title: Anterior cruciate ligament reconstruction-rehabilitation research methodological quality: a systematic review with world region comparisons.
abstract: OBJECTIVE
  A systematic review and world region comparison of combined ACL reconstruction-rehabilitation studies was performed.
  
  
  METHODS
  Studies that combined ACL surgical-rehabilitative management published between January 1990 and June 2014 were evaluated. The combined terms "rehabilitation" and "anterior cruciate ligament reconstruction" or "ACL reconstruction" were used to search the CINAHL Plus, Cochrane Library, MEDLINE, PEDro, and PubMed databases. A total of 5920 studies were initially identified. Inclusion criteria reduced this total to 299 studies that underwent abstract review. Following this, 155 studies underwent full text review and 109 met all inclusion criteria for Modified Coleman Methodology Score (MCMS) evaluation.
  
  
  RESULTS
  Overall, MCMS were 74.0 ± 17 (mean ± standard deviation). Europe had slightly greater MCMS than North America (P = 0.041). Specific MCMS components that displayed significant world region differences included use of an independent investigator (Europe > North America and Asia; P = 0.047), including a patient-completed written assessment (Europe > North America and Asia; P = 0.009), allowing the patient to complete the assessment without medical, surgical, or rehabilitation personnel intervention (Europe > North America and Asia; P = 0.009), and use of well-described subject selection or inclusion criteria (Europe > North America and Asia; P = 0.004). Tegner Activity Scale (P = 0.042) and VAS-Pain Scale (P = 0.007) use was greater in Europe compared with other world regions. Primary rehabilitation theme frequency was comparable between world regions (n.s.).
  
  
  CONCLUSIONS
  Regional research methodological quality differences were observed. Europe displayed a slightly greater MCMS for combined ACL reconstruction-rehabilitation studies. With this information, research groups can design better team-based approaches to ensure that study findings provide sufficient significance to foster meaningful patient care improvements.
  
  
  METHODS
  Systematic review, Level III.
authors: Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, 550 S. Jackson Street, 1st Floor, ACB, Louisville, KY, 40202, USA.
authors: Artur
authors: A
authors: Proniewicz
authors: Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, 550 S. Jackson Street, 1st Floor, ACB, Louisville, KY, 40202, USA.
authors: Paul
authors: P
authors: Mazzone
authors: Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, 550 S. Jackson Street, 1st Floor, ACB, Louisville, KY, 40202, USA. jnyland@spalding.edu.|Athletic Training Program, Kosair Charities College of Health and Natural Sciences, Spalding University, 901 South 4th Street, Louisville, KY, 40203-2188, USA. jnyland@spalding.edu.
authors: John
authors: J
authors: Nyland
authors: Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, 550 S. Jackson Street, 1st Floor, ACB, Louisville, KY, 40202, USA.
authors: Jeff
authors: J
authors: Wera
authors: Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, 550 S. Jackson Street, 1st Floor, ACB, Louisville, KY, 40202, USA.
authors: Justin
authors: J
authors: Givens
mesh_terms: D000070598:Anterior Cruciate Ligament Injuries / Q000534:rehabilitation* / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000534:rehabilitation*; D005060:Europe; D006801:Humans; D009656:North America; D011183:Postoperative Complications / Q000601:surgery; D012107:Research Design / Q000592:standards*
keywords: ACL; Rehabilitation; Research methodology; Surgical reconstruction; Systematic review