A mapping review of randomized controlled trials in the spinal cord injury research literature

Evaluation of quality and quantity of randomized controlled trials in hepatobiliary surgery: A scoping/mapping review

AIM

To evaluate the quantity and quality of randomized controlled trials (RCTs) in hepatobiliary surgery and for identifying gaps in current evidences.

METHODS

A systematic search was conducted in MEDLINE (via PubMed), Web of Science, and Cochrane Controlled Register of Trials (CENTRAL) for RCTs of hepatobiliary surgery published from inception until the end of 2023. The quality of each study was assessed using the Cochrane risk-of-bias (RoB) tool. The associations between risk of bias and the region and publication date were also assessed. Evidence mapping was performed to identify research gaps in the field.

RESULTS

The study included 1187 records. The number and proportion of published randomized controlled trials (RCTs) in hepatobiliary surgery increased over time, from 13 RCTs (.0005% of publications) in 1970-1979 to 201 RCTs (.003% of publications) in 2020-2023. There was a significant increase in the number of studies with a low risk of bias in RoB domains (p < .01). The proportion of RCTs with low risk of bias improved significantly after the introduction of CONSORT guidelines (p < .001). The evidence mapping revealed a significant research focus on major and minor hepatectomy and cholecystectomy. However, gaps were identified in liver cyst surgery and hepatobiliary vascular surgery. Additionally, there are gaps in the field of perioperative management and nutrition intervention.

CONCLUSION

The quantity and quality of RCTs in hepatobiliary surgery have increased over time, but there is still room for improvement. We have identified gaps in current research that can be addressed in future studies.

Comprehensive and Visualized Analysis of Interventional Clinical Trials of Spinal Cord Injury in the Past Two Decades: A Bibliometric Study

OBJECTIVE

The aim of this study was to provide a bibliometric analysis of reported clinical trials of interventional spinal cord injury (SCI) and present the current status, global trends, and scholars' knowledge in this field.

METHODS

Data were obtained from PubMed and Web of Science (WOS) Core Collection. A literature screening process was conducted to select reports of interventional SCI clinical trials. Qualitative and quantitative analysis was performed based on information from the WOS database. Co-occurrence analysis of keywords, collaboration analysis, and co-citation analysis were performed using VOSviewer.

RESULTS

A total of 849 articles were selected for analysis. Therapeutic strategies in the articles were classified into 10 subgroups. Locomotor training, local complication-related treatments, and neuromodulation are the top 3 subgroups. Spinal Cord was the most productive and most frequently cited journal in SCI clinical trials. The most productive country, institution, and author are the United States, the University of Miami, and Harvey LA, respectively. The collaboration network analysis shows that researchers and institutions from the United States, Canada, the United Kingdom, and Australia were the pivotal driving forces in this field. Spinal cord injury, rehabilitation, individuals, electrical stimulation, and exercise are the top 5 most frequent keywords. The co-citation analysis shows that the most frequently cited references are all international standards and guidelines of SCI clinical trials.

CONCLUSIONS

There is a broad research collaboration network, although it is distributed unevenly worldwide. International standards and guidelines are needed to conduct high-quality clinical trials in the future.

Developing spinal cord injury physiotherapy clinical practice guidelines: a qualitative study to determine how physiotherapists and people living with spinal cord injury use evidence

STUDY DESIGN

Generic qualitative design.

OBJECTIVES

Australian and New Zealand SCI physiotherapists are developing clinical practice guidelines for the physiotherapy management of people living with spinal cord injury. To guide the development of the guidelines it was important to understand how physiotherapists and people living with spinal cord injury use evidence to choose interventions and the potential barriers and facilitators to the uptake of the clinical practice guidelines.

SETTING

Spinal Cord Injury Centres in Sydney, Australia and New Zealand.

METHODS

Focus groups and interviews with physiotherapists and people living with spinal cord injury were recorded, transcribed, and subjected to thematic analysis.

RESULTS

A total of 75 participants took part in the study, 45 physiotherapists and 30 people living with spinal cord injury. Three main themes were identified from the data: (1) Types and sources of evidence that influence treatment choices, (2) the many factors determining treatment choices, and (3) ways in which clinical practice guidelines could influence treatment.

CONCLUSIONS

Clinical practice guidelines have the potential to reduce the barriers identified by physiotherapists in accessing and interpreting research evidence on interventions for people living with spinal cord injury. Supported implementation of guidelines is required to demonstrate their benefit and encourage physiotherapists to factor in evidence when balancing the multiple factors influencing choice of physiotherapy intervention.

Systematic reviews in spinal cord injury: A step-by-step guide for rehabilitation science learners and clinicians

BACKGROUND

The COVID-19 pandemic has created opportunity for multiple rehabilitation science learners and clinicians to critically evaluate and synthesize published research in the field of spinal cord injury (SCI) rehabilitation.

OBJECTIVE

To provide a step-by-step guide for rehabilitation science learners and clinicians outlining how to conduct rigorous systematic reviews in the field of SCI.

RESULTS

Steps for conducting a systematic review (SR) include: (1) formation of the SR team consisting of interprofessional experts; (2) formulation of the research question(s) with patient/population/problem, Intervention, Comparison, and Outcome (PICO) specification; (3) determination of inclusion and exclusion criteria; (4) development of SR protocol and registration; (5) development of the search strategies (database specific); (6) screening of titles and abstracts (level 1 screening), and full-texts (level 2 screening); (7) quality assessment of the included studies; (8) data extraction; (9) summary of findings and discussion; and, (10) dissemination of results.

