Cochrane News

Cochrane Library Editorial: Appraising pay‐for‐performance in healthcare in low‐ and middle‐income countries through systematic reviews

8 months 2 weeks ago

Pay-for-performance (P4P) is an approach whereby individuals, teams or facilities within the health system are given money or other rewards for meeting service‐related targets, carrying out specific tasks or for meeting specific quality or health outcome thresholds. P4P has been one of the most ideologically charged topics in recent years in global health. It has attracted considerable investment, promotion, innovation, and assessment, but the issue of its effectiveness, efficiency and long‐term effects remains controversial.

A newly published Cochrane Library Editorial explores the challenges encountered by those who have conducted P4P systematic reviews and offers suggestions for future reviews and research on P4P. Karin Diaconu, lead author from Queen Margaret University in Edinburgh, says:

“This editorial offers an overview of 4 challenges we met with when evaluating 171 studies on pay-for-performance for systematic reviews. It also provides our reflections on the priorities for future evidence syntheses. We hope this editorial will help guide future studies and evidence synthesis projects about P4P.” 

Thursday, May 26, 2022
Muriah Umoquit

Watch the video of our World Health Assembly side-event on using evidence to address health challenges

8 months 3 weeks ago

Now is the time to ‘up our game’ in using evidence to address health challenges

The COVID-19 pandemic created a once-in-a-generation focus on evidence. We now have the opportunity to systematize the aspects of evidence use that are going well and to address the many gaps.

Alongside the 75th World Health Assembly, Cochrane and the Global Commission on Evidence to Address Societal Challenges co-hosted a virtual side event which brought together a global panel to discuss some of these issues.


  • Dr Soumya Swaminathan, Chief Scientist, WHO
  • Fitsum Assefa Adela, Ministry of Planning and Development, Ethiopia
  • Steven J. Hoffman, member of Canada's WHA delegation; Scientific Director, CIHR Institute of Population & Public Health
  • Dr Maria Endang Sumiwi, Director General of Public Health at the Ministry of Health, Indonesia
  • John Lavis, Co-Lead, Evidence Commission
  • Dr John Grove, Director of Quality Assurance for Norms and Standards, WHO


  • Judith Brodie, Interim CEO, Cochrane
  • Sylvia de Haan, Head of Advocacy, Communications and Partnerships, Cochrane

About the session

During the roundtable, leaders from WHO Member States who use evidence to guide national decision-making were encouraged to reflect on their work – and share what they need from evidence producers, evidence intermediaries, and multilateral organizations. Cochrane, the WHO Evidence-informed Policy Network and the Evidence Commission then discussed their shared vision and recommendations.

The session was a dialogue between both the demand and supply side of evidence – highlighting the key priorities for the evidence-informed future we want and need, and the conditions needed to get us there.


Related links:

Friday, May 27, 2022
Muriah Umoquit

COVID-19: Interventions to reduce the risk of coronavirus infection among workers outside healthcare settings

8 months 3 weeks ago

'Interventions to reduce the risk of coronavirus SARS‐CoV‐2 (severe acute respiratory syndrome coronavirus‐2) infection among workers outside healthcare settings'

What is the aim of this review?

Coronavirus (COVID‐19) is a respiratory infectious disease that has spread globally. People infected with SARS‐CoV‐2 (severe acute respiratory syndrome coronavirus‐2) can develop critical illnesses and may die, particularly older people, and those with underlying medical problems. Different interventions that attempt to prevent or reduce workers' exposure to SARS‐CoV‐2 in the workplace have been implemented during the pandemic. This Cochrane Review evaluated the effects of these interventions on the COVID‐19 infection‐rate, absenteeism, COVID‐19‐related mortality, and adverse events.  

What was studied in this review?

The authors searched for studies that examined interventions according to the following four categories: 1) elimination (for example self‐isolation strategies); 2) engineering controls (for example barriers to separate or distance co‐workers, and workers from members of the public); 3) administrative controls (for example working from home); 4) personal protective equipment (for example use of face masks or other types of face covering). We included studies of any worker outside the healthcare setting. We searched for studies without language or time restrictions. 

