eLetters

416 e-Letters

  • ICON abbreviation

    International CONsensus (https://bjsm.bmj.com/content/54/8/442)

  • Please clarify

    What does ICON stand for? I could not find the meaning of the abbreviation in the text?

  • Standardized data collection can lead to more insightful outcomes

    This meta-analysis undertaken by Currier et al. is welcomed to help further understanding of resistance-based training regimen for strength and hypertrophy. Currier et al. identified that future work to identify the optimal protocol and dose for specific exercise prescriptions is needed. While this recommendation is uncontentious, they could have perhaps gone further. The literature is flooded with different types of studies which incorporate strength-related protocols and is reflected in the number of records excluded in this study. For future studies and - where applicable - existing studies should use a harmonized data collection approach which is common in areas of medicine, for example when attempting to characterize infectious diseases (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7266570/). Ensuring that categorical variables such as age, sex, ethnicity, somatotype, exercise experience, and other appropriate biological parameters are all collected in a standardized way, with datasets made available for reuse could lead to better stratification of data, thus resulting in better insights for future analyses and meta-analyses like the one undertaken by Currier et al.

  • Response to: Did the authors consider the ICIQ-FLUTs (Neil Heron)

    On behalf of all authors, I would like to express our gratitude for the attention given to our work and for providing a thorough response.
    We agree that the ICIQ-FLUTs tool has been identified as a reliable instrument for evaluating lower urinary tract symptoms (LUTS); however, our objective extended beyond solely assessing LUTS. We aimed to incorporate a comprehensive range of symptoms, encompassing pelvic organ prolapse, anal incontinence, and pelvic pain.
    Additional and complete information regarding the rationale behind this decision can be found in the Supplementary file 3.
    Then, we sought the expertise of panellists in rating each symptom for potential inclusion in the tool.
    I am open to further discuss. Thank you again.
    Regards,
    Silvia

  • Included studies?

    Dear Authors,

    Well done on putting together this paper. Massive undertaking to complete a systematic review of 950 included studies.

    I have researched the area of exercise and cardiac rehabilitation for TIA and minor stroke patients. I was therefore keen to know if you included these papers in your review as it wasn’t clear from the supplemental papers I reviewed? For example,

    Heron N, Kee F, Mant J, Reilly PM, Cupples M, Tully M, Donnelly M. Stroke Prevention Rehabilitation Intervention Trial of Exercise (SPRITE) - a randomised feasibility study. BMC Cardiovasc Disord. 2017 Dec 12;17(1):290. doi: 10.1186/s12872-017-0717-9. PMID: 29233087; PMCID: PMC5727948.

    Heron N, Kee F, Mant J, Cupples ME, Donnelly M. Rehabilitation of patients after transient ischaemic attack or minor stroke: pilot feasibility randomised trial of a home-based prevention programme. Br J Gen Pract. 2019 Sep 26;69(687):e706-e714. doi: 10.3399/bjgp19X705509. PMID: 31501165; PMCID: PMC6733604.

    Heron N. Cardiac rehabilitation for the transient ischaemic attack (TIA) and stroke population? Using the Medical Research Council (MRC) guidelines for developing complex health service interventions to develop home-based cardiac rehabilitation for TIA and 'minor' stroke patients. Br J Sports Med. 2019 Jul;53(13):839-840. doi: 10.1136/bjsports-2018-099593. Epub 2018 Sep 4. PMID: 30181325; PMCID: PMC6585273.

    These papers show the benefit of physical activity and ex...

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  • Did the authors consider the ICIQ-FLUTs

    Dear Giagio et Al,

    I read with interest your PFD -SENTINEL paper and thank you for putting together this consensus process.

    As practising sport medicine physicians, we have an interest in lower urinary tract symptoms (LUTs), including incontinence, within our athletic population, both males and females. LUTs, as part of pelvic floor dysfunction, are reportedly common in the general population (2) and vary with the age of the population surveyed – with one recent survey estimating a prevalence of over 70% in those over the age of 70 years olds (3). LUTs is a group of various symptoms related to urination and can include leaking urine, sudden and frequent urges to pass urine, having a weak urine stream or a feeling that you have not completely emptied your bladder. LUTS, and particularly Urinary Incontinence (UI), are considered to be a female health problem that is inevitable and the result of life and health events such as pregnancy, childbirth, and menopause (Casey, E. & Temme, K. 2017). The issue of LUTs is less well understood in male athletes although it has been reported to be present in approximately 15% of athletes surveyed in one study (1). The acceptance of these symptoms, particularly within female athletes, often leads to under reporting or poor engagement with health care practitioners to assess and manage the condition (Anderson & Anderson 2011, Almousa & Bandin Van Loon, 2019, Rodríguez-López, E.S., et al. 2020). The impact of LUT...