CONCLUSIONS

The enclosed ten steps for conducting SRs in SCI rehabilitation research have the potential to significantly improve the quality of evidence synthesis and the associated inferences. The importance of assembling team with diverse expertise is emphasized to assure a quality product with the potential to influence practice and inform the content of clinical practice recommendations.

Impact of interprofessional collaboration on chronic disease management: Findings from a systematic review of clinical trial and meta-analysis

Improvement of chronic disease management demands effective collaborative relationships between health and social-care which is achieved through teamwork. Interprofessional Education (IPE) and Interprofessional Collaboration (IPC) are recognized as essential for the delivery of effective and efficient healthcare. Although IPC and IPE are key components of primary care, evidence of studies evaluating how an IPE intervention prior to IPC improved chronic patient outcomes remains scarce. The aim of this study was to assess the impact of IPC interventions on the management of chronic patients compared to usual care. A systematic review and meta-analysis of Randomized Controlled Trials (RCTs) on IPC interventions on chronicity management and their impact on clinical and process outcomes was conducted. Of the 11,128 papers initially retrieved, 23 met the inclusion criteria. Meta-analyses results showed the reduction of systolic blood pressure (Mean Difference (MD) -3.70; 95 % CI -7.39, -0.01), glycosylated hemoglobin (MD -0.20; 95 % CI -0.47, -0.07), LDL cholesterol (MD -5.74; 95 % CI -9.34, -2.14), diastolic blood pressure (MD -1.95; 95 % CI -3.18, -0.72), days of hospitalization (MD -2.22; 95 % CI -4.30, -0.140). A number of positive findings for outcomes related to IPC were found reflecting an improvement of quality of care and an enhancement in the delivery of patient-centered and coordinated care. Moreover, the need for a purposeful systemic approach linking interprofessional education with interprofessional collaboration and patient health and wellbeing is necessary.

Traumatic Spine Injury: Which Discrepancy Between the Research Output and the Actual Burden of the Disease?

OBJECTIVE

Traumatic spinal injury (TSI) is a global health issue contributing to morbidity and mortality, especially in low- and middle-income countries. The aim of this study is to compare the epidemiological estimates of TSI with the corresponding amount of published papers for different regions.

METHODS

A bibliometric analysis was performed by collecting the number of publications concerning TSI from the PubMed database. Results were sorted according to the different geographical World Health Organization regions. A "publication-to-volume ratio" was obtained by comparing the average number of documents per year with the number of TSI cases across each region.

RESULTS

A total of 2304 articles were detected from 2008 to 2018. The major publishing regions were North America (AMR-US/Can: 843 articles, 36.6%) and Europe (EUR: 833, 36.2%), then Western Pacific (WPR: 410, 17.8%), Eastern Mediterranean (EMR: 73, 3.2%), South-East Asia (SEAR: 71, 3.1%), Latin America (AMR-L: 55, 2.4%), Africa (AFR: 19, 0.8%). The United States is the most publishing country in AMR-US/Can (86.0%), and Germany in EUR (22.4%). In 2018, EUR published 36.6% of papers versus AMR-US/Can 26.5% and WPR 25.7%, thanks to an increase in Chinese publications. The highest publication ratios of 4.63 and 2.68 were found for AMR-US/Can and EUR, respectively. The other were EMR (0.22), WPR (0.18), AMR-L (0.07), SEAR (0.03), and AFR (0.01).

CONCLUSIONS

A marked divide is currently found between countries with a high burden of TSI and those where there is most research interest, estimated as amount of publications. Data demonstrate the need for increased inclusiveness in guidelines generation from high-income countries including collection and analysis from low- and middle-income countries.

Work and SCI: a pilot randomized controlled study of an online resource for job-seekers with spinal cord dysfunction

STUDY DESIGN

A prospective, parallel randomized controlled trial (RCT).

OBJECTIVES

To test the preliminary effects of an online resource targeted to job-seekers with spinal cord injury or disorder (SCI/D), and to determine the feasibility of proceeding to a full-scale RCT.

SETTING

A community cohort in Australia.

METHODS

Forty-eight adults (M = 42 years, SD = 10.95, 27 males) were randomized to receive 4-weeks access to the Work and SCI resource (n = 25) or to a wait-list control group (n = 23). The Work and SCI intervention involved six stand-alone learning modules which provided job-searching and career-planning information through text, videos, and interactive activities. Self-report measures were administered at baseline and after 4 weeks: Job Procurement Self-Efficacy Scale (JSES), Life Orientation Test-Revised (LOT-R), and Patient Health Questionnaire-9 (PHQ-9).

RESULTS

Online usage data identified high uptake of the Work and SCI resource, although study attrition was problematic. Intention-to-treat analyses failed to reach statistical significance, whereas complete data revealed a significant interaction effect for optimism (LOT-R).

CONCLUSION

Further research to develop and enhance Work and SCI is indicated. Remediable strategies to optimize recruitment and statistical power in a future definitive RCT are discussed.

SPONSORSHIP

This project was funded by the auDA Foundation (project 16019).