Assessing methodological quality of primary studies is an essential component of systematic reviews. Following a systematic review which used a domain based system [United States Preventative Services Task Force (USPSTF)] to assess methodological quality, a commonly used numerical rating scale (Downs and Black) was also used to evaluate the included studies and comparisons were made between quality ratings assigned using the two different methods. Both tools were used to assess the 20 randomized and quasi-randomized controlled trials examining an exercise intervention for chronic musculoskeletal pain which were included in the review. Inter-rater reliability and levels of agreement were determined using intraclass correlation coefficients (ICC). Influence of quality on pooled effect size was examined by calculating the between group standardized mean difference (SMD). Inter-rater reliability indicated at least substantial levels of agreement for the USPSTF system (ICC 0.85; 95% CI 0.66, 0.94) and Downs and Black scale (ICC 0.94; 95% CI 0.84, 0.97). Overall level of agreement between tools (ICC 0.80; 95% CI 0.57, 0.92) was also good. However, the USPSTF system identified a number of studies (n = 3/20) as “poor” due to potential risks of bias. Analysis revealed substantially greater pooled effect sizes in these studies (SMD −2.51; 95% CI −4.21, −0.82) compared to those rated as “fair” (SMD −0.45; 95% CI −0.65, −0.25) or “good” (SMD −0.38; 95% CI −0.69, −0.08). In this example, use of a numerical rating scale failed to identify studies at increased risk of bias, and could have potentially led to imprecise estimates of treatment effect. Although based on a small number of included studies within an existing systematic review, we found the domain based system provided a more structured framework by which qualitative decisions concerning overall quality could be made, and was useful for detecting potential sources of bias in the available evidence.

Objective To compare an accelerated intervention incorporating early therapeutic exercise after acute ankle sprains with a standard protection, rest, ice, compression, and elevation intervention. Design Randomised controlled trial with blinded outcome assessor. Setting Accident and emergency department and university based sports injury clinic. Participants 101 patients with an acute grade 1 or 2 ankle sprain. Interventions Participants were randomised to an accelerated intervention with early therapeutic exercise (exercise group) or a standard protection, rest, ice, compression, and elevation intervention (standard group). Main outcome measures The primary outcome was subjective ankle function (lower extremity functional scale). Secondary outcomes were pain at rest and on activity, swelling, and physical activity at baseline and at one, two, three, and four weeks after injury. Ankle function and rate of reinjury were assessed at 16 weeks. Results An overall treatment effect was in favour of the exercise group (P=0.0077); this was significant at both week 1 (baseline adjusted difference in treatment 5.28, 98.75% confidence interval 0.31 to 10.26; P=0.008) and week 2 (4.92, 0.27 to 9.57; P=0.0083). Activity level was significantly higher in the exercise group as measured by time spent walking (1.2 hours, 95% confidence interval 0.9 to 1.4 v 1.6, 1.3 to 1.9), step count (5621 steps, 95% confidence interval 4399 to 6843 v 7886, 6357 to 9416), and time spent in light intensity activity (53 minutes, 95% confidence interval 44 to 60 v 76, 58 to 95). The groups did not differ at any other time point for pain at rest, pain on activity, or swelling. The reinjury rate was 4% (two in each group). Conclusion An accelerated exercise protocol during the first week after ankle sprain improved ankle function; the group receiving this intervention was more active during that week than the group receiving standard care. Trial registration Current Controlled Trials ISRCTN13903946.

We present theory and experiments for a microwave-to-digital photonic link capitalizing on the linearity of optical phase modulation and coherent optical I/Q demodulation to achieve unprecedented gain and dynamic range performance. We demonstrate, with an optical amplifier noise limited system, direct demodulation spur-free dynamic range (SFDR), gain, and noise figure of 126.8 dB-Hz^2/3 (86.8 dB in 1 MHz noise bandwidth), 8 dB, and 18.6 dB, respectively for inputs up to 1 GHz. Additionally we demonstrate complimentary all-photonic downconversion allowing the extension of input operating bandwidth to a modulator limited 40 GHz. Demonstrated microwave to intermediate frequency conversion loss ranges from <; 4 dB @ 4 GHz to <; 13 dB @ 40 GHz. Linear all-photonic downconversion and demodulation is demonstrated at 3 and 10 GHz with optical amplifier noise limited SFDR better than 107 dB-Hz^2/3 (67 dB in 1 MHz noise bandwidth). System design issues are discussed including critical parametric sensitivities and optical-electrical-digital sub-system dynamic range matching and technology capability for downconverting microwave-to-digital SFDR performance in excess of 125 dB-Hz^2/3 (85 dB in 1 MHz) with current technology.