Strategies to improve the credibility of meta-analyses in spine surgery: a systematic survey

Evaniew, Nathan; Watt, Leon van der; Bhandari, Mohit; Ghert, Michelle; Aleem, Ilyas; Drew, Brian; Guyatt, Gordon

doi:10.1016/j.spinee.2015.05.018

Cited by 15 publications

(28 citation statements)

References 80 publications

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“…This is consistent with other reviews assessing quality by journal impact factor. 1,41 Our analysis is limited to SRs of spine surgery published in 2018 in 4 spine journals with an impact factor >2.0. Our review did not evaluate aspects of SR quality outside of the domains of the AMSTAR 2 instrument.…”

Section: Discussionmentioning

confidence: 99%

Critically Low Confidence in the Results Produced by Spine Surgery Systematic Reviews: An AMSTAR-2 Evaluation From 4 Spine Journals

Dettori

Skelly

Brodt

2020

Global Spine Journal

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Study Design: A systematic cross-sectional survey of systematic reviews (SRs). Objective: To evaluate the methodological quality of spine surgery SRs published in 2018 using the updated AMSTAR 2 critical appraisal instrument. Methods: We identified the PubMed indexed journals devoted to spine surgery research in 2018. All SRs of spine surgical interventions from those journals were critically appraised for quality independently by 2 reviewers using the AMSTAR 2 instrument. We calculated the percentage of SRs achieving a positive response for each AMSTAR 2 domain item and assessed the levels of confidence in the results of each SR. Results: We identified 28 SRs from 4 journals that met our criteria for inclusion. Only 49.5% of the AMSTAR 2 domain items satisfied the AMSTAR 2 criteria. Critical domain items were satisfied less often (39.1%) compared with noncritical domain items (57.3%). Domain items most poorly reported include accounting for individual study risk of bias when interpreting results (14%), list and justification of excluded articles (18%), and an a priori establishment of methods prior to the review or registered protocol (18%). The overall confidence in the results was rated “low” in 2 SRs and “critically low” in 26. Conclusions: The credibility of a SR and its value to clinicians and policy makers are dependent on its methodological quality. This appraisal found significant methodological limitations in several critical domains, such that the confidence in the findings of these reviews is “critically low.”

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Section: Discussionmentioning

confidence: 99%

Critically Low Confidence in the Results Produced by Spine Surgery Systematic Reviews: An AMSTAR-2 Evaluation From 4 Spine Journals

Dettori

Skelly

Brodt

2020

Global Spine Journal

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“…Finally, IDE study results should report objective, radiographic measures in addition to subjective clinical outcome measures. Future studies should also utilize checklists to reduce bias in clinical research [52].…”

Section: Author Suggestions For Confirmation Biasmentioning

confidence: 99%

Bias in cervical total disc replacement trials

Radcliff

Siburn

Murphy

et al. 2017

Curr Rev Musculoskelet Med

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Purpose of review Cervical disc replacement (CDR) has emerged as a motion-preserving alternative to anterior cervical discectomy and fusion in selected cases. Despite favorable literature, CDR is not universally accepted because of concerns regarding bias in the existing literature. The purpose of this review is to identify the possible biases in the disc replacement literature. Recent findings Recent studies that compare CDR and ACDF have demonstrated equivalent or superior outcomes, lower rates of secondary surgery, and equivalent safety at mediumand long-term follow-up. In our review, we identified four types of bias that may affect the CDR literature: publication bias, external validity, confounding bias, and financial conflicts of interest. Summary Bias, whether intentional or unintentional, can impact the interpretation and outcome of CDR studies. Recognition of this issue is critical when utilizing the existing literature to determine the efficacy of CDR and designing future studies.

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“…Meta-analyses are powerful tools to support evidence-based care, but they require high methodological credibility in order to avoid misleading conclusions [6]. This Cochrane review did not assess confidence in the pooled estimates, and it did not consider whether small but statistically significant treatment effects were clinically meaningful.…”

Section: Take-home Messagesmentioning

confidence: 99%