scholarly journals Spin in the reporting, interpretation, and extrapolation of adverse effects of orthodontic interventions: protocol for a cross-sectional study of systematic reviews

2019 ◽  
Vol 4 (1) ◽  
Author(s):  
Pauline A. J. Steegmans ◽  
Nicola Di Girolamo ◽  
Reint A. Meursinge Reynders
Keyword(s):  
Adverse Effects ◽  
Systematic Reviews ◽  
Linear Models ◽  
Data Extraction ◽  
Policy Implications ◽  
Eligibility Criteria ◽  
Cross Sectional ◽  
Cochrane Reviews ◽  
Cochrane Database ◽  
Study Results

Abstract Background Titles and abstracts are the most read sections of biomedical papers. It is therefore important that abstracts transparently report both the beneficial and adverse effects of health care interventions and do not mislead the reader. Misleading reporting, interpretation, or extrapolation of study results is called “spin”. In this study, we will assess whether adverse effects of orthodontic interventions were reported or considered in the abstracts of both Cochrane and non-Cochrane reviews and whether spin was identified and what type of spin. Methods Eligibility criteria were defined for the type of study designs, participants, interventions, outcomes, and settings. We will include systematic reviews of clinical orthodontic interventions published in the five leading orthodontic journals and in the Cochrane Database. Empty reviews will be excluded. We will manually search eligible reviews published between 1 August 2009 and 31 July 2019. Data collection forms were developed a priori. All study selection and data extraction procedures will be conducted by two reviewers independently. Our main outcomes will be the prevalence of reported or considered adverse effects of orthodontic interventions in the abstract of systematic reviews and the prevalence of “spin” related to these adverse effects. We will also record the prevalence of three subtypes of spin, i.e., misleading reporting, misleading interpretation, and misleading extrapolation-related spin. All statistics will be calculated for the following groups: (1) all journals individually, (2) all journals together, and (3) the five leading orthodontic journals and the Cochrane Database of Systematic Reviews separately. Generalized linear models will be developed to compare the various groups. Discussion We expect that our results will raise the awareness of the importance of reporting and considering of adverse effects and the presence of the phenomenon of spin related to these effects in abstracts of systematic reviews of orthodontic interventions. This is important, because an incomplete and inadequate reporting, interpretation, or extrapolation of findings on adverse effects in abstracts of systematic reviews can mislead readers and could lead to inadequate clinical practice. Our findings could result in policy implications for making judgments about the acceptance for publication of systematic reviews of orthodontic interventions.

scholarly journals Search for unpublished data by systematic reviewers: an audit

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e017737 ◽  
Author(s):  
Hedyeh Ziai ◽  
Rujun Zhang ◽  
An-Wen Chan ◽  
Nav Persaud
Keyword(s):  
Publication Bias ◽  
Systematic Reviews ◽  
Data Extraction ◽  
Grey Literature ◽  
Cochrane Library ◽  
Eligibility Criteria ◽  
Ovid Medline ◽  
Cochrane Reviews ◽  
Unpublished Studies ◽  
Cochrane Database

ObjectivesWe audited a selection of systematic reviews published in 2013 and reported on the proportion of reviews that researched for unpublished data, included unpublished data in analysis and assessed for publication bias.DesignAudit of systematic reviews.Data sourcesWe searched PubMed and Ovid MEDLINE In-Process & Other Non-Indexed Citations between 1 January 2013 and 31 December 2013 for the following journals:Journal of the American Medical Association,The British Medical Journal,Lancet,Annals of Internal Medicineand theCochrane Database of Systematic Reviews. We also searched the Cochrane Library and included 100 randomly selected Cochrane reviews.Eligibility criteriaSystematic reviews published in 2013 in the selected journals were included. Methodological reviews were excluded.Data extraction and synthesisTwo reviewers independently reviewed each included systematic review. The following data were extracted: whether the review searched for grey literature or unpublished data, the sources searched, whether unpublished data were included in analysis, whether publication bias was assessed and whether there was evidence of publication bias.Main findings203 reviews were included for analysis. 36% (73/203) of studies did not describe any attempt to obtain unpublished studies or to search grey literature. 89% (116/130) of studies that sought unpublished data found them. 33% (68/203) of studies included an assessment of publication bias, and 40% (27/68) of these found evidence of publication bias.ConclusionA significant fraction of systematic reviews included in our study did not search for unpublished data. Publication bias may be present in almost half the published systematic reviews that assessed for it. Exclusion of unpublished data may lead to biased estimates of efficacy or safety in systematic reviews.

