Displaying publications 1 - 20 of 36 in total

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  1. Abdul-Karim S, Abdul-Hamid MS, Ho CA, Ling J
    Malays Orthop J, 2023 Mar;17(1):160-171.
    PMID: 37064621 DOI: 10.5704/MOJ.2303.019
    INTRODUCTION: The purpose of this study is to determine the validity, reliability, and responsiveness of the Malay Shoulder Pain and Disability Index (M-SPADI) in Malay speakers suffering from shoulder pain.

    MATERIALS AND METHODS: The M-SPADI, the Numerical Rating Scale (NRS), and measurements of shoulder active range of motion (AROM) were completed by 140 patients with shoulder pain (68 with rotator cuff pathology and 72 with other shoulder pathology). Thirty-four patients were retested for test-retest reliability with M-SPADI after an average of 9.2 days. M-SPADI was performed on twenty-one individuals three months after completing treatment for rotator cuff disorders to assess response.

    RESULTS: The results of exploratory factor analysis revealed a bidimensional structure for M-SPADI. M-SPADI disability score was significantly greater in patients with rotator cuff pathologies (median = 31.87, IQR 82.50) than in patients with other shoulder pathologies (median = 20.00, IQR 23.84). In multi-group factor analysis, measurement invariance revealed no significant difference between the two groups (p>0.05). There was a significant positive correlation between M-SPADI and NRS (Pain = 0.86, Disability = 0.75, Total = 0.82, p=0.005), and a significant negative correlation between M-SPADI and shoulder AROM (Pain = -0.34 to -0.67, Disability =-0.44 to -0.73, Total =0.43 to -0.72, p=0.005). M-SPADI had a high degree of internal consistency (Cronbach's 0.92 for pain and 0.95 for disability). Test-retest reliability was moderate to excellent (ICC Pain = 0.84, ICC Disability = 0.78, ICC Total = 0.81, p=0.001), and the smallest detectable change ranges (Pain = 8.74, Disability = 3.21, Total = 3.83) were less than the minimal detectable change ranges (Pain = 21.57, Disability = 6.82, Total = 8.79). The area under the receiver operating characteristic curve (AUC) for M-SPADI was greater than 0.90 (Pain = 0.99, Disability = 0.94, Total = 0.96).

    CONCLUSION: The M-SPADI has established construct validity, internal consistency, test-retest reliability, and responsiveness. The M-SPADI is a reliable and valid instrument for evaluating shoulder pain among Malay-speaking individuals. In addition, the M-SPADI disability subscale may be useful for monitoring functional score changes in patients with rotator cuff pathology.

  2. Omar MK, Abdul-Karim S
    Malays Orthop J, 2021 Mar;15(1):32-42.
    PMID: 33880146 DOI: 10.5704/MOJ.2103.006
    Introduction: This study was designed to produce a validated and reliable Malay version of the Identification of Functional Ankle Instability (IdFAI-M) questionnaire.

    Materials and method: The cross-cultural adaptation was conducted based on standard guidelines to produce the Malay version of the Identification of Functional Ankle Instability (IdFAI-M) questionnaire. The reliability and validity testing were then performed among one hundred and twenty-three physically active University of Malaya students. Among them, twenty-two students also participated in the second return of the questionnaire over a two-week interval, which was then evaluated for test-retest reliability testing.

    Results: The content validity for item-level (I-CVI) and Kappa values for all items were more than 0.7, respectively and the all scales-level (S-CVI) values were 0.983 (consistency), 0.967 (representativeness), 1.00 (relevance) and 0.983 (clarity). The questionnaire also demonstrated excellent reliability with an intraclass correlation coefficient (ICC2.1) above 0.850 for all items. It was observed that outer loading of most items were more than the minimum acceptable value (0.7). Fornell-Larcker criterion demonstrate all values for each reflective construct was larger than the correlations with other constructs, indicating discriminant. The cross-loading values of each item has shown a weak correlation with all other constructs, except for the one to which it was theoretically associated.

