Background and PurposeThe methodological quality of randomized controlled trials (RCTs) is commonly evaluated in order to assess the risk of biased estimates of treatment effects. The purpose of this systematic review was to identify scales used to evaluate the methodological quality of RCTs in health care research and summarize the content, construction, development, and psychometric properties of these scales. MethodsExtensive electronic database searches, along with a manual search, were performed. ResultsOne hundred five relevant studies were identified. They accounted for 21 scales and their modifications. The majority of scales had not been rigorously developed or tested for validity and reliability. The Jadad Scale presented the best validity and reliability evidence; however, its validity for physical therapy trials has not been supported. Discussion and ConclusionMany scales are used to evaluate the methodological quality of RCTs, but most of these scales have not been adequately developed and have not been adequately tested for validity and reliability. A valid and reliable scale for the assessment of the methodological quality of physical therapy trials needs to be developed. T he medical literature is an important resource to guide clinical decision making and research. The evaluation of the methodological quality of studies is an essential step in the process of selecting the best clinical literature. According to Verhagen et al, 1 assessment of methodological quality involves evaluation of internal validity (the degree to which a study's design, conduct, and analysis have minimized biases) and external validity (the extent to which the results of a study can be generalized outside the experimental situation) as well as statistical analysis of primary research. Taken together, these validity constructs are important in determining the methodological quality of primary research. Khan et al 2 pointed out that some reasons for performing quality assessment include: to determine a minimum quality threshold for the selection of the primary studies for a systematic review; to explore differences in quality as an explanation for heterogeneity in study results; to weigh the results in proportion to the quality in metaanalysis; and, more importantly, to guide interpretation of findings, help determine the strength of inferences, and guide recommendations for future research and clinical practice.The assessment of the quality of controlled trials is essential because variations in the quality of trials can affect the conclusions about the existing evidence. 3 In a review of trials evaluating primarily medical treatments, Moher and colleagues 4,5 demonstrated that trials that did not include features such as blinding and allocation concealment tended to report an exaggerated treatment effect compared with trials that did include these features. These facts emphasize the importance of methodological quality assessment in order to provide accurate information on therapeutic effects.Trial quality can be divided ...
results of this study suggest that motor control exercises and graded activity have similar effects for patients with chronic nonspecific low back pain.
People with chronic pain commonly report impaired cognitive function. However, to date, there has been no systematic evaluation of the body of literature concerning cognitive impairment and pain. Nor have modern meta-analytical methods been used to verify and clarify the extent to which cognition may be impaired. The objective of this study was to systematically evaluate and critically appraise the literature concerning working memory function in people with chronic pain. The study was conducted along Cochrane collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. A sensitive search strategy was designed and conducted with the help of an expert librarian using 6 databases. Twenty-four observational studies evaluating behavioural and/or physiological outcomes in a chronic pain group and a control group met the inclusion criteria. All studies had a high risk of bias, owing primarily to lack of assessor blinding to outcome. High heterogeneity within the field was found with the inclusion of 24 papers using 21 different working memory tests encompassing 9 different working memory constructs and 9 different chronic pain populations. Notwithstanding high heterogeneity, pooled results from behavioural outcomes reflected a consistent, significant moderate effect in favour of better performance by healthy controls and, with the exception of one study, pooled results from physiological outcomes reflected no evidence for an effect. Future research would benefit from the use of clearly defined constructs of working memory, as well as standardised methods of testing.
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