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Some Cochrane risk of bias items are not important in osteoarthritis trials: A meta-epidemiological study based on Cochrane reviews

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  • Julie Bolvig
  • Carsten B Juhl
  • Isabelle Boutron
  • Peter Tugwell
  • Elizabeth A T Ghogomu
  • Jordi Pardo Pardo
  • Tamara Rader
  • George A Wells
  • Alain Mayhew
  • Lara Maxwell
  • Hans Lund
  • Henning Bliddal
  • Robin Christensen
  • Editorial Board of the Cochrane Musculoskeletal Group
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OBJECTIVE: To evaluate the impact of bias-related study characteristics on treatment effects in osteoarthritis (OA) trials.

STUDY DESIGN: Based on OA trials included in Cochrane reviews the impact of study characteristics on treatment effect estimates were evaluated. Characteristics included items of the risk of bias tool (RoB), trial size, single vs multi-site, and source of funding. Effect sizes were calculated as standardized mean differences (SMDs). Meta-regression was performed to identify "relevant study-level covariates" that decreases the between-study variance (τˆ2).

RESULTS: Twenty reviews including 126 OA trials with a high degree of heterogeneity was included (τˆ2=0.1247). Among RoB domains only patient blinding had an impact on the results (reducing heterogeneity according to τˆ2 <7%). Inadequate blinding of patients yielded larger effects (SMDDifference = 0.15; 95% CI: 0.11 to 0.29, P=0.035). The most important study characteristic was trial size (heterogeneity reduced by 25%), with small trials reporting larger effects (SMDDifference = 0.29; 95% CI: 0.16 to 0.42, P<0.001).

CONCLUSION: In musculoskeletal reviews addressing pain, all the items included in the Cochrane risk of bias tool might not be equally important. OA trial results may be affected by bias constructs that are not yet fully elucidated.

Original languageEnglish
JournalJournal of Clinical Epidemiology
ISSN0895-4356
DOIs
Publication statusPublished - 5 Dec 2017

    Research areas

  • Journal Article, Review

ID: 52352850