Improvement In Methodological Quality Research Articles

An evaluation of the methodological quality of published guidelines for the surgical treatment of pleural mesothelioma.

To benchmark their quality, a project was designed to analyze the methodology of previous guidelines and recommendations for malignant pleural mesothelioma projects. A narrative literature search was conducted, and each guideline was evaluated using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool and rated on a seven-point scale for its many items and domains. Six guidelines that met the inclusion requirements were evaluated. Due to greater development rigor and editorial independence, the engagement of scientific societies was associated with an improvement in methodological quality. According to the standards of AGREE II, the methodological quality of earlier guidelines was relatively low. Nonetheless, two previously published guidelines could serve as a template for the establishment of the most effective methodological quality guidelines.

Multicomponent or Resistance Training for Nursing Home Residents: A Systematic Review With Meta-Analysis.

To perform a systematic review with meta-analysis to verify the effects of multicomponent and resistance training on the physical performance in older adult residents in long-term care, as well as to compare these modalities. Systematic review with meta-analysis of randomized controlled trials. Older adults age over 60years who are nursing home residents in long-term care. Seven electronic databases (PubMed, Embase, Central, Web of Science, SportDiscus, LILACS, and SCIELO) were searched from their inception until May 1, 2022. The methodological quality was assessed using PEDro scale. Mean difference and 95% confidence interval were pooled using a random-effects model. The significance level established was P value of ≤.05 for all analyses. A total of 30 studies were included in the qualitative review (n= 1887, mean age 82.68years and 70% female). Multicomponent training appeared in 19 studies and resistance training in 12 studies. Out of these, 17 studies were incorporated into the meta-analysis. Multicomponent training and resistance training showed statistically significant difference (P ≤ .05) in the physical performance of institutionalized older adults compared with the control groups (usual care); this was evaluated with the Short Physical Performance Battery (+1.2 points;+2 points), 30-second chair-stand (approximately+3 repetitions; both), and Timed Up and Go (-4seconds on mean; both) tests. Comparisons between multicomponent and resistance training did not show statistically significant differences in any of the physical outcomes evaluated. The studies provide evidence that both multicomponent training and resistance training may be effective in improving the physical performance of institutionalized older adults. Further studies with more representative sample numbers, an improvement in methodological quality, and a more specified prescription of the training used are necessary.

Policy Analysis for Prevention and Control of Influenza in Aged Care.

This study aimed to analyze national influenza infection control policy documents within aged care settings by identifying the consistencies, inconsistencies, and gaps with the current evidence and by evaluating methodological quality. Aged care providers can use these findings to identify their policy documents' strengths and weaknesses. A quality and content analysis of national level policy documents. Aged care settings rely on national agencies' policy recommendations to control and prevent outbreaks. There is limited research on the effectiveness of control measures to prevent and treat influenza within aged care settings. Because of the complexities around aged care governance, the primary responsibility in developing a comprehensive facility-level, infection-prevention policy, falls to the providers. The analysis was conducted using the (1) International Appraisal of Guidelines, Research and Evaluation assessment tool, containing 23 items across 6 domains; and the (2) Influenza Related Control Measures in Aged Care settings checklist, developed by the authors, with 82 recommendations covering: medical interventions, nonmedical interventions, and physical layout. There were 19 documents from 9 different high-income countries, with a moderately high methodological quality in general. The quality assessment's average score was 40.2% (95% CI 31.9%-44.7%). "Stakeholder involvement" ranked third, and "Editorial independence" and "Rigor of development" had the lowest average scores across all domains. The content analysis' average score was 37.2% (95% CI 10.5%-21.5%). The highest scoring document (59.1%) included term definitions, cited evidence for recommendations, and clear measurable instructions. "Physical Layout" had the least coverage and averaged 21.9% (95% CI 4.2%-37.5%), which shows a substantial gap in built environment recommendations. Existing policy documents vary in their comprehensiveness. The higher scoring documents provide an ideal model for providers. The checklist tools can be used to assess and enhance documents. Further research on document end-user evaluation would be useful, as there is room for improvement in methodological quality and coverage of recommendation coverage, especially related to physical layout.

