Wednesday, October 25, 2006

Keeping SRs up to date

Clinical Evidence has a chapter on tennis elbow and one of the interventions is corticosteroid injections. For the short-term relief of pain it is rated as likely to be beneficial (based on a search carried out in 2005). Late last month the BMJ published a RCT on tennis elbow and one of the interventions was corticosteroid injections (click here). This concluded:

"Physiotherapy combining elbow manipulation and exercise has a superior benefit to wait and see in the first six weeks and to corticosteroid injections after six weeks, providing a reasonable alternative to injections in the mid to long term. The significant short term benefits of corticosteroid injection are paradoxically reversed after six weeks, with high recurrence rates, implying that this treatment should be used with caution in the management of tennis elbow."

The Clinical Evidence chapter relied on a 1999 systematic review and subsequent RCTs.

So, we have one SR (from 1999) and a number of other RCTs. This begs the question 'how long before these RCTs are incorporated into a new systematic review?'. This question must be true for any number of interventions.

Given the massive changes in technology and open-access, is it really too hard to free up the meta-analyses and allow (with strict conditions) users to simply add new trial data as it comes along? Each review would have inclusion criteria and as long as these were met then the data could be added. Doing this online would allow for the instantaneous updating of the meta-analysis.

This issue came up as a GP contacted the ATTRACT service asking how he should react to the new BMJ article. Our response, probably unhelpfully, is that it is not our role to weigh up new research against prior research. Ultimately, you need to wait for a new systematic review! Using the olds methods we'd need to wait for months or more likely years. With an online system you could update it in hours.

The software, if not already there, would hardly be tough to create. Those wanting up to date information would surely want it. So why is there no pressure for this to happen?

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