What are the main findings of this review?

The author team screened more than 13 thousand reports, and included one study, conducted in 162 secondary and post‐secondary schools in England, from March to June 2021. The study enrolled more than 24 thousand workers. In the 86 schools in the control group (standard isolation), staff who were considered COVID‐19 contacts through contact tracing were required to self‐isolate at home for 10 days. In the 76 schools in the intervention group (test‐based attendance), staff who were considered COVID‐19 contacts through contact tracing were not required to isolate. Instead, they took a daily rapid test (lateral flow antigen test) for seven days. If the rapid test was negative, the staff member could go to work. If the rapid test was positive, the staff member would self‐isolate. The researchers wanted to know if there was a difference in COVID‐related absence between the two methods. 

The author team are uncertain whether a strategy of test‐based attendance changes COVID‐19 infection rates (any infection; symptomatic infection) compared with routine isolation after contact with a person with COVID‐19. COVID‐related absence may be lower or similar in the test‐based attendance group. 

However, they were uncertain about these findings, because the number of infections was very low among the participants. Mortality, adverse events, quality of life, and hospitalisation were not measured. Seventy‐one per cent of the test‐based attendance group followed the strategy; the researchers did not report on compliance for the standard isolation group. 

The team identified one ongoing study that also addressed the effects of screening in schools.

Another ongoing study is evaluating the effects of using a face shield to prevent COVID‐19 transmission. 

The authors did not find any studies that studied engineering or administrative controls.

Matteo Bruschettini, Director of Cochrane Sweden, who led the review explains, 

“Millions of scientific papers are published every year, and during the pandemic there were many about covid-19. It is not an easy task to keep up to date with the results of all these. Systematic reviews are one way of weighing up all the studies carried out in a specific field and providing an overview of the results of these studies.  This review investigating how workplace interventions reduced the spread of covid-19 assessed 13, 000 scientific articles published on the subject, however only one study could be included in the review. 

Almost none of the studies had the study design required to answer the question of whether the effects of the intervention reduced the risk of SARS-CoV-2 infection in non-healthcare workplaces. This surprised us. These systematic reviews are important because they can provide answers to questions that are of extreme concern to millions of people in workplaces around the world. 

We were able to identify two studies that had not been completed by September 2021 that may be included in the future. One assesses the benefit of face shields in preventing covid infection and the other looks at covid-19 screening in schools.”

How up‐to‐date is this review?

The author team searched for studies that were available up to 14 September 2021.


Monday, May 9, 2022
Katie Abbotts

Cochrane seeks Director of Development - UK remote

8 months 4 weeks ago

Specifications: Full Time (Permanent role)
Salary: £85,000 per annum
Location: UK, homebased and remote-working (attendance at meetings will be expected to pursue development and build relations)
Application Closing Date:  Monday 6th June 2022, 9am GMT. The recruitment agency will be longlisting applications as soon as they receive them, so please apply early to register your interest. 

Cochrane aims to put evidence at the heart of health decision-making globally. They collaborate to produce trusted synthesized evidence, make it accessible to all, and advocate for its use. Cochrane is seeking a Director of Development to work with their global community to grow fundraising income and ensure Cochrane has a sustainable and successful future.

Cochrane is a charity and a global, independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making vast amounts of research evidence useful for informing decisions about health. They do this by synthesising research findings to produce the best available evidence on what works. Their work has been recognised as the international gold standard for high quality, trusted information.

As a member of the Executive Leadership Team, this new role will lead the Development Directorate (which includes fundraising, advocacy, communications, partnerships, member and supporter engagement) and will establish a fundraising operation that works collaboratively to deliver significant global income growth. The Director of Development will play a key part in the transformation of the organisation as part of the 2021-2023 Strategy to ensure that Cochrane maintains its relevance and pre-eminence into the future.

Cochrane is seeking an ambitious individual who relishes a challenge, loves collaborative working, delivers results and has extensive experience of successfully delivering strategy. The ideal candidates will possess an understanding and experience of international fundraising, strong relationship management skills, and experience of working at director-level. Finally, you will be enterprising and a strategic thinker with the ability to seek and find creative solutions and foster innovation in your teams.