Foot and Ankle Characteristics in Gout: A Systematic Review

Objectives: Gout has a predilection for the foot and ankle, but the impact of gout has limited presence in the literature. The aim of this systematic review was to synthesise existing literature which has investigated the characteristics of foot and ankle involvement in gout; identifying consensus and highlighting areas for further study. Methods: Studies were included if they were published in English and involved participants over 18 years of age with gout, and presented original findings relating to outcome measures associated with the foot and ankle. Methodological quality was assessed using a modified version of the Quality Index Tool. Results. Of 707 studies identified, 16 met the inclusion criteria and were included in this review. The mean (range) quality score was 68.1% (38.9%-88.9%). Compared to controls, participants with gout reported higher levels of activity limitation, foot-related pain and disability and walked more slowly. Plain radiography, dual-energy Computer Tomography and diagnostic ultrasound consistently demonstrated pathological features of gout in the first metatarsophalangeal joint and Achilles tendon. However, studies offered limited quality, particularly around recruitment strategies, validity and potential impact of confounding factors, making definitive statements difficult. Conclusions: This systematic review highlights the negative impact of gout on the structure and function of the foot and ankle causing significant impairment and disability. To effectively guide management, improvements in methodological quality are recommended.

Systematic Reviews and Meta-Analysis in Spine Surgery-How Good Are They in Methodological Quality? A Systematic Review.

Study Design:Systematic review.Objectives:To assess the methodological quality of systematic reviews and meta-analyses in spine surgery over the past 2 decades.Materials and Methods:We conducted independent and in duplicate systematic review of the published systematic reviews and meta-analyses between 2000 and 2019 from PubMed Central and Cochrane Database pertaining to spine surgery involving surgical intervention. We searched bibliographies to identify additional relevant studies. Methodological quality was evaluated with AMSTAR score and graded with AMSTAR 2 criteria.Results:A total of 96 reviews met the eligibility criteria, with mean AMSTAR score of 7.51 (SD = 1.98). Based on AMSTAR 2 criteria, 13.5% (n = 13) and 18.7% (n = 18) of the studies had high and moderate level of confidence of results, respectively, without any critical flaws. A total of 29.1% (n = 28) of the studies had at least 1 critical flaw and 38.5% (n = 37) of the studies had more than 1 critical flaw, so that their results have low and critically low confidence, respectively. Failure to analyze the conflict of interest of authors of primary studies included in review and lack of list of excluded studies with justification were the most common critical flaw. Regression analysis demonstrated that studies with funding and studies published in recent years were significantly associated with higher methodological quality.Conclusion:Despite improvement in methodological quality of systematic reviews and meta-analyses in spine surgery in current decade, a substantial proportion continue to show critical flaws. With increasing number of review articles in spine surgery, stringent measures must be taken to adhere to methodological quality by following PRISMA and AMSTAR guidelines to attain higher standards of evidence in published literature.

Quality Assessment of Prospective Cohort Studies Evaluating Arthroscopic Treatment for Femoroacetabular Impingement Syndrome: A Systematic Review.

Background:Femoroacetabular impingement (FAI) syndrome is a cause of pain and reduced range of motion in the hip joint. Given the limited number of randomized controlled trials, prospective cohort studies constitute the dominant part of the available prospective evidence evaluating relevant clinical outcomes after arthroscopic hip surgery for FAI.Purpose:To assess the methodological quality of prospective cohort studies evaluating arthroscopic surgery for FAI and to determine whether there has been an improvement in methodological quality over time.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic literature search was performed in PubMed, Embase (OvidSP), and the Cochrane Library. Included studies were clinical prospective cohort studies of primary arthroscopic surgery for cam and/or pincer morphology FAI. Methodological quality was assessed with the Methodological Index for Non-randomized Studies (MINORS). The mean MINORS score for studies published during the first 5 years of the period was compared with those published during the last 5 years to evaluate methodological improvement over time. The methodological quality of randomized controlled trials was also assessed with the Coleman Methodology Score.Results:The search yielded 53 studies. There were 34 noncomparative studies, 15 nonrandomized comparative studies, and 4 randomized controlled trials. The included studies were published between 2008 and 2017. The mean ± SD MINORS score for noncomparative and comparative studies was 10.4 ± 1.4 of 16 possible and 18.7 ± 2.0 of 24 possible, respectively. The mean Coleman Methodology Score for randomized controlled trials was 79.0 ± 7.0 of 100 possible.Conclusion:The methodological quality of prospective cohort studies evaluating arthroscopic surgery for FAI is moderate for comparative and noncomparative studies. Common areas for improvement include unbiased assessment of study endpoints and prospective sample-size calculations. Despite an increase in the number of published studies, an improvement in methodological quality over time was not observed.

