373 e-Letters

  • Agreed.

    For readers who are following the debate about how training load may relate to injury, Dr Johann Windt considers the implication of the correlation that is pointed out here. Thanks to all the authors. k2


  • A few unanswered questions

    The study raises two questions that one of the authors might be able to help with:

    First, the authors report both within group and between group changes in body fat in the abstract. But it is unclear why the authors chose the within-group changes (28% fat loss) as the study conclusion than the between-group change.

    The within group change showed a fat loss of 0.45 kg (28%) in favor of interval training (IT), while the between-group changes showed a large difference of 2.28 kg of fat loss in favor of IT. Considering the large difference in fat loss, and some studies recommending to avoid within group differences in meta-analysis, it would be helpful if the authors could comment on this.

    Second, maintaining lean body mass (LBM) is one of the primary reasons to include exercise as part of a weight loss strategy. So it is not clear why the authors chose not to include lean body mass as one of the outcomes. It would have certainly helped the reader to make a decision regarding the choice of exercise for weight loss.

    Finally, congratulations to all the authors for asking a very relevant question!.

  • Methodological concerns in patients with femoroacetabular impingement: is ROM deficit really absent?

    We thank Freke et al. (1) for their systematic review about physical impairments in patients with symptomatic femoroacetabular impingement, nonetheless we have some remarks about methods and results of the article, in particular for range of motion (ROM) outcome.
    A meta-analysis of ROM was performed without reporting an overall estimate. Taking into account the amount of studies included and their information, a meta-analysis should have been accomplished. Nonetheless, authors concluded that individuals with symptomatic FAI demonstrated no difference in hip ROM in any direction of movement. This conclusion was unexpected taking into account the findings reported in the primary studies included), and in the previous systematic review published in 2015 (2), that showed instead a reduced ROM.
    This discrepancy in literature is already discussed by the Warwick agreement (3), where authors stated that “the evidence on hip range of motion (ROM) in FAI syndrome is surprisingly contradictory” due to contrasting published systematic reviews (1) (2).
    Therefore, we checked the accuracy of results reported, analyzing the data reported for every movement assessed in primary studies comparing those reported in this systematic review. We noted some issues in the represented forest plots.
    Firstly, some included studies (4), (5), (6), (7) were reported twice in the meta-analysis for different times points or reporting double data of the same patients obtained by two...

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  • Letter in response to: The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial.

    Dear Editor,

    I would like to congratulate the British Journal of Sports Medicine for the publication of the study ‘The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial’ conducted by Harøy et al.[1]. The study investigated the effect of the adductor strengthening programme on the prevalence of groin problems among football players. The findings are incredibly important for the development of sports medicine because of their clinical relevance.

    Regarding the methodology of this study, rather than giving criticism, I would like to suggest the authors if they can provide additional information or even a follow-up article on the game performance of the football teams involved in this study. As mentioned in the article, the authors have considered the groin pain causing time loss, decreasing participation or performance of the players [1]. Meanwhile, the previous study literally found that a lower incidence rate was strongly correlated with the number of goals, games won and even team ranking position [2,3]. Therefore, readers are interested whether the performance could be improved too since the results showed a significant reduction in the prevalence of groin pain in the players.

    Similar studies have been conducted to investigate the effect of a specific strength training programme on players’ injury prevalence and individuals’ performance [4]. However, no data was included to refl...

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  • Exercise-associated hyponatraemia and medication

    I had been a sufferer of exercise-associated hyponatraemia for at least a year, when I was living on a farm, as a direct result of drinking bore water. Unlike most bores which are overmineralized and dirty, these ones tapped into deep aquifers, that sourced ultra purified water. Because the water is trapped under deep layers of dolomites and Saprolites, the only way it can travel deeper into the earth is by passing through the micro pores of rocks, which results in micro filtration and ultra purification.

    But humans are adaptable to drinking pure water and pure water alone isn't going to make a normal person hyponatraemic, I had at one stage performing a labour intensive job as a tree surgeon. Also, because I have ADHD, I am medicated with adder-all.

    My situation was quite rare because I was living on a farm, drinking bore water and had a job pruning trees in residential areas, in the city. There, one would sweat heavily and would be drinking city water, which is one recipe for water that has a good mineral trace element content to it, but going home later that evening meant a diet of pure drinking water or cooking foods in pure water. This messed me up and affected my clear state of mind, often its a state of delirium that you start to feel as one of the typical symptoms.

