ISSN 1517-8692 printed version
ISSN 1806-9940 versão on-line



Scope and Politics

Revista Brasileira de Medicina do Esporte (RBME) (Brazilian Journal of Sports Medicine), the official publication of the Brazilian Society of Exercise and Sports Medicine (SBMEE), is published every two months, with six editions per year (Jan/Feb, Mar/Apr, May/Jun, Jul/Aug, Sep/Oct and Nov/Dec), and versions in Portuguese, English and Spanish. RBME is indexed in the following bibliographic databases: SciELO, Web of Science, Excerpta Medica-EMBASE, Physical Education Index, LILACS, SIRC-Sportdiscus, and Scopus.
The publication fully adheres to the international recommendations of the International Committee of Medical Journal Editors (ICMJE), commonly referred to as the Vancouver Convention, and its standardization requirements [].

Publication Fee: To ensure the sustainability and continuity of RBME, we inform authors that starting in January 2014, an article publishing fee was introduced. Authors are now required to pay a fee for articles accepted for publication. This fee will be charged upon approval of the article. Following acceptance of the manuscript and notification by the editor-in-chief, the author(s) must make a bank deposit in the name of the Associação Brasileira de Medicina do Esporte (Brazilian Association of Sports Medicine), CNPJ (Corporate Taxpayer’s ID) 30.504.005-0001-12, Bradesco Bank, Agency 0449, Account number 0001353-6. The receipt of deposit should then be sent to the email address, stating the protocol number of the work (RBME-0000), the title of the article, and the name of the corresponding author. This publication fee is R$2000 (US$600) for articles submitted to the English or Portuguese versions of the journal.

Translation Rate: RBME is published in three versions: English, Portuguese and Spanish. At the present time, the Spanish version is produced without any additional fee. Articles may be submitted in Portuguese and/or English. If an article is approved, it must then be submitted in the other language if the original submission was in one language only. Thus, if the article was submitted in English, a version in Portuguese must be sent, and vice versa. If the author would like the translation be arranged by RBME, a request must be made within five days. Otherwise, the author must submit the translated version within twenty-five days after the notification of acceptance for publication (see the translation fees and other information in the tables below). If the second language is not delivered within the time stipulated, the article will be canceled.
Therefore, for approved articles, translation into the other language is compulsory. We recommend sending the articles in both languages in the initial submission to facilitate production. Any changes requested by the author after the article has been accepted and is in the editing phase must be made to both versions.
Translation arranged by the author:
1- Authors who submit their article in one language only must send an email to, within 5 working days of the acceptance for publication, stating whether the translation is to be arranged by RBME or by the author.
2-The translated version must be sent within twenty-five consecutive days of the date of notification of acceptance for publication.
3-We recommend that all articles undergo a complete review of the English before they are submitted. If any changes are required later on, this may incur additional fees, or the article may be rejected.
4-Once the layout is completed, a final proof will be returned to the author. In this stage only minor corrections may be made. If we do not hear from the author with any corrections within two days, this will be deemed the final version.
If the translated version is not received within twenty-five days, the publication of the article will be cancelled.
Translation arranged by RBME:
1- Authors who submit their article in one language only must send an email to, within 5 working days of the acceptance for publication, stating whether the translation is to be arranged by RBME or by the author.
2-Translation Fee: Articles will be divided into three Groups (see options below) for payment of the translation into Portuguese/English, together with the publication fee:
3-Authors will have up to seven consecutive days, from the date of receipt of the communication, to make the payment as instructed in the section Publication Fee, above.
4-Once the layout is completed, a final proof will be returned to the author. In this stage, only minor corrections may be made. If we do not hear from the author with any corrections within two days, this will be considered the final version.

Publication Fee + Translation Fee

Group 1: 

Submission of articles in two versions: English and Portuguese. Only a Publication Fee of R$2000 (US$600) will be charged.

