Human tendon adaptation in response to mechanical loading: a systematic review and meta-analysis of exercise intervention studies on healthy adults

Bohm, Sebastian; Mersmann, Falk; Arampatzis, Adamantios

doi:10.1186/s40798-015-0009-9

Sports Medicine - Open

Table 3 Methodological quality and risk of bias assessment of the included studies

From: Human tendon adaptation in response to mechanical loading: a systematic review and meta-analysis of exercise intervention studies on healthy adults

Study	Methodological quality																																		Risk of bias
	Internal validity																Statistical validity			External validity														Total score [%]	Sequence	Allocation	Blinding	Outcome	Report	Other
	1.1 ^a	1.2 ^a	1.3 ^a	1.4 ^a	2.1A ^b	2.1B ^b	2.1C ^b	2.1D ^b	2.1E ^b	2.1F ^b	2.1G ^b	2.2A ^b	2.2B ^b	3A ^b	3B ^b	Score [%]	4 ^a	5 ^a	Score [%]	6.1 ^a	6.2 ^a	7A ^b	7B ^b	7C ^b	7D ^b	7E ^b	7F ^b	8A ^b	8B ^b	8C ^b	8D ^b	8E ^b	Score [%]	Total score [%]
Albracht et al., 2013 [15]	+	-	-	+	-	+	+	+	-	+	-	/	/	-	+	51	+	-	50	+	+	+	+	+	+	+	+	-	+	+	+	+	95	65	Unclear	Unclear	Unclear	Yes	Yes	Yes
Arampatzis et al., 2007 [29]	+	+	+	+	-	+	+	+	-	+	-	+	+	+	-	87	+	-	50	+	+	+	+	+	+	+	+	+	+	+	+	-	95	77	Unclear	Unclear	Unclear	Yes	Yes	Yes
Arampatzis et al., 2010 [28]	+	+	+	-	-	+	+	+	-	+	-	+	+	+	-	72	+	-	50	+	+	+	+	+	+	+	+	+	+	+	+	-	95	72	Unclear’	Unclear’	Unclear	Yes	Yes	Yes
Bohm et al. [31]	+	+	+	+	-	+	+	+	+	+	+	+	+	+	+	98	+	+	100	+	+	+	+	+	+	+	+	+	+	+	+	+	100	99	Unclear	Unclear	Unclear	Yes	Yes	Yes
Carroll et al., 2011 [61]	+	+	+	-	+	-	-	-	-	+	+	+	+	-	+	70	+	-	50	+	+	+	-	+	+	+	+	+	+	+	+	+	96	72	Unclear’	Unclear’	Yes	Yes	Yes	Yes
Fletcher et al., 2010 [17]	+	-	-	+	-	+	+	-	+	+	-	/	/	+	+	60	+	-	50	+	+	+	+	+	+	+	+	+	+	+	+	+	100	70	Unclear	Unclear	Unclear	Yes	Yes	Yes
Fouré et al., 2009 [71]	+	-	-	+	-	+	-	-	-	-	-	/	/	+	+	46	+	-	50	+	+	-	-	+	-	+	+	+	+	+	+	+	88	61	Unclear	Unclear	Unclear	Unclear	Yes	Yes
Foure et al., 2010a,b, 2011 [38,56,57]	+	-	+	+	-	+	-	-	-	+	-	-	+	+	+	63	+	-	50	+	+	-	-	+	-	+	+	+	+	+	+	+	88	67	Unclear	Unclear	Unclear	Yes	Yes	Yes
Foure et al., 2013 [43]	+	-	+	+	-	+	-	-	-	+	-	-	+	+	+	63	+	-	50	+	+	-	-	+	-	+	+	+	+	+	+	+	88	67	Unclear	Unclear	Unclear	Yes	Yes	Yes
Hansen et al., 2003 [62]	+	-	+	-	-	-	-	+	+	+	-	+	+	-	+	56	+	-	50	+	+	-	+	+	+	+	+	+	+	+	+	+	96	67	Unclear’	Unclear’	Unclear	Yes	Yes	Yes
Hougthon et al., 2013 [39]	+	+	+	+	-	+	+	+	+	+	-	-	+	+	+	84	+	+	100	+	+	-	-	+	+	+	+	+	+	+	+	+	92	92	Unclear	Unclear	Unclear	Yes	Yes	Unclear⁺
Kongsgaard et al., 2007 [24]	+	+	+	-	+	+	-	+	-	+	-	+	+	+	+	74	+	-	50	+	+	+	-	+	+	+	+	+	+	+	+	+	96	73	Unclear’	Unclear’	Yes	Yes	Yes	Yes
Kubo et al., 2001a,b [37,42]	+	+	+	-	-	-	-	-	-	-	+	+	-	+	+	66	+	-	50	+	+	+	+	+	+	+	+	+	+	+	+	+	100	72	Unclear’	Unclear’	Unclear	Yes	Yes	Yes
Kubo et al., 2002 [25]	+	-	+	-	-	-	-	-	-	-	+	+	-	+	+	52	+	-	50	+	+	+	-	+	+	+	+	+	+	+	+	+	96	66	Unclear’	Unclear’	Unclear	Yes	Yes	Yes
Kubo et al., 2003 [63]	+	+	+	+	-	-	-	-	-	-	+	/	/	+	+	86	+	-	50	+	+	+	-	+	+	+	+	+	+	+	+	+	96	77	Unclear	Unclear	Unclear	Yes	Yes	Yes
Kubo et al., 2006a [40]	+	-	+	-	-	-	-	+	-	+	+	+	-	+	-	49	+	-	50	+	+	+	+	+	+	+	+	+	+	+	+	-	95	65	Unclear’	Unclear’	Unclear	Yes	Yes	Yes
Kubo et al., 2006b [87]	+	-	+	+	+	-	-	+	-	+	+	+	+	+	+	80	+	-	50	+	+	+	+	+	+	+	+	+	+	+	+	+	100	77	Unclear	Unclear	Unclear	Yes	Yes	Yes
Kubo et al., 2006c [88]	+	-	+	-	+	-	-	+	-	+	-	+	+	+	-	56	+	-	50	+	+	+	+	+	+	+	+	+	+	+	+	-	95	67	Unclear’	Unclear’	Unclear	Yes	Yes	Yes
Kubo et al., 2007 [59]	+	-	+	-	-	-	-	+	-	+	+	+	-	+	+	56	+	-	50	+	+	+	+	+	+	+	+	+	+	+	+	+	100	69	Unclear’	Unclear’	Unclear	Yes	Yes	Yes
Kubo et al., 2009 [60]	+	-	+	-	+	-	-	+	-	+	-	+	+	+	-	56	+	-	50	+	+	+	+	+	+	+	+	+	+	+	+	-	95	67	Unclear’	Unclear’	Unclear	Yes	Yes	Yes
Kubo et al., 2010 [52]	+	-	+	+	-	-	-	+	-	+	+	+	+	+	+	78	+	-	50	+	+	+	+	+	+	+	+	+	+	+	+	+	100	76	Unclear	Unclear	Unclear	Yes	Yes	Yes
Kubo et al., 2012 [72]	+	-	+	+	-	-	-	+	-	+	+	+	+	+	-	70	+	-	50	+	+	+	+	+	+	+	+	+	+	+	+	+	100	73	Unclear	Unclear	Unclear	Yes	Yes	Yes
Malliaras et al., 2013 [41]	+	+	+	+	+	-	-	+	-	+	+	-	-	+	+	80	+	-	50	+	+	+	+	+	+	+	+	+	+	+	+	+	100	77	Unclear	Yes	Yes	Yes	Yes	Yes
Seynnes et al., 2009 [30]	+	+	+	-	+	-	-	+	+	-	-	+	+	+	+	78	+	-	50	+	+	+	-	+	+	+	+	+	+	+	+	+	96	74	Unclear’	Unclear’	Unclear	Yes	Yes	Yes