scholarly journals Managing overlap of primary study results across systematic reviews: practical considerations for authors of overviews of reviews

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Carole Lunny ◽  
Dawid Pieper ◽  
Pierre Thabet ◽  
Salmaan Kanji
Keyword(s):  
Case Studies ◽  
Systematic Reviews ◽  
Data Extraction ◽  
Methodological Approach ◽  
Study Data ◽  
Primary Study ◽  
Eligibility Criteria ◽  
Overlapping Data ◽  
Study Results ◽  
Yield Trends

Abstract Background Overviews often identify and synthesise a large number of systematic reviews on the same topic, which is likely to lead to overlap (i.e. duplication) in primary studies across the reviews. Using a primary study result multiple times in the same analysis overstates its sample size and number of events, falsely leading to greater precision in the analysis. This paper aims to: (a) describe types of overlapping data that arise from the same primary studies reported across multiple reviews, (b) describe methods to identify and explain overlap of primary study data, and (c) present six case studies illustrating different approaches to manage overlap. Methods We first updated the search in PubMed for methods from the MOoR framework relating to overlap of primary studies. One author screened the studies titles and abstracts, and any full-text articles retrieved, extracted methods data relating to overlap of primary studies and mapped it to the overlap methods from the MOoR framework. We also describe six case studies as examples of overviews that use specific overlap methods across the steps in the conduct of an overview. For each case study, we discuss potential methodological implications in terms of limitations, efficiency, usability, and resource use. Results Nine methods studies were found and mapped to the methods identified by the MOoR framework to address overlap. Overlap methods were mapped across four steps in the conduct of an overview – the eligibility criteria step, the data extraction step, the assessment of risk of bias step, and the synthesis step. Our overview case studies used multiple methods to reduce overlap at different steps in the conduct of an overview. Conclusions Our study underlines that there is currently no standard methodological approach to deal with overlap in primary studies across reviews. The level of complexity when dealing with overlap can vary depending on the yield, trends and patterns of the included literature and the scope of the overview question. Choosing a method might be dependent on the number of included reviews and their primary studies. Gaps in evaluation of methods to address overlap were found and further investigation in this area is needed.

scholarly journals Reporting of the Role of the Expert Searcher in Cochrane Reviews

2006 ◽  
Vol 1 (4) ◽  
pp. 3 ◽  
Author(s):  
Li Zhang ◽  
Margaret Sampson ◽  
Jessie McGowan
Keyword(s):  
Systematic Reviews ◽  
Search Strategy ◽  
Data Extraction ◽  
Cochrane Library ◽  
Eligibility Criteria ◽  
Statistical Decision ◽  
Cochrane Reviews ◽  
Statistical Decisions ◽  
Search Quality

Introduction - This study applied the principles of evidence based information practice to clarify the role of information specialists and librarians in the preparation of Cochrane systematic reviews and to determine whether information specialists impact the quality of searching in Cochrane systematic reviews. Objectives - This research project sought to determine how the contribution of the person responsible for searching in the preparation of Cochrane systematic reviews was reported; whether the contribution was recognized through authorship or acknowledgement; the qualifications of the searcher; and the association between the type of contributorship and characteristics of the search strategy, assessability, and the presence of certain types of errors. Methods - Data sources: The Cochrane Database of Systematic Reviews, The Cochrane Library 3 (2002). Inclusion criteria: The study included systematic reviews that met the following criteria: one or more sections of the Cochrane Highly Sensitive Search Strategy were utilised, primary studies were either randomised controlled trials (RCTs) or quasi-RCTs, and included and excluded studies were clearly identified. Data extraction: Two librarians assessed the searches for errors, establishing consensus on discordant ratings. Results - Of the 169 reviews screened for this project, 105 met all eligibility criteria. Authors fulfilled the searching role in 41.9% of reviews studied, acknowledged persons or groups in 13.3%, a combination in 9.5%, and the role was not reported in 35.2% of reviews. For the 78 reviews in which meta-analyses were performed, the positions of those responsible for statistical decisions were examined for comparative purposes. The statistical role was performed by an author in 47.4% of cases and unreported in the same number of cases. Insufficient analyzable data was obtained regarding professional qualifications (3/105 for searching, 2/78 for statistical decisions). Search quality was assessed for 66 searches across 74 reviews. In general, it was more possible to assess the search quality when the searcher role was reported. An association was found between the reporting of searcher role and the presence of a consequential error. There was no association between the number of consequential errors and how the contribution of the searcher was reported. Conclusions - Qualifications of the persons responsible for searching and statistical decision-making were poorly reported in Cochrane reviews, but more complete role reporting is associated with greater assessability of searches and fewer substantive errors in search strategies.

