On the reliability and validity of manual muscle testing: a literature review New diagnostic and therapeutic approach to thyroid-associated orbitopathy based on applied kinesiology and homeopathic therapy. Test-retest-reliability and validity of the Kinesiology muscle test. Interrater reliability in assessing quality of diagnostic accuracy studies using the QUADAS tool. A preliminary assessment. The therapeutic value of yoga in neurological disorders Gestational diabetes risk factors and long-term consequences for both mother and offspring: a literature review Systematic Reviews of Diagnostic Test Accuracy Assessing the evidence for the use of chiropractic manipulation in paediatric health conditions: A systematic review. Yoga and Mindfulness as Therapeutic Interventions for Stroke Rehabilitation: A Systematic Review The identification of bias in studies of the diagnostic performance of imaging modalities. How to Appraise the Effectiveness of Treatment Reducing patient delay with symptoms of acute coronary syndrome: a research protocol for a systematic review of previous interventions to investigate which behaviour change techniques are associated with effective interventions Editorial: an author's checklist for measure development and validation manuscripts. PROBAST: A Tool to Assess Risk of Bias and Applicability of Prediction Model Studies: Explanation and Elaboration Evidence-based decisions about herbal products for treating mental disorders. Identifying quality improvement intervention evaluations: is consensus achievable? Complementary therapies and integrative medicine in lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Mantram repetition for stress management in veterans and employees: a critical incident study. Applied kinesiology unreliable for assessing nutrient status. A blinded investigation into the accuracy of reflexology charts. Appraising the quality of randomized controlled trials: inter-rater reliability for the OTseeker evidence database. Kinesiology Taping reduces lymphedema of the upper extremity in women after breast cancer treatment: a pilot study The effectiveness of group medical visits on diabetes mellitus type 2 (dm2) specific outcomes in adults: a systematic review
INTRODUCTION A body of basic science and clinical research has been generated on the manual muscle test ( MMT ) since its first peer- review ed publication in 1915 . The aim of this report is to provide an historical overview , literature review , description , synthesis and critique of the reliability and validity of MMT in the evaluation of the musculoskeletal and nervous systems . METHODS Online re sources were search ed including Pubmed and CINAHL ( each from inception to June 2006 ) . The search terms manual muscle testing or manual muscle test were used . Relevant peer- review ed studies , commentaries , and review s were selected . The two review ers assessed data quality independently , with selection st and ards based on predefined method ologic criteria . Studies of MMT were categorized by research content type : inter- and intraexaminer reliability studies , and construct , content , concurrent and predictive validity studies . Each study was review ed in terms of its quality and contribution to knowledge regarding MMT , and its findings presented . RESULTS More than 100 studies related to MMT and the applied kinesiology chiropractic technique ( AK ) that employs  MMT  in its methodology were review ed , including studies on the clinical efficacy of MMT  in the diagnosis of patients with symptomatology . With regard to analysis there is evidence for good reliability and validity in the use of MMT for patients with neuromusculoskeletal dysfunction . The observational cohort studies demonstrated good external and internal validity , and the 12 r and omized controlled trials ( RCTs ) that were review ed show that MMT findings were not dependent upon examiner bias . CONCLUSION The MMT employed by chiropractors , physical therapists , and neurologists was shown to be a clinical ly useful tool , but its ultimate scientific validation and application requires testing that employs sophisticated research models in the areas of neurophysiology , biomechanics , RCTs , and statistical analysis OBJECTIVES To investigate pathogenetic mechanisms related to the lacrimal and lymphatic gl and s in patients with thyroid-associated orbitopathy ( TAO ) , and the potential of applied kinesiology diagnosis and homeopathic therapeutic measures . DESIGN Prospect i ve . SETTING S/LOCATION Thyroid outpatient unit and a specialized center for complementary medicine ( WOMED , Innsbruck ; R.M. and H.M. ) . SUBJECTS Thirty-two ( 32 ) patients with TAO , 23 with a long-st and ing disease , and 9 showing discrete initial changes . All patients were euthyroid at the time of the investigation . INTERVENTIONS Clinical investigation was done , using applied kinesiology methods . Departing from normal reacting muscles , both target organs as well as therapeutic measures were tested . Affected organs will produce a therapy localization ( TL ) that turns a normal muscle tone weak . Using the same approach , specific counteracting therapies ( i.e. , tonsillitis nosode and lymph mobilizing agents ) were tested . OUTCOME MEASURES Change of lid swelling , of ocular movement discomfort , ocular lock , tonsil reactivity and Traditional Chinese Medicine criteria including tenderness of San Yin Jiao ( SP6 ) and tongue diagnosis were recorded in a grade d fashion . RESULTS Positive TL reactions were found in the subm and ibular tonsillar structures , the pharyngeal tonsils , the San Yin Jiao point , the lacrimal gl and , and with the functional ocular lock test . Both Lymphdiaral ( Pascoe , Giessen , Germany ) and the homeopathic preparation chronic tonsillitis nosode at a C3 potency ( Spagyra , Grödig , Austria ) counteracted these changes . Both agents were used therapeutically over 3 - 6 months , after which all relevant parameters showed improvement . CONCLUSIONS Our study demonstrates the involvement of lymphatic structures and flow in the pathogenesis of TAO . The tenderness of the San Yin Jiao point correlates to the above mentioned changes and should be included in the clinical evaluation of these patients OBJECTIVES To assess the test-retest-reliability and validity of the Health Kinesiology muscle test . PATIENTS Seven patients with clinical ly and allergologically confirmed wasp venom allergy . DESIGN Four Health Kinesiology-examiners tested each patient in a r and om order for 10 verum and 10 placebo bottles . All examiners used the anterior deltoid as indicator muscle . Patients and examiners were completely blinded . OUTCOME MEASURES Weak muscle holds were rated as ' sensitivity ' towards the test substance , stable holding as normal ( not sensitive ) . RESULTS An overall kappa of 0.03 ( 95%-CI : -0.02 - 0.07 ) indicates the test is not reliable . Individual kappas do not substantially vary from examiner to examiner . Sensitivity and specificity were estimated at 40 % and 60 % . CONCLUSIONS The results suggest that the use of Health Kinesiology as a diagnostic tool is not more useful than r and om guessing . This should at least be true in patients with insect venom allergy that are tested by examiners with average skills RATIONALE AND OBJECTIVES Quality Assessment of Diagnostic Accuracy Studies ( QUADAS ) is a new tool to measure the method ological quality of diagnostic accuracy studies in systematic review s. We used data from a systematic review of magnetic resonance spectroscopy ( MRS ) in the characterization of suspected brain tumors to provide a preliminary evaluation of the inter-rater reliability of QUADAS . MATERIAL S AND METHODS A structured literature search identified 19 diagnostic accuracy studies . These publications were distributed r and omly to primary and secondary review ers for dual independent assessment . Review ers recorded method ological quality by using QUADAS on a custom- design ed spreadsheet . We calculated correlation , percentage of agreement , and kappa statistic to assess inter-rater reliability . RESULTS Most studies in our review were judged to have used an accurate reference st and ard . Conversely , the MRS literature frequently failed to specify the length of time between index and reference tests or that the clinicians were unaware of the index test findings when reporting the reference st and ard . There