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  • Response: Who should undertake the SCOAT6?

    Response: Who should undertake the SCOAT6?

    Thank you for your interest in the Sports Concussion Office Assessment Tools, the SCOAT6 and Child SCOAT6. These tools were developed to guide clinicians internationally, using evidence-based components.1 The evidence shows that concussion in children, adolescents and adults affects multiple clinical domains, and the office assessment must address the clinically relevant domains, which will be different in each concussed individual. Using the symptom scales, and interview with the patient, the clinician can identify which clinical domains are endorsed. This guides the clinician towards the appropriate components of the Child SCOAT6 / SCOAT6. Incorporated into the tools are Green “recommended” sections and Orange “optional” sections, to assist the time-challenged clinician in focusing on the most relevant modalities.2,3

    Developing the Office tools was a balancing act that primarily considered producing a thorough, multimodal assessment tool but one that was also easy to use and not too lengthy. For instance, we could not ignore research supporting the value of the VOMS but opted for the recently validated modified VOMS which is a validated briefer version.4,5

    The scientifically derived clinical reality is that the office assessment of concussed athletes requires a multimodal assessment. Trying to perform a proper multimodal assessment in a 10-minute time period is neither appropriate nor realistic. The concu...

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  • Primary and community care assessment of concussions

    Dear Authors,

    Great work on putting together the child SCOAT6 and this is a really helpful piece for the office sport medicine doctors. However, what about the community healthcare teams, eg General Practitioners, GPs, what tool should they be using? Particularly bearing in mind the time constraints of community health contacts, eg GP consults in the UK are most often limited to 10 minutes. What can we expect non-specialist sport medicine doctors to do to help make the concussion diagnosis and therefore initiate appropriate management promptly? Should we be making a childSCATgp?

    More patients will be attending primary and community care facilities with concussion as the general knowledge around the diagnosis increases and with new policies and procedures identifying community resources to make the concussion diagnosis and management . Indeed, within the UK, there has recently been grassroots concussion protocols released and they advise that all concussions should be diagnosed by a healthcare practitioner. This will cause a number of patients, both children and adults. to present to community practitioners seeking a diagnosis and we therefore need a community tool to diagnose and manage concussions for the non-specialist healthcare practitioners. Time for a consensus meeting to discuss community, non-specialist concussion diagnosis and management?

  • Who should undertake the SCOAT6?

    Dear Authors,

    Great work on putting together the SCOAT6 and this is a really helpful piece for the office sport medicine doctors. However, what about the community healthcare teams, eg General Practitioners, GPs, what tool should they be using? Particularly bearing in mind the time constraints of community health contacts, eg GP consults in the UK are most often limited to 10 minutes. What can we expect non-specialist sport medicine doctors to do to help make the concussion diagnosis and therefore initiate appropriate management promptly? Should we be making a SCATgp?

  • Response to “Expression of concern over the Aspetar consensus for rehabilitation after ACL reconstruction: Premature position on the efficacy of cross-education”

    Dear Editor,
    We thank these researchers for their concern regarding our recent clinical practice guideline1 and the accompanying interactive infographic. 2 We appreciate the opportunity to clarify and reply to these concerns.

    The authors appear under the misapprehension that this was a consensus statement. The current work is a clinical practice guideline. According to the GRADE Handbook3: “users of guidelines may be frustrated with the lack of guidance when the guideline panel fails to make a recommendation” and: “clinicians themselves will rarely explore the evidence as thoroughly as a guideline panel, nor will they devote as much thought to the trade-offs, or the possible underlying values and preferences in the population”. Accordingly, GRADE encourages panels to deal with their discomfort and to make recommendations even when confidence in effect estimate is low and/or desirable and undesirable consequences are closely balanced.

    The authors argue that there is currently insufficient evidence to reach a consensus recommendation regarding the exclusion of cross-education for post-ACLR rehabilitation. They propose re-evaluating the specific "Not Recommended" position and instead suggest that a "No Recommendation" stance would be more appropriate due to the lack of data. As noted, this is a clinical practice guideline (not a consensus statement) where we prioritise actionable information over agreement.

    It is worth noting t...

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