An international, Delphi consensus study to identify priorities for methodological research in behavioural trials: A study protocol

Background: Effective behaviour change interventions are needed to impact important health outcomes, including morbidity and mortality. However, the uptake and impact of behavioural interventions have been limited by methodological challenges. The International Behavioural Trials Network (IBTN) was established in 2013 to facilitate global improvement in methodological quality of behavioural trials. There has been no formal process, within the network or in the broader literature, to define the most important research priorities to achieve this aim. In this project, we will conduct an international, Delphi consensus study to identify and achieve consensus on priorities for methodological research in behavioural trials among IBTN members. Methods: Fifteen core members of IBTN, who are experts in the field of behavioural intervention research, will be invited to generate a list of all items they consider priority areas for methodological research in trials of behavioural interventions. The IBTN Research Prioritisation team (the authors) will review all items generated, removing duplicates and merging similar topics, and generate a ‘long-list’ of items. This long-list will be sent to the 15 IBTN core members for approval. We will then administer two online Delphi surveys to all IBTN members. In the first survey, respondents will be asked to rate the importance of each item on a nine-point scale and rank their top five priorities. In the second survey, respondents will receive feedback on others’ responses and a reminder of their own responses in survey 1, and will be asked to re-rate items and re-select their ‘top five’. Discussion: Findings from the project will be used to inform the research agenda of the IBTN and to make recommendations for future research.

An international, Delphi consensus study to identify priorities for methodological research in behavioural trials: A study protocol

Background: Effective behaviour change interventions are needed to impact important health outcomes, including morbidity and mortality. However, the uptake and impact of behavioural interventions have been limited by methodological challenges. The International Behavioural Trials Network (IBTN) was established in 2013 to facilitate global improvement in methodological quality of behavioural trials. There has been no formal process, within the network or in the broader literature, to define the most important research priorities to achieve this aim. In this project, we will conduct an international, Delphi consensus study to identify and achieve consensus on priorities for methodological research in behavioural trials among IBTN members. Methods: Fifteen core members of IBTN, who are experts in the field of behavioural intervention research, will be invited to brainstorm a complete list of all items they consider priority areas for methodological research in trials of behavioural interventions. The IBTN Research Prioritisation team (the authors) will review all items generated, removing duplicates and merging similar topics, and generate a ‘long-list’ of items. This long-list will be sent to the 15 IBTN core members for approval. We will then administer two online Delphi surveys to all IBTN members. In the first survey, respondents will be asked to rate the importance of each item on a nine-point scale and rank their top five priorities. In the second survey, respondents will receive feedback on others’ responses and a reminder of their own responses in survey 1, and will be asked to re-rate items and re-select their ‘top five’. Discussion: Findings from the project will be used to develop the research agenda of the IBTN and to make recommendations for future research.

Effectiveness of acupuncture in the treatment of shoulder pain: a systematic review of published randomised clinical trials

