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Gupta S, Tiwari R, Goel R. The critical appraisal of randomized controlled trials published in an Indian journal to assess the quality of reporting: A retrospective, cross-sectional study. Perspect Clin Res 2022; 13:33-37. [PMID: 35198426 PMCID: PMC8815670 DOI: 10.4103/picr.picr_169_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 02/05/2020] [Accepted: 02/11/2020] [Indexed: 11/04/2022] Open
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Ngah VD, Mazingisa AV, Zunza M, Wiysonge CS. A Review of Adherence and Predictors of Adherence to the CONSORT Statement in the Reporting of Tuberculosis Vaccine Trials. Vaccines (Basel) 2020; 8:E770. [PMID: 33339360 PMCID: PMC7766843 DOI: 10.3390/vaccines8040770] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 12/20/2022] Open
Abstract
The statement on Consolidated Standards of Reporting Trials (CONSORT) ensures transparency in the reporting of randomized trials. However, it is unclear if the statement has led to improvement in the quality of reporting of tuberculosis (TB) vaccine trials. We explored the quality of reporting of TB vaccine trials according to the latest version of the CONSORT statement, released in 2010. We searched PubMed and the Cochrane Central Register of Controlled Trials in August 2019. We conducted screening, study selection, and data extraction in duplicate; and resolved differences through discussion. We assessed reporting to be adequate if trials reported at least 75% of the CONSORT 2010 items. We conducted a trend analysis to assess if there was improvement in reporting over time. We also used logistic regression to assess factors associated with adequate reporting. We included 124 trials in the analyses. The mean proportion of adherence was 67.3% (95% confidence interval 64.4% to 70.1%), with only 46 (37%) trials having adequate reporting. There was a significant improvement in the quality of reporting over time (p < 0.0001). Trials published in journals with impact factors between 10 and 20 were more likely to have adequate reporting (odds ratio 9.4; 95% confidence interval 1.30 to 67.8), compared to lower-impact-factor journals. Despite advances over time, the reporting of TB vaccine trials is still inadequate and requires improvement.
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Affiliation(s)
- Veranyuy D. Ngah
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505 Cape Town, South Africa; (M.Z.); (C.S.W.)
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, 7501 Cape Town, South Africa;
| | - Akhona V. Mazingisa
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, 7501 Cape Town, South Africa;
| | - Moleen Zunza
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505 Cape Town, South Africa; (M.Z.); (C.S.W.)
| | - Charles S. Wiysonge
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505 Cape Town, South Africa; (M.Z.); (C.S.W.)
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, 7501 Cape Town, South Africa;
- School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, 7925 Cape Town, South Africa
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Catillon M. Trends and predictors of biomedical research quality, 1990-2015: a meta-research study. BMJ Open 2019; 9:e030342. [PMID: 31481564 PMCID: PMC6731820 DOI: 10.1136/bmjopen-2019-030342] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 05/13/2019] [Accepted: 08/01/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To measure the frequency of adequate methods, inadequate methods and poor reporting in published randomised controlled trials (RCTs) and test potential factors associated with adequacy of methods and reporting. DESIGN Retrospective analysis of RCTs included in Cochrane reviews. Time series describes the proportion of RCTs using adequate methods, inadequate methods and poor reporting. A multinomial logit model tests potential factors associated with methods and reporting, including funding source, first author affiliation, clinical trial registration status, study novelty, team characteristics, technology and geography. DATA Risk of bias assessments for random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data and selective reporting, for each RCT, were mapped to bibliometric and funding data. OUTCOMES Risk of bias on six methodological dimensions and RCT-level overall assessment of adequate methods, inadequate methods or poor reporting. RESULTS This study analysed 20 571 RCTs. 5.7% of RCTs used adequate methods (N=1173). 59.3% used inadequate methods (N=12 190) and 35.0% were poorly reported (N=7208). The proportion of poorly reported RCTs decreased from 42.5% in 1990 to 30.2% in 2015. The proportion of RCTs using adequate methods increased from 2.6% in 1990 to 10.3% in 2015. The proportion of RCTs using inadequate methods increased from 54.9% in 1990 to 59.5% in 2015. Industry funding, top pharmaceutical company affiliation, trial registration, larger authorship teams, international teams and drug trials were associated with a greater likelihood of using adequate methods. National Institutes of Health funding and university prestige were not. CONCLUSION Even though reporting has improved since 1990, the proportion of RCTs using inadequate methods is high (59.3%) and increasing, potentially slowing progress and contributing to the reproducibility crisis. Stronger incentives for the use of adequate methods are needed.
