Clinical heterogeneity was a common problem in Cochrane reviews of physiotherapy and occupational therapy

van den Ende, Cornelia H.M.; Steultjens, Esther M.J.; Bouter, Lex M.; Dekker, Joost

doi:10.1016/j.jclinepi.2005.12.014

« Previous Next »Journal of Clinical Epidemiology
Volume 59, Issue 9 , Pages 914-919.e2, September 2006

Clinical heterogeneity was a common problem in Cochrane reviews of physiotherapy and occupational therapy

Cornelia H.M. van den Ende
- Radboud University Nijmegen Medical Centre, Department of Pediatric Oncology/Hematology, 804, P.O. Box, 9101, 6500 HB Nijmegen, The Netherlands, and St. Maartenskliniek, Postbox 9011, 6500 GM, Nijmegen, The Netherlands
- Corresponding author. Tel.: +31 24 361 6928; fax: +31 24 361 9348.
Esther M.J. Steultjens
- Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500 BN Utrecht, The Netherlands
Lex M. Bouter
- Institute for Research in Extramural Medicine (EMGO Institute), VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
Joost Dekker
- Department of Rehabilitation Medicine, Institute for Research in Extramural Medicine (EMGO Institute), VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands

Accepted 12 December 2005. published online 24 June 2006.

Abstract

Background and Objective

To identify the strategies used to deal with the clinical heterogeneity of interventions and multiple outcome measures used in Cochrane reviews on physiotherapy and occupational therapy.

Methods

A search for systematic reviews on physiotherapy and occupational therapy in the Cochrane Library was performed. Data on the method of categorization of interventions, on measures, and on the method of data synthesis were systematically extracted.

Results

52 reviews were identified. In 22 (42%) reviews only one index intervention was evaluated, in the other 30 reviews index interventions were categorized. A large diversity in the number and type of outcome measures was found (median 6.5, range 1–23). In 48% of the reviews one or more primary outcome measures were defined. In 52% of the reviews no quantitative data synthesis was performed, whereas five different methods for qualitative data synthesis were applied in 11 reviews.

Conclusions

Limitation to a few outcome measures and explicit procedures for the categorization of interventions might increase the transparency and reproducibility of systematic reviews on physiotherapy and occupational therapy. Qualitative data synthesis is not often applied, although it is a useful tool to summarize results if a quantitative synthesis is not appropriate. International consensus on a method for qualitative synthesis is clearly needed.

Keywords: Evidence-based medicine, Heterogeneity, Meta-analysis, Occupational therapy, Physiotherapy, Review