Critically Appraised Topics

1. In adults with shoulder joint impingement is the intervention of stabilization exercises and/or postural correction versus any treatment or no intervention effective in reducing pain and increasing function?
2. Is one-off management versus a course of treatment more effective in terms of reducing pain and function for patients over 50 years old with osteoarthritis of the knee joint?
3. Do physiotherapy telephone consultations for adult patients with musculoskeletal conditions affect patient satisfaction, condition-specific outcomes and healthcare utilisation?
4. Is manual physical therapy more effective than other physical therapy approaches in reducing pain and disability in adults with post-whiplash injury?
5. Is hand therapy more effective than usual care in maintaining function and improving coping in adults with hand arthiritis?
6. In adults with glenohumeral joint adhesive capsulitis are mobilisation techniques in combination with exercise more effective in reducing pain and improving function compared to exercise alone?
7. Does standing a patient on the day of surgery following a primary unilateral total hip or knee replacement reduce the length of hospital stay?
8. Are physiotherapy-led stabilisation exercises effective in reducing pain and disability in adults with chronic neck pain?
9. In adults with adhesive capsulitis (frozen shoulder) does the use of distension injections improve pain, function and range of movement when compared to usual care?
10. In adults with Carpal Tunnel Syndrome who have had an injection, is immediate post-injection immobilisation splinting more effective than no splinting for symptoms of pins and needles, pain and function?
11. Is splinting more clinically effective and cost-effective in decreasing pain and improving function in adults with DeQuervains syndrome than usual care?
12. What proportion of patients undergoing Total Knee Replacement (TKR) have a poor outcome?
13. What factors determine poor functional outcome following Total Knee Replacement (TKR)?
14. Does exercise or splinting in the treatment of trigger finger reduce pain, improve range of movement, grip strength, function and return to work when compared with usual care?
15. In adults with chronic trochanteric bursitis is physiotherapy more effective in reducing pain than usual care?
16. In adults with Lateral Elbow Tendinopathy (Tennis Elbow) does the treatment of Low Level Laser Therapy improve pain and function when compared to usual physiotherapy care?
17. In patients presenting with acute or chronic tendinopathies, what is the incidence of harm for those receiving steroid injections compared to those receiving usual care?
18. In an adult population is a corticosteroid injection a safe and effective treatment for tennis elbow compared to usual care?
19. In adults with degenerative meniscal tears in the knee, is physiotherapy as a clinical and cost effective as surgery?
20. In adults with hand pain and stiffness, is wax therapy and exercise more effective in reducing pain and improving function than wax therapy alone? 
21. Is exercise therapy effective in reducing pain and restoring normal function in adults with chronic plantar fasciitis/heel pain? 
22. In adults with Coccydynia is physiotherapy more effective in reducing pain than usual care?
23. In adults with neural leg pain, is a caudal epidural as effective as physiotherapy in reducing pain return to work and function?
24. In adults and children with musculoskeletal pain is Hydrotherapy/Aquatic Therapy as clinically & cost effective as land based Physiotherapy in terms of pain & function?
25. In adults with chronic lateral epicondylitis (tennis elbow) are eccentric exercises more effective in reducing pain and improving function than concentric exercises?
26. Is a suprascapular nerve block an effective method of reducing pain and disability in adults with shoulder pain?
27. In adult patients immediately post primary total knee replacement (TKR) for osteoarthritis (OA), is group therapy more clinically effective than an individual programme for pain and function?
28. Does acupuncture improve pain, function and quality of life for adults with fibromyalgia?
29. In patients with arthroscopic cuff repair, does early mobilisation improve pain and functional outcomes?
30. In adults who have undergone a total hip replacement (THR) is there a difference in dislocation rates between those who have been advised about following hip replacement precautions versus those who have not?
31. Is a clinically guided steroid injection as effective in terms of pain relief and improved function as an ultrasound-guided injection for patients with first CMC joint osteoarthritis (OA)?
