Upsurge of Sports Injuries and Their Treatment

"Only 50% of randomized trials have high level of confidence in arthroscopy and sports medicine"-a spin-based assessment

PURPOSE

Pioneering works on the quality appraisal of RCTs have recognized and addressed most of the issues that affect the RCT quality but some issues such as "Writers' bias" or "Spin" are yet to be sorted out. Spin, particularly in the abstracts, is a potential source of deception to the readers. The purpose of this study is to grade the RCTs of arthroscopy and sports medicine based on a spin in their abstracts, analyze the prevalence of spin, and explore methods to remove spin.

METHODS

250 recent RCTs from the top 5 arthroscopy and sports medicine journals were selected. Baseline data of the articles were collected. Consort Adherence Score (CAS) was calculated. The abstracts of the RCTs were graded using the Level Of Confidence (LOC) grading tool developed by the Orthopaedic Research Group. The association of the spin grade with other characteristics of the articles was analyzed.

RESULTS

The median CAS for the included studies was 9 (IQR 8-10). It was found that only 49.6% (n = 124) articles had high LOC with no or one non-critical spin in the abstract. 20.8% (n = 52) had Moderate LOC with more than one non-critical spin. 19.6% (n = 49) had at least one critical spin and 10% (n = 25) had more than one critical flaw making their results have Low and Critically Low LOC, respectively. Of the ten variables analyzed in multivariate regression analysis, it was found that CAS was the only significant factor that determines the level of confidence in the abstract of RCTs CONCLUSION: Spin is prevalent in abstracts of sports medicine and arthroscopy journals with 50.4% having some form of spin. Grading the LOC of the RCTs based on spin is the necessity of the day for the readers. Only 49.6% of the RCTs had high LOC. Objective structuring of the abstracts would help eliminate spin in the future.

LEVEL OF EVIDENCE

Level 1.

The Upsurge in Research and Publication on Articular Cartilage Repair in the Last 10 Years

This study aims to study the publication trends in articular cartilage repair (ACR) techniques, over the last 10 years. A literature search was performed on the PubMed, Web of Science, and SCOPUS databases. We used suitable keywords and Boolean operators (articular cartilage injury AND "marrow stimulation OR microfracture (MFx)," "osteochondral autograft," "osteochondral allograft" and "autologous chondrocyte implantation (ACI)," "scaffold"), on January 1, 2019. Trends in publication on these topics were analyzed, focusing on publications over the last 10 years, type of research, authors, institution, and country. There was an increasing trend in publications related to ACR. A search on PubMed revealed 698, 225, 293, 857, and 982 documents on searching for "articular cartilage" AND "marrow stimulation OR microfracture," "osteochondral autograft," "osteochondral allograft," "ACI," and "scaffold," respectively. Similar searches revealed 1154, 219, 330, 1727, and 2742 documents on Web of science and 934, 301, 383, 944, and 2026 on SCOPUS, respectively, in the same order of topics. Overall, most papers were published from the United States and European countries, and Cole BJ was the most published author. There was an increasing trend in the number of publications as well as citations, with international collaboration among researchers. It implies that this field is growing rapidly. The authors from globally recognized and leading clinical institutions in the developed world contributed maximally to these publications. Most of these papers were published in high-impact arthroscopy subspecialty journals. Level of evidence: Level IV.

Health behaviors, outcomes and their relationships among young men aged 18-24 years in a rural area of north India: A cross-sectional study

Background

There is limited information related to health behaviors and their related factors among young men in rural setting of India. This study was conducted to investigate multiple health risk behaviors and outcomes among young men aged 18–24 years in rural India.

Methods

This was a community-based cross-sectional survey conducted in the Ballabgarh block of Faridabad district, Haryana, India. Information regarding socio-demographic details, substance use, injury & violence, mental health and sexual behaviors were collected using a semi-structured interview schedule. Age adjusted prevalence estimates of behaviors and outcomes are computed along with 95% Confidence Intervals. Mediation analysis was carried out to examine relationships between socio-demographic variables, select behaviors and outcomes reported in the study.

Results

A total of 836 young men participated in the study, with mean (SD) age of 20.6 (1.9) years. The age-adjusted prevalence (with 95% Confidence Interval) for ever use of tobacco, alcohol, and other substances was 34.2% (33.9, 34.5), 23.4% (23.2, 23.6), and 4.5% (4.4, 4.5), respectively. Loneliness and suicidal thoughts were reported by 237 and 35 youth men with age adjusted prevalence as 28.6%, 95% CI: 28.4–28.8 and 4.3%, 95% CI: 4.23–4.31, respectively. A total of 330 young men met serious injury in past one year (prevalence 39.3%, 95%CI: 39.01–39.67). Almost one-third of men (prevalence 30.6%, 95%CI: 30.34–30.85) had engaged in pre-marital sexual intercourse. Current substance use was found to be significant mediator for associations with socio-demographic variables studied for dependent variables viz. pre-marital sexual intercourse and serious injury.

Conclusion

High prevalence of various risk behaviors and outcomes was found in young men aged 18–24 years in our rural setting. It is imperative that multi-component health intervention package be rolled out to address these.

Sports Pharmacology: A Medical Pharmacologist's Perspective

Abuse of substances or methods to enhance the performance is becoming very common in the sports, which often destroys the spirit of competition. The regulatory bodies for sports have reported rates ranging from 5% to 31% for the use of performance-enhancing substances among athletes. Athletes can have serious injuries and morbidities, leading to poor health with the use of such substances. Commonly abused agents in sports include anabolic-androgenic steroids and its analogs, blood, erythropoietin, growth hormone and its derivatives, nutritional supplements, creatine, amphetamines, beta-hydroxy-beta-methylbutyrate (HMB), stimulants, and analgesics. Health-care professionals need to be careful while prescribing medicines to sportspersons. Knowledge of exercise physiology, pharmacology of the commonly used agents for sports-related injuries, and agents used for doping could help the sportspersons and health-care professionals to avoid the embarrassment arising because of misuse of these agents. Sports pharmacology includes study of the various aspects of the drug use and abuse in sports and treatment of sports-related injuries. Focusing on sports pharmacology in the medical curriculum can help the upcoming health-care professionals to support the sportspersons to improve the quality of their life by using various drugs and other substances within the standardized limits and avoid embarrassment of doping.