Group 2: 

Submission of articles in Portuguese only. A Publication Fee of R$2000 plus a Translation Fee of R$850 will be charged, making a total of R$2850 (US$850).

Group 3: 

Submission of articles in English only. A Publication Fee of R$2000 plus a Translation Fee of R$500 will be charged, making a total of $2500 (US $750).


For articles submitted for evaluation from February 2019, there will be an additional translation fee for the Spanish version of R$850.

Note: For fully paid-up members of the Brazilian Society of Sports Medicine and Exercise (SBMEE) the Publication Fee will be reduced to R$1700 (US $530).
On submission of the manuscript, after filling out the registration form, the author must read and agree to the terms of originality, relevance and quality, and to the payment of the applicable fees. Once these obligations have been acknowledged, the manuscript will be registered in the system for evaluation.

If payment is not received within seven days, from the date of receipt of the communication of acceptance of the article for publication, this will result in the publication of the article being canceled.


Manuscript outlining and preparation

Instructions for Submission of Articles: 
Articles must be submitted directly via the SciELO online submission system: The following supplementary documents should be submitted together with the article: (1) Term of Disclosure of Potential Conflicts of Interest; (2) Term of Copyright Transfer; and (3) Statement of Authors' Contribution, with the ORCID (Open Researcher and Contributor ID)number of each author. Articles or supplementary documents submitted by email, post, or any means other than to the electronic address mentioned above will not be accepted.

Double submission: Articles submitted to RBME will only be considered for publication on the condition that they have not been published elsewhere, or are not under consideration for publication in another periodical, whether wholly or in part. RBME will not consider articles for publication if the information contained in them has been made available on the Internet for public access. If a submitted article includes any material, such as figures or tables, obtained from any other published source, it must be accompanied by a copy of the original material, and the original author’s written permission to reproduce the material must also be provided. 

Plagiarism: RBME adopts Similarity Check/Ithenticate plagiarism detection system. Nevertheless, all content published in the articles is the authors’ sole responsibility. Should plagiarism be detected, in any form, the authors of the submitted article will be contacted by RMBE and asked to provide an explanation. If any plagiarism comes to light after the journal is published, the article in question will not be withdrawn from the edition; an addendum of plagiarism will be affixed to the publication, with explicit identification on the cover sheet in a full-sized strip detailing the content. The Journal will not be responsible for notifying the original author about the plagiarized content.

Conflict of Interest: The author should make explicit any potential conflict of interest related to the submitted article, in accordance with the rules of the National Health Surveillance Agency (RDC 102/2000) and the Federal Board of Medicine (Resolution no. 1.595/2000). The purpose of this requirement is to inform publishers, reviewers and readers about any professional and/or financial relationships (such as sponsorships and corporate affiliations) with financial agents related to pharmaceutical products or equipment involved in the work that could potentially influence the interpretations and conclusions of the article. A Conflict of Interest Statement will be published at the end of every article. 

Bioethics of experiments on human beings
All experiments involving human beings should follow the specific resolution of the Brazilian National Health Council (no. 196/96) available at, including signing an Informed Consent Form and protection of the research subjects’ confidentiality. In experimental studies involving human beings, the authors should indicate whether the procedures followed the ethical standards of the committee responsible for human experimentation (institutional and national) and the Declaration of Helsinki of 1975, revised in 2008. A Statement of Approval from the local ethics committee should be sent via the online system Plataforma Brasil. Studies conducted in humans must comply with ethical standards and must obtain the informed consent of the research subjects, according to Resolution 466/2012 of the National Health Council of the Brazilian Ministry of Health, which gives the Code of Ethics for Research involving Human Beings, or for authors outside Brazil, such studies must be comply with the standards of the Committee on Publication Ethics (COPE).

