Julia Pozzetti Daou, Rachel Riera, Rafael Leite Pacheco
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An in-depth analysis of how this expected diverseness is reflected in indirectness judgments on the certainty of synthesized evidence is lacking.</p>\n </section>\n \n <section>\n \n <h3> Aims and Objectives</h3>\n \n <p>To analyze the certainty of evidence from all Cochrane reviews of surgical interventions for the treatment of patients with bone fractures and the reasons for indirectness downgrading.</p>\n </section>\n \n <section>\n \n <h3> Method</h3>\n \n <p>A meta-research analysis of all Cochrane systematic reviews that compare any surgical interventions in patients with any type of bone fracture. A sensitive search was conducted in the Cochrane Database of Systematic Review from inception to 16 October 2024.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>The certainty of the evidence of all Cochrane reviews of surgical interventions for patients with fractures is very low or low in 66.5% of eligible outcomes. Indirectness contributed to the certainty downgrade in only 12.26% of outcomes (26/212), and of those, the indirectness was related to the intervention in 11.5% (4/26). The results show that although the certainty of evidence of surgical interventions for patients with fractures is usually downgraded, indirectness is not a common cause of concern.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>The certainty of evidence for surgical interventions in patients with fractures is typically downgraded, often to very low. However, indirectness is not a common reason for such downgrading. The anticipated diverseness regarding surgery techniques, materials, and surgeon and center experience was not impactful in the overall certainty of evidence in the Cochrane reviews that were included.</p>\n </section>\n </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 3","pages":""},"PeriodicalIF":2.1000,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70091","citationCount":"0","resultStr":"{\"title\":\"Reasons for Downgrading the Certainty of Evidence for Indirectness in Synthesis of Surgical Procedures for Patients With Fractures: A Meta-Research Analysis\",\"authors\":\"Julia Pozzetti Daou, Rachel Riera, Rafael Leite Pacheco\",\"doi\":\"10.1111/jep.70091\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Rationale</h3>\\n \\n <p>Indirectness occurs when the synthesized evidence may not be directly applied to the relevant clinical context. A common argument used by surgeons is that evidence that arises from clinical trials is limited due to a lack of fidelity regarding surgery techniques, materials, and surgeon and center experience. Considering that there are many particularities in surgical interventions for the treatment of bone fractures, diverseness is expected among trials that randomized patients to compare surgical procedures. 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Indirectness contributed to the certainty downgrade in only 12.26% of outcomes (26/212), and of those, the indirectness was related to the intervention in 11.5% (4/26). The results show that although the certainty of evidence of surgical interventions for patients with fractures is usually downgraded, indirectness is not a common cause of concern.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>The certainty of evidence for surgical interventions in patients with fractures is typically downgraded, often to very low. However, indirectness is not a common reason for such downgrading. 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引用次数: 0
摘要
当合成证据不能直接应用于相关的临床背景时，就会发生间接性。外科医生常用的一个论点是，由于手术技术、材料、外科医生和中心经验缺乏保真度，临床试验产生的证据是有限的。考虑到骨折治疗的手术干预有许多特殊性，在随机患者比较手术方法的试验中，预计会有多样性。缺乏对这种预期的多样性如何反映在对综合证据确定性的间接判断中的深入分析。目的和目的分析所有Cochrane综述中关于骨折患者手术干预治疗的证据的确定性以及间接降级的原因。方法对所有Cochrane系统评价进行meta研究分析，比较任何类型骨折患者的任何手术干预。在Cochrane系统评价数据库（Cochrane Database of Systematic Review）中进行了敏感检索，检索时间为建立之日至2024年10月16日。结果：66.5%的符合条件的结局中，所有Cochrane综述对骨折患者进行手术干预的证据确定性非常低或较低。间接导致确定性降低的结果仅为12.26%(26/212)，其中，间接与干预相关的比例为11.5%（4/26）。结果表明，尽管骨折患者的手术干预证据的确定性通常被降低，但间接性并不是引起关注的常见原因。结论骨折患者手术干预的证据确定性通常降低，通常降至非常低。然而，间接并不是这种降级的常见原因。预期的手术技术、材料、外科医生和中心经验的多样性对纳入Cochrane综述的证据的总体确定性没有影响。
Reasons for Downgrading the Certainty of Evidence for Indirectness in Synthesis of Surgical Procedures for Patients With Fractures: A Meta-Research Analysis
Rationale
Indirectness occurs when the synthesized evidence may not be directly applied to the relevant clinical context. A common argument used by surgeons is that evidence that arises from clinical trials is limited due to a lack of fidelity regarding surgery techniques, materials, and surgeon and center experience. Considering that there are many particularities in surgical interventions for the treatment of bone fractures, diverseness is expected among trials that randomized patients to compare surgical procedures. An in-depth analysis of how this expected diverseness is reflected in indirectness judgments on the certainty of synthesized evidence is lacking.
Aims and Objectives
To analyze the certainty of evidence from all Cochrane reviews of surgical interventions for the treatment of patients with bone fractures and the reasons for indirectness downgrading.
Method
A meta-research analysis of all Cochrane systematic reviews that compare any surgical interventions in patients with any type of bone fracture. A sensitive search was conducted in the Cochrane Database of Systematic Review from inception to 16 October 2024.
Results
The certainty of the evidence of all Cochrane reviews of surgical interventions for patients with fractures is very low or low in 66.5% of eligible outcomes. Indirectness contributed to the certainty downgrade in only 12.26% of outcomes (26/212), and of those, the indirectness was related to the intervention in 11.5% (4/26). The results show that although the certainty of evidence of surgical interventions for patients with fractures is usually downgraded, indirectness is not a common cause of concern.
Conclusion
The certainty of evidence for surgical interventions in patients with fractures is typically downgraded, often to very low. However, indirectness is not a common reason for such downgrading. The anticipated diverseness regarding surgery techniques, materials, and surgeon and center experience was not impactful in the overall certainty of evidence in the Cochrane reviews that were included.
期刊介绍：
The Journal of Evaluation in Clinical Practice aims to promote the evaluation and development of clinical practice across medicine, nursing and the allied health professions. All aspects of health services research and public health policy analysis and debate are of interest to the Journal whether studied from a population-based or individual patient-centred perspective. Of particular interest to the Journal are submissions on all aspects of clinical effectiveness and efficiency including evidence-based medicine, clinical practice guidelines, clinical decision making, clinical services organisation, implementation and delivery, health economic evaluation, health process and outcome measurement and new or improved methods (conceptual and statistical) for systematic inquiry into clinical practice. Papers may take a classical quantitative or qualitative approach to investigation (or may utilise both techniques) or may take the form of learned essays, structured/systematic reviews and critiques.
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