Quality Assessment Tool and Data Extraction

Methodological quality of individual RCTs was assessed using the Physiotherapy Evidence Database (PEDro) tool (http://www.pedro.fhs.usyd.edu.au/scale_item.html). PEDro was originally developed for the purpose of accessing bibliographic details and abstracts of randomized-controlled trials (RCT), quasi-randomized studies and systematic reviews in physiotherapy. PEDro has been used to assess both pharmacological and non-pharmacological studies with good agreement between raters at an individual item level and in total PEDro scores (Foley et al. 2006).  Maher et al. (2003) found the reliability of PEDro scale item ratings varied from “fair” to “substantial,” while the reliability of the total PEDro score was “fair” to “good.

The PEDro is an 11-item scale, in which the first item relates to external validity and the other ten items assess the internal validity of a clinical trial. One point was given for each satisfied criterion (except for the first item, which was given a YES or NO), yielding a maximum score of ten. The higher the score, the better the quality of the study and the following cut-points were used: 9-10 (excellent); 6-8 (good); 4-5 (fair); <4 (poor).  A point for a particular criterion was awarded only if the article explicitly reported that the criterion was met.  The scoring system is detailed in Appendix 2. Two independent raters reviewed each article. Scoring discrepancies were resolved through discussion.

AMSTAR (A MeaSurement Tool to Assess systematic Reviews) is an instrument used in assessing the methodological quality of systematic reviews of RCTs. Two agreements are required during quality assessment ensuring lower risk of bias. The AMSTAR tool is attached in the Appendices of this section.

Data were extracted to form tables.  Sample subject characteristics (Population), nature of the treatment (Intervention), measurements (Outcome Measures) and key results are presented in the tables.  In cases, where a single study overlapped into multiple chapters (e.g., treadmill training has effects on the cardiorespiratory, lower extremity and bone health), the results focus on the outcomes relevant to that chapter.