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Research Article
23 December 2020

Reasons and factors associated with inconclusiveness of systematic reviews about interventions for neuropathic pain

Authors: Svjetlana Dosenovic https://orcid.org/0000-0003-1708-0767 [email protected], Andria Dujmic https://orcid.org/0000-0002-4424-3827, Danijela Nujic https://orcid.org/0000-0002-7741-2236, Ivana Vuka https://orcid.org/0000-0003-4756-1529, Goran Tintor, Antonia Jelicic Kadic https://orcid.org/0000-0002-1873-960X, and Livia Puljak https://orcid.org/0000-0002-8467-6061Author Info & Affiliations
Volume 10, Number 1
https://doi.org/10.2217/cer-2020-0165
PDFFormats

Abstract

Aim: Systematic reviews (SRs) are frequently inconclusive. The aim of this study was to analyze factors associated with conclusiveness of SRs about efficacy and safety of interventions for neuropathic pain (NeuP). Materials & methods: The study protocol was registered in the PROSPERO database (No. CRD42015025831). Five electronic databases (Medical Literature Analysis and Retrieval System Online, Cochrane Database of Systematic Reviews, Cumulative Index for Nursing and Allied Health Literature, Database of Abstracts of Reviews of Effects and Psychological Information Database) were searched until July 2018 for SRs about NeuP management. Conclusion statements for efficacy and safety, and characteristics of SRs were analyzed. Conclusiveness was defined as explicit statement by the SR authors that one intervention is better/similar to the other in terms of efficacy and safety. Methodological quality of SRs was assessed with the AMSTAR (A MeaSurement Tool to Assess systematic Reviews) tool. Results: Of 160 SRs, 37 (23%) were conclusive for efficacy and/or safety. In the SRs, conclusions about safety were missing in half of the analyzed abstracts, and a third of the full texts. Conclusive SRs included significantly more trials and participants, searched more databases, had more authors, conducted meta-analysis, analyzed quality of evidence, and had lower methodological quality than inconclusive SRs. The most common reasons for the lack of conclusiveness indicated by the SR authors were the small number of participants and trials, and the high heterogeneity of included studies. Conclusion: Most SRs about NeuP treatment were inconclusive. Sources of inconclusiveness of NeuP reviews need to be further studied, and SR authors need to provide conclusions about both safety and efficacy of interventions.

Lay abstract

Systematic reviews (SRs) analyze the evidence from research studies to provide recommendations on the efficacy and safety of medical interventions. Clear conclusions whether an intervention is efficacious and safe are important for patients, clinicians and policymakers, to enable informed decisions. Neuropathic pain (NeuP) is caused by the injury to the nerves. In this study factors associated with conclusiveness of SRs about efficacy and safety of interventions for the treatment of NeuP were analyzed. Our results showed that the majority of analyzed SRs do not provide a definitive answer, more so if reviews were conducted by higher methodological standards. Conclusive reviews included significantly more trials and patients. Sources of inconclusiveness of NeuP reviews need to be further studied.

Supplementary Material

File (suppl_file.zip)
File (supplementary table 1.docx)
File (supplementary table 2.docx)
File (supplementary table 3.docx)

