Compared to what? An analysis of comparators in trials informing the National Institute of Clinical Excellence (NICE) low back pain guideline.
Clinical practice guidelines
Comparator bias
Low back pain
Sciatica
Journal
Brazilian journal of physical therapy
ISSN: 1809-9246
Titre abrégé: Braz J Phys Ther
Pays: Brazil
ID NLM: 101615124
Informations de publication
Date de publication:
14 Nov 2023
14 Nov 2023
Historique:
received:
24
01
2023
revised:
04
10
2023
accepted:
05
11
2023
medline:
19
11
2023
pubmed:
19
11
2023
entrez:
19
11
2023
Statut:
aheadofprint
Résumé
Low back pain (LBP) is the leading cause of disability globally. Clinical practice guidelines (CPGs) have been developed in hopes of encouraging evidence-based care for LBP. However, poor quality of trials that underpin CPGs can lead to misleading recommendations for LBP. To categorize the comparator used in trials included in the National Institute of Clinical Excellence (NICE) LBP CPG and describe the proportion and association of suboptimal comparators with NICE recommendation. We conducted a cross-sectional analysis to describe the proportion of trials included in the NICE LBP CPG that used a suboptimal comparator. If comparators used an ineffective treatment, a treatment of unknown effectiveness, or no or minimal treatment then they were considered suboptimal. We included 408 trials and analyzed 580 comparators used in the trials. 30.9% of the comparators used in the trials were suboptimal. Trials testing invasive treatments (32.4%) had the highest proportion of suboptimal comparators followed by non-surgical (32.3%) and pharmacological (19.0%) treatments. Trials using suboptimal treatments were less likely to have their treatment recommended (odds ratio: 0.68; 95% CI: 0.47, 0.98) for use by NICE. There is a concerning proportion of suboptimal comparators used in LBP trials that may be misleading CPG recommendations, funding allocation decisions, and ultimately clinical practice. Efforts to increase the use of optimal comparators in LBP trials are urgently needed to better understand what treatments should be recommended.
Sections du résumé
BACKGROUND
BACKGROUND
Low back pain (LBP) is the leading cause of disability globally. Clinical practice guidelines (CPGs) have been developed in hopes of encouraging evidence-based care for LBP. However, poor quality of trials that underpin CPGs can lead to misleading recommendations for LBP.
OBJECTIVES
OBJECTIVE
To categorize the comparator used in trials included in the National Institute of Clinical Excellence (NICE) LBP CPG and describe the proportion and association of suboptimal comparators with NICE recommendation.
METHODS
METHODS
We conducted a cross-sectional analysis to describe the proportion of trials included in the NICE LBP CPG that used a suboptimal comparator. If comparators used an ineffective treatment, a treatment of unknown effectiveness, or no or minimal treatment then they were considered suboptimal.
RESULTS
RESULTS
We included 408 trials and analyzed 580 comparators used in the trials. 30.9% of the comparators used in the trials were suboptimal. Trials testing invasive treatments (32.4%) had the highest proportion of suboptimal comparators followed by non-surgical (32.3%) and pharmacological (19.0%) treatments. Trials using suboptimal treatments were less likely to have their treatment recommended (odds ratio: 0.68; 95% CI: 0.47, 0.98) for use by NICE.
CONCLUSION
CONCLUSIONS
There is a concerning proportion of suboptimal comparators used in LBP trials that may be misleading CPG recommendations, funding allocation decisions, and ultimately clinical practice. Efforts to increase the use of optimal comparators in LBP trials are urgently needed to better understand what treatments should be recommended.
Identifiants
pubmed: 37980717
pii: S1413-3555(23)00084-9
doi: 10.1016/j.bjpt.2023.100563
pmc: PMC10692652
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
100563Informations de copyright
Copyright © 2023 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier España, S.L.U. All rights reserved.
Références
BMC Health Serv Res. 2020 Oct 22;20(1):970
pubmed: 33092579
J R Soc Med. 2013 Jan;106(1):30-3
pubmed: 23358277
BMC Med Res Methodol. 2022 Jul 5;22(1):184
pubmed: 35790902
Trials. 2016 Aug 17;17(1):406
pubmed: 27530915
J Clin Epidemiol. 2009 Oct;62(10):1021-30
pubmed: 19282144
JAMA Oncol. 2019 Jun 01;5(6):887-892
pubmed: 31046071
Lancet. 2018 Jun 9;391(10137):2356-2367
pubmed: 29573870
J Clin Epidemiol. 2008 Apr;61(4):344-9
pubmed: 18313558