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Hwang NM, Samuel JT, Thompson AA, Mayfield CK, Abu-Zahra MS, Kotlier JL, Petrigliano FA, Liu JN. Reporting Bias in the Form of Positive Spin Is Highly Prevalent in Abstracts of Systematic Reviews on Primary Repair of the Anterior Cruciate Ligament. Arthroscopy 2024:S0749-8063(23)01022-8. [PMID: 38171422 DOI: 10.1016/j.arthro.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/04/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE To analyze reporting bias in the form of spin present in systematic reviews and meta-analyses on the topic of primary anterior cruciate ligament (ACL) repair. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed throughout this study. Peer-reviewed systematic reviews were collected from 3 databases (PubMed, Scopus, and SPORTDiscus), and their abstracts were assessed for the 15 most common types of spin. Articles were excluded if they were not published in English, had no evidence, were retracted, were published without an abstract, did not have full text available, or included cadaveric or nonhuman subjects. Full text quality was assessed using AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews Version 2). Fisher exact tests were used to examine associations between the different types of spin and other study characteristics such as AMSTAR 2 confidence rating, study design, and level of evidence. RESULTS Spin was present in the abstracts of 13 of 15 articles (86.7%). There were significant associations between PRISMA adherence and lower incidences of spin types 3, 6, and 8 (P = .029 for each). A critically low AMSTAR 2 confidence rating was significantly associated with an increased incidence of spin type 9 (P = .01), and a higher AMSTAR 2 score was significantly associated with decreased spin type 4 and type 5 (P = .039 and P = .048, respectively). A more recent year of publication was correlated with a lower incidence of spin type 14 (P = .044). CONCLUSIONS Spin is present in most systematic reviews and meta-analyses regarding primary repair of the ACL, with two-thirds of abstracts spinning evidence in favor of ACL repair. Standardized guidelines including the PRISMA guidelines and the AMSTAR 2 assessment tool were negatively correlated with spin. More recently published articles were found to contain significantly less spin, as were articles published in journals with higher Clarivate Impact Factors and Scopus CiteScores. LEVEL OF EVIDENCE Level V, systematic review of Level III through V studies.
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Affiliation(s)
- N Mina Hwang
- University of Southern California Epstein Family Center for Sports Medicine at Keck Medicine of University of Southern California, Los Angeles, California, U.S.A
| | - Justin T Samuel
- City University of New York School of Medicine, New York, New York, U.S.A
| | - Ashley A Thompson
- University of Southern California Epstein Family Center for Sports Medicine at Keck Medicine of University of Southern California, Los Angeles, California, U.S.A
| | - Cory K Mayfield
- University of Southern California Epstein Family Center for Sports Medicine at Keck Medicine of University of Southern California, Los Angeles, California, U.S.A
| | - Maya S Abu-Zahra
- University of Southern California Epstein Family Center for Sports Medicine at Keck Medicine of University of Southern California, Los Angeles, California, U.S.A
| | - Jacob L Kotlier
- University of Southern California Epstein Family Center for Sports Medicine at Keck Medicine of University of Southern California, Los Angeles, California, U.S.A
| | - Frank A Petrigliano
- University of Southern California Epstein Family Center for Sports Medicine at Keck Medicine of University of Southern California, Los Angeles, California, U.S.A..
