Risk of Bias Tool in Systematic Reviews/Meta-Analyses of Acupuncture in Chinese Journals

Abstract

BackgroundUse of a risk of bias (ROB) tool has been encouraged and advocated to reviewers writing systematic reviews (SRs) and meta-analyses (MAs). Selective outcome reporting and other sources of bias are included in the Cochrane ROB tool. It is important to know how this specific tool for assessing ROB has been applied since its release. Our objectives were to evaluate whether and to what extent the new Cochrane ROB tool has been used in Chinese journal papers of acupuncture.MethodsWe searched CBM, TCM database, CJFD, CSJD, and the Wanfang Database from inception to March 2011. Two reviewers independently selected SRs that primarily focused on acupuncture and moxibustion, from which the data was extracted and analyzed.ResultsA total of 836 SRs were identified from the search, of which, 105 were included and four are awaiting assessment. Thirty-six of the 105 SRs were published before release of the Cochrane ROB tool (up to 2009). Most used the Cochrane Handbook 4.2 or Jadad's scale for risk or quality assessment. From 2009 to March 2011 69 SRs were identified. While “risk of bias” was reported for approximately two-thirds of SRs, only two SRs mentioned use of a “risk of bias tool” in their assessment. Only 5.8% (4/69) of reviews reported information on all six domains which are involved in the ROB tool. A risk of bias graph/summary figure was provided in 2.9% (2/69) of reviews. Most SRs gave information about sequence generation, allocation concealment, blindness, and incomplete outcome data, however, few reviews (5.8%; 4/69) described selective reporting or other potential sources of bias.ConclusionsThe Cochrane “risk of bias” tool has not been used in all SRs/MAs of acupuncture published in Chinese Journals after 2008. When the ROB tool was used, reporting of relevant information was often incomplete.

The Geometric Increase in Meta-Analyses from China in the Genomic Era

“…One exception is an empirical evaluation of systematic reviews of acupuncture from China. The evaluation suggested that the systematic reviews conducted lacked rigor in appraising the risk of bias in included studies [21]. Likewise, empirical investigations in some other fields, including single genetic association studies of candidate genes, clinical trials, and randomized trials on acupuncture have suggested that Chinese studies present a prominent excess of significant results [22]–[25] that requires cautious interpretation.…”

Reporting quality of systematic reviews with Moxibustion

“…As most Chinese journals did not require the registration, protocol, and update on time for these moxibustion SRs, thus the reporting of these three items was very low. Consistent with previous studies, the reporting compliance of these three items in Chinese SRs, particularly in the interventions of Chinese herbal medicines, acupuncture, and massage (Tuina) was seriously inadequate [18][19][20]. Secondly, except for the registration and protocol, the reporting of "Search" (item 8) was unsatisfactory because more than half of the included SRs only provided some keywords for search instead of a comprehensive search strategy according to the PRISMA requirement.…”

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“…In order to compare use of the Cochrane risk of bias tool and to find any differences when reporting six domains in the tool, we compared our findings with the findings in Hopewell's study [21] which assessed the reviews published in Cochrane and Non-Cochrane journals. Also with the findings in Liu's study [31] which assessed the SRs of acupuncture in Chinese journals.…”

“…However, these studies failed to evaluate the use of the Cochrane risk of bias tool, and there are limited published data focusing on how this tool is used when carrying out SRs. We identified one study which evaluated the use of risk of bias tools in SRs of acupuncture in Chinese journals [31].…”