Expanding Knowledge About Music and Well-Being in Carceral Settings: A Methodological Review

This methodological review includes literature (1987-2022) concerning the role and influence of musical practices-including music therapy and participatory music interventions-on well-being in carceral settings such as jails, prisons, and immigration detention centers. We provide a thorough description of key methodological procedures used in 55 studies: (1) Key Elements of Research Questions; (2) Types of Musical Practices; (3) Musical Genres; (4) Methodologies and Designs; (5) Locations; (6) Theoretical Frameworks; and (7) Samples. Our review indicates that there is difficulty in conducting research in prisons due to limitations imposed on researchers, a paucity of randomized-control trials, and limited generalizability of results due to the heterogeneity of methodological approaches. We suggest that the literature base would benefit from increased attention to issues related to sampling procedures, research questions related to race and gender identity, as well as the delineation between the types of musical practices utilized by music interventions.

Suicide among Cancer Patients: Current Knowledge and Directions for Observational Research

Cancer is a major public health concern associated with an increased risk of psychosocial distress and suicide. The reasons for this increased risk are still being characterized. The purpose of this study is to highlight existing observational studies on cancer-related suicides in the United States and identify gaps for future research. This work helps inform clinical and policy decision-making on suicide prevention interventions and ongoing research on the detection and quantification of suicide risk among cancer patients. We identified 73 peer-reviewed studies (2010-2022) that examined the intersection of cancer and suicide using searches of PubMed and Embase. Overall, the reviewed studies showed that cancer patients have an elevated risk of suicide when compared to the general population. In general, the risk was higher among White, male, and older cancer patients, as well as among patients living in rural areas and with lower socioeconomic status. Future studies should further investigate the psychosocial aspects of receiving a diagnosis of cancer on patients' mental health as well as the impact of new treatments and their availability on suicide risk and disparities among cancer patients to better inform policies.

Use of mixed methods research in intervention studies to increase young people's interest in STEM: A systematic methodological review

Introduction

Mixed methods research intervention studies integrate quantitative evaluation approaches, such as randomized controlled trials and quasi-experimental designs, with qualitative research to evaluate the effectiveness, efficacy, or other results of an intervention or program. These types of studies, which have attracted growing attention in recent years, enhance the scope and rigor of the evaluation. While various frameworks that summarize the justifications for carrying out these types of studies and provide implementation guidance have been published in the last few years in the health sciences, we do not know whether such frameworks have been properly implemented in the social and educational sciences. This review examined the methodological features and reporting practices of mixed methods intervention studies aimed at increasing young people's interest in STEM.

Methods

A systematic search was carried out in APA PsycNET, ERIC, ProQuest, Scopus, and Web of Science, and a hand search in 20 journals. We included peer-reviewed English-language articles that reported intervention studies with a quantitative component measuring outcomes specific to increasing secondary school students' interest in STEM fields, a qualitative component conducted before, during, or after the quantitative component, and evidence of integration of both components. Qualitative content analysis and ideal-type analysis were used to synthesize the findings.

Results

We found 34 studies; the majority published in the last ten years. Several patterns of mixed methods application were described in these studies, illustrating the unique insights that can be gained by employing this methodology. The reporting quality of the included studies was generally adequate, especially regarding the justification for using a mixed methods intervention design and the integration of the quantitative and qualitative components. Nonetheless, a few reporting issues were observed, such as a lack of detail in the presentation of the mixed methods design, an inadequate description of the qualitative sampling and analysis techniques, and the absence of joint displays for representing integration.

Discussion

Authors must pay attention to these issues to ensure that the insights obtained by the use of mixed methods research are effectively communicated.

Recruitment and implementation challenges were common in stepped-wedge cluster randomized trials: results from a methodological review

OBJECTIVE

To explore challenges in recruitment and intervention implementation in recent stepped-wedge cluster randomized trials (SW-CRTs).

STUDY DESIGN AND SETTING

We searched PubMed to identify primary reports of SW-CRTs (2019-2020). Two reviewers independently screened studies and extracted data from each report. Recruitment challenge was defined as planned number of clusters or participants not achieved, or any reported changes made to the design to address recruitment difficulties. Implementation challenge was defined as early, late or no implementation of the intervention in at least one cluster.

