The relationship of publication language, study population, risk of bias, and treatment effects in acupuncture related systematic reviews: a meta-epidemiologic study

BMC Medical Research Methodology

Research

Lijiao Yan¹  Janne Esill²  Lingxiao Chen³  Wenhao Zhang⁴  Yuan Yao⁴  Jingxi Wu⁴  Fang Fang⁵  Liang Yao⁶  Qi Wang⁷  Xu Hui⁸  Jing Li⁸  Kehu Yang⁹  Dang Wei^1,10  Lei Lan^1,11  Huijuan Li^1,12  Yanfang Ma^1,13  Xiaowen Feng^1,14  Anya Shi^1,14  Yifan Qiao^1,14  Chengdong Qiao^1,15  Peijing Yan^1,16 

[1]Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China

[2]Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China

[3]Institute of Global Health, University of Geneva, Geneva, Sweden

[4]Faculty of Medicine and Health, The Back Pain Research Team, Sydney Musculoskeletal Health, The Kolling Institute, University of Sydney, Sydney, NSW, Australia

[5]First Clinical Medical College of Lanzhou University, Lanzhou, China

[6]Guangzhou University of Chinese Medicine, Guangzhou, China

[7]Health Research Methodology, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada

[8]Health Research Methodology, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada

[9]Health Policy PhD Program and McMaster Health Forum, McMaster University, Hamilton, ON, Canada

[10]Health technology Assessment Centre, Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China

[11]Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China

[12]Health technology Assessment Centre, Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China

[13]Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China

[14]Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China

[15]Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden

[16]School of Acupuncture, Moxibustion and Massage, Chengdu University of Traditional Chinese Medicine, Chengdu, China

[17]School of Chinese Medicine, Hong Kong Chinese Medicine Clinical Study Center, Hong Kong Baptist University, Hong Kong, China

[18]School of Chinese Medicine, Hong Kong Chinese Medicine Clinical Study Center, Hong Kong Baptist University, Hong Kong, China

[19]Chinese EQUATOR Centre, Hong Kong, China

[20]Second Clinical Medical College of Lanzhou University, Lanzhou, China

[21]The First Hospital of Lanzhou University, Lanzhou, China

[22]West China school of public health, Sichuan university, Chengdu, China

关键词: Systematic reviews;    Acupuncture;    Meta-epidemiologic study;    Risk of bias;    Publication language;   

DOI  :  10.1186/s12874-023-01904-w

 received in 2022-09-09, accepted in 2023-03-27,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThere are debates in acupuncture related systematic reviews and meta-analyses on whether searching Chinese databases to get more Chinese-language studies may increase the risk of bias and overestimate the effect size, and whether the treatment effects of acupuncture differ between Chinese and non-Chinese populations.MethodsIn this meta-epidemiological study, we searched the Cochrane library from its inception until December 2021, and identified systematic reviews and meta-analyses with acupuncture as one of the interventions. Paired reviewers independently screened the reviews and extracted the information. We repeated the meta-analysis of the selected outcomes to separately pool the results of Chinese- and non-Chinese-language acupuncture studies and presented the pooled estimates as odds ratios (OR) with 95% confidence interval (CI). We calculated the Ratio of ORs (ROR) by dividing the OR of the Chinese-language trials by the OR of the non-Chinese-language trials, and the ROR by dividing the OR of trials addressing Chinese population by the OR of trials addressing non-Chinese population. We explored whether the impact of a high risk of bias on the effect size differed between studies published in Chinese- and in non-Chinese-language, and whether the treatment effects of acupuncture differed between Chinese and non-Chinese population.ResultsWe identified 84 Cochrane acupuncture reviews involving 33 Cochrane groups, of which 31 reviews (37%) searched Chinese databases. Searching versus not searching Chinese databases significantly increased the contribution of Chinese-language literature both to the total number of included trials (54% vs. 15%) and the sample size (40% vs. 15%). When compared with non-Chinese-language trials, Chinese-language trials were associated with a larger effect size (pooled ROR 0.51, 95% CI 0.29 to 0.91). We also observed a higher risk of bias in Chinese-language trials in blinding of participants and personnel (97% vs. 51%) and blinding of outcome assessment (93% vs. 47%). The higher risk of bias was associated with a larger effect estimate in both Chinese-language (allocation concealment: high/unclear risk vs. low risk, ROR 0.43, 95% CI 0.21 to 0.87) and non-Chinese-language studies (blinding of participants and personnel: high/unclear risk vs. low risk, ROR 0.41, 95% CI 0.23 to 0.74). However, we found no evidence that the higher risk of bias would increase the effect size of acupuncture in Chinese-language studies more often than in non-Chinese-language studies (the confidence intervals of all ROR in the high-risk group included 1, Table 3). We further found acupuncture appeared to be more effective in Chinese than in non-Chinese population (Table 4).ConclusionsThe findings of this study suggest the higher risk of bias may lead to an overestimation of the treatment effects of acupuncture but would not increase the treatment effects in Chinese-language studies more often than in other language studies. The difference in treatment effects of acupuncture was probably associated with differences in population characteristics.Trial registrationWe registered our protocol on the Open Science Framework (OSF) (https://doi.org/10.17605/OSF.IO/PZ6XR).

【 授权许可】

CC BY   
© The Author(s) 2023

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