was good correlation ( rho = 0.78 ) between review ers in assessment of the overall number of quality criteria met . However , mean agreement for individual QUADAS questions was only fair ( kappa = 0.22 ) and ranged from no agreement beyond chance ( kappa < 0 ) to moderate agreement ( kappa = 0.58 ) . CONCLUSION Inter-rater reliability in our study was relatively low . Nevertheless , we believe that QUADAS potentially is a useful tool for highlighting the strengths and weaknesses of existing diagnostic accuracy studies . Low reliability suggests that different review ers will reach different conclusions if QUADAS is used to exclude " low- quality " articles from meta-analyses . We discuss methods for improving the validity and reliability of QUADAS Background : The ancient mind and body healing methods of yoga recently sparked fervor in the scientific community as an alternative and complementary means of therapy . Since the World Health Organization officially began promoting yoga in developing countries in 1978 , yoga has been cited for its therapeutic potential and has been widely recognized in Western culture . However , as an increasing number of people practice yoga for remedial purpose s , research ers raise two important questions : 1 ) Is yoga a valid complementary management and rehabilitation treatment modality ? 2 ) What conditions show promise of treatment with this intervention ? . Objective : This review article uses comprehensive scientific , evidence -based studies to analyze the efficacy of various basic and applied aspects of yoga in disease prevention and health promotion . It specifically intends to expose the effects of yoga in neurological disorders , particularly epilepsy , stroke , multiple sclerosis , Alzheimer 's disease , peripheral nervous system disease , and fibromyalgia . Material s and Methods : Information was gathered from various re sources including PubMed , Ovid , MD-Consult , USC , and U.C.L.A. libraries . Studies were selected and review ed on the basis of sample size , control , r and omization , double-blinding , and statistical analysis of results . Results : The pratice of yoga and meditation demonstrates statistically encouraging physiological and psychological improvements in the aforementioned neurological disorders . However , there were certain flaws and inadequacies in the study design s employed to evaluate the same . A critical analysis of these studies is presented . Conclusions : With the aim to focus attention on this widespread yet largely unexamined treatment modality , this paper seeks to provide direction and support for further research necessary to vali date yoga as an integrative , alternative , and complementary therapy ABSTRACT Introduction : Established risk factors for gestational diabetes mellitus ( GDM ) include ethnicity , obesity , and family history of diabetes . Untreated GDM patients have higher rates of maternal and perinatal morbidity . GDM is an independent risk factor for future longer-term risk of type 2 diabetes mellitus ( T2DM ) , metabolic syndrome , cardiovascular morbidity , malignancies , ophthalmic , psychiatric , and renal disease in the mother . Offspring risk long-term adverse health outcomes , including T2DM , subsequent obesity , impacted neurodevelopmental outcome , increased neuropsychiatric morbidity , and ophthalmic disease . Areas covered : We critically review data from retrospective , prospect i ve , and meta- analysis studies pertaining to established GDM risk factors , complications during pregnancy and birth ( both mother and offspring ) , and long-term consequences ( both mother and offspring ) . Expert commentary : Many of the adverse consequences of GDM might be avoided with proper management and treatment . Patients belonging to high-risk ethnic groups , and /or with body mass index ≥ 25 kg/m2 , and /or known history of diabetes in first-degree relatives may benefit from universal screening and diagnostic criteria proposed by the International Association of Diabetes and Pregnancy Study Group ( IADPSG ) . The IADPSG one-step method has several advantages , including simplicity of execution , greater patient-friendliness , and higher diagnostic accuracy . Additionally , evidence suggests that the recent increased popularity of bariatric surgery will help to decrease GDM rates over next 5 years . Similarly , metformin may be useful for treating and preventing obstetrical complications in confirmed GDM patients Diagnosis is a critical component of health care , and clinicians , policymakers , and patients routinely face a range of questions regarding diagnostic tests . They want to know whether testing improves outcome ; what test to use , purchase , or recommend in practice guidelines ; and how to interpret test results . Well- design ed  diagnostic test accuracy studies can help in making these decisions , provided that they transparently and fully report their participants , tests , methods , and results as facilitated , for example , by the STARD ( St and ards for Reporting of Diagnostic Accuracy ) statement ( 1 ) . That 25-item checklist was published in many journals and is now adopted by more than 200 scientific journals worldwide . As in other areas of science , systematic review s and meta- analysis of accuracy studies can be used to obtain more precise estimates when small studies addressing the same test and patients in the same setting are available . Review s can also be useful to establish whether and how scientific findings vary by particular subgroups , and may provide summary estimates with a stronger generalizability than estimates from a single study . Systematic review s may help identify the risk for bias that may be present in the original studies and can be used to address questions that were not directly considered in the primary studies , such as comparisons between tests . The Cochrane Collaboration is the largest international organization preparing , maintaining , and promoting systematic review s to help people make well-informed decisions about health care ( 2 ) . The Collaboration decided in 2003 to make preparations for including systematic review s of diagnostic test accuracy in their Cochrane Data base of Systematic Review s. To enable this , a working group ( Appendix ) . was formed to develop methodology , software , and a h and book The first diagnostic test accuracy review was published in the Cochrane Data base in October 2008 . In this paper , we review recent method ological developments concerning problem formulation , location of literature , quality assessment , and meta- analysis of diagnostic accuracy studies by using our experience from the work on the Cochrane H and book . The information presented here is based on the recent literature and up date s previously published guidelines by Irwig and colleagues ( 3 ) . Definition of the Objectives of the Review Diagnostic test accuracy refers to the ability of a test to distinguish between patients with disease ( or more generally , a specified target condition ) and those without . In a study of test accuracy , the results of the test under evaluation , the index test , are compared with those of the reference st and ard determined in the same patients . The reference st and ard is an agreed-on and accurate method for identifying patients who have the target condition . Test results are typically categorized as positive or negative for the target condition . By using such binary test outcomes , the accuracy is most often expressed as the test 's sensitivity ( the proportion of patients with positive results on the reference st and ard that are also positive on the index test ) and specificity ( the proportion of patients with negative results on the reference st and ard that are also negative on the index test ) . Other measures have been proposed and are in use ( 46 ) . It has long been recognized that test accuracy is not a fixed property of a test . It can vary between patient subgroups , with their spectrum of disease , with the clinical setting , or with the test interpreters and may depend on the results of previous testing . For this reason , inclusion of these elements in the study question is essential . In order to make a policy decision to promote use of a new index test , evidence is required that using the new test increases test accuracy over other testing options , including current practice , or that the new test