Intra‐articular hyaluronic acid injection in treating knee osteoarthritis: assessing risk of bias in systematic reviews with <scp>ROBIS</scp> tool

Xing, Dan; Wang, Bin; Zhang, Wei; Yang, Ziyi; Hou, Yunfei; Chen, Yaolong; Lin, Jianhao

doi:10.1111/1756-185x.13192

Cited by 5 publications

(13 citation statements)

References 62 publications

(154 reference statements)

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“…Our ROBIS tool results showed that most of the systematic reviews had high risk of bias. Similar findings have been observed in previous studies appraising risk of bias in other research areas using the ROBIS tool [ 76 , 78 ]. For instance, 18 (58%) out of 31 systematic reviews evaluating the effectiveness of intra-articular hyaluronic acid injection in treating knee osteoarthritis had high ( n = 16) or unclear ( n = 2) risk of bias [ 78 ].…”

Section: Discussionsupporting

confidence: 91%

“…Similar findings have been observed in previous studies appraising risk of bias in other research areas using the ROBIS tool [ 76 , 78 ]. For instance, 18 (58%) out of 31 systematic reviews evaluating the effectiveness of intra-articular hyaluronic acid injection in treating knee osteoarthritis had high ( n = 16) or unclear ( n = 2) risk of bias [ 78 ]. Another survey assessing systematic reviews about psoriasis found that most reviews (86%) were classified as high risk of bias [ 76 ].…”

Section: Discussionsupporting

confidence: 91%

“…Risk of bias is linked to methodological quality of systematic reviews but provides further evaluation on how methodological limitations were considered to form conclusions. In this sense, the ROBIS tool is increasingly being used to assess risk of bias not only in systematic reviews [ 41 , 76 , 78 ] but also in guideline committees that evaluate evidence level (e.g., Australian government, National Health and Medical Research Council). Our ROBIS tool results showed that most of the systematic reviews had high risk of bias.…”

Section: Discussionmentioning

confidence: 99%

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Reporting bias in the literature on the associations of health-related behaviors and statins with cardiovascular disease and all-cause mortality

et al. 2018

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Reporting bias in the literature occurs when there is selective revealing or suppression of results, influenced by the direction of findings. We assessed the risk of reporting bias in the epidemiological literature on health-related behavior (tobacco, alcohol, diet, physical activity, and sedentary behavior) and cardiovascular disease mortality and all-cause mortality and provided a comparative assessment of reporting bias between health-related behavior and statin (in primary prevention) meta-analyses. We searched Medline, Embase, Cochrane Methodology Register Database, and Web of Science for systematic reviews synthesizing the associations of health-related behavior and statins with cardiovascular disease mortality and all-cause mortality published between 2010 and 2016. Risk of bias in systematic reviews was assessed using the ROBIS tool. Reporting bias in the literature was evaluated via small-study effect and excess significance tests. We included 49 systematic reviews in our study. The majority of these reviews exhibited a high overall risk of bias, with a higher extent in health-related behavior reviews, relative to statins. We reperformed 111 meta-analyses conducted across these reviews, of which 65% had statistically significant results (P < 0.05). Around 22% of health-related behavior meta-analyses showed small-study effect, as compared to none of statin meta-analyses. Physical activity and the smoking research areas had more than 40% of meta-analyses with small-study effect. We found evidence of excess significance in 26% of health-related behavior meta-analyses, as compared to none of statin meta-analyses. Half of the meta-analyses from physical activity, 26% from diet, 18% from sedentary behavior, 14% for smoking, and 12% from alcohol showed evidence of excess significance bias. These biases may be distorting the body of evidence available by providing inaccurate estimates of preventive effects on cardiovascular and all-cause mortality.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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Reporting bias in the literature on the associations of health-related behaviors and statins with cardiovascular disease and all-cause mortality

et al. 2018

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“…We would like to highlight that despite the fact that in the last 15 years many randomized controlled trials and at least 40 meta-analyzes have been published on the effectiveness and safety of IAHA for the treatment of KOA, there is still much controversy and uncertainty on this topic. [ 31 ] If we consider only some of the meta-analyzes published in the past 5 years, we will see that some of them recommend IAHA as a very effective and safe treatment, [ 24 , 32 – 34 ] while others contraindicate this intervention, [ 31 , 35 , 36 ] both due to its low effectiveness, as well as the lack of safety. We can explain these conflicting results for several reasons: the low quality of the meta-analyzes, [ 31 ] individual differences in the formulation of the IAHA, [ 30 ] specific clinical characteristics of the patients [ 37 ] and even the presence of conflicts of interest (declared or not) by the authors of the studies and/or financing of studies by the industry.…”

Section: Discussionmentioning

confidence: 99%

“…Each of these situations was assessed in at least 1 meta-analysis. [ 31 , 38 ] In the first meta-analysis, [ 31 ] the authors assessed 31 systematic reviews about the efficacy and safety of HA for KOA therapy and assessed RoB using the ROBIS tool. There were only 41.9% of with low RoB (there were 13 systematic reviews with low RoB, 47 with high RoB, and 2 with unclear RoB).…”