Cochrane welcomes applications from a wide range of perspectives, experiences, locations and backgrounds; diversity, equity and inclusion are key to their values.

Friday, May 6, 2022 Category: Jobs
Muriah Umoquit

Cochrane seeks Quality Assurance Editor - UK Remote Work

8 months 4 weeks ago

Specifications: Full Time 6 month Fixed Term contract (potential opportunity to extend)
Salary:  circa £40,000 per annum
Location: UK, Remote
Application Closing Date: 18 May 2022 (midnight GMT)

The Evidence Production and Methods Directorate in Cochrane is made up of three departments that are responsible for the efficient and timely production of high-quality Cochrane Reviews addressing research questions that are most important to decision makers.

As Quality Assurance Editor within Cochrane’s Editorial Department, you will assess whether protocols, reviews and updates submitted to Cochrane’s Central Editorial Service have met Cochrane’s methodological standards. You will recommend editorial decisions based on the quality of the methods in the articles submitted, provide feedback to authors on their articles, and support members of the Central Editorial Service with methods queries. 

Cochrane is a global independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making the vast amounts of evidence generated through research useful for informing decisions about health. We do this by identifying, appraising and synthesizing individual research findings to produce the best available evidence on what can work, what might harm and where more research is needed.

  • For further information on the role and how to apply, please click here
  • The deadline to receive your application is by 18 May 2022. 
  • The supporting statement should indicate why you are applying for the post, and how far you meet the requirements, using specific examples.
  • Note that we will assess applications as they are received, and therefore may fill the post before the deadline.
  • Read our Recruitment Privacy Statement 

Wednesday, May 4, 2022 Category: Jobs
Muriah Umoquit

Global Evidence Summit – Postponed to 9 – 13 September 2024

9 months ago

Dear Friends and Colleagues

Due to the continued global impact of COVID-19 (coronavirus) with ongoing reduced/restricted travel from many regions, and the advent of geo-political instability and risks in the European region, we have taken the decision to postpone the Global Evidence Summit (GES 2), due to be hosted in Prague between 2 – 6 October 2023.

The Global Organising Committee (comprising four partners:  Cochrane, JBI, GIN and Campbell) concluded, with the agreement of our local host - CEBHC-KT and Masaryk University, that the most appropriate decision is to postpone the Summit until 9 – 13 September 2024. As global leaders in evidence-informed healthcare, the partners take very seriously our responsibility and duty of care to our communities in the face of continuing risks.

However, we are committed to working together, along with additional organizations, to present the third Annual World EBHC Day on 20 October, 2022. This is a global initiative that raises awareness of the need for better evidence to inform healthcare policy, practice and decision making to improve health outcomes globally.

This second postponement of the second Global Evidence Summit is disappointing news for all of us and we would like to thank the vast number of people, including our local hosts, who have been working hard on preparations over the past year. We are in no doubt that we will be able to build successfully on the work accomplished so far to ensure that when GES 2 does go ahead in September 2024 in Prague it will be everything we anticipated: a world-class scientific event and a memorable gathering of the evidence-based healthcare community. 

We thank you for your ongoing support and commitment to the Global Evidence Summit and will look forward to meeting again for this unique event in 2024. 

Recent developments have shown the world can be volatile and unpredictable, requiring us to remain vigilant and responsive – collaborations such as this are even more important.   We hope that you all remain safe and well during these extraordinary times. 

Miloslav Klugar
Director, CEBHC-KT (Czech Cochrane, JBI and GRADE centres), Chair of the GES Scientific Committee

Judith Brodie
Interim CEO, Cochrane

Zoe Jordan
Executive Director, JBI

Elaine Harrow
CEO, Guidelines International Network

Vivian Welch,
Interim CEO, The Campbell Collaboration

Wednesday, May 4, 2022
Muriah Umoquit

Global rollout of rapid molecular tests for tuberculosis over the last 12 years: Cochrane Review summarizes research on recipient and provider views

9 months ago

A potential game-changer in the tuberculosis epidemic was how the tuberculosis community viewed rapid molecular tests for tuberculosis and tuberculosis drug resistance. This was 12 years ago, with the launch of Xpert MTB/RIF, which gives results in less than two hours, simultaneously diagnosing tuberculosis and testing if the bacteria have rifampicin resistance, a type of drug-resistant tuberculosis. Multidrug-resistant tuberculosis is caused by resistance to at least both rifampicin and isoniazid, the two most effective first-line drugs used to treat tuberculosis. 

