2009 Updated Method Guidelines for Systematic Reviews in the Cochrane Back Review Group

Institute for Work and Health, 481 University Avenue, Toronto, Ontario, Canada.
Spine (Impact Factor: 2.3). 09/2009; 34(18):1929-41. DOI: 10.1097/BRS.0b013e3181b1c99f
Source: PubMed


Method guidelines for systematic reviews of trials of treatments for neck and back pain.
To help review authors design, conduct and report systematic reviews of trials in this field.
In 1997, the Cochrane Back Review Group published Method Guidelines for Systematic Reviews, which was updated in 2003. Since then, new methodologic evidence has emerged and standards have changed. Coupled with the upcoming revisions to the software and methods required by The Cochrane Collaboration, it was clear that revisions were needed to the existing guidelines.
The Cochrane Back Review Group editorial and advisory boards met in June 2006 to review the relevant new methodologic evidence and determine how it should be incorporated. Based on the discussion, the guidelines were revised and circulated for comment. As sections of the new Cochrane Handbook for Systematic Reviews of Interventions were made available, the guidelines were checked for consistency. A working draft was made available to review authors in The Cochrane Library 2008, issue 3.
The final recommendations are divided into 7 categories: objectives, literature search, inclusion criteria, risk of bias assessment, data extraction, data analysis, and updating your review. Each recommendation is classified into minimum criteria (mandatory) and further guidance (optional). Instead of recommending Levels of Evidence, this update adopts the GRADE approach to determine the overall quality of the evidence for important patient-centered outcomes across studies and includes a new section on updating reviews.
Citations of previous versions of the method guidelines in published scientific articles (1997: 254 citations; 2003: 209 citations, searched February 10, 2009) suggest that others may find these guidelines useful to plan, conduct, or evaluate systematic reviews in the field of spinal disorders.