has equivalent accuracy but offers other advantages ( 79 ) . As with the evaluation of interventions , systematic review s need to include comparative analyses between alternative testing strategies and should not focus solely on evaluating the performance of a test in isolation . In relation to the existing situation , 3 possible roles for a new test can be defined : replacement , triage , and add-on ( 7 ) . If a new test is to replace an existing test , then comparing the accuracy of both tests on the same population and with the same reference st and ard provides the most direct evidence . In triage , the new test is used before the existing test or testing pathway , and only patients with a particular result on the triage test continue the testing pathway . When a test is needed to rule out disease in patients who then need no further testing , a test that gives a minimal proportion of falsenegative results and thus a relatively high sensitivity should be used . Triage tests may be less accurate than existing ones , but they have other advantages , such as simplicity or low cost . A third possible role of a new test is add-on . The new test is then positioned after the existing testing pathway to identify false-positive or false-negative results after the existing pathway . The review should provide data to assess the incremental change in accuracy made by adding the new test . An example of a replacement question can be found in a systematic review of the diagnostic accuracy of urinary markers for primary bladder cancer ( 10 ) . Clinicians may use cytology to triage patients before they undergo invasive cystoscopy  , the reference st and ard for bladder cancer . Because cytology combines high specificity with low sensitivity ( 11 ) , the goal of the review was to identify a tumor marker with sufficient accuracy to either replace cytology or be used in addition to cytology . For a marker to replace cytology , it has to achieve equally high specificity with improved sensitivity . New markers that are sensitive but not specific may have roles as adjuncts to conventional testing . The review included studies in which the test under evaluation ( several different tumor markers and cytology ) was evaluated against cystoscopy or histopathology . Included studies compared 1 or more of the markers , cytology only , or a combination of markers and cytology . Although information on accuracy can help clinicians make decisions about tests , good diagnostic accuracy is a desirable but not sufficient condition for the effectiveness of a test ( 8) . To demonstrate that using a new test does more good than harm to patients tested , r and omized trials of test- and -treatment strategies and review s of such trials may be necessary . However , with the possible exception of screening , in most cases , such r and omized trials are not available and systematic review s of test accuracy may provide the most useful evidence available to guide clinical and health policy decision making and use as input for decision and cost-effectiveness analysis ( 12 ) . Identification and Selection of Studies Identifying test accuracy studies is more difficult than search ing for r and omized trials ( 13 ) . There is not a clear , unequivocal keyword or indexing term for an accuracy study in literature data bases comparable with the term r and omized , controlled trial . The Medical Subject Heading sensitivity and specificity may look suitable but is inconsistently applied in most electronic bibliographic data bases . Furthermore , data on diagnostic test accuracy may be hidden in studies that did not have test accuracy estimation as their primary objective . This complicates the efficient identification of diagnostic test accuracy studies in electronic data bases , such as MEDLINE . Until indexing systems properly code studies of test accuracy , search ing for them will remain challenging and may require additional manual search es , such as screening reference lists . In the development of a comprehensive search strategy , review authors can use search strings that refer to the test(s ) under evaluation , the target condition , and the patient description or a subset of these . For tests with a clear name that are used for a single purpose , search ing for publications in which those tests are mentioned may suffice . For other review s , adding the patient description may be necessary , although this is also often poorly indexed . A search strategy in MEDLINE should contain both Medical Subject Headings and free text words . A search strategy for articles about tests for bladder cancer , for example , should include as many synonyms for bladder cancer as possible in the search strategy , including neoplasm , carcinoma , transitional cell , and hematuria . Several method ological electronic search filters for diagnostic test accuracy studies have been developed , each attempting to restrict the search to articles that are most likely to be test accuracy studies ( 1316 ) . These filters rely on indexing terms for research methodology and text words used in reporting results , but they often miss relevant studies and are unlikely to decrease the number of articles one needs to screen . Therefore , they are not recommended for systematic review s ( 17 , 18 ) . The incremental value of search ing in language s other than English and in the gray literature has not yet been fully investigated . In systematic review s of intervention studies , publication bias is an important and well-studied form of bias in which the decision to report and publish studies is linked to their findings . For clinical trials , the magnitude and determinants of publication bias have been identified by tracing the publication history of cohorts of trials review ed by ethics committees and research boards ( 19 ) . A consistent observation has been that studies with significant results are more likely to be published than studies with nonsignificant findings ( 19 ) . Investigating publication bias for diagnostic tests is problematic , because many studies are done without ethical review or study registration ; therefore , identification of cohorts of studies from registration to final publication status OBJECTIVE To review the biomedical literature up to and including 2003 , and determine the extent of the evidence related to the therapeutic application of chiropractic manipulation for paediatric health conditions . No critical appraisal of the evidence is undertaken . DATA SOURCES The indexed manual therapy sector including medical , chiropractic , physiotherapy , naturopathic and osteopathic literature was search ed . This included PubMed ; the Manual , Alternative , and Natural Therapy Index System ; the Cumulative Index to Nursing and Allied Health Literature ; the Index to Chiropractic Literature ; the Paediatric Economic Data base Evaluation Project ; the Cochrane Library ; the Canadian Coordinating Office for Health Technology Assessment data base ; and the Agency for Healthcare Research and Quality data base . Other re sources included research conference and symposium proceedings , and the references of identified studies . RESULT The search identified 1731 articles , of which 166 met the eligibility criteria . Two review ers determined by consensus each citation 's appropriate level on the strength of evidence scale . There was one systematic review , nine r and omized controlled trials , one observational study , 141 descriptive case studies and 14 conference abstract s. SUMMARY Health cl aims made by practitioners regarding the application of chiropractic manipulation as a health care intervention for paediatric health conditions are , for the most part , supported by low levels of scientific evidence . Chiropractors , in particular , employ manipulation for the treatment of a wide variety of paediatric health conditions . The evidence rests primarily with clinical experience , descriptive case studies and a few r and omized controlled trials . There is a need for more rigorous scientific inquiry to examine the value of manipulative therapy in the treatment of paediatric conditions . To advance the health interests of paediatric patients , health care decisions made on the basis of expert opinion or clinical experience must integrate the best research evidence available from high- quality , scientific studies Aim . This paper reports a systematic review and critical