| 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 • Team • Expertise |
| 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 • Weaknesses identified in some Cochrane reviews |
| Article Type | Editorial |
| Article Subtype | Comment/letter |
| First Author Country | United States |
| Aim | To highlight a number of methodological flaws and errors in a Cochrane review on spinal cord stimulation (SCS) for low back pain. |
| Level of Investigation | Descriptive |
| 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. |
| Number of systematic reviews included | 1 |
| Number of eligible systematic reviews assessed | 1 |
| Treatment impacted | Not Applicable |
| Treatment impacted description | |
| Interpretation impacted | Not Applicable |
| Interpretation impacted description |