Applying the Risk of Bias Tool in a Systematic Review of Combination Long-Acting Beta-Agonists and Inhaled Corticosteroids for Persistent Asthma 英文参考文献.docVIP

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Applying the Risk of Bias Tool in a Systematic Review of Combination Long-Acting Beta-Agonists and Inhaled Corticosteroids for Persistent Asthma 英文参考文献.doc

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Applying the Risk of Bias Tool in a Systematic Review of Combination Long-Acting Beta-Agonists and Inhaled Corticosteroids for Persistent Asthma 英文参考文献

ApplyingtheRiskofBiasToolinaSystematicReviewof CombinationLong-ActingBeta-AgonistsandInhaled CorticosteroidsforPersistentAsthma LisaHartling1*,KennethBond1,BenVandermeer1,JenniferSeida1,DonnaM.Dryden1,BrianH.Rowe2,3 1Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada, 2Department of Emergency Medicine, UniversityofAlberta,Edmonton,Alberta,Canada,3SchoolofPublicHealth,UniversityofAlberta,Edmonton,Alberta,Canada Abstract Background: The Risk of Bias (RoB) tool is used to assess internal validity of randomized controlled trials (RCTs). Our objectiveswereto:1)evaluateinter-rateragreementoftheRoBtool;2)determinethetimetoaccesssupplementalstudy information; 3) compare the RoB tool with the Jadad scale and Schulz allocation concealment (AC); and 4) examine the relationshipbetweenRoBandeffectestimates. Methods: Weconductedasystematicreviewoflong-actingbetaagonists(LABA) combined withinhaledcorticosteroids (ICS) for adults with persistent asthma. Two reviewers independently assessed 107 trials using RoB, Jadad, and AC. One reviewer searched for study protocols. We assessed inter-rater agreement using weighted Kappa (k) and the correlation betweentoolsusingKendall’sTau(t).MeandifferencesineffectsizesforRCTswithdifferentRoBwerecalculated using inversevariancemethodandrandomeffectsmodel. Results:TrialshadgoodJadadscores(median4,IQR3-4);however,85%hadunclearACand87%highRoB.Thefactorthatmost influencedRoBwasthepotentialinappropriateinfluenceofstudysponsors(95%industryfunded).AgreementonRoBdomains wasfair(k=0.40)toalmostperfect(k=0.86),andmoderateforoverallRoB(k=0.41).MediantimetocompleteRoBassessments was21minutes(IQR14-27)and12minutes(IQR9-16)tosearchforprotocols.Protocolswereidentifiedfor5/42studies(12%);in3 casestheassessmentofselectiveoutcomereportingchanged.TherewaslowcorrelationbetweenoverallRoBvs.Jadad(t =0.04, p=0.3)andAC(t=20.02,p=0.7).Analysescomparingeffectestimatesandriskshowednoimpor