In defence of reviews of small trials: underpinning the generation of evidence to inform practice

Handoll, Helen; Langhorne, Peter

doi:10.1002/14651858.ed000106

Cited by 6 publications

(3 citation statements)

References 9 publications

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“…It has been questioned before what is the value of systematic review including poor evidence and small studies [32]. However, such systematic reviews are valuable because they are highlighting the paucity of evidence and the low quality of available information [33]. Our systematic review is such a case.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of pulsed radiofrequency as a method of dorsal root ganglia stimulation for treatment of non-neuropathic pain: a systematic review

et al. 2020

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Background: We systematically reviewed the evidence on the efficacy and safety of dorsal root ganglion (DRG) targeted pulsed radiofrequency (PRF) versus any comparator for treatment of non-neuropathic pain. Methods: We searched MEDLINE, CINAHL, Embase, PsycINFO, clinicaltrials.gov and WHO clinical trial register until January 8, 2019. All study designs were eligible. Two authors independently conducted literature screening. Primary outcomes were pain intensity and serious adverse events (SAEs). Secondary outcomes were any other pain-related outcome and any other safety outcome that was reported. We assessed the risk of bias using the Cochrane tool and Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I). We conducted narrative evidence synthesis and assessed the conclusiveness of included studies regarding efficacy and safety. Results: We included 17 studies with 599 participants, which analyzed various pain syndromes. Two studies were randomized controlled trials; both included participants with low back pain (LBP). Non-randomized studies included patients with the following indications: LBP, postsurgical pain, pain associated with herpes zoster, cervicogenic headache, complex regional pain syndrome type 1, intractable vertebral metastatic pain, chronic scrotal and inguinal pain, occipital radiating pain in rheumatoid arthritis and chronic migraine. In these studies, the PRF was usually initiated after other treatments have failed. Eleven studies had positive conclusive statements (11/17) about efficacy; the remaining had positive inconclusive statements. Only three studies provided conclusiveness of evidence statements regarding safetytwo indicated that the evidence was positive conclusive, and one positive inconclusive. The risk of bias was predominantly unclear in randomized and serious in non-randomized studies.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of pulsed radiofrequency as a method of dorsal root ganglia stimulation for treatment of non-neuropathic pain: a systematic review

et al. 2020

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“…We must therefore evaluate whether or not each systematic review provides a reasonable and meritorious collection of strong scientific evidence. In their presentation of the case that small clinical reviews are not wasteful, Handoll and Langhorne (2015) concluded that when systematic reviews contained inadequately powerful studies, "the evidence was insufficient to inform practice." They then highlighted how the gradual development of a series of thematic reviews could subsequently inform practice.…”

Section: Systematic Reviews With Meta-analysesmentioning

confidence: 99%

“…They then highlighted how the gradual development of a series of thematic reviews could subsequently inform practice. This is not questioned, but what must be more closely examined is the merit of the one-off, lowerpowered systematic review; such reviews primarily highlight evidence deficiencies (Handoll and Langhorne 2015). Accordingly, the nonclinical application of systematic reviews is cautioned.…”

Section: Systematic Reviews With Meta-analysesmentioning

confidence: 99%

Towards best practice in physical and physiological employment standards

Petersen

Andérson²,

Tipton

et al. 2016

Appl. Physiol. Nutr. Metab.

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While the scope of the term physical employment standards is wide, the principal focus of this paper is on standards related to physiological evaluation of readiness for work. Common applications of such employment standards for work are in public safety and emergency response occupations (e.g., police, firefighting, military), and there is an ever-present need to maximize the scientific quality of this research. Historically, most of these occupations are male-dominated, which leads to potential sex bias during physical demands analysis and determining performance thresholds. It is often assumed that older workers advance to positions with lower physical demand. However, this is not always true, which raises concerns about the long-term maintenance of physiological readiness. Traditionally, little attention has been paid to the inevitable margin of uncertainty that exists around cut-scores. Establishing confidence intervals around the cut-score can reduce for this uncertainty. It may also be necessary to consider the effects of practise and biological variability on test scores. Most tests of readiness for work are conducted under near perfect conditions, while many emergency responses take place under far more demanding and unpredictable conditions. The potential impact of protective clothing, respiratory protection, load carriage, environmental conditions, nutrition, fatigue, sensory deprivation, and stress should also be considered when evaluating readiness for work. In this paper, we seek to establish uniformity in terminology in this field, identify key areas of concern, provide recommendations to improve both scientific and professional practice, and identify priorities for future research.Key words: employment standards, human rights, standard setting, cut-scores, reliability, validity.Résumé : La portée de l'expression normes physiques relatives à l'emploi étant vaste, cet article met l'accent sur les normes associées à l'évaluation physiologique de l'aptitude au travail. On utilise généralement ces normes d'emploi dans le domaine de la sécurité publique et des interventions d'urgence (p. ex. policier, pompier, militaire); ceci étant, il est toujours possible d'améliorer la qualité scientifique de ce domaine de recherche. Historiquement, la majorité de ces emplois sont occupés par des hommes, ce qui pourrait inclure un biais lié au sexe lors de l'analyse des exigences physiques et de la fixation des seuils de performance. Il semble acquis que les travailleurs plus âgés occupent au fil du temps des postes moins exigeants physiquement. Toutefois, comme ce n'est pas toujours le cas, le maintien à long terme des aptitudes au travail pourrait s'avérer problématique. Depuis longtemps, on porte peu d'attention à la marge d'incertitude concernant les seuils de coupure. L'établissement d'un intervalle de confiance au seuil de coupure pourrait combler cette incertitude. On devrait possiblement prendre en compte les effets de la pratique et de la variabilité biologique sur les résultats des tests. La plu...

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