scholarly journals Indirect comparisons of treatments based on systematic reviews of randomised controlled trials

2009 ◽  
Vol 63 (6) ◽  
pp. 841-854 ◽  
Author(s):  
S. J. Edwards ◽  
M. J. Clarke ◽  
S. Wordsworth ◽  
J. Borrill
Keyword(s):  
Systematic Reviews ◽  
Randomised Controlled Trials ◽  
Controlled Trials ◽  
Randomised Controlled ◽  
Indirect Comparisons

Evidence-Based Practice: The Cochrane Collaboration, and Occupational Therapy

1998 ◽  
Vol 65 (3) ◽  
pp. 144-151 ◽  
Author(s):  
Robyn L. Hayes ◽  
John J. McGrath
Keyword(s):  
Systematic Reviews ◽  
Randomised Controlled Trials ◽  
Best Practice ◽  
Evidence Based Practice ◽  
Occupational Therapists ◽  
Cochrane Collaboration ◽  
Controlled Trials ◽  
Evidence Based ◽  
Randomised Controlled ◽  
The Cochrane Collaboration

This paper describes how occupational therapists can become involved in the Cochrane Collaboration — a well-developed tool for facilitating the involvement of health professionals and lay people in evidence-based practice. The Cochrane Collaboration is a growing international project intended to systematically locate, conduct systematic reviews (including metaanalyses) of, and disseminate information on all available randomised controlled trials of interventions in any area of health. In particular, occupational therapists can use the Cochrane Collaboration to become better informed about best practice and evaluate research in their areas of interest, and learn skills related to conducting randomised controlled trials, systematic reviews, and meta-analyses.

scholarly journals Intra-articular saline injection as effective as corticosteroids, platelet-rich plasma and hyaluronic acid for hip osteoarthritis pain: a systematic review and network meta-analysis of randomised controlled trials

2020 ◽  
pp. bjsports-2020-102179
Author(s):  
Aaron Gazendam ◽  
Seper Ekhtiari ◽  
Anthony Bozzo ◽  
Mark Phillips ◽  
Mohit Bhandari
Keyword(s):  
Systematic Review ◽  
Functional Outcomes ◽  
Randomised Controlled Trials ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Hip Osteoarthritis ◽  
Controlled Trials ◽  
Saline Injection ◽  
Randomised Controlled ◽  
Indirect Comparisons

ObjectiveIntra-articular (IA) injections represent a commonly used modality in the treatment of hip osteoarthritis (OA). Commonly used injections include corticosteroids (CCS), hyaluronic acid (HA) and platelet-rich plasma (PRP). A network meta-analysis allows for comparison among more than two treatment arms and uses both direct and indirect comparisons between interventions. The objective of this network meta-analysis is to compare the efficacy of the various IA injectable treatments in treating hip OA at up to 6 months of follow-up.DesignThis is a systematic review and network meta-analysis. Bayesian random-effects model was performed to assess the direct and indirect comparisons of all treatment options.Data sourcesPubMed, Embase, Cochrane Central Register of Controlled Trials, Scopus and Web of Science, from inception to October 2019.Eligibility criteria for selected studiesRandomised controlled trials assessing the efficacy of CCS, HA, PRP and placebo in the form of IA saline injection for patients with hip OA.ResultsEleven randomised controlled trials comprising 1353 patients were included. For pain outcomes at both 2–4 and 6 months, no intervention significantly outperformed placebo IA injection. For functional outcomes at both 2–4 and 6 months, no intervention significantly outperformed placebo IA injection. Regarding change from baseline at 2–4 months and 6 months, pooled data demonstrated that all interventions (including placebo), with the exception of HA+PRP, led to a clinically important improvement in both pain, exceeding the minimal clinically important difference.ConclusionEvidence suggests that IA hip saline injections performed as well as all other injectable options in the management of hip pain and functional outcomes.

scholarly journals Outcomes reported on the management of COPD exacerbations: a systematic survey of randomised controlled trials

2019 ◽  
Vol 5 (2) ◽  
pp. 00072-2019 ◽  
Author(s):  
Alexander G. Mathioudakis ◽  
Mia Moberg ◽  
Julie Janner ◽  
Pablo Alonso-Coello ◽  
Jørgen Vestbo
Keyword(s):  
Outcome Measures ◽  
Systematic Reviews ◽  
Randomised Controlled Trials ◽  
Core Outcome Set ◽  
Controlled Trials ◽  
Significant Heterogeneity ◽  
Core Outcome ◽  
Copd Exacerbations ◽  
Outcome Set ◽  
Randomised Controlled