    Conclusions: The Malay version of the IdFAI (IdFAI-M) is a reliable and valid instrument that can be readily utilised to subjectively assess ankle instability.

  3. Nadzirah, S., Ab Karim, S., Ghazali, H., Othman, M.
    MyJurnal
    On-campus foodservices were thought to be the first choice for university students to dine in. However, these seemingly captive consumers have been opting for off-campus foodservice as their preferred outlet. This paper aims to uncover specific factors that motivate undergraduate students to dine-in at university foodservice facilities using Profile Accumulation Technique (PAT). PAT is a semi-quantitative method that provides freedom for informants to answer in their own terms and words, alternatively the data could be analyzed statistically. 115 questionnaires were distributed to students and staff of a local university. Findings include a list of factors (positive perception, negative perception and expectations) that the students considered to be significant in determining their choice of food outlet. These factors are then descriptively analyzed to determine attributes influencing university customer preferences. This paper significantly contributes in providing a deeper insight into factors that influences dining choice of university foodservice's customers in Malaysia.
  4. Karim SM, Ratnam SS, Hutabarat H, Hanafiah J, Simanjuntak P, Teoh SK, et al.
    Ann Acad Med Singap, 1982 Oct;11(4):508-12.
    PMID: 7165272
    2a 2b dihomo 15(S) 15 methyl PGF2 alpha methyl ester (dihomo 15 me PGF2 alpha) in intramuscular doses of 0.5 mg 8 hourly was used in 631 patients with abnormal intrauterine pregnancy comprising 282 cases of intrauterine fetal death, 233 cases of missed abortion, 34 and 82 cases respectively anencephalic and molar pregnancies. The study was carried out as a collaborative project between the University Departments of Obstetrics and Gynaecology in Singapore (Singapore), Medan (Indonesia) and Kuala Lumpur (Malaysia) during the period June 1974 and November 1979. Six hundred patients (95.1%) aborted or delivered in a mean time of 11.3 hours (S.D. +/- 7.0) with an average of 1.8 injections of the prostaglandin analogue per patient. Side effects included vomiting (23.6%; mean 0.45 episodes per patient), diarrhoea (44.4%; mean 1.00 episode per patient), cold and shivering (11.9%) and pyrexia (12.4%). One patient sustained a cervical laceration which did not require repair. There were no complications.
  5. Naeem MA, Karim S, Yarovaya L, Lucey BM
    Ann Oper Res, 2023 Apr 18.
    PMID: 37361088 DOI: 10.1007/s10479-023-05330-5
    Financial markets are exposed to extreme uncertain circumstances escalating their tail risk. Sustainable, religious, and conventional markets represent three different markets with various characteristics. Motivated with this, the current study measures the tail connectedness between sustainable, religious, and conventional investments by employing a neural network quantile regression approach from December 1, 2008 to May 10, 2021. The neural network recognized religious and conventional investments with maximum exposure to tail risk following the crisis periods reflecting strong diversification benefits of sustainable assets. The Systematic Network Risk Index spots Global Financial Crisis, European Debt Crisis, and COVID-19 pandemic as intensive events yielding high tail risk. The Systematic Fragility Index ranks the stock market in the pre-COVID period and Islamic stocks during the COVID sample as the most susceptible markets. Conversely, the Systematic Hazard Index nominates Islamic stocks as the chief risk contributor in the system. Given these, we portray various implications for policymakers, regulatory bodies, investors, financial market participants, and portfolio managers to diversify their risk using sustainable/green investments.
  6. Hakim MA, Juraimi AS, Hanafi MM, Selamat A, Ismail MR, Karim SM
    J Environ Biol, 2011 Sep;32(5):529-36.
    PMID: 22319865
    An investigation was made to see the salt tolerance of 10 weed species of rice. Properly dried and treated seeds of weed species were placed on 9 cm diameter petridishes lined with Whatman No. 1 filter paper under 6 salinity regimes, viz. 0 (control), 4, 8, 16, 24 and 32 dS m(-1). The petri dishes were then kept in germinator at 25 +/- 1.0 degrees C and 12 hr light. The number of germinated seeds were recorded daily. The final germination percentage, germination index (GI), seedling vigour index, mean germination time and time for 50% germination were estimated. Root and shoot lengths of the weed seedlings were measured at 20 days after salt application and relative growth values were calculated. Results revealed that salinity decreased final germination percentage, seed of germination as measured by GI, and shoot and root length in all the species. Germination of most of the weed seeds was completely arrested (0) at 32 dS m(-1) salinity except in E. colona (12%) and C. iria (13.9%). The species C. iria, E. colona, J. linifolia and E. crusgalli showed better germination (above 30%) upto 24 dS m(-1) salinity level and were regarded as salt-tolerant weed species. J. linifolia, F. miliacea, L. chinensis and O. sativa L. (weedy rice) were graded as moderately tolerant and S. zeylanica, S. grosus and C. difformis were regarded as least tolerant weed species.
