ObjectivesTo conduct the first systematic review from an epidemiological perspective regarding the association between high-heeled shoe wear and hallux valgus, musculoskeletal pain, osteoarthritis (OA) and both first-party and second-party injury in human participants without prior musculoskeletal conditions.SettingA systematic review of international peer-reviewed scientific literature across seven major languages.Data sourcesSearches were conducted on seven major bibliographic databases in July 2015 to initially identify all scholarly articles on high-heeled shoes. Supplementary manual searches were conducted. Titles, abstracts and full-text articles were sequentially screened to identify all articles assessing epidemiological evidence regarding the association between high-heeled shoe wear and hallux valgus, musculoskeletal pain, OA and both first-party and second-party injury in human participants without prior musculoskeletal conditions. Standardised data extraction and quality assessment (Threats to Validity tool) were conducted.Primary and secondary outcome measuresMusculoskeletal pain or OA as assessed by clinical diagnosis or clinical assessment tool. First-party or second-party injury.Results644 unique records were identified, 56 full-text articles were screened and 18 studies included in the review. Four studies assessed the relationship with hallux valgus and three found a significant association. Two studies assessed the association with OA and neither found a significant association. Five studies assessed the association with musculoskeletal pain and three found a significant association. Eight studies assessed first-party injury and seven found evidence of a significant injury toll associated with high-heeled shoes. One study provided data on second-party injury and the injury toll was low.ConclusionsHigh-heeled shoes were shown to be associated with hallux valgus, musculoskeletal pain and first-party injury. No conclusive evidence regarding OA and second-party injury was found. Societal and clinical relevance of these findings is discussed. Concern is expressed about the expectation to wear high-heeled shoes in some work and social situations and access by children.

Singing may benefit the speech of people with PD, although evidence is not unequivocal. Further research is required to assess wider benefits including on functional communication, cognitive status, motor function and quality of life. Substantial methodological limitations were identified in the existing literature. Recommendations are made for advancing the state of the literature.

BackgroundHigh-heeled shoes (high heels) are frequently worn by many women and form an important part of female gender identity. Issues of explicit and implicit compulsion to wear high heels have been noted. Previous studies and reviews have provided evidence that high heels are detrimental to health. However, the evidence base remains fragmented and no review has covered both the epidemiological and biomechanical literature. In addition, no review has considered the psychosexual benefits that offer essential context in understanding the public health challenge of high heels.MethodsWe searched seven major bibliographic databases up to November 2016, in addition to supplementary searches. We initially identified all review articles of any design that assessed either the psychosexual benefits or negative musculoskeletal health effects of high heels, the latter looking at both the epidemiological and biomechanical perspectives. We additionally considered additional primary studies on areas that had not been reviewed before or in which a marked lack of evidence had been noted. Data were extracted onto standardised forms. Proportionate second review was conducted.ResultsA total of 506 unique records were identified, 27 full-text publications were screened and 20 publications (7 reviews and 13 additional studies) were included in our evidence synthesis. The most up-to-date epidemiological review provides clear evidence of an association between high heel wear and hallux valgus, musculoskeletal pain and first-party injury. The body of biomechanical reviews provides clear evidence of changes indicative of increased risk of these outcomes, as well as osteoarthritis, which is not yet evidenced by epidemiological studies. There were no reviews on psychosexual benefits, but all five identified original studies provided evidence of increased attractiveness and/or an impact on men’s behaviour associated with high heel wear. With regard to second-party injury, evidence is limited to one descriptive study and eight case reports.ConclusionsOur evidence synthesis clearly shows that high heels bring psychosexual benefits to women but are detrimental to their health. In light of this dilemma, it is important that women’s freedom of choice is respected and that any remaining issues of explicit or implicit compulsion are addressed.

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BackgroundThere is evidence that participation in performing arts brings psychosocial benefits in the general population. In recent years, there has been substantial interest in the potential therapeutic benefits of performing arts for people with chronic neurological conditions. A lack of effective evidence synthesis, however, made it difficult to evaluate the evidence base and future research directions. We conducted the first systematic review of the potential benefit of singing for people with Parkinson’s disease (PD) on speech, communication, cognition, motor function and quality of life outcomes. Here, we present an updated version of this systematic review up to January 2017.MethodsSeven standard academic health bibliographic databases, including MEDLINE and EMBASE, were searched up to January 2017 using MeSH terms and keywords corresponding to (Parkinson’s disease AND (Singing OR Music OR Music therapy). Supplementary searches were also conducted in Google Scholar and bibliographies of relevant articles. We considered full-text original articles assessing the potential benefit of singing for human participants with clinically diagnosed PD on speech impairment, functional communication, cognitive status, motor function or quality of life using any appropriate quantitative design. Narrative synthesis was conducted using standard forms. Proportionate second review was conducted. Study quality was assessed using the Threats to Validity tool.ResultsA total of 490 unique records were identified, 30 full-text publications were screened and eight studies included in the review. All eight studies assessed the impact of singing on speech, of which six found evidence of benefit. Two studies assessed quality of life, one finding evidence of benefit. One study assessed functional communication and found no evidence of benefit. No studies assessed cognitive or motor function. One study was assessed at low risk of bias, one at medium risk of bias and six at high risk of bias.ConclusionIncluded studies provide evidence that singing benefits the speech of people with PD. However, evidence is limited with regard to wider benefits, especially those of a psychosocial nature such as functional communication and quality of life, which are areas of high important to people with PD. A key limitation of our review is that most studies were at high risk of bias. Groups such as Parkinson’s UK run choirs for people with PD – this seems a good idea and has some evidence base, but further more rigorous studies are required to provide a stronger evidence base to support greater healthcare provider-community organisation partnerships.