| | - Joseph N Liu
- University of Southern California Epstein Family Center for Sports Medicine at Keck Medicine of University of Southern California, Los Angeles, California, U.S.A
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Wang D, Wang L, Tong X, Liu S, Fan H, Zhang Y. Spin in the abstracts of randomized controlled trials of nurse-led care: A cross-sectional study. Int J Nurs Stud 2023; 145:104543. [PMID: 37451071 DOI: 10.1016/j.ijnurstu.2023.104543] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 05/26/2023] [Accepted: 05/26/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Nurse-led models of care had been reported as effective intervention approaches for improving health management and reducing hospitalizations of target patients in a number of studies. However, the reporting quality of studies in the field varied and there was a lack of literature evaluation. OBJECTIVE The objective of the study was to assess the reporting quality and spin of abstracts of published randomized controlled trials which had statistically not significant primary outcomes. Moreover, potential factors associated with the presence of spin were also assessed. METHODS Studies on nurse-led care were retrieved from PubMed from January 1st, 2017, to December 31st, 2021. Only randomized controlled trials with statistically not significant primary outcomes were included. Study screening and data extraction were carried out by two reviewers independently. The reporting quality of each abstract was evaluated by the Consolidated Standards of Reporting Trials statement, and spin strategies were analyzed using a pre-designed assessment form. Potential predictors for the presence of spin were analyzed by multivariate logistic regressions. RESULTS The overall reporting quality of the included 75 randomized controlled trial abstracts was not satisfying, with a median score of 16-item Consolidated Standards of Reporting Trials statement at 6 (IQR 5, 8). Forty abstracts used at least one spin strategy in abstracts. Among them, 18 (45.0 %) used spin strategies in the result section and 39 (97.5 %) had spin in the conclusion section. The most common spin strategy identified in abstracts was focusing on statistically significant secondary outcomes (12/40, 30.0 %) in the result section and claiming benefit with no consideration of statistically not significant results for the primary outcomes (32/40, 80.0 %) in the conclusion section. Based on the definition, 29 (72.5 %) abstracts were assessed to have high level of spin in the conclusions of abstracts. By multivariate logistic regression analyses, it was found that only geographic origin (reference: studies from Asian countries, OR = 0.118, 95 % CI 0.027 to 0.511, P = 0.004) and the Consolidated Standards of Reporting Trials statement score (reference: lower score, OR = 0.625, 95 % CI 0.470 to 0.829, P = 0.001) were significantly associated with the presence of spin in abstracts. CONCLUSION Among the randomized controlled trials with statistically not significant primary outcomes in the field of nurse-led care, the reporting quality of abstracts needs to be improved. Trials from Asian countries and with lower Consolidated Standards of Reporting Trials statement scores are more likely to present spin in abstracts. Findings reported in the result and conclusion sections of these abstracts need to be interpreted with caution.
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Affiliation(s)
- Dongguang Wang
- Department of Respiratory and Critical Care Medicine and National Clinical Research Center for Geriatrics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Lian Wang
- Department of Respiratory and Critical Care Medicine and National Clinical Research Center for Geriatrics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Xiang Tong
- Department of Respiratory and Critical Care Medicine and National Clinical Research Center for Geriatrics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Sitong Liu
- Department of Respiratory and Critical Care Medicine and National Clinical Research Center for Geriatrics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Hong Fan
- Department of Respiratory and Critical Care Medicine and National Clinical Research Center for Geriatrics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu 610041, China.
| | - Yonggang Zhang
- Department of Periodical Press and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, China; Nursing Key Laboratory of Sichuan Province and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, China; Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China.
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Muthu S, Chellamuthu G, Hathwar KSK, Ramakrishnan E, Dakshinamoorthy AP, Jeyaraman M. Analysis of Spin in RCTs of Spine Surgery Using ORG-LOC Grading Tool. Indian J Orthop 2022; 56:1882-1890. [PMID: 36310551 PMCID: PMC9561437 DOI: 10.1007/s43465-022-00697-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/18/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Even in highly credible research models, such as randomised control trials (RCTs), many pitfalls do exist that a practitioner must be aware of, to get the actual sense of the research. The one such pitfall that is much more common but ironically less explored is the Writers' bias or the spin. Particularly in the abstracts, it is a potential source of deception to the readers. METHODS We selected 250 recent RCTs from the top 5 spine journals. Baseline data and CONSORT Adherence Score (CAS) were collected. Abstracts of the RCTs were graded using the level of confidence (LOC) grading tool developed by the Orthopaedic Research Group. All possible associations of spin were studied to assess the significance. RESULTS The median CAS was 11 (IQR 10-12). Only 47.6% (n = 119) articles had High LOC with no or one non-critical spin in abstract. 12.4% (n = 31) had Moderate LOC and 28% (n = 70) had Low LOC. The rest had Critically Low LOC with more than one critical spin. Of the variables analyzed in multivariate regression analysis, only CAS had a (negative) correlation with the LOC of the abstracts. CONCLUSIONS Spin-based grading of RCTs is the need of the hour to aid readers to interpret the true essence of research papers. 40% of the RCTs in top spine journals had low to critically low LOC. Objective structuring of abstracts with adherence to CONSORT guidelines is the way forward to prevent spin.