  7. Naeem MA, Karim S, Tiwari AK
    Comput Econ, 2022 Aug 05.
    PMID: 35966025 DOI: 10.1007/s10614-022-10296-w
    The increasing concerns of investors toward green bonds and their appealing nature of diversification has motivated the current research to study the risk connectedness between green and conventional assets spanning from August 2014 to December 2020. We first estimate the dynamic equi-correlations through DECO-GARCH. Next, we assess the dynamic and static risk connectedness in the median, extreme low, and extreme high quantiles arguing that spillovers vary across different time periods particularly during economically intense time periods. Finally, we analyzed the hedge ratio and hedge effectiveness between green bonds and other assets. We find that equi-correlations are intense during economic shocks such as the Shale oil crisis, Brexit, US interest rate hike, and COVID-19 pandemic. The volatility analysis at average, lower, and upper quantiles also validate time-varying attributes of green and conventional assets. Further, network figures of green and conventional assets identify potential diversification opportunities. Meanwhile, the hedge effectiveness indicates that green bonds are effective hedge for precious metals and cryptocurrencies. Our findings draw multiple implications for policymakers, green investors, financial market participants, and regulatory authorities regarding flight-to-safety during crisis times and maintaining a diverse portfolio to escape potential losses.
  8. Leong, Q.L., Ab Karim, S., Selamat, J., Mohd Adzahan, N., Karim, R., Rosita, J.
    MyJurnal
    This study aimed to analyze consumers’ perceptions and acceptance toward ‘belacan’. Results
    showed internal reliability of above 0.7 for sections analyzed. Factor analysis found two underlying factors in the section designed to examine consumers’ perceptions. The overall consumers’ perception had a positive and moderate correlation with their acceptance and was significant at .01. Results also showed that ‘belacan’ consumption level was relatively frequent and well accepted by all races in Malaysia. The findings of the study would be noteworthy to the fishery industry and the small and medium industry (SME) in Malaysia in meeting consumers’ needs.
  9. Sobhi, B., Noranizan, M., Ab Karim, S., Abdul Rahman, R., Bakar, J., Ghazali, Z.
    MyJurnal
    Chili shrimp paste (CSP) is a favorite condiment in Southeast Asia. Microbial spoilage makes CSP unsuitable for consumption within several days. Thermal treatment was applied to produce microbiologically safe CSP. The effect of heating process on physicochemical and sensorial properties of CSP was studied. Heating at the optimum condition (21.6 min, 80 ˚C) has been shown effective and reliable in controlling microorganisms in CSP. Complete inactivation of peroxidase activities could not be accomplished at the optimal point, and significant reduction of the total phenolic and capsaicinoids contents was observed. Sensorial evaluation indicated that thermally processed CSP was less preferred by panelists when compared to freshly prepared samples of dry weight respectively.
  10. Karim SM, Lim SM, Ilancheran A, Ratnam SS, Ang LT, Ng KH, et al.
    Ann Acad Med Singap, 1982 Oct;11(4):503-7.
    PMID: 7165271
    Prostaglandin E2 administered orally and combined with amniotomy was used for induction of labour at or near term in 1533 patients. The study was carried out as a collaborative project between the University Departments of Obstetrics and Gynaecology in Singapore, Medan (Indonesia) and Kuala Lumpur (Malaysia). The overall success rates for Medan, Kuala Lumpur and Singapore were 95.6%, 88.1% and 84.7% respectively.
  11. Ahmad-Shushami AH, Abdul-Karim S
    Malays Orthop J, 2020 Mar;14(1):28-33.
    PMID: 32296479 DOI: 10.5704/MOJ.2003.005
    Introduction: Football and futsal were the main sports in the Malaysian Games. However, they were associated with a risk of injury. The purpose of the study was to analyse the incidence, circumstances, and characteristics of football and futsal injuries during the Malaysian Games of 2018.