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Affiliation(s)
- Maryaline Catillon
- Ph.D. Program in Health Policy, Harvard University, Cambridge, Massachusetts, USA
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Favier R, Crépin S. The reporting of harms in publications on randomized controlled trials funded by the "Programme Hospitalier de Recherche Clinique," a French academic funding scheme. Clin Trials 2018; 15:257-267. [PMID: 29498543 DOI: 10.1177/1740774518760565] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND/AIMS Accurate information on harms arising from medical interventions is essential for assessing benefit-risk ratios. Since 2004, there has been an extension of the Consolidated Standards of Reporting Trials statement for reporting harms data in publications on randomized clinical trials. The objective of our study was to assess the quality of this reporting from academic randomized clinical trials on drugs. METHODS We searched for articles on randomized clinical trials funded between 2004 and 2008 by the "Programme Hospitalier de Recherche Clinique." We included all published randomized clinical trials that assessed drugs. Harm-related data were extracted and compared with the Consolidated Standards of Reporting Trials Harms extension, and the space in the articles devoted to harms data was measured. RESULTS In total, 37 randomized clinical trials met the inclusion criteria. The median harm score was 9/18. In 73.0% of the randomized clinical trials, the reporting of adverse events was selective. Less than 50% of articles provided information on reasons for drug discontinuation that were related to adverse events. The score and the space allocated to harms were higher in antineoplastic and immunomodulating drugs randomized clinical trials, while the median proportion of the space in the results section allocated to harms was 16.8%. In 67.6% of the articles, the space allocated to the authors' list and affiliations was greater than the space in the results section allocated to descriptions of harms. No significant improvement in the score or the space allocation was observed during the study period. CONCLUSION Reporting of harms in French academic drug randomized clinical trials is suboptimal; moreover, this shortcoming is a critical barrier to evaluating the benefit-risk ratio of drug randomized clinical trials. Thus, the authors should be encouraged to adhere to the Consolidated Standards of Reporting Trials Harms extension.
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Affiliation(s)
- Romain Favier
- Service de Pharmacologie, Toxicologie et Pharmacovigilance, CHU de Limoges, France
| | - Sabrina Crépin
- Service de Pharmacologie, Toxicologie et Pharmacovigilance, CHU de Limoges, France
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You YN, Cho MR, Kim JH, Park JH, Park GC, Song MY, Choi JB, Han JY. Assessing the quality of reports about randomized controlled trials of scalp acupuncture combined with another treatment for stroke. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:452. [PMID: 28877716 PMCID: PMC5588620 DOI: 10.1186/s12906-017-1950-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 08/29/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND This study was designed to assess the quality of reporting on randomized controlled trials (RCTs) of scalp acupuncture for the treatment of stroke. METHODS The following 8 databases were systematically investigated from their inception to December 2015: PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, National Institute of Informatics Scholarly and Academic Information Navigator, National Digital Science Library, Korean Traditional Knowledge Portal, and Korean Studies Information Service System. RCTs utilizing scalp acupuncture as an intervention for stroke were selected, and the quality of reports was assessed based on the Consolidated Standards of Reporting Trials 2010 statement (CONSORT) and Standards for Reporting Interventions in Controlled Trials of Acupuncture 2010 (STRICTA). For each study, the overall quality score (OQS) of 13 CONSORT items, a combined key methodological index score (MIS) of 5 CONSORT items, and the OQS of 17 STRICTA items were measured. RESULTS The original reports of 63 RCTs were ultimately obtained, and the median CONSORT OQS was 7 (minimum 2, maximum 11). Particularly, the items 'trial design', 'sample size', 'ancillary analyses', and 'harms' had a positive rate of less than 10%. The median MIS was 1 (minimum 0, maximum 5), with 'allocation concealment and implementation' and 'intent-to-treat analysis (ITT) analysis' having a positive rate of less than 10%. The median STRICTA OQS was 11 (minimum 6, maximum 14), and only the items 'sample size' and 'intent-to-treat analysis' were reported, with a positive rate of less than 10%. The mean CONSORT OQS increased by approximately 0.81 for each 5-year period in which manuscripts were published (95% confidence interval: 0.43 to 1.19; p < 0.001). No variable was significantly associated with MIS in the ordinal regression model. CONCLUSION The quality of reports on RCTs investigating scalp acupuncture treatment for stroke was moderate to low. Furthermore, reporting of some items was either insufficient or inadequate in the majority of studies. In order to improve and standardize the quality of RCTs investigating scalp acupuncture for stroke, CONSORT and STRICTA guidelines should be utilized more frequently.
