ObjectivesTo systematically review the efficacy of unicompartmental knee arthroplasty on forgotten joint score (FJS) in patients with knee osteoarthritis.MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, CBM, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) and cohort studies on unicompartmental knee arthroplasty on FJS in patients with knee osteoarthritis from inception to December 31st, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 2 RCTs and 11 cohort studies were included. The results of meta-analysis based on RCTs showed that: compared to posterior stabilized total knee arthroplasty (PS-TKA), unicompartmental knee arthroplasty could improve FJS on 12-month (MD=9.23, 95%CI 0.53 to 17.93, P=0.04) after operation. The results of meta-analysis based on cohort studies showed that: compared to PS-TKA, unicompartmental knee arthroplasty could improve FJS on 6-week (MD=8.90, 95%CI 6.87 to 10.94, P<0.000 01), 6-month (MD=18.72, 95%CI 8.71 to 28.74, P=0.000 2), 1-year after operation (MD=13.41, 95%CI 8.87 to 17.95, P<0.000 01), and the last follow-up (MD=0.99, 95%CI 0.47 to 1.54, P=0.000 2).ConclusionsCurrent evidence shows that, comparing with PS-TKA, unicompartmental knee arthroplasty in knee osteoarthritis shows advantage in the improvement of FJS. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
Interpretation of results of clinical research should not only focus on statistical significance (P value less than 0.05) but also clinical significance. The minimal clinically significance difference (MCID) assists to answer the question with the results being clinically significant. In addition, MCID plays an important role in evidence assessment during clinical guideline development, sample size estimation for clinical trials, and clinical decision-making. This paper primarily introduces the terminology and definition of MCID and four common methods used to estimate MCID.
ObjectiveTo systematically review the outcomes reported in clinical trials of post-stroke dysarthria.MethodsPubMed, The Cochrane Library, EMbase, CNKI, Sinomed, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) of post-stroke dysarthria from inception to December 6th, 2019. Two reviewers independently screened literature, extracted data and analyzed outcomes using qualitative method.ResultA total of 112 RCTs involving 39 outcomes (therapeutic effect assessment outcomes and safety outcomes) were included. The top 4 outcomes were the Frenchay dysarthria assessment scale, the dysarthria examination method developed by the Chinese rehabilitation center, the evaluation of the speech therapists or clinicians and GRBAS.ConclusionsCurrent evidence shows that there is no acceptable outcomes for post-stroke dysarthria. It is recommended to improve the suitable assessment scale for Chinese to improve quality of studies on post-strohe dysarthria.
Objective To define an objective evaluation model for metadata integrity of randomized controlled trials (RCTs) in traditional Chinese medicine (TCM), and to evaluate the data integrity of RCT reports published in TCM journals. Methods Retrieving Chinese medicine RCT literature and extracting data, using the metadata specification list and customized evaluation model defined in the project "Intelligent Construction and Application Demonstration of the Evidence System of Chinese Medicine Dominant Diseases" to analyze RCTs from the perspective of data integrity. Results A metadata interface specification and an objective evaluation model for RCT metadata integrity were proposed. A total of 37 361 articles of 10 diseases from 1986 to 2020 were evaluated. Among them, 6 743 reports failed to meet the basic requirements of metadata specifications. The proportion of reports with no missing required items was between 73% and 97%. "tcm_disease" and "num_drop_total" had a greater impact on completeness for the required items. The reporting rates of the items in the "age_sd" and "history_sd" in the "group" section, and "dosage", "dosage_form" and "dosage_freq" in the "interventions" section were low. The average score of RCT report was 71.39 points. Conclusions There is room for improvement in the integrity of RCT data in TCM, and data reporting is urgently required to be standardized. The metadata specification and completeness objective evaluation model proposed in this study can provide references for improving the data integrity of clinical trial reports of TCM.
It is a complex and time-consuming process to rate the certainty (quality) of evidence from network meta-analysis. This paper aims to introduce a web application for rating the certainty of network meta-analysis-the CINeMA. CINeMA is based on GRADE framework and contribution matrix of network meta-analysis, which considers 6 domains including within-study bias, across-studies bias, indirectness, imprecision, heterogeneity, and incoherence.
In 2014, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group published guidance in BMJ to evaluate the certainty of the evidence (confidence in evidence, quality of evidence) from network meta-analysis. GRADE working group suggested rating the certainty of direct evidence, indirect evidence, and network evidence, respectively. Recently, GRADE working group has published a series of papers to improve and supplement this approach. This paper introduces the frontiers and advancement of GRADE approach to rate the certainty of evidence from network meta-analysis.
Acute diarrhea has a high incidence in children. Pediatric tuina has been widely used in children with acute diarrhea in China. However, there is no guideline on the treatment of tuina for children with acute diarrhea. This guideline was developed following evidence-based principles and the World Health Organization handbook for guideline development. The linked systematic review was conducted following the Cochrane handbook. The quality of evidence and the strength of recommendations were evaluated using the GRADE approach. The reporting followed the RIGHT statement. Seven clinical questions (2 foreground questions and 5 background questions) were identified by literature review and expert consensus. Based on the linked systematic review and through comprehensive consideration of the balance of benefit and harm, quality of evidence, patient preferences, and other resources, we formulated the recommendations using Delphi expert consensus. We suggested combination of a weak recommendation for tuina with Western medicine usual care to treat children with acute diarrhea. This guideline can be used by clinicians and nurses in the department of traditional Chinese medicine pediatrics, and department of pediatric tuina, and can also be used as a reference for relevant clinicians of Western medicine and is also applicable to all institutions that practice tuina treatment.