Meta-analysis of dropout rates in randomized controlled clinical trials

Gehling, M.; Hermann, Bertrand; Tryba, M.

doi:10.1007/s00482-011-1057-9

Cited by 20 publications

(14 citation statements)

References 35 publications

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“…49 Long-term follow-up has been associated with increased dropout rate. 50 Apart from the relatively high dropout rate that might be encountered in chronic pain studies, 51 RCTs evaluating anaesthetic interventions tend to have short follow-up periods. This could account for the relatively low (4.6%) observed attrition rate in the present systematic review.…”

Section: Discussionmentioning

confidence: 99%

Pitfalls in reporting sample size calculation in randomized controlled trials published in leading anaesthesia journals: a systematic review

Abdulatif

Mukhtar

Obayah

2015

British Journal of Anaesthesia

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We have evaluated the pitfalls in reporting sample size calculation in randomized controlled trials (RCTs) published in the 10 highest impact factor anaesthesia journals.Superiority RCTs published in 2013 were identified and checked for the basic components required for sample size calculation and replication. The difference between the reported and replicated sample size was estimated. The sources used for estimating the expected effect size (Δ) were identified, and the difference between the expected and observed effect sizes (Δ gap) was estimated.We enrolled 194 RCTs. Sample size calculation was reported in 91.7% of studies. Replication of sample size calculation was possible in 80.3% of studies. The original and replicated sample sizes were identical in 67.8% of studies. The difference between the replicated and reported sample sizes exceeded 10% in 28.7% of studies. The expected and observed effect sizes were comparable in RCTs with positive outcomes (P=0.1). Studies with negative outcome tended to overestimate the effect size (Δ gap 42%, 95% confidence interval 32-51%), P<0.001. Post hoc power of negative studies was 20.2% (95% confidence interval 13.4-27.1%). Studies using data derived from pilot studies for sample size calculation were associated with the smallest Δ gaps (P=0.008).Sample size calculation is frequently reported in anaesthesia journals, but the details of basic elements for calculation are not consistently provided. In almost one-third of RCTs, the reported and replicated sample sizes were not identical and the assumptions for the expected effect size and variance were not supported by relevant literature or pilot studies.

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Section: Discussionmentioning

confidence: 99%

Pitfalls in reporting sample size calculation in randomized controlled trials published in leading anaesthesia journals: a systematic review

Abdulatif

Mukhtar

Obayah

2015

British Journal of Anaesthesia

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“…An explanation for the negative attitude towards tramadol could be the high prevalence of side effects [22,23], which may result to therapy switching or discontinuation, and thus a negative evaluation of its effectiveness by GPs [24,25]. Furthermore, the GPs’ negative attitudes towards the effectiveness of topical NSAIDs, glucosamine, and hyaluronic acid intra-articular injections might be explained by the discrepancies between the recommendations of the SCS and the Dutch NHG-standard for non-traumatic knee complaints in adults [6].…”

Section: Discussionmentioning

confidence: 99%

Agreement of general practitioners with the guideline-based stepped-care strategy for patients with osteoarthritis of the hip or knee: a cross-sectional study

et al. 2013

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BackgroundTo improve the management of hip or knee osteoarthritis (OA), a multidisciplinary guideline-based stepped-care strategy (SCS) with recommendations regarding the appropriate non-surgical treatment modalities and optimal sequence for care has been developed. Implementation of this SCS in the general practice may be hampered by the negative attitude of general practitioners (GPs) towards the strategy. In order to develop a tailored implementation plan, we assessed the GPs’ views regarding specific recommendations in the SCS and their working procedures with regard to OA.MethodsA survey was conducted among a random sample of Dutch GPs. Questions included the GP’s demographical characteristics and the practice setting as well as how the management of OA was organized and whether the GPs supported the SCS recommendations. In particular, we assessed GP’s views regarding the effectiveness of 14 recommended and non-recommended treatment modalities. Furthermore, we calculated their agreement with 7 statements based on the SCS recommendations regarding the sequence for care. With a linear regression model, we identified factors that seemed to influence the GPs’ agreement with the SCS recommendations.ResultsFour hundred fifty-six GPs (37%) aged 30–65 years, of whom 278 males (61%), responded. Seven of the 11 recommended modalities (i.e. oral Non-Steroidal Anti-Inflammatory Drugs, physical therapy, glucocorticoid intra-articular injections, education, lifestyle advice, acetaminophen, and tramadol) were considered effective by the majority of the GPs (varying between 95-60%). The mean agreement score, based on a 5-point scale, with the recommendations regarding the sequence for care was 2.8 (SD = 0.5). Ten percent of the variance in GPs’ agreement could be explained by the GPs’ attitudes regarding the effectiveness of the recommended and non-recommended non-surgical treatment modalities and the type of practice.ConclusionIn general, GPs support the recommendations in the SCS. Therefore, we expect that their attitudes will not impede a successful implementation in general practice. Our results provide several starting points on which to focus implementation activities for specific SCS recommendations; those related to the prescription of pain medication and the use of X-rays. We could not identify factors that contribute substantially to GPs’ attitudes regarding the SCS recommendations regarding the sequence for care.

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“…Several previous studies have described rates of therapy discontinuation and switching among OA patients, but these have mainly been among patients initiated on NS‐NSAIDs and Cox‐2s, 38–40 data on other recommended OA therapies are lacking. More recently, a meta‐analysis evaluating discontinuation because of loss of efficacy or adverse events associated with opioid therapy in clinical trials of OA patients reported that the significantly greater discontinuation rate with opioids relative to placebo (odds ratio 1.3; 95% confidence interval 1.2 to 1.4) was primarily related to adverse events 41 . However, controlled clinical trials are often not representative of general clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Therapy Switching, Augmentation, and Discontinuation in Patients with Osteoarthritis and Chronic Low Back Pain

et al. 2012

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Meta-analysis of dropout rates in randomized controlled clinical trials

Abstract: In spite of analgesic effects, many osteoarthritis patients prefer to stop chronic opioid use, because of adverse events. Therefore, opioids are not generally recommended in osteoarthritis.

Cited by 20 publications

References 35 publications

Pitfalls in reporting sample size calculation in randomized controlled trials published in leading anaesthesia journals: a systematic review

Pitfalls in reporting sample size calculation in randomized controlled trials published in leading anaesthesia journals: a systematic review

Agreement of general practitioners with the guideline-based stepped-care strategy for patients with osteoarthritis of the hip or knee: a cross-sectional study

Therapy Switching, Augmentation, and Discontinuation in Patients with Osteoarthritis and Chronic Low Back Pain

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