Limitations of the Cochrane review of spinal cord stimulation for low back pain

Ref ID 1064
First Author P.S. Staats
Journal PAIN PRACTICE
Year Of Publishing 2023
URL https://onlinelibrary.wiley.com/doi/10.1111/papr.13263
Keywords Cochrane
Pain
Problem(s) Limited quality assessment or no risk of bias
Lack of clinical expert/ stakeholder/ user perspective
Ignores setting or context of included studies which limits review applicability
Errors in study inclusion or omission of relevant studies
Number of systematic reviews included 1
Summary of Findings The letter authors raise a number of flaws and errors including (but not limited to) the following: 1) Population: there are differences in the eligibility criteria which introduces heterogeneity into the populations of the included studies. 2) Intervention: the review included mostly experimental modes of SPC are not generalizable to other types of stimulation and do not reflect spinal cord stimulation as applied in clinical practice. 3) Comparators: restriction to the comparators in the review excluded more than 10 clinical trials published in the last 8 years. 4) Outcomes: Six of the eight studies included in the meta-analysis for the comparison do not report outcomes specifically for back pain intensity, desite it being one of the main outcomes. Further, the results are presented incorrectly in one of the figures which suggests that the results favor medical management when they indeed favor SCS plus medical management. 5) Study design: RCTs, quasi-randomized trials and crossover trials were considered for inclusion, but there are over 3000 reports of original research studies which should be taken into consideration when evaluating the certainty of evidence of the whole body of evidence.
Did the article find that the problem(s) led to qualitative changes in interpretation of the results? Not Applicable
Are the methods of the article described in enough detail to replicate the study?