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Ho L, Cheung YMK, Choi CCC, Wu IX, Mao C, Chung VCH. Methodological quality of systematic reviews on atopic dermatitis treatments: a cross-sectional study. J DERMATOL TREAT 2024; 35:2343072. [PMID: 38626923 DOI: 10.1080/09546634.2024.2343072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/26/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Systematic reviews (SRs) could offer the best evidence supporting interventions, but methodological flaws limit their trustworthiness in decision-making. This cross-sectional study appraised the methodological quality of SRs on atopic dermatitis (AD) treatments. METHODS We searched MEDLINE, EMBASE, PsycINFO, and Cochrane Database for SRs on AD treatments published in 2019-2022. We extracted SRs' bibliographical data and appraised SRs' methodological quality with AMSTAR (A MeaSurement Tool to Assess systematic Reviews) 2. We explored associations between methodological quality and bibliographical characteristics. RESULTS Among the 52 appraised SRs, only one (1.9%) had high methodological quality, while 45 (86.5%) critically low. For critical domains, only five (9.6%) employed comprehensive search strategy, seven (13.5%) provided list of excluded studies, 17 (32.7%) considered risk of bias in primary studies, 21 (40.4%) contained registered protocol, and 24 (46.2%) investigated publication bias. Cochrane reviews, SR updates, SRs with European corresponding authors, and SRs funded by European institutions had better overall quality. Impact factor and author number positively associated with overall quality. CONCLUSIONS Methodological quality of SRs on AD treatments is unsatisfactory. Future reviewers should improve the above critical methodological aspects. Resources should be devolved into upscaling evidence synthesis infrastructure and improving critical appraisal skills of evidence users.
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Affiliation(s)
- Leonard Ho
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Yolenda Man Kei Cheung
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Cyrus Chung Ching Choi
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Irene Xinyin Wu
- Xiangya School of Public Health, Central South University, Changsha, Hunan, China
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan, China
| | - Chen Mao
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Vincent Chi Ho Chung
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
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Bougioukas KI, Karakasis P, Pamporis K, Bouras E, Haidich AB. amstar2Vis: An R package for presenting the critical appraisal of systematic reviews based on the items of AMSTAR 2. Res Synth Methods 2024; 15:512-522. [PMID: 38316610 DOI: 10.1002/jrsm.1705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 01/14/2024] [Accepted: 01/18/2024] [Indexed: 02/07/2024]
Abstract
Systematic reviews (SRs) have an important role in the healthcare decision-making practice. Assessing the overall confidence in the results of SRs using quality assessment tools, such as "A MeaSurement Tool to Assess Systematic Reviews 2" (AMSTAR 2), is crucial since not all SRs are conducted using the most rigorous methods. In this article, we introduce a free, open-source R package called "amstar2Vis" (https://github.com/bougioukas/amstar2Vis) that provides easy-to-use functions for presenting the critical appraisal of SRs, based on the items of AMSTAR 2 checklist. An illustrative example is outlined, describing the steps involved in creating a detailed table with the item ratings and the overall confidence ratings, generating a stacked bar plot that shows the distribution of ratings as percentages of SRs for each AMSTAR 2 item, and creating a "ggplot2" graph that shows the distribution of overall confidence ratings ("Critically Low," "Low," "Moderate," or "High"). We expect "amstar2Vis" to be useful for overview authors and methodologists who assess the quality of SRs with AMSTAR 2 checklist and facilitate the production of pertinent publication-ready tables and figures. Future research and applications could further investigate the functionality or potential improvements of our package.
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Affiliation(s)
- Konstantinos I Bougioukas
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, Thessaloniki, Greece
| | - Paschalis Karakasis
- Second Department of Cardiology, Aristotle University of Thessaloniki, General Hospital "Hippokration", Thessaloniki, Greece
| | - Konstantinos Pamporis
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, Thessaloniki, Greece
| | - Emmanouil Bouras
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Anna-Bettina Haidich
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, Thessaloniki, Greece
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Bethel K, Faciszewski H, Ballis S, Sullivan M, Wieland LS. Determining the Completeness of Registration and Reporting in Systematic Reviews of Yoga for Health. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024; 30:336-344. [PMID: 37967461 PMCID: PMC11001950 DOI: 10.1089/jicm.2022.0785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Introduction: Yoga is a mind-body practice often used to improve health. Systematic reviews (SRs) of randomized controlled trials on yoga for health are foundational to evidence-based yoga interventions and require rigorous and transparent methods, including preparation of a protocol (e.g., PROSPERO) and following SR reporting guidelines (e.g., Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA]). Objective: To evaluate the availability of protocols and the completeness of reporting for SRs on yoga for health. Methods: We used a previously assembled database of SRs focused on the use of yoga for health. The authors independently extracted data on protocol availability, PROSPERO registration, and reporting for each PRISMA 2009 checklist item. Discrepancies were discussed or referred to a third author. We used Stata 10 software to produce descriptive statistics and tests for relationships between registration, reporting, and publication year, country, and journal type. Results: We included 147 reviews published between 2005 and 2019. The most common first author country was the United States or Germany (total 67/147; 46%), and the most common journal type was specialty journals (71/147; 48%). Most reviews (116/147; 79%) made no mention of a protocol or registration, and only 15/147 (10%) reviews were linked to an accessible protocol or registration. Most SRs published in 2010 or later mentioned or cited PRISMA (97/139; 70%), and individual PRISMA items were addressed between 10% and 100% of the time. PRISMA reporting improved; over time, but there was no relationship with country or journal type. Discussion: This study identifies a need for increased SR registration for yoga research. The assessment of PRISMA reporting did not evaluate the comprehensiveness with which each item was reported, and while trends are encouraging, there is likely room for improvement. We recommend registering all yoga SRs and following updated PRISMA and recent yoga-specific guidelines for reporting. This may increase transparency, minimize bias, and produce high-quality data to inform evidence-based yoga practices.
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Affiliation(s)
- Kelli Bethel
- Department of Yoga Therapy, Maryland University of Integrative Health, Laurel, MD, USA
| | - Hallie Faciszewski
- Division of Physical Therapy, Emory School of Medicine, Emory University, Atlanta, GA, USA
| | - Stephanie Ballis
- Division of Physical Therapy, Emory School of Medicine, Emory University, Atlanta, GA, USA
| | - Marlysa Sullivan
- Department of Yoga Therapy, Maryland University of Integrative Health, Laurel, MD, USA
| | - L. Susan Wieland
- Department of Family Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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Karakasis P, Bougioukas KI, Pamporis K, Fragakis N, Haidich AB. Appraisal methods and outcomes of AMSTAR 2 assessments in overviews of systematic reviews of interventions in the cardiovascular field: A methodological study. Res Synth Methods 2024; 15:213-226. [PMID: 37956538 DOI: 10.1002/jrsm.1680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 10/17/2023] [Accepted: 10/17/2023] [Indexed: 11/15/2023]
Abstract
This study aimed to assess the methods and outcomes of The Measurement Tool to Assess systematic Reviews (AMSTAR) 2 appraisals in overviews of reviews (overviews) of interventions in the cardiovascular field and identify factors that are associated with these outcomes. MEDLINE, Scopus, and the Cochrane Database of Systematic Reviews were searched until November 2022. Eligible were overviews of cardiovascular interventions, analyzing systematic reviews (SRs) of randomized controlled trials (RCTs). Extracted data included characteristics of overviews and SRs and AMSTAR 2 appraisal methods and outcomes. Data were synthesized using descriptive statistics and logistic regression to explore potential associations between the characteristics of SRs and extracted AMSTAR 2 overall ratings ("High-Moderate" vs. "Low-Critically low"). The original results on individual AMSTAR 2 items were entered into the official AMSTAR 2 online tool and the recalculated overall confidence ratings were compared to those provided in overviews. All 34 overviews identified were published between 2019 and 2022. Rating of overall confidence following the algorithm suggested by AMSTAR 2 developers was noted in 74% of overviews. The 679 unique included SRs were mainly of "Critically low" (53%) or "Low" (18.7%) confidence and underperformed in items 2 (Protocol, no = 65.2%) and 7 (List of excluded studies, no = 84%). The following characteristics of SRs were significantly associated with higher overall ratings: Cochrane origin, pharmacological interventions, including exclusively RCTs, citation of methodological and reporting guidelines, protocol, absence of funding and publication after AMSTAR 2 release. Generally, overviews' authors tended to deviate from the original rating scheme and ascribe higher ratings to SRs compared to the official AMSTAR 2 online tool. Most SRs included in overviews of cardiovascular interventions have critically low or low confidence in their results. Overviews' authors should be more transparent about the methods used to derive the overall confidence in SRs.
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Affiliation(s)
- Paschalis Karakasis
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Second Cardiology Department, Hippokration General Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos I Bougioukas
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Pamporis
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Fragakis
- Second Cardiology Department, Hippokration General Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anna-Bettina Haidich
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Ho L, Chen X, Kwok YL, Wu IXY, Mao C, Chung VCH. Methodological quality of systematic reviews on sepsis treatments: A cross-sectional study. Am J Emerg Med 2024; 77:21-28. [PMID: 38096636 DOI: 10.1016/j.ajem.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/22/2023] [Accepted: 12/04/2023] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVE Systematic reviews (SRs) offer updated evidence to support decision-making on sepsis treatments. However, the rigour of SRs may vary, and methodological flaws may limit their validity in guiding clinical practice. This cross-sectional study appraised the methodological quality of SRs on sepsis treatments. METHODS We searched MEDLINE, EMBASE, and Cochrane Database for eligible SRs on randomised controlled trials on sepsis treatments with at least one meta-analysis published between 2018 and 2023. We extracted SRs' bibliographical characteristics with a pre-designed form and appraised their methodological quality using AMSTAR (A MeaSurement Tool to Assess systematic Reviews) 2. We applied logistic regressions to explore associations between bibliographical characteristics and methodological quality ratings. RESULTS Among the 102 SRs, two (2.0%) had high overall quality, while respectively four (3.9%), seven (6.9%) and 89 (87.3%) were of moderate, low, and critically low quality. Performance in several critical methodological domains was poor, with only 32 (31.4%) considering the risk of bias in primary studies in result interpretation, 22 (21.6%) explaining excluded primary studies, and 16 (15.7%) applying comprehensive searching strategies. SRs published in higher impact factor journals (adjusted odds ratio: 1.19; 95% confidence interval: 1.05 to 1.36) was associated with higher methodological quality. CONCLUSIONS The methodological quality of recent SRs on sepsis treatments is unsatisfactory. Future reviewers should address the above critical methodological aspects. More resources should also be allocated to support continuous training in critical appraisal among healthcare professionals and other evidence users.
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Affiliation(s)
- Leonard Ho
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Xi Chen
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong; Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Yan Ling Kwok
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Irene X Y Wu
- Xiangya School of Public Health, Central South University, Changsha, Hunan, China; Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan, China
| | - Chen Mao
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Vincent Chi Ho Chung
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong; School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
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Santos VS, Fandim JV, Silva FG, Hatakeyama BA, Fioratti I, Costa LOP, Saragiotto BT, Yamato TP. Evaluation of methodological and reporting quality of systematic reviews on conservative non-pharmacological musculoskeletal pain management in children and adolescents: A methodological analysis. Musculoskelet Sci Pract 2024; 69:102902. [PMID: 38211435 DOI: 10.1016/j.msksp.2023.102902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND There are no studies investigating the methodological and report quality of systematic reviews of non-pharmacological interventions for musculoskeletal pain management among children and adolescents. OBJECTIVE To evaluate the methodological and reporting quality of systematic reviews on conservative non-pharmacological pain management in children and adolescents with musculoskeletal pain. METHODS Searches were conducted on the Cochrane Database of Systematic Reviews, Medline, Embase, and three other databases. Two pairs of reviewers independently assessed each article according to the predetermined selection criteria. We assessed the methodological quality of systematic reviews, using the AMSTAR 2 checklist and the quality of reporting, using PRISMA checklist. Descriptive analysis was used to summarise the characteristics of all included systematic reviews. The percentage of systematic reviews achieving each item from the AMSTAR 2, PRISMA checklist and the overall confidence in the results were described. RESULTS We included 17 systematic reviews of conservative non-pharmacological pain management for musculoskeletal pain in children and adolescents. Of the 17 systematic reviews included, nine (53%) were rated as "critically low", seven (41%) were rated as "low", and one (6%) was rated as "high" methodological quality by AMSTAR-2. The reporting quality by items from PRISMA range from 17.6% (95% CI 6.2 to 41) to 100% (95% CI 81.6 to 100). CONCLUSION This systematic review of physical interventions in children and adolescents showed overall 'very low' to 'high' methodological quality and usually poor reporting quality.
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Affiliation(s)
- Veronica Souza Santos
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | - Junior V Fandim
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | - Fernanda Gonçalves Silva
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | - Bruna Alves Hatakeyama
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | - Iuri Fioratti
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | - Leonardo Oliveira Pena Costa
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | - Bruno T Saragiotto
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil; Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Tiê P Yamato
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil; Faculty of Medicine and Health, University of Sydney, Australia; Nepean Blue Mountains Local Health District, NSW, Australia.
