Wu Irene Xy, Wang Huan, Zhu Lin, Chen Yancong, Wong Charlene Hl, Mao Chen, Chung Vincent Ch
Xiangya School of Public Health, Central South University, Changsha, China.
Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
Ther Adv Musculoskelet Dis. 2020 Sep 23;12:1759720X20959967. doi: 10.1177/1759720X20959967. eCollection 2020.
Healthcare providers need reliable evidence for supporting the adoption of new interventions, of which the source of evidence often originates from systematic reviews (SRs). However, little assessment on the rigor of SRs related to osteoarthritis interventions has been conducted. This cross-sectional study aimed to evaluate the methodological quality and predictors among SRs on osteoarthritis interventions.
Four electronic databases (Cochrane Database of Systematic Reviews, MEDLINE, Embase, and PsycINFO) were searched, from 1 January 2008 to 10 October 2019. An SR was eligible if it focused on osteoarthritis interventions, and we performed at least one meta-analysis. Methodological quality was assessed using the validated AMSTAR 2 instrument. Multivariate regression analyses were conducted to assess predictors of methodological quality.
In total, 167 SRs were included. The most SRs were non-Cochrane reviews (88.6%), and 54.5% investigated non-pharmacological interventions. Only seven (4.2%) had high methodological quality. Respectively, eight (4.8%), 25 (15.0%), and 127 (76.0%) SRs had moderate, low, and critically low quality. Main methodological weaknesses were as follows: only 16.8% registered protocol , 4.2% searched literature comprehensively, 25.7% included lists of excluded studies with justifications, and 30.5% assessed risk of bias appropriately by considering allocation concealment, blinding of patients and assessors, random sequence generation and selective reported outcomes. Cochrane reviews [adjusted odds ratio (AOR) 251.5, 95% confidence interval (CI) 35.5-1782.6], being updates of previous SRs (AOR 3.9, 95% CI 1.1-13.7), and SRs published after 2017 (AOR 7.7, 95% CI 2.8-21.5) were positively related to higher methodological quality.
Despite signs of improvement in recent years, most of the SRs on osteoarthritis interventions have critically low methodological quality, especially among non-Cochrane reviews. Future SRs should be improved by conducting comprehensive literature search, justifying excluded studies, publishing a protocol, and assessing the risk of bias of included studies appropriately.
医疗服务提供者需要可靠的证据来支持新干预措施的采用，而证据来源通常来自系统评价（SRs）。然而，很少有人对与骨关节炎干预措施相关的系统评价的严谨性进行评估。这项横断面研究旨在评估骨关节炎干预措施系统评价的方法学质量及其预测因素。
检索了四个电子数据库（Cochrane系统评价数据库、MEDLINE、Embase和PsycINFO），时间跨度为2008年1月1日至2019年10月10日。如果一项系统评价聚焦于骨关节炎干预措施且至少进行了一项荟萃分析，则该系统评价符合纳入标准。使用经过验证的AMSTAR 2工具评估方法学质量。进行多变量回归分析以评估方法学质量的预测因素。
总共纳入了167项系统评价。大多数系统评价是非Cochrane综述（88.6%），54.5%的系统评价研究了非药物干预措施。只有7项（4.2%）具有较高的方法学质量。分别有8项（4.8%）、25项（15.0%）和127项（76.0%）系统评价具有中等、低和极低质量。主要的方法学弱点如下：只有16.8%的系统评价注册了方案，4.2%全面检索了文献，25.7%列出了排除研究清单并给出理由，30.5%通过考虑分配隐藏、患者和评估者的盲法、随机序列生成以及选择性报告结果来适当评估偏倚风险。Cochrane综述[调整优势比（AOR）251.5，95%置信区间（CI）35.5 - 1782.6]、是先前系统评价的更新版本（AOR 3.9，95% CI 1.1 - 13.7）以及2017年后发表的系统评价（AOR 7.7，95% CI 2.8 - 21.5）与较高的方法学质量呈正相关。
尽管近年来有改善的迹象，但大多数关于骨关节炎干预措施的系统评价方法学质量极低，尤其是在非Cochrane综述中。未来的系统评价应通过进行全面的文献检索、为排除的研究提供理由、发表方案以及适当评估纳入研究的偏倚风险来加以改进。