Yet, diagnostic tests only have an impact on health if they are put to use in a correct and timely manner. To ensure diagnostics are accessible and utilized, we need to understand the views of recipients and providers who have used these tests, and a new qualitative evidence synthesis review published by the Cochrane Infectious Diseases Group (CIDG) pulls together all relevant research to date on Xpert MTB/RIF and similar tests. The authors also wanted to understand the implications of the review findings on effective implementation and health equity.

Rapid molecular tests have been shown to be accurate in diagnosing tuberculosis and rifampicin resistance and are recommended by the World Health Organization as the initial test in people with presumptive tuberculosis, replacing sputum microscopy, a test from the 19th century. These tests have many benefits, including the fact that they do not require well-equipped laboratories and skilled personnel, and can be carried out in community health settings, nearer to where people live. This is particularly relevant in low- and middle-income countries, settings with a high burden of tuberculosis.

Examining the evidence from 32 included studies, the review author team identified aspects of these tests that users valued  most and challenges to realizing those values.  People with tuberculosis valued an accurate diagnosis (knowing what is wrong with me), avoiding delays, and keeping diagnostic-associated cost low. Similarly, healthcare providers valued test accuracy and confidence in results (which helps in starting treatment), rapid results, and keeping cost to people seeking a diagnosis low. In addition, providers valued diversity of sample types (for example, gastric aspirate specimens and stool in children) and ability to detect drug resistance early. Laboratory professionals appreciated the improved ease of use compared to microscopy and increased staff satisfaction.

Reported challenges included reluctance to test for tuberculosis owing to stigma or cost concerns; health system inefficiencies such as poor quality of specimens, difficulty in transporting specimens, lack of sufficient staff or equipment, increased workload for providers, inefficiencies in integrating the test into clinic routines and clinicians relying too much on the test result at expense of their own experience with diagnosing tuberculosis; as well as implementation processes hampered by insufficient  data about real-life situations, lack of inclusion of all relevant stakeholders (local decision-makers, providers or people seeking a diagnosis), and conflicts of interest between donors and people implementing the tests.

Nora Engel, lead author of the review, explains: 

“The findings reveal a fundamental paradox between supporting technological innovations but not in parallel investing in health system infrastructure strengthening. The view that these low-complexity diagnostics are a solution to overcome deficiencies in laboratory infrastructure and lack of skilled professional is misleading. Implementation of new diagnostic technologies, like those considered in this review, will need to tackle the challenges identified in this review including weak infrastructure and systems, and insufficient data on ground level realities prior and during implementation, as well as problems of conflicts of interest in order to ensure quality care and equitable use of resources.”

The review authors called for future research to examine the implications of repurposing diagnostic infrastructure and equipment for COVID-19 and the issue of competition for diagnostic resources more generally.

Engel N, Ochodo EA, Karanja PW, Schmidt BM, Janssen R, Steingart KR, et al. Rapid molecular tests for tuberculosis and tuberculosis drug resistance: a qualitative evidence synthesis. Cochrane Database of Systematic Reviews 2022, Issue 4. Art. No.: CD014877. DOI: 10.1002/14651858.CD014877.pub2

This news article was first published on the LSTM website.

Monday, May 2, 2022
Muriah Umoquit

Cochrane releases RevMan Web software for non-Cochrane systematic reviews

9 months ago

Cochrane is delighted to announce the availability for the first time of RevMan Web, its popular, web-based systematic-review production software, to the wider community beyond Cochrane – to support evidence synthesis development and evidence-based medicine education. Cochrane expects interest in use of the tool from those in guideline and Health Technology Assessment organisations, universities and medical schools, and many other research sectors.

