Design characteristics of comparative effectiveness trials for the relief of symptomatic dyspepsia: A systematic review

Use of the pragmatic-explanatory continuum indicator summary tool in low- and middle-income country settings: systematic review

OBJECTIVES

To systematically review and characterize the literature on using the pragmatic-explanatory continuum indicator summary (PRECIS) tools in low- and middle-income countries (LMICs), focusing on successes, challenges, and potential improvements to enhance applicability across diverse settings.

STUDY DESIGN AND SETTING

A systematic search of PubMed to identify peer-reviewed articles applying PRECIS tools to LMIC-based research. Data extraction focused on trial characteristics, modifications, and use of PRECIS tools. Narrative synthesis was used to outline successes, challenges, and recommendations.

RESULTS

A total of 40 articles met the selection criteria. The PRECIS tools were mostly (n = 39, 97.5%) used for purposes other than trial design. Significant variation was seen in methods of use and reporting. Most (n = 32, 80%) used PRECIS-2, valued for its reliability, ability to quantify pragmatism, assess trial design, and identify research gaps. Challenges included the tools' subjectivity, absence of information needed for scoring, interpretation of scores, and application to non-Western contexts and multinational trials. Recommendations for improvement included refining scoring criteria, translating guidance, and developing additional educational resources.

CONCLUSION

The PRECIS tools have successfully supported research globally and are perceived as reliable research tools with multiple strengths. Further guidance and refinement would enable consistent application and reporting, particularly as the tools have frequently been used for purposes other than their original intention. Most challenges were similar to high-income settings; however, translation and application of the tools to traditional medicine, international trials, and research-naïve settings were highlighted as LMIC-focused issues requiring consideration.

PLAIN LANGUAGE SUMMARY

The pragmatic-explanatory continuum indicator summary (PRECIS) tools were created to help researchers design better studies. The tools were developed mainly by researchers from developed Western nations. Therefore, it is possible that the PRECIS tools are not as relevant to other places. To help improve the usefulness of the tools in all settings, our team wanted to learn from the experiences of people who had already used PRECIS in low- and middle-income countries. We systematically searched for academic papers on this topic published before May 2022 and found 40 relevant articles. The articles showed that the PRECIS tools had been successfully used in many, often unexpected, ways to support research. Some researchers struggled with using the tool to assess research conducted by others, as relevant information was not available. Researchers recommended translating the tools to other languages and asked for more guidance to use the tool in specific circumstances, such as Chinese herbal medicine and large international research projects. Advice on the best ways to use the PRECIS tools and report the findings would also be beneficial. We share these findings to help those designing the next version of the tool make it useful for researchers working in all parts of the world.

Comments, suggestions, and criticisms of the Pragmatic Explanatory Continuum Indicator Summary-2 design tool: a citation analysis

INTRODUCTION

The pragmatic explanatory continuum indicator summary (PRECIS) tool, initially published in 2009 and revised in 2015, was created to assist trialists to align their design choices with the intended purpose of their randomised controlled trial (RCT): either to guide real-world decisions between alternative interventions (pragmatic) or to test hypotheses about intervention mechanisms by minimising sources of variation (explanatory). There have been many comments, suggestions, and criticisms of PRECIS-2. This summary will be used to facilitate the development of to the next revision, which is PRECIS-3.

METHODS

We used Web of Science to identify all publication types citing PRECIS-2, published between May 2015 and July 2023. Citations were eligible if they contained 'substantive' suggestions, comments, or criticism of the PRECIS-2 tool. We defined 'substantive' as comments explicitly referencing at least one PRECIS-2 domain or a concept directly linked to an existing or newly proposed domain. Two reviewers independently extracted comments, suggestions, and criticisms, noting their implications for the update. These were discussed among authors to achieve consensus on the interpretation of each comment and its implications for PRECIS-3.

RESULTS

The search yielded 885 publications, and after full-text review, 89 articles met the inclusion criteria. Comments pertained to new domains, changes in existing domains, or were relevant across several or all domains. Proposed new domains included assessment of the comparator arm and a domain to describe blinding. There were concerns about scoring eligibility and recruitment domains for cluster trials. Suggested areas for improvement across domains included the need for more scoring guidance for explanatory design choices.

DISCUSSION

Published comments recognise PRECIS-2's success in aiding trialists with pragmatic or explanatory design choices. Enhancing its implementation and widespread use will involve adding new domains, refining domain definitions, and addressing overall tool issues. This citation review offers valuable user feedback, pivotal for shaping the upcoming version of the PRECIS tool, PRECIS-3.