title: The Method Quality of Cross-Over Studies Involved in Cochrane Systematic Reviews A study of the immediate effects of glycerine-filled insoles, contoured prefabricated orthoses and flat insoles on single-leg balance, gait patterns and perceived comfort in healthy adults
abstract: Background It is possible that cross-over studies included in current systematic review s are being inadequately assessed , because the current risk of bias tools do not consider possible biases specific to cross-over design . We performed this study to evaluate whether this was being done in  cross-over studies included in Cochrane  Systematic Review s ( CSRs ) . Methods We search ed the Cochrane Library ( up to 2013 issue 5 ) for CSRs that included at least one cross-over trial . Two authors independently undertook the study selection and data extraction . A r and om sample of the CSRs was selected and we evaluated whether the cross-over trials in these CSRs were assessed according to criteria suggested by the Cochrane h and book . In addition we reassessed the risk of bias of these cross-over trials by a checklist developed form the Cochrane h and book . Results We identified 688 CSRs that included one or more cross-over studies . We chose a r and om sample of 60 CSRs and these included 139 cross-over studies . None of these CSRs undertook a risk of bias assessment specific for cross-over studies . In fact items specific for cross-over studies were seldom considered anywhere in quality assessment of these CSRs . When we reassessed the risk of bias , including the 3 items specific to cross-over trials , of these 139 studies , a low risk of bias was judged for appropriate cross-over design in 110(79 % ) , carry-over effects in 48(34 % ) and for reporting data in all stages of the trial in 114(82 % ) . Assessment of biases in cross-over trials could affect the GRADE assessment of a review ’s findings . Conclusion The current Cochrane risk of bias tool is not adequate to assess cross-over studies . Items specific to cross-over trials leading to potential risk of bias are generally neglected in CSRs . A proposed check list for the evaluation of cross-over trials is provided Background Footwear interventions are often prescribed to assist with the management of lower limb pain , injury and disease . Commercially available shoe insoles and orthoses are increasingly incorporating novel design features to alleviate foot and lower limb symptoms , but this may be at a cost to optimal functional performance . This study compared the immediate effects of wearing glycerine-filled insoles , contoured prefabricated orthoses , and flat insoles , on balance and gait measures . Methods Thirty healthy adults ( 17 men , 13 women ; mean [ SD ] age : 24.3 [ 2.5 ] years ) performed tests of single-leg st and ing with eyes open ( Kistler force platform ) , star excursion balance test , and level-ground walking ( GAITRite ® walkway system ) , under three r and omised conditions : wearing glycerine-filled insoles , prefabricated orthoses , and flat ( control ) insoles , within their own footwear . Centre of pressure movement ( anterior-posterior and mediolateral range and st and ard deviation , total path velocity ) , star excursion balance test reach distance , and temporospatial gait variables were collected . Perceived comfort of the inserts was scored immediately after use on a 100 mm visual analogue rating scale . After trialling all inserts each participant ranked their level of comfort from least to most . Results Centre of pressure measures , star excursion balance test reach distance , or temporospatial gait variables did not differ between the three inserts ( all P values > 0.088 ) . Significant between-condition differences were reported for comfort ranking ( P = 0.031 ) , but not rating scores ( P = 0.638 ) . Weak to moderate negative correlations ( r values ranged between −0.368 and −0.406 ) were observed between visual analogue scale comfort rating for the flat insoles and prefabricated orthoses , star excursion balance test and gait measures . Conclusions Single-leg st and ing balance , star excursion balance test performance , and level-ground walking patterns in  asymptomatic adults  do not appear to differ when wearing glycerine-filled insoles , contoured prefabricated orthoses , or flat insoles . Perceived comfort may be related to the biomechanical or clinical effectiveness of novel footwear interventions , and requires further investigation . Importantly , these findings are specific to a healthy population and further research is needed to determine the long-term effects of glycerine-filled insoles in patients with known balance impairments
target: A moderate level of evidence was found in support of using cushioned material s in reducing discomfort/fatigue among st and ing workers .
  A limited level of evidence exists in favour of using insoles over anti-fatigue mats .
background: This systematic review up date s the current state of evidence on the effectiveness of softer flooring and cushioned shoe insoles on reducing  musculoskeletal discomfort amongst workers who are required to st and for prolonged periods to work and the impact of factors such as age and gender on the outcomes .