Evidence from systematic reviews on photobiomodulation of human bone and stromal cells: Where do we stand?

This study summarizes the available evidence from systematic reviews on the in vitro effects of photobiomodulation on the proliferation and differentiation of human bone and stromal cells by appraising their methodological quality. Improvements for future studies are also highlighted, with particular emphasis on in vitro protocols and cell-related characteristics. Six reviews using explicit eligibility criteria and methods selected in order to minimize bias were included. There was no compelling evidence on the cellular mechanisms of action or treatment parameters of photobiomodulation; compliance with quality assessment was poor. A rigorous description of laser parameters (wavelength, power, beam spot size, power density, energy density, repetition rate, pulse duration or duty cycle, exposure duration, frequency of treatments, and total radiant energy), exposure conditions (methods to ensure a uniform irradiation and to avoid cross-irradiation, laser-cell culture surface distance, lid presence during irradiation) and cell-related characteristics (cell type or line, isolation and culture conditions, donor-related factors where applicable, tissue source, cell phenotype, cell density, number of cell passages in culture) should be included among eligibility criteria for study inclusion. These methodological improvements will maximize the contribution of in vitro studies on the effects of photobiomodulation on human bone and stromal cells to evidence-based translational research.

The effectiveness of mandibular advancement devices in the treatment of obstructive sleep apnoea in adults: a methodological quality assessment of systematic reviews.

BACKGROUND AND OBJECTIVES: There is growing interest in the use of mandibular advancement devices (MADs) for the treatment of obstructive sleep apnoea (OSA). Many systematic reviews (SRs) have investigated their effectiveness, but the applicability of SR results is affected by their methodological quality. This study critically appraises the methodological quality of SRs on this topic using a more detailed and updated version of A MeaSurement Tool to Assess systematic Reviews (AMSTAR). MATERIALS AND METHODS: The literature was searched for SRs on MAD effectiveness in adults (≥18 years of age) for OSA treatment as compared with other non-surgical or surgical interventions or no intervention. Any objective or subjective measures of treatment outcome were considered eligible. AMSTAR2 was used to assess methodological quality. RESULTS: The literature search yielded 64 potential reports; 10 met the eligibility criteria. All SRs had more than one critical flaw in AMSTAR2, so their methodological quality was rated as critically low. The most common issues included non-registration of study protocol, absence of list of excluded studies, no acknowledgment of fundings of included studies, no impact of risk of bias on SR results or interpretation and discussion of results, and data extraction not in duplicate. LIMITATIONS: If a SR was not clearly identified by title or abstract as a SR or meta-analysis, it may have been missed during the screening process. CONCLUSIONS: The methodological quality of SRs was suboptimal and warrants further improvement in order to provide strong evidence of MAD effectiveness and increase applicability of SR results for clinical decision-making.