van der Velde Gabrielle, van Tulder Maurits, Côté Pierre, Hogg-Johnson Sheilah, Aker Peter, Cassidy J David, Carragee Eugene, Carroll Linda, Guzman Jaime, Haldeman Scott, Holm Lena, Hurwitz Eric, Nordin Margareta, Peloso Paul
Institute for Work and Health, Toronto, Ontario, Canada.
Spine (Phila Pa 1976). 2007 Apr 1;32(7):796-806. doi: 10.1097/01.brs.0000258903.67718.d5.
Systematic review.
To determine whether results and conclusions on the effectiveness of exercise for workers with neck pain vary with the Cochrane Back Review Group Guidelines and best-evidence synthesis review methods. To identify methodologic weaknesses associated with these review methods that may impact on the validity of their results.
The Cochrane Back Review Group Guidelines and best-evidence synthesis have different approaches to appraising trial quality and incorporating quality into data synthesis. The impact of different review methods on the reproducibility and validity of review results is unknown.
Systematic search of Medline, Embase, CINAHL, and Cochrane databases, without language restrictions. Twelve trials were selected. Two review methods were used to appraise trial quality and to incorporate quality into data synthesis. As recommended by the Cochrane Back Review Group Guidelines, trials were assigned quality scores using a scale. Results of all 12 trials were stratified into levels of evidence according to their scores. Based on these results, no treatment recommendation could be formulated. Best-evidence synthesis critically appraised methodology; trials were accepted on the strength of their scientific merit or rejected due to risk of bias. According to the 4 trials accepted for best-evidence synthesis, workers should be activated with exercise given its beneficial effect on patient-perceived recovery. Both the Cochrane Back Review Group Guidelines and best-evidence synthesis reviews were found to have weaknesses associated with their methods.
Review results and conclusions are sensitive to methods for appraising trial quality and incorporating quality into data synthesis when the evidence consists largely of low-quality trials. Both the Cochrane Back Review Group Guidelines and best-evidence synthesis methods were found to have strengths and methodologic weaknesses that healthcare decision-makers should be aware of when interpreting systematic reviews.
系统评价。
确定关于颈部疼痛工人运动疗法有效性的结果和结论是否因Cochrane背部综述组指南及最佳证据综合评价方法而异。识别与这些综述方法相关的可能影响其结果有效性的方法学弱点。
Cochrane背部综述组指南和最佳证据综合在评估试验质量及将质量纳入数据综合方面有不同方法。不同综述方法对综述结果的可重复性和有效性的影响尚不清楚。
对Medline、Embase、CINAHL和Cochrane数据库进行系统检索，无语言限制。选取了12项试验。使用两种综述方法评估试验质量并将质量纳入数据综合。按照Cochrane背部综述组指南的建议，使用一个量表为试验赋予质量分数。根据分数将所有12项试验的结果分层为证据级别。基于这些结果，无法制定治疗建议。最佳证据综合严格评估方法学；试验根据其科学价值被接受或因偏倚风险被拒绝。根据被最佳证据综合接受的4项试验，鉴于运动对患者自我感觉的恢复有有益作用，应鼓励颈部疼痛工人进行运动。发现Cochrane背部综述组指南和最佳证据综合评价均存在与它们的方法相关的弱点。
当证据主要由低质量试验组成时，综述结果和结论对评估试验质量及将质量纳入数据综合的方法敏感。发现Cochrane背部综述组指南和最佳证据综合方法都有优点和方法学弱点，医疗保健决策者在解释系统评价时应予以注意。
