Abstract
BackgroundNetwork meta-analysis (NMA) has rapidly grown in use during the past decade for the comparison of healthcare interventions. While its general use in the comparison of conventional medicines has been studied previously, to our awareness, its use to assess complementary and alternative medicines (CAM) has not been studied. A scoping review of the literature was performed to identify systematic reviews incorporating NMAs involving one or more CAM interventions.MethodsAn information specialist executed a multi-database search (e.g., MEDLINE, Embase, Cochrane), and two reviewers performed study selection and data collection. Information on publication characteristics, diseases studied, interventions compared, reporting transparency, outcomes assessed, and other parameters were extracted from each review.ResultsA total of 89 SR/NMAs were included. The largest number of NMAs was conducted in China (39.3%), followed by the United Kingdom (12.4%) and the United States (9.0%). Reviews were published between 2010 and 2018, with the majority published between 2015 and 2018. More than 90 different CAM therapies appeared at least once, and the median number per NMA was 2 (IQR 1–4); 20.2% of reviews consisted of only CAM therapies. Dietary supplements (51.1%) and vitamins and minerals (42.2%) were the most commonly studied therapies, followed by electrical stimulation (31.1%), herbal medicines (24.4%), and acupuncture and related treatments (22.2%). A diverse set of conditions was identified, the most common being various forms of cancer (11.1%), osteoarthritis of the hip/knee (7.8%), and depression (5.9%). Most reviews adequately addressed a majority of the PRISMA NMA extension items; however, there were limitations in indication of an existing review protocol, exploration of network geometry, and exploration of risk of bias across studies, such as publication bias.ConclusionThe use of NMA to assess the effectiveness of CAM interventions is growing rapidly. Efforts to identify priority topics for future CAM-related NMAs and to enhance methods for CAM comparisons with conventional medicine are needed.Systematic review registrationhttps://ruor.uottawa.ca/handle/10393/35658
Highlights
Network meta-analysis (NMA) has rapidly grown in use during the past decade for the comparison of healthcare interventions
The use of NMA to assess the effectiveness of complementary and alternative medicine (CAM) interventions is growing rapidly
Identified literature and general characteristics In total, literature searching for this review identified a total of 3948 unique abstracts, 90 of which were retained as eligible network meta-analyses that included one or more CAM interventions according to the criteria described earlier [27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111,112,113,114,115]
Summary
Network meta-analysis (NMA) has rapidly grown in use during the past decade for the comparison of healthcare interventions. Past research has suggested that reviews of CAM interventions have been associated with certain areas of strength and weakness in terms of rigor relative to systematic reviews of other types of interventions [11], and challenges regarding clinical trial design and priority setting have been identified [12]. Methodologic research related to the conduct of NMA has grown rapidly, and its use is supported by helpful implementation tools including reporting guidance, overviews of adapted procedures for judging the strength of evidence, and published considerations for critical appraisal by decision-makers [20,21,22,23]
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