appraisal of the evidence on the effectiveness of behavioral therapies such as yoga and mindfulness practice s for stroke rehabilitation . Background . The experience of stroke can have a negative impact on both psychological and physical health and on quality of life . Yoga and relevant practice s are promising therapies that have been used with patients with a variety of conditions . In order to draw conclusions on effectiveness for stroke patients , the evidence requires systematic assessment . Methods . A comprehensive search of major biomedical and complementary medicine data bases was conducted . Relevant research was categorized by study type and appraised according to study design . Results . Five r and omized controlled clinical trials and four single case studies were found . Additionally , one qualitative research study was identified . Studies reported positive results , including improvements in cognition , mood , and balance and reductions in stress . Modifications to different yoga practice s make comparison between studies difficult , and a lack of controlled studies precludes any firm conclusions on efficacy . Conclusion . Yoga and mindfulness could be clinical ly valuable self-administered intervention options for stroke rehabilitation . Further research is needed to evaluate these specific practice s and their suitability in stroke rehabilitation The dem and for evidence -based healthcare is increasing nationally and internationally and it is equally necessary in both diagnostic and therapeutic practice . Evidence may be collected and combined by means of a systematic literature review of published and unpublished data on a well-defined topic . The output of such review s is then available to guide health policy , influence good practice or direct research . Published guidelines are available on the performance of systematic review s , especially those of r and omized controlled trials . Although there is an extensive literature base of research data in diagnostic imaging there are few such trials , but it is still possible to perform systematic review s. With the alternative study design s encountered it is important to be aware of the main threats to study validity . In this paper the biases likely to be encountered in studies of diagnostic performance are review ed , with particular reference to diagnostic imaging tests . The biases are sub-divided into three categories . The first category is patient selection and covers the validity of generalizing results beyond the study population . The other two , concerning study design and execution and the interpretation of results , affect the likely validity of the results of a study . An underst and ing of these factors is an essential prerequisite for those undertaking or using a systematic literature review in the field of diagnostic imaging . The definitions form the foundations of a defensible review protocol Before implementing a new therapy , we should ascertain the benefits and risks of the therapy and assure ourselves that the re sources consumed during the intervention will not be exorbitant . In the hierarchy of research design s , the results of r and omized controlled trials , especially if systematic ally review ed , are considered the highest level of evidence . We suggest a three-step approach to using an article from the medical literature to guide your patient care . We recommend that readers ask whether the study can provide valid results , review the results , and consider how the results can be applied to patient care . Given the time constraints of busy surgical practice s and surgical training programs , applying this analysis to every relevant article will be challenging . However , the basis of this process is essentially what we all do many times each week when making decisions about whether and how to treat patients . Making this process explicit with guidelines to assess the strength of the available evidence can serve to improve patient care . It also allow us to defend therapeutic interventions based on available evidence and not anecdote Introduction Delay to presentation with symptoms of acute coronary syndrome ( ACS ) is common meaning many fail to achieve optimal benefit from treatments . Interventions have had variable success in reducing delay . Evidence suggests inclusion of behaviour change techniques ( BCTs ) may improve effectiveness of interventions but this has not yet been systematic ally evaluated . Data from other time-critical conditions may be relevant . Methods and analysis A systematic review will be undertaken to identify which BCTs are associated with effective interventions to reduce patient delay ( or prompt rapid help-seeking ) among people with time-critical conditions ( eg , chest pain , ACS , lumps , stroke , cancer and meningitis ) . A systematic search of a wide range of data bases ( including Cochrane Library , MEDLINE , EMBASE , CINAHL , PsycInfo ) and grey literature will be undertaken to identify all relevant intervention studies ( r and omised controlled trials , controlled clinical trials and cohort studies ) . Two independent review ers will screen abstract s to identify relevant studies , apply inclusion criteria to full papers , assess method ological quality and extract data . Primary outcome measure Change in patient decision time BCTs reported in each of the included studies will be categorised and presented according to the latest reliable taxonomy . Results of included studies will be synthesis ed , exploring relationships between inclusion of each BCT and effectiveness of the overall intervention . Where possible , means and SDs for differences in delay time will be calculated and combined within meta-analyses to derive a st and ardised mean difference and 95 % CI . Analysis of ( 1 ) all time-critical and ( 2 ) ACS-only interventions will be undertaken . Ethics and dissemination No ethical issues are anticipated . Results will be su bmi tted for publication in a relevant peer- review ed journal A recent special issue of the Journal of Pediatric Psychology included papers focused on evidence -based assessment across several broad domains of assessment in pediatric psychology ( e.g. , adherence , pediatric pain , and quality of life ) . In one of these papers , Holmbeck et al. ( 2008 ) review ed strengths and limitations of existing measures of psychosocial adjustment and psychopathology , concluding that many measures lacked supporting psychometric data ( e.g. , basic indices of reliability and validity ) that would permit a complete evaluation of these measures . Given that measure development and validation papers are frequently published in JPP ( Brown , 2007 ) , it is important that we attend to guiding psychometric principles when developing and disseminating data on new measures to be employed with pediatric population s ( Nunnally & Bernstein , 1994 ) . Thus , the purpose of this paper is to present and describe a checklist for authors to use when su bmi tting measure development papers to JPP . This checklist is included in the Appendix and is also included at the following link on the JPP website : http://www.oxfordjournals.org/our_journals/jpepsy/for _ authors /measure%20development%20checklist.pdf Findings presented by Holmbeck et al. ( 2008 ) indicated that 34 of the 37 measures review ed met pre-established “ evidence -based assessment ” ( EBA ) criteria for “ well-established ” measures ( Cohen et al. , 2008 ) . To be considered “ well-established , ” a measure had to have been presented in at least two peer- review ed journal articles by different investigatory teams , have demonstrated adequate levels of reliability and validity , and be accompanied by supporting information ( e.g. , a measure manual ) . Although most measures that we review ed met these criteria , we also found that most of the 34 “ well-established ” measures were hampered by at least one major psychometric flaw and /or lacked important psychometric data . We concluded that a more fine-grained EBA classification system is needed . One important distinction in this literature relates to differences between empirically supported assessment and evidence -based assessment . This type of distinction was first discussed in the literature on clinical interventions ( e.g. , Spring , 2007 ) . An empirically supported intervention is one that has demonstrated efficacy in r and omized clinical trials or clinic-based