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Affiliation(s)
- Young-Nim You
- Clinical Research Center, DongShin University Gwangju Oriental Hospital, Gwangju City, Republic of Korea
| | - Myung-Rae Cho
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine Dong-Shin University, Naju City, Republic of Korea
| | - Jae-Hong Kim
- Clinical Research Center, DongShin University Gwangju Oriental Hospital, Gwangju City, Republic of Korea
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine Dong-Shin University, Naju City, Republic of Korea
| | - Ju-Hyung Park
- Clinical Research Center, DongShin University Gwangju Oriental Hospital, Gwangju City, Republic of Korea
| | - Gwang-Cheon Park
- Clinical Research Center, DongShin University Gwangju Oriental Hospital, Gwangju City, Republic of Korea
| | - Min-Yeong Song
- Department of Korean Rehabilitation Medicine, College of Korean Medicine Dong-Shin University, Naju City, Republic of Korea
| | - Jin-Bong Choi
- Department of Korean Rehabilitation Medicine, College of Korean Medicine Dong-Shin University, Naju City, Republic of Korea
| | - Jae-Young Han
- Department of Physical & Rehabilitation Medicine, Chonnam National University Medical School and Hospital, Gwangju City, Republic of Korea
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You YN, Cho MR, Park JH, Park GC, Song MY, Choi JB, Na CS, Han JY, Shin JC, Kim JH. Assessing the quality of reports about randomized controlled trials of scalp acupuncture treatment for vascular dementia. Trials 2017; 18:205. [PMID: 28464917 PMCID: PMC5414371 DOI: 10.1186/s13063-017-1945-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 04/12/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the quality of reports about randomized controlled trials (RCTs) of scalp acupuncture (SA) for the treatment of vascular dementia (VD). METHOD A systematic search of reports published through to December 2015 was performed in eight databases. The quality of RCTs that used SA as an intervention for VD was evaluated based on the 2010 Consolidated Standards for Reporting of Trials (CONSORT) and 2010 Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA) guidelines. Thirteen items from the CONSORT guideline were scored to give an overall quality score (OQS, range 0-13), and a combined key methodological index score (MIS) (range 0-5) of five key methodological items was measured. The OQS of 17 items from the STRICTA guideline (range 0-17) was also measured. RESULTS In total, 26 reports were evaluated. The median OQS based on the CONSORT guideline was 8 (minimum 5, maximum 11), and "trial design," "sample size," "ancillary analyses," and "harms" had a positive rate of less than 10%. The median MIS was 2 (minimum 0, maximum 5), with "allocation concealment and implementation," "blinding," and "intent-to-treat analysis" having a positive rate of less than 15%. The median OQS based on the STRICTA guideline was 12 (minimum 8, maximum 14), with "extent to which treatment was varied (1c)," "number of needle insertions per subject per session (2a)," and "setting and context of treatment (4b)" having a positive rate of less than 10%. CONCLUSIONS The overall quality of reports on RCTs of SA treatment for VD was moderate to low. The quality of methodological items was markedly lower than that of other items. The CONSORT and STRICTA guidelines should be used more frequently to standardize the quality of RCT reports of SA treatment for VD.