32. Does acupuncture improve pain, function and quality of life for adults with fibromyalgia?
33. Would repeat steroid injections be more beneficial than physiotherapy-targeted exercise for 'trochanteric bursitis/trochanteric pain syndrome' (TPS) in older females giving pain relief for over six months duration?
34. In adults with shoulder subacromial pain/subacromial impingement syndrome is shoulder decompression surgery more clinically and cost-effective than physiotherapy in reducing pain and improving function.
35. In patients with Benign Joint Hypermobility Syndrome (BJHS) is targeted physiotherapy more effective than generalised Physiotherapy.
36. Does the use of an Isokinetic Strengthening Programme improve outcomes in adults following unilateral ACL Reconstruction versus usual rehabilitation?
37. In adults with De Quervain tenosynovitis, are exercises more effective in reducing pain and improving function than usual care?
38. In an adult population post wrist fracture, is an exercise rehabilitation programme more effective than self-management or no intervention in reducing pain and restoring function? 
39. In adults with trigger thumb/finger does splinting improve outcomes for pain and function compared to usual care? 
40. In adults with chronic DeQuervains tenosynovitis does exercise reduce pain and improve function more than usual care? 
41. In patients with non-operatively (conservatively) managed tendo-achilles (TA) ruptures, is accelerated rehabilitation superior to routine rehabilitation for reducing pain and return to function time, without increasing adverse events of tendon lengthening and re-rupture rates? 
42. In adults with chronic coccydynia, is the intervention of corticosteroid injection with or without internal coccyx manipulation more effective in reducing coccyx pain than usual care?
43. Are image-guided injections more clinically effective than palpation-guided injections for acromioclavicular joint (ACJ) pain?  
44. In adults and children with musculoskeletal pain and inflammatory arthritis, does hydrotherapy, compared with usual care/dry land physiotherapy, reduce pain and function, improve well-being and return to work/school and is it cost effective? 
45. In the adult population, does the spurlings sign/test have good sensitivity and specificity in detecting Cervical radiculopathy? 
46. In patients over the age of 40 with plantarfasciopathy, is wearing a night splint for 3 months effective in reducing pain when compared to exercise therapy? 
47. In adults with adhesive capsulitis (frozen shoulder) does the use of distension injections improve pain, function and range of movement when compared to lower-volume, steroid injections? 
48. In adults with chronic shoulder pain is a nerve ablation procedure (for the suprascapular nerve) as effective in reducing pain, in the long term compared with usual care? 
49. Does the addition of a knee brace, restricting range of movement, provide improved outcomes compared to rehabilitation alone in meniscal repairs? 
50. In adults with inflammatory arthritis and persistent knee synovitis, does yttrium synovectomy improve pain and function? 
51. In adults with ankle osteoarthritis is exercise/physiotherapy/rehabilitation/conservative treatment more effective than surgical options?
52. In patients presenting acute tendinopathies, what is the incidence of harm for those receiving steroid injections compared to those receiving usual care? 
53. In adults with chronic anterior knee pain are Vastus Medialis Oblique (VMO) strengthening exercises alone more effective in reducing pain and improving function than general lower limb strengthening exercises?
54. In elderly patients with ankle fractures who are unable to safely mobilise non-weight bearing using appropriate walking aids; does allowing partial weight bearing of the affected leg reduce the length of time spent in hospital, reduce complications of bed-rest, prevent referral to temporary community care and reduce mobility compared to non-ambulatory care. 
55. Do patients with long-term musculoskeletal or rheumatology conditions that attend regular hydrotherapy sessions utilise NHS services less (e.g. clinical review with GP/Consultants/Allied Health Professionals) compared to those who do not attend regular hydrotherapy? 
56. What is the clinical effectiveness of extracorporeal shock-wave therapy (SWT) in managing chronic tennis elbow? 
57. In adults with ankle osteoarthritis (OA), is total ankle replacement/fusion/debridement better than no treatment for pain and function, risks and harms and adverse events? 
58. Is resistance exercise beneficial to improve function, mobility, and quality of life, in patients with fibromyalgia? 
59. Is graded exercise beneficial in improving function, mobility, and quality of life, in patients with chronic musculoskeletal pain? 
