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Eldabe S, Nevitt S, Copley S, Maden M, Goudman L, Hayek S, Mekhail N, Moens M, Rigoard P, Duarte R. Does industry funding and study location impact findings from randomized controlled trials of spinal cord stimulation? A systematic review and meta-analysis. Reg Anesth Pain Med 2024; 49:272-284. [PMID: 37611944 DOI: 10.1136/rapm-2023-104674] [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: 05/10/2023] [Accepted: 08/13/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND/IMPORTANCE Concerns have been raised that effects observed in studies of spinal cord stimulation (SCS) funded by industry have not been replicated in non-industry-funded studies and that findings may differ based on geographical location where the study was conducted. OBJECTIVE To investigate the impact of industry funding and geographical location on pain intensity, function, health-related quality of life and adverse events reported in randomized controlled trials (RCTs) of SCS. EVIDENCE REVIEW Systematic review conducted using MEDLINE, CENTRAL, EMBASE and WikiStim databases until September 2022. Parallel-group RCTs evaluating SCS for patients with neuropathic pain were included. Results of studies were combined in random-effects meta-analysis using the generic-inverse variance method. Subgroup meta-analyses were conducted according to funding source and study location. Risk of bias was assessed using Cochrane RoB 2.0 tool. FINDINGS Twenty-nine reports of 17 RCTs (1823 participants) were included. For the comparison of SCS with usual care, test for subgroup differences indicate no significant differences (p=0.48, moderate certainty evidence) in pain intensity score at 6 months for studies with no funding or funding not disclosed (pooled mean difference (MD) -1.96 (95% CI -3.23 to -0.69; 95% prediction interval (PI) not estimable, I2=0%, τ2=0)), industry funding (pooled MD -2.70 (95% CI -4.29 to -1.11; 95% PI -8.75 to 3.35, I2=97%, τ2=2.96) or non-industry funding (MD -3.09 (95% CI -4.47 to -1.72); 95% PI, I2 and τ2 not applicable). Studies with industry funding for the comparison of high-frequency SCS (HF-SCS) with low-frequency SCS (LF-SCS) showed statistically significant advantages for HF-SCS compared to LF-SCS while studies with no funding showed no differences between HF-SCS and LF-SCS (low certainty evidence). CONCLUSION All outcomes of SCS versus usual care were not significantly different between studies funded by industry and those independent from industry. Pain intensity score and change in pain intensity from baseline for comparisons of HF-SCS to LF-SCS seem to be impacted by industry funding.
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Affiliation(s)
- Sam Eldabe
- Department of Pain Medicine, The James Cook University Hospital, Middlesbrough, UK
| | - Sarah Nevitt
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Sue Copley
- Anaesthesia and Pain Management, James Cook University Hospital, Middlesbrough, UK
| | - Michelle Maden
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Lisa Goudman
- Department of Neurosurgery, UZ Brussel, Brussel, Belgium
| | - Salim Hayek
- Anesthesiology, Case Western Reserve University, Unviersity Hospitals, Cleveland, Ohio, USA
| | | | - Maarten Moens
- Department of Neurosurgery, UZ Brussel, Brussel, Belgium
| | - Phillipe Rigoard
- PRISMATICS Lab, Poitiers, France
- Department of Neurosurgery, Poitiers University Hospital, Poitiers, France
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Günther D, Herbst E, Laky B, Lattermann C, Mathis DT, Rössler P, Schüttler KF, Wafaisade A, Kopf S. Herausforderungen von Evidenzlevel-1-Studien in der Unfallchirurgie und Orthopädie. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00469-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungRandomisierte kontrollierte klinische Studien stellen für chirurgische Fachdisziplinen eine Herausforderung dar. Dieser Artikel beschreibt die Besonderheiten und Schwierigkeiten solcher Studien. Wann immer möglich, sollte das höchste Evidenzlevel angestrebt werden. Ist ein hohes Evidenzlevel allerdings methodisch nicht korrekt erreichbar, sollte das bestmögliche nächste Evidenzlevel erzielt werden. Die Bewertung, auch im Hinblick auf die Kostenerstattung, sollte daher gerade in chirurgischen Disziplinen nicht ausschließlich am Evidenzlevel festgemacht werden. Vielmehr sollte im Rahmen von Expertengremien und unter Zuhilfenahme der besten, verfügbaren Evidenz beurteilt werden.