RESULTS

Of 55 SW-CRTs, 18 (33%) had a recruitment challenge, 23 (42%) had none, and for 14 (26%) it was impossible to judge. At least one implementation challenge was present in 24 (44%), 8 (15%) had none, and for 23 (42%) it was impossible to judge. Of the 35 (64%) trials with recruitment or implementation challenges, 18 (72%) had one or more modifications of their design, most often a modification of the trial duration.

CONCLUSION

Investigators must be aware of the risks of recruitment or implementation challenges when considering use of a SW-CRT design. Mitigating strategies should be adopted when planning the trial. More transparent reporting of planned and actual design features is required.

Risk of bias in chiropractic mixed methods research: a secondary analysis of a meta-epidemiological review

OBJECTIVE

To examine the risk of bias in chiropractic mixed methods research.

METHODS

We performed a secondary analysis of a meta-epidemiological review of chiropractic mixed methods studies. We assessed risk of bias with the Mixed Methods Appraisal Tool (MMAT) and used generalized estimating equations to explore factors associated with risk of bias.

RESULTS

Among 55 eligible studies, a mean of 62% (6.8 [2.3]/11) of MMAT items were fulfilled. In our adjusted analysis, studies published since 2010 versus pre-2010 (adjusted odds ratio [aOR] = 2.26; 95% confidence interval [CI], 1.39 to 3.68) and those published in journals with an impact factor versus no impact factor (aOR = 2.21; 95% CI, 1.33 to 3.68) were associated with lower risk of bias.

CONCLUSION

Our findings suggest opportunities for improvement in the quality of conduct among published chiropractic mixed methods studies. Author compliance with the MMAT criteria may reduce methodological bias in future mixed methods research.

A Systematic Review of Momentary Assessment Designs for Mood and Anxiety Symptoms

Background: Altering components of ecological momentary assessment (EMA) measures to better suit the purposes of individual studies is a common and oftentimes necessary step. Though the inherent flexibility in EMA has its benefits, no resource exists to provide an overview of the variability in how convergent constructs and symptoms have been assessed in the past. The present study fills that gap by examining EMA measurement design for mood and anxiety symptomatology. Methods: Various search engines were used to identify 234 relevant studies. Items administered, data collection schedules (i.e., beeps per day), response scales (i.e., Likert), data collection platforms (i.e., apps), and psychometric properties (i.e., reliability) were extracted. Results: Study designs varied greatly in all aspects across the identified papers. Over 4,600 extracted items were qualitatively analyzed, resulting in the identification of 12 themes. The most EMA items focused on affect, with categories such as "happiness" and "tension" appearing most frequently. We provide all of our data extraction in the format of an open-source database. Limitations: Despite our best attempts to include as much of the relevant literature as possible, this review and the accompanying database are not exhaustive, but can easily be built upon to include other, newer studies. Conclusions: The fact that the affect theme featured both positive and negative emotional constructs highlights the dichotomous focus on valence and affect within the literature surrounding anxious and depressive symptomatology. We hope that our database will act as a helpful design decision-making resource for researchers studying this kind of symptomatology in the future. Systematic Review Registration: PROSPERO (CRD42019139409).

Report Quality of Generalized Linear Mixed Models in Psychology: A Systematic Review

Generalized linear mixed models (GLMMs) estimate fixed and random effects and are especially useful when the dependent variable is binary, ordinal, count or quantitative but not normally distributed. They are also useful when the dependent variable involves repeated measures, since GLMMs can model autocorrelation. This study aimed to determine how and how often GLMMs are used in psychology and to summarize how the information about them is presented in published articles. Our focus in this respect was mainly on frequentist models. In order to review studies applying GLMMs in psychology we searched the Web of Science for articles published over the period 2014–2018. A total of 316 empirical articles were selected for trend study from 2014 to 2018. We then conducted a systematic review of 118 GLMM analyses from 80 empirical articles indexed in Journal Citation Reports during 2018 in order to evaluate report quality. Results showed that the use of GLMMs increased over time and that 86.4% of articles were published in first- or second-quartile journals. Although GLMMs have, in recent years, been increasingly used in psychology, most of the important information about them was not stated in the majority of articles. Report quality needs to be improved in line with current recommendations for the use of GLMMs.