RevMan Web facilitates the creation of meta-analyses, forest plots, risk-of-bias tables, and other systematic review elements. It is acknowledged to be easy-to-use – and is also widely used in learning or training about systematic review production.

Cochrane is making RevMan Web available for use by institutions or individuals for their own systematic review development work. The product is presented on a Software-as-a-Service basis: Cochrane offers a hosted service, comprising the software and cloud storage of all review data uploaded. 

Charlotte Pestridge, Cochrane’s Director of Publishing and Technology, says this is a hugely exciting opportunity:

“Making RevMan Web more widely available is an important element in Cochrane’s contribution to healthcare research and our mission to deliver evidence-informed policy and practice through the production of systematic reviews. It is important for Cochrane to be able to support the production of high-quality reviews using Cochrane standards and methodologies. Many review-producing organisations, including key Cochrane stakeholders, already use RevMan.”

 RevMan Web is now available by subscription to government and commercial organizations. Availability for academic institutions and individual subscribers is expected to come on stream before the end of 2022. Free access will be available in Reseach4Life Hinari low and middle-income countries.

To find out more:

Wednesday, June 1, 2022
Muriah Umoquit

Cochrane seeks Evidence Synthesis Development Editor - UK

9 months ago

Specifications: Permanent
Salary: circa £45,000 per annum
Location: UK
Application Closing Date:  5 June 2022

The Evidence Production and Methods Directorate in Cochrane is made up of three departments that are responsible for the efficient and timely production of high-quality Cochrane Reviews addressing research questions that are most important to decision makers.

As Evidence Synthesis Development Editor in the Methods and Evidence Synthesis Development team, you will be working on new and updated Cochrane Reviews prior to their completion and submission for editorial process. The role-holder will need to ensure that protocols and new or updated reviews will meet Cochrane’s quality standards.

The role-holder will need to be able to recognise when to refer methodological questions to colleagues with specialist methods expertise in the Methods Support Unit or Cochrane Methods Groups for further advice, especially around the assessment of bias and statistical methods.

Cochrane is a global independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making the vast amounts of evidence generated through research useful for informing decisions about health. We do this by identifying, appraising and synthesizing individual research findings to produce the best available evidence on what can work, what might harm and where more research is needed.

How to apply

  • For further information on the role and how to apply, please click here
  • The deadline to receive your application is by 5 June 2022. 
  • The supporting statement should indicate why you are applying for the post, and how far you meet the requirements, using specific examples.
  • Note that we will assess applications as they are received, and therefore may fill the post before the deadline.
  • Read our Recruitment Privacy Statement 

Tuesday, May 24, 2022 Category: Jobs
Lydia Parsonson

Cochrane launches report summarising what we have heard from our diversity and inclusion listening and learning exercise

9 months 1 week ago

Cochrane wants to welcome people, no matter who they are or where they live. The more varied perspectives we have, the better we can provide evidence to help inform health and healthcare decisions.

In October 2021, we launched our listening and learning exercise that aimed to gather data, views and experiences regarding diversity and inclusion in Cochrane. Between October and January we heard from over 1,300 people and we are pleased to publish the findings in this new report.

We encourage everyone to read this report and we have made a summary of the report available in multiple languages to increase accessibility.

Chris Champion, Head of People Services, says

“Cochrane is a worldwide organisation that aspires to be diverse and inclusive. We want everyone to be able to participate in Cochrane, regardless of who they are and where they come from. This matters to Cochrane, because if we are more inclusive, we will be able to provide better and more relevant evidence to our users who are at the heart of our vision.”

Thank you to everyone who contributed to this important process. It is clear that we can do a lot more to be a diverse and inclusive organisation, so the important work starts now as we take action in response to these findings.

