Recent KSR Evidence critical appraisals

  • 1

    A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: are guidelines evidence-based?

    Davies, J. ; Read, J.

    Risk of Bias Assessment: High

    Eligibility criteria were not explicitly defined. Only English language studies published in peer-reviewed journals were considered for inclusion in the review. A limited range of databases was searched for study selection process. Search terms were provided but a full search strategy was not reported. No information was provided on the number of reviewers involved in the study selection process and data extraction process. Relevant study results appear to have been extracted. There was no formal assessment of the methodological quality of the included studies. The method of analysis was not explained clearly in the methodology section.

    Bottom line The current evidence suggests that antidepressant withdrawal reactions are widespread and nearly half of them are severe. Hence, the U.K.'s current National Institute for Health and Care Excellence and the American Psychiatric Association's depression guidelines need to be updated immediately. The review had significant methodological weaknesses, so the findings should be interpreted with caution. Further, well-designed studies focused on the dependency-forming nature of antidepressants are needed.

    Addict Behav 2018;Epub ahead of print();

  • 2

    Effects of vitamin D supplementation on musculoskeletal health: a systematic review, meta-analysis, and trial sequential analysis

    Bolland, M.J. ; Grey, A. ; Avenell, A.

    Risk of Bias Assessment: High

    The search strategies were not very sensitive, relevant studies may have been missed.

    Bottom line Evidence indicates that vitamin D supplementation may not prevent fractures or falls, or have clinically meaningful effects on bone mineral density. In addition, there were no differences between the effects of higher and lower doses of vitamin D. There is little justification to use vitamin D supplements to maintain or improve musculoskeletal health. Restriction to one index term for vitamin D in the searches means some relevant studies may have been missed. There was some evidence of publication bias.

    Lancet Diabetes Endocrinol 2018;Epub ahead of print();

  • 3

    Can screening instruments accurately determine poor outcome risk in adults with recent onset low back pain? A systematic review and meta-analysis

    Karran, E. L. ; McAuley, J. H. ; Traeger, A. C. ; Hillier, S. L. ; Grabherr, L. ; Russek, L. N. ; Moseley, G. L.

    Risk of Bias Assessment: High

    The use or search terms for prognostic/predictive studies, and the inclusion of an English language limit, may have resulted in relevant studies being missed by the searches. Weaknesses in the analysis methods and risk of bias assessments limit the usefulness of the reported results.

    Bottom line The results of this review suggest that low back pain screening instruments may perform better in predicting poor disability and absenteeism outcomes than in predicting poor pain outcomes. However, the evidence presented is not sufficiently robust to support firm conclusions. The use or search terms for prognostic/predictive studies, and the inclusion of an English language limit, may have resulted in relevant studies being missed by the searches. Weaknesses in the analysis methods and risk of bias assessments limit the usefulness of the reported results.

    BMC Med 2017;15(1);

  • 4

    Assessment of efficacy and tolerability of medicinal cannabinoids in patients with multiple sclerosis: a systematic review and meta-analysis

    Torres-Moreno, M. ; Papaseit, E. ; Torrens, M. ; Farre, M.

    Risk of Bias Assessment: Low

    The assessment identified no major methodological shortcomings with the systematic review. The abstract focused on statistically significant results, however, full results are presented in the study and the appendices.

    Bottom line Results of this systematic review showed that cannibinoids might be more effective than placebo in addressing spasticity of adults with MS. However, this was limited to self-reported spasticity, i.e. when spasticity was assessed by the more objective Ashworth scale, no statistically significant differences were seen. Similarly, cannabinoids might be beneficial for the treatment of pain and bladder dysfunction in adults with MS. More adverse events were seen in patients treated with cannabinoids compared to placebo, however, no differences in serious adverse events were noted. There are some differences in different forms of medicinal cannabinoids which need to be considered. Overall, the systematic review was well conducted and the results are likely to be reliable. Future research should focus further on the effectiveness of different drug forms and the clinical relevance of these findings.

    JAMA Network Open 2018;1(6);

  • 5

    Comparison of effects of seven treatment methods for distal radius fracture on minimizing complex regional pain syndrome

    Wang, J. H. ; Sun, T.

    Risk of Bias Assessment: High

    A restriction to the Chinese and English language means that some relevant studies may have been missed. The search terms were reported, but full details of the search strategy were not reported. No information was provided regarding the number of authors involved in the study selection process.

    Bottom line The current evidence indicates that bridging external fixation, K-wire fixation, dorsal plating, volar plating, dorsal and volar plating, plaster fixation and non-bridging external fixation can have no marked difference in risk of complex regional pain syndrome in distal radius fracture patients. A restriction to the Chinese and English language means that some relevant studies may have been missed. The search terms were reported, but full details of the search strategy were not reported. No information was provided regarding the number of authors involved in the study selection process.

    Arch Med Sci 2017;13(1);163-73

  • 6

    Prophylactic vaccination against human papillomaviruses to prevent cervical cancer and its precursors

    Arbyn, M. ; Xu, L. ; Simoens, C. ; Martin‐Hirsch, P. P. L.

    Risk of Bias Assessment: Low

    All domains were considered at low concern. A range of comments were made about the review which can be found or are cited in the comments section of the review in the Cochrane Library.

    Bottom line HPV vaccines protect against cervical precancer in adolescent girls and women vaccinated between 15 and 26 years of age. The protection is lower when a part of the population is already infected with HPV. Longer-term follow-up is needed to assess the impact on cervical cancer. There are limited data from trials on the effect of vaccines on deaths, stillbirth and babies born with malformations. However, no increased risk of serious adverse effects, miscarriage or pregnancy termination was found. These findings are likely to be reliable.

    Cochrane Database Syst Rev 2018, 5, CD009069, 10.1002/14651858.CD009069.pub3

  • 7

    Percutaneous endoscopic lumbar discectomy for recurrent lumbar disc herniation

    Li, X. ; Hu, Z. ; Cui, J. ; Han, Y. ; Pan, J. ; Yang, M. ; Tan, J. ; Sun, G. ; Li, L.

    Risk of Bias Assessment: Unclear

    Search terms were provided but a full search strategy was not reported, therefore it was not possible to judge if all relevant studies had been retrieved.

    Bottom line The evidence indicated that operative time, blood loss and complication rates were significantly reduced with percutaneous endoscopic lumbar discectomy in patients with recurrent lumbar disc herniation in comparison with open lumbar microdiscectomy. Whereas, the difference between the treatment groups were similar in terms of pain reduction, global perceived effect (MacNab score), re-operation and recurrence rate. Hence, percutaneous endoscopic lumbar discectomy could be used as an alternative to the conventional procedure in the treatment of recurrent lumbar disc herniation. Search terms were provided, but a full search strategy was not reported, therefore it was not possible to judge if all relevant studies had been retrieved. Further high-quality randomised controlled trials were required to address the present review question.

    Int J Surg 2016;27();8-16