References

1.
Momosaki R, Tsuboi M, Yasufuku Y et al. Conclusiveness of Cochrane reviews in physiotherapy: a systematic search and analytical review. Int. J. Rehabil. Res. 42(2), 97–105 (2019).
PubMed
Google Scholar
2.
Cohen S, Lubetzky R, Mimouni FB, Marom R, Mandel D. Conclusiveness of the Cochrane reviews in pediatric-gastroenterology: a systematic analysis. Eur. J. Gastroenterol. Hepatol. 25(2), 252–254 (2013).
PubMed
Google Scholar
3.
Cohen S, Mandel D, Mimouni FB, Marom R, Lubetzky R. Conclusiveness of the Cochrane reviews in nutrition: a systematic analysis. Eur. J. Clin. Nutr. 68(2), 143–145 (2014).
PubMed
Google Scholar
4.
Mandel D, Littner Y, Mimouni FB, Lubetzky R. Conclusiveness of the Cochrane neonatal reviews: a systematic analysis. Acta Paediatr. 95(10), 1209–1212 (2006).
PubMed
Google Scholar
5.
Yin S, Chuai Y, Wang A, Zhang L. Conclusiveness of the Cochrane reviews in gynaecological cancer: a systematic analysis. J. Int. Med. Res. 43(3), 311–315 (2015).
PubMed
Google Scholar
6.
Zhang X, Wu Z, Zhao H, Li C, Wu J, Dai G. Conclusiveness of the Cochrane reviews in palliative and supportive care for cancer: a systematic analysis. Am. J. Hosp. Palliat. Med. 34(1), 53–56 (2017).
PubMed
Google Scholar
7.
Lohman D, Schleifer R, Amon JJ. Access to pain treatment as a human right. BMC Med. 8(1), 8 (2010).
PubMed
Google Scholar
8.
Dworkin RH, O'connor AB, Backonja M et al. Pharmacologic management of neuropathic pain: evidence-based recommendations. Pain 132(3), 237–251 (2007).
PubMed
Google Scholar
9.
Dosenovic S, Jelicic Kadic A, Miljanovic M et al. Interventions for neuropathic pain: an overview of systematic reviews. Anesth. Analg. 125(2), 643–652 (2017).
PubMed
Google Scholar
11.
Turk DC, Dworkin RH, Allen RR et al. Core outcome domains for chronic pain clinical trials: IMMPACT recommendations. Pain 106(3), 337–345 (2003).
PubMed
Google Scholar
12.
Shea BJ, Grimshaw JM, Wells GA et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med. Res. Methodol. 7, 10 (2007).
PubMed
Google Scholar
13.
Stein C, Eibel B, Sbruzzi G, Lago PD, Plentz RDM. Electrical stimulation and electromagnetic field use in patients with diabetic neuropathy: systematic review and meta-analysis. Braz. J. Phys. Ther. 17(2), 93–104 (2013).
PubMed
Google Scholar
14.
Zhang WW, Li MQ, Liu L. [Meta-analysis of gabapentin in the treatment of postherpetic neuralgia]. Chin. J. Contemp. Neurol. Neurosurg. 13(9), 760–765 (2013).
Google Scholar
15.
Watts RW, Silagy CA. A meta-analysis on the efficacy of epidural corticosteroids in the treatment of sciatica. Anaesth. Intensive Care 23(5), 564–569 (1995).
PubMed
Google Scholar
16.
Zheng C, Ou W, Shen H, Zhou Z, Wang J. Combined therapy of diabetic peripheral neuropathy with breviscapine and mecobalamin: a systematic review and a meta-analysis of Chinese studies. Biomed Res. Int. 2015, 680756 (2015).
PubMed
Google Scholar
17.
Wang SL, Wang H, Nie HY, Bu G, Shen XD. The efficacy of pregabalin for acute pain control in herpetic neuralgia patients: a meta-analysis. Medicine (Baltimore) 96(51), e9167 (2017).
PubMed
Google Scholar
18.
Guyatt GH, Oxman AD, Vist G et al. GRADE guidelines: 4. Rating the quality of evidence--study limitations (risk of bias). J. Clin. Epidemiol. 64(4), 407–415 (2011).
PubMed
Google Scholar
19.
Handoll HHG, Langhorne P. In defence of reviews of small trials: underpinning the generation of evidence to inform practice. Cochrane Database Syst Rev. 11 (2015).
Crossref
PubMed
Google Scholar
20.
Roberts I, Ker K. How systematic reviews cause research waste. Lancet 386(10003), 1536 (2015).
PubMed
Google Scholar
21.
Guyatt G, Oxman AD, Akl EA et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J. Clin. Epidemiol. 64(4), 383–394 (2011).
