Journal of clinical epidemiology
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To identify methods to support the node-making process in network meta-analyses (NMAs) of nonpharmacological treatments. ⋯ Despite the importance of NMA in the delivery of evidence when several interventions are available for a single indication, recommendations on the reporting of the node-making process in NMAs are lacking, and reporting of the node-making process in NMAs seems insufficient.
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Randomized Controlled Trial Multicenter Study Pragmatic Clinical Trial
A prospective cohort and extended comprehensive-cohort design provided insights about the generalizability of a pragmatic trial: the ProtecT prostate cancer trial.
Randomized controlled trials (RCTs) deliver robust internally valid evidence but generalizability is often neglected. Design features built into the Prostate testing for cancer and Treatment (ProtecT) RCT of treatments for localized prostate cancer (PCa) provided insights into its generalizability. ⋯ The design features of the ProtecT RCT provided data to assess the representativeness of the prospective cohort and generalizability of the findings of the RCT. Greater attention to collecting data at the design stage of pragmatic trials would better support later judgments by clinicians/policy-makers about the generalizability of RCT findings in clinical practice.
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To summarize the evidence on content and structural validity of 17 patient-reported outcome measures (PROMs) to measure physical functioning in patients with low back pain (LBP). ⋯ The content validity of PROMs to measure physical functioning in patients with LBP is understudied. Structural validity of several widely used PROMs is problematic.
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This article describes conceptual advances of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group guidance to evaluate the certainty of evidence (confidence in evidence, quality of evidence) from network meta-analysis (NMA). Application of the original GRADE guidance, published in 2014, in a number of NMAs has resulted in advances that strengthen its conceptual basis and make the process more efficient. ⋯ Two principles of the original GRADE NMA guidance are that we need to rate the certainty of the evidence for each pairwise comparison within a network separately and that in doing so we need to consider both the direct and indirect evidence. We present, discuss, and illustrate four conceptual advances: (1) consideration of imprecision is not necessary when rating the direct and indirect estimates to inform the rating of NMA estimates, (2) there is no need to rate the indirect evidence when the certainty of the direct evidence is high and the contribution of the direct evidence to the network estimate is at least as great as that of the indirect evidence, (3) we should not trust a statistical test of global incoherence of the network to assess incoherence at the pairwise comparison level, and (4) in the presence of incoherence between direct and indirect evidence, the certainty of the evidence of each estimate can help decide which estimate to believe.
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Comparative Study
The new measuring multimorbidity index predicted mortality better than Charlson and Elixhauser indices among the general population.
The aim of the study was to develop and validate an updated morbidity index for short-term mortality risk, using chronic conditions identified from routine hospital admission ICD-10 data. ⋯ The M3 index had improved predictive performance for 1-year mortality risk over Charlson and Elixhauser indices, allowing better adjustment for mortality risk from chronic conditions. This provides an important tool for population-level analyses of health outcomes.