Department of Anesthesiology & Intensive Care Medicine, University Hospital Split, Split, Croatia.
University of Split School of Medicine, Split, Croatia.
J Comp Eff Res. 2021 Jan;10(1):67-75. doi: 10.2217/cer-2020-0165. Epub 2020 Dec 23.
Systematic reviews (SRs) are frequently inconclusive. The aim of this study was to analyze factors associated with conclusiveness of SRs about efficacy and safety of interventions for neuropathic pain (NeuP). The study protocol was registered in the PROSPERO database (No. CRD42015025831). Five electronic databases (Medical Literature Analysis and Retrieval System Online, Cochrane Database of Systematic Reviews, Cumulative Index for Nursing and Allied Health Literature, Database of Abstracts of Reviews of Effects and Psychological Information Database) were searched until July 2018 for SRs about NeuP management. Conclusion statements for efficacy and safety, and characteristics of SRs were analyzed. Conclusiveness was defined as explicit statement by the SR authors that one intervention is better/similar to the other in terms of efficacy and safety. Methodological quality of SRs was assessed with the AMSTAR (A MeaSurement Tool to Assess systematic Reviews) tool. Of 160 SRs, 37 (23%) were conclusive for efficacy and/or safety. In the SRs, conclusions about safety were missing in half of the analyzed abstracts, and a third of the full texts. Conclusive SRs included significantly more trials and participants, searched more databases, had more authors, conducted meta-analysis, analyzed quality of evidence, and had lower methodological quality than inconclusive SRs. The most common reasons for the lack of conclusiveness indicated by the SR authors were the small number of participants and trials, and the high heterogeneity of included studies. Most SRs about NeuP treatment were inconclusive. Sources of inconclusiveness of NeuP reviews need to be further studied, and SR authors need to provide conclusions about both safety and efficacy of interventions.
系统评价（SRs）经常无法得出结论。本研究旨在分析与干预神经病理性疼痛（NeuP）疗效和安全性的 SR 结论性相关的因素。研究方案已在 PROSPERO 数据库（编号 CRD42015025831）中注册。直到 2018 年 7 月，我们在五个电子数据库（医学文献分析和检索系统在线、Cochrane 系统评价数据库、护理和联合健康文献累积索引、效果摘要数据库和心理信息数据库）中搜索了有关 NeuP 管理的 SR。分析了疗效和安全性的结论陈述以及 SR 的特征。结论性被定义为 SR 作者明确表示，一种干预措施在疗效和安全性方面优于/等同于另一种干预措施。使用 AMSTAR（评估系统评价的测量工具）工具评估了 SR 的方法学质量。在 160 篇 SR 中，有 37 篇（23％）在疗效和/或安全性方面具有结论性。在 SR 中，分析的摘要中有一半和三分之一的全文都缺少有关安全性的结论。具有结论性的 SR 包括了更多的试验和参与者，检索了更多的数据库，有更多的作者，进行了荟萃分析，分析了证据质量，并且方法学质量比无结论性的 SR 低。SR 作者表示缺乏结论性的最常见原因是参与者和试验数量少，以及纳入研究的异质性高。大多数关于 NeuP 治疗的 SR 都没有结论。需要进一步研究导致 NeuP 综述缺乏结论的原因，并且 SR 作者需要提供有关干预措施的安全性和疗效的结论。