    Materials and method: During the tournament, 14 teams participated in men's football, 12 teams in men's futsal and 11 teams in women's futsal. The biannual event involved athletes aged under 21 years. A medical report form used by FIFA Medical Assessment and Research Centre (F-Marc), was provided to the physiotherapists and team doctors of all the teams to report all injuries after each match.

    Results: The response rate was 84.62% in football and 59.76% in futsal. A total of 48 injuries were reported from 26 football matches, equivalent to 64.64 injuries per 1000 match hours (95%CI 46.35 to 82.93). In futsal, a total of 48 injuries from 41 matches were reported, equivalent to 292.42 injuries per 1000 match hours (95% CI 209.7 to 375.14). The rate of injury in women futsal players was higher compared to men: 358.21 versus 247.04 injuries per 1000 match hours (p=0.224). Futsal recorded higher injuries per 1000 match hours than football (p<0.001).

    Conclusion: The rate of severe injury in futsal and football recorded in the study as compared to previous studies gave rise to serious concerns. Hence, there was an urgent need to pay more attention to injury prevention strategies.

  12. Tagami T, Tanaka H, Shin SD, Ma MH, Ko PC, Karim S, et al.
    Acute medicine & surgery, 2019 05 22;7(1):e430.
    PMID: 31988755 DOI: 10.1002/ams2.430
    Aim: As a population ages, it can impact on the characteristics and outcomes of cardiogenic out-of-hospital cardiac arrest (OHCA) patients. This study aimed to evaluate the relationship between the age incidence of cardiogenic OHCA and population aging.

    Methods: This was a post-hoc analysis of the Pan Asian Resuscitation Outcomes Study (PAROS) database. Data on the population old-age dependency ratio (i.e. elderly/non-elderly) were extracted from publicly accessible sources (United Nations and World Health Organization).

    Results: We analyzed 40,872 OHCA cases from seven PAROS countries over the period 2009 to 2013. We found significant correlation between the population old-age dependency ratio and elderly/non-elderly ratio in OHCA patients (r = 0.92, P = 0.003). There was a significant correlation between the population old-age dependency ratio and risk differences of 30-day survival rates for non-elderly and elderly OHCA patients (r = 0.89, P = 0.007).

    Conclusions: Our findings suggest that the proportion of elderly among OHCA patients will increase, and outcomes could increasingly differ between elderly and non-elderly as a society ages progressively. This has implications for planning and delivery of emergency services as a society ages.

