Creating clinically relevant knowledge from systematic reviews: the challenges of knowledge translation

Scott, N. Ann; Moga, Carmen; Barton, Pamela M.; Rashiq, Saifee; Schopflocher, Donald; Taenzer, Paul; Harstall, Christa

doi:10.1111/j.1365-2753.2007.00830.x

Cited by 31 publications

(31 citation statements)

References 26 publications

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“…The choice between these depends on the objective of the review, but it is clear that meta-analyses are more applicable to decision making (e.g., clinical, policy) when they are exploratory in nature [14,28,53,75,99]. The trials included in a systematic review may be so very similar that the summary effect estimate is the most reasonable and applicable metric [114].…”

Section: Discussionmentioning

confidence: 99%

“…For example, while some guidance exists describing what to include in reports of systematic reviews (e.g., the PRISMA statement [9]), characteristics of the intervention that are necessary to apply their findings are infrequently provided [10][11][12][13]. This has led to some preliminary work on how to extract clinically relevant information from systematic reviews [14]. Furthermore, systematic reviews commonly show substantial heterogeneity in estimated effects (statistical heterogeneity), possibly due to methodological, clinical or unknown features in the included trials [15].…”

Section: Introductionmentioning

confidence: 99%

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Investigating clinical heterogeneity in systematic reviews: a methodologic review of guidance in the literature

2014

Br Dent J

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Background: While there is some consensus on methods for investigating statistical and methodological heterogeneity, little attention has been paid to clinical aspects of heterogeneity. The objective of this study is to summarize and collate suggested methods for investigating clinical heterogeneity in systematic reviews. Methods: We searched databases (Medline, EMBASE, CINAHL, Cochrane Library, and CONSORT, to December 2010) and reference lists and contacted experts to identify resources providing suggestions for investigating clinical heterogeneity between controlled clinical trials included in systematic reviews. We extracted recommendations, assessed resources for risk of bias, and collated the recommendations.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Investigating clinical heterogeneity in systematic reviews: a methodologic review of guidance in the literature

2014

Br Dent J

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“…While guidance exists describing what to include in reports of systematic reviews (e.g., the PRISMA statement) [11], characteristics of the intervention that are necessary to apply their findings are frequently not provided [12-14]. This has led to some preliminary work on how to extract clinically relevant information from systematic reviews [15]. Furthermore, systematic reviews commonly show substantial heterogeneity in estimated effects, possibly due to methodological, clinical or other unknown features (e.g., missing or unpublished data) in the included trials [16].…”

Section: Introductionmentioning

confidence: 99%

Consensus-based recommendations for investigating clinical heterogeneity in systematic reviews

Gagnier

Morgenstern

Altman

et al. 2013

BMC Med Res Methodol

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BackgroundCritics of systematic reviews have argued that these studies often fail to inform clinical decision making because their results are far too general, that the data are sparse, such that findings cannot be applied to individual patients or for other decision making. While there is some consensus on methods for investigating statistical and methodological heterogeneity, little attention has been paid to clinical aspects of heterogeneity. Clinical heterogeneity, true effect heterogeneity, can be defined as variability among studies in the participants, the types or timing of outcome measurements, and the intervention characteristics. The objective of this project was to develop recommendations for investigating clinical heterogeneity in systematic reviews.MethodsWe used a modified Delphi technique with three phases: (1) pre-meeting item generation; (2) face-to-face consensus meeting in the form of a modified Delphi process; and (3) post-meeting feedback. We identified and invited potential participants with expertise in systematic review methodology, systematic review reporting, or statistical aspects of meta-analyses, or those who published papers on clinical heterogeneity.ResultsBetween April and June of 2011, we conducted phone calls with participants. In June 2011 we held the face-to-face focus group meeting in Ann Arbor, Michigan. First, we agreed upon a definition of clinical heterogeneity: Variations in the treatment effect that are due to differences in clinically related characteristics. Next, we discussed and generated recommendations in the following 12 categories related to investigating clinical heterogeneity: the systematic review team, planning investigations, rationale for choice of variables, types of clinical variables, the role of statistical heterogeneity, the use of plotting and visual aids, dealing with outlier studies, the number of investigations or variables, the role of the best evidence synthesis, types of statistical methods, the interpretation of findings, and reporting.ConclusionsClinical heterogeneity is common in systematic reviews. Our recommendations can help guide systematic reviewers in conducting valid and reliable investigations of clinical heterogeneity. Findings of these investigations may allow for increased applicability of findings of systematic reviews to the management of individual patients.

