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Baldeh T, MacDonald T, Kosa SD, Lawson DO, Stalteri R, Olaiya OR, Alotaibi A, Thabane L, Mbuagbaw L. More pilot trials could plan to use qualitative data: a meta-epidemiological study. Pilot Feasibility Stud 2020; 6:164. [PMID: 33292715 PMCID: PMC7597013 DOI: 10.1186/s40814-020-00712-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 10/18/2020] [Indexed: 12/11/2022] Open
Abstract
Background Pilot trials often use quantitative data such as recruitment rate and retention rate to inform the design and feasibility of a larger trial. However, qualitative data such as patient, healthcare provider, and research staff perceptions of an intervention may also provide insights for a larger trial. Methods As part of a larger study investigating the reporting of progression criteria in pilot studies, we sought to determine how often pilot studies planned to use qualitative data to inform the design and feasibility of a larger trial and the factors associated with plans to use qualitative data. We searched for protocols of pilot studies of randomized trials in PubMed between 2013 and 2017. Results We included 227 articles. Only 92 (40.5%; 95% confidence interval [CI] 34.1–47.2) reported plans to collect qualitative data. The factors associated with collecting qualitative data were large studies (defined as sample size ≥ 60; adjusted odds ratio [aOR] 2.77; 95% CI 1.47–5.23; p = 0.002) and studies from Europe (aOR 3.86; 95% CI 1.68–8.88; p = 0.001) compared to North America and the rest of the world. Pilot trials with pharmacological interventions were less likely to plan to collect qualitative data (aOR 0.20; 95% CI 0.07–0.58; p = 0.003). Conclusions Qualitative data is not used enough in pilot trials. Large pilot trials, pilot trials from Europe, and pilot trials of non-pharmacological interventions are more likely to plan for qualitative data.
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Affiliation(s)
- Tejan Baldeh
- Department of Health Research Methods, Evidence and Impact, McMaster University Health Sciences Centre, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 4K1, Canada.
| | - Tonya MacDonald
- Department of Health Research Methods, Evidence and Impact, McMaster University Health Sciences Centre, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 4K1, Canada.,School of Midwifery, Laurentian University, Sudbury, ON, Canada
| | - Sarah Daisy Kosa
- Department of Health Research Methods, Evidence and Impact, McMaster University Health Sciences Centre, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 4K1, Canada.,Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Daeria O Lawson
- Department of Health Research Methods, Evidence and Impact, McMaster University Health Sciences Centre, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 4K1, Canada
| | - Rosa Stalteri
- Department of Health Research Methods, Evidence and Impact, McMaster University Health Sciences Centre, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 4K1, Canada
| | - Oluwatobi R Olaiya
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Ahlam Alotaibi
- Department of Pediatrics, Princess Noura University, Riyadh, Saudi Arabia
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University Health Sciences Centre, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 4K1, Canada.,Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Departments of Paediatrics and Anaesthesia, McMaster University, Hamilton, ON, Canada.,Centre for Evaluation of Medicine, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University Health Sciences Centre, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 4K1, Canada.,Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Centre for the Development of Best Practices in Health, Yaounde, Cameroon
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Mbuagbaw L, Lawson DO, Puljak L, Allison DB, Thabane L. A tutorial on methodological studies: the what, when, how and why. BMC Med Res Methodol 2020; 20:226. [PMID: 32894052 PMCID: PMC7487909 DOI: 10.1186/s12874-020-01107-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/27/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Methodological studies - studies that evaluate the design, analysis or reporting of other research-related reports - play an important role in health research. They help to highlight issues in the conduct of research with the aim of improving health research methodology, and ultimately reducing research waste. MAIN BODY We provide an overview of some of the key aspects of methodological studies such as what they are, and when, how and why they are done. We adopt a "frequently asked questions" format to facilitate reading this paper and provide multiple examples to help guide researchers interested in conducting methodological studies. Some of the topics addressed include: is it necessary to publish a study protocol? How to select relevant research reports and databases for a methodological study? What approaches to data extraction and statistical analysis should be considered when conducting a methodological study? What are potential threats to validity and is there a way to appraise the quality of methodological studies? CONCLUSION Appropriate reflection and application of basic principles of epidemiology and biostatistics are required in the design and analysis of methodological studies. This paper provides an introduction for further discussion about the conduct of methodological studies.
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Affiliation(s)
- Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
- Biostatistics Unit/FSORC, 50 Charlton Avenue East, St Joseph's Healthcare-Hamilton, 3rd Floor Martha Wing, Room H321, Hamilton, Ontario, L8N 4A6, Canada.