Qualitative and Quantitative Method Integration in Diabetes Communication Research: Applications and Contributions

This article is a systematic methodological literature review with the goal of understanding how and why health communication researchers are using mixed methods research (MMR) to better understand interpersonal communication between diabetes patients, their loved ones, and health care professionals. First, we provide a brief overview of MMR, followed by a discussion of the appropriateness of using MMR in health research. We then explain our search procedures for identifying MMR studies about interpersonal diabetes communication and describe our analysis of the identified studies. We then offer a brief, quantitative summary of our findings and provide details of exemplar studies to illustrate the unique value added by using MMR. We conclude the article with a discussion of implications and recommendations for the use of MMR in diabetes communication research.

Practical mixed methods strategies used to integrate qualitative and quantitative methods in community-based primary health care research

BACKGROUND

Mixed methods (MM) are common in community-based primary health care (CBPHC) research studies. Several strategies have been proposed to integrate qualitative and quantitative components in MM, but they are seldom well conceptualized and described. The purpose of the present review was to identify and describe practical MM strategies and combinations of strategies used to integrate qualitative and quantitative methods in CBPHC research.

METHODS

A methodological review with qualitative synthesis (grouping) was performed. Records published in English in 2015 were retrieved from the Scopus bibliographic database. Eligibility criteria were: CBPHC empirical study, MM research with detailed description of qualitative and quantitative methods and their integration. Data were extracted from included studies and grouped using a conceptual framework comprised of three theoretical types of MM integration, the seven combinations of these types and nine practical strategies (three per type of integration) and multiple combinations of strategies.

RESULTS

Among the 151 articles reporting CBPHC and MM studies retrieved, 54 (35.7%) met the inclusion criteria for this review. The included studies provided examples of the three theoretical types of MM integration, the seven combinations of these types as well as the nine practical strategies. Overall, 15 combinations of these strategies were observed. No emerging strategy was observed that was not predicted by the conceptual framework.

CONCLUSIONS

This review can provide guidance to CBPHC researchers for planning, conducting and reporting practical strategies and combinations of strategies used for integrating qualitative and quantitative methods in MM research.

Assessment of Instruments for Measurement of Delirium Severity: A Systematic Review

Importance

Measurement of delirium severity has been recognized as highly important for tracking prognosis, monitoring response to treatment, and estimating burden of care for patients both during and after hospitalization. Rather than simply rating delirium as present or absent, the ability to quantify its severity would enable development and monitoring of more effective treatment approaches for the condition.

Objectives

To present a comprehensive review of delirium severity instruments, conduct a methodologic quality rating of the original validation study of the most commonly used instruments, and select a group of top-rated instruments.

Evidence Review

This systematic review was conducted using literature from Embase, PsycINFO, PubMed, Web of Science, and Cumulative Index to Nursing and Allied Health Literature, from January 1, 1974, through March 31, 2017, with the key words delirium, severity, tests, measures, and intensity. Inclusion criteria were original articles assessing delirium severity and using a delirium-specific severity instrument. Final listings of articles were supplemented with hand searches of reference listings to ensure completeness. At least 2 reviewers independently completed each step of the review process: article selection, data extraction, and methodologic quality assessment of relevant articles using a validated rating scale. All discrepancies between raters were resolved by consensus.

Findings

Of 9409 articles identified, 228 underwent full text review, and we identified 42 different instruments of delirium severity. Eleven of the 42 tools were multidomain, delirium-specific instruments providing a quantitative rating of delirium severity; these instruments underwent a methodologic quality review. Applying prespecified criteria related to frequency of use, methodologic quality, construct or predictive validity, and broad domain coverage, an expert panel used an iterative modified Delphi process to select 6 final high-quality instruments meeting these criteria: the Confusion Assessment Method-Severity Score, Confusional State Examination, Delirium-O-Meter, Delirium Observation Scale, Delirium Rating Scale, and Memorial Delirium Assessment Scale.

Conclusions and Relevance

The 6 instruments identified may enable accurate measurement of delirium severity to improve clinical care for patients with this condition. This work may stimulate increased usage and head-to-head comparison of these instruments.

Current Practices in Data Analysis Procedures in Psychology: What Has Changed?