effectiveness trials . An evidence -based intervention has empirical support in the manner just described , but also “ integrates research evidence , clinical expertise , and patient preferences and characteristics … empirically-supported treatments  ( ESTs )  are an important component of evidence -based practice ( EBP ) , but EBP can not be reduced to ESTs ” ( Spring , 2007 , p.611 ) . Applying these terms to the field of assessment and measure development efforts , an empirically supported assessment measure would be one that demonstrates satisfactory psychometric characteristics , broadly defined . To be evidence based , the measure should also demonstrate utility in clinical setting s , be useful in making diagnoses , be sensitive to treatment effects , and /or provide incremental validity above and beyond other similar measures . Although papers in the special issue of JPP frequently referred to “ evidence -based assessment ” ( Cohen et al. , 2009 ) , the articles included in the issue tended to evaluate the degree to which the measures were empirically-supported rather than evidence based . To be “ evidence -based , ” our review s would have needed to integrate an evaluation of clinical utility , diagnostic utility , and treatment sensitivity with the empirical psychometric data presented in each review . As noted , the published review s were more likely to focus on the latter rather than on the former . As suggested by Mash and Hunsley ( 2005 ) , detailed EBA profiles would provide a complete evaluation of evidence across each of several psychometric and clinical ly relevant dimensions , including : ( a ) internal consistency , ( b ) test – retest reliability , ( c ) the availability of normative data , ( d ) content validity , ( e ) construct validity , ( f ) convergent and discriminant validity , ( g ) criterion-related validity , ( h ) incremental validity , ( i ) clinical utility , ( j ) diagnostic utility , and ( k ) treatment sensitivity . The focus on incremental validity and clinical and diagnostic utility raises the bar from a focus on “ empirical support ” ( i.e. , where the focus would tend to be primarily on psychometric data ) to a broad focus on the “ evidence base ” for a measure . In developing the checklist that is the focus of this article , we attempted to provide a list of criteria relevant to establishing the evidence base ( and not just empirical support ) for a measure . In addition to shifting the focus from providing “ empirical support ” for a measure to providing an “ evidence base ” for our instruments , a checklist for measure development papers would permit JPP review ers to evaluate such papers in the same way that review ers of r and omized clinical trials make use of the Consoli date d St and ards of Reporting Trials ( CONSORT ) checklist and flowchart ( Altman et al. , 2001 ) . The CONSORT checklist contains reporting st and ards with respect to method ological features of and the manner in which results are reported in clinical trials . Moreover , authors are required to provide a flowchart that describes details of sample recruitment and attrition during the course of the study . Thus , a checklist for measure development papers would serve two interrelated purpose s : ( a ) it would provide guidance to authors as they embark on the measure development process and would provide a list of criteria authors can use as they develop an evidence base for their measures , and ( b ) it would begin to st and ardize the manner in which psychometric and other assessment -related data are presented in measure development papers for this journal . Before providing a more detailed overview of the checklist , it is important to note that this checklist is rather exhaustive ( see Appendix ) . As such , it represents what would “ ideally ” be expected for a measure development or validation manuscript rather than minimal criteria for such papers . No one paper can provide a complete evaluation of all important psychometric and clinical ly relevant dimensions that will establish once- and -for-all the evidence base for a measure . Instrument refinement is part of a measure development process that gradually builds an evidence base for a scale ( see Smith & McCarthy , 1995 , for suggestions on measure refinement ) . Indeed , the validation of any measure is a cumulative process that occurs across many different types of research studies and across research programs Prediction models in health care aim to predict for an individual whether a particular outcome , such as disease , is present ( diagnostic models ) or whether it will occur in the future ( prognostic models ) ( 16 ) . Diagnostic models can be used to refer patients for further testing , to initiate treatment , or to inform patients . Prognostic models can be used to aid decisions about preventive lifestyle changes , therapeutic interventions , or monitoring strategies or to stratify risk in r and omized trial design and analysis ( 7 , 8) . Potential users of prediction models include health care professionals , policymakers , guideline developers , patients , and the general public . The medical literature contains thous and s of studies developing and validating prediction models and often has numerous prediction models for the same target population and outcomes . For example , more than 60 models address breast cancer prognosis ( 9 ) , more than 250 exist in obstetrics ( 10 ) , and nearly 800 predict outcomes in patients with cardiovascular disease ( 11 ) . This proliferation of prediction models will increase further with the growth of personalized or precision medicine . Systematic review s are considered the most reliable form of evidence when addressing r and omized therapeutic studies and studies of diagnostic test accuracy ( 12 ) . In the era of personalized and precision medicine , interest in systematic review s of prediction model studies is rapidly growing , as exemplified by the formation of the Cochrane Prognosis Methods Group to support systematic review s of prognosis , including prediction model studies ( 13 , 14 ) . Guidance to facilitate systematic review s of prediction models has been developed ( Table 1 ) , including for search strategies ( 15 , 4143 ) , formulation of the review question ( 16 , 17 ) , data extraction ( 16 ) , and meta- analysis ( 17 , 2225 , 40 , 44 , 45 ) . Table 1 . Guidance on Conducting Systematic Review s of Prediction Model Studies  Assessment of risk of bias ( ROB ) is an essential step in any systematic review . Shortcomings in study design , conduct , and analysis can result in study estimates being at ROBthat is , at risk of results being flawed or distorted . When interpreting results from a systematic review , readers can draw stronger conclusions from a review based on primary studies at low ROB than from one based on studies at high or unclear ROB ( 46 ) . Identifying the studies most relevant to the setting s and population s targeted in the review ( based on the applicability of primary studies to the review question ) is also important . We therefore developed PROBAST ( Prediction model Risk Of Bias ASsessment Tool ) to address the lack of suitable tools design ed specifically to assess ROB and applicability of primary prediction model studies . PROBAST consists of 4 domains containing 20 signaling questions to facilitate ROB assessment ( 39 ) . The structure and rating system are similar to those in tools design ed to assess ROB in r and omized trials ( revised Cochrane ROB Tool [ ROB 2.0 ] ) , diagnostic accuracy studies ( QUADAS-2 [ Quality Assessment of Diagnostic Accuracy Studies 2 ] ) , and systematic review s ( ROBIS ) ( 37 , 47 , 48 ) . Although PROBAST was design ed for use in systematic review s of prediction model studies , it can also be used as a general tool for critical appraisal of ( primary ) prediction model studies . Here , we describe the rationale behind the domains and signaling questions , how to use them , and how to reach domain-level and overall judgments about ROB and applicability of primary studies to a review question . At the Web site ( www.probast.org ) , 5 filled-in examples from across the medical field illustrate these processes . Because this is an area of active research , the tool , examples , and accompanying guidance will be up date d when needed , and the latest version of PROBAST should always be downloaded from the Web site . Focus