Bioethics of experiments on animals 
The work described in the article must have been conducted according to the ethical principles for animal experimentation, according to Law 11,794/08, which sets out the procedures for the scientific use of animals, and stipulates that research projects must be submitted to the research ethics committee of the Institution concerned (
For more information, go to the website of the National Council for Control of Animal Experimentation (CONCEA) ( and the Brazilian Board of Animal Experimentation (COBEA) (

Clinical Trials: RBME supports the policies of the World Health Organization (WHO) and the International Committee of Medical Journal Editors (ICMJE) for registering clinical trials, recognizing the importance of these initiatives for the international registration and dissemination of information about open-access clinical studies. Therefore, clinical research articles will only be accepted for publication if they have received an identification number in one of the Clinical Trial Registers validated by the WHO and ICMJE criteria [], the email addresses for which are available on the ICMJE website.

Peer Review: After complete verification by the editorial Secretariat, and a Preliminary analysis by the editors (desk review), the article can be submitted for a double-blind peer review by reviewers with experience and professional competence in the respective area of the work, who will issue opinions that will be used by the editors when deciding on whether to accept it for publication. The evaluation criteria include: originality, relevant contribution to the field, appropriate methodology, clarity, and timely relevance. In view of the increasing number of submissions to RBME, articles will also be evaluated for their relevance and contribution to specific knowledge in the field. Thus, an article with appropriate methodology and consistent results may not be accepted for publication if it is deemed by the editors to be of low relevance. This decision not to accept an article may not be appealed or disputed by the authors. Articles accepted for publication may undergo editorial changes to facilitate clarity and understanding, without, however, altering their content. 


  • The analysis procedure for all scientific contributions is as follows:
    Editorial Secretary → Editor-In-Chief → Associate Editors and Members of the Editorial Board.
  • All papers sent to RBME will be submitted for initial evaluation by the editors (desk review), who will decide whether or not to send it for peer review.
  • Only submissions that strictly adhere to the specified norms and that include all the required supplementary documents will be forwarded to the editors.
  • If any documents are missing, the article will be kept on file for seven days.
  • The author will have thirty days from the date of receipt of the communication, to make any changes requested by the reviewers. Failure to meet this deadline will result in the article being withdrawn from the review process.
  • Once the article has been accepted for publication, no voluminous or substantial changes will be accepted. The same applies to the final proof of the article.
  • Requests sent by RBME prior to approval of the article shall be made via the SciELO online submission system.
  • Requests sent by RBME after approval of the article must be made by the email address and no longer via SciELO online submission system.
  • The subject line used in the should not be altered, and any matters not related to the subject of the email should be addressed in a separate email, giving it an appropriate subject line and stating the identification number of the article.
  • The final layout of the versions in Portuguese, English and Spanish will be sent to the author, who should return them within forty-eight hours, with only minimum changes. If the author does not reply within this period, these will be deemed the final versions for publication, and no changes may be made thereafter.

Copyright: All statements published in the articles are the author’s sole responsibility. However, all published material becomes the property of the publisher, which assumes the copyright. Therefore, no material published in RBME may be sold or published without the written permission of the publisher. All authors of articles submitted to RBME must write and sign a Copyright Transfer Agreement, which will come into effect on the date of acceptance of the work. 

Preparation Of Articles: The RBME journal only accepts the following types of article: original article, review article, systematic review, update, meta-analysis, Case report, letter to the editor, and editorial.
All submitted articles must be typed in double space, Arial 12 font, on A4 pages, without line or paragraph numbering. Figures and tables must be presented at the end of the article, each on a separate page. The locations for insertion of tables or figures must be clearly marked in the body of the text. Numbers less than ten should be written out in full, while numbers greater than ten should be written in Arabic numerals. Articles that do not follow the instructions for authors in regard to style and format will be returned by the Editorial Board without being reviewed.
Measurements should be expressed in the International System (Système International, SI), available at and standard units, where applicable. It is recommended that authors do not use abbreviations in the title, and limit their use in the abstract and throughout the text. Generic names should be used for all drugs. Pharmaceutical products may be referred to by their commercial names, but the manufacturer’s name, city or country, or email address must be included in parentheses, in the Material and Methods section.

