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Miranda JS, Abbade LPF, Abbade JF, Thabane L, Mbuagbaw L, Pascon GC, Campanili TCGF, Santos LP, de Gouveia Santos VLC. Deficiencies in reporting inclusion/exclusion criteria and characteristics of patients in randomized controlled trials of therapeutic interventions in pressure injuries: a systematic methodological review. Int Wound J 2023; 21:e14351. [PMID: 37904609 PMCID: PMC10824623 DOI: 10.1111/iwj.14351] [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: 05/30/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 11/01/2023] Open
Abstract
Wound care is a complex procedure and the related research may include many variables. Deficiencies in the sample inclusion and exclusion criteria may limit the generalizability of randomized controlled trials (RCTs) for wound patients in the real world. This study aimed to evaluate deficiencies in reporting the inclusion and exclusion criteria and the characteristics of patients in RCTs of pressure injuries (PI) therapeutic interventions. We conducted a systematic methodological review in which 40 full text RCTs of PI treatment interventions published in English, from 2008 to 2020, were identified. Data on the general characteristics of the included RCTs and data about inclusion/exclusion criteria and characteristics of patients were collected. The inclusion/exclusion criteria were categorized into five domains (definition of disease, precision, safety, ethical/legal and administrative). Study duration (in weeks) was 8.0 (quartile 1: 2.0; quartile 3: 48.0); only 5.0% of the trials mentioned race, skin colour or ethnicity, and 37.5% reported the duration of the wound. Only 9 (22.5%) studies reported the drugs that the included patients were using and 10 (25.0%) RCTs reported adverse events. The presence of the five domains was observed only in 12.5% of RCTs and only 12 (30.0%) had the precision domain. Much more research is required in systematic assessments of the external validity of trials because there is substantial disparity between the information that is provided by RCTs and the information that is required by clinicians. We concluded that there are deficiencies in reporting of data related to inclusion/exclusion criteria and characteristics of patients of RCTs assessing PI therapeutic interventions.
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Affiliation(s)
- Jéssica Steffany Miranda
- Research Group in Enterostomal Therapy: stomas, acute and chronic wounds and urinary and anal incontinences. School of NursingUniversity of São PauloSão PauloBrazil
| | - Luciana P. F. Abbade
- Department of Dermatology and RadiotherapySão Paulo State University Julio de Mesquita Filho ‐ Faculty of Medicine, Botucatu CampusSão PauloBrazil
| | - Joelcio Francisco Abbade
- Department of f Gynecology and ObstetricsSão Paulo State University Julio de Mesquita Filho ‐ Faculty of Medicine, Botucatu CampusSão PauloBrazil
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact (HEI)McMaster UniversityHamiltonOntarioCanada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact (HEI)McMaster UniversityHamiltonOntarioCanada
| | - Gisele Chicone Pascon
- Research Group in Enterostomal Therapy: stomas, acute and chronic wounds and urinary and anal incontinences. School of NursingUniversity of São PauloSão PauloBrazil
| | | | - Larissa Paula Santos
- Research Group in Enterostomal Therapy: stomas, acute and chronic wounds and urinary and anal incontinences. School of NursingUniversity of São PauloSão PauloBrazil
| | - Vera Lúcia Conceição de Gouveia Santos
- Research Group in Enterostomal Therapy: stomas, acute and chronic wounds and urinary and anal incontinences. School of NursingUniversity of São PauloSão PauloBrazil
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van Wyk L, Boers KE, Gordijn SJ, Ganzevoort W, Bremer HA, Kwee A, Delemarre FMC, van Pampus MG, Bloemenkamp KWM, Roumen FJME, van Lith JMM, Mol BWJ, Thornton JG, Scherjon SA, le Cessie S. Perinatal death in a term fetal growth restriction randomized controlled trial: the paradox of prior risk and consent. Am J Obstet Gynecol MFM 2020; 2:100239. [PMID: 33345938 DOI: 10.1016/j.ajogmf.2020.100239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The disproportionate intrauterine growth intervention trial at term was an intention to treat analysis and compared labor induction with expectant monitoring in pregnancies complicated by fetal growth restriction at term and showed equivalence for neonatal outcomes. OBJECTIVE To evaluate trial participation bias and to examine the generalizability of the results of an obstetrical randomized trial. STUDY DESIGN We used data from participants and nonparticipants of a randomized controlled trial-the disproportionate intrauterine growth intervention trial at term (n=1116) -to perform a secondary analysis. This study compared induction of labor and expectant management in women with term growth restriction. Data were collected in the same manner for both groups. Baseline characteristics and neonatal and maternal outcomes were compared. The primary outcome was a composite measure of adverse neonatal outcome. Secondary outcomes were delivery by cesarean delivery and instrumental vaginal delivery; length of stay in the neonatal intensive care, neonatal ward, and the maternal hospital; and maternal morbidity. RESULTS Nonparticipants were older, had a lower body mass index, had a higher level of education, smoked less, and preferred expectant management. The time between study inclusion and labor onset was shorter in participants than in nonparticipants. Notably, 4 perinatal deaths occurred among nonparticipants and none among participants. Among nonparticipants, there were more children born with a birthweight below the third centile. The nonparticipants who had expectant management were monitored less frequently than the participants in both the intervention and the expectant arm. CONCLUSION We found less favorable outcomes and more perinatal deaths in nonparticipants. Protocol-driven management, differences between participants and nonparticipants, or the fact that nonparticipants had a preference for expectant management might explain the findings.
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Affiliation(s)
- Linda van Wyk
- Leiden University Medical Center, Leiden, the Netherlands; Haaglanden Medical Center, the Hague, the Netherlands; University Medical Center Groningen, Groningen, the Netherlands.
| | - Kim E Boers
- Haaglanden Medical Center, the Hague, the Netherlands
| | - Sanne J Gordijn
- University Medical Center Groningen, Groningen, the Netherlands
| | | | | | - Anneke Kwee
- University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | | | | | | | - Ben W J Mol
- Monash University Health Services, Clayton, Australia
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Ye W, Li X, Gu W, Guo X, Han F, Liu S. A comparison of diagnostic consistency for asthma-chronic obstructive pulmonary disease overlap and clinical characteristics study. BMC Pulm Med 2019; 19:249. [PMID: 31852476 PMCID: PMC6921380 DOI: 10.1186/s12890-019-1024-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 12/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The diagnostic criteria for asthma-chronic obstructive pulmonary disease overlap have not been unified. Different studies have used different criteria, and this has led to diagnostic inconsistencies. METHODS We collected data of patients who were older than 40 years and hospitalised because of chronic bronchial diseases. One hundred and seventy-one patients were included in this study. We compared seven different diagnostic criteria, examined their consistency, and analysed differences among groups classified with each set. RESULTS The prevalence of ACO ranged between 7.02 and 27.49% depending on the criteria applied. The patients who met the Soler-Cataluna et al. criteria also met the GesEPOC criteria. Rhee has proposed the strictest diagnostic criteria; hence, the number of patients who met these criteria was the smallest, and those patients also met the diagnostic criteria proposed by the other studies. We found that applying the different sets of criteria did not lead to the selection of the same population, while there were no statistical differences in age, disease duration, allergens, and inflammatory markers. CONCLUSIONS The diagnostic criteria of ACO have not been unified, which hinders the design and progress of clinical studies that would investigate the ACO phenotypes and underlying mechanisms.