    But then I also go back to the adder-all, which may have some role in making me vulnerable, because its an amphetamine and similar to the way ecstasy makes people become wate...

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  • BJSM encourages comments alongside papers - such as this example

    Many of you will be familiar with The BMJ and its popular 'Rapid Responses'. Because we are a sister journal to The BMJ (and part of the same publishing company of course) we have the same Platform and we encourage you to use it.

  • What's this got to do with sports medicine?

    Why is this in BJSM? In general, it is best to have papers go through peer review in the most relevant journal to their subject matter to ensure that the production team is well placed to find suitable editors and reviewers.

  • Comment and questions to Mottola et al (2019): 2019 Canadian guideline for physical activity throughout pregnancy

    Letter to the Editors
    Br J Sports Med
    J Obstet Gynecol Canada
    Oslo, Nov 23rd 2018
    Comment and questions to Mottola et al (2019): 2019 Canadian guideline for physical activity throughout pregnancy
    We have read the Canadian guideline for physical activity throughout pregnancy with great interest. We note that the guideline team have made their recommendation regarding pelvic floor muscle training (PFMT) based on evidence from a systematic review from the same research group (Davenport et al 2018). The main results of this review are in line with the latest Cochrane review (Woodley et al 2017) on the same topic; while there are some methodological differences and variations in which studies were included or not (two of the largest studies on PFMT was left out from the Davenport review; Mørkved et al 2003 and Stafne et al 2012), the findings in terms of size and precision of effect are similar, although Davenport et al used odds ratio and Woodley et al used risk ratio for their summary statistic. Davenport et al reported that PFMT gave a 50% reduction in prenatal UI and a 35% reduction in postnatal UI, but the guideline team concluded a “weak recommendation” for PFMT because UI was not rated as a "critical outcome" and the evidence was of "low quality". We find this conclusion at odds with the evidence and the interpretation of the evidence based on the guideline team’s own criteria.
    The Canadian guideline grades...

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  • Evidence based physiotherapy needs evidence based statements from researchers

    The editorial article by Zadro, O’Keefe and Maher1 entitled ‘Evidence based physiotherapy needs evidence based marketing’, highlighted both the importance of conveying clear, consistent messages and having robust data to support any statements that appear in the public domain. To use the words of the authors, statements or claims by physiotherapists or physiotherapy organisations should be grounded in ‘rock solid research data’. Their article however, appears to fall foul of the very thing they are railing against. The mid-section of the paper, which discusses the marketing of the timing and type of PT treatment, contains a misleading statement which lacks the solid evidence that the authors call for.

    The authors state “Early access to harmful or ineffective physical therapy treatments (e.g. kinesiotape and electrotherapy), irrespective of timing, is unlikely to improve patient outcomes” The claim that some physiotherapy treatments e.g. Kinesiotape and electrotherapy are ‘harmful’ to patients is unsupported by the robust data that the authors mandate. ‘Electrotherapy’ for instance is a broad umbrella definition for a range of treatments ranging from neuromuscular electrical stimulation and extracorporeal shock wave therapy, (both of which, have recent systematic reviews to support their efficacy 2, 3 ), through to therapeutic ultrasound which has little or no evidence to support its efficacy. Crucially though, none of these examples have any robust RCT data to sugg...

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  • Response to the Need for Evidence-Based Marketing

    The editorial by Zadro and Colleagues' calls for caution in marketing physical therapy services, and focuses on a lack of high-quality evidence to support all current claims made for PT First. Of this, we 100% agree. The purpose of our response is to highlight considerations we feel may be beyond the research-based concentration outlined in the authors’ editorial.

    First and foremost, effective marketing strategies are influenced by many factors and vary depending on targeted end users, policy makers, and payers. These factors account for variations in the delivery of medical care, payment models, and the role of enforcing organizations. In Australia, it has been reported that a majority of patients receive appropriate evidence-based care for challenging and costly conditions such as low back pain.[1] In countries such as the United States, which boasts high rates of unnecessary imaging,[2] and high percentages of opioid prescriptions as initial treatment choices for nonspecific low back pain (>50% of patients), care is less guideline based[3], and heavily influenced by direct-to-consumer marketing strategies. The United States is immersed in a situation in which many high-risk, low-value treatments are easier to obtain, with insurance policies that comprehensively cover low-value care earlier (opioid prescriptions and steroid injections[4]); whereas low-risk, high-value interventions, such as those available from physical therapy, often require more out-of-p...

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