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Shahraki-Mohammadi A, Keikha L, Zahedi R. Investigate the relationship between the retraction reasons and the quality of methodology in non-Cochrane retracted systematic reviews: a systematic review. Syst Rev 2024; 13:24. [PMID: 38217029 PMCID: PMC10785437 DOI: 10.1186/s13643-023-02439-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/19/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND This systematic review aimed to investigate the relationship between retraction status and the methodology quality in the retracted non-Cochrane systematic review. METHOD PubMed, Web of Science, and Scopus databases were searched with keywords including systematic review, meta-analysis, and retraction or retracted as a type of publication until September 2023. There were no time or language restrictions. Non-Cochrane medical systematic review studies that were retracted were included in the present study. The data related to the retraction status of the articles were extracted from the retraction notice and Retraction Watch, and the quality of the methodology was evaluated with the AMSTAR-2 checklist by two independent researchers. Data were analyzed in the Excel 2019 and SPSS 21 software. RESULT Of the 282 systematic reviews, the corresponding authors of 208 (73.75%) articles were from China. The average interval between publish and retraction of the article was about 23 months and about half of the non-Cochrane systematic reviews were retracted in the last 4 years. The most common reasons for retractions were fake peer reviews and unreliable data, respectively. Editors and publishers were the most retractors or requestors for retractions. More than 86% of the retracted non-Cochrane SRs were published in journals with an impact factor above two and had a critically low quality. Items 7, 9, and 13 among the critical items of the AMSTAR-2 checklist received the lowest scores. DISCUSSION AND CONCLUSION There was a significant relationship between the reasons of retraction and the quality of the methodology (P-value < 0.05). Plagiarism software and using the Cope guidelines may decrease the time of retraction. In some countries, strict rules for promoting researchers increase the risk of misconduct. To avoid scientific errors and improve the quality of systematic reviews/meta-analyses (SRs/MAs), it is better to create protocol registration and retraction guidelines in each journal for SRs/MAs.
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Affiliation(s)
- Azita Shahraki-Mohammadi
- Medical Library and Information Sciences, School of Allied Medical Sciences, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Leila Keikha
- Medical Library and Information Sciences, School of Allied Medical Sciences, Zahedan University of Medical Sciences, Zahedan, Iran.
| | - Razieh Zahedi
- Medical Librarianship and Information Sciences, Tehran University of Medical Sciences, Tehran, Iran
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Kolaski K, Logan LR, Ioannidis JPA. Guidance to best tools and practices for systematic reviews. Br J Pharmacol 2024; 181:180-210. [PMID: 37282770 DOI: 10.1111/bph.16100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 06/08/2023] Open
Abstract
Data continue to accumulate indicating that many systematic reviews are methodologically flawed, biased, redundant, or uninformative. Some improvements have occurred in recent years based on empirical methods research and standardization of appraisal tools; however, many authors do not routinely or consistently apply these updated methods. In addition, guideline developers, peer reviewers, and journal editors often disregard current methodological standards. Although extensively acknowledged and explored in the methodological literature, most clinicians seem unaware of these issues and may automatically accept evidence syntheses (and clinical practice guidelines based on their conclusions) as trustworthy. A plethora of methods and tools are recommended for the development and evaluation of evidence syntheses. It is important to understand what these are intended to do (and cannot do) and how they can be utilized. Our objective is to distill this sprawling information into a format that is understandable and readily accessible to authors, peer reviewers, and editors. In doing so, we aim to promote appreciation and understanding of the demanding science of evidence synthesis among stakeholders. We focus on well-documented deficiencies in key components of evidence syntheses to elucidate the rationale for current standards. The constructs underlying the tools developed to assess reporting, risk of bias, and methodological quality of evidence syntheses are distinguished from those involved in determining overall certainty of a body of evidence. Another important distinction is made between those tools used by authors to develop their syntheses as opposed to those used to ultimately judge their work. Exemplar methods and research practices are described, complemented by novel pragmatic strategies to improve evidence syntheses. The latter include preferred terminology and a scheme to characterize types of research evidence. We organize best practice resources in a Concise Guide that can be widely adopted and adapted for routine implementation by authors and journals. Appropriate, informed use of these is encouraged, but we caution against their superficial application and emphasize their endorsement does not substitute for in-depth methodological training. By highlighting best practices with their rationale, we hope this guidance will inspire further evolution of methods and tools that can advance the field.
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Affiliation(s)
- Kat Kolaski
- Departments of Orthopaedic Surgery, Pediatrics, and Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Lynne Romeiser Logan
- Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University, Syracuse, New York, USA
| | - John P A Ioannidis
- Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University School of Medicine, Stanford, California, USA
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Hosseinian SZ, Haghighatdoost F, Hajihashemi P, Adibi P. Effects of gluten on dyspeptic symptoms: a systematic review and meta-analysis of clinical trials. Nutr Rev 2023; 82:9-33. [PMID: 37115663 DOI: 10.1093/nutrit/nuad034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
CONTEXT Research on the effects of gluten on dyspeptic symptoms has shown conflicting results. OBJECTIVE The aim of this systematic review and meta-analysis of clinical trials was to assess the effects of gluten on dyspeptic symptoms. DATA SOURCES A systematic search of the PubMed, ISI Web of Science, Scopus, Cochrane, and Embase online databases was performed up to May 2022. DATA EXTRACTION Randomized controlled trials (RCTs) and non-RCTs that examined the impact of a gluten-free diet, a low-gluten diet, or a gluten challenge on dyspeptic symptoms, including early satiety, epigastric pain, bloating, and nausea, were selected independently by 2 authors. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework was used to assess the certainty of the evidence. Results were pooled using a random-effects model and expressed as weighted mean differences (WMDs) and 95%CIs. DATA ANALYSIS Of the 7641 citations retrieved, 27 articles (18 RCTs and 9 non-RCTs) were included in the systematic review. Of those, 5 RCTs were eligible for the meta-analysis. The pooled results indicated that gluten challenge significantly increased the severity of bloating (WMD = 0.67; 95%CI, 0.37-0.97; I2 = 81.8%; n = 6), early satiety (WMD = 0.91; 95%CI, 0.58-1.23; I2 = 27.2%; n = 5), and epigastric pain (WMD = 0.46; 95%CI, 0.17-0.75; I2 = 65.8%; n = 6). However, the effect of gluten challenge on the severity of nausea (WMD = 0.13; 95%CI, -0.17 to 0.43; I2 = 0.0%, n = 5) was nonsignificant. CONCLUSION Gluten challenge significantly worsened dyspeptic symptoms, including bloating, early satiety, and epigastric pain, but did not affect nausea. These findings suggest that gluten restriction could be efficient in reducing dyspeptic symptoms. Well-designed large RCTs recruiting homogenous groups of patients with functional dyspepsia are needed to clarify the effectiveness of gluten restriction on dyspeptic symptoms.
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Affiliation(s)
- Seyedeh-Zeynab Hosseinian
- are with the Isfahan Gastroenterology and Hepatology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fahimeh Haghighatdoost
- is with the Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parisa Hajihashemi
- are with the Isfahan Gastroenterology and Hepatology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Peyman Adibi
- are with the Isfahan Gastroenterology and Hepatology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Li H, Lu L, Han Z, Liu Z, Pan J, Wang Y, Gao X, Cai Y, Zhao T, Nie Q, Zhang H, Zhang D, Jin S. Effect of different exercise regimens on LVEF and restenosis incidence in patients after PCI: a network meta-analysis and an overview of systematic reviews. Front Cardiovasc Med 2023; 10:1241343. [PMID: 38034391 PMCID: PMC10686069 DOI: 10.3389/fcvm.2023.1241343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/23/2023] [Indexed: 12/02/2023] Open
Abstract
Objective We aimed to evaluate the effects of different exercise rehabilitation (ER) programs on LVEF and the incidence of restenosis in patients after percutaneous coronary intervention (PCI) through a systematic review and an integrated network meta-analysis (NMA) to provide a reference for the clinical formulation of ER programs for PCI patients. Methods Meta-analyses of the effects of different types of ER programs on LVEF and the incidence of reinfarction in post-PCI patients were retrieved from 11 domestic and foreign databases. The methodological and reporting quality of the included systematic reviews were evaluated using the AMSTAR 2 and PRISMA statements. The GRADE scoring system was used to evaluate the quality of evidence found in the studies included in the meta-analysis, and studies with high and intermediate-quality evidence were qualitatively analyzed. Stata software (version 16.0) was used to conduct an integrated NMA of the original RCTs with moderate and low risk of bias. Result Sixteen meta-analyses were included in this evaluation. The reporting quality of the included meta-analyses was relatively complete, and the methodological quality was low. Seventy RCTs were included in the NMA. The results showed that all types of rehabilitative exercises were safe and effectively increased LVEF and reduced the incidence of coronary restenosis in patients. The comprehensive exercise program was the most likely to improve LVEF, and the comprehensive exercise program, early exercise program, and high-intensity interval exercise were better than aerobic exercise. Comprehensive exercise programs, early exercise programs, and aerobic exercise reduced the incidence of restenosis in patients. However, Chinese Qigong did not reduce the incidence of restenosis in patients, and there was a risk of bias and inconsistency in the quantitative analysis of restenosis incidence. Conclusion Comprehensive exercise programs have the greatest therapeutic significance in improving cardiac output and reducing restenosis rates in post-PCI patients. The early exercise program has great potential but requires kinesiologists to work with physicians to structure the program and strengthen out-of-hospital management. Aerobic exercise has the least therapeutic significance, and Chinese Qigong is suitable for promotion based on its better efficacy than aerobic exercise and may be an alternative to aerobic exercise, but more experimental evidence is needed. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/, PROSPERO CRD42022374590.
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Affiliation(s)
- Hongpeng Li
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Li Lu
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhongyu Han
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhixiang Liu
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Juanhong Pan
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yongsheng Wang
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiuhua Gao
- Department of Rehabilitation, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yijin Cai
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Tianyu Zhao
- Department of Rehabilitation, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qian Nie
- Second Department of Cardiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hongcai Zhang
- Second Department of Cardiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Di Zhang
- Department of Rehabilitation, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Song Jin
- Department of Rehabilitation, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Kolaski K, Logan LR, Ioannidis JPA. Guidance to best tools and practices for systematic reviews. Acta Anaesthesiol Scand 2023; 67:1148-1177. [PMID: 37288997 DOI: 10.1111/aas.14295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 06/09/2023]
Abstract
Data continue to accumulate indicating that many systematic reviews are methodologically flawed, biased, redundant, or uninformative. Some improvements have occurred in recent years based on empirical methods research and standardization of appraisal tools; however, many authors do not routinely or consistently apply these updated methods. In addition, guideline developers, peer reviewers, and journal editors often disregard current methodological standards. Although extensively acknowledged and explored in the methodological literature, most clinicians seem unaware of these issues and may automatically accept evidence syntheses (and clinical practice guidelines based on their conclusions) as trustworthy. A plethora of methods and tools are recommended for the development and evaluation of evidence syntheses. It is important to understand what these are intended to do (and cannot do) and how they can be utilized. Our objective is to distill this sprawling information into a format that is understandable and readily accessible to authors, peer reviewers, and editors. In doing so, we aim to promote appreciation and understanding of the demanding science of evidence synthesis among stakeholders. We focus on well-documented deficiencies in key components of evidence syntheses to elucidate the rationale for current standards. The constructs underlying the tools developed to assess reporting, risk of bias, and methodological quality of evidence syntheses are distinguished from those involved in determining overall certainty of a body of evidence. Another important distinction is made between those tools used by authors to develop their syntheses as opposed to those used to ultimately judge their work. Exemplar methods and research practices are described, complemented by novel pragmatic strategies to improve evidence syntheses. The latter include preferred terminology and a scheme to characterize types of research evidence. We organize best practice resources in a Concise Guide that can be widely adopted and adapted for routine implementation by authors and journals. Appropriate, informed use of these is encouraged, but we caution against their superficial application and emphasize their endorsement does not substitute for in-depth methodological training. By highlighting best practices with their rationale, we hope this guidance will inspire further evolution of methods and tools that can advance the field.
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Affiliation(s)
- Kat Kolaski
- Departments of Orthopaedic Surgery, Pediatrics, and Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Lynne Romeiser Logan
- Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University, Syracuse, New York, USA
| | - John P A Ioannidis
- Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University School of Medicine, Stanford, California, USA
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12
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Cherian JM, Samuel S, Sabu AM, Thomas AM, Injety RJ. Dental implants in growing patients: A quality assessment of systematic reviews. J Oral Biol Craniofac Res 2023; 13:610-615. [PMID: 37565026 PMCID: PMC10410509 DOI: 10.1016/j.jobcr.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/10/2023] [Accepted: 07/20/2023] [Indexed: 08/12/2023] Open
Abstract
Background Dental implants in the recent past have become indispensable in restoring loss of space and support as well as aiding the aesthetics. Although in practice for a few years there is no consensus on the protocols for placement and usage of dental implants in growing jaws. Objective The present study aims to evaluate evidence-based literature on single or multiple dental implant placements in children(up to 17 years) and to identify areas lacking and gaps in knowledge. The quality assessment tool,namely AMSTAR-2, will also aim to evaluate the quality of said research around paediatric dental implants. Design The study was prospectively registered on the Open Science Framework https://osf.io/e59bt/?view_only=ec8fb69455c240ecbfc7379734784bf7.For source selection, electronic searches were performed on MEDLINE, EMBASE, Scopus databases as well as Google Scholar for all English language systematic reviews and meta analysis on dental implants placed on children up to 17yrs of age by 2 reviewers, wherein the publications until December 2020 were included. A final dataset of 4 systematic reviews were incorporated and analysed using the AMSTAR-2 grading tool. Results It was seen that only one study showed moderate overall confidence while one low overall confidence as per the AMSTAR-2. The other 2 systematic reviews were of critically low confidence levels. Hence, the existing systematic reviews on the subject are not of high quality. Most of the reviews have no consensus regarding use and placement of implants in growing patients. Conclusion More research and stricter adherence to the quality assessment guidelines is recommended for all future systematic reviews regarding dental implant in children.
