Hoderlein X.1, Moseley A.2, Elkins M.3
1Hochschule 21, Buxtehude, Germany, 2The George Institute for Global Health, Musculoskeletal Division, Sydney, Australia, 3Centre for Education & Workforce Development, Rozelle, Australia
Background: Clinical research is cumulative: what is known and unknown should be evaluated before a randomised controlled trial is conducted and the results of a trial should be interpreted with reference to existing clinical research in order to position the results in the totality of the available evidence. Citation of high-quality clinical research in the Introduction section would indicate that existing research informed the design of the study, while citation in the Discussion section would indicate that trial results were being integrated into existing evidence. An analysis of highly cited medical journals revealed that systematic reviews were rarely cited in the Introduction and Discussion sections of reports of trials, but citation of existing research in physiotherapy trials has not been investigated.
Purpose: This study aimed to investigate the extent to which reports of clinical trials use high-quality clinical research to
(1) justify the need for the trial in the Introduction and
(2) interpret the trial's results in the Discussion.
Secondary aims were to determine if citation has improved with time and is associated with trial quality.
(1) justify the need for the trial in the Introduction and
(2) interpret the trial's results in the Discussion.
Secondary aims were to determine if citation has improved with time and is associated with trial quality.
Methods: Data were extracted from 221 randomised trials that were randomly selected from the Physiotherapy Evidence Database (PEDro): 70 published in 2001 and 151 published in 2015 (10% sample of all trial reports published in each year). The PEDro score for each trial was also downloaded.
Results: Overall 41% of trial reports cited a systematic review or other high-level evidence in the Introduction section. Citation improved with time: 50% for 2015 and 20% for 2001 (relative risk 2.5, 95% confidence interval 1.5 to 4.1). For the Discussion section, only one trial (published in 2015) out of 221 integrated the results of the trial into an existing meta-analysis. There was no relationship between citation of existing research and the PEDro score.
Conclusion(s): Published reports of randomised trials evaluating physiotherapy interventions increasingly cite a systematic review in the Introduction section, but integration with existing research in the Discussion section is very rare.
Implications: Increasing the citation of high-quality clinical research in the Introduction and Discussion sections would assist clinicians to use the trial results to guide clinical practice. Citation and integration could be increased by amending existing checklists and editorial guidelines. Authors could be encouraged to cite relevant high-quality clinical research in their trial reports by making editorial guidelines more specific.
Funding acknowledgements: The Australian Physiotherapy Association, Motor Accident Insurance Commission, Transport Accident Commission, Chartered Society of Physiotherapy; and 46 other physiotherapy organisations.
Topic: Research methodology & knowledge translation
Ethics approval: Ethics approval was not required.
All authors, affiliations and abstracts have been published as submitted.