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Affiliation(s)
- Wenjing Ye
- Department of Respiratory Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665, Kongjiang Road, Shanghai, 200092, China
| | - Xiaoming Li
- Department of Respiratory Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665, Kongjiang Road, Shanghai, 200092, China
| | - Wen Gu
- Department of Respiratory Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665, Kongjiang Road, Shanghai, 200092, China.
| | - Xuejun Guo
- Department of Respiratory Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665, Kongjiang Road, Shanghai, 200092, China.
| | - Fengfeng Han
- Department of Respiratory Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665, Kongjiang Road, Shanghai, 200092, China
| | - Song Liu
- Department of Respiratory Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665, Kongjiang Road, Shanghai, 200092, China
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Mukka S, Sjöholm P, Chammout G, Kelly-Pettersson P, Sayed-Noor AS, Sköldenberg O. External Validity of the HOPE-Trial: Hemiarthroplasty Compared with Total Hip Arthroplasty for Displaced Femoral Neck Fractures in Octogenarians. JB JS Open Access 2019; 4:e0061. [PMID: 31334467 PMCID: PMC6613851 DOI: 10.2106/jbjs.oa.18.00061] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Randomized controlled trials (RCTs) are the most reliable way of evaluating the effect of new treatments by comparing them with previously accepted treatment regimens. The results obtained from an RCT are extrapolated from the study environment to the general health care system. The ability to do so is called external validity. We sought to evaluate the external validity of an RCT comparing the results of total hip arthroplasty with those of hemiarthroplasty for the treatment of displaced femoral neck fractures in patients ≥80 years of age. METHODS This prospective, single-center cohort study included 183 patients ≥80 years of age who had a displaced femoral neck fracture. All patients were screened according to the inclusion and exclusion criteria for an RCT comparing total hip arthroplasty and hemiarthroplasty. The population for this study consisted of patients who gave their informed consent and were randomized into the RCT (consenting group, 120 patients) as well as those who declined to give their consent to participate (non-consenting group, 63 patients). The outcome measurements were mortality, complications, and patient-reported outcome measures. Follow-up was carried out postoperatively with use of a mailed survey that included patient-reported outcome questionnaires. RESULTS We found a statistically significant and clinically relevant difference between the groups, with the non-consenting group having a higher risk of death compared with the consenting group. (hazard ratio, 4.6; 95% confidence interval, 1.9 to 11.1). No differences were found between the groups in terms of patient-reported outcome measures or surgical complications. CONCLUSIONS This cohort study indicates a higher mortality rate but comparable hip function and quality of life among eligible non-consenters as compared with eligible consenters when evaluating the external validity of an RCT in patients ≥80 years of age with femoral neck fracture. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Sebastian Mukka
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Pontus Sjöholm
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Ghazi Chammout
- Departments of Orthopedics and Clinical Sciences at Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Paula Kelly-Pettersson
- Departments of Orthopedics and Clinical Sciences at Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Arkan S Sayed-Noor
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Olof Sköldenberg
- Departments of Orthopedics and Clinical Sciences at Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
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Representativeness of the participants in the smoking Cessation in Pregnancy Incentives Trial (CPIT): a cross-sectional study. Trials 2016; 17:426. [PMID: 27565625 PMCID: PMC5002204 DOI: 10.1186/s13063-016-1552-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 08/13/2016] [Indexed: 11/10/2022] Open
Abstract
Background The limited representativeness of trial samples may restrict external validity. The aim of this study was to ascertain the representativeness of the population enrolled in the Cessation in Pregnancy Incentives Trial (CPIT), a therapeutic exploratory study to examine the effectiveness of financial incentives for smoking cessation during pregnancy. Methods CPIT participants (n = 492) were compared with all self-reported smokers at maternity booking who did not participate in the trial (n = 1982). Both groups were drawn from the National Health Service (NHS) Greater Glasgow and Clyde area over a 1-year trial enrolment period. Variables used for comparison were age, area-based deprivation index, body mass index, gestation, and carbon monoxide (CO) breath test level. Chi-square and Mann-Whitney U tests were used to compare groups. Results From January to December 2012, 2474/13,945 (17.7 %) women, who booked for maternity care, self-reported as current smokers (at least one cigarette in the last week). Seven hundred and fifty-two were ineligible for trial participation because of a CO breath test level of less than 7 parts per million (ppm) used as a biochemical cut-off to corroborate self-report of current smoking. At telephone consent 301 could not be contacted, 11 had miscarried, 16 did not give consent and 3 opted out after randomisation, leaving 492 participants for analysis. There were no differences in demographic or clinical characteristics between trial participants, and self-reported smokers not enrolled in the trial in terms of CO breath test (as a measure of smoking level for those with a CO level of 7 ppm or higher), material deprivation (using an area-based measure), maternal age and maternal body mass index. Gestation at booking was statistically significantly lower for participants. Conclusions To ensure that all trial participants were smokers, biochemical validation excluded self-reported smokers with a CO level of less than 7 ppm from taking part in the trial, which excluded 30 % of self-reported smokers who were ‘lighter’ smokers. The efficacy of financial incentives would not have been likely to decrease if ‘lighter’ smokers had been included in the trial population. Trial participants were slightly earlier in their pregnancy at maternity booking, but this difference would not clinically affect the provision of financial incentives if provided routinely. Overall, the trial population was representative of all self-reported smokers with regard to available routinely collected data. Appropriate comparison of trial and target populations, with detailed reporting of exclusion criteria would contribute to the understanding of the wider applicability of trial results. Trial registration Current Controlled Trials ISRCTN87508788. Registered/Assigned on 1 September 2011.
