Abstract
BackgroundThe Cochrane risk of bias tool is commonly criticized for having a low reliability. We aimed to investigate whether training of raters, with objective and standardized instructions on how to assess risk of bias, can improve the reliability of the Cochrane risk of bias tool.MethodsIn this pilot study, four raters inexperienced in risk of bias assessment were randomly allocated to minimal or intensive standardized training for risk of bias assessment of randomized trials of physical therapy treatments for patients with knee osteoarthritis pain. Two raters were experienced risk of bias assessors who served as reference. The primary outcome of our study was between-group reliability, defined as the agreement of the risk of bias assessments of inexperienced raters with the reference assessments of experienced raters. Consensus-based assessments were used for this purpose. The secondary outcome was within-group reliability, defined as the agreement of assessments within pairs of inexperienced raters. We calculated the chance-corrected weighted Kappa to quantify agreement within and between groups of raters for each of the domains of the risk of bias tool.ResultsA total of 56 trials were included in our analysis. The Kappa for the agreement of inexperienced raters with reference across items of the risk of bias tool ranged from 0.10 to 0.81 for the minimal training group and from 0.41 to 0.90 for the standardized training group. The Kappa values for the agreement within pairs of inexperienced raters across the items of the risk of bias tool ranged from 0 to 0.38 for the minimal training group and from 0.93 to 1 for the standardized training group. Between-group differences in Kappa for the agreement of inexperienced raters with reference always favored the standardized training group and was most pronounced for incomplete outcome data (difference in Kappa 0.52, p < 0.001) and allocation concealment (difference in Kappa 0.30, p = 0.004).ConclusionsIntensive, standardized training on risk of bias assessment may significantly improve the reliability of the Cochrane risk of bias tool.
Highlights
The Cochrane risk of bias tool is commonly criticized for having a low reliability
We recently found that reliability of the risk of bias tool might improve if raters receive intensive standardized training [8]
Standardized training worse training better. To our knowledge, this prospective pilot study is the first to indicate that the reliability of the risk of bias tool may be improved by a standardized training of inexperienced raters
Summary
The Cochrane risk of bias tool is commonly criticized for having a low reliability. We aimed to investigate whether training of raters, with objective and standardized instructions on how to assess risk of bias, can improve the reliability of the Cochrane risk of bias tool. Systematic reviews and meta-analyses of randomized clinical trials (RCTs) are central to evidence-based clinical decision-making [1, 2]. RCTs are the gold standard design for assessing the effectiveness of treatment interventions. In 2008, the Cochrane Collaboration published a tool and guidelines for the assessment of risk of bias in RCTs [5, 6].
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