title: Study quality on groin injury management remains low: a systematic review on treatment of groin pain in athletes.
abstract: BACKGROUND
  Groin pain in athletes is frequent and many different treatment options have been proposed. The current level of evidence for the efficacy of these treatments is unknown.
  
  
  OBJECTIVE
  Systematically review the literature on the efficacy of treatments for groin pain in athletes.
  
  
  METHODS
  Nine medical databases were searched in May 2014.
  
  
  METHODS
  treatment studies in athletes with groin pain; randomised controlled trials, controlled clinical trials or case series; n>10; outcome measures describing number of recovered athletes, patient satisfaction, pain scores or functional outcome scores. One author screened search results, and two authors independently assessed study quality. A best evidence synthesis was performed. Relationships between quality score and outcomes were evaluated. Review registration number CRD42014010262.
  
  
  RESULTS
  72 studies were included for quality analysis. Four studies were high quality. There is moderate evidence that, for adductor-related groin pain, active exercises compared with passive treatments improve success, multimodal treatment with a manual therapy technique shortens the time to return to sports compared with active exercises and adductor tenotomy improves treatment success over time. There is moderate evidence that for athletes with sportsman's hernia, surgery results in better treatment success then conservative treatment. There was a moderate and inverse correlation between study quality and treatment success (p<0.001, r=-0.41), but not between study quality and publication year (p=0.09, r=0.20).
  
  
  CONCLUSIONS
  Only 6% of publications were high quality. Low-quality studies showed significantly higher treatment success and study quality has not improved since 1985. There is moderate evidence for the efficacy of conservative treatment (active exercises and multimodal treatments) and for surgery in patients with adductor-related groin pain. There is moderate evidence for efficacy of surgical treatment in sportsman's hernia.
authors: Aspetar Sports Groin Pain Center, Orthopaedic and Sports Medicine Hospital, Doha, Qatar Arthroscopic Center Amager, SORC-C, Copenhagen University Hospital, Amager-Hvidovre, Denmark.
authors: Andreas
authors: A
authors: Serner
authors: Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
authors: Casper H
authors: CH
authors: van Eijck
authors: Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
authors: Berend R
authors: BR
authors: Beumer
authors: Aspetar Sports Groin Pain Center, Orthopaedic and Sports Medicine Hospital, Doha, Qatar Arthroscopic Center Amager, SORC-C, Copenhagen University Hospital, Amager-Hvidovre, Denmark.
authors: Per
authors: P
authors: Hölmich
authors: Aspetar Sports Groin Pain Center, Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
authors: Adam
authors: A
authors: Weir
authors: Department of Orthopaedics, Erasmus University Medical Centre, Rotterdam, The Netherlands.
authors: Robert-Jan
authors: RJ
authors: de Vos
mesh_terms: D015746:Abdominal Pain / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D001265:Athletic Injuries / Q000628:therapy*; D004812:Epidemiologic Methods; D019317:Evidence-Based Medicine; D005260:Female; D006119:Groin / Q000293:injuries*; D006801:Humans; D008297:Male; D011787:Quality of Health Care; D009626:Terminology as Topic; D016896:Treatment Outcome; D055815:Young Adult
keywords: Effectiveness; Groin; Methodological; Orthopaedics; Overuse
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