From a methodological point of view however, a prospective design for investigation of the relatively rare event of revision needed after RTSA would demand high resources and most probably a multicenter design.
To our knowledge, this is the first study that aimed to evaluate the inflammatory response in a multilateral fashion by the use of a prospective design for prediction and diagnosis of VAP.
The present study used a prospective design to elucidate predictors of distress.
Therefore, there is a need for more studies, mainly with a prospective design to fully establish the consequences of PIR.
In a prospective design, knowledge of exposure status may bias classification of the outcome.
143 Recently, van der Schaft et al 144 also conducted a systematic review that included 25 studies with a cross-sectional design and six studies with a prospective design; three of these studies showed cross-sectional as well as prospective data.
The shortcomings of these studies were mainly the lack of a prospective design and lack of information on non-respondents.
It has the advantages of a prospective design and use of a new classification system recommended by the ICRS.
Future studies could include a prospective design and measures of cost-effectiveness of this workplace intervention.