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Affiliation(s)
- Joe Mathew Cherian
- Department of Pedodontics and Preventive Dentistry, Christian Dental College, Ludhiana, 141008, India
| | - Shannon Samuel
- Department of Pedodontics and Preventive Dentistry, Christian Dental College, Ludhiana, 141008, India
| | - Aneeta Mary Sabu
- Department of Oral and Maxillofacial Surgery, Christian Dental College, Ludhiana, 141008, India
| | - Abi M. Thomas
- Department of Pedodontics and Preventive Dentistry, Christian Dental College, Ludhiana, 141008, India
| | - Ranjit J. Injety
- Department of Community Medicine, Christian Medical College Ludhiana, 141008, India
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13
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Abstract
Data continue to accumulate indicating that many systematic reviews are methodologically flawed, biased, redundant, or uninformative. Some improvements have occurred in recent years based on empirical methods research and standardization of appraisal tools; however, many authors do not routinely or consistently apply these updated methods. In addition, guideline developers, peer reviewers, and journal editors often disregard current methodological standards. Although extensively acknowledged and explored in the methodological literature, most clinicians seem unaware of these issues and may automatically accept evidence syntheses (and clinical practice guidelines based on their conclusions) as trustworthy. A plethora of methods and tools are recommended for the development and evaluation of evidence syntheses. It is important to understand what these are intended to do (and cannot do) and how they can be utilized. Our objective is to distill this sprawling information into a format that is understandable and readily accessible to authors, peer reviewers, and editors. In doing so, we aim to promote appreciation and understanding of the demanding science of evidence synthesis among stakeholders. We focus on well-documented deficiencies in key components of evidence syntheses to elucidate the rationale for current standards. The constructs underlying the tools developed to assess reporting, risk of bias, and methodological quality of evidence syntheses are distinguished from those involved in determining overall certainty of a body of evidence. Another important distinction is made between those tools used by authors to develop their syntheses as opposed to those used to ultimately judge their work. Exemplar methods and research practices are described, complemented by novel pragmatic strategies to improve evidence syntheses. The latter include preferred terminology and a scheme to characterize types of research evidence. We organize best practice resources in a Concise Guide that can be widely adopted and adapted for routine implementation by authors and journals. Appropriate, informed use of these is encouraged, but we caution against their superficial application and emphasize their endorsement does not substitute for in-depth methodological training. By highlighting best practices with their rationale, we hope this guidance will inspire further evolution of methods and tools that can advance the field.
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Affiliation(s)
- Kat Kolaski
- Departments of Orthopaedic Surgery, Pediatrics, and Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lynne Romeiser Logan
- Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University, Syracuse, NY, USA
| | - John P.A. Ioannidis
- Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University School of Medicine, Stanford, CA, USA
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14
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Kolaski K, Logan LR, Ioannidis JPA. Guidance to best tools and practices for systematic reviews. BMC Infect Dis 2023; 23:383. [PMID: 37286949 DOI: 10.1186/s12879-023-08304-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/03/2023] [Indexed: 06/09/2023] Open
Abstract
Data continue to accumulate indicating that many systematic reviews are methodologically flawed, biased, redundant, or uninformative. Some improvements have occurred in recent years based on empirical methods research and standardization of appraisal tools; however, many authors do not routinely or consistently apply these updated methods. In addition, guideline developers, peer reviewers, and journal editors often disregard current methodological standards. Although extensively acknowledged and explored in the methodological literature, most clinicians seem unaware of these issues and may automatically accept evidence syntheses (and clinical practice guidelines based on their conclusions) as trustworthy.A plethora of methods and tools are recommended for the development and evaluation of evidence syntheses. It is important to understand what these are intended to do (and cannot do) and how they can be utilized. Our objective is to distill this sprawling information into a format that is understandable and readily accessible to authors, peer reviewers, and editors. In doing so, we aim to promote appreciation and understanding of the demanding science of evidence synthesis among stakeholders. We focus on well-documented deficiencies in key components of evidence syntheses to elucidate the rationale for current standards. The constructs underlying the tools developed to assess reporting, risk of bias, and methodological quality of evidence syntheses are distinguished from those involved in determining overall certainty of a body of evidence. Another important distinction is made between those tools used by authors to develop their syntheses as opposed to those used to ultimately judge their work.Exemplar methods and research practices are described, complemented by novel pragmatic strategies to improve evidence syntheses. The latter include preferred terminology and a scheme to characterize types of research evidence. We organize best practice resources in a Concise Guide that can be widely adopted and adapted for routine implementation by authors and journals. Appropriate, informed use of these is encouraged, but we caution against their superficial application and emphasize their endorsement does not substitute for in-depth methodological training. By highlighting best practices with their rationale, we hope this guidance will inspire further evolution of methods and tools that can advance the field.
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Affiliation(s)
- Kat Kolaski
- Departments of Orthopaedic Surgery, Pediatrics, and Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Lynne Romeiser Logan
- Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University, Syracuse, NY, USA
| | - John P A Ioannidis
- Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University School of Medicine, Stanford, CA, USA
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15
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Kolaski K, Logan LR, Ioannidis JPA. Guidance to best tools and practices for systematic reviews. Syst Rev 2023; 12:96. [PMID: 37291658 DOI: 10.1186/s13643-023-02255-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/19/2023] [Indexed: 06/10/2023] Open
Abstract
Data continue to accumulate indicating that many systematic reviews are methodologically flawed, biased, redundant, or uninformative. Some improvements have occurred in recent years based on empirical methods research and standardization of appraisal tools; however, many authors do not routinely or consistently apply these updated methods. In addition, guideline developers, peer reviewers, and journal editors often disregard current methodological standards. Although extensively acknowledged and explored in the methodological literature, most clinicians seem unaware of these issues and may automatically accept evidence syntheses (and clinical practice guidelines based on their conclusions) as trustworthy.A plethora of methods and tools are recommended for the development and evaluation of evidence syntheses. It is important to understand what these are intended to do (and cannot do) and how they can be utilized. Our objective is to distill this sprawling information into a format that is understandable and readily accessible to authors, peer reviewers, and editors. In doing so, we aim to promote appreciation and understanding of the demanding science of evidence synthesis among stakeholders. We focus on well-documented deficiencies in key components of evidence syntheses to elucidate the rationale for current standards. The constructs underlying the tools developed to assess reporting, risk of bias, and methodological quality of evidence syntheses are distinguished from those involved in determining overall certainty of a body of evidence. Another important distinction is made between those tools used by authors to develop their syntheses as opposed to those used to ultimately judge their work.Exemplar methods and research practices are described, complemented by novel pragmatic strategies to improve evidence syntheses. The latter include preferred terminology and a scheme to characterize types of research evidence. We organize best practice resources in a Concise Guide that can be widely adopted and adapted for routine implementation by authors and journals. Appropriate, informed use of these is encouraged, but we caution against their superficial application and emphasize their endorsement does not substitute for in-depth methodological training. By highlighting best practices with their rationale, we hope this guidance will inspire further evolution of methods and tools that can advance the field.
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Affiliation(s)
- Kat Kolaski
- Departments of Orthopaedic Surgery, Pediatrics, and Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Lynne Romeiser Logan
- Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University, Syracuse, NY, USA
| | - John P A Ioannidis
- Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University School of Medicine, Stanford, CA, USA
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16
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Kolaski K, Logan LR, Ioannidis JPA. Guidance to Best Tools and Practices for Systematic Reviews. JBJS Rev 2023; 11:01874474-202306000-00009. [PMID: 37285444 DOI: 10.2106/jbjs.rvw.23.00077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
» Data continue to accumulate indicating that many systematic reviews are methodologically flawed, biased, redundant, or uninformative. Some improvements have occurred in recent years based on empirical methods research and standardization of appraisal tools; however, many authors do not routinely or consistently apply these updated methods. In addition, guideline developers, peer reviewers, and journal editors often disregard current methodological standards. Although extensively acknowledged and explored in the methodological literature, most clinicians seem unaware of these issues and may automatically accept evidence syntheses (and clinical practice guidelines based on their conclusions) as trustworthy.» A plethora of methods and tools are recommended for the development and evaluation of evidence syntheses. It is important to understand what these are intended to do (and cannot do) and how they can be utilized. Our objective is to distill this sprawling information into a format that is understandable and readily accessible to authors, peer reviewers, and editors. In doing so, we aim to promote appreciation and understanding of the demanding science of evidence synthesis among stakeholders. We focus on well-documented deficiencies in key components of evidence syntheses to elucidate the rationale for current standards. The constructs underlying the tools developed to assess reporting, risk of bias, and methodological quality of evidence syntheses are distinguished from those involved in determining overall certainty of a body of evidence. Another important distinction is made between those tools used by authors to develop their syntheses as opposed to those used to ultimately judge their work.» Exemplar methods and research practices are described, complemented by novel pragmatic strategies to improve evidence syntheses. The latter include preferred terminology and a scheme to characterize types of research evidence. We organize best practice resources in a Concise Guide that can be widely adopted and adapted for routine implementation by authors and journals. Appropriate, informed use of these is encouraged, but we caution against their superficial application and emphasize their endorsement does not substitute for in-depth methodological training. By highlighting best practices with their rationale, we hope this guidance will inspire further evolution of methods and tools that can advance the field.
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Affiliation(s)
- Kat Kolaski
- Departments of Orthopaedic Surgery, Pediatrics, and Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Lynne Romeiser Logan
- Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University, Syracuse, New York
| | - John P A Ioannidis
- Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University School of Medicine, Stanford, California
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Jin S, Park SM, Choi SY, Park SY, Kim JH. Quality assessment of systematic reviews with meta-analysis in undergraduate nursing education. NURSE EDUCATION TODAY 2023; 126:105833. [PMID: 37187084 DOI: 10.1016/j.nedt.2023.105833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 04/04/2023] [Accepted: 04/22/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Little attention has been given to the methodological quality of meta-analyses in nursing education. This warrants further improvements in meta-analyses in nursing education. OBJECTIVE This study aimed to assess the methodological quality of meta-analysis in the field of undergraduate nursing education. DESIGN This was a methodological study to review the methodological quality of systematic reviews (SRs) with meta-analysis. METHODS Exhaustive literature searches were performed using five comprehensive databases. Between 1994 and 2022, 11,827 studies were identified, and 41 full-text articles met the inclusion criteria. Two researchers extracted data using A Measurement Tool to Assess Systematic Reviews (AMSTAR)-2. The Chi-square test was conducted to make comparisons before and after 2017, the year AMSTAR-2 was released. RESULTS A comprehensive literature retrieval strategy, inclusion and exclusion criteria, literature selection, and data extraction were observed in nursing education more than in other disciplines. Improvements to be made include pre-specifying the protocol, providing a list of excluded studies with their exclusion reasons, reporting the source of funding for the included studies, assessing and discussing the potential impact of risk of bias, as well as investigating and discussing publication bias and its impact. CONCLUSIONS The number of SRs with meta-analyses in nursing education is increasing. This warrants efforts to improve the quality of research. In addition, guidelines for reporting SRs in the field of nursing education should be constantly updated.
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Affiliation(s)
- Songxian Jin
- College of Nursing, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul 06591, Republic of Korea
| | - Seon-Min Park
- College of Nursing, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul 06591, Republic of Korea
| | - Seung-Yi Choi
- College of Nursing, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul 06591, Republic of Korea
| | - So Young Park
- College of Nursing, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul 06591, Republic of Korea
| | - Jung-Hee Kim
- College of Nursing, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul 06591, Republic of Korea.
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18
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De Santis KK, Pieper D, Lorenz RC, Wegewitz U, Siemens W, Matthias K. User experience of applying AMSTAR 2 to appraise systematic reviews of healthcare interventions: a commentary. BMC Med Res Methodol 2023; 23:63. [PMID: 36927334 PMCID: PMC10018966 DOI: 10.1186/s12874-023-01879-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND 'A Measurement Tool to Assess Systematic Reviews, version 2' (AMSTAR 2) is a validated 16-item scale designed to appraise systematic reviews (SRs) of healthcare interventions and to rate the overall confidence in their results. This commentary aims to describe the challenges with rating of the individual items and the application of AMSTAR 2 from the user perspective. DISCUSSION A group of six experienced users (methodologists working in different clinical fields for at least 10 years) identified and discussed the challenges in rating of each item and the general use of AMSTAR 2 to appraise SRs. A group discussion was used to develop recommendations on how users could deal with the identified challenges. We identified various challenges with the content of items 2-16 and with the derivation of the overall confidence ratings on AMSTAR 2. These challenges include the need (1) to provide additional definitions (e.g., what constitutes major deviations from SR protocol on item 2), (2) to choose a rating strategy for multiple conditions on single items (e.g., how to rate item 5 if studies were selected in duplicate, but consensus between two authors was not reported), and (3) to determine rules for deriving the confidence ratings (e.g., what items are critical for such ratings). Based on these challenges we formulated specific recommendations for items 2-16 that AMSTAR 2 users could consider before applying the tool. Our commentary adds to the existing literature by providing the first in-depth examination of the AMSTAR 2 tool from the user perspective. The identified challenges could be addressed by additional decision rules including definitions for ambiguous items and guidance for rating of complex items and derivation of confidence ratings. We recommend that a team consensus regarding such decision rules is required before appraisal procedure begins. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Karina Karolina De Santis
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany
| | - Dawid Pieper
- Brandenburg Medical School Theodor Fontane (MHB), Center for Health Services Research (ZVF-BB), Brandenburg an der Havel, Germany
| | - Robert C Lorenz
- Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany
| | - Uta Wegewitz
- Federal Institute for Occupational Safety and Health (BAuA), Division 3 Work and Health, Berlin, Germany
| | - Waldemar Siemens
- Faculty of Medicine, Institute for Evidence in Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Katja Matthias
- Faculty of Electrical Engineering and Computer Science, University of Applied Sciences Stralsund, Stralsund, Germany.
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Moore A, Fisher E, Eccleston C. Flawed, futile, and fabricated-features that limit confidence in clinical research in pain and anaesthesia: a narrative review. Br J Anaesth 2023; 130:287-295. [PMID: 36369016 DOI: 10.1016/j.bja.2022.09.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/26/2022] [Accepted: 09/26/2022] [Indexed: 11/11/2022] Open
Abstract
The randomised controlled trial is the foundation of clinical research; yet there is concern that many trials have flaws in design, conduct, and reporting that undermine trustworthiness. Common flaws in trials include high risk of bias, small size, outcomes irrelevant to clinical care and patient's experience, and inability to detect efficacy even if present. These flaws carry forward into systematic reviews, which can confer the label of 'high-quality evidence' on inadequate data. Trials can be futile because their flaws mean that they cannot deliver any meaningful result in that different results in a small number of patients would be sufficient to change conclusions. Some trials have been discovered to be fabricated, the number of which is growing. The fields of anaesthesia and pain have more fabricated trials than other clinical fields, possibly because of increased vigilance. This narrative review examines these themes in depth whilst acknowledging an inescapable conclusion: that much of our clinical evidence is in trouble, and special measures are needed to bolster quality and confidence.