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Mikkelsen LR, Petersen AK, Mechlenburg I, Mikkelsen S, Søballe K, Bandholm T. Description of load progression and pain response during progressive resistance training early after total hip arthroplasty: secondary analyses from a randomized controlled trial. Clin Rehabil 2016; 31:11-22. [DOI: 10.1177/0269215516628305] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To describe a progressive resistance training intervention implemented shortly after total hip arthroplasty, including a detailed description of load progression, pain response and adverse events to the training. Design: Secondary analyses of data from the intervention group in a randomized controlled trial. Subjects: This study reports data from the intervention group ( n = 37). Interventions: The protocol described supervised progressive resistance training of the operated leg two days/week in addition to home-based exercise five days/week and for 10 weeks. The relative load progressed from 12 repetition maximum to 8 repetition maximum during 10 weeks for the exercises: knee extension, hip abduction, -flexion and -extension. Main measures: Training load in kilograms (kg) for each exercise, hip pain during, before and after exercise using the Visual Analog Scale and adverse events during the initial four weeks of training. Results: The majority of patients experienced only moderate hip pain during exercise (range in median across exercises and sessions: 5–35 mm Visual Analog Scale) and mild pain at rest (median: 1–18 mm Visual Analog Scale), both of which decreased over time ( p < 0.001), despite a substantial increase in absolute training load (67%–166 % across exercises, p < 0.001). Out of 152 training sessions, short term pain response (an increase >20 mm Visual Analog Scale) occurred in 13 patients in 24 training sessions. Conclusion: Progressive resistance training as described in the present study can be implemented shortly following total hip arthroplasty with substantial load progression and no overall exacerbation of postoperative pain. Some patients may experience a short term pain response. Trial Registration (primary trial): NCT01214954
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Affiliation(s)
- Lone R Mikkelsen
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Annemette K Petersen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
- Centre of Research in Rehabilitation (CORIR), Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Inger Mechlenburg
- Centre of Research in Rehabilitation (CORIR), Aarhus University Hospital and Aarhus University, Aarhus, Denmark
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Mikkelsen
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Kjeld Søballe
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Bandholm
- Physical Medicine & Rehabilitation Research – Copenhagen (PMR-C), Copenhagen University Hospital, Hvidovre, Denmark
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
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7
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Andersen KV, Nikolajsen L, Daugaard H, Andersen NT, Haraldsted V, Søballe K. Local infiltration analgesia is not improved by postoperative intra-articular bolus injections for pain after total hip arthroplasty. Acta Orthop 2015; 86:647-53. [PMID: 26312445 PMCID: PMC4750761 DOI: 10.3109/17453674.2015.1081340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 06/27/2015] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE The effect of postoperative intra-articular bolus injections after total hip arthroplasty (THA) remains unclear. We tested the hypothesis that intra-articular bolus injections administered every 6 hours after surgery during the first 24 hours would significantly improve analgesia after THA. PATIENTS AND METHODS 80 patients undergoing THA received high-volume local infiltration analgesia (LIA; 200 mg ropivacaine and 30 mg ketorolac) followed by 4 intra-articular injections with either ropivacaine (100 mg) and ketorolac (15 mg) (the treatment group) or saline (the control group). The intra-articular injections were combined with 4 intravenous injections of either saline (treatment group) or 15 mg ketorolac (control group). All patients received morphine as patient-controlled analgesia (PCA). The primary outcome was consumption of intravenous morphine PCA and secondary outcomes were consumption of oral morphine, pain intensity, side effects, readiness for hospital discharge, length of hospital stay, and postoperative consumption of analgesics at 3, 6, and 12 weeks after surgery. RESULTS There were no statistically significant differences between the 2 groups regarding postoperative consumption of intravenous morphine PCA. Postoperative pain scores during walking were higher in the treatment group from 24-72 hours after surgery, but other pain scores were similar between groups. Time to readiness for hospital discharge was longer in the treatment group. Other secondary outcomes were similar between groups. INTERPRETATION Postoperative intra-articular bolus injections of ropivacaine and ketorolac cannot be recommended as analgesic method after THA.
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Affiliation(s)
| | | | | | - Niels T Andersen
- Biostatistics Section, Department of Public Health, Aarhus University, Aarhus
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Mikkelsen LR, Mechlenburg I, Søballe K, Jørgensen LB, Mikkelsen S, Bandholm T, Petersen AK. Effect of early supervised progressive resistance training compared to unsupervised home-based exercise after fast-track total hip replacement applied to patients with preoperative functional limitations. A single-blinded randomised controlled trial. Osteoarthritis Cartilage 2014; 22:2051-8. [PMID: 25305374 DOI: 10.1016/j.joca.2014.09.025] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 08/26/2014] [Accepted: 09/30/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine if 2 weekly sessions of supervised progressive resistance training (PRT) in combination with 5 weekly sessions of unsupervised home-based exercise is more effective than 7 weekly sessions of unsupervised home-based exercise in improving leg-extension power of the operated leg 10 weeks after total hip replacement (THR) in patients with lower pre-operative function. METHOD A total of 73 patients scheduled for THR were randomised (1:1) to intervention group (IG, home based exercise 5 days/week and PRT 2 days/week) or control group (CG, home based exercise 7 days/week). The primary endpoint was change in leg extension power at 10 week follow up. Secondary outcomes were isometric hip muscle strength, sit-to-stand test, stair climb test, 20 m walking speed and patient-reported outcome (HOOS). RESULTS Sixty-two completed the trial (85%). Leg extension power increased from baseline to the 10 week follow up in both groups; mean [95% CI] IG: 0.29 [0.13; 0.45] and CG: 0.26 [0.10; 0.42] W/kg, with no between-group difference (primary outcome) (P = 0.79). Maximal walking speed (P = 0.008) and stair climb performance (P = 0.04) improved more in the IG compared to CG, no other between-group differences existed. CONCLUSIONS In this trial, supervised PRT twice a week in addition to 5 weekly sessions of unsupervised exercise for 10 weeks was not superior to 7 weekly sessions of unsupervised home-based exercise for 10 weeks in improving the primary outcome, leg-extension power of the operated leg, at the primary endpoint 10 weeks after surgery in THR patients with lower pre-operative function. TRIAL REGISTRATION NCT01214954.