  13. Hadi DM, Naeem MA, Karim S
    Int J Hosp Manag, 2022 Jul;104:103243.
    PMID: 35571508 DOI: 10.1016/j.ijhm.2022.103243
    This study investigated the connectedness of top ten hospitality stocks in the world and the impact of the COVID-19 pandemic on this connectedness. For this purpose, we employ the time-varying parameter vector autoregressions (TVP-VAR) to examine the return connectedness among the world's top ten hospitality stocks. We further utilize the wavelet coherence measure to test the impact of COVID-related indexes on the connectedness across the hospitality stocks from January 1, 2020 to July 16, 2021. Our findings explore a strong connectedness among the hospitality stocks, although the total connectedness index is considerably affected by the first wave, the second wave, and the approval of COVID-19 vaccines. France and UK hospitality stocks appeared to be dominant and were the highest net transmitters of spillover shocks to other sample stocks. We document that the COVID-19 pandemic is the prime driver of the hospitality stocks' connectedness during the sample period. Aside from the contribution to hospitality and finance literature, our conclusions and implications can also benefit parties such as hospitality firm managers, investors, portfolio managers, and policymakers.
  14. Khan K, Lustig G, Bernstein M, Archary D, Cele S, Karim F, et al.
    Clin Infect Dis, 2022 Aug 24;75(1):e857-e864.
    PMID: 34893824 DOI: 10.1093/cid/ciab1008
    BACKGROUND: People living with HIV (PLWH) have been reported to have a higher risk of more severe COVID-19 disease and death. We assessed the ability of the Ad26.CoV2.S vaccine to elicit neutralizing activity against the Delta variant in PLWH relative to HIV-negative individuals. We also examined effects of HIV status and suppression on Delta neutralization response in SARS-CoV-2-infected unvaccinated participants.

    METHODS: We enrolled participants who were vaccinated through the SISONKE South African clinical trial of the Ad26.CoV2.S vaccine in healthcare workers (HCWs). PLWH in this group had well-controlled HIV infection. We also enrolled unvaccinated participants previously infected with SARS-CoV-2. Neutralization capacity was assessed by a live virus neutralization assay of the Delta variant.

    RESULTS: Most Ad26.CoV2.S vaccinated HCWs were previously infected with SARS-CoV-2. In this group, Delta variant neutralization was 9-fold higher compared with the infected-only group and 26-fold higher relative to the vaccinated-only group. No decrease in Delta variant neutralization was observed in PLWH relative to HIV-negative participants. In contrast, SARS-CoV-2-infected, unvaccinated PLWH showed 7-fold lower neutralization and a higher frequency of nonresponders, with the highest frequency of nonresponders in people with HIV viremia. Vaccinated-only participants showed low neutralization capacity.

    CONCLUSIONS: The neutralization response of the Delta variant following Ad26.CoV2.S vaccination in PLWH with well-controlled HIV was not inferior to HIV-negative participants, irrespective of past SARS-CoV-2 infection. In SARS-CoV-2-infected and nonvaccinated participants, HIV infection reduced the neutralization response to SARS-CoV-2, with the strongest reduction in HIV viremic individuals.