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Affiliation(s)
| | - Emma Fisher
- Centre for Pain Research, University of Bath, Bath, UK
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20
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Chys M, De Meulemeester K, De Greef I, Murillo C, Kindt W, Kouzouz Y, Lescroart B, Cagnie B. Clinical Effectiveness of Dry Needling in Patients with Musculoskeletal Pain-An Umbrella Review. J Clin Med 2023; 12:jcm12031205. [PMID: 36769852 PMCID: PMC9917679 DOI: 10.3390/jcm12031205] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
The number of systematic reviews (SR) summarizing the literature regarding the clinical effects of Dry Needling (DN) has increased rapidly. Yet, rigorous evidence about the clinical effectiveness of this technique is still lacking. The aim of this umbrella review is to summarize the evidence about the clinical effects of trigger point DN on musculoskeletal disorders across all body regions. PubMed, Web of Science and Embase were searched to identify SRs examining the effect of DN (as a stand-alone intervention or combined with another treatment modality) compared to sham/no intervention or a physical therapy (PT) intervention with at least one clinical outcome in the domain of pain or physical functioning. Risk of bias (RoB) was assessed with the AMSTAR-2 tool. Quantification of the overlap in primary studies was calculated using the corrected covered area (CCA). The electronic search yielded 2286 results, of which 36 SRs were included in this review. Overall, DN is superior to sham/no intervention and equally effective to other interventions for pain reduction at short-term regardless of the body region. Some SRs favored wet needling (WN) over DN for short-term pain reductions. Results on physical functioning outcomes were contradictory across body regions. Limited data is available for mid- and long-term effects. DN has a short-term analgesic effect in all body regions and may be of additional value to the interventions that are used to date in clinical practice. Several studies have shown an additional treatment effect when combining DN to physiotherapeutic interventions compared to these interventions in isolation. There is a substantial need for the standardization of DN protocols to address the problem of heterogeneity and to strengthen the current evidence.
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Affiliation(s)
- Marjolein Chys
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
- Correspondence:
| | | | - Indra De Greef
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | - Carlos Murillo
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
- Pain in Motion International Research Group, 1000 Brussels, Belgium
| | - Wouter Kindt
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | - Yassir Kouzouz
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | - Bavo Lescroart
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
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The Efficacy of Strength Exercises for Reducing the Symptoms of Menopause: A Systematic Review. J Clin Med 2023; 12:jcm12020548. [PMID: 36675477 PMCID: PMC9864448 DOI: 10.3390/jcm12020548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The aim of this systematic review was to determine whether strength exercises improve the symptoms of menopause and to provide an update on the most recent scientific evidence on the type and regimen of exercise that help reduce the symptoms. METHODS An electronic search of scientific databases was performed from 2015 to 2022. Randomized clinical trials that analyzed the effects of strength exercises versus other types of interventions, considering all the outcome measures of interest, were included in this review. RESULTS We found 5964 potential articles. After applying the selection criteria, we selected 12 of the articles. The studies compared strength exercises versus other therapies or compared strength exercises versus no intervention in one of the groups. The results showed improvements in the strength of the legs and pelvic floor, physical activity, bone density, metabolic and hormonal changes, heart rate and blood pressure and a change in hot flashes. CONCLUSIONS There is evidence that strength exercises can be beneficial for improving strength, physical activity, bone density and hormonal and metabolic levels. In terms of the appropriate type of strength training, the evidence is still unclear given that the same benefits are achieved by various types of exercises.
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Kolaski K, Romeiser Logan L, Ioannidis JPA. Guidance to best tools and practices for systematic reviews1. J Pediatr Rehabil Med 2023; 16:241-273. [PMID: 37302044 DOI: 10.3233/prm-230019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
Data continue to accumulate indicating that many systematic reviews are methodologically flawed, biased, redundant, or uninformative. Some improvements have occurred in recent years based on empirical methods research and standardization of appraisal tools; however, many authors do not routinely or consistently apply these updated methods. In addition, guideline developers, peer reviewers, and journal editors often disregard current methodological standards. Although extensively acknowledged and explored in the methodological literature, most clinicians seem unaware of these issues and may automatically accept evidence syntheses (and clinical practice guidelines based on their conclusions) as trustworthy.A plethora of methods and tools are recommended for the development and evaluation of evidence syntheses. It is important to understand what these are intended to do (and cannot do) and how they can be utilized. Our objective is to distill this sprawling information into a format that is understandable and readily accessible to authors, peer reviewers, and editors. In doing so, we aim to promote appreciation and understanding of the demanding science of evidence synthesis among stakeholders. We focus on well-documented deficiencies in key components of evidence syntheses to elucidate the rationale for current standards. The constructs underlying the tools developed to assess reporting, risk of bias, and methodological quality of evidence syntheses are distinguished from those involved in determining overall certainty of a body of evidence. Another important distinction is made between those tools used by authors to develop their syntheses as opposed to those used to ultimately judge their work.Exemplar methods and research practices are described, complemented by novel pragmatic strategies to improve evidence syntheses. The latter include preferred terminology and a scheme to characterize types of research evidence. We organize best practice resources in a Concise Guide that can be widely adopted and adapted for routine implementation by authors and journals. Appropriate, informed use of these is encouraged, but we caution against their superficial application and emphasize their endorsement does not substitute for in-depth methodological training. By highlighting best practices with their rationale, we hope this guidance will inspire further evolution of methods and tools that can advance the field.
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Affiliation(s)
- Kat Kolaski
- Departments of Orthopaedic Surgery, Pediatrics, and Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lynne Romeiser Logan
- Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University, Syracuse, NY, USA
| | - John P A Ioannidis
- Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University School of Medicine, Stanford, CA, USA
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Miroshnikov AB, Smolensky AV. [Impact of isometric training on blood pressure: an umbrella study of systematic reviews and meta-analyses]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2023; 100:46-53. [PMID: 37735795 DOI: 10.17116/kurort202310004146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
High blood pressure causes 45% of deaths from heart diseases and 51% of deaths from stroke. OBJECTIVE To conduct systematic search and summarize the systematic reviews and/or meta-analyses about impact of isometric training on blood pressure. MATERIAL AND METHODS Systematic search for publications in PubMed, Cochrane Library and Epistemonikos databases for the period from January of 2017 yr. to 19 of January 2023 yr. was carried out. The search was done by keywords: isometric exercises, isometric training, blood pressure, arterial hypertension, static resistance training, handgrip test. Methodological quality of included articles was assessed using the «Assessment of methodological quality of systematic reviews» (AMSTAR-2) tool. The number of systematic reviews equal 15 was analyzed. RESULTS The overall methodological quality of 15 included reviews, obtained by AMSTAR-2, revealed a very low confidence rate (critically low confidence, 10 publications) for results of systematic review and meta-analyses. In total, analysis and generalization of all results of included systematic reviews about blood pressure decrease by isometric training showed, that systolic blood pressure against the background of this method decreases on average by 6.1±2.0 mm Hg, and diastolic blood pressure - by 3.0±1.0 mm Hg. CONCLUSION Authors of 15 systemic reviews, included in an umbrella study, reached a common conclusion about isometric training efficacy in secondary prevention of arterial hypertension.
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Affiliation(s)
- A B Miroshnikov
- Russian University of Sport «State Central Order of Lenin Institute of Physical Education (SCOLIPE)», Moscow, Russia
| | - A V Smolensky
- Russian University of Sport «State Central Order of Lenin Institute of Physical Education (SCOLIPE)», Moscow, Russia
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Lara-Palomo IC, Gil-Martínez E, Ramírez-García JD, Capel-Alcaraz AM, García-López H, Castro-Sánchez AM, Antequera-Soler E. Efficacy of e-Health Interventions in Patients with Chronic Low-Back Pain: A Systematic Review with Meta-Analysis. Telemed J E Health 2022; 28:1734-1752. [PMID: 35532971 DOI: 10.1089/tmj.2021.0599] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction: Low-back pain (LBP) is the leading cause of disability worldwide. Around 75-84% of the world's population will experience LBP at some point, establishing it as a major global health problem. e-Health is the remote delivery of therapeutic services, clinical information, and medical care, and may prove a very useful approach to tackle this pathology. Objectives: To evaluate the efficacy of e-health-based interventions in improving the symptoms of chronic LBP. Methods: A systematic review with meta-analysis was performed in PubMed, Web of Science, and PEDro until January 2022 through the assessment of methodological quality of systematic reviews (AMSTAR). Studies were included in which e-health interventions were used as experimental treatment compared to physical therapy to determine changes in back-specific functional status and pain in patients with chronic LBP. Two reviewers examined the sources individually, calculated the risk of bias, and extracted the data (PROSPERO number CRD42022306130). The effect size was calculated using the standardized mean difference (SMD) and its confidence interval (95% CI). Results: A total of 9 randomized controlled trials with 3,180 participants were included. The results of the findings showed an effect of e-health compared to other physical therapy on short-term (SMD = -0.59, 95% CI: -1.77 to 0.59) and intermediate short-term (SMD = -0.40, 95% CI: -0.91 to 0.11) pain intensity and back-specific functional status in the short term (SMD = -0.20, 95% CI: -0.81 to 0.41) and intermediate short term (SMD = -0.30, 95% CI: -0.74 to 0.14). The effect of e-health compared to minimal intervention on short-term intermediate pain intensity (SMD = -0.64, 95% CI: -1.72 to 0.45) and short-term intermediate back-specific functional status (SMD = -0.39, 95% CI: -0.87 to 0.09). Conclusions: e-Health interventions based on self-maintenance and education are as effective on pain and back-specific functional status as other face-to-face or home-based interventions in patients with chronic LBP, with moderate scientific evidence.
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Affiliation(s)
| | - Esther Gil-Martínez
- Department of Nursing, Physiotherapy and Medicine, Almería University, Almería, Spain
| | | | | | - Héctor García-López
- Department of Nursing, Physiotherapy and Medicine, Almería University, Almería, Spain
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Match Analysis in Team Ball Sports: An Umbrella Review of Systematic Reviews and Meta-Analyses. SPORTS MEDICINE - OPEN 2022; 8:66. [PMID: 35553279 PMCID: PMC9100301 DOI: 10.1186/s40798-022-00454-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 04/22/2022] [Indexed: 12/30/2022]
Abstract
Abstract
Background
Match analysis has evolved exponentially over the past decades in team sports resulting in a significant number of published systematic reviews and meta-analyses. An umbrella review of the available literature is needed to provide an integrated overview of current knowledge and contribute to more robust theoretical explanations of team performance.
Methods
The Web of Science (all databases), PubMed, Cochrane Library (Cochrane Database of Systematic Reviews), Scopus, and SPORTDiscus databases were searched for relevant publications prior to 19 February 2021. Appraisal of the methodological quality of included articles was undertaken using the tool for Assessing the Methodological Quality of Systematic Reviews (AMSTAR-2). Twenty-four studies were reviewed that met the following criteria: (1) contained relevant data from match analyses in team ball sports; (2) were defined as systematic reviews or/and meta-analyses; and (3) were written in the English language.
Results
The overall methodological quality of the 24 included reviews, obtained through the AMSTAR-2, revealed very low confidence ratings (Critically Low, n = 12) for the results of most systematic reviews of match analyses in team ball sports. Additionally, the results showed that research is focused mainly on four levels of analysis: (1) dyadic (microlevel); (2) individual (molecular level; predominant); (3) group (mesolevel), and (4) team dynamics (macrolevel). These levels of analysis included tactical, technical, physical, and psychosocial variables. Team performance was contextualized at two levels, with reference to: (1) match context (e.g. match status, match location, match period, quality of opposition) and (2) sociodemographic and environmental constraints (sex, age groups, competitive level, altitude, temperature, pitch surface).
Conclusions
The evolution of methods for match analysis in team ball sports indicates that: (1) an individual-level performance analysis was predominant; (2) the focus on intermediate levels of analysis, observing performance in dyadic and group interactions, has received less attention from researchers; (3) neglected areas of research include psychosocial aspects of team sports and women’s performance; and (4) analyses of match contexts need greater depth.
Registration: The protocol was registered in the International Platform of Registered Systematic Review and Meta-Analysis Protocols with the number 202080067 and the DOI number https://doi.org/10.37766/inplasy2020.8.0067.
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Xie PP, István B, Liang M. Sex-specific differences in biomechanics among runners: A systematic review with meta-analysis. Front Physiol 2022; 13:994076. [PMID: 36213228 PMCID: PMC9539551 DOI: 10.3389/fphys.2022.994076] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
Patellofemoral disorders are more common in female runners compared to their male counterparts. Differences in biomechanical characteristics between groups of runners could provide insight into the causes of higher rates of injury in female versus male runners, which would be useful to physical therapists and athletic trainers in development of individualized injury prevention programs. This review compares the differences in biomechanical characteristics between female and male runners. Electronic databases, including PubMed, Scopus, Web of Science, and Embase were searched in December 2021 for studies evaluating sex-specific differences in lower limb mechanics of healthy participants during running. Two independent reviewers determined the inclusion and quality of each research paper. Meta-analyses were used where possible. A total of 13 studies were selected. Means and standard deviations of reported data were retrieved from each selected paper for comparison of results. Three biomechanical variables, including dynamics, muscle activation, and kinematics, were compared between female and male runners. However, no differences were found in kinetic variables or muscle activation between groups due to insufficient data available from the selected studies. Meta-analyses of kinematic variables revealed that female runners exhibited significantly greater hip flexion angle, hip adduction angle, and hip internal rotation angle, but smaller knee flexion angle compared to male runners during running. We found significant differences in kinematic variables between female and male runners, which could influence the training advice of physical therapists and athletic trainers who work with runners, and inform the development of injury prevention programs.