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Affiliation(s)
- L R Mikkelsen
- Interdisciplinary Research Unit, Elective Surgery Centre, Silkeborg Regional Hospital, Denmark; Lundbeck Centre for Fast-track Hip and Knee Arthroplasty, Denmark.
| | - I Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Denmark.
| | - K Søballe
- Department of Orthopaedic Surgery, Aarhus University Hospital, Denmark.
| | - L B Jørgensen
- Interdisciplinary Research Unit, Elective Surgery Centre, Silkeborg Regional Hospital, Denmark; Institute of Clinical Medicine, Aarhus University, Denmark.
| | - S Mikkelsen
- Interdisciplinary Research Unit, Elective Surgery Centre, Silkeborg Regional Hospital, Denmark.
| | - T Bandholm
- Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Physiotherapy, Copenhagen University Hospital, Hvidovre, Denmark; Department of Orthopaedic Surgery and Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark.
| | - A K Petersen
- Department of Physiotherapy- and Occupational Therapy, Aarhus University Hospital, Denmark; Centre of Research in Rehabilitation (CORIR), Institute of Clinical Medicine, Aarhus University, Denmark.
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Fernandes N, Bryant D, Griffith L, El-Rabbany M, Fernandes NM, Kean C, Marsh J, Mathur S, Moyer R, Reade CJ, Riva JJ, Somerville L, Bhatnagar N. Outcomes for patients with the same disease treated inside and outside of randomized trials: a systematic review and meta-analysis. CMAJ 2014; 186:E596-609. [PMID: 25267774 PMCID: PMC4216275 DOI: 10.1503/cmaj.131693] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND It is unclear whether participation in a randomized controlled trial (RCT), irrespective of assigned treatment, is harmful or beneficial to participants. We compared outcomes for patients with the same diagnoses who did ("insiders") and did not ("outsiders") enter RCTs, without regard to the specific therapies received for their respective diagnoses. METHODS By searching the MEDLINE (1966-2010), Embase (1980-2010), CENTRAL (1960-2010) and PsycINFO (1880-2010) databases, we identified 147 studies that reported the health outcomes of "insiders" and a group of parallel or consecutive "outsiders" within the same time period. We prepared a narrative review and, as appropriate, meta-analyses of patients' outcomes. RESULTS We found no clinically or statistically significant differences in outcomes between "insiders" and "outsiders" in the 23 studies in which the experimental intervention was ineffective (standard mean difference in continuous outcomes -0.03, 95% confidence interval [CI] -0.1 to 0.04) or in the 7 studies in which the experimental intervention was effective and was received by both "insiders" and "outsiders" (mean difference 0.04, 95% CI -0.04 to 0.13). However, in 9 studies in which an effective intervention was received only by "insiders," the "outsiders" experienced significantly worse health outcomes (mean difference -0.36, 95% CI -0.61 to -0.12). INTERPRETATION We found no evidence to support clinically important overall harm or benefit arising from participation in RCTs. This conclusion refutes earlier claims that trial participants are at increased risk of harm.
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Affiliation(s)
- Natasha Fernandes
- Faculty of Medicine (Natasha Fernandes, Mathur), University of Ottawa, Ottawa, Ont.; Faculty of Health Sciences (Bryant, Marsh, Moyer) and Schulich School of Medicine and Dentistry (Bryant), The University of Western Ontario, London, Ont.; Department of Clinical Epidemiology and Biostatistics (Bryant, Griffith), Department of Medicine (Nisha Fernandes), Health Sciences Library (Bhatnagar), Department of Family Medicine (Riva) and Division of Gynecologic Oncology (Reade), McMaster University, Hamilton, Ont.; Faculty of Dentistry (El-Rabbany), University of Toronto, Toronto, Ont.; School of Medical and Applied Sciences (Kean), Central Queensland University, Rockhampton, Australia; Department of Orthopaedic Surgery (Somerville), London Health Sciences Centre, London, Ont.
| | - Dianne Bryant
- Faculty of Medicine (Natasha Fernandes, Mathur), University of Ottawa, Ottawa, Ont.; Faculty of Health Sciences (Bryant, Marsh, Moyer) and Schulich School of Medicine and Dentistry (Bryant), The University of Western Ontario, London, Ont.; Department of Clinical Epidemiology and Biostatistics (Bryant, Griffith), Department of Medicine (Nisha Fernandes), Health Sciences Library (Bhatnagar), Department of Family Medicine (Riva) and Division of Gynecologic Oncology (Reade), McMaster University, Hamilton, Ont.; Faculty of Dentistry (El-Rabbany), University of Toronto, Toronto, Ont.; School of Medical and Applied Sciences (Kean), Central Queensland University, Rockhampton, Australia; Department of Orthopaedic Surgery (Somerville), London Health Sciences Centre, London, Ont
| | - Lauren Griffith
- Faculty of Medicine (Natasha Fernandes, Mathur), University of Ottawa, Ottawa, Ont.; Faculty of Health Sciences (Bryant, Marsh, Moyer) and Schulich School of Medicine and Dentistry (Bryant), The University of Western Ontario, London, Ont.; Department of Clinical Epidemiology and Biostatistics (Bryant, Griffith), Department of Medicine (Nisha Fernandes), Health Sciences Library (Bhatnagar), Department of Family Medicine (Riva) and Division of Gynecologic Oncology (Reade), McMaster University, Hamilton, Ont.; Faculty of Dentistry (El-Rabbany), University of Toronto, Toronto, Ont.; School of Medical and Applied Sciences (Kean), Central Queensland University, Rockhampton, Australia; Department of Orthopaedic Surgery (Somerville), London Health Sciences Centre, London, Ont
| | - Mohamed El-Rabbany
- Faculty of Medicine (Natasha Fernandes, Mathur), University of Ottawa, Ottawa, Ont.; Faculty of Health Sciences (Bryant, Marsh, Moyer) and Schulich School of Medicine and Dentistry (Bryant), The University of Western Ontario, London, Ont.; Department of Clinical Epidemiology and Biostatistics (Bryant, Griffith), Department of Medicine (Nisha Fernandes), Health Sciences Library (Bhatnagar), Department of Family Medicine (Riva) and Division of Gynecologic Oncology (Reade), McMaster University, Hamilton, Ont.; Faculty of Dentistry (El-Rabbany), University of Toronto, Toronto, Ont.; School of Medical and Applied Sciences (Kean), Central Queensland University, Rockhampton, Australia; Department of Orthopaedic Surgery (Somerville), London Health Sciences Centre, London, Ont
| | - Nisha M Fernandes
