Objective: To summarize the effects of surgical treatment compared to conservative treatment in femoroacetabular impingement syndrome in the short, medium, and long term. Study Design: Systematic review Methods: The following databases were searched on 14/09/2020: MEDLINE, EMBASE, CENTRAL, Web of Science, and PEDro. There were no date or language limits. The methodological quality assessment was performed using the PEDro scale and the quality of the evidence followed the GRADE recommendation. The outcomes pain, disability, and adverse effects were extracted. Results: Of 6264 initial studies, three met the full-text inclusion criteria. All studies were of good methodological quality. Follow up ranged from six months to two years, with 650 participants in total. The meta-analyses found no difference in disability between surgical versus conservative treatment, with a mean difference (MD) between groups of 3.91 points (95% CI –2.19 to 10.01) at six weeks, MD of 5.53 points (95% CI –3.11 to 14.16) at 12 weeks, and 3.8 points (95% CI –6.0 to 13.6) at 24 months. The quality of the evidence (GRADE) varied from moderate to low across all comparisons. Conclusion: There is moderate-quality evidence that surgical treatment is not superior to conservative treatment for femoroacetabular impingement syndrome in the short term, and there is low-quality evidence that it is not superior in the medium term. Level of evidence: Therapy, level 1a. Registration number: PROSPERO CRD42019134118

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This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm COMMENTARY ON: "KINESIO TAPING IN TREATMENT OF CHRONIC NON-SPECIFIC LOW BACK PAIN: A SYSTEMATIC REVIEW AND META-ANALYSIS"We recently read the systematic review by Sheng et al. on the effects of Kinesio Taping in patients with chronic non-specific low back pain (1). Although the research question of this systematic review was similar to those addressed in other reviews (2, 3), the results were completely different. This is the first systematic review to conclude that Kinesio Taping is efficacious for patients with low back pain.A possible reason for this unique finding is that the authors only included trials published between 2012 and 2015 (despite Table I presenting trials published in 2016 and 2017). Also, the authors only included trials published in Chinese or English. Finally, no trials that compared Kinesio Taping with placebo, minimal interventions, or a wait-and-see approach were included in the review. The Cochrane Handbook for Systematic Reviews of Interventions (3) clearly warns of "language bias" (4), as studies published in non-English languages appear to have larger effects on interventions than studies published in English (most of the included trials are from China). In addition, the Cochrane Handbook strongly recommends that authors do not restrict the eligibility criteria based on publication dates. Finally, excluding placebo-controlled trials neglects the gold standard of clinical research. It is a pity that the reviewers did not point out these major fatal flaws, which ended up completely spinning the results.The results of Sheng et al.'s review (1) are highly misleading for the following reasons: Firstly, by using questionable inclusion criteria many trials with very large samples and low risk of bias were excluded (e.g. Added et al. 2016 (5) and Parreira et al. 2014 (6)). Such trials can easily be found in PubMed and Physiotherapy Evidence Database (PEDro), for example. Secondly, the review included only trials that showed results in favour of Kinesio Taping, and ignored trials with negative results (i.e. spinning of results ( 7)). This is evident in both of the forest plots included in the systematic review. The issue of selection bias, due to including only positive trials, is clearly evident in the review. We strongly suggest that the results of this systematic review are interpreted with scepticism, as the positive effects were clearly overestimated. Systematic reviews are considered the "gold standard" for determining the effectiveness of interventions and should be conducted in the most rigorous way possible. In this letter we have summarized the main points that could mislead readers to believe that Kinesio Taping could benefit people with chronic nonspecific low back pain.

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