60. In patients with Benign Joint Hypermobility Syndrome (BJHS) is targeted physiotherapy more effective than generalised physiotherapy?
61. In adults with chronic low back pain, are core stability exercises more effective in improving function and decreasing pain compared to a general exercise programme?
62. What do patients think about being assessed by a physiotherapist instead of a general practitioner for their musculoskeletal problems in primary care? 
63. In adults with lateral hip pain post Total Hip Replacement (THR) (anterior lateral approach), is physiotherapy more effective in reducing pain and improving function than corticosteroid injection? 
64. In adults with ankle OA, is hyaluronic acid injection better than no treatment or conservative treatment, for pain, function, and patient satisfaction? 
65. Does standing a patient on the day of surgery following a primary unilateral total hip or knee replacement reduce the length of hospital stay? 
66. Do physiotherapy telephone consultations for adult patients with musculoskeletal conditions affect patient satisfaction, condition specific outcomes and health utilisation?
67.  Does relative motion regime (including the use of a Yoke splint) provide improved outcomes (finger ROM, strength, with fewer complications of tenolysis and reduced ruptured rates) compared to usual care in the rehabilitation of finger extensor tendon repairs in zones 4 to 7? (Usual care includes static and dynamic splints with exercise regimes). 
68. What is the clinical effectiveness of extracorporeal Shock Wave Therapy or barbotage in the management of rotator cuff calcific tendinopathy? 
69. In adults with mild to moderate carpal tunnel syndrome (CTS) are physiotherapy led exercises better than no treatment in improving pain and function?
70. In adults with Subacromial Impingement Syndrome (SIS) is physiotherapy supervised exercise (ex) more clinically effective than a patient information session or leaflet only?
71. Are 24 hour use splints more effective than night splints in the improvement of symptoms in mild to moderate carpal tunnel syndrome?
72. In adults with ankle osteoarthritis (OA) is conservative management (excluding injections)/rehabilitation/exercise better than no treatment for pain/swelling/quality of life/function/delaying or preventing surgery?
73. Does exercise or splinting in the treatment of trigger finger reduce pain, improve range of movement, grip strength, function and return to work when compared with usual care? 
74. In adults with neural leg pain (sciatica), is a cauda epidural as effective as physiotherapy in reducing pain, return to work and restoring function? 
75. In adults with subacromial shoulder pain do psychological factors influence the outcome? 
76. In adult patients with a diagnosis of osteoarthritis of the knee, does running cause harm in comparison with standard strengthening exercises?
77. In an adult population are eccentric exercises effective in reducing pain and improving function in ‌Achilles tendinopathy?
78. What is the clinical effectiveness of extracorporeal Shock Wave Therapy or barbotage in the management of rotator cuff calcific tendinopathy?
79. Is this resistance exercise beneficial to improve function, mobility, quality of life in adult patients with fibromyalgia? 
80. Is graded exercise beneficial in improving function, mobility and quality of life in adult patients with chronic musculoskeletal pain? 
81. In patients with a chronic/degenerate rotator cuff tear of the shoulder, is surgical repair as effective as physiotherapy in improving function and reducing pain?
82. In adults with greater trochanteric pain syndrome (GTPS) is an injection of local anaesthetic and corticosteroid equally clinically and cost-effective at reducing pain and improving function than a physiotherapy led exercise regime?
83. For adults with musculoskeletal neck pain, is shoulder/neck acupuncture plus exercises the same as exercises alone for reducing pain in the short term?
84. In adults with adhesive capsulitis (frozen shoulder) does the use of high volume injection of local anaesthetic, saline and corticosteroid improve pain, function and range of movement when compared to low volume injection of local anaesthetic and corticosteroid?
85. In an adult population with trigger finger or thumb, is a clinically guided steroid injection as effective as surgical release in resolving symptoms of triggering?
86. In adults with femoroacetabular impingement (FAI), is there any clinical or cost-effective differences between physiotherapy and surgery?
