物理治疗Cochrane系统评价的结论性分析：一项方法学研究[0413]

IF 3.6 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation Pub Date : 2025-04-01 DOI:10.1016/j.apmr.2025.01.046

Kailei Eustis, Ana Paula Freire, Gordon Smilanich, Italo Ribeiro Lemes, Mark Elkins, Rafael Zambelli Pinto

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引用次数: 0

摘要

目的确定与物理治疗领域相关的结论性Cochrane综述的比例，并调查结论性是否随着时间的推移而增加。DesignMethodological研究。SettingPEDro数据库。随机选择200篇Cochrane系统综述，从2000-2005年、2006-2010年、2011-2015年和2016-2020年四个出版期各选50篇。InterventionsNot适用。主要结局指标：选取两名独立评价者：发表年份、国家、Cochrane综述组、受试者、干预措施、比较物、主要结局、随机对照试验数量、总累积入组患者数量以及进一步研究的需要。采用建议、评估、发展和评价分级（GRADE）对证据的确定性进行评估，等级从极低到高。如果有主要结局的GRADE数据，则使用，否则在一组预先指定的标准后，审稿人将GRADE方法应用于剩余结局。为了分析随时间的变化，对GRADE比例、降级标准、研究结论性和报告的进一步研究需要使用独立性卡方检验。结果评分非常低的结果在23年间从2000-2005年的14%显著增加到2016-2020年的34% （P<.001）。低评分的结果在同一时期呈下降趋势，中等或高评分的结果保持一致。高评分结果的比例从未超过每个时间段的5%，占整个样本的3%。偏倚风险是最普遍的降级原因，占所有结果降级的45%。不一致性在时间上从2000-2005年的1%增加到2016-2020年的9% （P< 0.001）。研究结论保持不变（P> 0.05），占样本中所有研究的4%。结论性研究的比例在2016-2020年最高，50项研究中有4项（8%）。报告不需要进一步研究的研究也没有变化（P> 0.05），每个时间段的研究不超过14%，总体不超过9%。Cochrane综述被认为是结论性的比例并没有随着时间的推移而改变，在已发表的综述中仍然占很小的比例。具有高确定性证据的结果也很少，并且保持不变。需要在物理治疗领域进行进一步的研究，以提供更高质量的证据并提高系统评价的结论性。

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Analysis of Conclusiveness over Time of Cochrane Systematic Reviews in Physiotherapy: A Methodological Study 0413

Objectives

To determine the proportion of conclusive Cochrane reviews relevant to the field of physiotherapy and to investigate whether conclusiveness has been increasing over time.

Design

Methodological study.

Setting

PEDro database.

Participants

Two hundred Cochrane systematic reviews were randomly selected, with 50 from each of the 4 publication periods: 2000-2005, 2006-2010, 2011-2015, and 2016-2020.

Interventions

Not applicable.

Main Outcome Measures

Two independent reviewers extracted: year of publication, country, Cochrane Review Group, participants, intervention, comparators, primary outcomes, number of randomized controlled trials, total cumulative number of patients enrolled, and the need for further studies. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE), ranging from very low to high. GRADE data from primary outcomes were used if available, otherwise reviewers applied the GRADE approach to remaining outcomes after a set of prespecified criteria. To analyze change over time, chi-square tests of independence were used for GRADE proportions, criteria for downgrades, study conclusiveness, and reported need for further studies.

Results

Outcomes rated very low significantly increased over the 23 period from 14% in 2000-2005 to 34% in 2016-2020 (P<.001). Low-rated outcomes trended downward over the same period and outcomes rated moderate or high remained consistent. Proportion of high-rated outcomes never exceeded 5% per time period and composed 3% of the entire sample. Risk of bias was the most prevalent reason for downgrade, composing 45% of all outcome downgrades. Inconsistency demonstrated a time-wise increase from <1% in 2000-2005 to 9% in 2016-2020 (P<.001). Study conclusiveness remained unchanged (P>.05) and consisted of 4% of all studies in the sample. Proportion of conclusive studies was highest in 2016-2020 with 4 out of 50 (8%). Studies reporting no further research needs were also unchanged (P>.05) and did not exceed 14% of studies per time period, or 9% overall.

Conclusions

The proportion of Cochrane reviews deemed conclusive has not changed over time and remains a very small proportion of those published. Outcomes with high certainty of evidence are also few and remain unchanged. Further research is necessary in the physiotherapy field to provide higher quality evidence and improve conclusiveness in systematic reviews.

Disclosures

none.

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来源期刊

Archives of physical medicine and rehabilitation 医学-康复医学

CiteScore

6.20

自引率

4.70%

发文量

495

审稿时长

38 days

期刊介绍： The Archives of Physical Medicine and Rehabilitation publishes original, peer-reviewed research and clinical reports on important trends and developments in physical medicine and rehabilitation and related fields. This international journal brings researchers and clinicians authoritative information on the therapeutic utilization of physical, behavioral and pharmaceutical agents in providing comprehensive care for individuals with chronic illness and disabilities. Archives began publication in 1920, publishes monthly, and is the official journal of the American Congress of Rehabilitation Medicine. Its papers are cited more often than any other rehabilitation journal.