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Affiliation(s)
- Ping-Ping Xie
- College of Science and Technology, Ningbo University, Ningbo, China
| | - Bíró István
- Faculty of Engineering, University of Szeged, Szeged, Hungary
| | - Minjun Liang
- Faculty of Sports Science, Ningbo University, Ningbo, China
- *Correspondence: Minjun Liang,
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Döring N, Conde M, Brandenburg K, Broll W, Gross HM, Werner S, Raake A. Can Communication Technologies Reduce Loneliness and Social Isolation in Older People? A Scoping Review of Reviews. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811310. [PMID: 36141581 PMCID: PMC9517063 DOI: 10.3390/ijerph191811310] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/31/2022] [Accepted: 09/03/2022] [Indexed: 05/14/2023]
Abstract
BACKGROUND Loneliness and social isolation in older age are considered major public health concerns and research on technology-based solutions is growing rapidly. This scoping review of reviews aims to summarize the communication technologies (CTs) (review question RQ1), theoretical frameworks (RQ2), study designs (RQ3), and positive effects of technology use (RQ4) present in the research field. METHODS A comprehensive multi-disciplinary, multi-database literature search was conducted. Identified reviews were analyzed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework. A total of N = 28 research reviews that cover 248 primary studies spanning 50 years were included. RESULTS The majority of the included reviews addressed general internet and computer use (82% each) (RQ1). Of the 28 reviews, only one (4%) worked with a theoretical framework (RQ2) and 26 (93%) covered primary studies with quantitative-experimental designs (RQ3). The positive effects of technology use were shown in 55% of the outcome measures for loneliness and 44% of the outcome measures for social isolation (RQ4). CONCLUSION While research reviews show that CTs can reduce loneliness and social isolation in older people, causal evidence is limited and insights on innovative technologies such as augmented reality systems are scarce.
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Affiliation(s)
- Nicola Döring
- Media Psychology and Media Design Group, Technische Universität Ilmenau, 98693 Ilmenau, Germany
- Correspondence:
| | - Melisa Conde
- Media Psychology and Media Design Group, Technische Universität Ilmenau, 98693 Ilmenau, Germany
| | - Karlheinz Brandenburg
- Electronic Media Technology Group, Technische Universität Ilmenau, 98693 Ilmenau, Germany
| | - Wolfgang Broll
- Virtual Worlds and Digital Games Group, Technische Universität Ilmenau, 98693 Ilmenau, Germany
| | - Horst-Michael Gross
- Neuroinformatics and Cognitive Robotics Lab, Technische Universität Ilmenau, 98693 Ilmenau, Germany
| | - Stephan Werner
- Electronic Media Technology Group, Technische Universität Ilmenau, 98693 Ilmenau, Germany
| | - Alexander Raake
- Audiovisual Technology Group, Technische Universität Ilmenau, 98693 Ilmenau, Germany
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Ferguson T, Olds T, Curtis R, Blake H, Crozier AJ, Dankiw K, Dumuid D, Kasai D, O'Connor E, Virgara R, Maher C. Effectiveness of wearable activity trackers to increase physical activity and improve health: a systematic review of systematic reviews and meta-analyses. Lancet Digit Health 2022; 4:e615-e626. [PMID: 35868813 DOI: 10.1016/s2589-7500(22)00111-x] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/22/2022] [Accepted: 05/27/2022] [Indexed: 05/27/2023]
Abstract
Wearable activity trackers offer an appealing, low-cost tool to address physical inactivity. This systematic review of systematic reviews and meta-analyses (umbrella review) aimed to examine the effectiveness of activity trackers for improving physical activity and related physiological and psychosocial outcomes in clinical and non-clinical populations. Seven databases (Embase, MEDLINE, Ovid Emcare, Scopus, SPORTDiscus, the Cochrane Library, and Web of Science) were searched from database inception to April 8, 2021. Systematic reviews of primary studies using activity trackers as interventions and reporting physical activity, physiological, or psychosocial outcomes were eligible for inclusion. In total, 39 systematic reviews and meta-analyses were identified, reporting results from 163 992 participants spanning all age groups, from both healthy and clinical populations. Taken together, the meta-analyses suggested activity trackers improved physical activity (standardised mean difference [SMD] 0·3-0·6), body composition (SMD 0·7-2·0), and fitness (SMD 0·3), equating to approximately 1800 extra steps per day, 40 min per day more walking, and reductions of approximately 1 kg in bodyweight. Effects for other physiological (blood pressure, cholesterol, and glycosylated haemoglobin) and psychosocial (quality of life and pain) outcomes were typically small and often non-significant. Activity trackers appear to be effective at increasing physical activity in a variety of age groups and clinical and non-clinical populations. The benefit is clinically important and is sustained over time. Based on the studies evaluated, there is sufficient evidence to recommend the use of activity trackers.
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Affiliation(s)
- Ty Ferguson
- Alliance for Research in Exercise, Nutrition, and Activity, University of South Australia, Adelaide, SA, Australia
| | - Timothy Olds
- Alliance for Research in Exercise, Nutrition, and Activity, University of South Australia, Adelaide, SA, Australia
| | - Rachel Curtis
- Alliance for Research in Exercise, Nutrition, and Activity, University of South Australia, Adelaide, SA, Australia
| | - Henry Blake
- Alliance for Research in Exercise, Nutrition, and Activity, University of South Australia, Adelaide, SA, Australia
| | - Alyson J Crozier
- Alliance for Research in Exercise, Nutrition, and Activity, University of South Australia, Adelaide, SA, Australia
| | - Kylie Dankiw
- Alliance for Research in Exercise, Nutrition, and Activity, University of South Australia, Adelaide, SA, Australia
| | - Dorothea Dumuid
- Alliance for Research in Exercise, Nutrition, and Activity, University of South Australia, Adelaide, SA, Australia
| | - Daiki Kasai
- Alliance for Research in Exercise, Nutrition, and Activity, University of South Australia, Adelaide, SA, Australia
| | - Edward O'Connor
- Alliance for Research in Exercise, Nutrition, and Activity, University of South Australia, Adelaide, SA, Australia
| | - Rosa Virgara
- Alliance for Research in Exercise, Nutrition, and Activity, University of South Australia, Adelaide, SA, Australia
| | - Carol Maher
- Alliance for Research in Exercise, Nutrition, and Activity, University of South Australia, Adelaide, SA, Australia.
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Li L, Asemota I, Liu B, Gomez-Valencia J, Lin L, Arif AW, Siddiqi TJ, Usman MS. AMSTAR 2 appraisal of systematic reviews and meta-analyses in the field of heart failure from high-impact journals. Syst Rev 2022; 11:147. [PMID: 35871099 PMCID: PMC9308914 DOI: 10.1186/s13643-022-02029-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 07/14/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Measurement Tool to Assess systematic Reviews (AMSTAR) 2 is a critical appraisal tool for systematic reviews (SRs) and meta-analyses (MAs) of interventions. We aimed to perform the first AMSTAR 2-based quality assessment of heart failure-related studies. METHODS Eleven high-impact journals were searched from 2009 to 2019. The included studies were assessed on the basis of 16 domains. Seven domains were deemed critical for high-quality studies. On the basis of the performance in these 16 domains with different weights, overall ratings were generated, and the quality was determined to be "high," "moderate," "low," or "critically low." RESULTS Eighty-one heart failure-related SRs with MAs were included. Overall, 79 studies were of "critically low quality" and two were of "low quality." These findings were attributed to insufficiency in the following critical domains: a priori protocols (compliance rate, 5%), complete list of exclusions with justification (5%), risk of bias assessment (69%), meta-analysis methodology (78%), and investigation of publication bias (60%). CONCLUSIONS The low ratings for these potential high-quality heart failure-related SRs and MAs challenge the discrimination capacity of AMSTAR 2. In addition to identifying certain areas of insufficiency, these findings indicate the need to justify or modify AMSTAR 2's rating rules.
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Affiliation(s)
- Lin Li
- Department of Medicine, Cook County Health, Chicago, IL, USA.
| | | | - Bolun Liu
- Department of Medicine, Cook County Health, Chicago, IL, USA
| | - Javier Gomez-Valencia
- Division of Cardiology, Cook County Health, Rush University Medical Center, Chicago, IL, USA
| | - Lifeng Lin
- Department of Statistics, Florida State University, Tallahassee, Florida, USA
| | | | - Tariq Jamal Siddiqi
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
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Kim S, Mortera M, Heyn P, Sood P, Wen PS, Chen Wong D, Tanveer S, Hu X. An overview of systematic reviews on the pharmacological randomized controlled trials for reducing intracranial pressure after traumatic brain injury. Brain Inj 2022; 36:829-840. [PMID: 35708261 DOI: 10.1080/02699052.2022.2087102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND There is a need for an overview of systematic reviews (SRs) examining randomized clinical trials (RCTs) of pharmacological interventions in the treatment of intracranial pressure (ICP) post-TBI. OBJECTIVES To summarize pharmacological effectiveness in decreasing ICP in SRs with RCTs and evaluate study quality. METHODS Comprehensive literature searches were conducted in MEDLINE, PubMed, EMBASE, PsycINFO, and Cochrane Library databases for English SRs through October 2020. Inclusion criteria were SRs with RCTs that examined pharmacological interventions to treat ICP in patients post-TBI. Data extracted were participant characteristics, pharmacological interventions, and ICP outcomes. Study quality was assessed with AMSTAR-2. RESULTS Eleven SRs between 2003 and 2020 were included. AMSTAR-2 ratings revealed 3/11 SRs of high quality. Pharmacological interventions included hyperosmolars, neuroprotectives, anesthetics, sedatives, and analgesics. Study samples ranged from 7 to 1282 patients. Hyperosmolar agents and sedatives were beneficial in lowering elevated ICP. High bolus dose opioids had a more deleterious effect on ICP. Neuroprotective agents did not show any effects in ICP management. RCT sample sizes and findings in the SRs varied. A lack of detailed data syntheses was noted. AMSTAR-2 analysis revealed moderate-to-high quality in most SRs. Future SRs may focus on streamlined reporting of dosing and clearer clinical recommendations. CONCLUSIONS PROSPERO-Registration: CRD42015017355.
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Affiliation(s)
- Sonya Kim
- Department of Neurology and Department of Rehabilitation Medicine, New York University Grossman School of Medicine, New York, USA
| | - Marianne Mortera
- NYU Steinhardt, Department of Occupational Therapy, New York University, New York, USA
| | - Patricia Heyn
- Marymount Center for Optimal Aging, School of Health Sciences, College of Health and Education, Marymount University, Arlington, Virginia, USA
| | - Pallavi Sood
- Marymount Center for Optimal Aging, School of Health Sciences, College of Health and Education, Marymount University, Arlington, Virginia, USA
| | - Pey-Shan Wen
- Lewis College of Nursing & Health Professions, Georgia State University, Atlanta, Georgia, USA
| | - Diana Chen Wong
- NYU Steinhardt, Department of Occupational Therapy, New York University, New York, USA
| | - Sarah Tanveer
- Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore, Maryland, USA
| | - Xiaolei Hu
- Department of Community Medicine and Rehabilitation, Umeå University, 901 85 Umeå, Sweden
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Cheung AKL, Wong CHL, Ho L, Wu IXY, Ke FYT, Chung VCH. Methodological quality of systematic reviews on Chinese herbal medicine: a methodological survey. BMC Complement Med Ther 2022; 22:48. [PMID: 35197038 PMCID: PMC8867833 DOI: 10.1186/s12906-022-03529-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systematic reviews (SRs) synthesise the best evidence of effectiveness and safety on Chinese herbal medicine (CHM). Decision-making should be supported by the high-quality evidence of prudently conducted SRs, but the trustworthiness of conclusions may be limited by poor methodological rigour. METHODS This survey aimed to examine the methodological quality of a representative sample of SRs on CHM published during January 2018 to March 2020. We conducted literature search in Cochrane Database of Systematic Reviews, MEDLINE via Ovid, and EMBASE via Ovid. Eligible SRs must be in Chinese or English with at least one meta-analysis on the treatment effect of any CHM documented in the 2015 Chinese Pharmacopoeia. Two reviewers extracted the bibliographical characteristics of SRs and appraised their methodological quality using AMSTAR 2 (Assessing the Methodological Quality of Systematic Reviews 2). The associations between bibliographical characteristics and methodological quality were investigated using Kruskal-Wallis tests and Spearman's rank correlation coefficients. RESULTS We sampled and appraised one hundred forty-eight SRs. Overall, one (0.7%) was of high methodological quality; zero (0%), four (2.7%), and one-hundred forty-three (96.6%) SRs were of moderate, low, and critically-low quality. Only thirteen SRs (8.8%) provided a pre-defined protocol; none (0%) provided justifications for including particular primary study designs; six (4.1%) conducted a comprehensive literature search; two (1.4%) provided a list of excluded studies; nine (6.1%) undertook meta-analysis with appropriate methods; and seven (4.7%) reported funding sources of included primary studies. Cochrane reviews had higher overall quality than non-Cochrane reviews (P < 0.001). SRs with European funding support were less likely to have critically-low quality when compared with their counterparts (P = 0.020). SRs conducted by more authors (rs = 0.23; P = 0.006) and published in higher impact factor journals (rs = 0.20; P = 0.044) were associated with higher methodological quality. CONCLUSIONS Our results indicated that the methodological quality of SRs on CHM is low. Future authors should enhance the methodological quality through registering a priori protocols, justifying selection of study designs, conducting comprehensive literature search, providing a list of excluded studies with rationales, using appropriate method for meta-analyses, and reporting funding sources among primary studies.