  15. Rozman NAS, Tong WY, Leong CR, Anuar MR, Karim S, Ong SK, et al.
    Sci Rep, 2020 02 24;10(1):3307.
    PMID: 32094395 DOI: 10.1038/s41598-020-60364-0
    Essential oil of Homalomena pineodora inhibits diabetic pathogens; however, the activity was not sustainable when applied as wound dressing. This study aims to synthesise the essential oil nanoparticle using chitosan. The nanoparticles were synthesised with ion gelation method, confirmed by spectroscopic analysis. The spherical nanoparticles display a size of 70 nm, with strong surface charge of +24.10 mV. The nanoparticles showed an initial burst release followed by a slow release pattern for 72 h, following the first order of kinetic. The release behaviour was ideal for wound dressing. The antimicrobial activity was broad spectrum. The formation of nanoparticle enhanced the antimicrobial efficacy of the essential oil. The nanoparticle also showed a concentration-dependent killing behaviour on time-kill assay. In the 3D collagen wound models, the nanoparticles reduced the microbial growth by 60-80%. In conclusion, H. pineodora nanoparticles showed pharmaceutical potential in inhibiting microbial growth on diabetic ulcers.
  16. Rasool M, Iqbal J, Malik A, Ramzan HS, Qureshi MS, Asif M, et al.
    PMID: 24795768 DOI: 10.1155/2014/641597
    Oxidative stress, lipid peroxidation, and transaminase reactions are some of the mechanisms that can lead to liver dysfunction. A time-dependent study was designed to evaluate the ability of silymarin (SLN) and glycyrrhizin (GLN) in different dosage regimens to lessen oxidative stress in the rats with hepatic injury caused by the hepatotoxin carbon tetrachloride. Wistar male albino rats (n = 60) were randomly assigned to six groups. Group A served as a positive control while groups B, C, D, E, and F received a dose of CCl4 (50% solution of CCl4 in liquid paraffin, 2 mL/kg, intraperitoneally) twice a week to induce hepatic injury. Additionally, the animals received SLN and GLN in different doses for a period of six weeks. CCl4 was found to induce hepatic injury by significantly increasing serum alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and thiobarbituric acid reactive substances while decreasing total protein and the activities of reduced glutathione, superoxide dismutase, and catalase. Treatment with various doses of SLN and GLN significantly reduced ALT, AST, ALP, and TBARS levels and increased GSH, SOD, and CAT levels. Our findings indicated that SLN and GLN have hepatoprotective effects against oxidative stress of the liver.
  17. Shaikh Abdul Karim S, Md Tahir FA, Mohamad UK, Abu Bakar M, Mohamad KN, Suleiman M, et al.
    Int J Emerg Med, 2020 Oct 28;13(1):50.
    PMID: 33115412 DOI: 10.1186/s12245-020-00308-7
    BACKGROUND: During the COVID-19 pandemic, many countries instituted closure of borders from international and local travels. Stranded citizens appeal to their governments to embark on citizen repatriation missions. Between February and April 2020, the Government of Malaysia directed repatriation of its citizens from China, Iran, Italy and Indonesia. We describe the preparation and execution of the repatriation mission using chartered commercial aircraft. The mission objectives were to repatriate as many citizens based on aircraft capacity and prevent onboard transmission of the disease to flight personnel.

    RESULTS: Five repatriation missions performed was led by the National Agency for Disaster Management (NADMA) with the Ministry of Health providing technical expertise. A total of 432 citizens were repatriated from the missions. The operations were divided into four phases: the pre-boarding screening phase, the boarding and in-flight phase, the reception phase and the quarantine phase. The commercial aircraft used were from two different commercial airlines. Each mission had flight crew members between 10 and 17 people. There were 82 positive cases detected among the repatriated citizens. There was a single positive case of a healthcare worker involved in the mission, based on the sample taken on arrival of the flight. There were no infections involving flight team members.

    CONCLUSION: Medical flight crew must be familiar with aircraft fittings that differ from one commercial airline to another as it influences infection control practices. A clear understanding of socio-political situation of a country, transmission routes of a pathogen, disease presentation, and knowledge of aviation procedures, aircraft engineering and design is of great importance in preparing for such missions. Our approach of multidiscipline team involvement managed to allow us to provide and execute the operations successfully.