scholarly journals Publication practices of sub-Saharan African Cochrane authors: a bibliometric study

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e051839
Author(s):  
Lawrence Mbuagbaw ◽  
Anel Schoonees ◽  
Joy Oliver ◽  
Dachi Arikpo ◽  
Solange Durão ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Data Extraction ◽  
Sub Saharan Africa ◽  
Bibliometric Study ◽  
Test Accuracy ◽  
Eligibility Criteria ◽  
Cochrane Reviews ◽  
Publication Practices ◽  
Sub Saharan ◽  
Overviews Of Systematic Reviews

IntroductionCochrane Africa (https://africa.cochrane.org/) aims to increase Cochrane reviews addressing high priority questions in sub-Saharan Africa (SSA). Researchers residing in SSA, despite often drawing on Cochrane methods, training or resources, conduct and publish systematic reviews outside of Cochrane. Our objective was to investigate the extent to which Cochrane authors from SSA publish Cochrane and non-Cochrane reviews.MethodsWe conducted a bibliometric study of systematic reviews and overviews of systematic reviews from SSA, first by identifying SSA Cochrane authors, then retrieving their first and last author systematic reviews and overviews from PubMed (2008 to April 2019) and using descriptive analyses to investigate the country of origin, types of reviews and trends in publishing Cochrane and non-Cochrane systematic reviews over time. To be eligible, a review had to have predetermined objectives, eligibility criteria, at least two databases searched, data extraction, quality assessment and a first or last author with a SSA affiliation.ResultsWe identified 657 Cochrane authors and 757 eligible systematic reviews. Most authors were from South Africa (n=332; 51%), followed by Nigeria (n=126; 19%). Three-quarters of the reviews (71%) were systematic reviews of interventions. The intervention reviews were more likely to be Cochrane reviews (60.3% vs 39.7%). Conversely, the overviews (23.8% vs 76.2%), qualitative reviews (14.8% vs 85.2%), diagnostic test accuracy reviews (16.1% vs 83.9%) and the ‘other’ reviews (11.1% vs 88.9%) were more likely to be non-Cochrane reviews. During the study period, the number of non-Cochrane reviews increased more than the number of Cochrane reviews. About a quarter of the reviews covered infectious disease topics.ConclusionCochrane authors from SSA are increasingly publishing a diverse variety of systematic reviews and overviews of systematic reviews, often opting for non-Cochrane journals.

scholarly journals Methodological quality assessment in systematic reviews in health sciences that included observational studies: a cross-sectional study/ Avaliação da qualidade metodológica em revisões sistemáticas na área das ciências da saúde que incluíram estudos observacionais: um estudo transversal

2021 ◽  
Vol 4 (5) ◽  
pp. 23002-23018
Author(s):  
Carla Massignan ◽  
Luciana Butini Oliveira ◽  
Lia Rosana Honnef ◽  
Júlia Meller de Oliveira ◽  
Karyn Lehmkuhl ◽  
...  
Keyword(s):  
Quality Assessment ◽  
Systematic Reviews ◽  
Observational Studies ◽  
Methodological Quality ◽  
Data Extraction ◽  
Sample Size Calculation ◽  
Health Science ◽  
Eligibility Criteria ◽  
Cross Sectional ◽  
Protocol Registration

There is great variability in methodological quality assessment (MQ) systematic reviews (SRs). We identified how MQ assessment in SRs that included observational studies in Health Science is applied and explored associated characteristics. A search was conducted in PubMed and five trained reviewers randomly selected 1,025 references after sample size calculation. Only SR published in English (September 2019/2020) were included. Selection and data extraction were conducted in two phases. Data were analyzed descriptively and using logistic regressions. After eligibility criteria application, 205 SRs were included. Only 27.8% informed the protocol registration and 80.0% described having followed a reporting guideline. Proportion’ SRs did not seem to present MQ assessment (OR 4.22; 95% CI: 1.38-12.87; P =0.01). SRs that did not register the study protocol (9.70; 95% CI: 1.95-48.27; P 0.001), those that did not inform the included study design (5.96; 95% CI: 1.63-21.77; P 0.001) and those without MA (OR 8.90; 95% CI: 2.79-28.43; p0.001) increased the odds of not evaluating MQ. Newcastle-Ottawa (47.5%), Joanna Briggs Institute (8.2%) and National Institute of Health (7.1%) were the most commonly used MQ tools. Lack of protocol registration, absence of information about the design of included studies, absence of MA, and proportion’ SRs were associated with lack of MQ assessment.