Checklist: RBME strongly recommends that the authors follow the standards given in the Checklist and Flowchart indicated for the type of article submitted:
CONSORT- controlled and randomized trials
STARD - diagnostic Accuracy Studies
MOOSE - meta-analyses and systematic reviews of observational studies
Prism - systematic reviews and meta-analyses
STROBE - observational studies
RATS - qualitative studies

Abbreviations: The use of abbreviations should be kept to a minimum. Abbreviations should be defined when used for the first time in the abstract and also in the text. Non-standard abbreviations should not be used, unless they appear at least three times in the text.
Units of measurement (3 ml or 3 mL, not 3 milliliters) or standard scientific symbols (e.g., Na for sodium) are not considered abbreviations, and therefore do not need to be defined. Abbreviate chemical substances and terms used for therapeutic combinations. Abbreviations on figures and tables may be used if space is limited, but should be defined in the caption, even if they have been defined in the text of the article itself.

Identification of the authors: The ORCID number (Open Researcher and Contributor ID, of each author should be given in the statement of authors’ contributions, as outlined below.

Statement of authors’ contributions: This must be included at the end of the article, using two minimum criteria of authorship, which include:

  • Substantial contribution to the concept or design of the work, or to the acquisition, analysis or interpretation of the data for the work;
  • Writing or critically reviewing the manuscript and its intellectual content;
  • Final Approval of the version of the manuscript to be published;
  • Agreeing to take responsibility for all aspects of the study, to ensure that any issue related to the integrity or accuracy of any portion of it is duly investigated and resolved.

All articles must include a description of the authors' contributions, using the following model:
"Each author made significant individual contributions to this manuscript. MJ (0000-0000-0000-0000)*: writing, revision and performing the surgeries; CPV (0000-0000-0000-0000)*: surgeries, analysis of the data, and writing; JVC (0000-0000-0000-0000)*: statistical analysis, surgeries and revision; OMA (0000-0000-0000-0000)*: analysis of slides and revision; MASP (0000-0000-0000-0000)*: writing and revision, and intellectual concept; ACA (0000-0000-0000-0000)*: surgery, writing, statistical analysis, intellectual concept and preparation of the entire research project. *ORCID (Open Researcher and Contributor ID).”

File Format: Use Microsoft Word® For Windows®text editor or equivalent. Files in PDF format will not be accepted. Tables and graphs should be in their original, editable file format (Excel, Access, PowerPoint, etc.). Figures should be in jpg or tif format, with high resolution (300 dpi). Figures should be included in the Word file, but should also be sent separately (submitted as supplementary documents, in their original files, along with the article submission).

Title Page: The title page should contain (1) the category of the article; (2) the title of the article which must be objective and informative. It must be written in Portuguese, English and Spanish with up to 80 characters each; (3) the full name of each author; institution; relevant academic degrees of origin (e.g. physician, physiotherapist, psychologist, physical education professional, etc.); city, state and country; (4) name of the corresponding author, with full address, telephone number and email address. The authors’ academic titles should not be included. The full name of each author (without abbreviations); and their institutional affiliation (note: The hierarchical units should be presented in descending order, e.g., University, college or Institute and Department) should be shown. The full names of the institutions and courses/programs should be shown, in the original language of the institution, or in English if the original is in a non-Latin script (e.g. Arabic, Mandarin, Greek);

Abstract: Each article must include abstracts in Portuguese, English and Spanish. Each version of the abstract should contain no more than 300 words. A structured version is mandatory for original articles, and must include an introduction, objectives, methods, results and conclusion. Review articles and other types of article do not require a structured abstract. Graphical abstracts will be accepted. In this case, the information should consist of a concise, pictorial and visual image of the main conclusions of the article. This could be either the concluding figure from the article or a figure that is designed specially for the purpose, which captures the content of the article for readers at a single glance. Figures include all illustrations, such as photographs, drawings, maps, graphics, etc., and must be identified with the name of the article.
The submission of a graphical abstract is optional, and should be sent in separate file, properly identified. The file must have the file extension .tif and/or .jpg. Files with .xls (Excel) extensions are also accepted; .eps; .psd for illustrations, including graphs, drawings and diagrams.
Abstracts should include the Level of Evidence and the Type of Study, according to the classification table annexed at the end of this text.

