A methodological quality assessment of systematic reviews and meta-analyses of antidepressants effect on low back pain using updated AMSTAR

Nociceptive, neuropathic, or nociplastic low back pain? The low back pain phenotyping (BACPAP) consortium's international and multidisciplinary consensus recommendations

The potential to classify low back pain as being characterised by dominant nociceptive, neuropathic, or nociplastic mechanisms is a clinically relevant issue. Preliminary evidence suggests that these low back pain phenotypes might respond differently to treatments; however, more research must be done before making specific recommendations. Accordingly, the low back pain phenotyping (BACPAP) consortium was established as a group of 36 clinicians and researchers from 13 countries (five continents) and 29 institutions, to apply a modified Nominal Group Technique methodology to develop international and multidisciplinary consensus recommendations to provide guidance for identifying the dominant pain phenotype in patients with low back pain, and potentially adapt pain management strategies. The BACPAP consortium's recommendations are also intended to provide direction for future clinical research by building on the established clinical criteria for neuropathic and nociplastic pain. The BACPAP consortium's consensus recommendations are a necessary early step in the process to determine if personalised pain medicine based on pain phenotypes is feasible for low back pain management. Therefore, these recommendations are not ready to be implemented in clinical practice until additional evidence is generated that is specific to these low back pain phenotypes.

Quality of systematic reviews in HIV: The case of clinical outcomes associated with patient medication adherence

AIM

Use of systematic reviews (SRs) as first-level evidence for guideline recommendations hinges on review quality. In particular, US guidelines for adherence-related recommendations in the treatment of human immunodeficiency virus (HIV) are not based on available SRs of adherence-outcome relationships; it is unclear why. No published studies report on the quality of SRs on HIV adherence and outcomes, which may be driving the lack of use. We describe the quality of this body of literature.

METHODS

Literature searches were conducted in Ovid MEDLINE, EMBASE, CINAHL, PubMed Central, the Cochrane Library, Science Citation Index, Web of Science, ScIELO Citation Index, and Ovid Emcare. Screening and quality assessments were performed in duplicate using AMSTAR 2. Funding sources and impact factors of publishing journals were also extracted, and correlations between quality rankings and numbers of critical weaknesses versus impact factors were assessed using Spearman's rank correlation coefficient.

RESULTS

Nine SRs of 1141 records met eligibility criteria. Overall confidence in the results was critically low for most (78%) SRs. Underperformance was found across all AMSTAR 2 domains. Impact factor (a surrogate or journal reputation) did not correlate with quality.

CONCLUSIONS

SRs do not necessarily comprise top-level evidence despite the availability of quality appraisal tools and reporting guidance, which could explain the lack of SR evidence in US HIV medication adherence-related guideline recommendations. All parties to evidence synthesis publication should require quality assessment of studies.

Methodological quality of systematic reviews on treatments for osteoporosis: A cross-sectional study

PURPOSE

Systematic reviews (SRs) provide the best evidence on the effectiveness of treatment strategies for osteoporosis. Carefully conducted SRs provide high-quality evidence for supporting decision-making, but the trustworthiness of conclusions can be hampered by limitation in rigor. We aimed to appraise the methodological quality of a representative sample of SRs on osteoporosis treatments in a cross-sectional study.

METHODS

Cochrane Database of Systematic Reviews, EMBASE, MEDLINE, and PsycINFO were searched for SRs on osteoporotic treatments. AMSTAR (A MeaSurement Tool to Assess systematic Reviews) 2 was used to evaluate methodological quality of SRs. Associations between bibliographical characteristics and methodological quality ratings were explored using multivariate regression analyses.

RESULTS

A total of 101 SRs were appraised. Overall, one (1.0%) was rated "high quality", three (3.0%) were rated "moderate quality", eleven (10.9%) were rated "low quality", and eighty-six (85.1%) were rated "critically low quality". Ninety-nine (98.0%) did not explain study design selection, eighty-five (84.2%) did not provide a list of excluded studies (84.2%), and eighty-five (84.2%) did not report funding sources of included studies. SRs published in 2018 or after were associated with higher overall quality [adjusted odds ratio (AOR): 5.48; 95% confidence interval (CI): 1.12-26.89], while SRs focused on pharmacological interventions were associated with lower overall quality [AOR: 0.24; 95% CI: 0.06-0.96].

CONCLUSION

The methodological quality of the included SRs is far from satisfactory. Future reviewers must strengthen rigor by improving literature search comprehensiveness, registering and publishing a priori protocols, and optimising study selection and data extraction. Better transparency in reporting conflicts of interest among reviewers, as well as sources of funding among included primary studies, are also needed.

The 22nd Anniversary of the Cochrane Back and Neck Group

STUDY DESIGN

Retrospective review and literature review.

OBJECTIVE

The aim of this study was to provide an update on The Cochrane Back and Neck (CBN) activities.

SUMMARY OF BACKGROUND DATA

Low back pain (LBP) affects 80% of people at some time in their lives. CBN Group has been housed in Toronto at the Institute for Work & Health since 1996 and has published 85 reviews and 32 protocols in the Cochrane Library.

METHODS

Narrative review of CBN publications, impact factor, usage data, and social media impact.

RESULTS

In the past 3 years, CBN conducted priority setting with organizations that develop clinical practice guidelines for LBP. CBN editors and associate editors published key methodological articles in the field of back and neck pain research. The methodological quality of CBN reviews has been assessed by external groups in a variety of areas, which found that CBN reviews had higher methodological quality than non-Cochrane reviews. CBN reviews have been included in 35 clinical practice guidelines for back and neck conditions. The 2018 journal impact factor of CBN is 11.154, which is higher than the 2018 impact factor for CDSR (7.755). CBN reviews ranked 4th among 53 Cochrane review groups in terms of Cochrane Library usage data. The most accessed CBN review was "Yoga treatment for chronic non-specific low-back pain" which had 9689 full-text downloads. CBN is active on Twitter with 3958 followers.

CONCLUSION

CBN has published highly utilized systematic reviews and made important methodological contributions to the field of spine research over the past 22 years within Cochrane.

LEVEL OF EVIDENCE

4.