The design and methods used for this review comply with CRD’s Guidance for Undertaking Reviews in Healthcare (13) and are reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA 2020) (14). This systematic review has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the registration ID: CRD42022302723
Search strategy
The search used sensitive topic-based strategies designed for every database with no time frame, geographical, or language restrictions. On the 15th of May 2022, FM performed the search in the following databases: MEDLINE (PubMed), Scopus, Cochrane Central Register of Controlled Trials, Web of Science. Our complete search strategy is available in (Appendix S1). We have also done the forward and backward citations for the included studies and updated our search on the 22nd of March 2023.
Eligibility criteria
Studies with anterior shoulder dislocation patients, either first or recurrent episodes, regardless of age, gender, or ethnicity that used and compared supervised self-reduction techniques such as Boss-Holtzach-Matter, Milch, and Stimson to other techniques were included. Case reports, case series, letters, correspondence, and commentary were all excluded.
Citations found through searches are integrated into the Rayyan QCRI app (15), a web-based tool that uses natural language processing, artificial intelligence, and machine learning technologies to expedite the screening of record titles and abstracts. Duplicates were identified and eliminated.
Two reviewers (MD, MMMN) independently reviewed all titles and abstracts for chosen papers that met inclusion criteria. The full text of all eligible records that were retrieved was then examined by the same two writers, and the final articles were included in our review. A third author (FM) resolved disagreements between reviewers. The reasons for exclusions were documented and are included in a table in the final evaluation (Appendix S2) . In the results, we report the study selection process utilizing PRISMA flow diagrams of study selection.
Data extraction
MD and MMMN extracted the data independently using a standardized form. If necessary, they addressed any issues by consulting a third review author (FM). The most important outcomes were success rate, pain reduction, and reduction time.
Risk of bias
Two authors (MD, MMMN) will independently evaluate all the eligible included studies and record supporting information for judgments of risk of bias in each domain (low, unclear, or high). They discussed any disagreements and document their decisions. We report the risk of bias judgments in each domain for each included study in the risk of bias summary (Appendix RB1). Judgments for each of the domains across all included studies were also reported in risk of bias graphs.
Risk of bias was categorized as ’low risk’, ’high risk’, or ’unclear risk’ which is described in the Cochrane Handbook for Systematic Reviews of Interventions(16).
Statistical analysis
We combined and compared the outcome data between the physician-assisted vs self-reduction techniques for each extracted outcome. Pooled estimates of odd ratios (ORs) for dichotomous outcomes and mean differences (MDs) for maximum pain intensity were calculated with 2-sided 95% confidence intervals (CIs) using a random-effects model and restricted maximum likelihood estimator.
Heterogeneity was explored through the use of the Cochrane Q test for heterogeneity and the I2 statistic. Publication bias was evaluated with funnel plots Galbraith plot. All analysis was performed with STATA version 17.0.