- Faculty of Medicine (Natasha Fernandes, Mathur), University of Ottawa, Ottawa, Ont.; Faculty of Health Sciences (Bryant, Marsh, Moyer) and Schulich School of Medicine and Dentistry (Bryant), The University of Western Ontario, London, Ont.; Department of Clinical Epidemiology and Biostatistics (Bryant, Griffith), Department of Medicine (Nisha Fernandes), Health Sciences Library (Bhatnagar), Department of Family Medicine (Riva) and Division of Gynecologic Oncology (Reade), McMaster University, Hamilton, Ont.; Faculty of Dentistry (El-Rabbany), University of Toronto, Toronto, Ont.; School of Medical and Applied Sciences (Kean), Central Queensland University, Rockhampton, Australia; Department of Orthopaedic Surgery (Somerville), London Health Sciences Centre, London, Ont
| | - Crystal Kean
- Faculty of Medicine (Natasha Fernandes, Mathur), University of Ottawa, Ottawa, Ont.; Faculty of Health Sciences (Bryant, Marsh, Moyer) and Schulich School of Medicine and Dentistry (Bryant), The University of Western Ontario, London, Ont.; Department of Clinical Epidemiology and Biostatistics (Bryant, Griffith), Department of Medicine (Nisha Fernandes), Health Sciences Library (Bhatnagar), Department of Family Medicine (Riva) and Division of Gynecologic Oncology (Reade), McMaster University, Hamilton, Ont.; Faculty of Dentistry (El-Rabbany), University of Toronto, Toronto, Ont.; School of Medical and Applied Sciences (Kean), Central Queensland University, Rockhampton, Australia; Department of Orthopaedic Surgery (Somerville), London Health Sciences Centre, London, Ont
| | - Jacquelyn Marsh
- Faculty of Medicine (Natasha Fernandes, Mathur), University of Ottawa, Ottawa, Ont.; Faculty of Health Sciences (Bryant, Marsh, Moyer) and Schulich School of Medicine and Dentistry (Bryant), The University of Western Ontario, London, Ont.; Department of Clinical Epidemiology and Biostatistics (Bryant, Griffith), Department of Medicine (Nisha Fernandes), Health Sciences Library (Bhatnagar), Department of Family Medicine (Riva) and Division of Gynecologic Oncology (Reade), McMaster University, Hamilton, Ont.; Faculty of Dentistry (El-Rabbany), University of Toronto, Toronto, Ont.; School of Medical and Applied Sciences (Kean), Central Queensland University, Rockhampton, Australia; Department of Orthopaedic Surgery (Somerville), London Health Sciences Centre, London, Ont
| | - Siddhi Mathur
- Faculty of Medicine (Natasha Fernandes, Mathur), University of Ottawa, Ottawa, Ont.; Faculty of Health Sciences (Bryant, Marsh, Moyer) and Schulich School of Medicine and Dentistry (Bryant), The University of Western Ontario, London, Ont.; Department of Clinical Epidemiology and Biostatistics (Bryant, Griffith), Department of Medicine (Nisha Fernandes), Health Sciences Library (Bhatnagar), Department of Family Medicine (Riva) and Division of Gynecologic Oncology (Reade), McMaster University, Hamilton, Ont.; Faculty of Dentistry (El-Rabbany), University of Toronto, Toronto, Ont.; School of Medical and Applied Sciences (Kean), Central Queensland University, Rockhampton, Australia; Department of Orthopaedic Surgery (Somerville), London Health Sciences Centre, London, Ont
| | - Rebecca Moyer
- Faculty of Medicine (Natasha Fernandes, Mathur), University of Ottawa, Ottawa, Ont.; Faculty of Health Sciences (Bryant, Marsh, Moyer) and Schulich School of Medicine and Dentistry (Bryant), The University of Western Ontario, London, Ont.; Department of Clinical Epidemiology and Biostatistics (Bryant, Griffith), Department of Medicine (Nisha Fernandes), Health Sciences Library (Bhatnagar), Department of Family Medicine (Riva) and Division of Gynecologic Oncology (Reade), McMaster University, Hamilton, Ont.; Faculty of Dentistry (El-Rabbany), University of Toronto, Toronto, Ont.; School of Medical and Applied Sciences (Kean), Central Queensland University, Rockhampton, Australia; Department of Orthopaedic Surgery (Somerville), London Health Sciences Centre, London, Ont
| | - Clare J Reade
- Faculty of Medicine (Natasha Fernandes, Mathur), University of Ottawa, Ottawa, Ont.; Faculty of Health Sciences (Bryant, Marsh, Moyer) and Schulich School of Medicine and Dentistry (Bryant), The University of Western Ontario, London, Ont.; Department of Clinical Epidemiology and Biostatistics (Bryant, Griffith), Department of Medicine (Nisha Fernandes), Health Sciences Library (Bhatnagar), Department of Family Medicine (Riva) and Division of Gynecologic Oncology (Reade), McMaster University, Hamilton, Ont.; Faculty of Dentistry (El-Rabbany), University of Toronto, Toronto, Ont.; School of Medical and Applied Sciences (Kean), Central Queensland University, Rockhampton, Australia; Department of Orthopaedic Surgery (Somerville), London Health Sciences Centre, London, Ont
| | - John J Riva
- Faculty of Medicine (Natasha Fernandes, Mathur), University of Ottawa, Ottawa, Ont.; Faculty of Health Sciences (Bryant, Marsh, Moyer) and Schulich School of Medicine and Dentistry (Bryant), The University of Western Ontario, London, Ont.; Department of Clinical Epidemiology and Biostatistics (Bryant, Griffith), Department of Medicine (Nisha Fernandes), Health Sciences Library (Bhatnagar), Department of Family Medicine (Riva) and Division of Gynecologic Oncology (Reade), McMaster University, Hamilton, Ont.; Faculty of Dentistry (El-Rabbany), University of Toronto, Toronto, Ont.; School of Medical and Applied Sciences (Kean), Central Queensland University, Rockhampton, Australia; Department of Orthopaedic Surgery (Somerville), London Health Sciences Centre, London, Ont
| | - Lyndsay Somerville
- Faculty of Medicine (Natasha Fernandes, Mathur), University of Ottawa, Ottawa, Ont.; Faculty of Health Sciences (Bryant, Marsh, Moyer) and Schulich School of Medicine and Dentistry (Bryant), The University of Western Ontario, London, Ont.; Department of Clinical Epidemiology and Biostatistics (Bryant, Griffith), Department of Medicine (Nisha Fernandes), Health Sciences Library (Bhatnagar), Department of Family Medicine (Riva) and Division of Gynecologic Oncology (Reade), McMaster University, Hamilton, Ont.; Faculty of Dentistry (El-Rabbany), University of Toronto, Toronto, Ont.; School of Medical and Applied Sciences (Kean), Central Queensland University, Rockhampton, Australia; Department of Orthopaedic Surgery (Somerville), London Health Sciences Centre, London, Ont
| | - Neera Bhatnagar
- Faculty of Medicine (Natasha Fernandes, Mathur), University of Ottawa, Ottawa, Ont.; Faculty of Health Sciences (Bryant, Marsh, Moyer) and Schulich School of Medicine and Dentistry (Bryant), The University of Western Ontario, London, Ont.; Department of Clinical Epidemiology and Biostatistics (Bryant, Griffith), Department of Medicine (Nisha Fernandes), Health Sciences Library (Bhatnagar), Department of Family Medicine (Riva) and Division of Gynecologic Oncology (Reade), McMaster University, Hamilton, Ont.; Faculty of Dentistry (El-Rabbany), University of Toronto, Toronto, Ont.; School of Medical and Applied Sciences (Kean), Central Queensland University, Rockhampton, Australia; Department of Orthopaedic Surgery (Somerville), London Health Sciences Centre, London, Ont