of PROBAST PROBAST is design ed to assess primary studies that develop , vali date , or up date ( for example , extend ) multivariable prediction models for diagnosis or prognosis ( Boxes 1 and 2 ) . A multivariable prediction model is defined as any combination or equation of 2 or more predictors ( such as age , sex , symptoms , signs , disease stage , or biomarkers ) for estimating for an individual the probability or risk of having ( diagnosis ) or developing ( prognosis ) a particular outcome ( 1 , 4 , 68 , 49 , 50 ) . Other names for prediction model include risk prediction model , predictive model , prediction index or rule , and risk score ( 1 , 38 , 4951 ) . Box 1 . Types of diagnostic and prognostic modeling studies or reports addressed by PROBAST . Adopted from the TRIPOD ( Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis ) and CHARMS ( CHecklist for critical Appraisal and data extraction for systematic Review s of prediction Modelling Studies ) guidance ( 8 , 16 ) . Box 2 . Differences between diagnostic and prognostic prediction model studies . PROBAST = Prediction model Risk Of Bias ASsessment Tool . Diagnostic and Prognostic Models Diagnostic prediction models estimate the probability that a certain outcome , the target condition , is currently present . Diagnostic prediction model studies typically include individuals who are suspectedbut not yet knownto have the target condition . Prognostic prediction models estimate the probability that a future outcome or event will occur , such as death , disease recurrence , disease complication , or therapy response . The time period of prediction can vary from hours ( for example , preoperatively predicting postoperative nausea and vomiting ) to years ( for example , predicting lifelong risk for a coronary event ) . Although many prognostic models enroll patients with an established diagnosis , this does not have to be the starting point , as seen in models for predicting development of diabetes in pregnant women ( 52 ) or of osteoporotic fractures in the general population ( 53 ) . Consistent with the TRIPOD ( Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis ) statement ( 7 , 8) , PROBAST thus broadly defines prognostic models as those predicting a future outcome in persons at risk for that outcome . Diagnostic and prognostic model studies often use different terms for predictors and outcomes ( Box 2 ) . The cancer literature frequently distinguishes between prognostic and predictive models , such that predictive models identify individuals with differential treatment effects ( 54 ) . These types of ( predictive ) models are outside the scope of this article . Types of Predictors , Outcomes , and Modeling Techniques PROBAST can be used to assess any type of diagnostic or prognostic prediction model aim ed at individualized predictions regardless of the predictors used ; outcomes being predicted ; or methods used to develop , vali date , or up date ( for example , extend ) the model . Predictors range from demographic characteristics , medical history , and physical examination results ; to imaging results , electrophysiology , blood , urine , or tissue measurements , and disease stages or characteristics ; to results from omics and other new biological measurements . Predictors are also called covariates , risk indicators , prognostic factors , determinants , index test results , or independent variables ( 4 , 68 , 49 , 50 , 55 , 56 , 57 ) . PROBAST distinguishes between c and i date predictors and predictors included in the final model ( 57 ) . C and i date predictors are variables considered potentially predictive of the outcome presence ( diagnosis ) or occurrence (prognosis)that is , all those evaluated in the study regardless of whether they are included in the final multivariable model . PROBAST primarily addresses prediction models for binary and time-to-event outcomes because these are the most common in medicine . However , the tool can also be used to assess models predicting nonbinary outcomes , such as continuous scores ( for example , pain scores or cholesterol levels ) or categorical outcomes ( for example , the Glasgow Coma Scale ) . Almost all PROBAST signaling questions apply equally to continuous and categorical outcomes , except questions addressing number of outcome events per predictor and certain measures of model performance ( such as the c-statistic ) , which are not relevant to continuous outcomes . Prediction models usually involve regression modeling techniques , such as logistic regression or survival models . Prediction models may also be developed or vali date d using nonregression techniques , such as neural networks , r and om forests , or support vector machines . As the use of routine care ( and big ) data increases , additional modeling techniques are becoming more common , including machine and artificial learning models . The main differences between studies using regression and other types of prediction modeling include the methods of data analysis ; nonregression development models can often have greater risks of overfitting when data are sparse , and the potential lack of transparency can affect the applicability and usability of the models . In the section on tailoring PROBAST with additional signaling questions , we provide guidance about how PROBAST can be adapted to address other types of outcomes and modeling techniques . Types of Review Questions PROBAST can be used to assess different types of systematic review questions . For some review questions , all prediction model studies are relevant ( including both development and validation ) , but for other questions only validation studies are relevant . Box 3 gives examples of potential review questions for both prognostic and diagnostic prediction models where PROBAST is applicable . CHARMS ( CHecklist for critical Appraisal and data extraction for systematic Review s of prediction Modelling Studies ) and Table 2 provide explicit guidance on how to frame a focused question for review s of prediction model studies ( 16 , 17 ) . Box 3 . Examples of systematic review questions for which PROBAST is suitable . There are various different questions that systematic review s Herbal products are becoming increasingly mainstream . This is not simply a comment on their popularity , but on the level and rigor of scientific research and acceptance by clinical investigators , as well as the attention being paid to these therapeutic options by government bodies . A recent trial published in the Journal of the American Medical Association ( JAMA ) evaluating St. John 's wort for depression demonstrates this shift.1 Several features of this trial are noteworthy . Not only was the trial of rigorous design and published in a highly reputed journal , but it was completed by a group of high profile and experienced US psychiatric research ers who are generally associated with research ing pharmaceuticals . In the past , the quality of trials involving herbal products and other alternative treatment options for psychiatric and other disorders has been criticized.2 Criticisms have included failing to account for biases and confounders , using nonst and ardized products and poor study design . However , in the last 5 years , MEDLINE ( www.ncbi.nlm.nih.gov/ PubMed ) has indexed over 50 r and omized controlled trials ( RCTs ) investigating complementary medicines for treating mental disorders , suggesting that an increasing number of alternative approaches are being tested using what is approaching gold st and ard methods . This number is likely an underestimate because MEDLINE search strategies , even those devised by experts , can fail to locate a significant number of relevant trials.3 It is also well recognized that MEDLINE does not index all relevant journals in the area of complementary medicines.4 The Cochrane Controlled Trials Register of the Cochrane Library ( www.cochranelibrary.com ) , which lists clinical trials that have been identified through regular search ers of MEDLINE , EMBASE and h and search es of clinical journals , is considered an authoritative source of RCTs .5 For illustrative purpose s only , a selection of RCTs from the Cochrane Library of herbal products used for psychiatric indications is listed in Table 1.1,6,7,8,9,10,11,12,13 Table 1 Considering that the amount of good- quality research regarding herbals in psychiatric disorders appears to be exp and