87. In patients with Dupuytrens disease is there any conservative management; injection/stretches/splinting beneficial compared to no treatment at all in improving pain/ROM/function outcomes prior to any surgical intervention?
88. In patients with musculoskeletal (MSK) disease, is a physiotherapy virtual treatment as clinically effective and as acceptable to clinicians and patients compared to face to face physiotherapy treatment/rehabilitation?
89. In patients with musculoskeletal (MSK) disease, is a physiotherapy virtual consultation (VC) as clinically effective and as acceptable to clinicians and patients when compared to a face to face physiotherapy consultation?
90. Are text messages more cost-effective than telephone reminders in improving outpatient consultation attendance rates?
91. In adults with plantar heel pain, are clinically guided steroid injections more effective than physiotherapy/usual care in reducing pain and improving function?
92. In adult patients with non-specific low back pain without radicular signs, does the use of neurological tests compared to no neurological tests affect treatment choice and patient outcome?
93. In adults with plantar heel pain (plantar fasciitis), are gel insoles more effective than customised (functional) orthotics for reducing pain?
94. Is exercise therapy combined with foot orthoses more effective in treating tibialis posterior tendinopathy than exercise or foot orthoses alone?
95. Is bupivacaine more effective at reducing pain and improving function than lidocaine when treating patients with a suprascapular nerve block (SSNB) injection?
96. In adults with Patella tendinopathy, is exercise plus load management education programme more effective than usual care in reducing pain and improving function? Also, see 'Implementing change following CAT group conclusions: process of events'.You can download and use the leaflet by clicking here.
97. In adults with plantar fasciitis, is an exercise and load management education programme more effective than usual care in reducing pain and improving function? You can download and use the leaflet by clicking here: Tendinopathy patient leaflet
98. In adults with rotator cuff tendinopathy ,  is an exercise and load management education programme more effective than usual care in reducing pain and improving function? You can download and use the leaflet by clicking here.
99. In adults with lateral ankle sprain is an orthosis plus strengthening exercises compared to strengthening exercises alone more effective in managing pain?
100. In adults with tennis elbow (lateral elbow pain), is an exercise and load management education programme more effective than usual care in reducing pain and improving function? You can download and use the leaflet by clicking here: Tendinopathy patient leaflet
101. In adults with achilles tendinopathy, is an exercise and load management education programme more effective than usual care in reducing pain and improving function? You can download and use the leaflet by clicking here.
102. Does the addition of a hip brace (limiting flexion and adduction of the hip) when used post relocation for primary hip dislocations, prevent recurrent dislocation when compared to usual care (hip precautions and advice) or no intervention in adults who have a hip prosthesis? 
103. In an adult population presenting with musculoskeletal pain in primary care, does the provision of Musculoskeletal First Contact Practitioners (FCP) increase patient satisfaction and improve outcomes (pain and function) when compared to usual care?
104. In adults with chronic shoulder pain, do exercises prescribed by a physiotherapist, help reduce pain compared to those who do not receive exercise?
105. In adults with dementia, is the use of colour contrasted toilet facilities more effective than a uniform colour in maintaining safety, dignity and independence?
106. In patients with Osteoarthritis (OA) of the knee does the use of more than two corticosteroid injections in 2 years affect pain and function compared to usual care; and does this accelerate the osteoarthritis within the knee?
107. In adults with anterior knee pain is the addition of foot orthoses to knee exercises more effective compared to no foot orthoses?
108. In adults with longstanding tennis elbow (Lateral Elbow Tendinopathy LET), are passive treatments as effective as exercises at reducing pain and increasing function?
109. In adults in hospital following primary knee replacement are functional exercises more effective in improving mobility, range of knee motion and length of stay compared to bed exercises?
110. Are there any contraindications to rehabilitation post-stroke in pregnancy?
111. In adults with subacromial pain, do corticosteroid injections (CSI) provide long term benefits to pain, function or cost effectiveness, at 12 months and beyond, versus usual care?