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Affiliation(s)
- Young-Nim You
- Clinical Research Center, DongShin University Gwangju Oriental Hospital, Gwangju City, Republic of Korea
| | - Myung-Rae Cho
- Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine Dong-Shin University, Naju City, Republic of Korea
| | - Ju-Hyung Park
- Clinical Research Center, DongShin University Gwangju Oriental Hospital, Gwangju City, Republic of Korea
| | - Gwang-Cheon Park
- Clinical Research Center, DongShin University Gwangju Oriental Hospital, Gwangju City, Republic of Korea
| | - Min-Yeong Song
- Department of Korean Rehabilitation Medicine, College of Korean Medicine Dong-Shin University, Naju City, Republic of Korea
| | - Jin-Bong Choi
- Department of Korean Rehabilitation Medicine, College of Korean Medicine Dong-Shin University, Naju City, Republic of Korea
| | - Chang-Su Na
- Department of Meridian and Acupoint, College of Korean Medicine Dong-Shin University, Naju City, Republic of Korea
| | - Jae-Young Han
- Department of Physical & Rehabilitation Medicine, Chonnam National University Medical School & Hospital, Gwangju City, Republic of Korea
| | - Jeong-cheol Shin
- Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine Dong-Shin University, Naju City, Republic of Korea
| | - Jae-Hong Kim
- Clinical Research Center, DongShin University Gwangju Oriental Hospital, Gwangju City, Republic of Korea
- Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine Dong-Shin University, Naju City, Republic of Korea
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Karpouzis F, Bonello R, Pribicevic M, Kalamir A, Brown BT. Quality of reporting of randomised controlled trials in chiropractic using the CONSORT checklist. Chiropr Man Therap 2016; 24:19. [PMID: 27284400 PMCID: PMC4899907 DOI: 10.1186/s12998-016-0099-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 05/06/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Reviews indicate that the quality of reporting of randomised controlled trials (RCTs) in the medical literature is less than optimal, poor to moderate, and require improving. However, the reporting quality of chiropractic RCTs is unknown. As a result, the aim of this study was to assess the reporting quality of chiropractic RCTs and identify factors associated with better reporting quality. We hypothesized that quality of reporting of RCTs was influenced by industry funding, positive findings, larger sample sizes, latter year of publication and publication in non-chiropractic journals. METHODS RCTs published between 2005 and 2014 were sourced from clinical trial registers, PubMed and the Cochrane Reviews. RCTs were included if they involved high-velocity, low-amplitude (HVLA) spinal and/or extremity manipulation and were conducted by a chiropractor or within a chiropractic department. Data extraction, and reviews were conducted by all authors independently. Disagreements were resolved by consensus. OUTCOMES a 39-point overall quality of reporting score checklist was developed based on the CONSORT 2010 and CONSORT for Non-Pharmacological Treatments statements. Four key methodological items, based on allocation concealment, blinding of participants and assessors, and use of intention-to-treat analysis (ITT) were also investigated. RESULTS Thirty-five RCTs were included. The overall quality of reporting score ranged between 10 and 33 (median score 26.0; IQR = 8.00). Allocation concealment, blinding of participants and assessors and ITT analysis were reported in 31 (87 %), 16 (46 %), 25 (71 %) and 21 (60 %) of the 35 RCTs respectively. Items most underreported were from the CONSORT for Non-Pharmacological Treatments statement. Multivariate regression analysis, revealed that year of publication (t32 = 5.17, p = 0.000, 95 % CI: 0.76, 1.76), and sample size (t32 = 3.01, p = 0.005, 95 % CI: 1.36, 7.02), were the only two factors associated with reporting quality. CONCLUSION The overall quality of reporting RCTs in chiropractic ranged from poor to excellent, improving between 2005 and 2014. This study suggests that quality of reporting, was influenced by year of publication and sample size but not journal type, funding source or outcome positivity. Reporting of some key methodological items and uptake of items from the CONSORT Extension for Non-Pharmacological Treatments items was suboptimal. Future recommendations were made.