Shoulder pain is a leading musculoskeletal pain complaint, and is responsible for high morbidity with marked impact on quality of life. Acupuncture is a modality commonly employed in the treatment of shoulder conditions; however, past systematic reviews investigating its effectiveness have been inconclusive, noting a paucity of good quality research. A new body of research has since been published, and is included within this review. The objective of this systematic review was therefore to investigate the current evidence base for the effectiveness of acupuncture in the treatment of shoulder pain. Four electronic databases (CINAHL Plus, MEDLINE, Cochrane and Physiotherapy Evidence Database (PEDro)) were searched, from inception to November 2013. Hand search of reference lists and grey literature was completed. Search terms included acupuncture, electroacupuncture, dry needling, shoulder pain, subacromial, frozen shoulder, rotator cuff, randomised controlled trial, controlled clinical trial, and placebo. Included studies were published English language randomised controlled trials of insertional acupuncture treatment for persistent shoulder pain in adults. Predefined data extraction criteria were used. Quality review was completed independently by two authors. Narrative analysis was conducted. Twenty randomised controlled trials were included with a total of 1951 participants. There was variability in methodological rigour, with thirteen studies having high methodological quality, but only four having low risk of bias. Acupuncture is more effective in the short-term for patients with all shoulder pain conditions than a waiting list control group, mock or placebo treatment. Acupuncture was more effective in the short-term (high quality study) and medium-term (low quality study) than physiotherapy and exercise for frozen shoulder. Acupuncture combined with physiotherapy or exercise was found in two studies (one high quality, one low quality) to be more effective for frozen shoulder than physiotherapy or exercise alone in the short and medium term. Two low quality studies found that conventional acupuncture was less effective for frozen shoulder in the short-term than acupuncture with additional stimulation. It was equally as effective for rotator cuff dysfunction as ultrasound and corticosteroid injection in two separate high quality studies. For non-specific shoulder pain a low quality study found acupuncture equally as effective as manual therapy, and a high quality study found it more effective than physiotherapy in the medium term. Adverse effects are temporary and mild. This systematic review suggests that acupuncture can be a safe and effective treatment for shoulder pain, when used alongside other management strategies as part of a multi-modal treatment package. The benefits and costs of using acupuncture as a stand-alone treatment for shoulder pain as compared to a different active treatment cannot be justified based on these results. Unfortunately the impact of individual study results is lessened by deficiencies in methodological quality, threatening the robustness of evidence in this area. The decision to use acupuncture as a treatment for shoulder pain should include consideration of patient choice, the other treatment methods employed, and the costs and resources involved in using acupuncture. Therapists, commissioners of musculoskeletal healthcare services, and patients, all have great interest in successful treatment options for shoulder pain, given its prevalence and impact on morbidity. This review has demonstrated the need for improved heterogeneity in future research on the use of acupuncture for shoulder pain, in particular regarding the use of standardised outcome measures of both pain and function; and the need for improvements in methodological quality of trials, especially in relation to comparator interventions and the credibility of blinding.

Journal impact factor and methodological quality of surgical randomized controlled trials: an empirical study.

The journal impact factor (IF) is often used as a surrogate marker for methodological quality. The objective of this study is to evaluate the relation between the journal IF and methodological quality of surgical randomized controlled trials (RCTs). Surgical RCTs published in PubMed in 1999 and 2009 were identified. According to IF, RCTs were divided into groups of low (<2), median (2-3) and high IF (>3), as well as into top-10 vs all other journals. Methodological quality characteristics and factors concerning funding, ethical approval and statistical significance of outcomes were extracted and compared between the IF groups. Additionally, a multivariate regression was performed. The median IF was 2.2 (IQR 2.37). The percentage of 'low-risk of bias' RCTs was 13% for top-10 journals vs 4% for other journals in 1999 (P<0.02), and 30 vs 12% in 2009 (P<0.02). Similar results were observed for high vs low IF groups. The presence of sample-size calculation, adequate generation of allocation and intention-to-treat analysis were independently associated with publication in higher IF journals; as were multicentre trials and multiple authors. Publication of RCTs in high IF journals is associated with moderate improvement in methodological quality compared to RCTs published in lower IF journals. RCTs with adequate sample-size calculation, generation of allocation or intention-to-treat analysis were associated with publication in a high IF journal. On the other hand, reporting a statistically significant outcome and being industry funded were not independently associated with publication in a higher IF journal.

Quality of Reporting and Study Design of CKD Cohort Studies Assessing Mortality in the Elderly Before and After STROBE: A Systematic Review.