scholarly journals The methodological quality of COVID-19 systematic reviews is low, except for Cochrane reviews: a meta-epidemiological study

2020 ◽  
Author(s):  
Yuki KATAOKA ◽  
Shiho Oide ◽  
Takashi Ariie ◽  
Yasushi Tsujimoto ◽  
Toshi A. Furukawa
Keyword(s):  
Epidemiological Study ◽  
Systematic Reviews ◽  
Methodological Quality ◽  
Mean Difference ◽  
Measurement Tool ◽  
Cross Sectional ◽  
Cochrane Reviews ◽  
Cochrane Database ◽  
The Mean

Objectives: The objective of this study was to investigate the methodological quality of COVID-19 systematic reviews (SRs) indexed in medRxiv and PubMed, compared with Cochrane COVID Reviews. Study Design and Setting: This is a cross-sectional meta-epidemiological study. We searched medRxiv, PubMed, and Cochrane Database of Systematic Reviews for SRs of COVID-19. We evaluated the methodological quality using A MeaSurement Tool to Assess systematic Reviews (AMSTAR) checklists. The maximum AMSTAR score is 11, and minimum is 0. Higher score means better quality. Results: We included 9 Cochrane reviews as well as randomly selected 100 non-Cochrane reviews in medRxiv and PubMed. Compared with Cochrane reviews (mean 9.33, standard deviation 1.32), the mean AMSTAR scores of the articles in medRxiv were lower (mean difference -2.85, 95%confidence intervals (CI): -0.96 to -4.74) and those in PubMed was also lower (mean difference -3.28, 95% CI: -1.40 to -5.15), with no difference between the latter two. Conclusions: It should be noted that AMSTAR is not a perfect tool of assessing quality SRs other than intervention. Readers should pay attention to the potentially low methodological quality of COVID-19 SRs in both PubMed and medRxiv but less so in Cochrane COVID reviews.

scholarly journals Factors underpinning discrepant findings from reviews on the same topic: A systematic analysis of Cochrane and non-Cochrane reviews

2019 ◽  
Author(s):  
Claudia Hacke ◽  
David Nunan
Keyword(s):  
Systematic Reviews ◽  
Methodological Quality ◽  
Data Extraction ◽  
Meta Analysis ◽  
List Type ◽  
Eligibility Criteria ◽  
Cochrane Reviews ◽  
And Performance ◽  
Meta Analyses

AbstractObjectiveTo explore factors underpinning discrepancies in reported pooled effect estimates from Cochrane and non-Cochrane systematic reviews answering the same question.Study Design and SettingWe observed discrepant pooled effects in 23 out of 24 pairs of meta-analyses from Cochrane and non-Cochrane systematic reviews answering the same question. Here we present the results of a systematic assessment of methodological quality and factors that explain the observed quantitative discrepancies. Methodological quality of each review was assessed using AMSTAR (Assessing the Methodological Quality of Systematic Reviews). Matched pairs were contrasted at the macro- (review methodology), meso- (application of methodology) and micro- (data extraction) level and reasons for differences were derived.ResultsAll Cochrane reviews had high methodological quality (AMSTAR 8-11), whereas the majority (87.5%) of non-Cochrane reviews were classified as moderate (AMSTAR 4-7). Only one pair included exactly the same studies for their respective meta-analyses but there was still a discrepancy in the pooled estimate due to differences in data extraction. One pair did not include any study of its match and for one pair the same effect estimates were reported despite inclusion of different studies. The remaining pairs included at least one study in their match. Due to insufficient reporting (predominantly affecting non-Cochrane reviews) we were only able to completely ascertain the reasons for discrepancies in all included studies for 9/24 (37.5%) pairs. Across all pairs, differences in pre-defined methods (macro-level) including search strategy, eligibility criteria and performance of dual screening could possibly explain mismatches in included studies. Study selection procedures (meso-level) including disagreements in the interpretation of pre-defined eligibility criteria (14 matches) were identified as reasons underpinning discrepant review findings. Comparison of data extraction from primary studies (micro-level) was not possible in 13/24 pairs as a result of the non-Cochrane review providing insufficient details of the studies included in their meta-analyses. Two out of 24 pairs completely agreed on the numerical data presented for the same studies in their respective meta-analysis. Both review types provided sufficient information to check the accuracy of data extraction for 8 pairs (45 studies) where there were discrepancies. An assessment of 50% (22 studies) of these showed that reasons for differences in extracted data could be identified in 15 studies. We found examples for both types of review where data presented were discrepant from that given in the source study without a plausible explanation.ConclusionMethodological and author judgements and performance are key aspects underpinning poor overlap of included studies and discrepancies in reported pooled effect estimates between topic-matched reviews. Though caution must be taken when extrapolating, our findings raise the question as to what extent the entire meta-analysis evidence-base accurately reflects the available primary research both in terms of volume and data. Reinforcing awareness of the application of guidelines for systematic reviews and meta-analyses may help mitigate some of the key issues identified in our analysis.What is new?Key findings Non-Cochrane reviews were of a lower overall methodological quality compared with Cochrane reviews. Discrepant results of meta-analyses on the same topic can be attributed to differences in included studies based on review author decision, judgements and performance at different stages of the review process.What this adds to what was known?This study provides the most robust analysis to date of the potential methodological factors underpinning discrepant review findings between matched meta-analyses answering the same question. Assessing differences between reviews at the macro-, meso-, and micro-levels is a useful method to identify reasons for discrepant meta-analyses at key stages of the review process.What is the implication and what should change now?There is a need for a standardised approach to performing matched-pair analysis of meta-analyses and systematic reviews answering the same question. Our paper provides a base for this that can be refined by replication and expert consensus.