112. In adults with chronic pain, is the MSK-HQ a valid and reliable tool to detect changes in patient function?
113. In adults with Diffuse Idiopathic Skeletal Hyperostosis (DISH) is exercises more effective in improving outcomes compared to usual care?
114. In adults with MSK pain, is a programme of manual handling and psychosocial support more effective at reducing employee’s sickness absence?
115. In patients with mallet finger deformity following acute finger extension injury or avulsion fracture does a bespoke mallet splint improve outcomes and appearance and reduce complication compared to off the self-splints?
116. Should all people following a transient ischaemic attack (TIA) [mini-stroke] be assessed by a Stroke Specialist Therapist?
117. What is the clinical effectiveness of intra-articular platelet rich plasma (PRP) injections in the management of knee osteoarthritis (KOA)
118. In adults with chronic pain, is the MSK-HQ a valid and reliable tool to detect changes in patient function?
119. In adults with Hypermobility is a multidisciplinary group pain management approach as effective as usual physio in improving function, quality of life, self-efficacy and is it cost effective.
120. In adults with plantar heel pain (more commonly known as plantar fasciitis (PF)), does extra corporeal shockwave therapy (ESWT) improve pain and function compared to corticosteroid injection (CSI) therapy?
121. In an adult population with musculoskeletal pain, does adding a vitamin D supplement to usual care reduce pain and improve function and activity levels?
122. In patients with calcific tendinitis of the shoulder , is the addition of barbotage to a corticosteroid injection (CSI) as effective in terms of pain and function compared to CSI alone?
123. Is there a clinically significant difference in outcome when performing hydrodilatation to treat adhesive capsulitis (frozen shoulder) in adults when there is a degenerative rotator cuff tear present compared to when there is no tear present?
124. Within an NHS organisation does the provision of an internal transfer scheme for nurses support nursing workforce retention?
125. In menopausal women with tendinopathy does the addition of HRT to usual physiotherapy care improve outcomes?
126. In adults with low back pain and leg length discrepancy (LLD), does the use of a correctional foot orthosis compared to no correctional foot orthosis improve pain?

Our group regularly updates our critically appraised topics. However there are occasions where the topic is no longer of clinical interest to the group. We have archived the CAT topic here so you can still see the evidence, which was current up to the search date:

1. In the adult population undergoing surgical arthroscopic treatment for knee articular chondral defect, is the use of CPM (continuous passive motion) effective in reducing pain and  improving function‌?
2. Does the addition of an isokinetic speed programme improve outcomes in patients receiving a unilateral primary Achilles tendon repair‌?
3. Are interscalene nerve blocks an effective means of delivering pain relief to patients following shoulder surgery‌?
4. Is electrotherapy more effective than other physical therapy approaches in reducing pain and disability in adults with supraspinatus tendonitis? Is one modality of electrotherapy more effective than another‌?
5. Is Trancutaneous Nerve Stimulation effective in Relieving pain in Acute Soft Tissue Injuries in Adults‌?
6. In adult humans with plantar fasciitis does a sustained stretch of the calf muscles or triceps surae have an beneficial effect on pain, range of movement and return to normal daily activity‌?
7. What is the outcome for patients with fibromyalgia receiving cognitive-behavioural therapy‌?
8. Is acupuncture an effective method of reducing pain in outpatient physiotherapy attendees with acute soft tissue injuries or fractures, compared to usual physiotherapy‌?
9. What are the relative benefits of different models of access to Health Care Practitioners for musculoskeletal patients in Primary Care‌?
10. Where (AHP’s: Physiotherapists, Occupational therapists and Podiatrists) work in a Trauma and Orthopaedic (T&O) setting, investigations are requested as part of patient management. How do AHP’s compare with Nursing staff and doctors in their referral rate for x-rays and positive findings (e.g. fractures or pathologies found)?
11. In adults on bed rest with a foot drop due to traumatic spinal cord injury does a timed application of a Passive Ankle - Foot Orthosis (PAFO) prevent adaptive shortening of gastrocnemius in comparison to daily passive stretching undertaken by a healthcare professional?