PubMed
Google Scholar
22.
Conway A, Conway Z, Soalheira K, Sutherland J. High quality of evidence is uncommon in Cochrane systematic reviews in anaesthesia, critical care and emergency medicine. Eur. J. Anaesthesiol. 34(12), 808–813 (2017).
PubMed
Google Scholar
23.
Cooper NJ, Jones DR, Sutton AJ. The use of systematic reviews when designing studies. Clin. Trials 2(3), 260–264 (2005).
PubMed
Google Scholar
24.
Mimouni M, Mimouni F, Segev F. Conclusiveness of the Cochrane eye and vision group reviews. BMC Res. Notes 8(1), 242 (2015).
PubMed
Google Scholar
25.
Moseley AM, Elkins MR, Herbert RD, Maher CG, Sherrington C. Cochrane reviews used more rigorous methods than non-Cochrane reviews: survey of systematic reviews in physiotherapy. J. Clin. Epidemiol. 62(10), 1021–1030 (2009).
PubMed
Google Scholar
26.
Fleming PS, Seehra J, Polychronopoulou A, Fedorowicz Z, Pandis N. Cochrane and non-Cochrane systematic reviews in leading orthodontic journals: a quality paradigm? Eur. J. Orthod. 35(2), 244–248 (2013).
PubMed
Google Scholar
27.
Petticrew M, Wilson P, Wright K, Song F. Quality of Cochrane reviews is better than that of non-Cochrane reviews. BMJ 324(7336), 545 (2002).
PubMed
Google Scholar
28.
Shea BJ, Hamel C, Wells GA et al. AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. J. Clin. Epidemiol. 62(10), 1013–1020 (2009).
PubMed
Google Scholar
29.
Moher D, Tetzlaff J, Tricco AC, Sampson M, Altman DG. Epidemiology and reporting characteristics of systematic reviews. PLoS Med. 4(3), e78 (2007).
PubMed
Google Scholar
30.
Dosenovic S, Jelicic Kadic A, Vucic K, Markovina N, Pieper D, Puljak L. Comparison of methodological quality rating of systematic reviews on neuropathic pain using AMSTAR and R-AMSTAR. BMC Med. Res. Methodol. 18(1), 37 (2018).
PubMed
Google Scholar
31.
Tunis SR, Clarke M, Gorst SL et al. Improving the relevance and consistency of outcomes in comparative effectiveness research. J. Comp. Eff. Res. 5(2), 193–205 (2016).
PubMed
Google Scholar
32.
Williamson PR, Altman DG, Blazeby JM et al. Developing core outcome sets for clinical trials: issues to consider. Trials 13, 132–132 (2012).
PubMed
Google Scholar
33.
Krsticevic M, Dosenovic S, Dimcea DA et al. Outcome domains, outcome measures, and characteristics of randomized controlled trials testing nonsurgical interventions for osteoarthritis. J. Rheumatol. 47(1), 126–131 (2020).
PubMed
Google Scholar
34.
Puljak L, Dosenovic S, Boric K. Importance of consistent outcomes in randomized controlled trials and systematic reviews about anesthesiology and pain. Pain Manag. 8(4), 251–253 (2018).
PubMed
Google Scholar
35.
Boric K, Boric M, Dosenovic S et al. Authors’ lack of awareness and use of core outcome set on postoperative pain in children is hindering comparative effectiveness research. J. Comp. Eff. Res. 7(5), 463–470 (2018).
PubMed
Google Scholar
36.
Dosenovic S, Nikolic Z, Ivancev B, Kadic AJ, Puljak L. Awareness and acceptability of Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials core outcome set for chronic pain among surveyed neuropathic pain authors. J. Comp. Eff. Res. 8(9), 671–683 (2019).
PubMed
Google Scholar
37.
Dosenovic S, Jelicic Kadic A, Jeric M et al. Efficacy and safety outcome domains and outcome measures in systematic reviews of neuropathic pain conditions. Clin. J. Pain 34(7), 674–684 (2018).
PubMed
Google Scholar
38.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 6(7), e1000097 (2009).
PubMed
Google Scholar
39.
Babić A, Poklepovic Pericic T, Pieper D, Puljak L. How to decide whether a systematic review is stable and not in need of updating: analysis of Cochrane reviews. Res. Synth. Methods (2020) (Epub ahead of print).
Crossref
PubMed
Google Scholar
|