Methodological quality: 1 Study design (1.1 Mechanical properties, 1.2 Material properties, 1.3 Morphological properties, 1.4 Control group), 2 Methods (2.1 Mechanical properties, 2.1A Object of investigation, 2.1B Gravitational forces, 2.1C Axes misalignment, 2.1D Antagonistic muscle activation, 2.1E Lever arm measured, 2.1F Joint angle change, 2.1G Used multiple trials, 2.2 Morphological properties, 2.2A MRI, 2.2B different positions), 3 Cofactors (3A Gender, 3B Activity level), 4 Statistical tests, 5 Power analysis, 6 Eligibility (6.1 Participants, 6.2 Variables), 7 Description exercise protocol (7A Intensity, 7B Duration single stimulus, 7C Repetitions, 7D Sets, 7E Weeks, 7F Times per week), 8 Description participants (8A Gender, 8B Age, 8C Body height, 8D Body weight, 8E Activity level). The single criteria were rated (+, point; -, no point; /, not included) and used to calculate the quality score for each category (i.e., internal, statistical, and external validity). The average of the three scores gives the total score. ^aA full point was assigned to each sub-category for the calculation of the score in the respective validity section (assigned points/possible points * 100). ^bThe sub-categories of the respective block were pooled to a single point (assigned points/possible points). Risk of bias [46]: Sequence, adequate sequence generation; Allocation, allocation concealment; Blinding, blinding outcome assessor; Outcome, incomplete outcome data; Report, selective outcome reporting; Other, other sources of bias. Judgments: Yes, low risk of bias; Unclear, insufficient information reported (’, only one group; ⁺, significant difference of baseline tendon cross-sectional area values between the control and training group). The three studies of Foure et al. [38,56,57] and the two studies of Kubo et al. [37,42] were merged as one, since the results of one intervention were reported in different publications.

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