BackgroundThe STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement was published in October 2007 to improve quality of reporting of observational studies. The aim of this review was to assess the impact of the STROBE statement on observational study reporting and study design quality in the nephrology literature.Study DesignSystematic literature review.Setting & PopulationEuropean and North American, Pre-dialysis Chronic Kidney Disease (CKD) cohort studies.Selection Criteria for StudiesStudies assessing the association between CKD and mortality in the elderly (>65 years) published from 1st January 2002 to 31st December 2013 were included, following systematic searching of MEDLINE & EMBASE.PredictorTime period before and after the publication of the STROBE statement.OutcomeQuality of study reporting using the STROBE statement and quality of study design using the Newcastle Ottawa Scale (NOS), Scottish Intercollegiate Guidelines Network (SIGN) and Critical Appraisal Skills Programme (CASP) tools.Results37 papers (11 Pre & 26 Post STROBE) were identified from 3621 potential articles. Only four of the 22 STROBE items and their sub-criteria (objectives reporting, choice of quantitative groups and description of and carrying out sensitivity analysis) showed improvements, with the majority of items showing little change between the period before and after publication of the STROBE statement. Pre- and post-period analysis revealed a Manuscript STROBE score increase (median score 77.8% (Inter-quartile range [IQR], 64.7–82.0) vs 83% (IQR, 78.4–84.9, p = 0.05). There was no change in quality of study design with identical median scores in the two periods for NOS (Manuscript NOS score 88.9), SIGN (Manuscript SIGN score 83.3) and CASP (Manuscript CASP score 91.7) tools.LimitationsOnly 37 Studies from Europe and North America were included from one medical specialty. Assessment of study design largely reliant on good reporting.ConclusionsThis study highlights continuing deficiencies in the reporting of STROBE items and their sub-criteria in cohort studies in nephrology. There was weak evidence of improvement in the overall reporting quality, with no improvement in methodological quality of CKD cohort studies between the period before and after publication of the STROBE statement.

Ganoderma lucidum (Reishi mushroom) for cancer treatment.

Ganoderma lucidum is a natural medicine that is widely used and recommended by Asian physicians and naturopaths for its supporting effects on immune system. Laboratory research and a handful of preclinical trials have suggested that G. lucidum carries promising anticancer and immunomodulatory properties. The popularity of taking G. lucidum as an alternative medicine has been increasing in cancer patients. However, there is no systematic review that has been conducted to evaluate the actual benefits of G. lucidum in cancer treatment. To evaluate the clinical effects of G. lucidum on long-term survival, tumour response, host immune functions and quality of life in cancer patients, as well as adverse events associated with its use. We searched an extensive set of databases including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, NIH, AMED, CBM, CNKI, CMCC and VIP Information/Chinese Scientific Journals Database was searched for randomised controlled trials (RCTs) in October 2011. Other strategies used were scanning the references of articles retrieved, handsearching of the International Journal of Medicinal Mushrooms and contact with herbal medicine experts and manufacturers of G. lucidum. For this update we updated the searches in February 2016. To be eligible for being included in this review, studies had to be RCTs comparing the efficacy of G. lucidum medications to active or placebo control in patients with cancer that had been diagnosed by pathology. All types and stages of cancer were eligible for inclusion. Trials were not restricted on the basis of language. Five RCTs met the inclusion criteria and were included in this review. Two independent review authors assessed the methodological quality of individual trials. Common primary outcomes were tumour response evaluated according to the World Health Organization (WHO) criteria, immune function parameters such as natural killer (NK)-cell activity and T-lymphocyte co-receptor subsets, and quality of life measured by the Karnofsky scale score. No trial had recorded long-term survival rates. Associated adverse events were reported in one study. A meta-analysis was performed to pool available data from the primary trials. Results were gauged using relative risks (RR) and standard mean differences (SMD) for dichotomous and continuous data respectively, with a 95% confidence interval (CI). The methodological quality of primary studies was generally unsatisfying and the results were reported inadequately in many aspects. Additional information was not available from primary trialists. The meta-analysis results showed that patients who had been given G. lucidum alongside with chemo/radiotherapy were more likely to respond positively compared to chemo/radiotherapy alone (RR 1.50; 95% CI 0.90 to 2.51, P = 0.02). G. lucidum treatment alone did not demonstrate the same regression rate as that seen in combined therapy. The results for host immune function indicators suggested that G. lucidum simultaneously increases the percentage of CD3, CD4 and CD8 by 3.91% (95% CI 1.92% to 5.90%, P < 0.01), 3.05% (95% CI 1.00% to 5.11%, P < 0.01) and 2.02% (95% CI 0.21% to 3.84%, P = 0.03), respectively. In addition, leukocyte, NK-cell activity and CD4/CD8 ratio were marginally elevated. Four studies showed that patients in the G. lucidum group had relatively improved quality of life in comparison to controls. One study recorded minimal side effects, including nausea and insomnia. No significant haematological or hepatological toxicity was reported. Our review did not find sufficient evidence to justify the use of G. lucidum as a first-line treatment for cancer. It remains uncertain whether G. lucidum helps prolong long-term cancer survival. However, G. lucidum could be administered as an alternative adjunct to conventional treatment in consideration of its potential of enhancing tumour response and stimulating host immunity. G. lucidum was generally well tolerated by most participants with only a scattered number of minor adverse events. No major toxicity was observed across the studies. Although there were few reports of harmful effect of G. lucidum, the use of its extract should be judicious, especially after thorough consideration of cost-benefit and patient preference. Future studies should put emphasis on the improvement in methodological quality and further clinical research on the effect of G. lucidum on cancer long-term survival are needed. An update to this review will be performed every two years.