12. In the adult population, is eccentric or concentric exercise more effective for the return of function in Subacute or chronic Achilles tendonopathies?
13. Examine the effectiveness of rehabilitation programmes in primary flexor tendon repairs following surgical reconstruction at 12 weeks and 12 months in terms of pain, disability, function and return to work.
14. Does the use of massage in the treatment of traumatic hand injury improve range of movement, grip strength, function, swelling and return to work when compared with usual care?
15. Does appointment duration for musculoskeletal outpatient physiotherapy or occupational therapy in primary or secondary care settings, have an effect on managerial, clinical or patient outcomes?
16. Should urinalysis be routinely performed prior to intra-articular corticosteroid injection in order to avoid potential exacerbation of an underlying urinary tract infection
17. In adult humans with peripheral musculoskeletal injury (who have not had previous repair) is the length of time of sustained active or passive stretching more effective than other aspects of stretching for increasing return to work function and activity?
18. Is day or night time splinting more effective than usual care in improving pain, function and reducing sensory disturbance in adults with Carpal Tunnel symptoms? 
19. In adults on bed rest with a foot drop due to traumatic spinal cord injury does a timed application of a Passive Ankle - Foot Orthosis (PAFO) prevent adaptive shortening of gastrocnemius in comparison to daily passive stretching undetaken by healthcare professional? 
20. In an adult population undergoing primary total knee replacement (TKR) does the addition of Transcutaneous Electrical Nerve Stimulation (TENS) to usual care improve pain management & as a result improve ange of movement (ROM) within 3 months post-operatively? 
21. Is an exercise regime in addition to routine mobilization/gait re-education of improved benefit to function/QOL in post-operative adult THRs? 
22. Following Anterior Talo-Fibular Ligament (ATFL) reconstruction in adult humans, does the use of an air-cast splint post op have any beneficial effect on pain, range and activities of daily living (ADL)? 
23. Is use of physiotherapy assistants/technicians in the delivery of treatment for patients with musculoskeletal conditions as effective as treatment delivered by qualified physiotherapists only? 
24. Can threshold values for the Oxford hip and knee score determine the need for joint replacement surgery? 
25. In adults with chronic trochanteric bursitis is physiotherapy more effective in reducing pain than usual care?
26. Is multidisciplinary management of chronic low back pain more effective in terms of reducing pain, improving function and increasing return to work compared with unidisciplinary treatment?

1. In patients requiring wound cleansing or wound irrigation in general practice settings is sterile saline superior to tap water in reducing or preventing would infection and promoting healing?
2. In children under 7 years of age does the administration of Dexamethasone result in better outcomes for Croup than the administration of Prednisolone?
3. In adult males with prostate cancer, which is the most clinically and cost-effective drug; Prostap (Leuproelin) or Zoladex (Goserelin)? 
4. Is an aseptic technique (using sterile dressing packs (SDPs)) superior to a clean technique when performing wound care procedures in primary care? 
5. Are side effects reduced if practice nurses administer the intramuscular (IM) contraceptive injection via the ventrogluteal site compared to the dorsogluteal site? 
6. Is there evidence to show that participation in walking groups can benefit health outcomes? 
7. Do group consultations or shared medical appointments improve outcomes for patients with long-term conditions? 
8. Is there evidence to support the clinical effectiveness of Bio-oil for post-surgical wounds, scars or stretch marks etc?
9. In patients undergoing minor dermatological procedures, does the application of Savlon antiseptic cream post-operatively, as opposed to leaving the wound dry, increase the incidence of poor wound healing/delayed wound healing or infection (or poor outcomes in general)? 
10. For the management of Gout in UK Primary Care: is nurse-led management more effective than GP-led management? 
11. In patients that are vitamin B12 deficient is oral vitamin B12 supplementation as effective as intramuscular B12 injection?
12. In patients taking anti-hypertensive medication does taking the medication (at night) before bedtime as opposed to usual regime, reduce the risk of MI, stroke, postural hypotension and side-effects whilst maximising the therapeutic benefit?