Study quality on groin injury management remains low: a systematic review on treatment of groin pain in athletes

TY - JOUR

T1 - Study quality on groin injury management remains low

T2 - a systematic review on treatment of groin pain in athletes

AU - Serner, Andreas

AU - van Eijck, Casper H

AU - Beumer, Berend R

AU - Hölmich, Per

AU - Weir, Adam

AU - de Vos, Robert-Jan

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

PY - 2015/6/1

Y1 - 2015/6/1

N2 - Background: Groin pain in athletes is frequent and many different treatment options have been proposed. The current level of evidence for the efficacy of these treatments is unknown. Objective: Systematically review the literature on the efficacy of treatments for groin pain in athletes. Methods: Nine medical databases were searched in May 2014. Inclusion criteria: treatment studies in athletes with groin pain; randomised controlled trials, controlled clinical trials or case series; n>10; outcome measures describing number of recovered athletes, patient satisfaction, pain scores or functional outcome scores. One author screened search results, and two authors independently assessed study quality. A best evidence synthesis was performed. Relationships between quality score and outcomes were evaluated. Review registration number CRD42014010262. Results: 72 studies were included for quality analysis. Four studies were high quality. There is moderate evidence that, for adductor-related groin pain, active exercises compared with passive treatments improve success, multimodal treatment with a manual therapy technique shortens the time to return to sports compared with active exercises and adductor tenotomy improves treatment success over time. There is moderate evidence that for athletes with sportsman's hernia, surgery results in better treatment success then conservative treatment. There was a moderate and inverse correlation between study quality and treatment success (p<0.001, r=-0.41), but not between study quality and publication year (p=0.09, r=0.20). Conclusions: Only 6% of publications were high quality. Low-quality studies showed significantly higher treatment success and study quality has not improved since 1985. There is moderate evidence for the efficacy of conservative treatment (active exercises and multimodal treatments) and for surgery in patients with adductor-related groin pain. There is moderate evidence for efficacy of surgical treatment in sportsman's hernia.

AB - Background: Groin pain in athletes is frequent and many different treatment options have been proposed. The current level of evidence for the efficacy of these treatments is unknown. Objective: Systematically review the literature on the efficacy of treatments for groin pain in athletes. Methods: Nine medical databases were searched in May 2014. Inclusion criteria: treatment studies in athletes with groin pain; randomised controlled trials, controlled clinical trials or case series; n>10; outcome measures describing number of recovered athletes, patient satisfaction, pain scores or functional outcome scores. One author screened search results, and two authors independently assessed study quality. A best evidence synthesis was performed. Relationships between quality score and outcomes were evaluated. Review registration number CRD42014010262. Results: 72 studies were included for quality analysis. Four studies were high quality. There is moderate evidence that, for adductor-related groin pain, active exercises compared with passive treatments improve success, multimodal treatment with a manual therapy technique shortens the time to return to sports compared with active exercises and adductor tenotomy improves treatment success over time. There is moderate evidence that for athletes with sportsman's hernia, surgery results in better treatment success then conservative treatment. There was a moderate and inverse correlation between study quality and treatment success (p<0.001, r=-0.41), but not between study quality and publication year (p=0.09, r=0.20). Conclusions: Only 6% of publications were high quality. Low-quality studies showed significantly higher treatment success and study quality has not improved since 1985. There is moderate evidence for the efficacy of conservative treatment (active exercises and multimodal treatments) and for surgery in patients with adductor-related groin pain. There is moderate evidence for efficacy of surgical treatment in sportsman's hernia.

KW - Abdominal Pain

KW - Adolescent

KW - Adult

KW - Athletic Injuries

KW - Epidemiologic Methods

KW - Evidence-Based Medicine

KW - Female

KW - Groin

KW - Humans

KW - Male

KW - Quality of Health Care

KW - Terminology as Topic

KW - Treatment Outcome

KW - Young Adult

U2 - 10.1136/bjsports-2014-094256

DO - 10.1136/bjsports-2014-094256

M3 - Review

C2 - 25633830

SN - 0306-3674

VL - 49

SP - 1

EP - 11

JO - British Journal of Sports Medicine

JF - British Journal of Sports Medicine

IS - 12

M1 - 813

ER -