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Affiliation(s)
- Andy K L Cheung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Charlene H L Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Leonard Ho
- School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Irene X Y Wu
- 5/F, Xiangya School of Public Health, Central South University, 238 Shang-Ma-Yuan-Ling Alley, Kai-Fu District, Changsha, Hunan, China.
| | - Fiona Y T Ke
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Vincent C H Chung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong.,School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
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Nagendrababu V, Faggion CM, Pulikkotil SJ, Alatta A, Dummer PMH. Methodological assessment and overall confidence in the results of systematic reviews with network meta-analyses in Endodontics. Int Endod J 2022; 55:393-404. [PMID: 35080025 DOI: 10.1111/iej.13693] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/28/2022]
Abstract
AIM The aims of the study were to assess the methodological quality of systematic reviews with network meta-analyses (NMAs) in Endodontics using the "A MeaSurement Tool to Assess systematic Reviews" (AMSTAR 2) tool, and to evaluate the overall confidence in the results of the individual reviews included in the analysis. METHODOLOGY Systematic reviews with NMAs within the specialty of Endodontics published in English were identified from the PubMed, EbBSCOhost and SCOPUS databases from inception to July 2021. Two reviewers were involved independently in the selection of the reviews, data extraction, methodological quality assessment and overall confidence rating. Disagreements were resolved by discussion between the reviewers to achieve consensus; if disagreements persisted, a third reviewer made the final decision. The methodological quality of the included NMAs was appraised using the AMSTAR 2 checklist, which contains 16 items. The reviewers scored each item - 'Yes' - when the item was fully addressed, 'Partial Yes' - when the item was not fully addressed, or 'No' - when the item was not addressed. The overall confidence in the results of each review was classified as 'High', 'Moderate', 'Low' or 'Critically low' based on the criteria reported by the AMSTAR 2 developers. RESULTS Twelve systematic reviews with NMAs were included. All the NMAs adequately reported Item 1 ("Did the research questions and inclusion criteria for the review include the components of PICO?"), Item 8 ("Did the review authors describe the included studies in adequate detail?"), Item 9 ("Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review?") and Item 16 ("Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review?") , whereas only one NMA reported Item 10 adequately ("Did the review authors report on the sources of funding for the studies included in the review?"). The overall confidence in the results of eight reviews was categorised as "Critically low", one review was "Low", two reviews were "Moderate" and one review was "High". CONCLUSION The overall confidence in the results for the majority of systematic reviews with NMAs in Endodontics was judged to be 'Critically low' as their methodological quality was below the necessary standard. AMSTAR 2 and PRISMA for NMA guidelines are available to guide authors to produce high quality systematic reviews with NMAs and for Editors and peer-reviewers when assessing submissions to journals.
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Affiliation(s)
- Venkateshbabu Nagendrababu
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE
| | - Clovis M Faggion
- Faculty of Dentistry, Department of Periodontology and Operative Dentistry, University Hospital Münster, Münster, Germany
| | | | - Alaa Alatta
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE
| | - Paul M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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Häuser W, Fisher E, Perrot S, Moore RA, Makri S, Bidonde J. Non-pharmacological interventions for fibromyalgia (fibromyalgia syndrome) in adults: an overview of Cochrane Reviews. Hippokratia 2022. [DOI: 10.1002/14651858.cd015074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Winfried Häuser
- Department of Psychosomatic Medicine and Psychotherapy; Technische Universität München; München Germany
| | - Emma Fisher
- Cochrane Pain, Palliative and Supportive Care Group; Pain Research Unit, Churchill Hospital; Oxford UK
| | - Serge Perrot
- Service de Médecine Interne et Thérapeutique; Hôtel Dieu, Université Paris Descartes, INSERM U 987; Paris France
| | | | - Souzi Makri
- Cyprus League Against Rheumatism; Nicosia Cyprus
| | - Julia Bidonde
- School of Rehabilitation Science, College of Medicine; University of Saskatchewan; Saskatoon Canada
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Igelström E, Campbell M, Craig P, Katikireddi SV. Cochrane's risk of bias tool for non-randomized studies (ROBINS-I) is frequently misapplied: A methodological systematic review. J Clin Epidemiol 2021; 140:22-32. [PMID: 34437948 PMCID: PMC8809341 DOI: 10.1016/j.jclinepi.2021.08.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES We aimed to review how 'Risk of Bias In Non-randomized Studies-of Interventions' (ROBINS-I), a Cochrane risk of bias assessment tool, has been used in recent systematic reviews. STUDY DESIGN AND SETTING Database and citation searches were conducted in March 2020 to identify recently published reviews using ROBINS-I. Reported ROBINS-I assessments and data on how ROBINS-I was used were extracted from each review. Methodological quality of reviews was assessed using AMSTAR 2 ('A MeaSurement Tool to Assess systematic Reviews'). RESULTS Of 181 hits, 124 reviews were included. Risk of bias was serious/critical in 54% of assessments on average, most commonly due to confounding. Quality of reviews was mostly low, and modifications and incorrect use of ROBINS-I were common, with 20% reviews modifying the rating scale, 20% understating overall risk of bias, and 19% including critical-risk of bias studies in evidence synthesis. Poorly conducted reviews were more likely to report low/moderate risk of bias (predicted probability 57% [95% CI: 47-67] in critically low-quality reviews, 31% [19-46] in high/moderate-quality reviews). CONCLUSION Low-quality reviews frequently apply ROBINS-I incorrectly, and may thus inappropriately include or give too much weight to uncertain evidence. Readers should be aware that such problems can lead to incorrect conclusions in reviews.
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Affiliation(s)
- Erik Igelström
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square 99 Berkeley Street, Glasgow, G3 7HR.
| | - Mhairi Campbell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square 99 Berkeley Street, Glasgow, G3 7HR
| | - Peter Craig
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square 99 Berkeley Street, Glasgow, G3 7HR
| | - Srinivasa Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square 99 Berkeley Street, Glasgow, G3 7HR
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Kolaski K, Romeiser Logan L, Goss KD, Butler C. Quality appraisal of systematic reviews of interventions for children with cerebral palsy reveals critically low confidence. Dev Med Child Neurol 2021; 63:1316-1326. [PMID: 34091900 DOI: 10.1111/dmcn.14949] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 01/07/2023]
Abstract
AIM To evaluate the methodological quality of recent systematic reviews of interventions for children with cerebral palsy in order to determine the level of confidence in the reviews' conclusions. METHOD A comprehensive search of 22 databases identified eligible systematic reviews with and without meta-analysis published worldwide from 2015 to 2019. We independently extracted data and used A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR-2) to appraise methodological quality. RESULTS Eighty-three systematic reviews met strict eligibility criteria. Most were from Europe and Latin America and reported on rehabilitative interventions. AMSTAR-2 appraisal found critically low confidence in 88% (n=73) because of multiple and varied deficiencies. Only 7% (n=6) had no AMSTAR-2 critical domain deficiency. The number of systematic reviews increased fivefold from 2015 to 2019; however, quality did not improve over time. INTERPRETATION Most of these systematic reviews are considered unreliable according to AMSTAR-2. Current recommendations for treating children with CP based on these flawed systematic reviews need re-evaluation. Findings are comparable to reports from other areas of medicine, despite the general perception that systematic reviews are high-level evidence. The required use of current widely accepted guidance for conducting and reporting systematic reviews by authors, peer reviewers, and editors is critical to ensure reliable, unbiased, and transparent systematic reviews. What this paper adds Confidence was critically low in the conclusions of 88% of systematic reviews about interventions for children with cerebral palsy (CP). Quality issues in the sample were not limited to systematic reviews of non-randomized trials, or to those about certain populations of CP or interventions. The inclusion of meta-analysis did not improve the level of confidence in these systematic reviews. Numbers of systematic reviews on this topic increased over the 5 search years but their methodological quality did not improve.
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Affiliation(s)
- Kat Kolaski
- Department of Orthopedics, Wake Forest University, Winston-Salem, NC, USA.,Department of Pediatrics, Wake Forest University, Winston-Salem, NC, USA
| | - Lynne Romeiser Logan
- Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Katherine D Goss
- Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University, Syracuse, NY, USA
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Abstract
BACKGROUND Low back pain has been the leading cause of disability globally for at least the past three decades and results in enormous direct healthcare and lost productivity costs. OBJECTIVES The primary objective of this systematic review is to assess the impact of exercise treatment on pain and functional limitations in adults with chronic non-specific low back pain compared to no treatment, usual care, placebo and other conservative treatments. SEARCH METHODS We searched CENTRAL (which includes the Cochrane Back and Neck trials register), MEDLINE, Embase, CINAHL, PsycINFO, PEDro, SPORTDiscus, and trials registries (ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform), and conducted citation searching of relevant systematic reviews to identify additional studies. The review includes data for trials identified in searches up to 27 April 2018. All eligible trials have been identified through searches to 7 December 2020, but have not yet been extracted; these trials will be integrated in the next update. SELECTION CRITERIA We included randomised controlled trials that assessed exercise treatment compared to no treatment, usual care, placebo or other conservative treatment on the outcomes of pain or functional limitations for a population of adult participants with chronic non-specific low back pain of more than 12 weeks' duration. DATA COLLECTION AND ANALYSIS Two authors screened and assessed studies independently, with consensus. We extracted outcome data using electronic databases; pain and functional limitations outcomes were re-scaled to 0 to 100 points for meta-analyses where 0 is no pain or functional limitations. We assessed risk of bias using the Cochrane risk of bias (RoB) tool and used GRADE to evaluate the overall certainty of the evidence. When required, we contacted study authors to obtain missing data. To interpret meta-analysis results, we considered a 15-point difference in pain and a 10-point difference in functional limitations outcomes to be clinically important for the primary comparison of exercise versus no treatment, usual care or placebo. MAIN RESULTS We included 249 trials of exercise treatment, including studies conducted in Europe (122 studies), Asia (38 studies), North America (33 studies), and the Middle East (24 studies). Sixty-one per cent of studies (151 trials) examined the effectiveness of two or more different types of exercise treatment, and 57% (142 trials) compared exercise treatment to a non-exercise comparison treatment. Study participants had a mean age of 43.7 years and, on average, 59% of study populations were female. Most of the trials were judged to be at risk of bias, including 79% at risk of performance bias due to difficulty blinding exercise treatments. We found moderate-certainty evidence that exercise treatment is more effective for treatment of chronic low back pain compared to no treatment, usual care or placebo comparisons for pain outcomes at earliest follow-up (MD -15.2, 95% CI -18.3 to -12.2), a clinically important difference. Certainty of evidence was downgraded mainly due to heterogeneity. For the same comparison, there was moderate-certainty evidence for functional limitations outcomes (MD -6.8 (95% CI -8.3 to -5.3); this finding did not meet our prespecified threshold for minimal clinically important difference. Certainty of evidence was downgraded mainly due to some evidence of publication bias. Compared to all other investigated conservative treatments, exercise treatment was found to have improved pain (MD -9.1, 95% CI -12.6 to -5.6) and functional limitations outcomes (MD -4.1, 95% CI -6.0 to -2.2). These effects did not meet our prespecified threshold for clinically important difference. Subgroup analysis of pain outcomes suggested that exercise treatment is probably more effective than education alone (MD -12.2, 95% CI -19.4 to -5.0) or non-exercise physical therapy (MD -10.4, 95% CI -15.2 to -5.6), but with no differences observed for manual therapy (MD 1.0, 95% CI -3.1 to 5.1). In studies that reported adverse effects (86 studies), one or more adverse effects were reported in 37 of 112 exercise groups (33%) and 12 of 42 comparison groups (29%). Twelve included studies reported measuring adverse effects in a systematic way, with a median of 0.14 (IQR 0.01 to 0.57) per participant in the exercise groups (mostly minor harms, e.g. muscle soreness), and 0.12 (IQR 0.02 to 0.32) in comparison groups. AUTHORS' CONCLUSIONS We found moderate-certainty evidence that exercise is probably effective for treatment of chronic low back pain compared to no treatment, usual care or placebo for pain. The observed treatment effect for the exercise compared to no treatment, usual care or placebo comparisons is small for functional limitations, not meeting our threshold for minimal clinically important difference. We also found exercise to have improved pain (low-certainty evidence) and functional limitations outcomes (moderate-certainty evidence) compared to other conservative treatments; however, these effects were small and not clinically important when considering all comparisons together. Subgroup analysis suggested that exercise treatment is probably more effective than advice or education alone, or electrotherapy, but with no differences observed for manual therapy treatments.
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Affiliation(s)
- Jill A Hayden
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Jenna Ellis
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Rachel Ogilvie
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Antti Malmivaara
- Centre for Health and Social Economics (CHESS), National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Maurits W van Tulder
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, Netherlands
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Moore RA, Fisher E, Häuser W, Bell RF, Perrot S, Bidonde J, Makri S, Straube S. Pharmacological therapies for fibromyalgia (fibromyalgia syndrome) in adults - an overview of Cochrane Reviews. Hippokratia 2021. [DOI: 10.1002/14651858.cd013151.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Emma Fisher
- Cochrane Pain, Palliative and Supportive Care Group; Pain Research Unit, Churchill Hospital; Oxford UK
| | - Winfried Häuser
- Department of Psychosomatic Medicine and Psychotherapy; Technische Universität München; München Germany
| | - Rae Frances Bell
- Emerita, Regional Centre of Excellence in Palliative Care; Haukeland University Hospital; Bergen Norway
| | - Serge Perrot
- Service de Médecine Interne et Thérapeutique; Hôtel Dieu, Université Paris Descartes, INSERM U 987; Paris France
| | - Julia Bidonde
- School of Rehabilitation Science, College of Medicine; University of Saskatchewan; Saskatoon Canada
| | - Souzi Makri
- Cyprus League Against Rheumatism; Nicosia Cyprus
| | - Sebastian Straube
- Department of Medicine, Division of Preventive Medicine; University of Alberta; Edmonton Canada
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Moore RA, Fisher E, Finn DP, Finnerup NB, Gilron I, Haroutounian S, Krane E, Rice ASC, Rowbotham M, Wallace M, Eccleston C. Cannabinoids, cannabis, and cannabis-based medicines for pain management: an overview of systematic reviews. Pain 2021; 162:S67-S79. [PMID: 32804833 DOI: 10.1097/j.pain.0000000000001941] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/22/2020] [Indexed: 01/08/2023]
Abstract
ABSTRACT Cannabinoids, cannabis, and cannabis-based medicines (CBM) are increasingly used to manage pain, with limited understanding of their efficacy and safety. We assessed methodological quality, scope, and results of systematic reviews of randomised controlled trials of these treatments. Several search strategies sought self-declared systematic reviews. Methodological quality was assessed using both AMSTAR-2 and techniques important for bias reduction in pain studies. Of the 106 articles read, 57 were self-declared systematic reviews, most published since 2010. They included any type of cannabinoid, cannabis, or CBM, at any dose, however administered, in a broad range of pain conditions. No review examined the effects of a particular cannabinoid, at a particular dose, using a particular route of administration, for a particular pain condition, reporting a particular analgesic outcome. Confidence in the results in the systematic reviews using AMSTAR-2 definitions was critically low (41), low (8), moderate (6), or high (2). Few used criteria important for bias reduction in pain. Cochrane reviews typically provided higher confidence; all industry-conflicted reviews provided critically low confidence. Meta-analyses typically pooled widely disparate studies, and, where assessable, were subject to potential publication bias. Systematic reviews with positive or negative recommendation for use of cannabinoids, cannabis, or CBM in pain typically rated critically low or low (24/25 [96%] positive; 10/12 [83%] negative). Current reviews are mostly lacking in quality and cannot provide a basis for decision-making. A new high-quality systematic review of randomised controlled trials is needed to critically assess the clinical evidence for cannabinoids, cannabis, or CBM in pain.
