Most healthcare interventions tested in Cochrane Reviews are not effective according to high quality evidence: a systematic review and meta-analysis.
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BORIS DOI
Publisher DOI
PubMed ID
35447356
Description
OBJECTIVE
To estimate the proportion of healthcare interventions tested within Cochrane Reviews that are effective according to high-quality evidence.
STUDY DESIGN AND SETTING
We selected a random sample of 2428 (35%) of all Cochrane Reviews published between 1 January 2008 and 5 March 2021. We extracted data about interventions within these reviews that were compared with placebo, or no treatment, and whose outcome quality was rated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). We calculated the proportion of interventions whose effectiveness was based on high-quality evidence according to GRADE, had statistically significant positive effects, and were judged as beneficial by the review authors. We also calculated the proportion of interventions that suggested harm.
RESULTS
Of 1567 eligible interventions, 87 (5.6%) had high quality evidence on first-listed primary outcomes, positive, statistically significant results and were rated by review authors as beneficial. Harms were measured for 577 (36.8%) interventions, 127 of which (8.1%) had statistically significant evidence of harm. Our dependence on the reliability of Cochrane author assessments (including their GRADE assessments) was a potential limitation of our study.
CONCLUSION
Most healthcare interventions studied within recent Cochrane Reviews are not supported by high quality evidence, and harms are under-reported.
To estimate the proportion of healthcare interventions tested within Cochrane Reviews that are effective according to high-quality evidence.
STUDY DESIGN AND SETTING
We selected a random sample of 2428 (35%) of all Cochrane Reviews published between 1 January 2008 and 5 March 2021. We extracted data about interventions within these reviews that were compared with placebo, or no treatment, and whose outcome quality was rated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). We calculated the proportion of interventions whose effectiveness was based on high-quality evidence according to GRADE, had statistically significant positive effects, and were judged as beneficial by the review authors. We also calculated the proportion of interventions that suggested harm.
RESULTS
Of 1567 eligible interventions, 87 (5.6%) had high quality evidence on first-listed primary outcomes, positive, statistically significant results and were rated by review authors as beneficial. Harms were measured for 577 (36.8%) interventions, 127 of which (8.1%) had statistically significant evidence of harm. Our dependence on the reliability of Cochrane author assessments (including their GRADE assessments) was a potential limitation of our study.
CONCLUSION
Most healthcare interventions studied within recent Cochrane Reviews are not supported by high quality evidence, and harms are under-reported.
Date of Publication
2022-08
Publication Type
article
Subject(s)
600 - Technology::610 - Medicine & health
Keyword(s)
Evidence epidemiology harm quality safety systematic review
Language(s)
en
Contributor(s)
Howick, Jeremy | |
Koletsi, Despina | |
Ioannidis, John P A | |
Madigan, Claire | |
Loef, Martin | |
Walach, Harald | |
Sauer, Sebastian | |
Kleijnen, Jos | |
Seehra, Jadbinder | |
Johnson, Tess | |
Schmidt, Stefan |
Additional Credits
Zahnmedizinische Kliniken, Klinik für Kieferorthopädie
Series
Journal of clinical epidemiology
Publisher
Elsevier
ISSN
0895-4356
Access(Rights)
open.access