Section: Discussionmentioning

confidence: 99%

Viscossuplementation for the treatment of osteoarthritis of the knee

Pereira

et al. 2020

Medicine

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Background: Knee osteoarthritis (KOA) is a common chronic disease with worldwide prevalence of 10% to 79%, with costs ranging from $560 to $635 billion for year in United States of America. The main guidelines recommend interventions with undesirable adverse events (AE) or highly dependent on the patient's persistence. Thus, intra-articular (IA) therapies appear to be attractive in patients with KOA, as well as a valid therapy by maximizing effects locally in the joint and limiting systemic AE. Presently, the main available IA therapies are corticosteroids and hyaluronic acid. As several meta-analyses about the efficacy of intra-articular hyaluronic acid (IAHA) for treatment of KOA with discordant results were published, we decided to conduct an umbrella review to summarize this efficacy Methods: We will search MEDLINE/PubMed, EMBASE, Cochrane Library, and Virtual Health Library (BVS) from inception to February 2020 for systematic reviews with meta-analyses of randomized clinical trials that investigate IAHA for therapy of KOA. Grey literature will be searched in Opengray platform, Research Gate, and Google Scholar. The reference lists of eligible studies will be screened. The search will be performed without language restriction. We will include any type of IAHA as experimental intervention and different types of oral or intra-articular placebo or medications as controls. The primary outcome will be measures of efficacy as the Western Ontario and McMaster Universities Osteoarthritis Index. A synthesis of the evidence will be conducted and data will be presented in tables. Two reviewers will independently appraise the quality of included meta-analyses using the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2) tool and will classify the included systematic reviews into high, moderate, low, or critically low levels of confidence. Results: The results of this study will be published in a peer-reviewed journal. Ethics and dissemination: No ethical approval is required since this study data is based on published literature. Protocol registration number: PROSPERO CRD42019120269 ( https://www.crd.york.ac.uk/PROSPERO/#joinuppage ).

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Quality of systematic reviews and meta‐analyses in dermatology

Muthiah,

Lee,

Koh

et al. 2024

Cochrane Evidence Synthesis and Methods

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IntroductionAlthough the number of published systematic reviews and meta‐analyses in dermatology has increased over the past decade, their quality is unknown.ObjectiveThe objective of this study was to determine the change in risk of bias, methodological quality and reporting quality of systematic reviews and meta‐analyses in dermatology between 2010 and 2019.MethodsWe conducted a comparative study of systematic reviews and meta‐analyses published in the 10 highest‐ranked dermatology journals in 2010 and 2019. Studies were identified through electronic searches of MEDLINE, Embase, and eight other bibliographic databases. Risk of bias and methodological quality were assessed in duplicate with the risk of bias in systematic reviews (ROBIS) and A MeaSurement Tool to Assess systematic Reviews‐2 (AMSTAR‐2) tools, respectively, with the latter only applied to studies of interventions. Reporting quality was assessed with the Preferred Reporting Items of systematic reviews and Meta‐Analyses (PRISMA) 2009 and PRISMA for abstracts (PRISMA‐A) 2013 statements.ResultsWe included 27 systematic reviews and meta‐analyses published in 2010 and 127 published in 2019. There was no evidence of a difference in the proportion of systematic reviews and meta‐analyses at high/unclear risk of bias with ROBIS (Fisher's exact test = 1.00) or critically low methodological quality using AMSTAR‐2 (Fisher's exact test = 0.456), between 2010 and 2019. There was evidence of a difference in proportion of PRISMA (t(26) = 2.7, p = 0.01), and very strong evidence of a difference in proportion of PRISMA‐A (t(26) = 4.2, p < 0.001) checklist items adequately reported between 2010 and 2019. The difference in mean proportion of PRISMA checklist items adequately reported was 3.6 items more (95% confidence interval [CI]: 1.8–5.4 items more) in 2019 (mean = 10.7 items, SD = 2.4 items) than in 2010 (mean = 7.1 items, SD = 2.9 items), and of PRISMA‐A checklist items adequately reported was 1.1 items more (95% CI: 0.2–2.0 items more) in 2019 (mean = 5.6 items, SD = 1.5 items) than in 2010 (mean = 4.4 items, SD = 1.7 items)ConclusionsNo improvement was observed in the overall methodological quality of included systematic reviews and meta‐analyses; however, there was strong evidence of improvement in the overall reporting quality.

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Intra‐articular hyaluronic acid injection in treating knee osteoarthritis: assessing risk of bias in systematic reviews with ROBIS tool

Cited by 5 publications

References 62 publications

Reporting bias in the literature on the associations of health-related behaviors and statins with cardiovascular disease and all-cause mortality

Reporting bias in the literature on the associations of health-related behaviors and statins with cardiovascular disease and all-cause mortality

Viscossuplementation for the treatment of osteoarthritis of the knee

Quality of systematic reviews and meta‐analyses in dermatology

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