This paper analyzes current practices in psychology in the use of research methods and data analysis procedures (DAP) and aims to determine whether researchers are now using more sophisticated and advanced DAP than were employed previously. We reviewed empirical research published recently in prominent journals from the USA and Europe corresponding to the main psychological categories of Journal Citation Reports and examined research methods, number of studies, number and type of DAP, and statistical package. The 288 papers reviewed used 663 different DAP. Experimental and correlational studies were the most prevalent, depending on the specific field of psychology. Two-thirds of the papers reported a single study, although those in journals with an experimental focus typically described more. The papers mainly used parametric tests for comparison and statistical techniques for analyzing relationships among variables. Regarding the former, the most frequently used procedure was ANOVA, with mixed factorial ANOVA being the most prevalent. A decline in the use of non-parametric analysis was observed in relation to previous research. Relationships among variables were most commonly examined using regression models, with hierarchical regression and mediation analysis being the most prevalent procedures. There was also a decline in the use of stepwise regression and an increase in the use of structural equation modeling, confirmatory factor analysis, and hierarchical linear modeling. Overall, the results show that recent empirical studies published in journals belonging to the main areas of psychology are employing more varied and advanced statistical techniques of greater computational complexity.

Methods used to assess the performance of biomarkers for the diagnosis of acute kidney injury: a systematic review and meta-analysis

PURPOSE

Methods used to explore biomarkers for acute kidney injury (AKI) might have a major impact on the results and the use of these biomarkers. We evaluated the methods used to investigate biomarkers of AKI.

MATERIALS AND METHODS

A systematic review and meta-analysis were performed using a computerized search of the MEDLINE and the EMBASE databases (PROSPERO CRD42017059618). Articles reporting biomarker's performance to diagnose AKI were included. The outcome included a description of the methods used to assess the performance of biomarkers to diagnose AKI.

RESULTS

Among the 295 included studies, assessment of biomarkers was the primary endpoint in 284 with sample size calculation in only 8% of cases. Eighty-five percent of the studies summarized the performance of biomarkers with receiver operating characteristic (ROC) curves; however, 74 studies (25%) did not provide the threshold, sensibility or specificity. A total of 176 studies evaluated more than one biomarker, and only 25% combined biomarkers to increase diagnostic performance. We determined that the definition of AKI and study design impacted the diagnostic performance using uNGAL (urinary neutrophil gelatinase-associated lipocalin) as an example. Major publication bias was identified.

CONCLUSIONS

Most articles that reported biomarkers of AKI performance present methodological weaknesses. Basic rules should be provided to increase the quality of reporting in this area.

The role of pragmatism in explaining heterogeneity in meta-analyses of randomised trials: a protocol for a cross-sectional methodological review

INTRODUCTION

There has been increasing interest in pragmatic trials methodology. As a result, tools such as the Pragmatic-Explanatory Continuum Indicator Summary-2 (PRECIS-2) are being used prospectively to help researchers design randomised controlled trials (RCTs) within the pragmatic-explanatory continuum. There may be value in applying the PRECIS-2 tool retrospectively in a systematic review setting as it could provide important information about how to pool data based on the degree of pragmatism.

OBJECTIVES

To investigate the role of pragmatism as a source of heterogeneity in systematic reviews by (1) identifying systematic reviews with meta-analyses of RCTs that have moderate to high heterogeneity, (2) applying PRECIS-2 to RCTs of systematic reviews, (3) evaluating the inter-rater reliability of PRECIS-2, (4) determining how much of this heterogeneity may be explained by pragmatism.

METHODS

A cross-sectional methodological review will be conducted on systematic reviews of RCTs published in the Cochrane Library from 1 January 2014 to 1 January 2017. Included systematic reviews will have a minimum of 10 RCTs in the meta-analysis of the primary outcome and moderate to substantial heterogeneity (I²≥50%). Of the eligible systematic reviews, a random selection of 10 will be included for quantitative evaluation. In each systematic review, RCTs will be scored using the PRECIS-2 tool, in duplicate. Agreement between raters will be measured using the intraclass correlation coefficient. Subgroup analyses and meta-regression will be used to evaluate how much variability in the primary outcome may be due to pragmatism.

DISSEMINATION

This review will be among the first to evaluate the PRECIS-2 tool in a systematic review setting. Results from this research will provide inter-rater reliability information about PRECIS-2 and may be used to provide methodological guidance when dealing with pragmatism in systematic reviews and subgroup considerations. On completion, this review will be submitted to a peer-reviewed journal for publication.