scholarly journals Evaluating the relationship between citation set size, team size and screening methods used in systematic reviews: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Katie O’Hearn ◽  
Cameron MacDonald ◽  
Anne Tsampalieros ◽  
Leo Kadota ◽  
Ryan Sandarage ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Full Text ◽  
Gold Standard ◽  
Data Extraction ◽  
Statistical Testing ◽  
Computer Assisted ◽  
Screening Methods ◽  
Team Size ◽  
Cross Sectional ◽  
Set Size

Abstract Background Standard practice for conducting systematic reviews (SRs) is time consuming and involves the study team screening hundreds or thousands of citations. As the volume of medical literature grows, the citation set sizes and corresponding screening efforts increase. While larger team size and alternate screening methods have the potential to reduce workload and decrease SR completion times, it is unknown whether investigators adapt team size or methods in response to citation set sizes. Using a cross-sectional design, we sought to understand how citation set size impacts (1) the total number of authors or individuals contributing to screening and (2) screening methods. Methods MEDLINE was searched in April 2019 for SRs on any health topic. A total of 1880 unique publications were identified and sorted into five citation set size categories (after deduplication): < 1,000, 1,001–2,500, 2,501–5,000, 5,001–10,000, and > 10,000. A random sample of 259 SRs were selected (~ 50 per category) for data extraction and analysis. Results With the exception of the pairwise t test comparing the under 1000 and over 10,000 categories (median 5 vs. 6, p = 0.049) no statistically significant relationship was evident between author number and citation set size. While visual inspection was suggestive, statistical testing did not consistently identify a relationship between citation set size and number of screeners (title-abstract, full text) or data extractors. However, logistic regression identified investigators were significantly more likely to deviate from gold-standard screening methods (i.e. independent duplicate screening) with larger citation sets. For every doubling of citation size, the odds of using gold-standard screening decreased by 15 and 20% at title-abstract and full text review, respectively. Finally, few SRs reported using crowdsourcing (n = 2) or computer-assisted screening (n = 1). Conclusions Large citation set sizes present a challenge to SR teams, especially when faced with time-sensitive health policy questions. Our study suggests that with increasing citation set size, authors are less likely to adhere to gold-standard screening methods. It is possible that adjunct screening methods, such as crowdsourcing (large team) and computer-assisted technologies, may provide a viable solution for authors to complete their SRs in a timely manner.

scholarly journals Gender disparity between authors in leading medical journals during the COVID-19 pandemic: a cross-sectional review

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e051224
Author(s):  
Vaidehi Misra ◽  
Frozan Safi ◽  
Kathryn A Brewerton ◽  
Wei Wu ◽  
Robin Mason ◽  
...  
Keyword(s):  
Data Extraction ◽  
Gender Disparity ◽  
High Impact ◽  
Original Research ◽  
Eligibility Criteria ◽  
Cross Sectional ◽  
Medical Journals ◽  
The Usa ◽  
Study Characteristics ◽  
Data Elements