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“…[1][2][3][4] The initial goal of the Ambassador Program was to develop and test a case-based interactive multidisciplinary workshop as a model of knowledge translation. In following up this initial work, the programme team next identified knowledge gaps in the assessment and management of low back pain (LBP) among primary-care practitioners through a provincewide survey.…”

Section: Introductionmentioning

confidence: 99%

The Alberta Health Technology Assessment (HTA) Ambassador Program: The Development of a Contextually Relevant, Multidisciplinary Clinical Practice Guideline for Non-specific Low Back Pain: A Review

Cutforth

Peter²,

Taenzer³

2011

Physiotherapy Canada

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Purpose: To describe the development of a contextually relevant multidisciplinary clinical practice guideline (CPG) for non-specific low back pain (LBP) and to discuss its value to the management of LBP and the practice of physiotherapy. Method: To mitigate an identified knowledge gap for Alberta primary-care practitioners in the management of non-specific LBP, a collaborative process was developed to engage multidisciplinary health care providers in designing a primary-care CPG for non-specific LBP. A comprehensive review of published LBP guidelines identified the seven highest-quality CPGs; these were used to inform a multidisciplinary guideline development group (GDG) as they developed the CPG. Results: The GDG constructed a CPG for non-specific LBP along with point-of-care decision-support and patient-education tools. Conclusions: The Ambassador Program on Low Back Pain worked with front-line clinicians from across Alberta to review the best available evidence in developing a CPG responsive to the Alberta context. This CPG is intervention specific and provides a wide range of primary-care practitioners with the best available evidence to inform their clinical decisions in managing non-specific LBP. RÉ SUMÉObjectif : Dé crire l'é laboration d'une ligne directrice multidisciplinaire de pratique clinique pertinente au contexte pour la lombalgie non spé cifique et discuter de sa valeur pour la gestion de la lombalgie et la pratique de la physiothé rapie. Mé thode : Dans le but d'atté nuer les lacunes dans les connaissances des praticiens en soins primaires de l'Alberta dans la gestion de la lombalgie non spé cifique, un mode de collaboration a é té mis sur pied pour que les fournisseurs de soins de santé de multiples disciplines participent à l'é laboration d'une ligne directrice clinique en soins primaires pour la lombalgie non spé cifique. Une analyse approfondie des lignes directrices pour la lombalgie a permis de ré pertorier sept lignes directrices de la plus grande qualité ; elles ont é té utilisé es pour inspirer le groupe multidisciplinaire dans la cré ation d'une ligne directrice. Ré sultats : Le groupe multidisciplinaire a é laboré une ligne directrice pour la lombalgie non spé cifique de mê me qu'une aide à la dé cision sur les lieux de soins et des outils é ducatifs pour le patient. Conclusions : L'é quipe de l'Ambassador Program on Low Back Pain a travaillé avec des cliniciens de premiè re ligne de partout en Alberta pour analyser les meilleures preuves scientifiques disponibles pour l'é laboration d'une ligne directrice clinique convenant au contexte de l'Alberta. Cette ligne directrice est une intervention pré cise et offre à un large é ventail de praticiens en soins primaires les meilleures preuves scientifiques disponibles pour les aider dans leurs dé cisions cliniques pour la gestion de la lombalgie non spé cifique.Mots clé s : communication multidisciplinaire, lignes directrices de pratique, lombalgie, pratique fondé e sur l'expé rience clinique, ré adaptation 278

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Creating clinically relevant knowledge from systematic reviews: the challenges of knowledge translation

Cited by 31 publications

References 26 publications

Investigating clinical heterogeneity in systematic reviews: a methodologic review of guidance in the literature

Investigating clinical heterogeneity in systematic reviews: a methodologic review of guidance in the literature

Consensus-based recommendations for investigating clinical heterogeneity in systematic reviews

The Alberta Health Technology Assessment (HTA) Ambassador Program: The Development of a Contextually Relevant, Multidisciplinary Clinical Practice Guideline for Non-specific Low Back Pain: A Review

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