ing steadily , treatment review s , unless up date d regularly , quickly become out date d and serve a limited purpose . Such review s are also not particularly useful for making individual patient treatment decisions ; they tend not to address specific clinical questions adequately , but rather , provide the reader with a general awareness of the topic . As such , this paper is not intended to comprehensively review the benefits and risks of herbal products commonly used for psychiatric disorders . Recent examples of such review s can be found elsewhere.14,15,16,17 Instead , the purpose of this review is to present the steps involved in taking an evidence -based approach to clinical decision making regarding the use of herbal products in psychiatry . The reader will be oriented to the evidence -based process using examples of herbal product use for mental disorders . Methods and tools that facilitate rapid access to the best clinical research about herbal products will be presented . In addition , special issues concerning herbal therapies that differ from the evaluation of pharmaceutical products will be introduced and discussed Background The diversity of quality improvement interventions ( QIIs ) has impeded the use of evidence review to advance quality improvement activities . An agreed-upon framework for identifying QII articles would facilitate evidence review and consensus around best practice s. Aim To adapt and test evidence review methods for identifying empirical QII evaluations that would be suitable for assessing QII effectiveness , impact or success . Design Literature search with measurement of multilevel inter-rater agreement and review of disagreement . Methods Ten journals ( 2005 - 2007 ) were search ed electronically and the output was screened based on title and abstract . Three pairs of review ers then independently rated 22 articles , r and omly selected from the screened list .  Kappa statistics and percentage agreement were assessed . 12 stakeholders in quality improvement , including QII experts and journal editors , rated and discussed publications about which review ers disagreed . Results The level of agreement among review ers for identifying empirical evaluations of QII development , implementation or results was 73 % ( with a paradoxically low kappa of 0.041 ) . Discussion by raters and stakeholders regarding how to improve agreement focused on three controversial article selection issues : no data on patient health , provider behaviour or process of care outcomes ; no evidence for adaptation of an intervention to a local context ; and a design using only observational methods , as correlational analyses , with no comparison group . Conclusion The level of review er agreement was only moderate . Reliable identification of relevant articles is an initial step in assessing published evidence . Advancement in quality improvement will depend on the theory- and consensus-based development and testing of a generalizable framework for identifying QII evaluations BACKGROUND Physicians are often asked about complementary therapies by patients with cancer , and data show that the interest in and use of these therapies among patients with cancer is common . Therefore , it is important to assess the current evidence base on the benefits and risks of complementary therapies ( modalities not historically used in modern Western medicine ) . METHODS A systematic literature review was carried out and recommendations were made according to the American College of Chest Physicians Evidence -Based Clinical Practice Guidelines development methodology . RESULTS A large number of r and omized controlled trials , systematic review s , and meta-analyses , as well as a number of prospect i ve cohort studies , met the predetermined inclusion criteria . These trials addressed many different issues pertaining to patients with lung cancer , such as symptoms of anxiety , mood disturbance , pain , quality of life , and treatment-related side effects . The available data cover a variety of interventions , including acupuncture , nutrition , mind-body therapies , exercise , and massage . The body of evidence supports a series of recommendations . An evidence d-based approach to modern cancer care should integrate complementary therapies with st and ard cancer therapies such as surgery , radiation , chemotherapy , and best supportive care measures . CONCLUSIONS Several complementary therapy modalities can be helpful in improving the overall care of patients with lung cancer AIM This paper reports a study assessing the usefulness of a mantram repetition programme . BACKGROUND Complementary/alternative therapies are becoming commonplace , but more research is needed to assess their benefits . A 5-week programme teaching a ' mind-body-spiritual ' technique of silently repeating a mantram - a word or phrase with spiritual meaning - to manage stress was developed . A mantram was chosen by individuals , who were taught to repeat it silently throughout the day or night to interrupt unwanted thoughts and elicit the relaxation response . METHODS Participants who attended a 5-week course were invited to participate in the study . Of those who consented , a r and omly selected subset ( n = 66 ) was contacted approximately 3 months after the course for a telephone interview using the critical incident interviewing technique . Participants were asked whether the intervention was helpful or not , and if helpful , to identify situations where it was applied . Interviews were transcribed and incidents were identified and categorized to create a taxonomy of uses . The data were collected in 2001 - 2002 . RESULTS Participants included 30 veterans , mostly males ( 97 % ) , and 36 hospital employees , mostly females ( 86 % ) . Mean age was 56 years ( sd = 12.94 ) . Fifty-five participants ( 83.3 % ) practice d the technique and reported 147 incidents where the programme was helpful . Outcomes were organized into a taxonomy of incidents using four major categories that included managing : ( a ) emotions other than stress ( 51 % ) ; ( b ) stress ( 23.8 % ) ; ( c ) insomnia ( 12.9 % ) ; and ( d ) unwanted thoughts ( 12.3 % ) . A group of raters review ed the categories for inter-rater reliability . CONCLUSIONS The majority of participants from two distinct sample s reported that the mantram programme was helpful in a variety of situations . The critical incident interviewing method was found to be practical , efficient , and thorough in collecting and analyzing data . Such qualitative methods contribute to underst and ing the benefits of mind-body complementary therapies Applied kinesiology is a technique used to assess nutritional status on the basis of the response of muscles to mechanical stress . In this study , 11 subjects were evaluated independently by three experienced applied kinesiologists  for four nutrients ( thiamin , zinc , vitamin A , and ascorbic acid ) . The results obtained by those applied kinesiologists were compared with ( a ) one another , ( b ) st and ard laboratory tests for nutrient status , and ( c ) computerized isometric muscle testing . Statistical analysis yielded no significant interjudge reliability , no significant correlation between the testers and st and ard biochemical tests for nutrient status , and no significant correlation between mechanical and manual determinations of relative muscle strength . In addition , the subjects were exposed in a double-blind fashion to supplements of thiamin , zinc , vitamin A , and ascorbic acid and two placebos ( pectin and sucrose ) and then re-tested . According to applied kinesiology theory , " weak " ( indicating deficiency ) muscles are strengthened when the subject is exposed to an appropriate nutritional supplement . Statistical analysis revealed no significant differences in the response to placebo , nutrients previously determined ( by muscle testing ) to be deficient , and nutrients previously determined ( by muscle testing ) to be adequate . Even though the number of subjects ( 11 ) and nutrients ( 4 ) tested was limited , the results of this study indicated that the use of applied kinesiology to evaluate nutrient status is no more useful than r and om guessing OBJECTIVES Reflexology is an increasingly popular complementary therapy in which parts of the body are deemed to be represented on the soles of the feet . The aim of this study was to investigate whether this representation can be used as a valid method of diagnosis . METHODS Three experienced reflexologists took part in this study . Eighteen adults with one or more of six specified conditions were identified from primary care records .  