Keywords: The article must include no fewer than three and no more than six keywords, in the Portuguese, English and Spanish versions, based on the Health Sciences Descriptors (DeCS), or the Medical Subject Headings (MeSH) of the National Library of Medicine, available in, or based on the Medical Subject Headings (MeSH) of the Index Medicus (

Introduction: The Introduction should include: (1) objective justification for the study, with references of relevance to the subject, without giving an extensive review; (2) purpose of the article. 

Materials and Methods: This section should describe the experiments (quantitative and qualitatively) and the procedures in sufficient detail to enable other researchers to reproduce the results or continue the study. It should contain: (1) a clear description of the sample used; (2) an informed consent form for experimental studies involving human beings; (3) identification of the methods, devices (name of the manufacturer should be mentioned in parentheses) and procedures used; (4) a brief description and references for published, but not widely known methods; (5) a detailed description of new or modified methods; (6) where relevant, include statistical analyses and the programs used. 
Important: When reporting experiments involving humans or animals, indicate whether the procedures followed the norms of the Ethical Committee on Human Experiments of the institution where the research was conducted, and whether the procedures are in accordance with the Helsinki Declaration of 1995 and Animal Experimentation Ethics, respectively. Authors should include a statement indicating that the protocol was approved by the Ethics Committee of the Institution (the institution with which at least one of the authors is affiliated), with the respective identification number. It should also mention that an Informed Consent Form was signed by all the study subjects.

Results: Present the results in logical sequence in the text, using tables and figures. Avoid excessive repetition of data in the text, tables or figures. Emphasize only the most important discoveries. 

Discussion: Emphasize the original and important aspects of the study and the conclusions that arise from it. Avoid repeating information already presented in other parts of the manuscript. For experimental studies, emphasize the relevance and limitations of the results, comparing with the literature, and including implications for future studies. 

Conclusion: Should be clear and concise, based on the results obtained, establishing a connection with clinical implications, while avoiding excessive generalization. The same emphasis should be given to studies with negative or positive results. Recommendations can be included, where relevant.

Acknowledgements: Where relevant, include acknowledgements or recognition of people who have contributed to the development of the work but do not qualify as co-authors. Sources of funding, such as research assistance and study grants, should be acknowledged in this section. The authors should obtain written permission to mention the names and institutions of all those mentioned in this section. 

References: Citations to references should be numbered in the order in which they appear in the text, in superscript font, e.g,: 1,2,3. References cited only in tables or figures should be numbered according to the order established by the first mention of the table or the figure in the text. The style of bibliographical references should follow the rules of the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (International Committee of Medical Journal Editors, available at Ann Intern Med. 1997;126(1):36-47 Some examples are given below. Journal titles should be abbreviated according to the Index Medicus (List of Journals Indexed, available at: If the journal is not listed in this index, the abbreviation suggested by the journal itself should be used. Abstracts of papers presented at events should only be used if they are the only source of information. All references from the current year or the previous five years should appear in bold font.