Drainage after Modified Radical Mastectomy - A Methodological Mini-Review

Breast cancer is a socially relevant group of malignant conditions of the mammary gland, affecting both males and females. Most commonly the surgical approach of choice is a modified radical mastectomy (MRM), due to it allowing for both the removal of the main tumor mass and adjacent glandular tissue, which are suspected of infiltration and multifocality of the process, and a sentinel axillary lymph node removal. Most common post-surgical complications following MRM are the formation of a hematoma, the infection of the surgical wound and the formation of a seroma. These post-surgical complications can, at least in part, be attributed to the drainage of the surgical wound. However, the lack of modern and official guidelines provides an ample scope for innovation, but also leads to a need for a randomized comparison of the results. We compared different approaches to wound drainage after MRM, reviewed based on the armamentarium, number of drains, location, type of drainage system, timing of drain removal and no drainage alternatives. Currently, based on the general results, scientific and comparative discussions, seemingly the most affordable methodology with the best patient outcome, with regards to hospital stay and post-operative complications, is the placement of one medial to lateral (pectoro-axillary) drain with low negative pressure. Ideally, the drain should be removed on the second or third postoperative day or when the amount of drained fluid in the last 24 hours reaches below 50 milliliters.

Trends in Mediation Analysis in Nursing Research: Improving Current Practice

The purpose of this study was to describe common approaches used by nursing researchers to test mediation models and evaluate them within the context of current methodological advances. MEDLINE was used to locate studies testing a mediation model and published from 2004 to 2015 in nursing journals. Design (experimental/correlation, cross-sectional/longitudinal, model complexity) and analysis (method, inclusion of test of mediated effect, violations/discussion of assumptions, sample size/power) characteristics were coded for 456 studies. General trends were identified using descriptive statistics. Consistent with findings of reviews in other disciplines, evidence was found that nursing researchers may not be aware of the strong assumptions and serious limitations of their analyses. Suggestions for strengthening the rigor of such studies and an overview of current methods for testing more complex models, including longitudinal mediation processes, are presented.

A methodological review of qualitative case study methodology in midwifery research

AIM

To explore the use and application of case study research in midwifery.

BACKGROUND

Case study research provides rich data for the analysis of complex issues and interventions in the healthcare disciplines; however, a gap in the midwifery research literature was identified.

DESIGN

A methodological review of midwifery case study research using recognized templates, frameworks and reporting guidelines facilitated comprehensive analysis.

DATA SOURCES

An electronic database search using the date range January 2005-December 2014: Maternal and Infant Care, CINAHL Plus, Academic Search Complete, Web of Knowledge, SCOPUS, Medline, Health Collection (Informit), Cochrane Library Health Source: Nursing/Academic Edition, Wiley online and ProQuest Central.

REVIEW METHODS

Narrative evaluation was undertaken. Clearly worded questions reflected the problem and purpose. The application, strengths and limitations of case study methods were identified through a quality appraisal process.

RESULTS

The review identified both case study research's applicability to midwifery and its low uptake, especially in clinical studies. Many papers included the necessary criteria to achieve rigour. The included measures of authenticity and methodology were varied. A high standard of authenticity was observed, suggesting authors considered these elements to be routine inclusions. Technical aspects were lacking in many papers, namely a lack of reflexivity and incomplete transparency of processes.

CONCLUSION

This review raises the profile of case study research in midwifery. Midwives will be encouraged to explore if case study research is suitable for their investigation. The raised profile will demonstrate further applicability; encourage support and wider adoption in the midwifery setting.

Mediation analysis in nursing research: a methodological review

Mediation statistical models help clarify the relationship between independent predictor variables and dependent outcomes of interest by assessing the impact of third variables. This type of statistical analysis is applicable for many clinical nursing research questions, yet its use within nursing remains low. Indeed, mediational analyses may help nurse researchers develop more effective and accurate prevention and treatment programs as well as help bridge the gap between scientific knowledge and clinical practice. In addition, this statistical approach allows nurse researchers to ask - and answer - more meaningful and nuanced questions that extend beyond merely determining whether an outcome occurs. Therefore, the goal of this paper is to provide a brief tutorial on the use of mediational analyses in clinical nursing research by briefly introducing the technique and, through selected empirical examples from the nursing literature, demonstrating its applicability in advancing nursing science.

Methodological review of the quality of reach out and read: does it "work"?

