The confidence in the results of physiotherapy systematic reviews in the musculoskeletal field is not increasing over time: a meta-epidemiological study using AMSTAR 2 tool

Nicola Ferri; Elisa Ravizzotti; Alessandro Bracci; Giulia Carreras; Paolo Pillastrini; Mauro Di Bari

doi:10.1016/j.jclinepi.2024.111303

The confidence in the results of physiotherapy systematic reviews in the musculoskeletal field is not increasing over time: a meta-epidemiological study using AMSTAR 2 tool

J Clin Epidemiol. 2024 Feb 24:169:111303. doi: 10.1016/j.jclinepi.2024.111303. Online ahead of print.

Authors

Nicola Ferri¹, Elisa Ravizzotti², Alessandro Bracci³, Giulia Carreras⁴, Paolo Pillastrini⁵, Mauro Di Bari⁶

Affiliations

¹ Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy; Division of Occupational Medicine, IRCCS University Hospital of Bologna S Orsola-Malpighi Polyclinic, Bologna, Italy. Electronic address: nicola.ferri11@unibo.it.
² Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health (DINOGMI), University of Genoa, Genoa, Italy.
³ Department for Life Quality Studies (QUVI), University of Bologna, Rimini, Italy.
⁴ Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy.
⁵ Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy; Division of Occupational Medicine, IRCCS University Hospital of Bologna S Orsola-Malpighi Polyclinic, Bologna, Italy.
⁶ Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Geriatrics, Department of Medicine and Geriatrics, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.

PMID: 38402999
DOI: 10.1016/j.jclinepi.2024.111303

Abstract

Objectives: To assess the confidence in the results of systematic reviews on the effectiveness of physiotherapy for musculoskeletal conditions in the past 10 years and to analyze trends and factors associated.

Methods: This is a metaepidemiological study on systematic reviews (SRs) with meta-analysis of randomized controlled trials (RCTs). MEDLINE, Cochrane Database of Systematic Reviews, CINAHL, and PEDro were searched for SRs of RCT on physiotherapy interventions for musculoskeletal disorders from December 2012 to December 2022. Two researchers independently screened the records based on the inclusion criteria; a random sample of 100 studies was selected, and each journal, author, and study variable was extracted. The methodological quality of SRs was independently assessed with the AMSTAR 2 tool. Any disagreement was solved by consensus.

Results: The confidence in SRs results was critically low in 90% of the studies, and it did not increase over time. Cochrane reviews are predominantly represented in the higher AMSTAR 2 confidence levels, with a statistically significant difference compared to non-Cochrane reviews. The last author's H-index is the only predictor of higher confidence among the variables analyzed (OR 1.04; 95% CI: 1.01, 1.06).

Conclusion: The confidence in SRs results is unacceptably low. Given the relevance of musculoskeletal disorders and the impact of evidence synthesis on the clinical decision-making process, there is an urgent need to improve the quality of secondary research by adopting more rigorous methods.

Keywords: Critical appraisal; Evidence-based practice; Methods; Musculoskeletal diseases; Physical and rehabilitation medicine; Systematic reviews as topic.