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Affiliation(s)
| | - Emma Fisher
- Centre for Pain Research, University of Bath, Bath, United Kingdom
- Cochrane Pain, Palliative, and Supportive Care Review Groups, Oxford University Hospitals, Oxford, United Kingdom
| | - David P Finn
- Pharmacology and Therapeutics, School of Medicine, Galway Neuroscience Centre and Centre for Pain Research, NCBES, National University of Ireland Galway, Galway, Ireland
| | - Nanna B Finnerup
- Department of Clinical Medicine, Danish Pain Research Center, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Ian Gilron
- Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital and Queen's University, Kingston, ON, Canada
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
- School of Policy Studies, Queen's University, Kingston, ON, Canada
| | - Simon Haroutounian
- Division of Clinical and Translational Research, Washington University Pain Center, St. Louis, MO, United States
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, United States
| | - Elliot Krane
- Department of Anesthesiology, Perioperative and Pain Medicine, and Pediatrics, Stanford University School of Medicine, Stanford, Palo Alto, CA, United States
| | - Andrew S C Rice
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, United Kingdom
| | - Michael Rowbotham
- Department of Anesthesia, Pain Management Center, University of California San Francisco, San Francisco, CA, United Kingdom
- Sutter Health, CPMC Research Institute, California Pacific Medical Center Research Institute, San Francisco, CA, United States
| | - Mark Wallace
- Division of Pain Medicine, Department of Anesthesiology, University of California San Diego, San Diego, CA, United States
| | - Christopher Eccleston
- Centre for Pain Research, University of Bath, Bath, United Kingdom
- Cochrane Pain, Palliative, and Supportive Care Review Groups, Oxford University Hospitals, Oxford, United Kingdom
- Department of Clinical and Health Psychology, Ghent University, Ghent, Belgium
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Heidari Z, Rashidi Pour Fard N, Clark CCT, Haghighatdoost F. Dairy products consumption and the risk of hypertension in adults: An updated systematic review and dose-response meta-analysis of prospective cohort studies. Nutr Metab Cardiovasc Dis 2021; 31:1962-1975. [PMID: 33985895 DOI: 10.1016/j.numecd.2021.02.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 12/12/2022]
Abstract
AIMS With an increase in the number of published prospective cohort studies, we sought to summarize the relationship between dairy products consumption and the risk of hypertension (HTN). DATA SYNTHESIS We searched PubMed, Web of Science, Embase, Science direct, and Scopus. Pooled RRs and 95% CIs were calculated using a random effects model. The certainty of the evidence was assessed by Grading of Recommendations Assessment, Development and Evaluation (GRADE). Sixteen studies were included in the current meta-analysis. We found an inverse association between total dairy products (RR = 0.90; 95% CI: 0.87, 0.94; n = 16), low-fat dairy products (RR = 0.86; 95% CI: 0.77, 0.96; n = 8), milk (RR = 0.94; 95% CI: 0.90, 0.99; n = 11), and fermented dairy (RR = 0.95; 95% CI: 0.91, 0.99; n = 8) consumption and the risk of HTN. However, in subgroup analysis, despite a significant association for total dairy products in women, Americans, longer and larger studies, and self-reported HTN, no associations were found in males, Europeans, or Asians, and studies which followed participants for <10 years or had <3000 participants or measured HTN. Dose-response analysis revealed a non-linear association between total dairy products and milk consumption and the risk of HTN, but a linear association for low-fat dairy products. CONCLUSIONS Higher dairy products consumption was associated with reduced risk of HTN. This association was dependent on sex, geographical region of study, and the stage of HTN. However, the certainty of the evidence was graded either as low or very low.
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Affiliation(s)
- Zahra Heidari
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran; Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Cain C T Clark
- Centre for Intelligent Healthcare, Coventry University, Coventry, CV1 5FB, UK
| | - Fahimeh Haghighatdoost
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
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Ford JJ, Bower SE, Ford I, de Mello MM, Carneiro SR, Hahne AJ. Effects of specific muscle activation for low back pain on activity limitation, pain, work participation, or recurrence: A systematic review. Musculoskelet Sci Pract 2021; 52:102297. [PMID: 33563575 DOI: 10.1016/j.msksp.2020.102297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Jon J Ford
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, 3085, Australia.
| | | | | | | | | | - Andrew J Hahne
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, 3085, Australia.
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Clemente FM, Afonso J, Sarmento H. Small-sided games: An umbrella review of systematic reviews and meta-analyses. PLoS One 2021; 16:e0247067. [PMID: 33577611 PMCID: PMC7880470 DOI: 10.1371/journal.pone.0247067] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/29/2021] [Indexed: 02/06/2023] Open
Abstract
Objective This umbrella review was conducted to summarize the evidence and qualify the methodological quality of SR and SRMA published on small-sided games in team ball sports. Methods A systematic review of Web of Science, PubMed, Cochrane Library, Scopus, and SPORTDiscus databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results From the 176 studies initially identified, 12 (eight SR and four SRMA) were fully reviewed, and their outcome measures were extracted and analyzed. Methodological quality (with the use of AMSTAR-2) revealed that seven reviews had low quality and five had critically low quality. Two major types of effects of SSGs were observed: (i) short-term acute effects and (ii) long-term adaptations. Four broad dimensions of analysis were found: (i) physiological demands (internal load); (ii) physical demands (external load) or fitness status; (iii) technical actions; and (iv) tactical behavior and collective organization. The psychological domain was reduced to an analysis of enjoyment. The main findings from this umbrella review revealed that SSGs present positive effects in improving aerobic capacity and tactical/technical behaviors, while neuromuscular adaptations present more heterogeneous findings. Factors such as sex, age group, expertise, skill level, or fitness status are also determinants of some acute effects and adaptations. Conclusion The current umbrella review allowed to identify that most of the systematic review and meta-analysis conducted in SSGs presents low methodological quality considering the standards. Most of the systematic reviews included in this umbrella revealed that task constraints significantly change the acute responses in exercise, while SSGs are effective in improving aerobic capacity. Future original studies in this topic should improve the methodological quality and improve the experimental study designs for assessing changes in tactical/technical skills.
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Affiliation(s)
- Filipe Manuel Clemente
- Escola Superior Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial de Nun’Álvares, Viana do Castelo, Portugal
- Instituto de Telecomunicações, Delegação da Covilhã, Lisboa, Portugal
- * E-mail:
| | - José Afonso
- Centre for Research, Education, Innovation and Intervention in Sport, Faculty of Sport of the University of Porto, Porto, Portugal
| | - Hugo Sarmento
- Research Unit for Sport and Physical Activity, Faculty of Sport Sciences and Physical Education, University of Coimbra, Coimbra, Portugal
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Wang X, Welch V, Li M, Yao L, Littell J, Li H, Yang N, Wang J, Shamseer L, Chen Y, Yang K, Grimshaw JM. The methodological and reporting characteristics of Campbell reviews: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1134. [PMID: 37133262 PMCID: PMC8356304 DOI: 10.1002/cl2.1134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Background The Campbell Collaboration undertakes systematic reviews of the effects of social and economic policies (interventions) to help policymakers, practitioners, and the public to make well‐informed decisions about policy interventions. In 2010, the Cochrane Collaboration and the Campbell Collaboration developed a voluntary co‐registration policy under the rationale to make full use of the shared interests and diverse expertise from different review groups within these two organizations. In order to promote the methodological quality and transparency of Campbell intervention reviews, the Methodological Expectations of Campbell Collaboration Intervention Reviews (MECCIR) were introduced in 2014 to guide Campbell reviewers. However, there has not been a comprehensive review of the methodological quality and reporting characteristics of Campbell reviews. Objectives This review aimed to assess the methodological and reporting characteristics of Campbell intervention reviews and to compare the methodological quality and reporting completeness of Campbell reviews published before and after the implementation of MECCIR. A secondary aim was to compare the methodological quality and reporting completeness of reviews registered with Campbell only versus those co‐registered with Cochrane and Campbell. Search Methods We searched the Campbell Library to identify all the completed intervention reviews published between 1 January 2011 to 31 January 2018. Selection Criteria One researcher downloaded and screened all the records to exclude non‐intervention reviews based on reviews’ title and abstract. A second researcher checked the full text of all the excluded records to confirm the exclusion. In case of discrepancies, the two researchers jointly agreed on the final decision. Data Collection and Analysis We developed the abstraction form based on mandatory reporting items for methods, results, and discussion from the MECCIR reporting standards Version 1.1; and additional epidemiological characteristics identified in a similar study of systematic reviews in health. Additionally, we judged the methodological quality and completeness of reporting of each included review. For methodological quality, we used the AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews 2) instrument; for reporting completeness we used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) checklist. We rated reporting as either complete/partial or not reported. We described characteristics of the included reviews with frequencies and percentages, and median with interquartile ranges (IQRs). We used Stata version 12.0 to conduct multiple linear regressions for continuous data and the ordered logistic regressions for ordered data to investigate associations between prespecified factors and both methodological quality and completeness of reporting. Main Results We included 96 Campbell reviews, 46 were published between January 2011 and September 2014 (pre‐MECCIR) and 50 between October 2014 and January 2018 (post‐MECCIR). Twenty‐two of 96 (23%) reviews were co‐registered with Cochrane. For overall methodological quality, 16 (17%) reviews were rated as high, 40 (42%) as moderate, 24 (25%) as low and 16 (17%) as critical low using AMSTAR 2. Reviews published after the release of MECCIR had better methodological quality ratings than those published before MECCIR (odds ratio [OR] =6.61, 95% confidence interval [CI] [2.86, 15.27], p < .001). The percentages of reviews of high or moderate quality were 76% (post‐MECCIR) and 39% (pre‐MECCIR). Reviews co‐registered with Cochrane were rated as having better methodological quality than those registered only with Campbell (OR = 5.57, 95% CI [2.13, 14.58], p < .001). The percentages of reviews of high or moderate quality were 77% versus 53% between co‐registered and Campbell registered only reviews. Twenty‐five of 96 reviews (26%) completely or partially reported all 27 PRISMA checklist items. The median number of items reported across reviews was 25 (IQR, 22–26). Reviews published after the release of MECCIR reported 2.80 more items than those published before MECCIR (95% CI [1.74, 3.88], p < .001); reviews co‐registered on Campbell and Cochrane reported 1.98 more items than reviews only registered in Campbell (95% CI [0.72, 3.24], p = .003). An increasing trend over time was observed for both the percentage of high and moderate methodological quality of reviews and the median number of PRISMA items reported. Authors' Conclusions Many features expected in systematic reviews were present in Campbell reviews most of the time. Methodological quality and reporting completeness were both significantly higher in reviews published after the introduction of MECCIR in 2014 compared with those published before. However, this may also reflect general improvement in the reporting the methodology of systematic reviews over time or associations with other characteristics which were not assessed such as funding or experience of teams. Reviews co‐registered with Cochrane were of higher methodological quality and more complete reporting than reviews only registered in Campbell.
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Affiliation(s)
- Xiaoqin Wang
- Evidence‐based Medicine Centre of Lanzhou UniversityLanzhouChina
- Clinical Epidemiology Program, Ottawa Hospital Research InstituteOttawaOntarioCanada
- Michael G. DeGroote Institute for Pain Research and Care, McMaster UniversityHamiltonOntarioCanada
| | | | - Meixuan Li
- Evidence‐based Medicine Centre of Lanzhou UniversityLanzhouChina
| | - Liang Yao
- Department of Health Research Methods, Evidence and ImpactMcMaster UniversityHamiltonOntarioCanada
| | - Julia Littell
- Graduate School of Social Work and Social Research, Bryn Mawr CollegeBryn MawrPennsylvaniaUSA
| | - Huijuan Li
- Evidence‐based Medicine Centre of Lanzhou UniversityLanzhouChina
| | - Nan Yang
- Evidence‐based Medicine Centre of Lanzhou UniversityLanzhouChina
| | - Jianjian Wang
- Evidence‐based Medicine Centre of Lanzhou UniversityLanzhouChina
- School of Public Health, Lanzhou UniversityLanzhouChina
| | - Larissa Shamseer
- School of Public Health, University of OttawaOttawaOntarioCanada
- Li Ka Shing Knowledge Institute, St. Michael's HospitalTorontoOntarioCanada
| | - Yaolong Chen
- Evidence‐based Medicine Centre of Lanzhou UniversityLanzhouChina
| | - Kehu Yang
- Evidence‐based Medicine Centre of Lanzhou UniversityLanzhouChina
| | - Jeremy M. Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research InstituteOttawaOntarioCanada
- Department of MedicineUniversity of OttawaOttawaOntarioCanada
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Riley S, Swanson BT, Sawyer SF, Brismée JM, Staysniak G. Should low-quality evidence dominate high-level evidence? A systematic review and meta-analysis of systematic reviews of musculoskeletal physical therapy interventions. J Man Manip Ther 2020; 29:203-215. [PMID: 33200689 DOI: 10.1080/10669817.2020.1839728] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To determine the: 1) quality of articles cited in systematic reviews (SRs); 2) methodological quality of the SRs; and 3) impact of quality on level 1A evidence. METHODS SRs related to musculoskeletal physical therapy interventions were identified. The methodological quality of the SRs and articles cited by the SRs were assessed by two blinded reviewers. Data analysis was performed by a third blinded researcher. Additional comparisons were made based on the Journal Impact Factor, spin, financial bias, and conflict of interest. RESULTS Twenty-four SRs were identified; 21/24 SRs had 'critically low' quality on the AMSTAR 2. Thirty-four percent of included studies were 'low quality,' and 58% of SRs included studies that had unreported external validity. One-half of the SRs represented 'spin,' and one-third of the SRs generated conclusions based on low-quality clinical trials. DISCUSSION The 'critically low' SRs methodological quality was exacerbated by low-quality research inclusion. Most SRs failed to follow best practices, including prospective registration and integration of professional librarians in the search process. Based on the high proportion of SRs that include low-quality trials and overall low methodological quality, further discussion regarding practice recommendations on level vs. quality of evidence is warranted. LEVEL OF EVIDENCE 1a.
