The purpose of this Question Verification Form is to enable Priority Setting Partnerships (PSPs) to describe clearly how they checked that their questions were unanswered, before starting the interim prioritisation stage of the process.
The JLA requires PSPs to be transparent and accountable in defining their own scope and evidence checking process. This will enable researchers and other stakeholders to understand how individual PSPs decided that their questions were unanswered, and any limitations of their evidence checking.
Name of the PSP
First Time Soft Tissue Knee Injuries
Please describe the scope of the PSP
The scope of the First Time Soft Tissue Knee Injuries PSP is defined as:
- The prevention, diagnosis, management and delivery of services relating to first time soft tissue knee injuries
- The first injury causing disability, which may lead to repeated injuries. These can be sports related or secondary to work and accidents e.g. twisting your knee whilst walking. They can cause swelling, pain, instability, difficulty walking and reduced movement of the affected knee.
- Include patella (kneecap) dislocations, ligament injuries, cartilage injuries (meniscus/joint surface)
- Include patients who are 12 years and older
The PSP will exclude from its scope questions about:
- Chronic injuries (i.e. not first injury)
- Patients younger than 12 years old
- Fractures
Please provide a brief overview of your approach to checking whether the questions were unanswered
Questions submitted by patients, carers and clinicians to the survey were collated and categorised into indicative questions. These preliminary questions were agreed on by the Steering Group. The verification process aimed to determine which of these questions are unanswered by research to date.
Our search strategy was stepwise starting with the most reliable sources and working down. This enabled answered questions to be identified efficiently.
The following process was followed for each question:
- Guidelines (NICE, SIGN, Royal College or Professional association e.g. BOA, BASK, BOSTAA) were reviewed to determine whether they covered that question. If they did, then evidence behind the guidelines was reviewed. Where this evidence was low-quality, e.g. observational research or expert consensus, this was discussed with the steering group to determine whether to consider the question answered or unanswered.
- Cochrane reviews were searched using keywords specific to each question. Where a review called for further research, the question was not considered answered. If the systematic review was older than 5 years old, recent RCTs were also searched to ensure the question had not been answered more recently.
- Database searches were conducted using keywords specific to each question. Randomised controlled trials (RCTs) were reviewed as well as long -term prospective cohort studies, and if no strong conclusion could be drawn from the study, the question was considered unanswered.
- Ongoing and future trials were reviewed on registries. These were used to identify questions that may be answered in the coming years. The aim was not to exclude questions at this stage but to take these in to account to help refine the questions for the interim workshops and prioritise those taken to the final workshop.
Please list the type(s) of evidence you used to verify your questions as unanswered
- National Guidelines (NICE, BOA, BASK, BOSTAA)
- Systematic Reviews, including Cochrane
- Clinical trials including RCTs and cohort prospective trials were reviewed
- Ongoing and future trials were logged
Please list the sources that you searched in order to identify that evidence
Systematic review/meta analysis or RCT evidence found via:
- Cochrane Central Register of Controlled Trials
- EMBASE, Medline, Pubmed
- PEDro (For Physio literature)
- The WHO International Clinical Trials Registry Platform Search Portal (http://www.who.int/ictrp/en),
- the US National Institute of Health Trials Registry (https://clinicaltrials.gov)
- Published UK national guidelines – NICE, BOA, BASK, BOSTAA
What search terms did you use?
Keywords of each question were used in each database and tailored to each question.
Main soft tissue knee injury search with limits (adolescent ages + adults, clinical trials, randomised control trials, systematic review, meta analyses):
1 soft tissue knee injur*.mp. 18
2 knee injuries/ or anterior cruciate ligament injuries/ or patellar dislocation/ or tibial meniscus injuries/ 30363
3 1 or 2 30363
4 Cartilage, Articular/ 32345
5 Knee/ 15650
6 4 and 5 475
7 ligament.mp. or ligaments.ti,ab. [mp=title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms] 89998
8 5 and 7 1514
9 meniscus.mp. or menisci.ti,ab. [mp=title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms] 16006
10 5 and 9 495
11 patella dislocation.ti,ab. 224
12 patellar dislocation.ti,ab. 1249
13 11 or 12 1406
14 3 or 6 or 8 or 10 or 13 32338
15 ((ligament or tibial meniscus or articular cartilage) adj3 (injur* or tear* or torn*)).ti,ab. 11312
16 14 or 15 38405
17 limit 16 to (("adolescent (13 to 18 years)" or "young adult (19 to 24 years)" or "adult (19 to 44 years)" or "young adult and adult (19-24 and 19-44)" or "middle age (45 to 64 years)" or "middle aged (45 plus years)" or "all aged (65 and over)" or "aged (80 and over)") and (clinical trial, all or meta analysis or randomized controlled trial or "systematic review")) 1950
18 16 and 17 1950
Relevant terms and synonyms were used for each questions following the above base search.
Please describe the parameters of the search (eg time limits, excluded sources, country/language) and the rationale for any limitations
- Recent evidence (last 5 years) was seen to be stronger than older evidence.
- The search was limited to English only for clinical guidelines.
- No language limitation for systematic reviews or studies.
Names of individuals who undertook the evidence checking
- Humza Osmani
- All uncertainties were discussed with the Steering Group
On what date was the question verification process completed?
14/09/22
Any other relevant information
Consultant Orthopaedic Surgeons from Cambridge, Warwick, Leeds and Sheffield were all consulted to confirm no significant papers were missed.