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Affiliation(s)
- Sathish Muthu
- grid.512630.3Orthopaedic Research Group, Coimbatore, Tamil Nadu India
| | | | - K. S. Karthika Hathwar
- grid.415029.b0000 0004 1765 9100Department of Orthopaedics, Karnataka Institute of Medical Sciences, Hubli, Karnataka India
| | | | | | - Madhan Jeyaraman
- grid.512630.3Orthopaedic Research Group, Coimbatore, Tamil Nadu India
- grid.444354.60000 0004 1774 1403Department of Orthopaedics, Faculty of Medicine, Sri Lalithambigai Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, Tamil Nadu India
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Kim MS, Hasan LK, Fathi A, Hasan SK, Haratian A, Bolia IK, Petrigliano FA, Weber AE, Gamradt SC, Liu JN. Evaluation of spin in systematic reviews and meta-analyses of superior capsular reconstruction. J Shoulder Elbow Surg 2022; 31:1743-1750. [PMID: 35472573 DOI: 10.1016/j.jse.2022.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Small, preliminary studies and the systematic reviews on superior capsular reconstruction (SCR) that collate data are at increased risk spin. This study's primary objective was to identify, describe, and account for the incidence of spin in systematic reviews of SCR. This study's secondary objective was to characterize the studies in which spin was identified to determine whether identifiable patterns of characteristics exist among studies with spin. METHODS This study was conducted per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using a predetermined protocol. A search was conducted on the PubMed and Embase databases for systematic reviews and meta-analyses on SCR. Screening and data extraction were conducted independently by 2 authors. Each included study's abstract was assessed for the presence of the 15 most common types of spin, with full texts reviewed during cases of disagreement or for clarification. General data that were extracted included study title, authors, publication year, journal, level of evidence, study design, funding source, reported adherence to PRISMA guidelines, preregistration of the study protocol, and primary and secondary outcome measures. Full texts were used in the assessment of study quality per AMSTAR 2. RESULTS We identified 53 studies during our search, of which 17 met the inclusion criteria. At least 1 form of spin was observed in all 17 studies. The most common types of spin were type 5 ("The conclusion claims the beneficial effect of the experimental treatment despite a high risk of bias in primary studies") and type 9 ("Conclusion claims the beneficial effect of the experimental treatment despite reporting bias"), both of which were observed in 11 studies (11 of 17, 65%). A statistically significant association between lower level of evidence and type 5 ("The conclusion claims the beneficial effect of the experimental treatment despite a high risk of bias in primary studies") was observed (P = .0175). A statistically significant association was also found between more recent year of publication and the spin category misleading interpretation (P = .0398), and between lower AMSTAR 2 score and type 13 ("Failure to specify the direction of the effect when it favors the control intervention") (P = .0260). No other statistical associations between other study characteristics were observed. CONCLUSION Spin is highly prevalent in abstracts of SCR systematic reviews and meta-analyses. An association was found between the presence of spin and lower level of evidence, year of publication, and AMSTAR 2 ratings.
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Affiliation(s)
- Michael S Kim
- USC Epstein Family Center for Sports Medicine, Department of Orthopaedic Surgery, Keck Medicine of USC, Los Angeles, CA, USA
| | - Laith K Hasan
- USC Epstein Family Center for Sports Medicine, Department of Orthopaedic Surgery, Keck Medicine of USC, Los Angeles, CA, USA
| | - Amir Fathi
- USC Epstein Family Center for Sports Medicine, Department of Orthopaedic Surgery, Keck Medicine of USC, Los Angeles, CA, USA
| | - Shurooq K Hasan
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, MD, USA
| | - Aryan Haratian
- USC Epstein Family Center for Sports Medicine, Department of Orthopaedic Surgery, Keck Medicine of USC, Los Angeles, CA, USA
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine, Department of Orthopaedic Surgery, Keck Medicine of USC, Los Angeles, CA, USA
| | - Frank A Petrigliano
- USC Epstein Family Center for Sports Medicine, Department of Orthopaedic Surgery, Keck Medicine of USC, Los Angeles, CA, USA
| | - Alexander E Weber
- USC Epstein Family Center for Sports Medicine, Department of Orthopaedic Surgery, Keck Medicine of USC, Los Angeles, CA, USA
| | - Seth C Gamradt
- USC Epstein Family Center for Sports Medicine, Department of Orthopaedic Surgery, Keck Medicine of USC, Los Angeles, CA, USA
| | - Joseph N Liu
- USC Epstein Family Center for Sports Medicine, Department of Orthopaedic Surgery, Keck Medicine of USC, Los Angeles, CA, USA.
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