Two reflexologists , who were blinded to the patients ' conditions and monitored , then examined each patient 's feet and rated the probability that each of the six conditions was present . RESULTS There is little evidence that the distribution of ratings vary with the status of the condition . Receiver operating curves suggest that this diagnostic method is very poor at distinguishing between the presence and absence of conditions . Inter-rater reliability ( kappa ) scores were very low , providing no evidence of agreement between the examiners . CONCLUSION Despite certain limitations to the data provided by this study , the results do not suggest that reflexology techniques are a valid method of diagnosis RATIONALE AND AIMS ' OTseeker ' is an online data base of r and omized controlled trials ( RCTs ) and systematic review s relevant to occupational therapy . RCTs are critically appraised and rated for quality using the ' PEDro ' scale . We aim ed to investigate the inter-rater reliability of the PEDro scale before and after revising rating guidelines . METHODS In study 1 , five raters scored 100 RCTs using the original PEDro scale guidelines .  In study 2 , two raters scored 40 different RCTs  using revised guidelines . All RCTs were r and omly selected from the OTseeker data base .  Reliability was calculated using Kappa and intraclass correlation coefficients [ ICC ( model 2,1 ) ] . RESULTS Inter-rater reliability was ' good to excellent ' in the first study ( Kappas > or= 0.53 ; ICCs > or= 0.71 ) . After revising the rating guidelines , the reliability levels were equivalent or higher to those previously obtained ( Kappas > or= 0.53 ; ICCs > or= 0.89 ) , except for the item , ' groups similar at baseline ' , which still had moderate reliability ( Kappa = 0.53 ) . In study 2 , two PEDro scale items , which had their definitions revised , ' less than 15 % dropout ' and ' point measures and variability ' , showed higher reliability . In both studies , the PEDro items with the lowest reliability were ' groups similar at baseline ' ( Kappas = 0.53 ) , ' less than 15 % dropout ' ( Kappas < or= 0.68 ) and ' point measures and variability data ' ( Kappas < or= 0.68 ) . CONCLUSION The PEDro scale is a reliable instrument for rating the quality of RCTs . Revised rating guidelines are provided for scale items that are difficult to rate , and helped to improve inter-rater reliability Introduction Secondary lymphedema affects approximately 40 % of women treated for breast cancer and is recognized as a major problem associated with the therapy of malignant tumors . Consequently , new therapeutic methods are constantly being sought to effectively eliminate the condition . One of the new forms of edema management , especially in the initial stages of edematous development , is Kinesiology Taping ( KT ) . Aim of the study The aim of the study was to assess the effects of KT applications on the extent of lymphedema of the upper extremity in women post cancer treatment . Material and methods The study group consisted of 28 women after axillary lymphadenectomy due to breast cancer . All the patients were diagnosed with grade I secondary lymphedema .  Kinesiology Taping was applied to a total of 14 r and omly selected women . The remaining 14 patients constituted a control group . The extent of lymphedema was measured using a centimeter tape and Limb Volumes Professional 5.0 software . Results A significant reduction in the extent of lymphedema ( p = 0.0009 ) was achieved in the KT group between baseline and post-treatment assessment s. No such reduction , however , was found in the control group ( p = 0.36 ) . Conclusions Kinesiology Taping applications are an effective method of early-stage edema management .  Kinesiology Taping may be a safe new therapeutic option in patients who are contraindicated for the use of other methods Background The prevalence of diabetes mellitus is ubiquitous . Complications and costs of diabetes are rising and are depleting limited re sources . It is imperative for healthcare professionals and patients alike to confront this chronic condition by exploring new interventions . An innovative health care delivery model has emerged in the last 25 years in the form of the group medical visit . Group medical visits can range from of six to twenty patients scheduled together with time allotted for individual care as well as in the group setting . Objectives The review objective was to conduct a systematic review and meta‐ analysis to synthesize the best available evidence related to effectiveness of group medical visits on HbA1c , blood pressure and cholesterol measurements /levels for adult patients with type II diabetes in outpatient setting s. Search strategy A three‐step literature search for studies in English language from 1990 to 2010 was conducted utilising ( a ) a primary search of Medline , CINAHL , PsycINFO and Cochrane Central Register of Controlled Trials , ( b ) a secondary search of non‐indexed data bases , and ( c ) a search of the grey literature . In addition , a manual review of the reference lists of all identified reports and articles was performed to identify additional studies . Inclusion criteria All r and omised and quasi‐experimental studies of adult patients ( > 18 ) with type II diabetes mellitus seen in outpatient health setting s were considered if they met one or more of the following diagnostic outcome measurements : haemoglobin A1c , systolic and diastolic blood pressure , and low density lipoprotein cholesterol . Critical appraisal , data collection and analysis Each of the eligible articles was review ed by two independent review ers . Disagreements between the review ers were resolved through discussion , or with a third review er . Studies that met the inclusion criteria were assessed for method ological quality using the JBI st and ardized critical appraisal tools . Data extraction was undertaken using the st and ardised data extraction tool from JBI‐MAStARI . Main results The search strategy identified 2,040 articles in the published and unpublished literature . Of these , 11 r and omised controlled trials and 4 quasi‐experimental trials met the inclusion criteria and represented 2240 patients included in the final review . There are clear benefits of group medical visits for patients ' HbA1c levels which are consistent in the post‐intervention and change from baseline effect sizes . The most significant effect observed is with the change from baseline results . Some evidence suggests post‐intervention and change from baseline systolic blood pressure improvement at the nine to twelve month interval and change from baseline improvement at the 4 year timeframe . There is no evidence that group visits improve LDL cholesterol values of the group visit participants . Conclusions Group medical visits should be considered by clinicians as an effective non‐pharmacologic intervention that can have a positive impact on biologic markers such as haemoglobin A1c and systolic blood pressure . Implication s for practice The evidence suggests that the most powerful model of Group medical visits ( GMV ) is when a clinician prescriber is present during or immediately after GMV sessions for medication reconciliation or individual patient needs . Implication s for research Future research should include this GMV intervention in r and omised controlled trials across different health systems and socio‐economic and ethnic groups
Conclusion : There is insufficient evidence for diagnostic accuracy within kinesiology , the validity of muscle response and the effectiveness of kinesiology for any condition .
Introduction : Kinesiology is a diagnostic , therapeutic complementary therapy utilising subtle change in manual muscle testing results to evaluate the body ’s energetic balance and select healing modalities .
Anecdotal evidence suggests kinesiology is helpful , therefore we wished to critically review the literature .
Aims : ( 1 ) To ascertain if diagnostic accuracy including inter-examiner reliability has been established . (
2 ) To review whether there is evidence for its therapeutic effectiveness . (
3 ) To critically assess the quality of relevant studies .