ObjectivesEvaluate gender differences in authorship of COVID-19 articles in high-impact medical journals compared with other topics.DesignCross-sectional review.Data sourcesMedline database.Eligibility criteriaArticles published from 1 January to 31 December 2020 in the seven leading general medical journals by impact factor. Article types included primary research, reviews, editorials and commentaries.Data extractionKey data elements were whether the study topic was related to COVID-19 and names of the principal and the senior authors. A hierarchical approach was used to determine the likely gender of authors. Logistic regression assessed the association of study characteristics, including COVID-19 status, with authors’ likely gender; this was quantified using adjusted ORs (aORs).ResultsWe included 2252 articles, of which 748 (33.2%) were COVID-19-related and 1504 (66.8%) covered other topics. A likely gender was determined for 2138 (94.9%) principal authors and 1890 (83.9%) senior authors. Men were significantly more likely to be both principal (1364 men; 63.8%) and senior (1332 men; 70.5%) authors. COVID-19-related articles were not associated with the odds of men being principal (aOR 0.99; 95% CI 0.81 to 1.21; p=0.89) or senior authors (aOR 0.96; 95% CI 0.78 to 1.19; p=0.71) relative to other topics. Articles with men as senior authors were more likely to have men as principal authors (aOR 1.49; 95% CI 1.21 to 1.83; p<0.001). Men were more likely to author articles reporting original research and those with corresponding authors based outside the USA and Europe.ConclusionsWomen were substantially under-represented as authors among articles in leading medical journals; this was not significantly different for COVID-19-related articles. Study limitations include potential for misclassification bias due to the name-based analysis. Results suggest that barriers to women’s authorship in high-impact journals during COVID-19 are not significantly larger than barriers that preceded the pandemic and that are likely to continue beyond it.PROSPERO registration numberCRD42020186702.

scholarly journals The effective interventions to improve long-term physiotherapy exercise adherence among patients with lower limb osteoarthritis. A systematic review

2021 ◽  
Author(s):  
Pathmanathan Cinthuja ◽  
Nidhya Krishnamoorthy ◽  
Gamalendira Shivapatham
Keyword(s):  
Systematic Review ◽  
Lower Limb ◽  
English Language ◽  
Data Extraction ◽  
Exercise Adherence ◽  
Case Control Studies ◽  
Eligibility Criteria ◽  
Cross Sectional ◽  
Booster Sessions

Abstract Introduction: Osteoarthritis (OA) is a chronic condition that severely effects work life balance impacting psychosocial and socio-economic aspects. Physiotherapy exercise is one of the intervention methods for the management of OA. Adherence to the exercise by patients is essential for the effective management of OA. Objectives: To determine different methods used to enhance physiotherapy exercise adherence for more than 12 months among patients with osteoarthritis and to report the effective method to enhance exercise adherence among people with lower limb osteoarthritis. Design: Systematic review Methods: PubMed, Pedro, Web of Science, and EMBASE databases searched for randomized controlled trials, cohort studies, case-control studies, and cross-sectional studies published in the English language from 2000 to 2020. The date of data extraction was 04 September 2020. Two independent researchers conducted literature search, assessed eligibility, extracted data, conducted methodology quality assessment using the PEDro scale, and conducted risk of bias assessment. A narrative synthesis of key outcomes is presented; preferred Reporting Items for Systematic review was used to report the review. The study protocol was registered in the Prospero (Prospero ID: CRD42020205653). Results: The primary search strategy identified 5839 potentially relevant articles, of which 5157 remained after discarding duplicates. After screening based on title and abstract, 40 papers were potentially eligible for inclusion. Five of these papers met all predefined eligibility criteria. Introducing methods to enhance exercise adherence has caused a significant increase in exercise adherence for the short term (less than six months or 12 months). There were no significant differences, long-term adherence with different methods, reported. The results indicate that booster sessions (89.69%) and telephone-linked communication (86%) had higher percentages for the exercise adherence. Secondary outcomes such as pain, stiffness, function, show positive outcomes with increasing exercise adherence. However, there were no significant differences reported. Conclusion: The booster sessions and telephone-linked communication appear to enhance exercise adherence for more than 12 months among patients with osteoarthritis. However, a number of high-quality studies are inadequate to confirm our findings. Therefore, more studies with higher methodological quality are needed to determine the best strategies to enhance long-term exercise adherence among people with osteoarthritis. Key terms: Osteoarthritis, Long term, Exercise adherence

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