ECONOMIC EVALUATION STUDIES OF SELF-MANAGEMENT INTERVENTIONS IN CHRONIC DISEASES: A SYSTEMATIC REVIEW.

To our knowledge, there has been no overall systematic review focusing on the methodological quality of full economic evaluation studies of self-management interventions. Our objective was to systematically review the literature of full economic evaluation studies of self-management interventions in adult chronic patients and to investigate their methodological quality and cost-effectiveness. A data extraction form was developed to assess general and randomized controlled trial (RCT) -related characteristics, quality, of the RCTs, economic information and quality of the economic evaluation studies by means of a quality assessment (CHEC-list for trial-based studies, adjusted CHEC-list for model-based studies). Twenty-three reports were found. Sixteen studies (73 percent) lack information on the control intervention(s). Only one study fulfilled all three criteria for quality of RCTs and five studies (23 percent) did not meet any of these criteria. This review included one model-based study; the other studies were trial-based economic evaluation studies based on a RCT. Eight studies (35 percent) used a societal perspective and 12 (60 percent) synthesized costs and effects. Seven studies were categorized into the highest category (<15 score), nine studies into the "moderate" group (9-14 score), six studies received a "low" score (<8) on the CHEC-list. Eighteen studies found the self-management intervention(s) to be cost-effective compared with other interventions Conclusions: Self-management interventions for adult chronic patients were heterogeneous and there was no clear, well-considered definition of self-management. Overall, the methodological quality of the full economic evaluation studies was moderate and, therefore, cost-effectiveness results must be interpreted with caution. Future research will benefit from further improvements in methodological quality of both economic study design and analysis, as well as a taxonomy for describing self-management interventions and their contents.

Update on the Methodological Quality of Research Published in The American Journal of Sports Medicine