1) standard journal article
Up to six authors may be listed. If there are more, list the first six authors, followed by et al.
Example: Author(s). Title of the article. Title of the journal. Year;Volume(issue number):first-last page numbers.
Goate AM, Haynes AR, Owen MJ, Farrall M, James LA, Lai LY, et al. Predisposing locus for Alzheimer’s disease on chromosome 21. Lancet. 1989;1(8634):352-5.
2) Institutional Author
The Royal Marsden Hospital Bone-Marrow Transplantation Team. Failure of syngeneic bone-marrow graft without preconditioning in post-hepatitis marrow aplasia. Lancet. 1977;2(8041):742-4.
3) Book with author(s) responsible for the entire content
Armour WJ, Colson JH. Sports injuries and their treatment.  2nd ed. London: Academic Press; 1976. 
4) Book with editor(s) as author(s)
Diener HC, Wilkinson M, editors. Drug-induced headache. New York: Springer-Verlag; 1988.
5) Book chapter 
Weinstein L, Swartz MN. Pathologic properties of invading microorganisms. In: Sodeman WA Jr, Sodeman WA, editors. Pathologic physiology: mechanisms of disease. Philadelphia: Saunders; 1974. p.457-72.
6) Electronic Material
Author(s). Title of the article. Abbreviated journal title [support]. Date of publication [date accessed, with the phrase "accessed on"]; Volume (number):first-last pages or [approximate number of pages]. Website with the phrase "Available at:" Example: Pavezi N, Flores D, Perez CB. Proposição de um conjunto de metadados para descrição de arquivos fotográficos considerando a Nobrade e a Sepiades. Transinf.
[Internet]. 2009 [Access on 2010 Nov 8]; 21(3):197-205. Available at:

Tables: Tables must be created in 1.5 line spacing, and should be planned for a width of one (8.7 cm) or two columns (18 cm) and up to 12 lines. Each table must have a succinct title. Explanatory Notes will be included in footnotes. The table should contain dispersion means and measures (Standard Deviation, Standard Error of the Mean, etc.) and should not contain any irrelevant decimal places. Abbreviations should be consistent with those used in the text and figures. The identification codes for table items must be listed in the order in which they appear, in the horizontal direction, and must be identified using standard symbols. Charts and tables must be sent in their original, editable files (Word, Excel) and not as images.

Figures: In the printed version of RBME, figures in black and white will be accepted. Images in color may be published if color is essential to the scientific content of the article. In these cases, the authors will be responsible for the additional cost. Color figures may be included in the electronic version of the article at no additional cost to the authors. Drawings and figures should be consistent and as simple as possible, but informative. Grayscale should not be used. All lines must be solid. For bar charts, for example, use black/white bars with diagonal lines in either direction, grid lines, horizontal and vertical lines. RBME does strongly advises against the use of photographs of equipment and animal experiments. Figures should be printed with good contrast and should be no wider than single column width (8.7 cm). If the figure is of an X-ray or photograph, we suggest including the size scale, where relevant.
Please note that it is the author’s responsibility to obtain permission from the copyright holder to reproduce figures (or tables) that have previously been published in other sources. According to the principles of open access, the authors must have permission from the copyright holder if they wish to include images that have been published in other unopened access journals. This permission must be indicated in the captions to figures, and the original source must be included in the list of references.
The submission of videos is optional, and will accompany the online version of the article. Videos should be submitted together with the article, in a separate file, accompanied by a caption. Videos must be sent in MP4 digital format.

Types of articles 
Original Article: RBME accepts all kinds of original research in the areas of Exercise and Sports Sciences and Medicine, including research involving human beings, and experimental research. The article should contain the following items: a structured Abstract, keywords, Introduction, Materials and Methods, Results, Discussion, and Conclusions.
Review Articles: Review Articles are usually commissioned by the editor to be written by authors with proven experience in the area. These express the author's experience and should not simply reflect a review of the literature. Review Articles should address specific topics in order to update readers on specific themes, topics or issues in the areas of Medicine and Exercise and Sport Sciences. The Editorial Board will evaluate the quality of the article, the relevance of the chosen theme, and the proven merit of the authors in the specific area addressed. If any of the above items is deemed inadequate, the article will be rejected by the editors, without being submitted to a peer review.
Systematic Review/update/meta-analysis: RBME encourages authors to submit systematic literature review articles in the areas of Exercise and Sports Sciences and Medicine. The Editorial Board will evaluate the quality of the article, the relevance of the chosen theme, the bibliographic search procedure, the criteria for inclusion of the articles and the statistical treatment used. If any of the above items is deemed inadequate, the article will be rejected by the editors, without being submitted to a peer review.