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DE MORAES VINÍCIUSYNOE, RUFF PRISCILAFRANTZ, FERNANDES CARLOSHENRIQUE, SANTOS JOÃOBAPTISTAGOMESDOS, BELLOTI JOÃOCARLOS, FALOPPA FLÁVIO. APPLICABILITY OF RANDOMIZED TRIALS IN HAND SURGERY: SURVEY STUDY. ACTA ORTOPEDICA BRASILEIRA 2018; 26:154-157. [PMID: 30038536 PMCID: PMC6053970 DOI: 10.1590/1413-785220182603170123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the applicability of randomized clinical trials and whether certain factors (surgeon experience/journal impact factor) influence their applicability. METHODS In this survey study we used the Pubmed/Medline database to select 32 consecutive randomized clinical trials published between 2013 and 2015, involving hand surgery (high/low impact). These studies were independently assessed by 20 hand surgeons (with more or less than 10 years of practice) who answered 4 questions regarding their applicability. Agreement was assessed using Cohen's kappa and comparison of proportions via chi-square statistics. P-value <5% constituted statistical significance. RESULTS A total of 640 evaluations were produced, generating 2560 responses. A weak correlation was observed between less and more experienced respondents (kappa <0.2; range 0.119-0.179). Applicability between the least and most experienced respondents was similar (p = 0.424 and p = 0.70). Stratification by journal impact factor showed no greater propensity of applicability (p = 0.29) for any of the groups. CONCLUSIONS Low agreement was found between the respondents for the applicability of the randomized studies. Surgeon experience and journal impact do not seem to influence this decision. Level of Evidence II, Prospective comparative study.
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Malavolta EA, Demange MK, Gobbi RG, Imamura M, Fregni F. RANDOMIZED CONTROLLED CLINICAL TRIALS IN ORTHOPEDICS: DIFFICULTIES AND LIMITATIONS. Rev Bras Ortop 2015; 46:452-9. [PMID: 27027037 PMCID: PMC4799300 DOI: 10.1016/s2255-4971(15)30261-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 03/21/2011] [Indexed: 12/02/2022] Open
Abstract
Randomized controlled clinical trials (RCTs) are considered to be the gold standard for evidence-based medicine nowadays, and are important for directing medical practice through consistent scientific observations. Steps such as patient selection, randomization and blinding are fundamental for conducting a RCT, but some additional difficulties are presented in trials that involve surgical procedures, as is common in orthopedics. The aim of this article was to highlight and discuss some difficulties and possible limitations on RCTs within the field of surgery.
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Affiliation(s)
- Eduardo Angeli Malavolta
- Attending Physician in the Shoulder and Elbow Group, Institute of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - Marco Kawamura Demange
- MSc in Medicine. Attending Physician in the Knee Group, Institute of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - Riccardo Gomes Gobbi
- Attending Physician in the Knee Group, Institute of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - Marta Imamura
- PhD in Medicine. Collaborating Professor in the School of Medicine, University of São Paulo (USP); Physician in the Division of Physical Medicine and Rehabilitation, Institute of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - Felipe Fregni
- PhD in Medicine. Head of the Neuromodulation Laboratory and Clinical Research Teaching Center, Harvard Medical School, Boston, MA
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Cochrane in CORR®: Arthroplasty versus fusion in single-level cervical degenerative disc disease. Clin Orthop Relat Res 2014; 472:802-8. [PMID: 24078169 PMCID: PMC3916614 DOI: 10.1007/s11999-013-3284-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 09/04/2013] [Indexed: 01/31/2023]
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Fisher CG, DiPaola CP, Noonan VK, Bailey C, Dvorak MFS. Physician-industry conflict of interest: public opinion regarding industry-sponsored research. J Neurosurg Spine 2012; 17:1-10. [DOI: 10.3171/2012.4.spine11869] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The nature of physician-industry conflict of interest (COI) has become a source of considerable concern, but is often not discussed in the research setting. With reduced funding available from government and nonprofit sources, industry support has enthusiastically grown, but along with this comes the potential for COI that must be regulated. In this era of shared decision making in health care, society must have input into this regulation. The purpose of this study was to assess the opinions of a North American population sample on COI regarding industry-funded research and to analyze population subgroups for trends.