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Affiliation(s)
- Sean Riley
- Physical Therapy Program, Sacred Heart University, Fairfield, CT, USA
| | - Brian T Swanson
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT, USA
| | - Steven F Sawyer
- Department of Rehabilitation Sciences and Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Jean-Michel Brismée
- Department of Rehabilitation Sciences and Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Factors associated with the reporting quality of low back pain systematic review abstracts in physical therapy: a methodological study. Braz J Phys Ther 2020; 25:233-241. [PMID: 33246869 DOI: 10.1016/j.bjpt.2020.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/03/2020] [Accepted: 10/26/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Abstracts of systematic reviews (SR) are frequently used to guide clinical decision-making. However, if the abstract is inadequately reported, key information may be missing and it may not accurately summarize the results of the review. OBJECTIVE We aimed to investigate 1) if abstracts are fully reported; 2) if abstract reporting is associated with review/journal characteristics in physical therapy for low back pain (LBP); and 3) if these abstracts are consistent with the corresponding full texts. METHODS We searched the Physiotherapy Evidence Database for SRs in physical therapy for LBP published between 2015 and 2017. Associations between abstract reporting quality and review/journal characteristics were explored with linear regression. Abstract reporting was assessed with the 12 item Preferred Reporting Items for Systematic Reviews and Meta-Analyses for abstracts (PRISMA-A) checklist. Consistency of reporting between abstracts and the full text was evaluated by comparing responses to each item of the PRISMA-A using Kappa coefficients. Methodological quality of the reviews was assessed with A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2). RESULTS We included 66 SRs, 9 Cochrane and 57 non-Cochrane. Review methodological quality ranged from 'high' (8%) to 'critically low' (76%). The mean ± SD of the "total number of PRISMA-A fully reported items" (range 0-12 points for fully reported items) was 4.1 ± 1.9 points for non-Cochrane review abstracts and 9.9 ± 1.1 points for Cochrane abstracts. Factors associated with reporting quality of abstracts were: journal impact factor (ß 0.20; 95% CI: 0.06, 0.35), number of words in abstract (ß 0.01; 95% CI: 0.00, 0.01) and review methodological quality ('critically low' with ß -3.06; 95% CI: -5.30, -0.82; with 'high' as reference variable). There was typically inconsistent reporting between abstract and full text, with most Kappa values lower than 0.60. CONCLUSIONS The abstracts of SRs in physical therapy for LBP were poorly reported and inconsistent with the full text. The reporting quality of abstracts was higher in journals with a higher impact factor, in abstracts with a greater number of words, and when the review was of higher methodological quality.
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Chugh A, Patnana AK, Kumar P, Chugh VK, Khera D, Singh S. Critical analysis of methodological quality of systematic reviews and meta-analysis of antibiotics in third molar surgeries using AMSTAR 2. J Oral Biol Craniofac Res 2020; 10:441-449. [PMID: 32884898 PMCID: PMC7453117 DOI: 10.1016/j.jobcr.2020.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/16/2020] [Accepted: 07/19/2020] [Indexed: 12/18/2022] Open
Abstract
The clinicians usually prescribe antibiotics to reduce post-operative complications during third molar surgeries. However, in the absence of clear conclusions regarding the use of antibiotics in third molar surgeries, present systematic review was planned to assess the quality of systematic reviews evaluating the efficiency of antibiotics in reducing post-operative complications. The literature search was done in Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL), PUBMED, EMBASE, and Google scholar. Systematic reviews published in English during the period from January 1990 to December 2019 were included. The maxillary and mandibular third molars indicated for extraction either because of infection, orthodontic or prophylactic reasons were included. From 526 screened studies, thirteen reviews were qualified for qualitative analysis. The qualities of the included reviews were evaluated using the AMSTAR 2 tool. The included reviews were also evaluated based on the number of authors, geographic region, impact factor of the published journal, year of publication, and the number of citations for each review. One high quality, eight moderate quality, three low quality, and one critically low-quality reviews were observed in the present review. No statistically significant difference was observed between the included reviews based upon the analysis of the number of authors, geographic region, impact factor of the published journal, year of publication, and the number of citations for each review. Considering the observations form the high and moderate-quality reviews, the present systematic review concludes that antibiotics effectively aid in reducing the post-operative complications and frequency of observation of dry socket.
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Affiliation(s)
- Ankita Chugh
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Arun Kumar Patnana
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pravin Kumar
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vinay Kumar Chugh
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Daisy Khera
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Surjit Singh
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Abstract
STUDY DESIGN Retrospective review and literature review. OBJECTIVE The aim of this study was to provide an update on The Cochrane Back and Neck (CBN) activities. SUMMARY OF BACKGROUND DATA Low back pain (LBP) affects 80% of people at some time in their lives. CBN Group has been housed in Toronto at the Institute for Work & Health since 1996 and has published 85 reviews and 32 protocols in the Cochrane Library. METHODS Narrative review of CBN publications, impact factor, usage data, and social media impact. RESULTS In the past 3 years, CBN conducted priority setting with organizations that develop clinical practice guidelines for LBP. CBN editors and associate editors published key methodological articles in the field of back and neck pain research. The methodological quality of CBN reviews has been assessed by external groups in a variety of areas, which found that CBN reviews had higher methodological quality than non-Cochrane reviews. CBN reviews have been included in 35 clinical practice guidelines for back and neck conditions. The 2018 journal impact factor of CBN is 11.154, which is higher than the 2018 impact factor for CDSR (7.755). CBN reviews ranked 4th among 53 Cochrane review groups in terms of Cochrane Library usage data. The most accessed CBN review was "Yoga treatment for chronic non-specific low-back pain" which had 9689 full-text downloads. CBN is active on Twitter with 3958 followers. CONCLUSION CBN has published highly utilized systematic reviews and made important methodological contributions to the field of spine research over the past 22 years within Cochrane. LEVEL OF EVIDENCE 4.
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Sanchis-Sánchez E, Lluch-Girbés E, Guillart-Castells P, Georgieva S, García-Molina P, Blasco JM. Effectiveness of mechanical diagnosis and therapy in patients with non-specific chronic low back pain: a literature review with meta-analysis. Braz J Phys Ther 2020; 25:117-134. [PMID: 32773288 DOI: 10.1016/j.bjpt.2020.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/06/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To determine the effectiveness of mechanical diagnosis and therapy (MDT) in patients with chronic low back pain (CLBP) compared to other traditional physical therapy interventions. METHODS Randomized controlled trials investigating the effect of MDT compared to other traditional physical therapy interventions in individuals with CLBP were considered eligible. For the purpose of this review, MDT was compared to active and passive physical therapy interventions. Independent reviewers assessed the eligibility of studies, extracted data, and assessed the risk of bias. The primary outcomes investigated were pain and disability. RESULTS Fourteen studies were included in the review. Of these, 11 provided data to be included in the meta-analyses. Our findings showed that MDT was no more effective in decreasing pain (standardized mean difference [SMD]=0.01, 95% confidence interval [CI]: -0.44, 0.46) and disability (SMD=0.08, 95% CI: -0.53, 0.68) than other active treatments. Similar results were found when comparing MDT to other passive treatments for pain (SMD=-0.39, 95% CI: -0.90, 0.11) and disability (SMD=-0.13, 95% CI: -0.29, 0.03). CONCLUSION There is low to moderate quality evidence that MDT is not superior than other traditional physical therapy interventions in improving pain and disability in people with CLBP.
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Affiliation(s)
- Enrique Sanchis-Sánchez
- Department of Physical Therapy, University of Valencia, Valencia, Spain; IRIMED Joint Research Unit (La Fe - UV), Valencia, Spain
| | - Enrique Lluch-Girbés
- Department of Physical Therapy, University of Valencia, Valencia, Spain; Pain in Motion Research Group, Department of Human Physiology (Chropiver), Vrije Universiteit, Brussels, Belgium.
| | | | - Sylvia Georgieva
- Department of Methodology and Behavioral Sciences, University of Valencia, Valencia, Spain
| | | | - Jose-María Blasco
- Department of Physical Therapy, University of Valencia, Valencia, Spain; Group of Physiotherapy in the Ageing Processes: Socio-sanitary and Healthcare Strategies, Valencia, Spain; IRIMED Joint Research Unit (La Fe - UV), Valencia, Spain
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Storman M, Storman D, Jasinska KW, Swierz MJ, Bala MM. The quality of systematic reviews/meta-analyses published in the field of bariatrics: A cross-sectional systematic survey using AMSTAR 2 and ROBIS. Obes Rev 2020; 21:e12994. [PMID: 31997545 DOI: 10.1111/obr.12994] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/24/2019] [Accepted: 12/09/2019] [Indexed: 12/17/2022]
Abstract
High-quality systematic reviews (SR) and meta-analyses (MA) are considered to be reliable sources of information. This study aims to assess the quality of studies published as SR or MA in the field of bariatrics in 2016 and 2017. We identified SR and MA in the field of bariatrics by searching electronic databases (MEDLINE, Embase, and Cochrane Database of Systematic Reviews). Eligible studies were those identified as SR/MA in the title/abstract, which aimed to assess any outcome in patients with morbid obesity undergoing or scheduled to undergo bariatric surgery. Two authors independently reviewed all titles and abstracts, assessed full texts of potentially eligible studies, and assessed the quality of included studies. Any discrepancies were resolved by the third reviewer. We evaluated the quality and risk of bias of each SR/MA using AMSTAR 2 checklist and ROBIS tool, respectively. Seventy-eight of 4236 references met inclusion criteria and were assessed for their quality/risk of bias. The methodological quality of 99% of all papers was classified as "critically low." A total of 6% of the studies were at low risk of bias, and 78% were assessed as being at high risk of bias. The methodological quality of studies published in 2016 and 2017 as SR/MA is highly unsatisfactory.
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Affiliation(s)
- Monika Storman
- Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Dawid Storman
- Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna W Jasinska
- Students' Research Group, Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz J Swierz
- Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | - Malgorzata M Bala
- Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland.,Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland.,Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
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Mc Morrow R, Kriza C, Urbán P, Amenta V, Amaro JAB, Panidis D, Chassaigne H, Griesinger CB. Assessing the safety and efficacy of TAVR compared to SAVR in low-to-intermediate surgical risk patients with aortic valve stenosis: An overview of reviews. Int J Cardiol 2020; 314:43-53. [PMID: 32434749 PMCID: PMC7322533 DOI: 10.1016/j.ijcard.2020.04.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/20/2020] [Accepted: 04/06/2020] [Indexed: 12/19/2022]
Abstract
Background Transcatheter aortic valve replacement (TAVR) was initially introduced to treat patients with aortic valve stenosis (AS) at high-risk for surgical aortic valve replacement (SAVR). Today, there is ample evidence supporting TAVR in high-risk groups. However, in recent years TAVR has been extended to low-to intermediate risk groups and relevant clinical evidence is still emerging, leaving some uncertainties. Methods To obtain information on TAVR versus SAVR in low-to intermediate risk groups, we conducted an overview of systematic reviews following PRISMA guidelines and based on a systematic search of EMBASE, MEDLINE, Cochrane and CRD databases. We focused on systematic reviews assessing mortality and VARC 2 as clinical outcomes. Results The majority of the 11 systematic reviews included in our study reported no differences in mortality between TAVR and SAVR at short and long-term follow-up times. Two reviews that included the most recent RCTs on low-risk patients reported a decreased mortality risk with TAVR at one-year follow-up. Regarding the secondary endpoints of stroke and MI, the majority of studies presented similar results for TAVR and SAVR. Acute Kidney Injury, Bleeding Complications, Atrial Fibrillation were less frequent with TAVR, with lower risk of Permanent Pacemaker Implantation and Aortic Regurgitation with SAVR. Conclusions Our overview indicated that TAVR is a promising intervention for low-to-intermediate surgical risk patients; however additional evidence from longer term follow-up is needed to confirm these findings. This overview highlights inconsistencies about reporting and presentation of data, most notably limited clarity on effects of risk of bias on trial results. We reviewed the evidence for TAVR and SAVR in low-to intermediate risk patients. Most reviews found no difference in mortality between TAVR and SAVR. Acute Kidney Injury, Bleeding and Atrial Fibrillation were less frequent with TAVR. Pacemaker Implantation and Aortic Regurgitation were less frequent with SAVR. Most reviews found no difference for Stroke and Myocardial Infarction.
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Affiliation(s)
| | - Christine Kriza
- European Commission, Joint Research Centre (JRC), Ispra, Italy.
| | - Patricia Urbán
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - Valeria Amenta
- European Commission, Joint Research Centre (JRC), Ispra, Italy
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Nascimento DP, Gonzalez GZ, Araujo AC, Costa LOP. Journal impact factor is associated with PRISMA endorsement, but not with the methodological quality of low back pain systematic reviews: a methodological review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 29:462-479. [DOI: 10.1007/s00586-019-06206-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 09/30/2019] [Accepted: 11/02/2019] [Indexed: 12/28/2022]
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