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

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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.

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    • "We evaluated the ROB for the included studies according to the Cochrane Collaboration's ROB assessment tool [39]. We rated ROB for each item using " Yes (Y, low ROB), " " Unclear (U, uncertain or unknown ROB), " or " No (N, high ROB). "
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    ABSTRACT: . Pharmacopuncture is a new form of acupuncture combining acupuncture with herbal medicine, and it has been used under various conditions in Korea. The aim of this study is to establish clinical evidence for the safety and efficacy of pharmacopuncture in Korea. Methods . We searched 9 databases and two relevant journals up to December 2014 using keywords, such as pharmacopuncture. All randomized, controlled trials evaluating pharmacopuncture under any conditions in Korea were considered. Results . Twenty-nine studies involving 1,211 participants were included. A meta-analysis of two studies on obesity showed that 5 to 8 weeks of pharmacopuncture reduced weight, waist circumference, and body mass index (BMI) more than normal saline injections. In the 5 studies of musculoskeletal conditions, 7 to 30 days of pharmacopuncture had additional effects on the reduction of pain intensity, and this benefit was maintained by limiting analyses to studies with a low risk of bias for randomization and/or allocation concealment. Conclusions . This systematic review suggests the potential of pharmacopuncture for obesity and musculoskeletal diseases. However, it is difficult to recommend pharmacopuncture as an evidence-based treatment because of methodological flaws and small sample sizes of the included studies. Further well-designed trials are needed to draw a definitive conclusion.
    Full-text · Article · Jan 2016 · Evidence-based Complementary and Alternative Medicine
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    • ""  Each item will be evaluated as " yes (low risk of bias) " , " unclear (unclear risk of bias) " and " no (high risk of bias) " . The overall methodological quality of one single trial will be evaluated as " low risk of bias " when at least six items are rated as " yes " and no serious flaws are identified (e.g., 80% dropout rate was identified in one study group) [1] . Only studies rated as " low risk of bias " can be included for analysis. "
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    ABSTRACT: Study protocol and selected searching strategies as the supporting information for a published systematic review in PLoS ONE: Tan J-Y, Suen LKP, Wang T, Molassiotis A. (2015). Sham Acupressure Controls Used in Randomized Controlled Trials: A Systematic Review and Critique. PLoS ONE, 10(7): e0132989. doi:10.1371/journal.pone.0132989.
    Full-text · Article · Jul 2015 · PLoS ONE
    • "A systematic review of randomised controlled trials (RCTs) was conducted according to a predefined protocol using the method guidelines of the Back Review Group of the Cochrane Col- laboration,[45] the Cochrane handbook,[46] and is reported in line with PRISMA.[47] Eligibility criteriaTable 1 details study eligibility criteria using Population Intervention Comparison Outcome Study Design (PICOS).[47] "
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    ABSTRACT: Background: Whiplash Associated Disorder (WAD) is a cervical injury as a consequence of an acceleration-deceleration force, usually from a road traffic accident. The annual UK incidence of WAD is approximately 300,000. The annual economic cost related to WAD is estimated as $3.9 billion in the US and €10 billion in Europe with the cost of insurance claims having risen from £7 to £14 billion in a decade. This reflects a considerable financial burden internationally. 93% patients can be classified as WADII [neck complaint, musculoskeletal sign(s)], and are commonly managed by physiotherapy. Patients experience both physical and psychological problems. 40–60% patients experience chronic symptoms, with moderate to severe pain and disability. Effectiveness of conservative management (physiotherapy, behavioural approaches) of WADII in the acute stage is important to prevent chronicity, and at present is unclear. Purpose: To evaluate the effectiveness of conservative management of acute WADII. Methods: A systematic review and meta-analysis of RCTs was conducted according to a pre-defined protocol. Two independent reviewers searched the literature to 1/1/2014, assessed risk of bias using the Cochrane risk of bias tool, and extracted data. A third reviewer mediated any disagreement. Pre-defined terms enabled searching key electronic databases. Additional trials were identified from reference lists, authors, key journals and the grey literature. Included trials evaluated acute (<4 weeks) WADII, any conservative intervention (physiotherapy, behavioural approaches), using ≥1 outcome measure(s) important to the International Classification of Function, Disability and Health. Quantitative synthesis was possible for trials with comparability of intervention, outcome measurement, and assessment points. Meta-analyses compared effect sizes, with random effects as the primary analyses using STATA software (version 12). Results: Fifteen trials (n = 1676 participants, 9 countries) were included. All trials were assessed as high risk of bias (very good reviewer agreement, K = 0.87). Meta-analyses enabled 4 intervention comparisons: conservative versus standard/control, active versus passive, behavioural versus standard/control, and early versus late. Conservative intervention was effective for pain reduction at 6 months (95%CI: −20.14 to −3.38) and 1–3 years (−25.44 to −3.19), and improvement of cervical mobility in the horizontal plane at <3 months (0.43 to 5.60) compared with standard/control intervention. Active intervention was effective for pain reduction at 6 months (-17.19 to −3.23) and 1–3 years (−26.39 to −10.08) compared with passive intervention. Behavioural intervention was more effective than standard/control intervention for pain reduction at 6 months (−15.37 to −1.55), and improvement of cervical movement in the coronal (0.93 to 4.38) and horizontal planes (0.43 to 5.46) at 3–6 months. For early (<4 days) versus late (>10 days) intervention, there were no statistically significant differences. Conclusion(s): Conservative and active interventions may be useful for pain reduction in patients with acute WADII. Additionally, cervical horizontal mobility could be improved by conservative intervention. The employment of a behavioural intervention (e.g., act-as-usual, education and self-care including regularly exercise) could have benefits for pain reduction and improvement of cervical movement. Implications: An adequately powered, low risk of bias trial is required to evaluate the effectiveness of an active behavioural intervention for acute WADII patients.
    No preview · Conference Paper · May 2015
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