Evidence-based medicine needs patient and public involvement to remain relevant: A proposal for a new curriculum

The quality and reporting of recommendation documents to enhance the integrity of clinical trials: A systematic review and critical appraisal

BACKGROUND

Randomised clinical trials (RCTs) hold the highest validity level in effectiveness research. However, there is a growing concern regarding their trustworthiness. We aimed to appraise the quality and reporting of recommendation documents regarding research integrity to describe their contribution towards fostering RCT integrity.

METHODS

Following prospective registration (https://doi.org/10.17605/OSF.IO/DN93K), searches of electronic databases (Scopus, PubMed, Google Scholar) and relevant websites were performed from inception to 30 July 2023 without language limitations. Data extraction and document appraisal using adapted versions of AGREE II, RIGHT and ACCORD checklists were carried out in duplicate. Appraisal data were synthesised as % of the maximum score and documents were classified as: good≥70%, average 50-69%, and poor<50%.

RESULTS

From 1310 citations 14 recommendation documents were selected. Of these, 11 documents (78%) were of poor quality according to all three appraisal checklists. Reviewer agreement was 86-100% regarding the checklist items. The top three documents were: "International multi-stakeholder consensus statement on clinical trial integrity" (score 70% on AGREE II, 96% on RIGHT and 88% on ACCORD); "Development of consensus on essential virtues for ethics and research integrity" (score 51% on AGREE II, 71% on RIGHT and 77% on ACCORD); and "Hong Kong principles for assessing researchers" (score 19% on AGREE II, 57% on RIGHT and 10% on ACCORD).

CONCLUSION

There is a room from improvement in the quality and reporting of recommendation documents to help fostering RCT integrity. All stakeholders in the RCT lifecycle making concerted efforts to improve trust in evidence-based medicine need robust guidance to underpin research integrity policies and guidelines.

[International Multi-stakeholder Consensus Statement on Clinical Trial Integrity]

BACKGROUND

Science integrity initiatives require specific recommendations for randomised clinical trials (RCT).

OBJECTIVE

To prepare a set of statements for RCT integrity through an international multi-stakeholder consensus.

METHODS

The consensus was developed via multi-country multidisciplinary stakeholder group composition and engagement; evidence synthesis of 55 systematic reviews concerning RCT integrity; anonymised two-round modified Delphi survey with consensus threshold based on the average percent of majority opinions; and, a final consensus development meeting.

RESULTS

There were 30 stakeholders representing 15 countries from 5 continents including trialists, ethicists, methodologists, statisticians, consumer representative, industry representative, systematic reviewers, funding body panel members, regulatory experts, authors, journal editors, peer-reviewers and advisors for resolving integrity concerns. Delphi survey response rate was 86.7% (26/30 stakeholders). There were 111 statements (73 stakeholder-provided, 46 systematic review-generated, 8 supported by both) in the initial long list, with 8 additional statements provided during the consensus rounds. Through consensus the final set consolidated 81 statements (49 stakeholder-provided, 41 systematic review-generated, 9 supported by both). The entire RCT life cycle was covered by the set of statements including general aspects (n=6), design and approval (n=11), conduct and monitoring (n=19), reporting of protocols and findings (n=20), post-publication concerns (n=12), and future research and development (n=13).

CONCLUSION

Implementation of this multi-stakeholder consensus statement is expected to enhance RCT integrity.

Lifestyle Interventions in an Aged Population: Challenges and Opportunities from a Public Health Perspective

In recent decades, the prevalence of non-communicable diseases (NCDs) such as obesity, type 2 diabetes mellitus, cancer and cardiovascular disease has increased worldwide [...].

Developing a digital mind body medicine supportive care intervention for people with amyotrophic lateral sclerosis using stakeholder engagement and design thinking

Background

Amyotrophic lateral sclerosis disease (ALS) is also called the disease of a thousand farewells. Consequently, it is important to offer supportive care interventions that can be applied continuously during the whole course of the disease. People with ALS are interested in complementary and integrative medicine. Due to ALS' progressive nature, digital solutions might be most feasible and accessible for people with ALS in the long-term.

Objectives

In our study, we explored with stakeholders which digital complementary and integrative medicine interventions and formats are considered as supportive for people with ALS, and which settings are needed by the people with ALS to incorporate the interventions in everyday life.

Methods

We used a participatory research approach and conducted a stakeholder engagement process, applying a design thinking process with qualitative research methods (interviews, workshops).