Case Report: Specific clinical cases that bring relevant and illustrative information about the diagnosis or treatment of a particular case that is rare in Exercise and Sport Medicine. The articles must be objective and accurate, and must include the following: abstract; introduction; an objective report containing the history, physical examination and findings of complementary exams, as well as treatment and follow-up; discussion, explaining in detail the clinical implications of the case in question, and comparing with the literature, highlighting similar cases reported in the literature; bibliographic references.

Letter to the editor: Letters addressed to the Chief Editor of RBME will be considered for publication if they promote intellectual discussion about a particular article that was recently published in the journal. Letters to the editor must include an informative title and follow the instructions above for publication. They must be no longer than 500 words. If accepted, a copy will be sent to the author of the original article that prompted the discussion, inviting him or her to submit a replica that will be published along with the letter.


Manuscripts Sending

Submission of articles: Since January 2008, RBME has adopted the SciELO online Publication and Submission System available at Authors should follow the registration instructions and include the articles in the system itself.


[This chart was adapted from material published by the Centre for Evidence-Based Medicine, Oxford, UK. For more information, please see]
Type of Studies


Therapeutic Studies—
Investigating the
Results of Treatment

Prognostic Studies—
Investigating the
Effect of a Patient
Characteristic on the
Outcome of Disease

Diagnostic Studies—
Investigating a
Diagnostic Test

Economic and Decision
Analyses—Developing an
Economic or Decision Model


High quality randomized trial with statistically
significant difference or no statistically significant difference but narrow confidence intervals
Systematic reviewb of Level I RCTs (and study results were homogenousc)

High quality prospective study d (all patients were enrolled at the same point in their disease with ≥80%
of enrolled patients)
Systematic reviewb of Level I studies

Testing of previously developed diagnostic criteria on consecutive patients 
(with universally applied
reference ‘‘gold’’  standard)
Systematic reviewb of Level I studies

Sensible costs and alternatives; values obtained from many studies; with
multiway sensitivity analyses
Systematic reviewb of Level I studies


Lesser quality RCT (eg, < 80% followup, no blinding, or improper
comparative studye
Systematic reviewf of Level II studies or Level I studies with inconsistent results

Untreated controls from an RCT
Lesser quality prospective study (eg, patients enrolled at different points in their disease or <80% followup)
Systematic reviewb of Level II studies

Development of diagnostic criteria on consecutive patients (with universally applied reference ‘‘gold’’ standard)
Systematic reviewb of Level II studies

Sensible costs and lternatives; values obtained from limited studies; with multiway sensitivity analyses
Systematic reviewb of Level II studies


Case control studyg
Retrospectivef comparative studye 
Systematic reviewb of Level III studies

Case control studyg

Study of nonconsecutive patients; without consistently applied reference ‘‘gold’’ standard
Systematic reviewb of Level III studies
Case-control study
Poor reference standard

Analyses based on limited alternatives and costs; and
poor estimates
Systematic reviewb of Level III studies


Case seriesh

Case series


Analyses with no sensitivity analyses


Expert opinion

Expert opinion

Expert opinion

Expert opinion

a  A complete assessment of quality of individual studies requires critical appraisal of all aspects of the study design.
b A combination of results from two or more prior studies.
c Studies provided consistent results.
d  Study was started before the first patient enrolled.
e  Patients treated one way (eg, cemented hip arthroplasty) compared with a group of patients treated in another way (eg, uncemented hip
arthroplasty) at the same institution.
f  The study was started after the first patient enrolled.
f  Patients identified for the study based on their outcome, called ‘‘cases’’ eg, failed total arthroplasty, are compared with patients who did not
have outcome, called ‘‘controls’’ eg, successful total hip arthroplasty.
h  Patients treated one way with no comparison group of patients treated in another way.


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