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Affiliation(s)
| | - Rod Bonello
- />School of Health Professions, Murdoch University, South St., Murdoch, 6150 WA Australia
| | - Mario Pribicevic
- />Department of Chiropractic, Macquarie University, Balaclava Rd., North Ryde, 2109 NSW Australia
| | - Allan Kalamir
- />Department of Chiropractic, Macquarie University, Balaclava Rd., North Ryde, 2109 NSW Australia
| | - Benjamin T. Brown
- />Department of Chiropractic, Macquarie University, Balaclava Rd., North Ryde, 2109 NSW Australia
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Mittal N, Mittal R, Kumar H, Medhi B. Sodium glucose co-transporter 2 inhibitors for glycemic control in type 2 diabetes mellitus: Quality of reporting of randomized controlled trials. Perspect Clin Res 2016; 7:21-7. [PMID: 26955572 PMCID: PMC4763513 DOI: 10.4103/2229-3485.173777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Sodium glucose co-transporter 2 inhibitors represent a novel class of antidiabetic drugs. The reporting quality of the trials evaluating the efficacy of these agents for glycemic control in type 2 diabetes mellitus has not been explored. Our aim was to assess the reporting quality of such randomized controlled trials (RCTs) and to identify the predictors of reporting quality. Materials and Methods: A systematic literature search was conducted for RCTs published till 12 June 2014. Two independent investigators carried out the searches and assessed the reporting quality on three parameters: Overall quality score (OQS) using Consolidated Standards of Reporting Trials (CONSORT) 2010 statement, Jadad score and intention to treat analysis. Inter-rater agreements were compared using Cohen's weighted kappa statistic. Multivariable linear regression analysis was used to identify the predictors. Results: Thirty-seven relevant RCTs were included in the present analysis. The median OQS was 17 with a range from 8 to 21. On Jadad scale, the median score was three with a range from 0 to 5. Complete details about allocation concealment and blinding were present in 21 and 10 studies respectively. Most studies lacked an elaborate discussion on trial limitations and generalizability. Among the factors identified as significantly associated with reporting quality were the publishing journal and region of conduct of RCT. Conclusions: The key methodological items remain poorly reported in most studies. Strategies like stricter adherence to CONSORT guidelines by journals, access to full trial protocols to gain valuable information and full collaboration among investigators and methodologists might prove helpful in improving the quality of published RCT reports.
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Affiliation(s)
- Niti Mittal
- Department of Pharmacology, Pt. B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Rakesh Mittal
- Department of Pharmacology, Pt. B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Harish Kumar
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bikash Medhi
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Quality of randomized controlled trials reporting in the treatment of melasma conducted in China. Trials 2015; 16:156. [PMID: 25872530 PMCID: PMC4399216 DOI: 10.1186/s13063-015-0677-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 03/25/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is no existing report on the quality of randomized controlled trials (RCTs) of melasma treatment currently conducted in China. This study aims to assess the quality of RCT- reporting in the treatment of melasma conducted in China. METHODS Several databases were searched from their inception through to August 2014. In order to rate the report quality, we scored 1 for the item if it was reported in CONSORT 2010 and 0 for the item if it was not definitely stated or was not clear. For overall quality score (OQS), 13 items were scored and calculated with a range of 0 to 13. Five items ('randomization', 'allocation concealment', 'blinding', 'baseline characteristics' and 'intention-to-treat (ITT) analysis') were scored and a key methodological index score (MIS) was calculated with a range of 0 to 5 for each trial. RESULTS A total of 246 relevant RCTs were included in the final analysis. The median OQS was 7, with a minimum of 4 and a maximum of 11. Some items' information was insufficient, especially in the categories of 'trial design', 'sample size', 'recruitment' and 'ancillary analyses' with a positive rate of less than 20%. The median MIS was 1 with a minimum of 0 and a maximum of 3. Some items' reporting was poor, especially in the categories of 'randomization', 'allocation concealment and implementation', 'blinding' and 'ITT analysis' with a positive rate of less than 10%. The mean OQS increased by about 0.52 for manuscripts published in the period of 5-year increments (95% CI: 0.32 to 0.72; P < 0.001). With regard to the MIS, no variable was statistically significant in the ordinal regression model. CONCLUSION The reporting quality of RCTs in the treatment of melasma conducted in China is not satisfactory especially in key methodological items. Reporting of RCTs in this field should meet and keep up with the standards of the CONSORT statement.
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