Randomised controlled trials (RCTs) evaluating the management of acute exacerbations of chronic obstructive pulmonary disease (COPD) report heterogeneous outcome measures, thus rendering their results incomparable, complicating their translation into clinical practice. As a first step in the development of a core outcome set that will aim to homogenise outcome measures in future RCTs, we assessed the outcomes reported in recent relevant RCTs and systematic reviews.We conducted a methodological systematic review (https://www.crd.york.ac.uk/prospero/ registration number CRD42016052437) of RCTs and systematic reviews on COPD exacerbation management indexed on Medline and PubMed during the last decade. We evaluated their methodology, specifically focusing on the reported outcome measures.Based on 123 RCTs and 38 systematic reviews, we found significant variability in the outcomes reported and in their definition. Mortality, which was assessed in 82% of the included trials, was the most frequently assessed outcome, followed by the rate of treatment success or failure (63%), adverse events (59%), health status, symptoms and quality of life (59%), lung function (47%), and duration of exacerbations (42%).The significant heterogeneity in the selection and definition of outcome measures in RCTs and systematic reviews limits the interpretability and comparability of their results, and warrants the development of a core outcome set for COPD exacerbations management.

scholarly journals The impact of outcome reporting bias in randomised controlled trials on a cohort of systematic reviews

BMJ ◽  
2010 ◽  
Vol 340 (feb15 1) ◽  
pp. c365-c365 ◽  
Author(s):  
J. J Kirkham ◽  
K. M Dwan ◽  
D. G Altman ◽  
C. Gamble ◽  
S. Dodd ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Randomised Controlled Trials ◽  
Reporting Bias ◽  
Controlled Trials ◽  
Outcome Reporting Bias ◽  
Outcome Reporting ◽  
Randomised Controlled ◽  
The Impact

scholarly journals Mesh fixation techniques for inguinal hernia repair: an overview of systematic reviews of randomised controlled trials

Hernia ◽  
2021 ◽  
Author(s):  
A. Alabi ◽  
N. Haladu ◽  
N. W. Scott ◽  
M. Imamura ◽  
I. Ahmed ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Systematic Reviews ◽  
Randomised Controlled Trials ◽  
Mesh Fixation ◽  
Controlled Trials ◽  
Fixation Techniques ◽  
Randomised Controlled

Abstract Purpose Inguinal hernia repair using surgical mesh is a very common surgical operation. Currently, there is no consensus on the best technique for mesh fixation. We conducted an overview of existing systematic reviews (SRs) of randomised controlled trials to compare the risk of chronic pain and recurrence following open and laparoscopic inguinal hernia repairs using various mesh fixation techniques. Methods We searched major electronic databases in April 2020 and assessed the methodological quality of identified reviews using the AMSTAR-2 tool. Results We identified 20 SRs of variable quality assessing suture, self-gripping, glue, and mechanical fixation. Across reviews, the risk of chronic pain after open mesh repair was lower with glue fixation than with suture and comparable between self-gripping and suture. Incidence of chronic pain was lower with glue fixation than with mechanical fixation in laparoscopic repairs. There were no significant differences in recurrence rates between fixation techniques in open and laparoscopic mesh repairs, although fewer recurrences were reported with suture. Many reviews reported wide confidence intervals around summary estimates. Despite no clear evidence of differences among techniques, two network meta-analyses (one assessing open repairs and one laparoscopic repairs) ranked glue fixation as the best treatment for reducing pain and suture for reducing the risk of recurrence. Conclusion Glue fixation may be effective in reducing the incidence of chronic pain without increasing the risk of recurrence. Future research should consider both the effectiveness and cost-effectiveness of fixation techniques alongside the type of mesh and the size and location of the hernia defect.

scholarly journals Reducing bias in trials from reactions to measurement: the MERIT study including developmental work and expert workshop

2021 ◽  
Vol 25 (55) ◽  
pp. 1-72
Author(s):  
David P French ◽  
Lisa M Miles ◽  
Diana Elbourne ◽  
Andrew Farmer ◽  
Martin Gulliford ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Randomised Controlled Trials ◽  
Research Council ◽  
Medical Research Council ◽  
Controlled Trials ◽  
Measurement Reactivity ◽  
Health Related ◽  
Randomised Controlled ◽  
Expert Workshop ◽  
Improve Health