Results

Due to the unpredictable course of the disease on their loss of abilities, people with ALS welcome online settings because they are accessible and easy to implement in their daily life. Stakeholders considered the following implementation factors for a complementary and integrative medicine intervention as essential: short-term realization of planned interventions, short duration of interventions, and user-friendliness in terms of accessibility and applicability. Concerning the complementary and integrative medicine interventions, the people with ALS preferred mind body medicine interventions, such as breathing, mindfulness and relaxation exercises.

Conclusions

Short-term treatment intervals and short online mind body medicine interventions align with the needs of people with ALS. The complementary and integrative medicine interventions as well as the digital infrastructure must meet the special accessibility and applicability needs of people with ALS.

International multi-stakeholder consensus statement on clinical trial integrity

OBJECTIVE

To prepare a set of statements for randomised clinical trials (RCT) integrity through an international multi-stakeholder consensus.

METHODS

The consensus was developed via: multi-country multidisciplinary stakeholder group composition and engagement; evidence synthesis of 55 systematic reviews concerning RCT integrity; anonymised two-round modified Delphi survey with consensus threshold based on the average percentage of majority opinions; and, a final consensus development meeting. Prospective registrations: (https://osf.io/bhncy, https://osf.io/3ursn).

RESULTS

There were 30 stakeholders representing 15 countries from five continents including triallists, ethicists, methodologists, statisticians, consumer representatives, industry representatives, systematic reviewers, funding body panel members, regulatory experts, authors, journal editors, peer-reviewers and advisors for resolving integrity concerns. Delphi survey response rate was 86.7% (26/30 stakeholders). There were 111 statements (73 stakeholder-provided, 46 systematic review-generated, 8 supported by both) in the initial long list, with eight additional statements provided during the consensus rounds. Through consensus the final set consolidated 81 statements (49 stakeholder-provided, 41 systematic review-generated, 9 supported by both). The entire RCT life cycle was covered by the set of statements including general aspects (n = 6), design and approval (n = 11), conduct and monitoring (n = 19), reporting of protocols and findings (n = 20), post-publication concerns (n = 12), and future research and development (n = 13).

CONCLUSION

Implementation of this multi-stakeholder consensus statement is expected to enhance RCT integrity.

Prospective Evaluation of Two Cohorts of Non-Operatively Treated Patients with Displaced vs. Minimally and Non-Displaced Distal Radius Fractures

BACKGROUND

Distal radius fractures (DRFs) in the elderly are common. Recently, the efficacy of operative treatment of displaced DRFs in patients above 65 years of age has been questioned and it has been suggested that non-operative treatment should be the gold standard. However, the complications and functional outcome of displaced vs. minimally and non-displaced DRFs in the elderly has not been evaluated yet. The aim of the present study was to compare non-operatively treated displaced DRFs vs. minimally and non-displaced DRFs in terms of complications, PROMs, grip strength and range of motion (ROM) after 2 weeks, 5 weeks, 6 months and 12 months.

METHODS

We used a prospective cohort study that compared patients with displaced DRFs (n = 50), i.e., >10 degrees of dorsal angulation after two reduction attempts, with patients with minimally or non-displaced DRFs after reduction. Both cohorts received the same treatment of 5 weeks of dorsal plaster casting. Complications and functional outcomes (quick disabilities of the arm, shoulder and hand (QuickDASH), patient-rated wrist/hand evaluation (PRWHE), grip strength and EQ-5D scores) were assessed after 5 weeks, 6 months and 12 months post-injury. The protocol of the VOLCON RCT and present observational study has been published (PMC6599306; clinicaltrials.gov: NCT03716661).

RESULTS

One year after 5 weeks of dorsal below-elbow casting of low-energy DRFs in patients ≥ 65 years old, we found a complication rate of 6.3% (3/48) in minimally or non-displaced DRFs and 16.6% (7/42) in displaced DRFs (p = 0.18). However, no statistically significant difference was observed in functional outcomes in terms of QuickDASH, pain, ROM, grip strength or EQ-5D scores.

DISCUSSION

In patients above 65 years of age, non-operative treatment, i.e., closed reduction and dorsal casting for 5 weeks, yielded similar complication rates and functional outcomes after 1 year regardless of whether the initial fracture was non-displaced/minimally displaced or still displaced after closed reduction. While the initial closed reduction should still be attempted in order to restore the anatomy, failure to achieve the stipulated radiological criteria may not be as important as we thought in terms of complications and functional outcome.