Blinding is challenging in randomised controlled trials of physical, psychological, and self-management therapies for pain, mainly because of their complex and participatory nature. To develop standards for the design, implementation, and reporting of control interventions in efficacy and mechanistic trials, a systematic overview of currently used sham interventions and other blinding methods was required. Twelve databases were searched for placebo or sham-controlled randomised clinical trials of physical, psychological, and self-management treatments in a clinical pain population. Screening and data extraction were performed in duplicate, and trial features, description of control methods, and their similarity to the active intervention under investigation were extracted (protocol registration ID: CRD42020206590). The review included 198 unique control interventions, published between 2008 and December 2021. Most trials studied people with chronic pain, and more than half were manual therapy trials. The described control interventions ranged from clearly modelled based on the active treatment to largely dissimilar control interventions. Similarity between control and active interventions was more frequent for certain aspects (eg, duration and frequency of treatments) than others (eg, physical treatment procedures and patient sensory experiences). We also provide an overview of additional, potentially useful methods to enhance blinding, as well as the reporting of processes involved in developing control interventions. A comprehensive picture of prevalent blinding methods is provided, including a detailed assessment of the resemblance between active and control interventions. These findings can inform future developments of control interventions in efficacy and mechanistic trials and best-practice recommendations.

Sham interventions in randomized clinical trials (RCTs) of physical, psychological, and self-management (PPS) therapies for pain are highly variable in design and believed to contribute to poor internal validity. However, it has not been formally tested whether the extent to which sham controls resemble the treatment under investigation consistently affects trial outcomes, such as effect sizes, differential attrition, participant expectancy, and blinding effectiveness. Placebo- or sham-controlled RCTs of PPS interventions of clinical pain populations were searched in 12 databases. The similarity of control interventions to the experimental treatment was rated across 25 features. Meta-regression analyses assessed putative links between employed control interventions, observed effect sizes in pain-related outcomes, attrition, and blinding success. The sample included 198 unique control interventions, dominated by manual therapy and chronic musculoskeletal pain research. Meta-analyses indicated small-to-moderate benefits of active treatments over control interventions, across subgroups of manual therapies, exercise, and rehabilitation, and psychological intervention trials. Multiple meta-regression modelling demonstrated that similarity between sham control and tested interventions predicted variability in pain-related outcomes, attrition, and blinding effectiveness. Influential variables were differences relating to the extent of intervention exposure, participant experience, and treatment environments. The results support the supposed link between blinding methods and effect sizes, based on a large and systematically sourced overview of methods. However, challenges to effective blinding are complex and often difficult to discern from trial reports. Nonetheless, these insights have the potential to change trial design, conduct, and reporting and will inform guideline development.

Kicking strikes are fundamental in combat sports such as Taekwondo, karate, kickboxing, Muay Thai, and mixed martial arts. This review aimed to explore the measurement methods, kinematics such as velocities, kinetics such as impact force, determinants, and injury potential of kicking strikes in combat sports. Searches of Academic Search Premier, The Allied and Complementary Medicine Database, CINAHL Plus, MEDLINE, SPORTDiscus, Scopus, and Web of Science databases were conducted for studies that measured kicking velocity and impact force. A total of 88 studies were included in the review. Studies most frequently involved only male participants (49%) aged between 18 and 30 years of age (68%). Studies measuring velocity predominantly implemented camera-based motion capture systems (96%), whereas studies measuring impact force displayed considerable heterogeneity in their measurement methods. Five primary strikes were identified for which foot velocities ranged from 5.2 to 18.3 m/s and mean impact force ranged from 122.6 to 9015 N. Among the techniques analysed, the roundhouse kick exhibited the highest kicking velocity at 18.3 m/s, whilst the side kick produced the highest impact force at 9015 N. Diverse investigation methodologies contributed to a wide value range for kicking velocities and impact forces being reported, making direct comparisons difficult. Kicking strikes can be categorised into throw-style or push-style kicks, which modulate impact through different mechanisms. Kicking velocity and impact force are determined by several factors, including technical proficiency, lower body strength and flexibility, effective mass, and target factors. The impact force generated by kicking strikes is sufficient to cause injury, including fracture. Protective equipment can partially attenuate these forces, although more research is required in this area. Athletes and coaches are advised to carefully consider the properties and potential limitations of measurement devices used to assess impact force.

To systematically investigate trustworthiness (methodological rigor, transparency, good governance, research integrity, and absence of misconduct) in randomized controlled trials (RCTs) of osteopathic manual therapy. This prospectively registered review (PROSPERO-ID: CRD42023457697) searched MEDLINE, EMBASE, CINAHL, AMED, PEDro, ostmed.dr, and Chiroindex for RCTs evaluating osteopathic treatments (January 2021-June 2024). Risk of bias (RoB) was assessed using Cochrane tool 2, while trustworthiness was assessed with the Cochrane Pregnancy and Childbirth Screening Tool and the REAPPRAISED checklist. Journal trustworthiness, misleading representations in abstracts ("spin"), and results plausibility (via meta-analysis) were also assessed. Findings were synthesized descriptively. Sixty-one RCTs were included (median sample size 45, interquartile range (IQR) 30-76), largely studying healthy volunteers (29%). Most had high RoB (74%), and only 7% acknowledged potential conflicts from authors' professional ties. No journals appeared on cautionary lists, although 23% of articles were published within 2 months of submission. Only 27% of contactable authors engaged with reviewers. Seven abstracts (12%) were free of spin. Methodological concerns included poor missing data handling (31%), selective analyses (38%), unacknowledged multiple testing (36%), and outcome switching (12%). Meta-analysis found two outliers and five further with very large effects, while 19% provided inadequate data for pooling. Limitations include incomplete reports and lack of validated trustworthiness assessment tools. Adherence to best practices in osteopathic RCTs needs improvement to enhance evidence-based decision-making, reduce research waste, and enhance reproducibility. Further research should explore whether these findings apply to other small, under-resourced fields. Clinical trials are studies that test if medical treatments work. Doctors and others use these studies to decide how to care for patients or which treatments should be paid for. For clinical trials to be helpful, they need to follow rules to show they can be trusted. For example, researchers can build trust by sharing their plans before they start, reporting all their results honestly and answering questions about their work. In this project, we looked at 61 clinical trials from a 3.5-year period that tested a hands-on treatment called "osteopathic manual therapy." We checked how well these trials followed the rules for trustworthy research. We found that many trials had problems. For example, important research steps were skipped (such as properly registering the study on appropriate online platforms before starting, following the steps described in the registration documents, and correctly examining the collected data). Often, results were also made to look better than they really are, or it was not clearly explained what happened during the study. Only a few researchers answered questions when we asked them. This shows that some osteopathic trials need to do better so people can trust the results. We also suggest ways researchers can improve trustworthiness in the future.