- Centre for the Development of Best Practices in Health, Yaoundé, Cameroon.
| | - Daeria O Lawson
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Livia Puljak
- Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, Ilica 242, 10000, Zagreb, Croatia
| | - David B Allison
- Department of Epidemiology and Biostatistics, School of Public Health - Bloomington, Indiana University, Bloomington, IN, 47405, USA
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit/FSORC, 50 Charlton Avenue East, St Joseph's Healthcare-Hamilton, 3rd Floor Martha Wing, Room H321, Hamilton, Ontario, L8N 4A6, Canada
- Departments of Paediatrics and Anaesthesia, McMaster University, Hamilton, ON, Canada
- Centre for Evaluation of Medicine, St. Joseph's Healthcare-Hamilton, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
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Mbuagbaw L, Kosa SD, Lawson DO, Stalteri R, Olaiya OR, Alotaibi A, Thabane L. The reporting of progression criteria in protocols of pilot trials designed to assess the feasibility of main trials is insufficient: a meta-epidemiological study. Pilot Feasibility Stud 2019; 5:120. [PMID: 31700654 PMCID: PMC6827233 DOI: 10.1186/s40814-019-0500-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 09/16/2019] [Indexed: 11/10/2022] Open
Abstract
Introduction Pilot and feasibility trials are conducted to determine feasibility or to collect information that would inform the design of a larger definitive trial. Clear progression criteria are required to determine if a definitive or main trial is feasible and how it should be designed. We sought to determine how often progression criteria are reported and the associated factors. Methods We conducted a methodological review of protocols for pilot randomised trials published in three journals that publish research protocols (BMJ Open, Trials, Pilot and Feasibility Studies), using a PubMed search (2013–2017). We extracted bibliometric information including the country in which the study was conducted, source of funding, type of intervention, use of a primary feasibility outcome, sample size reporting, and justification. We used generalised linear models to determine the factors associated with reporting progression criteria. Results Our search retrieved 276 articles, of which 49 were not eligible. We included 227 articles. Overall, 45/227 (19.8%; 95% confidence interval [CI] 14.8–25.6) reported progression criteria. Protocols published in more recent years were significantly associated with higher odds of reporting progression criteria (adjusted odds ratio [aOR] 1.40; 95% CI 1.03–1.92; p = 0.034). Pilot trials from Europe (aOR 0.19; 95% CI 0.08–0.48; p < 0.001) and the rest of the world (aOR 0.05; 95% CI 0.01–0.18; p < 0.003) compared to North America were significantly associated with lower odds of reporting progression criteria. Journal, source of funding, sample size, intervention type, and having a primary outcome related to feasibility were not significantly associated with reporting progression criteria. Conclusion Progression criteria are not often explicitly stated in protocols of pilot trials leaving room for varied interpretation of findings. The development of formal guidance for progression criteria in protocols of pilot trials is warranted.
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Affiliation(s)
- Lawrence Mbuagbaw
- 1Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON Canada.,2Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare-Hamilton, 50 Charlton Avenue East, 3rd Floor Martha Wing, Room H321, Hamilton, ON L8N 4A6 Canada.,Centre for the Development of Best Practices in Health, Yaoundé, Cameroon
| | - Sarah Daisy Kosa
- 1Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON Canada.,4Toronto General Hospital, University Health Network, Toronto, ON Canada
| | - Daeria O Lawson
- 1Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON Canada
| | - Rosa Stalteri
- 1Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON Canada
| | - Oluwatobi R Olaiya
- 5Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON Canada
| | - Ahlam Alotaibi
- 6Department of Pediatrics, McMaster University, Hamilton, ON Canada
| | - Lehana Thabane
- 1Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON Canada.,2Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare-Hamilton, 50 Charlton Avenue East, 3rd Floor Martha Wing, Room H321, Hamilton, ON L8N 4A6 Canada.,7Departments of Paediatrics and Anaesthesia, McMaster University, Hamilton, ON Canada.,8Centre for Evaluation of Medicine, St Joseph's Healthcare-Hamilton, Hamilton, ON Canada.,9Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON Canada
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Scola LFC, Moseley AM, Thabane L, Almeida M, Costa LDCM. A methodological survey on reporting of pilot and feasibility trials for physiotherapy interventions: a study protocol. BMJ Open 2019; 9:e020580. [PMID: 31122962 PMCID: PMC6538092 DOI: 10.1136/bmjopen-2017-020580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Pilot and feasibility trials aim to test whether a full trial can be conducted or if any procedures must be changed for the full trial. Pilot trials must be reported in a transparent, accurate and complete way. In this report, we present a protocol for a methodological survey with the following aims: (1) to determine the percentage of physiotherapy trial reports which claim to be pilot or feasibility trials that evaluate feasibility, (2) to determine the aspect of feasibility evaluated in the primary objectives of the pilot or feasibility trials, (3) to describe the completeness of reporting of abstracts and full articles of pilot or feasibility trials using the Consolidated Standards of Reporting Trials (CONSORT) extension to randomised pilot and feasibility trials and (4) to investigate factors associated with completeness of reporting of pilot or feasibility trials. METHODS AND ANALYSIS Reports of randomised controlled trials indexed in the Physiotherapy Evidence Database (PEDro) that claim to be pilot or feasibility trials and published in 2011-2017 will be included. Two independent reviewers will confirm eligibility and classify the aspect of feasibility being evaluated in the objectives of the included pilot or feasibility trials. Completeness of reporting of both the abstract and the full article will be evaluated using the CONSORT extension to randomised pilot and feasibility trials. The primary analysis will be a descriptive analysis about the reporting quality of abstracts and full texts of pilot and feasibility trials. We will use generalised estimating equation analysis to explore factors associated with completeness of reporting. ETHICS AND DISSEMINATION The results of this study will be disseminated by presentation at conferences and will be submitted for publication in a peer-reviewed journal. Ethical approval is not necessary for this study.
