PubMed · 11719938
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G Bodeker. 2001. Evaluating Ayurveda.. https://doi.org/10.1089/10755530152639693
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CONTEXT: Reliable interpretation of the results of a controlled trial entails setting its results in the context of similar research. A previous study showed that most reports of controlled trials published in 5 general medical journals in May 1997 were deficient in this respect. We assessed the extent to which reports of controlled trials published in the same 5 journals discussed new results in light of the totality of evidence from other controlled trials. METHODS: Assessment of the discussion sections in all 33 reports of randomized trials published during May 2001 in Annals of Internal Medicine, BMJ, JAMA, The Lancet, and The New England Journal of Medicine. RESULTS: Three reports appeared to have been the first published trials to address the questions studied. In none of the remaining 30 reports were the results of the new trial discussed in the context of an updated systematic review of other trials. Although reference was made to relevant systematic reviews in 3 of these 30 reports, there was no integration, quantitative or qualitative, of the results of the new trials in an update of these reviews. In the remaining 27 reports, there was no evidence that any systematic attempt had been made to set the new results in the context of previous trials. CONCLUSIONS: Between 1997 and 2001, there was no evidence of progress in the proportion of reports of trials published in general medical journals that discussed the new results within the context of, or with reference to, up-to-date systematic reviews of relevant evidence from other controlled trials.
CONTEXT: Publication of research protocols minimizes bias by explicitly stating a priori hypotheses and methods without prior knowledge of results. METHODS: We conducted a retrospective comparative study to assess the extent to which the content of published Cochrane reviews had changed compared with their previously published protocols and to assess any potential impact these changes may have had in introducing bias to the study. We identified previously published protocols for new Cochrane reviews appearing in The Cochrane Library; 2000, issue 3. The texts of published protocols and completed reviews were compared. Two raters independently identified changes to the different sections of the protocol and classified the changes as none, minor, or major. RESULTS: Of the 66 new Cochrane reviews, we identified a previously published protocol for 47 reviews. Of these, 43 reviews had at least 1 section that had undergone a major change compared with the most recently published protocol. The greatest variation between protocols and reviews was in the methods section, in which 68% of reviews (n = 32) had undergone a major change. Changes made in other sections that may have resulted in the introduction of bias included narrowing of objectives, addition of comparisons or new outcome measures, broadening of criteria for the types of study design included, and narrowing of types of participants included. CONCLUSIONS: Research protocols, even if published, are likely to remain, at least to some extent, iterative documents. We found that a large number of changes were made to Cochrane reviews, some of which could be prone to influence by prior knowledge of results. Even if many of the changes between protocol and review improve the overall study, the reasons for making these should be clearly identified and documented within the final review.
PURPOSE: Low back pain (LBP) constitutes one of the most difficult and costly medical problems in industrial countries, with a prevalence of 25 to 30% in an adult lifetime span and an incidence of about 5% per year. METHOD: Based on risk factors cited in the pertinent literature, the evaluation, diagnosis and therapeutic options for LBP are outlined. Especially the latter can be highlighted on the basis of a large number of systematic reviews. RESULTS: Bed rest is no longer regarded as an effective treatment for episodes of acute LBP, except when the patient has evident clinical signs of nerve root compression. Exercise therapy comprises a wide range of concepts and underlying physiological principles. Different concepts are discussed. Evidence suggests no specific effects of exercise therapy in acute LBP. In chronic LBP, exercise as well as combined treatment with several modalities appear to be superior to conventional medical care. In the past decade, reconditioning of the paraspinal muscles is being given increasing importance in research. Several studies indicate the effectiveness of vigorous strengthening of paraspinal and trunk muscles on pain and even disc surgery. Different underlying pathologies seem to respond equally well to this concept. Back school concepts are not proven to have long-term effects on LBP. The literature on electrotherapy and massage in LBP is generally sparse. Nevertheless, some studies suggest the effectiveness of electrotherapy on pain reduction at least in the short term. Spinal mobilization seems to be effective in reducing pain. CONCLUSION: Based on these evidence-based conclusions, the patient's medical history, the investigation and the diagnosis the clinician has to devise an individual treatment plan that takes the deficiencies and requirements of the patient into account.