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Letter to the Editor
DOI: 10.1016/j.bjpt.2020.05.006
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Available online 31 May 2020
Reply to letter to editor on “The addition of blood flow restriction to resistance exercise in individuals with knee pain: A systematic review and meta-analysis”
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Iván Cuyul-Vasqueza, Héctor Gutiérrez-Espinozab,c,
Corresponding author
kinehector@gmail.com

Corresponding author.
, Felipe Araya-Quintanillab,d
a Faculty of Health, Therapeutic Process Department, Temuco Catholic University, Temuco, Chile
b Rehabilitation in Health Research Center, CIRES, Universidad de las Américas, Echaurren Street 140, 3rd floor, Santiago, Chile
c Physical Therapy Department, Clinical Hospital San Borja Arriaran, Santiago, Chile
d Faculty of Health Sciences, Universidad SEK, Santiago, Chile
Highlights

  • The effect of resistance exercise with BRF is not more effective that resistance exercise in in patients with knee pain.

  • Our study was unable to demonstrate the clinical benefits of resistance exercise with BRF in subjects with knee pain.

  • Further studies are needed to support the clinical effect of BRF in pain intensity and knee function in these patients.

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Dear Editor

We appreciate the comments on our article “The addition of blood flow restriction to resistance exercise in individuals with knee pain: a systematic review and meta-analysis” (Cuyul-Vásquez et al.1). We would like to take the opportunity to address several points raised in these comments.

First, it is important to consider that performing subgroup analyses for meta-analysis with less than 10 studies and with high heterogeneity among the included studies, is not recommended.2,3 In our meta-analysis for pain intensity, the small number of included clinical trials (n = 5), the considerable heterogeneity (i2 = 76%) of these trials, and the lack of plausible interaction, justify our decision not to report a subgroup analysis. We understand how the contrast between the results of previous investigations and the findings of our study could be questioned. For this reason, in response to your letter, we performed a subgroup analysis for pain intensity, independently combining studies that used high intensity versus low intensity resistance exercises in the control group.

The comparison between low intensity resistance exercise (30%-1RM) combined with blood flow restriction (BFR) versus high intensity resistance exercise (70% -1RM),4–6 showed no benefits of BFR for pain relief (pooled SMD = -0.08, 95% CI = -0.41, 0.26, p = 0.66, I2: 24,7,8 the pooled SMD also showed no added effectiveness of BFR on pain relief (SMD= -0.51, 95% CI = -1.57, 0.55, p = 0.34, I2: 87%). Therefore, both comparisons are not statistically and clinically significant.9 While this subgroup analysis is affected by the limitations described in the first point of this letter, these findings support the conclusions of our systematic review with meta-analysis, that adding BFR to resistance exercise does not provide additional benefits to decrease knee pain.1

Conflicts of interest

The authors declare no conflicts of interest.

References
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I. Cuyul-Vásquez, A. Leiva-Sepúlveda, O. Catalán-Medalla, F. Araya-Quintanilla, H. Gutiérrez-Espinoza.
The addition of blood flow restriction to resistance exercise in individuals with knee pain: A systematic review and meta-analysis.
[2]
M. Richardson, P. Garner, S. Donegan.
Interpretation of subgroup analyses in systematic reviews: A tutorial.
Clin Epidemiol Glob Heal, 7 (2019), pp. 192-198
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Higgins JPT, Thomas J, Chandler J., Cumpston M., Li T., Page M.J., Welch VA. Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019). Cochrane, 2019. Available from www.training.cochrane.org/handbook.
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R.B. Ferraz, B. Gualano, R. Rodrigues, et al.
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N.A. Segal, G.N. Williams, M.C. Davis, R.B. Wallace, A.E. Mikesky.
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[9]
A.C. Lee, J.B. Driban, L.L. Price, W.F. Harvey, A.M. Rodday, C. Wang.
Responsiveness and minimally important differences for 4 patient-reported outcomes measurement information system short forms: Physical function, pain interference, depression, and anxiety in knee osteoarthritis.
J Pain, 18 (2017), pp. 1096-1110
Copyright © 2020. Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia
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Brazilian Journal of Physical Therapy

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