Monday, April 25, 2022
Muriah Umoquit

Cochrane Infectious Diseases Group seeks Research Associate - Liverpool, UK

9 months 2 weeks ago

Salary: £35,326 per annum
Contract type: Full-time Fixed term until March 2024
Closing date: 15 May 2022

LSTM’s Centre for Evidence Synthesis in Global Health runs the “Research, Evidence and Development Initiative” (READ-It) and contains the Cochrane Infectious Diseases Group (CIDG). The CIDG was established in 1995. They are world leaders in evidence synthesis related to public health in the tropics. They have a wide portfolio of Cochrane reviews in malaria and neglected tropical diseases, amongst other topics.

Teams are already in place for some of the reviews and they have experienced technical specialists in all areas. The successful candidate will assure the delivery of a portfolio of high-quality Cochrane reviews according to LSTM’s strategic plan.   You will be part of the READ-It Management Team and assure the delivery of the CIDG Partners deliverables.

Key Responsibilities are (but not limited to):

  • Provide editorial feedback to the Managing Editor throughout the review life cycle
  • To stay up to date with Cochrane methods, standards, and procedures and ensure reviews are in compliance
  • Work with the CIDG team in ensuring efficient and effective editorial processes are in place
  • Assessing technical and academic aspects of reports from READ-It Partners, and the draft READ-It annual reports to funders
  • Actively manage review delivery and report and discuss progress of Liverpool associated outputs with the READ-It Management Team
  • Participate in READ-It Management Team meetings, Partner meetings, and Advisory Group meetings
  • Liaise with READ-It Liverpool staff and the Head of the Department of Clinical Sciences (DoCS) to assure appropriate line management including the performance conversation process
  • Assure delivery of the CIDG strategic plan in relation to reviews by supporting teams and helping overcome review production obstacles
  • Work with stakeholders, editors, and the CRG strategic advisory group in taking on new topics and teams in line with priorities, stakeholder needs and CIDG capacity
  • Deliver seminars for Diploma and Master students
  • Actively contribute to submissions for grant funding

The Candidate will ideally be:

Candidates must be experienced in Cochrane systematic reviews to work in our Liverpool team and with our global partners to help assure the delivery of the CIDG strategic plan. 

  • Hold a Postgraduate professional qualification, such as the Diploma of Tropical Medicine, or health-related Masters’ degree
  • Have knowledge of systematic reviews and RCT trial basics
  • Have knowledge and an interest in LMICs and infectious disease problems
  • Understand qualitative and quantitative research methods
  • Be experienced in the critical appraisal of medical literature at postgraduate level

For a confidential discussion about this role, please contact Paul Garner at: sends e-mail)

Additional benefits of joining LSTM:

  • 30 days annual leave, plus bank holidays, plus Christmas closure days
  • Generous occupational pension schemes
  • Government backed “cycle to work” scheme.
  • Affiliated, discounted staff membership to the University of Liverpool Sports Centre
  • Plus, a host of additional family friendly policies

Closing Date: 15th May 2022 
More information and to apply:

Tuesday, April 19, 2022 Category: Jobs
Muriah Umoquit

Cochrane seeks Editorial Assistant - Flexible location, remote

9 months 3 weeks ago

Specifications: Full Time 1 year Fixed Term contract/Consultancy contract
Salary:  £25,540 per annum
Location: Flexible (remote)
Application Closing Date: 22 April 2022 (midnight GMT)

Cochrane has established a Central Editorial Service to support the efficient and timely publication of high-quality systematic reviews in the Cochrane Library. The reviews that are published through the Central Editorial Service address some of the research questions considered to be the most important to decision makers. The Central Editorial Service is also instrumental in running a pilot aiming to improve editorial independence and efficiency within Cochrane. The Editorial Assistant role will play a key role in operationalising this pilot.

The Editorial Assistant will perform editorial tasks to support the smooth running of the Editorial Service. Tasks will include, but are not limited to: performing checks on manuscripts on submission and before publication; supporting the peer-review process including inviting peer reviewers and tracking progress; assisting authors and peer reviewers to use Cochrane’s Editorial Management System; running editorial reports for the Editorial Service Executive Editor; arranging and preparing documents for editorial meetings; and supporting the Head of Editorial in projects aimed at improving or developing editorial systems and processes.
Cochrane is a global independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making the vast amounts of evidence generated through research useful for informing decisions about health. We do this by identifying, appraising and synthesizing individual research findings to produce the best available evidence on what can work, what might harm and where more research is needed.

