The assessment of the quality of randomized controlled trials published in Indian medical journals

The utilization of systematic review evidence in formulating India's National Health Programme guidelines between 2007 and 2021

Evidence-informed policymaking integrates the best available evidence on programme outcomes to guide decisions at all stages of the policy process and its importance becomes more pronounced in resource-constrained settings. In this paper, we have reviewed the use of systematic review evidence in framing National Health Programme (NHP) guidelines in India. We searched official websites of the different NHPs, linked to the main website of the Ministry of Health and Family Welfare (MoHFW), in December 2020 and January 2021. NHP guideline documents with systematic review evidence were identified and information on the use of this evidence was extracted. We classified the identified systematic review evidence according to its use in the guideline documents and analysed the data to provide information on the different factors and patterns linked to the use of systematic review evidence in these documents. Systematic reviews were mostly visible in guideline documents addressing maternal and newborn health, communicable diseases and immunization. These systematic reviews were cited in the guidelines to justify the need for action, to justify recommendations for action and opportunities for local adaptation, and to highlight implementation challenges and justify implementation strategies. Guideline documents addressing implementation cited systematic reviews about the problems and policy options more often than citing systematic reviews about implementation. Systematic reviews were linked directly to support statements in few guideline documents, and sometimes the reviews were not appropriately cited. Most of the systematic reviews providing information on the nature and scale of the policy problem included Indian data. It was seen that since 2014, India has been increasingly using systematic review evidence for public health policymaking, particularly for some of its high-priority NHPs. This complements the increasing investment in research synthesis centres and procedures to support evidence-informed decision making, demonstrating the continued evolution of India's evidence policy system.

Assessment of Reporting Quality of Drug-Related Randomized Controlled Trials Conducted in India and Published in MEDLINE-Indexed Indian Journals Over a Decade: A Systematic Review

Poorly published trials may result in biased and erroneous healthcare decisions. We conducted this systematic review to evaluate the reporting quality of drug-related randomized controlled trials (RCTs) conducted in India and published in MEDLINE-indexed Indian journals over a decade (between January 1, 2011, and December 31, 2020), as per the Consolidated Standards of Reporting Trials (CONSORT) Checklist 2010. An extensive literature search was conducted using the terms "Randomized controlled trial AND India." The full-length papers were extracted for RCTs related to drugs. Two independent investigators assessed each article against the checklist containing 37 criteria. Each article was scored 1 or 0 against each criterion which was finally summed up and evaluated. None of the articles fulfilled all 37 criteria. A compliance rate of >75% was seen in only 15.5% of articles. More than 75% of articles fulfilled a minimum of 16 criteria. Major checklist points observed to be deficient were "important changes to methods after trial commencement" (7%), "interim analysis and stopping guidelines" (7%), and "description of similarity of interventions while blinding" (4%). There remains ample room for improvement regarding research methodology and manuscript preparation in India. Moreover, journals should stringently implement the CONSORT Checklist 2010 to enhance the standard and quality of publications.

Quality of the Systematic Reviews in Cochrane Gynecological Cancer Group and Their Understudied RCTs

Purpose

Gynecological cancers are common neoplasms in clinical settings with a high impact on the economy of communities. The medical literature is an essential resource to guide clinical decision-making, and misconduct in researches undermines the credibility and integrity of research in general. We aimed to evaluate the quality of Cochrane gynecological cancers reviews and their understudies RCTS among the different biases dimensions.

Methods

This cross-sectional analytical study was performed on 118 systematic reviews published by the Cochrane gynecological cancers Group up to June 2021. The risk of bias was assessed in each Cochrane survey using the Joanna Bridges Institute (JBI) critical assessment tool consisting of 11 questions. The JBI checklist for systematic reviews and research syntheses is available at https://jbi.global/critical-appraisal-tools. After a systematic critical evaluation of the reviews and meta-analysis, we extracted a different bias from all of their understudied RCTs examined in these systematic reviews, which were evaluated by systematic review authors using a standard bias risk tool developed by the Cochrane Group.

Results

Cochrane gynecological cancers reviews had high quality based on appraise results using the JBI appraisal checklist. In addition, all of the included studies used PRISMA standards for reporting their results. However, in their understudied RCTs, the most prevalent risk of bias was unclear selection bias (allocation concealment) and performance bias (blinding of participants and personnel). Also, the highest risk of bias was blinding participants and personnel (performance bias) and incomplete outcome data (attrition bias). Our results showed that the lowest risk of bias was incomplete outcome data (attrition bias) and random sequence generation (selection bias).

Conclusion

Although most Cochrane gynecological cancers reviews had high quality, unclear performance bias was the highest in their understudied RCTs, indicating structural deficiencies.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13224-022-01655-6.

Compliance of Published Randomized Controlled Trials on the Effect of Physical Activity on Primary Dysmenorrhea with the Consortium's Integrated Report on Clinical Trials Statement: A Critical Appraisal of the Literature

Background

Randomized Controlled Trials (RCTs) are reliable methods for the evaluation of treatment effectiveness, which should be rigorous and must report with clarity. This study aimed to assess the compliance of published RCTs about the effect of physical activity on primary dysmenorrhea with the CONSORT 2017 statement.

Materials and Methods

In this study, the review of literature was carried out based on Consolidated Standards Of Reporting Trials (CONSORT). All the clinical trials focused on the effect of the physical activity on primary dysmenorrhea indexed in Web of Science, Pubmed, Scopus, Google Scholar, Science Direct, Embase, Magiran and Scientific Information Database (SID) were searched using keywords of dysmenorrhea, randomized clinical trial, physical activity and exercise from 2000 to 2019. Out of 1423 articles, 30 RCTs were critically appraised using CONSORT 2017 checklist. The reporting quality score of articles was identified between zero and 43.

Results

The compliance rate with the CONSORT checklist was 55.58%. The mean (SD) score of the reporting quality was 23.37 (-5.15) with a minimum of 16 and a maximum of 37. The maximum weakness was in reporting the sample size and full trial protocol 23.33% and 6.67% respectively. Regarding new items of the consort 2017, if the blinding was not possible, the description of any attempts to limit bias was not described in 70% of articles.

Conclusions

Reporting sample size, trial protocol, method of blinding, and control of bias are issues that require more attention in reporting of RCT studies. We recommend that the authors use the CONSORT 2017 statement for conducting and reporting the clinical trials.