  18. Karim S, Naeem MA, Meero AA, Rabbani MR
    Environ Sci Pollut Res Int, 2023 Mar;30(15):42829-42844.
    PMID: 34826080 DOI: 10.1007/s11356-021-17459-6
    The current research presents fresh insights on empirically presenting the relationship between ownership structure and corporate sustainable performance of two emerging markets: Malaysia and Pakistan. Moreover, the moderating role of gender diversity is observed on the relationship between ownership structure and corporate sustainable performance. Dynamic estimator, named system generalized method of moments, is used for estimations that control for potential dynamic endogeneity, simultaneity, and reverse causality. Findings reveal that ownership concentration and state ownership are negatively related to economic, social, and environmental indicators of CSP both in Malaysia and Pakistan, whereas directors' ownership is positively associated with all sustainability indicators. Financial institution's ownership showed a positive significant impact on CSP in Malaysia, whereas an insignificant relationship is observed in Pakistan. Meanwhile, the moderating impact of women directors on the relationship between ownership structure and corporate sustainable performance reveals a significant impact in Malaysia and an insignificant impact in Pakistan. Generally, the findings of the study have practical implications for regulatory authorities, securities commissions, and policymakers of Malaysia and Pakistan. Moreover, there is a need to bring reforms into corporate governance structures in Pakistan, where weak economic conditions leave a frail impact of ownership structure on CSP and an insignificant moderating impact of board gender diversity.
  19. Karim S, Naeem MA, Tiwari AK, Ashraf S
    Ann Oper Res, 2023 May 03.
    PMID: 37361090 DOI: 10.1007/s10479-023-05365-8
    The sustainability issues have been surmounted in the last decades. The digital disruption caused by blockchains and other digitally backed currencies has raised several serious concerns for policymakers, governmental agencies, environmentalists, and supply chain managers. Alternatively, sustainable resources are environmentally sustainable and naturally available resources which are employable by several regulation authorities to reduce the carbon footprint and attain energy transition mechanisms to support sustainable supply chains in the ecosystem. Using the asymmetric time-varying parameters vector auto-regressions approach, the current study examines the asymmetric spillovers between blockchain-backed currencies and environmentally supported resources. We find clusters between blockchain-based currencies and resource-efficient metals, highlighting similar-class dominance of spillovers. We portrayed several implications of our study for policymakers, supply chain managers, the blockchain industry, sustainable resources mechanisms, and regulatory bodies to emphasize that natural resources play a significant role in attaining sustainable supply chains servicing the benefits to society at large and to other stakeholders.
  20. Goh SL, Jaafar Z, Gan YN, Choong A, Kaur J, Kundakci B, et al.
    PLoS One, 2021;16(5):e0252204.
    PMID: 34038486 DOI: 10.1371/journal.pone.0252204
    INTRODUCTION: Prolotherapy and other injections, primarily acting on pathways associated with maladaptive tissue repair, are recommended for recalcitrant chronic soft tissue injuries (CSTI). However, selection of injection is challenging due to mixed results. This network meta-analysis (NMA) aimed to compare prolotherapy with other therapies, particularly injections, for CSTI and establish robustness of the results.

    METHODOLOGY: Pubmed, Medline, SPORTDiscus and Google scholar were searched from inception to 4th January 2021 for randomised controlled trials (RCTs) involving injection therapies (e.g. blood derivatives, corticosteroid, hyaluronic acid, botulinum toxin) for CSTI. The primary and secondary outcomes were pain and function, respectively, at (or nearest to) 6 months. Effect size (ES) was presented as standardised mean difference with 95% confidence interval (CI). Frequentist random effect NMA was used to generate the overall estimates, subgroup estimates (by region and measurement time point) and sensitivity analyses.

    RESULTS: A total of 91 articles (87 RCTs; 5859 participants) involving upper limb (74%), lower limb (23%) and truncal/hip (3%) injuries were included. At all time points, prolotherapy had no statistically significant pain benefits over other therapies. This observation remained unchanged when tested under various assumptions and with exclusion of studies with high risk of bias. Although prolotherapy did not offer statistically significant functional improvement compared to most therapies, its ES was consistently better than non-injections and corticosteroid injection for both outcomes. At selected time points and for selected injuries, prolotherapy demonstrated potentially better pain improvement over placebo (<4 months: shoulder [ES 0.65; 95% CI 0.00 to 1.30]; 4-8 months: elbow [ES 0.91; 95% CI 0.12 to 1.70]; >8 months: shoulder [ES 2.08; 95% CI 1.49, to 2.68]). Injections generally produced greater ES when combined with non-injection therapy.

    CONCLUSION: While clinical outcomes were generally comparable across types of injection therapy, prolotherapy may be used preferentially for selected conditions at selected times.

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