Ferreira Christiane Alves, Loureiro Carlos Alfredo Salles, Saconato Humberto, Atallah Alvaro Nagib
Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil.
Sao Paulo Med J. 2011 Mar;129(2):85-93. doi: 10.1590/s1516-31802011000200006.
Well-conducted randomized controlled trials (RCTs) represent the highest level of evidence when the research question relates to the effect of therapeutic or preventive interventions. However, the degree of control over bias between RCTs presents great variability between studies. For this reason, with the increasing interest in and production of systematic reviews and meta-analyses, it has been necessary to develop methodology supported by empirical evidence, so as to encourage and enhance the production of valid RCTs with low risk of bias. The aim here was to conduct a methodological analysis within the field of dentistry, regarding the risk of bias in open-access RCTs available in the Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde) database.
This was a methodology study conducted at Universidade Federal de São Paulo (Unifesp) that assessed the risk of bias in RCTs, using the following dimensions: allocation sequence generation, allocation concealment, blinding, and data on incomplete outcomes.
Out of the 4,503 articles classified, only 10 studies (0.22%) were considered to be true RCTs and, of these, only a single study was classified as presenting low risk of bias. The items that the authors of these RCTs most frequently controlled for were blinding and data on incomplete outcomes.
The effective presence of bias seriously weakened the reliability of the results from the dental studies evaluated, such that they would be of little use for clinicians and administrators as support for decision-making processes.
当研究问题涉及治疗或预防干预措施的效果时,精心设计的随机对照试验(RCT)代表了最高级别的证据。然而,不同研究之间,RCT对偏倚的控制程度差异很大。因此,随着对系统评价和荟萃分析的兴趣日益增加以及其产量不断提高,有必要开发以实证证据为支撑的方法,以鼓励并提高产生低偏倚风险的有效RCT。本文旨在对牙科学领域内Lilacs(拉丁美洲和加勒比地区卫生科学文献)数据库中开放获取的RCT的偏倚风险进行方法学分析。
这是一项在圣保罗联邦大学(Unifesp)开展的方法学研究,该研究使用以下维度评估RCT的偏倚风险:分配序列产生、分配隐藏、盲法以及不完整结局数据。
在分类的4503篇文章中,只有10项研究(0.22%)被认为是真正的RCT,其中只有一项研究被归类为低偏倚风险。这些RCT的作者最常控制的项目是盲法和不完整结局数据。
偏倚的实际存在严重削弱了所评估牙科研究结果的可靠性,以至于这些结果对临床医生和管理人员在决策过程中几乎没有帮助。