A review of prospective registration of trials published in nursing science journals in 2017

Assessment of consistency between peer-reviewed publications and clinical trial registrations in nursing journals

BACKGROUND

The inconsistencies between randomized clinical trials (RCTs) registrations and peer-reviewed publications may distort trial results and threaten the validity of evidence-based medicine. Previous studies have found many inconsistencies between RCTs registrations and peer-reviewed publications, and outcome reporting bias is prevalent.

AIMS

The aims of this review were to assess whether the primary outcomes and other data reported in publications and registered records in RCTs of nursing journals were consistent and whether discrepancies in the reporting of primary outcomes favored statistically significant results. Moreover, we reviewed the proportion of RCTs for prospective registration.

METHODS

We systematically searched PubMed for RCTs published in the top 10 nursing journals between March 5, 2020, and March 5, 2022. Registration numbers were extracted from the publications, and registered records were identified from the registration platforms. The publications and registered records were compared to identify consistency. Inconsistencies were subdivided into discrepancies and omissions.

RESULTS

A total of 70 RCTs published in seven journals were included. The inconsistencies involved sample size estimation (71.4%), random sequence generation (75.7%), allocation concealment (97.1%), blinding (82.9%), primary outcomes (60.0%) and secondary outcomes (84.3%). Among the inconsistencies in the primary outcomes, 21.4% were due to discrepancies and 38.6% resulted from omissions. Fifty-three percent (8/15) presented discrepancies in the primary outcomes that favored statistically significant results. Additionally, although only 40.0% of the studies were prospective registrations, the number of prospectively registered trials has trended upward over time.

LINKING EVIDENCE TO ACTION

While not including all RCTs in the nursing field, our sample reflected a general trend: inconsistencies between publications and trial registrations were prevalent in the included nursing journals. Our research helps to provide a way to improve the transparency of research reports. Ensuring that clinical practice has access to transparent and reliable research results are essential to achieve the best possible evidence-based medicine.

How prospective trial registration can prevent selective outcome reporting and salami slicing?

BACKGROUND

Pre-registration of a clinical trial before the first participant is recruited can help to prevent selective outcome reporting and salami-slicing that can distort the evidence base for an intervention and result in people being offered care or treatment that is not effective. Rates of clinical trial registration in nursing and midwifery are low.

AIM

To use a hypothetical example from midwifery practice to illustrate how selective outcome reporting and salami-slicing can distort the evidence base.

FINDINGS

A trial of immersion in water during labour and birth is used to consider issues in outcome selection and how researchers may be drawn to switch primary outcomes or report different outcomes across multiple papers.

DISCUSSION

In nursing and midwifery science, selective outcome and salami reporting are seemingly common. Prospective trial registration is intended to prevent these practices, enhancing the quality and integrity of the work.

CONCLUSION

Clinical trials are a robust form of primary research evidence and directly impact clinical practice. Researchers must ensure their trials are correctly registered and editors need to reconcile submitted papers and registration entries as part of the review process.

A study protocol for a feasibility trial of telephone-delivered Adherence Therapy for adults with type 2 diabetes

AIMS

Adherence therapy is a candidate intervention to improve medication adherence and clinical outcomes in patients with type 2 diabetes. The feasibility of conducting a trial of adherence therapy in this population has not been established. The objective of this study is therefore to test the feasibility of conducting a randomized controlled trial of adherence therapy in a Middle Eastern context.

DESIGN

A single-centre randomized controlled feasibility trial of adherence therapy in patients with type 2 diabetes.

METHODS

We will undertake an initial cultural adaptation of a telephone-delivered form of adherence therapy in four patients in a Middle Eastern context. Our subsequent feasibility trial will aim to recruit 40 non-adherent diabetic patients that will be randomly allocated to receive eight weekly 30-min telephone adherence therapy sessions delivered by a diabetes educator versus treatment as usual. Key outcomes of interest include the number of patients invited to take part in the trial that consent to participate and then go on to complete treatment.

RESULT

The findings of this study will determine the feasibility of undertaking a full randomized controlled trial of adherence therapy in patients with type 2 diabetes.

The safety and efficacy of acceptance and commitment therapy against psychotic symptomatology: a systematic review and meta-analysis

OBJECTIVE

Acceptance and commitment therapy (ACT) is a third-wave psychological intervention that has attracted considerable clinical and research attention. A previous meta-analysis of ACT trials in psychosis reported a large effect size of ACT against overall psychotic symptomatology. However, there were critical methodological issues in the review that justify replication.

METHODS

Systematic review and meta-analysis of randomized controlled trials (RCTs) testing ACT vs. any comparator condition in a sample of adults with psychosis. The outcome of interest was overall psychotic symptomatology.

RESULTS

The search identified seven published and eight unpublished trials (of which we were able to obtain data from one). Data on symptomatology were extracted from six trials that involved 274 participants. The summary effect size (Hedge's G) for overall symptomatology was small and not significant (-0.21, 95%CI -0.60-0.18). Trials were generally rated as having a high risk of bias. Safety reporting was inadequate across included trials.

CONCLUSIONS

Our observed effect size contrasted with that reported in a previous meta-analysis; differences were likely explained by errors in data extraction. The findings of this review suggest that there is currently inadequate evidence to conclude that ACT is a safe and effective treatment against psychotic symptomatology.

SYSTEMATIC REVIEW REGISTRATION

CRD42018097200.