A considerable percentage of American children and adults fail to learn adequate literacy skills and read below a third grade level. Shared book reading is perhaps the single most important activity to prepare young children for success in reading. The primary objective of this manuscript was to critically review the methodological quality of Read Out and Read (ROR), a clinically based literacy program/intervention that teaches parents strategies to incorporate while sharing books with children as a method of preventing reading difficulties and academic struggles. A PubMed search was conducted. Articles that met three criteria were considered. First, the study must be clinically based and include parent contact with a pediatrician. Second, parental counseling ("anticipatory guidance") about the importance of parent-child book reading must be included. Third, only experimental or quasi-experimental studies were included; no additional criteria were used. Published articles from any year and peer-reviewed journal were considered. Study quality was determined using a modified version of the Downs and Black (1998) checklist assessing four categories: (1) Reporting, (2) External Validity, (3) Internal Validity-Bias, and (4) Internal Validity-Confounding. We were also interested in whether quality differed based on study design, children's age, sample size, and study outcome. Eleven studies met the inclusion criteria. The overall quality of evidence was variable across all studies; Reporting and External Validity categories were relatively strong while methodological concerns were found in the area of internal validity. Quality scores differed on the four study characteristics. Implications related to clinical practice and future studies are discussed.

Poor reporting quality of key Randomization and Allocation Concealment details is still prevalent among published RCTs in 2011: a review

RATIONALE, AIMS AND OBJECTIVES

Randomized controlled trials (RCTs) are powerful tools; it is essential that these trials are not only conducted rigorously, but reported accurately. The aim of this paper was to describe the reporting quality among a set of RCTs published in 2011 on methodological details essential to judging the adequacy of allocation concealment methods employed.

METHODS

Medline was searched using the Ovid platform to identify all those RCTs published in January 2011 in core clinical journals. Methodological details in relation to allocation concealment were extracted from the identified RCTs to allow the reporting quality to be assessed. If the information was not available in the paper the corresponding author was contacted.

RESULTS

Eighty-five papers were identified, 74% (n = 63) endorsed the CONSORT statement. 73% (n = 62) required the author to be contacted for further information. Sequence generation methods were ascertained in 74% of trials, allocation concealment method in 41%, details of who recruited participants and who generated the randomization sequence in 38%.

CONCLUSIONS

There is evidence to suggest that in 2011 key methodological information relating to allocation concealment is still not reported well in RCTs. Authors and journal editors need to ensure explicit and clear methods are reported in RCTs published.

Allocation concealment: a methodological review

RATIONALE, AIMS AND OBJECTIVES

The accurate reporting of the trial methodology and results is essential for accurate judgement on the quality of the research. This review aims to assess the impact of the adequacy of allocation concealment on treatment effect estimates.

METHODS

A search was performed in MEDLINE (via the Ovid platform) to identify all randomized controlled trials (RCTs) indexed in January 2011 within its set of 'core clinical journals'. Meta-regression was undertaken on a subset of two arm trials to quantify the association between adequacy of allocation concealment and effect size.

RESULTS

Adequate allocation concealment methods were used in 27% (n = 23) of included trials. There was insufficient information given in 68% (n = 58) of trials to make a judgement on allocation concealment. Meta-regression showed that there was a trend, not statistically significant, towards a smaller effect size between adequacy of allocation concealment and effect sizes.

CONCLUSION

This review highlighted that research needs to be reported to a higher standard and there are many trials reporting poor methods of allocation concealment within the small sample of trials included in this review.

What should an ideal spinal injury classification system consist of? A methodological review and conceptual proposal for future classifications

Since Böhler published the first categorization of spinal injuries based on plain radiographic examinations in 1929, numerous classifications have been proposed. Despite all these efforts, however, only a few have been tested for reliability and validity. This methodological, conceptual review summarizes that a spinal injury classification system should be clinically relevant, reliable and accurate. The clinical relevance of a classification is directly related to its content validity. The ideal content of a spinal injury classification should only include injury characteristics of the vertebral column, is primarily based on the increasingly routinely performed CT imaging, and is clearly distinctive from severity scales and treatment algorithms. Clearly defined observation and conversion criteria are crucial determinants of classification systems' reliability and accuracy. Ideally, two principle spinal injury characteristics should be easy to discern on diagnostic images: the specific location and morphology of the injured spinal structure. Given the current evidence and diagnostic imaging technology, descriptions of the mechanisms of injury and ligamentous injury should not be included in a spinal injury classification. The presence of concomitant neurologic deficits can be integrated in a spinal injury severity scale, which in turn can be considered in a spinal injury treatment algorithm. Ideally, a validation pathway of a spinal injury classification system should be completed prior to its clinical and scientific implementation. This review provides a methodological concept which might be considered prior to the synthesis of new or modified spinal injury classifications.