McMaster University

McMaster University

Strategies to improve the credibility of meta-analyses in spine surgery

We are pleased to share with you a recent publication in the Spine Journal. This publication is entitled "Strategies to improve the credibility of meta-analyses in spine surgery: A systematic survey."

Find the abstract below and click here to access the full-version of the article.

Evaniew N, van der Watt L, Bhandari M, Ghert M, Aleem I, Drew B, Guyatt G. Strategies to improve the credibility of meta-analyses in spine surgery: A systematic survey. Spine J. 2015 May 19. [Epub ahead of print]

Abstract

BACKGROUND CONTEXT: Meta-analyses are powerful tools that can synthesize existing research, inform clinical practice, and support evidence-based care. These studies have become increasingly popular in the spine surgery literature, but the rigor with which they are being conducted has not yet been evaluated.

PURPOSE: Our primary objectives were to evaluate the methodological quality (credibility) of spine surgery meta-analyses and to propose strategies to improve future research. Our secondary objectives were to evaluate completeness of reporting and identify factors associated with higher credibility and completeness of reporting.

DESIGN: Systematic survey of meta-analyses OUTCOME MEASURES: We evaluated credibility according to the Users' Guide to the Medical Literature and completeness of reporting according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist.

METHODS: We systematically searched MEDLINE, EMBASE, and The Cochrane Library, and two reviewers independently assessed eligibility, credibility, and completeness of reporting. We used multivariable linear regression to evaluate potential associations. Inter-rater agreement was quantified using kappa and intra-class correlation (ICC) coefficients.

RESULTS: We identified 132 eligible meta-analyses of spine surgery interventions. The mean credibility score was 3 out of 7 (standard deviation [SD] 1.4; ICC 0.86), with agreement for each item ranging from 0.54 (moderate) to 0.83 (almost perfect). Clinical questions were judged as sensible in 125 (95%), searches were exhaustive in 102 (77%), and risk of bias assessments were undertaken in 91 (69%). Seven (5%) meta-analyses addressed possible explanations for heterogeneity using a priori subgroup hypotheses and 24 (18%) presented results that were immediately clinically applicable. Investigators undertook duplicate assessments of eligibility, risk of bias, and data extraction in 46 (35%), and rated overall confidence in in the evidence in 24 (18%). Later publication year, increasing Journal Impact Factor, increasing number of databases, inclusion of RCTs, and inclusion of non-English studies were significantly associated with higher credibility scores (p<0.05). The mean score for reporting was 18 out of 27 (SD 4.4; ICC 0.94).

CONCLUSIONS: The credibility of many current spine surgery meta-analyses is limited. Researchers can improve future meta-analyses by performing exhaustive literature searches, addressing possible explanations of heterogeneity, presenting results in a clinically useful manner, reproducibly selecting and assessing primary studies, addressing confidence in the pooled effect estimates, and adhering to guidelines for complete reporting.

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