Do we need to improve the reporting of evidence in tendinopathy management? A critical appraisal of systematic reviews with recommendations on strength of evidence assessment

Abstract

Objective: To critically appraise the quality of published systematic reviews (SRs) of randomised controlled trials (RCTs) in tendinopathy with regard to handling and reporting of results with special emphasis on strength of evidence assessment.

Data sources: Medline from inception to June 2020.

Study eligibility: All SRs of RCTs assessing the effectiveness of any intervention(s) on any location of tendinopathy.

Data extraction and synthesis: Included SRs were appraised with the use of a 12-item tool devised by the authors arising from the Preferred Reporting Items in Systematic Reviews and Meta-Analyses statement and other relevant guidance. Subgroup analyses were performed based on impact factor (IF) of publishing journals and date of publication.

Results: A total of 57 SRs were included published in 38 journals between 2006 and 2020. The most commonly used risk-of-bias (RoB) assessment tool and strength of evidence assessment tool were the Cochrane Collaboration RoB tool and the Cochrane Collaboration Back Review Group tool, respectively. The mean score on the appraisal tool was 46.5% (range 0%-100%). SRs published in higher IF journals (>4.7) were associated with a higher mean score than those in lower IF journals (mean difference 26.4%±8.8%, p=0.004). The mean score of the 10 most recently published SRs was similar to that of the first 10 published SRs (mean difference 8.3%±13.7%, p=0.54). Only 23 SRs (40%) used the results of their RoB assessment in data synthesis and more than half (n=30; 50%) did not assess the strength of evidence of their results. Only 12 SRs (21%) assessed their strength of evidence appropriately.

Conclusions: In light of the poor presentation of evidence identified by our review, we provide recommendations to increase transparency and reproducibility in future SRs.

Keywords: evidence based review; tendinopathy; tendon.

Figure 1

PRISMA flow diagram of included studies. PRISMA, Preferred Reporting Items in Systematic Reviews and Meta-Analyses.

Figure 2

Subgroup analyses comparing the mean scores of reviews published in a higher versus a lower impact factor (IF) journals. Those published in higher if journals (>4.7; n=10) had a significantly higher mean score than those (n=47) in lower if journals (68.3% vs 41.8%, difference 26.5%±8.8%, p=0.004) (A). The first 10 published SRs (2006–2012) had a slightly lower mean score (48.3%) than the 10 most recently published ones (2019–2020; 56.6%) with a statistically insignificant difference (8.3%±13.7%, p=0.54; B). SRs, systematic reviews.