Background Measurement can affect the people being measured; for example, asking people to complete a questionnaire can result in changes in behaviour (the ‘question–behaviour effect’). The usual methods of conduct and analysis of randomised controlled trials implicitly assume that the taking of measurements has no effect on research participants. Changes in measured behaviour and other outcomes due to measurement reactivity may therefore introduce bias in otherwise well-conducted randomised controlled trials, yielding incorrect estimates of intervention effects, including underestimates. Objectives The main objectives were (1) to promote awareness of how and where taking measurements can lead to bias and (2) to provide recommendations on how best to avoid or minimise bias due to measurement reactivity in randomised controlled trials of interventions to improve health. Methods We conducted (1) a series of systematic and rapid reviews, (2) a Delphi study and (3) an expert workshop. A protocol paper was published [Miles LM, Elbourne D, Farmer A, Gulliford M, Locock L, McCambridge J, et al. Bias due to MEasurement Reactions In Trials to improve health (MERIT): protocol for research to develop MRC guidance. Trials 2018;19:653]. An updated systematic review examined whether or not measuring participants had an effect on participants’ health-related behaviours relative to no-measurement controls. Three new rapid systematic reviews were conducted to identify (1) existing guidance on measurement reactivity, (2) existing systematic reviews of studies that have quantified the effects of measurement on outcomes relating to behaviour and affective outcomes and (3) experimental studies that have investigated the effects of exposure to objective measurements of behaviour on health-related behaviour. The views of 40 experts defined the scope of the recommendations in two waves of data collection during the Delphi procedure. A workshop aimed to produce a set of recommendations that were formed in discussion in groups. Results Systematic reviews – we identified a total of 43 studies that compared interview or questionnaire measurement with no measurement and these had an overall small effect (standardised mean difference 0.06, 95% confidence interval 0.02 to 0.09; n = 104,096, I 2 = 54%). The three rapid systematic reviews identified no existing guidance on measurement reactivity, but we did identify five systematic reviews that quantified the effects of measurement on outcomes (all focused on the question–behaviour effect, with all standardised mean differences in the range of 0.09—0.28) and 16 studies that examined reactive effects of objective measurement of behaviour, with most evidence of reactivity of small effect and short duration. Delphi procedure – substantial agreement was reached on the scope of the present recommendations. Workshop – 14 recommendations and three main aims were produced. The aims were to identify whether or not bias is likely to be a problem for a trial, to decide whether or not to collect further quantitative or qualitative data to inform decisions about if bias is likely to be a problem, and to identify how to design trials to minimise the likelihood of this bias. Limitation The main limitation was the shortage of high-quality evidence regarding the extent of measurement reactivity, with some notable exceptions, and the circumstances that are likely to bring it about. Conclusion We hope that these recommendations will be used to develop new trials that are less likely to be at risk of bias. Future work The greatest need is to increase the number of high-quality primary studies regarding the extent of measurement reactivity. Study registration The first systematic review in this study is registered as PROSPERO CRD42018102511. Funding Funded by the Medical Research Council UK and the National Institute for Health Research as part of the Medical Research Council–National Institute for Health Research Methodology Research Programme.

scholarly journals Systematic reviews and meta-analyses comparing mortality in restrictive and liberal haemoglobin thresholds for red cell transfusion: protocol for an overview of systematic reviews

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e029828 ◽  
Author(s):  
Kevin M Trentino ◽  
Shannon L Farmer ◽  
Frank M Sanfilippo ◽  
Michael F Leahy ◽  
James Isbister ◽  
...  
Keyword(s):  
Blood Cell ◽  
Systematic Reviews ◽  
Red Blood Cell ◽  
Randomised Controlled Trials ◽  
Red Blood Cell Transfusion ◽  
Controlled Trials ◽  
Overview Of Systematic Reviews ◽  
Randomised Controlled ◽  
Meta Analyses

IntroductionThere has been a significant increase in the number of systematic reviews and meta-analyses of randomised controlled trials investigating thresholds for red blood cell transfusion. To systematically collate, appraise and synthesise the results of these systematic reviews and meta-analyses, we will conduct an overview of systematic reviews.Methods and analysisThis is a protocol for an overview of systematic reviews. We will search five databases: MEDLINE, Embase, Web of Science Core Collection, PubMed (for prepublication, in process and non-Medline records) and Google Scholar. We will consider systematic reviews and meta-analyses of randomised controlled trials evaluating the effect of haemoglobin thresholds for red blood cell transfusion on mortality. Two authors will independently screen titles and abstracts retrieved in the literature search and select studies meeting the eligibility criteria for full-text review. We will extract data onto a predefined form designed to summarise the key characteristics of each review. We will assess the methodological quality of included reviews and the quality of evidence in included reviews.Ethics and disseminationFormal ethics approval is not required for this overview as we will only analyse published literature. The findings of this study will be presented at relevant conferences and submitted for peer-review publication. The results are likely to be used by clinicians, policy makers and developers of clinical guidelines and will inform suggestions for future systematic reviews and randomised controlled trials.PROSPERO registration numberCRD42019120503.

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