Background: In recent years, the number of articles in The American Journal of Sports Medicine (AJSM) has risen dramatically, with an increasing emphasis on evidence-based medicine in orthopaedics and sports medicine. Hypothesis: Despite the increase in the number of articles published in AJSM over the past decade, the methodological quality of articles in 2011-2013 has improved relative to those in 2001-2003 and 1991-1993. Study Design: Meta-analysis. Methods: All articles published in AJSM during 2011-2013 were reviewed and classified by study design. For each article, the use of pertinent methodologies, such as prospective data collection, randomization, control groups, and blinding, was recorded. The frequency of each article type and the use of evidence-based techniques were compared relative to 1991-1993 and 2001-2003 by use of Pearson χ2 testing. Results: The number of research articles published in AJSM more than doubled from 402 in 1991-1993 and 423 in 2001-2003 to 953 in 2011-2013. Case reports decreased from 15.2% to 10.6% to 2.1% of articles published over the study period (P < .001). Cadaveric/human studies and meta-analysis/literature review studies increased from 5.7% to 7.1% to 12.4% (P < .001) and from 0.2% to 0.9% to 2.3% (P = .01), respectively. Randomized, prospective clinical trials increased from 2.7% to 5.9% to 7.4% (P = .007). Fewer studies used retrospective compared with prospective data collection (P < .001). More studies tested an explicit hypothesis (P < .001) and used controls (P < .001), randomization (P < .001), and blinding of those assessing outcomes (P < .001). Multi-investigator trials increased (P < .001), as did the proportion of articles citing a funding source (P < .001). Conclusion: Despite a dramatic increase in the number of published articles, the research published in AJSM shifted toward more prospective, randomized, controlled, and blinded designs during 2011-2013 compared with 2001-2003 and 1991-1993, demonstrating a continued improvement in methodological quality.

The effectiveness of group reminiscence therapy for loneliness, anxiety and depression in older adults in long-term care: A systematic review

Loneliness, anxiety and depression are common problems for older adults in long-term care. Reminiscence therapy is a non-pharmacological intervention that may be of some benefit. In comparison to individual reminiscence therapy, group reminiscence therapy is a preferred option when dealing with the resource constraints of long-term care. The aim of this paper was to systematically review the literature in order to explore the effectiveness of group reminiscence therapy for older adults with loneliness, anxiety and depression in long-term care. Results indicated that group reminiscence therapy is an effective treatment for depression in older adults, however to date, there is limited research support for its effectiveness to treat loneliness and anxiety. Further research and an improvement in methodological quality, such as using qualitative and mixed methods approaches, is recommended to help establish an evidence base and provide better understanding of the effectiveness of group reminiscence therapy.

Systematic reviews addressing microsurgical head and neck reconstruction.

Systematic reviews frequently form the basis for clinical decision making and guideline development. Yet, the quality of systematic reviews has been variable, thus raising concerns about the validity of their conclusions. In the current study, a quality analysis of systematic reviews was performed, addressing microsurgical head and neck reconstruction. A PubMed search was performed to identify all systematic reviews published up to and including December 2012 in 12 surgical journals. Two authors independently reviewed the literature and extracted data from the included reviews. Discrepancies were resolved by consensus. Quality assessment was performed using AMSTAR. The initial search retrieved 1020 articles. After screening titles and abstracts, 987 articles were excluded. Full-text review of the remaining 33 articles resulted in further exclusion of 18 articles, leaving 15 systematic reviews for final analysis. A marked increase in the number of published systematic reviews over time was noted (P = 0.07). The median AMSTAR score was 5, thus reflecting a "fair" quality. No evidence for improvement in methodological quality over time was noted. The trend to publish more systematic reviews in microsurgical head and neck reconstruction is encouraging. However, efforts are indicated to improve the methodological quality of systematic reviews. Familiarity with criteria of methodological quality is critical to ensure future improvements in the quality of systematic reviews conducted in microsurgery.

The efficacy of Acceptance and Commitment Therapy: An updated systematic review and meta-analysis

Acceptance and Commitment therapy (ACT) has attracted a lot of interest during the last 10–15 years with a strong increase of the number of randomized controlled trials (RCTs). The present review and meta-analysis includes 60 RCTs (4234 participants) on psychiatric disorders, somatic disorders, and stress at work. The mean effect size across all comparisons was small (0.42). Compared to the Öst (2008) meta-analysis there was no significant improvement in methodological quality and deterioration in effect size (from 0.68). When ACT was compared to various forms of cognitive or behavioral treatments a small and non-significant effect size of 0.16 was obtained. An evidence-base evaluation showed that ACT is not yet well-established for any disorder. It is probably efficacious for chronic pain and tinnitus, possibly efficacious for depression, psychotic symptoms, OCD, mixed anxiety, drug abuse, and stress at work, and experimental for the remaining disorders.

