Among the strengths of the study are its large sample

The gap

Evidence profile

Stated in the limitations and future work sections of the source papers, classified as general, spanning 4 journals.

Supporting evidence — 4 representative gaps

• Ocular injuries in padel: findings from a survey on frequency, risk factors, and perceptions toward protective eyewear (2026) · Eye · doi

  Among the strengths of the study are its large sample size and specific focus on ocular trauma, an area that remains under- explored in the existing sports and eye medicine literature. However, some limitations may hamper the reliability of the proposed results. Several effect estimates, especially those for the highest playing-frequency categories and for advanced or profes- sional skill levels, are accompanied by wide 95%CIs, likely reflecting sparse data within certain strata and heterogeneity in self-reported exposures. Although the direction of associations was consistent across analyses and supported by adequate statistical power, the reliance on self-reported data introduces potential recall bias and inaccurate estimation of In particular, ocular diagnoses (i.e., both pre-existing conditions and padel-related injuries) were reported by respondents through a structured questionnaire rather than confirmed by ophthalmic examination, raising the possibility of misclassification or misunderstanding of medical terminology (e.g., “macular edema” or “retinal detach- ment”). Moreover, although the questionnaire underwent internal review and pilot testing, it did not undergo formal external injury severity.

  generalstated in limitationsevidence 5/5
  Keywords: reported ocular existing self questionnaire among strengths large sample size specific focus trauma area remains
• Inhaled methoxyflurane for fracture reduction in prehospital extremity trauma: an observational review of HEMS clinical practice (2026) · Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine · doi

  This was a retrospective single-service HEMS analysis using clinician-completed electronic records entered after patient care, and is therefore vulnerable to documentation bias, incomplete recording, and some recall error. The cohort denominator was cases in which IMF was selected and delivered to support manipulation/reduction, rather than all traumatic limb injuries attended by the service. In addition, there was no prospective protocol mandating IMF as first-line therapy. The database does not contain sufficient searchable fields to allow reliable retrospective ascertainment of all limb injuries potentially suitable for IMF. As a result, confounding by indication (clinician case selection) is likely, and the reported associations may under- or overestimate effects if interpreted beyond this IMF-selected cohort. Associations observed in these data (including pre-medication) should not be interpreted as causal because of clinician selection and residual confounding. Clinical intent also had to be inferred from free-text documentation. Consequently, IMF’s role may have been misclassified in some cases (for example, where methoxyflurane was given as analgesia before procedural sedation rather than as a genuine attempt at IMF-facilitated reduction), which may underestimate the apparent success of the IMF-assisted pathway. Although equivocal cases were reviewed in detail by more than one investigator, reasons for unsuccessful reduction or escalation (e.g., pain-limited procedure, mechanical difficulty, or elective escalation) were not documented consistently enough to permit reliable subgroup categorisation. Timing of concomitant analgesia was also inconsistently recorded, limiting inference regarding sequencing or co-administration. Finally, several subgroup analyses (including anatomical location) contained small numbers, resulting in imprecise estimates and wide confidence intervals. These findings should therefore be interpreted cautiously and considered hypothesis-generating. Dowsing et al.

  generalstated in limitationsevidence 5/5
  Keywords: clinician cases reduction interpreted service cohort selected tion rather limb injuries reliable confounding selection including
• The experience of individuals following non-surgical management of Achilles tendon rupture in the United Kingdom – a qualitative study (2026) · PLOS One · doi

  This study provides a novel insight on the early stages of recovery as participants were recruited within 12 months of injury. This contrasts with previous studies that have often focused on longer-term experiences, with participants recalling events years after ATR [12]. By focusing on this earlier timeframe, the study captures more immediate perceptions of the initial injury and recovery. The percentage of male participants was consistent with previous ATR investigations in the UK and the sample con- sisted of range of ethnicities [9]. The age of participants was higher than in previous qualitative investigations that focused on return to sport post ATR [12,31]. This difference likely reflects the decision in the present study not to exclude older adults, who are experiencing an increasing incidence of ATR [33]. As the average age of ATR rises, it is essential that the older cohort perspectives are understood and reflected in clinical decision-making. PLOS One | https://doi.org/10.1371/journal.pone.0352761 June 29, 2026 10 / 13 Participants were recruited from a single NHS ATR clinic, which may limit the transferability of findings to other healthcare settings, particularly those outside the UK or with different immobilisation protocols. Furthermore, the study included only individuals treated non-surgically and may not represent surgically managed patients. Future research could compare experiences across treatment approaches to understand how clinical pathways influence recovery experiences. Long term functional deficits have been reported following ATR [4–6]. Due to the qualitative nature of this study, the relationship between reported fear of re-injury and objective measures of Achilles performance are unknown. Triangulating qualitative findings with functional outcomes in future studies would provide an understanding of how patient experience aligns with functional capacity.

  generalstated in limitationsevidence 5/5
  Keywords: participants recovery injury previous experiences qualitative functional recruited focused term investigations decision older clinical surgically
• Functional outcomes and rehabilitation behaviors following ankle sprain in amateur padel players: a cross-sectional study (2026) · Frontiers in Medicine · doi

  Several limitations should be considered when interpreting these findings. The cross-sectional design precludes causal inference and limits the ability to establish temporal relationships between exposure, injury, and recovery outcomes. Data were collected exclusively through self-reported questionnaires, without objective verification by medical record review or clinical examination, introducing the potential for recall bias, reporting bias, and injury misclassification. Because ankle sprain history was self-reported, mild injuries may have been underreported, whereas recurrent injuries may have been overreported. The predefined 12-month recall period may have reduced reporting accuracy, particularly for less severe injuries. Recall reliability was not formally assessed, and a post-hoc sensitivity analysis using a shorter recall period was not feasible because such data were not collected. Participant recruitment through convenience sampling and social media platforms may also have introduced selection bias by preferentially enrolling individuals who were more active, engaged with padel, or health-conscious than the broader amateur padel population. Because participation was voluntary, the response rate could not be determined, and the characteristics of participants and non-participants could not be compared, thereby limiting the representativeness and generalizability of the findings. Generalizability is further constrained by the inclusion of amateur padel players from a single geographic region. Moreover, the absence of objective clinical and biomechanical assessments limited the comprehensive evaluation of injury severity and functional impairment, while self-reported pain scores may have been influenced by individual differences in pain perception and thresholds. Residual confounding is also possible because several potentially important variables, including previous musculoskeletal injuries other than ankle sprains, baseline lower extremity muscle strength, sport-specific training volume (e.g., frequency of matches or training sessions), and BMI categorized according to established clinical classifications, were not assessed and may have influenced both injury risk and functional outcomes. Future prospective longitudinal studies incorporating objective clinical verification, biomechanical and functional assessments, shorter follow-up intervals, and comprehensive adjustment for relevant confounding variables are needed to better establish causal relationships and evaluate the effectiveness of targeted injury prevention and rehabilitation strategies in reducing ankle sprain incidence and long-term functional deficits among padel players.

  generalstated in future workevidence 5/5
  Keywords: injury clinical recall injuries padel functional self reported objective cation bias ankle several ndings causal

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