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改进推荐意见评估、制定与评价证据表的分级 第4部分:一项三臂非劣效性随机试验表明,采用新格式可提高对研究结果总结表内容的理解。

Improving grading of recommendations assessment, development, and evaluation evidence tables part 4: a three-arm noninferiority randomized trial demonstrates improved understanding of content in summary of findings tables with a new format.

作者信息

Morgan Rebecca L, Yepes-Nuñez Juan José, Ewusie Joycelyne, Mbuagbaw Lawrence, Chang Stephanie, Baldeh Tejan, Hempel Susanne, Helfand Mark, Shekelle Paul, Wilt Timothy J, Schünemann Holger J

机构信息

Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada.

Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada; School of Medicine, Universidad de los Andes, Bogotá, Colombia.

出版信息

J Clin Epidemiol. 2023 Feb;154:125-135. doi: 10.1016/j.jclinepi.2022.12.001. Epub 2022 Dec 8.

Abstract

OBJECTIVES

To evaluate alternative formats of summary of findings (SoF) tables for single comparison with multiple outcomes.

STUDY DESIGN AND SETTING

We conducted a three-arm randomized controlled noninferiority trial (RCT) in the following systematic review (SR) users: researchers, clinical practice guideline developers, health care providers, policymakers, and knowledge transfer organizations to measure understanding, accessibility, satisfaction, and preference across the current grading of recommendations assessment, development, and evaluation (GRADE) SoF, an alternative GRADE SoF, or an adapted evidence-based practice center (EPC) program SoF table.

RESULTS

One Hundred Seventy-Nine participants were randomized, and 129 participants completed the RCT (n = 47 current GRADE, n = 41 alternative GRADE, n = 41 adapted EPC). Understanding the certainty of evidence and treatment effect was comparable across groups. The adapted EPC SoF table was inferior for quantifying risk and RD compared to the alternatives (<35% correct vs. >85% correct). Participants reported increased satisfaction when SoF tables presented number needed to treat (NNT), anticipated absolute effect differences, and narrative syntheses for evidence that could not be meta-analyzed. Participants reported accessibility to information as significantly better in both GRADE SoF tables, when compared with the adapted EPC SoF table. Participants preferred the alternative GRADE SoF table format.

CONCLUSION

The alternative GRADE SoF table is a promising format for SR users preferring a comprehensive presentation of SR results for single comparisons.

摘要

目的

评估用于单一比较多个结局的研究结果总结(SoF)表的替代格式。

研究设计与背景

我们在以下系统评价(SR)使用者中开展了一项三臂随机对照非劣效性试验(RCT):研究人员、临床实践指南制定者、医疗服务提供者、政策制定者以及知识转移组织,以衡量对当前推荐评估、制定与评价分级(GRADE)SoF、替代GRADE SoF或改编的循证实践中心(EPC)项目SoF表的理解、可及性、满意度和偏好。

结果

179名参与者被随机分组,129名参与者完成了RCT(n = 47名使用当前GRADE,n = 41名使用替代GRADE,n = 41名使用改编的EPC)。各组对证据确定性和治疗效果的理解相当。与其他两种格式相比,改编的EPC SoF表在量化风险和风险差方面表现较差(正确回答率<35% 对比>85%)。当SoF表呈现治疗所需人数(NNT)、预期绝对效果差异以及无法进行荟萃分析的证据的叙述性综合时,参与者报告的满意度有所提高。与改编的EPC SoF表相比,参与者报告称两种GRADE SoF表中的信息可及性明显更好。参与者更喜欢替代GRADE SoF表格式。

结论

对于希望全面呈现单一比较的SR结果的SR使用者而言,替代GRADE SoF表是一种很有前景的格式。

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