Download full-text


Available from: Maurits van Tulder, Oct 02, 2015
755 Reads
  • Source
    • "For systematic reviews that used different scales, distribution-based methods were used to operationalize clinical relevance, that is, weighted mean difference (WMD) or standardized mean difference (SMD) for continuous outcomes, and odds ratio (OR) or relative ratio (RR) for dichotomous outcomes. Findings were determined to be clinically relevant based on the effect size only, and the degree was specified in accordance with the 2009 Updated Guidelines for Systematic Reviews in the Cochrane Back Review Group [42] "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective. As evidence of the effectiveness of acupuncture for low back pain (LBP) is inconsistent, we aimed to critically appraise the evidence from relevant systematic reviews. Methods. Systematic reviews of randomized controlled trials (RCTs) concerning acupuncture and LBP were searched in seven databases. Internal validity and external validity of systematic reviews were assessed. Systematic reviews were categorized and high quality reviews assigned greater weightings. Conclusions were generated from a narrative synthesis of the outcomes of subgroup comparisons. Results. Sixteen systematic reviews were appraised. Overall, the methodological quality was low and external validity weak. For acute LBP, evidence that acupuncture has a more favorable effect than sham acupuncture in relieving pain was inconsistent; it had a similar effect on improving function. For chronic LBP, evidence consistently demonstrated that acupuncture provides short-term clinically relevant benefits for pain relief and functional improvement compared with no treatment or acupuncture plus another conventional intervention. Conclusion. Systematic reviews of variable quality showed that acupuncture, either used in isolation or as an adjunct to conventional therapy, provides short-term improvements in pain and function for chronic LBP. More efforts are needed to improve both internal and external validity of systematic reviews and RCTs in this area.
    Evidence-based Complementary and Alternative Medicine 03/2015; 2015:328196. DOI:10.1155/2015/328196 · 1.88 Impact Factor
  • Source
    • "Two phase search strategy to accelerate the search process Randomized controlled trials/quasi-randomized trials included Searched four databases (including three databases recommended as a minimum by Cochrane Back (Furlan et al., 2009) and Cochrane Musculoskeletal Review Groups (Maxwell et al., 2006) guidelines for systematic reviews) Only electronically available/accessible records included No searches made of unpublished literature/grey literature Up to two attempts to contact authors made but not continued after 3 weeks English language articles only included Narrative transparent synthesis strategy used 3. Results "
    [Show abstract] [Hide abstract]
    ABSTRACT: Osteoarthritis (OA) and chronic low back pain (CLBP) are two of the most common and costly musculoskeletal conditions globally. Healthcare service demands mean that multiple condition group-based interventions are of increasing clinical interest, but no reviews have evaluated the effectiveness of group-based physiotherapy-led self-management interventions (GPSMI) for both conditions.Objectives This rapid review aimed to evaluate the effectiveness of GPSMI for OA and CLBP.DesignRapid reviews are an increasingly valid means of expediting knowledge dissemination and are particularly useful for addressing focused research questions.Method The electronic databases MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews and Cochrane Register of Controlled Trials were searched. Structured group-based interventions that aimed to promote self-management delivered by health-care professionals (including at least one physiotherapist) involving adults' with OA and/or CLBP were included. The screening and selection of studies, data extraction and risk of bias assessment were conducted independently by two reviewers.Results22 Studies were found (10 OA, 12 CLBP). No significant difference was found between the effectiveness of GPSMI and individual physiotherapy or usual medical management for any outcome.ConclusionsGPSMI is as clinically effective as individual physiotherapy or usual medical management, but the best methods of measuring clinical effectiveness warrant further investigation. Further research is also needed to determine the cost-effectiveness of GPSMI and its implications.
    Journal of Bone and Joint Surgery; 11/2014
  • Source
    • "The overall quality of the evidence for each outcome in the included studies was assessed using the GRADE approach [43, 44], as recommended by the updated Cochrane Back Review Group method guidelines [38]. The GRADE approach specifies 4 levels of quality, the highest rating being for RCT evidence. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Nonspecific back pain is common, disabling, and costly. Therefore, we assessed effectiveness of osteopathic manipulative treatment (OMT) in the management of nonspecific low back pain (LBP) regarding pain and functional status. Methods: A systematic literature search unrestricted by language was performed in October 2013 in electronic and ongoing trials databases. Searches of reference lists and personal communications identified additional studies. Only randomized clinical trials were included; specific back pain or single treatment techniques studies were excluded. Outcomes were pain and functional status. Studies were independently reviewed using a standardized form. The mean difference (MD) or standard mean difference (SMD) with 95% confidence intervals (CIs) and overall effect size were calculated at 3 months posttreatment. GRADE was used to assess quality of evidence. Results: We identified 307 studies. Thirty-one were evaluated and 16 excluded. Of the 15 studies reviewed, 10 investigated effectiveness of OMT for nonspecific LBP, 3 effect of OMT for LBP in pregnant women, and 2 effect of OMT for LBP in postpartum women. Twelve had a low risk of bias. Moderate-quality evidence suggested OMT had a significant effect on pain relief (MD, -12.91; 95% CI, -20.00 to -5.82) and functional status (SMD, -0.36; 95% CI, -0.58 to -0.14) in acute and chronic nonspecific LBP. In chronic nonspecific LBP, moderate-quality evidence suggested a significant difference in favour of OMT regarding pain (MD, -14.93; 95% CI, -25.18 to -4.68) and functional status (SMD, -0.32; 95% CI, -0.58 to -0.07). For nonspecific LBP in pregnancy, low-quality evidence suggested a significant difference in favour of OMT for pain (MD, -23.01; 95% CI, -44.13 to -1.88) and functional status (SMD, -0.80; 95% CI, -1.36 to -0.23), whereas moderate-quality evidence suggested a significant difference in favour of OMT for pain (MD, -41.85; 95% CI, -49.43 to -34.27) and functional status (SMD, -1.78; 95% CI, -2.21 to -1.35) in nonspecific LBP postpartum. Conclusion: Clinically relevant effects of OMT were found for reducing pain and improving functional status in patients with acute and chronic nonspecific LBP and for LBP in pregnant and postpartum women at 3 months posttreatment. However, larger, high-quality randomized controlled trials with robust comparison groups are recommended.
    BMC Musculoskeletal Disorders 08/2014; 15(1):286. DOI:10.1186/1471-2474-15-286 · 1.72 Impact Factor
Show more