLUSION: The diagnostic criteria and outcome measures used in RCTs about CTS are heterogeneous, rendering comparison of studies difficult. Most studies use unstructured clinical criteria associated with ENMG for diagnosis. The Boston Questionnaire is the most frequently used main instrument to measure outcomes. REGISTRATION: PROSPERO (CRD42020150965- https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=150965).

Glenoid Bone Loss - A Retrospective Evaluation of Functional Outcomes after Bone Block Surgery for Anterior Shoulder Instability in High-demand Athletes / Falha óssea na glenoide - Uma avaliação retrospectiva dos desfechos funcionais após cirurgia de bloqueio ósseo para instabilidade anterior do ombro em atletas de alta demanda

Abstract Objective This study assesses the relationship between the glenoid bone loss size and range of motion, functional outcomes, and complications in high-performance athletes undergoing bone block surgery for anterior shoulder instability. Methods This retrospective study evaluated postoperative outcomes in athletes submitted to bone block surgery for anterior shoulder instability. In 5 years, 41 shoulders underwent the procedure; 20 had bone losses up to 15%, and 21 shoulders presented bone losses ranging from 15% and 25%. Results There was no statistically significant difference regarding postoperative complications, new dislocations, and the rate of return to sports. In addition, the quantitative criteria evaluated, i.e., ranges of motion and functional scores, showed no statistically significant difference between groups. Conclusion The size of the bone loss per se does not seem to affect functional outcomes and complications from these procedures, which are safe techniques for small and large bone losses.

Resumo Objetivo Avaliar a relação do tamanho do defeito ósseo da glenoide no arco de movimento, nos resultados funcionais e nas complicações em pacientes atletas de alta performance submetidos a cirurgia de bloqueio ósseo para instabilidade anterior do ombro. Método Estudo retrospectivo no qual foram avaliados os resultados pós-operatórios de atletas submetidos a cirurgia de bloqueio ósseo para instabilidade anterior do ombro. Em 5 anos foram 41 ombros operados, sendo 20 deles com até 15% de defeito ósseo e 21 com defeitos entre 15% e 25%. Resultados Não houve diferença estatisticamente significativa com relação a complicações pós-operatórias, novas luxações, e na taxa de retorno ao esporte. Os critérios quantitativos avaliados - arcos de movimento e escores funcionais - também não apresentaram diferença estatisticamente significativa entre os grupos. Conclusão O tamanho do defeito ósseo por si só não parece afetar os resultados funcionais e as complicações desses procedimentos, sendo uma técnica segura tanto para defeitos pequenos, quanto para os maiores.

Electronic cigarette awareness and use among students at the Federal University of Mato Grosso, Brazil / Conhecimento e uso do cigarro eletrônico entre estudantes da Universidade Federal de Mato Grosso

ABSTRACT Objective: To analyze the prevalence of electronic cigarette (e-cigarette) awareness and experimentation among university students, as well as the characteristics associated with that awareness. Methods: This was a cross-sectional study, conducted in 2015, in which 489 university students at the Federal University of Mato Grosso (Cuiabá campus), Brazil, were interviewed with the use of a specific questionnaire. We estimated the prevalence of e-cigarette awareness and use, as well as analyzing the major characteristics associated with that awareness and use. Results: The prevalence of e-cigarette awareness was 37%, and the rate of e-cigarette experimentation was 2.7%. Awareness of e-cigarettes was found to be associated with marital status, work status, the level of parental education, and the presence or absence of smokers in the family. Conclusions: A high proportion of university students were aware of e-cigarettes. Although the prevalence of those who had experimented with e-cigarettes was low, there is concern that there could be an increase in the use of these types of device. There is a need for measures targeting university students, in order to build awareness of and prevent e-cigarette use.

RESUMO Objetivo: Analisar a prevalência do conhecimento e experimentação do cigarro eletrônico (CE) entre universitários, bem como as características associadas ao conhecimento desse tipo de dispositivo. Métodos: Estudo transversal, utilizando-se questionário específico, onde foram entrevistados 489 estudantes da Universidade Federal de Mato Grosso (Campus Cuiabá) no ano de 2015. Estimou-se a prevalência e foram analisadas as principais características relacionadas ao conhecimento e uso do CE. Resultados: A prevalência de conhecimento do CE foi de 37%, e a taxa de experimentação foi de 2,7%. Verificou-se associação entre o conhecimento do CE com o estado civil, estado laboral do estudante, nível de escolaridade dos pais e presença de fumantes na família. Conclusões: Foi alta a proporção de universitários que conhecem o CE. Apesar de ser pequena a prevalência dos que o experimentaram, torna-se preocupante um possível aumento do consumo desse tipo de dispositivo. Medidas devem ser direcionadas aos jovens dentro das instituições universitárias a fim de promover a conscientização e prevenção do uso do CE.