Quantity and quality of psychotherapy trials for depression in the past five decades

BackgroundOver the years randomized controlled trials (RCTs) of various psychotherapies for treating depression have provided evidence to demonstrate the interventions’ efficacy/effectiveness. However, recent researches suggest that the quality of some RCTs were actually less than ideal, which could hence have biased their results. The present study aims to assess (1) the changes in characteristics of RCTs of psychotherapies for treating adult depression; (2) the temporal changes in their trial quality, and (3) the quality differences among different therapeutic approaches. MethodsWe included 135 RCTs of psychotherapies treating adult depression published from year 1969 to 2011. Temporal changes in trials’ characteristics including their quantity and quality were assessed at study-level and arm-level. Quality differences among different schools of psychotherapy were assessed at arm-level. ResultsChanges in quantity and improvements in methodological quality were found at study-level. Positive changes in trial quality at arm-level were observed in most aspects. Comparisons made across different schools of psychotherapy revealed statistically significant differences among them, with earlier behavior therapy trials doing worst and more recent third wave cognitive-behavior therapy doing best. LimitationsWe could not determine whether the observed changes in quality resulted from actual improvement in trial quality and/or from improved reporting. The relatively smaller number of arms for several types of interventions could weaken the representativeness when making comparisons across psychotherapeutic approaches. ConclusionOur study revealed positive temporal changes in both trial quantity and quality over the past five decades and has also spotted possible areas for further improvement.

Mindfulness-based therapies in the treatment of functional gastrointestinal disorders: a meta-analysis.

Background. Functional gastrointestinal disorders are highly prevalent and standard treatments are often unsatisfactory. Mindfulness-based therapy has shown benefit in conditions including chronic pain, mood, and somatization disorders. Objectives. To assess the quality and effectiveness reported in existing literature, we conducted a meta-analysis of mindfulness-based therapy in functional gastrointestinal disorders. Methods. Pubmed, EBSCO, and Cochrane databases were searched from inception to May 2014. Study inclusion criteria included randomized, controlled studies of adults using mindfulness-based therapy in the treatment of functional gastrointestinal disorders. Study quality was evaluated using the Cochrane risk of bias. Effect sizes were calculated and pooled to achieve a summary effect for the intervention on symptom severity and quality of life. Results. Of 119 records, eight articles, describing seven studies, met inclusion criteria. In six studies, significant improvements were achieved or maintained at the end of intervention or follow-up time points. The studies had an unclear or high risk of bias. Pooled effects were statistically significant for IBS severity (0.59, 95% CI 0.33 to 0.86) and quality of life (0.56, 95% CI 0.47 to 0.79). Conclusion. Studies suggest that mindfulness based interventions may provide benefit in functional gastrointestinal disorders; however, substantial improvements in methodological quality and reporting are needed.

Update in Internal Medicine Residency Education: A Review of the Literature in 2010 and 2011

Evidence-based practice in education requires high-quality evidence, and many in the medical education community have called for an improvement in the methodological quality of education research. Our aim was to use a valid measure of medical education research quality to highlight the methodological quality of research publications and provide an overview of the recent internal medicine (IM) residency literature. We searched MEDLINE and PreMEDLINE to identify English-language articles published in the United States and Canada between January 1, 2010, and December 31, 2011, focusing on IM residency education. Study quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI), which has demonstrated reliability and validity. Qualitative articles were excluded. Articles were ranked by quality score, and the top 25% were examined for common themes, and 2 articles within each theme were selected for in-depth presentation. The search identified 731 abstracts of which 223 articles met our inclusion criteria. The mean (±SD) MERSQI score of the 223 studies included in the review was 11.07 (±2.48). Quality scores were highest for data analysis (2.70) and lowest for study design (1.41) and validity (1.29). The themes identified included resident well-being, duty hours and resident workload, career decisions and gender, simulation medicine, and patient-centered outcomes. Our review provides an overview of the IM medical education literature for 2010-2011, highlighting 5 themes of interest to the medical education community. Study design and validity are 2 areas where improvements in methodological quality are needed, and authors should consider these when designing research protocols.