For further information on the role and how to apply, please click here.  The supporting statement should indicate why you are applying for the post, and how far you meet the requirements, using specific examples. Note that we will assess applications as they are received, and therefore may fill the post before the deadline.
Deadline for applications: 22 April 2022 (midnight GMT).

Friday, April 8, 2022 Category: Jobs
Lydia Parsonson

Featured review: Control interventions in randomized trials among people with mental health disorders

9 months 3 weeks ago

New Cochrane Review: Control interventions in randomised trials for people with a mental health disorder


  • Researchers use many different control interventions in randomized trials on treatments for patients with mental health disorders, but there is little consensus on how to report and adequately design these controls. This practice has widespread consequences for the evidence base underpinning psychiatric treatments
  • The choice, design and reporting of a control intervention is just as important as the experimental treatment in a randomized trial with psychiatric patients. This is not reflected in most randomized trials with mental health patients, as control interventions are often poorly reported upon and lack methodological rigor
  • Some psychiatric treatments may be recommended based on just having compared the treatment with a waitlist or no-treatment control in a randomized trial, which may give a misleading picture of how effective the treatment is

Erlend Faltinsen, lead author,  commented, "There is a need to develop methodological guidelines on how to design and report upon control interventions in randomized trials on psychiatric treatments, as trialists working in the field of mental health do not have a solid evidence-based framework to draw from on this issue."

Why was this review conducted?
The review investigates the beneficial and harmful effects between different control interventions in randomized trials with mental health patients. We wanted to investigate how control interventions differ from each other and to lay the empirical groundwork to develop methodological guidelines on reporting, and the design of control interventions in psychiatric randomized trials.

What did the authors do?
The authors conducted a Cochrane systematic review and meta-analysis to assess the benefits and harms between placebo, usual care (or treatment as usual) and waitlist controls versus receiving no treatment.  In that way they assessed how effective and harmful different control interventions in psychiatric randomized trials are.

What did they find?

  • 96 randomized trials were included and the trials involved 15 different types of mental health disorders
  • When combining three different types of placebos, the beneficial effects compared with no-treatment or wait-list controls was small to moderate
  • There was no significant difference between usual care controls and wait-list or no-treatment on benefits. The same was true for waitlist versus no-treatment controls
  • Psychological placebos (non-active controls used mostly in psychotherapy research) showed moderate effects compared with no treatment whereas placebos used for physical treatments like surgery showed a small effect. We found no significant effects of pharmacological placebos versus no treatment
  • There was little data on harms between the control interventions and the findings on harms were insignificant
  • The control interventions were mostly poorly reported upon and there was little rationale for why a given control was used in most reports

What are the limitations of the evidence?
The certainty of the evidence was rated low to very low, and the risk of bias was rated high in all studies. The authors mostly included randomized trials with three intervention arms to compare two controls, which causes issues with blinding of participants and trial personnel. This limitation was due to the methodological objective of the review and may be viewed as part of the review itself rather than a flaw in the evidence-base. Many of the studies were small, however, leading to risk of small-study effects, which limits the evidence.

What gaps did the authors identify?
There is a need to develop methodological guidelines on control interventions in psychiatric randomized trials, as trialists working in the field of mental health do not have a solid evidence-based framework to work from when choosing and reporting upon controls

What important related questions were not addressed in this review?
The review did not compare usual care with placebo interventions, which would have been relevant. It did not quantify the level of reporting issues and rationale for choosing a control in a psychiatric randomized trial, which also would have been relevant.

Who will find this review most relevant?
Psychiatric researchers and especially those who conduct randomized trials will find the review relevant for their research work. It may also appeal to trialists in general and methodologists.

How up to date is this review?
The search was conducted in March 2018. The researchers were not able to screen records after this date, since the search process was very large and extracting data was exceptionally time-consuming.

Friday, April 8, 2022
Lydia Parsonson
13 hours 7 minutes ago
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