Methods
A survey was developed for face and content validity, underwent focus group evaluation for clarity and bias reduction, and was administered via the World Wide Web. Demographic and general survey results were summarized as a percentage for each answer, and subgroup analysis was done using logistic regression. Generalizability of the sample to the US population was also assessed.
Results
Of 541 surveys, 40 were excluded due to missing information, leaving 501 surveys for analysis. The sample population was composed of more females, was older, and was more educated than a representative cross-section of the American population. Respondents support multidisciplinary surgeon-industry COI regulation and trust doctors and their professional societies the most to head this effort. Respondents trust government officials and company representatives the least with respect to regulation of COI. Most respondents feel that industry-sponsored research can involve physicians and be both objective and beneficial to patients.
Conclusions
Most respondents in this study felt that surgeons should be involved in industry-sponsored research and that more research, regardless of funding source, will ultimately benefit patients. The majority of respondents distrust government or industry to regulate COI. The development of evidence-based treatment recommendations requires the inclusion of patient preference. The authors encourage regulatory bodies to follow suit and include society's perspective on regulation of COI in research.
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Affiliation(s)
- Charles G. Fisher
- 1Department of Orthopaedics, University of British Columbia, and
- 2Combined Neurosurgery and Orthopaedic Spine Program, Vancouver General Hospital, Vancouver, British Columbia
| | - Christian P. DiPaola
- 3Department of Orthopedics, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts
| | - Vanessa K. Noonan
- 1Department of Orthopaedics, University of British Columbia, and
- 2Combined Neurosurgery and Orthopaedic Spine Program, Vancouver General Hospital, Vancouver, British Columbia
| | - Christopher Bailey
- 4Division of Orthopedics, Department of Surgery, University of Western Ontario, London, Ontario, Canada; and
| | - Marcel F. S. Dvorak
- 1Department of Orthopaedics, University of British Columbia, and
- 2Combined Neurosurgery and Orthopaedic Spine Program, Vancouver General Hospital, Vancouver, British Columbia
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Chung KC, Kotsis SV, Berger RA, Van Ummersen G. The relationship between industry and surgery. J Hand Surg Am 2011; 36:1352-9. [PMID: 21664768 DOI: 10.1016/j.jhsa.2011.05.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 04/20/2011] [Accepted: 05/01/2011] [Indexed: 02/02/2023]
Abstract
This article examines industry's involvement in medicine, particularly with respect to surgeons and clinical research, as well as continuing medical education. We describe some historical events involving industry and how these events have led to guidelines by various organizations to handle conflicts of interest. We also review the advantages and disadvantages of collaborating with industry and provide practical guides for interactions with industry in terms of clinical research, continuing medical education, and clinical practice. With careful consideration to protect all parties involved, collaboration with industry can be advantageous to surgeons, industry, and patients.
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Affiliation(s)
- Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI 48109-0340, USA.
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Sussmann PS, Simmen BR, Goldhahn J, Sculco TP. Challenges for Large Orthopaedic Hospitals Worldwide-An ISOC Position Statement. HSS J 2010; 6:57-60. [PMID: 20012504 PMCID: PMC2821489 DOI: 10.1007/s11420-009-9144-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Accepted: 11/04/2009] [Indexed: 02/07/2023]
Abstract
Since the foundation of the International Society of Orthopaedic Centers in 2006, the group has continued to grow, with currently 11 members worldwide. During the 2008 annual meeting, the bylaws and mission of the group were approved as well as the acceptance of two additional members. Strict inclusion criteria were established to keep the group both small and effective. The goal of the 2008 meeting and this position statement is to identify current challenges in both research and education for large-volume orthopedic hospitals and to discuss possible approaches and solutions.
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Affiliation(s)
| | - Beat R. Simmen
- Schulthess Klinik, Lengghalde 2, CH-8008 Zurich, Switzerland
| | - Joerg Goldhahn
- Schulthess Klinik, Lengghalde 2, CH-8008 Zurich, Switzerland
| | | | - Thomas P. Sculco
- Hospital for Special Surgery, 535 East 70th Street, New York, NY USA
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