Why methods matter in a meta-analysis: a reappraisal showed inconclusive injury preventive effect of Nordic hamstring exercise

Franco M. Impellizzeri*, Alan McCall, Maarten van Smeden

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

3 Citations (Scopus)

Abstract

Objectives: The Nordic hamstring exercise (NHE) has been strongly recommended to reduce hamstring injuries in previous meta-analyses (50% reduction in risk of injury). To underline the importance and impact of adopting appropriate methodology for evidence synthesis, we revisited the study selection, reanalyzed and updated the findings of the most recent meta-analysis. Study Design and Setting: Only randomized control trials (RCT) using NHE as one of the prevention arms were selected. Summary effects for risk ratios (RR) for original studies included in the earlier meta-analysis, and new studies identified (update), were re-estimated under the random-effects model and presented with 95% confidence intervals (CI) and prediction intervals (PI). Tentative recommendations were provided according to the Grading of Recommendations Assessment, Development and Evaluation. Results: Only five RCTs out of the 15 studies included in the earlier meta-analysis randomized to NHE. Our update revealed one additional RCT. The point estimate (RR) for the five RCTs previously considered RCTs was 0.56 (95% CI, 0.20–1.52; 95% PI, 0.06–5.14, parametric, and 0.13–1.80, nonparametric). After the update, the RR was 0.59 (95% CI, 0.27–1.29; 95% PI 0.10–3.29, parametric, and 0.17–1.52, nonparametric). Conclusion: Contrary to the conclusions of a recent meta-analysis, as well as earlier meta-analyses, by using more appropriate methodology, the evidence underpinning the protective effect of NHE so far remains inconclusive and mostly derived from high risk of bias RCTs. At best, only conditional recommendation can be provided (for soccer) and future RCTs are warranted.

Original languageEnglish
Pages (from-to)111-124
Number of pages14
JournalJournal of Clinical Epidemiology
Volume140
DOIs
Publication statusPublished - Dec 2021

Keywords

  • Bias
  • Heterogeneity
  • Injury
  • Meta-analysis
  • Prevention
  • Research synthesis
  • Sports medicine

Fingerprint

Dive into the research topics of 'Why methods matter in a meta-analysis: a reappraisal showed inconclusive injury preventive effect of Nordic hamstring exercise'. Together they form a unique fingerprint.

Cite this