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Affiliation(s)
- Luiz Felicio Cadete Scola
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
- Department of Physical Therapy, Centro Universitário Anhanguera, São Paulo, Brazil
| | - Anne M Moseley
- Institute for Musculoskeletal Health, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Lehana Thabane
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Matheus Almeida
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
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Chung VCH, Wu X, Hui EP, Ziea ETC, Ng BFL, Ho RST, Tsoi KKF, Wong SYS, Wu JCY. Effectiveness of Chinese herbal medicine for cancer palliative care: overview of systematic reviews with meta-analyses. Sci Rep 2015; 5:18111. [PMID: 26669761 PMCID: PMC4680970 DOI: 10.1038/srep18111] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 11/12/2015] [Indexed: 12/15/2022] Open
Abstract
Chinese herbal medicines (CHM) are often used in managing cancer related symptoms but their effectiveness and safety is controversial. We conducted this overview of meta-analyses to summarize evidence on CHM for cancer palliative care. We included systematic reviews (SRs) with meta-analyses of CHM clinical trials on patients diagnosed with any type of cancer. Methodological quality of included meta-analyses was assessed with the Methodological Quality of Systematic Reviews (AMSTAR) Instrument. Fifty-one SRs with meta-analyses were included. They covered patients with lung (20 SRs), gastric (8 SRs), colorectal (6 SRs), liver (6 SRs), breast (2 SRs), cervical (1 SR), esophageal (1 SR), and nasopharyngeal (1 SR) cancers. Six SRs summarized evidence on various types of cancer. Methodological quality of included meta-analyses was not satisfactory. Overall, favorable therapeutic effects in improving quality of life among cancer patients have been reported. Conflicting evidence exists for the effectiveness of CHM in prolonging survival and in reducing chemotherapy and/or radiotherapy related toxicities. No serious adverse effects were reported in all included studies. Evidence indicated that CHM could be considered as an option for improving quality of life among patients receiving palliative care. It is unclear if CHM may increase survival, or reduce therapy related toxicities.
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Affiliation(s)
- Vincent CH Chung
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Xinyin Wu
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Edwin P. Hui
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong
- Comprehensive Cancer Trials Unit, The Chinese University of Hong Kong, Hong Kong
| | - Eric TC Ziea
- Chinese Medicine Department, Hong Kong Hospital Authority, Hong Kong
| | - Bacon FL Ng
- Chinese Medicine Department, Hong Kong Hospital Authority, Hong Kong
| | - Robin ST Ho
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Kelvin KF Tsoi
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
- Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong
| | - Samuel YS Wong
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Justin CY Wu
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong
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Chung VCH, Ho RST, Wu X, Fung DHY, Lai X, Wu JCW, Wong SYS. Are meta-analyses of Chinese herbal medicine trials trustworthy and clinically applicable? A cross-sectional study. JOURNAL OF ETHNOPHARMACOLOGY 2015; 162:47-54. [PMID: 25554640 DOI: 10.1016/j.jep.2014.12.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 12/18/2014] [Accepted: 12/18/2014] [Indexed: 06/04/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Meta-analysis (MA) on Chinese herbal medicine (CHM) trials is increasingly published and indexed in major international databases but their trustworthiness and clinical applicability is uncertain. We aimed to assess the characteristics and methodological quality of MA on CHM. MATERIALS AND METHODS Cross-sectional study. MA published during 1993-2013 was sampled from MEDLINE, EMBASE, Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effect. Bibliographical characteristics were abstracted and methodological quality was assessed using the validated AMSTAR tool by two independent reviewers. RESULTS Total of 201 MA were included and half were published in or after 2009. Only 7.5% being updates of previous reviews. Majority are published in journals with low or no impact factor, with a median of 1.5. These MA demonstrated methodological strengths in ensuring comprehensive literature search, providing characteristics of the included studies, assessing the scientific quality of included studies and appropriately using the scientific quality of included studies in formulating conclusions. Nevertheless, weaknesses in protocol provision, listing of included and excluded studies, inclusion of grey literature, use of appropriate meta-analytic technique as well as reporting of funding sources were prevalent. CHM and control interventions pooled in majority of MA are found to have substantial clinical heterogeneity in terms of composition, dosage form and route of administration. CONCLUSIONS There are rooms for improvement in methodological rigor, and in choosing clinically homogenous interventions and control for statistical pooling. These shortcomings limit the trustworthiness and clinical applicability of existing MA on CHM trials. To overcome the limitations of pair-wise meta-analysis in synthesizing trials comparing different CHM and control interventions, the potential of network meta-analysis should be explored.
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Affiliation(s)
- Vincent C H Chung
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong; Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Robin S T Ho
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Xinyin Wu
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong; Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong.
| | - Daisy H Y Fung
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Xin Lai
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Justin C W Wu
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Samuel Y S Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong; Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong
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