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10
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Zhang X, Wu Y, Kang D, Wang J, Hong Q, Le Peng. The external validity of randomized controlled trials of hypertension within China: from the perspective of sample representation. PLoS One 2013; 8:e82324. [PMID: 24324771 PMCID: PMC3855762 DOI: 10.1371/journal.pone.0082324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 10/31/2013] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To explore external validity of randomized controlled trials (RCTs) of hypertension within China from the view of sample representation. METHODS Comprehensive literature searches were performed in Medline, Embase, Cochrane Central Register of Controlled Trials (CCTR) et al and advanced search strategies were used to locate hypertension RCTs as well as observational studies conducted in China during 1996 to 2009 synchronously. The risk of bias in RCTs and observational studies was assessed by two modified scales respectively, and then both types of studies with 3 or more grading scores were included for the purpose of evaluating of external validity. Following that the study characteristics relative to sample representation were extracted from RCTs and observational studies synchronously, and the later were taken as external references for validating sample representation of RCTs. RESULTS 226 hypertension RCTs and 21 observational studies were included for final analysis. Comparing samples with observational studies, the mean age of samples within RCTs was 54.46 years, significantly lower than that of observational studies (66.35 years) (P=0.002). The average disease course in patients of RCTs was 3.89 years and grade III hypertensive patients accounted for 17%; both were lower than that of the observational studies (12.96 years, P<0.001; 34%, P=0.026 respectively). In addition, the proportions of patients with complications due to heart failure, stroke, diabetes, or coronary heart disease in RCTs were 8%, 5%, 12% and 11% correspondingly, all of which were significantly less than that of observational studies (11%, 18%, 17% and 29%). CONCLUSION Sample characteristics within hypertension RCTs were significantly different from those in observational studies. The samples in most RCTs were under-represented. It's feasible to take samples of observational studies as a mirror of the actual composition of hypertension patients in the real world, if the reporting of observational studies is abundant and available.
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Affiliation(s)
- Xin Zhang
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuxia Wu
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, China
- Department of Internal Medicine, Mianyang people’s hospital, Mianyang City, China
| | - Deying Kang
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jialiang Wang
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qi Hong
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, China
| | - Le Peng
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, China
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11
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Andersen K, Nikolajsen L, Haraldsted V, Odgaard A, Søballe K. Local infiltration analgesia for total knee arthroplasty: should ketorolac be added? Br J Anaesth 2013; 111:242-8. [DOI: 10.1093/bja/aet030] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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12
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Chester R, Shepstone L, Daniell H, Sweeting D, Lewis J, Jerosch-Herold C. Predicting response to physiotherapy treatment for musculoskeletal shoulder pain: a systematic review. BMC Musculoskelet Disord 2013; 14:203. [PMID: 23834747 PMCID: PMC3717132 DOI: 10.1186/1471-2474-14-203] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 05/28/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People suffering from musculoskeletal shoulder pain are frequently referred to physiotherapy. Physiotherapy generally involves a multimodal approach to management that may include; exercise, manual therapy and techniques to reduce pain. At present it is not possible to predict which patients will respond positively to physiotherapy treatment. The purpose of this systematic review was to identify which prognostic factors are associated with the outcome of physiotherapy in the management of musculoskeletal shoulder pain. METHODS A comprehensive search was undertaken of Ovid Medline, EMBASE, CINAHL and AMED (from inception to January 2013). Prospective studies of participants with shoulder pain receiving physiotherapy which investigated the association between baseline prognostic factors and change in pain and function over time were included. Study selection, data extraction and appraisal of study quality were undertaken by two independent assessors. Quality criteria were selected from previously published guidelines to form a checklist of 24 items. The study protocol was prospectively registered onto the International Prospective Register of Systematic Reviews. RESULTS A total of 5023 titles were retrieved and screened for eligibility, 154 articles were assessed as full text and 16 met the inclusion criteria: 11 cohort studies, 3 randomised controlled trials and 2 controlled trials. Results were presented for the 9 studies meeting 13 or more of the 24 quality criteria. Clinical and statistical heterogeneity resulted in qualitative synthesis rather than meta-analysis. Three studies demonstrated that high functional disability at baseline was associated with poor functional outcome (p ≤ 0.05). Four studies demonstrated a significant association (p ≤ 0.05) between longer duration of shoulder pain and poorer outcome. Three studies, demonstrated a significant association (p ≤ 0.05) between increasing age and poorer function; three studies demonstrated no association (p > 0.05). CONCLUSION Associations between prognostic factors and outcome were often inconsistent between studies. This may be due to clinical heterogeneity or type II errors. Only two baseline prognostic factors demonstrated a consistent association with outcome in two or more studies; duration of shoulder pain and baseline function. Prior to developing a predictive model for the outcome of physiotherapy treatment for shoulder pain, a large adequately powered prospective cohort study is required in which a broad range of prognostic factors are incorporated.
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Affiliation(s)
- Rachel Chester
- School of Allied Health Professions, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK.
