Analysis

What is missing from descriptions of treatment in trials and reviews?

BMJ 2008; 336 doi: http://dx.doi.org/10.1136/bmj.39590.732037.47 (Published 26 June 2008) Cite this as: BMJ 2008;336:1472
  1. Paul Glasziou, professor of evidence based medicine1,
  2. Emma Meats, research assistant1,
  3. Carl Heneghan, senior clinical research fellow1,
  4. Sasha Shepperd, NIHR research scientist in evidence synthesis 2
  1. 1Centre for Evidence-Based Medicine, Department of Primary Health Care, University of Oxford, Oxford OX3 7LF
  2. 2Department of Public Health, University of Oxford
  1. Correspondence to: P Glasziou paul.glasziou{at}dphpc.ox.ac.uk
  • Accepted 21 March 2008

Replicating non-pharmacological treatments in practice depends on how well they have been described in research studies

Have you ever read a trial or review and wondered exactly how to carry out treatments such as a “behavioural intervention,” “salt reduction,” or “exercise programme”? Although CONSORT and related initiatives have focused on the assessment of validity and presentation of results,1 2 less attention has been given to the adequacy of the description of the treatment used. For pharmacological treatments the description would need to include the dose, titration, route, timing, duration, and any monitoring used. For complex treatments the problems are even greater.

Why are full descriptions of treatment important?

The uptake of positive findings from trials is often slow and sometimes negligible.3 Reasons for this slow uptake include clinicians not becoming aware of the results, perceiving the results as either invalid or not relevant to their patients, or simply not remembering to use the treatment.4 5 An additional barrier, which has received less attention, is clinicians’ ability to carry out the treatment on the basis of the information provided in the published reports. For example, after receiving numerous requests for additional details from doctors and patients, the author of a randomised trial on graded exercise for chronic fatigue syndrome6 subsequently published a supplementary article with a more detailed “prescription.”7 Similarly, it is not possible to set upa stroke unit, offer low fat diets, or give smoking cessation advice without sufficient details on the components that were planned and delivered.8

Extent of the problem

To assess the extent of problems with descriptions of treatment we prospectively assessed 80 consecutive studies selected for abstraction in the journal Evidence-Based Medicine from October 2005 to October 2006. The journal is aimed specifically at doctors working in primary care and general medicine, and it provides summaries of research that is highly …

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