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13
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Biau DJ, Greidanus NV, Garbuz DS, Masri BA. No difference in quality-of-life outcomes after mobile and fixed-bearing medial unicompartmental knee replacement. J Arthroplasty 2013; 28:220-226.e1. [PMID: 22770856 DOI: 10.1016/j.arth.2012.05.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 05/19/2012] [Indexed: 02/01/2023] Open
Abstract
This is a retrospective study comparing the clinical outcomes of mobile vs fixed medial unicompartmental knee replacements. Patients were identified from a prospectively collected database. Demographic data and pre- and postoperative outcomes (Oxford, Western Ontario and McMaster Universities Osteoarthritis Index, Short Form Health Survey-12, and satisfaction) were collected-104 knees (90 patients) with minimum 2-years of follow-up: 37 mobile and 67 fixed-bearing. At baseline, the median age was 60 years (mobile) and 66 (fixed); body mass index was significantly higher (32) for the mobile group than for the fixed (28). At follow-up, the groups differed only in the Oxford score: median 83 (mobile) and 90 (fixed). There is no difference in outcomes between mobile and fixed unicompartmental knee replacements.
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Affiliation(s)
- David J Biau
- Department of Orthopaedics, Division of Lower Limb Reconstruction and Oncology, University of British Columbia, Vancouver, British Columbia, Canada
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14
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Tourabaly I, Boutron I, Nizard R, Ravaud P. ASSIST applicability scoring of surgical trials. an investigator-reported assessment tool. PLoS One 2012; 7:e42258. [PMID: 22916125 PMCID: PMC3419723 DOI: 10.1371/journal.pone.0042258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 07/03/2012] [Indexed: 11/29/2022] Open
Abstract
Context We aimed to develop a new tool for assessing and depicting the applicability of the results of surgical randomized controlled trials (RCTs) from the trial investigators' perspective. Methods We identified all items related to applicability by a systematic methodological review, and then a sample of surgeons used these items in a web-based survey to evaluate the applicability of their own trial results. For each applicability item, participants had to indicate on a numerical scale that was simplified as a three-item scale: 1) items essential to consider, 2) items requiring attention, and 3) items inconsequential to the applicability of the results of their own RCT to clinical practice. For the final tool, we selected only items that were rated as being essential or requiring attention for at least 25% of the trials evaluated. We propose a specific process to construct the tool and to depict applicability in a graph. We identified all investigators of published and registered ongoing RCTs assessing surgery and invited them to participate in the web-based survey. Results 148 surgeons assessed applicability for their own trial and participated in the process of item selection. The final tool contains 22 items (4 dedicated to patients, 5 to centers, 5 to surgeons and 8 to the intervention). We proposed a straightforward process of constructing the graphical tool: 1) a multidisciplinary team of investigators or other care providers participating in the trial could independently assess each item, 2) a consensus method could be used, and 3) the investigators could depict their assessment of the applicability of the trial results in 4 graphs related to patients, centers, surgeons and the intervention. Conclusions This investigator-reported assessment tool could help readers define under what conditions they could reasonably apply the results of a surgical RCT to their clinical practice.
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Affiliation(s)
- Idriss Tourabaly
- Inserm, U738, Paris, France; Assistance Publique des Hôpitaux De Paris, Hôpital Hôtel Dieu, Centre d'épidémiologie Clinique, Paris, France; University Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
- Assistance Publique des Hôpitaux de Paris, Hôpital Lariboisière, Service de Chirurgie Orthopédique et Traumatologique, Paris, France; University Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Isabelle Boutron
- Inserm, U738, Paris, France; Assistance Publique des Hôpitaux De Paris, Hôpital Hôtel Dieu, Centre d'épidémiologie Clinique, Paris, France; University Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
- * E-mail:
| | - Rémy Nizard
- Assistance Publique des Hôpitaux de Paris, Hôpital Lariboisière, Service de Chirurgie Orthopédique et Traumatologique, Paris, France; University Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Philippe Ravaud
- Inserm, U738, Paris, France; Assistance Publique des Hôpitaux De Paris, Hôpital Hôtel Dieu, Centre d'épidémiologie Clinique, Paris, France; University Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
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15
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Boyer P, Boutron I, Ravaud P. Scientific production and impact of national registers: the example of orthopaedic national registers. Osteoarthritis Cartilage 2011; 19:858-63. [PMID: 21362489 DOI: 10.1016/j.joca.2011.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Revised: 12/28/2010] [Accepted: 02/03/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE National arthroplasty registers are often cited as examples of a non-randomized design that have made an essential contribution to advances in assessing arthroplasty procedures. We aimed to compare national registers to randomized controlled trials (RCTs) and meta-analyses in the field of arthroplasty in terms of scientific production and impact. METHOD We systematically searched Medline via PubMed and the registers' websites to select all articles from national registers, RCTs and meta-analyses assessing hip and knee arthroplasty. The scientific production and impact were evaluated by number of publications, number of citations (total and the 3-year citation counts), and information on the 2008 journal impact factor (IF), for each design and identified articles. We also contacted representatives of all the selected registers to determine the availability of the data for external research projects. RESULTS We retrieved information on 13 active national hip or knee arthroplasty registers; for 9, data were available for research projects under specific conditions. Overall, 190 publications in peer-reviewed journals resulted from national arthroplasty registers, 476 from RCTs, and 40 from meta-analyses. We found 4,112 citations for national register reports, 7,328 for RCT reports and 552 for meta-analysis reports. The median [interquartile [IQR] range] number of citations for register, RCT and meta-analysis reports in the 3-year period after publication was 3.5 [1.0-6.0], 2.0 [1.0-6.0], and 2.5 [0.5-7.5], respectively. CONCLUSION Publications from national registers may have the highest impact among the 3 designs in terms of median citation counts, but data from RCTs remain the most productive evidence in the arthroplasty field. Because of the number of patients recruited by registers, the quality of data collected, and the potential availability of data, scientific production and impact from national registers should be improved.
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Affiliation(s)
- P Boyer
- Orthopaedic Department, AP-HP (Assistance Publique des Hôpitaux de Paris), Hôpital Bichat-Claude Bernard, Paris, France.
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16
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Pibouleau L, Boutron I, Reeves BC, Nizard R, Ravaud P. Applicability and generalisability of published results of randomised controlled trials and non-randomised studies evaluating four orthopaedic procedures: methodological systematic review. BMJ 2009; 339:b4538. [PMID: 19920015 PMCID: PMC2778750 DOI: 10.1136/bmj.b4538] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To compare the reporting of essential applicability data from randomised controlled trials and non-randomised studies evaluating four new orthopaedic surgical procedures. DATA SOURCES Medline and the Cochrane central register of controlled trials. STUDY SELECTION All articles of comparative studies assessing total hip or knee arthroplasty carried out by a minimally invasive approach or computer assisted navigation system. DATA EXTRACTION Items judged to be essential for interpreting the applicability of findings about such procedures were identified by a survey of a sample of orthopaedic surgeons (77 of 512 completed the survey). Reports were evaluated for data describing these "essential" items and the number of centres and surgeons involved in the trials. When data on the number of centres and surgeons were not reported, the corresponding author of the selected trials was contacted. Results 84 articles were identified (38 randomised controlled trials, 46 non-randomised studies). The median percentage (interquartile range) of essential items reported for non-randomised studies compared with randomised controlled trials was 38% (25-63%) versus 44% (38-45%) for items about patients, 71% (43-86%) versus 71% (57-86%) for items considered essential for all interventions, and 38% (25-50%) versus 50% (25-50%) for items about the context of care. More than 80% of both study types were single centre studies, with one or two participating surgeons. CONCLUSION The reporting of data related to the applicability of results was poor in published articles of both non-randomised studies and randomised controlled trials and did not differ by study design. The applicability of results from the trials and studies was similar in terms of number of centres and surgeons involved and the reproducibility of the intervention.
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MESH Headings
- Arthroplasty, Replacement, Hip/methods
- Arthroplasty, Replacement, Hip/standards
- Arthroplasty, Replacement, Knee/methods
- Arthroplasty, Replacement, Knee/standards
- Clinical Trials as Topic
- Data Collection/standards
- Humans
- Minimally Invasive Surgical Procedures/methods
- Minimally Invasive Surgical Procedures/standards
- Randomized Controlled Trials as Topic
- Surgery, Computer-Assisted/methods
- Surgery, Computer-Assisted/standards
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Rothwell PM. Commentary: External validity of results of randomized trials: disentangling a complex concept. Int J Epidemiol 2009; 39:94-6. [PMID: 19776246 DOI: 10.1093/ije/dyp305] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Peter M Rothwell
- University Department of Clinical Neurology, Level 6, West Wing, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK.
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18
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Ahmad N, Boutron I, Moher D, Pitrou I, Roy C, Ravaud P. Neglected external validity in reports of randomized trials: the example of hip and knee osteoarthritis. ACTA ACUST UNITED AC 2009; 61:361-9. [PMID: 19248133 DOI: 10.1002/art.24279] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate data reporting related to external validity from randomized controlled trials (RCTs) assessing pharmacologic and nonpharmacologic treatment for hip and knee osteoarthritis (OA). METHODS All RCTs assessing pharmacologic treatments and nonpharmacologic treatments for hip and knee OA indexed between January 2002 and December 2006 were selected. A sample of 120 articles were randomly selected: 30 each assessing pharmacologic treatments, surgery or technical interventions, rehabilitation, and nonimplantable devices. RESULTS The country was clearly reported in 25 (21%) reports, the setting described in 40 (33%) reports, and the number of centers in 54 (45%). Details about the centers (volume of care) were given in 24 (20%) reports. Rates were lower for surgical trials for the country (3%), the setting (3%), the number of centers (13%), and details about the centers (7%). The intervention was adequately described in all pharmacologic reports and in >80% of rehabilitation reports. The technical procedure was given in all surgical intervention trial reports, but the type of anesthesia was reported in 4 (13%), preoperative care in 2 (7%), and postoperative care in 15 (50%). The device was described in 93% of device trial reports, but the manufacturer was reported in only 33%. CONCLUSION There is low reporting of data related to external validity in reports of RCTs assessing pharmacologic and nonpharmacologic treatments for hip and knee OA.
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Affiliation(s)
- Nizar Ahmad
- INSERM U738, Assistance Publique Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Université Paris 7, Paris, France
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Larsen K, Hvass KE, Hansen TB, Thomsen PB, Søballe K. Effectiveness of accelerated perioperative care and rehabilitation intervention compared to current intervention after hip and knee arthroplasty. A before-after trial of 247 patients with a 3-month follow-up. BMC Musculoskelet Disord 2008; 9:59. [PMID: 18442380 PMCID: PMC2396162 DOI: 10.1186/1471-2474-9-59] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Accepted: 04/28/2008] [Indexed: 01/23/2023] Open
Abstract
Background In Denmark, approximately 12,000 hip and knee arthroplasties were performed in 2006, and the hospital costs were close to US$ 110,000,000. In a randomized clinical trial, we have recently demonstrated the efficacy of accelerated perioperative care and rehabilitation intervention after hip and knee arthroplasty compared to current intervention under ideal circumstances. We do not, however, know whether these results could be reached under usual circumstances of healthcare practice. We therefore investigated whether length of stay after implementation of accelerated perioperative care and rehabilitation after hip and knee arthroplasty could be reduced in a normal healthcare setting, and how the achieved results matched those observed during the randomized clinical trial. Methods An effectiveness study as a before-after trial was undertaken in which all elective primary total hip and total knee arthroplasty patients were divided into a before-implementation group receiving the current perioperative procedure, and an after-implementation group receiving the new accelerated perioperative care and rehabilitation procedures as provided by a new multi-disciplinary organization. We used the Breakthrough Series Collaborative Model for implementation. The primary outcome measure was in hospital length of stay (LOS), and the secondary outcome measure was adverse effects within 3 months postoperatively. Results We included a total of 247 patients. Mean LOS was significantly (P < 0.001) reduced by 4.4 (95% CI 3.8–5.0) days after implementation of the accelerated intervention, from 8.8 (SD 3.0) days before implementation to 4.3 (SD 1.8) days after implementation. No significant differences in adverse effects were observed. LOS in this effectiveness study was significantly lower than LOS reported in the efficacy study. Conclusion Accelerated perioperative care and rehabilitation intervention after hip and knee arthroplasty was successfully and effectively implemented. Results obtained during usual hospital circumstances matched the results achieved under ideal circumstances in this group of patients.
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Affiliation(s)
- Kristian Larsen
- Orthopedic Research Unit, Regional Hospital Holstebro, Denmark.
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Poolman RW, Petrisor BA, Marti RK, Kerkhoffs GM, Zlowodzki M, Bhandari M. Misconceptions about practicing evidence-based orthopedic surgery. Acta Orthop 2007; 78:2-11. [PMID: 17453386 DOI: 10.1080/17453670610013358] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Rudolf W Poolman
- Division of Orthopedic Surgery, McMaster University, Ontario, Canada.
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